Q: Dr. Eppley, I am in need of secondary chin surgery. I am a female and am 34 years old. One year ago this month I had a chin implant removed due to a number of reasons including bad positioning and shape. It was in for five years and was not replaced with another. It was inserted and removed orally and it was fixated with a screw. It has left me with soft tissue complications and still gives perception like the implant hasn’t been removed. I found the a link where you go into detail about chin implant complications nearly identical to what I have currently. It describes how you would tackle the problem and seems you have extensive experience in the procedure. It seems I’m finding it very difficult to find someone in my country who can tackle the issue. From my pictures would you class my soft tissue deformity as a mild case of Witch’s Chin?
A: Thank you for sending all of the pictures. You definitely do not have a Witch’s chin deformity. At rest you have a perfectly normal position of the soft tissue chin pad on the bone. Your deformity appears when you animate and the soft tissue contractions (dimpling deformity) appear. This is the result of the soft tissues being stretched out by the implant and then, with the implant being gone, its support is lost and there is now too much soft tissue. This will create an abnormality on contraction which you now have.
Treatment options include:
1) Doing nothing. It is not predictable that any improvement can be gained.
2) Replace the implant and recreate the soft tissue support. (although placed from a submental position and tighten the mentalis muscle from below)
3) Do a submental approach to the mentalis muscle repair with excision and midline reapproximation.
Dr. Barry Eppley
Q: i am going to have my chin shortened by cutting the bone, a procedure known as a vertical chin reduction. But I wanted to know something that is very important to me. After the surgery, the people that know me which i see everyday, will they see the difference in my face without me telling them? Will they know I have had some type of surgery? I am worried that they might say something like ‘Hey, what happened to your face?’ or something like that.
A: It is perfectly normal to assume that everyone that sees you after surgery will know exactly what you have had done. In reality, we give other people too much credit when it comes to perception. Most people, other than those who know us closely, see our faces in a more overall impression but not a lot of detail. Known as a facial gestalt, it is the image of our face people know, not the specific details. Therefore, after surgery people make see some difference (hopefully positive) but can not usually put their fingers on what was done. They will perceive that you look better, more refreshed, etc but they rarely can tell what part of the face was changed.
This is particularly true in anti-aging facial surgery (facelifts, eyelid tucks etc) but is also true in structural facial surgery. (rhinoplasty, otoplasty, facial implants, etc) Just because you know it doesn’t mean everyone else will. This is also because of another basic human characteristic….we are all more focused on ourselves than anyone else. Almost every human is more interested in how they look as opposed to how other people look.
Dr. Barry Eppley
Q: I have seen your chin osteotomy video on Youtube. I’m from Vietnam. May I have your advice? I really need it. I had my chin done about 6 weeks ago. My chin bone was cut and moved forward about 8mm and now I have 3 small pieces of stainless steel in my chin bone. (like small rings). My doctor says that it’s ok to have those stainless steel in my chin for the rest of my life. Is that right? And the sad thing is that I regret that I had my chin cut. In fact, I just wish I hadn’t had the surgery. Should I now have my chin bone moved back? Can everything be like it was before or would my chin just be weaker? Can I get rid of that stainless steel in my chin if I have my chin moved back to its place just like it was before?
A: I have never had the experience in my Indianapolis plastic surgery practice of a patient ever regretting having their chin bone moved forward. This is a completely avoidable concern by using computer imaging prior to surgery. The chin is one of the two (the nose is the other) most easily and accurately computer imaged areas of the face. You can know precisely before surgery what it will likely look like afterwards. I am assuming that the regret from this patient is that they do not like the ‘new look’. Maybe it is moved too far forward or maybe it shouldn’t have been done at all. This is clearly a preventable case of surgical remorse.
While today’s facial bone surgery uses very small titanium plates and screws, the use of stainless steel wire (rings) is historic and perfectly safe. The use of bone wiring is still done in many parts of the world due to its lower cost. There is no concern with them there nor should they ever need to be removed.
Just as the chin can be cut and brought forward, it can be brought back to where it once was. This is much easier and quicker than the original surgery. If that is what one wants to do, I would do it within three months of the original surgery since there is minimal bone healing at this point. Chin osteotomies usually take at least six months to become completely healed back together. The use of wires or plates does have to be done to hold the bone together so it heals properly. The key to moving the chin back is to tighten the mentalis muscle back together well. Since it has been stretched out and expanded, it needs to be shortened and tightened once the bone is moved back and set. If not, you will end up with soft tissue sag known as a witch’s chin deformity.
Dr. Barry Eppley