What Happens If I Break My Facial Bones After Getting Custom Facial Implants?

Q: Dr. Eppley, 1. How would my face look smiling? That was something I forgot to ask during our 10 minute consultation and something the retouched images from your initial e-mail reply didn’t show. Is there any way to predict, or responsibly hypothesize what I’ll look like smiling after implants?

2. This is probably a silly question, but you said custom implant recipients tend to be more prone to wanting revisions. Do we live in such a world that if I’m not satisfied with the end results, costs are waived for revisions or implant removal? If so, what waived costs or discounts are offered?

3. I like to think catastrophically sometimes to try to be as prepared as possible, so bear with me on these next few which get a little dark. What happens if I’m in an accident after surgery and break bones where I have implants? Would I need to have them removed and have you to re-do them after the bone was mended?Are there activities I’ll need to avoid to ensure the implants don’t shift or break?

4. This one gets a little darker so I apologize in advance and hope you see my intent comes from a good place and the desired to think ahead and be prepared: Okay, let’s say we’re halfway through implant design or maybe I’ve gotten the implants and I’m happy with them but something happens and they need to be repaired but you’ve either retired or gotten struck by lightning or, for whatever reason, just aren’t available. Do you have a rolodex of surgeons you trust to do these surgeries just as well or better than you? If so, who are they? Even though it wouldn’t be particularly self-serving, is there anyone who you feel could do these implants just as well or better than you?

Thank you so much for taking the time to help me learn as much as possible before I start this journey with you and your team! I really appreciate it.

A: In answer to your custom facial implant questions:

1) I have not yet had any issues in facial animation with infraorbital-malar (IOM) or jawline implants. The only potential issue with smiling would be with the IOM implants. But because they are in higher position than standard cheek implants they are more out of the way when the cheek tissues bunch up with smiling.

2) This is a very important question and I would ask my staff about that very issue for which there is a revisional surgery policy. It spells out the risks and the patient obligations should that occur. Such revisions are not what I want but when you put implants anywhere the body that risk is very real and not insignificant.

3) The issue of trauma to the implanted site is a common question. The reality is that it has never yet occurred or one in which no patient has ever had an actual scenario as you have described that has been relayed to me. From a trauma standpoint custom IOM and jawline implants are like putting bumpers on the bones. It would be very hard (albeit not impossible) to fracture the bones underneath them. In essence they are like shock absorbers.

4) Admittedly a bit darker but not a completely impractical question. There are other surgeons in the US who do perform these surgeries. It is a very small number but they exist. Most are not going to have my experience in designing or perform these surgeries. I can not tell you whether any of them are poorer, as good or better than me at it, regardless of their experience since there is no assessment method to make that comparison.

Dr. Barry Eppley

Indianapolis, Indiana