how to avoid dehiscence on the jaw implant?

[RazerGlazer]

Anybody knows?

Anyone had jaw implants and first they had dehiscence and then they revision it and now it looks normal(without dehiscence) ?

 

[politically correct]

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

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:

 

[RazerGlazer]

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:

Thanks.

Unfortunately mine looks much worse.

Idk man..

 

[politically correct]

Thanks.

Unfortunately mine looks much worse.

Idk man..

Can I see your designs? Is your plan to get a repair? Who was your surgeon?

 

[RazerGlazer]

Can I see your designs? Is your plan to get a repair? Who was your surgeon?

it was giant.

Got operated by Pagnoni.

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

 

[Deleted member 16280]

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.

 

[longjohnmong]

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

How's the chin look?

 

[Deleted member 16280]

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:

Have you done anything to address it? I have a similar amount to you. I’m planning on radiesse filler.

 

[longjohnmong]

@RealSurgerymax proposed a possible solution that involved sewing the muscle to the implant, iirc.

 

[hansmoleman]

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:

An actually useful comment on this forum? Wow, I must be dreaming. Thanks, man.

 

[hansmoleman]

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

the original surgery and the first revision were both done by Pagnoni? did he say anything about what went wrong?

 

[RazerGlazer]

@RealSurgerymax proposed a possible solution that involved sewing the muscle to the implant, iirc.

its still not guaranteed that it will work tho.

 

[RazerGlazer]

Have you done anything to address it? I have a similar amount to you. I’m planning on radiesse filler.

i was thinking fat graft

 

[longjohnmong]

its still not guaranteed that it will work tho.

Well, yeah, I don't think there are any guarantees.

 

[RazerGlazer]

Well, yeah, I don't think there are any guarantees.

its a ... disaster.

i just put like 50 units of botox in my masseteurs / per side.

lets see

 

[RazerGlazer]

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.

that dent its just the naked implant

its not normal

 

[Truemaxxer]

that dent its just the naked implant

its not normal

can you show your lower third and how it does look without ur fingers stretching the skin

 

[RazerGlazer]

can you show your lower third and how it does look without ur fingers stretching the skin

 

[Truemaxxer]

View attachment 2551933

looks a bit narrow but still good obv depending on the before also

 

[RazerGlazer]

looks a bit narrow but still good obv depending on the before also

I dont think its narrow. the width its perfect otherwise would look to squarish.

 

[Truemaxxer]

View attachment 2551936

I dont think its narrow. the width its perfect otherwise would look to squarish.

good improvment tbh

whats your zygo to bigonial ratio in the after

 

[Deleted member 50702]

whats wrong with the implant here

View attachment 2551933

 

[politically correct]

its still not guaranteed that it will work tho.

I chatted to a maxfac about this, in his opinion this isnt possible

 

[Deleted member 16280]

that dent its just the naked implant

its not normal

So this indentation is what, a gap between the implant and the bone?

 

[politically correct]

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

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

 

[politically correct]

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

This was my original design

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

 

[politically correct]

its a ... disaster.

i just put like 50 units of botox in my masseteurs / per side.

lets see

that will make the problem worse no?

 

[hansmoleman]

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

Did you finally get another implant after bimax?

 

[politically correct]

View attachment 2552019
So this indentation is what, a gap between the implant and the bone?

So its either dihescence or implant reveal,

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

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

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

 

[politically correct]

Did you finally get another implant after bimax?

not yet, not 100% sure im going to go ahead with it

 

[politically correct]

View attachment 2551933

If you do re-do them, I would consider not doing any vertical lenghtening, something like this but maybe even less flare and more rounded

I cant lie though from the front what you have looks very good

 

[Deleted member 16280]

So its either dihescence or implant reveal,
View attachment 2552032

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

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

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

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.

 

[GRINCHN’4$URGERY]

Thanks.

Unfortunately mine looks much worse.

Idk man..

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?

 

[RazerGlazer]

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

This guy got implants?

 

[politically correct]

This guy got implants?

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

 

[Looksmaxerfr13]

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:

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