Large silicone chin implant removed, some chin & lower lip ptosis. How to treat?

[linoob]

I had a silicone implant removed after 10 months as it was fitted poorly and had migrated.

Initially, after the implant was fitted I didn't have too many cosmetic concerns.

The implant is out now and while my chin doesn't look bad, my lower lip is a concern as it's sitting much lower than before and exposing ~2mm or so of my bottom teeth.

Just wondering if anyone out there has experienced a similar issue as from what I understand this can be a very difficult problem to correct.

I've met with another much more qualified maxfac surgeon who is consdering fitting customized chin implant with fixation via a submental incision. We're hoping this will fill the void left by the old implant and stretch some of the soft tissue as there is very little if any bone supporting it.

We discussed genioplasty also, but I told him I did not want anymore unecessary trauma or scarring taking place in or around the mentalis muscle, nor did I want an increased risk of further lower lip / chin ptosis.

Has anyone else had a similar problem?

Was it corrected by genioplasty?

Alternatively, have you found genioplasty helped to raise your lower lip level?

[linoob]

You know you're f**ked when even jawsurgeryforums doesn't have an answer 

[Post bimax]

Seems as though nobody else has had a similar experience.  It's possible the soft tissue will return to it's previous position over time, but also possible it won't.  Probably more likely if you're younger.

Replacing the old implant with a fixed implant seems like a decent idea. Probably PEEK material would be best as it seems you need something custom

[GJ]

Usually it's the opposite where the genio, implant, or scarring can cause the lip to pull down. If genio, removing hardware is rumored (by surgeons) to help, but talking to actual patients they say it rarely does. Given you had an implant and then had it removed, I'd have to guess scarring is the cause. Was the lower lip noticeable immediately after removing the implant, or was it during the healing/scarring process it started to look lower? If the latter you can isolate it to scarring.

[linoob]

Usually it's the opposite where the genio, implant, or scarring can cause the lip to pull down. If genio, removing hardware is rumored (by surgeons) to help, but talking to actual patients they say it rarely does. Given you had an implant and then had it removed, I'd have to guess scarring is the cause. Was the lower lip noticeable immediately after removing the implant, or was it during the healing/scarring process it started to look lower? If the latter you can isolate it to scarring.

Good theories.

Before surgery my lower lip was nice and high, zero lower teeth show.

After implant surgery it dropped a little as swelling subsided to where I noticed it but it wasn't bad.

Now the implant was removed I noticed instantly that it's lower again.

The surgeon who removed it did so very conservativeoy, as he made a small incision in the mentalis and slid the implant out - no resuspension or full mentalis release.

My theory is that the implant was supporting / pushing the soft tissues up, as right now with no implant I have almost no anterior support on my gonion / chin.

I'm hoping a revised and custom PEEK implant will restore some lower lip competence and height.

[GJ]

Yeah another thing would be to take your before and after records, if you have scans, and bring them to someone to see if that muscle was damaged. I didn't think of that, but that's possible. Do you have any symptoms that the muscle would be detached or damaged?

[kavan]

Mentalis muscle.

Origin: incisive fossa of mandible

Insertion: Skin of chin/ Mentolabial sulcus (groove between lower lip and chin)

Muscles move things at their insertion points. So if where it inserts/inserted got lowered during a surgery to put it in, remove it, the insertion area would have changed and that could be why one gets more lower teeth show. This can happen with the INTRA-ORAL incision to place, replace, remove etc a chin implant.

For that reason, doctors putting in chin implants (eg. Yaremchuck and Eppley) prefer to place them via an under chin incision (not through the mouth as in intra-oral).

However, to the best of my knowledge, when they are to correct a situation where there is more lower teeth show due to a prior surgery, they do the intra oral incision in order to alter the insertion point to a more favorable position that supports lower lip more.

[linoob]

Yeah another thing would be to take your before and after records, if you have scans, and bring them to someone to see if that muscle was damaged. I didn't think of that, but that's possible. Do you have any symptoms that the muscle would be detached or damaged?

I know for a fact the surgeon who placed the implant intraorally did a poor and inadequate job.

He never re-approximated the mentalis at the appopriate level, meaning it now attaches lower on my mandible than it did previously.

Even after my implant was fitted I noticed slight lower teeth show, which then became worse after the implant was removed.

The muscle itself appears to be okay, according to the maxfac who removed it, although it doesn't change the fact that it's now more inferior than it once was.

Thanks for the thoughts, though.

[linoob]

Mentalis muscle.

Origin: incisive fossa of mandible

Insertion: Skin of chin/ Mentolabial sulcus (groove between lower lip and chin)

Muscles move things at their insertion points. So if where it inserts/inserted got lowered during a surgery to put it in, remove it, the insertion area would have changed and that could be why one gets more lower teeth show. This can happen with the INTRA-ORAL incision to place, replace, remove etc a chin implant.

For that reason, doctors putting in chin implants (eg. Yaremchuck and Eppley) prefer to place them via an under chin incision (not through the mouth as in intra-oral).

However, to the best of my knowledge, when they are to correct a situation where there is more lower teeth show due to a prior surgery, they do the intra oral incision in order to alter the insertion point to a more favorable position that supports lower lip more.

Yes, you are correct.

Unfortunuiately though even the best of the best (Eppley, Yaremchuck) all admit that the surgery is demanding, diffcult and unpredictable especially in terms of long term prognosis.

This makes me so sad.

[kavan]

Yes, you are correct.

Unfortunuiately though even the best of the best (Eppley, Yaremchuck) all admit that the surgery is demanding, diffcult and unpredictable especially in terms of long term prognosis.

This makes me so sad.

Yes, I often get the right answer and you too are correct to point out the surgery is demanding and perhaps questionable prognosis to an area operated on multi-times.

I would suggest holding off on surgery for a while to explore a possible TEMPORARY solution, in particular an experiment to SEE IF some extra VOLUME to the chin reduces the lower tooth show.

Find an injector who will inject some SALINE to the chin to SEE IF that lifts the lower lip. The saline will 'go away' within a few hours. IF that works, the temporary solution would be FILLER of similar volume of the saline. (note volume injected). If surgery avoidance is goal after that, filler can be re-injected after it dissipates. Each filler has a 'stay in there' time span. Later down the line, you can re-evaluate whether to get the implant,placed sub-mentally. Implant should be similar volume as what ever volume is successful in lifting the lower lip.

[linoob]

Yes, I often get the right answer and you too are correct to point out the surgery is demanding and perhaps questionable prognosis to an area operated on multi-times.

I would suggest holding off on surgery for a while to explore a possible TEMPORARY solution, in particular an experiment to SEE IF some extra VOLUME to the chin reduces the lower tooth show.

Find an injector who will inject some SALINE to the chin to SEE IF that lifts the lower lip. The saline will 'go away' within a few hours. IF that works, the temporary solution would be FILLER of similar volume of the saline. (note volume injected). If surgery avoidance is goal after that, filler can be re-injected after it dissipates. Each filler has a 'stay in there' time span. Later down the line, you can re-evaluate whether to get the implant,placed sub-mentally. Implant should be similar volume as what ever volume is successful in lifting the lower lip.

I really appreciate your suggestions man, thanks.

I was looking at a similar route to you.

I'm consulting with a local maxfac who is possibly going to design and build a custom chin implant for me.

I have quite a recessed chin and with the implant removed and capsule left behind there is almost no boney anterior support support for these soft tissues.

I'm hoping an implant alone will be enough to restore me chin to where I was not so unhappy.

[kavan]

best of luck to you.

[thedude]

What is the best treatment for chin ptosis after a chin implant? Re-suspension of the chin muscle/tissue? I have this problem too and was surprised the surgeon I consulted was not really wanting to do much with it. I thought at the least they would want to sew things back together so it's not just hanging there.

[linoob]

What is the best treatment for chin ptosis after a chin implant? Re-suspension of the chin muscle/tissue? I have this problem too and was surprised the surgeon I consulted was not really wanting to do much with it. I thought at the least they would want to sew things back together so it's not just hanging there.

From what I can establish so far the best approach is:

- Resuspension with MITEK suture anchors (Suspend mentalis more superiorly)
- PEEK / Titanium implants with fixation OR Genioplasty (Provide shelf of support for soft tissues)
- Submental tuck (To remove any remaining / drooping soft tissues)
- Lower V-Y plasty to further reduce lip descent / teeth show