Can I Have A Custom Midface Implants If I Have Had Maxillary Skeletal Expansion In The Past?

Q: Dr. Eppley, I had a couple specific questions regarding custom silicone midface implants (covering the front part of the zygoma as well as the arch up to the temporal bone and the infra orbital rim) and genioplasty 

1.) Would there be any issue on your end with performing the implants on a patient who has had MSE in the past? (maxillary skeletal expander). I ask because the way in which the bizygomatic width increases after this procedure (multiple studies confirm it does) is still unclear to me. If the frontozygomatic sutures are loosened I can imagine some sort of extra width possible without compromising the height or at least the perceived height of the cheekbone. Otherwise, if its fully from a sort of rotation where the arches are angled outward, wouldnt the cheekbones appear lower set post op since the area of the zygomatic arch that protrudes laterally the most would now be lower than pre mse? If this is the case, could you place implants to make the upper-most part of the arch the widest again and resolve this? Would getting both mse and custom implants on the zygomatic arches be redundant then, strictly from an aesthetic vantage point (as opposed to sarpe in lieu of mse and then implants at a later date)? 

2.) Can a genioplasty be performed such so that the chin travels along the occlusal plane, eliminating unsightly step off points and increasing vertical height as well as anterior projection ?? (I imagine if such a thing is done, the chin is simply mobilized and fully removed from the mandible and re positioned, then new bone fills in or if the movement was large enough to necessitate this, a graft is used as a buttress). 

Thank you very much for the help and Id like to extend my thanks for the entirety of your blog, its very helpful to be able to read succinct snippets of your insight and send inquires to such an authority within the field in a colloquial manner. 

A: In answer to your questions:

1) Regardless of what type of maxillary expansion you may have had your frontozygomatic sutures are not ‘loose’ or have been loosed in so doing. Any discussion about your facial skeletal form at any level can not be done on an informed basis without the knowledge of your bony anatomy from a 3D CT scan.

2) While the chin bone can be moved in any direction some bony irregularities along the inferior border and in the convex shape of the anterior chin surface are inevitable. The magnitude of them depends of type of chin movements done.

Dr. Barry Eppley

Indianapolis, Indiana