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Dr. Barry Eppley

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Posts Tagged ‘medpor chin implants’

Technical Strategies – Recycled Medpor Chin Implant in Sliding Genioplasty

Saturday, June 13th, 2015


When a chin implant ‘fails’ it may be replaced or revised by a sliding genioplasty. Chin implant failure can usually be defined as an implant that had not met the patient’s aesthetic desires due to design, size or positioning issues. This is most commonly seen when a chin implant is used for larger chin deficiencies whose horizontal and vertical dimensional needs are at the fringe or beyond what a standard performed implant can achieve. Recurrent chin implant problems such as asymmetry and visible or palpable edges are another indication to consider moving from a synthetic to an autogenous or more natural chin augmentation solution.

Medpor Chin Implant Removal Dr Barry Eppley IndianapolisMedpor is a chin implant material, which while used far less than that of silicone chin implants, is a favorite among some patients and surgeons. While it is a biomaterial that does offer good tissue adherence and fixation it can suffer the same chin implant problems that silicone implants do. The material composition does not make it immune to similar aesthetic issues. While many surgeons state that Medpor facial implants are impossible to very difficult to remove that perception is a relative one when they are compared to silicone. I have removed many Medpor facial implants and they all can be removed in their entirety with careful surgical technique. They rarely come out as one piece by rather in multiple smaller sections.

Medpor Chin Implant Removal and Sliding Genioplasty Dr Barry Eppley IndianapolisMedpor Implant in Sliding Genioplasty Dr Barry Eppley IndianapolisWhen a sliding genioplasty is used to replace a chin implant, it is sometimes more prone to having a ‘step’deformity’ than that of an implant. The aesthetic consequence of this step and the merits of filling it in can be debated. But should the surgeon choose to do so, it can be filled in with a wide variety of materials. A cost effective approach of filling in the step deformity of a sliding genioplasty is to ‘recycle’ the removed chin implant material. With a Medpor chin implant this would be placing the multiple pieces of the implant material that became that way from removal. Since this implant material already has tissue ingrowth on it it can be come quickly ingrown with further tissue, thus serving as an ‘autoalloplast’ so to speak.

Having used recycled Medpor chin implants in over a dozen sliding genioplasties no infections have occurred and the step has been aesthetically covered eliminating the risk of a much deeper labiomental fold.

Dr. Barry Eppley

Indianapolis, Indiana

The Removal Of Medpor Chin Implants

Sunday, May 15th, 2011

The most common method of chin augmentation is to use a synthetic implant. While there are a large number of chin implant sizes and styles, the compositions of them are more limited. The two most commonly used materials for chin implants are silicone elastomer and porous polyethylene. (Medpor) Each has their own merits and surgeon advocates but both can work well with good placement technique.

One of the highly touted advantages of Medpor implants is that they develop some degree of tissue ingrowth due to its semi-porous material property . This is opposed to the completely smooth surface of silicone implants which develop a surrounding scar capsule instead. While this tissue ingrowth is advantageous for long-term implant stability, it also makes the removal of Medpor facial implants difficult.

The difficulty with removing Medpor facial implants is well chronicled, particularly across the internet. Despite this purported difficulty, I have not had the same experience. Over the years, I have had the opportunity to remove or remove and replace numerous Medpor implants, most commonly those of the chin. While they are more difficult to remove than silicone implants, which literally slide right out, that difference in difficulty is only a comparative one. They are not impossible to remove nor are they ‘extensively destructive’ to the surrounding tissues to do so.

Many times in their removal it is easier to remove them in pieces as they fragment fairly easily. Here is a recent case I did where another surgeon secured a chin implant in with 8 screws! While I am a fan of screw fixation  for facial implants, the reason for 8 screws in a single chin implant is  unclear. With so many screws, the Medpor chin implant needed to be removed in pieces to access all of the screws.

A new Medpor chin implant, of a different size and style, was inserted and secured with two new screws. The underlying bone showed no resorption and the overlying soft tissues had but a thin capsule. There was nothing abnormal about the revised chin implant site.

Medpor facial implants should not be viewed as overly difficult or destructive to remove should they need be. The material easily fragments helping preserve the tissue quality of the recipient site.  

Dr. Barry Eppley

Indianapolis, Indiana

Three Considerations in Chin Augmentation Surgery

Thursday, November 12th, 2009

Chin augmentation has been a procedure that has a near seventy-five year history of being done in humans. It remains as a fairly simple and highly effective method for improving the most prominent area of the lower third of the face. Many different materials have been used to serve as a chin implant but synthetic technology accounts for most augmentations due to their ease of use, low cost, and long-term stability of the result.

For patients considering chin augmentation, there are three considerations one should ponder. While many plastic surgeons have their preferred methods, usually with good reasons, patients today are better educated and can participate more fully in preoperative planning.

The first consideration is that of the choice of implant material. Vulcanization technology has allowed for silicone rubber (silastic) to long be the only material of choice. Silicone chin implants are the least expensive and the most flexible and they can be inserted through the smallest of incisions. Medpor (polyethylene) and polytetrafluoroethylene (PTFE or Gore-Tex) are more recent chin implant materials who have a long history in many other types of surgical implants. Medpor is fairly stiff (needs bigger incisions to insert) and is porous, which in theory offers some biologic advantages. (vascular ingrowth) PTFE is softer than even silicone with some limited porosity on its surface.

The different chemical compositions and properties of the implant materials may seem confusing.  But in my opinion, they are no proven biologic advantages to any of the implant materials. They all will work. The body still sees them as a well-tolerated foreign body which becomes encapsulated. The important differences between them, in my opinion,  relates to the second consideration….what different styles, shapes, and sizes do the various manufacturers offer. Chin augmentation today can create a wide variety of geometric changes to this part of the lower jaw… from round to square, central to more lateral projections, to even include the creation of a chin cleft or dimple. Think about your chin shape carefully and how it will affect your overall facial shape. What shape does it have now and what would you like it to become? Do you want a more sculpted and more defined facial look? Do you want to overcome a larger nose and a shorter neck? Do you want it to look more masculine or feminine? Many implant styles and sizes exist. Consult carefully with your plastic surgeon to get the look you are after that best fits your face.

Lastly, what insertion route for the implant do you prefer? They can be placed through an incision under the chin (submental) or through the inside of the mouth. (vestibular) Each has its own advantages and disadvantages. In the right hands, either approach can work successfully. The most versatile and least prone to potential problems is the submental approach. Many patients worry about the potential scar but that is an unnecessary concern. Coming from below has the advantages of getting the implant down at the inferior edge of the bone, permits easy screw insertion if desired, and allows neck liposuction or submentoplasty to be performed through the same incision. The submental approach is also associated with the least potential for mentalis muscle dysfunction and lower lip incompetence.

Chin augmentation today offers subtle but important aesthetic options for patients to consider. There is no one single way or one implant that is better than another. Consult with a plastic surgeon who is well versed with the different materials and approaches so you are not getting just the ‘standard approach’, but a chin augmentation surgery that has been designed for you.  

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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