Can You Reattach The Masseter Muscles After Jaw Angle Implants?

Q: Dr. Eppley, Hello I had jaw implants titanium 6 weeks ago. I definitely have masseter dehiscience, not so visible right now because there is swelling and botox still working. The implant is 10mm vertical and only 1mm wide. My surgeon is lost and does not offer any solution apart of “remove the implant” I know this is well too early to do anything but I prefer to anticipate. What you would you recommandé to correct a masseter dehiscience? Visually I think the masseter is 1.5cm above the lower part of the imp’ants, and the horizontal size of the “sharp triangle” is 3cm For information it’s almost not perceptible so far, even when contracting. I guess at 6 weeks I still have a lot of swelling that cover the problem, + the botox that decreased the size of the masseter (2 weeks before the operation) Here is my question: Do you think it can drastically be more visible in the future than today? Do you think the muscle can continue to retract upward : actually, do you te command me to not chew and not masticate for some time to prevent further retractation? If I would consider the silicon implant, what would be the price? I may come from France, it seams you are the only one in the world to do so? I understand it will highly mask the default while resting, but what about the bulge when biting, it will still be very high compared to the angle? Isn’t it awkward? And what about trying to reattach the masseter? Thank you for your first answers… I’m just anticipating something to do with you at the end of the year..

A:In the treatment of masseteric muscle dehiscence the vast majority of patients are seen far removed from their initial surgery where the retraction is fixed, scarred and the muscle permanently shortened. As a result camouflage approaches such as a soft tissue jaw angle implant is the most effective soft tissue contouring procedure.

Your situation is different in that you are only six weeks postop. While the relocation of the masseter muscle is difficult and not assured you are so early after surgery that it is reasonable to consider an attempt at muscle reattachment. This is done through a small external incision right over the back end of the jaw angle area which may be combined with an intra oral one to properly identify and secure sutures to the muscle. It is made more difficult by the added length that the muscle needs to be relocated by the jaw angle implant. Whileit is unpredictable as to how effective the procedure could be it certainly seems reasonable to try at this very early postoperative period.

Dr. Barry Eppley

Plastic Surgeon