Jaw Reduction Reversal Surgery
Q: Dr. Eppley, I am interested in jaw reduction reversal surgery. I’m looking to fix the aesthetics of my face after an over-done jaw reduction surgery. My jaw bone was sliced off up to 1cm below my ear, which gives me a long-chin, long-face and aged appearance that I find difficult to get accustomed to.
My surgeon wants to do custom jaw implants made of PEEK to reconstruct my jaw to the original state or to my liking. In your experience, is surgically going into this site again highly prone to complications?
My surgeon has experience with PEEK implants for craniofacial and maxillofacial use, but not in the context of reversing a badly done v-line surgery (it is a very uncommon surgery here.) I’m worried that having done this surgery will make me more prone to complications.
My biggest worry is the disruption of the sling muscle or tearing of the masseter muscle. Would this complication risk be extremely high? I feel like this nightmare is neverending and I’m extremely weary of having to go through surgery a 3rd time to fix such a problem if it were to occur.
Also, what is your opinion on the longevity of PEEK implants? I am having difficulty finding any case studies on the material’s longevity or delayed infection risk, which worries me as well.
A: In answer to your jaw reduction reversal surgery questions:
1) A custom implant approach is the only method to reconstruct the previously removed jaw angle/jawline bone. One can have a debate about the implant material and I would submit the body doesn’t care what is used as it will treat it all the same with the same risks. (infection, wound dehisce, asymmetry, over/underdone….all of the standard risks from this type of surgery)
2) The material properties you need to think about is not their biology (which is what most patients and surgeons focus on…which is actually not that important for the reason I have just mentioned) but the mechanics of the implant’s placement and the potential capability of secondary revision should that be needed. (and that risk is much higher in a scarred and anatomically altered area) In other words, how easy is the implant to get in initially and OUT if a revision is needed. A PEEK implant is very rigid which makes it harder to place (bigger incision), requires greater tissue dissection (larger pocket) and is less adaptable. If a surgeon has never used this material in a tight and confined space like the jaw angles and their PEEK experience comes from doing skull implant surgery (a big wide open space) they will likely be in for a surprise during surgery.
3) When you have a jaw angle/jawline reduction surgery by definition you already have a massteric muscle tear….you just can’t see it because the vertical height of the jaw angle is so reduced and the muscle has shortened around it. There is a very good chance that may become apparent when the vertical height of the ramus is restored. I am not saying that it will absolutely occur but the prior surgery may have already created it. That is unknown that can not be predicted before surgery but the patient needs two be aware of that issue.
Dr. Barry Eppley