Chin Implant Ruined my Smile. New Jersey, NJ

My original motivation for getting plastic surgery was to reshape my nose, but in the process of vetting doctors, I learned that my chin was also very recessed and would supposedly benefit greatly from a chin implant. After picking a nose revisionist doctor and undergoing surgery, I learned he used a large silicone terino extended anatomical implant, secured with 1 center screw. I had suspicions that the implant was malpositioned the day after surgery because of a slanted white line that appeared above my chin, as well as the one-sided hardness in that part of my face.

On my 1 and 2 week post op appointments, my doctor could not tell for sure if the hard lump that had formed shortly thereafter, half way up between my chin and smile line, was the implant wing or just swelling. As the first few weeks to 1.5 months went by, the whole left side of my face was super swollen compared to the right, peaking around my left jowl/smile line area. A visit to another doctor about 7 weeks post op confirmed the implant wing was shifted way up about an inch from the left corner of my lip.

Even more concerning to me was that this entire time, my bottom lower lip was severely 'tethered' up to where I couldn't smile, or move my lower lips much when talking. I was regularly emailing my doctor pictures showing the swelling in my left cheek, and finally visited him again 3 months post op. The swelling in my cheek was much improved but still present by then, and my lower lip STILL tethered. About 4 months post op, I can still only show about 3/4 of my lower teeth when I try to lower my lower lip. My lip essentially has improved over the first 2 months and has shown no progress since. This has severely impacted my smile, and I'm so self conscious of it. If I smile too widely, the middle of my lower lip stays tethered up, causing a very unnatural affect. I've read so many reviews on this board and elsewhere and totally expected my lower lip to return to normal 6-9 weeks post op, or by 3 months at the very latest. I have visited 4 plastic surgeons, an ENT, and an oral surgeon and no one knows why my lower lip is acting this way. I suffered no numbness at all post op, and over the 6-9 week period my lower lip movement did improve, but its function is only about 60% back to what it used to be. As much as I like the affect the implant gives to my chin, I dislike the bulge in my left cheek still present 4 months post op from the malpositioned wing and hate how my smile has changed. My theory is that if i remove the implant without replacement, and my lip movement returns shortly thereafter, then I know that my muscles could not stretch enough to compensate for the added chin volume. If my lower lip is still tethered up several weeks after removal, then my muscles were fine and a nerve was simply damaged during the original surgery. If it is a nerve causing my middle lower lip to tether, then I will know, in hindsight (post implant removal), that my lower lip function would have returned if I gave it several more months time to heal. In which case, I may consider a smaller implant in the future. I've seriously considered removing the implant and doing a sliding genioplasty, but the oral surgeon has scared me away with the countless possible complications, and of course no guarantees with my lower lip function.

My original doctor said he can only remove the implant, not replace it, and that it would cost me 2k in anesthesia and OR fees (dr fee waived, but that's still a lot of money). Unfortunately, I also learned from an ENT that I have a moderate amount of scar tissue in my nose that's been affecting my breathing since surgery, and I'll need to be put to sleep to have them cut out (I get faintish if I have needles, etc. flying around my face, so there's no way I would get through this procedure with only local anesthesia). My original surgeon possibly contributed to this scar tissue problem by not cleaning my nose out at all post rhinoseptoplasty, so I can't expect him to treat this issue as it requires multiple cleanings post op. Insurance will also cover this scar tissue complication, so I am diligently searching for an ENT/PS combo type doctor that is in network in the DC area who can do both procedures at the same time - remove the chin implant and cut out the scar tissue in my nose. But this is not easy to find by any means!

I've written this review because I am at my wits end with this chin implant, and I am hoping someone out in this community sees my review and can lend me some advice or share their experience if they've encountered a similar problem like mine. In googling this problem online, I can't find another case where just the middle of the lower lip doesn't retract down with the rest of the lip. Thanks for reading, and I'll reply back / post updates.

I left out an important detail that's particularly relevant when it comes to this kind of complication.. the implant was not placed intraorally. It was placed through an incision under my chin, and my current understanding is that the implant isn't sitting too high.

I have a new theory on why my smile is uneven/crooked. The two wings of the implant are each creating their own augmentation to the soft tissue. The left side seems to be tucked correctly between the bone and soft tissue, effectively pushing the soft tissue slightly forward the way a chin implant normally would. The right side, with the malpositioned wing, is probably sitting ABOVE most of the soft tissue - the entire length of the wing is pretty palpable, and I get a persistent but barely noticeable pain along the wingspan. Part of my left cheek where the implant wing rides high seems 'sucked in', which further fuels my theory that the wing is above the soft tissue; compressing the tissue instead of lifting it slightly off the bone the way the right wing does. Therefore, the function of my lower lip is slightly different depending on which half your looking at.

Also, I'm wondering if the shape of the large Terino extended anatomical implant is causing my center lower lip to flatten out when stretched down. The dimensions posted on the Implantech site shows it has an upside-down U shape in the center of the implant. This differs from the regular extended anatomical, which has a pretty straight, rectangular shape across the central piece. The 'peak' in the center of the Terino extended implant may be why my center lower lip seems more pushed up than the rest of my lip when I smile.

Maybe I'll bounce this theory off of another PS? If this theory holds true, then a medium sized extended anatomical (non-torino) should be a fair compromise between outright removal of the implant and keeping some chin augmentation. I would likely get my smile back - or at least one that is not crooked!

I've gone for a second consultation with Dr. Steven Davison in DC about getting a revision surgery. I've visited at least 5 surgeons now (Dr. Chaboki, Dr. Somenek, Dr. Schoenfeld, Dr. French, and Dr. Bitar) in addition to Dr. Davison. The other doctors I'm not too comfortable with for one reason or another (anyone care to vouch for any of them?). I'm still on the fence with Dr. Davison as he is not dedicated to facial plastic surgery, does just 20 chin implants a year on average (common problem), and only had 1 before/after image to show me of past implant surgeries performed on males because "hardly any gave consent". Despite this, he made observations about this x-ray where other doctor's hardly glanced at it in comparison. The implant is not sitting against the chin bone, the screw is irritating the bone, and I am getting way more projection than the implant was meant to give (~.9mm instead of .6mm). It is sitting a smidge high, and is angled upward. He seemed confident about the revision (unlike one of the top docs listed here), and in correcting at least part of my smile problem, where the wing rides high and snags my cheek, pulling my lips back slightly with it. He is likely to replace it with a large conform extended anatomical, and secure it with just sutures and post op chin sling. He thinks the reduction in projection he is expecting of .3mm or so will help with my center lower lip being tethered up. This is a long shot, but does anyone have any experience with him, or think he may otherwise not be one of the better surgeons for this procedure? I kind of wanted Dr. Bitar but he refuses to revise chin implants or anything at all until a year has passed.

I also have a skype consultation coming up with Dr. Barry Eppley this weekend to discuss my issue here and maybe get his opinion on Dr. Davison.

I can't believe I've lost the better part of a year thanks to this chin and nose job. I've secluded myself from friends and am less effective at work. I really want this implant out or replaced ASAP.