Author Topic: Why do most implant results suck?  (Read 12170 times)

ppsk

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Why do most implant results suck?
« on: January 11, 2017, 11:30:13 AM »
There are only two implant results I have ever seen on the internet that i would consider good. A handful i would consider adequate. The rest serve to either make you wonder what the patient payed for or even make them look worse, bloated and what not.

Ive been thinking about this, and while you should take my amateur opinion with a grain of salt, i have to conclude this: it is not complicated technically to install jaw angle implants. I.e Its a prosthetic jaw angle that must be positioned over the real jaw angle. Theres not a whole lot of grey area.

So why then do jaw augmentation results frequently look s**t? Ruling out obvious cases of misalignment/poor placement, it seems obvious to me that the results must be down to A) the design of the implant and/or B) the material.

The latter aspect is what i want to discuss. Has anyone inspected/handled facial implants? I cannot shake my suspicion that a large reason for the lackluster results is because the most widely used material - silicone - is nothing at all like bone. Surgeons frequently seem to describe their preference for being able to "mold" and "shape" silicone in the room - this strikes me as odd. Imagine trying to shape or mold real bone, it wouldnt happen without some heavy tools, certainly heavier than a scalpel.

I suspect this is why the aesthetic outcome is frequently poor. The suggestion from surgeons like Eppley is that the "sharp jaw" look is not possible when the patient has fatty tissues, and I agree, but I highly doubt it is THAT rare to have a male patient, especially young ones, who are lean before the surgery. There is one example of this, but bizarrely, you have to dig through the annals of Eppley's blog to find it, and here are the results:

http://exploreplasticsurgery.com/case-study-9/

to be quite fair to Eppley, it is a GOOD result. But if you notice, there is a lack of projection around the gonion/angle despite the pronounced flare on the 3d image design, which i suspect is because the silicone is being compressed or "squished" by the powerful masseter muscle. I suspect even a good implant design and operation is let down by the material properties of silicone. Something much closer to bone in density and hardness, like PEEK, would provide superior results i assume.

There is only one surgery/surgeon i know of that explicitly uses PEEK for facial implants, and that is profilosurgical in Australia. If it is being used in the nanny worry wort bureaucratic nightmare state of Australia its is for damn sure being used elsewhere, but i am having no luck finding out.

Lefortitude

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Re: Why do most implant results suck?
« Reply #1 on: January 11, 2017, 06:25:13 PM »
1) Silicone is inferior to medpor in terms of aesthetic result, longevity etc

2) Everyone who goes in for aesthetic surgery has a different deficiency.  Sometimes it projection, sometimes its width, sometimes its angle, and often its a combination.  If someone who needs a bimax or a chin wing or a side wing and goes in to epply for a consult hes getting custome implants, and the results will be underwhelming

3) Most young men who have jaw augmentation with implants opt not to have their pictures on the internet.  Ive seen them in surgeons offices, and theyre good (with medpor)

4) Australia is also one of the only places that uses hydroxyapatite facial implants which seem to have incredible results as seen:

https://www.realself.com/review/melbourne-au-cheek-augmentation-chubby-droopy-face-weak-facial-bones



 


ppsk

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Re: Why do most implant results suck?
« Reply #2 on: January 12, 2017, 12:58:45 AM »
1) Silicone is inferior to medpor in terms of aesthetic result, longevity etc

2) Everyone who goes in for aesthetic surgery has a different deficiency.  Sometimes it projection, sometimes its width, sometimes its angle, and often its a combination.  If someone who needs a bimax or a chin wing or a side wing and goes in to epply for a consult hes getting custome implants, and the results will be underwhelming

3) Most young men who have jaw augmentation with implants opt not to have their pictures on the internet.  Ive seen them in surgeons offices, and theyre good (with medpor)

4) Australia is also one of the only places that uses hydroxyapatite facial implants which seem to have incredible results as seen:

https://www.realself.com/review/melbourne-au-cheek-augmentation-chubby-droopy-face-weak-facial-bones

So on 1. you would agree with me that the density and hardness of the material is crucial to its aesthetic outcome? This seems obvious to me but some surgeons insist otherwise. Anything that is flexible/soft enough to be forced through a small incision seems obvious to me it is flexible and soft enough to be compressed by the tissues of the face, not least the powerful masseter muscle. PEEK is similar to medpor i believe? except PEEK does not have the porosity (or maybe it does) for tissue ingrowth, which is the only area I believe medpor is not preferable to silicone (i would rather have the implant fixed in place by titanium screws than by tissue ingrowth)

If you dont mind answering, which surgeons did you see in office?

hydroxyapatite is interesting but I assume would be quite brittle and easily damaged by a blow to the face.

earl25

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Re: Why do most implant results suck?
« Reply #3 on: January 12, 2017, 06:09:27 AM »
That's the best HA result I've seen by a country mile.


I agree with others on the board, it seems like a fake review

Lefortitude

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Re: Why do most implant results suck?
« Reply #4 on: January 12, 2017, 11:19:54 AM »
Ive seen a few surgeons, but theyre all in canada so i doubt youd be familliar. 

Id consider the tissue ingrowth to be one of the reasons medpor is superior to silicone.  Titanium screws are used in securing medpor implants as well in most cases (as is the case with my surgeon). The ingrowth and vasculization of the implant takes a few months, so if the immediate outcome isnt as expected revision isnt extensively difficult.  Once the implant is vascularized there is essentially zero percent infection rate, whereas silastic implants can get infected years in the future. 



 

Lazlo

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Re: Why do most implant results suck?
« Reply #5 on: January 12, 2017, 02:40:25 PM »
That's the best HA result I've seen by a country mile.

I've heard Brian Mendelsohn is a HUGE quack and an asshole. I think because he's offering something different he's really cashing in on that by aggressively posting about it and ramping up he website --I've seen it change radically over the past few years but GIVE ZERO real looking before and afters --it's all either unnoticeable or f**king photoshopped.

ppsk

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Re: Why do most implant results suck?
« Reply #6 on: January 12, 2017, 03:36:49 PM »
I've heard Brian Mendelsohn is a HUGE quack and an asshole. I think because he's offering something different he's really cashing in on that by aggressively posting about it and ramping up he website --I've seen it change radically over the past few years but GIVE ZERO real looking before and afters --it's all either unnoticeable or f**king photoshopped.

Thats my impression too.

Its a bit on the nose when he is saying HA turns into real bone while other doctors who have also used HA are saying that it is simply does not.

Lefortitude

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Re: Why do most implant results suck?
« Reply #7 on: January 12, 2017, 04:38:06 PM »
i think the general consensus is that it does not.  However, the material is some of the closest we have in practice to day to the properties of real bone.

ppsk

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Re: Why do most implant results suck?
« Reply #8 on: January 12, 2017, 04:47:39 PM »
Ive seen a few surgeons, but theyre all in canada so i doubt youd be familliar. 

Id consider the tissue ingrowth to be one of the reasons medpor is superior to silicone.  Titanium screws are used in securing medpor implants as well in most cases (as is the case with my surgeon). The ingrowth and vasculization of the implant takes a few months, so if the immediate outcome isnt as expected revision isnt extensively difficult.  Once the implant is vascularized there is essentially zero percent infection rate, whereas silastic implants can get infected years in the future. 

thats really interesting lefortitude

I thought medpor was discontinued, is this not the case?

Lestat

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Re: Why do most implant results suck?
« Reply #9 on: January 14, 2017, 01:31:45 AM »
Once the implant is vascularized there is essentially zero percent infection rate, whereas silastic implants can get infected years in the future. 

That's nonsense. An infection can always occur. The infection rate with medpor implants is between 5-10%. I agree that bone erosion with medpor cheek implants does NOT happen if the implant is properly secured with titanium screws which prevents it from shifting.

Lestat

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Re: Why do most implant results suck?
« Reply #10 on: January 14, 2017, 01:57:17 AM »
Thats my impression too.

Its a bit on the nose when he is saying HA turns into real bone while other doctors who have also used HA are saying that it is simply does not.

Granules (HA):

70% of bone is made up of HA.
It has the ability to integrate in bone structures & support bone ingrowth, without breaking down or dissolving it (i.e it is bioactive).

HA doesn't turn into bone but bone grows around it, it is like telling bone where to grow (it is scientifically proven!).

Please take a look at M.M. power point presentation (first link).

https://www.google.de/?gws_rd=ssl#q=hydroxyapatite+mommaerts+ppt

Lefortitude

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Re: Why do most implant results suck?
« Reply #11 on: January 14, 2017, 10:45:54 AM »
That's nonsense. An infection can always occur. The infection rate with medpor implants is between 5-10%. I agree that bone erosion with medpor cheek implants does NOT happen if the implant is properly secured with titanium screws which prevents it from shifting.

can you source that or are you just bias against implants?

http://link.springer.com/article/10.1007/BF00437109 

that article "clinical experience with medpor porous polyethalyene implants" cites <2%

http://journals.lww.com/jcraniofacialsurgery/Citation/1993/07000/Use_of_Medpor_Porous_Polyethylene_Implants_in_140.7.aspx

this source cites less than 1% for the reason i stated above, which you so quickly dismissed as bulls**t.  there are dozens more like it.

produce a source or ur talking out of ur ass

Lord-of-the-Cartilage

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Re: Why do most implant results suck?
« Reply #12 on: January 14, 2017, 11:01:09 AM »
It can only boil down to the shape and material, silicone will always look like putty, medpore gives great results if the shape is right. I have never seen PEEK but I know that is what Zurich University uses now, they previously used medpor so they must see some advantage to it.
Harvest, Harvest, Wherever You May Be; I Am the Lord of the Cartilage, Said He.

Lestat

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Re: Why do most implant results suck?
« Reply #13 on: January 14, 2017, 11:01:29 AM »
produce a source or ur talking out of ur ass

https://www.ncbi.nlm.nih.gov/pubmed/26276064

(...) followed by infection rate (7.2%)(...).

Most Medpor implants were placed at the mandibular angle and the orbital floor.

ditterbo

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Re: Why do most implant results suck?
« Reply #14 on: January 14, 2017, 11:10:30 AM »
It can only boil down to the shape and material, silicone will always look like putty, medpore gives great results if the shape is right. I have never seen PEEK but I know that is what Zurich University uses now, they previously used medpor so they must see some advantage to it.

Medpor implants are meant to be carved unless you're talking strictly customs. Dr's like medpor because of the (scar??) tissue ingrowth, less chance of rotation or movement long term, can be shaped during surgery, and (falsely) it doesn't cause bone resorption or have a significantly lower infection rate vs silicone.