Chin Implant Surgery Recovery
Q: Dr. Eppley, I had custom chin implant surgery placed two days ago and I have noticed there is an indentation along the side of the chin on the right side that is not present on the left side. I am concerned that this may represent an implant malposition. I know you told me before surgery as well as our visit that day after surgery not to overanalyze or interpret what I am seeing now when there is a lot of swelling present.
A: You are correct in that I mentioned during your most recent postoperative visit (yesterday) to avoid making any preliminary assessments about how any facial implant looks in the short-term, particularly in the weeks to first month after the surgery.
But your question is understandable and I have the unique insight into how the implant was placed and positioned during your surgery and the great intraoperative attention that is paid to the placement of such implants. From that perspective I have confidence in its symmetric placement and there was certainly no evidence of any asymmetry when it was placed.
To provide you with some insight into why the placement of facial implants is often associated with asymmetry in the early healing process, it is necessary to understand how implants are placed and how the body heals around them. It is not just about swelling as a tissue reaction as, if that was true, all swelling around implants would be perfectly symmetric on both sides of the face.
To place an implant in the body, the tissues must be widely raised around it. (pocket creation)This pocket is always much bigger than the implant itself so the implant can be positioned properly without deformations of the implant’s shape. The elevation of the tissue pockets (the disinserting of tissues off of the bone) is never exactly the same on both side of the face and does not need to be…what matters is that there is enough room for the implant to be placed and positioned as desired. Because there is no swelling of tissues during surgery (just the release of the tissue attachments) the external result of the implant can be seen to be symmetric. (if it is properly placed) BUT…when the postoperative swelling ensues the tissues that swell the most are those that have been disinserted. (tissues swell more when they have lost their attachments than those that have not) THUS given that the raised tissue pockets are never completely identical on both sides of the face the external swelling that ensues is often asymmetric. In short, the swelling really represents the extent of pocket creation and not that of the implant’s shape or position.
Understanding this biologic response also provides insight into the recovery process. To see the final result around any implant, one must wait to see two healing processes be completed…resolution of swelling of the tissues AND the readapting of the tissues back around the implant. (the so called shrink wrap effect) This is a process that takes a full 6 to 8 weeks to be completely realized in both phases….and sometimes even longer.
I hope this explanation provides insight into why, at this early postoperative time period, I am not concerned. I have seen these early facial asymmetries around implants many times. While the final result awaits to be seen, the healing process around the implant must be allowed to play out.
Dr. Barry Eppley