There are only two materials of which jaw angle implants are made, silicone and Medpor. While there are material differences between the two as well as each offer their own styles and sizes, there are surgeon advocates for either jaw angle implant material. With the proper implant selection and good surgical technique both materials can produce good jaw angle augmentation results.
Silicone jaw angle implants have recently introduced new widening and vertical lengthening styles with various sizes. They now offer superior designs for today’s male and female jawline enhancement patients. But Medpor jaw angle implants continue to be placed and many have been inserted in the past.
Revision or removal of such porous Medpor facial implant materials is well known to be difficult due to the tissue ingrowth. What was once an initial biologic advantage turns into a surgical challenge should secondary implant manipulation be needed. Surgical opinions vary as to this surgical challenge and range from difficult to impossible to do. The ante goes up considerably in the jaw angle area which is regarded as the most difficult type of facial implant to place.
Having done many revisional jaw angle implant surgeries, I have had the opportunity to remove a lot of Medpor implants. Most certainly there are far more difficult than a silicone implant but they can be successfully removed. Care has to be taken in dissecting the capsule off of the masseter muscle and, in particular, the inferior border where branches of the facial artery can be inadvertently cut in stripping off the very adherent scar tissue. The implant material comes off the bone the easiest probably because the underlying bone can be safely used as a fulcrum.
It is fairly uncommon to ever remove the jaw angle implant in a completely intact state. Far more commonly the material needs to be segmentalized. Interestingly Medpor material becomes somewhat softer after implantation due to the tissue ingrowth. Thus it often breaks apart during removal.
I have yet to see Medpor jaw angle implants, or any Medpor facial implant, that could not be removed in its entirety. But it can be traumatic to the tissues and the postoperative swelling from doing so may be greater than that seen during their initial placement.
Dr. Barry Eppley