Are My Custom Jaw Angle Implants Too Big?:

Q: Dr. Eppley, I just had customized jaw angle implants done one week ago. I suspect the result will not be of my liking. I wanted a wider jaw from the front (along with more defined angular jawline from the sides), and to enhance a more “broad like” or harmonic jawline that has a smoother transition from the chin to the ramus. My chin is small and pointy so the transition in between the jaw angles and chin (ramus) was not smooth and harmonic, and that gave me a non aesthetic appearance. When I asked them for a wider jaw, I insisted that I will like the implants to reach my chin so that it will be balanced, but after the intervention, my face looks like a hamster (I red your page though about how the first week looks disproportionate and should wait more weeks) but my fears are the following: 1. The jaw angles now looks massively wider in comparison to my chin which is very thin, so the look is not harmonic. 2. There is no smooth and aesthetic transition between the jaw angles and the chin! 3. My jaw angles  don’t look “defined”. They are bulky, round and doesn’t add up definition and “angle-ness”to my jaw angles, so it just looks bigger, but not aesthetically sharp like a model.They are custom PEEKk material and now I’m scared as they’re harder to remove later. I am scared this is somewhat what the result might end up looking like.Thank you for your response in advance.

A:As you have noted in your inquiry, you are absolutely correct, it is impossible to know what your results will really be at 10 days after surgery. At this early postoperative time period you have less than 50% of the swelling that has gone down and it will take six weeks to see what the 90% reduction in swelling will be. This does not even account for the shrink wrap affect which causes further size reduction over the following 2 to 3 months. Many patients freak out at 7 to 10 days after surgery because there is no way to prepare someone for the massive swelling that will occur particularly in the jaw angle area.

Therefore it is important that you give the postoperative process 6 to 8 weeks before even making a preliminary judgment about the result. There should be no concerns about tissue ingrowth into PEEK implants as that simply does not occur no matter how it is touted. I have removed many PEEK implants and I find their removals to be very similar to that of silicone material with little to no tissue ingrowth or adhesion.

With the fear of secondary removal being more difficult later eliminated it is in your best interest to let the recovery process evolve and wait to see what the real result is. Even if you knew right now that they were too big and absolutely needed to be replaced that simply would not happen in the first 6 to 8 weeks after surgery as the tissues have not properly healed. Reopening incisions before proper healing has occurred will result in secondary wound breakdown and implant exposure and infection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon