1 Month After Implantech Chin Implant, Unhappy With the Shape. (photo)

Question

1 mo. ago received an Implantech medium ext. anatomical chin implant. Based on specs, the small is only .5 mm smaller in projection but smaller all the way around in width and a bit shorter from top to bottom. If I am ok with the projection of the medium but unhappy with the final shape it takes (thinking thickness from top to bottom) @ 3 months out, it seems the small will sacrifice little in projection, but may offer the more subtle finer change needed in shape. Is this a fair assessment?

Barry L. Eppley, MD, DMD · Answer

The first thing to realize is that the final shape of the chin after implant placement will take a full 3 months to see. What you see at one month will change further as the tissues around the implant heal and shrink down around it. For the sake of argument, let's assume that what you are seeing is the same months later. What you probably don't like is that the shape of the chin is too full or big to the sides. This is a common aesthetic problem in anatomic or extended wing chin implant designs in women. A female chin should have more projection but little side width to keep a more aesthetically pleasing triangular shape. To make this correction later, you can always modify the implant in place by removing those wings and reducing its height a little. This would be a better manuever to do than replace it with a smaller implant, particularly if you like the amount of projection that you currently have.

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

Hi, I have performed many chin implant surgeries using silastic chin implants for over 30 year.  Depending on whether the implant was placed through the mouth or using a small, curved incision under the chin (my preferred method)....you time to full healing and "final results" is a month or so away.  This healing time may decrease the bulkiness that you see which is related to some residual swelling.  The degree of your physical activity, during this first post op month, can also contribute to continued swelling.  Having said all of that, your rationale is correct and if you feel that the medium sized implant is a bit too bulky for your face, it can be replaced with a size small at 3-4 month post op.  I rarely use medium sized EAC's in women for the reasons that you stated. There are numerous shapes and sizes of silastic chin implants, some of which are rather old shapes that do not yield the desired "natural" aesthetic results.  The Curvilinear shape is an example that is similar to the old "button" implants (had no wings or lateral tapering elements of the newer EAC design) that created a "pharaoh" shaped chin.  The EAC or extended anatomical chin implant style offers, in my experience and humble opinion, the most natural, aesthetic result when augmenting the chin.  The EAC in a size small is the most common implants that I use in women ( size medium in men ).  Proper placement and the appropriate approach (placing the incision under the chin and not inside the mouth) are also key to obtaining the best aesthetic result.  I prefer placement of a  silastic chin implant through a small, curved incision under the chin (submental) instead of through the mouth for the following reasons:
*The submental approach is sterile while the intra-oral approach is not.
*The submental approach requires limited dissection as it is much closer to where the chin implant needs to be placed along the center (front) and lower most sections of the chin on each side (where the wings are placed).  The intra-oral approach by contrast requires dissection all the way down the entire section of the chin in order to reach the same areas for chin implant placement.  The intra-oral leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.  In my opinion and experience there is no need to secure a silastic chin implants with sutures and 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. 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.  
Hope this helps.

Sheldon S. Kabaker, MD FACS (retired) · Answer

Without preoperative pictures to compare, I cannot say what would work best for you. The height of the chin is less than ideal but if it was long before, the implant , if properly placed, would yield this look. Less projection would make the sublabial sulcus look less deep and the chin pad  not so long .  The beauty of chin implants is that it  is a reversible procedure. The present implant could be removed and replaced with a differnet sized oneor an  implant with a different shape, it could be repositioned , and it could be trimmed. What does your surgeon say?

1 Month After Implantech Chin Implant, Unhappy With the Shape. (photo)

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1 Month After Implantech Chin Implant, Unhappy With the Shape. (photo)

Answers (3)

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Everything you need to know about Chin Implant

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