Is It Safe To Put In Custom Midface Implant At The Same Time At Plate and Screw Removal?
Q: Dr. Eppley, I’m now a year post double jaw surgery. I’m looking at midface implants to address midface recession. I attached a picture of myself from yesterday. I also attached a picture of an implant design I think I’ll need. Is it ok to put all these implants in at the same time as plate removal? The implants would go on top of where the screws were. Will this increase the rate of infection?
Also I am looking to have rhinoplasty after implants heal. I’m nervous about the transition from midface to nose sides. How is the transition between the cheek and nose area made as natural as possible? Thank you for answering my questions!
A: In answer to your custom midface augmentation questions:
1) I would be very cautious about implant placement at the same time as plate and screw removal. In removimg certain screws (and sometimes a plate area) from a Lefort I osteotomy a communication between the maxillary sinus and the implant which increases the risk of infection.. I would have to see x-rays which show the hardware locations which would be very evident in a 3D CT scan. On the one hand you would like to achieve two positive changes during the same surgery as long as does not significantly increase the risk of infection. I have done it many times before and if I see small communication I seal the hole with bone wax and then place the implant at the same time…and it has never caused a problem. But it is still prudent to check and x-ray beforehand.
2) The relevance of a rhinoplasty if an underlying midface implant exists is at the osteotomy line if nasal bone osteotomies are to be done. Thus it relevant in the implant design to keep it away from the nasomaxillary junction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon