Fat grafting after having a chin implant removed? (photos)

Question

I've had a facelift, neck lift and chin implant. Unfortunately my implant has been removed three times. The first two were because the implant shifted. Got an infection 3 months later and had to have the implant taken out. My dr has recommened a fat grafting and which I'm going to have next month. What are the long term results for this area? The other issue I have is bunching in that area from strong muscles. Botox definetly helps but is an expensive maintenance cost that I'd like to avoid.

John J. Martin, Jr., MD · Answer

A fat transfer should help to replace some volume there.  You will have some scar tissue, so may need to have it done more than once depending on the amount of fat that survives.  The additional volume will help with the wrinkling but may also need to continue with the botox there.

Thomas Trevisani, MD · Answer

Fat grafting certainly is an accepted technique for certain augmentation areas including the chin. Keep in mind that over time- the majority of the fat will disappear. Some will be retained but difficult to predict just how much. I realize you haven't mentioned it but you might consider a rhinoplasty- in order to decrease or minimize the overall impact of your chin. This will profoundly improve your profile- just a suggestion and thought..

Barry L. Eppley, MD, DMD · Answer

The bunching of the chin pad is due to scar contracture and loss of volume from the loss of the chin implant. Fat grafting is a reasonable alternative to another implant and is understandably more appealing than a sliding genioplasty to you. (which is really the ideal choice at this point as it solves the chin deficiency and the soft tissue bunching) The take of the fat graft will be limited as well as the amount of chin augmentation that it can achieve but it has no real downsides to it.

Curtis Perry, MD · Answer

Transferred fat is a great material to augment the chin area. Compared with implants there is much less post op discomfort, the risk of infection is as close to zero as possible, there is no shifting afterwards and contouring is often much better than with an implant. I have used fat after chin implant infections with good success. You do present some challenges. Your strong muscle action and tight skin over the chin probably contributed to the malpositioning of the implant and will probably distort of the fat grafts. It is very important that you get a strong Botox or Dysport injection about a week before your procedure to stop the action of the mentalis muscles. The repeated procedures and the infection appear to have created some fibrous, contracted areas that seem to have soften since the first post op photo. One can only determine the degree of this by palpation. Because you probable started with a small skin envelope and there there is probably some fibrosis from your earlier issues. You should get a good improvement but you will need to be patient. You should think of having a series of injections instead of trying to over cram the grafts in one procedure which will lesson overall survival rate. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

Using fat transfer as an alternative to a chin implant is much more limited.The total amount of volume of fat that will survive in a small area is limited.Because you have had three failed chin implants does not necessarily mean you're not a candidate to have itching implant but it should be done by someone who has a lot of experience.A better procedure for you it may be a sliding genioplasty.I personally believe that long-lasting fillers like radiesse will work much better and be much more accurate than fat transfer to compensate for the loss of your chin implant.Botox typically works well to smooth out the chin.There are no long lasting alternatives.The good news is that it generally requires very little Botox to get a decent results in this area.Sometimes 5 to 10 units is sufficient.Best,Mats Hagstrom M.D.

Martin B. Weiss, MD (retired) · Answer

Fat grafting to enlarge and smooth the chin area can produce some very nice results. Make sure any underlying infection has been fully treated. Your surgeon may give you some antibiotic just before and after the procedure. Botox could be injected several weeks prior to the fat grafting to relax any muscles that might be causing dimpling of the skin.  You might not need any Botox after the fat grafting. When tunneling is done by the surgeon to deposit the fat grafts, it can be done to also release some of the scar tissue between your chin bone and the overlying skin.  This would help to smooth the skin as well.  Additional fat can be grafted at a later date if you would like more.  Fat grafts survive for variable periods of time depending on technique and location.  In my experience, fat grafts tend to survive to a greater extent and more permanently in relatively stationary areas such as the chin and less so in highly mobile areas such as the lips.  Fat grafts frequently look and feel more natural than solid implants and are less prone to infection, in my opinion. Hope you get a great result.

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