Can The Plates and Screws and Hydroxyapatite Granules Be Removed After A LeFort I Osteotomy Surgery?

Q: Dr. Eppley ,I am writing to you because 3 years ago I had Lefort 1, BSSO and a cheekbone augmentation with hydroxyapatite granules.

Since this year, I have noticed the cheekbone (implant/granules) grew much larger, mainly on the left side. It has been getting bigger still and it protrudes much more from the side. Especially in the last 6 months, it seems like the “implant” is migrating upwards towards my eye; or a new bone layer is growing near and/or around my eye socket. My left eye is closing up as new bone grows, or hydroxyapatite moves underneath and on de outer corner of the eye as well.

Another issue is that my face, especially in my cheek area, has been swelling up slowly over the past year as well. On the upper jaw, the area where the plates and screws were placed, it feels sensitive and is more swollen. I believe this is due to an infection of either the plates or the implant.

Could there be new bone growing on and around the hydroxyapatite implant, years after placement?

Could this be the reason for the possible plate infection?

I am very worried about what is happening in my face, and I was hoping we could have a consultation about the removal or at least reducing of the hydroxyapatite implant and the plates and screws.”

A: The first place to start is to get a 3D CT scan of your face in which all metal hardware as well as the sites of HA implants can be seen. This will then provide a guide for surgical removal. There is no indication that you have any infection as this is not how infections present nor would they occur in such a delayed time period. This is all due to scar tissue buildup and how the body has responded to the HA granules.

Dr. Barry Eppley

World-Renowned Plastic Surgeon