Custom Jaw Implant for Facial Asymmetry Correction
Q: Dr. Eppley, I am a 39 year old male who was born with a noticeable asymmetry in my face. This is most pronounced on my right lower which is not as full/pronounced as my left side. It has always bothered me for as long as I can remember so I finally decided to do something about it. In January of this year I consulted with a local facial plastic surgeon who seemed confident that he would be able to eliminate the asymmetry with an off-the-shelf implant and so I ended up scheduling surgery a week later. I had some initial concerns because the consultation only took about 15 minutes and no details of the surgery or what my options were was presented. The doctor sent me out for a 3D CT scan prior we did not look at the scan and measure out where the asymmetry was and what areas needed to be augmented and by how much. I reluctantly decided to proceed regardless of my intuition telling me not to and this ended up being a costly mistake. About a month after surgery when the swelling began to subside, I noticed that the implant he choose actually ended up causing more asymmetry than I originally had. The implant he chose was a Medpor type implant that under augmented my horizontal deficiency by 50% and over augmented my vertical deficiency by 100% as well as changing the mandibular angle (something that I didn’t want to do as the angles matched before surgery).
During my follow-up visit the doctor agreed that this was not a good outcome and said he would redo the surgery with a custom jaw implant. However he has now abandoned me and has left me now with this Medpor implant that needs to be removed immediately. Thus I am looking for a doctor to help me out in this situation. I would like my current implant removed and a new custom implant put in in its place.
A: I am sorry to hear of your unfortunate outcome. In treating facial asymmetry, ‘winging it’ throws multiple variables into an already difficult problem and that usually never works out well. There is no doubt that a 3D CT scan needs to be done at the minimum for diagnostic assessment. But in 2015 designing a custom implant for facial bone asymmetry gives one the best chance for substantially improving facial symmetry. Since you already have a 3D CT scan you can proceed expeditiously to beginning the custom jaw implant design.
Dr. Barry Eppley