Custom Jaw Implant

Q: Dr. Eppley, I’m interested in a Custom Jaw Implant for a stronger more chiseled jawline, however the barrier which is holding me back seems to be concern over the infection rate. I recently had a consult with a respected surgeon in this field who prefers Medpor over Silicone, and I’ve read a few posts online from people who claim they have knowledge in this area saying Medpor achieves a more chiseled bone-like look when compared to Silicone. Personally I’m against the idea of having something so nasty to remove, so my question really is can Silicone match Medpor in it’s ability to produce natural bone-like look?

I’ve seen a few jawline implant results in the UK, all using Silicone and all end up looking sub-par, ending with a larger jawline but not a better looking one (a blockhead type look). Though I assume some of this is down to the surgeons lack of experience and the implant design, having a chiseled end result is very important to me hence the concern over the implants ability to give this. 

Back to my initial problem with infection rates, how common a problem is this and if one does have an infection how easy is it to replace the implant and start over?

A: Thank you for your inquiry about a custom jaw implant. In answer to your questions about any type of jaw implant, but particularly that of a custom design:

  1. There is no one material advantage over another when it comes to creating an external effect. That would make no biologic sense at all. It is all about the design of the implant, just like it would be anywhere else on the face or the body. The implant’s shape and dimensions, and its push on the overlying tissues, controls any external effect. Thus there is no difference in whether the implant is composed of Medpor or Silicone. Any surgeon or anyone else that says so simply does not know of what they speak.
  2. Beyond its design, the effect of a custom jaw implant is also heavily influenced by the thickness of the soft tissues which sit on top of it. You can not take a fuller, thicker-skinned face and give it a well-defined and angular jawline. The thicker facial tissues simply won’t permit that effect to be seen. When trying to do so with any implant, all that will happen is that the patient’s face will just get bigger and fuller. The patients that get the best jawline results have thinner faces where a proper design, even if it is not particularly big, shows through the tissues.
  3. Like any other surgery that is technically challenging, the design and proper placement of a custom jawline implant is not easy. It is not something that a surgeon does once a year and gets any good at it. I have done hundreds of them and I keep learning both design and technical lessons from just about each case. The learning curve is very steep with this type of facial surgery.
  4. In my experience the infection rates with Medpor have always been higher than silicone because it has an irregular surface that can hold on to bacteria more easily. (cellular adhesion) But an infected implant, regardless of its composition, is easier to remove than one that isn’t. It is the Medpor implant that is not infected that is the challenge and the number of patients who request removal or removal/replacement for aesthetic reasons occurs 10X more frequently than infection.

Dr. Barry Eppley

Indianapolis, Indiana