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Archive for the ‘chin implant’ Category

Chin Implant Imprinting

Wednesday, August 26th, 2015

 

The use of a chin implant for an increase in lower facial projection is often combined with other procedures (e.g., rhinoplasty) as well as done as an isolated chin augmentation. It has a long history of use in aesthetic facial surgery dating back over fifty years and nearly every available biomaterial has been tried as some form of a chin implant. But the use of silicone chin implants today constitutes the majority of chin augmentation devices used.

One phenomenon of placing a silicone chin implant (it also occurs with other biomaterials as well) is that of ‘chin implant erosion’. This is an erroneous term that implies that a chin implant is actively eating into or destroying the chin bone underneath it. (aka an active inflammatory process occurring as a a result of a bone reaction in response to a leaking of silicone molecules from the implant) That perception and propagated term is far from what actually occurs.

Chin Implant Imprinting 3 Dr Barry Eppley IndianapolisThe chin is a unique facial area for augmentation because it is a projecting bony structure with tight tissue attachments that wrap around it. Thus when an implant is placed between the chin bone and the overlying soft tissues it will exert some forces (pressure) on the underlying and overlying soft tissues. The body will relieve this pressure with passive adaptation to it. Since the chin implant can not change due to its synthetic inert structure, the surrounding tissue must. As a result, the chin implant will often (although not always) settle a millimeter or two into the bone as a form of pressure relief. This can be seen in great detail as the serial number, size indicator or any grooves or markings on the implant can be seen on the bone surface as the implant is removed.

Chin Implant Imprinting Dr Barry Eppley IndianapolisThis passive bony remodeling phenomenon to a chin implant is benign and self-limiting. It has little to no impact on the external aesthetic chin augmentation result and does not affect the quality of the underlying bone. Because most chin implants are placed in the subperiosteal plane this settling will also allow some bony growth to often extend up along the sides of the implant. Such bony overgrowth can be seen clearly intraoperatively as well as on CT scans. This bony overgrowth further implies that the implant is not causing a destructive bony process.

There are very rare cases where chin implant settling has placed the mandibular incisor tooth roots at risk or has caused some dental sensitivity. This is a direct result of a chin implant being placed far too high over the much thinner cortical bone near the tooth roots. As a result, passive implant settling may occur deeper into the bone and appear very close radiographically to the tooth roots. This is the direct result of an incorrect chin implant placement.

It is time to eliminate the term ‘chin implant erosion’ due to its biologic inaccuracy and replace it with a term that correctly identifies it with the passive bony remodeling process that it is. The better descriptor would be ‘chin implant imprinting’.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Geniopasty with Indwelling Chin Implant

Sunday, May 3rd, 2015

 

Background: Horizontal chin augmentation can be done using either a synthetic chin implant or a sliding genioplasty. There are advantages and disadvantages with either approach and they must be considered in an individual patient basis. The decision in any patient ultimately depends on their perception of an alloplastic vs. an autogenous approach, the risks of the procedure and its recovery and what other dimensional changes of the chin that are needed beyond just that of the horizontal change.

But the use of a chin implant does not always produce the desired amount of chin augmentation change that every patient desires. This may be due to inadequate implant selection, the chin implant settling into the bone thus losing some horizontal projection, chin implant malposition or an accommodation to the initial chin augmentation result.

When further improvement is desired after an initial chin implant augmentation, the options are either a larger implant or to convert it to a sliding genioplasty method. A larger implant is usually done as this is the simplest revisional approach provided that a new implant can create the desired horizontal change. When a larger chin implant offers but a modest additional augmentation (e.g., 5mms or less) the the sliding genioplasty option becomes a consideration. It would be either that or have a custom chin/jaw implant made.

Chin Implant Settling (Erosion) Dr Barry Eppley IndianapolisCase Study: This 26 year-old male wanted additional chin augmentation after having a prior chin implant placed several years previously. He always felt that is lower jaw was smaller. His original chin implant provided 7mms of horizontal projection but it could be seen that it had settled into the bone a few millimeters. He opted for a sliding genioplasty as he felt that would more reliably give him long-term augmentation.

Sliding Genioplasty with Chin Implant intraop Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was used to access the chin. The chin implant was easily identified and it was nestled nicely into the bone. A horizontal osteotomy cut was made above it from side to side and the bone downfractured. The chin segment was then advanced 12mms and stabilized with a step plate and screws. The chin implant was never moved from its original position during the procedure.

Sliding Genioplasty with Chin Implant result Dr Barry Eppley IndianapolisSliding Genioplasty with Chin Implant 3D CT scan Dr Barry Eppley IndianapolisA sliding genioplasty can be successfully done with an indwelling chin implant. It can be argued that this is a good technique to take advantage of some of the prior procedure (and investment) and gain additional horizontal augmentation. Whatever implant settling has occurred into the bone has already reached its peak and no further inward change would be anticipated.

Case Highlights:

1) An unsuccessful chin implant result can be improved by a sliding genioplasty.

2) It is not always necessary to remove an existing chin implant when doing a sliding genioplasty.

3) A sliding genioplasty can be performed by making the osteotomy cut above the chin implant and moving both forward simultaneously.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Square Chin Implant and Vertical Cleft Creation

Friday, February 27th, 2015

square chin implant dr barry eppley indianapolisChin augmentation is most commonly done by placement of a synthetic silicone implant. Chin implants today come in a wide variety of dimensions, historically providing only horizontal projection, but now available in vertical lengthening styles as well. For men chin implants are even available to provide an increase in width, also known as a square chin look, to provide a more masculine chin/jawline appearance.

One other chin feature that is often desired in men is that of a chin cleft. Certain chin implants have a central cleft in them in an effort to create a midline cleft with the chin augmentation. While it looks good on the implant, it does not translate to creating that effect on the outside after implant placement. It simply is not that easy to create a vertical chin as it does not come exclusively from a defect or notch in the bone, contributions also come from a muscular diastasis as well.

square chin split implant technique dr barry eppley indianapolisvertical chin cleft creation technique dr barry eppley indianapolisTo effectively create a vertical chin cleft at the same time as placing a chin implant, it requires a concerted effort to make it appear. The chin implant is first split down the midline and separated. A 5 to 7mm gap is made between the implant. Because the implant is now in two pieces it is necessary to secure each implant half by screw fixation. Then a bone hole is made through the bottom of the chin in the midline. This allows a permament suture to be placed that is used to pul the mentalis muscle down into the implant gap. A stronger effect can be created by removing some soft tissue under the skin as well before passing the suture. How tight the suture is tied down will impact the degree of cleft creation. The shape of the cleft (its width) is also influenced by the size of the midline implant gap.

Square Chin Implant with Cleft result Dr Barry Eppley IndianapoliisA vertical chin cleft can be done at the same time as a square chin implant augmentation in men. Breaking up the wider square chin with a cleft helps add a visual feature of interest and disrupts a completely flat horizontal line across the bottom of the chin.

Dr. Barry Eppley

Indianapolis, Indiana

Jaw Makeovers for Men and Women

Thursday, January 15th, 2015

 

Strong Male Jawline Dr Barry Eppley IndianapolisThe jaw makeover seems to be one of the newer requested facial cosmetic procedures. Women and men grab their necks and stroke their jawline looking back on the days when it was much tighter and more defined. Men are particularly focused on their jawline feeling that a more prominent one would improve their appearance as well as other aspects of their life. A small hint of this elevated level of interest in the jawline is shown by the increased number of chin augmentation procedures done over the past decade.

The reality is that there is not really one jaw makeover procedure or technique. Rather there is a large number of procedures that can be done that offer some degree of jawline enhancement. They range from minimally invasive procedures like skin tightening ultrasound and radiofrequency treatments, injectable fillers, liposuction, fat injections, standard preformed chin and jaw angle implants and custom total wrap around jawline implants. Conceptually they create a more prominent jawline through either skeletal augmentation or to reshape the soft tissues around the existing jawline.

But it is important to understand that not all jaw makeover treatments are created equal. One should not expect that a little skin tightening and filler or fat injections will create the same jawline effect as chin and jaw angle implants. Of course it all depends on where one starts and how deficient the underlying jawline anatomy is.

Superman Jawline Dr Barry Eppley IndianapolisThe motivation for the increase in jaw makeover procedures is multifactorial. Stronger jawlines have also been desirable for men and dates back to antiquity. Actually there has never been a time when a weak chin or obtuse neck angle has been in demand or shown to enhance one’s appearance. But recent fashion and style does have an impact which leads one to look at the influence of the many recent superhero movies in the past decade or so. These comic book characters now on display on the big screen inadvertently suggest a relationship between a strong jawline and ‘enhanced powers’. It has also long been established that stronger facial features in men (as well as height) have an advantage in the work place and for job advancement.

Strong female jawline Dr Barry Eppley IndianapolisWhile women historically have been aesthetically pleasing with a softer jawline, stronger jawlines through increased definition and angularity has become more popular. This trend of female jaw aesthetics can be seen in contemporary models and some actresses and celebrities. Why stronger jawlines in women are appealing is a matter of debate. But strong skeletonized facial features in a woman suggest strength, fitness and a strong will.

Fillers and skin tightening procedures can create a better jawline but it is important to understand that these results are more modest and are only temporary. A lower facelift unmasks the ‘old’ jawline that once existed and has become obscured with sagging jowl and neck skin. It creates an improved jawline by unmasking the old one. Bone implants create the strongest change in jawlines that are permanent and the most visible. With a stronger push to the overlying skin due to the material, greater angularity and definition can be achieved. Younger jaw makeovers are usually skeletally based while ‘older’ ones incorporate some soft tissue management as well due to aging.

Dr. Barry Eppley

Indianapolis, Indiana

Three Dimensional Chin Augmentation – The Vertically Lengthening Implant

Monday, January 13th, 2014

 

Chin augmentation is one of the more popular and historic facial contouring procedures. While often done alone for a ‘short chin’, it is just as commonly done with many other facial procedures such as rhinoplasty and facelifts. Other than rhinoplasty, it is one of the oldest of the facial restructuring procedures having been done in one manner or the other for almost 75 years.

Chin Projection Measurement Dr Barry Eppley IndianapolisWhen most think of augmenting the deficient chin, it is almost always perceived dimensionally as a lack of horizontal projection. Profile assessment, done by either lateral cephalometric or picture analysis, makes an assessment of where the most projecting point of the chin falls relative to a vertical line dropped down from forehead, nose or lip structures. Thus chin augmentation is most commonly seen as how many millimeters the chin point is deficient. Knowing what this horizontal chin deficiency is in actual numbers allows the plastic surgeon to choose a chin implant whose sizes is determined by their horizontal thickness. (which are in the range of 3mm to 10mm from most manufacturers)

While a deficient chin most assuredly does have a horizontal deficiency, this assessment alone make be inadequate for some ‘short chin’ patients. Since many short chins are associated with an overall underdeveloped lower jaw, other chin dimensions may be deficient as well. The vertical dimension has historically been overlooked or under evaluated in many chin augmentation patients.

A vertical chin deficiency can exist in isolation but most commonly occurs as part of a horizontal deficiency as well. The chin essentially is rotated backward and up due to the overall jaw shortness. When using traditional implants in this type of aesthetic chin problem, the soft tissue chin point comes forward but still doesn’t look quite ‘right’ as the vertical shortness of the chin is not corrected. (and may even look worse as it is magnified by the horizontal augmentation)

Every chin implant ever manufactured is based on correcting a horizontal chin shortness. The implants are designed to be placed low on the chin bone (pogonion) to provide maximal horizontal correction. While some small amount of vertical height increase of the chin may be obtained (1 to 2mms) by placing the implant very low on the chin bone (on the edge), this is not going to improve the really vertically challenged chin. Not to mention contemporary chin implants are not designed to sit that low and may be positionally unstable and prone to rotation and asymmetry.

vertical lengthening chin implant indianapolis dr barry eppleyA new design of a chin implant is now available that can address the combined vertical and horizontally deficient chin. Made to be positioned along the lower edge of the symphysis (anterior jawline) as opposed to in front of it, it provides a 45 degree directional augmentation to the chin prominence. (forward and down) The implant tapers back along the jawline to the parasymphysis and prejowl areas so as to blend into jawline without an obvious demarcation or step off in the jawline. While the implant does wrap around the lower edge of the chin and jawline, screw fixation is advised for optimal stability. (a small depression in the midline of the implant has been placed for central screw fixation if desired) Given the length of the screw needed, a 2.0mm titanium screw is recommended.

Vertical Lengthening Chin Implant sizes Dr Barry Eppley IndianapolisThe vertically lengthening chin implant offers better augmentation results in the patient who has more of a ‘three-dimensional’ chin deficiency. Proper patient selection is important to pick up a vertically short chin that may remain or become more evident with traditional horizontal chin augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Missing Element in Jawline Enhancement

Monday, October 28th, 2013

 

A strong jawline is a well known perceived desirable facial feature. While an obvious aesthetic asset in men, it is even so in women as long as the chin does not protrude too much. What what makes up a nice and well defined jawline? The jawline comes from the mandible or lower jaw which is anatomically made up of five distinct components that is essentially a paired L-shape curvilinear structure that meets in the middle. Its anatomic components and their aesthetic corollaries are the symphysis (chin), parasymphysis (prejowl), body (middle of the jawline), ramus (angle) and the condyle. (jaw joint which has no aesthetic relevance) Chin implants increase the projection of the symphysis, jaw angle implants increase the width or length of the ramus and prejowl implants increase the fullness of the parasymphysis. But there is no off-the-shelf standard implant for the body of the mandible that would connect whatever is done at the opposite ends of the jawline. (chin and jaw angles) This is the missing piece of aesthetic jawline enhancement, the ability to make a smooth and stronger jawline along the sides. Currently, only custom made implants can do body jawline augmentation. or the wrap around jawline implant which includes all elements of making a well defined jawline.

Dr. Barry Eppley

The Role of the Chin in Profileplasty

Sunday, July 28th, 2013

 

It is very common that multiple procedures are done on the face at the same time. Whether it be for anti-aging effects or for reshaping a face, combinations of procedures produce more profound changes. This is because the face is made up of many different parts and making significant changes often requires altering more than one facial area.

The benefits of combination facial surgery are commonly seen in nose and chin surgery. Since the nose and chin make up the dominant structures of one’s facial profile, it is not surprise that the combination of rhinoplasty and chin augmentation have become known as a profileplasty. Profileplasty refers to any cosmetic procedure that would improve the appearance of the profile which is an aesthetic and proportionate relationship of the nose, chin and neck. Thus profileplasty is not just rhinoplasty and chin augmentation, although this is the most common one in the young, but also includes a facelift and chin augmentation which is most common in older patients.

It is easy to understand why rhinoplasty can be so important to profile changes as the nose sits at the center of the face. Even very subtle nose changes can be visually appreciated in the profile view. Lowering of the nasal bridge and reshaping the nasal tip in a large nose or augmenting the dorsal line and increasing tip projection in a smaller/flatter nose not only changes the shape of the nose but one’s profile as well.

Just like the nose the chin has an equal, if not greater, impact on one’s profile than even the nose. This is because the chin sits in the middle of the facial profile between the nose and the chin. Whether it is too small or too big, the chin influences the perception of both the nose and the neck. The nose, however, does not influence the appearance of the neck angle and a necklift does not alter the perception of one’s nose shape.

In many patients the best profile changes come from a change in the lower face. Chin surgery can improve facial proportion, creating a better balance between the upper face (forehead, nose and lips) and the neck. As a well known example, even a well shaped nose can seem larger if the face has a smaller chin. Even if some nose changes are done, the more important procedure might be chin augmentation on improving the appearance of the nose.

Chin surgery is often perceived as an augmentative operation but that is a limited view of the different types of available chin surgery. Chin augmentation historically is seen as an increased in horizontal projection, how much forward position of the chin is needed. While this can be done with either an implant to sit on top of the bone or to move the chin bone itself (sliding genioplasty), they change the shape of the chin differently. A chin implant can improve the horizontal projection of the chin but can do little for increasing the length or vertical height of the chin. Often more vertical height is needed when the chin is significantly short. Unlike a chin implant, a sliding genioplasty can not only bring the chin forward but can lengthen or shorten its vertical height as well.

While chin implants have historically lacked the ability for vertical elongation, new chin implants styles will soon be available that provide concurrent vertical lengthening as well. Rather than sitting completely on the bone, these newer designs sit on the ledge of the chin bone (halfway between the front and under edges of the chin bone) to create their effects.

While sliding genioplasties can lengthen the height of the chin, there are limits as to how much the bone can be moved forward. To keep the back of the moved chin bone in contact with the front edge of the fixed chin bone, the amount of bone advancement is usually limited to 10 to 12 mms. Very short chins often need much more than that to achieve an ideal chin position. In these cases a chin implant can be placed on top of the advanced chin bone (implant overlay) to achieve an additional 3mm to 5mms of further horizontal chin projection.

Chin reduction is not as commonly done for profile changes and has a checkered history. The most common chin reduction method is done as an intraoral burring or shaving of the front edge of the chin bone. While simple, it is rarely effective as no more than a few millimeters of bone is reduced and no change occurs in the soft tissue thickness. Often patients complain of seeing no change after this surgery and may even develop some soft tissue redundancy or sagging afterwards. The use of a reverse sliding genioplasty is also ill-advised as, while it does move the whole chin bone back, it pushes the attached soft tissues into the neck creating an undesired bulge.

The most effective chin reductions are done from a submental (under the chin) approach where the bone can be more dramatically reduced in all dimensions if needed and the excess soft tissues excised  and tightened. (tucked) While this does create a scar under the chin, it can remain imperceptible if its length remains curved to parallel the shape of the jawline and it stays within the confines of a vertical line dropped down from the corners of the mouth.

When considering profileplasty, or even an isolated chin augmentation or reduction procedure, the use of computer imaging is critical. It can not only confirm which procedures are beneficial but, more importantly, the magnitude of those desired changes. A plastic surgeon can never really know what ‘flavor’ of change any patient desires and such imaging helps to establish what that is. While computer imaging is never a guarantee as to how the final result will look, it provides a method of visual communication to help the surgeon not guess as to the patient’s profileplasty goals.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Facelift with Chin-Prejowl Augmentation

Monday, June 17th, 2013

 

Background:  Aging of the face takes on many predictable changes but none is more evident than what occurs along the jawline. The once more discernible and sharp jawline becomes lost as jowls appear and the neck sags. The neck angle becomes more obtuse, the chin may appear shorter, and the transition between the face and the neck becomes obscured. This falling down of the facial tissues over the ledge of the jaw bone into the neck typically occurs due to loss of osteocutaneous ligament support to the skin.

The facelift operation reverses the soft tissue components of this aging process. A facelift is really an isolated neck-jowl procedure that removes fat from the neck, tightens neck muscles (platysma), lifts up the intervening layer of soft tissue between the muscle and the skin (SMAS) on the side of the face, and relocates and removes excess face and neck as it is elevated past the ears.

But often forgotten, and many patients do not see it themselves, is the bony support of the jawline. The strength of the chin and the jawline backs to the bony angles has an influence on how much and how quickly the facial aging process proceeds. Inherently weak chins and a shorter jawline with high mandibular angles indicates a weak system for the prevention of facial tissues from falling over the ‘ledge’ and lack of support to hold the neck tissues up.

As part of any facelift, consideration should always be given to augmenting the jawline. Most commonly, this is seen a simple chin augmentation as weak chins are easy to spot. Chin implant augmentation adds length to the jawline and adds a complementary effect to the restoration of a more acute neck angle. In other cases, an extended implant that incorporates the prejowl area better defines the front half of the jawline.

Case Study: This 65 year-old female wanted to improve her saggy neck and jowls that had been slowly getting worse over the past decade. She was a very thin lady with very little subcutaneous fat. She had rolls of skin over the jowls and into the neck with prominent platysmal bands. Her chin had some horizontal shortness and her jaw angles were extremely high, creating a 45 degree angle to her mandibular plane.

Under general anesthesia, a facelift was performed. Initially, a submental incision was made and skin flaps raised to expose the platysma muscle. The muscle edges were exposed with cautery and a sutured together from under the chin down to the thyroid cartilage. A combined chin-prejowl implant was placed on the chin bone back behind the mental nerve on the lower edge of the bone. Incisions were made around the ears in a retrotragal fashion and long skin flaps raised to connect with those previously made in the neck. Her SMAS tissue was very thin and imbrication by sutures was done rather than raising the flaps. Excess skin was brought back over the ears, the excess removed, and the outline of the ear re-established.

Her recovery was very typical for a facelift and she looked fairly non-surgical in just over two seeks after her procedure. Her jawline was sharp again and the chin had more projection although not overly so. Even the outline of her high mandibular angles could be clearly discerned.

Skeletal jawline augmentation is an underutilized technique in facelift surgery. Its use in patients that have a congenitally short jaw is extremely beneficial and will highly compliment the soft tissue rearrangement. But even in patients that do not have an obvious chin deficiency the jawline can be made more prominent with a prejowl implant that adds minimal horizontal chin projection.

Case Highlights:

1) The woman with a short jaw, as evidenced by a small chin and high mandibular angles, will develop considerable neck and jowl soft tissue sagging as she ages.

2) While a facelift is the standard approach to neck and jowl sagging, adding skeletal support through chin augmentation helps recreate a more visible jawline.

3) Chin and jawline implants can be a valuable addition to lower facial rejuvenation.

Dr. Barry Eppley

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Facial Procedures

Saturday, June 15th, 2013

 

The facial aging process is one that is well known as everyone will eventually see it on their face. The eyes get heavy, the brows descend, the cheek fall, jowls develop and the neck sags. Women become concerned earlier in the aging process and proceed to do procedures to treat or slow it down in an overall more comprehensive manner. Men take a much more delayed approach to it often waiting until one facial area becomes a major concern or until the facial aging process is fairly advanced.

While the face ages largely similar in both men and women, the facial procedures used to treat them are often done differently. Not as many men have facelifts as their aging neck and jowls are more tolerated. But in men that have facelifts they must be done very carefully, respecting the natural hairlines of the temples and behind the ears and being careful not to displace the beard skin into the ear canal. Incisions must be placed very inconspicously and often less of a tightening result must be accepted to keep the scars hidden. That is not a bad thing as men look better underdone than having their faces pulled too tight anyway.

While men also develop heavy upper eyelid skin and lower eyelid bags just like women, their eyelid lifts (blepharoplasties) need to be done more conservatively. Browlift options in men are more limited due to the frequent lack of adequate scalp hair and a well defined frontal hairline. The most common male browlift method is through the upper eyelid (transpalpebral browlift) using the endotine device to accomplish the lift. This produces a very modest browlift but creates no visible scars and with more conservative eyelid skin and fat removals can avoid overfeminizing the male face and creating an unnatural overdone look.

Men do not engage in as many Botox and injectable fillers treatments as women as some wrinkles and signs of aging are more tolerated. A more natural result for men is one that reduces the worst of the wrinkles but does not eliminate all of them. This is the same reason men, at best, will only do a bare minimum of facial skin care. Many men would rather seek more definitive surgical procedures, or do nothing at all, that engage in non-surgical procedures that require frequent efforts to maintain.

Facial reshaping surgery is vastly different in men than women. Male rhinoplasties must keep a high and straight dorsal line and avoid an overly upturned tip while most women desire a smaller less projecting tip and lower dorsal lines. The shape of the face in men is dominated by a strong jaw and requests for chin, jaw angle and even total jawline enhancements are not uncommon to pursue a more masculine appearance and even the so called ‘male model’ look. Men favor higher more angular cheek augmentations while women prefer a lower more anterior rounded cheek prominence. Men pursue brow bone surgery for either reduction of an overlying prominent one or for augmentation to create a more masculine brow prominence and a more backward sloping forehead profile.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Reducing the Risk of Complications in Chin Implant Augmentation

Thursday, April 18th, 2013

 

Chin augmentation is the original facial implant procedure and is still the most commonly one performed today. Several different materials of chin implants are available and a wide variety of styles and sizes exist from different manufacturers. Despite the apparent diversity of chin implant options, it is generally viewed as a ‘very simple and safe’ aesthetic facial operation.

But despite this seemingly simplicity, complications from chin implants are not rare. Infection, implant asymmetry/displacement and aesthetic dissatisfaction do occur and are probably more common than plastic surgeons care to know. Part of this is due to the fact that a synthetic material implanted anywhere in the body always has some risk and another reason for complications is also due to surgical technique.

While the chin bone has few vital structures around it, there is the mental nerves to the periphery and the mentalis muscle which drapes directly over the front part of the bone. To clarify the important anatomy that is involved in the placement of chin implants, an article was published in the April 2013 issue of the journal of Plastic and Reconstructive Surgery entitled ‘The Safe Zone for Placement of Chin Implants’. Using fresh cadaver dissections, the location of the exit from the bone of the mental nerves was consistently around 1.5 cms above the lower border of the jaw and located between the first and second premolar (bicuspid) teeth. The origin of the mentalis muscle was at the base of the anterior mandibular sulcus at the incisor roots (the level of the outer labiomental sulcus) and descends downward to insert into the chin soft tissue pad in a fan-shaped manner.

While this article provides no new anatomic information that hasn’t been known for some time, it helps the novice plastic surgeon be aware of the subperiosteal location in which to stay when placing chin implants. (below the muscular origin of the muscle and the mental nerves) Its relevance to the patient is in several issues to ponder when undergoing chin implant augmentation.

While some patients like to avoid a submental scar in placing the implant, one is at greater risk of mentalis muscle problems going from inside the mouth if the muscle is not put back together properly. The submental incisional approach is probably ‘safer’ in many cases and in most surgical hands. In addition, while a 1.5 cm pathway below the mental nerves is fairly generous for the wings of most chin implants, large implants and even custom jawline implants that are bigger are at greater risk of injuring the nerve during dissection and/or have an implant impinge on it afterwards causing lip and chin numbness/pain.

Dr. Barry Eppley

Indianapolis, Indiana 

 


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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