Your Questions
Your Questions
Q: Dr. Eppley, I am in need of jaw angle implant revision surgery, I had large, off the shelf, silicone jaw implants done two weeks ago. To me (at this stage) they look too big and are asymmetrical. As you can see from the photographs there is a distinct difference to both sides of my face, with one jaw side being lower than the other. i am also concerned that they bulge and “round out” my face from under the ears. also believe they made my face longer and squarer. I want badly to correct this and if this entails customized implants that achieve (or approach) symmetry, I hope you can help.
A: Let me start by first making a general comment about jaw angle implant surgery in men. Just about every patient in the first few weeks or month after surgery thinks that the implants are too big, asymmetrical or both. While they may very well be (I obviously don’t know what you looked like before and what your aesthetic goals were…and the beard adds another visual element which may or may not be helpful in interpretation of the results), what is important to know is that 50% of the final result is seen at 3 weeks, 75% of the result is seen by 6 weeks and it takes a full 3 months to see every detail of the final result in any form of facial skeletal augmentation surgery. So at just two weeks after surgery what you are currently seeing may or may not be a harbinger of the eventual outcome of the procedure.
I say this because I have seen numerous men jump too quickly into jaw angle implant revision surgery…long before the final result was apparent. There is an accomodation phase to the new look and that does not happen for most patients in the swelling phase of the recovery period.
The two most common complications from any facial implant surgery, in particular jaw angle implants, is what you are feeling now…over/undersizing and asymmetry. Given that you are still somewhat swollen it it hard for me to know what look you were trying to achieve and what makes the way it looks now not desired. Did you have computer imaging done before our surgery to get a feel for the look you could achieve in your face? Your description suggests that they are too big (wide) and are of a lateral design…which would account for the rounded lower face look. I suspect these are 11mm wide lateral angle implants. Such dimensions can also make the face look more square and longer (which is what many jaw angle patients want) but this style implant has very rounded edging.
Jaw angle implant asymmetry is a function of placement and how secure the implants are onto the bone. They were placed from inside the mouth but where they secured with screws?
I ask these questions because the solution to your jaw angle implant concerns may already lie within you (modification of existing implants and their positioning) While custom implants can always be made, I would first look at whether what you have can be salvaged to the right amount of jaw angle augmentation and symmetry…consisting of the simplest and most economic approach to jaw angle implant revision surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been on your website which is quite impressive….I had jaw implants/small chin implant and a little lipo on the neck/jaw area. It’s been 8 weeks exactly and although a major amount of swelling has subsided, it still seems too large and one side is quite noticeably larger than the other…..not symmetrical….my surgeon is a notable surgeon so I have faith in him but just feeling a little down that at 8 weeks I’m still a little looking like a super hero and I’m a relatively small woman with a “small” profile so to speak….also my smile is still effected as my lower lip does not lower to show the same amount of lower teeth….is this all normal…..the swelling, asymmetry and these feelings of despair…..thanks for your advice.
A: All I can say about your present surgical situation is what I have seen in my own practice. If the jaw angle implants are too large at this point in your recovery, particularly for a woman, then they are simply too large for your face/aesthetic desires. If there is jaw angle asymmetry at 8 weeks after surgery, even though some subtle amounts of swelling may still go down, is indicative of asymmetry of the jaw angle implant positions. Jaw angle implants are very difficult to place perfectly symmetric and it is not rare to have a malposition of one which will appear like a ‘lump’ on that side of the jaw angle. Putting these two together would indicate to me that you are headed towards a revision, downsizing the implants and adjusting at least one of their positions. It is not a question of if…but when. Your plastic surgeon will tell you to wait longer because of ‘swelling’ but the final outcome will not change. If the jaw angle implants are silicone then there no harm in waiting as they are easy to remove and replace. If the jaw angle implants are made of Medpor, then sooner is better than later due to tissue ingrowth.
Dr. Barry Eppley
Indianapolis,Indiana