Chin Augmentation operation: After 3 years still have pulled muscle in my chin, advice?

Question

I did chin augmentation surgery three years ago, my doctor placed the implant through my mouth (large size), I'm ok with the aesthetic outcome but my concern is that I still feel numbness, I have a pulled muscle in my chin. I would like to ask you if that is normal?

Alejandro Nogueira, MD · Answer

It is true the vast majority of surgeons use the implants instead of the osseous surgery to adjust the chin, but this is a matter just of lack of experience and comfort ease; implants play no role when there is an autologous alternative which, actually, has plenty of superior advantages.
Being an option, chin implants have serious disadvantages, especially in the mid and long term, patients are rarely happy with them after 5-6 years, all are out sooner or later. A quick research just on this website sheds light on the common, frequent and serious complications and side effects chin implants entail, like dislocation, malpositioning, infection, over or under corrections, visibility, fake looks, nerve damage, chronic pain, poor aesthetic results and in general patients' dissatisfaction; not to forget chin implants are not versatile, they are unable to provide vertical increase, horizontal axis modifications and in most cases sufficient anterior projection; as obvious as it sounds but we have to bear in mind chin implants play absolutely no role when the chin needs reduction of one of the spatial axes; actually it is very common receiving patients who seek chin implant removal and replacement by an osseous genioplasty in the same procedure.
Fillers, another tempting resource, are a very dangerous option in chin reshaping, potentially destructive, unable to reshape and enhance respecting the basic principles of anatomical beauty, leading to mid and long term serious complications (granulomas, deformities, fistulae, etc) and the worst is they can't be removed in most cases.
Burring the chin is, strictly said, osseous chin surgery but should neither be performed, ever, since just flattens the chin by destroying the natural dome of the jaw, deletes the labiomental crease and due to the detachment of the mentalis tendon this technique commonly leads to a droopy double chin, a serious aesthetic complication.
A multidimensional sliding genioplasty allows to a versatile surgeon full customization for augmenting, reducing and leveling the chin in any of its spatial axes, leading to a myriad of combinations to suit every individual's chin anatomy and facial balance requirements; you can masculinize, feminize, round or make square, increase, decrease, supply bone graft, remove bone portions, slide fragments, etc. This absolutely impossible with other method than multidimensional sliding geniplasty, a technique providing a series of advantages among which worth mentioning:-lifetime procedure, no more revision or renewal procedures, unlike implants-more natural than implants, the procedure is totally undetectable -no visibility of implant edges during gestures, expression is even improved, nicer smile-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 and tightens up the jowls, creating a beneficial side effect in form of an indirect facelift and neck lift, all patients see their face indirectly rejuvenated; implants do not offer this feature-no future displacements or neuritis of mental nerves-no droopy double chin (the mentalis tendon is not detached) -way lower rate of postoperative complications if compared with implants, like infections, displacements, neuritis, etc-no need for complex plates and screws or teeth braces that may need future removal; just steel wires synthesis may suffice, they stay buried into bone callus producing no disturbance
The cons for the patient are essentially the costs associated with osseous genioplasties, however it sounds cheap if you consider the lifetime benefits; obviously the main disadvantage happens on surgeon's side, since it is more technically demanding than chin implants, few surgeons are experienced or comfortable with multidimensional osseous genioplasties (though I personally perform 100% of the chin procedures by this osseous method); patients have difficulty in finding surgeons experienced and comfortable in osseous genioplasties able to freely modify the chin shape and size based on their aesthetic and gender goals.
You'll find in this website hundreds of negative experiences with chin implants in the short and mid term, do read my profile's Q&A and you'll find them too. I am doing osseous genioplasties for more than 15 years with the highest success and no one patient sought afterwards switching to chin implants, totally the opposite, I did many chin implant removals and one-staged osseous genioplasties to replace the implant and enhance the result.
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

Larry S. Nichter, MD, MS, FACS · Answer

Without an exam your question cannot be answered.  You will need to see an Oral/Maxillofacial surgeon to see if othognathic surgery, genioplasty or using an implant is best for your specific case. It should be noted that patients with severely weak jaws or abnormally functioning jaws may be better treated with other facial surgery (orthognathic surgery), although a chin augmentation may be an option at a later time. These patients should seek the advice of a plastic surgeon to determine which course is right for them. Here is some information to help you make this decision: Candidates for Chin Augmentation - Patients whose chin profiles are weak but have normally functioning jaws are candidates for Chin Augmentation. Many of these candidates have used injectable fillers in the past to strengthen the protrusion of their chins, but are looking for a permanent solution. If you are one of these patients, then you are a likely candidate for chin augmentation
#weakchin #chinimplant

Somyos Kunachak, MD - Account Suspended · Answer

Hi Grandys, Numbness in most cases, resolve within a year from surgery. Persistent numbness may mean persistent impinging of the sensory nerve by the implant but this needs further evaluation. As for the pulled muscle, I am not quite sure what you mean, but normally, a large implant may interfere with muscle contraction and may even displace the muscle.

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.  Prolonged numbness may be due to injury of the sensory nerve(s) to the chin called the mental nerve which is at greater risk of injury when the implant is placed from inside of the mouth due to the added tissue dissection.  The mentalis muscle attachment is also cut with that approach as discussed below.  This may be why you feel like the muscle is "pulled". 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.  This leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.
*The added areas of dissection in the intra oral approach, allow upward migration of the implant as well as an increased risk of nerve injury.  Damage to a sensory nerve will create numbness and or an ache type discomfort while injuring the motor nerve will result in an inability to "lower" the corner of the mouth and lower lip.  While some of these symptoms can rarely be experienced in the immediate post op period as the mentalis muscle accommodates the chin implant....these symptoms should be gone within a few weeks post op.
 If you are experiencing any of the above symptoms you may want to discuss these with your Chin Implant Surgeon and perhaps even get a 3-D scan of the face or lower face that will show the position of the implant.  If some nerve injury has occurred, it can take a year or 2 for this to improve to whatever extend that will occur.  If the scan shows one or both wings of the implant are impinging (placing pressure) upon the mental nerve...the implant can be removed and another implant placed below the mental nerve which "may" improve or eliminate the numbness.Hope this helps.

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