Intraoral VS submental incision for genial implant? (Photos)

Question

I am having a genial (chin) implant. No lipo or neck procedure. The doctor said he will go intraorally, I've heard differing opinions on this due to risk of infection & migration of the implant... Is this the best option ? If not can I request him to do it submental ?

Miguel Mascaro, MD · Answer

It really depends on the comfort level of your surgeon.  Intraoral has its pros (no visible incision), however, it also has its cons (exposure to intraoral bacteria).  That being said, I originally trained in intraoral approach, and subsequently did more and more submentally as part of my neck lift practice (since I am making the incision there anyway).  The long story short is, what your surgeon feels most comfortable with and has had the most success with - thats the right answer.  Best of luck!

Alejandro Nogueira, MD · Answer

About your chin, you are NOT a case for a chin implant; in general 
chin implants are very problematic (dislocation, artificialnes, dynamic 
deformities, short lifetime, early removal due to pain or disturbances, 
bone imprint and cortex thinning, infections, etc) and the osseous 
genioplasties (sliding, augmentation with grafting or reduction) are way
 superior and unparalleled in safety, naturalness, beauty and 
versatility.
Your chin is three-dimensionally small (microgenia), this means you 
need vertical increase, horizontal widening and anterior advancement, 
thus making you a case for the three-dimensional augmentation 
genioplasty, with bone grafting supply (donors elbow / hip) and a very 
well planned preop antropometry of the craniofacial relations, and 
needless to say with good aesthetic judgement.
Do seek the advice of a good facial surgeon with experience in 
osseous augmentation genioplasties. Beware: a simple sliding genioplasty
 would not work for you, you'd get a sharp "witch's chin", you must 
also widen it moderately (avoiding masculinization, just to round its 
contour and fill the sides) and increase vertically (to balance it with the rest of your 
face). In good hands the results are simply awesome.
Feel free to request any additional information.

David A. Sieber, MD, FACS · Answer

I tend to agree with the others on here that the location of the incision is largely dictated by the surgeons level of comfort. I use a submental (chin) incision almost exclusively because I think it gives me better control of the pocket position and it also does not expose the implant to the bacteria in the mouth. Talk over the options again with your surgeon to see about the pros and cons. Best of luck!~Dr. Sieber

Inessa Fishman, MD · Answer

The incision for intraoral versus external approach in the placement of a chin implant depends on surgeon preference, which in turn, is based on training, experience, and the decision to combine chin augmentation with other procedures.  I prefer intraoral approach for chin augmentation, as I have had more experience with this in my training, it avoids an externally visible scar, and I believe it is less disruptive to the surrounding musculature.  That being said, I will often place an implant through an external approach when already using an under-the-chin incision for a neck lift or other neck surgery.   Infection risk is not significantly different between the two approaches.  In all, I do not think here is no "best" option for approach in chin augmentation.  Discuss your concerns with your surgeon, and best of luck with your procedure and recovery!

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many chin augmentations using chin implants over the past 30 years.  From the photos, your chin is quite weak and you do appear to be a good candidate for a chin implant surgery.  I always place the silastic chin implant through a small, curved incision under the chin...typically in less than 30 minutes often using local infiltration alone.  
 The intra-oral method is: far more invasive; has a greater degree of tissue dissection which means more swelling, bruising and recovery time; is a non sterile approach as the mouth in filled with bacteria unlike skin that can be prepped for surgery; requires cutting of the mentalis muscle attachment that can't be adequately re-attached...this means the implant can migrate upward after placement (I have seen this on numerous occasions when other surgeons used this approach and the patient subsequently came asking for replacement of the implant that had moved upward).  For all of these reasons, I use the submental approach and am confused why anyone would want a chin implant placed through the mouth.
 In case the argument has been made that somehow an intra oral approach is needed because the chin implant must be secured with metal screws, I strongly disagree with that argument.  I have placed chin implants in Military, SWAT, Law Enforcement Officers and various types of professional fighters that are extremely active without the need to secure the implant with metal screws or sutures.  I do ask facial implant patients to sleep on an airline type U-shaped pillow for one month after which time the periosteum has secured the implant from moving.
Hope this help.

Richard P. Rand, MD, FACS (retired) · Answer

The advantage of the external approach is that the implant is not exposed to the bacterial contamination found in the mouth in front of the lower teeth, lowering the risk of infection requiring implant removal. I think most prefer this approach.

Intraoral VS submental incision for genial implant? (Photos)

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