What are the chances that a chin implant will move?

Question

So I've been thinking about getting a chin implant and to be honest I am still a bit scared that it could move (I do not want the one fixed with titanium screws). My question is how often would you say it happens that an implant moves (x\50 people) and what is to be done if it does. Can it just be moved back or fixed in place with something other than screws? Also I know that there will be damage to the jaw bone, how serious is that, can it cause really serious problems in the future? Thank you!

Michael Kulick, MD, DDS · Answer

Hello,It is not typical for a chin implant to move, less than 1% of the time in my experience. I usually use silastic implants that are put onto the chin from within the mouth so that there is no external skin incision. I do not use screws but sutures to hold the implant in place. Screws are safe and some doctors like to use them. However, an altered implant position may not be noticeable until 6 months after surgery due to post operative swelling. Often, slight displacement cannot be noticed unless one feels the skin and notices the displacement. This most often occurs with extended chin implants that really help with the contour at the jawline below the corner of the mouth.  In these settings, usually nothing is done. If there is a visual change in the skin contour, the original incision can be re-used, the "pocket" that the implant exists in re-opened and the implant positioned corrected. It does not require screws nor does the above procedure damage the bone.

Michael P. Morrissette, DDS, FACS · Answer

Occasionally a chin implant will migrate when not properly secured. A post-operative CT will show the position of the chin implant nicely if you have any concerns. I'm not sure of your objection to the placement of a titanium screw to secure the implant? Titanium screws are used in facial and orthopedic surgery daily and some people have a significant amount of titanium plates and screws in their body. In my experience, when an implant has migrated it is best removed. It is unusual to have any damage to the jawbone from the placement of chin implants.

Manish H. Shah, MD, FACS · Answer

Hello,Thanks for your question. If a chin implant is placed into a strategically dissection soft-tissue pocket, it really should never move. When I perform chin implant surgery, I make an exact pocket, and I suture the implant to the periosteum with permanent suture. I have never had an implant move from normal day to day activity. I have seen implants move after sufficient trauma. In those cases, I've just reopened the incision and repositioned the implant. It has always done the trick. I use smooth silicone implants. I hope this helps.Good luck,Dr. Shah

Edmund Fisher, MD · Answer

Chin implants are fortunately one of the safest implants you can get. Occasionally the patient experiences some trauma during the first week and the implant moves. This is usually easily addressed with a quick revision procedure. There is definitely a higher rate of movement with "extended implants".  The implant is easily fixed in place with a permanent suture to the tough covering of the bone, the periosteum. The perisoteum is closed around the implant, further securing it. Studies show some bone resporption from the pressure of the implant, but I've never seen this be an issue, not even in a 70 year old lady I did a chin implant on 10 years ago.

William Portuese, MD · Answer

Is very rare for a chin implant to move if it has been sewn in place and is been placed in the proper anatomical pocket. When placing a chin implant, one of the most important parameters is making the precise pocket to place it in.  In our practice, we do not use any screws to fix the implant.For diagrams of the implants themselves and many before-and-after examples, please see the link and the video below

Jeffrey Jumaily, MD · Answer

Implants can move if not secured and if not in a tight pocket. I secure all implants with a small suture that prevents it from moving, rather than screws. If the implant moves (if not secured), it can be repositioned. The bone resorption that is reported with these implants is generally mild and avoided if implant is placed above the periosteum (layer of tissue over the bone), basically, no serious consequences in the long run. Best wishes

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

Hi, I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  Non smiling photos of your face from the front and side would help in the evaluation.  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.    In my experience there is no need to secure a silastic chin implant with sutures or screws when the following conditions are met:
 * Select a silastic chin implant ( I prefer the EAC) that doesn't have too much projection (thickness) as this becomes a problem stabilizing the implant under the periosteum when the implant is too thick.
 * Place the implant through a small curved incision under the chin which allows direct access to the periosteum (under the mentalis muscle) while preserving the muscle attachments.  This prevents upward migration of the implant which can occur when the intra-oral approach is used that severs the muscle attachments.
 * While the center or body of the chin implant should be placed at a perpendicular angle the chin bone in order to provide the proper forward projection to the chin, the "wings" of the implant should be at a lower level and follow the inferior (bottom) edge of the jaw line on either side of the chin.  When properly dissected and placed, this will be below the mental nerve foramen and be just wide enough of a dissection to accommodate the tapering wing.  There isn't enough room in this technique to allow the wings to migrate upward and contact the mental nerve.  In contrast if the dissection, along the sides of the chin (jaw line) are performed too high...this will place the mental nerve in danger and if the side dissection is too wide, the wings will have a space within which to migrate upward.
 * We have all of our chin implant patients avoid touching and feeling their chin implant for 1 month post op.  We also ask that they sleep on a U-shaped airline pillow for the same time.
  Our experience when following the technique described above is that the silastic chin implant does not need to be secured with sutures or screws and does not move.  I have placed silastic chin implants in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  In addition, I have had the opportunity on numerous occasions to replace silastic chin implants (placed by others) that had been screwed into the bone.  During the replacement it was evident that the metal screws pushed right through the soft silastic implant as it was tightened down on the hard chin bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.  Hope this helps.

P. Craig Hobar, MD(retired) · Answer

Thank you for your question! In my practice, I typically place one single titanium screw to ensure proper placement and prevent it from moving horizontally or vertically. I do believe it is important to keep it in place for fear of having to return to the operating room and reposition the implant. Titanium is very safe to leave in the body and the screws are typically only 6-7mm long. In some cases, the implant can be sutured through a small hole made in the bone to hold it in place. If you do not want it fixated at all, it is still possible it will remain in the proper position. There is typically only a small "pocket" that is made for the implant to be placed and should not move too drastically. That being said, I have seen patients come back with implants that were not fixated and they have slipped off of the front created an unnatural appearance referred to as a "witches chin." If this happens, I will encourage the patient to have the implant fixated when repositioned. With a chin implant there should be no damage to the bone with an experienced surgeon. The implant sits on top of the bone and does not alter the overall structure or strength of the actual bone.

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