Q: Dr. Eppley, I am after a very large chin implant (actually, probably a custom wraparound implant, but my question is in relation to the chin). I would like a vertical lengthening of 2cm to achieve a huge looking chin that i desire. I would likely get a vertical lengthening genioplasty at an earlier stage but I will still need the implant to get the rest. In addition to the large length increase, i’d like it to be very wide and square. But I’m aware the skin cannot stretch this much in the chin. Is it possible to use a tissue expander in the chin before the implant, much like you use in the scalp for large skull implants?
A: In relation to achieving such a large vertical increase for a large chin implant, you would need to take a three step approach. First, A vertical lengthening genioplasty needs to be done of about 8mms. Three to six months later, a vertical lengthening chin implant needs to be placed from a submental approach. These two together will approach a vertical chin increase and chin pad soft tissue expansion of 13 to 15mms. Then a custom wrap around jawline implant could be used to complete the maximal vertical chin increase.
While a tissue expander could be placed in the chin, there are multiple problems with its use in this anatomic location. The incision for its placement would be right over the expander and that is a recipe for wound breakdown and exposure of the implant during the expansion process. There is also the problem of where to place the remote port to inject fluid to expand it as it is not practical to have it handing down from the chin or sticking out into the mouth.
Dr. Barry Eppley