Your Questions
Your Questions
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: D. Eppley,I am interested in a chin implant revision surgery. I had a chin implant placed through a mouth incision which has left me with a lot of issues. Will moving the chin implant to a lower and better location correct all the issues I’ve been having? Maybe even the dimpling. Don’t know if you can tell from some of the photos, but the doctor that put in the chin implant had also did a submental tuck. Will you be using the same implant or replacing with a new one? You mentioned moving it to a better location on the bone but you also mentioned that a new implant positioned lower may also be a possibility. I don’t want my chin to look bigger. So will placing it right on the chin bone make my chin look longer?
A: Whether a new chin implant is needed or not for your chin implant revision is not absolutely clear to me right now. If you are happy with what horizontal projection it provides and are not unhappy about its width then I would say just use the one you have. When moving the existing implant it may be necessary to shorten its height so it does not create a vertically longer chin. That would be the only reason to consider a new implant to prevent that occurrence. Knowing what style and size of chin implant you currently have in place would be helpful in that regard but that is information you may not likely have. Thus that is a judgment that would have to be made on an intraoperative basis.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a silicone chin implant placed on June 12th and it has been discovered that the right wing was malpositioned, it protruded through my gum line. I have the revision done on June 18th, and there is no improvement whatsoever, the right wing is still siting very high above the jaw bone. What would be the best chin implant revision option?
A: I am sorry to hear of your unfortunate chin implant experience. It usually does not proceed down this complicated postoperative course. To have have had your type of chin implant complications would suggest two things. First the chin implant was placed through an intraoral incision. This is the most way chin implant wings get too high. Second, the implant was not secured to the bone with screw fixation. (which is ideally needed in intraorallly placed chin implants) Thus migration of the one wing of the implant into the mouth.(vestibule) The chin implant revision solution is to remove the implant, close the intraoral wound and immediately replace the chin implant through a submental skin incision and then rigidly secure it to the bone with a screw. With some form of fixation efforts at repositioning a chin implant in a slippery encapsulated pocket are prone to failure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant placed through a submental incision three months ago. I’m really in a tough spot with the chin implant because I really can’t live with this crooked smile I’ve had since post op, but no doctor knows what’s causing it or how to correct it. I’m seriously thinking of removing it without replacement in the hope that my smile will return, but I have concerns about post removal complications like witches chin deformity or scar tissue balling. If I remove it, it will be five to six months post op at the earliest. This was a large extended anatomical implant, and I’ve read doctor opinions on Real Self where they’ve expressed concerns about removing a large implant without replacement more than a few months post op. What is your take on all this? Should I only have a doctor perform this procedure if he does it a certain way? For example, only go with a plastic surgeon that can recognize, during surgery, if a submental tuck up is needed, as well as one that has me wear a chin compression sling post op? I wonder too if, since my jaw is on the smaller side, could this implant be ‘too tall’ and be limiting my mentalis muscle, in turn affecting my smile? If I were to go with another implant, should I be sure the doctor’s comfortable shaving it down to be no taller than say 1.0cm or even less than that? The large Terino implant is 1.3cm at its tallest point in the center. Please see the 2 attached 2 X-ray’s taken recently if they are of any help in your assessment.Thanks for your help!
A: With a chin implant that is only adding 6mms of horizontal projection, I would have no great concerns that removing it would create a witch’s chin deformity or a chin ptosis. If the implant is removed I would see no reason that a submental tuck would be needed. Simply putting back and tightening the mentalis muscle should be enough. When trying to solve a problem, don’t complicate it by adding too many variables. Either simply remove the implant or have the one you have now repositioned a bit lower on the bone. It is sitting just a tad high on the bone right now. While that may or may not solve issues, these are simple chin implant revision maneuvers that at the least will not create any further complications.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I got a 7mm Medpor Chin Implant put in on January 20, and I want it removed ASAP. Its too bulky and makes my face look less feminine than before. What are the chances of my face going back to the way it was before? Would another implant need to be put in? my doctor doesn’t do silicone chin implants for their tendency to drop overtime so Medpor it was. I’ve heard how difficult these implants can be to remove, what’s your experience with removing them? If I was to replace with a silicone implant, is it better to do it when removing the other or a few months later?
A: I am not surprised that a Medpor implant is too bulky for a female. While that implant needs to be removed, it is important to always remember that you had a chin implant placed for a reason and that was to correct a chin deficiency. This may be the wrong implant but that does not mean that there is no merit to having a chin implant at all. A better shaped and more feminine chin implant made from silicone would offer horizontal advancement with far less width if any at all. I would strongly consider replacing the implant rather than merely removing it. I have to see you throw away the complete effort.
I have removed many Medpor implants. While they are not as easy to remove as silicone it can be done. I have never heard of silicone implants ‘dropping over time’. There jus no biologic explanation for that and something I have never seen. It is better to remove and replace at the same time (with screw fixation of the new silicone implant) than to delay. The only reason to delay/stage it is if you are uncertain that you really want an implant at all. But that will change what is done during the implant removal. If you are just removing then you need to do a submental tightening of tissues since the tissues have been expanded to avoid a chin pad drop/ptosis.That ail not be necessary with a chin implant replacement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin implant revision. I had a chin implant done (via inside mouth) ten years ago. II think it was Medpor, 3mm. Profile is great. From the front view – one side is lovely, but the other side is way too long for my face. It’s put my whole face out of sync. I read that it is hard to remove Medpor, and it is great from side view, and one half of the front view – so, I am wondering if it’s possible to go in and shave down one side a little, to make it more even and smaller on that side. Also, what downtime would be like for this? Is this something you would be happy to do?
A: Medpor facial implants are difficult to remove due to tissue adherence but not impossible. But if you are happy with most aspects of your chin implant then it should be modified in place rather than removing it. Medpor is much easier to trim/shave once it has been in placed for awhile as the material softens slightly with tissue ingrowth. The easiest way to do your chin implant revision in which the goal is to trim one side of the chin implant which is vertically long is to do it from below (small submental incision) which provides the most direct access. This would also have the easiest and quickest recovery. It can be done, of course, also from an intraoral approach as well if the submental scar is a potential concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant procedure last year with a medium silicone chin implant. The picture on the left (attachment) shows me right now with the implant, the picture on the right is me with a photoshopped chin projection. I downloaded this plastic surgery app that allows users to play around with digital imaging, and so I extended my chin horizontally to my ideal and dream chin projection. I also took a Qtip and placed it on my lips straight down and then measured the space from where the Qtip drops down to where my chin is at now, and it seems that I am 10 more mm’s away from having the chin in the photoshopped picture. But remember, the current chin implant now gave me 5mm’s, so technically if it’s taken out I would need a total of 15mm’s to achieve my ideal projection. I wish I would of known all this prior because it looks like all the money I spent on this current implant is now going to go down the drain as I am not even half satisfied and just keep dre aming about the chin on the right. I came across your site, and I guess my question to you is that with all that said, how can we go about getting me to the projection I want? Would I need both a genioplasty and implant together? Because I know the biggest implant made is only a 10mm. I just want to do it right this time so I never have to deal with it again.
A: Given that you have a chin implant already in place, it may be best to do a sliding genioplasty for your chin implant revision. (technically chin augmentation revision) The chin implant would stay on the front edge of it, so you still get value of having done the prior procedure, and move the chin forward 8 to 10mms. Otherwise, you would have to have a custom chin implant made to cover the total 15mms horizontal projection desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision. I wrote to you awhile back about getting a button style chin implant after a chin reduction by sliding genioplasty. My chin was reduced about 4mm. I then got a 3mm button chin implant placed, hoping to reverse the outcome of the chin reduction. Thankfully I’ve had no complications but I know have the look of slight jowls of both sides of the implant, especially on the left side. I’ve tried fillers but I really can’t afford to get fillers placed every year. Have you ever placed an extended anatomical implant with wings that measure 1mm in thickness? Have you ever placed an extended anatomical that has one wing thicker than the other to fix asymmetry? Thanks for your time.
A: Most chin implant wings, if they are made of silicone, are very thin often being only 1 to 2mms in thickness as they taper back along the jawline. The chin implant wings can be adjusted in length and thickness to compensate for asymmetry between the two sides. That is not an uncommon modification done in some chin augmentation patients whether it is a primary surgery or a chin implant revision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision. I had a silicone chin implant a few years ago which was terrible and looked awkward. So 1 year ago I replaced it with a Medpor chin implant which is no doubt much much better than that original nightmare. But this Medpor chin implant does not look rigid as opposed to silicone. It looks more like a “U” shape instead of “V” shape. The edges are not sharp as opposed to the famous MB picture either. So what is your suggestion, is it possible to add some medpor cuts to the edges to make it look more sharp do you think? Or is it a common issue with all Medpor chin implants? Thanks a lot for your great experience and knowledge.
A: The success of any chin implant to create a specific chin shape is not material based. It depends on the shape of the implant and the thickness of the overlying soft tissues and underlying bone shape. You did not state what style of Medpor chin implant you have which would be helpful to know. But Medpor implants in general are thicker and ‘bulkier’ than most silicone implants because the material from which it is made is machined into shape rather than poured into a mold like silicone.
The ideal chin shape image you are showing is more of a square shape unlike yours which is more circular and long. Whether your existing chin implant can be shaped into that form would depend on knowing what shape and thickness your existing implant is. It certainly could be improved but tot what degree can not predicted without further information. Medpor implants are generally bulky and some improvement in its form can usually be obtained by giving it a more angular shape.
I would point out that shaping an indwelling chin implant has its limitations based on the existing incision length and access to it. It is often better to place/replace an implant that has been shaped before it is put in with the dimensions that one wants.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking a chin implant revision. I had a Medpor round chin implant six months ago. I’m not satisfied with the thick sides with visible edges at the end and round shape. I want a square front but with shorter thinner more blended wings. About 1 months ago, I went back to the same doctor for a minor revision. Since he doesn’t do square implant he decided to shave down the sides to fix the problem. Result is very bad as he shaved down the front part of the sides but didn’t go back to the end edges. Now I have a very narrow pointy front ( worse than before revision the round front) and still with thick wings and visible ends. But the good news is that he told me the implant did not grow into the tissue yet and is very easy to remove at this time. So I’m now seeking a revision to remove my current implant with a wide square looking one but with short thin blended wings. I really don’t want to go under general if it’s possible since my Medpor chin implant is not that attached.
A: When it comes to a chin implant revision, it rarely works well when chin implants are trimmed in place. To really properly trim them, they need to be removed and modified outside of the patient and then put back in. However with the trimming now done to your existing chin implant, a new one is really needed now to achieve your goals. Having removed many Medpor facial implants, I do not believe that ‘the implant is not attached’ or that it does not have good tissue adherence. If that were really true then your surgeon should just have removed the implant to modify it if it was that simple. There is no doubt it can be removed but it will have considerable tissue adherence and is not a procedure that I would do under local anesthesi.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking a chin implant revision. I had a Medpor extended large chin implant and I’m seeking for a revision. One reason I’m not satisfied is the sides are very wide and do not blend in my own jawline and I can feel the edges where it ends. Another reason I’m not satisfied is I want a square looking chin shape. I did tons of research and I found out that Terino style 2 has a square wide front looking but sides are not as long and thick as my medpor implant. That means I will get a square looking front but more blended and with thin side wings. But the only problem is the Terino style 2 doesn’t have big projections at all, the maximum is about 6 mm while my current one is 9mm projection and I at least need that much since my chin is very receded. What can I do? I want Terino style 2 square chin implant but with more projection.
A: This is a simple chin implant revision problem to solve. I call it the wafer technique or the stacking of a certain thickness of a wafer of material under the front part of the implant so it adds more horizontal projection. This could be done by using a section of the existing medpor implant cut down to fit behind the new one just in the front, a 3mm wafer will make the square chin implant equal your existing horizontal projection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had plastic surgery done nearly 4 years ago that has left me what I consider deformed. I don’t resemble myself and there were so many mistakes the doctor made to my face. I am deeply saddened and depressed over this not only because of the cost but that I’m left disfigured and violated. I had my nose done where the doctor inserted a silicone implant promising that he would be able to correct my slight deviation with it. That was not achieved and my nose appears even more deviated, my nose looks short, and my nostrils more visible. I have thin skin so I feel you can almost make out the implant when looking at me. I would very much like to correct the mentioned issues. Also he performed an extraoral jaw reduction on me that left me further disfigured. He overcorrected and now my face has the appearance of a horse. I would like to restore the lost volume and give my face back it’s natural contour. Not to mention the incisional scar is very unsightly. It’s almost two inches long and is hypertrophic and red. I would like to revise the scar to make it less noticeable. I also had a silicone chin implant placed but it does not fit my face. It’s too big and wide and I would just like it removed and possibly have fat grafting to that area instead. I would possibly like other areas to be fat grafted as well such as my nasolabial fold and the hollows of my eyes.
A: From a nose standpoint, if you had an initial nasal deviation overlaying silicone implant on a nose that is deviated will actually make the nasal deviation look worse not better. So your outcome is not a surprise since you have to lay the implant on the existing nasal base. With thin skin and implant encapsulation, implant visibility often appears years later. From a short nose and nostril visibility standpoint, I am not sure how an implant would have caused that per se with the exception of a high bridge and dorsal line may make the amount of tip projection/rotation perceptibly look shorter and more rotated. From a secondary rhinoplasty correction standpoint, it appears that the implant would need to be removed and cartilage grafting done to augment and lengthen the nose with tip derogation as well as correction of the underlying nasal deviation which almost certainly has a septal deviation as a core root of the problem. The question is where the cartilage needs to be harvested from and that would depend on how much is needed. The debate is always whether it would be a combined septal/ear donor site or whether more is needed which requires rib cartilage. I would need to see some side view pictures to have a better idea in that regard.
From your prior jaw reduction procedure, I am assuming that the incisions and now red scars are at the back of the jaw behind the angles. (a side view picture would show that better) When you say you have lost volume and has changed you facial appearance (I don’t know if I would go so far as calling it horse-like), that likely implies that it looks too long because of the lost jaw angle volume and a steeper mandibular plane angle. (high in back and steeply slopes downward towards the chin) Restoring lost volume from prior jaw reduction in my experience is done by adding a jawline implant closer to the lost angle area to add some vertical length and a little bit of width.
Revisions of the jaw angle reduction scars can certainly be done and would likely result in a better outcome since they would not have the original traction. (pulling and stretching the skin to cut the bone) The interesting question about your scars is whether that access should be used for the placement of the implants since you have them already. That would make your recovery much easier than from gong inside the mouth. Whether the implants can be used forms standard stock sizes or should be custom made from a 3D CT scan is another issue to debate.
One of the may problems with chin implants done in women is that they are are often too wide as extended anatomic styles are often used. The question here is whether it should be replaced with a smaller central button style chin implant (which is far more appropriate for female faces) or replace with a fat graft with its unknown survival rate.
Lastly, fat grafting can be done for the nasolabial folds and eye hollows with the only real issue bend their survival is the risk of some unevenness or lumpiness in the eye hollow area due to the thin skin. This can usually be minimized by using a micronized fat grafting technique where the fat particles are made very small before injecting.
I hope these comments are helpful and if you can send some side view pictures that would be useful for further analysis.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of a chin implant revision. My surgeon used a 10mm Medpor chin implant. My face was round and small before, now its very long and wide so I look masculine. I’m female by the way. Is 1 month too early to tell? The shape of it has not changed since the first day after surgery and I hate it. I have attached some pictures of me before surgery and the way I am now.
A: The timing of a chin implant revision depends on when one is certain that its size and shape are not satisfactory. Even though it is just one month after surgery, if the chin augmentation looks too big and wide to you, it is because it is. I usually use the benchmark period of six weeks after surgery for one to have 90% of the facial implant result. Medpor chin implants have a very poor taper to them due to the material thickness and their extensions backward along the jawline are destined to make many women have wide looking chins. A large 10mm implant is most assuredly going to cause this widening effect. While you clearly appear to have been a good candidate for a chin augmentation, I am afraid that you appear to have the wrong implant style for your female facial features. Both your pictures and how you feel at this point indicate that clearly this is the case. I would suggest that you have a chin implant revision that either has the existing chin implant reshaped or exchange it for a chin implant that better matches your feminine facial shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have done a lot of research regarding chin implant revision and your name keeps popping up. I have a very weak jaw line/chin and I have a medium middleman chin implant placed with the wings cut off. The surgeon had to go back in three times intraorally to fix protruding wings and misplacement. The implant is still very high up and pushing my bottom lip up. I also have permanent muscle damage to my lip. I have denting and scarring in my chin. My last surgery was 6 months ago. I would like my neck to be tighter along with a new implant. I would also like to see if a revision rhinoplasty would fit in my budget. I had nose surgery about two years ago. The surgeon performed a pinch rhino when I’m more concerned about the bump in my nose. It still looks quite bulbous, I would like a small petite nose. I have attached several pictures and the web page called real self with other pics and doctor’s comments. Thank you for your time.
A: From a chin implant revision standpoint, intraoral placement if not placed in the proper position low on the chin bone and screwed in, has a high risk of riding up high in the chin. To properly revise this implant, the questions are whether to keep this existing implant and properly position it (ideally now from a submental approach) or to change the implant to a different style. Since you have never had a proper assessment of what this implant offers due to its many revisions and still high position, that may be a hard judgment for you to make. I would suggest a submental approach with a new implant altogether, removing the old one at the same time.
From a nose standpoint, there is certainly room for improvement from both a better hump reduction and a shorter, thinner and slightly more uplifted tip with a revisional rhinoplasty. I have attached some imaging to show what I think can be done from where you are now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need with a chin implant revision or a chin implant removal. I had a chin implant done about 10 months ago and I am still experiencing numbness and a slightly crooked smile on the left side. The most alarming part is that smile does not “go down” as much as it used to. My smile feels tight and almost like I am fighting against my chin to smile. Am I just still recovering from the numbness or should I get it removed? I liked my smile before and now it is too small and strained looking…I have a round face and sometime’s I think the implant makes it look rounder (and not thinner/ more defined which is what I wanted). My entire lower left side was numb after surgery so it has come back significantly…but still so slow in 10 months. Do you have any suggestions?
A: You are describing symptoms of a chin implant that is too ‘big’. The feeling of tightness in the chin and the stiffness from it is either due to a very tight pocket or an implant that is a little too big for the tissues. The fact that your chin looks rounder also indicated that it is ill-shaped for a female which should have more of a triangular-shape and not rounded like the implant that is in there. Given that you had the chin augmentation procedure for a reason, I would suggest a chin implant revision rather than a chin implant removal. The implant needs to removed, reshaped and then repositioned rather than just throwing away the entire effort. You did not say which way the chin implant was put in (intraoral vs. submental) but I am going to guess it was placed intraorally which can often be a source of these type of symptoms.
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 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
Indianapolis, Indiana
Q: Dr. Eppley, I undergone a genioplasty 18 months ago where a 5mm medpor implant was inserted through the chin. It improved my profile view and made my face more masculine, but it hated how it looked from the front, making my lower face square while I originally had a V-shape that I liked. The new chin was larger and squarer than my lower dental arch, so it looked weird at different angles. I asked for a revision 6 months ago where my surgeon shaved the wings off and tried to better adapt to my natural asymmetry. Today it still looks weird to me, even though it made me get some of my original features back. The bulging is now more isolated in the front, which is another kind of weird, as a matter of speak. I am now fairly certain I want it out, even if it means losing the profile improvement.
My questions:
– How dangerous is it to remove medpor after 18 months ? I know you wrote it’s only relatively more difficult compared to silastic (my surgeon says the same), but it is my face I have to be really careful with what I do next. Am I facing some loss of tissue/bone/muscle ? Do I risk some sagging (perhaps having reduced the implant’s size first will help in that regard ?) ? And if I getsome sagging, does getting more weight (planned anyway) will also fill up the skin so that it’s not so much of an issue ?
– when the medpor wings were shaved, doesn’t that necessarily suppose shaving integrated tissue/bone ? If so, does that mean I have now less bone structure than before ?
– Is there any way of moving a chin forward without making wider (and still blend in with the mandible) ? Is sliding genioplasty better at maintaining the original shape (since the bone already has the patient’s natural shape) ?
Thanks a lot for the time you spend helping out online.
A: One of the most overlooked features of chin augmentation is how it can change the front view. Most chin implants, particularly those of Medpor designs, will have an appreciable widening effect. When removing a chin implant, the issue is always one of the potential for soft tissue ptosis or sag. Just like a breast implant, once the tissues are expanded, they may not go back to their original shape. That is going tgo highly depend on the degree of expansion (size of the implant) an how long it has been in place. This can be partiually or completely overcome with mentalis muscle resuspension. Removing a Medpor implant does not mean losing any bone. The concept of bone ingrowth into Medpor is overstated and does not really occur to any appreciable degree, if at all. Removing the implant and doing a sliding genioplasty is a better alternative than just removing the implant alone. By so doing you will still end up with the profile improvement, keep a narrower chin (all sliding genioplasties actually keep or make the chin more narrow not wider) and will pick up any soft tissue and avoid/treat any soft tissue sagging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a large chin implant placed three months ago. It looks OK but it has pulled my lower lip in to my mouth and I have no projection of my lower lip. The implant was not screwed in and is rising up and the bottom of the implant is not parallel with the bottom of the chin. When I have my mouth closed and lift my lower lip up higher into my upper lip it feels like muscle is wrapping around the implant and causing a very tight feeling. Will I aways be able to feel the implant? If so that is ok. but I would like for someone to at least be honest with me. If you do not know, that is ok. Just say so. I have only been able to talk to people that have had it as long as me or people who have removed the implant because they still felt it. Would sliding genioplasy solve that?
A: When I hear chin implant experiences like yours, it usually indicates that an intraoral placement route was done and either the implant was initially placed low enough but has slide upward (silicone) or was never quite placed low enough. (Medpor) Everything you are describing indicates that the implant is riding up too high in the chin. In conjunction with an intraoral route of placement (if that was done), the mentalis muscle may be partially disinserted or scarred down creating an inversion of the lower lip. With good implant placement and size selection, all edges of the implant should blend fairly smoothly into the surrounding bone. Until I have some more information about your chin implant surgery (route of insertion, size and type of implant) I can not yet answer the question as to whether improvement will come from implant repositioning/muscle repair or removal and replacement with a sliding genioplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seriously contemplating having chin revision surgery done by you due to a persistent unilateral numbness on the right side of my chin and lower lip area. This has been causing me a lot of distress for almost 2 years. On top of this, my right mentalis muscle doesn’t contract properly which causes a very noticable crooked smile and asymmetries in other facial expressions.
Here is a short history of what was done on my chin. About 3 years ago a plastic surgeon placed a Medpor chin implant with a 5mm projection via intraoral incision. It was the implant shown in this photo, but with a fair amount of custom reshaping. There were several issues after the first surgery though. While the left side seemed to be alright, the right side wasn’t. The implant was shaped assymmetrically (less prominent on the right angle. The right wing protruded about 2mm from the chin bone, i.e. it didn’t touch the bone which resulted in a bad transition as well as serious irritation and pain that wouldn’t resolve. The implant appeared to protrude slightly more on the right frontal part than on the left. Therefore my surgeon injected hyaluronic acid on the left frontal part to temporarily ameliorate this assymmetry until revision surgery. There was also numbness and lack of motor control of the chin and lower lip. The numbness and lack of motor control eventually fully resolved, but it took a whole year! However, the other problems made a revision surgery necessary. In this surgery the following was done. An intraoral incision merely on the right side (only the right muscle was cut through!), taking away the back part of the right wing to ease the irritation and pain, placing additional MedPor material on the right angle of the chin implant to make it more prominent and placing additional MedPor material on the left frontal part of the chin implant. The revision surgery took care of the irritation and ameliorated the assymmetries, meaning the chin now looked more symmetrically although still not perfect.
Unfortunately, the revision surgery brought more bad than good things. Now the major issue is that even after almost 2 years since revision surgery I still have unilateral numbness in my right chin and lower lip area and serious lack of motor control of my right mentalis muscle. This all became gradually better, but the progress has long halted and I am pretty certain that the remaining numbness and lack of motor control won’t improve any further with time. My surgeon said the odd behaviour of my right mentalis is caused by scar tissue located on the left frontal part pulling on the right side. I have no idea if this is possible. I rather think that the problem is not the scar tissue, but the mentalis muscle itself. Maybe it was not properly resuspended. This is were I need your opinion the most. I attached some images and a video so you can get a better idea of my problems. Among the images is an xray scan that faintly shows the chin implant. Maybe this helps you determine if the implant impinges on some nerve. Also, would you say that my chin is sagging somewhat? Can this be fixed? As a side note I should mention that I have a tendency for scarring and fairly bad wound healing.
Based on my description I have several question that you can hopefully answer:
– What would be your general advise in a situation like this?
– How would you approach another revision surgery? Does the mentalis muscle have to be resuspended? Is there hope it will return to normal functioning?
– Was it a sound approach to only make an incision through the right mentalis muscle? Wasn’t this screaming for a muscle dysbalance later on?
– Would it make sense to make an incision under the chin and not inside the mouth should a revision surgery be necessary again? It seems like cutting through my muscles is causing a lot of complications. But I guess the intraoral approach is necessary if the mentalis muscle has to be resuspended, right?
– Do you think the implant is aesthetically OK?
– Is it a good idea to take out the old implant and place a new and maybe smaller one? I suspect the current one might be slightly too large.
I’d like to thank you very much in advance for taking the time to read and respond to my email. Hopefully you have some encouraging news for me.
A: Thank you for your inquiry. I have reviewed your history, pictures and video and can make the following comments:
1) Your case illustrates why placing a firm and inflexible Medpor chin implant through the mouth is generally a bad idea, it is associated with a significant risk of all the complications that you have experienced. But that is water over the dam now.
2) I find the aesthetics of your chin result very acceptable and certainly don’t think it is too big.
3) I would NEVER think at this point of trying to remove and replace your chin implant. That is a disaster waiting to happen. Given what has transpired up to the present and the difficult with removing Medpor implants, the risk of worse nerve and muscle problems is very likely. It may not be perfect but a perfect chin result for you is no longer a reasonable goal. I would advise that you accept a reasonable aesthetic outcome. Revisional surgery for you, as you have learned, has a lot more risk of problems than it does in making things better.
4) It would be highly unlikely at this point that, even if the implant was impinging on the nerve (which I doubt) that relieving it is going to cause return of feeling. The nerve fibers have atrophied and the damage is irreversible at this point.
5) I do not think you have chin ptosis or sagging.
6) As for mentalis muscle dysfunction, I would have a very low level of confidence that any efforts at trying to resuspend the muscle would end up in the long run giving you a better result than you have now.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have had multiple jaw implants that have left me with an unsatisfactory result. My jaw is naturally asymmetrical so it was hard for the surgeon to match left side to right side I suppose. He tried to fix the asymmetry by shaving down the implants, then another surgery to add implant on the right side which just made it bumpy and stuff. I think I just need to start over with newly designed implants. In addition I also want a reverse sliding genioplasty, my chin sticks out too far and looks unnatural. I can get a 3D print of my skull and a physical 3D exact model from a computer, so that new implants can be made to make my face sides perfectly symmetrical. I have attached a video which described in detail exactly what I don’t like about my jaw result.
A: I have seen your video and your problem is one I have seen many times. I can make the following comments:
1) Jaw angle implant asymmetry is not uncommon and is a result, most of the time, from different placements on the jaw angle rather than some inherent bony asymmetry. Bony asymmetry does not help but it is actually very difficult to get perfect symmetry (alignment of flare) between two jaw angle implants.
2) The problem you have on our left side is that the two implants (chin and jaw angle) do not meet, thus leaving a depression or lack of smoothness between the two. That, again, is reflective of the asymmetrical placement of the jaw angle implant on the left which is further back and higher than the right one. Note that your right side is smooth probably due to the better position of the right jaw angle implant.
3) Correcting jaw angle asymmetry, in my experience, rarely works by just shaving down the implants while they are in place. The implant almost always has to be removed, modified if necessary and then reinserted in a better position. Modifying it while in the patient is treating implant malposition by adjusting the shape or thickness of the implant, potentially worsening the problem or at the least ending up no better for the efforts.
4) You are correct in now assuming that the best approach to the problem is to get a 3D model of your jaw, see exactly where the implants are and make new implants if needed.
5) As for your chin, I do not have the advantage of knowing what you looked like before. But your chin result is not particularly abnormal or unexpected. It may be more projection than you want but many chin implants when placed on a smaller chin will end up with that result. It may look like it is sticking out and the labiomental sulcus will deepen. Medpor chin implants are thicker and more bulky than other materials and this may also be part of the aesthetic problem. You may simply benefit from a smaller projecting chin implant design.
In conclusion, making a completely symmetric 3-piece chin and angle jawline enhancement is not as easy as it looks on a skeletal model and you, unfortunately, are reflective of some of the problems which can occur. But your next step of getting a 3D analysis of what you have and why it looks that way is the only effective way to move forward.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a jaw/chin implant 14 weeks ago, it was two separate pieces that were screwed in. I would assume most of my swelling is gone but I have asymmetry as one side is lower….my Dr. is a reputable surgeon and is working with me, we meet approx every 5 weeks or so….he said if necessary he can go in to the one side, make a small incision and file it down some (not remove it)…he also put some filler in the area right where the implant starts at the jaw so you can see it….said there is permanent filler we can use down the road….I guess my question is how does this sound to you…..is filing down of an implant an option when there is tweeking to do?? I greatly appreciate your help….also is filler routinely used to help “fill in” near and around an implant for a more natural appearance and do you advise that. Thank you for your time!
A: Let me make sure I understand exactly what implant you have. Using the term jaw/chin implant could be either an isolated chin implant or a combination chin and jaw angle implants. I suspect you mean a chin implant because it is two-pieces which would also make it a Medpor two-piece chin implant. If there is asymmetry between the two positions of the two pieces and you are certain that it is not just swelling (more than 3 months after surgery), the best approach is to go in, unscrew the implant, reposition it higher and screw it back into place. There is nothing wrong with cutting down the lower side but that can be harder than it seems to do smoothly and evenly with the implant in place. As a general rule it is always better to fix the primary problem (implant) rather than investing in camouflaging the problem by injectable fillers.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am one month post surgery for chin implant done through the mouth. There has been a lump on one side right below the jaw line that is very hard, size of a pencil eraser. My sugeon want to correct it in the office under local anesthesia but plans on taking it out and putting it back in and going through the mouth again. This terrifies me for many reasons. I just now got all feeling back in my lower lip. I had a lot of pain from the stitches and I’m afraid of a worse outcome, and being awake in the office. I’d rather be put out. Should I get a second opinion? He is ready to do the revision now.
A: I think the timing for the chin implant revision is appropriate but you should have it done under the circumstances of which you are most comfortable. You should tell your surgeon you are not comfortable under local and perhaps he will consider some IV sedation which can feel very much like going to sleep. If not, then you will have to consider another surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to place the wing of a chin implant separately from the front part of the implant by cutting it loose? On one side of the jawline my implant wing crosses the bone and sticks out. My jawline is asymmetric and is higher on one side. On the higher side the wing sticks out. My doctor told me the implant wing can’t be placed upward and inserted on line with the jawline because the shape of the implant doesnt allow it. The wings on the implant don’t have the right angle to match my higher jawline. Placing it on line with the jawline would stress the implant and eventually lead to malposition. Is it possible to cut the wing loose from the implant and place it separately from the rest of the implant on line with the jawline?
A: The simple answer to your question is yes. You are referring to a chin implant revision due to a wing malposition. Although the malposition in your case is a direct result of your own anatomy which is not symmetric. During your revision, the wing can be separated from front or main bofy of the implant. But that alone will not make the wing move into the desired position. The implant pocket must be modified as well to accommodate the desired position of the implant wing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision. I had a chin implant about six months ago and the doctor said it would look just like I wanted. Well it hasn’t and he appears to have chosen the wrong implant. What I wanted was a much wider and more square chin look and it doesn’t look that way at all. I have done some imaging on my picture to show you what chin look I am after. What is the best type of chin implant to achieve my desired look?
A: The imaged change that you desire in the width of your chin can not be made by almost any off-the-shelf preformed chin implant. Even square chin implants do not add that much width. If you look carefully, the widest part of the chin goes past a vertical line dropped down from the corners of the mouth. That is beyond the widths of most existing chin implants.
There is however a way to do it with one and only one preformed implant, the Medpor RZ extended square chin implant. It is possible to exceed its natural width because of its central connector. It is actually inserted in two separate pieces and then attached once in place. You can increase the width of the chin by a full centimeter by not snapping it together but by leaving the two pieces spaced apart and made ‘one-piece’ by only the thin bridge of the connector.
The other option is to make a one-piece design out of silicone that contains all the desired dimensions and is placed as a single piece implant. (aka custom chin implant)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant placed over a year ago that ended up with my chin being asymmetric. I had a Ct scan which showed that the implant was ‘cockeyed’ in position with the left side being much higher than the right. I then had a revision done on it and my surgeon placed a new implant but it still does not look right even though it is only one month after surgery. I am going to get another CT scan but if it shows that it is still not symmetrically placed what should I do now?
A: Chin implant displacement can occur because the implant wings are asymmetrical or the entire chin implant is positioned too high on the chin bone. Asymmetry of the implant wings has become more common today due to the widespread use of newer chin implant designs that have extensions or wings with fine feather edges. While they are of great value in creating a more natural chin appearance, particularly in men, great care must be taken to get symmetric pocket developments that are long enough to accomodate the length of the implant. Too high of an implant position is quite commonly seen with the intraoral approach for insertion. In either case, secondary correction is straightforward with implant repositioning/pocket adjustment with secure fixation of the implant to its new bony position. To do that I prefer the use of screws to assure what I have obtained in surgery forever stays that way. Why chin implant revision was not successful is most likely that a new more symmetric implant pocket was not created and the implant was securely fashioned to the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I had a revision chin surgery to correct chin ptosis. Ever since, I am unable to protrude my lower lip when speaking. I also noticed that when I smile, the right side of my lower lip remains elevated while the left side goes down into a natural smile position. My ENT stated that the sulcus is unusually high, and the speech pathologist stated that they can not help me improve my speech as it a mechanical issue. My question is…Can the sulcus be lowered to my natural state and can the mentalis or the depressor labi inferior muscle (whichever was suspended..not sure) be released to enable me to speak, smile, etc..normally once again? I greatly appreciate your time.
A:With a high or scar contracted vestibular sulcus of the anterior mandible, the lower lip may well be restricted in movement. The role of the vestibule between the lip and the teeth is a valuable one and allows independent lip movement from that of the jaw. The key to successful vestibular lengthening is to appreciate that this represents a loss of mucosal tissue. Simply releasing scar or moving tissues around in an attempt to deepen or lengthen the vestibule will not work. It will simply be negated by scar contracture. What is needed is a vestibular release combined with a small skin or mucosal graft. Buccal mucosa is my preference for small amounts of vestibular deepening. The graft must be held in place for 7 to 10 days with a specially-designed small intraoral bolster.
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant placed about 4 months ago. After I got my implant I was delighted as I thought the chin projection made my face look more defined and also gave a nice strength to it both from the front and the side. As the initial swelling decreased over time it still looked acceptable. Now it has gotten to the point where I almost hate it because it makes me look too much like I used to earlier especially from the front. I have always hated how my mouth would be so overprojected and my chin slightly receded. While this problem had gone away after I got the implant is, it has now come back and I couldn’t be more dissapointed. I also hate how round my chin appears now. I was talking to my Dr about it and he just said its just how swelling goes down but I hate this final result. I want my final result to be what it looked like around a month and a half ago. I have asked my Dr how to recapture that and he mentioned maybe a square chin but he didn’t seem convinced at all. As a patient I cannot figure out what is it I need. That is why I wanted your opinion on this but I have also been skeptical of a larger implant cause I don’t want to add unnecessary length to my face.
A: The time to judge the final outcome from most facial implants, and particularly a chin implant, is around 3 to 4 months after surgery. That is when all of the visible swelling is gone and, most importantly, the chin tissues have adapted and settled around the implant so you can see the final shape and size change. Since you are at this time period, you are now looking at the final effects of the chin implant that is in place. Based on the way you feel about the result, it appears that you feel it does not have adequate horizontal projection and it provides too round of a chin contour. A new implant with more horizontal projection and a more square-shaped or non-anatomic shaped (less lateral wings) implant style is needed. It would be helpful to know exactly what type of implant and its dimensions that you currently have to make more specific new chin implant recommendations.
Dr. Barry Eppley
Indianapolis, Indiana