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The mesh implant is just another form of chin augmentation. Its my preferred method but its a chin implant. The sulcus is independent of the type of material. It has to do more with the patient's anatomy and the size of the implant or degree of augmentation. Some patients with a deep sulcus will not tolerate much additional projection, in order to avoid a pointy or witches chin appearance, regardless of how much projection they may need.
Porex and mersilene mesh are very different materials. Its hard to explain without seeing it. Porex is pre made like silastic or gortex. Mesh is a permanent soft "cheese cloth" like material that I stack into the desired thickness and cut into the desired shape.
Any trauma to any implant may cause infection or shifting. Shifting is not much of an issue with mersilene mesh.
My suggestion is to avoid punches to your face regardless of having an implant or not!
It has the same rate of infection. It has a lower to almost no risk of bone resorption since it is not hard and yes it can be shaped in different ways although if you want to add width to the chin the best bet is to use pre-made implants which have lateral extensions.
I had a medium silicone implant placed through a chin incision a couple years ago. I haven't had any complications, but the implant is too small. Would it be possible to replace it with a larger mersilene implant? I probably don't need more than an additional 4mm augmentation. Also, can the implant be placed through an incision in the mouth (even though the silicone implant was placed from under the chin)? I'm in the process of making a career change to a profession where people will be able to view the underside of my chin. Since it took over a year for my chin scar to heal to the point where it's no longer red, I'd like to avoid a repeat of that process. If I come see you, how long would I need to stay in the area for? Finally, can you give me an idea of what you charge for this procedure, including surgery fee, anesthesia, OR fee, etc...?
1) not sure its a good idea to mess with something thats pretty good. Enemy of good is better in many situations. you may get a bigger implant but then it may get infected. Think is just a few more millimeters is worth the added risk
2) if you are happy with what you have but want slightly bigger then you should find out exactly what you have (part number and all) and then see what other implants you can get that are precisely bigger in the way you want it to be. Its impossible to get it perfectly right any other way because we cannot plan for what you need until we remove what you have and with the intra-op swelling, you may end up with another implant thats pretty much the same size if its not planned well ahead of time
also dr naderi do you fixate the mersilene mesh implant? is it with permanent sutures or removeable sutures? if so how long are the sutures kept in? also when does the main risk of shifting or infection go away? like at what stage does the mersilene mesh incorporate also after implantation are patients never aloud to sleep on face again? ttyl thanks
I place only one absorbable suture from the middle of the implant to the periosteum and thats all that is needed. This implant is practically impossible to shift or move. But any implant has a risk of infection and that risk never goes to zero.
thanks dr naderi also my surgery is on Tuesday my plastic surgeon is using iv sedation and doing a external incision he's using the mersilene mesh he prescribed me apo-cephalexin 500 mg to take for 7 days 3 times a day and polysporin ointment with gauze. im just wondering in all the mersilene implants you've done how many infections have you seen? did you use external incision? i know you said risk of infection is always there but how long after surgery is it safe to think that the infection is not there and have peace of mind? also how many infections did you find long-term like after a longer period of time and what can you recommend i do to prevent infection? and last question when is it safe to sleep on side of face? ttyl thanks alot dr naderi sorry for all the questions i'll relist them below so its easier to see them.
-in all the mersilene implants you've done how many infections have you seen?
- did you use external incision?
- how long after surgery is it safe to think that the infection is not there and have peace of mind?
-how many infections did you find long-term like after a longer period of time and what can you recommend i do to prevent infection?
-last question when is it safe to sleep on side of face?
The infection rate is roughly around 1-3% but all chin implant material have roughly the same infection rates. I just prefer the mersilene mesh for its natural contour and natural feel and look. Doing an incision under the chin keeps the infection rate lower theoretically as opposed to from inside the mouth but I use both types of incisions depending on the patient. The highest risk of infection is in the first few weeks after surgery but you are right, they can get infected at anytime, usually due to dental issues. Mersilene mesh has a very low risk of shifting so sleeping on the side of the face within a week or two is more than enough time.
The problem with Mersilene mesh is that its harder to remove than silicone but not harder than medpore.
thanks dr naderi for the help so say everthings fine but down the road i get a dental infection is that what causes the late infection? also from the external route how many infections have you seen short term and long term infection? and lastly how many infected implants required removal?....sorry for all the questions i know your very busy ttyl thanks again for taking the time to come on the forum boards. (i'll re-list questions below)
-so say everthings fine but down the road i get a dental infection is that what causes the late infection?
-also from the external route how many infections have you seen short term and long term infection?
-Have you ever had permanent numbness from the implant?
-and lastly how many infected implants required removal?
Late infections are probably caused by bacteria in the blood or from direct spread from a tooth abscess but anything can cause it such as trauma to the jaw.
I have seen infections from both routes. Not sure how many. Not that many. Infections that occur later on can be sometimes salvaged with long term antibiotics. More accute infections and more aggressive ones require implant removal.
If you are nervous then just dont do it. No one "needs" a chin implant. Its not like needing a new heart or liver. But if you want it, then you have to accept the slight risk.
I received a mesh chin implant in 1997. Over the years, it has become more prominent, and "witch-like". It is somewhat asymmetrical and a groove is vislble at either lateral end, where it meets my own anatomy. I have been told that revision or replacement is not advised, as it could result in an even worse outcome. One physician recommended Radiesse to minimize the disconnect between the implant and my jaw. Have you had experience with this? What other alternatives are there?
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