Author Topic: Definitive Guide to Facial Implants: Reality Edition 2019  (Read 7402 times)

micjawsurgery

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #15 on: April 29, 2019, 03:14:58 PM »
A lot of conflicting info on implants. Eppley is a big proponent of silicone which a lot of other surgeons do not like. BUT he's probably done more silicone custom implants of late then a lot of other surgeons. And I could not find any independent research on bone erosion/resorption happening in silicone implants in areas other than the chin. I also read a paper by Dr. Binder that concluded from his experience that clinically significant bone erosion was not found in implants other than those in the chin area.
https://www.doctorbinder.com/pdf/Academic/Aesthetic-Facial-Implants-Papel-Book-Chapter.pdf

Eppley screws in his silicone implants to prevent micro-movements. They're also custom made for a better fit. If there's no movement due to the screws, fit, and scar tissue pocket, then there should not be progressive bone loss. Eppley does mention bone adaptation but it is minor:

"The concept of bone loss around facial implants is a fallacious one. More accurately there can be passive bone adaption to a facial implant based on where it sits. This process is completely benign and self-limiting. But even this is not a biologic phenomenon I have seen in the midface across the orbital rims or cheeks."

Honestly it all sounds very appealing coming from him, which is the problem. There are articles like this warning about silicone https://www.2passclinic.com/why-theres-no-place-for-silicon-implants-in-facial-augmentation/

kavan

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #16 on: April 29, 2019, 07:08:13 PM »
A lot of conflicting info on implants. Eppley is a big proponent of silicone which a lot of other surgeons do not like. BUT he's probably done more silicone custom implants of late then a lot of other surgeons. And I could not find any independent research on bone erosion/resorption happening in silicone implants in areas other than the chin. I also read a paper by Dr. Binder that concluded from his experience that clinically significant bone erosion was not found in implants other than those in the chin area.
https://www.doctorbinder.com/pdf/Academic/Aesthetic-Facial-Implants-Papel-Book-Chapter.pdf

Eppley screws in his silicone implants to prevent micro-movements. They're also custom made for a better fit. If there's no movement due to the screws, fit, and scar tissue pocket, then there should not be progressive bone loss. Eppley does mention bone adaptation but it is minor:

"The concept of bone loss around facial implants is a fallacious one. More accurately there can be passive bone adaption to a facial implant based on where it sits. This process is completely benign and self-limiting. But even this is not a biologic phenomenon I have seen in the midface across the orbital rims or cheeks."

Honestly it all sounds very appealing coming from him, which is the problem. There are articles like this warning about silicone https://www.2passclinic.com/why-theres-no-place-for-silicon-implants-in-facial-augmentation/

Hope you know that the the article you linked to as to 'no room for silicone implants...' shows Dr Y's patient BUT NO attribution to him. Anyway Y now uses silicone for custom stuff.
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Lestat

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #17 on: April 30, 2019, 01:18:23 PM »
Regarding bone erosion with silicone chin implants I found this very interesting:

"The patient with the longest follow-up (17 years), presented with a bone erosion of 0.8 mm; meanwhile, the patient with the shortest, had a bone erosion with 1 mm."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110682/

Post bimax

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #18 on: May 01, 2019, 06:52:00 AM »
Regarding bone erosion with silicone chin implants I found this very interesting:

"The patient with the longest follow-up (17 years), presented with a bone erosion of 0.8 mm; meanwhile, the patient with the shortest, had a bone erosion with 1 mm."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110682/

Per that study, 1 of the 15 participants had 2mm of erosion. That's pretty substantial. I can't imagine having a complication requiring implant removal and ending up with an even weaker profile after.

I wonder if fixating silicone implants with screws like Eppley does has a meaningful impact on erosion.

micjawsurgery

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #19 on: May 01, 2019, 10:21:40 AM »
Screw fixation is for the early stages after the implant is placed I believe. Eventually the body forms scar tissue around the implant that is suppose to hold it in place. Eppley screws it in place for extra security.

Bone erosion comes down to 2 factors: micromovements (not being held in place & bad fit against the bone) which screw fixation + custom printing should be able to minimize, and the body's response to silicone.

If bone erosion doesn't cause functional issues I don't think there's much to worry about. we lose bone as we age anyways. yeah you might need a bigger implant later on but I don't think it'll hamper the aesthetic result much. So I've gotten over that issue with silicone.

But what I am worried about is silicone toxicity, if you google "breast implant illness" there's a lot of women that report troubles with their silicone implants. And some surgeons even talk about it: https://www.youtube.com/watch?v=moX9UmRA3SM
And there's some studies talking about low grade long term inflammation with silicone implants

kavan

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #20 on: May 01, 2019, 12:08:44 PM »
Screw fixation is for the early stages after the implant is placed I believe. Eventually the body forms scar tissue around the implant that is suppose to hold it in place. Eppley screws it in place for extra security.

Bone erosion comes down to 2 factors: micromovements (not being held in place & bad fit against the bone) which screw fixation + custom printing should be able to minimize, and the body's response to silicone.

If bone erosion doesn't cause functional issues I don't think there's much to worry about. we lose bone as we age anyways. yeah you might need a bigger implant later on but I don't think it'll hamper the aesthetic result much. So I've gotten over that issue with silicone.

But what I am worried about is silicone toxicity, if you google "breast implant illness" there's a lot of women that report troubles with their silicone implants. And some surgeons even talk about it: https://www.youtube.com/watch?v=moX9UmRA3SM
And there's some studies talking about low grade long term inflammation with silicone implants


There are many forms of silicone. For face implants it can be hard silicone or soft silicone. With breast implants it is FLUID silicone. So silicone used for face implants DIFFERS from that used in breast implants which had been an issue. Escaping FLUID silicone (when the breast implant BREAKS) can gum up the lymphatic system or just get stuck somewhere it should not be where it causes the inflammation.

So, I would not worry about silicone toxicity arising from SOLID silicone implants whether they be hard or soft flexible type. Totally different from silicone fluid escaping into the system from a broken breast implant.
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ben from UK

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #21 on: May 02, 2019, 11:24:29 PM »
Screw fixation is for the early stages after the implant is placed I believe. Eventually the body forms scar tissue around the implant that is suppose to hold it in place. Eppley screws it in place for extra security.

Bone erosion comes down to 2 factors: micromovements (not being held in place & bad fit against the bone) which screw fixation + custom printing should be able to minimize, and the body's response to silicone.

If bone erosion doesn't cause functional issues I don't think there's much to worry about. we lose bone as we age anyways. yeah you might need a bigger implant later on but I don't think it'll hamper the aesthetic result much. So I've gotten over that issue with silicone.

But what I am worried about is silicone toxicity, if you google "breast implant illness" there's a lot of women that report troubles with their silicone implants. And some surgeons even talk about it: https://www.youtube.com/watch?v=moX9UmRA3SM
And there's some studies talking about low grade long term inflammation with silicone implants

I don't think toxicity is a thing to worry about with silicone in the face as like Kavan says it's hard material. The bigger danger imo is infection, but this is also the case with other implants. Once infected, implants have to be removed in most cases. This causes additional soft tissue damage/scar tissue etc., sometimes disruption of the masseter. Infection can happen at any time but usually displays between 6 and 12 weeks after surgery. The external approach through incision underneath the chin (most common) reduces the risk of infection. The external approach can be used when it comes to jawimplants as well (rizdon procedure), but this causes visable scars. If you have a black beard, it's less visible but still visible when you shave. Most surgeons don't use the Rizdon approach.

ODog

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #22 on: May 06, 2019, 09:34:52 PM »
I don't think toxicity is a thing to worry about with silicone in the face as like Kavan says it's hard material. The bigger danger imo is infection, but this is also the case with other implants. Once infected, implants have to be removed in most cases. This causes additional soft tissue damage/scar tissue etc., sometimes disruption of the masseter. Infection can happen at any time but usually displays between 6 and 12 weeks after surgery. The external approach through incision underneath the chin (most common) reduces the risk of infection. The external approach can be used when it comes to jawimplants as well (rizdon procedure), but this causes visable scars. If you have a black beard, it's less visible but still visible when you shave. Most surgeons don't use the Rizdon approach.

I have to wonder about this. If the immune system can deliver all-out attack on foreign material in the body and create an infective response, there should at least be concern about possible low levels of chronic inflammation, which has all kinds of negative impact on health. In fact, I shouldn’t say possible, but virtually guaranteed. For example when you eat inflammatory foods, they can cause acute inflammation, e.g. you break out in hives or get some kind of severe skin or digestive reaction, etc. This is akin to getting an infection with an implant. Or it can cause low level inflammation like feeling tired, brain fog, generalized joint pain, etc., which is basically the body “sort of” rejecting the offending substance without delivering a full immune response. You don’t associate the food (or implant) to these low  level symptoms but they are indeed evidence of the body being slowly damaged over time.

It’s not like the body gets used to the foreign (to the body) substance or material over time either and adapts or whatever, the inflammation will always exist on a sub-clinical level slowly wreaking havoc in the body, which is what happens to people who eat a s**tty diet over a long period of time not thinking it’s doing  anything to their health. One day they wake up with a litany or health problems and wonder what’s causing it all, well it always starts with inflammation. What is inflammation actually? It’s the body fighting against something it’s engineered system has not been designed (by evolution) to expect or deal with, such as processed food or an IMPLANT.

So when I heard the story a while back about women with breast implants being diagnosed with chronic fatigue syndrome, it made intuitive sense to me and I wasn’t surprised at all.

Tbh I’ve been thinking for a long time about getting an implant for some body thingy I have (not facial), and I wish a really smart, holistic (no not the cheasy naturopath type) health expert could give a detailed answer on how an implant might cause low level inflammation. The problem is that certain people whom I have in mind who are super intelligent in multiple disciplines and could develop a sound answer to this question DON’T ever get asked a questions like this... only plastic surgeons do and we know what their answer is going to be. You can’t just ask a regular doctor either, they don’t know anything. 
« Last Edit: May 06, 2019, 09:45:44 PM by ODog »

Lestat

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #23 on: May 06, 2019, 10:12:51 PM »
What I can tell you is that Titan is very well tolerated by the body. That shows the decades of experience. Therefore, titanium implants would be the first choice for me. To silicone and medpor I can not say anything, only that the risk of infection of such materials is significantly higher than that of titanium and that says quite a lot I think. Surgeons use silicone because it is much cheaper, easier to install, and if necessary easier to remove, like titanium implants.

Post bimax

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #24 on: May 07, 2019, 03:56:10 AM »
What I can tell you is that Titan is very well tolerated by the body. That shows the decades of experience. Therefore, titanium implants would be the first choice for me. To silicone and medpor I can not say anything, only that the risk of infection of such materials is significantly higher than that of titanium and that says quite a lot I think. Surgeons use silicone because it is much cheaper, easier to install, and if necessary easier to remove, like titanium implants.

Do any good US surgeons use titanium/PEEK? Almost everyone I see uses silicone or Medpor. There’s a great PS in my area but he only uses medpor and doesn’t do SG advancements which sucks.

kavan

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #25 on: May 07, 2019, 03:27:29 PM »
I have to wonder about this. If the immune system can deliver all-out attack on foreign material in the body and create an infective response, there should at least be concern about possible low levels of chronic inflammation, which has all kinds of negative impact on health. In fact, I shouldn’t say possible, but virtually guaranteed. For example when you eat inflammatory foods, they can cause acute inflammation, e.g. you break out in hives or get some kind of severe skin or digestive reaction, etc. This is akin to getting an infection with an implant. Or it can cause low level inflammation like feeling tired, brain fog, generalized joint pain, etc., which is basically the body “sort of” rejecting the offending substance without delivering a full immune response. You don’t associate the food (or implant) to these low  level symptoms but they are indeed evidence of the body being slowly damaged over time.

It’s not like the body gets used to the foreign (to the body) substance or material over time either and adapts or whatever, the inflammation will always exist on a sub-clinical level slowly wreaking havoc in the body, which is what happens to people who eat a s**tty diet over a long period of time not thinking it’s doing  anything to their health. One day they wake up with a litany or health problems and wonder what’s causing it all, well it always starts with inflammation. What is inflammation actually? It’s the body fighting against something it’s engineered system has not been designed (by evolution) to expect or deal with, such as processed food or an IMPLANT.

So when I heard the story a while back about women with breast implants being diagnosed with chronic fatigue syndrome, it made intuitive sense to me and I wasn’t surprised at all.

Tbh I’ve been thinking for a long time about getting an implant for some body thingy I have (not facial), and I wish a really smart, holistic (no not the cheasy naturopath type) health expert could give a detailed answer on how an implant might cause low level inflammation. The problem is that certain people whom I have in mind who are super intelligent in multiple disciplines and could develop a sound answer to this question DON’T ever get asked a questions like this... only plastic surgeons do and we know what their answer is going to be. You can’t just ask a regular doctor either, they don’t know anything.

Your argument fails to distinguish between CHRONIC inflammation that arises from a steady supply of irritants from a ONE TIME introduction of a foreign material that the body walls off by the INITIAL inflammatory response to it's entry. For that reason, your contention that inflammation will 'always exist' (after introduction of a solid silicone implant), is NOT convincing to me. Here is why:

With silicone breast implants, the problem was their breaking where leaks of the highly viscous (thick) silicone within escaped. But initially, the women did not know that because the the breast volume from them looked the SAME. All they knew was that they were having a bunch of symptoms. Further diagnostic explorations revealed leaks from the implants which in turn were correlated with a CHRONIC inflammatory response associated with some of the health complaints. Such inflammatory responses are MEASURABLE as in high C reactive protein.

The body will have an INITIAL inflammatory response to any foreign material placed inside. But it peters out after it STAYS PUT and becomes encapsulated. So the body can get used to it where it does not kick up constant or chronic inflammation. Constant inflammation is chronic inflammation which is kicked off by a STEADY SUPPLY of irritants such as leaky silicone breast implants or food irritants. The inflammation process for constant introduction of irritants doesn't peter out. It becomes CHRONIC and can be MEASURED. Solid silicone implants are not associated with chronic or continued inflammation because they don't continue to introduce a steady supply of IRRITANTS into the immune system as do food irritants or leaking silicone. So, I'm not sure you distinguish the different between constant introduction of irritants that kick up chronic inflammation and a one time introduction of a foreign material encapsulated by the initial inflammatory process to wall it off.

A leaking silicone implant and daily intake of food 'irritants' ('s**tty diet') can kick up CHRONIC inflammation because they introduce a STEADY SUPPLY of irritants. But here, your ARGUMENT likens similar chronic inflammation to something (solid silicone face implant) AFTER it's totally encapsulated and not actually introducing a constant supply of irritants.  Hence, I would not equate or conflate things that don't relate with chronic IRRITANTS arising from bad foods and leaking breast implants with solid silicone implants.

Not sure what is meant by 'low level sub clinical' inflammation other that it implies a type of inflammation low enough that CAN'T be measured. C-Reactive protein tests (CRP), of which there is a really sensitive one and sedimentation rate tests CAN measure levels of inflammation where all levels BELOW a certain range would be considered GOOD/EXCELLENT as in NO inflammation issue to fret about. So, if this 'low level sub clinical level' of inflammation you speak of is something that can't be measured BECAUSE it's below a level considered good/excellent, it is therefore nothing to worry about because having a level of inflammation that is so LOW it can't be measured clinically is a GOOD thing.

Your argument made here, fails to convince me because you don't distinguish chronic or continued inflammation (brought on by introduction of a steady supply of irritants) from the initial inflammatory response where a one time introduction of a material is walled off. It's not an argument that can be buttressed by 'possible sub clinical low levels of chronic inflammation'. WHY? Because inflammation that is so LOW where it's called 'sub clinical' or where it could not be measured (on a C-reactive protein test that measures levels of inflammation) would be nothing to worry about. I'm not sure you realize that a 'low sub clinical level of inflammation' (which you say could be a problem with solid silicone implants) would NOT be considered an inflammation problem at all if it defied clinical measurement.

You know that there are tests to measure levels of inflammation right?
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scramfranklin

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #26 on: May 14, 2019, 07:32:58 PM »
Can Jaw/chin implants make a brachyfacial more mesofacial? I would initially think so since you could add more height to the lower third.

My jaw surgeon's analysis classified my as a "severe brachyfacial" and his plan is mostly linear advancement (I am having a consultation with a second surgeon this fall). Depending on what the second surgeon suggests, I'll make a decision regarding jaw surgery, but was wondering what I could do afterwards to improve aesthetics in case I would like to make my brachy face more meso.

I realize there is more to attractiveness than just facial type (meso, brachy, and doli); so it's just a hypothetical question as of right now

kavan

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #27 on: May 15, 2019, 10:48:54 AM »
Brachyfacial could be short 'middle 1/3' and/or short 'lower 1/3'. But the look is often characterized by a broad SQUARE face and LOW mandibular plane angle.

The main aim of jaw implants is to broaden the jaws and/or DECREASE the MPA as to address narrow jaw to jaw distance and a HIGH MPA.
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scramfranklin

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #28 on: May 15, 2019, 02:29:33 PM »
Brachyfacial could be short 'middle 1/3' and/or short 'lower 1/3'. But the look is often characterized by a broad SQUARE face and LOW mandibular plane angle.

The main aim of jaw implants is to broaden the jaws and/or DECREASE the MPA as to address narrow jaw to jaw distance and a HIGH MPA.

That makes sense to me. But would it be reasonable to add height evenly along the jawline in order to slightly lengthen lower third height, while for the most part, maintaining the MPA?

It's not something I will consider until after jaw surgery. You looked at my surgeons plans before (and rightfully had concerns), but I got some more info from him: https://imgur.com/a/2Qyx52l

He wants to advance both jaws 7mm and the chin 5.5mm. Very slight CCW rotation of the mandible. I may ask for a couple more mm advancement and slight CW rotation of the upper jaw so my teeth won't be slanted "down" from the front to the back and see what he says.

 I'm still exploring options and have a consultation with another respected surgeon in the fall and will probably choose a third to consult with as well.

Also.. thoughts on my palate? I appreciate the effort you put into helping people on the site.

kavan

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Re: Definitive Guide to Facial Implants: Reality Edition 2019
« Reply #29 on: May 15, 2019, 03:23:08 PM »
Your palate looks wide enough given brachys have BROAD faces and that's from the palate.

Both jaws by same/similar amount is close to linear advancement which is consistent with brachys who have pretty good bites.

Since brachys usually have short chins, then a type of genio that BOTH advances it and elongates it which is not a sliding genio which is a diagonally upward movement. You might need a type of genio that moves chin diagonally DOWNWARD (down and out) with a bone buttress in between the cut parts. Diagonally downward that way is CLOCKWISE rotation to the chin which can be used to offset 'short' lower 1/3 or 'short chin' common with brachys.

I don't know of a jaw implant that increases the MPA. But the type of genio I mentioned could help give that effect.

Think about a jaw implant only if you want to ARTICULATE the back angle. But that is a wait and see process. Not something I can advise on at this point in time.

ETA: elongating the jaw 'evenly' does not transform brachy into meso or doli. You would still be brachy.
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