How Can My Infected Chin Implant Be Salvaged?
Q: Dr. Eppley, I am a 37 year-old man who had a chin implant done put five months ago using biocoral in a subperiosteal position placed through the mouth. This was not my first intent to correct my chin. Afew years ago a sliding genioplasty was done which failed (muscles put the fragment back in position) This time it went bad again, implant and bad postop tension made the muscle attachment drop and intraoral incision is not healing properly. (granulation tissue is going out of stitch defects) I really need a surgeon confident in re-anchoring mentalis muscle. I also need correction of my implant to check if it’s transforming into bone properly, there is some imbalance to correct and a prominent screw to remove.
A: Let me first make some general comments about genioplasty just based on what you have described. First, Sliding gebnioplasties should not fail to hold their position in today’s world no matter how strong the mentalis muscles are. Contemporary plate and screw fixation holds any genioplasty in place. Either the fixation was not done properly or wire fixation was used, an historic method of fixation last used in the 1980s. Secondly, an hydroxyapatite block implant (biocoral) will never transform into bone. Bone may grow up against it but it will always be like a synthetic implant. Third, it is now apparent that you have a non-healing wound likely caused by chronic implant exposure and low-grade infection. This is confirmed by the granulation tissue present and the exposed screw. It is now apparent that this implant is doomed and there is no way muscle is going to be pulled up over it and heal. Either it is too big or chronically infected, but either way keeping the indwelling implant is doubtful. I suspect you are going to have to look at implant removal, a new sliding genioplasty done and mentalis muscle resuspenion to end up with a healed and an improved aesthetic result.
Dr. Barry Eppley