Your Questions
Your Questions
Q: Dr. Eppley, I have consulted with various surgeons regarding my Medpor orbital rim implants as I would like to have them removed. However, these surgeons seem divided in thought – with some claiming that it’s impossible to remove as it causes too much damage, while others said that it would be possible but difficult. This has left me slightly confused as to what the actuality of Medpor removal is. Based on your experiences, do you think removing these Medpor implants with minimal soft tissue damage would be possible if the surgeon were meticulous about it?
A: In short, the removal of Medpor implants can be safely done. I have removed numerous Medpor implants over the years from the chin, jaw angles, cheeks and orbital rims. While it is true that there are much more adherent than silicone (which isn’t at all), there are far from impossible to remove. I have yet to see a Medpor implant that has any bone ingrowth for which they are touted to have. One very interesting feature about Medpor implant removal is that they are less hard after they have been implanted in the body and have had tissue ingrowth than when they are initially put in. This is undoubtably due to water absorption into the interstices of the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had implants for submalar augmentation placed through mouth on September 2nd and then had them removed one month later. I also had a small premaxillary implant put in through the nose. I removed them because they were too big and the premaxillary implant changed the way my nose looked. The implants have been out for one week. I know that some of the undesirable effects were swelling and that I didn’t give them a real chance. But the anxiety they were causing me on a daily basis was too much. I can’t find any information as to why my nose looks different still after removal, it is wider and the nostrils look rounder and slightly more upturned. Is it possible it won’t go back to pre op look? Could scar tissue have formed that quickly or is it just swelling and if so when should I expect it to truly resolve. The cheeks and lower face are still very swollen also, will this eventually return to pre op look also given that they were in and out so quickly? When can I expect to look like me again? My muscles are a bit tight but overall seem to be functioning without any issues to the nerves and I can smile. Thanks and I look forward to your response.
A: Certainly one week after implant removal, there will be residual swelling and facial distortions. By your own admission you know this and it will take several months before you can judge the final outcome. I would have no doubt that the cheeks area will return completely to normal. Whether the nasal base will is unknown. In placing premaxillary implants the attachments to the nose around the pyriform aperture and the anterior nasals spine are disrupted. This may cause the nostrils to end up slightly wide than before but this is a possibility not a certainty.You must wait three months after facial implant surgery, either after their placement or removal, before seeing the final results.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, you have mentioned your experiences with porex facial implant removals. I am looking to get my pair of porex cheek implants removed that were placed about a year ago. I am 26 years old and hoping my face will be able to return to its pre-surgical state, but given the scar tissue must be removed am I setting my expectations too high? I am worried that if they are removed my cheeks could be even more depressed than before my original surgery.
A: I have heard and read about the ‘scar tissue’ that must be taken with Medpor facial implant removals numerous times. From my perspective, it is largely a myth and not reality. It is very similar to them being hard to remove as well. Both those issues stem from a comparative experience with that of silicone facial implants. Compared to the very easy removal of any silicone-based implant (it is very smooth so it slides in and out easily), the porous outer surface of Medpor does make it more ‘difficult’ but then anything would be hard compared to silicone. Medpor implants can be removed with just a little more effort and there is no reason to be taking out any scar tissue (known as the surrounding capsule) with them.
Therefore, when it comes to removing your Medpor cheek implants, a potential loss of volume in the cheeks will not come from having had scar tissue removed. But it is likely that it will occur due to a common implant sequelae known as tissue expansion. Depending upon the size of the implants you have in, there will likely be some cheek volume loss and/or sagging due to the stretching of the overlying tissues and the separation of the attachments of the tissues to the bone. Once the implants are removed, these tissues may not stick back down just the way they were before surgery. This potential problem can be countered by either inserting a smaller replacement implant, performing soft tissue resuspension, or inserting a dermal graft into the implant space to act as a ‘natural’ implant volume replacement. Whether any of these are appropriate for you is impossible me to tell based on the information that you have provided.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a botched chin and jaw implant procedures from an inexperienced surgeon who had never done the procedures before and things didn’t turn out well. I have had both the chin implant and the jaw implant taken out. That was about a year ago. Now there is significant scar tissue and also sagging along the jaw implant lines (but not so much on the chin). Could I send photos to you? Could you be able to fix my problem and me go back to the normal chin and jaw I had before? I have read much of your material on the web and would be very grateful if you could deal with my problem and fix it to the best of your abilities.
A: Facial implants expand the contours of the implanted bone site at the expense of soft tissue stretching as well. When implants are removed, the overlying soft tissue may or may not shrink back down to its former position. The larger and bigger the implant, the less likely the soft tissue will have any recoil. This is also affected by how long the implants have been in place.
In the jaw, chin implants typically pose the greatest problem with ptosis or soft tissue sagging after removal. Jaw angle implants usually cause less of a problem because most are of the lateral augmentation design and don’t disrupt the attachment of the pteryomasseteric muscle sling at the inferior border of the jaw. This is more of a potential concern in inferolateral augmentation jaw angle implant styles.
Correction of soft tissue problems as you describe may require muscle repair back to the bone or it may be improved by overlying soft tissue suspension. I would need to see some pictures of your issues and what type of implants were initially placed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I was wondering if you had any experience using Acell Matristem tissue regeneration products? It is the stuff that was used to regrow finger tips, for scar revision/removal, and now in hair transplants. The reason I ask is because I have a medpor jaw implant and was considering having it removed but I understand that one of the difficulties with this is soft tissue damage. I’m under the assumption that the Matristem product would make this a non-issue but I wanted to know what your thoughts and possible experience has been with it.
A: I have used Acell Matristem and am very familiar with its working properties and its results. I have also revised and/or removed many Medpor facial implants and do not their removal as problematic as many suggest. They are not difficult to remove and do not leave behind significant soft tissue damage or tissue loss. They are only ‘difficult’ when you compare them to silicone facial implants which slide right out. So that assessment is a comparative one.
Your consideration of Acell particle implantation at the time of facial implant removal I assume is to repair the soft tissue damage left behind. That can certainly be done and may or may not be of benefit. If your intent is to implant Acell in the hope that it can replace the volume lost by removing the implant would not be a reasonable expectation.
Dr. Barry Eppley
Indianapolis, Indiana