Custom Facial Implants

Q: Dr. Eppley, Lately I have been following your articles and blogs specifically for jaw chin and cheek implants, and have noticed that the custom facial implants can be made to any size but it is the skin stretch that limits the size one can get. My question is, if the skin can stretch a lot when someone gains weight, then can the skin also be “pre-stretched” to prepare for substantially large facial implants of a size that you would not normally want to insert without having the skin gained some laxity?

A: The issue with soft tissue stretch in custom facial implants is one that is exclusively limited to that of the chin area, specifically the dimensions of vertical and horizontal increases. This is not an issue back along the jawline or along the jaw angle area where the tissues have substantially more laxity. I have learned that when the chin is significantly vertically lengthened (10 to 15mms) the soft tissue chin pad may ‘ride up’ in front of the implant rather than staying at the very bottom where the maximal chin projection should be. It is also theoretically possible that such large vertical chin increases could contribute to lower lip incompetence. This situation is very rare, however, as very few patients would ever need to have this degree of dimensional change in the chin.

In these rare patients, pre-stretching the chin tissues would be accomplished by either placing an initial chin implant or, preferably, doing a sliding genioplasty first to set the stage for the eventual larger implant.

Dr. Barry Eppley

Indianapolis, Indiana