Should I Have New Custom Facial Implants Made?

Q: Dr. Eppley, I had Double Jaw Surgery three years ago and was very happy with the results. But as swelling went down, the HA paste turned out to not add much augmentation at all to my gonial angle/jaw width/cheeks. Two years laterI had a custom wraparound implant and infraorbital implants done and then a revision shortly after to fix a chin asymmetry and protruding infraorbital implant on my right side (you could see it sticking up a bit on my skin).

I’m unsure if I like the level of anterior projection in my cheeks from the infraorbital implant and wish I had more lateral/zygote projection.

However, the main issues are, essentially, asymmetries in the chin and possibly too much augmentation (my chin passes the line of congruence with my bite). As well as fixing the visible/palpable stepoff in the right infraorbital implant.I was told by my surgeon that a revision would be further sculpting the already-placed implants but I’m wondering if remaking them would lead to a more “perfect” result.

One major difficulty of my implant surgery was the HA paste from my double jaw surgery–he had to scrape it off to try and get the implants to fit flat and said it was one of the toughest implant surgeries he’s had to do. And also that my right infraorbital issue is because it’s sitting on top of a plate from my double jaw surgery..

I’m looking to get a different opinion and inquire if you would have any suggestions for me and possibly having a revisional surgery done.

A: In reading your inquiry I can make the following comments:

I would be very cautious about the pursuit of perfection in facial augmentation results, particularly when it involves implants. You have already learned some valuable lessons from your prior surgeries….each surgery leads to its own unique set of postoperative issues. The closer you get get to good the more relevant these tradeoffs become. (risk vs benefit ratio)
You have chosen an implant material, which while reversible, is very traumatic to the tissues to remove…much more so than putting it in. That has great relevance in the risk vs benefit ratio consideration.
Without even reviewing any information on your case my initial response is to fix the most obvious problems (chin projection and right IOM implant) and accept that result as it is once that is completed. That is the most obvious path to concluding your facial surgeries.

Dr. Barry Eppley

World-Renowned Plastic Surgeon