Q:Dr. Eppley, I came across your website and your blog. From what I gather, you have extensive experience dealing with complex chin augmentation cases. I have had three chin implants placed in the past (the first was mersilene mesh, replaced with silicone, and then replaced with Medpor), all giving less than ideal augmentation. The silicone one was replaced by Medpor because my chin felt really sensitive and uncomfortable. My doctor said it was due to bone erosion and that Medpor would be better. However, the area still feels sensitive. Currently, I have the RZ Large Medpor Square Chin implant in and it’s smaller than the previous XL silicone chin implant I had, so the chin contour is very strange now as a result of putting in a smaller implant. I saw one p[lastic surgeon who told me that due to all the erosion as a result of the implants, I may not have much bone to augment. I believe that without the implants, my horizontal chin deficiency is around 13mms. My chin could also use a bit of height. Given all this, I have seen one of your cases where you combined sliding genioplasty with an implant. Do you believe this is viable in my situation?
A: Certainly chin augmentation history is complex but you now learned several important issues. First, no preformed off the shelf implant alone can create the chin augmentation effect that you desire. Secondly, the chin sensitivity has nothing to do with the often misused term, ‘bone erosion’ or the implant material. This is more of a soft tissue stretch issue as the implants have gotten larger over your first and original much smaller chin implant.
At this point, you have only two viable options for chin shape improvement. Either get a custom chin implant made from a 3D CT scan that can meet the dimensional needs that you want and now know better or use a sliding genioplasty combined with a chin implant to create a dual autogenous/alloplastic change. How viable the latter approach would be be based on knowing what the bone looks like now. The best way to get that information, which is critical at this juncture so that you have the best chance of having a fourth and final chin augmentation procedure, is a 3D CT scan. This will show the amount and shape of the chin bone as well as the implant that sits on top of it, all of which can be measured to the millimeter to know how likely a sliding genioplasty will ‘work’ and what size implant would need to be used in conjunction to get the chin dimensions that you need.
Dr. Barry Eppley