Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / Chin Implants vs. Chin Filler: What Actually Works Long-Term?
Transcript
- Announcer (00:02): You're listening to Alabama the Beautiful. Kirstin (00:05): Hey, Dr. Koehler and Dr. Gardner. Dr. Koehler (00:07): Hey, Kirsten. Dr. Gardner (00:08): Hey, Kirsten. Kirstin (00:08): What do y'all want to talk about today? Dr. Koehler (00:11): Yeah, you know you're in charge of that. Kirstin (00:12): That's right. And don't you forget it. All right. We're going to talk about chin augmentation and how chin augmentation is the underrated key to facial harmony. Dr. Koehler (00:25): Okay. Sounds great. Kirstin (00:26): Right now in social media, the keyword is facial balancing. Dr. Koehler (00:32): Okay. Kirstin (00:32): Okay. Why do you think the chin is such an overlooked part of the face? Dr. Koehler (00:37): Well, I didn't really know that it was, but now you're telling me it is. I mean, I think it's just probably not in the top procedures that people seek out. And oftentimes, the thing that you'll hear most commonly when people come in for a nose evaluation is if a certain person has a big nose but a weak chin or whatever, and there's not balance throughout the face, that is when a surgeon typically is bringing up the conversation of a chin when the patient didn't come to the consult to talk about a chin. So there are certain procedures, like if somebody comes in to talk about their neck but they've got a weak chin, then we might talk about a chin. Especially for women because not a lot of women are looking to have super strong chins. Whereas I'd say for men, more common that a guy will seek out a chin implant, but even then it doesn't matter male or female. It's just not a super popular procedure that people seek out. Kirstin (01:49): Well, if somebody says, "I just want a sharper jawline," how does that end up being that the chin is the issue? Dr. Koehler (01:58): It depends because if they had a sharper jawline, let's say when they were younger, then the cause of their lack of sharpness to their jawline might be weight gain. It could be just aging in general and laxity of the tissue. So then getting a better jawline could mean doing a deep neck lift. It could mean a lot of things, but definitely in that discussion would be looking at the person's profile to make sure that they have enough chin projection because sometimes adding something simple like a chin implant, which is not a complicated procedure to do, can really make a nice difference in somebody's jawline without doing anything really aggressive. So it depends on the circumstances. There are lots of reasons for a poorly defined jawline. Kirstin (02:45): You kind of touched on it a little bit already, but what does a chin implant do for someone's face? Dr. Koehler (02:50): Well, it's primarily going to improve their appearance in like a 45 degree or lateral view so that in their profile, their chin is going to project more. And without pulling up pictures and kind of showing you, but you can go on our website and you can see examples of chin augmentations. And some of them are subtle and it's just like breast implants. People have different preferences. Some people like a really strong chin and some people, they're like, "I want more of a chin, but I don't want it to be super obvious." So it's no different than breast implants. I mean, some people like them bigger, some people like them smaller. So you can go and look and see different examples of how it can improve the appearance. But again, it's a pretty straightforward procedure. It's a nice to do. And so if a person doesn't have enough projection of their chin, then that can really help. (03:42): And there's a few things, there are exceptions to that rule because sometimes if a person's got a weak chin, but they also have a real deep labia mental sulcus, so that groove between your lip and your chin, if they've got a deep groove there, you don't want to do a chin implant on those people. It'll make that groove deeper and it'll look worse. So sometimes the people have a weak jawline because they've actually got a skeletal discrepancy and their lower jaw maybe didn't grow enough or maybe their upper jaw and their lower jaw, just there's a difference in the two upper and lower jaws. So sometimes jaw surgery is a better option, but that's not something that we do here in our office. But if it's a severe discrepancy, the jaw surgery would be the thing to do. Kirstin (04:32): Okay. What's the biggest myth you hear about chin implants? Dr. Koehler (04:38): I don't know. I think probably just like anything else, it's going to make you look plastic or look fake or something like, I don't know what the word would be, but especially when people start talking about body parts that maybe they're just not familiar with. Some people, like they have bicep implants and there's calf implants and all these kinds of things that people do. And a lot of times that people's reaction are like, "What? Peck implants, bicep implants? Why don't you just work out or something like that. " Chin implant is also one of those that it's just, I mean, I think people just think that maybe it's excessive, but really when you look at the examples, it's not at all. It doesn't make people look artificial. In fact, if anything, if it's done properly and in the right patient, it just is a nice enhancing procedure. Kirstin (05:26): Yeah. The ones I've seen you do, like we spoke about already, their face just looks balanced. It looks natural, not like there's a big fat piece of chin in there. Dr. Koehler (05:36): Yeah. Well, it should be the kind of thing that if I showed an after picture to anybody and said, "Hey, can you guess what the ... " Not showing a before picture, but just say, "Oh, what do you think this person had done to their face?" I mean, it's probably not even going to make the top 10 of things that somebody might say they had done. So anyhow, should be a noticeable improvement, but not unnatural. Kirstin (06:02): What do they feel like to the patient once they're in, or once they're healed, what does the implant feel like? Dr. Koehler (06:10): Similar to any other implant, we tell people with breast implants, or I tell patients, I'm like, "It's probably not going to feel like it's part of your body for at least three months." So when you touch yourself, you're like, you know that there's something in there. Same thing with your chin. When you touch it, it feels like there's something weird inside of you, but there will come a point, and it's usually after a few months where it absolutely feels exactly like it belongs and it's part of you and it doesn't feel weird or unnatural. So that just takes time. And really as a doctor, when you feel people that have a chin implant, sometimes it's hard to, you're like, "Oh yeah, there is an implant in there because it just feels like the bone because it's right along the bone. And if it's a solid silicone implant, sometimes it's kind of like you have to really look and you're like, oh yeah, that's an implant." But that's probably the biggest thing. Kirstin (06:59): Well, that kind of answers my next question because I was going to ask if it feels weird or obvious once they're in, but you just said sometimes you can't even hardly tell. Dr. Koehler (07:08): Yeah, no, it definitely feels weird for a while and then it goes away. And the other thing that definitely we see, and I try to warn patients about it ahead of time, but their smile is going to look different right at first and how they speak or move their mouth initially is going to not seem normal. And that's just because we've lifted up the muscles to place the implant in. Things aren't working quite 100% normal. So it's like people who are close to them might notice it, but people who, like if you didn't see this person regularly, you might not notice a difference. But there's definitely a difference in the movement of the lips at first, and then that all goes away. Kirstin (07:50): If you've got a guy with clean, trimmed facial hair like Dr. Gardner, is that going to be somebody that's going to ask for a chin implant or is it going to make a difference? Dr. Koehler (07:59): Who are you talking about that's got clean, trimmed facial hair? Kirstin (08:02): This guy right here. Dr. Koehler (08:04): Hold on. I don't know. It's looking a little bushy to me really, honestly. I think you need to- Kirstin (08:10): It looks smooth. Dr. Koehler (08:12): All right. Kirstin (08:13): Camera illusion. Dr. Koehler (08:14): So what was your question? Sorry. Kirstin (08:16): If he's got facial hair, so is a chin implant going to make a difference for him? Dr. Koehler (08:20): Well, most people have facial hair to disguise their horribly weak chins. Not in my case. I don't, I did not. No, but a lot of people that do have goatees and stuff like that, a lot of times they do have weaker chins and that's one of the reasons they grow beards. It gives them the appearance of a stronger jawline. So yeah, a lot of times people like that, those guys, I mean, they may shave their face if they had that stronger looking chin. Kirstin (08:53): I do have to just comment that my husband has an amazing, really strong jaw and I do not like when he doesn't have facial hair. Keep the facial hair. Dr. Koehler (09:02): Yeah. That goes well. Anyhow. Kirstin (09:04): Okay. Dr. Koehler (09:05): It's in phases. Kirstin (09:06): How does a chin implant compare with jaw filler or chin filler? Dr. Koehler (09:14): Well, you know what I'm going to say about this, right? Kirstin (09:16): Let's talk about it. Dr. Koehler (09:16): Well, I think filler along the jawline is, I don't want to say stupid, but I don't recommend it. I'm not a fan of it. Not to say that you can't do it, and I'm not saying there isn't maybe a right reason to do it, but in general, my gut is just like ... First of all, so if you take a chin implant, and actually, I have some here that I show patients to look at before they get an actual implant, but the volume of that implant is ... I mean, they're not huge, but it's significant. Okay. One syringe of filler is one milliliter. So just to simulate what that chin implant is going to look like, you're probably going to have to inject several syringes of filler just to kind of simulate it what it looks like. And it's temporary. So I guess if a person wanted to just kind of know, "Well, maybe what would I look like if I had a more prominent chin? (10:14): Can we do that with filler?" Well, you can, but I don't think it simulates it exactly like an implant either because the implant is going to give more push than that filler will again. It's going to kind of spread out more and not give as much push. So I don't know. I'm just not a huge fan of filler in the jawline. I don't think that it does very much. And in order to get a result, you probably have to inject a lot of filler to make it to where you actually can see a significant difference. And I just, I don't know. I personally think if you really want that, there's surgical things that can be done to improve it. I would not waste my money on filler. That's just me. Kirstin (10:55): If somebody's had filler, can you then turn around and put a chin implant in? Dr. Koehler (11:00): You can, but you might have to go and dissolve it beforehand so that you can at least get the right size chin implant because if you put in the wrong size and then the filler, I don't know how much filler was in there and then it goes away and now all of a sudden, oh, it's not a big enough implant. So first thing would be to reverse filler if you have it. So definitely let your doctor know that you have filler because they'll want to reverse that ahead of time. And then, yeah, but you can put an implant in. It's not a problem. I mean, it doesn't prevent you from being able to put an implant in. Kirstin (11:32): How about recovery? Dr. Koehler (11:34): The recovery's really not that bad. I mean, in a week, you might have bruising, but nowadays, the way we do things, I mean, most people hardly even have any bruising. So it's going to be swollen. And like I said, you might feel like your smile isn't 100% right or whatever, but you could be back in public for sure in a week. There's no reason why you couldn't be out doing whatever. Kirstin (11:56): Do you have a favorite chin augmentation story? Dr. Koehler (12:00): There is a case that I did that was very rewarding only because like this lady already had a chin implant. It had displaced significantly and it made her face look really long. And anyhow, it didn't look right. But I went in there and it was rather challenging to get everything the way I wanted it. But in the end, it was very rewarding because she really did need a chin. It's just the chin implant that she had was facing the exact opposite direction. It was pointing down and anyhow, needed to be repositioned significantly. Dr. Gardner (12:34): That brings up a good point. Can you talk about the different types of chin implants and which ones you prefer? Dr. Koehler (12:40): I like to use the solid silicone implants. They make some that are Gore-Tex and there's other materials too that are used more solid and porous materials. But solid silicone is the best in my opinion for chin implants because you don't get soft tissue ingrowth, whereas like Gore-Tex you would and some of these other materials, you'll get soft tissue ingrowth, which is fine and it makes the implant very stable. But if you ever decided you wanted to remove it, it becomes a real difficult job to remove it if there's soft tissue ingrowth. Whereas silicone, you could put that implant in. And if you came back two years later and you said, "You know what? I don't really want an implant. Can you take it out? " No problem. Make an incision, get in there. You could pull that implant out and it surgically would not be traumatizing to the patient. (13:30): It comes out easily. And if an implant was ever to get, let's say infected or like early on in the healing, let's say they got a little superficial skin infection or something like that. The good thing about being a solid silicone implant is it's much less likely for the implant itself to get infected, but porous implants or any device that's got pores to it, if bacteria gets in there, you're not going to get rid of that. You'll have to replace the implant. And sometimes with silicone implants, there's a little bit of grace there. If somebody does have a little superficial infection, you can nurse it along, give them some antibiotics, and yeah, it'll all be fine. So my favorite for facial implants is solid silicone. And then there's some different varieties. They come in different shapes. So if you like a more of a square chin, you can do that. (14:22): And there's also some that are a little more moldable, like they conform a little better to the jawline. Kirstin (14:30): Okay. I have two questions. First question. When you say Gore-Tex, like the boots that Dr. Gardner's wearing in the woods, Gore-Tex? Dr. Koehler (14:38): Yeah, not from his boots, but yes, from the same ... Yeah, it's a Gore-Tex- Kirstin (14:44): Same material? Dr. Koehler (14:45): Yeah. Kirstin (14:45): Huh, cool. Okay. Second, do people come in and try on chins like they try on poops, or do you just decide what shape fits them the best? Dr. Koehler (14:56): It's a discussion. We talk about what shape we're going for. And I'm typically just using the standard type of ... I'm not using these wild shapes. Most people are not going for any ... They're just looking for more projections. So there's a couple different implant styles that I like, and then we talk about the size and what the goal is. And then at surgery, we'll try on ... We have little sizers that we can put in to kind of go, let's see how this looks. And if it doesn't look big enough, we can put a bigger one in. So we have sizers that we can use, but most of it just comes from the conversation with the patient. Unfortunately, you can try to simulate it, but the simulations are not accurate. So unfortunately, you can see what you would look like with an implant, like if you had more chin, but to be able to be accurate enough to say, "Okay, image me with this size implant and then do this size." We just don't have that ability. Kirstin (15:54): Okay. You got any follow-up questions, Dr. Gardner? Dr. Gardner (15:58): Interestingly, used to, they had a button type. Have you ever had to take any of those old button? Dr. Koehler (16:06): Yeah. Okay. So now that you're jogging my memory here about some interesting stories. So I will tell ... Yeah, so the old button implant, which was just a little right in the front of the chin type of thing. The problem with those implants, well, one, a lot of times back then nobody was securing the implants, so they were just stuck in a little pocket and left there. And that micro movement that can occur if an implant is not in a secure pocket, that can cause bone resorption underneath the implant or it can just result in displacement of the implant. But that was the problem with those button implants is that they would create pressure on the anterior part of the chin, and so you'd get bone resorption. And so the newer implants wrap around the jawline, so they kind of go from here to here kind of thing. (16:55): They just go right around the corner. And the analogy is like sleeping on a bed of nails versus a nail. That button implant has all the pressure concentrated right at the front of your chin. And there's a lot of force in a small area whereas the newer implants, the force is distributed a little bit more evenly across the entire implant. And so the thought is that you're going to get less resorption of the bone over time with an implant like these newer implants. I did do a case back probably, it would have been early 2000. I remember I had this patient that had this osteolytic lesion of their mandible. And anyhow, I went in there and it was an old ... It was a Marlex mesh that somebody had rolled up and just stuffed in along the jawline as an implant. And it had created this major resorption of the whole jawbone. (17:56): And I had to cut all that out and anyhow, bone graft it. And anyhow, it was a fun, interesting case. But yeah, so generally implants are really very safe, especially these newer implants. I think they're very ... I mean, can they have problems? I mean, all devices potentially can, but chin implants are pretty low risk and the newer implants are nice. And some of these problems, like I mentioned about bone resorption, I mean, can that happen? Sure, but typically not to any great extent. Kirstin (18:27): Okay. So we learned number one, keep the beard. Dr. Koehler (18:32): Yeah. Keep the beard, especially if you have a weak chin. Don't shave the beard or come see me for a chin implant and then you can have a even better beard. Kirstin (18:42): Yes, a better beard. Okay. All right. Do you have a burning question per Dr. Koehler, Dr. Gardner, or me? Leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. All right, doctors, go back to making Alabama beautiful. Dr. Koehler (18:59): All right, thanks Kirstin. Dr. Gardner (19:00): Thanks. Announcer (19:02): Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternshoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.