Masseter Muscle Disinsertion
Q: Dr. Eppley, I am interested in fixing a problem that has developed after jaw angle implant surgery. Here are some photos of the area. The first is with my teeth clenched, and the second is when they are relaxed. The rest are an attempt to demonstrate the deformity with the light available in my living room. I would be happy to take more photos if necessary.
The deformity was evident a few weeks after surgery, when the swelling subsided, and I was informed by the surgeon that the masseters would remodel. They have not changed. It feels to me also that the insertion point in the mandible is too anterior, creating a bulge in the cheek when really I wanted a hollow, and instead bulk posteriorly.
I feel the position of the implants is great. The issue (to me) is that the masseter muscle does not sit over the angle of the implant. I feel like I have two mandibular angles.
A: What you have is masseter muscle disinsertion from the jaw angle implant procedure. In the process of putting in the implants the pterygomasseteric cling has become disrupted and now the masseter muscle has retracted up over the implants. This is a well known aesthetic sequelae from the pro cedure that does happen in some patients. It is not usually possible to move the masseter muscle back down over the implants, it is scarred and contracted upward. I have tried that procedure from a neck incision numerous times with variable and limited success. The only really effective treatment at this point is Botox injections to try and shrink down the size of the muscle that becomes evident when clenching or chewing.
Dr. Barry Eppley