Implant surgery, also referred to as mentoplasty, is a plastic surgery procedure designed to permanently augment the size of one’s chin with the use of an implant. Chin implant surgery may be performed on its own, though it is often combined with rhinoplasty in order to achieve the best facial balance. Good candidates for chin implants include healthy men and women whose chins are lacking in projection.
Dr. Moynihan performs the chin implant procedure at his office or an outpatient surgical center. The procedure usually takes one hour to complete and can be performed with local anesthesia, general anesthesia or sedation. A small incision is placed in the crease beneath the chin which, when mature, results in a well-camouflaged, imperceptible scar. Dr. Moynihan prefers this incision location over an intraoral incision as it involves decreased infection rates, prevents migration of the implant superiorly, and avoids damage to the muscles responsible for lower lip movement. Once the incision is made, a silastic implant is inserted into the chin area.
Recovery after chin implant surgery takes three to seven days. Swelling and bruising may occur. Patients may experience some discomfort which can be controlled with medication, and talking and smiling may be difficult during the first few days. Stitches are removed in one week. Patients may return to work within three to seven days and resume light exercise in about one week. More strenuous activities will need to be postponed for about two weeks.
How much does the surgery cost?
There are three fees for any surgery. The surgeon’s fee is between $2000-4000.
The facility fee (operating room) is quoted by increments of time and this procedure typically takes approximately one hour to perform.
The anesthesiologist fee is quoted by increments of time and this procedure typically takes approximately one hour.
What type of anesthesia is used to perform the procedure?
Typically the procedure is performed under sedation (aka ‘twilight’ anesthesia). The medicine is delivered via the vein and once stopped the patient awakes almost instantaneously and with little after effects as in general anesthesia. If the procedure is performed with a rhinoplasty (the only procedure that typically use anesthesia), the chin implant would be performed with general anesthesia (breathing tube in place and somewhat of a washed out feeling the following two days).
How much swelling and bruising is expected following the procedure?
Since the placement of the chin implant is under deep structures of the jaw (see the section ‘how is the chin implant secured’), there typically is no bruising. There is obvious swelling the first 3-5 days which is most noticeable from the exaggerated augmentation of the chin and stiffness of the lower lip along with somw ‘jowling’ of the cheeks. Typically the swelling has reduced to a presentable level between the third and fifth postoperative day. At 7-10 days postoperatively, the swelling is reduced by 80%. The vast majority of the swelling has subsided by three months.
Implant placement, external approach or through the mouth?
I only place implants though and external incision under the chin. The incision is approximately 1.5 cm in length and an inverted v-shape. There are three reasons why I only place a chin implant via an external incision rather than through the mouth. 1. There is less bacteria present on the skin surface than the mouth. This reduces the chances of the implant becoming infected. 2. In order to place an implant a pocket to receive the implant needs to be made larger than the implant. So if the implant is placed from within the mouth and from above, the larger pocket allows the implant to be migrate upward. An implant that migrates upward will create an unnatural look. If the pocket is made from below via an external incision, the only place an implant can migrate is downward which is not noticeable cosmetically. 3. It is possible to damage facial musculature that is responsible for your characteristic smile when placing an implant from within the mouth. This is not a risk from the external approach.
How is the implant secured?
The implant is placed under the lining of the bone-periosteum. The periosteum is a dense layer of tissue that is tightly adhered to the bone. Once the implant is placed, the implant is secured with a 6 month dissolving stitch that allows the periosteum to ‘shrink-wrap’ around the implant. With several weeks the implant completely secured and extremely difficult to dislodge.
Who is a candidate for chin augmentation?
Those persons with an under-projected jaw. A person’s profile is held in balance with a strong jaw profile. An appropriately sized jaw projection differs by gender. When looking at someone’s profile, a male’s jaw should come up to or just past an imaginary line dropped down vertically from a person’s lower lip. A female’s jaw line typically comes just short of the line down from the lip.
Persons with an abnormal bite, either under or overbite, can have a chin implant placed but also have the option to have just jaw surgery (orthognathic surgery) to correct both the bite and jaw projection.
Which type of chin implant do you use?
I use a silastic implant in all chin implant cases. The most common silastic implant that I use is a Mittleman pre-jowl extended implant. Using a silastic implant has two advantages: 1. It allows sculpting of the implant to suit each persons anatomy. 2. If a person is unhappy with an implant no matter how much time has passed since the placement of the implant, the implant can be removed in the office with very little difficulty.
For males that want a ‘squarer’ jaw, I use a terrino implant. Terrino implant is square implant that allows masculinization of the jaw.
How much pain is to be expected from a chin implant?
The first two days the main complaint is tightness and pressure from the implant. This sensation passes within the first two days.
What complications are possible from the surgery?
Complications are extremely rare with chin implant surgery. Infection is a possibility and if it occurs it requires removal of the implant. Chances of infection are significantly reduced by use of a operating room and various OR techniques that can be explained in the office. Permanent or temporary numbness of the lower lip and chin region. This is reduced by marking the most likely area of the mental nerve on the patient’s skin prior to sedating the patient while in the upright position.
Cosmetic concerns- which include too big, too small, not symmetric or simply not happy with overall cosmetic appearance. Chronic pain- very rare occurrence often is associated very large implants and revision surgical cases. Most often resolves with time or removing the implant.
How do I know what size implant I will need?
Impossible to say the exact size that will be used. The first step is to have a profile photo imaged with computer software to decide on the ideal cosmetic result. Once agreed upon, this image is taken to the operating room and the results are reproduced with placement of the proper sized implant.