Did My Surgeon Get My Custom Jawline Implant Design Wrong?

Q: Dr. Eppley, I’m a big fan of your work and optimistic you’ll be able to help me out.

I recently had a custom jaw implant surgery on December 27th, 2022. I’m convinced the implant is the wrong shape completely, and that my doctor missed the mark on every aspect of it. Specifically, I believe it’s way too wide at the angles (nearly surpassing my cheekbones), the slope to the chin starts too far forward, the chin is too wide and bulbous. 

My objective in getting the implant was create a jaw structure but with angularity. What I have currently is a jaw that is oversized in my opinion, washes out the natural definition of my face and cheekbones instead of bringing balance to them, and has created a wide body face instead of an angular one in harmony with my other features. I feel like a Leggo or charicature.

Below I have included the same photos I used as inspiration photos with my surgeon, as well as the 3D imaging of my jaw and the implant.

My surgeon is saying I’m still swollen, which I believe to an extent, but is essentially blaming the outcome on my “soft tissue and skin thickness and tightness”. I am 33 with normal skin tightness for someone of my age. I am also in decent shape. I’m 6 months in and when comparing my results to his other patients, I appear extremely swollen.

I’m desperate for a second opinion and some guidance, especially as my doctor has said many conflicting things over my experience working with him. 

I look forward to hearing from you and having the opportunity to discuss this in greater detail live 

A:Thank you for your inquiry and sending all of your information to which I can say the following:

1) At six months after surgery the result is what it is.  No further improvements are going to be seen. For facial augmentation changes the results are 99% apparent by 3 months after the surgery. That is the time frame to judge the success of a custom facial implant.

2) When I see a design and lots of inspiration photos, but no patient photos, I automatically know this is a case of unrealistic expectations and/or unachievable goals. Implant designs are based are target images based on the patient’s own face not some ideal model face. That is not your face nor does it have your soft tissue composition. If your surgeon did not take your own pictures and do some computer imaging to determine what is and is not possible then the surgery never had a chance to be aesthetically successful. It was doomed from the beginning as implant designs are based on your facial imaging not what some model looks like. 99% of male patients are never going to achieve the inspiration photos you have shown, I would have shut down that perception right from the beginning. Thus the question was never where you going to achieve those inspiration goals…but how close or far away would you end up from them.

3) The aesthetic effect of a custom facial implant is based on the design as well as its placement. I would never assume the implant is sitting in place exactly like it is on the design file, particularly in the jaw angle area. That can make major changes in its aesthetic effects. You would never move forward and do a new design unless you knew exactly where it is positioned. (new 3D CT scan)

Dr. Barry Eppley

World-Renowned Plastic Surgeon