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FACIAL IMPLANTS


A small or recessive chin can make a person look weak and can be the source of ridicule. An underdeveloped lower jaw, with malocclusion or an overbite requires a combination of orthodontia and major maxillofacial surgery to move the entire jawbone forward to correct the imbalance. However, often the teeth are in normal alignment yet the chin itself is underdeveloped. In such an instance, major surgery is not necessary. Placement of a small prosthetic implant either through an incision beneath the chin or one inside the mouth, provides a simple yet highly effective correction of this problem.

Similarly, flat cheekbones can make a person seem sad or old looking and can throw off facial balance, which is a definite factor in facial beauty. Cheek implants can provide the volume and shape to correct that aesthetic issue.
Implants are designed from a variety of materials. Dr. Creasman uses a silicone rubber prosthesis with an anatomical design which wraps around the entire lower edge of the jaw, tapering naturally and avoiding translation of muscle forces directly over the central prominence of the bony chin. He often modifies the implant to shape the chin to meet specific patient goals, if possible. Such implants have been in use for decades, and have a very established safety record.

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The Consultation

Dr. Creasman will take a medical history and perform a directed physical examination during your consultation. Of particular importance is your dental history. If you have dental occlusion (bite) problems, a referral to either an orthodontist or a maxillofacial surgeon may be indicated. The general health of your gum tissue as well as your teeth are important in deciding whether you are a candidate for a chin implant.

One primary aesthetic landmark is the profile view of your chin as it relates to you lips and other facial features. After examining you, digital images will be taken of you with a sophisticated 3-D imaging program so you can see yourself from any angle. Dr. Creasman can then manipulate those images using simulation software to show you how your appearance might change with placement of a chin implant. Together, you can collaborate onhow you want your chin enhanced which optimizes your chances for a result that pleases you.

Not infrequently, those individuals who have underdeveloped chins also have significant accumulations of fat in the neck that respond well to liposuction. Many patients seeking nasal reshaping are also candidates for chin enhancement as well. Dr. Creasman will evaluate these related issues, and if relevant in your case, can demonstrate what other related procedures might do for you, if you wish.

Risks of Chin Implant Surgery

Chin augmentation enjoys a very low risk profile, but there are nevertheless complications that can occur. These would include bleeding, infection, malposition (crookedness of the implant requiring reoperation), loss of sensation to the lower lip, weakness of the muscles which depress the lower lip, over- or under-augmentation, palpability of the implant, and general dissatisfaction. Implants left in place for many years may slip as one ages, due to the tendency for the jawbone to get smaller, particularly if the teeth are extracted. Rarely, the implant can erode into tooth roots, causing problems with lower dentition, but this should not occur if the implant is placed properly just at the lower edge of the jawbone. Delayed infections of the implant can occur, and may result in the need to remove the implant many years later, but this is very unusual.

Before Your Procedure

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen just prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. You should avoid any dental procedures for one month before and one month after placement of a chin implant.

Prophylactic antibiotics are given orally prior to surgery to reduce the risk of surgical wound infection and continued for several days afterwards. A prescription for pain medication is written at the time of your preoperative visit, so that you have your pain pills when you return home from the operation. Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take the post-operative photographs at 3 months after your procedure.

You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks have been described herein and are also discussed at the consultation.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after surgery, for your comfort and safety. You should be able to drive yourself to the first follow up visit, which is typically 2-3 days after your operation.

The Operation

As an isolated procedure, chin enhancement is done under a local anesthetic and intravenous sedation. It is not uncommon for this procedure to be done at the time of a rhinoplasty (nasal surgery), or a facelift. As mentioned, after the area is anesthetized with a local anesthetic, a small incision is placed under your chin. A space is developed just large enough to admit the implant that was decided upon during the preoperative evaluation. After confirming the choice of implant, the implant to be placed is bathed in an antibiotic solution to lessen the risk of contamination and infection. Frequently, Dr. Creasman sculpts the implant to make adjustments to its shape or size. The implant is positioned and secured in position with sutures. Incisions on the skin are closed with sutures that need to be removed in 4-5 days. A small dressing to immobilize the area is applied. The procedure typically takes about 30 minutes.

The Recovery Period

The chin and lower lip are numb from the local anesthetic, much in the same way one feels after a dental procedure. This usually lasts for a couple of hours after you leave the office. You should take a pain pill as soon as you arrive home, and you should try to eat with the medication to avoid nausea. You should ingest a “dental soft” diet, which avoids excessive chewing. Jaw movement will tend to increase swelling of the chin and lips. It is helpful to apply cold compresses to the area to reduce swelling and bruising. One needs to be very careful not to ingest hot liquids so as to avoid burns until the sensation returns. Frequent mouth washing with an oral antibiotic mouse rinse and meticulous dental care are also important.

Mild to moderate swelling is to be anticipated, which usually takes a week or so to subside. Pain is typically mild, and is well controlled with pain medication. Patients usually express that they “feel different” with their new chin and it sometimes takes several weeks to months to adapt to the presence of the implant, particularly with smiling and speaking. Once the swelling and normal wound healing near completion in about six weeks, most people have adapted to their new chin, and begin to appreciate the improved balance and strength of their profile. Often, when reviewing pre-operative photographs, patients express surprise at how different they used to look, and how much better they feel about themselves.

Facial Implants/Cheeks

A cheek enhancement is a cosmetic surgical procedure used to build up a person’s cheekbones and thus bring a more desired balance to the face. A relatively flat cheekbone area can be enhanced or made more prominent with the insertion of a silicone rubber cheek implant. The implants may be inserted in conjunction with other procedures, like a facelift, or they may be inserted as a separate procedure. They can be placed either through an incision in the mouth, through a lower eyelid incision if eyelid surgery is being performed, or through a facelift incision. Many people prefer an injectable filler that avoids surgery, but if a permanent cheek augmentation is desired, then an implant is indicated.

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The Consultation

Dr. Creasman will take a medical history, including any history of congenital or developmental abnormalities, as well as any history of facial bone fractures. After this, a thorough physical examination of the face is carried out and digital images are taken. Using sophisticated 3D medical imaging software, a computer simulation of the appearance of your face with enhancement of your cheekbones can be generated, which helps you decide with the doctor if this is an operation that will meet your expectations. Different sizes of implants are available, and these can be held up to your face to show you how they are positioned and give you an estimate of the effect as well.

Risks of Cheek Implant Surgery

Risks include bleeding, infection, malposition or crookedness of the implants leading to (or stemming from) facial asymmetry, palpability, numbness, weakness of facial muscles, over- or under-augmentation, pulling down of the lower eyelid when combined with eyelid surgery, internal scarring possibly resulting in chronic pain. Some of these complications may require additional surgery for correction or improvement.

The Pre-operative Period

It is imperative that patients refrain from ingesting any medications or other substances which could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation, however seemingly trivial, should be reported to our office. Dental procedures should be avoided one month before and one month after surgery.

Both an oral rinse and oral antibiotic pills are prescribed prior to surgery and continued for several days afterwards to reduce the risk of surgical wound infection. A prescription for pain medication is written at your preoperative visit, so that you have your pain pills when you return home from the operation.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 months after your procedure.

You will be asked to sign a surgical consent which enumerates the risks of the procedure in detail. These risks have been described herein and are also discussed at the consultation.

You will need to arrange for an escort to drive you to and from our office operating suite. It is a good idea to have someone stay with you for at least 24 hours after surgery, for you comfort and safety.

The Operation

The procedure takes approximately an hour and is done under a local anesthetic with intravenous sedation. Dr. Creasman carefully marks the outline on your cheek skin where the implant will be placed. The incision is made usually inside the mouth and the tissues lifted off of the bone, creating a space just large enough to accommodate the implant. The implants are then placed and secured with temporary stitches passed through your skin. These are removed a few days after surgery. The incision is closed with self-absorbing sutures, which dissolve in a week to ten days.

After your procedure, you will spend a short time of observation in our recovery room, after which you will be discharged into the company of an adult escort.

The Post-operative Period

Minimal to moderate pain and swelling should be expected, but is usually well controlled with the pain medication prescribed by the doctor. Ice compresses applied to the face in the first few days help to minimize swelling. You should avoid excessive talking and chewing. Frequent iced saltwater rinses of the mouth help to keep the incision clear of any food debris, and minimize the risk of infection. You will be seen after a couple of days.

Most patients return to work in a few days, but swelling continues for a week to ten days, but is not as noticeable to those around you as it will be to you. It takes about six weeks for all of the swelling to settle down so that you are stable with regard to the amount of augmentation.

Quick Contact

Contact us: Phone 408-369-9300
Email us at: appointment@creasman.com

2400 Samaritan Drive Suite 206
San Jose, CA 95124

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