Q: Dr. Eppley, About 2 years ago I had a chin implant put in during a rhinoplasty revision in Miami. It looks great BUT the lisp NEVER went away. It resolved to about 90% and continues to have good days and bad. The chin implant is a medium size. I’ve spoken to a neurologist as well and he does not feel this could have anything to do with mental nerve irritation as there is no area of numbness. At this point I’m quite frustrated and got a CT hoping to see some gross abnormality or slipping of the implant. The CT shows only a slight periosteal reaction (not-osteo per the radiologist) on the right and a .5cm asymmetry of implant riding posteriorly on the right. Could this be the cause of this? I do notice a corresponding limitation to my ability to retract my lower lip on right. Searching the internet, you seem to have the most facial implant experience so I wanted to get your opinion as general consensus thus far (including a speech pathologist) seems to think replacing it with an implant that projects less would be the answer.
A: This is not a postop problem with chin implants that I have personally seen before. I would not feel that the size of the chin implant nor its position is the problem. There are lots of chin implant patients with gross asymmetry of their implants and they don’t have any speech issues. Conversely there are patients with huge chin implants that don’t have a lisp either. It sounds like there is a mild weakness of the marginal mandibular branch of the facial nerve, which affects the retraction of the lower lip, which can be a source of a lisp. That is a lower lip problem that I have seen before. Recovery of a marginal mandibular nerve weakness, which is a monofasicular nerve, will have reach its potential by two years after surgery. Thus I would have no confidence that any manipulation of your indwelling chin implant would offer any improvement in your current speech issue. You can, of course, prove or disprove that conjecture by replacing the current implant that you have. But the chance of improvement to me would be very unlikely.
Dr. Barry Eppley