How Can I Fix My Chin Excess/Irregularities After Chin Implant Removal?
Q: Dr. Eppley, I had a chin implant removal and a genioplasty about three years ago. I had the implant in for over 20 years. It was placed too high, but I really did not like how long, square and masculine my chin looked. The genioplasty took about 4.5mm in vertical height off and moved forward approx 3mm. I believe my surgeon did a good job as far as the bone went, but the tissue did not shrink down to the bone like he thought it would. It looks like my old chin, but deflated and it seems longer to me. The pocket from my old implant is dimpled and textured along with the soft tissue irregularity from my old chin shape. I have also lost feeling in my lower gums which I am assuming will be permanent considering the length of time since the surgery. It is very difficult to smile. If I smile really big, my chin juts out and looks longer and dished out. My lower lip is pulled in and now my lips are uneven and look crooked when I talk. The muscle feels constantly tight and uncomfortable. My surgeon has done botox and filler in my chin but I can’t keep doing that indefinitely. I am concerned he doesn’t know what to do about my situation. So that’s why I am writing to you. I have been reading your articles online looking for some answers. Thank you for taking the time to read this and look at my photos. If you have time, please let me know if there is a way to at least make it look better. Maybe then the loss of function would be more tolerable. Thank you.
A: Thank you for your inquiry and sending your pictures. When reductive chin procedures are done, whether by a primary chin reduction or an implant/genioplasty change, you have to be aware that the expanded soft tissue chin pad is never going to shrink down smoothly to a smaller bone support. This is a fundamental chin concept that many surgeons and patients frequently overlook.The naturally tighter already stretched out soft tissue chin pad will end up with exactly what has occurred in your case. When the mentalis muscle length shortens, scar/muscle contraction occurs and external contour irregularities will invariably occur.
This is a very difficult problem to try to improve and injectable strategies are the logical initial treatment strategies. There are surgical strategies to try and improve the situation with the concept that some of the problem comes from soft tissue excess. A submental tuck will certainly shorten its length and may or may not improve some of the contour irregularities. And it will probably provide improvement of the chin pad protrusion when you smile. However it is not clear that it would provide any improvement on lower lip symptoms such as tightness, asymmetry or pull down.
Dr. Barry Eppley