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The following information has been prepared to enable you to understand
what chin implants are, what they are intended to do what they may or
may not achieve, what the risks are, and in general what you will likely
experience after the surgery. Please read this information carefully and
comment if there is anything you do not understand, please ask questions.
GENERAL INFORMATION
Exciting new developments in chin augmentation include new implant shapes
textured surfaces, and more biocompatible implants. The face is now divided
into zones and custom implants are prepared for the patient. This further
introduces aesthetic enhancement into facial implant surgery over the
conventional one-sizes-fits-all philosophy of implant placement.
The implants are usually made of dimethalpolysiloxane,which is a silicone
compound. Occasionally other materials may be used. Prior to the surgery,
the type, size, and method of placement of the implants will be discussed
carefully with you.
THE ANESTHESIA
Chin implant surgery is performed under a "light" general anesthetic (patient
is asleep). This technique provides excellent operating conditions while
affording maximal patient comfort and safety. The anesthetic is administered
by a board certified doctor anesthesiologist who remains in attendance
throughout the operation. All of the required monitoring, anesthetic delivery
and emergency equipment are present at all times. Further information,
including any questions you may have, will be explained and discussed
fully by our anesthesiologist prior to your surgery.
PRE-OPERATIVE PREPARATIONS
You must be in good health to undergo any elective cosmetic surgery. A
physical examination and routine lab work will need to be performed by
your own primary physician. If you do not have a primary doctor, we can
refer you to local doctors in our area. We do not provide these services.
It will be required that all this pre-op paperwork is in our office
1-2 weeks prior to surgery.
It is very important that our office is aware of any medical conditions
and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks
after surgery. This would impede your healing greatly. Talk to us about
options.
It is a required that someone drive you home upon your discharge. Also
arrange for transportation to and from our office for your post-operative
appointments until your doctor gives you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to
surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended.
You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on
hand easy to prepare foods. A soft diet, such as mashed potatoes, yogurt,
applesauce, soups, Jell-O are helpful the first 24-48 hours after surgery.
THE SURGICAL PROCEDURE
The procedure is frequently done in conjunction with a facelift or other
facial surgery, or may be done as an isolated operation. It is usually
done under general anesthesia in our outpatient surgery center. It also
may be performed under local anesthesia with sedation if so desired. There
is absolutely no pain involved during the procedure because of the anesthetic.
The procedure takes approximately one hour to perform.
RISKS AND COMPLICATIONS
As with any surgical procedure, there is some risk. Certainly the administration
of any medication of any sort can rarely have an unpredictable and in
extreme cases fatal outcome. Every caution is taken to prevent possible
drug sensitivity and if it should occur, to treat it properly and avoid
any dire consequences.
Motor nerve injury is rare yet because the motor nerves
usually are not vulnerable to injury from this kind of procedure. If such
an injury occurs, temporary or permanent damage to facial muscles of expression
may result. Weakness of the smiling muscles however is usually due to
trauma to the muscles themselves, and in almost all cases can be expected
to abate completely within a few weeks although some cases have taken
up to six months to a year to completely return to function.
Infection. Infection occurring immediately after surgery
is quite uncommon because of the use of antibiotics and the careful surgical
technique used in the procedure. However, late infection meaning infection
occurring anywhere after three to six months may occur due to a dental
abscess or other infection which seeds the blood stream with bacteria,
causing bacteria to lodge on the implant and create a localized infection.
In most cases, infection of this nature is readily responsive to antibiotics
but on rare occasions, the infection is recalcitrant to antibiotic therapy,
and the only treatment is to remove the implant and let is heal for a
period of up to three months or longer to completely eradicate the infection.
At that time, the implant may be reinserted.
It is wise to remember that foreign bodies of any sort can be the focus
of an infection, and so that when infection occurs or when one goes to
the dentist for a cleaning or other dental work, one is encouraged to
take antibiotics immediately prior to that procedure. This is the same
prophylaxis that is recommended for patients with certain kinds of heart
disease, patients with breast implants, patients with joint replacement
surgeries and patients with pace makers or other foreign bodies dwelling
within their system. This simple precaution prevents infection quite reliably.
Malposition is quite unusual but may occur and be apparent
immediately after the surgery. It is unlikely that implants will move
or "slip" to a different position once they have healed. It must be remembered
that faces are rarely symmetrical and that sometimes this asymmetry is
not perceived prior to surgery, only becoming noticed by the patient after
surgery has been performed. Asymmetry if significant can be only corrected
by re-operation in which the implant is repositioned or a different type
of implant is inserted.
Hematoma, which is a small collection of blood within
the implant pocket is quite unusual but may occur and require reopening
of the wound to take out the blood clot. It is not dangerous, but must
be treated properly to avoid either malposition or an unusual amount of
scar tissue post-operatively.
WHAT TO EXPECT AFTER SURGERY
The swelling should begin to subside within three to five days along with
the discomfort. It is not uncommon to experience some temporary numbness
in the lip or weakness of the smile. This is just due to the body's inflammatory
response to any surgical operation and usually within one to three weeks
both of these functions are returned to normal. It is expected that you
will be presentable in approximately one week.
Dressings- Immediately after surgery, a chin strap with foam padding is
applied, and worn for 3-4 days.
POST OPERATIVE CARE
Wearing the chin-strap with foam padding is required for the first
72 hrs, then you may shower, and discard the padding. Continue
wearing chin-strap for an additional week, or as advised by Dr. Moelleken.
Wash face gently with a mild soap and water. AVOID scrubbing
around the chin area.
It is expected that you will remain somewhat quiet and sedentary for the
first few days after surgery. This is to reduce the swelling and reduce
the chances of bleeding in the area around the implant. After the first
week, in the absence of other procedures that require a longer convalescence,
normal activity may be resumed although it would be wise to avoid sports
or exercise for up to three weeks after the surgery.
It is important to keep your head elevated for the next
7-10 days. Sleep on your back with 2-3 pillows underneath
your head and avoid rolling on your sides.
After 10 days, make-up may be applied unless advised otherwise by the
doctor.
Please wait 2 months after surgery before having any dental work done.
AS WITH ANY FACIAL SURGERY, AVOID BENDING FORWARD, AS THIS CREATES
STRAIN ON ALL INCISIONS THAT ARE HEALING.
Report to office:
- Any excessive pain.
- Any rise in body temperature over 100 degrees.
- Any excessive bleeding.
DO NOT brush teeth vigorously for 1 week after surgery
- use child's tootbrush gently.
AVOID excessive talking and smiling for 3 days after surgery.
FINISH ALL THE ANTIBIOTICS PRESCRIBED TO YOU BY THIS OFFICE.
RESUMPTION OF PHYSICAL ACTIVITIES
GENERAL RULES OF THUMB
TWO, FOUR, SIX RULE
First week: TAKE IT EASY!!! PATIENTS WHO ARE TOO VIGOROUS
FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks: take long walks on a flat surface. No other
kind of workouts. Any activity that would raise your blood pressure would
compromise the healing incisions and newly developing blood supply.
At four weeks: light exercise such as aerobics, but no
weight training. Start light. For example, if you normally do 30 minutes
on a treadmill, begin with 15 minutes, then increase as your body gets
used to things. Use of vitamin C and E concentrate and scar-fade gel should
begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks: resume all previous activities with clearance
from Dr. Moelleken. Avoid sun exposure to incision site for months following
surgery, as this may result in a hyperpigmented scar.
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