Thank
you for your question.
You submitted your question with some photos and you describe in your question a situation
where you underwent a chin implant procedure approximately a year prior.
And it appears from how you describe that you never were really comfortable after the
procedure was done.
You describe that you feel the implant from the inside of your mouth and that you have
been dealing with a sensation of tightness and numbness.
And you’re asking if whether or not this is a result of the implant pressing on the
mental nerve and whether or not removal will be indicated to help provide you with relief.
Well, I can certainly share with you my guidance with this limited information and photos in
the absence of a physical exam or the details of your actual surgery.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Chin implant placement is very common in facial aging practice such as mine to help enhance
the projection of the chin depending on the indication and the degree of correction necessary
as well as in the past few years, the use of fillers to enhance chins without implantation
so I have a lot of experience in this area.
So to begin with, I think you’re definitely in the right track in terms of the causing
or the association of the implant putting pressure on the nerve causing you to have
these sensations.
The anatomy is always with the source of explanation.
Essentially, the mental nerve or the nerves that exit through the mental foramen of the
mandible are usually high enough away from the tail of an anatomical chin implant such
that it is usually not a problem with impingement.
And so the routine follow-up for a patient who has a chin implant is pretty straightforward.
And patients usually feel very happy about having the projection of their chin and don’t
really think much about it.
Now, like any other implant and no matter how experienced the surgeon is, it’s good
until it’s not.
And sometimes the implant can be displaced and behave in ways that you don’t really
would expect.
And practicing in New York City, I have seen patients come for second opinions about their
chin implants done by some of the most well established and highly experienced surgeons
in the country and in the world and they still have problems and challenges.
So that’s just the reality of the practice of surgery.
I think one of the ways to also understand this in my first question would be is how
large was the chin implant.
A lot of times people who have strong overbites where the mandible and the maxilla, the upper
jawbone is actually misaligned such that there’s a significant overbite.
Very often, there’s a significant amount of projection needed which means that if a
person isn’t going through orthognathic surgery or what’s called a sliding genioplasty
or like I said, orthognathic surgery where the bones are broken and realigned and plates
and everything else are done, sometimes a surgeon will try to be more ambitious and
place a larger chin implant to give the patient more projection.
And it’s not just the projection or the thickness of the implant on the front that’s
there but also the tail of the implant can also be wider and that can be what maybe the
factor variable in your situation.
Now colleagues of mine would sometimes trim these implants and try to have the patient
basically go through an implant exchange.
Others, myself included, would probably just take out the implant and allow for some healing
to occur to see if at least the patient can become comfortable again.
So I think that ultimately it is important for you to have this dialogue with your surgeon
who placed the implant.
The original operating surgeon knows what was done, knows the details, the type of implant
that was placed and would probably be best qualified to remove the implant for you if
so indicated.
As an aside, you may not necessarily want to just get another implant.
You may want to, as I mentioned earlier, explore the possibility of any dental oral maxillofacial
solutions.
And if you want to be even more conservative, you can also go with long lasting injectable
fillers.
As I mentioned, we do something called Structural Volumizing where we place injectable fillers
that are thicker at the level of the bone to provide chin projection which, because
this is on the bone, actually works very well and can last for more than one year and is
very straightforward and it takes not that long to do.
So I think that you don’t have to necessarily hesitate about losing the appearance in favor
with dealing with your discomfort because I think it’s very difficult for you to clearly
keep functioning if this is bothering you as much as it is at this point.
And since there is an anatomic solution that can probably help you, I think that probably
makes the most sense.
So I hope that was helpful, I wish you the best of luck and thank you for your question.