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Posts Tagged ‘custom chin implant’

Case Study – The Extended Custom Chin Implant in Facial Deformities

Sunday, November 29th, 2015

 

Background: Soft tissue contractures of the face cause a variety of deformities. Even with normal underlying bone structures, loss of overlying soft tissue volume and shape can make the face appear deficient and distorted. This is most classically illustrated by burn patients who suffer the greatest amounts of soft tissue loss and deformity when suffering extensive burns to the face. But there are a variety of other diseases and medical conditions that can also cause soft tissue facial contractures.

The jawline is one of the most notable features of the lower face as it creates a clear separation of the face from the neck. Also because it is the only bone that moves on the face, its projecting prominence helps create a distinct facial profile. A more evident  lower jawline and a nicely shaped chin prominence is valued as part of a proportionate and attractive shape. Distortion of its overlying soft tissue along the bony jawline can create a distinct degree of distortion of its form including the anterior projecting chin and lips.

Case Study: This 46 year female presented with an overall facial deformity caused by a rare medical condition with extensive soft tissue deformities and scars. She had been through dozens of soft tissue procedures of the face, through excision and reconstruction, that led to her present facial state.

Extended Chin Implant design and placement Dr Barry Eppley IndianapolisCustom Extended Chin Implant result side view Dr Barry Eppley IndianapolisShe subsequently underwent a variety of reconstructive procedures including injectable fat grafting, dermal-fat grafts, lip reconstructions and an extended custom chin implant to augment the chin and the jawline behind it. The implant was designed from a 3D CT scan of the patient.

Custom Extended Chin Implant result oblique view Dr Barry Eppley IndianapolisCustom Extended Chin Implant result front view Dr Barry Eppley IndianapolisThe re-establishment of facial volume from contracture and volume loss can be aided by augmentation of the bone beneath it. While this is of value over any of the bony prominences of the face, the extent of the surface area of the jawline makes it most useful in this boundary area between the face and the neck. Such a custom chin implant serves a tissue expander to stretch out the contracted overlying soft tissues.

Highlights:

  1. Chin augmentation can include the entire length of the  body of the mandible back to the angle with a custom designed chin implant
  2. Adding volume and structure along the jawline can expand the overlying soft tissue in cases of contracture and deformity.

3) Adequate chin projection and a straighter jawline improve facial proportions.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Extended Chin Implant

Tuesday, October 6th, 2015

Background: Chin augmentation is the commonly performed facial bone augmentation site. Chin implants have been around for almost fifty years in a preformed fashion. A large number of different chin implant styles and sizes now exist that seemingly can treat just about every type of aesthetic chin deformity.

Chin Implant with lateral wings compared to a central button chin implant Dr Barry Eppley IndianapolisThe single greatest change/advance in chin implants over the past decade has been the concept of adding wings or lateral extensions. This makes sense for most chin augmentations to avoid a ‘bump-like’ appearance on the front edge of the chin and to have the implant flow more smoothly around the bony curvature of the chin. These wings can extend back onto the parasymphyseal area and front portion of the body of the mandible. The purpose of chin implant wings is not to add volume but to create a smooth transition between the implant and the jawline.

But not all aesthetic chin deformities truly stop at the front edge of the mandible. While the jaw behind the chin may not be especially short, the lower edge of the jawline is often not well defined. Adding volume or definition alone the jawline with a chin augmentation can be of benefit to some patients.

Case Study: This 50 year old female had numerous surgeries in the past to treat a medical problem that left her with multiple problems of the lip, chin and jawline. As part of her treatment strategy, an extended chin implant was planned to build up her chin as well as back along the jawline. The goal was to create a volumetric effect along the entire jawline.

Extended Chin Implant design and placement Dr Barry Eppley IndianapolisUnder general anesthesia she had multiple procedures done (e.g., fat grafting, lip resuspension) as well as an extended chin implant through an existing submental incision.

Custom Extended Chin Implant result oblique view Dr Barry Eppley IndianapolisCustom Extended Chin Implant result front view Dr Barry Eppley IndianapolisAt six months after surgery, it can be seen that the effect of the extended chin implant was beyond that of just horizontal chin augmentation. The entire jawline behind the chin just short of the jaw angles had augmentation to make it slightly wider and more defined.

The extended chin implant concept is a much longer extension than that of the traditional winged chin implant. It can provide true increased jawline definition behind the chin since it is designed to do so. Such an extended chin implant can have numerous applications to other patients who need/want jawline definition but not necessarily stronger jaw angles.

Highlights:

1) Augmentation of the jawline can be done beyond that of the chin using a specially designed preformed implant.

2) Creating a more defined jawline extending backwards from the chin can be done with an extended chin implant.

3) The wings of all preformed chin implant do not extend much beyond the sides of the chin.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Female Custom Chin Implant

Monday, September 7th, 2015

 

Background: Chin augmentation is the most commonly performed jawline enhancement procedure. It is also along with rhinoplasty the most common facial bone reshaping operation. Placing an implant over the end of the chin bone is conceptually simple. But the wide variety of chin implant styles and sizes demonstrates that the aesthetics of chin augmentation is not so simple.

Female Chin Augmentation Surgery Dr Barry EppleyWhile there are no gender specific chin implants made, it is clear that there are differences in the male and female chin. The ideal male chin is known to be stronger (greater horizontal projection), wider and have a more angular or square shape. Conversely the ideal female chin is more narrow, triangular in shape and can tolerate slightly less horizontal projection. The selection and use of chin implants is often done taking these aesthetic concepts into consideration. Unfortunately often they are not and this can create one reason for dissatisfaction from chin implant surgery.

For many female improvement in their chin shape comes best from an overall ‘cupping effect’ on the chin. The chin may need some modest horizontal augmentation but may need some vertical increase as well. The implant then needs to blend into the sides of the chin to maintain a more triangular shape. Such an implant shape does not come in any standard form and must be custom made.

Custom Chin Implant design front view Dr Barry Eppley IndianapolisCustom Chin Implant design side view Dr Barry Eppley IndianapolisCase Study: This 46 year old female wanted her chin shape improved but did not desire just a simple horizontal advancement. She wanted a modest change but one that had more of an overall chin shape augmentation but still keep a feminine look. She also had bony chin asymmetry as evidenced by a vertically longer genial tubercle on the right side. From her 3D CT scan a custom chin implant was designed and made. The implant design corrected her asymmetry but also keep a more triangular shape.

Custom Chin Implant placement intraop Dr Barry Eppley IndianapolisCustom Chin Implant design top view Dr Barry Eppley IndianapolisUnder general anesthesia the custom chin implant was placed through a small 2 cm incision in the submental skin crease. The implant as expected (and should) fit perfectly over the chin bone. It was secured into placed with a single 1.5mm titanium screw

Chin augmentation can be accomplished in the majority of cases by using preformed standard implant styles and sizes. From one manufacturer alone (Implantech) there are seven different styles of implants with three or four different sizes. For most people this assortment will be more than adequate. But not every chin augmentation patient fits the normal implant options and this is the role that a custom chin implant serves.

A custom chin implant is often thought of as being for extreme cases where the amounts of chin dimensional changes exceeds what the standard implant can do. While this is certainly one role that a custom chin implant can do well, they can also be used for more modest chin shape changes that are not served by performed standard styles.

Highlights:

1) Chin augmentation is most commonly performed by a variety of standard styles and sizes of implants.

2) Standard styles of chin implants can not add consistent vertical length and can not create a cupping effect over the chin bone.

3) A custom chin implant can be made in any shape and can be a better option for certain types of female chin deficiencies.

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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