jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Reality on December 22, 2018, 04:54:28 PM
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PREFACE
I've read so many medical journals and peer reviewed articles regarding facial implants, that overall, it's starting to feel cryptic and I'm becoming vexed. What's more, is that in- context of real world application concerning viability: Bio-compatibility & long-term stability of facial implants; most of the aforementioned become null & void (i.e. statistics & numbers don't exactly translate into reality: viable outcomes)
Furthermore, my healing is complete and soon I will have to make a decision as to which implant material to utilize for my mandible and jaw angles. Previous to this, I had seriously considered a CW to increase my bigonial distance (posterior width of the lower jaw) but it seems impractical and quixotic (for my case). I am still considering total Orthognathic surgery, depending on the practitioner. However, I've currently been receiving plenty of mixed feedback from different surgeons (i.e. I would be a good candidate for jaw surgery or it isn't necessary etc...). So, at this stage I am still researching and committed to consultations. Moreover, I'm not sure I wish to invest my time with such a lengthy expedition, as I already know that I can "get away" with implants. The key is, what type of implants and who has the experience to perform with exact prowess.
With that said, many of you have messaged me sharing similar concerns and/or situations, akin to myself and are also looking for information/answers. That's great and you can still do so but I think it even better if we can all openly discuss this topic on the forum.
The aims of this thread are to:
• Provide a summation of real-world firsthand accounts, from those who've had or currently have; experience with facial implants.
• Discuss those surgeons who utilize implantation, as well as the materials & methodologies of which they employ.
Simply stated, this topic should not be opaque and my hope is that we can all add to the transparency, in order to make the most appropriate decision with respect to our situations.
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R͚e͚a͚l͚i͚t͚y͚ Rͦͯͦͯeͦͯͦͯaͦͯͦͯlͦͯͦͯiͦͯͦͯtͦͯͦͯyͦͯͦͯ
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Personally, I don't really know that much about implants, but I glanced at something
called CT-Bone. I'm curious to your thoughts on this?
It says: "CT-Bone® is a bone-like customized implant that can be 3D
printed and is converted to real bone by the patient."
Website: https://www.xilloc.com/ct-bone/ (https://www.xilloc.com/ct-bone/)
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Below you can find an about 100 page long presentation of a Belgian specialist who works with titanium to create custom jaw implants. It is the most in-depth report on the topic I have ever seen with detailed pictures on the procedure and before/after pics.
I did a lot of research myself and can really recommend you to take the time to check it out:
https://ufile.io/1eg2i (https://ufile.io/1eg2i)
(It will take some time to load since it is a 50mb .PDF)
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Titanium and peek are the best implant material. Another thing is that it's impossible for any surgeon to precisely predict the outcome of implants and thus create the right size based on a skull model. There's alot of guessing which makes it a tricky procedure.
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Below you can find an about 100 page long presentation of a Belgian specialist who works with titanium to create custom jaw implants. It is the most in-depth report on the topic I have ever seen with detailed pictures on the procedure and before/after pics.
I did a lot of research myself and can really recommend you to take the time to check it out:
https://ufile.io/1eg2i (https://ufile.io/1eg2i)
(It will take some time to load since it is a 50mb .PDF)
File's been deleted
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Does anyone here plan to get an implant in 2019?
What material will you use?
Is it custom created?
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I apologize as I've neglected this thread: it was supposed to be a comprehensive write up of each implant material, however I've been busy with projects & other endeavors. Eventually, I will have a write up for those interested.
@Tim06 The plan is to combine an osteotomy (genio), with a wraparound implant made from PEEK.
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Definitely interested to hear more. Especially why you have chosen peek over titanium? Also who are the surgeons to go to?
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The ideal implant should be free of long term complications being infection and erosion/resorption.
Otherwise how is it a better alternative to osteotomies.
My knowledge on implant materials is relatively little but it seems almost every implant carries some sort of complication risk long term.
If there are any that do not I would imagine these would be the best material.
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The ideal implant should be free of long term complications being infection and erosion/resorption.
Otherwise how is it a better alternative to osteotomies.
My knowledge on implant materials is relatively little but it seems almost every implant carries some sort of complication risk long term.
If there are any that do not I would imagine these would be the best material.
There is no implant material that is free of potential infection. There is also no osteotomy that is free of potential infection. Remember that with osteotomies, surgeons use foreign material as well (screws, plates etc.). Even without plates and screws, you can get an infection with osteotomies, which can cause absorption of the bonegraft if a bonegraft is used.
Complication risk with implants is highest in short term (infection). Between 6 and 12 weeks is when most infections happen.
Every surgery on the face has high risk potential: dissatisfaction with results, infection, asymmetry, unnatural results, numbness, erosion, etc. To get out of a surgery completely satisfied, with no complications, the chances are low. Osteotomies are risky as well. Lots of cases with asymmetry, longfaces, blunted jawangles, etc.
The industry is pretty much in an error & trial phase and most patients follow hypes they read on the net. So if someone say fillers are great, they fly to brasil to get dangerous permanent fillers. Someone else posts good results from chinwing, and they all think chin wing is the miracle cure. And that's how it goes.
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Infections with osteotomies are rare compared to implants and can in most cases be treated with antibiotics. if not, the infected screws and plates can always be removed even in local anesthetic (at least six months after surgery), which does not affect the aesthetic result.
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Infections with osteotomies are rare compared to implants and can in most cases be treated with antibiotics. if not, the infected screws and plates can always be removed even in local anesthetic (at least six months after surgery), which does not affect the aesthetic result.
True,
The risdon approach (external) would lower the risk of infection of jawimplants, just like an external approach of a chin implant reduces the risk of infection. But I don't know how visible that scar would be. It doesn't look very aestethic to walk around with a visible scar. A scar under the chin is not very visible.
I think most infections occur due to a bad bacteria entering the site during surgery. Not much you can do about it except cleaning the whole mouth a couple of months prior to the surgery by your dentist. Surgeons always say that the risk of infection is very low, and they state percentages of 2 or 3%, some of them say they never had a client with an infection. It seems very unlikely, unless they almost never perform this procedure. The risk is appr. 15% one surgeon told me, but maybe he wasn't telling the truth as well and the real number is higher. I personally don't believe the percentages stated in research. Some research articles are written by plastic surgeons themselves. They aren't objective. It also depends on the timeframe.
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True,
The risdon approach (external) would lower the risk of infection of jawimplants, just like an external approach of a chin implant reduces the risk of infection. But I don't know how visible that scar would be. It doesn't look very aestethic to walk around with a visible scar. A scar under the chin is not very visible.
I think most infections occur due to a bad bacteria entering the site during surgery. Not much you can do about it except cleaning the whole mouth a couple of months prior to the surgery by your dentist. Surgeons always say that the risk of infection is very low, and they state percentages of 2 or 3%, some of them say they never had a client with an infection. It seems very unlikely, unless they almost never perform this procedure. The risk is appr. 15% one surgeon told me, but maybe he wasn't telling the truth as well and the real number is higher. I personally don't believe the percentages stated in research. Some research articles are written by plastic surgeons themselves. They aren't objective. It also depends on the timeframe.
Same with nerve damage from orthognathic surgery. Surgeons always lie and downplay the risks, and say "permanent numbness is rare". Yet almost everybody has at least some numbness, even if it's a small patch.
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The problem is every seller of a product downgrades the negative. The chances are higher to sell your product if you downgrade risks. If surgeon A says: the risk of infection with jawimplants is 15% and surgeon B says 2%, surgeon B has more chance to sell the procedure. They are forced to lie due to the system. The buyer/consumer is dumb and easily manipulated, especially when it comes to eastethic procedures, cause alot of clients are desperate. They also want to hear positive things, so they are fed with positive stories, they are showed the best results, etc.
That's why you see fake percentages on Realself for example. It's a selling game. Maybe the risk of chin implant is very low, but you can't use that percentage on jaw angle implants or wrap around implants, and I guess many surgeons just switch the numbers. In most countries, the rules aren't very strict, but usually you are not allowed to misinform clients. They use a consent form but there are many ways to inform clients/communicate. You can choose your words carefully, you can hide information, etc. That's how businesses work. There is no real control anyway, no real percentages on the net, lots of misinformation. It's a mess.
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The problem is every seller of a product downgrades the negative. The chances are higher to sell your product if you downgrade risks. If surgeon A says: the risk of infection with jawimplants is 15% and surgeon B says 2%, surgeon B has more chance to sell the procedure. They are forced to lie due to the system. The buyer/consumer is dumb and easily manipulated, especially when it comes to eastethic procedures, cause alot of clients are desperate. They also want to hear positive things, so they are fed with positive stories, they are showed the best results, etc.
That's why you see fake percentages on Realself for example. It's a selling game. Maybe the risk of chin implant is very low, but you can't use that percentage on jaw angle implants or wrap around implants, and I guess many surgeons just switch the numbers. In most countries, the rules aren't very strict, but usually you are not allowed to misinform clients. They use a consent form but there are many ways to inform clients/communicate. You can choose your words carefully, you can hide information, etc. That's how businesses work. There is no real control anyway, no real percentages on the net, lots of misinformation. It's a mess.
Unfortunately, surgeons are a law unto themselves.
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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/
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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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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/
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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.
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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
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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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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.
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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.
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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.
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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.
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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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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
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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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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.
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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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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.
Thanks Kavan. I'll bring up that type of genio, and take things one step at a time. Jaw surgery/genio first.
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Thanks Kavan. I'll bring up that type of genio, and take things one step at a time. Jaw surgery/genio first.
Yes. Bring up the type of 'down and out' genio with bone buttress inbetween to advance and elongate to give clockwise rotation effect to chin.
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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?
Personally, I don't really know that much about implants, but I glanced at something
called CT-Bone. I'm curious to your thoughts on this?
It says: "CT-Bone® is a bone-like customized implant that can be 3D
printed and is converted to real bone by the patient."
Website: https://www.xilloc.com/ct-bone/ (https://www.xilloc.com/ct-bone/)
I wonder about the low level inflammation caused by something foreign, even titanium. More studies are just starting to come out about the low level inflammation from dental implants. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107454/
The CT-Bone looks impressive, is that approved for use in the United States?Has anyone ever seen a jaw implant used to fix bone erosion in my picture below. Can an an implant even be formed for this? If the defect i am seeking to repair was caused by stress shielding of the plates and screws from jaw surgery, does it increase the risk of implant failure. Basically want to know if i should leave it alone unless its an active process still at this point.
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Any thoughts regarding PEEK vs. Titanium? I've heard Titanium looks very promising, but I've also heard some max-facs say that it's too heavy and not something you'd want to put in your face. Looking at DeFrancq's PEEK results however, I have to say they're a bit lackluster.