Q: Dr. Eppley, I would like to have jaw angle implants placed on both sides. Even though I have jaw angle asymmetry, getting custom implants is currently out of my budget. Do you think I could still get great results with doing a CT scan and having you pick “off the shelf” implants based on my CT scan? Or would I be better off coming back in a year or two after saving up? Also, what about the possibility of using this “artefill” permanent filler instead of an implant? Do you have any experience with that?
A: What you are referring to is using a combination of a your jaw model from a CT scan and using off-the shelf implants to get the best result. That is what I call a 'semi-custom facial implant' approach in which the stock implants are modified before surgery on the model. An advantage with this approach that you do not have in surgery as you can never see the jaw angles in full detail and certainly can't really compare their anatomical differences. A semi-custom approach is reasonable if the anatomical problem is really one of asymmetry and the changes desired do not exceed what off-the shelf implants would normally do. In other words, you can do some adjustments to the shape and size (reduction) of the implants but you can't add to them. If one is looking for changes that go beyond the scope of existing shapes of current implants then only truly custom-fabricated implants will do. My perception is that you probably fit more into the semi-custom jaw angle implant approach.
As for 'permanent' injectable fillers, that does not really exist. No injectable filler, Artefill included, is a permanent filler. (if you do it enough times, some permanency of the result will occur due to its non-resorbable PMMA bead content) But on a practical basis, and I will assume that you can get a similar result to a facial implant (which you really can't), the cost of the filler based on volume needed will have allowed you to have had custom facial implant surgery…for a result that is not equivalent. The real role of injectable fillers as a substitute for facial skeletal augmentation is a temporary trial to see if augmenting any facial skeletal area is worth actually having the real surgery.
Dr. Barry Eppley