Is My Masseter Muscles Displaced After Jaw Angle Implant Surgery?

Q: Dr. Eppley, I saw Dr Eppley respond to a question regarding muscle displacement after a jaw jaw implant and I’ve been told that might have been what happened to me, so perhaps Dr Eppley can help me! 

I had surgery with an oral surgeon and he placed two gore-tex gonial implants in the back of my jaw and two near my chin.  I ended up asking for the gonial to be removed as I did not like the look. Afterwards I unfortunately noticed strange differences to my face that I didn’t understand. One was that I had volume loss on the back sides of my back jaw angle. At first I thought that I had bone loss from the surgery. Multiple other surgical consults have recommended an oral appliance for treatment of it.

A:Indeed what you have described appears to be the correct diagnosis, masseter muscle dehiscence, after the placement of jaw angle implants. Such a postoperative sequelae is not completely rare if the surgeon is not careful about how to elevate the insertion of the masseter muscle in the placement of jaw angle implants.  I have seen many masseter muscles dehiscences as well as having treated them. That being said you cannot reposition the muscle is that is not usually a successful reconstructive surgery. Once the muscle has lost its insertion its fibers are shortened and rarely can they brought back to length. But even if they could most patients would not prefer an incision behind the jaw angles to do so. Does any treatment for it becomes more of an effort of camouflage rather than actually addressing the anatomic nature of it. Most commonly it can be treated by Botox injections to the elevated muscle to reduce its prominent and/or combined with injectable fillers or fat injections to the now deficient jaw angle area. In my extensive experience in treating it I usually find it most effectively treated by a soft tissue jaw angle implants placed 1 cm incision behind the jaw angles which heals well.

The one thing I know for certain, as you have already mentioned, is that no oral device is going to solve or improve this anatomic muscle problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon