Chin is not smooth when mouth is open - Replace Chin Implant or add filler? (Photos)

Question

I got a small chin implant 10 years ago and I have never had a smooth chin when my mouth is closed. It always looks orange peel like. Will a bigger implant make this any better? Is filler an option?

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

Dear Friendly60536,

Thank you for sharing your photos. Based on these views, I would not assume that a bigger implant will make this problem better. In my experience, chin dimpling or an “orange peel” look can happen when the mentalis muscle is overactive, or when an implant is too large and puts the muscle under strain as it tries to function normally. The mentalis muscle is the main target when treating cobblestone chin with botulinum toxin, and published literature also notes that mentalis dysfunction can occur after chin augmentation.

A simple first step is to see whether the dimpling is tied to muscle activity. If the problem becomes more obvious when you animate the chin, BOTOX® can be a very useful test as well as a treatment. There is peer-reviewed literature showing botulinum toxin can safely and effectively treat mentalis dysfunction and cobblestone chin, although it has to be placed carefully because poor placement can cause lower lip weakness or smile asymmetry.

If the orange peel appearance is not really from muscle pull, then I start thinking more about soft tissue issues, such as subdermal fat loss or scarring under the skin. In that setting, BOTOX®  alone will not fully fix the problem. Over time, nanofat treatment (in-office treatment) may help improve the skin quality and soften the irregularity, especially when the problem is related to scarring or thin soft tissue. The literature on nanofat shows benefit for scars, wrinkles, and skin quality, but it is more of an improvement treatment than a perfect correction.

So my overall advice would be this: do not rush into a larger implant. First, determine whether the issue is dynamic muscle activity or a soft tissue problem. If it is dynamic, BOTOX®  is a very reasonable place to start. If it is more of a scar or soft tissue problem, then treatments such as nanofat may be more helpful over time. In some patients, both issues are present, and that is why a careful exam matters.

A complete in-person evaluation with a board-certified facial plastic surgeon or plastic surgeon would be the best next step. That evaluation should look at implant size and position, mentalis muscle activity, lower lip function, and the quality of the soft tissue over the chin before deciding on any revision.

Best,

Dr. Earl Stephenson Jr.
ESJ Aesthetics | “Where confidence takes shape!”

Michael P. Morrissette, DDS, FACS · Answer

In the lateral photo, your chin appears small and still underprojected. I would recommend removing the implant and advancing your chin forward 8-9 mm and lengthening it slightly with a sliding genioplasty. This will give you improved facial balance. The skin will be stretched, which may improve texture and relieve some Mentalis muscle strain. Some texture problems require a CO2 laser, chemical peel, or microneedling. The sliding genioplasty moves your natural chin forward, and the surgery is performed in the office with sedation anesthesia. The surgery does not require braces or affect the teeth.

Eric M. Joseph, MD · Answer

Many people have a pebbly or orange peel texture to their skin of the chin, due to a hyperactive mentalis muscle. Since you have a natural looking chin implant, I believe the path of least resistance would be a trial of a neurotoxin. I hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

Darryl J. Blinski, MD · Answer

Your photos demonstrate the orange peeling effect of the skin following chin implant initial attempt should be to use a very thin capital H capital A filler example skinvive. Expect fee to be $500-$800. If after attempting this filler you’re still not happy I might then return to very very low-dose micro Botox again best of virtual concert with.

Chin is not smooth when mouth is open - Replace Chin Implant or add filler? (Photos)

Answers (4)

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