Q: Dr. Eppley, I am interested in chin augmentation. I am a 52 year old male in good health with no serious medical conditions. Three years ago I had a platysmaplasty, rhinoplasty, lip lift, and implants in my chin, jaw angles, and cheeks. The chin implant subsequently became infected. The infection resulted in the removal of the chin and jaw angle implants several months later. Only the chin implants remain. My primary concern now is that my chin appears weak. I’m also concerned about the sagging appearance on underneath left side of my chin and the very visible scar below my chin from the previous surgeries. Regarding the jaw angle implants, I understand that my posterior mandible is quite narrow, but my eyes are also narrowly set and jaw angle implants accentuate that feature. I learned this clearly from the very wide jaw angle implants I had from my first surgery. So, jaw angle implants are problematic for me for that reason. Also, the chin and jaw angle implants that I had moved significantly after surgery, which I would also like to avoid with any subsequent implants. Please let me know if you can fix any implants with screws so that they do not move.
A: In reading your history, you have lost the benefits of your chin augmentation due to infection, your implants shifted after surgery and the jaw angle implants were an aesthetic detriment. In addition the submental scar is very wide and there is a little tissue sag on the left side of the chin.
A new chin implant can certainly be done and I almost always secure this in by double screw fixation. This could be put in from your existing submental scar. Your submental scar is wide because it has been placed behind the submental skin crease in the skin of the neck. This is not an ideal location as horizontal incisions in the neck skin tend to widen. The best that can be done with that scar is to excise it completely and hope that it heals more narrow this time. A new chin implant should pick up any loose skin along the jawline.
Jaw angle implants are more than just about widening the jaw angle as you appear to have had lateral widening jaw angle implants used. There are also different styles of jaw angle implants that merely make a pronounced jaw angle without making it wider. You may initially have just had a wrong style implant used.
Dr. Barry Eppley