Background: Silicone chin augmentation remains a popular treatment for microgenia because its placement appears deceptively simple. However, when extrusion, displacement, capsular contracture following implant removal, overaugmentation, or malposition occurs, a revision operation may be required. Secondary chin surgery is challenging because (1) implant removal alone may produce a disfigured chin; and (2) placement of a new implant in an oversized misshapen pocket demands precision, control, and reliability. Methods: The textured implant may be placed by means of an intraoral or extraoral route. The extraoral route is usually chosen except when transoral procedures (e.g., mentalis suspension) are required. The superior 30 to 50 percent of a standard textured implant is always removed and then tapered anteriorly at a 45-degree angle to reduce its sharp front edge. The lateral wings are also reduced and tapered. Two pilot holes are drilled in each half of the implant and then it is divided in the midline. Each half is inserted and secured individually. The medial screw is placed first and nearly fully tightened. Then, holding the implant exactly along the inferior border of the mandible, the distal screw is placed and both screws are tightened completely. The lower border of the implant should be exactly along the lower border of the mandible. The soft tissues are closed in three layers over a drain. Results: This technique has been used to treat more than 100 patients. Selected photographs illustrate this technique. Conclusion: This article explains how to place a textured implant efficiently and effectively under light premedication and local anesthesia.
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