Postoperative Custom Jawline Implant Concerns
Q: Dr. Eppley, I am seeking a second opinion on my custom jawline implant placement. I’ve attached a few pictures I took today. One of the front facing photos is a duplicate with some arrows pointing to the four issues I have mentioned below. In addition, I’m attaching a PDF case report which was given to me shortly before my procedure done last year. It contains images of my jaw and the implant design.
For the reference photos:
1) The imbalance on the chin where I can feel a separation/shifting of implant.
2) This is harder to see, but I have a gristle-like mass along my right side of the middle jawline (under the skin, but over the implant). I makes the lower right jaw area look bigger than the left side.
3) Especially when flexing/biting down you can see the right side muscle seems much bigger.
4) The profiles show how the back edges of the jaw go behind the ear farther than I would like.
Let me know your thoughts.
A: Thank you for sending all of your pictures. What I can tell from them is the following:
1) The jaw angle implant portion extends posteriorly beyond the posterior ramus of the jaw angle and its natural curve, hence ‘being too close to the ear’.
2) There is masseteric muscle sling dehiscence which is why there is a bulge way above the inferior border of the implant in the jaw angle area.
3) What the mass represents in the middle third of the jawline can not be determined by your pictures alone.
4) Like #3, what the imbalance of the chin represents is impossible to know from your pictures alone.
The next important step in the diagnostic process is to get a new 3D CT scan and compare your current implant positioning on the bone to what you see on the outside as well as where it ideally should be. I don’t really see any design flaws in the initial implant with the exception that when you make the angle portion of the implant go beyond your natural bony jaw angle that is what can happen….the implant gets back too far and sticks out behind the muscle. This issue is magnified when the masseteric sling gets separated doing placement. This is not a criticism of your surgeon, these are just pearls that I have learned by doing hundreds of custom jawline implants. It seems straightforward on paper but there is a steep learning curve to doing the actual custom jawline implant procedure.
Dr. Barry Eppley