how to avoid dehiscence on the jaw implant?

RazerGlazer

RazerGlazer

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Anybody knows?

Anyone had jaw implants and first they had dehiscence and then they revision it and now it looks normal(without dehiscence) ?
 
No way to guarantee it, but from what i've read:
  1. Have a design that doesn't go 'backwards' ie. towards your ear
  2. The more 'downward' the implant stretches the masseter the higher the risk ie. an implant that flares outwards to add width is less risky than one that projects downward to try to lengthen the ramus
  3. Overall size of implant
  4. Get a good surgeon
  5. Having super sharp designs doesnt necessarily increase the risk of it, however it makes it LOOK way worse if you do get dihescence and your implant has super sharp flared edges
Speaking as someone who got implants and had mild dihescence on one side and very mild on the other, it was barely noticeable and didnt spoil the result at all really. I think this is because my design was modest and also not too sharp / flared, although I did try to add vertical height. Had I had a huge set of implants (like this guy below) it would look so much worse
1699908158179

1699908201835


I think other than than those things theres a huge degree of luck involved

If it does happen to you, you can disguise the aesthetic deficit by using fat graft, filler or having a repair, the repairs have low success rate though

The other way you can mask it is having an external incision and covering the exposed portion with aloderm. But some european surgeons wont do this for you, as a lot of maxfacs only do intraoral incisions and they would never risk putting aloderm in through the mouth as because its non-vascularised the infection risk is high so they just stick to fat grafts. As far as I know only Eppley doesn the extraoral aloderm repair

see below:
 
Last edited:
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politically correct said:
No way to guarantee it, but from what i've read:
  1. Have a design that doesn't go 'backwards' ie. towards your ear
  2. The more 'downward' the implant stretches the masseter the higher the risk ie. an implant that flares outwards to add width is less risky than one that projects downward to try to lengthen the ramus
  3. Overall size of implant
  4. Get a good surgeon
  5. Having super sharp designs doesnt necessarily increase the risk of it, however it makes it LOOK way worse if you do get dihescence and your implant has super sharp flared edges
Speaking as someone who got implants and had mild dihescence on one side and very mild on the other, it was barely noticeable and didnt spoil the result at all really. I think this is because my design was modest and also not too sharp / flared, although I did try to add vertical height. Had I had a huge set of implants (like this guy below) it would look so much worse
View attachment 2549904
View attachment 2549905

I think other than than those things theres a huge degree of luck involved

If it does happen to you, you can disguise the aesthetic deficit by using fat graft, filler or having a repair, the repairs have low success rate though

The other way you can mask it is having an external incision and covering the exposed portion with aloderm. But some european surgeons wont do this for you, as a lot of maxfacs only do intraoral incisions and they would never risk putting aloderm in through the mouth as because its non-vascularised the infection risk is high so they just stick to fat grafts. As far as I know only Eppley doesn the extraoral aloderm repair

see below:
Click to expand...

Thanks.

Unfortunately mine looks much worse.

Idk man..
 

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CristianT said:
Thanks.

Unfortunately mine looks much worse.

Idk man..
Click to expand...
Can I see your designs? Is your plan to get a repair? Who was your surgeon?
 
politically correct said:
Can I see your designs? Is your plan to get a repair? Who was your surgeon?
Click to expand...
it was giant.

Got operated by Pagnoni.

Im planning a revision, yes. third one. thinking to do a chin wing tbh

1699992999169


1699993010762
 
  • +1
Reactions: bradpittshairline
I also have small divots at my gonions where I got my implants but I always thought it was just the implant being too small for the massetter.
 
politically correct said:
No way to guarantee it, but from what i've read:
  1. Have a design that doesn't go 'backwards' ie. towards your ear
  2. The more 'downward' the implant stretches the masseter the higher the risk ie. an implant that flares outwards to add width is less risky than one that projects downward to try to lengthen the ramus
  3. Overall size of implant
  4. Get a good surgeon
  5. Having super sharp designs doesnt necessarily increase the risk of it, however it makes it LOOK way worse if you do get dihescence and your implant has super sharp flared edges
Speaking as someone who got implants and had mild dihescence on one side and very mild on the other, it was barely noticeable and didnt spoil the result at all really. I think this is because my design was modest and also not too sharp / flared, although I did try to add vertical height. Had I had a huge set of implants (like this guy below) it would look so much worse
View attachment 2549904
View attachment 2549905

I think other than than those things theres a huge degree of luck involved

If it does happen to you, you can disguise the aesthetic deficit by using fat graft, filler or having a repair, the repairs have low success rate though

The other way you can mask it is having an external incision and covering the exposed portion with aloderm. But some european surgeons wont do this for you, as a lot of maxfacs only do intraoral incisions and they would never risk putting aloderm in through the mouth as because its non-vascularised the infection risk is high so they just stick to fat grafts. As far as I know only Eppley doesn the extraoral aloderm repair

see below:
Click to expand...

Have you done anything to address it? I have a similar amount to you. I’m planning on radiesse filler.
 
@RealSurgerymax proposed a possible solution that involved sewing the muscle to the implant, iirc.
 
  • +1
Reactions: RealSurgerymax
politically correct said:
No way to guarantee it, but from what i've read:
  1. Have a design that doesn't go 'backwards' ie. towards your ear
  2. The more 'downward' the implant stretches the masseter the higher the risk ie. an implant that flares outwards to add width is less risky than one that projects downward to try to lengthen the ramus
  3. Overall size of implant
  4. Get a good surgeon
  5. Having super sharp designs doesnt necessarily increase the risk of it, however it makes it LOOK way worse if you do get dihescence and your implant has super sharp flared edges
Speaking as someone who got implants and had mild dihescence on one side and very mild on the other, it was barely noticeable and didnt spoil the result at all really. I think this is because my design was modest and also not too sharp / flared, although I did try to add vertical height. Had I had a huge set of implants (like this guy below) it would look so much worse
View attachment 2549904
View attachment 2549905

I think other than than those things theres a huge degree of luck involved

If it does happen to you, you can disguise the aesthetic deficit by using fat graft, filler or having a repair, the repairs have low success rate though

The other way you can mask it is having an external incision and covering the exposed portion with aloderm. But some european surgeons wont do this for you, as a lot of maxfacs only do intraoral incisions and they would never risk putting aloderm in through the mouth as because its non-vascularised the infection risk is high so they just stick to fat grafts. As far as I know only Eppley doesn the extraoral aloderm repair

see below:
Click to expand...


An actually useful comment on this forum? Wow, I must be dreaming. Thanks, man.
 
  • +1
Reactions: politically correct
longjohnmong said:
@RealSurgerymax proposed a possible solution that involved sewing the muscle to the implant, iirc.
Click to expand...
its still not guaranteed that it will work tho.
 
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Reactions: RealSurgerymax
RoyaleWithCheese said:
I also have small divots at my gonions where I got my implants but I always thought it was just the implant being too small for the massetter.
Click to expand...
that dent its just the naked implant

its not normal
 
CristianT said:
that dent its just the naked implant

its not normal
Click to expand...
can you show your lower third and how it does look without ur fingers stretching the skin
 
Truemaxxer said:
looks a bit narrow but still good obv depending on the before also
Click to expand...
1699999566977


I dont think its narrow. the width its perfect otherwise would look to squarish.
 
  • +1
Reactions: bradpittshairline
CristianT said:
it was giant.

Got operated by Pagnoni.

Im planning a revision, yes. third one. thinking to do a chin wing tbh

View attachment 2551774

View attachment 2551775
Click to expand...
Yeah they are very flared and that is a lot of vertical height that you added so based on what ive read, this is a high risk design, but ive seen bigger designs than this not get the issue

Part of the problem with this much flare is, even though it can amazing if your massetter covers the implant (kind of like the below), it looks obvious if you get dihescence

1700004168113
 
Last edited:
CristianT said:
it was giant.

Got operated by Pagnoni.

Im planning a revision, yes. third one. thinking to do a chin wing tbh

View attachment 2551774

View attachment 2551775
Click to expand...
This was my original design

1700003115456
1700003125411
1700003135446


I also got dihescence, but because my design was more rounded you basically couldnt even notice it

Don't get me wrong, allthough I was happy with my design from the side and 3/4 profile, I wished at the time I'd flared the gonions a bit more as the result from the front was ok if slightly underwhelming

The design like the one you had look amazing when you have soft tissue coverage, but the sharpness and flare means if you do get dihescence its very obvious

Maybe try a rounder design if you decide to go with implants again, maybe like a half way house between what you got and the rounder design in these pics, but no guarantees either way
 
Last edited:
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Reactions: Deleted member 25705
politically correct said:
This was my original design

View attachment 2552021View attachment 2552022View attachment 2552023

I also got dihescence, but because my design was more rounded you basically couldnt even notice it

The design like the one you had look amazing when you have soft tissue coverage, but the sharpness and flare means if you do get dihescence its very obvious

Maybe try a rounder design if you decide to go with implants again
Click to expand...

Did you finally get another implant after bimax?
 
RoyaleWithCheese said:
View attachment 2552019
So this indentation is what, a gap between the implant and the bone?
Click to expand...
So its either dihescence or implant reveal,
1700003555693



exploreplasticsurgery.com

Plastic Surgery Case Study - Soft Tissue Jaw Angle Implants For Contour Correction of Masseteric Muscle Dehiscence - Explore Plastic Surgery

One treatment option for the contour defect of masseteric muscle dehiscence is the placement of ultrasoft solid silicone implants.
exploreplasticsurgery.com

What Is The Risk Of Masseter Muscle Dehiscence in Custom Jawline Implant Surgery? - Plastic Surgeon | Dr. Barry L. Eppley, MD

Q: Dr. Eppley, After giving careful thought to the imaging and other considerations, I would like to further seek your expertise. I’m seriously considering scheduling a procedure soon, but need to make sure I ask your advice on some things, first. Accordingly, at your earliest convenience, would...
www.eppleyplasticsurgery.com www.eppleyplasticsurgery.com

How Successful Is Masseter Muscle Repair For Dehiscence From Implant Placement? - Plastic Surgeon | Dr. Barry L. Eppley, MD

Q: Dr. Eppley, How can my masseter muscle dehiscence be fixed after a custom jawline implant was placed? A: What you really have is a combination of both masseter muscle dehiscence and, most importantly, what is known as implant reveal. (an implant design issue) Your jawline implant design was...
www.eppleyplasticsurgery.com www.eppleyplasticsurgery.com

exploreplasticsurgery.com

Avoiding Jaw Angle Implant Reveal in Custom Jawline Implant Designs - Explore Plastic Surgery

In designing custom jawline implants the temprtation to square out the jaw angle design should be avoided to prevent aesthetic implant reveal.
exploreplasticsurgery.com
 
  • +1
Reactions: Deleted member 16280
politically correct said:
So its either dihescence or implant reveal,
View attachment 2552032


exploreplasticsurgery.com

Plastic Surgery Case Study - Soft Tissue Jaw Angle Implants For Contour Correction of Masseteric Muscle Dehiscence - Explore Plastic Surgery

One treatment option for the contour defect of masseteric muscle dehiscence is the placement of ultrasoft solid silicone implants.
exploreplasticsurgery.com

What Is The Risk Of Masseter Muscle Dehiscence in Custom Jawline Implant Surgery? - Plastic Surgeon | Dr. Barry L. Eppley, MD

Q: Dr. Eppley, After giving careful thought to the imaging and other considerations, I would like to further seek your expertise. I’m seriously considering scheduling a procedure soon, but need to make sure I ask your advice on some things, first. Accordingly, at your earliest convenience, would...
www.eppleyplasticsurgery.com www.eppleyplasticsurgery.com

How Successful Is Masseter Muscle Repair For Dehiscence From Implant Placement? - Plastic Surgeon | Dr. Barry L. Eppley, MD

Q: Dr. Eppley, How can my masseter muscle dehiscence be fixed after a custom jawline implant was placed? A: What you really have is a combination of both masseter muscle dehiscence and, most importantly, what is known as implant reveal. (an implant design issue) Your jawline implant design was...
www.eppleyplasticsurgery.com www.eppleyplasticsurgery.com

exploreplasticsurgery.com

Avoiding Jaw Angle Implant Reveal in Custom Jawline Implant Designs - Explore Plastic Surgery

In designing custom jawline implants the temprtation to square out the jaw angle design should be avoided to prevent aesthetic implant reveal.
exploreplasticsurgery.com
Click to expand...
Thanks. I think implant reveal is what I have. My implant design provided vertical augmentation because my ramus was quite short, so it was necessary. But I’m hoping when I add radiesse the dents smooth out. Sounds like it should help.
 
CristianT said:
Thanks.

Unfortunately mine looks much worse.

Idk man..
Click to expand...
I have a bunch of questions, hope this isn’t too much but grateful if you answer.

What was the post op care routine?

Were there any specific instructions you found challenging to follow?

Any specific event or discomfort before noticing the dehiscence?

What do you think caused it?

What did Paganini have to say about it? Will you return to him for the revision?

Did he make any change to your recovery protocol?

Any advice for someone about to do the same thing?

What would you have done differently in hindsight?
 
politically correct said:
Yeah they are very flared and that is a lot of vertical height that you added so based on what ive read, this is a high risk design, but ive seen bigger designs than this not get the issue

Part of the problem with this much flare is, even though it can amazing if your massetter covers the implant (kind of like the below), it looks obvious if you get dihescence

View attachment 2552053
Click to expand...
This guy got implants?
 
CristianT said:
This guy got implants?
Click to expand...
no but this is how the result of flared implants is supposed to look if your get muscle coverage, it mimics the look of people who naturally have flared gonions like the below

1700089253768
 
politically correct said:
No way to guarantee it, but from what i've read:
  1. Have a design that doesn't go 'backwards' ie. towards your ear
  2. The more 'downward' the implant stretches the masseter the higher the risk ie. an implant that flares outwards to add width is less risky than one that projects downward to try to lengthen the ramus
  3. Overall size of implant
  4. Get a good surgeon
  5. Having super sharp designs doesnt necessarily increase the risk of it, however it makes it LOOK way worse if you do get dihescence and your implant has super sharp flared edges
Speaking as someone who got implants and had mild dihescence on one side and very mild on the other, it was barely noticeable and didnt spoil the result at all really. I think this is because my design was modest and also not too sharp / flared, although I did try to add vertical height. Had I had a huge set of implants (like this guy below) it would look so much worse
View attachment 2549904
View attachment 2549905

I think other than than those things theres a huge degree of luck involved

If it does happen to you, you can disguise the aesthetic deficit by using fat graft, filler or having a repair, the repairs have low success rate though

The other way you can mask it is having an external incision and covering the exposed portion with aloderm. But some european surgeons wont do this for you, as a lot of maxfacs only do intraoral incisions and they would never risk putting aloderm in through the mouth as because its non-vascularised the infection risk is high so they just stick to fat grafts. As far as I know only Eppley doesn the extraoral aloderm repair

see below:
Click to expand...

I have a coworker who just had 10mm jaw implant, great angularity on the side, but looks rounded from the from, cause angles are behind the masseters
Like you said his implant are back far towards the bone
 
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