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Cheek & Chin Implants

Procedures  | Cheek & Chin Implants

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Facial harmony is the sum of a number of factors beginning with the skeleton, then influenced by the muscle, fat, and cartilage under the skin, and finally by the skin itself. In trying to achieve as attractive a face as possible, analysis of the projections and contours created by these structures must be analyzed. This is done by direct physical examination, use of an imaging computer, and occasionally x-rays of the face.

Many studies have been published defining, by mathematical analysis of facial contour, what constitutes an "attractive" face. Although there is great variability and subjectivity in appreciation of facial beauty, there are numerical standards that are usefully applied to facial analysis when planning an operation to change facial features.
 

General Questions...

    • What are cheek and chin implants made of?

    Space prohibits discussion of all materials available for augmentation. In general, the implants can be made of foreign material that is malleable such as silicone. Another type of foreign material implant is rigid (bone-like). An example is Medpore (this is the type of implant I most often use). Autogenous grafts (harvested directly from the patient) are also used in special circumstances.

    Malleable implants are easy to use and can be placed through very small incisions. Silicone is the most commonly used example and, for the most part, works well. Silicone, however, has a smooth surface and becomes encapsulated by the body. When in contact with bone, the pressure of the smooth surface can cause the bone to resorb (dissolve). This is, in my estimation, a significant problem. I have seen a case of a chin implant dissolving so much bone that it came to rest against the tooth roots. The implant had to be removed because of pain and danger to the teeth. Also, as bone resorbs, the aesthetic advantage is lost as the implant slowly falls back in space.

    Medpore is a rigid and porous material that is "bioincorporated" after placement and is the material I use the most. The body responds to the presence of a foreign body as it does to silicone. However, because of the "holes" in the material, a smooth confining capsule does not form. Instead, the tissues grow into the implant thereby supporting it in three dimensional space. As a result, there is no formal pressure exerted on the bone and resorption does not occur (at least to the extent of that seen with silicone).

    Autogenous material is occasionally used. It has the advantage of coming from the patient's own body so is completely compatible. However, it must be retrieved so a donor site is required. There are also restrictions on the shape and volume that will be available for correction of a given problem.
    • What are the risks of cheek and chin implants?

    Most implant placements are short and safe operations. There is no significant blood loss and the incisions are generally small and inconspicuously placed. The major immediate short term risk is infection, slightly higher when porous implants are used but still relatively rare. Sometimes and antibiotic will cure the infection without removal of the implant. Other times the implant must be removed for the infection to be cleared up.

    Implants may be positioned incorrectly or be too large or small. This is usually noticed when the swelling subsides in a couple of weeks. A revision is required for these problems to be corrected. Although not a large procedure, few patients rejoice at returning to the operating room. It is, however, a correctable problem.

    Sensory nerve damage is possible, especially with chin implant placement. The lower lip may feel numb for a period of time if the mental nerve is stretched. Normal function should return when the swelling subsides. Although permanent numbness is possible, I have never actually seen this occur. Care in isolation and retraction of the two mental nerves will decrease the frequency and duration of this temporary problem.
    • What if I don't like the way I look with an implant?

    In spite of pre-op imaging, an occasional patient may dislike the aesthetic product of an implant. Most patients take some time to get psychologically adjusted to the new facial features but nearly all are pleased in the end. In general, it takes about 6 months for patients to make the full adjustment. We prefer that patients allow this time interval to pass before insisting upon removal of the prosthesis for aesthetic dissatisfaction. After this period of accommodation, if the results are still unwanted, it is a simple matter to remove the implant and return to the preoperative state. Fortunately, patients almost never exercise this option.
    • Do cheek or chin implants ever move around?

    Migration of the implant does not occur. Regardless of the type, the body creates barriers that disallow any significant movement of the prostheses. Implant placement is usually and short and safe operation. There are few complications.
    • Is there much pain after placement of a cheek or chin implant?

    Post-operative pain is usually modest and controlled with medication. The diet is modified to avoid chewing for several days. Oral hygiene is important but must be done carefully so as not to disrupt the suture line. After a couple of weeks regular diet and oral care return to normal.

About the procedure...

    • Is cheek or chin augmentation difficult to perform?

    Cheek and chin enhancement, though usually technically simple, requires rigorous analysis of the entire facial framework. In most patients, a straightforward approach is indicated. In others, more sophisticated treatment may be in a patient's best interests.
    • What type of anesthesia is used for placement of cheek and chin implants?

    When cheek or chin implants are placed as part of another operation (e.g. facelift), the anesthetic appropriate to that procedure is used. Otherwise, when the implants are inserted as an independent procedure, local anesthesia aided by an intravenous sedative usually is adequate. Patients, of course, who prefer a general anesthetic will be accommodated. There is no significant safety advantage with either approach.
    • Are cheek or chin implants ever placed in conjunction with other operations?

    The aesthetic benefits of other facial operations (such as a rhinoplasty or "nose job") may be enhanced by a seemingly unrelated operation (such as a chin implant). The computer may be very useful to both the surgeon and the patient when deciding upon which procedure or combination of procedures will yield the best result.
    • Where are the incisions for cheek and chin implant placement?

    Cheek and chin implants can be placed through the mouth or, rarely, through an external incision. A cheek implant as part of a facelift would take advantage of the incisions through which the facelift is performed.

    Cheek implants, of which there is almost always two, may be placed by incisions made through the inside of the mouth where the lip creates a dome as it inserts into the bone of the cheek. The incision is usually an inch or so in length and has the advantage of leaving no external scar. It provides direct access to the surgeon. The main disadvantage is that the mouth, in spite of preoperative preparation, cannot be made completely sterile. Theoretically, the infection rate is higher. Clinically, this may not be true.

    Cheek implants can also be inserted through the lower eyelid if they are small enough and malleable enough to be squeezed through this confined space. Again, the advantage is that there is no external incision. The main disadvantage is the small access port to the cheek and the risk of functional or positional disturbances to the lower lid. Only the malleable materials, such as silicone, are suitable for a lower eyelid approach.

    Similarly, the chin implant may be placed through the mouth or through a skin incision. When entering through the mouth, the incision is made where the bottom of the lower lip meets the jaw. A small incision is made and dissection exposes the bone and creates a space for placement of the implant. There are two large sensory nerves in the area that must be identified and preserved.

    An incision under the chin is also commonly used. To avoid a long incision in this visible area, the malleable implants, such as silicone or Gore-Tex, are used. Chin implants are also placed when a facelift is performed through concomitant incisions. Most facelifts involve an incision under the chin used to reconstruct the neck.
    • How long do cheek or chin implants last?

    The implants are placed with the expectation that they will last for the life of the patient. They do not need to be periodically replaced and will eventually come to be viewed as a part of the body. Some have advocated that antibiotics be taken to protect the implants if procedures are undertaken that can dump bacteria into the blood (dental work or gastrointestinal manipulation). It is debatable that this is necessary.

    Adverse long term effects of the implants have not been noted save for the local problems with silicone implants listed above. Very rarely, an implant can get infected many years after its placement. The exact mechanism for this delayed problem is not really known.

    Removal of the prosthesis is generally required when this happens. It can be replaced after the inflammation from the infection has subsided if the patient so desires.

    The satisfaction rate for patients who have been properly selected is very high. Most are ecstatic about the aesthetic result and only wish that they had the procedure earlier. These high marks can only be achieved if the patients are properly selected and informed.

    The implants are commonly placed under twilight sedation augmented with local anesthesia.