Do You Do Custom Jawline Implants for Asymmetry?

Q: Dr. Eppley, I am looking for a clinic to carry out a custom, patient-specific mandibular/facial implant (PSI) — a personalized prosthesis in titanium or PEEK, designed by CAD-CAM from a CT scan — in order to correct a facial asymmetry. I am not looking for dental implants.

I would like to ask:

1. Do you design and place custom (patient-specific) mandibular/facial implants for asymmetry? In which materials (titanium, PEEK or others)?

2. Is the design and manufacturing carried out in-house or through an external provider? Where are they manufactured, and with what certification?

3. Can you work from an existing CT scan (DICOM), or would a new one be required?

4. Which surgeon would perform the procedure, and how many cases of this type have you carried out? Do you have clinical cases or before/after photos?

5. What would be the surgical approach (intraoral or external), the duration, the type of anesthesia and the length of hospital stay?

6. Could you provide an itemized estimate (consultation, 3D planning, design, manufacturing, surgery, hospital, anesthesia and follow-up) and the expected timeline?

7. For a patient travelling from abroad: do you offer an initial remote assessment (based on photos and a CT scan)? How many trips and days would be needed, and how is the follow-up handled afterwards?

8. What are the main risks?

A:Much of these questions seem to be based on a lack of knowledge of the tremendous amount of online information that I have on numerous websites. I would advise that you visit www.eppleycustom facial implants.com as well as look at the Photo Gallery on www.eppleyplastic surgery.com under Custom Facial Implants in which most of your questions would be answered.

That being said I will provide some abbreviated answers to your questions:

1) Yes, I have done over 1,500 custom  jawline implant surgeries alone.

2) The design and manufacturing of any custom facial implant is done through various companies that provide those medical devices at their facilities. There is no surgein in the United States that would legally be allowed to provide any in-house design and implant fabrications for placement in humans.

3) Whether an existing scan can be used depends on whether it is a 3-D scan and what its quality is. I can only make that determination by seeing it.

4) I perform all of the surgeries myself and I will refer you back to the websites previously listed to provide the information that you request.

5) All custom implant surgeries are performed under general anesthesia and jawline implants are no exception. All jawline implants are placed through three incisions, one submental and the other two intraoral. Some patients prefer all three incisions to be external but that would be the exception.

6) From the time of acquiring the 3-D CT scan and going through the design and manufacturing process that is a 2 to 3 month timeline. But that can vary based upon the material selected. For example titanium vs PEEK.

7) All preoperative evaluations are done virtually as well as the implant design process. A patient only comes here for the actual surgery and would likely return home within 2 to 3 days after the surgery. All follow-ups are also done virtually.

8) Like all implant related surgery the three main risks remain the same; infection, implant placement asymmetry, and over/under sizing.

Dr. Barry Eppley

Plastic Surgeon