Q: Dr. Eppley, Should I take out a 10 year old chin implant (silicone button type) first several months before a sliding genioplasty? Or can it be done at the same session as the genioplasty? If the latter (keep chin implant in until genioplasty operation), will it affect the accuracy of the cephalometric analysis? What about scar tissue – should it be removed first several months and healed up before the genioplasty? Which way is recommended to produce the result?
A: A sliding genioplasty is a good chin implant replacement method. It can fill the void left by the removal of the chin implant and replaces it with one’s own chin bone. There is no reason to stage the replacement of a chin implant with a sliding genioplasty. That creates an additional operation that provides no benefit to treatment planning or making the tissue bed any better prepared. The chin implant and its scar tissue layer against the bone can easily be removed and the sliding genioplasty performed unimpeded. It is not necessary to remove the capsule (scar tissue) up against the soft tissue side of the chin. The sliding genioplasty also provides the opportunity to creat different dimensional changes than an implant. (such as vertical lengthening, vertical chin shortening, chin narrowing/widening)
Dr. Barry Eppley
Q: Dr. Eppley, I had chin implant replacement done 3 months ago. I had a Medpor chin implant replaced by a silicone square chin implant as I wanted more squareness to my chin and wanted it wider. Today is officially 3 months after surgery and it’s been frustrating for me. Two sides of my chin where the previous wing were removed are still presenting irregularity and swelling. When I touch it it feels kinda soft and tissue like. I’m not sure it’s the capsule or scar tissue still remaining there. It makes the two side of chin still look like swollen and the jawline is not straight at all. But it is definitey improved since the first month after surgery .I’m just really anxious about it everyday now and I’m wondering when will it fully healed? I have searched online and some people says steroid injection can be done. Should I do that? I’m pretty sure the implant placement itself is fine but the capsule or scar tissue is making it look bad. I hope you can help me 🙂
A: Full and complete healing after any facial skeletal surgery can take up to 6 to 12 months after surgery to see and feel the final result. This can certainly be true for revisional chin implant surgery where one iimplant (that is well scarred in) is replaced by another chin implant. The important question is whether the fullness that you see is do to scar tissue/healing or that the implant is simply too wide/big. If it feels soft and tissue like then I would say there is still healing going on and more time would be the appropriate answer. I would not advise steroids as that is an uncontrolled drug treatment that can have adverse soft tissue effects (atrophy and indentations) and thus it can create just as many problems as it may solve. The only injectable treatment to consider is 5-FU injections which can help settle scar tissue but has no soft tissue atrophy effects. Otherwise, if the sides of the chin feel hard, then this is an implant issue where it may be too big or wide
The steps to take now are either 5-FU injections and/or continue to give it more time. At the minimum I would give it at least six months from the last surgery before contemplating anything invasive.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about chin implant replacement. I had a Medpor chin implant placed six months ago. As time has gone by with healing,and my face has slimmed down a bit, the chin implant looks too boxy. Here are some questions I have:
1. Could removal of the medpor implant cause any damage, or unsightly scarring? That’s why we wanted to explore shaving it while still attached. It just sounded so much easier than ripping it out, and possibly causing problems with the underlying bone, etc.
2. The implant that was put in was much more square than my original chin and I was never happy with it but was encouraged to give it the “time” test. Time only made things worse. My worry now is upon removal is the stretching that has occurred in the skin and tissues. Would there possibly be sagging if we go to a smaller implant?
3.. If we sent you some pictures, is it possible to only come out there one time — for the surgery?
4. Finally, I should mention that I am a cleft lip and palate patient who went in for a rhinoplasty (which we’ve already had a revision), and the doctor suggested the chin augmentation. We agreed it needed to be done, but we got WAY too much of a good thing. Thanks so much for your expertise and advice.
A: Having removed numerous Medpor chin implants, I have found them not unduly difficult to remove or particularly destructive to the surrounding tissues. It is always helpful to know what style and size Medpor chin implant was removed beforehand to plan for its replacement and to choose a more smaller more feminine type of chin implant design.
I rarely would advise trying to modify a Medpor chin implant in place as that usually does not turn out well. The access and visibility is difficult and asymmetry of some kind is often the result. Most of the Medpor chin implants that I have removed and replaced have that exact history…initial placement and subsequent revision (with asymmetry) and now they want it removed and replaced.
As long as some type of chin implant replacement is done, soft tissue sagging is not usually a concern. It is the total removal and no replacement where that is more of a potential issue.
This is the type of procedure where you come the day before to meet, have surgery and return home the next day. There are no other visits needed beforehand or after. Any follow-up can be done by phone, e-mail or Skype.
Dr. Barry Eppley
Q: Dr. Eppley, I have medpor chin implant that was put in 6 years ago intra-orally. The implant is a bit big for my liking, making my chin look a bit too boxy and masculine, and the projection from the side is too much. Can this implant simply be shaved down rather than completely removed? And if it was inserted through the mouth, does that mean it would have to be approached from the outside? Thanks so much for your expertise.
A: Trying to shave the existing implant in place will usually end up with an undesireable result. If one wants to modify an existing implant, it is always best to remove the implant, modify it outside the patient and put it back in. Since medpor implants are quite adherent to the tissues, removing them almost always requires it to be done in pieces this virtually destroying the implant. It would be better to figure out what the proper dimensions of the chin implant that are needed (based on what you know doesn’t work well) and remove the existing implant and replace it with a new one that has the desired form. Most women need smaller more triangular chin shapes (less boxy) and many chin implant designs are really made more for men.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 37 year old male. I have been feminizing my face for the last few years. I’ve already had my brows shaved and my hairline brought down. I wonder if you can help with 2 other areas that trouble me.
(1) I used to have a narrow, pointed chin. Unfortunately I had it shaved flat. Then I had a shaved medpor medium sized anatomical implant inserted. But my chin still looks wide, rounded (not pointed) and too long.
I have read a lot about you. I understand that you can use a smaller implant and shave the wings off to make it more narrow, and shave the point of the implant to be more pointed and shorter.
I have enclosed a photo of how it used to look, which I liked, and how it looks now which I don’t like.
(2) I also had high and narrow cheek implants inserted. Unfortunately the left implant became displaced after a car accident
and then removed. So now I only have the right implant in.
I wondered if you could place feminine implants in to replace the cheek implant i already have.
A: In looking at your chin and cheeks and your accompanying commentary, I can offer the following recommendations:
1) Your chin is now broader and more masculine than it was because of the use of an anatomical chin implant design. The Medpor chin implants have very broad wings that add fullness to the side of the chin making it wider. That could be changed by either altering the implant you have in place (difficult to do because of the material) or remove and replace it with a more central button implant style which will return the chin to more or of a triangular shape. The length of the chin may just be a function of the size and location of the indwelling implant. But if some real vertical chin shortening is needed, the lower edge of the chin bone will need to be reduced.
2) The cheek implants you have in place produce a more sculpted male look being high and lateral. A more feminine cheek appearance requires a rounded more anterior cheek look. That could be achieved by replacing the cheek implants you have in now with those that are better shaped for that look.
Dr. Barry Eppley
Q: Dr. Eppley, I want to get a new chin augmentation procedure. I had one done over 20 years ago but I always thought it wasn’t enough. It was done from an incision inside my mouth. In getting a new and larger implant, would the old chin implant have to be removed?
A: Whether your existing chin implant would be removed or not during the placement of a new one is an intraoperative decision. In theory, one would assume that the old one would have to go to make way for the new one. But this is not always true. Given that your original chin implant was placed over 20 years ago and was placed from an intraoral approach, it is likely that it is very small and positioned high on the bone. If it is not in the way, I will often leave the old one and placed a new one right on top or below it taking advantage of whatever augmentative effect it already provides. If it is positioned low I may either remove it, or if it has settled into the bone, I may just shave off the prominent part of the old chin implant to make a smooth platform for the new one to rest on.
Dr. Barry Eppley
Q: Dr. Eppley, I had a chin implant placed six months ago. The implant was fairly small (4mm) and didn’t seem to make much of a difference. I then had the implant replaced about a months ago for a larger one because I wanted to see an actual difference. Now my chin is huge! The surgeon who redid it didn’t show me my any pictures of what the result would look like or did he show me the size of implant that he would use. I was just told the measurements and didn’t see it. So needless to say I am not happy and am looking for a really good surgeon who would be able to go in and replace the implant for a more aesthetically pleasing one for a small petite female. I have a slender face but the new implant just makes it look longer and because of how large it now is, I can’t smile right, etc. Please let me know if this is something that could be considered. Thank you.
A: I can appreciate your dilemma. A 4mm implant is not really visible in just about anyone. But it is also easy to go too big and wide in a female. Too wide an implant in a female is a common problem that I see. Chin implants in women have to take into account different size and shape considerations. What you would use in a women can be different than that of a man. I would need to see some pictures of where you were when you started and what you look like now if that is possible. I am certain you can get a much better result than you have now just based on your description alone. I suspect it is the wings of the implant that are as much of a culprit as that of the actual horizontal projection.
Dr. Barry Eppley
Q : I had a chin implant 9 years ago, when I smile its seems to be without form, like flat. And after X-rays I noticed that the implant is placed higher up where it should be (close to my teeth). A doctor told me it would be very laborious, because it would be two operations, one to remove the chin implant which would remain a hole, wait 3-6 months to heal the skin and the second to put the new implant from under the chin. Is there another solution? Thanks!
A: It is very common to have a chin implant that ends up being positioned too high on the chin bone when it is placed from inside the mouth and is not secured with a screw. When the implant is too high on the bone, it loses some of the projection or forward position of the chin that it would otherwise have.
Replacing a misplaced chin implant is fairly easy and can be routinuely done in a single operation. I have never heard of having to do it in two operations nor does that make any biologic sense to me. Going through a small submental (under the chin) incision, a new lower pocket can be made, the old implant removed, and a new chin implant placed and secured. In some cases, I have left the old chin implant where it was and just placed a new one beneath it. If someone has a deep labiomental crease, keeping a ‘spacer’ (old implant) high can help push that area out and prevent it from becoming deeper.
Dr. Barry Eppley