Q: Dr. Eppley, I have had multiple jaw implants that have left me with an unsatisfactory result. My jaw is naturally asymmetrical so it was hard for the surgeon to match left side to right side I suppose. He tried to fix the asymmetry by shaving down the implants, then another surgery to add implant on the right side which just made it bumpy and stuff. I think I just need to start over with newly designed implants. In addition I also want a reverse sliding genioplasty, my chin sticks out too far and looks unnatural. I can get a 3D print of my skull and a physical 3D exact model from a computer, so that new implants can be made to make my face sides perfectly symmetrical. I have attached a video which described in detail exactly what I don’t like about my jaw result.
A: I have seen your video and your problem is one I have seen many times. I can make the following comments:
1) Jaw angle implant asymmetry is not uncommon and is a result, most of the time, from different placements on the jaw angle rather than some inherent bony asymmetry. Bony asymmetry does not help but it is actually very difficult to get perfect symmetry (alignment of flare) between two jaw angle implants.
2) The problem you have on our left side is that the two implants (chin and jaw angle) do not meet, thus leaving a depression or lack of smoothness between the two. That, again, is reflective of the asymmetrical placement of the jaw angle implant on the left which is further back and higher than the right one. Note that your right side is smooth probably due to the better position of the right jaw angle implant.
3) Correcting jaw angle asymmetry, in my experience, rarely works by just shaving down the implants while they are in place. The implant almost always has to be removed, modified if necessary and then reinserted in a better position. Modifying it while in the patient is treating implant malposition by adjusting the shape or thickness of the implant, potentially worsening the problem or at the least ending up no better for the efforts.
4) You are correct in now assuming that the best approach to the problem is to get a 3D model of your jaw, see exactly where the implants are and make new implants if needed.
5) As for your chin, I do not have the advantage of knowing what you looked like before. But your chin result is not particularly abnormal or unexpected. It may be more projection than you want but many chin implants when placed on a smaller chin will end up with that result. It may look like it is sticking out and the labiomental sulcus will deepen. Medpor chin implants are thicker and more bulky than other materials and this may also be part of the aesthetic problem. You may simply benefit from a smaller projecting chin implant design.
In conclusion, making a completely symmetric 3-piece chin and angle jawline enhancement is not as easy as it looks on a skeletal model and you, unfortunately, are reflective of some of the problems which can occur. But your next step of getting a 3D analysis of what you have and why it looks that way is the only effective way to move forward.
Dr. Barry Eppley