What Is The Best Implant To Use After Double Jaw Surgery?

Q: Dr. Eppley, I had MMA surgery 12 months ago. Now looking for custom peek implants to restore jawline continuity and improve asymmetry (not looking to make the left and right the exact same measurements, but mirror each other congruently for perceived symmetry/facial balance).

The questions I have are:

1) Do you use custom peek implants or just custom silicone?

2) Is it likely the implant on the right side would be visible or look uncanny (at rest and during movement) since it would be adding height and width through jawline continuity to congruently mirror the left side and restore lost contour from bone loss from the mma surgery? Essentially do you think it would have poor soft tissue coverage, and if so would that likely make the implant visible (exposing ledges of the implant and visible transitions between the mastication muscles to the implant)?

3) I don’t want to add any width or true vertical height to the left side that wasn’t there prior to surgery, but I would like to restore some of the contour that was lost from bone loss and fill in the bsso gap so the jawline is a little more smooth at the bsso plate. Would that be a high risk/low reward for the left side? or a good idea to create better facial symmetry/balance?

4) Since the right side is adding a decent amount of vertical height (guessing around 6mm at the peak deficit) , how likely is it for masseter dehiscence to occur?

A:Thank you for your inquiry, sending your scans and detailing your surgical implant objectives to which I can make the following comments:

1) When it comes to implant material I use whichever material the patient wants provided the material does not limit surgical placement and achieving the desired aesthetic effects.

2) I believe what you are asking about soft tissue coverage over the jaw angles is do you have any increased risk of masseteric muscle dehiscence. That answer lies in the observation that any patient who has had prior jaw angle surgery, weather from an osteotomy or prior implant, where muscle has previously been elevated are at an increased risk of a soft tissue coverage problem. How significant that risk is is going to vary with each patient but it is fair to say that risk is higher thanthe patient whi has had no prior surgery at all.

3) Trying to achieve the minimal contouring effects on the left side is going to be very difficult to do without some added width and height. You can’t make an implant of any material less than 2 mm in thickness so are by definition there is going to be some augmented change minimal as it may be. In just looking at what you have drawl on the left side as your objective I would say leave it alone.

4) I refer you to answer number 2 above.

Dr. Barry Eppley

Plastic Surgeon