Chin augmentation with an implant is a common and relatively simple operation in most cases. However like all plastic surgery procedures that require an implant to create much of the result, implant-related complications can occur. These complications can include inadequate to oversizing of the implant, infection, and shifting and malposition of the implant. Many chin implant problems can be solved by simple revisions such as adjusting the implant’s position or changing the implant’s size or shape.
One chin implant problem that poses a more difficult problem is fixing an implant that is too big or one that has to be removed in its entirety. Or the appearance of the chin after an implant has already been removed, known as a ‘witch’s chin’ deformity. The expanded soft tissues of the chin will not simply shrink back down and be like they were before the implant was ever placed. Just like removing a breast implant, the overlying expanded skin will sag after the support of the implant is lost.
Management of the soft tissues of the chin from implant expansion can be dealt with in several ways. If the augmentation of the original chin implant is still desired (but an implant is not), then the bone of the chin can be moved forward in a procedure known as an osteoplastic genioplasty. The forward movement of the bone will serve the same purpose as the implant and will ‘re-expand’ the soft tissue envelope of the chin. The mentalis muscle can also be further tightened from the inside of the mouth where this operation is performed. If the implant is not going to be replaced or was removed previously (and no new implant is desired), then the skin and muscle must be retightened. This is done using the original incision underneath the chin (or a new one must be made if the the chin implant was put in from inside the mouth) The loose muscle and skin is removed and tightened from below. This technique will prevent chin tissue sag after a chin implant is removed or will correct the witch’s chin deformity that exists from a prior chin implant removal.
In some cases, it may be possible to lift and tighten the sagging chin tissues from inside the mouth. This technique requires special suture-bone anchors or screws placed into the bone onto which sutures can be used to hold the new position of the lifted chin muscle.
Revision of chin implants requires knowledge and skill at performing a variety of chin procedures including moving the bone and methods to resuspend and retighten loose chin tissues.
Dr. Barry Eppley
Indianapolis, Indiana