Should I Use An Off-The-Shelf or Custom Jaw Angle Implant To Correct My Asymmetry?

Q: Dr. Eppley, I am interested in getting a mandibular angle implant surgery (on one side only) to correct asymmetry on the lower part of my face. In other words, I am looking to match the side that is flatter to the side that is fuller. I had asymmetry in the mandibular area since birth. It bothered me a bit less since the overall facial volume/baby fat camouflaged the asymmetry somewhat when I was younger. But as I aged and lost facial volume, I started noticing the issue become more apparent to the point where I feel the need to address it. Moreover, the lack of fullness in the mandibular area not only causing visible asymmetry but also does not provide adequate support for the upper face, which exacerbates the sunken/gaunt appearance. I have looked into fillers but I prefer a permanent solution in the form of an implant. 

1. Based on the picture, would you recommend “off the shelf” or a custom implant to address the issue? Or any other type of implant? 

2. It is also important to me that an implant is made out of silicon and NOT porous polyethylene, as I would not want to have anything in my face that can’t be easily removed if there is an issue down the road. Also, from doing my research about this procedure, I think it is important for a surgeon to secure an implant with screws to avoid any type of implant migration. Do you agree? 

3. Also, I would like to know the recovery (how quickly can you return to work, etc.) associated with this type of surgery. 

Thank you very much and I look forward to your response.

A:In answer to your jaw angle asymmetry questions:

1 I would never try and use a standard implant to correct jaw angle asymmetry. All that will do is just create a different type of jaw angle asymmetry. These asymmetries may seem ‘simple’ to correct but they are not. It requires implant design precision to do so and only a custom approach gets the best chance to optimize jaw angle asymmetry.

2) Solid silicone is my custom implant material of choice for the very reason you have mentioned. There is no type of jaw angle implant that should be placed without screw fixation.

3) Swelling is the primary recovery issue which will take 2 to 3 weeks to look non-surgical and up to 3 months after surgery to really judge the final aesthetic result.

Dr. Barry Eppley

Indianapolis, Indiana