Would A Custom Chin Implant Work Best?

Q: Dr. Eppley, I’ve given it a lot of thought and done some research over the internet. I’ve been having problems resulting from a previous jaw/chin reduction. And I really want my face bone structure to go back to where it was, or close to my original chin/jaw line. I need help and really want a chin/jaw implant(s).

See my chin in 2013 CT scan. A surgeon reduced my chin in 2013, I had a CT scan in 2014 and realised the surgeon took off about 4.27 mm. Until this day, the soft tissue (chin area) just has never felt right. It feels out of place, uncomfortable. I’m always pulling my chin skin down. The chin skin dips down when I smile. (side profile) I have 2 new dimples. My chin area, just right below my lower lip(right side), protrudes when I smile. (very noticeable) I hope this is not to do with mantalis suspension. The stitching line which the surgeon has done does look lower than my original mantalis line along the gum line right below my lower teeth. Saliva also drips, when I sleep, drips down the corner edge of my right side lower lip (I’m not so bothered. But I don’t know if it’s implication of any issue? 

I really want my old chin back with a chin implant; hopefully it will solve some problems. I’d rather have chin implant incision under my chin, it sounds like the incision inside the mouth can affect the muscle or tissue affecting the lips?

1. Is it possible, that I have my chin augmented so that it will be the same as my original chin in 2013 CT scan? (Unfortunately, the CT scan in 2013 is all pictures, no raw data, so I don’t know if that  CT scan can help in making a chin implant to achieve the original chin size or length?)(However, my new 2014 CT does have the raw data needed to make custom jaw/chin implants. But my chin has been reduced on 2014 CT)

2. What kind of chin implant will I need, vertical or horizontal? (I dare not do chin sliding osteotomy.)

3. Logic tells me I will also need to do a jaw line augmentation to line up with my desired chin. I’m thinking it’s best to do a custom chin/jaw implant. So will this be  3 pieces implant or 1 implant that wraps around? For best results.

4. What material will the implant(s) be made of? If silicone, what kind of silicone exactly? Heard of silastic but usually associated w/ chin implants. 

A: Thank you for sending the pictures and a detailed description of your chin concerns. Based on the pictures I assume your chin reduction was done through an intraoral approach. An intraoral approach to a vertical chin reduction should be done by a vertical wedge ostectomy through the middle of the chin bone (vertical reduction bony genioplasty) to preserve the attachments to the bottom of the chin bottom to prevent soft tissue ptosis. (or an empty soft tissue pocket as the chin tissue will fail to adhere to the bone) In looking at the CT scan, and it may be a function of your drawing, it looks like just the bottom of the chin was cut off. (a lower chin ostectomy) That would be a very unusual approach to a vertical chin reduction but would account for many of your current symptoms. This you have two current problems, an aesthetically shorter chin (which perhaps may not be a concern for you) and soft tissue chi ptosis/mentalis sag.

The optimal way to correct these chin concerns is a custom chin implant with a jawline extension as a one piece implant. (one could argue that a vertical lengthening bony genioplasty would also be appropriate but you have excluded that option. While there is no true way to know exactly match your previous chin (since the DICOM data is not available), the design could be reasonably guessed. It is only a question of how far back along the jawline one wants to go. This looks like it would be a pure vertical lengthening chin implant. Such custom chin implants are made of solid silicone material. The term silicone and Silastic are synonymous. The name Silastic was trademarked in 1948 by the Dow Corning company for their silicone polymer product and it is name that is still occasionally used today been though the Dow Corning company no longer makes any aesthetic silicone products.

This custom chin implants should fill in the loose tissue at the bottom of the chin and eliminate that feeling of looseness of the soft tissue at the end of the chin. The only residual concern is that of your salivary drooling and that raises the question of whether mentalis muscle resuspension should be done at the same time. If you have lower lip incompetence/sag I would say yes. But if not I would leave it alone and see effect the chin bone restoration achieves.

Dr. Barry Eppley

Indianapolis, Indiana