Jaw Angle Implant Removals and the Risk of Soft Tissue Sagging
Q: Dr. Eppley, I am writing with hopes for more information on jaw angle implant removals. It seems jaw angle implants are relatively rare compared to other facial implants so it is difficult to find any information or cases online regarding them let alone their removal. I have seen that you have experience working with this type of procedure. I would be extremely grateful for any information you can provide relating to my case.
I have always had a weaker mandible and likely should have received orthognathic surgery for this when I underwent orthodontics many years ago, as had been recommended by my orthodontist at the time. As I got older, however, the main concerns were the significant amount of mentalis strain that caused my chin to ball up when I closed my mouth and my moderately recessed chin.
My concerns led me to a consultation with a maxillofacial surgeon as I believed I needed to either get orthognathic surgery as had been previously suggested by my orthodontist or a genioplasty to move my chin into better position to address my concerns. The surgeon told me I could undergo a ‘masking’ procedure that would make it appear as if I had the correct orthodontic treatment done, which was a genioplasty in conjunction with a complete jawline build-up with Gore-tex material. I was told that the jaw implants were necessary to do in conjunction with genioplasty to achieve a ‘balanced’ jawline.
I decided to undergo the masking procedure and had a maximal advancement genioplasty with approximately 5mm hand carved Gore-tex jaw angle implants as well as Gore-tex strips in the mid-jaw region to connect the genioplasty with the jaw angle implants. There is also a small Gore-tex strip that was placed across the front of my chin for additional contouring in the labiomental fold.
Due to various concerns, I am adamant to just have the implants removed. The original surgeon refused to do so.
My main questions are:
– What would be the likely consequences/risks of removing 5mm Gore-tex jaw implants, if any? I am a young woman and the implants have been in for about a year. Would there be risk of skin sagging/facial deformity or would my skin likely bounce back similar to how it was pre-op?
– If it is likely that my skin will contract normally, how quickly would it take for my face to return back to normal and what changes could I expect in the shape of my face from the tissue changes caused by the implants?
– Most importantly, what would the impact of removing jaw implants that were placed in conjunction with a genioplasty be? It is difficult to imagine what the outcome would be since the procedure was not isolated. Would it make my chin look very disproportionate to my face?
Thank you so much for taking the time to review my case and questions.
A: Thank you for your inquiry. While the use of ePTFE (the contemporary name for Gore-Tex) for jaw angle augmentation is very rare, it has a long history of use all over the face. In my experience I will occasionally use it to supplement standard or custom facial implants if needed and hand carve ePTFE blocks for some facial augmentation procedures. (I believe your jaw angle implants are probably ePTFE blocks)
While ePTFE does have more tissue adherence than silicone, for example, it can be removed if one is experienced in doing so. While I have no idea what you looked like now or before your surgery, 5mm thick jaw angle implants are not very big and, unlike facial implants in other facial areas where soft tissue sagging may be a potential post removal issue, this has a very low likelihood to occur in the jaw angle area. This is because it is the only facial implanted area that is placed under such thick muscle and the attachments to the skin lie above the muscle and not below it.
Dr. Barry Eppley