I can feel my chin implant from inside my mouth. Is it too high and pressing on my mental nerve? (Photos)

Question

I've had a my chin implant for slightly over a year now and it's had numbness and tightness the entire time. I thought it would eventually get back to normal but it never did. But tonight I was feeling the inside of my mouth and realized I can actually feel the implant from inside my mouth. I can only feel it on the numb side. Does this mean that the implant is too high and is pressing on my mental nerve? Is there any chance that removing it will relieve some of the pressure/tightness/numbness?

Charles S. Lee, MD, FACS · Answer

I would have the implant removed. Upward migration of implants placed from inside the mouth is not uncommon; however, for many patients an external incision under the chin is visible. For that reason i prefer an incision inside the mouth and then securing the implant with a small miniscrew (it does not set off TSA metal detectors).

Michael P. Morrissette, DDS, FACS · Answer

The position of the chin implant can be determined with a cone beam CT scan. If it has migrated from the anterior chin, it should removed. I recommend a follow-up with your surgeon to determine if the implant has indeed moved. The CT will clearly show the position of the implant. Good luck

Louis W. Apostolakis, MD · Answer

Hello,Sorry to hear of your issues.  If you have numbness now consistently for a year since your surgery in the pattern of the mental nerve, then clearly the nerve has been compromised by the surgery.  It was either damaged during surgery to an extent that it could not recover, or the nerve is being pinched.  Removal of the implant may allow a pinched nerve to recover, but this is not guaranteed.  Typically, you should not be able to feel the implant when probing the inside of your mouth.  The fact that the two sides are different also leads me to believe the implant is mal-positioned.Best Regards,Dr. A

Chase Lay, MD · Answer

If you've had numbness for a year you probably need to take the implant out.  You could perhaps replace it in future months or years but that's up to you.  Being able to feel the implant in some fashion inside the mouth may be within the realm of normal but we really can't say over realself.com so I'd see a few facial plastic surgeons or oral surgeons for advice.  Also, talk to you surgeon.In my experience issues with sensation, tightness, or discomfort is often improved if not eliminated by removal.Chase Lay MD

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted some photos, and describe undergoing a chin implant procedure approximately a year prior. You describe that you were never really comfortable after the procedure was done, you feel the implant from the inside of your mouth, and you have been dealing with tightness and numbness. You’re asking whether or not this is a result of the implant pressing on the mental nerve, and if removal will help provide you with relief.
I can share with you my guidance with this limited information and photos, in the absence of a physical exam and the details of your surgery. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Chin implant surgery is very common in facial aging practice such as mine to help enhance the projection of the chin, depending on the indication and the degree of correction necessary. In the past few years, we’ve been using fillers to enhance chins without implantation, so I have a lot of experience in this area.
I think you’re definitely in the right track in terms of the cause, or the association of the implant putting pressure on the nerve and giving you these sensations. The anatomy is always with the source of explanation. The mental nerve, or the nerves that exit through the mental foramen of the mandible are usually high enough away from the tail of an anatomical chin implant that it is usually not a problem with impingement. The routine follow-up for a chin implant patient is pretty straightforward, and they usually feel very happy about having projection of their chin, and don’t really think much about it.
Like any other implant, no matter how experienced the surgeon is, it’s good until it’s not. Sometimes the implant can be displaced and behave in ways you don’t really would expect. Practicing in New York City, I have seen patients come for second opinions about their chin implants done by some of the most well established and highly experienced surgeons in the country, and in the world, and they still have problems and challenges, so that’s just the reality of the practice of surgery.
My first question would be how large was the chin implant. Often people who have strong overbites where the mandible and the maxilla, the upper jawbone is misaligned such that there’s a significant overbite. Very often, there’s a significant amount of projection needed which means that if a person isn’t going through orthognathic surgery where the bones are broken and realigned and plates and everything else are done, or a sliding genioplasty, sometimes a surgeon will be more ambitious and place a larger chin implant to give the patient more projection. It’s not just the projection or the thickness of the implant on the front, but also the tail of the implant can be wider, which may be the variable factor in your situation. Colleagues of mine would sometimes trim these implants, and have the patient go through an implant exchange. Others like myself would probably take out the implant, and allow for some healing to occur to see if at least the patient can become comfortable again.
It is important for you to have this dialogue with your surgeon who placed the implant. The original operating surgeon knows what was done, knows the details, the type of implant that was placed, and would probably be best qualified to remove it if indicated. As an aside, you may not want to get another implant. You may want to explore the dental, oral, and maxillofacial solutions. 
If you want to be more conservative, you can also go with long lasting injectable fillers. As I mentioned, we do something called Structural Volumizing where we place thicker injectable fillers at the level of the bone to provide chin projection. Since this is on the bone, it works very well  and can last for more than one year. It is very straightforward and doesn’t take long to do. You don’t have to hesitate about losing the appearance in favor of dealing with your discomfort. It’s very difficult for you to keep functioning if this is bothering you as much as it is right now. Since there is an anatomic solution that can probably help you, I think that probably makes the most sense. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Val Lambros, MD, FACS (retired) · Answer

sounds like it to me. It might be a good idea to explore the area and replace the implant in a lower position and hold it there. YOu may or may not get feeling back.

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.  If you've had numbness and discomfort the entire time (one year) since chin implant surgery this is highly unusual and you should see your Chin Implant Surgeon for evaluation.  You shouldn't be able to feel any portion of the chin implant on the inside of your mouth.  The mentalis muscle attachment should be between the inside of your mouth and the front of the implant while the wings (of the chin implant) should go along the lower edges of the jaw line on either side of the chin (well below the mental nerves).  When an intra oral approach is used to place the chin implant the muscle attachment is disrupted and the the entire chin area must be dissected in order to properly place the implant.  Unfortunately, this allows upward migration of the implant which is why I prefer using a small, curved incision under the chin for placing the implant. 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.

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