Why do most implant results suck?

[Lestat]

Same, have you noticed any resorption? I am sure mine have shrunk to some degree.
One night I had to sleep on this stupid concrete thing and lay on the side of my face and now that cheekbone looks less good I think.

What do you think is the best implant material that is available at the moment?

A little bit maybe. It is hard to tell. Imo ha and bio oss are the best implant materials at the moment.

[Lord-of-the-Cartilage]

Yes I agree that they should be safe options in terms of how the body handles those materials, I don't like that they can't give hard and severe shapes.

Do you think that drinking a substantial amount of alcohol, and my god I mean substantial, would increase resorption of the cartilage?

[ppsk]

Same, have you noticed any resorption? I am sure mine have shrunk to some degree.
One night I had to sleep on this stupid concrete thing and lay on the side of my face and now that cheekbone looks less good I think.

What do you think is the best implant material that is available at the moment?

Everything I've read on PEEK makes it seem pretty ideal in so far as having a material that is similar in density and hardness to bone, low rate of infection, not degraded by body fluids.

US surgeons dont seem to be saying boo about it, but I guarantee the moment the FDA approves it for facial implants they will start singing its praises. I'm guessing whatever regulatory bodies are in the EU and places like Australia already approved it a while ago, or don't differentiate between implants approved for the cranium vs the face.

[Lestat]

Everything I've read on PEEK makes it seem pretty ideal in so far as having a material that is similar in density and hardness to bone, low rate of infection, not degraded by body fluids.

US surgeons dont seem to be saying boo about it, but I guarantee the moment the FDA approves it for facial implants they will start singing its praises. I'm guessing whatever regulatory bodies are in the EU and places like Australia already approved it a while ago, or don't differentiate between implants approved for the cranium vs the face.

Good observation! Prof. S. recommend me a Peek implant for my jawline. One problem with Peek is that it is very expensive. S. told me that. He wanted to attach it with titanium screws.
I asked him about bone erosion, how many mm, "1mm in 5 years"?
S. said yesyes, only a very small amount of bone. It is not clinically significant.

[Lord-of-the-Cartilage]

Good observation! Prof. S. recommend me a Peek implant for my jawline. One problem with Peek is that it is very expensive. S. told me that. He wanted to attach it with titanium screws.
I asked him about bone erosion, how many mm, "1mm in 5 years"?
S. said yesyes, only a very small amount of bone. It is not clinically significant.

Stay away from him Lestat, he is a criminal now, unfortunately he was one of the most skilled surgeons at one time... now he is just a con man with a scalpel. I have such deliciously destructive things to say about him but will save those for my autobiography.

[Lord-of-the-Cartilage]

I believe rib is better. If it was me I would just leave it unless there's an aesthetic reason too.

I like how it looks even though it is asymmetric, (Sailer's favorite saying is "symmetry is overrated").
I am scared that it could get infected at any time, especially if someone hit me on the nose... which given my personality, seems quite imminent.

Also it will be resorbing the underlying bone, where as rib wouldn't.

[ppsk]

I'm skeptical that a harder jaw implant material will provide more angular results. I've seen a handful of silicone jaw implants that were excellent. I just think it's a hard task that takes artistic skill and luck.

I will pose this question to Eppley next time I talk with him.

Eppley on his blog pretty much already answered that question.

I think he is wrong, and he is saying any surgeon who says otherwise doesnt know what they are talking about. Well that's insulting to peoples intelligence, it is simply OBVIOUS that the hardness of the material will be a factor in how it supports the soft tissues! I do not think eppley is being sincere.

[Lord-of-the-Cartilage]

I forget which part of the skull it is that doesn't resorb when grafted, but if surgeons can use cadaver ribs then why not cadaver skull bones for implants?

[PopThemPills]

Bumping with another Peek example. Looks promising. I wonder how quickly this will gain acceptance?

[ppsk]

Bumping with another Peek example. Looks promising. I wonder how quickly this will gain acceptance?

I think it is more widespread than we think. A lot of surgeons don't detail what materials they can or will use on their websites. For example when i talked to Coceancig, he described he's used just about everything there is including ceramics and PMMA. Without knowing that experience, you would think these materials are super rare but PMMA for example has actually been used in reconstructive surgery as early as WW2 afaik

Its also worth remembering that a large portion of the "internet" image of plastic surgery is largely shaped by American surgeons, who are regulated by the FDA. Not the case in Europe or Australia who have different regulatory bodies, so its not surprising that american surgeons don't know anything about PEEK because they cannot use it in facial augmentation (Despite being approved for cranial defects) so its of no interest to them.

[Maxillofacial Scalpel]

While the definition of a good vs a bad post operative surgical result is open to discussion there are various reasons most results publicly available online don't meet most patients' aesthetic needs.

One is that the vast majority of people getting such procedures are not very comfortable of sharing their post operative results online. While this fact indicates that there might be a lot more negative experience with this type of surgery than one can imagine, it can also mean that there might also be much more positive experience and therefore better results.

Another reason is poor implant selection -if we're talking about out of the shelf implants- or poor implant design -in the case of  custom implants-.

The most important reason though is patient selection. This is a rather dissappointing reason but the truth is that the patients that would benefit the most from the implant procedures are the ones who don't have thick tissues around the jawline area. Keep in mind that this has not much to do with body weight since there are plenty of people who are overweight and still have a relatively lean and thin tissues facial appearance that would improve even more if they were to lose weight, but there are also patients that even if they went underweight their face would not lose a significant amount of fat.