Project Description

Dr Flood likes to use either silicone or Medpor (polyethylene) implants for chin and cheek augmentation. Both silicone and Medpor implants come in a variety of shapes and sizes. Silicone chin and cheek implants have the advantage of being smooth walled allowing them to slip through tiny incisions and be placed overlying the bone. However, the disadvantage is that the silicone chin and cheek implant may move about unless it is adequately fixed to the underlying bone with the aid of a screw.

Dr Flood prefers to use Medpor chin and cheek implants, when possible. Medpor is a porous substance that allows the patient’s tissues to grow into the outer layer of the implant. By the body partially incorporating the implant, this certainly reduces the risk of movement, as well as subsequent infection.

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Chin Implants

Chin implants are popular with both men and women. Men like chin implants as they provide them with a more masculine appearance. Females often desire chin implants to try and improve the relation of their lower lip and chin, as well as their chin with their neck.

Preoperative assessment involves photographic documentation of the face from a frontal, oblique and true lateral view. A lateral head x-ray is also performed to assess the degree of augmentation required to the bony chin point, (pogonion).

Assessment is also made of the patient’s occlusion to see whether a chin implant alone or whether jaw surgery would also be beneficial to the patient if they desire a perfect occlusion. At times consideration will be given to performing an osteotomy, which involves cutting the chin point and advancing it forwards and fixing it with special screws. This is called a genioplasty and no implant is required in such cases. This is beneficial in younger patients who will still be performing contact sports. Because the bone has moved and reset there is no problem in the future if the chin is struck inadvertently during contact sport.

Chin implant surgery is performed under general anaesthetic as a day surgery procedure. The incision line is hidden in the mucosa of the lower lip. The dissection is performed to the bone. The mental nerve is identified and preserved. The chin implant is placed directly on the bone and fixed with the aid of a titanium screw. At times a sizer is used as a temporary implant to assess the degree of projection required for the patient. Sizers, as the name suggests, come in all “sizes and shapes” to allow the surgery the accuracy of using the correct implant. Wound closure following implant insertion involves re-suspending the mantalis muscles and using dissolvable sutures inside the mouth.

Most patients have a degree of bruising for up to one week post-operatively. Swelling usually lasts between 1-3 weeks, depending on the size and type of implant used. Most patients can return to work after one week. Discomfort is present, however, most people are comfortable with the use of an anti-inflammatory drug. Antibiotics are given at the time of surgery, as well as a five day course post-operatively. Final definition to the chin may take up to 6-8 weeks to form.

Cheek Implants

High cheek bones seem to be attractive in both males and females. Cheek implants produce dramatic changes to the facial appearance. A pre-operative assessment is important with the aid of frontal, oblique and true lateral view photographs. X-rays were performed to assess the underlying bony skeleton. An examination of the patient’s occlusion is performed to see whether orthodontics and corrective jaw surgery would be an alternative to cheek implant surgery. If the patient is happy with their occlusion and does not desire corrective jaw surgery then a cheek implant is an appropriate form of treatment to improve cheek and peri-alar aesthetics.

A cheek implant is performed under general anaesthetic as a day surgery procedure. An incision is placed through the mucosa of the upper lip. The dissection is performed over the bone and the cheek, a sizer is often used to assess final size and shape of the permanent implant. Once the implant has been selected and inserted, titanium screws are used to fix the implant to the underlying cheek bone. Dissolvable sutures are used to close the wound. There are no external scars on the face. Most patients have a degree of bruising for a period of five days post-operatively. Swelling may take up to two weeks to subside. There is often minimal discomfort which is corrected by non-steroidal anti-inflammatory drugs. Final contour may take up to six to eight weeks to realise.

It is important for patients desiring cheek or chin implants to have a thorough assessment to see whether in fact corrective jaw surgery would be more beneficial for them. Patients who have a malocclusion may certainly present with a weak chin or flat cheek appearance. Only after a thorough examination can the right advice be given to the patient about what course of treatment would be most appropriate for them.