How Can I Fix The Fistulas That Developed Years After Getting A Wraparound Jaw Implant?

Q: Dr. Eppley, I had a full jaw implant three years ago by a surgeon in Europe. My jaw wraparound implant got infected a few months ago somehow and formed two fistulas on either corners of chin. I took antibiotics and so far no more problems thank god. But the muscle when I smile looks botched as it curves up then straight down giving me a witches chin as I smile. Are you able to fix the fistula holes and the irregular chin muscle ? My worry is if I try fixing anything the infection may return hence causing me to lose the entire implant. 

A: That is certainly unusual to have an infection years later. But the fact that it occurred in a such a delayed fashion and is on both sides of the chin suggests to me that this is where screws may be located and are the source of the fistulas. That aside a fistula represents an area of scar contracture and soft tissue deficiency. Thus they are acting as scar anchors that cause distortion when the chin pad moves. (smiling) They would need to be excised, a dermal-fat graft placed and then closed primarily. What effect that may have on recurrent infection is unknown since we don’t fully understand why it occurred so late after the initial surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon