How Can My Chin Implant Be Improved?

Q: Dr. Eppley, I have a chin implant questions/issue. In my opinion, I have a recessed chin and jaw. Eight years ago, I had a large silicone chin implant inserted, and liposuction below my chin. At my consultation, the plastic surgeon asked if I breathed through my mouth, which I realized I do. Ever since then, I have been on a quest to resolve this issue. I have been to an ENT doctor who said my nasal passages checked out fine. But since I feel that my chin implant did not provide me with enough projection (I am 41 years old but one year ago I had a platysmaplasty for loose skin beneath my chin), and my lips still do not close with out mentalis strain, and as I age I feel that my lack of a supportive jaw is not helping, I would really like to take action. Also, I recently discovered that chin implants have been known to cause bone erosion, which frightens me. I had braces as a teenager, and still have a bit of an overbite, but I do not know where that leaves me as far as options to both improve my appearance and breathing functions. I sincerely appreciate your time and thoughtfulness, as this is quite daunting to me.

A: The chin implant issue that you describe is a common one that I hear about. Between your appearance and breathing issues, your description suggests that your lower face/jawline appearance can be improved. With a naturally short lower jaw, a large chin implant that is still inadequate in projection and a residual mentalis strain, this indicates to me that you need a sliding genioplasty for a chin implant replacement. Besides the limitation of chin implant projection (10mms or less), increasing the chin point by an implant will not improve mentalis muscular function nor any lower lip incompetence should it exist. Your existing chin implant may have also developed some settling into the bone. (often erroneously referred to as ‘bone erosion’ which is not harmful) By removing your chin implant and performing a sliding genioplasty you will improve your chin projection, eliminate the mentalis strain, and also improve your neck profile. I would need to see some pictures of your face to verify these statements but your description is not a rare problem that I see with indwelling large chin implants.