Chin Implant Revision
Q: Dr. Eppley, I am interested in a chin implant revision. I had a chin implant done 15 years ago. The chin implant that was used at the time was too big, roundish and squarish for my heart-shaped face. I needed more chin projection than chin width. The chin implant was also put in crooked, one side was higher then the other. The doctor at the time also put in an additional implant shaped like a matchstick in the depression of my chin and at the bottom of the chin to offset the fact that it was crooked which I was not aware of until after the surgery. Within a week he took out the small implant from the center of the chin which then left a line scar. It was a terrible experience needless to say so I just left the big implant in and the scar until two years ago.
Finally I had the courage to get the chin corrected. I had several different consultations and finally decided on a plastic surgeon that supposedly had expertise in chin implants. We reviewed all the details with many photos and discussions. I finally had the surgery last year. Basically the plastic surgeon decided to use the original implant that I already had in instead of a custom one. He basically just went in and moved the implant downwards and that was it. The result was that it was still too round and big and now way too low. One side had already fallen after one week. The plastic surgeon said I needed a revision and they scheduled it a month later. I again explained to the plastic surgeon prior to the revision that the chin implant was too big and squarish for my heart shaped face. Again we reviewed photos etc…After the surgery the implant was the same. The plastic surgeon had just repositioned the implant slightly higher but it was still wide and squarish and very crooked. I was devastated to say the least.
One month later they scheduled me for another revision. I again voiced my concerns with the plastic surgeon and was assured that he understood what had to be done this time and that the implant had to be carved and shaped to my heart shaped face. After the surgery the implant had finally been reduced in size but was completely carved in a square shape and completely crooked.
Finally I was again scheduled for another revision two months later. Again more photos more discussion etc…The plastic surgeob finally carved the implant smaller and narrower to suit my heart shaped face. However it’s been carved unevenly and positioned off center and there’s a lot of puffiness formed in a wave on the top of the chin and it’s spongy and puffy. It’s a year next month since the last surgery so not sure if this is all scar tissue. I went for a followup last week out of concern with the total result and the plastic surgeon suggested cortisone shots which I did not want to do. I don’t believe that doing a patch up job of cortisone shots or fillers will correct this issue and it’s been very disheartening to think that this is the final result after all these surgeries. I am now considering doing another revision with a custom made chin implant to correct this once and for all. I came upon your profile on RealSelf and went through your website/blog/reviews and feel that you have considerable experience and knowledge in the chin area.
I have attached several photos for you to view and I look forward to speaking with you and thank you for your time in reviewing my situation.
A: Thank you for sending all of your pictures and detailing out your multiple chin surgery history. This is a tragic tale of chin implant augmentation surgery that was both ill-conceived and poorly performed. The fundamental problem, in my opinion, is that you really had the wrong type of chin augmentation surgery. When you have the natural chin anatomy that you have, placing an implant will be hard pressed to create a very satisfying result. Your chin is very horizontally short and subsequently vertically long. Your chin has a 45 to 60 degree angulation backward of the slope of the bone from it normal inclination. Any type of chin implant, particularly one that is placed low on the bone, is going to create vertical elongation and limited horizontal projection. This issue is compounded by the typical narrow width that such a chin shape will have in a female. Any standard chin implant that has wings will end up creating a long and wide chin. (squarish) You have experienced every problematic variation of trying to make a chin implant work in an anatomic situation where it just won’t do well.
With regard to the labiomental scar that is not the approach I would have utilized in your or any situation for the placement/removal of any form of labiomental implant.
Moving forward you have two chin implant revision options. The best option is to convert your chin augmentation to a sliding genioplasty and abandon the implant approach. Your chin needs to come forward and up. (vertically shortened) This is not what a chin implant can do. (as you now know well) The other approach is to make a true custom chin implant BUT shorten the length of the chin bone at the same time so that you still create the important vertical shortening effect.
I am sorry that you have had the outcomes which have occurred and I remain sympathetic about your chin surgery experience.
Dr. Barry Eppley