Yow Would You Change The Custom Jaw Implant That I Now Have That I Don’t Like?
Q: Dr. Eppley, I had a custom jaw implant by another surgeon in 2019, at first it looked good even though it was very swollen. But as swelling subsided, the implant lost all its angularity and Ive been left with a round looking facial shape, which is convex downwards at the mandible. In addition, the masseters detached causing asymmetry and since the doctor didn’t fill the first hole on the mandible with a screw, some soft tissue had filled it and now a small circle of my skin is attached there. If I undergo revision, are you able to fix these problems, especially the convexity /angular-less shape. How will you change the implant design from my current one which I have attached? including the prediction of the final result vs the actual. can I achieve the prediction?
A: Thank you for your inquiry and sending your picture. One of the advantages of having a jawline implant design and knowing the exact aesthetic outcome allows one to know with greater confidence on how a design change would be better. For me I could see in the original design that the jaw angles were too rounded and there is way too much material in the body of the mandible and could have predicted the lower facial shape outcome you have now. A linear jawline implant design may look good on an skeletal model but that design shape is not good for everyone.
But implant design improvements at the jaw angle, however, are going to be compromised now because you have masseteric muscle dehiscence. This implant-soft tissue contour mismatch is not going to be improved by a new implant design and would likely appear worse when the angles have greater angularity.
I have not seen great results with trying to bring back down the retracted muscle once it is scarred/shortened. In my experience it requires a soft tissue contouring method and would eventually consider soft tissue angle implants placed through a very small back of the angle skin incision. This would provide the most assured correction of the angle contour issue and great increased angularity at the same time.
But since you have to replace the implant anyway because of its rounded bowed shape, you might as well change the jaw angle area as well. But don’t expected a new design to solve the soft tissue jaw angle issue. That would have to he addressed secondarily as previously mentioned.
Dr. Barry Eppley