Untitled Document
Chin Implants & Augmentation
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Originally chin implants were
used for reconstruction for birth defects and trauma related incidents. Now,
they are being utilized to enhance a person's chin or to create symmetry within
the facial structure from a weak chin. With a chin implant, the face is
transformed into a more aesthetically pleasing shape.
They are commonly made from hard
Silicone:
"As an implantable biomaterial it is most
commonly used in the form of the dimethylsiloxane polymer which is a large
molecule of repetitive units containing silicon, oxygen and methane,
((CH3)3SiO-[(CH3)2SiO]x-Si(CH3)3).
The extent of polymerization determines the
viscosity of dimethylsiloxane and hence its physical state: liquid, gel or
solid. Short, linear chains of polymethylsiloxane result in oils or gels. Heat
and catalysts increase branch length and form solids. Silicone polymers are
easily contaminated with heavy metals, low-chain-length polymers, and other
impurities during the manufacturing process and their refinement requires
specialized filtration and sterilization. Only Medical grade silicone is
approved for implantation in the human body." Grand Rounds - Advanced
Biomaterials
Although, many medical device
companies are manufacturing newer types which are made from expanded
polytetrafluoro- ethylen (ePTFE), rigid polyethylene, hydroxyapatite
(processed coral; HA). The rigid polyethylene implants are usually screwed
into place into the bones of the face to prevent shifting of the implant
post-operatively. The (ePTFE) implants are designed to be porous so that the
tissues can attach themselves to the implant to prevent shifting.
First off, your doctor will
discuss your goals with you and he will explain what can be achieved
realistically. The usual goal of the typical patient is to "correct" a lacking
chin. Discuss with your surgeon the goals and general result you would like to
achieve. It is all individual. Just like you!
Your doctor will take into
account your facial dimensions and natural face shape. There are not too many
types of chin implants but enough to go over with your surgeon. The placement
as well as the size of the chin implants will be determined by you and your
doctor. Don't be afraid to speak your mind during this time.
The Chin augmentation operation
is most frequently performed using Light Sleep Anesthesia or combined with other
procedures, General Anesthesia. Light Sleep Anesthesia is the use of medicines
to induce a state of relaxation and a light sleep. After your arrival
additional medications are given intravenously which induce a profound state of
relaxation. Patients usually sleep during the operation. Much of the time
patients have very little memory of the operation itself. After this state is
achieved then medicines are given to produce numbness of the surgical area.
This procedure takes from 1 to 1
and 1/2 hours to perform. It may take longer if you choose to have chin and
cheek implants as well. Depending upon your facial structure the incisions will
be placed as inconspicuously as possible. For chin implants the incision can
either where the mouth gums and lip/facial skin meet of under the chin. The
risk of infection is higher if an incision is placed within the mouth area.
Although a strict post-operative oral hygiene regimen can decrease this risk.
There may be surgeons who only
wish to use a certain implant type or a certain incision. surgeons would give
you a choice. As the updated techniques are less scarring than the previous
ones. The doctor may school an oral approach where the only incisions are
placed within the mouth area. No visible scar is made and the oral incisions
heal much faster. However, oral techniques sometimes are plagued by a higher
rate of infection. Especially in those with problems with plaque build up or
poor dental hygiene.
There is also a procedure called
a Genioplasty, also referred to as a "sliding genioplasty" or chin advancement
surgery. This surgery is the use of a bone saw to trim a piece off the bottom of
the chin and "sliding" it forward and then fastening it with titanium screws.
Metal plates may also be used as well. Although a rarity, bone infection becomes
a risk.
Additionally, there is the use of
injectable Hydroxyapatite (HA, processed coral) paste. It should be performed
over a course of a few months and the look is gradual and a long process. Some
surgeons inject a lot of it at once but be advised that this is still a newer
application for cosmetic reasons and reportedly the paste is still "moldable"
for a few days. There is no osteoinduction (bone incorporation) as it is not
porous but there are reports of absorption.
Check with your doctor on the
preferred technique that he utilizes. He may very well prefer the traditional
methods out of not being aware of the newer ones or he may very well offer only
the newer ones, with the thought that the older techniques are "out of date".
This subject varies with surgeon to surgeon.
Don't be alarmed at the presence
of bruising and swelling. The swelling will begin to disappear within the
first 5-7 days. Many patients return to work with the help of camouflaging
cosmetics at about 5 days post-op. The swelling resembles inflammation of
wisdom teeth or their removal and sometimes this excuse is used at "the
office". Although please realize that the swelling may be apparent for months
and the defined, chiseled look that you so desire may not become evident for
quite a while.
The sutures, if any, will be
removed in approximately 3-5 days (sometimes 7-10). Your face will be swollen
for the first few days - this is normal. The removal should not hurt
extensively although your surgeon may feel the implant through your facial
tissues and this may hurt a little. The swelling should very much dissipate
after the first two weeks.
This depends on the incision
choice by you and your surgeon. It is quite possible to have either one of
these implants inserted with no visible scars whatsoever. Ask your doctor if he
is familiar with the oral incision location and what he thinks about it.
There will be some considerable
swelling associated with the trauma to the tissues. Especially if there were
screws involved. Bone trauma may hurt a little more than just tissue trauma so
take this into account when you decide on the technique. Although, it is hardly
enough pain to dissuade you from making an "incision decision". Please go into
this surgery well informed because many re-operations or removals are due to
patients not being able to handle the swelling at first. It can be quite
overwhelming at first.
You can expect to resume regular
activities in about 1-2 weeks. Although exercising should be be reserved for
after the third week. It really is individual but the swelling is quite
pronounced involving a facelift. There is bruising and of course a support will
be worn at night to alleviate tissue stress and to support the healing tissues
correctly. I wouldn't make any plans to attend any weddings or other functions
where you will be high profile for at least 4 weeks. Most patients return to
work within a week.
The results are immediate,
although you may think that the implant is too big at first glance. Give your
mind time to recognize the difference in swelling and augmentation. Most
patients are very satisfied with the augmentation results. Remember this key:
men sometimes think their chin after augmentation is too small where women tend
to think their chin post-operatively is too large and pronounced.
There is a chance of hematoma
(blood clots), seroma, numbness from nerve damage and hyperpigmentation
(permanent discolorations) caused by the bruising - although there is rarely
bruising with facial implants. There is the risk of implant shifting which
results in additional surgery to reposition the implant. There is the chance of
your disapproval which may result in a re-do or removal. There is also a chance
of asymmetry from tissues healing differently.
The silicone chin implants are
made to last your lifetime. Especially if the implants are the harder variety
and screwed into place, your risk of shifting is very minor. Although
anything having to do with inserting metal into bone run the risks of infection
and bone deterioration. however, most "bone screws" are manufactured of titanium
and just develop calcifications around the screws, if that, and nothing more.
Then again, everything is dependent upon the individual and as you should know
there is no "never" or "definite" in medical science.
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