Should I Switch My Chin Implant To A Sliding Genioplasty?

Q: Dr. Eppley, I underwent a chin implant five weeks ago and am unhappy with the result. It is too wide and blocky in appearance. I think I should switch to a sliding genioplasty. I am also concerned about long term bone erosion with a chin implant. What do you think?

A:Thank you for your very detailed inquiry. To which I can make the following general statements:

First you are only five weeks after your surgery which is way too early to make definitive judgments about the final results and what you may or may not do. I do not recommend nor do I operate on patients before their fourth month after surgery as is that is when the true effects of the final bits of swelling and shrink wrap effective the soft tissues have occurred.

Second I would be very cautious about making a radical change in your chin augmentation approach when the changes you are seeking may well be able to be achieved by an implant. Every operation, chin implant or sliding genioplasty, has its issues. There is no perfect operation whether it be chin argumentation or any other surgery…. particularly if one is going to evaluate the results under the microscope so to speak. The only valid reason in my opinion that you would switch to a sliding genioplasty, after the requisite four month postoperative period. Is that you have decided that you simply do not want any foreign material in your body. If that is the issue then whatever the aesthetic trade-offs are for a sliding genioplasty become irrelevant. The concerns that you have pointed out about a chin implant, soft tissue compression and so-called bone erosion, our biologic fallacies. They are commonly believed even among surgeons but they are simply incorrect about their understanding of what they are seeing. Implants do not cause bone erosion, they can cause implant settling which is a passive self-limiting reaction to the tissues to the interposition of an implant that violates the natural biologic boundaries of the soft tissues. This occurs in all implants throughout the body that’s not unique to the chin. But because of the frequency of dental x-rays it is the most observed phenomenon of all implants in the body. Be aware that even the sliding genioplasty has a response to the pressure displacement of the overlying soft tissue caused by the new bone position…. which means the moved chin bone will change its anterior shape often losing about a millimeter of projection over time. Yet nobody calls this well-known phenomenon bony erosion. It is just another example, in this case an autologous surgery, of biologic adaptation  of a bone shape that has changed anatomic position from what it was developed to be.

Third I would also caution any patient how about trying to take an overall good result and trying to make it ideal. As I often tell patients as well as other surgeons secondary or revision on surgery always presents the opportunity to make something worse or develop a complication the patient did not previously have. Just because your first surgery was uncomplicated and healed well is no guarantee that whatever you do the next time will do as well. This does not mean that one should never have secondary surgery within initially satisfactory result just let one needs to be mindful of the potential risk and fully understand what the trade-offs are.

Dr. Barry Eppley

World-Renowned Plastic Surgeon