Jaw Angle Implants Revision
Q: Dr. Eppley, Unfortunately, I come to you with an issue of a previous jaw implant surgery. The whole situation has been a mess. When you combine my ignorance on the procedure and the lack of explanation from a surgeon, bad things happen.There is a reason why I went to my previous doctor, and I can explain it to you, but I am afraid it’s too long.
I had 7mm Medpor jaw angle implants done. For some unknown and unexplained reason to me, my previous Doctor shaved off the outer part (lateral) of the implants. I had no lateral augmentation at all. This is not just my opinion, but the doctor agreed to this after the fact also. He told me he had shaved off the outer part of the implant. He never told me he would do this though.
I had the original procedure done six months ago. Three weeks ago we had a jaw angle implant revision. I reminded him over and over and over again that my original need was the vertical length and just a bit lateral.
He said that he was against silicone implants because, in time, silicone implants erode the bone. But he said that since I now have Medpor implant installed, he could place silicon implant on top of it. I told him that that would be ok with me as long as it gave me a little vertical length. He told me he could achieve that. I did ask him how many times?
We decided to go ahead with the surgery. He installed the Implantech contour type implant on top of the shaved off 7 mm Medpor implant. I never could understand how that would give me vertical length!! I felt as though I didn’t know what I was talking about and I agreed with him. (big mistake)
The first Medpor implants did make a minor positive change in the original first operation. From my profile view, it looked “better”. My natural jaw bone starts right under the ear. With the Medpor implant, it went to the back of the face a bit and it elongated the vertical line a little less than half of an inch. From the front view, there was no change at all. The round oval shape of my face didn’t change at all, and there was no lateral augmentation from the frontal view. Even if he hadn’t shaved off the outer part of the original 7mm Medpor implant, the angle would have still been above the line level of my mouth. (not ok)
The revision plan was to replace the 7mm with 11mm Medpor jaw angle implants. Upon consulting with him and after I saw the difference between the 7 and the 11 mm implants, I knew there was not going to be vertical length. The angle would have still been above my mouth line. I had no way of assessing or imagining how lateral the 11 mm would look on me since he had shaved off the original 7mm ones. So we decide to leave the 7mm in place and to add a silicon implant on top of it. I told him 100 times that the angle should come down vertically at least down to the level of my lips and that didn’t need much lateral length.
He told me that the contour silicon implant would give me vertical length naturally, but I asked him repeatedly as to how was that even possible???? He said he was sure. I felt I was already too deep into it to say no. I had paid two weeks in advance to replace the 7mm for the 11mm Medpor implants but we ended up going with a 10mm contour silicone on top of the shaved off 7mm.
Obviously, it didn’t give me vertical length, and now my face is too way too wide. Sure I would like some lateral augmentation, but not right under my ears. I looked better with the shaved off 7mm medpor implants than now.
As you can imagine, this has been a nightmare for me. I hate to come to you with this crap. I “believed” against all my intuition and common sense that those implants would give me some vertical length and some lateral. He said he would refund me the cost because it was a revision and it took him very little time. I was just supposed to pay for the costs, but he has disappeared. I came to him because he was recommended to me by other plastic surgeons. The original 7mm implant was not terrible; he just shouldn’t have shaved them off. When I compared the medpor 11mm to the 7mm, I realized that the only difference between the two was laterally and not vertically. This is the reason why I didn’t want to replace the 7mm for the 11mm ones.
The Idea of having the shaved off medpor 7mm ones plus the 10 mm silicon ones made sense to my uneducated thinking at the time. He said that that would give me what I was looking for. I do not look terrible per say, but I feel that I went backward to my original vertical length look, except wider.
I want to talk to you via Skype so that you can see me. I wonder if by taking out the current contour silicon implant and replacing it with a vertical length silicon implant would be a solution for me?
I did not need much at all!!! Just a tiny bit of vertical length. That’s all. I was not looking to have a huge strong jaw. I just wanted the angle to look a bit as if coming from the back of the face at about the level of my mouth. Just some symmetry and nothing major. All the forums and guys whom I had been talking to previously to the surgery agreed that I just needed a little bit vertical length and lateral. They are all disappointed and are furious to see what has happened to me. They did tell me to come to you, but I went for a revision. The original idea was to replace the 7mm for 11mm. Once I was in it, it seemed too late. It’s just a bad situation overall.
I hope this helps and I hope to talk to you soon.
A: Thank you for detailing out your jaw angle implant and jaw angle implant revision surgical history. While it is seemingly complex and I have not seen any pictures of you, the answer as to who to proceed is much more simple. You have but three options:
1) Remove the overlay silicone implants and live with the result of the first surgery. You now have a better perspective on what that outcome is. This is an assured approach since you already know that result.
2) Remove both pairs of indwelling implants and replace with new true vertical lengthening jaw angle implants. While I don’t know the exact implants you have had placed, I am certain they are not actual vertical lengthening jaw angle implants. (as they are not yet commercially available and only I have access to them)
3) There is, of course, always the ‘nuclear’ option which is just remove what you have and return back to your original jaw shape.
Dr. Barry Eppley