If I Remove My Chin Implant Should I Have A Sliding Genioplasty To Replace It?
Q: Dr. Eppley, I undergone a genioplasty 18 months ago where a 5mm medpor implant was inserted through the chin. It improved my profile view and made my face more masculine, but it hated how it looked from the front, making my lower face square while I originally had a V-shape that I liked. The new chin was larger and squarer than my lower dental arch, so it looked weird at different angles. I asked for a revision 6 months ago where my surgeon shaved the wings off and tried to better adapt to my natural asymmetry. Today it still looks weird to me, even though it made me get some of my original features back. The bulging is now more isolated in the front, which is another kind of weird, as a matter of speak. I am now fairly certain I want it out, even if it means losing the profile improvement.
– How dangerous is it to remove medpor after 18 months ? I know you wrote it’s only relatively more difficult compared to silastic (my surgeon says the same), but it is my face I have to be really careful with what I do next. Am I facing some loss of tissue/bone/muscle ? Do I risk some sagging (perhaps having reduced the implant’s size first will help in that regard ?) ? And if I getsome sagging, does getting more weight (planned anyway) will also fill up the skin so that it’s not so much of an issue ?
– when the medpor wings were shaved, doesn’t that necessarily suppose shaving integrated tissue/bone ? If so, does that mean I have now less bone structure than before ?
– Is there any way of moving a chin forward without making wider (and still blend in with the mandible) ? Is sliding genioplasty better at maintaining the original shape (since the bone already has the patient’s natural shape) ?
Thanks a lot for the time you spend helping out online.
A: One of the most overlooked features of chin augmentation is how it can change the front view. Most chin implants, particularly those of Medpor designs, will have an appreciable widening effect. When removing a chin implant, the issue is always one of the potential for soft tissue ptosis or sag. Just like a breast implant, once the tissues are expanded, they may not go back to their original shape. That is going tgo highly depend on the degree of expansion (size of the implant) an how long it has been in place. This can be partiually or completely overcome with mentalis muscle resuspension. Removing a Medpor implant does not mean losing any bone. The concept of bone ingrowth into Medpor is overstated and does not really occur to any appreciable degree, if at all. Removing the implant and doing a sliding genioplasty is a better alternative than just removing the implant alone. By so doing you will still end up with the profile improvement, keep a narrower chin (all sliding genioplasties actually keep or make the chin more narrow not wider) and will pick up any soft tissue and avoid/treat any soft tissue sagging.
Dr. Barry Eppley