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Feretti2011 10-07-2010 08:38 PM

Chin implant: screws vs. no screws & possible rhinoplasty combo
Hi everyone! I'm new here, and am a 27 year old female in Los Angeles. I have always been unhappy with my profile, and always particularly noticed how recessed my chin was. I always knew that at some point I would bite the bullet and get a chin implant, but waited it out for a few things: 1) i had other medical problems to deal with first (i had heart surgery in february), 2) figuring out which implant method would be the best for my case, and 3) getting up the nerve!!

Well I have a clean bill of health now & clearance for cosmetic procedures from my cardiac team, and after enduring open heart surgery, I now have the nerve for anything! So that just leaves me with deciding on an implant method and choosing a surgeon.

Here is my main concern: I am young and would need this implant to remain well for (hopefully) a long time to come. I have heard much about bone resorption and shifting over time, and would like to avoid these. I would like to do this procedure once and do it right. I read that the only way to avoid these issues is to fixate the implant with screws, yet haven't found a dr. who actually does it this way--everyone keeps insisting the un-fixated method is just as sturdy and fine. What are your thoughts on this & do you have any recommendations for a good surgeon for this?

My secondary issue is deciding whether to opt for a rhinoplasty as well. I am generally ok with the size and shape of my nose, except that it is bulbous at the tip and would just like to look a bit more refined. The two surgeons I have consulted with so far have agreed with this.

So far, I have had consults with two local surgeons: Dr. Kotler and Dr. Kanodia. Here are my thoughts on each, although I do not personally know anyone who has been a patient of either. Dr. Kanodia: Not the warmest guy, but I like his philosophy that a nose should never look perfect or touched, and his conservative approach--I wouldn't even want to tell anyone that I had my nose worked on if I thought I could get away with it. His samples do not look "nose jobby". So I liked his noses, but he said he is not that experienced with chins but can do it if i want. Not sure if this is a factor, but also he works with an anesthetist, not an MD. Even with clearance letters and OP reports from my entire cardiac team, he came back and told me he would need me off my aspirin regimen for 1 whole month before he would touch my nose and he spoke with my cardiologist about it who denied that request and said 1 week maximum. I've had oral surgery off aspirin for 5 days, and even for open heart surgery they only took me off for 5 days. So I'm not sure why he said that and denied my case...liability maybe? Too bad, because I really like his approach. So I went to see Dr. Kotler: I really liked him as a person, but his nose work did not impress me. Even though he claimed his approach is natural and conservative, it still looked "done" to me. His chins looked good but he said he's never used screws, and insisted they are not necessary for an optimal outcome long-term. He uses an MD anesthesiologist for the surgery, and said that he would only need me off my aspirin for 5-7 days. When I mentioned that Kanodia wanted 30 days, he was very confused as well.

So I'm on a time crunch, and not sure what to do... What do you think about the chin screws vs no screws? Any recommendations for surgeons for chin and/or nose? Would it be ridiculous to go to one for the chin, and then another for the nose? Here are some pics from my computer imaging session at Kotler's to help you visualize my situation:

The first is me currently, the middle is chin only, and third is chin/nose combo:

Any input is greatly appreciated!!! :o

AverageGuy 10-08-2010 08:43 PM


I also am getting both Rhino and Chin implant in February.

I've done my fair share of research and I haven't came across any surgeons that use screws. It appears that depending on the type of material the implant is made of it will mend with the tissue and bone.. I believe that's the porous type of implant, not the silicone type. I've done some research at where there are surgeons who answer questions and from what I gather you don't really have to worry about bone erosion if anything I believe it is very minimal at best.Once the implant heals after surgery there's no need to really worry about shifting, I've looked into this and surgeos agree that it would take quite a force to move the implant.. My surgeon said he's never had any problems with shifting or infection. But you should do some more research so that you know all your options and make a decision your comfortable with.

As far as the Rhinoplasty I think your right, you could probably use some definition in your tip.. but to be honest your nose isn't all that bad.

And for the altered images you posted, I do like the third one best with the Rhino and chin implant..

Hope this is of some help to you..

Feretti2011 10-08-2010 09:20 PM

Hi AverageGuy & thank you for your input!

I'm not sure where abouts you are located, but it's interesting to know that we've had the same experience regarding not encountering any surgeons who actually put the screw method in practice. I am considering the solid silicone implant, which although the surgeons I've consulted with have also said would take a major force to shift, is still not quite as secured as the porous implants--which type are you going with?

On the topic of screws though, here's an interesting article I found: Chin Surgery | Cosmetic Facial Plastic Surgery Richmond, VA

Regarding my imaging, I agree with you that I definitely do like the combo pic best. The only thing that makes me nervous is that, in my own opinion, I feel that tip work is a more difficult task than just shaving down a bump or something like that. Perhaps I'm wrong, but my logic tells me that, for example, when a bump is shaved down it's pretty basic. But forming the tip just seems riskier to me, since it's a matter of removing such tiiiny pieces of cartilege plus the fact that it's not immediately obvious how your cartilege & skin will settle over it...that could take up to a year. You're right, I don't think my nose is all THAT bad...I've definitely seen worse...just not as refined as I would like.

I appreciate your opinions. Do you have any imaging of yourself that you would like to share? When are you having your procedure?

JonathanA 10-08-2010 09:21 PM


Originally Posted by AverageGuy (Post 9209)
Once the implant heals after surgery there's no need to really worry about shifting, I've looked into this and surgeos agree that it would take quite a force to move the implant..

This isn't necessarily true. Mine shifted after almost seven years. It's rare, but it CAN happen and is something you should be aware of.


Feretti2011 10-08-2010 09:25 PM

Hi Jon! Did any event occure which caused your implant to shift, or it just happened all on its own? And what did you have to do to fix it?

I also have been told that an aquaintance who had a chin implant about a year ago has already had shifting, although I don't know any further details...

Grrr, what to do!??

AverageGuy 10-09-2010 07:24 AM

I'm located far east South of Boston and my surgeon is in New York.. My surgeon uses the silicone implant which seems to be the most popular from what I've seen. Mainly because with the porous implant because the tissue and bone attach to the implant if it ever needs to be removed I hear it can be quite difficult.. this is from what I gathered with my own research.

As far as the rhino I think just about any fairly skilled surgeon can shave down a bump.. but yeah from what I've seen tip work is more difficult.. be careful in choosing your surgeon.

Here, follow this link this is a before and after from a patient of the surgeon who will be doing my surgery. All I Can Say Is....AMAZING!!! - Rhinoplasty review - RealSelf

So it seems Jon had a rare case of shifting.. but overall there are risks involved with any surgery and I dont think there is any 100% guarantees.. you have to weight the risks with your need/want ..

la_angel 10-10-2010 02:30 PM

Were those morphs done by you or the doctors during your consults? I love the combination (last set) but in your situation I would be worried about needing a revision rhinoplasty (that is somewhat common for tip reduction, unfortunately). Do you mind me asking what your cardiac problem is? For a 27 year old to undergo open heart surgery it must be something serious :( I would just hate to see you do something that would endanger your life for cosmetic reasons. A silicone chin implant is an easy procedure from what I hear, but like I said the rhinoplasty may open up a whole can of worms (more general anesthesia and for a longer time) if a revision is needed.

JonathanA 10-10-2010 03:23 PM

Feretti -

No - there was no direct trauma to the area; it just happened. From what I've been told, this is very rare. In fact, it had been so many years that I had virtually forgotten that I had an implant!

I haven't had it fixed yet. I plan on having surgery in December. As of now, there is intermittent pain and numbness. Nothing terrible, but certainly uncomfortable.

Good luck with whatever you decide.


Feretti2011 10-10-2010 10:25 PM

Hi everyone! Sorry for the delayed response, busy day...

AverageGuy- your surgeons work on that link looks amazing!!! and I am PICKY, haha! I am excited for your results, it looks like you are in excellent hands :)

la_angel- i don't mind at all! i had a successful mitral valve repair in february, and both my cardiac surgeon & cardiologist gave me clearance for these cosmetic procedures with only specific antibiotic provisions for the anesthesiologist, and have provided clearance letters and a full op report for their review. i would never risk my health for cosmetic purposes and my doctors wouldn't allow me to either--but they said i'm good to go. i agree with you that the chin seems simpler, and as you said, am more nervous about finding someone who does amazing tip work. why is it that many people undergo revisions for their tip work? also, I discovered Dr. Frankel today via this site and his b/a pics look great--any opinions on him?

Jon- thanks for your info & good luck with your surgery! it's also great to hear that with time your implant felt so natural.

robyne00 10-11-2010 08:42 AM


Not to focus on your cardiac health, but did you have a repair done due to mitral valve prolapse? If so, this is a common issue, and as long as you have medical clearance I would not worry. Mitral valve prolapse does not usually occur in people in your age group, however, I personally know the youngest recipient of this procedure, as he is one of my better half's brothers. He was much younger than you when he had this procedure in it's formative years, and unfortunately, had to have two additional procedures by age 23. :(

Anyway, I definitely like the last set of pics. The combination looks excellent together. Really creates a great overall balance for your face, and puts everything in proportionate perspective. la_angel is right, as you might need a revision rhinoplasty, but you can take that as it comes. I will PM you today, as per your request. I apologize for the delay, and I thank you for your patience.

I definitely like the link that AverageGuy posted. Looks like some good as well as reputable work.

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