I don't understand modern implants

[Stei]

Hello there,

I'd like to gather your insights/opinions about "modern implants", I'm thinking specifically about Peek implants, but I guess this is also true for other kinds of materials.
I'd like to discuss that because I have one I'm really not happy with and I think one of the main reasons for that is because it doesn't look natural to me. Obviously, I was already worried about that during the planning phase. I thought the design was very simplistic, the surg and I spent months working on that but there were so many differences with an actual bone that I did not have enough time to address all the issues I could see.
Now I take a look at what other surgeons do and it looks like what I have is pretty much the norm, from what I could find. There are many pictures of Dr. Eppley's implants, for example (multiple pictures in):

https://imgur.com/a/7F7TbMT

Am I the only one stupefied by those jaw angles ? Do people ask for that kind of shape ? I just don't understand why it doesn't try to replicate the actual shape of a healthy bone ?  The structure of a bone is actually complex, there are curves in certain places and I feel like that implants add volume for the sake of adding volume. Maybe this explains why people complain about the lack of sharpness with implants.
Personally, I don't understand how one can achieve a natural look if the underlying structure is so different from a bone. Or maybe the implant/bone shape doesn't matter that much and all the work is done by the soft tissues ?

I'm sure it is not because we do not have the technological capacity. It shouldn't be so hard with 3D printing. I recently found this image : https://imgur.com/a/q0Kyw5p

So might it be laziness or lack of ambition from the surgeon ? or the firms that produce these implants ?

[kavan]

Jaw implant doctors are frequently hit with guys who want to look like BLOCK HEADS. But might not realize they are requesting that in the process of wanting to 'have what the model has' to the jaws .

[Post bimax]

Eppley is going to be among the worst offenders in this regard.  Look at his client base.  He's mentioned in almost every incel/puahate article.

Other surgeons are more discerning.  But at the end of the day, they are cosmetic surgeons selling a product.  If someone comes in asking for X, they're going to give them X.  Really it's incumbent on the patient to educate themselves on what constitutes good aesthetics.

[Stei]

I don't know if there are more discerning surgeons out there. I'd like to meet them for sure. First, it seems there are not many surgeons working with peek at the moment. I've seen Dr.Yaremchuk mentioned several times for implants. But his design is similar to the one above : https://imgur.com/a/rJtrCHi

As far as I'm concerned, I strongly insisted on the importance for me to have smthing close to natural and harmonious with my face (so no block head). What appealed to me in a wraparound implant was that it could cover all the irregularities on my bone, it was the whole idea. I had to undergo many jaw surgeries at young age which leave me with a sliced and still recessed jaw. Can't talk about that too openly for the moment, but the implant did not meet what i expected in this regard.

Really it's incumbent on the patient to educate themselves on what constitutes good aesthetics.

Yes, I guess in a certain extent. That's true about the general shape of the implant. This is why I tried to avoid full aesthetic surg. I did not want someone that would straightforwardly do what I ask, but someone with a strong knowledge of maxillofacial anatomy who would set limits and provide advice. Now I'm starting to think, perhaps it would have been a better call to choose a full aesthetic surg with a good eye for that.
Because what bothers me is the lack of definition of the implant. How can one knows about every detail that'll make a bone real or not ? You're the backer of the project, not the artist. Personally, I tried to work on that with my surgeon, but I feel the company he's working with made no effort.

[ben from UK]

You are right. It has several reasons, nobody knows for sure what it is yet, but bottomline is: fillers have been proven to create this hyperangular look on a consistent basis.  So, the question shouldn't be: why are there so many bloated cases with hard materials, but: how do we create a safe permanent filler mimicking results of temporary fillers.

There are two other things I want to mention:

1) People talk about designs when it comes to surgeons. But when you look at the designs from several surgeons, they are pretty much the same, globally. Design is one thing, but more important (probably) is how the soft tissue is layed around the implant during surgery and the surgical skills to do this.

2) When you look at the jawbone/structure of people with naturally good jaws, they never have the same structure as for example Eppley's designs. Sometimes, there's barely any difference between a ct from someone with a good jaw and someone with a bad jaw.

Conclusion: soft tissue and maybe masseter are much more important than we ever thought. A permanent filler is needed to recreate the hyperangular jawline, which implants almost never are able to create. Or, if it's possible to create it through hard material, a better material, and then we return to question 1: why do many implants create a bloated look? This is a tough question to answer. There's not much scientific research about it. My guess is: A) implants need to go up the face to be able to fix them, so they target areas of the face that shouldn't be thicker. For example, the area between the lower border of the jaw and the cheekbone should stay 'empty' in the ideal case. But implants go up to that area, creating a bloated and flat face without depth. B) They add mass to the bone. They add a layer on top of the bone. Same goes for chin implants. It looks a bit unnatural, the natural bone isn't that thick. C) phenotype might play a role in some cases as well. It's hard to go from oval to angular with hard material without making it look unnatural or bloated. D) jaw doesn't stand on its own. You have to look at it relative to cheekbones and chin.

That being said: some people have faces that are too small. Using hard material might not give them the superangularity, but could make them more aestethic looking, just by adding mass to the bone.

[ben from UK]

Jaw implant doctors are frequently hit with guys who want to look like BLOCK HEADS. But might not realize they are requesting that in the process of wanting to 'have what the model has' to the jaws .

Thing is, the model jaw seems to be achievable with fillers nowadays, so people who ask for model-jaws do have a legit question imo. Question is: why aren't implants able to replicate this?

Look at: https://www.instagram.com/igoorcostalves/?utm_source=ig_embed&ig_mid=75CD60D6-C616-4121-B50B-98FDBE661AC7

In my opinion, everything in life is trial and error. So, if implants aren't able to reproduce model-jaws on a consistent basis, people will seek for other solutions. If fillers are indeed the ultimate solution, one needs to develop a safe permanent filler that could last lifelong.

The user stupidjaws on this board only achieved super angularity through fillers. Neither implants nor chinwings seem to be able to reproduce that very angular jawline (at least not on a consistent basis).

The above examples with fillers is how the results of implants need to look like. Angular, with facial depth, no bloat. People pay alot of money for implants, many end up with a bloated face, rounded corners or no angularity. There must be a reason for this, and it's not stupidity from the side of the client. The client asks for a model jaw (read: angular, straight etc.), and that's clearly possible, looking at filler results. Surgeons say it's possible with implants, but many don't deliver on their promises.

[kavan]

Thing is, the model jaw seems to be achievable with fillers nowadays, so people who ask for model-jaws do have a legit question imo. Question is: why aren't implants able to replicate this?

Look at: https://www.instagram.com/igoorcostalves/?utm_source=ig_embed&ig_mid=75CD60D6-C616-4121-B50B-98FDBE661AC7

In my opinion, everything in life is trial and error. So, if implants aren't able to reproduce model-jaws on a consistent basis, people will seek for other solutions. If fillers are indeed the ultimate solution, one needs to develop a safe permanent filler that could last lifelong.

The user stupidjaws on this board only achieved super angularity through fillers. Neither implants nor chinwings seem to be able to reproduce that very angular jawline (at least not on a consistent basis).

The above examples with fillers is how the results of implants need to look like. Angular, with facial depth, no bloat. People pay alot of money for implants, many end up with a bloated face, rounded corners or no angularity. There must be a reason for this, and it's not stupidity from the side of the client. The client asks for a model jaw (read: angular, straight etc.), and that's clearly possible, looking at filler results. Surgeons say it's possible with implants, but many don't deliver on their promises.

Filler photos are taken on SAME day. What ever 'sharpness' you see on the SAME DAY gets blunted over time. The more you get fillers, the more you have to get refills or 'top ups'. Each refill creates more internal scar tissue (steel canulla to place creates scar tissue). Although scar tissue can give some augmentation, it also makes it harder to smoothly re-inject with each refill. So, it is not a one and done deal. Instagram docs who wow the audience with the jaw fillers act on the principle that the SAME DAY look will attract new patients and the patients who had it prior will keep coming back. So, it's more of a lucrative process for the filler doctor than a 'one and done' deal.

Fillers are in the soft tissue envelope and lend themselves more to selective sculpting than do implants. For example, you can shoot the filler in below the bone border without having to fixate it to the jaw bone as you do with an implant.

There was a perm filler; 'Bio-Alcamid' which was once used. But with time, it had MANY problems, one being LATE STAGE INFECTION. It was discontinued. A late stage infection with a perm filler is more problematic to remove than an infected implant. Has to be squeezed out which can dislodge it to other places to infect. With the bio-alcamid, people were getting terrible problems/infections with the stuff MANY YEARS AFTER they got it injected

A product used for BODY filling (which is much thicker than fillers used for face) was used on SJ and the product used on him was discontinued. It was used OFF LABEL from it's intended use (stuff like breast and butt filling).

[Lazlo]

What's wrong with the Yaremchuck results you posted above? They seem amazing. Great harmony, amazing cheekbones (exactly that model like look there), plus they look natural.

[tim06]

What many people and doctors actually fail to address is that having a defined and chiselled jawline is as much of a bone as it is a matter of the soft tissue. If you add an implant on top of the bone but below the soft tissue you can end up with odd results. While you have in mind something like this:


You end up like this: (scroll to the right)

[Lazlo]

i don't think that guy's results are terrible either --like he has more facial at and thicker skin but if he went on a major diet and got ripped it could look better.


Also with respect to filler, this doctor says you can't really get cheekbone definition or jawlines from filler. He said they're okay for smoothing transitions but not overall volume in any area. He's don'e a ton of research on this. So basically what Kavan said about the filler before and afters.

https://www.youtube.com/watch?v=8kg16UM3YnE

[PloskoPlus]

Also with respect to filler, this doctor says you can't really get cheekbone definition or jawlines from filler. He said they're okay for smoothing transitions but not overall volume in any area. He's don'e a ton of research on this. So basically what Kavan said about the filler before and afters.

https://www.youtube.com/watch?v=8kg16UM3YnE

Good find.

[PloskoPlus]

Muscle bulk alone is not enough for the same reason juiceheads at your local gym, while bigger than a fitness model, don't look as good.  Everything has to flow into everything else — size and shape of bones and muscles and how the muscles attach to the bones.  For example, some have bicep muscle bellies (regardless of how big they are in circumference) which seem to attach almost at their elbows, yet others have biceps which finish almost half-way down their upper arm.

[tim06]

i don't think that guy's results are terrible either --like he has more facial at and thicker skin but if he went on a major diet and got ripped it could look better.


Also with respect to filler, this doctor says you can't really get cheekbone definition or jawlines from filler. He said they're okay for smoothing transitions but not overall volume in any area. He's don'e a ton of research on this. So basically what Kavan said about the filler before and afters.

https://www.youtube.com/watch?v=8kg16UM3YnE

The idea of using fillers to create a good jawline is just too tempting, you go to a doctor sit still for 30 minutes and after that you have a great jawline for $1k. I have actually also considered getting fillers for just that reason, quick, no pain, low risks and its cheap compared to major surgeries. But sadly thats not how it works, and results quickly diminish after 1-2 months. I am not sure why there isn't something like injectible bone structure made of calcium that could just be injected on top of your bones to give projection.
HA-paste is close, but it sucks in all aspects, being clumsy and resulting in uneven bumpy results.

[ben from UK]

Filler photos are taken on SAME day. What ever 'sharpness' you see on the SAME DAY gets blunted over time. The more you get fillers, the more you have to get refills or 'top ups'. Each refill creates more internal scar tissue (steel canulla to place creates scar tissue). Although scar tissue can give some augmentation, it also makes it harder to smoothly re-inject with each refill. So, it is not a one and done deal. Instagram docs who wow the audience with the jaw fillers act on the principle that the SAME DAY look will attract new patients and the patients who had it prior will keep coming back. So, it's more of a lucrative process for the filler doctor than a 'one and done' deal.

Fillers are in the soft tissue envelope and lend themselves more to selective sculpting than do implants. For example, you can shoot the filler in below the bone border without having to fixate it to the jaw bone as you do with an implant.

There was a perm filler; 'Bio-Alcamid' which was once used. But with time, it had MANY problems, one being LATE STAGE INFECTION. It was discontinued. A late stage infection with a perm filler is more problematic to remove than an infected implant. Has to be squeezed out which can dislodge it to other places to infect. With the bio-alcamid, people were getting terrible problems/infections with the stuff MANY YEARS AFTER they got it injected

A product used for BODY filling (which is much thicker than fillers used for face) was used on SJ and the product used on him was discontinued. It was used OFF LABEL from it's intended use (stuff like breast and butt filling).

Yeah true. In theory, implants should be able to replicate the superangular look of fillers. But we're only in the infant stages when it comes to these kind of implants. The popularity of jawimplants only began to grow since around 2012. In about 10-20 years, techniques will be different, there will be more knowledge about it, etc. Some people get lucky now and do get a natural looking angular jawline. Other people have less luck and deal with a bloated look/blockhead. It's still trial and error. Me personally, I think the surgeon's skill is highly imoortant.
Yaremchuk seems to have the aestethic eye. I never saw or spoke to someone who really had a bad wrap around outcome with him, aestethically speaking. Surely, they'll exist, not everything goes according to the plan, but Yaremchuk has massive experience with this, compared to someone like defranq, who, it seems, only just began focussing on this particular procedure and has more experience in other aestethic procedures.

[ben from UK]

By the way, I think that the whole upper area of implants is aestethically useless. Ideally, you only target the lower base (see pic). Someone else said it before: millimeters are miles on a face. Every spot that doesn't need to ne augmented, shouldn't be augmented. I understand this is needed to fix the implant, but they should find a way to get rid of all useless parts and make it more 'lean', to avoid bloating etc.

I understand that when you get, for example 15-20 mm angles, the implant needs to go higher up, but if it's only 3-4 mm, it could be made more lean.