Will My Skin Sag If I Remove My Custom Jawline Implant for Orthognatic Surgery?
Q: Dr. Eppley, I wanted to provide an update since last we met. I’ve recently obtained new imaging and found out that my skeletal asymmetry is causing my bite to continue and to worsen and my right condyle is resorbing. Two well respected maxillofacial surgeons have both said my only option is orthognathic surgery. I’ve pushed hard for an orthodontic only option but apparently my asymmetry is too extreme where this wouldn’t solve it.
I’m very concerned of all the variables involved with my case specifically my wrap around implant. I think there are very few cases in existence of a patient who had implants who then got them removed and did jaw surgery. Neither or I, or even surgeons, can frankly give me any indication on how the soft tissue will respond after implant removal and subsequent jaw surgery. The consensus is though that I need to have the implant removed and wait at least 6 months for full healing before I can have surgery.
Since I know you’ve definitely removed your fair share of implants, could you give me an indication on what I’m in for? How will my skin respond? Am I looking at major sagging? Does the capsule stay or does it go away? Soft tissue response? Any major issues to really consider or will it pretty much go back to prior to my implant surgery. Is there an option to potentially do the jaw surgery then have new implants put in later on?
Your advice/input here would be greatly appreciated.
A: Contrary to your supposition that I have removed many jawline implants, that is not true. While placing hundreds of them I have removed less than 1% of them. And that has been done almost exclusively early after surgery due to infection. I do not recall removing a jawline implant that has been in for some time due to any aesthetic issues. Thus I can not speak to whether skin sag would be an issue or not. I suspect that it would not….but that is a conjecture not an opinion based on any clinical observation. The size of the implant would clearly have a role to play in that tissue response.
It is not clear to me why one would not just remove the implant and do the orthgnathic surgery at the same time, as that is what I would do, and I could think of no reason not to do so. This is no different than removing a chin implant and doing an immediate sliding genioplasty which I have done many times.
Dr. Barry Eppley