Can The Soft Tissue Problems From Custom PEEK Brow Bone, Infraorbital-Cheek and Jaw Angle Implants Be Fixed?

Q: Dr. Eppley, I had multiple custom PEEK facial implants with another surgeonI have soft tissue problems now. Attached are videos showing face now and implants used. My problems now are:

  • chin ptosis/lip incompetence after implant removal 
  • masseter not attached to mandible border
  • temple hollowing
  • lateral canthus hollowing

Can you tell me what can you do to correct these problems? 

A: In answer to your custom facial implant revision questions:

Besides the chin and lower lip incompetence issue, what you have in all three other areas is the almost expected sequelae of placing larger implants made out of a very stiff material that lacks feather edging…as the material does not permit it. It requires feather edging int the designs to not show the outline of the implants where they transition into the natural bone in the thinner tissues of the face above the jawline. Some of your issues are also a matter of implant design as they all look very bulky and lack a natural transition into the surrounding bone…a common design flaw. As a result you have the following:

1) Masseter Muscle Dehiscence – this is the result of over stripping of the soft tissue attachments which often needs to be done to place larger stiffer material jaw angle implants. This is also a risk when the implant design extends beyond the natural posterolateral jaw angle border. I ave seen it many times and trying to reposition the muscle back over the implant has a very low change of success and involves a neck scar. I have found it more productive to place a soft tissue jaw angle implant over the deficiency muscle area right under the skin in the subcutaneous plane.

2) Temporal Hollowing – This has occurred because there is now a mismatch between the ends of the brow bone implants and the temples and may also have occurred as a result of some stripping of the termporalis fascia and muscle along the anterior temporal lines near the brows. To improve that the brow-temporal disproportion a combination of feathering of the tail of the brow bone implant with adjacent temporal augmentation is needed.

3) Infraorbital Hollows – This is a design flaw with lack of bringing the implant design further up along the lateral orbital rim. When you augment the infraorbital and cheek area that much, the implant design must go up into the lateral orbital rims to create a natural transition. Otherwise this will create an infraorbital hollows as you now have. That can be treated by adding a lateral orbital rim implant to fill in the ‘defect.

4) Lower Lip Incompetence – I am presuming you had = a chin implant removed and now have this problem. When the chin loses structural support, the vestibule and lower lip will contract down lower than its normal position. This may or may not be associated with actual chin pad ptosis.. Beyond replacing the chin implant, soft tissue treatment options include mentalis muscle resuspension and/or fat grafting.

Dr. Barry Eppley
Indianapolis, Indiana