Jaw Angle Implants
Q: Dr. Eppley, I had custom jaw angle implants by you last week. I feel at this point that there might be some asymmetry between the two sides. My right side feels like it is not even with the left side. Can we do something about this now?
A: Thank you for the followup. We are now entering the postoperative time period in which the concerns about symmetry in facial implants for most young men occur. So it is important to review some basic points about your specific recovery and the protocol for managing potential facial implant asymmetry concerns:
1) At just two weeks after surgery, only about 50% of the swelling from this type surgery has gone down. But equally relevantly, facial swelling and its subsiding course are never even between the two sides. This would be particularly true in your case where the right jaw angle implant was operated on ‘twice’. As you may recall I shared with you that I closed and then reopened the right side to check and resecure the implant. This is relevant because that means there was twice the trauma to the right and the passage of the screwdriver 6X through the right masseter muscle as opposed to just once on the left masseter muscle. So there is going to be substantial differences in the resolution of the swelling between the two sides of the face as this early postoperative period.
2) That being said, you may well be right about the positioning of the right jaw angle implant…or you could just as equally be wrong. I have seen it occur both ways. There is simply no way to judge as this point by an external evaluation. I can not do it nor can any other surgeon. What I do know about your implants is that they have double screw fixation so the implant can not just be turned our pivoted on itself.
3) Because of this uncertainty it is important then to have a specific postoperative protocol and to understand the wound healing biology and logic behind it.
4) As I said before surgery, one can not get a good feel for the outcome of the surgery including symmetry before 6 to 8 weeks after surgery. This time frame is relevant not only to see what the final outcome of the surgery is but to know how to adjust an implant’s position should that be necessary. If you are going to use an external evaluation to judge how to move an implant then one had better wait to really know where it truly is. But this time frame is also relevant in that re-entry into a surgical wound early on carries with it great risk of secondary wound dehiscence, implant exposure and infection. The tissues are not of good quality until several months after surgery. Re-entry weeks or the first month after surgery places one at great risk for these additional postoperative problems. Patience in surgery truly does have its merits.
5) Whether it is early on or later in one’s postoperative recovery. the best and really only way to know about facial implant positioning is to get a 3D CT scan. This provides an unequivocal picture of the location of the implants. But of equal importance it also tells exactly the type of movements needed to best reposition the asymmetric implant side. Anything short of this information is just guessing in surgery.
In short, my recommendation is to wait until further swelling goes down until at least 6 weeks after surgery. No revisional surgery, if needed, is going to be done before that time period anyway for the reasons previously mentioned. One can get a 3D CT scan now or later but that would not change the time period of management. The 3D CT scan is the better alternative to any other surgeon or even myself making a judgment as to the current state of your jaw angle implants.
Dr. Barry Eppley