Q: Dr. Eppley, I have an infected chin implant and would like to have the implant replaced at the same time if it would prevent ptosis. Aesthetically, I am very satisfied with the implant. The only reason I am having it removed is because of the infection. Its just that my surgeon was saying (which I guess is the standard procedure) to wait four months to have it replaced. He said that he would do the replacement implant through the skin. What about replacing it and using antibiotic beads to reduce risk of reinfection? Is that possible or recommendable? Should I replace it with another medpor or silicone implant? Really for efficiency purposes it would be great if I could get it replaced in one surgery instead of two. Thank you.
A: one important question is why did this chin implant get infected so late after placement? This is important to know because you want to be able to avoid re-creating the very problem that caused it in the first place. My suspicion is that a large medpor implant placed through the mouth may have resulted in tissue thinning intraorally. That would be most evident if there were drainage holes from inside the mouth. In this scenario, it would be best to remove it from below, excise and close the intraoral tracks and secure a new implant as low on the chin bone as possible. The replacement should likely be a non-porous chin implant if you can get a replacement that has similar dimensions to what you have now. Do you know the catalog # and/or description and size of the implant you have in now. (there are only so many styles in Medpor…contoured two-piece, RZ extended (round or square) or two-piece chin) I am not opposed to an immediate Medpor replacement as it does have the potential to be infused with a Vancomycin solution. The antibiotic bead concept is an old one from Orthoopedic surgery using impregnanted PMMA beads. But the dimension of these beads, while good for a hip or knee, are too big for the chin area.
Dr. Barry Eppley