Background: The most common facial augmentation procedure is the chin implant. It has been done for over fifty years with the silicone implant as the most common device used for most of this time. It is often combined with a rhinoplasty but can also be done along or in conjunction with anti-aging procedures like a facelift or other face and jawline procedures like jaw angle implants.
Chin implant designs have evolved over the years with the standard style now used being an extended or anatomic shape. These longer wings that go back along the jawline from the central area of projection allow a smoother transition into the jawline without an obvious ‘bump’ sitting on the chin. This creates a more natural chin augmentation result.
But these extended wings on a chin implant have some potential disadvantages as well. They require a longer dissection along the jawline for the wings to fit. And great attention has to be paid to their symmetrical pocket development and placement. A slight degree of tilt to the implant can have the back end of the wings more significantly displaced up or down. In fact the number one complication of such chin implants today is wing asymmetry.
Case Study: This 60 year-old female had a prior history of a chin implant placed several years ago. She developed problems with chin asymmetry, a bulge in the right intraoral mandibular vestibule at the gumline and stiffness in moving the lower lip which also had some asymmetry.
Under general anesthesia through her existing submental scar, the chin implant pocket was opened and the implant removed. The implant had its right high up on the right side and low on the left side creating a clockwise tilt. The right implant pocket was opened up and lowered while the left implant pocket was opened and raised. The wings on the implant were shortened 7mms per side and placed in the midline and secured with a single 2.0 x 10mm screw. Closure was done in three layers.
The improvement in the appearance of the chin became evident as the swelling subsided over the first postoperative month. The chin was more symmetric as was the lip. The lip also moved more naturally. The chin will take several months to feel more soft and to have normal mentalis muscle function. There may also be some chin pad indentations develops as the part of the implant pocket that is no longer used needs to shrink back down to the bone. These chin pad soft tissue irregularities should eventually subside.
Many chin implant revision cases s are due to an asymmetry caused by a tilt of the implant (yaw) or a side to side shift. While the best way to prevent this from occurring is to secure it firmly when initially placed, this becomes doubly important when repositioning the implant during a chin implant revision.
Highlights:
1) Extended style chin implants can develop asymmetry by malposition of their long wings.
2) Repositioning an asymmetric chin implant (chin implant revision) is best stabilized by screw fixation in its new position to prevent relapse.
3) The extended chin implant can have its wings shortened if that is aesthetically advantageous at the time of repositioning.
Dr. Barry Eppley
Indianapolis, Indiana