Should I Have My Chin Implant Revised?

Q: Dr. Eppley, I am seriously contemplating having chin revision surgery done by you due to a persistent unilateral numbness on the right side of my chin and lower lip area. This has been causing me a lot of distress for almost 2 years. On top of this, my right mentalis muscle doesn’t contract properly which causes a very noticable crooked smile and asymmetries in other facial expressions.
Here is a short history of what was done on my chin. About 3 years ago a plastic surgeon placed a Medpor chin implant with a 5mm projection via intraoral incision. It was the implant shown in this photo, but with a fair amount of custom reshaping. There were several issues after the first surgery though. While the left side seemed to be alright, the right side wasn’t. The implant was shaped assymmetrically (less prominent on the right angle. The right wing protruded about 2mm from the chin bone, i.e. it didn’t touch the bone which resulted in a bad transition as well as serious irritation and pain that wouldn’t resolve. The implant appeared to protrude slightly more on the right frontal part than on the left. Therefore my surgeon injected hyaluronic acid on the left frontal part to temporarily ameliorate this assymmetry until revision surgery. There was also numbness and lack of motor control of the chin and lower lip. The numbness and lack of motor control eventually fully resolved, but it took a whole year! However, the other problems made a revision surgery necessary. In this surgery the following was done. An intraoral incision merely on the right side (only the right muscle was cut through!), taking away the back part of the right wing to ease the irritation and pain, placing additional MedPor material on the right angle of the chin implant to make it more prominent and placing additional MedPor material on the left frontal part of the chin implant. The revision surgery took care of the irritation and ameliorated the assymmetries, meaning the chin now looked more symmetrically although still not perfect.
Unfortunately, the revision surgery brought more bad than good things. Now the major issue is that even after almost 2 years since revision surgery I still have unilateral numbness in my right chin and lower lip area and serious lack of motor control of my right mentalis muscle. This all became gradually better, but the progress has long halted and I am pretty certain that the remaining numbness and lack of motor control won’t improve any further with time. My surgeon said the odd behaviour of my right mentalis is caused by scar tissue located on the left frontal part pulling on the right side. I have no idea if this is possible. I rather think that the problem is not the scar tissue, but the mentalis muscle itself. Maybe it was not properly resuspended. This is were I need your opinion the most. I attached some images and a video so you can get a better idea of my problems. Among the images is an xray scan that faintly shows the chin implant. Maybe this helps you determine if the implant impinges on some nerve. Also, would you say that my chin is sagging somewhat? Can this be fixed? As a side note I should mention that I have a tendency for scarring and fairly bad wound healing.
Based on my description I have several question that you can hopefully answer:
– What would be your general advise in a situation like this?
– How would you approach another revision surgery? Does the mentalis muscle have to be resuspended? Is there hope it will return to normal functioning?
– Was it a sound approach to only make an incision through the right mentalis muscle? Wasn’t this screaming for a muscle dysbalance later on?
– Would it make sense to make an incision under the chin and not inside the mouth should a revision surgery be necessary again? It seems like cutting through my muscles is causing a lot of complications. But I guess the intraoral approach is necessary if the mentalis muscle has to be resuspended, right?
– Do you think the implant is aesthetically OK?
– Is it a good idea to take out the old implant and place a new and maybe smaller one? I suspect the current one might be slightly too large.
I’d like to thank you very much in advance for taking the time to read and respond to my email. Hopefully you have some encouraging news for me.

A: Thank you for your inquiry. I have reviewed your history, pictures and video and can make the following comments:

1)      Your case illustrates why placing a firm and inflexible Medpor chin implant through the mouth is generally a bad idea, it is associated with a significant risk of all the complications that you have experienced. But that is water over the dam now.

2)      I find the aesthetics of your chin result very acceptable and certainly don’t think it is too big.

3)      I would NEVER think at this point of trying to remove and replace your chin implant. That is a disaster waiting to happen. Given what has transpired up to the present and the difficult with removing Medpor implants, the risk of worse nerve and muscle problems is very likely. It may not be perfect but a perfect chin result for you is no longer a reasonable goal. I would advise that you accept a reasonable aesthetic outcome. Revisional surgery for you, as you have learned, has a lot more risk of problems than it does in making things better.

4)      It would be highly unlikely at this point that, even if the implant was impinging on the nerve (which I doubt) that relieving it is going to cause return of feeling. The nerve fibers have atrophied and the damage is irreversible at this point.

5)      I do not think you have chin ptosis or sagging.

6)      As for mentalis muscle dysfunction, I would have a very low level of confidence that any efforts at trying to resuspend the muscle would end up in the long run giving you a better result than you have now.

Dr. Barry Eppley