Q: Dear Dr. Eppley , I had chin augmentation about two years ago with terino square chin imlpants, style 1. It looked for about two years but it has disappeared somewhat. I would like to know if it is possible to place another square chin implant, a Terino square chin implant style 2 on the top of the existing one and have it secureed with screws to add some more definition, squarnes and some more anterior projection. I think it makes sense to place the bigger one on the the top of the smaller and according to the dimensions on the Implantech website they would fit perfectly. Would you please express your opinion on this matter? I would greatly appreciate it.
A: In regards to your existing chin implant disappearing, that impression is likely a combination of two factors. Many patients after face and body augmentations suffer what I call ‘cosmetic accomodation’. They simply have gotten used to the look and it no longer looks as good or as big as it used to. Secondly, the implant may have suffered a little settling into the underlying bone of a fedw millimeters which is not uncommon particularly if the implant is not directly over the lowest edge of the basal bone. These two issues combined have likely resulted in your implant ‘disappearing’.
In regards to placing a style 2 directly over a style 1 silicone square chin implant, your assumptions fro a chin implant revision based on measurements are correct. There is a 10mm difference in the square width of the implants so a style 2 does fit rather nicely over a style 1. That would also add an additional 8mms of anterior projection as well. They would absolutely have to be secured with at least two screws placed on their lateral edges to prevent the shifting of one smooth surface against the other. The only contour concern is on the edge of the lateral wings where a more noticeable step-off may occur as the transition back to the bone will have a double-thick edge. I would advise the wings of the overlay implant to be trimmed and feathered about 10mms short of the underlying implant to avoid this problem.
Dr. Barry Eppley