Implantes de menton & misc.

INTRODUCTION: Many patients feel that a certain body part does not match their overall facial features or body physique. In certain situations, balance can be achieved by inserting an implant to receive the desired correction. Most patients have been exceedingly pleased with such operative procedures. The solid implants can be made of a soft, smooth silicone rubber or a porous material that resembles Gortex. The appropriate implant will be offered depending on the body location to be addressed. Lips may be augmented with a Gortex type graft, cadaver skin, or your own tissues, fat or a fat-skin combination. The Gortex grafts are permanent but not very popular because they are palpable and cause the lip to feel unnaturally firm. The cadaver (Alloderm®) as well as the patients own fat or dermal-fat grafts usually absorb with time. Lip enhancement is achieved most frequently and safely with an injection of an absorbable substance such as Restylane ®.

The most commonly performed procedure in this group is chin augmentation. Most people feel that a stronger chin is more aesthetically pleasing than weak chin. A weak chin will also make a nose look larger or a neck droopier than it actually is. Some patients are not aware of a relative chin weakness – we will discuss a chin augmentation with any weak-chinned patient considering a rhinoplasty or a face lift in order to create a more balanced profile.

Less frequently, patients will present with a narrow jaw and request enhancement of the angles of the mandible, or with a weaker upper jaw and request a “pre maxillary implant” that is inserted just under the nose. Implants can also be inserted to give someone more prominent cheek bones.

Most patients who present for nasal surgery are concerned with a nose that is too large for their face. Occasionally, we will see patients who have a deficient nasal bridge. The top of the nose can be enhanced with a variety of cartilage grafts (from the septum, ear or rib), cranial bone or with a man-made implant that comes from a box.

Some patients present with a concern about a flat pectoral area, small biceps, a weak gluteal area, or thin calves in spite of many hours spent working to enhance these areas in a gym. Such patients cannot build these muscles any further because of genetic limitations, and may be candidates for implants in the areas of concern. Occasionally, we will see a patient with a unilateral deformity due to an illness (such as polio or a birth defect) or an injury. An implant will frequently be able to minimize such asymmetries, but one must remember that especially with unilateral problems, perfect symmetry cannot be achieved – in such situations, the bone, muscle and skin will all be deficient and an implant alone will not be able to restore symmetry. With upper arm, chest wall or calf implants, usually, you can expect to see a 2-3 inch increase in your circumference.

The increase in size of any implanted site will be limited by the tightness of your tissues, but significant improvement can usually be achieved. As unfair as this might seem, the smaller your area of concern is to begin with, the smaller an implant will have to be selected during surgery, simply because there will not be any room to put in a bigger implant! On occasion, especially in patients who begin with very tight tissues, a secondary procedure to insert larger implants may become desirable a year or more later, after tissues have had an opportunity to stretch. Perfect symmetry does not exist in nature, and no inserted implant will ever be perfectly placed or symmetrical. It is important to understand that no person is perfectly symmetrical from one side to the other, even before a surgical procedure. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operation. And it is not unusual to have a greater degree of asymmetry after surgery than existed before implants were placed - this occurs because the formation of the scar layers around the implants and how the implants “settle” are not under the patient's or surgeon's control! Occasionally, the asymmetry is objectionable and a secondary procedure may be necessary to adjust an implant.

Juris Bunkis, M.D., F.A.C.S.
email:bunkis@ocps.com

Hisham M. Seify, M.D.
email: seify@ocps.com

Orange County Plastic Surgery
Medical Associations, Inc.
30212 Tomas, Suite 275
Rancho Santa Margarita, CA 92688
Phone: (949) 888-9700
Fax: (949) 888-9724