Chin and Cheek Implants - finally moving forward

Just a quick note that the surgery happened today and everything went smoothly. If you have questions about how the process unfolds, please comment, and I'm happy to elaborate. I have two photos I'd like to post, but RealSelf is telling me they're too large (although I've double-checked the size and they're fine). Hope there's a fix, and I'll add the pics later if there is. One is from immediately following surgery. One is from a few hours later. I hope these pictures will help other people getting one or the other or both of these procedures to have an idea of what to expect to see the day of surgery, which I know I was curious about: what those first looks in the camera phone would be like. Obviously, I'm swollen (and my hair is a mess). However, I already feel confident, from what I can see, that I'll be happy with the ultimate cosmetic result. It's amazing to look in the mirror and have . . . cheeks and a chin.

I had hoped to post sooner, but I was having some problems with the site, which still haven't completely resolved.

I was operated on last week Thursday, and as of the time I’m writing, it’s Monday—so, day four.



I tried to include two pictures, but the site is again telling me they are too large. Assuming I find a way to get them up later, I will describe them. One is from the day after surgery, and the other is from today. You’ll be able to tell which is which by the level of swelling: It has gone down quickly, even without prednisone (which my doctor advised me to avoid, because it interferes with the healing process). Icing with very gentle pressure several times a day, and sleeping with special post-surgical pillows that keep your head elevated, help. Oddly, where I’m noticing the swelling most today is my upper lip, where I had not noticed it before. Here’s my theory. My surgeon decided to make all the incisions (for both chin and cheeks) inside my mouth (that’s standard for cheek implants, but chin implants are also often done through a small external incision under the chin). To give the surgeon full access to my mouth, the anesthesiologist ran the breathing tube through my nose (I was under general anesthesia, so needed a breathing tube, which would usually go through the mouth). The incisions were closed with dissolvable sutures. From what I’ve read, the immune system recognizes dissolvable sutures as a foreign body and “attacks” them and that’s part of what causes them to break down. While this process unfolds, the area can feel sort of inflamed and swollen, and I hope that’s all that’s going on as far as the lip (note that the incisions sit in the crevice between the lip and gum—for both implants, but the upper part of the mouth for the cheeks and the lower for the chin).



The bruising has been minimal, although the one place where I am noticing it—and which you can see in the picture—is on my lower neck. That’s a bit strange, since my neck wasn’t worked on directly. The area under my chin—the jowls, I guess?—also feels a bit tender. Although neither area was operated on directly, my understanding is that a chin implant can “take up” some of the loose neck skin, and I’m guessing, if that happens in a dramatic enough way, there may be some signs of trauma in the area. On the upside, I’m happy to see that a considerable amount of loose neck skin is now gone.



Another thing I’ve noticed during recovery is that the skin on my face has been very flaky. From what I’ve read online, there are multiple factors that contribute to this, but it’s not unusual after surgery. Separately, there’s also some slight numbness on my lower right lip and the right side of my chin, but some temporary numbness is to be expected.



On Thursday, Friday, and Saturday, I was on a liquid diet, using meal replacement drinks like Ensure. This was necessary since the mouth becomes swollen and sore because of the intraoral incisions. The midface and lower face also take a while to regain normal animation and flexibility, so actually getting food past the lips is hard in the first two or three days after surgery. Yesterday, Sunday, I began to advance to soft solid foods.



The pain was moderate Thursday (again, the day of surgery), Friday, and Saturday. During that time, I was on a prescription painkiller. Yesterday and today, the pain has been mild enough for me to forego the pain medication. I am of course continuing the antibiotics until I finish the full course. I have also been using a prescription oral rinse. With the oral incisions, you can’t take normal care of your teeth for a bit, mainly because you don’t want to disturb the incisions, but you also need a way to minimize the exposure of the incisions to bacteria. The first couple days, you simply can’t brush, but you can use the prescription oral rinse, which works remarkably well to keep the mouth feeling clean. Yesterday, I began to brush the backs of my teeth and the chewing surfaces using a toothbrush intended for very young children. I will play it by ear as far as when I can resume normal dental hygiene.



Sleeping has been a bit of a challenge—not because of pain, but because I want to sleep on my back for about a month, to minimize the risk that sleeping on my side could cause an implant to shift. I normally sleep on my side. Staying on your back the whole night is harder than it sounds, but using one of those airplane-type pillows that wrap around your neck helps.



Overall, it has been an easy recovery, and I hope it stays that way.



I know I was wondering, pre-op, about what would keep the implants from moving around. It depends on the surgeon’s technique. In my case, the cheek implants have a thin coating of ePTFE, which allows a small amount of tissue ingrowth to help stabilize the implants. While the tissue ingrowth forms, the implant sits in a tight pocket that should help prevent a perceptible shift, and of course, I try to avoid any force or substantial pressure to the cheeks. The style of chin implant I wanted was only available in pure, uncoated silicone, which doesn’t integrate with the surrounding tissues. My surgeon used sutures to help secure it. By about six weeks, scar tissue will have formed a capsule around the chin implant, and that should also help prevent migration.



As for how I feel about the results—so far, I love them. From what I’ve read, you don’t see the “real” result until all the swelling is gone. Based on what I see now, I think that we chose the right sizes and shapes for the implants, that Dr. Sabry did a good job placing them, and that I was an appropriate candidate for the procedures.



The cheek implants, which were the submalar type, mostly augment the medial, fleshy part of my cheek, which is where I needed it. They also add a tiny bit more projection to the cheekbones. The contours of my midface are more normal now (they were pretty flat before, especially when my face was at rest), and I like them better. The nasolabial folds are softer. The cheek implants also—and this was a surprise—shifted a small scar that bothered me out of the frontal view of my face. I would caution male patients to be conservative about the size of cheek implants. Some fullness in the medial cheek supports a youthful look, but a very full medial cheek can make the face look feminine. My cheek implants are just mediums, and they provide significant augmentation. I considered large, and I’m glad I decided on medium instead. My understanding is that women can pull off larger submalar implants. Of course, you also have to consider how flat your cheeks are to start with.



The chin looks great to my eye. I like both the added forward projection and the added width. I also like the shape, which is slightly square. Note that we used an extra-large implant for my chin, which tells me that men can err on the more aggressive side with size selection for the chin, keeping in mind how receded the chin is to begin with. I had strongly considered large, which has about a millimeter less forward projection, but I think I would have missed that extra millimeter I got from the extra large. In the face, millimeters count.



I know this was a long post, but I tried to include all the info I wished I had been able to find in the lead-up to surgery. Hope it’s helpful. My updates will be a lot more concise.