Chin implant: under or above the periosteum?

Question

Referring to silastic implants, I read that placing it under the periosteum will help secure the implant in place without a screw. However, when placed above the periosteum, it prevents future bony reabsorption. What are the pros and cons of each and which technique do you prefer? Thanks!

Catherine Winslow, MD · Answer

Hello! I prefer Goretex implants which bypasses many of the issue of silicone such as movement and late infection and malposition. I prefer a contoured, extended implant for a more natural look to the chin. I personally place the lateral flanges under the periosteum and the central portion over the periosteum. Each surgeon will have a personal preference on what works for them. I recommend a consultation with a couple different surgeons experienced with chin augmentation. Good luck!

Zoran Potparic, MD · Answer

It doesn't seem to make much of a difference whether implant is on top or underneath periosteum. Most of surgeons would place it underneath because of tighter pocket and safer dissection. Whether it creates difference in long term bone erosion is still a question. Loss of bone underneath the implant may be visible on x-ray after many years; however, it is very hard to observe any changes in the size and shape of chin in most cases. Sliding genioplasty is another option for chin augmentation. Good luck.

Bahman Guyuron, MD · Answer

Bone erosion is largely related to the type of implants that is used. Porous implants are less likely to erode, specially if they are placed on the dense bone. Silicone implants are more likely to erode. The problem with placing the implant above the periosteum is that it increases the change for dimpling in chin on animation. The best procedure for chin surgery is sliding osteotomy which is more anatomical, less foreign material and is more versatile.

David R. Alfonso, MD, FACS · Answer

I typically place the silastic implant under the periosteum for optimal coverage and positioning the resorption of bone is minimal and not typically significant enough to notice

Barry L. Eppley, MD, DMD · Answer

None of those contentions about chin implants are accurate. The location of the chin implant placement, above or below the persiosteum, does not affect implant stability or the potential for implant settling into the bone a bit.

William Portuese, MD · Answer

In our practice, we place all Silastic chin implants underneath the periosteum without screw fixation. The implants are designed to be placed underneath the periosteum to hold   them in place. If they are not underneath the periosteum,  they will be floating around in the chin,  and will be palpable. Bone resorption present from a chin implant is only  noticed when an implant is removed, but it is not clinically significant.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many Chin Augmentations using chin implants for over 30 years.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   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 and highly effective.  The implant should be placed under the periosteum which will help to secure the implant.  In my experience the Periosteum wants to be attached to the underlying bone and within 1 month will stabilize the silastic chin or cheek implant.  If the implant is above this layer, it can and does move within the subcutaneous tissues.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, your are a good candidate for chin implant surgery.Hope this helps.

Richard W. Fleming, MD (retired) · Answer

I always place the chin implant under the periosteum because the dissection is much more precise and cleaner. Location will have no influence on the extent of bone erosion when using the silicone implants. I have never found that bone loss has been a problem over the past 35+ years.

Chin implant: under or above the periosteum?

Answers (8)

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