Chin implant isn't flat on right side of jaw, nerve pain when smiling in area of separation. I'm 2 wks post op. Is it normal?

Question

I am 2 weeks post op after chin augmentation. At my 10 day follow up, the surgeon said the implant wasn't flat against the bone on the right side, and put a little pressure on it to get it to conform. I felt sharp pain when he pushed it, and have felt intermittent sharp pain since, particularly when smiling or when eating. I have to stop myself from smiling too wide or I feel sharp pain. There is also bruising that won't heal where the implant is separated from the bone. Normal or nerve damage?

Raymond E. Lee, MD · Answer

Hi and thanks for posting your question. From what you write it sounds like part of the chin implant may have shifted out of place. An implant should reside flat against the jawbone. If it has shifted up, it may be impinging on a nerve aggravated when smiling, eating, or pushing on it.  I don't believe this is nerve damage but nerve stimulation when the implant moves due to the above reasons. If it was nerve damage then you would actually have numbness. Follow your surgeons instructions as it is early and the implant may settle in place. Please follow up with him closely.

Alejandro Nogueira, MD · Answer

The implant may be irritating the mental nerve and thus will need removal in the near future.Being an option, chin implants have serious disadvantages, specially in
the mid and long term, patients are rarely happy with them after 5-6
years, all are out by then or later.Consider the chin advancement by means of sliding genioplasty, the advantages are:-lifetime procedure, no more revision or renewal procedures-more natural than implants-no visibility of implant edges during gestures-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; implants do no offer this feature-horse-shoe enhancement, covering the chin and also the jaw sides of it-no future displacements or neuritis of mental nerves-practically zero infections and 100% healing of bones-no
need for complex plates and screws that may need future removal; just
steel wires synthesis may suffice, they stay buried into bone callusThe cons are:-expensive, but cheap if you consider the lifetime pros-technically
demanding, few surgeons are experienced or comfortable (though I
personally perform 100% of the chin augmentations by this osseous
method, always after offering the patients both options)-scary for the patient (though not so much if you explain well the stuff around it)This
is my advice to patients with weak chin, the sliding genioplasty above
all other options. After explaining pros and cons all my patients opt
for the osseous genioplasty and opt out implants or fillers.

P. Daniel Ward, MD · Answer

Hi Sarasweet, There can be asymmetry after chin augmentation that can take a frustratingly long time to resolve.  At 10 days, your symptoms could simply represent the normal healing process or it could be something that might need further investigation.  For example, you could have developed a hematoma (collection of blood) around the implant or you could have developed an infection.  The fact that your symptoms are not resolving and, if I understand what you said above correctly, potentially worsening, indicates that you should be evaluated to rule out other causes.  If your surgeon is able to rule out anything that needs to be taken care of in the short term, it is probably just a matter of time before your symptoms resolve.  Nerve damage is thankfully quite rare, but can occur.  Be sure to talk to your surgeon and bring up your concerns.Good luck!

Chin implant isn't flat on right side of jaw, nerve pain when smiling in area of separation. I'm 2 wks post op. Is it normal?

Answers (3)

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