Dr. Sam Lam Plastic Surgery Forum

Hello Dr. Lim,

Thank you for your expert advice. I had a chin implant approximately 6 weeks ago and it is too large at 1cm. It projects well beyond my lower lip and provides a "witch-like" profile. It is causing physical difficulties and it is embarrassing to be seen. My family and friends are also very concerned. The surgeon thinks "it looks great" and that "you'll get used to it". Question: When it is revised-removed or downsized-should it be 1) removed with a time certain for the pocket to heal and left alone, 2) removed allowing the pocket to heal, then a smaller one implanted or 3) a smaller one implanted during the same surgery in which the larger one is removed?

Many thanks!

Annia

Is your skin normally red? Is there any pain or tenderness? Infection? I assume not but it almost looks super swollen. Maybe you should ask your doctor more pointedly about how much swelling he thinks there is there? I usually tend to secure the implant onto the periosteum so that it is secure and close the muscle over it to keep things stable. That being said, I would say anytime you go back and do a quick revision in the first few weeks to months you can have more inflammation, swelling, and recovery. The surgery can also be more difficult. My only fear of going into the surgical plane and exchanging the implant out is that I don't know what the doctor did or where he put it. If there is a pocket created where I would not create a pocket then it makes things harder for me to create a new pocket without joining the two pockets. In other words, if I created the pocket and you want to downsize (which I have fortunately not encountered yet), I would probably go in and exchange the implant. If I don't know what the doc is doing in there, I might suggest for it to be removed first then come back later for a revision. Hope that makes sense.
Best of luck with your situation. I know it is not easy.
SML

Thank you Dr. Lam. As a former CVICU nurse, I appreciate the detail. Last week I scheduled a consultation with you regarding this chin implant and a rhinoplasty. However, the earliest availability was June 19. I wish you could see me now.

There is no infection, inflammation, numbness. This is a 1cm winged implant, with an insertion point through the mouth and in placed in the pocket over the chin and jaw line. It is simply too huge for my facial structure. My skin is tight and overly stretched to transparency, my speech/chewing is off, lower lip pushed back into my mouth... This is terribly distressing. Attached is a pre implant picture. I would much prefer your skill, but I just can't bear the though of keeping this in until we meet in mid June. 1) Could it be removed ASAP to give the skin time to heal before my appointment? or, 2) judging by the picture, could it be downsized to 2-3mm?, winged? ASAP. I understand your remars concerning increased inflammation/healing time, and so forth. I am willing to endure that to have some semblance of a normal looking face again. I just really wish you could see me now. Many thanks.

I'm truly sorry that my schedule is insane. I have to first respect my office staff who makes the schedule, then I have to respect my other patients too. Is there a way your surgeon can remove this and then we can talk about an insertion when the swelling goes down. Since he put it in, I think he knows where and how he put it in and it might be easier. I don't go through the mouth. I go through the neck. When the implant is out, I can probably size you better in the future. Your microgenia is not that bad, and I would say that at least you might look better just not to have an implant for now. Obviously, not trying to give you improper advice since I am not seeing you in person. Again, so sorry that I can't see you more quickly. At least I can give you mild psychological support through this forum.
best,
sml

Again, thank you most kindly. The ability to consult with you now within this forum has been such a blessing to me. You are a very gracious person for offering it. Having viewed many of your videos and teaching modules, I am enormously impressed with your approachability and willingness to share information and knowledge to all those who seek it. And of course your honest guidance, positive attitude and uplifting manner foster a feeling that all will be well. Wish I had known about you before having surgery--could have avoided a bad situation.

The chin implant removal is taking place in a few days, so there will be several weeks of healing before my appointment in June. Post-op instructions for the achievement of optimal healing would be most appreciated. Have a great day!

PS. Is there a way to spell check prior to submission?

thank you for the kind words. mine spell checks for me by redlining the words that are misspelled. i guess yours does not do that? look forward to meet you. have peace in your heart and best wishes with your implant removal.
namaste,
sml

Sadly, no misspelling redlines. WIll have to brush up on the ole proof-reading "red-eye". Have a great day!

sorry, maybe my browser. i use Mac's safari. that could be it.
look forward to meet you,
sml