Is the muscle bulge on the right side & slight paralysis on left side of chin permanent & if not, can it be fixed? (Photos)

Question

I had a recent chin implant replacement in feb & it ended up falling down below the jawline on the left side, the doctor did a revision 5 weeks later & I'm having even more issues. numbness & limited movement of lower lip on left side but then, another issue popped up which appears to be a bulging muscle on the other (right) side. It's sticking out when I smile, causing me to look even MORE distorted I am attaching a picture of the muscle which is also now accompanied with a large dimple.

Alejandro Nogueira, MD · Answer

I do quite regularly genioplasties, so do take as solid and grounded my advice, nevertheless better images and examination is required:-the numbness: may be caused by the multiple revisions and procedures, this is due to swelling, in that case it will subside overtime (months) and return to normal; however if the mental nerve has been accidentally severed... you'd rather get asap implant removal and nerve direct suture (unlikely) or interpositional segmental nerve grafting to restore the sensation at the left lip; how to know if the nerve is just affected by swelling or severed? if loss of sensation is not total, if it still keeps a slight perception and feeling... then it is not severed; if the sensation loss is absolute then... you should discuss this eventuality with your surgeon or even carry out an electroneurogram to check the nerve, or finally if the doubt persists an exploratory surgical revision to visualize the state of the nerve is more than indicated, and this should be done sooner the better, not urgent but asap to prevent nerve retraction, and this procedure has to be done by a surgeon expert in chin surgery, familiar with the location and anatomy of the mental nerve and also with basic microsurgical skills to repair the gap with a nerve graft (may it be necessary); I join both features: regular chin surgeon familiar with the nerves and neural microsurgery skills-the palsy: it is more likely due to swelling and only a temporary issue; the facial motor nerve at its mental branch is far from the implant pocket, not expectably damaged-the distortion of the right side: I think that crease is due to the disbalance when you express gestures, due to the palsy of the left side you have to over contract the right side and furthemore that right sides has no counter-action from the left side muscles; this will subside in parallel to palsy recovery-finally; I am totally against chin implants, they lead to a large number of complications, poor results, they are unstable, have short lifetime, look unnatural, lack versatility, etc... I do every year a bunch of chin implant carriers seeking conversion to osseous genioplasties, which are the golden standard in chin surgey; do research my timeline of Q&A to understand how often chin implants complications are reportedIf you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views.
Feel free to request any additional information from me.

Sam Naficy, MD, FACS · Answer

Sorry to hear about the issues you are having.  This is related to weakness of the nerves to your lower lip muscles.  The good news is that >90% of the time it will correct itself over the course of 3-4 months.

William Portuese, MD · Answer

At this point, is probably best to let everything settle down for several months  which will allow the healing process to be complete before making any decisions.

Val Lambros, MD, FACS (retired) · Answer

we would need to see preop smiling pictures to make sure that the skin fold you see is really new. What kind of implant is it and how was it placed/   In any event it's too early and you need to leave things alone for a while. So, send picture smiling and non smiling from before surgery and after.

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 the 30 years.  Non smiling photos of your lower face from the front and side would help in ethics's evaluation as well as some basic information regarding the chin implant, original surgery and the revision.  What material is the chin implant made from, shape, size and what approach was used in both surgeries?  In other words was the implant placed through the moth or a small incision under 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".  The 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.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  
  It's not uncommon to have slight restriction in moving the mouth, in particularly the lower lip following chin implant placement.  The intra-oral approach increases this as it has far more tissue dissection.  This is why I use a small, curved incision under the chin for chin implant placement.  The chin implant is placed (I believe it should be) below the chin muscle (Mentalis) and the covering of the bone.  The restriction, of lower lip movement, is due to the muscle accommodating the added volume and projection provided by the implant.  The movements typically return to normal in several weeks.  At 5 weeks you might still get an improvement in the numbness (mental nerve is the sensory nerve that's involved) and the weak left lower lip (marginal mandibular nerve...a branch of the facial nerve which is a motor nerve).  Neither of these nerves can be repaired if significantly injured and while some cross sensory innervation could decrease the numbness, there is no cross motor nerve innervation to depress or pull down the lower lip if the nerve is injured.  It will either heal or remain weak on its own.Hope this helps

Is the muscle bulge on the right side & slight paralysis on left side of chin permanent & if not, can it be fixed? (Photos)

Answers (5)

More Chin Implant Questions

I want a chin implant, the Mittelman Pre Jowl from Implantech. Which size? Large or X-Large?

Chin implant removal ASAP! I week post-op - already decided to get it removed.

Chin implant surgery. Can I have a second implant?

Bad bone structure or too much face fat or both? (Photo)

How do you treat hematoma after chin implant? (Photo)

WE SEND PRETTY
EMAILS