Custom Jawline Implant After Multiple Jaw Surgeries

Q: Dr. Eppley, I was wondering if you could answer a few questions regarding the custom wrap around type jaw implants I came across on your blog. I had a BSSO, Lefort 1 and sliding genioplasty about 8 years ago. Following that, I had custom medpor jaw implants placed to correct some significant notching that had developed around my jaw angles and along the genioplasty site. These implants added no length and very little width, only enough to make my jaw symmetrical. My bite is now perfect, and from a functional standpoint the surgery was a success. However, I have been extremely unhappy with the aesthetic results. First, my jaw remains very steep and narrow, giving the lower portion of my face an elongated, weak shape with an odd shaped protruding mouth that looks as if I have to strain to keep it closed. Also, my chin has a bit more horizontal projection after the genioplasty, but still looks relatively long and weak, especially when viewed from the front.

I am interested in the wrap around type implants because it seems to me that my lower jaw is deficient in all three dimensions. Also, I am not looking for anything too drastic, I would just like a more balanced, masculine lower face shape. I would like to know if I am a candidate for this surgery, given my previous procedure. Second, I noticed that you typically use silicone implants. My current implants are Medpor, and I really like how they feel completely natural, as if it’s my own bone. I don’t know if this has anything to do with the tissue ingrowth seen with the Medpor material, but I was wondering if there are any major differences in sensation when using silicone.

A: By your very own description you are the exact patient who is only going to get a much improved jawline result by a custom implant approach. Your history of prior jaw surgeries does not preclude you from having a jawline implant but the scar tissue and implant removals do make it more challenging than the patient who has never had any prior surgery. But in my practice your history is common and about half of custom jawline patients have a prior history of bone or implant surgeries.

The perception that Medpor implants feel ‘more like bone’ than silicone is a myth. There is no biomaterial or biomechanical basis for it. With bone as the implant backing, all currently used implant materials will feel the same.

Dr. Barry Eppley
Indianapolis, Indiana