Chin Surgery (Custom)

Common materials for chin implants include silicone, Medpor, titanium, and PEEK (polyetheretherketone). PEEK is largely considered the gold standard and is a solid but slightly flexible material that best simulates bone. It is highly biocompatible (accepted by the body without causing inflammation) and chemically stable so as not to corrode or break down. It is MRI-safe and radiolucent so as not to obscure future X-rays or imaging.

Silicone can be custom, but usually is not. It is has a rubbery or gummy consistency. The flexible nature has mobility and causes rubbing against the underlying bone (even if it’s secured) causing erosion of the bone.
Medpor implants can also be custom but, usually are not. They have small holes (pores) for soft tissue to grow into, which occurs progressively with time, and can make removal very complex and damaging to the surrounding soft tissue. If you have to remove a medpor implant, the sooner the better. I recommend to avoid them.
PEEK is a solid and smooth material that is always custom. These are always secured to the bone and I feel have the best surface characteristics, esthetics, and functionality to simulate chin bone (or cheek bones and jaw angles). They can be removed easily, and typically feel completely natural.. most patients describe them feeling “like myself”, “like nothing”, or “I don’t feel it”.

Chin implants, like all facial implants, can be custom or non-custom (stock)*. A genioplasty can also be custom or non-custom depending on the hardware (surgical guides and titanium plates). Custom hardware and custom implants are both  fabricated and designed from a patient’s CT scan, which we take in-office during the consultation. They are shaped and designed specifically for each patient’s anatomy and aesthetic goals. This virtual planning is done by computer and is reviewed with each patient along with predictive images before the custom material is made so we can get a very accurate idea of the end result. Adjustments can then be made to the design prior to production/fabrication as needed. 

*Non-custom (stock) implants are prefabricated in various shapes and sizes (S,M,L) and do not require a CT scan or virtual planning. In our practice we only offer custom facial implants and custom genioplasty.

We typically ask patients to remain in town for a period of 1 week before flying. However, car rides of 2-4 hours are ok the following day in most cases. (Dr. Hanna would still like to see you for a post-op visit at the 1-week mark.)

No. All incisions are inside the mouth. These incisions are placed in the deep folds of the mouth and are not visible once healed during speaking and smiling. We typically use sutures that dissolve on their own after a period of 1 week which do not require removal.

(When additional facial aesthetic procedures are performed, these may require separate skin incisions.)

Custom guided genioplasty can have different meanings. The way it is used in our practice describes a process where the surgery is performed virtually on a CT scan of the patient’s facial bones with soft tissue predictive images and sketches. When the desired facial aesthetic is achieved, the surgeon customizes the precise position of the bone cuts and custom-designs the titanium plates that will be used to fixate the bones into their desired positions. This is a highly accurate and precise method within 1-2mm of precision, allowing for smaller surgical access points (less invasive / “minimally” invasive), quicker surgical times, more stable plate fixation, and therefore better results overall (aesthetically and functionally) than other methods.

Not every jaw surgery requires genioplasty; however, in most cases when the jaws are not ideally developed, the chin is also not ideally developed. Repositioning the chin bone at this time allows for an ideal profile and aesthetic bone structure. Also, many times with asymmetries of the jaw, there is also asymmetry at the chin, which needs to be corrected as well.

A CT scan is required for proper diagnosis and evaluation of the bone structure so that the custom implants/hardware can be designed accurately. It is also needed to rule out any other complicating anatomical factors that would affect decisions regarding the treatment plan. In a genioplasty, there are also many different techniques in bone cut patterns that are specific for a patient’s bone structure, other anatomy, and aesthetic goals.

Most patients can expect some swelling and bruising for the first week after surgery. Usually after one week, patients can resume work and normal daily activities. Within one week, typically 90% of the swelling and bruising has resolved. The remaining 10% of settling will occur over the next 3-6 months, or sometimes up to a year.

Most patients can resume work (and are considered “restaurant-ready”) within 1 week. For social events such as weddings (guest), graduations, or holidays, one should allow at least 2 weeks for recovery.

All facial implants can be custom or non-custom (stock). Custom implants are fabricated and designed from a patient’s CT scan. They are shaped and designed specifically for each patient’s anatomy and aesthetic goals. This virtual planning is done by computer and is reviewed with each patient for adjustments. Non-custom (stock) implants are prefabricated in various shapes and sizes (S,M,L) and do not require a CT scan or virtual planning. In our practice we only offer custom PEEK chin implants.

You will notice an immediate improvement after surgery, though swelling will obscure the final result initially. The majority of swelling typically resolves within the first week.

1-2 hours

It is important to choose a surgeon who has: 1) The training and skill set in treating the maxillofacial structures, as well as soft tissue aesthetics of the face, head, and neck. Particularly valuable is the surgeons “fellowship” experience, which is elective higher level training performed after the standard residency training. Not every surgeon completes fellowship training. 2) An aesthetic sense that matches the patient’s.

The most common answers from patients who have facial implants: “It feels like nothing.” “I don’t feel it.” “It feels like me.” “I can’t even tell that something there.” “It feels completely natural.”

When the goal is to create bone structure, filler is not the best option for several reasons. It is a fluid gel material, so it does not lift or build structure, it “fills” like water fills a balloon. This creates a round jelly-like appearance of the skin in larger amounts. Many patients are satisfied with their fillers at first, but after 5-10 years of filler treatments, they feel their faces look swollen, round, heavy, or fat. They also can stay in the body for 10 years or more. Some literature suggests that large amounts injected over the years expands the skin and soft tissue, resulting in loose skin.

No.

Yes, no problem. Just let the technician know beforehand.

Yes, chin implants are considered a very safe procedure when done properly. They have a very low infection and complication rate. Facial implants have been placed for several decades, so it is not a new procedure. Techniques and materials have continued to improve. They are not only used for cosmetic purposes, but also reconstructive purposes, near vital structures such as the eye, brain, and spine with excellent safety metrics.

Essentially nothing; these implants are stable so they do not corrode or degrade. The added bone structure will offer better support to the soft tissue, so people will typically age better with less skin laxity (looseness) than they would have otherwise had.

In global literature between 2-5%. In our practice it is less than 1%.

This can usually be treated with antibiotics alone. Sometimes a fluid collection is present and can be drained. In very rare cases the implant would be removed, we would wait 1-2 months to allow the infection to clear, and then a new implant can be placed.

The hardware typically remains in place for life but can be removed if desired after a healing period of about 6 months once adequate bone healing has occurred.