why i personally don't love (silicone?) jaw implants

[stupidjaws]

we talked many times about how silicone implants give these "bloated" results.
volume increase but no angularity.

This patient was effin IDEAL. lean face, low bf, angularity was achievable. after the surgery he doesn't look any more attractive to me, just "fatter".

is it just me or do you guys love it? i think 90% of silicone jaw implants look like this

[attachment deleted by admin]

[Lefortitude]

I've seen a dozen of cases like this one.  The fact is, plastic surgeons who are still using silicone in cosmetic facial augmentation are just lazy and don't want to give up their old techniques.  I have seen some good chin implants but those are simple, and still get botched now and again.  The only place silicone belongs is in boobs.   

Medical science is moving faster now (since the advent of the internet) than ever before.  A lot of surgeons are just sub par at keeping up with it.  Medpor is superior to silicone.  There are other materials superior to medpor, but they're too new and only a select few surgeons around the world are practicing with them. 

I think cases like the one SJ showed are really alarming for a number of reasons.  He seems like the ideal candidate for jaw angle implants.  The surgeon was proud enough of this horrific result to publish it for advertising purposes.  I've seen CT scans of patients skulls after silicone was removed, and there is a CLEAR bone erosion occurring under the implant, even to a civilian like me.

I would like to end with the fact I have seen good results from medpor.  HA does not work in the jaw angles because of granule migration.  Bio-OSS seems to only work in small quantities.  Bone grafts get resorbed as onlays. PEEK is promising, and probably comparable in quality to medpor, if not slightly better.  At the end of the day, implantology just isn't there yet.  Osteotomies remain the gold standard of bone augmentation.

f**king lol at getting jaw angle implants when u already look like Jason Statham

[Milli_Meters]

What are the cons of Medpor?

[Lefortitude]

Cons of medpor: 

1) Basically impossible to remove properly:  Removal CAN be done, and will by some surgeons.  However, it causes pretty serious damage to the soft tissue because it integrates into the implant. 

2) Bone Erosion:  Completely unpredictable.  Depends on your body's biological response to the foreign material.  Can be significant.  After some years, you will probably see a noticeable reduction caused by erosion, at which point the level of tissue ingrowth makes it a nightmare to remove. 

3) Unnatural, unaesthetic results:  My theory is that this happens when you try and build on a single part of the face without addressing how the facial structure works in harmony with other parts.  for example, if someone is severely class 2 with mandibular retrognathia and hypoplasia, and you stick medpor onto their jaw angles, it will look ridiculous.  This is because jaws tend to grow forward before they grow outward, humans subconsciously pick up on these subtleties. 

4) Infection facilitating removal at the jaw angles is 1/10 (10%).

[Milli_Meters]

Cons of medpor: 

1) Basically impossible to remove properly:  Removal CAN be done, and will by some surgeons.  However, it causes pretty serious damage to the soft tissue because it integrates into the implant. 

2) Bone Erosion:  Completely unpredictable.  Depends on your body's biological response to the foreign material.  Can be significant.  After some years, you will probably see a noticeable reduction caused by erosion, at which point the level of tissue ingrowth makes it a nightmare to remove. 

3) Unnatural, unaesthetic results:  My theory is that this happens when you try and build on a single part of the face without addressing how the facial structure works in harmony with other parts.  for example, if someone is severely class 2 with mandibular retrognathia and hypoplasia, and you stick medpor onto their jaw angles, it will look ridiculous.  This is because jaws tend to grow forward before they grow outward, humans subconsciously pick up on these subtleties. 

4) Infection facilitating removal at the jaw angles is 1/10 (10%).

Thank you. Ching wings it is.

[ppsk]

Cons of medpor: 

1) Basically impossible to remove properly:  Removal CAN be done, and will by some surgeons.  However, it causes pretty serious damage to the soft tissue because it integrates into the implant. 

2) Bone Erosion:  Completely unpredictable.  Depends on your body's biological response to the foreign material.  Can be significant.  After some years, you will probably see a noticeable reduction caused by erosion, at which point the level of tissue ingrowth makes it a nightmare to remove. 

3) Unnatural, unaesthetic results:  My theory is that this happens when you try and build on a single part of the face without addressing how the facial structure works in harmony with other parts.  for example, if someone is severely class 2 with mandibular retrognathia and hypoplasia, and you stick medpor onto their jaw angles, it will look ridiculous.  This is because jaws tend to grow forward before they grow outward, humans subconsciously pick up on these subtleties. 

4) Infection facilitating removal at the jaw angles is 1/10 (10%).

erosion is not a phenomena noted in the literature, and even surgeons say it is only a phenomena unique to chin area. moreover, the ingrowth of medpor obviates the dead space which is what is the primary cause of erosion in implant materials - the near constant, even if imperceptible to the naked eye, movement of the implant against the bone. Honestly erosion other than the well documented issue with chin implants (silicone) seems like a boogeyman built up by internet chinese whispers.

I'm not sure where you got that number for infection rate either - most of the literature ive read places medpor infection rates at ~3%, lower (even if only slightly) than almost every other material again due to the ingrowth which they theorize allows the body to get immune products to the area in the rare event of infection.

agree on the results, which is why i am getting bimax before or perhaps even with medpor. Seems to me almost every male who is desiring jaw implants has deficient forward growth but is only focusing on the lateral. They seem to often go hand in hand...

[Lefortitude]

erosion is not a phenomena noted in the literature, and even surgeons say it is only a phenomena unique to chin area. moreover, the ingrowth of medpor obviates the dead space which is what is the primary cause of erosion in implant materials - the near constant, even if imperceptible to the naked eye, movement of the implant against the bone. Honestly erosion other than the well documented issue with chin implants (silicone) seems like a boogeyman built up by internet chinese whispers.

I'm not sure where you got that number for infection rate either - most of the literature ive read places medpor infection rates at ~3%, lower (even if only slightly) than almost every other material again due to the ingrowth which they theorize allows the body to get immune products to the area in the rare event of infection.

agree on the results, which is why i am getting bimax before or perhaps even with medpor. Seems to me almost every male who is desiring jaw implants has deficient forward growth but is only focusing on the lateral. They seem to often go hand in hand...

Its funny how much information contradicts when researching topics like these.  I was one phonecall away from getting medpor put into my face abour 6 months ago.  After researching further I decided its not for me. 

In regards to bone erosion, youre correct that the primary cause is due to micro movements of the implant against the bone.  That is often documented as the primary cause because its the predictable one.  If you put off shelf medpor into your face without screws, its gonna erode the bone.  thats a given. 

another reason for erosion is lifting the periostium and cutting off the bone from the blood supply via foreign body.  this is less predictable.  With the tissue ingrowth of medpor it is reduced, but its still unpredictable. 

Finally, the unpredictable cause of bone erosion is the bodys natural biological response to the implant.  this CANNOT be predicted.   (Sources: Eppleys website)

With regards to infection rate: 

When I was about to have medpor put into my face, I also thought the infection rate would be around 3% or less.  However, I soon learned its not that low for most cases.  The studies I read citing the 3% infection rate were usually conducted by implant specialists like Yaremchuk.  Perhaps the infection rate is cut down 70% when the implant is performed by a specialist like him. Perhaps their vested interest in performing implants made them report some fudged numbers.  I dont know.  What I do know is that the top craniofac maxfac in Canada agrees that the infection risk in the AVERAGE CASE is around 10% at the jaw angles.  Lestat has cited a number of studies confirming this.  Perhaps it just means if you want medpor go to a medpor specialist.

[stupidjaws]

i like medpor results a lot. rarely i see ugly bloated dudes with medpor. silicone is apalling though

[ppsk]

Its funny how much information contradicts when researching topics like these.  I was one phonecall away from getting medpor put into my face abour 6 months ago.  After researching further I decided its not for me. 

In regards to bone erosion, youre correct that the primary cause is due to micro movements of the implant against the bone.  That is often documented as the primary cause because its the predictable one.  If you put off shelf medpor into your face without screws, its gonna erode the bone.  thats a given. 

another reason for erosion is lifting the periostium and cutting off the bone from the blood supply via foreign body.  this is less predictable.  With the tissue ingrowth of medpor it is reduced, but its still unpredictable. 

Finally, the unpredictable cause of bone erosion is the bodys natural biological response to the implant.  this CANNOT be predicted.   (Sources: Eppleys website)

With regards to infection rate: 

When I was about to have medpor put into my face, I also thought the infection rate would be around 3% or less.  However, I soon learned its not that low for most cases.  The studies I read citing the 3% infection rate were usually conducted by implant specialists like Yaremchuk.  Perhaps the infection rate is cut down 70% when the implant is performed by a specialist like him. Perhaps their vested interest in performing implants made them report some fudged numbers.  I dont know.  What I do know is that the top craniofac maxfac in Canada agrees that the infection risk in the AVERAGE CASE is around 10% at the jaw angles.  Lestat has cited a number of studies confirming this.  Perhaps it just means if you want medpor go to a medpor specialist.

the 3% rate i cite is not from yaremchuk but from british and indian medical journals, probably actually quite a few years before yaremchuk had his own practice, or at least i would assume. We're talking its use in craniofacial reconstructions of all kinds, not just cosmetic elective procedures. Some newer studies and meta-analysises have it as low as 1% for infection specifically (S. Korea). Generally i would tend towards the less optimistic figures, so lets call it 3% 

It seems to be a well tolerated material in most of the face, except for one place i cannot remember - i want to say the bridge the nose? It is one of those areas that is apparently disaster laden no matter what the material is, due to the unique circumstances of the region.

[Lefortitude]

the 3% rate i cite is not from yaremchuk but from british and indian medical journals, probably actually quite a few years before yaremchuk had his own practice, or at least i would assume. We're talking its use in craniofacial reconstructions of all kinds, not just cosmetic elective procedures. Some newer studies and meta-analysises have it as low as 1% for infection specifically (S. Korea). Generally i would tend towards the less optimistic figures, so lets call it 3% 

It seems to be a well tolerated material in most of the face, except for one place i cannot remember - i want to say the bridge the nose? It is one of those areas that is apparently disaster laden no matter what the material is, due to the unique circumstances of the region.

Now that you mention it, I remember another top canadian maxfac told me that the medpor is better in the cranial area for reconstruction, with lower risks of infection.  If i remember correctly, he said the jaw angles have the highest risk of infection out of the entire head.

That being said, even in the worst case say 10%, is still not super high.

[Lestat]

At the end of the day, implantology just isn't there yet.  Osteotomies remain the gold standard of bone augmentation.

+1

[CCW]

ok, lets assume that osteotomy is gold standard for augmentation, altough it "only" moves bones (adds volume) and therefore doesn't shape them. But what would you do when you'd need to augment your midface? Undergon an osteotomy? I guess not.

LF3.

[Lefortitude]

ok, lets assume that osteotomy is gold standard for augmentation, altough it "only" moves bones (adds volume) and therefore doesn't shape them. But what would you do when you'd need to augment your midface? Undergon an osteotomy? I guess not.

midface osteotomies exist and are getting better and better at doing their job while minimizing morbidity. 

[ExtractionsRuinFaces]

To me he looks better in the before, terrible result lol.

[triot]

I've seen a dozen of cases like this one.  The fact is, plastic surgeons who are still using silicone in cosmetic facial augmentation are just lazy and don't want to give up their old techniques.  I have seen some good chin implants but those are simple, and still get botched now and again.  The only place silicone belongs is in boobs.   

Medical science is moving faster now (since the advent of the internet) than ever before.  A lot of surgeons are just sub par at keeping up with it.  Medpor is superior to silicone.  There are other materials superior to medpor, but they're too new and only a select few surgeons around the world are practicing with them. 

I think cases like the one SJ showed are really alarming for a number of reasons.  He seems like the ideal candidate for jaw angle implants.  The surgeon was proud enough of this horrific result to publish it for advertising purposes.  I've seen CT scans of patients skulls after silicone was removed, and there is a CLEAR bone erosion occurring under the implant, even to a civilian like me.

I would like to end with the fact I have seen good results from medpor.  HA does not work in the jaw angles because of granule migration.  Bio-OSS seems to only work in small quantities.  Bone grafts get resorbed as onlays. PEEK is promising, and probably comparable in quality to medpor, if not slightly better.  At the end of the day, implantology just isn't there yet.  Osteotomies remain the gold standard of bone augmentation.

f**king lol at getting jaw angle implants when u already look like Jason Statham

I actually think this a nice result.