Can Hydroxyapatite Paste Be Added To A Jaw Angle Augmentation Previously Done Using Hydroxyapatite Paste?

Q: Dr. Eppley, I had a sliding genioplasty five years ago and hydroxyapatite paste added to the jaw angles. However, the HA paste is VERY uneven and one side is rounded and the other more angular. I tried to have it removed but the surgeon was unable to remove it since it had integrated too much into my tissues. Could a small amount of HA paste be added to even it out? Ive tried fillers like Juvederm and Volux (designed for chin and jaw augmentation) and Radiesse in the past but they are still too soft to emulate bone and end up looking puffy after a few weeks.

A: You have encountered exactly what one would expect with using HA paste in the jaw angle areas…asymmetry and irregularities. It is hard enough to place preformed implants into the correct position over the jaw angle area let alone an amorphous paste.

I am not sure why the combined material/bone can not be removed despite having some bony integration which is exactly what one would expect to happen in a subperiosteal pocket with a thick overlying muscle layer. (it is a highly osteogenic site)  It is not easy but that should not be confused with can’t be done. But that issue aside secondary HA augmentation can be done. The relevant question is how much volume and where should it go….an imprecise secondary procedure for sure.

Dr. Barry Eppley

Indianapolis, Indiana