Is reasonable to request that the implant be adjusted by shaving down one side?

Question

I am unhappy with my Mepor medium sized chin implant as it is asymmetrical (my chin was asymmetrical to begin with, but now looks even more so due to the larger size). Questions: 1. Is it reasonable to request that the implant be adjusted by shaving down one side, in order to improve symmetry? Is this possible? 2. If I decide to remove the implant 6 months post surgery, is it standard to have to pay additional surgical fees to have this done, or would most surgeons only charge for the anesthesia, etc

Zoran Potparic, MD · Answer

You should discuss this issue of implant adjustment with your surgeon. Only of the basis of preoperative findings one can decide how much did addition of implant contributed to your current asymmetry. Trimming of implant is one possibility as well as replacement or removal of the implant. Every office has its own rules regarding revision surgery; you have to have in mind that less than expected results of surgery are not always result of poor surgery. Open discussion with your surgeon is best way to sort this out. Good luck.

Eric YK Li, MD · Answer

If you are asymmetrical to begin with, then yes, we can usually shave the implant down on on side.  That is the artistic element of the operation.  Regarding your second question, you would have to consult your original surgeon and ask about his/her revision policy.  Generally speaking, if you've changed your mind after the surgery then it is considered a new procedure with new costs.

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 have this conversation with your surgeon as the swelling and recovery time can vary dramatically based upon the approach (method of chin implant placement).  An intra-oral approach requires far more tissue dissection which requires additional recovery and healing time versus a submental approach (small, curved incision under the chin).  With a submental approach, the swelling would typically be resolved well before 3 months and at that time, the final result would be visible.   The shape (style) and size of the chin implant will also have a significant impact on the final result.  Sadly, medpor implants become integrated into the underlying bone as early as 1 month post-op.  They are very difficult to "shave down" or remove compared to silastic implants which is why I prefer using silastic chin implants.  We no longer accept medpor implant patients for removal and exchange.
  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.  
 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.  
 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.
 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.Hope this helps.

Is reasonable to request that the implant be adjusted by shaving down one side?

Answers (3)

Recommended reading

Everything you need to know about Chin Implant

Our mission is to create a world where every investment in modern beauty is Worth It.

Is reasonable to request that the implant be adjusted by shaving down one side?

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Chin Implant

Our mission is to create a world where every investment in modern beauty is Worth It.