Your Questions
Your Questions
Q: Dr. Eppley, I’m looking to have an angle jaw implant procedure done this summer. I However am not interested in adding too much width nor am I looking to add any length (Nothing vertical length). My goal is to gain some width but mainly I’d like to get a sharp (not round angle like) from the front as well as profile, Brat Pitts Jaw sort of thing but less wider and more natural looking. I was thinking about the lateral angle jaw angel implant until I came across this new implant on implanttech the other day that looks very promising in terms of what I’m looking for which is adding some width as well as a sharp/chiseled angle. It’s called Conform™ Mandibular Angle implant, On the description it states that it’s Evolved from years of feedback by leaders in the field and creates the magazine-model jaw angle desired by many patients. Its patented grid backing readily adapts to the gonial angle, while its extended design easily enables optional screw fixation. Fine anterior edges ensure a smooth implant transition.
I’d really like to hear your opinion about this since you are an expert in this particular procedure. Have you used this implant on any of your patients, and if so do you have any before and after picture available?! In your professional opinion does this new Conform™ Mandibular Angle implant deliver a chiseled angular projection to the jaw (Brad pitt alike, both from the front and side) rather than a round look?
Looking forward to hearing back from you very soon.
A: Thank you for your inquiry. I have intimate knowledge of every jaw angle implant that exist or will exist in the near future. The new Conform Mandibular Angle Implant is exactly the style of jaw angle implant that I wouldn’t use. It has a very rounded jaw angle shape that is situated about the mandibular angle point by a considerable amount. This will create a rounder/fatter looking jaw angle not the sharper more well defined jaw angle shape that your desire. It does not in my experience create the ‘magazine model jaw angel shape’. The newer widening jaw angle implant is better in that regard because it has a more defined angle shape and its point of maximum projection is directly at the lowest angle point. This jaw angle implant style has a much better chance of succeeding with that desired outcome.
The other way to be most assured of the optimal jaw angle shape is to have them custom made in exactly the shape you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Dr. Eppley, I am interested in facial asymmetry surgery. I have an an asymmetrical face due to irregular growth of the jaw bone. Will the chin reduction on the right side correct it? I also notice that the right side of my face has less soft tissue so will the jaw angle implant balance out my face? Thank you.
A: Your facial asymmetry correction surgery approach certainly appears to be the correct one. Based on your pictures, the right side of the chin is longer and the width of the right jaw angle is more narrow than those two jawline areas on the left side of your face. So a right vertical chin reduction and right lateral width jaw angle implant should create improved facial symmetry. The only question is whether one wants to make the judgments for the amount of vertical chin reduction an the amount of width needed in the jaw angle up to the surgeon’s aesthetic sense or whether to make a more scientific quantitative assessment of them. That may be best done using a 3D CT scan or, at the least, get a panorex and lateral cephalometric x-rays to make some preoperative measurements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of a jawline implant. I had a procedure to correct my jaw prognathism and teeth malocclusion. The surgery included sagittal split surgery of the mandible and LeFort osteotomy of the maxilla. While the LeFort osteotomy went well, unfortunately the sagittal split surgery which the surgeon had perform on my mandible were not very satisfactory. I’ve consulted with surgeon regarding the condition of my mandible and they all unanimously agree that my mandible were overly cut which resulted in an uneven contour of my lower jaw. The lining of my lower jaw project an unusual angle which stick out near the middle of my jaw. I had twice use fat graft to augment the area to recreate the mandible angle jaw line. While I am quite please with the result, unfortunately my body absorbs the fat rather quickly. I am looking into a more permanent solution, Such as silicone and synthetic bone. So here are my questions
1) Can silicone implant be used as an alternative to recreate my over dissected jaw line without adding width to my face?
2) I understand that synthetic bone can also be use to recreate my mandible jaw line. Assuming if silicone can also be used to recreate my mandible jaw line, which one would you suggest is a better option in term of result, Synthetic bone or silicone implant?
3) I am aware that both silicone implant and synthetic bone have its fair share of complication and risks. I am aware that both synthetic bone and silicone could to some degree absorb one own bone resulting in asymmetry. I am also aware that infection is also a likelihood. Beside the complication which I already mention, is there any other associated risk with either silicone implant or synthetic bone.
4) Unlike silicone, synthetic bone will create a permanent result. Assuming if I am unsatisfied with the result or infection occur, it there any alternative revision method?
5) What is the risk of nerve damages with this kind of procedure?
6) And finally could you please provide a detail explanation of each method? For example how would you secure the silicone implant to the mandible? Where is the incision site? How long is the surgery? etc.
Thank you for your time and attention. I look forward to hearing from you very soon.
A: Thank you for telling your surgical history and describing your mandibular problem and need for a jawline implant. Your bony defect is really an absence of the jaw angle area. This is confirmed by the successful, albeit short-lived, fat injection augmentation results. In short, you appear to have an indentation probably at the location of the vertical bony cut of the sagittal split osteotomy. While there are multiple methods to treat this bony jawline/jaw angle defect, without question the best method is a synthetic implant. One can argue that it could be comprised of either silicone or Medpor material (I have used both very successfully) but the key is the implant design. Adding vertical length in an appropriate shape is far more important than the material used to create it. Either way the implant is placed from inside the mouth (like the sagittal split as done and secured to the bone by screw(s) Unlike your description, I have not seen the complications of implant migration, lack of permanency or a high rate of infections. There is no risk of nerve damage from this procedure. It is one I have done that is very similar to that of replacing cut off or amputated jaw angles. The key is designing the proper implant shape which can be made to add length but not width. Ideally, it should be made off of a 3D CT scan to exactly mimic that of a more normal shape. At the least it should be handmade off of a model made from a CT scan.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My face is slightly asymmetrical; the right side of my face is less wide than the left side. Consequently, my jaw line is more square and substantial on the left, and less so (its a little more rounded) on the right. There is also a greater fat buildup in my right cheek, since it has less area to distribute itself over than the left. Finally, my nose has a fatty round tip (I am not sure of the proper medical term for it, but I can feel that the problem isn’t the cartilage, so it must be a fat buildup), and it obscures the definition of my nostrils.
So, the surgeries I would like to have done are 1) rhinoplasty (reducing and defining the tip of my nose; the cartilage and bone are fine), 2) buccal fat removal from my right cheek, and 3) a jaw implant on my right jaw to balance with the left side. Each of these features affects the others, so I assume that it is best done by the same doctor, and at the same time under general anesthesia. The reason I am writing to you about this is because of all the plastic surgeons I have researched, you are one of the only ones who explicitly does jaw implants, not just chin implants or facial injections. I understand my face will not be totally symmetrical after this procedure (my whole left skeleton is slightly wider than the right side), but I do want to balance out the corner of my jaw, the fat in my cheek, and the nose with the rest of the face.
I have attached an informal frontal shot of my face, so you have some sort of visual to accompany my description.
A: Thank you for your inquiry. I believe your description of your facial asymmetry and your approach to improve it is spot on. I would just make a few modifications/clarifications on your proposed procedures. First, the round tip of the nose is not primarily caused by the subcutaneous fat under the skin. It is a component to it and minimally modifiable due the risk of skin necrosis of the overlying skin. The major component to making one’s nasal tip less ‘fat’ is to modify the underlying lower alar cartilages, particularly that of the dome area. Thus a tip rhinoplasty changes the size and width of these cartilages to make the tip more refined. Second, a buccal lipectomy affects the fullness right under the cheekbone and not further out on the face. Lastly, the type of jaw angle implanted needed would be a lateral augmentation style that only adds width and not length to the jaw angle area.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I would like to ask about the inconsistency that I see and you have talked about in jaw angle implant outcomes. For some reason, results seem to be very inconsistent with this procedure even with the same plastic surgeon. Could you explain why this happens?
A: Jaw angle implants are a very tough procedure to do and ideal symmetry is often a problem. Even in the best and most experienced hands, asymmetry of identically shaped implants is not rare. While the implants may have an identical shape, the patient’s bone often does not and you are trying to precisely fit a preformed shaped implant that does not have an identical match to the bone on which it sits. In short, it is an imprecise science. The only really good symmetrical results that I see consistently is in the use of custom implants done off of a patient’s 3-D model. And this is for good reason, perfectly adapted implants that have been made to fit the patient’s jaw anatomy.
While jaw angle implants can make a significant aesthetic facial difference, one who undergoes the surgery needs to be willing to accept jaw angle asymmetry is a risk as well as it is impossible to guarantee any particular look that will result from the surgery. For the patient who is seeking a perfect result and will only be satisfied with such, jaw angle implants may not be a satisfying procedure for them. That does not mean that a very good result can not be obtained, but perfect asymmetry in any bilateral surgery (jaw angle implants not withstanding) is difficult to achieve.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 37 year old female with microtia of the left ear. I have thought long and hard about pursuing the reconstructive surgery but I have decided not to proceed with it. I think I have become a little more comfortable with the situation just understanding more about the condition and I am also deterred by the uncertainty and expense. I am however interested in any minimally invasive option to improve my facial asymmetry. Are facial implants an option to do so?
A: Thank you for sending your pictures. As I suspected in left hemifacial microsomia, the jaw on your affected side is smaller with no jaw angle present. Surprisingly the rest of your face above the jawline has minimal to no effect in terms of underdevelopment. You are correct in assuming that a jaw angle implant would be helpful. An implant could be placed that builds out the left jaw angle and jawline as it comes forward. This implant would be placed through the mouth and then screwed into the existing jaw bone. There are two ways to go about choosing the jaw angle implant style and shape. The ideal way is to custom make an implant off of your jaw model that would be made from a CT scan. While this is ideal, it adds considerable expense to the cost of the surgery. The other way is to use an off-the-shelf jaw angle implant and modify it during surgery to fit. It would not create as good a result as a custom implant but it would still make good improvement for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a jaw angle implant for just one side. I have facial symmetry on my right side which is smaller. Not sure why. I’m saving up for that type of procedure now. Is there anyway you can give me a ball park estimate of how much something like that would cost and is any part of it ever covered by insurance? Also, is the surgery normally done when you are asleep or awake and if it’s asleep will I wake up with a tube down my throat? I know it sounds like a dumb question but the thought of it makes me nervous. And lastly, how much of an improvement would this make because I know it won’t make me look perfectly symmetrical and everyone’s results are different. I just want to make sure it’s the best thing I can do.
A: If your facial asymmetry is relegated primarily to the posterior face in the jaw angle area, then unilateral augmentation can be very helpful. You just have to make sure that the asymmetry is located down by the bulk of the masseter muscle area. The effectiveness of jaw angle implant augmentation depends on the size and shape of the implant. How much width and if any vertical lengthening is needed are critical question before surgery to select the proper implant. Because this surgery is for cosmetic enhancement (appearance), it is not ever covered by insurance. The surgery is done through an intraoral approach and involves lifting up the masseter muscle. Thus this is a procedure that requires general anesthesia with endotracheal intubation. The tube will be removed before you wake up so this is not a concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, I have a rare problem. I think, although I am not sure, I have always slept on the left side of my face. Ad a result, I have an extremely strong left chin and not hardly a right chin at all. I was hoping for implants on the weak side or a reduction on the strong side whichever is best. I’m fine with what ever as long as I can look more symmetric. I have attached some photos so you can see what I am talking about. Thanks!
A: Thank you for sending your pictures. Based on your pictures, you do not have chin asymmetry. Rather you have facial asymmetry. The left side of your face is bigger than your right and this is most evident to you along the jawline and at the jaw angle. That is very evident in looking at your side views where the right side lack the prominence at the jaw angle that is seen on the left. Your chin is actually fairly straight. Usually with such facial asymmetry the chin will swing over to the right and be off midline. But this fortunately has not occurred in you.
You would benefit from a right jaw angle implant augmentation to try and get a better match to that of the left side. The jaw angle implant will both lower the angle and add width to it. The width of the jaw angle implant is actually the most important in your case. This will improve your facial symmetry considerably through this relatively simple jaw implant procedure.
Dr. Barry Eppley
Indianapolis Indiana