For decades, bone resorption has been the usual suspect when post-op imaging reveals changes beneath silicone chin implants. But a recent case-driven review by Madorsky and Meltzer calls into question much of that dogma. Instead of simply eroding bone, silicone implants may be igniting a more complex interplay between periosteal behavior, implant pressure, and bone remodeling — where neo-ossification may be just as common, if not more so, than resorption. Here’s what every aesthetic surgeon dealing in chin augmentation needs to understand about what’s really happening under the surface.
What You Thought Was Resorption … Might Be New Bone
The foundational idea of this study is that many cases interpreted as bone loss may actually be spur-like bone formation, or neo-ossification, triggered by subperiosteal dissection. The authors present a compelling case of a 61-year-old woman who, a decade post-implantation, developed an ossified shelf encapsulating the implant superiorly. Imaging suggested asymmetry and swelling, but surgery revealed the culprit: bone growing over the implant, not under it.
This pattern isn’t isolated. Historical radiographs cited in the literature showed similar “erosive” appearances but failed to consider the three-dimensional behavior of the periosteum. It’s possible we’ve been mistaking a valley bordered by bony spurs for resorption all along.
Periosteum in Overdrive
Periosteal elevation is the real driver behind many of the bony changes seen with silicone chin implants. When elevated, particularly with subperiosteal dissection, the periosteum’s inner cambium layer, rich in osteoprogenitor cells, initiates osteogenesis, a response well-documented in both facial plastic and dental implant literature. The implant itself can act as a physical barrier, directing this new bone growth to the periphery, often resulting in asymmetric shelfing or even entrapment of the implant.
Once trapped, the implant may exert mechanical pressure on surrounding bone, especially along the inferior mandible or near the mental foramen, potentially leading to localized resorption. However, this resorption is a secondary effect, not a primary flaw of the implant material. What’s often interpreted radiographically as erosion may, in reality, be the illusion created by surrounding bone overgrowth, not true central bone loss.
Surgical Technique Matters More Than Ever
Madorsky and Meltzer propose a shift in how we think about placement planes. Instead of full subperiosteal dissection, consider a hybrid approach: lateral subperiosteal release with central periosteal sparing. This could limit osteogenesis at the superior margin while maintaining implant stability.
Surgical approach plays a role in how periosteum is elevated. The study suggests that transoral incisions, particularly from superior positions, may leave the inferior periosteum intact and unlifted. This uneven elevation may lead to asymmetric bone remodeling, with new bone forming along the inferior border where tension and vascularized periosteum remain intact. This pattern of selective dissection may explain why inferior bony spurs appear so frequently in these cases.
For those concerned about infection or implant mobility, wide periosteal release remains an option, but expect more bone response.
Biomaterials Could Tip the Balance
Silicone’s biocompatibility is undisputed, but its smooth surface and mechanical stiffness make it a poor partner in regions of dynamic bone remodeling. The authors point toward porous polyethylene or expanded PTFE as alternative materials. These allow for tissue ingrowth, potentially dissipating stress at the bone interface and reducing entrapment risk. By promoting integration instead of resisting it, porous implants may mitigate both spur formation and secondary pressure resorption.
The Bottom Line: Don’t Just Blame the Implant
This article reframes how surgeons should interpret long-term outcomes from chin augmentation. Bone changes post-implantation are not a binary story of resorption vs. stability. They’re an evolving, nuanced interplay of surgical technique, periosteal biology, and material science. If you’re seeing radiographic changes in long-term implant patients, try looking beyond the shadows. It might not be what’s gone; it might be what’s grown.
The bottom line here for savvy surgeons:
- Don’t assume all radiographic “loss” is resorption. Consider neo-ossification.
- Periosteal elevation is a trigger. Use it selectively.
- Tight implant entrapment = higher risk of pressure erosion.
- Modify dissection planes to reduce unintended osteogenesis.
- Consider porous alternatives to silicone in high-risk zones.
Just remember: Bone is living tissue, and thus reacts. What you do during dissection determines how.
SOURCES: Plastic and Reconstructive Surgery
This piece is intended for informational purposes only and does not constitute medical or professional advice. The information provided is based on current medical literature and expert opinions, but individual patient outcomes may vary. Surgical procedures, including silicone chin implantation, carry inherent risks and complications. It is essential to consult with a qualified and board-certified plastic surgeon to discuss any specific medical needs and determine the most appropriate treatment plan. The content of this blog should not be used as a substitute for professional medical advice, diagnosis, or treatment.
