Q: Dr. Eppley, You suggested 10mm of vertical projection for both my jaw and chin. However, when I measured my face with a ruler, I determined that in order to achieve the 1/3 1/3 1/3 ratio, I would need between 15-20mm vertical lengthening. I am hoping we can design a chin implant that has close to 15mm of vertical length. In my experience am more worried about undershooting than overshooting. Is a 15mm vertical chin possible? If so, does it carry increased risk?
2) Can we use computer imaging to figure out the ideal dimensions? My left jaw projects significantly more than my right jaw.
3) With a custom 3-piece chin + jaw set that includes both vertical and horizontal projection, will there be a smooth transition in the space between the chin and jaw(body)
4) In terms of safety, what is the difference between my current Medpor implants and silicone? I heard that silicone breast implants may rupture.
5) Can silicone be flexibly shaped to my jaw contour using hot sterile saline the way Medpor can? And if so, would that mean that the easiest approach is to use a previous patient’s custom implants, and skip the CT scan?
6) How much vertical lengthening do my 7mm Mandibular Matrix jaw and chin implants already have? I can’t find the vertical jaw dimension online.
7) Since my current Medpor implants have been screwed in, how will you remove them? Do you “unscrew” them? I believe there are two screws anchoring each one of the pieces.
8) How many custom combined jaw+chin procedures have you done in the past? Are you the only one who does this?
A: In answer to your questions:
1) The vertical length of the jaw angles can be lengthened in the range of 15 to 20mms. The chin can not be done as much because of the lack of adequate soft tissue to recruit for coverage. A more realistic lengthening in 8 to 10 mms.
2) 2) Computer imaging is great to provide a general concept or trend but it would not be an accurate way to determine the desired millimeters of change. Unless the picture is taken so that the computer recognizes its size, it can not be used for estimating exact changes.
3) One of the main purposes of a custom 3-piece jawline implant system is to have a smooth transition between the chin and the jaw angles.
4) There is no danger is using silicone as a
facial implant material. It is a solid material unlike silicone breast implants. I ma not sure where you would get the concept that a silicone facial implant would rupture.
5) Silicone always adapts better to the bone than medpor. Medpor is a very stiff material that is minimally adaptable using ‘hot water’. This is not necessary with a silicone material.
6) It is impossible for me to say how much vertical lengthening your current implants provide since that is highly influenced by how they were placed in addition to their design.
7) Your current implants have to be unscrewed…that is the easy part in trying to remove them.
8) I have been making custom facial implants for 20 years. I can’t speak for who else may use this approach around the world.
Dr. Barry Eppley