Q: Dr. Eppley, I am ready to get my infected chin implan removed but since it is my face I want to make sure I’m getting the most qualified person to do it. If you were in my place are there any particular questions or concerns that I should make sure my surgeon has dealt with to reduce risk of nerve damage, ptosis since it is a pretty large implant? The implant was placed through the mouth. Also have you ever used hyperbaric oxygen therapy? Could it help reduce post operation healing time? How many
work days would I need to take off to be able to return to work? Would you use any head dress?
A: In theory , any surgeon that places chin implants should be able to remove them. The issue that you need to be aware of, particularly since this is a big implant and you are removing it from inside the mouth and are not replacing it, is the high likelihood that chin ptosis will result. (sagging of chin tissues off of the bone since that are now stretched)You will likely need a simultaneous muscle resuspension done at the same time to avoid this potential aesthetic problem. There is no benefit to hyperbaric oxygen (HBO) therapy in surgical removing an infected chin implant. HBO has benefit in irradiated tissues where the native blood supply is compromised. If the muscle is resuspended to the bone, there is no need for a chin dressing afterwards. A chin dressing is not going to prevent chin soft tissue sagging anyway.
Dr. Barry Eppley
Q: Dr. Eppley, I really appreciate you for trying to help me out at this miserable situation. I had chin implant removal surgery 16 days ago. Dr. took out my Medpore implant from inside my mouth. Fortunately the look of my chin has not changed dramatically but the problem is when I talk you can see my lower gum which is a disaster to me and hurting my confidence badly. I saw my surgeon one week after the surgery and he said I should wait for six weeks, but now after more than two weeks the problem looks getting worse. My question is if this problem gonna improve? if not is there any fixation in the future for this problem or not?
A: What you are experiencing is a soft tissue chin ptosis problem. When implants are removed from an intraoral approach, it is important to resuspend the mentalis muscles and soft tissues of the chin. Remember that they have been stretched out from the implant and then cut through for the removal of the implant. If not tightened and resuspended to the bone, they will both fall and contract downward, exposing increased tooth and gum and even creating lower lip incompetence. I doubt that the tissues will magically move upward as they heal. But I would wait three months after surgery and make a decision then. I suspect you will need a soft tissue/mentalis muscle suspension for correction of this problem.
Dr. Barry Eppley
Q: Dr. Eppley, I had a chin implant inserted 8 months ago, which turned out to be too big. I was very unsatisfied with the result and it was removed 2 months after the initial surgery, which is 6 months ago from now. The problem is that chin ptosis has developed. I am suspecting that adequate mentalis reattachment was not performed after the implant removal. Moreover, the central part of my lower lip would not move downwards, even when I smile widely, always covering my lower incisors totally. This seems different from typical lower lip incompetence caused by mentalis muscle ptosis, since I believe that ptosis of mentalis muscle causes lower lip to drop downward with inability to close mouth properly. This lower lip issue is not a newly developed problem, since it was present immediately after the initial implant insertion surgery and never went back to normal. Also, my lower lip seems to have become shorter in vertical length. My labiomental sulcus area looks like the soft tissue is fixed to the bone making it look unnatural when i speak or smile. I am thinking a mentalis resuspension would help my problems but my question is why would my lower lip not move downwards? This sometimes interfere with my pronunciation when I speak which bothers me a lot. One more question is would sliding genioplasty combined with mentalis resuspension give a better result than mentalis resuspension alone? I want to know the best solution to correct my problems. I am looking forward to your answer. Thank you.
A: You are correct in that the lower lip may sag with chin ptosis in some cases, but not always. Many chin ptosis patients have a normal lower lip position and function. Rarely you will have a patient like you who has the opposite lower lip problem in which the lip will not evert. This can occur if the implant was inserted from below (submental incision) and the implant pocket was made up close to the mandibular vestibule. This disrupts the attachments of the labiomental sulcus and blocks lower lip eversion. Even when the implant is subsequently removed, the muscle fibers remain disrupted.
Since there was a reason you had the chin implant in the first place, it would make the most sense to consider a sliding genioplasty. In that way all three problems can be simultaneously treated. (chin deficiency, chin ptosis, labiomental sulcus muscle repair)
Dr. Barry Eppley
Q: I had a chin reduction a couple of years ago and although I am happy with the new shape of the bone, I now have hanging soft tissue. Needless to say I am not happy with these results. I have visited five plastic surgeons and none of them wanted to fix this problem saying that it was dangerous to cut or reattach the muscles and the ending results could be worse. I am very dissapointed and have attached some before and after pictures for your review. I hope you can help.
A: Your pictures show quite clearly some soft tissue sag or ptosis off of the chin bone. It is most pronounced centrally which is what one would expect given that your chin reduction was most likely an intraoral burring approach done to the central button. To improve this problem there are two approaches, intraoral muscle resuspension or a submental tuckup. The intraoral approach uses a suture anchor to the bone to reattach the muscle and tighten it back done. This is a scarless approach. The submental tuckup uses an incision under the chin where the loose skin and muscle is removed and tucked or tightened to the bone. Each has its own advantages and disadvantages. The intraoral approach avoids a scar under the chin but the submental tuckup is a more reliable method.
There is no danger to performing this procedure and there is no chance of making the problem worse. Whoever has said has either never treated the problem or is completely unaware that such surgical correction exists.
Dr. Barry Eppley