Both custom implants and fat grafting are options available to finish facial reshaping after double jaw surgery—but they solve different problems. A few patients may ultimately benefit from a combination of the two.
1. What each method is best at
|
Goal |
Custom Implants |
Fat Grafting |
|
Increase bone-based projection |
? Excellent |
? |
|
Add width / structure |
? Excellent |
? |
|
Improve soft tissue volume |
?? Indirect |
? Excellent |
|
Correct under-eye hollowing |
?? (infraorbital implant) |
? Limited |
|
Improve jawline definition |
? Gold standard |
? |
|
Fine contour blending |
?? |
? |
|
Reversible / adjustable |
? |
? |
2. Custom Facial Implants
What they do
- Permanently change skeletal contour
- Add projection, width, and definition
- Create sharp transitions (jawline, cheekbones)
Common post-bimax uses
- Malar or infraorbital deficiency
- Jaw angle narrowing after mandibular setback
- Weak chin shape after sliding genioplasty
- Asymmetry revealed after occlusion correction
Pros
- Precise, predictable, permanent
- Corrects what soft tissue cannot
- Custom fit minimizes malposition
Cons
- Surgical placement
- Not easily adjustable once placed
- Risk (low): infection, exposure, revision
3. Fat Grafting
What it does
- Improves soft tissue volume and quality
- Smooths contours and transitions
- Camouflages mild asymmetries
Common post-Bimax uses
- Tear trough / infraorbital hollows
- Flat or deflated midface
- Perioral volume loss
- Softening implant edges
Pros
- Uses your own tissue
- Improves skin quality
- Can be staged and adjusted
Cons
- Unpredictable retention (50–70%, could even be 0%)
- Does not add structure
- Often requires repeat sessions
4. Longevity & predictability
|
Factor |
Implants |
Fat |
|
Immediate result |
Predictable |
Variable |
|
Long-term stability |
Permanent |
Partial resorption |
|
Symmetry control |
High |
Moderate |
|
Aging effects |
Stable framework |
Ages naturally |
5. Timing after Bimax surgery
- Implants: ideally 6–12 months post-op
- Fat grafting: can be done earlier (3–6 months) or later
- Fat grafting is often delayed until swelling has stabilized enough to avoid overfilling
6. Best approach: Hybrid strategy
This is the most common expert approach.
Implants
- Establish structure (cheek, jaw, chin)
Fat grafting
- Blend edges
- Improve under-eye and midface softness
- Address aging-related volume loss
Think of implants as improving the architectural frame, and fat as the exterior finish whea general rounded effect is needed.
7. Who should choose what?
Better implant candidates
- Clear structural deficiency
- Desire for strong definition
- Stable weight
- One-and-done preference
Better fat graft candidates
- Subtle volume loss
- Thin or aging soft tissues
- Willing to accept variability
- Preference for minimally invasive options
Bottom line
After Bimax surgery:
- Implants correct structure
- Fat grafting refines softness
- There may be a role for both implants and fat grafting but that would be very uncommon.
Dr. Barry Eppley
World-World-Renowned Plastic Surgeon