My surgery with Defrancq: Custom PEEK Jaw/chin wrap + Special Genioplasty

[LDNPari]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

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Whoa, how recessed are you to need 20mm of augmentation? That's going to carry an enormous risk. From what i've seen 5-7mm of jaw augmentation seems to be sufficient in most Eppley/Yaremchuk patients. I will definitely say from research, Yaremchuk seems to be the best at designing implants, the infection concern is always going to be there with jaw implant surgery, especially intra-orally. Who are you considering for your PEEK implants?

 

[Adrenochrome]

Lol I PMed you about your discord bro I couldn't find you by your username there
and I read that you wanna go back to Dr. Y...

My bad, I'll hit you up soon my guy (getting things organized for us).

Bro could you please just take this year off and grow a beard?
You need to recover mentally, financially and physically imo

^^ You're ACES brother 🂡 🂡 🂡 -wise words from a king.

Did you read @Anonymous999 experience? This is making me reconsider everything and count my blessings

This is the reality check that I and many other users in here need


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No way, I’m new to this website , I joined because I had to comment here after reading this from a link in google . I HAD THE EXACT THING. I got first surgery done with Eppley using silicon, but after reading that silicon could displace in the future I wanted it changing to peek , so I went to dr Noorman van der Dussen who is a very close friend of dr defrancq. Actually dr defrancq was also operating on me too with Noorman which was weird. I found this all out when I was in the operating bed . Defrancq secretary is Noorman daughter . But back to the result, first couple of weeks it came out just like the previous just more swelling but after a year I lost the angularity. It’s mainly due to the masseter muscle - I feel so depressed even suicidal. We should help each other fix this . I see u as hope . I can’t go back to Eppley because he warned me of getting the silicon removed. I’m always crying inside and super self conscious now

Absolutely brother but I think you should at-least try to reach out to Eppley to see what he says (if anything).

Slightly different but in the same vein: I reached out to Y. (my original surgeon) after my surgery with Defrancq and told him the situation straight up; he was neutral (as far as I know) and understanding about it.... Point being, at-least hit up E. as he was your original surgeon and see what transpires.

Actually, (since the Anonymous999 post) I've decided to consult with Eppley now too (never thought I would say that).

Keep me updated and I will you as well.

 

[Anonymous999]

Whoa, how recessed are you to need 20mm of augmentation? That's going to carry an enormous risk. From what i've seen 5-7mm of jaw augmentation seems to be sufficient in most Eppley/Yaremchuk patients. I will definitely say from research, Yaremchuk seems to be the best at designing implants, the infection concern is always going to be there with jaw implant surgery, especially intra-orally. Who are you considering for your PEEK implants?

5-7mm will be too small. Even if you're not recessed.

I believe the original ones I had in from 12 years ago were probably on the magnitude of 10mm or so. That's my guess. When I had the 15 and 20 mm in, I looked like a cartoon character actually. The 20 was too large and a tad convex/lantern. But the 15 was pretty much spot on - a good vertical drop.

It's fairly typical with guys when they get jaw implants that they wish they had gone bigger.

My bad, I'll hit you up soon my guy (getting things organized for us).




^^ You're ACES brother 🂡 🂡 🂡 -wise words from a king.

Did you read @Anonymous999 experience? This is making me reconsider everything and count my blessings

This is the reality check that I and many other users in here needed.

My experience differs slightly from yours @Adrenochrome in that I literally had implants in for 12 years and then lost them, so my psych is even more engrained to feel like I "need" them. As in, I don't even view implants as extra / a step up now; I view them as just getting me back to where I've been my entire adult life.

As I said, I would go external approach only now for the jaw + PEEK.

For malar/cheek, I'm lucky my Medpor ones got in without an issue because 1) you can only go intra-oral for malar, and 2) Medpor is most stable in the midface because the cheeks are a "cliff." Silicone and PEEK aren't as preferable at larger sizes apparently. I just pray I can get through life without any problems for my midface.

Thanks for reading my story. Once again, I didn't post here for me. After reading your first post, I had to create an account to let you know you're not alone having had a recent infection with Dr. Y.

Whoa, how recessed are you to need 20mm of augmentation? That's going to carry an enormous risk. From what i've seen 5-7mm of jaw augmentation seems to be sufficient in most Eppley/Yaremchuk patients. I will definitely say from research, Yaremchuk seems to be the best at designing implants, the infection concern is always going to be there with jaw implant surgery, especially intra-orally. Who are you considering for your PEEK implants?

I also would not say Dr. Y is the best at designing implants. He doesn't really listen and will design small. The designs will also come out asymmetric.

I said I wanted XXL for the malar and the original designs were ~5-5.5 mm. I wanted bigger, and then the new designs were 3.5 and 5.5. How does that even make sense? What if I had agreed to that? I'd be walking around with asymmetric cheeks.

And keep in mind, when he designed my jaw, the sides differed by 5 mm on the design and my result was hugely asymmetric.

When I got the second infection and had to have the big jaw/chin implants removed, after the fact I was weirdly OK with it because at least my symmetry was restored. It taught me that a lot of comfort really does come with just being symmetric.

I have 7.4 and 8.2 in right now for my cheeks, and I can tell you I'm glad I fought to make them bigger. I also have 3.5 and 4.5 mm of infraorbital rim.

I have enough humility where I cannot get high on my own supply. The more "up" I might get about my cheeks, that only means the more "down" I might get about my lower face. I've trained myself to be numb across the board and to be more humble about things.

 

[Adrenochrome]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

@Linoob
@Brandon10
@CristianT
@Barbarossa_
@AlexChase89
@Sal123
@Golden Glass
@crosshold
@Morpheus
@suddenurge
@kota
@Dr Shekelberg
@anti caking agents
@highT
@nastynas
@Britsky
@6ft4
@Joyride
@Cardiologyscribe
@ChaddeusPeuterschmit
@Chowdog
@Theonewhowillascend
@fonzee98
@Gonion
@Solo
@paulus1
@Slayerino
@ProjectAscension
@Dr.austeer
@Adrenochrome
@Saltner

Your story literally broke my heart man... Speechless... I cannot even fathom all that you've been through.
Thank you for sharing something so personal and I know, deeply hurtful.

Here's to healing, my brother

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

FACTS.... and it's an unrelenting and sadistic drive (internal force) to try and reclaim it.... self destructing in more ways than one.

I touched it again, and my chin blew open and hot pus and blood fell out all over the floor.

The imagery...

I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

So nonchalant ... very cold...

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

GOD THAT KILLS ME.... I only had mine in for 3 months and I was CRUSHED but 12 years.... NEXT LEVEL

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Right... it's that internal drive again... never satiated, rationalizing and ALWAYS ready to reclaim what was "lost". Like there's NO OTHER OPTION (even if it means sacrificing yourself in ways you couldn't imagine at the time).

I remember being en route, for removal, with infection on the plane and researching what procedure(s) I was going to get to fix my situation (ostomies, new implants or a combination of both etc...) didn't care or think about anything else.

The only goal was to FIX IT.

The only silver lining I had was that I got to keep my zygo implants.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection

Super sketchy - they hit me with 4k (not that it's any better!)

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm.

Same but only 6mm (all depends on pheno), though I agree with you that one needs to go much larger in the zygomatic region.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

I'm going to be honest man... I was SHOCKED when I read those measurements.... my jaw literally dropped.

I have NEVER seen measurements that large.

Until now, I thought I had some of the largest measurements with my prior wraparound (which really concerned me) but 20mm on one side and 23mm anterior projection on the chin ... just .... mind blown

I didn't even think one could fit 15-16mm anterior projection, let alone 23!

You must've been severely recessed i.e. literally a case for bimax + genio first and then, implants.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few tim Aes about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

That is extremely disturbing... Again... I mean just bringing in perspective here .... I thought I had it bad with a 1-2mm hole (on my second surgery i.e. the one detailed here) but you're talking about a hole that was 13-14mm deep (and probably larger originally)... the negligence is astounding ... dare I say criminal...

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

Right...

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

Ahh man.... I'm sorry this happened to you. People need to let this sink in because surgery is always talked about so nonchalantly on this forum.

This is it guys... this is what can and DOES happen.

The above is only the physical impact (which is much easier to remedy than the psychological aftermath).

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Not I, as I've mentioned many times here previously (not directed at you) that I was grateful to still have my cheek implants when I lost my wraparound (the only thing that "saved" me).

For sure more infection cases doesn't surprise me with Y. What would surprise me, is if more people like yourself and I, were to share their experiences publicly with others.

You know those ratings on realself are garbage (in general) now getting specific.... you know there's many more like us (assuming you haven't) who haven't shared their negative experiences regarding Y. (on realself)

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

As you said... take your time to let EVERYTHING heal (body and mind) before proceeding. I say that because (now) from my most recent surgical experience, I trust all internal incisions more than anything external.

I had much larger and deeper incision lines from PEEK; ALL internal and ZERO infection.

And actually, if I'm to get surgical with my observation based on both of our experiences, I would say that simply finding a different surgeon as you said i.e. NOT Y. would solve most of your problems moving forward.

Taking everything into account (your experience now), I have to reiterate and give Defrancq credit for surgical ability and aftercare (which I mentioned multiple times in my comments, as well as in my binary review).

To clarify, surgical ability and aftercare; do not translate to or equal, aesthetic ability (he does not yet poses design prowess). However, in @Anonymous999 case, I think it might be worth considering at-least consulting with someone "safe" i.e. able to provide stability like Defrancq if he's after long-term viability.

As for myself... thank you again @Anonymous999 for detailing your personal journey thus far. You've given me (and perhaps many others "I hope") some much needed clarity and reality to the path of ascension ...a sobering view of surgical sacrilege... malfeasance as it were.

Heal up man, looking forward to hearing of your success!

 

[Slayerino]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

@Linoob
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@Saltner

Fuck, such a horror story. I hope you're feeling better now. Reading it makes me want to give up my next surgeries. I still have to get a bimax and zygos/suborbital implants. I'll never get silicone or peek, I'll go with the HA paste. I need the extra mass to be "real", mine, proper bone, not a synthetic material.

How did you manage your social life with all these sudden changes happening? What did the people around you say?

 

[Anonymous999]

Your story literally broke my heart man... Speechless... I cannot even fathom all that you've been through.
Thank you for sharing something so personal and I know, deeply hurtful.

Here's to healing, my brother

Appreciate you taking the time to read it.

I'm going to be honest man... I was SHOCKED when I read those measurements.... my jaw literally dropped.

I have NEVER seen measurements that large.

Until now, I thought I had some of the largest measurements with my prior wraparound (which really concerned me) but 20mm on one side and 23mm anterior projection on the chin ... just .... mind blown

I didn't even think one could fit 15-16mm anterior projection, let alone 23!

You must've been severely recessed i.e. literally a case for bimax + genio first and then, implants.

I knew of the approximate measurements after seeing a patient example of Eppley on some website where the guy had 15mm on each side. On the CT design from Dr. Y, the measurements took into account the extra projection that my new cheeks conferred, meaning had I not had the big cheek implants put in prior, no, I would not have had those same measurements. I just find it odd that on the CT design things came out symmetrical with different sizes on each side, and yet the actual result was obvious for the asymmetry. The new surgeon I've talked to knows my story, and I told him I don't care what the CT shows - I want the implants the same size on both sides - and if that creates asymmetry, so be it, but I don't want different sizes again.

Regarding the chin projection, I've seen plenty of posts where Eppley has had patients getting 15mm with silicone. So this isn't unusual apparently. I just can't take the risk with my soft tissue elasticity being slightly compromised from prior infection. In addition, silicone is the easiest to insert. With PEEK, I think 12mm is a fair compromise.

I believe my original chin projection from 12 years ago was around ~10mm or so. Then when Dr. Y added more to it during the symmetry procedure, it probably got to around 15-17. I had very good projection. I reminisce for those days.

That is extremely disturbing... Again... I mean just bringing in perspective here .... I thought I had it bad with a 1-2mm hole (on my second surgery i.e. the one detailed here) but you're talking about a hole that was 13-14mm deep (and probably larger originally)... the negligence is astounding ... dare I say criminal...

My initial impression was that there was necrosis causing the hole and gum recession, or something of that nature. In reality, it was the sling sutures Dr. Yaremchuk and Dr. Nguyen used around my lower teeth that caused gum inflammation and caused them to recede. And Dr. Y admitted in email to my periodontist that the hole was there when I left Boston. So it's not something that opened after the fact. And as I said, my periodontist says for there to be a hole that large 2 weeks post-op, considering gingival tissue heals remarkably fast and well, the original defect must have been massive. He said he believes it was instrumentation error. But how will we ever know?

Not I, as I've mentioned many times here previously (not directed at you) that I was grateful to still have my cheek implants when I lost my wraparound (the only thing that "saved" me).

For sure more infection cases doesn't surprise me with Y. What would surprise me, is if more people like yourself and I, were to share their experiences publicly with others.

You know those ratings on realself are garbage (in general) now getting specific.... you know there's many more like us (assuming you haven't) who haven't shared their negative experiences regarding Y. (on realself)

I had originally left a glowing review of Dr. Y on Realself last year. I contacted them to have it removed. And I'm fairly sure the page doesn't exist anymore. Rather than leaving a negative review, I just asked them to take it down.

As you said... take your time to let EVERYTHING heal (body and mind) before proceeding. I say that because (now) from my most recent surgical experience, I trust all internal incisions more than anything external.

I had much larger and deeper incision lines from PEEK; ALL internal and ZERO infection.

I wish I could go intra-oral. I just cannot tolerate any more infection risk so am literally the perfect candidate for the external approach. I think any guy going in for a first-time surgery should try intra-oral. Maybe if the posterior angles are large enough, they will be able to more effectively conceal the incision lines. Once again, not ideal, but better than what I am now.

And actually, if I'm to get surgical with my observation based on both of our experiences, I would say that simply finding a different surgeon as you said i.e. NOT Y. would solve most of your problems moving forward.

I did have a little bit of Stockholm regarding Dr. Y. I venerated him after my original facial implants from 12 years ago. After my double-infection last year + seeing his complete utter lack of empathy, I see he puts himself above his patients. He could have at least asked once how I was doing. In person and through email, he not once showed any empathy.

Taking everything into account (your experience now), I have to reiterate and give Defrancq credit for surgical ability and aftercare (which I mentioned multiple times in my comments, as well as in my binary review).

To clarify, surgical ability and aftercare; do not translate to or equal, aesthetic ability (he does not yet poses design prowess). However, in @Anonymous999 case, I think it might be worth considering at-least consulting with someone "safe" i.e. able to provide stability like Defrancq if he's after long-term viability.

As for myself... thank you again @Anonymous999 for detailing your personal journey thus far. You've given me (and perhaps many others "I hope") some much needed clarity and reality to the path of ascension ...a sobering view of surgical sacrilege... malfeasance as it were.

Heal up man, looking forward to hearing of your success!

I really do hope there's a light at the end of the tunnel. As soon as Corona clears (and hopefully it's not endless), I will eventually go on to get surgery. I will post some sort of update in the future and come back here (or somewhere) and post. You might be like, "Oh yeah, I remember that anonymous999 guy from ages go."

Fuck, such a horror story. I hope you're feeling better now. Reading it makes me want to give up my next surgeries. I still have to get a bimax and zygos/suborbital implants. I'll never get silicone or peek, I'll go with the HA paste. I need the extra mass to be "real", mine, proper bone, not a synthetic material.

How did you manage your social life with all these sudden changes happening? What did the people around you say?

You would be mindblown to hear that people didn't even notice. A few people had said "Did you lose weight?" But no one actually noticed like you'd think. It might be more the case where guys like us are more prone to hone in on this type of analysis.

 

[Dude420]

Read this thread like a novel, holy fuck insane stories @Adrenochrome @Anonymous999 thanks for sharing!
You are confirming to me I'll never put a foreign object in my face. I had double jaw surgery (had apnea), now thinking about a genio, but I will probably not go further than that, would really like to improve my cheeks, don't think it is worth the risks, even more so factoring the cost. Would like to improve my mandible as well, but no way I am getting a huge implant there. I wonder if anyone tried improving the side of the jaw/gonial angle regions only by moving the bones in that area, there is less potential than with implants, but I saw that you can gain a decent amount of jaw width and ramus length through a chinwing (I wouldn't do a full chinwing because it seems too risky to me, it goes too close to the nerve and tries to move too large of a piece of bones).

 

[Saltner]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

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I admire your dedication. You are tough as a rock. Thanks for coming to this forum.

Also you mention that in CT scans and computer imagery the implant showed no asymmetries but after surgery there was visible asymmetries. I think I read somewhere that even if the implants made with CT scan look symmetric in computer imagery, the result might come out to be asymmetrical due to some soft tissue asymmetry ( I think I read this in Dr Eppley's blog ). This type of asymmetries are unpredictable. Again my memory is blurry and i'm not sure if i'm actually correct or mixing things. I tried searching for that page but couldn't find it. Maybe this has something to do with your case? Or maybe someone more knowledgeable can say something it?

 

[Moneymaxxed]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

@Linoob
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Incredible story, thank you for sharing. I too will never get an implant precisely because of experiences like this. Fillers only for me.

I genuinely wish you the best and hope you recover ASAP. It’s a shame that options for this are so costly, risky, and limited. I pray for a future where this can be done without so much pain and faith in a few old surgeons.

 

[Anonymous999]

I admire your dedication. You are tough as a rock. Thanks for coming to this forum.

Also you mention that in CT scans and computer imagery the implant showed no asymmetries but after surgery there was visible asymmetries. I think I read somewhere that even if the implants made with CT scan look symmetric in computer imagery, the result might come out to be asymmetrical due to some soft tissue asymmetry ( I think I read this in Dr Eppley's blog ). This type of asymmetries are unpredictable. Again my memory is blurry and i'm not sure if i'm actually correct or mixing things. I tried searching for that page but couldn't find it. Maybe this has something to do with your case? Or maybe someone more knowledgeable can say something it?

Thanks for reading my story. I really appreciate it.

The discrepancy in size wasn't soft tissue. Trust me. The posterior mandibular angles were 15mm and 20 mm for each side, respectively, and the result that followed literally reflected this - i.e., my right angle came out 5mm more jagged and projected. It is my suspicion that the implants didn't sit on the actual bone the way they did on the CT. In other words, rather than the "fits like a glove" description playing out in real life, what really happens is, they get the implant in there and then approximate the best they can where it's supposed to go. In any case, for my future implants I'm getting the same size on both sides - 15mm.

Incredible story, thank you for sharing. I too will never get an implant precisely because of experiences like this. Fillers only for me.

I genuinely wish you the best and hope you recover ASAP. It’s a shame that options for this are so costly, risky, and limited. I pray for a future where this can be done without so much pain and faith in a few old surgeons.

Thank you for reading my story. I really appreciate it.

 

[PubertyMaxxer]

@Adrenochrome what do you think about only getting the ct implant design from Yaremchuk and actually doing the surgery with Defranq?

 

[LDNPari]

@Adrenochrome what do you think about only getting the ct implant design from Yaremchuk and actually doing the surgery with Defranq?

that's literally exactly what he didn't and didn't like it lol

 

[PubertyMaxxer]

that's literally exactly what he didn't and didn't like it lol

Wdym? Would op have preferred that lookin back?

 

[LDNPari]

Wdym? Would op have preferred that lookin back?

So... you see, form and function (beautiful). Now, design-wise (this is where Y. Comes in again) because I knew exactly what I wanted (partly my former design as I already knew how I would look) and showed Defrancq my original Silicone implant draft -he was able to draft his own version of it but changed the taper of the gonial angles to be more natural (which is what I wanted) so it was perfect for me.

Basically was the same design except DeFrancq made it more "natural" and he says it ended up looking worse. He said he looks like an asymmetrical normie after surgery with DeFrancq where as he says he was modeling with Yaremchuk's implant. Also OP said he's going to most likely have surgery a 3rd time around with Yaremchuk again.

 

[Deleted member 5393]

where are the pics u scammer

 

[RealTruecel]

no pics? didn't read

 

[Ascensionrequired]

There is some interesting stuff you had to share here, but I would have liked to know why Defrancq is such an ass clown. I'm not a fan of his designs when I look at his site, but I also feel it's mostly pre operation bloat and gives a terrible idea of the final result. If those are the final results, and all his designs are rounded he's clearly inept at aesthetics. Didn't @Sal123 have an ok result with Defrancq? Well except for ripping up a masseter though?

No offense bro, I understand this shit takes a hit on you mentally, but I agree with @Bewusst that it's hard to take you seriously if you start a thread about jaw surgery/implants and eventually just start all out rambling about the end of times, Jews, Bill Gates, Corona being a sham, and some covert folk who are about to chip, control or kill us.

 

[Barbarossa_]

My bad, I'll hit you up soon my guy (getting things organized for us).

Np boss

Did you read @Anonymous999 experience? This is making me reconsider everything and count my blessings

This is the reality check that I and many other users in here need

Yes man it's heart breaking...
I always mentioned on here how guys talk about surgery like buying candy it's ridiculous!
but I can see why a lot of surgeons I talked to like doctor Z and Rameiri against implants and prefer osteotomies BUT believe it or not I read a lot of stories from people getting infection from the freaking mini plates that are used to hold the bone after the cut


This surgery thing is way worse than we ever thought brother

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

@Linoob
@Brandon10
@CristianT
@Barbarossa_
@AlexChase89
@Sal123
@Golden Glass
@crosshold
@Morpheus
@suddenurge
@kota
@Dr Shekelberg
@anti caking agents
@highT
@nastynas
@Britsky
@6ft4
@Joyride
@Cardiologyscribe
@ChaddeusPeuterschmit
@Chowdog
@Theonewhowillascend
@fonzee98
@Gonion
@Solo
@paulus1
@Slayerino
@ProjectAscension
@Dr.austeer
@Adrenochrome
@Saltner

My man I think you are being way too passive and that's why this psychopath Yaremchuk didn't tell you about this massive hole and how he fucked up your gums

You came back to him with infection and he charged you to remove the implants TWICE so he knew you won't file a law suite and malpractice

I know you wanna get your jaw back that you had for 12 years but I think you should focus some of your money and energy to file a malpractice law suite and get some of your money back from that psychopath
You have all the evidence you need from your periodontist just make it your life goal to cause him misery and headache like he caused you.

Some local maxillofacial surgeon one time told me these western surgeons for the most part are botchers in a lab coat and they only care about their bank account especially American ones and this seems so true comparing the after care you got from Y and the one Defranq provides

When shit hit the fan Defranq came to the clinic in his off days to check on @Adrenochrome which says a lot about his character as a human being.

Hope you heal well brother.

 

[Deleted member 1707]

What your binary code means? Secret message?

 

[Phoenix997]

I had a feeling Brusco was incompetent, glad to know my instincts were right.

Hope you avoid infection this time, or at the very least are able to salvage the implant with antibiotic irrigation in the event it happens.

Lol you mean you’ll have to get it removed and replaced with a superior material 50 years from now ? How terrible! Imagine the new options available then lol.

 

[Phoenix997]

More on my story:

I had chin/jaw + paranasal + malar/infraorbital rim implants placed nearly 12 years ago with Dr. Y that were not CT designed. They were MedPor. They were inserted successfully. Chin and jaw could have been made larger but my structure was made better than before.

So now you're probably wondering how this relates to my above post with the infections.

Continue reading.

Because my prior implants were not CT designed, he placed them the "bespoke" way, where he custom carved them during surgery. This sounds fancy, but you do not want to go this route.

Regarding the cheeks/infraorbital rim from 12 years ago:

The left side was designed slightly larger than the right. My suspicion is he made the left cheek 3-4 mm, and the right ~2mm.

Regarding the chin/jaw from 12 years ago:

Immediately after my chin/jaw surgery, literally the first time I got up to go to the bathroom still sedated in the recovery area, I noticed the left side of my chin was much larger than the right. I mentioned that to the nurse. She said "Dr. Y is a perfectionist. Impossible to know till swelling goes down. This is normal." But I wasn't wrong.

My final result was I had noticeable asymmetry in my chin for nearly 12 years that never stopped bothering me. This wasn't just self hyper-analysis where one is conscious of every millimeter. Essentially the left side was made significantly wider and larger than the right, where the most anterior part of the implant on the left extended laterally to the corner of my lips, but on the right, the implant receded back pretty close to the midline. Possibly a difference of at least 6-7mm. Think of it like someone you may know who has an asymmetry but you just don't say anything. I imagine that's how people were with me, just never saying anything. And I just learned to deal with it. But it became something I always started touching/palpating - a habit, like biting one's nails.

Because the cheek and chin on the left side were larger than on the right, this resulted in me always wanting to angle myself a certain way in photos because my left side looked slightly better.

Fast-forward 12 years:

I was videotaped doing something (up till this stage I never saw myself on video as an adult), and noticed the asymmetry. In photos I could angle my face to make myself look better and hide it, but on video I couldn't mask the asymmetry. It was so bad I didn't even want that video made public (and I didn't make it public).

This was the impetus for me reaching out to Dr Y again nearly 11-12 years later (a year and a half ago). He agreed to make the chin more symmetric, and even larger this time. He said we could accomplish this using a silicone Terino L-size square implant + add MedPor to it. Everything sounded great.

When I went in, I basically reiterated, "1) Symmetry symmetry symmetry. 2) Now that we're here, yes, larger. 3) Can you put a cleft in it?"

After the surgery, I noticed the chin was literally the same exact shape but just larger, so now the asymmetry was even worse. No cleft either. I also had a tail from the underlying silicone implant very palpable under the jawline on the left.

I asked the nurse about this and she agreed that it was again very asymmetrical. She was in the surgery and said that they had spent a lot of time intraoperatively trying to burr down the left side of the original implant.

I raised this point to him immediately in the recovery area the next morning about the asymmetry. He did his analysis and got me back into surgery that same afternoon (so two surgeries in less than 24 hours) - i.e., clearly he agreed with my assessment about the asymmetry. He then added MedPor to the right side to make it look more like the left. Basically layered stacks of MedPor.

My final result once again had no cleft, but it finally looked more symmetric. I called this the "paper mache chin," as it was literally various pieces of MedPor and silicone stuck and sewn together asymmetrically. On the outside, you wouldn't be able to tell, but for me, it really disturbed me. Months later after the swelling subsided, it would "crunch" and "crackle" when I'd push gently on the right side. Dr. Y reassured me the MedPor would not move but that I was just feeling the layers. As I said, I could also palpate and see the silicone implant tail under the mandible on the left. Once again, a "paper mache chin."

I then decided, "Well hey, he was able to make my chin more symmetric and slightly larger compared to 12 years ago, so he should be able to do the same for the cheeks right? I can finally have model cheeks maybe?"

So I contacted him again about the cheeks and we did custom CT designed malar implants. I said I wanted XXL size and had done my research on this stuff.

The first design came back ~5-5.5 mm on both sides. I knew this wasn't as big as I wanted, so I sent the design back.

The second design I received was 3.5 mm on the left and 5.5 mm on the right. What? How does that make sense? 1) I said I wanted larger, and 2) why all of a sudden is there now a 2 mm discrepancy between the sides, whereas in the first design they were within 0.2 mm of each other. I raised this point to Dr. Y + said I wanted XXL, once again. He said he would "talk to the engineers."

Third design came back as 7.4 mm on the right and 8.2 mm on the left. Good enough I thought. I basically went through an uncertainty period where I was like, "Will they be way too big? Will they not be big enough?" I just didn't know. But I figured it just wasn't a good bet pushing for larger. Everything I read online cautioned against going too large for cheeks.

I went in for the cheek surgery, and while I was in there preoperatively, I said to him, "Now that we're here, is it possible to take care of this palpable tail on the left side of my chin? And can you put a cleft in the chin?" Probably the third time I had asked him to put a cleft in the chin. He agreed to do the chin changes, but the focus was just eliminating the annoying palpable tail from the silicone implant. He didn't charge me extra for this.

After the surgery in the recovery area, they said things went well.

The nurse told me I didn't need to bother filling my antibiotic prescription because she could just give me the antibiotics I needed in a bag. So she did.

I took these as indicated for four days until they ran out. I thought this was unusual though because I recalled that 12 years earlier I had definitely been on antibiotics for at least a week. But I just didn't think anything of it. I had never had problems with surgery before and was too flustered with all of the swelling and sedation from pain meds to question the staff.

What I can comment on is something unusual about the bandages over the chin: something about how they made a cleft in it; this was not just a simple submental incision; there was a double-wire/filament of some kind on the outside of my chin pad that tracked into the underlying tissue itself - essentially a way for bugs to enter from the outside. I thought this was strange but, once again, I never had problems from surgery before so just didn't question it.

I spent a week in Boston doing standard post-operative recovery.

At one-week, they took the tapes off the chin and, bang, I had a really noticeable cleft. It looked stellar.

My midface was massively swollen so it was impossible to tell what the trajectory for the cheeks would be so far, but the chin looked great.

They then gave me the OK to fly back across the world.

This day that I was flying home I was the most confident about my looks that I've ever been in life. At least I got to taste it for a short window.

Within 24 hours of being home, I got a fever of 38.5 and a painful lymph node under my jaw. Crazy enough, I didn't even think anything of it and assumed maybe I was just unlucky and getting a cold but needed a day of rest.

Over the next two days I got really swollen around the chin. I thought it was just fluid from the midface moving downward.

I gently touched under the chin along the incision line and it felt very tenuous/thin. I knew something didn't feel right about it. I took a photo and could see pus through the skin. I touched it again, and my chin blew open and hot pus and blood fell out all over the floor. Lots of it. I freaked out and immediately took photos and sent to Dr. Y. He told me to come to Boston for treatment.

Bearing in mind, however, I live across the world, so I couldn't get there instantaneously.

I took an ambulance to the hospital and they opened the incision under the chin and irrigated all of the pus out. They also gave me antibiotics. I flew to Boston the next day and they put me on IV levofloxacin. We did two weeks of near-daily irrigation. I went on high-dose oral cephalexin + oral ciprofloxacin simultaneously. I had tubes/drains under my chin.

After two weeks, I had a small hole under my chin that was closing + granulating in. Dr. Y and the fellow said it looked a lot better and that it should close shortly. They gave me the OK to fly back across the world. I stayed on antibiotics for another ten days (so probably 3.5 weeks to a month).

After I went off the antibiotics, things got worse, not better. I took more photos and sent to Dr. Y.

I will never forget what happened next:

I was out with friends and I checked my email. It said, "There's clearly an infection present. Implants need to be removed. This can be done as soon as Monday. Please arrange with [Secretary]."

I was paralyzed. I didn't know what to do.

I had had implants in for 12 years without any problem whatsoever. Now I was going to lose it all.

I flew back to Boston and had the implants removed. I spent another two weeks there undergoing more drainage + had tubes under my chin.

But let's not lose hope. The plan was: recover quickly from this setback and get new CT-designed implants that will be even better than what I had before. Silver-lining right? Go through horrible infection + flying across the world + wasting all of this money, but, there's a light at the end of the tunnel. The irony is: I'll actually have better implants in the end that are perfectly symmetrical, larger, and even with a cleft.

Before I could move forward however, they charged me $5,000 for the implant removal. I found this odd, as they are the ones who caused the infection. But they were not willing to move forward on the CT design until I paid this. I was in such emotional turmoil over losing the implants that my sole focus was to streamline things and just pay, so I did.

Over the course of the following months, my cheeks healed well and, I have enough humility to not say they're modelesque, but they're a solid and striking feature for me now. I am glad I got the size I did. If you want "model" cheekbones, you need to push at least 7-8 mm. That might sound large, and it is, but I got the cheek result I was looking for. You could say I'm now someone you'd meet and notice my cheekbones as a feature.

We then designed a seemingly perfect chin/jaw wrap-around implant. I wanted this XXL, same as the cheeks. We also designed a cleft in it.

This is where things get weird again in terms of the design. He designed the right jaw angle 5mm larger than the left. I raised this concern to him. Looking at the CT, I could actually see for myself that my underlying bone structure was asymmetric, so I assumed, "OK, well a CT can't lie. I can see the difference for myself, so we'll run with it."

I did my research on sizes online and found quite a bit on Eppley. I had seen one or two cases where he did 15mm on each side of the jaw + 15mm on the chin with good result, so I had those as general guides for what to expect. I had also read Eppley say in one of his posts that chin implants could be as long as 17-19mm.

With Dr. Y, we did 20mm on the right side of my jaw; 15mm on the left. (Keep in mind my cheeks are now XXL as well). The chin was made 23mm anterior projection. The cleft we designed ~6-7mm deep.

Following the surgery, they said things went well but that they had to shave down the chin component to make it fit. This obliterated the cleft completely. The final result therefore must have been no greater than 15-17mm on the chin. They also could not fit in the anterior aspect of the jaw properly + had to shave it down. The posterior angles remained at 15 and 20 mm.

This discrepancy in size between the posterior angles was obvious following the surgery. Not sure how a CT scan can lie. But basically my right angle looked massive; the left one looked perfect. I was really disturbed by this asymmetry.

They also told me that the muscle and gingiva avulsed during the surgery and that they had to make intraoral incisions to suture things properly, but that, don't worry, because the incisions that were made were the exact same as would be made with an intraoral chin implant. In other words, "Had we gone intraoral to insert your chin implant, the incisions would be the same anyway, so don't worry. Things went well."

During the week of post-op follow-up in Boston, Dr. Y and the fellow stressed that the sutures he put under my teeth were “very sensitive” and that I needed to do everything I could not to disturb them by staying on a liquid/soft food diet + using the mouthwash as indicated + not touching, brushing, flossing, or even looking at the area for at least 3 weeks. I had expressed my concern a few times about not being able to brush/floss or even look at that area for at least three weeks, and he told me it was important and that, correct, I shouldn’t even look at the area so as to not disturb the “very sensitive sutures.” I then flew back home one week post-op.

After about one week home (so ~2 weeks post-op), I began developing increasing severe pain of my lower teeth and gums. This was something I simply couldn’t ignore. I took a very gentle peek and could see that the gums around my lower teeth were completely missing.

Until this point in my life, I had always had great teeth, so to see this was not only completely shocking, but terrifying. I emailed Dr. Y + clinic with photos, but he never responded directly to me. He always had the fellow (Dennis Nguyen) respond on his behalf.

The fellow said everything looked fine and to just not play with the area. But I knew something was incredibly wrong. I asked if I should go to a periodontist because of the root exposure. He said no I did not and that I should just let things heal as is. He also said the roots were not exposed.

I contacted a practicing dentist I know of 40 years. I sent the same photos to him and he said, “Not only are the roots exposed, the bone is exposed. You absolutely should see a periodontist to have him take a look.”

So the next day I went to a periodontist. I told him the details of my surgeries and how the sutures were “very sensitive” and to be very careful not to disturb anything. He took a look and immediately his face sank. He said to me that not only were my gums completely receded, but that I had a gaping hole about 13-14mm deep in which he could visibly see underlying muscle.

Because my implants were Medpor (porous, which allows bacteria to easily seed/hide), any opening to the oral cavity whatsoever is an immediate guarantee of infection + the need for implant removal. The perio then took three videos using my phone of my gums + the hole.

Bearing in mind, Dr. Yaremchuk + Dr. Nguyen had never mentioned the hole to me. They said everything went great.

I sent the videos by email to Dr. Y + clinic. I didn’t get a response, so I called them. After finally getting through, he looked at the videos and said that, yes, that hole was indeed present when I left Boston and that it had actually improved slightly. He said not to worry and that he would send an email to my perio, which he did.

The perio showed me the email in which Dr. Y admitted that there was a problem during the surgery and that the hole was present when I left Boston and had contracted slightly since. He said it should close in 10-14 days by secondary intention (on its own) and that irrigation should be fine.

In other words, Dr. Yaremchuk + Dr. Nguyen had never mentioned this gaping hole to me. Not only had they said the surgery went well, but they stressed not to look at the area whatsoever and to not go to a periodontist. However had I not gone to the periodontist, I never would have known that hole was there.

Isn't it reasonable to conclude that sending a patient home with an open intra-oral wound with Medpor implants guarantees infection? Perhaps Dr. Y and Dr. Nguyen knew that. And that's why they didn't want me to go to the perio, because they knew the hole would be discovered. Then, when I would finally present again with infection, they could play it off as things being unlucky as opposed to owning up to the fact that, yes, of course I had an infection again because the hole was clearly there.

I stayed on antibiotics for about three weeks after this surgery. I then began getting swelling again. I pushed on the bottom of my chin and pus came up through the hole in my mouth. I flew back to Boston and they removed the implants a second time. I spent another two weeks there undergoing drainage + tubes under my chin.

I then flew back across the world and, a week later, I coughed and one of the intraoral incisions from the jaw implants blew open and blood came rushing into my mouth. I couldn't stop the bleeding and lost about 700 mL of blood. Was all over the ground as if someone had been executed. I thought I was going to die and messaged my family telling them I was dying. Ambulance took me to the hospital. We stopped the bleeding by shoving gauze into my mouth. They cauterized the intraoral suture site at 3am and put in more sutures. I had those taken out a week later.

I emailed Dr. Y about losing blood and he said something along the lines of "Unusual trajectory" but that was it. He didn't even ask how I was doing. It became obvious he just wanted to bury the communication and slide me under the rug.

My gums were also destroyed, requiring two gingival grafts (a lot of pain and money). The final result is better than post-Dr. Y, but I can't get my original gum appearance back and have permanent recession around my lower teeth. Fortunately we usually don't show the lower gums when we smile, so you would never notice, but it's something I am aware of and will continue to live with.

I also have marginal mandibular nerve damage on the left, so I can't lower the left side of my mouth as well as I used to, so I try not to smile showing my teeth. My chin muscles are also weaker on the left side. I have slight oral incompetence right now with liquids, so I cannot swish fluids around my mouth without holding the left side of my mouth shut. It's improved slightly, but I still have muscular weakness.

I had a further chat with the periodontist about things + discussed what I knew about the surgery in detail. He's obviously not a craniofacial plastic surgeon, but being a periodontist, he has strong understanding of the oral cavity and craniofacial anatomy. He said to me that gingival mucosa heals incredibly well and fast, meaning that the 13-14mm hole we discovered two weeks post-op must have actually been a massive cavity following the surgery. Dr. Y had said in the email that the hole contracted slightly, but the perio said it had to have been much larger. He suspects there was an instrumentation error, that perhaps they "slipped" using an elevating device for the tissues. He's aware my implants were XXL and things take on greater risk, but based on the extent of my trauma, he suspects it was instrumentation error.

I now have no implants in around my chin/jaw, after having had stable ones in for 12 years. I avoid looking at old photos of myself and never realized how good I had it. My concern about the palpable tail of the chin implant is laughable now. I'd do anything to get back to where I was.

I should also mention that the scar under my chin, because it was left to heal by secondary intention (on its own because of the infections, as opposed to being sutured shut), has left me with disfigurement that is visible on left profile. The chin pad sags below the scar line several millimeters, so I basically have an old man, saggy chin now. From the right I look fine. As I said, I just avoid looking at myself. Just makes me depressed if I take a photo.

Because I lost my chin/jaw + gained the large cheek implants, my face now is completely different compared to before. I was very boxy and square before. Now I'm sort of triangular / more Asian almost. My midface is hands-down an improvement, but would I go back in time to before the big cheek implants if it meant I could get my chin/jaw implants back + original gums + full nerve function? Absolutely. I would never wish my experience upon anyone.

I should also mention that when I went in for the various infection complications, the nurses told me about a guy from the Middle East who had cheek implant infections prior to a sibling's wedding. They disclosed his name to me (wild; confidentiality??). I will of course not say it here. Not sure if that's the OP. And if it isn't, then there's yet another infection case out there that happened last year with Dr. Y.

Because of Corona, things have obviously slowed down for all of us. However there is a different surgeon with whom I'm looking to have PEEK implants inserted via external approach. I absolutely cannot tolerate a third infection so will not go intraoral.

I'm not rushing into things as I've needed to let my gums heal and my nerve function come back as much as possible, but I'm pretty firm that I will go PEEK and external approach.

I'm OK with taking on external scars around the posterior angles because, after what I've been through, I'd do anything just to get back close to where I was + without another infection. I also now know that 15mm is the perfect posterior angle size for me. I will also probably go for no more than 12mm anterior projection on the chin. I want 15 or so, but the larger we go, the greater the complication risk, and I just don't want to have more problems. Plan is also to design a deep cleft into the chin. So even though the eventual anterior projection won't be as much as I want, maybe the cleft can overall make for a very good effect.

Is there a light at the end of the tunnel?

Is there?

--

I left this long post here because 1) you guys should know about what I went through + what is possible with this type of surgery; and 2) This outlet truthfully just helps with my own psychological healing.

--

@Linoob
@Brandon10
@CristianT
@Barbarossa_
@AlexChase89
@Sal123
@Golden Glass
@crosshold
@Morpheus
@suddenurge
@kota
@Dr Shekelberg
@anti caking agents
@highT
@nastynas
@Britsky
@6ft4
@Joyride
@Cardiologyscribe
@ChaddeusPeuterschmit
@Chowdog
@Theonewhowillascend
@fonzee98
@Gonion
@Solo
@paulus1
@Slayerino
@ProjectAscension
@Dr.austeer
@Adrenochrome
@Saltner

Is this a fucking joke... holy fucking shit. Fuck implants.

 

[Moggy]

OP is literally insane, holy shit JFL @ "looksmaxxers". This reads like a diary of a madman. KYS OP.

 

[6ft4]

This is one hell of a thread

 

[6ft4]

From this thread I've gathered that Brusco, DeFranqc and Zarrinbal are all overrated
Are there any legit surgeons in Europe at all? (I need jaw surgery)

 

[Adrenochrome]

From this thread I've gathered that Brusco, DeFranqc and Zarrinbal are all overrated
Are there any legit surgeons in Europe at all? (I need jaw surgery)

For strictly jaw surgery in Europe, Tito MARIANETTI comes up a lot (check his B&A's)
There's a thread that mentions him from someone (on this forum) who had jaw surgery with him: https://looksmax.org/threads/jaw-surgery-in-europe.34314/

Also many threads on other forums (search them out).

Moreover, there's Alfaro in Spain (but expensive from what I hear)

There's also Raffiani.

 

[CristianT]

From this thread I've gathered that Brusco, DeFranqc and Zarrinbal are all overrated
Are there any legit surgeons in Europe at all? (I need jaw surgery)

https://looksmax.org/threads/my-double-jaw-surgery-genio-2-years-ago.56055/ - Tito Marianetti

https://looksmax.org/threads/pre-and-post.64100/ - Valerio Marianetti (Tito helped in surgery)

Skype: valerioramieri_1

I've talked to both of them and they give me pictures(not gonna share on forum cause they ask not to dox). I would say both of them are good results. You can ask them pictures as well to see for yourself.

 

[listz]

interessing

 

[suddenurge]

@Anonymous999 Wow what sad story. When you say that you are going with PEEK and external incision, are you referring to a chin implant only then? I know that Eppley and some other surgeons can insert a whole silicone jaw implant through a submental incision, but this is, of course, impossible with a material as rigid as PEEK.

In Europe, literally all plastic surgeons still work with silicone or medpor. It seems as if a few European maxfacs work with PEEK because PEEK is much more affordable in Europe than the US. Unfortunately, I think you will be hard-pressed to find a European maxfac to insert even a PEEK chin implant with an external incision. Only aesthetic/plastic surgeons routinely use an external approach, whilst maxfacs basically always use an internal approach. This is how they have been trained and the technique that they are comfortable with and also use for genioplasties etc. Most of them have probably never inserted a chin implant through a submental incision. Why? Because most patients prefer intraoral incisions and submental incisions are viewed by maxfacs as an inferior procedure used by "less skilled" plastic surgeons.

Even medpor has some flexibility, which can be enhanced by heating the medpor material. This is not the case for PEEK. Assuming you find a willing surgeon, given the implant size you require and the rigidness of PEEK, you would have to split the implant in two, to even have a chance of inserting it submentally.

Would you mind posting the implant design pics of your cheek implants? Since you seem so pleased with them it makes me curious about Dr. Y's design.

Best of luck to you. Keep us updated.

 

[Anonymous999]

@Anonymous999 Wow what sad story. When you say that you are going with PEEK and external incision, are you referring to a chin implant only then? I know that Eppley and some other surgeons can insert a whole silicone jaw implant through a submental incision, but this is, of course, impossible with a material as rigid as PEEK.

I plan on getting PEEK posterior mandibular implants via external approach. That is, yes, I will tolerate the external scars. These will be along the posterior ramus. The chin component will be inserted via submental. Should be three external incisions total. Obviously not ideal, but when you've been through what I have, intra-oral is just not wise at this stage.

In Europe, literally all plastic surgeons still work with silicone or medpor. It seems as if a few European maxfacs work with PEEK because PEEK is much more affordable in Europe than the US. Unfortunately, I think you will be hard-pressed to find a European maxfac to insert even a PEEK chin implant with an external incision. Only aesthetic/plastic surgeons routinely use an external approach, whilst maxfacs basically always use an internal approach. This is how they have been trained and the technique that they are comfortable with and also use for genioplasties etc. Most of them have probably never inserted a chin implant through a submental incision. Why? Because most patients prefer intraoral incisions and submental incisions are viewed by maxfacs as an inferior procedure used by "less skilled" plastic surgeons.

Even medpor has some flexibility, which can be enhanced by heating the medpor material. This is not the case for PEEK. Assuming you find a willing surgeon, given the implant size you require and the rigidness of PEEK, you would have to split the implant in two, to even have a chance of inserting it submentally.

I have found a good surgeon willing to do PEEK via external approach for the chin and jaw.

Would you mind posting the implant design pics of your cheek implants? Since you seem so pleased with them it makes me curious about Dr. Y's design.

Best of luck to you. Keep us updated.

My choice to not upload the photos or design to this page is because, yes, my cheeks came out well, however I do not want to glorify the surgeon who caused such trauma to my lower face and who demonstrated zero empathy or care for me. In other words, I do not want guys to say, "Terrible what happened to that anonymous999 guy, but actually I will admit his cheeks are good though yeah." I strongly advise not to go to Dr. Y and I will have done a disservice to this community if I inadvertently propelled anyone to go that route. Hear my words loud and clear as a warning. Be thankful I'm giving a clear warning here about Dr. Y.

There have been some people who have DMed me asking for photos. If you want photos, I will send them to you through DM if you message me and respect confidentiality. You might be able to send to a different surgeon asking if he/she can achieve something similar.

 

[CristianT]

https://looksmax.org/threads/my-surgery-before-and-after-your-opinion.112276/page-2

This guy made also jaw implants with Defrancq. Looks terrible, ngl. Poor guy.

 

[Anonymous999]

I am getting a flood of DMs since my last post. Here is the design I currently have in without me showing my actual face. You can send these along to a different surgeon.

My natural/underlying cheek structure is decent / not hypoplastic. So these implants on top have produced a good result for me.

Greatest value I can provide anyone here is this: if you want "model" cheekbones, you need to push into the 7-8+ range.

 

[LDNPari]

I am getting a flood of DMs since my last post. Here is the design I currently have in without me showing my actual face. You can send these along to a different surgeon.

My natural/underlying cheek structure is decent / not hypoplastic. So these implants on top have produced a good result for me.

Greatest value I can provide anyone here is this: if you want "model" cheekbones, you need to push into the 7-8+ range.

I thought you also got paranasal implants?

 

[Anonymous999]

I thought you also got paranasal implants?

They're still in from 12 years ago. They're radiolucent on the scan.

The CT design is just the XXL malar / infraorbital rim implants that I currently have in.

 

[SurgerySoon]

@Anonymous999 I just read through your post describing your experience with Dr. Y and I'm speechless; I'm sorry you had to go through all that. I actually had surgery with Dr. Y a little over a year ago (March 2019) to place custom midface and chin implants, along with submental lipectomy to get rid of my double chin. There are a few weird things worth mentioning about my situation. First of all, even though I only requested to have custom midface and chin implants created, Dr. Y ended up designing an entire wraparound jaw implant for me. I was unsure as to whether or not I wanted total jaw augmentation, though, so on the morning of surgery I just had Dr. Y cut off the chin portion of the wraparound implant and place that during surgery. The remaining two halves of my wraparound jaw implant are in storage at his facility, and I had been planning on going back to him either this summer or next fall to have the remainder of it placed.

I was lucky to avoid developing any infections, but I did develop a hematoma behind my chin that Dr. Y thinks was associated with the submental lipectomy. After I got in touch with him about via email a couple weeks after the surgery and showed him photos of it, he told me I needed to fly back to Boston to have it drained. I did, and luckily he didn't charge me for the draining procedure.

One of the things you said in your post that really resonated with me was your remark about Dr. Y's initial implant designs being too small. I 100% agree with that assessment, and that brings me to my next point. You mentioned that after you told him that you felt the initial cheek implant design didn't provide projection, he sent you a revised cheek implant design that provided 5.5 mm and 3.5 mm of projection with each cheek implant. Well, maybe it's just a coincidence, but check out the dimensions on my cheek implants below:



As you can see, my midface implants each provide 5.5 mm and 3.5 mm of projection. The thing is, at the time he sent me the implant designs about a month before my surgery, I had no idea if 5.5 mm and 3.5 mm would've been considered too little augmentation, too much augmentation, or just the right amount of augmentation. I had asked him over the phone a day or two after receiving the implant designs if he thought it would be a good idea to go 2-3 mm bigger on the midface implants since I wanted them to look sharp and angular, but he emphatically said NO - because the result could end up looking unnatural.

Anyways, by the time all the swelling had dissipated months later, I realized that even though my "new" cheeks were definitely an improvement over what I had before, they still didn't provide enough projection. What was especially painful about this realization is the fact that it's really easy to tell that another 2-3 mm on each side would look OBJECTIVELY better, in the sense that the extra projection would put me dangerously close to having model-tier cheekbones. In fact, I've had people tell me that it's not just the case that my face could accommodate more projection -- it would actually be a much-improved result if I did have the additional augmentation.

So that brings to my current situation. As I mentioned above, I was planning on going back to Dr. Y sometime within the next 6 months to have the rest of my wraparound jaw implant placed, as I can now see that I'd benefit from the additional height/width the rest of the jaw implant would give me.

About a month or so ago, I also emailed Dr. Y photos of what my midface currently looks like, told him I'd like to get a more chiseled/angular result (while still avoiding an overdone look), and asked him what his opinion was. This is the part that kind of pisses me off -- in his response to me, he acknowledged that my midface could accommodate more projection and all but admitted that my original midface implants were designed too small. So at this point, my biggest regret is that I didn't INSIST during that pre-surgery phone call that he add an extra 2-3 mm to each side.

That brings me to my next point. To put it simply, I have one of the shittiest eye areas you've ever seen, and one of the upcoming surgeries I'd like to have is a total eye area overhaul with an oculoplastic surgeon named Dr. Taban - procedures include orbital decompression, lateral canthoplasty, and lower eyelid retraction surgery. I mention that because to place my cheek implants, Dr. Y made a lower eyelid incision and placed them via that route (so there was no intraoral incision whatsoever). What both Dr. Taban and Dr. Y told me is that if I want to undergo lower eyelid retraction surgery in the future to raise my lower eyelids, then I need to avoid undergoing any additional procedures that involve making an incision into the lower eyelid, because every additional incision in that area contributes to scar tissue buildup and makes it less likely that I'll be able to get a desirable eye area overhaul surgery result.

So having established that, I asked Dr. Y if it would be possible to somehow augment my midface implants without having to do a complete revision, AND without having to do anything that involves making another lower eyelid incision. He responded to me via email and said that he could have an "onlay" implant layer designed/manufactured that he could simply place on top of my existing midface implants, and he said he could probably do it via an intraoral incision.

So anyways, until I had come across your post just a few minutes ago, those were my tentative future surgery plans - getting the rest of my wraparound jaw implant placed, and having the additional "onlay" implants placed on top of my existing midface implants (hopefully via an intraoral incision so as to not compromise my future eye area overhaul surgery results). However, after reading your post, I'm honestly not sure how I'm going to proceed forward now. I realize that having the remainder of my wraparound implant placed and getting a few more mm of projection would make for a comprehensive improvement to my looks, but at the same time, if I end up developing an infection that necessitates removal of both the onlay implant layer AND my original midface implants, I'd be devastated. Really not sure what I'm going to do at this point...

 

[Anonymous999]

@Anonymous999 I just read through your post describing your experience with Dr. Y and I'm speechless; I'm sorry you had to go through all that. I actually had surgery with Dr. Y a little over a year ago (March 2019) to place custom midface and chin implants, along with submental lipectomy to get rid of my double chin. There are a few weird things worth mentioning about my situation. First of all, even though I only requested to have custom midface and chin implants created, Dr. Y ended up designing an entire wraparound jaw implant for me. I was unsure as to whether or not I wanted total jaw augmentation, though, so on the morning of surgery I just had Dr. Y cut off the chin portion of the wraparound implant and place that during surgery. The remaining two halves of my wraparound jaw implant are in storage at his facility, and I had been planning on going back to him either this summer or next fall to have the remainder of it placed.

I was lucky to avoid developing any infections, but I did develop a hematoma behind my chin that Dr. Y thinks was associated with the submental lipectomy. After I got in touch with him about via email a couple weeks after the surgery and showed him photos of it, he told me I needed to fly back to Boston to have it drained. I did, and luckily he didn't charge me for the draining procedure.

Your situation is unique in that you're basically in a "halfway point" and he's the only one that has the remaining part of your implant. If you had never gone to him before I would advise against. You have to make that call. Just recognize that I too had had previous surgeries without an infection, but then got TWO IN A ROW with him.

One of the things you said in your post that really resonated with me was your remark about Dr. Y's initial implant designs being too small. I 100% agree with that assessment, and that brings me to my next point. You mentioned that after you told him that you felt the initial cheek implant design didn't provide projection, he sent you a revised cheek implant design that provided 5.5 mm and 3.5 mm of projection with each cheek implant. Well, maybe it's just a coincidence, but check out the dimensions on my cheek implants below:



As you can see, my midface implants each provide 5.5 mm and 3.5 mm of projection.

Guaranteed the difference in your measurements were error on his end. As I said in my prior post, I received a first design where they were within 0.2mm of each other. Then the second design was 2mm difference. I asked him how in the world that was possible. Then the final design came back ~0.8 difference. It's like, OK? Let's just throw a hail mary when we have a CT right here that's supposed to be mathematically exact.

I knew Dr. Y designs small because I had had previous surgeries and knew my implants could have been much bigger. I also looked at his patient examples on the website and could clearly see those patients would have benefitted from more projection.

The thing is, at the time he sent me the implant designs about a month before my surgery, I had no idea if 5.5 mm and 3.5 mm would've been considered too little augmentation, too much augmentation, or just the right amount of augmentation.

So obvious not enough augmentation.

5.5mm bilaterally is acceptable. 3.5mm is not.

The look you're envisioning for yourself is probably ~8mm bilaterally. (I have 7.4 and 8.2, so this is not speculation. And I had to FIGHT to get those sizes.).

Your situation annoys me because he decided to go with what was easy for him, not what was best for you.

I also believe your posterior angles could be designed bigger. Maybe 10-12mm at least.

I had asked him over the phone a day or two after receiving the implant designs if he thought it would be a good idea to go 2-3 mm bigger on the midface implants since I wanted them to look sharp and angular, but he emphatically said NO - because the result could end up looking unnatural.

For every one patient who whines about "Omg my 4mm shells are too noticeable!" There are 9 other patients who would have wanted a look only achievable with 7-8+ mm.

Anyways, by the time all the swelling had dissipated months later, I realized that even though my "new" cheeks were definitely an improvement over what I had before, they still didn't provide enough projection. What was especially painful about this realization is the fact that it's really easy to tell that another 2-3 mm on each side would look OBJECTIVELY better, in the sense that the extra projection would put me dangerously close to having model-tier cheekbones. In fact, I've had people tell me that it's not just the case that my face could accommodate more projection -- it would actually be a much-improved result if I did have the additional augmentation.

Once again, no kidding.

So that brings to my current situation. As I mentioned above, I was planning on going back to Dr. Y sometime within the next 6 months to have the rest of my wraparound jaw implant placed, as I can now see that I'd benefit from the additional height/width the rest of the jaw implant would give me.

About a month or so ago, I also emailed Dr. Y photos of what my midface currently looks like, told him I'd like to get a more chiseled/angular result (while still avoiding an overdone look), and asked him what his opinion was. This is the part that kind of pisses me off -- in his response to me, he acknowledged that my midface could accommodate more projection and all but admitted that my original midface implants were designed too small. So at this point, my biggest regret is that I didn't INSIST during that pre-surgery phone call that he add an extra 2-3 mm to each side.

Especially on the midface because it's not as easy to just go back in there and re-augment. As you've pointed out, the eyelid incisions are delicate and you don't really get many redos.

That brings me to my next point. To put it simply, I have one of the shittiest eye areas you've ever seen, and one of the upcoming surgeries I'd like to have is a total eye area overhaul with an oculoplastic surgeon named Dr. Taban - procedures include orbital decompression, lateral canthoplasty, and lower eyelid retraction surgery. I mention that because to place my cheek implants, Dr. Y made a lower eyelid incision and placed them via that route (so there was no intraoral incision whatsoever). What both Dr. Taban and Dr. Y told me is that if I want to undergo lower eyelid retraction surgery in the future to raise my lower eyelids, then I need to avoid undergoing any additional procedures that involve making an incision into the lower eyelid, because every additional incision in that area contributes to scar tissue buildup and makes it less likely that I'll be able to get a desirable eye area overhaul surgery result.

So having established that, I asked Dr. Y if it would be possible to somehow augment my midface implants without having to do a complete revision, AND without having to do anything that involves making another lower eyelid incision. He responded to me via email and said that he could have an "onlay" implant layer designed/manufactured that he could simply place on top of my existing midface implants, and he said he could probably do it via an intraoral incision.

You do not want a midface infection. Every time he goes in there through the mouth you're opening yourself up to that possibility. I agree that you should avoid the eyelid incisions as much as possible.

I believe overlay implants would give you a "crackling" or "crunching" effect like I had with my chin. I tell you this literally from experience where he did that for me - that is, overlaying Medpor on my chin. This isn't even speculation. To avoid this, you would need a brand new custom CT implant with eyelid incisions.

You have to ask yourself if you can live with your current cheek implants. If you get lower eyelid droop or an infection you will be kicking yourself for life.

So anyways, until I had come across your post just a few minutes ago, those were my tentative future surgery plans - getting the rest of my wraparound jaw implant placed, and having the additional "onlay" implants placed on top of my existing midface implants (hopefully via an intraoral incision so as to not compromise my future eye area overhaul surgery results). However, after reading your post, I'm honestly not sure how I'm going to proceed forward now. I realize that having the remainder of my wraparound implant placed and getting a few more mm of projection would make for a comprehensive improvement to my looks, but at the same time, if I end up developing an infection that necessitates removal of both the onlay implant layer AND my original midface implants, I'd be devastated. Really not sure what I'm going to do at this point...

As I said above, your situation is unique in that you seem to be in a "halfway" stage with your surgeries. If you were a new patient I would say avoid this surgeon.

What you need to do is weigh the risks of infection versus what your aesthetic goals are. Only you can make that decision.

Once again, I'm annoyed on your behalf that your original implants weren't designed optimally. But I'm also not surprised in the slightest because this surgeon doesn't truly listen to the goals of his patients.

 

[LDNPari]

They're still in from 12 years ago. They're radiolucent on the scan.

The CT design is just the XXL malar / infraorbital rim implants that I currently have in.

Are you liking the paranasal implant? I'm considering getting one but not sure if its really effective. Do you mind PMing the name of the surgeon you're working with to use PEEK?

 

[Anonymous999]

Are you liking the paranasal implant? I'm considering getting one but not sure if its really effective. Do you mind PMing the name of the surgeon you're working with to use PEEK?

Paranasal carries the most underwhelming effect unless you go "big." But I mean, who goes "big" with paranasal? Sounds unusual.

I believe mine are 2-3mm bilaterally. My advice is to design yours at least 4-5mm.

I suspect the effect is that it creates a slightly anti-aging convexity around the medial nasolabial fold. If you go "big" for paranasal, you might find you look younger. I imagine if I lost my paranasal for whatever reason I'd have more prominent nasolabial indentation.

 

[SurgerySoon]

Your situation is unique in that you're basically in a "halfway point" and he's the only one that has the remaining part of your implant. If you had never gone to him before I would advise against. You have to make that call. Just recognize that I too had had previous surgeries without an infection, but then got TWO IN A ROW with him.



Guaranteed the difference in your measurements were error on his end. As I said in my prior post, I received a first design where they were within 0.2mm of each other. Then the second design was 2mm difference. I asked him how in the world that was possible. Then the final design came back ~0.8 difference. It's like, OK? Let's just throw a hail mary when we have a CT right here that's supposed to be mathematically exact.

I knew Dr. Y designs small because I had had previous surgeries and knew my implants could have been much bigger. I also looked at his patient examples on the website and could clearly see those patients would have benefitted from more projection.



So obvious not enough augmentation.

5.5mm bilaterally is acceptable. 3.5mm is not.

The look you're envisioning for yourself is probably ~8mm bilaterally. (I have 7.4 and 8.2, so this is not speculation. And I had to FIGHT to get those sizes.).

Your situation annoys me because he decided to go with what was easy for him, not what was best for you.

I also believe your posterior angles could be designed bigger. Maybe 10-12mm at least.



For every one patient who whines about "Omg my 4mm shells are too noticeable!" There are 9 other patients who would have wanted a look only achievable with 7-8+ mm.



Once again, no kidding.




Especially on the midface because it's not as easy to just go back in there and re-augment. As you've pointed out, the eyelid incisions are delicate and you don't really get many redos.



You do not want a midface infection. Every time he goes in there through the mouth you're opening yourself up to that possibility. I agree that you should avoid the eyelid incisions as much as possible.

I believe overlay implants would give you a "crackling" or "crunching" effect like I had with my chin. I tell you this literally from experience where he did that for me - that is, overlaying Medpor on my chin. This isn't even speculation. To avoid this, you would need a brand new custom CT implant with eyelid incisions.

You have to ask yourself if you can live with your current cheek implants. If you get lower eyelid droop or an infection you will be kicking yourself for life.



As I said above, your situation is unique in that you seem to be in a "halfway" stage with your surgeries. If you were a new patient I would say avoid this surgeon.

What you need to do is weigh the risks of infection versus what your aesthetic goals are. Only you can make that decision.

Once again, I'm annoyed on your behalf that your original implants weren't designed optimally. But I'm also not surprised in the slightest because this surgeon doesn't truly listen to the goals of his patients.

I'm really being pulled in different directions over how to proceed forward, because I think I'd benefit so much from additional midface implant projection that it feels like I'd be leaving a lot of potential improvement on the table. Also, these were procedures I've been wanting to undergo for at least 6-7 years now, so in a way it's kind of devastating that once I finally managed to find the time and money to have them done, I didn't end up achieving the results I wanted. What makes it even more torturous to live with is the fact that I actually DO have the potential (in terms of my starting point or "base") to get the results I want.

On the topic of risking lower eyelid droop or other issues resulting from midface implant revision that could potentially compromise future eye area overhaul surgery results -- until I read your post, what I had considered doing was going with Dr. Y for both the eye area surgeries as well as the midface implant revision, since I understand that he has a lot of experience performing eye area procedures. That would hypothetically negate the risks of compromising the results of future eye area surgeries, since I'd literally be undergoing the eye area overhaul surgeries during the same procedure. However, now I'm thinking it might not be such a good idea to trust Dr. Y with those procedures.

Here's another potential option -- instead of going with Dr. Y for the midface implant revision surgery, what if I get a copy of the implant design software file for my midface implants and send it to another surgeon who has lots of experience placing midface implants, such as Dr. Eppley? The thing is, I actually think that the overall design morphology/shape of the implants themselves is perfect -- it's just that the implants themselves don't provide enough projection. Since Dr. Eppley doesn't seem to be associated with post-surgical infections to the same extent as Dr. Y, do you think it would be safe to go with him for midface implant revision surgery (assuming he can insert the implants through the mouth and avoid making a lower eyelid incision)? What I was thinking about doing is sending Eppley the actual design file for my midface implants and telling him to simply add 2-3 mm of projection (more to the smaller one) and otherwise keep the implant design exactly as it is.

BTW, when his office secretary sent me the implant designs about a month prior to my surgery, she included a quote from Dr. Y where he said that the difference in # of mm of projection between each cheek implant was due to asymmetry of the native skull features. I would like to think that really, truly is the explanation for why there's such a stark difference in the amount of projection between each implant, but your explanation is probably right.

Just out of curiosity, do you think there would be much of an infection risk if I did have the implants revised via a lower eyelid incision and just decided to take the gamble on whether it would compromise my future eye area surgery outcome?

 

[LDNPari]

I'm really being pulled in different directions over how to proceed forward, because I think I'd benefit so much from additional midface implant projection that it feels like I'd be leaving a lot of potential improvement on the table. Also, these were procedures I've been wanting to undergo for at least 6-7 years now, so in a way it's kind of devastating that once I finally managed to find the time and money to have them done, I didn't end up achieving the results I wanted. What makes it even more torturous to live with is the fact that I actually DO have the potential (in terms of my starting point or "base") to get the results I want.

On the topic of risking lower eyelid droop or other issues resulting from midface implant revision that could potentially compromise future eye area overhaul surgery results -- until I read your post, what I had considered doing was going with Dr. Y for both the eye area surgeries as well as the midface implant revision, since I understand that he has a lot of experience performing eye area procedures. That would hypothetically negate the risks of compromising the results of future eye area surgeries, since I'd literally be undergoing the eye area overhaul surgeries during the same procedure. However, now I'm thinking it might not be such a good idea to trust Dr. Y with those procedures.

Here's another potential option -- instead of going with Dr. Y for the midface implant revision surgery, what if I get a copy of the implant design software file for my midface implants and send it to another surgeon who has lots of experience placing midface implants, such as Dr. Eppley? The thing is, I actually think that the overall design morphology/shape of the implants themselves is perfect -- it's just that the implants themselves don't provide enough projection. Since Dr. Eppley doesn't seem to be associated with post-surgical infections to the same extent as Dr. Y, do you think it would be safe to go with him for midface implant revision surgery (assuming he can insert the implants through the mouth and avoid making a lower eyelid incision)? What I was thinking about doing is sending Eppley the actual design file for my midface implants and telling him to simply add 2-3 mm of projection (more to the smaller one) and otherwise keep the implant design exactly as it is.

BTW, when his office secretary sent me the implant designs about a month prior to my surgery, she included a quote from Dr. Y where he said that the difference in # of mm of projection between each cheek implant was due to asymmetry of the native skull features. I would like to think that really, truly is the explanation for why there's such a stark difference in the amount of projection between each implant, but your explanation is probably right.

Just out of curiosity, do you think there would be much of an infection risk if I did have the implants revised via a lower eyelid incision and just decided to take the gamble on whether it would compromise my future eye area surgery outcome?

I would not go to Eppley, that guy is a clown and has produced some really bad results. Also pretty sure he drove a woman to commit suicide after disfiguring her.

 

[SurgerySoon]

I would not go to Eppley, that guy is a clown and has produced some really bad results. Also pretty sure he drove a woman to commit suicide after disfiguring her.

But after reading about Anonymous999's nightmare saga, what are your thoughts on me going back to Dr. Y, even if just to get the rest of the wraparound implant placed?

 

[LDNPari]

But after reading about Anonymous999's nightmare saga, what are your thoughts on me going back to Dr. Y, even if just to get the rest of the wraparound implant placed?

I think Y is probably the best at designing implants from my research. I've consulted with Eppley and DeFrancq and both I feel are lacking. I think infection is a risk with whoever it is for these types of surgeries. Definitely can't defend the lack of aftercare or explain the asymmetries in the design, but I'd feel comfortable enough with Y to go with him for my surgery even after all the info. I don't think Y is a perfect option, but in the world of custom implant design, I'd say he's the best option. Eppley's designs are uncanny and comical (he has also run out of bone cement in surgery and left a patient unfinished), DeFrancq's designs are just underwhelmingly bad, Terino had good designs but he's ancient and don't know if he still practices - plus he's a Scientology quack, Ramirez had good before and afters as well but I'm pretty sure he had his medical license revoked in one state. The run of the mill Beverly Hills guys like Diamond, Champagne, and Dhir don't have nearly enough experience with custom implant surgery that I'd feel comfortable going to them. Outside of that, I can't think of a single other reputable custom implant surgeon. Basically, our options are extremely limited and they're all flawed, you just have to decide who is the least flawed, and in my case I think I will go with Y for his design and implementation even at the risk of infection (as that will always be a risk). I also don't think taking Y's design to another doctor will produce the same results, as that's what OP of this thread did when it took it to DeFrancq basically and he's unhappy with his result.

 

[mblade99]

hi to all,

pretty new to this forum but ive seen it around on google cuz of the knowledge on jaw surgeons and the like here. first of to the guy that started the thread and others who have posted their experiences here id like to say im so so sorry to hear about your experience to date and I really hope it gets to where you want it to be and that above all you're healthy emotionally, mentally and physically. can't have been easy going through all that.

secondly I have to say reading all your perspectives on surgeons here has been quite humbling and definitely made me really think about who I want to potentially get surgery with (and the ACTUAL cost of it!)

would really appreciate anyone here's help, advice and suggestions on what they think I can do with regards to getting the best results with jaw surgery on my thread; https://looksmax.org/threads/wanting-to-get-double-jaw-surgery-to-correct-asymmetry.129479/

looking to just have a one shot oral and maxillofacial surgery that will basically give my face more projection in the mid face, eye orbits, lower face, improve my facial asymmetry, fix the cant of my bite and eliminate my left jaw click totally. I imagine some type of BSSO, Lefort I or II would be necessary but obviously idk these procedures as well as some of you guys do. im going for a bittt more of a Francisco lachowski look if that makes sense

hoping to hear from anyone here tbh

 

[SurgerySoon]

I think Y is probably the best at designing implants from my research. I've consulted with Eppley and DeFrancq and both I feel are lacking. I think infection is a risk with whoever it is for these types of surgeries. Definitely can't defend the lack of aftercare or explain the asymmetries in the design, but I'd feel comfortable enough with Y to go with him for my surgery even after all the info. I don't think Y is a perfect option, but in the world of custom implant design, I'd say he's the best option. Eppley's designs are uncanny and comical (he has also run out of bone cement in surgery and left a patient unfinished), DeFrancq's designs are just underwhelmingly bad, Terino had good designs but he's ancient and don't know if he still practices - plus he's a Scientology quack, Ramirez had good before and afters as well but I'm pretty sure he had his medical license revoked in one state. The run of the mill Beverly Hills guys like Diamond, Champagne, and Dhir don't have nearly enough experience with custom implant surgery that I'd feel comfortable going to them. Outside of that, I can't think of a single other reputable custom implant surgeon. Basically, our options are extremely limited and they're all flawed, you just have to decide who is the least flawed, and in my case I think I will go with Y for his design and implementation even at the risk of infection (as that will always be a risk). I also don't think taking Y's design to another doctor will produce the same results, as that's what OP of this thread did when it took it to DeFrancq basically and he's unhappy with his result.

I agree that most of Eppley's implant designs look comical and uncanny, and that's why I would only consider taking the implant that was designed for me by Dr. Y to Dr. E - since he would only be placing it and not designing it, the likelihood of me ending up with an uncanny result would be all but zero.

I really do wish I could find out if my right cheek implant only projects by 3.5 mm (as opposed to 5.5 mm on the left) because of a legitimate skeletal asymmetry, or if the lesser amount of projection was the result of an actual design error on Dr. Y's part.

 

[randomvanish]

I would not go to Eppley, that guy is a clown and has produced some really bad results.

can you share those please ?

Also pretty sure he drove a woman to commit suicide after disfiguring her.

she was mentally ill obviously. didn't you see her videos ? total bullshit like "i cannot breathe".
why you all hate that guy too much ?

 

[Adrenochrome]

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[Anonymous999]

I agree that most of Eppley's implant designs look comical and uncanny, and that's why I would only consider taking the implant that was designed for me by Dr. Y to Dr. E - since he would only be placing it and not designing it, the likelihood of me ending up with an uncanny result would be all but zero.

I really do wish I could find out if my right cheek implant only projects by 3.5 mm (as opposed to 5.5 mm on the left) because of a legitimate skeletal asymmetry, or if the lesser amount of projection was the result of an actual design error on Dr. Y's part.

It is design error. This isn't speculation. I'm an actual patient who had a 3.5 and 5.5mm design sent to me by him as well after receiving one where the difference was only 0.2mm. And when I questioned it, the final design was 0.8mm difference. It's like, OK?

If you were to send that original CT to a different surgeon and not tell him about the prior design by Dr. Y, you'll find the design you receive to be much more symmetric. My suspicion is if you analyzed your proportions in the mirror, you'd probably be able to see the 2mm difference, no?

If you get new implants, fight for big, and fight for symmetric. It's your face. Don't let anyone tell you what implant is right for you.

By the way, and I didn't mention this earlier: I had unsuccessful forehead/brow surgery with Dr. Eppley years ago. The design came out looking absurd on me in real life and he had to remove the implant. Even more, he has promoted this unsuccessful design on his website as though it's a good patient example. How many guys have requested that implant I wonder.

 

[SurgerySoon]

It is design error. This isn't speculation. I'm an actual patient who had a 3.5 and 5.5mm design sent to me by him as well after receiving one where the difference was only 0.2mm. And when I questioned it, the final design was 0.8mm difference. It's like, OK?

If you were to send that original CT to a different surgeon and not tell him about the prior design by Dr. Y, you'll find the design you receive to be much more symmetric. My suspicion is if you analyzed your proportions in the mirror, you'd probably be able to see the 2mm difference, no?

If you get new implants, fight for big, and fight for symmetric. It's your face. Don't let anyone tell you what implant is right for you.

By the way, and I didn't mention this earlier: I had unsuccessful forehead/brow surgery with Dr. Eppley years ago. The design came out looking absurd on me in real life and he had to remove the implant. Even more, he has promoted this unsuccessful design on his website as though it's a good patient example. How many guys have requested that implant I wonder.

Yes, I do notice that there's an asymmetrical amount of projection between the left and right sides of my face, which really makes me regret not pushing harder for more symmetric (as well as bigger) implants in general.

Here's the thing, though - I know you said that you would NOT recommend anyone to have surgery with Dr. Y, but at the same time, between him and Eppley (and maybe Binder in LA), are there honestly any other surgeons who have anything close to a track record of tastefully designing and placing implants in male patients' faces?

That's the thing... even though my implants need to be bigger and more symmetrical, they still provide an objective improvement what my midface looked like before. At the same time, if you do a Google image search for male cheek implant result photos, almost all the results are feminine-looking and just generally bad. So if Dr. Y and Eppley are both bad choices these days, who else is left?

 

[Anonymous999]

Yes, I do notice that there's an asymmetrical amount of projection between the left and right sides of my face, which really makes me regret not pushing harder for more symmetric (as well as bigger) implants in general.

Here's the thing, though - I know you said that you would NOT recommend anyone to have surgery with Dr. Y, but at the same time, between him and Eppley (and maybe Binder in LA), are there honestly any other surgeons who have anything close to a track record of tastefully designing and placing implants in male patients' faces?

That's the thing... even though my implants need to be bigger and more symmetrical, they still provide an objective improvement what my midface looked like before. At the same time, if you do a Google image search for male cheek implant result photos, almost all the results are feminine-looking and just generally bad. So if Dr. Y and Eppley are both bad choices these days, who else is left?

I strongly, strongly advise not to have surgery with Dr. Yaremchuk.

Mark my words loud and clear as a warning. Rarely in life will you see such clear warnings.

We are all blinded by the thought of ideal outcome.

Coming from someone who's had unsuccessful surgeries with both Dr. Y and Dr. E (absolutely wild that I can say that), I would hands-down choose Dr. E over Dr. Y if I had to go to either again.

Because when I reflect, the unsuccessful surgery with Dr. E was due to the design, but his surgical process was otherwise fine.

If you go back to Dr. Y, your risk of infection is much higher. And as I communicated earlier, if you get a midface infection, especially after seeing this thread and my warnings, you will be kicking yourself for life. The current 2mm difference in augmentation + your desire for bigger, both of which slightly annoy you now, will be laughable in the future for you if you get an infection. I would do anything to get back to where I was.

The only kicker with Eppley is that he has an obsession with silicone. But XXL cheek implants "sit on a cliff" and are much more stably integrated as Medpor.

If I were in your position, I would avoid Dr. Y and consult with Dr. E. Explain to him in detail what your current state is. Ask him how he feels about infraciliary eyelid incisions and how often he does them. Assess his confidence. Ask him how he feels about putting in silicone vs Medpor (or even PEEK) over the bone after needing to remove your current Medpor implants.

You might be able to get XXL cheek implants without the need for extended infraorbital rim. If Eppley goes in through the mouth only, he could probably insert very good XXL cheek implants, allowing you to avoid the infraciliary incision. If you get 8+mm zygoma, even without extended IOR, your result will still be much better than what you have now. Essentially your zygoma will "out-power" any orbital deficiencies you think you have.

 

[SurgerySoon]

I strongly, strongly advise not to have surgery with Dr. Yaremchuk.

Mark my words loud and clear as a warning. Rarely in life will you see such clear warnings.

We are all blinded by the thought of ideal outcome.

Coming from someone who's had unsuccessful surgeries with both Dr. Y and Dr. E (absolutely wild that I can say that), I would hands-down choose Dr. E over Dr. Y if I had to go to either again.

Because when I reflect, the unsuccessful surgery with Dr. E was due to the design, but his surgical process was otherwise fine.

If you go back to Dr. Y, your risk of infection is much higher. And as I communicated earlier, if you get a midface infection, especially after seeing this thread and my warnings, you will be kicking yourself for life. The current 2mm difference in augmentation + your desire for bigger, both of which slightly annoy you now, will be laughable in the future for you if you get an infection. I would do anything to get back to where I was.

The only kicker with Eppley is that he has an obsession with silicone. But XXL cheek implants "sit on a cliff" and are much more stably integrated as Medpor.

If I were in your position, I would avoid Dr. Y and consult with Dr. E. Explain to him in detail what your current state is. Ask him how he feels about infraciliary eyelid incisions and how often he does them. Assess his confidence. Ask him how he feels about putting in silicone vs Medpor (or even PEEK) over the bone after needing to remove your current Medpor implants.

You might be able to get XXL cheek implants without the need for extended infraorbital rim. If Eppley goes in through the mouth only, he could probably insert very good XXL cheek implants, allowing you to avoid the infraciliary incision. If you get 8+mm zygoma, even without extended IOR, your result will still be much better than what you have now. Essentially your zygoma will "out-power" any orbital deficiencies you think you have.

I see what you mean about Dr. E's surgical technique possibly being superior (at least in the sense that a patient would be less prone to developing an infection as compared to if they went with Dr. Y). That's why I mentioned in a previous thread that I was thinking about getting a copy of my midface implant design file (the actual VSP software file), emailing it to Dr. E's office, and telling him to simply add 2-3 mm of projection to each implant (in addition to correcting the existing asymmetry).

That still leaves the question of whether or not I should go back to Dr. Y to have the remaining two halves of my wraparound jaw implant placed. He quoted me $8.5k for this procedure. For the sake of comparison, someone was quoted between $27-$28k by Dr. Dhir in LA back in 2018 and around $18k by Eppley. The thing is, as interest in having these procedures done has grown among males over the last 1-2 years, I've heard that Eppley has actually raised his prices within the past year, although I'm not sure about Dhir.

Having said that, do you think it would be worth risking the infection gamble to go back to Dr. Y to have the remaining pieces of my jaw implant placed, considering that it would cost less than 1/2 -1/3 of what it would cost to have it placed by other surgeons?

The only silver lining to the possibility of my wraparound jaw implant halves getting infected is that it would at least not compromise my midface or chin implant results, since I'm assuming he wouldn't have to reopen any of those incisions and therefore wouldn't have to touch/expose either the chin or midface implants in order to place the wraparound halves.

Also, just out of curiosity, why do you think Dr. Y has grown to be associated with so many cases of infection, asymmetry, hematoma, and other surgical "slip-ups" in recent years? Do you think he's just getting too old to maintain the dexterity and sterility required to be a surgeon?

Edit: I noticed that you referred to my implants as Medpor implants -- they are actually silicone (just for the record).

 

[Anonymous999]

I see what you mean about Dr. E's surgical technique possibly being superior (at least in the sense that a patient would be less prone to developing an infection as compared to if they went with Dr. Y). That's why I mentioned in a previous thread that I was thinking about getting a copy of my midface implant design file (the actual VSP software file), emailing it to Dr. E's office, and telling him to simply add 2-3 mm of projection to each implant (in addition to correcting the existing asymmetry).

That still leaves the question of whether or not I should go back to Dr. Y to have the remaining two halves of my wraparound jaw implant placed. He quoted me $8.5k for this procedure. For the sake of comparison, someone was quoted between $27-$28k by Dr. Dhir in LA back in 2018 and around $18k by Eppley. The thing is, as interest in having these procedures done has grown among males over the last 1-2 years, I've heard that Eppley has actually raised his prices within the past year, although I'm not sure about Dhir.

Having said that, do you think it would be worth risking the infection gamble to go back to Dr. Y to have the remaining pieces of my jaw implant placed, considering that it would cost less than 1/2 -1/3 of what it would cost to have it placed by other surgeons?

The only silver lining to the possibility of my wraparound jaw implant halves getting infected is that it would at least not compromise my midface or chin implant results, since I'm assuming he wouldn't have to reopen any of those incisions and therefore wouldn't have to touch/expose either the chin or midface implants in order to place the wraparound halves.

Also, just out of curiosity, why do you think Dr. Y has grown to be associated with so many cases of infection, asymmetry, hematoma, and other surgical "slip-ups" in recent years? Do you think he's just getting too old to maintain the dexterity and sterility required to be a surgeon?

Edit: I noticed that you referred to my implants as Medpor implants -- they are actually silicone (just for the record).

Did you specifically request silicone with Dr. Y prior? Medpor tends to be Dr. Y's standard go-to. I was actually surprised when the OP mentioned having had silicone with Dr. Y.

I would ditch going back to Dr. Y altogether and just have Eppley insert your cheeks and a new chin/jaw wrap-around. Tell him you want to avoid infraciliary incisions but want XXL.

I saw your jaw design and I think you could do 10-12mm on each side instead of 8mm. In other words, don't fret about "wasting" the remaining part of the implant that Dr. Y has in storage. You don't want that anyway. The same way Dr. Y designed your cheeks too small, he also designed the jaw with insufficient lateral projection.

Since you have silicone in, it shouldn't be a hassle for Eppley to just remove and replace.

See if Eppley can design your jaw with PEEK over silicone, or at least see how he feels about that. Ask him about the "hanging on the cliff" aspect of silicone/PEEK for the malar implants and his thoughts on longer term stability. Ask him if he'd consider Medpor + if he's ever used it + his view on infections with it (obviously higher, but ask him, because Medpor is ideal for malar).

He will likely push silicone on you across the board, so ask him the % of cases, both for jaw and malar, which have experienced displacements despite screw immobilization.