Chin Implant Ruined my Smile. New Jersey, NJ

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My original motivation for getting plastic surgery...

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.

Implant was placed via submental incision...

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!

Considering Dr. Steven Davison... also, x-ray (for those medically inclined)

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.

Depressed... but finally might have a solution

I had a Skype consultation with Dr. Barry Eppley today. We spoke about my chin implant and rhinoplasty complications, but mostly the chin implant. A bit to my surprise and disappointment, not even Dr. Eppley has ever seen my kind of chin implant complication before. But, he did have a convincing theory (though I will fudge it a bit as he spoke much faster than I could type).

This problem is essentially what people with intra oral chin implant patients are subject to, but in the exact opposite way. Whereas I got a tethered up lower lip, intra oral implant patients may get a droopy lower lip. This has to do with the way the mentalis muscle is reattached during surgery. Even with the submental approach, the mentalis muscle is cut and redraped over the chin implant. In my case, Dr. Eppley thinks the mentalis muscle was not properly redraped and reattached to the base of the chin bone. Without the proper anchoring, it balls up.

The probable solution is a chin implant capsulotomy (not even heard of on the internet, normally only done for breast implants). This is meant to release the muscle, redrape it down over the implant, and tuck it back in on the under side of the chin. This should relax the muscle and stretch it back out.

So the implants size or position hardly has any association with this issue, as it is most likely completely musculature related. To be extra safe, I might insist on a slightly smaller projection implant, but the next implant will regardless sit lower on the chin bone than where it is now, and probably not be screwed in.

I will email Dr. Eppley with this theory to ensure I got it right/didn't miscontrue things, then go back to the folks I consulted with and gauge how comfortable they are with doing these maneuvers. I really really really really hope I have turned a bend here and am on the home stretch of getting this problem corrected. As Dr. Eppley said, I have been getting the OK from doctors to revise the implant but never received a diagnosis for my problem. This theory may hopefully be the missing piece in getting a successful revision chin surgery.

Still scarring up inside (figuratively and literally)

Well Dr. Eppley's approach isn't exactly traditional and none of the doctor's I've consulted seem to have a clue. The responses back from other doctors all fell into the category of irreparable damage to the area- either from improper muscle dissection, nerve damage, improper muscle reattachment, or mentalis muscle strain.

I saw the operating doctor today, and I am ever so slightly relieved from his insistence that he did not touch the mentalis muscle or do anything under there that would have caused this affect. That tells me the mentalis muscle is either strained from the large implant or improperly attached. I don't trust him to remove it, and I'm scared of removing it at this point without replacement, so I'm looking into doctors in NYC who seem to know what they're doing. In other news, Dr. Posnick wants me to consider double jaw surgery.... ugh.

Finally did...something!

Hours back from a chin implant revision surgery (PM if you want the op doc name, I don't know if this revision will turn out well or not and don't want to deal with slander BS if things go south). As I understand it, a capsolotomy was performed, implant swapped out and 2 screws put in to hold it in place. They told me post op the implant they removed was "extra extra large" and the implant they put in is much smaller (and taller). No numbness, so far as I can tell. Just tightness and mild pain.

Question for the masses - is this chin implant strap wrapping around my chin and head supposed to be super tight? I'm afraid this thing will push the chin implant upwards, and out of its original angle. It's mild to moderately painful strapped in so tightly. I'll be seeing the doctor tomorrow anyways so I'll probably ask then.

Review last edited 04/14/16 at the request of the reviewer.

Anyone familiar with nerve/muscle repair?

My 'arch' is improving slowly, I think, but my lower center lip is still puffed up and flat when I smile.. like it is at rest and not being activated. I suspect the center screw, that stood way up and out above the first chin implant, has caused damage to either the muscle, nerve, or both. I'm researching neurologists and googling 'smile restoration' to see what I can find on this issue.. anyone with experience in this area, advice, doc recommendations, etc. PLEASE respond or PM me. My brief google search into this area suggests electrical stimulation, nerve or muscle grafting. I'm starting to think of this as a facial paralysis issue...

Chin implant screws can damage the mentalis muscle & nerve

Quote from
"The surgical technique involves the creation of an optimally sized subperiosteal pocket in which the chin implant is placed, minimising the risk of implant migration [1]. Although additional fixation techniques with sutures or screws can be used, this introduces a greater risk of damage to the mental nerve and mentalis muscle and is not necessary as a primary procedure"

The revision doctor said my screw was "a mile high" above the chin implant. It was also easily palpable in the center of my chin since that first surgery. He didn't even remove the screw, just cut it down 3mm. In my post op visit next month, I'll ask but I bet he didn't remove it because the screw head was stupidly deep into my mentalis muscle and so it would have risked more damage to dig it out and unscrew it.

I'm a strong 65% sure the screw is what is causing my center lower lip not to pull down. It lines up with where the screw was poking out. This insanely large screw is the only thing that made my first chin implant surgery unusual from the rest, and probably damaged the muscle and nerve. Now how do I fix it 1.5 years post op??!?!

Help.. anyone?

Here I am 3 months post revision.. no real improvement. Would anyone know how to move forward with fixing this??
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