Q: Dr. Eppley, I have a question on custom designed facial implants. I had custom designed jaw angle implants made that go from the jaw angle to the chin. I want them placed only through incisions from inside the mouth and no incisions on the outside. My original surgeon said that he could only get them in from an external incision which surprised me. I do not want that scar. Can you get them in from just inside the mouth?
A The custom design method for facial implants is truly amazing when visualized on a computer screen. The ability to create any shape and thickness of an implant and match the symmetry between facial sides, if needed, is impressive. But one limitation of computer designing implants is that it is done on an inanimate facial skeletal computer image that does not take into account the soft tissue cover…nor how such designed implants may be capable of being placed. Given that placing facial implants must be done in an inconspicuous and visible scar-free manner, being able to get a custom designed implant through the limitations of intraoral or discrete external facial incisions can be problematic.
Custom designing facial implants often allows larger and more encompassing implants to be created. But part of their design must take into consideration how they can be inserted and whether the overlying soft tissue cover will be adequate and still get the incision closed in a tension-free manner over it.
I have found it useful in many custom designed facial implants to have them sectioned or cut up into smaller implants so that they can be inserted from just inside the mouth. All sectioning the implants does is enable them to be placed through intraoral incisions. It does not affect the accuracy of their placement and, in some cases, may actually make them more accurately placed. One of the things you learn by doing a lot of custom implants over the years is that anything can be designed on a skull model or a 3D scanned image. Whether they can actually be placed (inserted through the limits of the incisions) and with good soft tissue cover, elements in the surgery that are often more important than the design for an uncomplicated result, is often another matter and must be considered beforehand to avoid an unpleasant intraoperative surprise.
Dr. Barry Eppley