Might Need to Take Implants Out and do Surgery...

[eastcoastian1]

What are centers?

Ugh, auto correct. Meant veneers.

[kavan]

Based on looking at your posting history which started in 2015, it looks like you had some pre-existing TMJ issues. So what ever issues you had 4 years ago could have progressed (gotten worse) as to what you see now. That would be so with or without the jaw implants.

[eastcoastian1]

Based on looking at your posting history which started in 2015, it looks like you had some pre-existing TMJ issues. So what ever issues you had 4 years ago could have progressed (gotten worse) as to what you see now. That would be so with or without the jaw implants.

That’s what I’m potentially thinking. What confuses me is how there could be such a drastic change within a few months.

[kavan]

That’s what I’m potentially thinking. What confuses me is how there could be such a drastic change within a few months.

Maybe a 'Straw that broke the camel's back' sort of thing.

[ben from UK]

Be very carefull with taking implants out. It can lead to the masseter muscle detaching or retracting upwards, leaving you with an additional flaw which is superhard if not impossible to fix. Sometimes, implants exert alot of force on the masseter, which is comparable to stretching an elastic. When you let go of this elastic, the elastic/masseter might pull back (in this case upwards), creating a bulge, which ruins the ogee line. It isn't always the case, but it might happen, and then you have new problems.

When I look at your pics, I don't find your bite that bad or destracting. You seem to have facial harmony with the implants. So think about wanting to take risks of cutting, scar tissue and other problems, etc.

[eastcoastian1]

Hi guys,

Thought I'd provide an update here.

I visited Dr. Relle and got an new images. My bite, as thought, has shifted significantly and my right condyle is showing signs of resorption. Relle basically told me there's no easy choice here and I kind of put myself in pickle by doing implants to camouflage major asymmetry issues instead of doing jaw surgery and THEN considering implants (take note guys). He told me all my options have risks. He said ortho only could "help" but it again would be more camouflaging and would take significant movement that could actually lead to more issues and theres a possibility I would need jaw surgery regardless and it would be for nothing. On the other hand, he said surgery would fix the functional issues but also said we would need to take the implants out first, wait six months, see how the soft tissue responds and then come up with surgical plan. He said when all is said and done, even with CCW, no way he can match the width of current implants.

So here I am.......needing to figure out what to do. Let me condyle and bite continue to worsen, try orthodontics alone and hope for the best, or bite the bullet and do the long process of jaw surgery then consider implants again if needed.

[Post bimax]

Hi guys,

Thought I'd provide an update here.

I visited Dr. Relle and got an new images. My bite, as thought, has shifted significantly and my right condyle is showing signs of resorption. Relle basically told me there's no easy choice here and I kind of put myself in pickle by doing implants to camouflage major asymmetry issues instead of doing jaw surgery and THEN considering implants (take note guys). He told me all my options have risks. He said ortho only could "help" but it again would be more camouflaging and would take significant movement that could actually lead to more issues and theres a possibility I would need jaw surgery regardless and it would be for nothing. On the other hand, he said surgery would fix the functional issues but also said we would need to take the implants out first, wait six months, see how the soft tissue responds and then come up with surgical plan. He said when all is said and done, even with CCW, no way he can match the width of current implants.

So here I am.......needing to figure out what to do. Let me condyle and bite continue to worsen, try orthodontics alone and hope for the best, or bite the bullet and do the long process of jaw surgery then consider implants again if needed.

Did he say JS would relieve your condyle issues?

And you can always put implants back in after JS (not considering cost)

[eastcoastian1]

Did he say JS would relieve your condyle issues?

And you can always put implants back in after JS (not considering cost)

Yeah. To fix bite, condyle, asymmetry......surgery. Particularly for the yaw and cant as my teeth on the right mostly don’t even connect.

The issue is we’re talking a LOT of surgery. Surgery to remove implants, surgery for bimax, then potential surgery again for new implants.

[PloskoPlus]

Does he think the implants in any way made your issues worse?

[eastcoastian1]

Does he think the implants in any way made your issues worse?

Didn’t imply that. Moreso that my original issue has gotten worse. My teeth on the right don’t even meet when biting now.

[eastcoastian1]

Are there any stories or literature about patients who had implants removed then did jaw surgery?
I’m really struggling on deciding what to do here....

[ben from UK]

Are there any stories or literature about patients who had implants removed then did jaw surgery?
I’m really struggling on deciding what to do here....

I never read something about it. I only read about soft tissue problems in some cases when taking implants out (chin ptosis and masseter bulge). It's very hard to fix soft tissue problems. Some people on this board had many revisions to fix for example chin ptosis. Soft tissue problems seem minor problems, but they are a hell of alot more difficult to fix than problems with bonestructure.

[eastcoastian1]

I never read something about it. I only read about soft tissue problems in some cases when taking implants out (chin ptosis and masseter bulge). It's very hard to fix soft tissue problems. Some people on this board had many revisions to fix for example chin ptosis. Soft tissue problems seem minor problems, but they are a hell of alot more difficult to fix than problems with bonestructure.

Yeah that makes sense. Another piece I’d need to figure out is if do take the implant out first, wait for it to heal, THEN do jaw surgery....or take implant out and do surgery at same time. Relle is pushing me to get the implant taken out first and to wait, but I’m scared s**tless of contraction issues, skin sagging, problems with the capsule, and overall just looking awful between implant removal and jaw surgery. Plus it’s just an extra surgery. Plus I feel like there’s less chance of some of the issues you mentioned if I’m filling some of that empty space right away with movement/advancement from the jaw surgery, instead of letting dead space linger for 6+ months.  But Relle says he wants to see how the soft tissue will respond.

Realistically though, I feel like I’ll end up getting implants again anyway as both Relle and Gunson both said they can’t replicate the look of the implant, especially the width, with jaw surgery alone. Prob do Medpor though this time.

[ben from UK]

Yeah that makes sense. Another piece I’d need to figure out is if do take the implant out first, wait for it to heal, THEN do jaw surgery....or take implant out and do surgery at same time. Relle is pushing me to get the implant taken out first and to wait, but I’m scared s**tless of contraction issues, skin sagging, problems with the capsule, and overall just looking awful between implant removal and jaw surgery. Plus it’s just an extra surgery. Plus I feel like there’s less chance of some of the issues you mentioned if I’m filling some of that empty space right away with movement/advancement from the jaw surgery, instead of letting dead space linger for 6+ months.  But Relle says he wants to see how the soft tissue will respond.

Realistically though, I feel like I’ll end up getting implants again anyway as both Relle and Gunson both said they can’t replicate the look of the implant, especially the width, with jaw surgery alone. Prob do Medpor though this time.

+ You could take implants again, but that doesn't mean they will look as good as these ones. The revision rate with implants is around 30 percent or even higher, so that means lots of people aren't happy with the results due to them being too big, too small, asymmetric or for other reasons. People with implants that do fit the face are very lucky, cause lots of surgeons that do these kind of procedures just have no clue what the hell they're doing aestethically. So many surgeons with absolutely zero knowledge about proportions and aestethics, and in the rare cases they do, they lack the artistic skills to perform it the right way. Oldskool surgeons still have 'the 80s mindset': the bigger the better; overdone nosejobs, extreme implants, etc. The really skilled ones know that the secret of beauty lies in the details.

That being said, if you're young, you can do alot of revisions without looking fake cause of the elasticity of the skin.

[eastcoastian1]

+ You could take implants again, but that doesn't mean they will look as good as these ones. The revision rate with implants is around 30 percent or even higher, so that means lots of people aren't happy with the results due to them being too big, too small, asymmetric or for other reasons. People with implants that do fit the face are very lucky, cause lots of surgeons that do these kind of procedures just have no clue what the hell they're doing aestethically. So many surgeons with absolutely zero knowledge about proportions and aestethics, and in the rare cases they do, they lack the artistic skills to perform it the right way. Oldskool surgeons still have 'the 80s mindset': the bigger the better; overdone nosejobs, extreme implants, etc. The really skilled ones know that the secret of beauty lies in the details.

That being said, if you're young, you can do alot of revisions without looking fake cause of the elasticity of the skin.

33 so kind of borderline lol.

I went to Dr. Y and left the measurements up to him and he went pretty conservative. I believe 8mm width added each side (which when it settled is down to about 6mm according to a doc recently). To be fair, I was so deficient before, that ANY increase would have been an improvement, which it was. I essentially had a long mid face with small lower third, and narrow V-shaped jaw with zero angles. Just adding the extra bulk really helped.

That said, still had issues with the angles (width and drop down) and every 3 months or so I get Radiesse filled, which looks awesome initially but fades really quick. Truth be told, if I didn't do jaw surgery, I prob would redo the implants anyway.