Crooked chin implant? Should I be concerned?

Question

5 wks post op from a chin implant placed under the chin. It looks great although I can feel the wing in my gums on the side, on the same side I had numbness and and paralysis which just this week is starting to subside.surgeon assured me it was fine the wing that I’m feeling just anchors the implant? He says if it starts to irritate me he can make an incision inside the mouth and cut the wing? Really not wanting to get another surgery. I also feel a tight muscle in my lip. Should I be concerned?

Michael P. Morrissette, DDS, FACS · Answer

I have experienced malposition of a chin implant and if there is no aesthetic concern there is no need to reposition.  A Ct scan of the chin and thorough clinical exam will reveal whether it is correctly positioned but minor problems of malposition do not need correction if aesthetics is acceptable. However, it is possible to reposition the implant.

Alejandro Nogueira, MD · Answer

It is true the vast majority of surgeons use the implants instead of the osseous surgery to adjust the chin, but this is a matter just of lack of experience and comfort ease; implants play no role when there is an autologous alternative which, actually, has plenty of superior advantages.
Being an option, chin implants have serious disadvantages, especially in the mid and long term, patients are rarely happy with them after 5-6 years, all are out sooner or later. A quick research just on this website sheds light on the common, frequent and serious complications and side effects chin implants entail, like dislocation, malpositioning, infection, over or under corrections, visibility, fake looks, nerve damage, chronic pain, poor aesthetic results and in general patients' dissatisfaction; not to forget chin implants are not versatile, they are unable to provide vertical increase, horizontal axis modifications and in most cases sufficient anterior projection; as obvious as it sounds but we have to bear in mind chin implants play absolutely no role when the chin needs reduction of one of the spatial axes; actually it is very common receiving patients who seek chin implant removal and replacement by an osseous genioplasty in the same procedure.
Fillers, another tempting resource, are a very dangerous option in chin reshaping, potentially destructive, unable to reshape and enhance respecting the basic principles of anatomical beauty, leading to mid and long term serious complications (granulomas, deformities, fistulae, etc) and the worst is they can't be removed in most cases.
Burring the chin is, strictly said, osseous chin surgery but should neither be performed, ever, since just flattens the chin by destroying the natural dome of the jaw, deletes the labiomental crease and due to the detachment of the mentalis tendon this technique commonly leads to a droopy double chin, a serious aesthetic complication.
A multidimensional sliding genioplasty allows to a versatile surgeon full customization for augmenting, reducing and leveling the chin in any of its spatial axes, leading to a myriad of combinations to suit every individual's chin anatomy and facial balance requirements; you can masculinize, feminize, round or make square, increase, decrease, supply bone graft, remove bone portions, slide fragments, etc. This absolutely impossible with other method than multidimensional sliding geniplasty, a technique providing a series of advantages among which worth mentioning:-lifetime procedure, no more revision or renewal procedures, unlike implants-more natural than implants, the procedure is totally undetectable -no visibility of implant edges during gestures, expression is even improved, nicer smile-improves the double chin effect at the sub-mental muscles (floor of mouth) hammock caused by lack of tension there; also improves the shape and tension of perioral muscles and tightens up the jowls, creating a beneficial side effect in form of an indirect facelift and neck lift, all patients see their face indirectly rejuvenated; implants do not offer this feature-no future displacements or neuritis of mental nerves-no droopy double chin (the mentalis tendon is not detached) -way lower rate of postoperative complications if compared with implants, like infections, displacements, neuritis, etc-no need for complex plates and screws or teeth braces that may need future removal; just steel wires synthesis may suffice, they stay buried into bone callus producing no disturbance
The cons for the patient are essentially the costs associated with osseous genioplasties, however it sounds cheap if you consider the lifetime benefits; obviously the main disadvantage happens on surgeon's side, since it is more technically demanding than chin implants, few surgeons are experienced or comfortable with multidimensional osseous genioplasties (though I personally perform 100% of the chin procedures by this osseous method); patients have difficulty in finding surgeons experienced and comfortable in osseous genioplasties able to freely modify the chin shape and size based on their aesthetic and gender goals.
You'll find in this website hundreds of negative experiences with chin implants in the short and mid term, do read my profile's Q&A and you'll find them too. I am doing osseous genioplasties for more than 15 years with the highest success and no one patient sought afterwards switching to chin implants, totally the opposite, I did many chin implant removals and one-staged osseous genioplasties to replace the implant and enhance the result.
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

Jonathan Kulbersh, MD · Answer

This is difficult to answer without pictures and will need an in-person evaluation. I recommend following up with your surgeon. If the implant is crooked, it can be repositioned. Hope this helps.

Michael I. Echavez, MD · Answer

The best way to tell if a chin implant is in the incorrect position is to examine the patient.  Normally by looking at the implant and feeling it in the patient, the position can be determined.  If you feel that your implant is in the wrong position and your surgeon feels otherwise, you could always get a second opinion.

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.  You should continue to follow up and have this discussion with your chin implant surgeon.  The wings should follow the bottom edge of the jaw line on either side of the chin.  If you are worried that one or both wings might be too high, you can have a 3-D facial scan (typically available at cosmetic dentists offices that do dental implants) to show the facial skeleton, implant location and nerve foramen (place where the sensory nerves exit the jaw bone).  This will allow you to see where the implant and wings are located.   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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