What Type Of Jawline Implant Do I Need?
Q: Dr. Eppley, I am in need of a jawline implant. I had a procedure to correct my jaw prognathism and teeth malocclusion. The surgery included sagittal split surgery of the mandible and LeFort osteotomy of the maxilla. While the LeFort osteotomy went well, unfortunately the sagittal split surgery which the surgeon had perform on my mandible were not very satisfactory. I’ve consulted with surgeon regarding the condition of my mandible and they all unanimously agree that my mandible were overly cut which resulted in an uneven contour of my lower jaw. The lining of my lower jaw project an unusual angle which stick out near the middle of my jaw. I had twice use fat graft to augment the area to recreate the mandible angle jaw line. While I am quite please with the result, unfortunately my body absorbs the fat rather quickly. I am looking into a more permanent solution, Such as silicone and synthetic bone. So here are my questions
1) Can silicone implant be used as an alternative to recreate my over dissected jaw line without adding width to my face?
2) I understand that synthetic bone can also be use to recreate my mandible jaw line. Assuming if silicone can also be used to recreate my mandible jaw line, which one would you suggest is a better option in term of result, Synthetic bone or silicone implant?
3) I am aware that both silicone implant and synthetic bone have its fair share of complication and risks. I am aware that both synthetic bone and silicone could to some degree absorb one own bone resulting in asymmetry. I am also aware that infection is also a likelihood. Beside the complication which I already mention, is there any other associated risk with either silicone implant or synthetic bone.
4) Unlike silicone, synthetic bone will create a permanent result. Assuming if I am unsatisfied with the result or infection occur, it there any alternative revision method?
5) What is the risk of nerve damages with this kind of procedure?
6) And finally could you please provide a detail explanation of each method? For example how would you secure the silicone implant to the mandible? Where is the incision site? How long is the surgery? etc.
Thank you for your time and attention. I look forward to hearing from you very soon.
A: Thank you for telling your surgical history and describing your mandibular problem and need for a jawline implant. Your bony defect is really an absence of the jaw angle area. This is confirmed by the successful, albeit short-lived, fat injection augmentation results. In short, you appear to have an indentation probably at the location of the vertical bony cut of the sagittal split osteotomy. While there are multiple methods to treat this bony jawline/jaw angle defect, without question the best method is a synthetic implant. One can argue that it could be comprised of either silicone or Medpor material (I have used both very successfully) but the key is the implant design. Adding vertical length in an appropriate shape is far more important than the material used to create it. Either way the implant is placed from inside the mouth (like the sagittal split as done and secured to the bone by screw(s) Unlike your description, I have not seen the complications of implant migration, lack of permanency or a high rate of infections. There is no risk of nerve damage from this procedure. It is one I have done that is very similar to that of replacing cut off or amputated jaw angles. The key is designing the proper implant shape which can be made to add length but not width. Ideally, it should be made off of a 3D CT scan to exactly mimic that of a more normal shape. At the least it should be handmade off of a model made from a CT scan.
Dr. Barry Eppley