Your Questions
Your Questions
Q: Dr. Eppley, I would like to send some photos so you could tell me the most appropriate surgery to have. I would like a wider face, a less pointy chin, a chin lift and jaw implants. I wore braces to correct an underbite and I had a mandibular osteotomy and genioplasty – the result is a long face. What can I do to bettr improve my overall appearance. I am 39 years old and terribly unhappy with my profile and double chins etc.
A: You have many of the sequeale of orthognathic surgery of the lower jaw which occur from both the surgery and aging. While a sagittal split mandibular advancement osteotomy and genioplasty have undoubtably done wonders for your bite and improved your facial profile, there are some skeletal deficiences from that surgery that have either been created or unmasked with aging that have affected your lower face. Your face has become narrower with that surgery as the jaw angles are usually lost from the ramus osteotomy and the chin becomes more narrower as its u-shape comes further forward. There also appears top be some asymmetry of the lower jaw with the left angular area being more deificient than the right. There is also the effects of aging as the neck has become fuller and dropped down due to soft tissue sagging. Collectively, all of these give you a narrow and longer appearing face with a double chin and obtuse neck angle.
This could be improved by a single procedure combining a chin-prejowl implant, mandibular angle implants, neck liposuction and a limited or short scar facelift. I have done some computer imaging from the front and sides to illustrate what changes may be possible through this approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a Medpor Lateral Augmentation Onlay Mandible Angle Implant for mandibular augmentation about nine months ago. While I am satisfied with the results, I desire more lateral augmentation of his mandible. I know from reading that it is possible to reduce Medpor Implants in a second operation if the patient feels the implant provides too much augmentation. Is it also possible to enhance an implanted Medpor implant, by placing some further Medpor material on top of the implant surface in a second operation? I thought it could be useful to place smaller pieces from Medpor sheets and place and secure (screw) them over the existing mandibular implants in order to increase their lateral projection. Would you advise to place additional Medpor over an incorporated Medpor implant? Do you know if Medpor is designed for this or are there any problems that might occur by enhancing an existing Medpor implant with further Medpor material? Thank you in advance for your efforts.
A: I see no problem why you can’t add more material on top of an existing Medpor implant. The important issue would be good security (screw fixation) to the underlying implant. I would be concerned about shifting or palpability of a multi-implant reconstruction not any interactive material problem or reaction.
It would be far better and easier, I think, to remove the existing implant and add to it on the back table…to assemble a good solid construct and then re-insert during the surgery. This may make it surgically easier to do. Or why not change just to a whole new bigger implant and be assured you have a solid one-piece construction?
Indianapolis Indiana
