Jaw Angle Restoration after Jawline Reduction Surgery

Q: Dr. Eppley, I wasn’t happy with the results from my jaw reduction surgery and am now looking into jaw implants for restorative purposes. I would like to make it clear that I would like to make improvements on my current physical appearance but not return completely to my facial bone structure pre-surgery.

I am debating between custom silicone jaw implants or using PMMA cement for jaw augmentation. I understand that bone cements are quite hard to shape intraorally, but my case might be the exception as I had my current jaw structure 3D printed in life size on a trip to China I had. 

I read somewhere that PMMA could be pre-formed and I think my 3D printed jaw could be extremely helpful in this case and eliminate the need for custom silicone implants.

I was wondering, is it viable to have my own implants shaped from PMMA cement this way? Using my own 3D printed jaw bone?

Can PMMA bone cement inserted through the mouth have a high chance of presenting infections later in life? (e.g. through trauma and such) I am looking at this surgery as a lifelong restoration and would hate if I had to reopen my incisions over and over due to infections.

Lastly, I am worried about the possibility of masseter muscle disinsertion (through placement of the implants and/or from having to take them out and reinsert them in the case that infection does occur.) Is this a common problem or not-rare occurrence in jaw augmentation surgery? I hear it is a very difficult problem to fix in the case it does happen, but I would still like to length my jaw (not widen) by 7~10mm or so.

A: In answer to your subtotal jaw angle restoration questions:

1) With a 3D CT scan or 3D model, a custom design can be done for either silicone or PMMA.

2) PMMA, otherwise known as plastic bone cement, can not be accurately shaped on an intraoperative basis.

3) There is no value to a PMMA implant either in design or material compoisition. The body is not going to attach or grow tissue into it. It does have a major disadvantage, it has a much higher infectivity risk than solid silicone.

4) Having had a prior jaw angle/line reduction, your risk os massteric muscle is substantially increased for vertical jawline restoration over primary jaw angle implant placement…with a risk probably close to 50%.

Dr. Barry Eppley

Indianapolis, Indiana