Intra-oral vs sub-mental chin implant

Question

Re: debate between chin implants placed intraorally vs sub-mental. The sub-mental approach to avoid infection and disturbing the mentalis muscle makes sense. Is the chin muscle always cut then reattached in the intraoral approach? If so, hard to see why any Dr. would prefer it. On the other hand there are many bad stories re: migration issues for both procedures. How does extrusion and nerve issues compare for both procedures. Anyone know the patient satisfaction stats for both procedures?

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Chin implants can be placed either submentally or intra-orally. It really depends on the surgeon's comfort level.  I have placed them in both ways. The intra-oral approach does  eliminate the scar  beneath the chin. It does go through the muscle but the muscle is easily re-approximated for good function and aesthetics.  The submental approach does have a decreased tendency for infection and  avoids cutting of the mentalis muscle.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about chin implant.Both intraoral and extraoral approaches for chin implant work very well in skilled hands. The submental approach is technically easier with a small 2 cm incision.To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have chin implant surgery or a related procedure(s).I hope this helps.

Barry L. Eppley, MD, DMD · Answer

Chin implants can be placed very successfully through either an intra-oral or a submental incisional approach with good surgical technique. I have done a lot of chin plants both ways. Is the submental approach theoretically technically easier with a quicker recovery? Yes it is. For a small 2 cm incision with minimal scar formation (for Caucasian patients) the intra-oral approach is 'harder' to justify for scar concerns only. But remember, regardless of the incisional approach used, chin implants can be poorly placed, over or undersized or otherwise achieve inadequate results based on issues of surgical technique and expereince

Joseph Niamtu, III · Answer

Can't believe this is even a debate.  There is not difference in final outcome.  The advantage of putting an implant in through the mouth is not scar on the face.  The disadvantage is that the recovery is a bit longer because of the disruption of the mentalis muscles.Infection is not an issue.  I think it is humorous that some surgeons berate intraoral placement of chins but at the same time place all their cheek implants from inside the mouth.It really does not matter, the preference should be what the patient wants and what method the surgeon feels most comfortable.I do personally feel that all facial implants should be screw retained regardless of the route of placement.  Then they will never migrate.  They might not move if not screw retained but I have re positioned many implants over the years that were placed by surgeons that did not secure them.  In addition to migration, micromovement causes inflammation which can lead to bone resorption and infection.  I feel that many implant problems can be mitigated by screw fixation.Joe Niamtu, III DMD Cosmetic Facial SurgeryRichmond, Virginia

Dennis Barek, MD (retired) · Answer

I have done both procedures and prefer intraoral. Technical details of pocket formation are important and proper insertion of implant make the risks very low. My complication rate over 40 years, is less than 1%Perioperative antibiotics are used in both cases.If done intraorally , through an incision above the sulcus, with a Mayo scissors you spread to bone and then cut down to the mentum. keeping a finger there so you don't go beyond. You keep the periosteal elevator ALWAYS on the bone, heading either to left or right side and rock it up and down pushing forward on the bone. With your other hand's index finger on the jawline, you prevent dissecting too low.Then do the other side You have to dissect one side longer so you can slip the implant way over to one side and then get the other end of the implant into the pocket. Then you center the implant.If the pocked is made correctly the implant does not have to be fixed to the bone or other tissues. A water tight, 2 layer  closure with absorbable suture is used.Only the lower fibers of the muscle are elevated and if you stay on the bone, nerve damage should not be an issue.

Intra-oral vs sub-mental chin implant

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