jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Schrödingers Jaw on February 17, 2016, 09:32:47 AM
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I feel uneasy about keeping implants in my face permanently, am I being paranoid here or are implants prone to complications over long time periods?
I plan orbital work and perhaps also jaw+cheek augmentation. Still very undecided on wether to pursue an osteotomy or implantation.
Are implants really a permanent solution?
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They are not a long term thing unfortunately. Implants are a way for greedy doctors looking to make a quick buck. One major complication with most cases of implants is bone resorption. The degree of bone resorption differs from cases to case - generally, the longer you have the implants the more you are at risk ...
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They are not a long term thing unfortunately. Implants are a way for greedy doctors looking to make a quick buck. One major complication with most cases of implants is bone resorption. The degree of bone resorption differs from cases to case - generally, the longer you have the implants the more you are at risk ...
I've seen people with implants for decades. The results were far better and marked than results from any osteotomy I've seen (jaw surgery aside), and no issues after decades. Guess it depends on who you'd ask.
This isn't very decisive...
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haven't seen one natural jaw implant result (live) in my life; seen about 4/5 from osteotomies:
i'm not talking of pictures but real people who had surgery.
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haven't seen one natural jaw implant result (live) in my life; seen about 4/5 from osteotomies:
i'm not talking of pictures but real people who had surgery.
Have you seen any orbital augment?
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no
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Have you seen any orbital augment?
Wouldn't you be afraid of possibly getting an infection so close to the your eyes with orbital implants
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Wouldn't you be afraid of possibly getting an infection so close to the your eyes with orbital implants
Well, my orbitals are quite bad. As long as the chance is low I think I'll take that risk actually.
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I've also never seen a natural jaw implant result perhaps due to the fact a natural result should also involve the upper jaw.
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If you go to a very good surgeon who places the implants correctly, there doesn't seem to be evidence of long term problems(though lack of proof doesn't always mean that there's no proof). Why I'd never consider it is because of the permanent risk of infection, if you play contact sports regularly and don't plan on quitting any time soon, imagine an injury where you get bashed in the face on the implants. Even with a sedentary lifestyle I wouldn't want to risk any sort of accidents.
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The implants can be removed easily if you get an infection. I'm not sure if I understand the big deal. And look into figures :doesn't seem many people get an infection in the first place. Compare it to complication rates of osteotomies.
Allover the results I've seen from implants were better than from osteotomy (not talking about bimax surgery). Simply because were the augmentation will be is more predictable and can be determined upfront. If you want augmentation somewhere you can get it with an implant. Not so much with bone: it is not a jigsaw puzzle that you can put together to just get augmentation where we need it.
I need orbital work, I'm trying to decide between having the same procedure as earl with Sinn (who is now 77 years old) or get implants with Yaremchuck.
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People are right on both ends of the spectrum here. Many people get implants and many people can keep them for decades without problems. Once put in, you can never go back to good as new. Here's a list of problems that can and do happen:
- Implant erodes and the fragments cause foreign body reactions.
- Bone erodes under the implant. I'm skeptical about this one. Bones shrink with age anyway.
- Improper implant contours. What's flush with bone at 30 probably isn't at 50. Good facial balance at 30 becomes bulky at 50. Implants don't recede with the rest of your face.
- Implants can migrate. Bones change, hardware moves, things loosen, etc.
- Implants harbor infections. Years or decades later. All surgeons see these, even those frequently mentioned here.
- Not all are removable. The ones with "bony ingrowth", not coming out. Like the new CT-bone ones.
- They can compress nerves. Particularly those infraorbital rim ones have to run around infraorbital nerve.
- Damage to soft tissue around them in surgery can be unaesthetic.
- They are hard to get symmetric and can become asymmetric with time
- You might not be a good surgical candidate for removal later if they cause problems
- 50 years is a REALLY long time for anything to survive, in or outside the body. It's 2016 so take a look at objects made in the 70s for comparison.
- You can only augment to today's deficiencies. As your face recedes you might want more to remain young looking.
- Osteotomies have their own problems. Sinus cavity exposure from jaw surgery is bad enough for example. Unpredictability. Difficult to access hardware. Irregular contours. You didn't ask, just to name a few.
On the plus sides:
- Bony deficiencies create other problems. Eyelid problems, dry eyes, etc
- Some people are unwilling to accept normal airway jaw surgery due to aesthetic compromise. Implants make it possible.
- The risks of implants may be better than facelifts
- Mental health problems from lack of confidence are no fun
The point is, yes implants really do have problems but just because they have problems doesn't mean you shouldn't do them. The alternatives have problems too. We don't get the option of a problem-free life. My impression is that doctors think that 50s is the optimal time to consider them because you're unlikely to live long enough to have to deal with the problems for long if you do. And, of course, the longer you wait the better your options will be. Who knows, maybe by then non-surgical solutions will exist, like growth hormone injections. Surgical options will improve, like lab grown augmentations, accurate soft tissue models, resorbable load bearing bone cements (+ benefits from less retraction), etc. Once you get surgery, you're stuck with those compromises for life.
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I have moderate orbital recession, negative vector, weak zygomatic projection around the eyes and all that.
I've narrowed my options down to either a modified lefort iii like earl had with doctor Sinn or implantation in which case I have my eyes on Yaremchuck.
Sinn is 77 years old and will likely be 78-79 when I have the money to hire him, on the other hand I am adverse against keeping those implants in my body for decades.
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molestrip great post, i lovethemoon you're an uneducated useless poster.
I had silicone chin implant and it eroded the bone, it was difficult to take out and also when out it caused a bulbous chin needing surgery to fix it.
Implants SUCK, all of them.
DO NOT get implants.
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I wasn't advocating for either approach, osteotomy or implant. But I do want to comment on the "surgical candidate" comment. Health problems can make surgery risky, type 2 diabetes for example interferes with healing. Why aren't more surgeons doing osteotomies? Best guess, results aren't as good.
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I've seen two cases of bone erosion because of implants:
A chin implant (CT-Scan) - this wasn't even erosion anymore. The implant literally inflitrated the bone like a tumor and touched the roots of the teeth. Ofc there was an infection along with it.
Cheek bone implants (CT-Scan and Skull model) - the bone was flattened like, the wasn't even the natural curve anymore, just a straight and flattened surface.
I wouldn't get implants. Never. Even though I'm in desperate need for cheekbone enhancement.
But everyone can do as they wish.
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I've seen two cases of bone erosion because of implants:
A chin implant (CT-Scan) - this wasn't even erosion anymore. The implant literally inflitrated the bone like a tumor and touched the roots of the teeth. Ofc there was an infection along with it.
Cheek bone implants (CT-Scan and Skull model) - the bone was flattened like, the wasn't even the natural curve anymore, just a straight and flattened surface.
I wouldn't get implants. Never. Even though I'm in desperate need for cheekbone enhancement.
But everyone can do as they wish.
But thousands of people get implants each year, how can it be so popular if there isn't a high satisfaction rate?
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Implants made of calcium phosphate will not erode the bone.
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it does not have a high satisfaction rate! find 1 happy patient!!!
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But thousands of people get implants each year, how can it be so popular if there isn't a high satisfaction rate?
I didn't say there isn't a high satisfaction rate (initially) I just said what the complications may be. The ones I mentioned was stuff that happened years after the surgeries, implants don't infiltrate bone in a week.
I also read many negative (almost all) reviews on RealSelf. Most of the people thought they were unnatural and then there were some catastrophic ones where e.g. the implants shifted and hurt tissue and caused somekind of lymphatic edemas afterwards (not cureable).
I don't know how high the incidence is. At least I think erosion is there in almost all cases. But I'm only talking about the standard implants. I never heard nor have seen something about orbital rim implants.
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" I have done many cases of cheek and chin implants over the past 25 years. I do not use jaw implants due to their higher incidence of issues after placement. One of these is the movement of the implants, even when they are screwed in...which is a must, due to the Masseter muscle that moves every time you open and close the mouth. In contrast, cheek or chin implants do not need to be screwed in place."
Francis palmer...
Said by a dr who already uses (awful) implants, so biased in favour of them....DO NOT USE IMPLANTS GUYS!
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" I have done many cases of cheek and chin implants over the past 25 years. I do not use jaw implants due to their higher incidence of issues after placement. One of these is the movement of the implants, even when they are screwed in...which is a must, due to the Masseter muscle that moves every time you open and close the mouth. In contrast, cheek or chin implants do not need to be screwed in place."
Francis palmer...
Said by a dr who already uses (awful) implants, so biased in favour of them....DO NOT USE IMPLANTS GUYS!
I guess I'll try my luck with Dr. Sinn then and have him dislodge and move my orbitals -even if he will be nearly 80 by the time I can afford him.
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I think I learned the hard way that implants are not the way to go. I had custom malar and infraorbital rim implants (silicone) with Dr. Yaremchuk two years ago, and although other people can't tell, I think they look sort of grotesque. The soft tissue sits strangely on them. There are so many things that are off about them. I look different, not better.
I really want to have them removed before I have double jaw surgery (is there any reason to have double jaw surgery first, and then remove the implants later? I'm conflicted about this.) I'm scared of the excess skin that will be left over, but hopefully the double jaw surgery will stretch it out.
I just wanted to chime in with some insights I've developed from my own experience. I think infraorbital rim augmentation wasn't right for me, even though the whole midface was recessed, because I also have small, deep set and somewhat close set eyes, and a prominent brow ridge. The implants make my eyes look even smaller and more deep set. I don't know if this means that (if that were possible surgically) my eyes should also be brought forward in a midface osteotomy, as in the whole orbital complex (a Lefort III doesn't do that, right?).
Another thing I wanted to say is that the risk of bone erosion is not as high as some of you guys think. It really only happens if the implant moves a lot, micromovements too. It's an issue with improperly secured chin or cheek implants. They should always be screwed in. Also, custom implants like mine attach perfectly to the bone underneath so they don't move at all.
Honestly my goal now is to have a class I skeleton, and f**k the midface. It was always my jawline that bothered me and not the midface. I can live with it. And I can always wait a couple decades for midface osteotomies to improve.
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I think I learned the hard way that implants are not the way to go. I had custom malar and infraorbital rim implants (silicone) with Dr. Yaremchuk two years ago, and although other people can't tell, I think they look sort of grotesque. The soft tissue sits strangely on them. There are so many things that are off about them. I look different, not better.
I really want to have them removed before I have double jaw surgery (is there any reason to have double jaw surgery first, and then remove the implants later? I'm conflicted about this.) I'm scared of the excess skin that will be left over, but hopefully the double jaw surgery will stretch it out.
I just wanted to chime in with some insights I've developed from my own experience. I think infraorbital rim augmentation wasn't right for me, even though the whole midface was recessed, because I also have small, deep set and somewhat close set eyes, and a prominent brow ridge. The implants make my eyes look even smaller and more deep set. I don't know if this means that (if that were possible surgically) my eyes should also be brought forward in a midface osteotomy, as in the whole orbital complex (a Lefort III doesn't do that, right?).
Another thing I wanted to say is that the risk of bone erosion is not as high as some of you guys think. It really only happens if the implant moves a lot, micromovements too. It's an issue with improperly secured chin or cheek implants. They should always be screwed in. Also, custom implants like mine attach perfectly to the bone underneath so they don't move at all.
Honestly my goal now is to have a class I skeleton, and f**k the midface. It was always my jawline that bothered me and not the midface. I can live with it. And I can always wait a couple decades for midface osteotomies to improve.
I was considering Yaremchuck for orbital implants. However my orbitals are for sure recessed, do you think implants just wasn't right for you or do you consider them a bad idea in general?
How was the consultation with dr. Y and how much did the it all cost?
Also really interested in recovery.
I believe you should remove your implant prior to getting jaw surgery, otherwise there is no telling how it will affect your face. They might be misplaced aftwerwards
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schroingers: he is CLEARLY stating implants are not good in general, not just for him.
He even told you he learned this the hard way, and i did so too....you've LUCKY you have people like us, don't get scammed!
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I also had a recessed midface including the infraorbital rim but the implants weren't an ideal way to solve that. I think they have a lot of problems and I don't think I'd ever recommend jaw/chin implants because there are much better alternatives, but maybe midface implants do have a niche since osteotomies in that region are so rare, difficult and unpredictable. Also unlike jaw implants, cheek implants can give anterior projection and not just lateral. If I could go back in time I probably wouldn't have done it, though.
HOWEVER I must say that since both my jaws are recessed, I have a very thick soft tissue envelope, and my buccinator is super hypertrophied due to improper swallowing (think trombone player), it's hard to judge the implants fairly. Part of why I think they look "grotesque" in some pictures is because my cheeks (not cheekbones) are just so thick and big. I want to wait if possible until after the double jaw surgery to judge the implants (getting a second opinion with Dr. Gunson to see if that's a possibility). Right now my face is 1 0 0. Maybe once it's 1 1 1 my opinion of the implants will change. I would hate to go to 0 1 1 and then miss the implants. They're actually pretty subtle. For whoever's interested, the implant size is about 2.5 mm at rim and 3 to 4.5 mm at malar. Interestingly, those 2.5 mm were already enough to give me a positive vector, which probably means that they weren't that recessed originally.
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My midface isn't really recessed just my orbitals. They've always been very weak, I suppose underdeveloped might be more accurate. I'll visit Sinn as soon as I got the funds but I'm very concerned about his age tbh.
If I cannot find a good alternative I will get implants anyway because, quite frankly, I don't think the area around my eyes can get much worse.
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I think I learned the hard way that implants are not the way to go. I had custom malar and infraorbital rim implants (silicone) with Dr. Yaremchuk two years ago, and although other people can't tell, I think they look sort of grotesque. The soft tissue sits strangely on them. There are so many things that are off about them. I look different, not better.
Why silicone and not medpor? I thought Dr Y was really into medpor?