My recently placed chin implant (7 days) is misaligned. Surgeon believes it is centered. I do not. How do I proceed from here?

Question

I recently had a chin implant put in (1 week ago). My surgeon thinks that it is centered. I strongly disagree even with some imbalanced swelling. To be specific he aligned it with my nose. My nose is not perfectly aligned with my face though and the implant is at least 3mm out of center of my mouth and more importantly my jaw. I care about my jaw line, not whether the implant is centered with my nose. How do I go about resolving the disagreement and what are my options for fixing it at this point?

Brock Ridenour, MD · Answer

It is way too early to pass judgement on your procedure. Remember that most chin and cheek implants are not custom designed. If you had a preexisting asymmetry in the size or shape of your chin, then you will still have some asymmetry afterwards. Since post-operative swelling is not typically uniform,  I suggest that you allow at least 6-8 weeks before you scrutinize the result.  Before and after photographs are often the best way to visualize the impact of the procedure on facial balance and harmony, and can also be used to point out any preexisting asymmetries. Discuss your concerns with your physician at the appropriate time. Best wishes.

Andrew P. Trussler, MD · Answer

Early healing after a chin implant can entail swelling and bruising around the implant and in the pocket. This can throw the result off under early scrutiny. Allowing the swelling and possible bruising to go down over the first 3 weeks is important. Taping and massage could be started after one week. Any implant can accentuate pre-existing asymmetry not picked up pre-operatively. I usually do cortical tunnels in the bone to help secure the implant to help prevent any shift. Early revision would not be entertained for at least a month.

David Tauber, MD · Answer

The face of most patients is asymmetric. The centerline of the face is defined by the outward appearance of the soft tissue of the nose, mouth and chin. These landmarks, however, often do no coincide and are often further malaligned with the skeletal midline of the mouth as defined by the central incisors of the maxilla and the mandible. One’s impression of the center of the face is formed by how one reconciles these various landmarks and by what landmark one gives the most importance. The subjective nature of defining the midline and the interplay of the chin with the the rest of the face makes chin augmentation more challenging then just inserting an implant. Chin augmentation requires a detailed analysis of the face and a discussion of patients concerns and expectations in order to formulate a successful surgical plan. Post operatively, assuming there is no infection, nerve entrapment, or gross malposition of the implant, patients should allow 1-2 months for the swelling to resolve before contemplating any changes. At that point, a detailed follow-up exam and discussion will help delineate the best treatment option.

Jonathan Kulbersh, MD · Answer

7 days after a chin implant, the area is still healing.  Secondary to the swelling in the area, it is very difficult to judge the final results.  I would allow the area to heal over a few months and the revisit your concerns.  If you are still unhappy at that time, I would consider moving the implant into a better location.  I would not recommend moving the implant at this time.  I hope this helps.

Yuly Gorodisky, DO, FACOS · Answer

The best way to resolve the disagreement is with photos and communication.  You should wait for swelling to settle and review your before and after photos and discuss if a revision would be beneficial. Sometimes an overall balance of the face is more desirable than symmetry, since we are all somewhat asymmetrical.

Barry L. Eppley, MD, DMD · Answer

If you are going to have a chin implant repositioning with your current surgeon, you are going to have to follow his/her after surgery schedule and thoughts. No surgeon is likely to agree about an implant positioning issue of a few millimeters in the first weeks after surgery in the face of swelling. It is likely that it will be a time frame of at least six weeks before most surgeons would consider an implant adjustment...if even then. But all you can to is to pleasantly bring up your concerns at your scheduled postop appointments.

My recently placed chin implant (7 days) is misaligned. Surgeon believes it is centered. I do not. How do I proceed from here?

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