Should I Replace My Chin Implant With A Sliding Genioplasty?

Q: Dr. Eppley, Hello, I’ve had a consultation with a surgeon in Beverly Hills about my chin implant revision who recommended I see Dr Eppley for a genioplasty instead.

I have had two chin implant surgeries over 10 years After the first surgery I woke up and the implant on the right side had slipped up quite high. You couldn’t see this but I had some numbness on that side for a while which eventually returned. Several years ago, I had a revision as I wanted to fix the implant not being straight and the revision actually made things much worse, as the left side now sticks out and you can see it. 

My surgeon said I had some bone resorption & bone wasn’t straight under the implant so he tried to file down the left side so the implant would sit in line but couldn’t make it sit straight. The right side is now fine/in line, so aesthetically I like the right side of my face/side profile but not my left. 

I have had 3 consultations since with different people about doing a implant revision & all have said I should do a sliding genioplasty instead, the last recommended you (Dr Eppley) so I’m hoping you can help!

A: When treating any facial implant malposition, chin implants included, there are several basic principles to create the greatest opportunity for success:

1) A preoperative 3D CT scan is needed to truly understand the actual implant position and how to best correct it. You can not rely on intraoperative ‘eyeballing’ alone as the incisional access does not provide full visual assessment of the implant and bone. As a result incomplete correction usually occurs and implant and bone manipulations are done that may never have really been needed.

2) Wherever the implant is positioned it needs screw fixation otherwise it is going to shift/move as soon as the incision is closed. Suture fixation never works in as established implant pocket for secure positioning.

Neither of these were done in your chin implant revision.

Converting to a sliding genioplasty in your situation is bit like trying to get rid of a mouse with a shotgun (imbalance between the solution and the problem). It may be appropriate if you didn’t like anything about the implant result or have simply decided you do not want an implant at all…which is not the impression I am getting. Sliding genioplasties have their own potential issues and you only make such a radical chin augmentation change when the problem justifies it.

Dr. Barry Eppley