Background: Chin implants are still the most commonly performed facial implant procedure. While done in women as well as in men, they are probably less often done in women. This is evidenced by looking at the large array of commercial chin implant options which are available of which most are of what is known as extended implant styles. This means that their resultant shape will create a chin in the front view that is wider…a look that probably most women do not desire.
It is very common in my practice to see women who had had prior chin implants done, months to decades later, that do not like their chin augmentation results. The reason is almost uniform that they felt their chin became too big and did not fit well with the rest of their face. The too big dimension could be in horizontal projection but most commonly is in the transverse or chin width dimension.
Replacing a female chin implant considers what are the dimensions that the implant has created that is undesirable. For women whose chin is too wide, a less extended chin implant stye should be considered or the existing chin implant can be modified if its other dimensional features are satisfactory.
Case Study: This female has a chin implant in place for 11 years that she never really like. She felt it was too bulky and made her lower face too wide. She did like, however, the horizontal projection that it provided. She also had some chronic right mental nerve dysesthesia that had never really improved from the initial surgery. She was uncertain of the implant material. All she knew was that it was placed through a submental incision of some length.
Under general anesthesia her existing submental incision was reopened and the implant material revealed…a two-piece Medpor chin implant that was secured with 4 titanium screws. While tedious the entire Medpor chin implant and its screws were able to be removed. It was replaced with an anatomic silicone chin implant that had the same projection but only half the width. (no extended wings).
The new chin implant was secured with double screw fixation, an essential technical maneuver that is always needed when the replacement does not fill the excavated pocket.
It is sometimes said that Medpor facial implants are impossible to remove. Having removed many I have never found that to be the case and have always been able to remove all aspects of the implant no matter how far away it is from the incision. Suffice it to say they are not as easy to remove as silicone but that should not be confused with impossible.
Highlights:
1) Medpor chin implant removal in women can be successfully done years later.
2) Chin implant replacements in women who have had extended wing chin implants should be of a more limited anatomic implant style.
3) Placing a smaller chin implant into a pocket where a larger chin implant has been removed requires screw fixation to avoid postoperative implant shifting.
Dr. Barry Eppley
Indianapolis, Indiana