Q: Dr. Eppley, I am in need of secondary chin surgery. I am a female and am 34 years old. One year ago this month I had a chin implant removed due to a number of reasons including bad positioning and shape. It was in for five years and was not replaced with another. It was inserted and removed orally and it was fixated with a screw. It has left me with soft tissue complications and still gives perception like the implant hasn’t been removed. I found the a link where you go into detail about chin implant complications nearly identical to what I have currently. It describes how you would tackle the problem and seems you have extensive experience in the procedure. It seems I’m finding it very difficult to find someone in my country who can tackle the issue. From my pictures would you class my soft tissue deformity as a mild case of Witch’s Chin?
A: Thank you for sending all of the pictures. You definitely do not have a Witch’s chin deformity. At rest you have a perfectly normal position of the soft tissue chin pad on the bone. Your deformity appears when you animate and the soft tissue contractions (dimpling deformity) appear. This is the result of the soft tissues being stretched out by the implant and then, with the implant being gone, its support is lost and there is now too much soft tissue. This will create an abnormality on contraction which you now have.
Treatment options include:
1) Doing nothing. It is not predictable that any improvement can be gained.
2) Replace the implant and recreate the soft tissue support. (although placed from a submental position and tighten the mentalis muscle from below)
3) Do a submental approach to the mentalis muscle repair with excision and midline reapproximation.
Dr. Barry Eppley