Chin Implant Ruined my Smile. New Jersey, NJ

I presume your daughter saw my review, freaked out, and opted out of getting a chin implant? :)

Your issue is way more common, and no it was not Dr. Eppley but he does do mentalis resuspension surgery. I think there is literally a hole where part of my chin muscle is supposed to be. I'd post it but these last couple updates haven't been worth the time to upload, frankly.

I had the first implant taken out and replaced in April this year, so about a year and 4 months post op. My last post here that you commented under is with the revision implant. Your only 9 weeks post op, so maybe whatever you have will recover.

and how is it now?

I can try more 'bigger name' max facs, as I currently just saw Dr. Posnick and Dr. Gunson, along with a few local no names. Dr. Gunson has a theory but my operating doctor thinks my muscles are fine and it's simple nerve damage. I don't want to believe that / that this will be permanent with no fix. There just has to be something to improve the situation.

Is the center of your chin pad hard feeling, like bone since post op? Can you take your index finger and physically pull the center chin pad down such that your lower lip pulls down as much as it used to if you did it naturally pre op?

I can't even physically move it down. It has been only 3 weeks post op though. Yes very hard for sure. I can pucker and move lips okay. It's tight but I can talk and move every direction but down. It's just stuck up high.

You mean like you can fully show your lower gums like pre op by naturally pulling down your whole lower lip as much as it goes? This is without using your finger right?

What I notice with my lip is the most I can pull down the center lower lip using that finger test is also the most that center piece of the lip will move down when I lower it naturally, by smiling or whatever other expression.

No - when my mouth is at rest I can use my finger to move my lip down to see a bit of my lower teeth (definitely no gums but about 1/2 of my lower teeth). But when I smile my lip moves upward and goes straight and covers almost 1/2 my upper teeth so I have little to no smile and I can't move it at all with my finger. It doesn't budge.

I forgot to mention to keep your lower jaw relaxed when you do the test,so that your chin muscle is relaxed. Also was your implant put in through the mouth or under the chin? At any rate, if you can only show 1/2 your lower teeth with this test, and your chin is hard, you are mostly just experiencing swelling and will have to wait another 1 to 1.5 months for it to resolve. If the center lower lip still rests high at that point without steady improvement every other week or so, then take a look again at this test, see what happens and we'll reevaluate.

Also re-read your review. you got a 12-13mm SG, an unknown size chin implant, cheek implants, buccal fat removal, and side and back jaw implants correct?

Yes that's correct. I know.. too many procedures at once! What was I thinking!? Everything was placed through the mouth and my x-Ray looks like yours does with the one screw raised in the centre (although it's holding the implant obviously). He also said there is a bit of implant above my chin to fill the hollow dip between my lip so I'm just kind of confused. So where are you at now? Have you given up hope on therapies or revisions? I really wanna figure this out with you!

And yes - I'm keeping my jaw relaxed for the test. I can move it down minimally. Enough to see a bit of lower teeth. But as soon as I smile that totally changes.

My case is about as figured out as it will get for the time being while I decide if I want to get bimax surgery and remove the chin implant at the same time. You're really early on in the healing process, but I can draw correlations with my own botched experience if you really want to get into the weeds this early on... PM me or keep calm for the first ~9 weeks post op for the typical chin augmentation recovery period.

Hi, thanks for writing & your sympathies. These days I just train myself to smile a lot less so that my lip corners never go 'below' the center lip. Looks natural (to the untrained eye) but is a tighter smile than prior. I do have a 3D CT scan that shows the implant is just slightly rotated, probably within the norm, but not really anything meaningful in the center area. In your case, a 3d ct would probably be pretty helpful to see your implant's position. I've reached out to Niamtu a year or so ago, but unfortunately he no longer deals with chin revision cases. Dr Eppley or Dr Zide may know what to do, but holding off on traveling to them for the time being. I think my overall lower face aesthetic issue is better treated with bimax than another isolated, mega chin augmentation. Question for you (related to researching my own issue but need a 'normal persons' results to compare). In the lower chin area where the implant is secured, is the chin tissue there very thin, and was it that way before and/or after the implant? So like can you feel the implant as if it's only covered by skin and nothing else - no fat, muscle, etc.. I ask because my chin area feels almost exactly like I'm feeling my elbow - hard as bone, and nothing to pinch because it's so stretched/tight. My latest theory (aside from irreparable screw damage) is that the chin implant pushed the mentalis muscle up out of the way of the implant. Normally the implant sits behind the mentalis muscle. Thanks!

In general custom implants are better than these off the shelf types. You can decide exactly how much advancement they'll give and in what areas, in consult with your PS. Also you won't get bamboozled on the overall size of the implant. I sure didn't want to go from a 7mm to 12mm size implant. The 12 looks somewhat better, but now I don't know how a smaller implant would've affected my smile. And now there's no returning from chin augmentation without being left with a saggy chin, due to how much heft was added to my chin.

not sure I understand but I'm sitting here feeling my chin and I the skin itself feels the same as it was before....not thinned out. I do feel hardness under my skin which I'm assuming is the implant, not muscle or fat. I can move the skin on top around a bit....so not stretched thing, although I have a strange pulling/dimple on one side of the chin I am hoping just from the size being off. not sure I helped....

Hi there can i ask dr zide fullname, i have a chin problem and need experinced chin doctors

Just looked him up...Barry Zide in NYC...is that the guy Ditterbo?

Thank you so much i try to reach dr niamtu but his website doesnt open and idk where to find his mail adress

wow just read reviews for Zide....so many are great and then a couple are horrendous (special to chin revision). Why did you not go further with Zide? This review reminded me of your case:
"Dr. Zide was recommended to me after having had an elective surgery for a chin implant go horrifyingly wrong. The original surgeries with another plastic surgeon left me with a destroyed "mentalis" muscle.. this is the muscle that holds up your bottom lip and helps you chew and speak. I was in a state where my mouth that had closed nicely and my lips came together easily, prior to this elective surgery.. was now gaping open, all of my bottom teeth showing. I could barely close my mouth only by pulling down my top lip which looked more than bizarre, and on top of that i was drooling and could not chew with my mouth closed. Obviously devastated I sought out 6 different plastic surgeons for help and the only person able to help me was Dr. Zide. He is an expert at what he does and is as charming as he is talented. After a long hard road of several reconstructive surgeries my mouth has regained most of it's original look. It closes with much more ease and looks so much more natural than it did before, I also have no problem chewing and am not drooling anymore. I am so happy with the results of the surgeries Dr. Zide has performed and I would recommend him to anyone"

(That message above was specific to Ditterbo)

Yeah the reviews on Zide are also a significant factor as to why I haven't seen him yet. He's also a LOT of money for a routine consult, but maybe that's just standard NYC markups. What you're describing there is the normal issue people have with mentalis muscle dysfunction. It droops down and needs to be stitched back upwards, which rarely holds in the long term for some reason. Over the phone and email, Zide would want to replace my chin implant with a medpor type, size & look of his choosing. or sg. Basically I have to decide if I want to do bimax and remove the implant concurrently or continue with the isolated chin surgeries. Bimax would be ideal if I can accommodate the recovery, cost etc..

Thanks for explaining how that area feels. I think I follow.. basically like you know how you pinch your cheek, you can feel the underlying fatty tissue getting squeezed between your fingers. Your chin, I believe around where the implant lies, is also supposed to be fairly squishy between your fingers. I'm not sure if it's normal for the implant to feel as if it's just behind my skin, with no fat muscle tissue etc. in between. You feel hardness under your skin, so like if you had to guess what's between your skin and the implant, probably nothing because there's nothing to pinch except the top layer skin itself? It's not that my chin skin is taught, it's just that there's nothing else between the implant and my finger.

Do you feel that your skin is thinned? If so, then it can really be the implant the hard thing you re describing. My idea is that it can be hard scar tissue that surrounds your chin implant. A fibrosis. Hard scar tissue forming around solid silicone implants are common in breast implants, called 'capsular contracture'. I didnt heard it happening in facial implants but it can be. Its like fibrosis. I removed my chin implant almost 5months ago and for the past 4months my chin (the area where the implant located) was super hard like a bone. And i was really confused because i know my bone was not that forward but it really did felt like my bone. Then suddenly it got very soft and squashy and finally i can touch my real bone which was far behind as i expected. So just an opinion. Wish you the best

So sad we all trusted in our professionals and here we are trying to diagnose ourselves and come up with solutions...

Lol well it's not for lack of trying. I've seen dozens of doctors to literally just talk about my lower lip issue. Surgery fixes 'static' issues, rarely dynamic ones like irregular lip movement. Doctors don't know how to correct those. But my theory that the muscle isn't in front of the implant (where it maybe should be) was actually repeated by dr. gunson when I saw him. Him and Eppley think the muscle needs to be pulled back down under the skin where the implant currently juts out. My complication in particular, with just the middle lip elevated, seems extremely rare according to many of the doctors I saw, and none have ever seen it before. I'm talking plastic surgeons, max facs, craniofacial docs. So though dsb, just to confirm, you do or don't feel your chin implant is hiding behind only a layer of skin? If you do feel the implant barely has anything draped over it besides skin, then maybe I should take dr. gunson's & eppley's theory with a smaller grain of salt.