What Is The Best Implant Material for V-Line Reversal Surgery?

Q: Dr. Eppley ,First of all, i would like to be very grateful on your amazing works and the comprehensive case studies you presented on your website. It is almost like a mini journal for me!I had zygoma reduction and mandibular angle reduction in Korea. I was told before by other doctors that I do not need either of those, but the doctor i went through promise me it would deal with my assymetry. In any case, they overshaven my jaw. I really liked my square jaw as it strangely gives me a youthful appearance, but they left me with a korean-style U shape.  I am very hopeful that I could undergo surgery with you. In that regard I have several questions:

1. How will 3d- customized medpore age, especially since the surrounding bone might lose density as we age while the medpore stays in size?

2. how is the strength of 3d customized medpore compared to bone? Is it sufficiently strong to uphold the soft tissue above (e.g. preventing sagging as we age)?

4. How will it feel when people touch? Will there be any possibility of people noticing the implants after it settles?

5. I heard that medpore is prone to infection at early stage? Is it true, if so what are the prevention and solution?

6. I did zygoma reduction from 45 degree. Is it possible to use medpore to (almost) return it to the previous width. I was concerned about the possibility of sagging eventhough my zygoma reduction is minor?

7. I heard medpore is not really recommended for cheek because it might protrude, and has that unnatural appearance and feeling? Is it true?

8. In your experience, how frequent is it that we need to change the medpore?

9. Will there be any bone resorption after medpore implants?

10. How does medpore compare to materials like Titanium and PCl?

11. I have the 3d CT scan with me ( before/after), is it possible for you to review it 

A: I have seen many such cases as yours (V-shape Regret) to which only customized implants can offer adequate restoration. In answer to your questions:

1) The alleged phenomenon of the loss of bone structure/density with age is a bit of a myth and I have never seen it in the thousands of 3D CT scans I have seen. It only has relevance if you lose most or all of your teeth.

2) It is not important that any implant has the strength of bone as that provides no functional/protective benefit…another myth based on what science I do not know. All cheek and jaw facial implants help support the facial soft tissue with aging as more structural support is always better than less.

3) All facial implants, regardless of material composition, will feel just like bone.

4) Medpor does have a higher rate of infection for which there are a variety of intra and postoperative strategies to try and prevent it. But if it gets infected it is coming out.

5) With custom implant designs you make them any way they need to be….regardless of whether the bone augmentation is major or minor.

6) Facial implants, regardless of material composition, are solid and do not degrade and need to be replaced. The only aesthetic implant in the body which at the time of placement is known to a high need of replacement due to device failure is breast implants.

7) refer to #1 above.

8) There are numerous differences amongst all facial implant materials but in the end all that matters is are they rigid or semi-rigid as that is what affects placement. Thus Medpor, like titanium and PCI, is a rigid material.

9) Having a before and after 3D CT scan is critical information for the facial bone restoration. The odds are, however, is that you have the images of the scans rather than the actual scan data…but that visual information will still be useful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon