What Type Of Revision Do I Need For My Asymmetric Jaw Angle Implants?

Q: Dr. Eppley, I recently had jaw angle implants and it has not turned out to be a good experience. My jaw angles were high and made the back part of my face looked weak and absent. My surgeon initially placed silicone implants but all they did was make my face look more wide and fatter and did nothing to make the jaw angle change I needed. My surgeon acknowledged that these implants were not the right types. I then had a second surgery done using Medpor jaw angle implants. Even though there was a lot of swelling after surgery, I noticed that my left side was very different from the other side. This has become only more apparent as the swelling has gone away. They look and feel completely different between the two sides. My surgeon says he wants to go in and shave down one of the implants but I have lost faith in him at this point. What do you recommend?

 A: Sorry to hear of your surgical misfortune. Jaw angle implants are, without question, the most difficult facial implant to do well, both in implant selection and in surgical placement. They are incrementally more difficult than the more commonly used chin and cheek implants. Symmetrical placement, because you have to put in each implant independently and without view of the other one, is challenging. One has to be very attentive to every detail of the implant position and to screw it into place, if possible, to ensure the best symmetry. The most difficult jaw angle implant to place are the Medpor ones because their material surface has a high degree of frictional resistance and they don’t slide in easily. That is the only jaw angle implant, however, that can drop the jaw angle down vertically. Most of the time, these implants have to be trimmed down to fit, removing the long anterior end. I have found it very beneficial to use the implant sizers first to fully develop the pocket and only place the final implant when the sizer slides it easily to the desired location. It would be impossible for me to say what is the best approach with your current jaw angle implant situation. I don’t know what you look like now nor do I know the details of your current implants and what is making them asymmetric. Shaving down the malpositioned implant may work but, more likely, the implant needs to be repositioned.

 Dr. Barry Eppley

 Indianapolis, Indiana