Can My Extruding Jaw Angle Implants Be Revised?
Q: Dr. Eppley, I had silicone chin, cheek and jaw implants placed.Within a month, the jaw implants and the chin implant had shifted. The right jaw angle implant actually shifted through the incision into my mouth.The doctor repositioned both implants in a revision surgery. I asked him about fixating the implants with screws, but he insisted that a stay suture would hold them. Despite the stay suture, this time the left implant shifted — through the incision and into my mouth. The right implant seemed to be fine. In a third surgery, the doctor repositioned the left implant, with a stay suture again. Lo and behold, I discovered this afternoon that the right jaw angle implant has again shifted through the incision. A tiny sliver of it is poking through sutures which I thought would have dissolved by now, but which have not. I would like to have both implants repositioned and fixed with a screw. Can you do this type of revision?
A: Thank you for sharing your story. I am very familiar with why you have had recurring problems and it is not a mystery as you undoubtably know. Smooth silicone jaw angle implants are easy to put in which is why many surgeons use them. But unless they are positioned properly down at the inferior border of the mandible and secured there by a screw, there is always the risk of extrusion. While many such placed silicone jaw angle implants do not migrate and extrude, it is not rare when it happens. I have seen numerous patients just in the past few years who have had an identical problem. I experienced it myself when I placed my first set of silicone jaw angle implants over ten years ago…and vowed never to go through the endless revisions again which always ended up with recurrent extrusion. There is nothing wrong with silicone jaw angle implants, and placing a screw in them is not easy, but the avoidance of an extrusion risk is well worth it.
Given that you may not have the opportunity to revise your jaw angle implants for months, I would strongly advise getting them out so the open wounds can heal. These openings cause the posterior mandibular vestibule to deepen and make less tissue available for a competent closure over any new implants that are placed which increases the infection risk in replacement surgery. This also allows the incision edges to heal and hold sutures better down the road.
Dr. Barry Eppley