LAM FACIAL PLASTICS

Dr. Lam -

I had a small silastic chin implant placed through a submental incision just over six years ago.

About three months ago, during a meal, I felt a sudden tingling/burning sensation just below my lower lip. Since then, I've felt intermittent pain and discomfort in my chin and have also noticed a very minor visual asymmetry. Examinations (including x-rays) confirmed that there is no infection or significant bone erosion. My dentist did not detect any tooth or gum issues.

What do you think might be causing this? One surgeon suggested the implant may have shifted. Have you ever seen this happen six years out (without major trauma)? I'm considering a replacement, but I want to make sure that a shift did occur before committing to another surgery.

Any input you can provide would be GREATLY appreciated.

Thanks!

-Jon

hmm, i do not know the answer. did you have a button style or an extended anatomic. if you had a button it could theoretically shift over time. i have seen that. with an extended version that is very unlikely.
best,
sml

Dr. Lam -

Thank you for the very prompt response!

The operative report only mentions a "small chin implant." I was shown a picture in a textbook of the implant was used, and it looks similar to an extended anatomical chin implant; however, I can not be 100% sure.

Assuming the implant did shift, how difficult is it to replace a silastic implant? One doctor suggested screwing in a Medpor implant, but I'm hesitant to pursue something so permanent. If I do decide to replace it, what material would you recommend?

Thanks again.

-Jon

if it is an extended anatomic it is near impossible to shift if it is done right, i.e., tucked into periosteal pockets. i personally am opposed to medpor because once you have a problem, good luck in getting that out. it is stuck in there. replacing an implant is not difficult if the first one was done right. i had to replace one a few years ago and the original doctor had placed the implant in the wrong plane in the wrong area and it was eroding into dental roots. that was a difficult exchange because there was no real periosteum left to secure the implant but i got it to work by barely sewing the muscle around the implant, which was also messed up. i would not jump the gun to replace it. see a doctor to evaluate the situation in person. you cannot go by my advice because i have not seen you nor seen the xray. wish i could give you more info.
best,
sml

Thanks, Dr. Lam.

I am visiting several surgeons next week and will take my time in making a decision.

One last question - what are your thoughts on using filler in this situation (or for chin augmentation in general)? Is it a useful, low-risk alternative to surgery or does it tend to produce unnatural results?

-Jon

a filler can only fill so much because the skin does not allow it to stretch first of all. second, if a filler is placed to stretch the skin too much it looks like soft tissue meaning that it can look fat and full rather than strong. our eyes can tell soft tissue from hard tissue. finally, if you go with a permanent filler i tend to do that only in someone a bit older (don't know your age) say 35 plus and also only conservatively. if you need a chin implant, you should have that instead of a filler. for aging of the face, that is another story. i believe chin implants can actually age someone if the intention is for rejuvenation. the reason is that as we get older, we hollow around the chin implant, and we need to fill the area around the bony chin to make it look younger. that is more complicated in a discussion that may not be relevant here.

Dr. Lam -

Thank you for all your help.

I opted to get a CT scan before committing to removal or replacement. Here are the findings:

1) Implant anterior to the mandible which crosses the right mental foramen. This could conceivably be compression of the right mental nerve. The superior margin of the implant is just inferior to the left mental foramen.

2) Minimal right sphenoid disease. Deviated septum. Paradoxical curvature of the middle turbinates.

What does the first finding, regarding the implant, suggest? Is the second - right sphenoid disease - anything to be worried about?

Thanks again.

-Jon

hi, obviously, i cannot dispense medical advice without your being my patient. however, it makes sense if it is hitting the mental foramen and you are having discomfort on that side that the implant could either have shifted or eroded into the area where it is affecting your nerve. you need to see a physician for clinical correlation. same thing goes for the sphenoid issue. i really cannot comment on a report without seeing you and doing a thorough history and intranasal exam (which i do not do with any scopes since i do not practice general head and neck surgery).
best,
sml

Hi Dr. Lam,

I ultimately decided to have the implant replaced with a silastic anatomical implant. Unfortunately, my face now appears very long and thin. This was not communicated through the imaging so I'm rather surprised.

What can be done to correct this? In an ideal situation, I would like to restore my previous face shape - a bit rounder - while maintaining some anterior projection. Is there a particular implant you might recommend for this? Will a third chin implant revision be complicated and/or risky?

Thanks,
Jon

implants can only do so much. i would probably recommend injectable fillers either temporary or permanent to manage some of the remaining issues you desire.
best,
sml