Multiple Custom Facial Implants
Q: Dr. Eppley, I am interested in custom facial implants of the jawline, infraorbital, and temporal Implants. My questions are:
•Will the chin part of my custom wrap around implant be inserted beneath the chin using the same incision site that was used for my current chin implant? I have read that inserting chin implants through the mouth carries the risk of losing lip feeling.
•Can you confirm that the jaw parts of the wrap around implant will be placed through the mouth?
•Can you confirm that the infraorbital-malar implants will be placed through the lower eyelid?
•Is there any risk of silicone implants becoming displaced by liquids within the soft tissues surrounding the implants in the future?
•Is silicone the best material to use for my goals? What about PEEK?
•What is masseteric-pterygoid sling disruption and should I be worried about it?
•Will there be any loss of movement, muscle swelling, nerve damage, numbness or loss of sensation post-surgery with any of the implants?
•My biggest fear is scarring, I know Dr Eppley said the incision scar for the forehead widening/temporal implants in the hairline would be small and it would not cause missing hair but I need assurances as I have seen two reviews below which talk about bad scarring. How wide and how long will the scars be in mm?
•Will I need to shave the side of my head for the placement of forehead widening/temporal implants?
•What other risks should I be aware of?
•What happens if the outcome does not turn out right or I am not happy with the result? Can implants be removed 3 to 5 days post-op?
A: In answer to your custom facial implant questions:
1) If you have a submental scar from a prior chin implant, that scar will be used as one of the three incisions needed for the placement of a custom jawline implant.
2) There is no other way to place the jaw angle portions of a custom jawline implant but through intraoral posterior vestibular incisions.
3) The lower eyelid incisional approach is the only way custom infraorbital-malar implants can be adequately placed.
4) There is no risk of facial implants being displaced by the normal interstitial fluid contents of the surrounding soft tissues.
5) Silicone is the best material because it can be precisely designed and made and is flexible which is critical for insertion through small incisions in the least traumatic fashion. Stiff materials are problematic for a wide variety of reasons including the much larger incisions and greater tissue trauma to place them.
6) Massteric sling disruption is always a possibility when any jaw angle implants are placed. Such risk is magnified if there is significant vertical lengthening of the jaw angle portion of the implant.
7) All placement of facial implants causes temporal swelling, muscle stiffness, facial distortion, and numbness around the surgical areas. Such expected soft tissue responses usually fully recovery within two months from the surgery.
8) The vertical hairline temporal implant scars are 3 cms in length and usually about 1mm wide.
9) No hair shaving is needed.
10) The biggest risks are aesthetic in nature and include implant asymmetry and lack of desired aesthetic outcomes. (too big, too small etc)
11) You should read the Revisional Surgery form and understand it in detail. No aesthetic outcome can be guaranteed despite the best effort of any implant design and surgical placement. Facial reshaping surgery with implants is the most psychologically challenging form of elective aesthetic facial surgery and can be very stressful for the patient. No revision of any implants are done for three months as the full healing process is not complete by then. You would not be able to tell anything about the final result at just 3 to 5 days after surgery when you are still very swollen.
Dr. Barry Eppley