What Are The Chances of Permanent Nerve Damage from Jaw Implants?

Q: Dr. Eppley, I’m 25 years old and my natural facial bone structure is lacking. I’m interested in getting chin and jaw implants, or possibly a wraparound implant if it is called for. I would appreciate if you could answer some general questions about the procedure, as you seem most experienced when it comes to facial augmentation with implants.

(1) When lowering the mandible angle, how many millimeters would you say is needed to be able to appreciate any sort of difference? If I were to get non-widening jaw implants that drop my angle down by say 5mm, would I be able to see a noticeable difference? While 5mm seems like quite a lot when it comes to chin implant projections or nasal implants, I’m not sure how 5mm would work for the angle.

(2) What % of patients or what % chance exists of getting a post-op infection? If the implant was to be inoculated with bacteria from the surgery itself, what time period post-op would it be most common to get an infection? I’m not very fond of the idea of having to pluck the implant back out if it were to happen.

(3) After surfing through RealSelf, I’ve learned that no branches of the facial nerve are affected by chin or jaw implants. The main nerve at risk of permanent or temporary damage seems to be the one that provides sensation to the lips and chin. Would you be able to expand on why some chin implant patients experience lip paralysis or their bottom lip moves strangely post surgery? If motor nerves are not affected, why does this happen?

(4) Have you ever had a patient experience permanent nerve damage from chin and jaw augmentations?

Thank you for your time. I hope you continue to help people surgically and with this blog as it has been a great educational tool for me and undoubtedly others as well.

A: In answer to your jawline augmentation questions:

  1. Whether a 5mm drop in your jaw angles would be aesthetically significant I can not say since I do not know what you look like or what your aesthetic jawline augmentation goals are.
  2. The chance of infection in any type of jawline augmentation procedure is in the 2% to 3% range. They typically do not appear until 3 weeks after the surgery. The initial treatment of such facial implant infections is an extended course of oral antibiotics of which about 50% resolve without the need for further surgery.
  3. It is not true that the only nerves at risk in any chin or jawline implant are the sensory mental nerves. There is also the marginal mandibular branch of the facial nerve that crosses over the inferior border of the lateral chin which supplies movement to the lower lip.(depressor anguli oris muscle) It is possible in some cases that this tiny nerve branch gets stretched and the affected lip side may take some time to recovert. I have never seen any cases permanent paralysis of the lower lip from traction injury to his nerve in jawline implants. That issues aside you are more likely referring to the initial changes of lower lip and chin movement from the swelling and initial expansion of the tissues…which filly resolves in most cases as full healing takes place weeks to months after the surgery.
  4. As noted above I have not yet seen any patient with permanent damage to either the aforementioned sensory and motor nerves branches around the chin from any form of bone or implant surgery.

Dr. Barry Eppley
Indianapolis, Indiana