Q: Dr. Eppley, I would like to inquire about scar revision in chin implant revision problems. I’ve had multiple unsuccessful Medpor chin implant surgery from the intraoral incision. Now it’s almost a one-year postop, and I have scar contracture both mucosa and under the skin.
Basically, the web banding inside the month feels very uncomfortable/stretching. The scar tissue (capsule) between the skin and the implant feels very thick, thus making the skin less pliable, which is especially evident when I make facial expressions.
Though I know each surgery is invasive and creates scar — is there any way to revise the scarring issue? Is that possible to release the intraoral mucosa scar (sth like z-plasty/v-y closure), excise the capsule, and change for a sliding genioplasty (which eliminates the recurrence of thick capsule)?
I’m a little confused, as I heard some surgeons said the new scar will always tighten after any surgery, and some surgeons said it’s not hard to revise the scar/excise the scar and make them feel comfortable. I would like to hear your opinion since you’re considered an expert in chin revision surgery. Will the scar revision surgery make things worse? Thanks, and I’m looking forward to hearing from you.
A: When you have scar contracture, tightness, fixed immobility and otherwise chronic discomfort, you are not going to improve the problem by shifting or rearranging the scarred tissues by any scar revision technique. The problem is lack of good tissue quality AND quantity. You have to add back new unscarred tissue into the chin implant revision surgery after release and/or excision of scar tissue. This is basic plastic surgery 101. Whether that is done by injectable fat grafting or the open placement of en bloc solid fat graft can be debated but the key is tissue recruitment. Every surgery does create scar tissue but it can also add new tissue as well.
Whether this should be done with the existing chin implant in place or removed and replaced with a sliding genioplasty depends on other factors not yet known to me.
Dr. Barry Eppley