Q: My problem is that one side of my actual jawline is naturally lower than the other. I had jaw angle implants placed and now it looks worse. The look, now with the implants, is even more asymmetric and unbalanced. The shorter side needed to be lengthened but, with the conventional Porex implant selection, obviously that was not possible. It looks like I will need to pursue the CT scan and customized implant option, yet my concern is not only the price, but also when this will need to be dealt with. I know these types of implants unite with the bone tissue quite strongly and as years go by, it becomes even more difficult to remove them from the face. I know it causes a great deal of trauma and involves a lot of risk on both the part of the patient and surgeon. I would appreciate your thoughts and help.
A: While the custom approach is certainly a possibililty (it adds about $5000 onto the procedure to get the final implants in hand and sterile), I am not certain that may be exactly what you need based on your description.
It sounds like asymmetry was the original issue and that is now exaggerated because of the implants used. Contrary to your perception, there are six different styles of jaw angle implants from Porex some of which are lateral augmentation and others which are inferolateral augmentation types.Choosing a different style of implant for each side may well have made for a better result. When asymmetry exists, it is important to first get a panorex film to look at the height and shape of the jaw angles. Then one can decide if the existing off-the-shelf implants may suffice.
As for secondary surgery on Porex implants, I have not found that it is unduly difficult to remove or that it has ever grown to the bone. Much is talked about that concern, but it is largely overblown in my experience. Yes it is much more ‘difficult’ than removing silicone implants, which by comparison slide right in and out, but it is not impossible or causes significantly more tissue trauma than that of the original implant surgery. All synthetic implants get a scar capsule around them. That capsule with Porex implants is more adherent due to some tissue ingrowth. But they do not unite with the bone or become part of them as an onlay implant.
Dr. Barry Eppley