Chin implant: how important is a titanium screw?

Question

I’ve had two consultations about getting a chin implant. One doctor said they use a screw to secure the implant to stop it from moving, while the other said it wasn’t necessary: that the pocket would fit to the implant perfectly and that it wouldn’t move. What are your thoughts on this? Is there a consensus or is it just down to personal preference of the doctor? Many thanks!

Barry L. Eppley, MD, DMD · Answer

Besides the size and shape of the implant, a good chin augmentation result requires proper placement on the bone and assurance that it will stay in the exact position placed. While many surgeons debate about the merits of screw fixation for the latter (positional stability) the question ought to be looked at in reverse. What are the negative aspects of screw fixation? What potential harm does it cause for the benefits that it provides?

Barry M. Weintraub, MD, FACS · Answer

There are several different ways of performing a chin augmentation -- and you are correct, different surgeons prefer different approaches. As a board certified plastic surgeon, I prefer to use anatomically shaped implants that do not require screws, and which I can custom carve to perfectly fit my patients’ specific anatomy. The reason I do not like to use screws is because they are not necessary:  if the pocket is absolutely exact and correct, the implant will not migrate (if placed with the intra-oral technique, which is what I do). Even more importantly, screws can, over the years, exert pressure on the bone which actually erodes the cortex of the bone. I have performed chin-implant removal surgery in which patients seek me out when they’re unhappy with chin implants placed by other surgeons, but the titanium screw(s) preclude the removal because they chin would not be anatomically sound were I to remove it due to the eroded cortex of the bone. For exactly this reason, I would discourage you from having an implant that requires screws.

Mats Hagstrom, MD (license on probation) · Answer

If the pocket is made perfectly then titanium screws fixation it’s not necessary.

If the implant pocket is not perfectly made then the implant will not sit in the correct position unless it’s secured with a screw. The procedure can be a little tricky because of muscle attachments so getting the pocket exactly right may sound easier than what it is.

The ability to add a screw gives a bit of assurance the implant is in the correct position.

Probably what’s more important is having a surgeon who has the most skill and experience rather than their approach.

Best,

Mats Hagstrom MD

Gerald Wittenberg, MSc, DMD (retired) · Answer

It is a common issue. However the idea of any surgical goal is to accurately achieve a certain result and the implant placement therefore should be 'certain" and idealized at surgery. The 'pocket' is not a defined space longterm and 'slippery' silastic implants in particular will change position. Occasionally the change is quite notable and other times the patientb s unaware of the contour changes.

Chin implant: how important is a titanium screw?

Answers (4)

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