Is It Wise To Stack Another Implant Behind My Existing Chin Implant For More Projection?

Q: Dr. Eppley, I underwent chin implantation (extended anatomical chin, large) 2 years ago, with postop course c/b persistent right lower lip numbness. We later found the right wing of the implant was malpositioned superiorly and could be clearly palpated externally and intraorally. Aesthetically, the malposition isn’t very noticeable. Right lower lip sensation is currently 85% of normal 

In a few weeks I’m tentatively scheduled for revision since my projection was insufficient (pictures attached, before implant and after). My surgeon plans to place silicone (cut from a block) behind the implant for more projection. But he said that he wouldn’t feel comfortable revising the implant wing since it could cause more trauma to the mental nerve and risk recurrent or worsened numbness. I’m concerned adding silicone behind the implant may make any minor asymmetric aesthetic differences more noticeable 

Is trauma to the mental nerve typical with revisions like these, or would I be better served by obtaining a formal second opinion/consult with you or another surgeon?

A: By your original preoperative picture and the type of chin deficiency you had a chin implant was not the best chin augmentation procedure for you. When the chin excess exceeds 10mms and the chin is vertically long a sliding genioplasty is the best approach. The chin can be moved significantly forward and vertically shortened. (see attached imaging) It is important to remember that chin implants worjk best for modest to mdoerate chin deficiencies not signifincant or major chin deficiences. 

Stacking silicone chin implants is rarely a good idea. (if you need that much projection and want to use an implant make a custom one as one piece) There is no biologic validity that removing your silicone implant is going to cause increased mental nerve damage. Furthermore why would you try and stack another implant behind a chin implant that is obviously malpositioned??

I assume you have a 3D CT scan which confirms the exact implant positioning on the bone and where the implant is believed to be sitting is not based on external assessment alone.

Dr. Barry Eppley

World Renowned Plastic Surgeon