Your Questions
Your Questions
Q: Dr. Eppley, I am interested in chin implant removal surgery. I had cosmetic surgery last year for cheek and chin implants. I was pleased with the experience and I am very happy with the cheek implants. However, I do not like the chin implant. The chin implant was very uncomfortable for the first few months and it took about 7 months for the swelling to completely go away. After the swelling had gone, I still did not like the look or feel of the implant. I decided to wait a few more months to see if the situation would change but it has not. I think it looks too bulbous and it still feels quite stiff.
The implant was put in from the chin. I would want to leave it out. Please find pictures attached how my chin looked before the implant (one year ago) and with the implant (now). Just to keep you in the picture, the reason for the chin implant was to help balance my face as I have quite a large overbite. After getting the implant, I don’t think that it really does balance my face and I have since been informed that this is because I would actually need a jaw surgery to improve the look of the overbite, not an implant. So, after the implant is removed, I will plan to get the jaw realignment surgery needed to correct the overbite.
A: Thank you for sending your pictures and providing the details of your surgical experience. From the submental incision the Medpor chin implant and any screws used to secure can be removed. Be aware that there may be some adverse aesthetic sequelae from its removal. Not that the chin tissues have been stretched out with the implant (which I would bet is not a small one), they will not retract back down completely. Thus you will likely develop some soft tissue chin sagging. (ptosis) To avoid this after chin implant removal problem, the soft tissues of the chin will need to be tightened back down to the bone at the time of the implant removal. (chin ptosis repair) This is not a problem that will be solved later by jaw advancement surgery since that affects the teeth position by the whole mandible coming forward. Such a bone movement will have no impact on the chin bone-soft tissue relationship even though the chin comes forward as the whole jaw moves forward.
I will have my assistant Camille pass along the cost of the surgery to you by tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision or removal. I had my initial chin implant placed about one year ago. Immediately I know it was too big. The doctor talked me into a revision and now it’s pointy and not the shape of areal chin. I Only wanted subtle chin projection. Now I wish I never had it done at all. I am worried about chin ptosis if it is removed especially after reading your info online and I don’t know what to do.
A: I think you have two chin implant revision or removal options:
1) Downsize the chin implant to a much smaller one with intraoral suspension. This still leaves some soft tissue support and has the lowest risk of chin ptosis, or
2) Remove the chin implant entirely and do an intraoral suspension and hope for the best. There is still a chance you may be able to avoid the chin ptosis problem. It is not always a 100% guarantee that it will always happen when a chin implant is removed. The risk is high but it is not 100%. There are successful ways to manage chin ptosis even it occurs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant placed submentally in June 2014 and removed in September 2014 due to neuralgia and difficulty smiling/moving. The implant was placed through a submental incision, medium mittleman pre-jowl implant through same incision. Now that 4 months has gone by, my chin sags and the muscles are stretched. It looks fine at rest but when I smile it rolls off the chin and dimples. I am devastated. I am determined to have this fixed. How long should I wait before considering surgery to repair?
A: As you have surmised, chin implant removal can cause sag of chin tissues which often is most apparent in dynamic motion such as smiling. With your face type why you had placed a longer winged pre jowl implant is puzzling but that is beyond the scope of this answer. That longer style implant strips off more tissue along the lower edge of the chin and mandibular bone. While usually that would restick back down into place after such a short period of implantation, yours obviously has not. How to treat this type of chin ptosis is difficult but there are two basic approaches. A submental approach aims to remove and tuck the loose tissues from the underside of the chin but does so at the expense of a submental scar. An intraoral approach aims to tuck the loose tissues back down/up but its success often depends on placing a small chin implant (button type) that helps fill the space where some of the original implant once was. (center of the bone) There are advantages and disadvantages to either approach as I have mentioned.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, If I had you take out my chin implant, would I get my original chin back, or will it look somewhat deformed from all the carving you have to do and all the ingrown tissue that has been produced since it was put it one year ago.
A: What happens to the chin with chin implant removal depends on numerous factors. What is the size of the implant, what is the composition of the implant (silicone vs Medpor) how long has it been in place, and what is the nature of the soft tissue pad sitting on top of it. By far the most important of these issues is the size of the implant and the material. Small sized chin implants composed of silicone material are the most likely to have a chin return to its original shape. Large implants, particularly those composed of Medpor which are more ‘destructive’ to remove, are less likely to have the chin return to its original shape. Usually it is not a bone change issue, but the stretch of the overlying soft tissues that poses the potential issue. In many cases managing the soft tissue by tightening or suspension helps solve any soft tissue deformity that may have been caused by the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wondering if chin reduction may be helpful for me. I had a chin implant which I was not keen on so I had it removed. It’s been two months now and the chin is not what it was, it looks more masculine and wider than it was originally. Do you think that this will improve?
A: A chin implant adds volume to the bone as an onlay but do so but stretching out the soft tissues of the chin that is on top of it. Thus, when a chin implant is removed, it requires the overlying soft tissues to shrink back down and readapt to the bone. Whether that can happen successfully is influenced by how large the original implant was, how long it was in and what the surgical approach was to place it. (submental vs. intraoral) I don’t think you can have an absolute certain answer for three to four months after its removal, but in many cases the chin will not return to its original shape. Even though it has only been two months, I would not be optimistic based on how your pictures look. Chin reduction surgery may be beneficial in chin removal cases like yours as it removes and tightens the loose soft tissues and may contour the chin bone as needed for additional chin shape contouring.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an intraoral large silicone chin implant placed about nine years ago and have had a lot of chin implant complications. am 31 years old now and since the beginning I got into a cycle of pain from chin swelling followed by tightness, numbness and itching sensations. Rare were the moments where my chin wasn´t swollen and pain free. The itching is basically in my right cheek. Four years ago I had a fibrosis inside this right part of my face and the doctor thought it was due to the tip of the implant so he had cut the cheek from the outside and cut the tip of the implant filling the hole left from the fibrosis with body fat. The appearance from the right cheek didn´t improve much and from then on I had to carry a scar from the procedure. About a year ago I had a fistula in the right gum that bleeds weekly. I´m terrified about the implant removal procedure been performed by the same doctor, the pain not going away due to eventual permanent nerve damage and bad looking chin appearance after removal. Do you know how to solve this by eliminating the pain and also leaving me with a good looking chin?
A: Chin implant complications of this magnitude are rare. I am not sure why you have such symptoms of itching and chronic pain but this long sequence of events suggests that the implant should be removed and your chin augmentation done with a sliding genioplasty. Moving the chin bone would eliminate any potential concerns about a foreign body in your chin and all the issues that have accompanied it. I would need to see some pictures of your chin for your further assessment but this does not sound like an implant salvageable situation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant done intra orally which gave me a strange double chin when I smiled. I had it removed 2 weeks later after the doctor told me removing it would make my chin go back to normal. My chin did not go back, it’s still deformed.
A: Intraoral chin implant placement is associated with a higher incidence of mentalis muscle deformity, particularly when the implant is removed if the muscle is not adequately resuspended/repositioned. In theory, a quick removal of an implant should not have allowed time for the overlying soft tissues to become stretched (past their elastic deformation state) and this is undoubtably what your surgeon meant by ‘it would go back to normal’. But that does not factor in the malposition of the muscle which it sounds like you have. Depending upon how long ago the chin implant removal was and what your chin looks like now, it may be improveable with a muscle resuspension procedure. Please send me some pictures at your convenience so I can see exactly the chin problem you now have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am ready to get my infected chin implan removed but since it is my face I want to make sure I’m getting the most qualified person to do it. If you were in my place are there any particular questions or concerns that I should make sure my surgeon has dealt with to reduce risk of nerve damage, ptosis since it is a pretty large implant? The implant was placed through the mouth. Also have you ever used hyperbaric oxygen therapy? Could it help reduce post operation healing time? How many work days would I need to take off to be able to return to work? Would you use any head dress?
A: In theory , any surgeon that places chin implants should be able to remove them. The issue that you need to be aware of, particularly since this is a big implant and you are removing it from inside the mouth and are not replacing it, is the high likelihood that chin ptosis will result. (sagging of chin tissues off of the bone since that are now stretched)You will likely need a simultaneous muscle resuspension done at the same time to avoid this potential aesthetic problem. There is no benefit to hyperbaric oxygen (HBO) therapy in surgical removing an infected chin implant. HBO has benefit in irradiated tissues where the native blood supply is compromised. If the muscle is resuspended to the bone, there is no need for a chin dressing afterwards. A chin dressing is not going to prevent chin soft tissue sagging anyway.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, have a medpor chin implant that I have had since 2008. It has become infected. I am taking antibiotics and soon I will have it removed. I don’t think my surgeon has ever removed a medpor chin implant. In your opinion is it too risky to have someone how hasn’t removed one before perform this surgery? How many medpor chin implants have you removed? Thank you.
A: Thank you for your inquiry. That is most unusual to develop an infection in a chin implant that has been in for years. Regardless, removal is the appropriate treatment now. I have removed/replaced numerous medpor facial implants over the years, most commonly the chin and jaw angle areas. Most of these have been for aesthetic purposes where they are well integrated into the tissues and can be challenging but successfully removed. I have done very few for infection reasons but they are always a little easier as they may not have ares that have a tight tissue bone due to the infection. I can not comment on whether your surgeon is up to the task in removing it but they should be prepared that it will not just slide or jump out like a silicone chin implant would.
The other issue you have to ponder is whether you want to do an immediate replacement or not. Some surgeons prefer to wait several months which is the standard approach while immediate replacement with a new chin implant can also be successful but with a slightly higher risk of recurrent infection. This can be successful because the infection is mostly in the porous material which, once removed, eliminates the primary source of the infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What easy is it to remove a chin implant I've had since 1993. It wraps halfway round my jaw and the muscle appears loose or detached one side of my chin and now have TMJ on that side (jaw locking, clickling . pain). I've never liked the implant and looking at old photo I didn't need it. Its given me too strong of a jawline and a longer face.
A: Certainly after nearly twenty years you have a very good idea of the benefit (or lack thereof) of a chin implant. Removal of an undesired chin implant is a lot easier than originally putting in. This is a simple extraction of an implant inside an existing pocket as opposed to creating a new pocket under the periosteum done during its original placement. This eliminates most of the pain, swelling and discomfort from the procedure. Because of the chin implant’s age, it undoubtably is silicone and not that big. You may think that it wraps halfway around the jawline but that would be very unusual in the early 1990s as so-called wrap around chin implants were not yet commercially available.
While removal of a chin implant is very straightforward, particularly with a silicone material, there is one consideration to look out for in its removal…a sagging chin pad or witch’s chin deformity afterward. This can occur when the implant is very large and provides a lot of support for the chin pad tissues. If this is a potential risk then the chin pad tissues will need to be resuspended at the time of implant removal to prevent this aesthetic complication.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a Medpor chin implant placed 3 years ago and now there is an exposure of the right corner of my implant. I know I have to remove it but my concern how I will look afterwards if it is removed. I like my look with the chin implant but now that I have to lose it I am afraid of looking like an old woman. I actually did this implant to help make my jaw bone stronger and correct the small skin sagging on my two side of my jaw bones. Tomorrow I have appointment with a facial plastic surgeon. Do you believe I am too concerned? Thank so much for understanding.
A: It sounds like to me that your chin implant was placed through the mouth (intraorally), which would be the only way the implant could be exposed at this point. Taking out the chin implant is going to have a negative impact on your chin and jawline appearance to be sure. It is likely that this implant is placed too high. You will likely have to have your current implant removed and allow it to heal for a few months. Then you can have a new implant placed through a submental skin incision form under the chin. It may be possible that a new implant can be placed at the same time as your exposed one is removed. But that would be impossible for me to say just based on your description alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, approximately six weeks ago I had a medium chin implant and super petite malar implants placed by anoral surgeon. All of the implants were Medpor material. In my initial consultation the doctor told me that such implants were completely reversible if I did not like them, or if something happened to the implant. In addition, he told me that they were of a silicone type material. Two weeks after surgery when I was expressing that I didn’t think I like the chin implant he told me that it was Medpor of which my understanding is it is more difficult to remove. Now I am six weeks after surgery, and while I think the chin implant has improved slightly, I still do not think I will end up with the result I wanted. I think the chin is too big. The doctor keeps telling me it looks great do not worry about it. I went to see another surgeon, (a facial plastic surgeon) he said that he believes that he can take out the chin implant and has done a few before. He said he is unsure if the chin will assume its original appearance and that the risk of permanent nerve damage to the chin for removal is quite substantial. The original implant was placed via a submental incision and I had loss of sensation for a month or so the first time. In your experience how often is the nerve damage permanent after removing this type of implant? Should I learn to live with the chin implant that is making me self-conscious?
A: Three comments based on my experience with a wide variety of chin implants:
1) You need to wait a full three months after any type of facial implant to get an accurate assessment of the final shape. It takes that long for all tissues to settle.
2) Medpor implants can be removed fairly easily in my experience. The risk of nerve damage is not much greater with its removal than with its placement in most cases. But it depends on the size of the implant and how long it has been in place.
3) Whether the chin will resume its normal shape depends on the size of the implant placed and how much the tissue has been stretched. If in doubt at its removal, the expanded soft tissue should be tucked and tightened to avoid any soft tissue ptosis.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am writing about my chin implant that I had placed three years ago at the time of my facelift. I did not even want a chin implant in the first place but my surgeon talked me into a small one. After this, there was a huge downward bulge on the right side (wing area). It was a flowers small implant inserted through the chin. When I went back to complained, he told me I was imagining it. I was so intimidated, I left it in even though it was impossible to miss it and I could not believe he denied it. Shortly thereafter, I got the courage to re-approach him. He conceded that maybe he could fix it a little this time and it was an incredibly painful experience, the numbing injections were horrible. He told me he was repositioning it but there was risk of nerve damage and that if I removed it completely (my first request) there was even more risk of nerve damage, so I was too scared to take it out completely. Well, he fixed it…but it is still bothering me – it hurts on that side – aches, pains and also I can easily still feel the bulge of the uneven placement even after that “fix”. I cannot lie down with that side of my face or it hurts quite a lot after a while. I am afraid it is an infection that flares up from time to time. Also, many of my teeth are showing cavities or rotting and I am wondering could this be bone erosion of some sort? I would like the chin implant removed, if possible – I am concerned about skin sagging, so I guess I would like the sub-mental tuck done too if you recommend that. Do you think I have a high risk of skin sagging?
A: The simple solution is to just have the chin implant removed. This is an easy procedure since it is a smooth silicone implant and has no risk of nerve damage or exacerbating one even if it already exists. Given that this is a small implant I doubt that there will be any risk of significant soft tissue chin ptosis. I would remove it through the original submental incision and do a slight tuckup of the chin soft tissues at the same time. Your chin implant is not the source of your teeth condition and there is no correlation whatsoever between it and your dental or medical health.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to change the shape of my chin. It seems too wide. Several years ago I went to a doctor for a rhinoplasty and came out with a rhinoplasty and a chin implant. I went in with no desire for a chin implant but in the consultation he suggested I had a recessed/ weak jaw and that a chin implant would correct it. So as a young naive first timer to plastic surgery I said ok and every doctor I’ve seen since can not understand why that first doctor recommended that.
I’ve had x-rays done of it and showed them to other doctors, one has said it is minor and not causing much protrusion at all. This he thought it best to leave in as removing it could cause a gap or “witches droop” as he called it .
Another doctor said it can easily be removed, and should be, so as usual Im confused. But I am erring on the side of caution and not touching it due to potential resulting problems. (i.e. its been there 15 years so I assume all the nerves/ muscles would have grown around it, thus to a non- medical mind as myself the removal of it seems complex) And by the way, that nose job was a failure too. Its the nose job where I pay $10,000 and come out looking exactly the same except with a round bulky nose.
A: Your chin implant information is very relevant, as while the chin implant may not have provided much horizontal projection, it often adds width. So it could be making a contribution to your chin width issue. This would depend on what type of chin implant it is, but most used today are of the extended or winged type which always adds width. That is usually fine for men but I almost never use them in women because of that issue. Women look better with a more angular or tapered chin.
A chin implant removal is actually very straightforward and not complex at all. The key is to make sure the mentalis muscle is adequately resuspended if done intraorally or a submental tuck-up is done if removed from below.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently looking to having my Goretex chin implant removed after five years. I have always been unhappy with it as it is simply too big for my face. Can you please let me know how it is removed, any issues I should know and what How To Get A Ex Back At 14 the process to do it involves.
A: Thank you for your inquiry. When it comes to removing a chin implant, it is often necessary to tighten the mentalis muscle/chin tissues at the same time to prevent chin ptosis or sagging afterwards. This is particularly relevant if it is a large implant and produced a significant stretch of the chin tissues. Much like a breast implant, what happens to the overlying expanded soft tissues on removal? The approach used for chin implant removal, intraoral vs. submental incision, would depend on how it was originally placed and how much loose chin tissues are expected to result. This could mean an intraoral mentalis muscle resuspension or a submental tuckup from underneath. There are, of course, some cases where simple implant removal is all that is needed…but these are only a minority of cases.
Regardless of what needs to be done, this is an outpatient done under sedation or general anesthesia. There is minimal recovery and discomfort afterwards. There are no restrictions after such surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a medpor chin implant placed in me about 18 months ago. I would like this removed and replaced with a smaller implant for several reasons (mechanical problems and aesthetic reasons). Can you remove the implant given the time frame I have had it? Thank you for your time.
A: Despite the fact that the Medpor material does allow for some superficial tissue ingrowth, it is by no means impossible or even that difficult to remove. The material gets the reputation for being difficult to remove as it is compared to silicone, which has a smooth and slippery surface which slides in and out of tissue pockets quite easily. But Medpor facial implants can be removed, it just requires a little more surgical effort and sometimes removing the old implant in pieces. The chin implant being in place 18 months does not impact the removal process anymore than if it was there 18 weeks or 18 years. Tissue ingrowth into the material occurs rapidly and very early after implantation. It does not get worse with longer times of implantation and, contrary to many opinions, does not get any bony ingrowth into it either. Since the tissue ingrowth just occurs into the outer layers of material, it does not get deeper or penetrate further beyojd a certain point.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, about six months ago I had a medpor chin implant inserted through an intraoral incision and secured with screws. Unfortunately, the wings were too large and malpositioned. I had a revision one month ago in which the implant was removed, trimmed and re-inserted. Now the implant is the right shape and size, but my lower lip feels shorter and tighter. The top halves of my lower teeth show with the lip at rest, and I can barely raise it enough to cover them. When raised, the lip is lower in the center than at the sides. After the original surgery I had the same problem but not as bad, and the lip eventually went back to normal. This time the lip seems worse, and I’m worried it might stay this way. My Dr. said getting the medpor implant out was “very difficult” and it took twice as long as he expected. The implant actually broke when he took it out and he added 2 extra screws to hold it together when he re-inserted it. My chin and lower lip where very swollen for two weeks afterward and the center of the lip is still slightly numb. I’m worried I might have a problem with my mentalis muscle. Does my lip issue sound like something that will go back to normal on its own or like something that will require correction? Thanks for any advice.
A: In your history you have said the key words…intraoral incision. When using this approach for chin augmentation, the superior bone attachments of the mentalis muscle are cut and have to be resutured at the end of the procedure. Besides the numbness,, it is common to have some lower lip tightening and little tethering until the tissues heal and relax again. Going through the muscle twice, particularly in a more extensive revisional procedure, traumatizes and scars the muscle again…making symptoms of tethering and lower lip retraction more significant. It is too early to tell whether this problem is temporary or permanent. If it has not significantly improved by three months after surgery then I would recommend a mentalis muscle v-y lengthening and resuspension procedure.
Dr. Barry Eppley
Indianapolis Indiana
Q: I just had a large chin implant placed two weeks ago with neck liposuction. I didn’t really feel I needed the implant in tyhe first place as I had a good chin. The implant is way too large and I don’t like how it feels. I am going to have it removed and I understand there can be sagging skin or nerve damage. Please please give me your advice as to what I can do to correct the sagging skin or rippling in the event that it does occur.
A: The first thing that I can say is it is only two weeks after surgery so there is still swelling, so it is hard to say yet that it may be too large. Also, it is very common to have a chin that feels stiff and wooden for weeks after surgery. This is a very unnatural feeling but it will eventually pass by six to eight weeks after surgery. So whether your feelings about the chin implant would be the same two months from as they are today is hard to say. Since I have no pictures of you, either before and after surgery, it is impossible for me to comment on whether the chin implant should or should not be removed.
That being said, if you are convinced that the chin implant needs to be removed then the sooner the better. The less time the chin soft tissues are stretched out the better. I would have no concern about nerve damage as removal does not cause that problem. It is all about whether the tissues will shrink back down without developing a sag. This problem can usually be averted by doing some soft tissue suspension during the implant removal.
Dr. Barry Eppley
Indianapolis Indiana