How Can These Bulges Above My Jaw Angle Implants Be Fixed?

Q: Dr. Eppley, I had facial feminization surgery that went a lot farther than I ever wanted or anticipated. My jaw got over reduced and ended up getting custom jaw angle implants as part of a set of larger revisions. I am overall happy the the implants they help me feel more like myself again. I do have a muscle defect where it bulges above the angle. I cant tell if the muscle is retracted or if it is an implant design issue. Most people dont notice so i have tried to live with it for the past 3 years, but it is noticeable enough to me, I think i want to look into something to treat. I saw dr eppley has a lot of experience treating this and wanted to discuss possible options. Thanks!

A: It would be fair to say, even without looking at pictures, that this would be a muscle defect retraction. Anytime you have jawline will reduction, particularly in the vertical direction, the muscle is going to retract and shorten to the reduced bone. Then when you go back and put in an angle implant the muscle is not going to follow it back down as it is forever shortened. Thus your  diagnosis is likely masseter muscle dehiscence which is a soft tissue contour deformity now over the implants. There are a variety of treatment options for it from fat grafting to soft tissue jaw angle implants. In my extensive experience I do not find fat grafting has much persistence in the defect area. The one treatment that seems to be most effective as soft tissue jaw angle implant which will have persistent volume. They are placed in the soft tissue defect area and not down on the bone like your existing Joel angle implants are. They have placed over small skin incision at the back end of the jaw angles.

Dr. Barry Eppley

Plastic Surgeon