What Is The Best Way To Modify My Too Large Custom PEEK Chin Implant?
Q: Dr. Eppley, In the last few days the swelling from my custom chin implant has decreased a bit and the chin has more normalized but it is still excessively vertically high because the implant is very large and I would like to reduce it above all in height with a revision, I would like to ask you:
1) Going back perhaps the best choice was to opt for a genioplasty but now I have an implant positioned and fixed with screws, having to reduce it, does it make sense to shave it with the bur rather than removing it and doing a genioplasty?
2) Is it possible to reduce the prosthesis by filing it without having to remove the implant from the chin? I think it would be less traumatic to the tissue and also easier to adjust with just the right amount of reduction to do.
3) For the revision, would you make a submental access instead of from inside the mouth as was done at the time of inserting the prosthesis in order not to traumatize the same tissues a second time?
A: The mistake that is often made is that surgeons think they can do adequate reduction/modification of an implant by an in situ technique. (leaving it in place) That may be successful for the most minor adjustments of it but that will never work in your case. That would definitely not be the way to do it. Unscrew it, remove it, do what modifications are needed and then immediately reimplant it. That is the only way to successfully do it.
I also might point out that this is PEEK material…an extremely tough material that does not respond easily to any modification of it. It is the least modifiable of all facial implant materials. It will take considerable work on the back table in surgery to make the needed changes. The challenge of that task should not be underestimated.
As an addendum if you look at three options you now have:
1) Replace with new PEEK chin implant with better design,
2) Replace with sliding genioplasty, or
3) modify the existing implant
Options #3 is actually the least favorable option from an aesthetic outcome standpoint….even if it seems the ‘simplest’.
The impact of surgical trauma relates to the re-opening of the incision which has to be done with all of them so that concern is really irrelevant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon