Your Questions
Your Questions
Q: Dr. Eppley, I had a chin implant done intra orally which gave me a strange double chin when I smiled. I had it removed 2 weeks later after the doctor told me removing it would make my chin go back to normal. My chin did not go back, it’s still deformed.
A: Intraoral chin implant placement is associated with a higher incidence of mentalis muscle deformity, particularly when the implant is removed if the muscle is not adequately resuspended/repositioned. In theory, a quick removal of an implant should not have allowed time for the overlying soft tissues to become stretched (past their elastic deformation state) and this is undoubtably what your surgeon meant by ‘it would go back to normal’. But that does not factor in the malposition of the muscle which it sounds like you have. Depending upon how long ago the chin implant removal was and what your chin looks like now, it may be improveable with a muscle resuspension procedure. Please send me some pictures at your convenience so I can see exactly the chin problem you now have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a mentalis muscle resuspension about 10 years ago. This was due to complications from a sliding genioplasty that made my chin huge, and a subsequent reduction a few years later. The suspension worked well but my lower gumline has slowly receded to the point where a few front teeth may be in jeopardy.Would dental implants affect the suspension in any way? It feels as if recently either my one tooth is infected or the suspension site has problems. Is it possible to redo the procedure if necessary? Also, would it be possible at this point to move the chin forward a bit due to some slack skin from the original procedures? Thank you for your time.
A: There are different types of mentalis muscle suspension procedures and I obviously don’t know which one you had done. Whether the suspension is the cause of your anterior mandibular gingival retraction I don’t know. But that issue aside, I see no reason that the teeth in jeopardy could not be removed and replaced by dental implants. The placement and soft tissue coverage around the implants would not negatively affect your prior suspension. It is always possible to redo your suspension at any time in the future. Moving the chin bone further forward (redoing your sliding genioplasty) would only help your soft tissue suspension effects as a whole new tightening of it would be done during that procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I really appreciate you for trying to help me out at this miserable situation. I had chin implant removal surgery 16 days ago. Dr. took out my Medpore implant from inside my mouth. Fortunately the look of my chin has not changed dramatically but the problem is when I talk you can see my lower gum which is a disaster to me and hurting my confidence badly. I saw my surgeon one week after the surgery and he said I should wait for six weeks, but now after more than two weeks the problem looks getting worse. My question is if this problem gonna improve? if not is there any fixation in the future for this problem or not?
A: What you are experiencing is a soft tissue chin ptosis problem. When implants are removed from an intraoral approach, it is important to resuspend the mentalis muscles and soft tissues of the chin. Remember that they have been stretched out from the implant and then cut through for the removal of the implant. If not tightened and resuspended to the bone, they will both fall and contract downward, exposing increased tooth and gum and even creating lower lip incompetence. I doubt that the tissues will magically move upward as they heal. But I would wait three months after surgery and make a decision then. I suspect you will need a soft tissue/mentalis muscle suspension for correction of this problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: There seems to be a multitude of people out there with chin/lip problems arising from intraoral surgery who don’t know where to turn or what to rely on to remedy their situation. Mostly their problems are attributed to mentalis detachment/loosening and scar tissue, particularly in the labiomental fold region. Chin/lip deformity poses a significant quality of life issues and must be taken seriously. A case study of scar revision in this instance, with before and after photos and details of the surgery, would be of great assistance. Mentalis resuspension seems straight forward enough if its loosened or detached from its origins. The question in my mind with regards to scar tissue excision, is how much mentalis muscle in the labiomental fold or chin pad region, can be safely excised before the mentalis can no longer function properly?
A: Ptosis, or sagging, of the soft tissues of the chin can occur after any form of chin surgery done through an intraoral (inside the mouth) approach. When it occurs, one surgical method to put the soft tissues back onto the chin bone is mentalis resuspension. This is fairly way to do and the most important technique for the procedure is how the muscle is secured back to the bone.
Generally speaking, the only scar tissue that ever needs to be removed during any chin revisional surgery is the scar capsule around an existing chin implant. (if the implant is being removed) This needs to be removed because it will not allow the overlying muscle to heal back onto the bone.
Dr. Barry Eppley
Indianapolis Indiana