@@jonathanzelkenmd Ahhhh, I hadn't thought of that. Nonetheless, I have some other procedures that are higher priority than jaw augmentation; so it will be a long time before I could even consider your work. I will remember you, though!
Thank you so much for talking about this could you do a more detailed video for patients wanting to know if they should get mandibular implants, chin implants or both?
It's one of the most difficult procedures to get it right aesthetically, with a high revision rate. One of the tricks is to use as little as possible to get the maximum effect possible. Problem is, if you don't do enough, it won't create the desired effect if your base is low. Doing too much leads to a bulky look in certain lights. One other thing is the masseters must not be pushed outwards too much, creating too much bloat at the cheek area. So when going up with the implant at the jaw area, it must be thin. One other problem is masseter disanhencement. It must be suited at the right place. The surgeon usually works from the mouth, so he can't 'see' exactly what he's doing. Soft tissue must be wrapped tightly around it. A lot of surgeons don't understand the importance of soft tissue.
Have you done many of these implant surgeries? I cant find any before and after pics other than one female on your website. I had a chin implant 7 years ago and want to replace it with a full jaw implant.
Thank you for the information. I have a question please about custom made implants. Once the implant is in and everything is set and done, how long does it last ? How many months or years ?
Dr. Zelken, which jaw angle implants do you use the most, and from which company? And do you always use screw fixation, even with MEDPOR? Thanks for this much-needed video!
@@jonathanzelkenmd The implant you're handling in the video--is it the RZ Mandibular Angle Implant? I'm planning my own jaw implant procedure, and am researching different implant shapes and styles. Thanks!
@Steve-q4h Hello Steve. I'm in the UK and have just had this procedure done in Turkey. I am very happy with the result. My surgeon is Dr Fatih Okyay MFO Surgery Antalya. Mention Ian Newton recommended you and you may get a better price.
I have a short ramus(not visible tbh)but a relatively long and sharp jawline but i feel like the chin is bit recessed Can jaw angle implants help aslo ig theres a need of chin implants alongside it to match the ratio and facial symmetry
hello doctor, Placing implants in the angle and jaw line will pull the soft tissues and have a lifting effect on the jowls and turkey neck? I have a high, short and stiff mandible.
Would PEEK or Titanium be a better option than silicone or polythene?, would be very curious of how many doctors are using them and if titanium can be customized like PEEK material
Yes titanium can be used as well. To be honest, I do not know of anyone using titanium for custom face implants at this time, besides the screws. I think silicone and medpor are also solid options but some of their material properties are imperfect.
Can you talk a bit about masseter dehiscence from jaw angle implants procedure? I had this procedure done in June 2024 & I have dehiscence both jaws. I’d like to schedule a consultation with you!
Yes, it’s possible but would take a much larger incision to shape and position the graft, and would not reliably take. Resorption would be unacceptable and unpredictable. Not to mention the donor site…
Dr. Zelken, Are polyethylene jaw implants capable of being removed after a certain timeframe if the final result isn’t satisfactory once healing is complete? If so, is a polyethylene jaw implant difficult to remove after a potential malposition? I’m a little confused as to the “absorption” part… Does the implant itself essentially become part of the actual jaw bone over time making it difficult for removal? What does the implant absorb? Very interesting video Thank you!
Thank you. Its not resorption so much as remodeling. And PEEK implants can certainly be removed. The risk of implant malposition is lower with custom devices that “key” in to position.
I am sorry you re dealing with this. I have not treated this complication before. If pressed, I would consider accessing the masseter through a deep plane facelift approach and repairing the dehiscence under direct visualization. Or you could remove the implant and let the tissue contract.
Never heard about gonial angle before watching this video and now I am curious: what is attractive exactly? The gonial angle itself or persons with an acute gonial angle? Also is there some kind of lower limit under which the gonial angle's sex appeal begins to decrease? My intuition is that under 90° a "fish face" effect would start to appear but idk maybe it is considered an attractive feature 🤷 Any thoughts on that?
Wow thanks for covering this so quick! Did have another question however. With the Stryker implant specifically, you mentioned it cups the gonial angle (which I assume means it slides underneath and around the back of the bone as well), but how would this impact the masseter muscle and where it attaches to the bone? Doesn't the masseter muscle insert/attach on top of the lateral or outside of the mandible? I would think this would tear the masseter or make it impossible for the implant to cup around the bone, as apposed to the implanttech where you mentioned it sorta sits on the bone. So how does an implant like this work when dealing with the masseter? Also is this a procedure you do often and have experience with? Thanks again for the video and featuring me haha.
The masseter doesn’t really connect to the bone directly. It becomes ligamentous and extends to the backside like a sling. The entire implant is placed underneath that sling without disrupting it. I have experience with this procedure and would like to perform jaw implant surgery more often.
What is the probability of silicone jaw implants moving position over time? I'm a bit concerned about having them screwed in case I don't like them but I also don't know how reliable silicone is. Thanks
Have you ever done a Jaw implant? I had cancer five years ago that left me without a lower jaw. I am cancer free but at what cost. Talk about quality of life.
Yes but it sounds like you are looking at a total mandibular reconstruction. I am sorry for your loss and glad you are cancer free, at the very least. Let me know if there’s anything I can do to help.
Please don't add the soft background music it really adds nothing. I'm sure everyone viewing this is totally focused on what you are saying and it just distracts from this.
Good to know. Some day, both my daughter and I will schedule a consultation (maybe when we win the lottery 😬). Chins and jaws are almost nonexistent in our DNA. 😒
Dr. are jaw implants an option for me - a sixty year old woman with minor jowling who is losing bone in her jaw in leiu of a facelift? I'm also have teeth bone issues - thanks for your input
You would need to seen. For the dental issues - it may impact the maxilla and mandible relationship but assuming not, you might not need jaw implants given mild jowling and the prospect of deep fat transfer.
More doctors need to talk about this, pro and cons about jaw implants surgery
the real qustion is why there are not more surgeons that talk about custom jaw implants?
Takes money away from fillers.
Are there before and after pictures?
Now I wish that I still lived in Newport Beach, cuz I'd pay you a visit in a heartbeat! I have been curious about this exact implant for a while.
We do offer virtual consultations and many of our patients are from out of state.
@@jonathanzelkenmd Ahhhh, I hadn't thought of that. Nonetheless, I have some other procedures that are higher priority than jaw augmentation; so it will be a long time before I could even consider your work. I will remember you, though!
Very informative.
What is the estimated cost of this procedure? I don't see it listed on your website. Thanks!
Thank you so much for talking about this could you do a more detailed video for patients wanting to know if they should get mandibular implants, chin implants or both?
Is there a way to make the gonian outward?
Absolutely
Thank you for posting this.
My pleasure. Its easy to make videos about my passion projects.
It's one of the most difficult procedures to get it right aesthetically, with a high revision rate. One of the tricks is to use as little as possible to get the maximum effect possible. Problem is, if you don't do enough, it won't create the desired effect if your base is low. Doing too much leads to a bulky look in certain lights. One other thing is the masseters must not be pushed outwards too much, creating too much bloat at the cheek area. So when going up with the implant at the jaw area, it must be thin. One other problem is masseter disanhencement. It must be suited at the right place.
The surgeon usually works from the mouth, so he can't 'see' exactly what he's doing. Soft tissue must be wrapped tightly around it. A lot of surgeons don't understand the importance of soft tissue.
These are all excellent points and many of the challenges can be addressed with custom PEEK implants.
What do you think about bone resorption caused by silicone implants?
I think it happens but is not as big a deal as you might think. Stay tuned for a video on the topic.
Have you done many of these implant surgeries? I cant find any before and after pics other than one female on your website. I had a chin implant 7 years ago and want to replace it with a full jaw implant.
What if someone has a sort of square looking face and wants a little more V-shape look. How much would that cost?
I second that!
very good work ! do you do any treatments in england uk ? thank you
I do not, sorry. Someday.
@@jonathanzelkenmd ever in Europe ?
Thank you for the information. I have a question please about custom made implants.
Once the implant is in and everything is set and done, how long does it last ? How many months or years ?
I have patients who have facial implants that were placed 40-50 years ago.
@@jonathanzelkenmdhow much does the surgery cost?
@@jonathanzelkenmd would it be possible to reduce an implant after 20 yrs ? ...like bone shave it / grind it into shape ?.... if too big
Dr. Zelken, which jaw angle implants do you use the most, and from which company? And do you always use screw fixation, even with MEDPOR? Thanks for this much-needed video!
I use Implantech silicone implants most often and rely on screw fixation most of the time. Especially with Medpor. My pleasure
@@jonathanzelkenmd Thanks!
@@jonathanzelkenmd The implant you're handling in the video--is it the RZ Mandibular Angle Implant? I'm planning my own jaw implant procedure, and am researching different implant shapes and styles. Thanks!
What’s better for comfort silicone or medpore
I do not think there is a difference
i want a cheek bone just like diamond face shape people have ..is it possible to get that
this is remarkable work doctor ! can you recommend any doctors in england uk that do jaw implants ? thank you
Thank you; I do not know any jaw angle implant surgeons in UK.
@@jonathanzelkenmd hopefully you can do a jaw implant for me as they look amazing !
@MarkMcgrath-z8e im looking for a UK recommendation too. Maybe even turkey
@Steve-q4h Hello Steve. I'm in the UK and have just had this procedure done in Turkey.
I am very happy with the result.
My surgeon is Dr Fatih Okyay
MFO Surgery Antalya.
Mention Ian Newton recommended you and you may get a better price.
I have a short ramus(not visible tbh)but a relatively long and sharp jawline but i feel like the chin is bit recessed Can jaw angle implants help aslo ig theres a need of chin implants alongside it to match the ratio and facial symmetry
You would certainly need to be examined to make this determination
you have any before/afters? also what is the healing time?
Hi there, we just posted one on our Instagram page @jonathanzelkenmd
hello doctor, Placing implants in the angle and jaw line will pull the soft tissues and have a lifting effect on the jowls and turkey neck? I have a high, short and stiff mandible.
It is certainly possible but you would have to be seen in person to better assess your question and set expectations
Is there a lot of downtime and is the swelling a factor.
Would PEEK or Titanium be a better option than silicone or polythene?, would be very curious of how many doctors are using them and if titanium can be customized like PEEK material
Yes titanium can be used as well. To be honest, I do not know of anyone using titanium for custom face implants at this time, besides the screws. I think silicone and medpor are also solid options but some of their material properties are imperfect.
@jonathanzelkenmd thank you
do you have any surgeons in the uk that you could recommend for this treatments ? thank you
I do not sorry
Can you talk a bit about masseter dehiscence from jaw angle implants procedure? I had this procedure done in June 2024 & I have dehiscence both jaws. I’d like to schedule a consultation with you!
Great idea!
Can you do bone (rib) instead of artificial elements?
Yes, it’s possible but would take a much larger incision to shape and position the graft, and would not reliably take. Resorption would be unacceptable and unpredictable. Not to mention the donor site…
Dr. Zelken,
Are polyethylene jaw implants capable of being removed after a certain timeframe if the final result isn’t satisfactory once healing is complete? If so, is a polyethylene jaw implant difficult to remove after a potential malposition?
I’m a little confused as to the “absorption” part… Does the implant itself essentially become part of the actual jaw bone over time making it difficult for removal? What does the implant absorb?
Very interesting video
Thank you!
Thank you. Its not resorption so much as remodeling. And PEEK implants can certainly be removed. The risk of implant malposition is lower with custom devices that “key” in to position.
What can one do for hypertrophied parotids due to bulimia?
Neurotoxins like Botox may be a starting point
do you know of any ways to fix masseter muscle disinsertion from jaw implants?
I am sorry you re dealing with this. I have not treated this complication before. If pressed, I would consider accessing the masseter through a deep plane facelift approach and repairing the dehiscence under direct visualization. Or you could remove the implant and let the tissue contract.
Can this be combined with a deep plane necklift procedure or would it not be recommended to do both at once?
Depends on your physical examination but its possible
@@jonathanzelkenmd Thank you!
Can genioplasty or Orthognathic surgery achieve this wider jaw angle or only with implants ?
What are the ramus lengthening limitations with porous polyethylene implant? Is 20 - 25 mm achievable?
If placed properly that would extend the pterygomasseteric sling considerably and may be too much. Of course you would need to be examined first.
Never heard about gonial angle before watching this video and now I am curious: what is attractive exactly? The gonial angle itself or persons with an acute gonial angle?
Also is there some kind of lower limit under which the gonial angle's sex appeal begins to decrease? My intuition is that under 90° a "fish face" effect would start to appear but idk maybe it is considered an attractive feature 🤷 Any thoughts on that?
What do you think about custom implants? Are they worth the extra cost? I am afraid if I go with off the shelf implants, they won't fit well
It truly depends on your anatomy and goals. Remember: off the shelf implants can be customized with a scalpel to some degree
Do the off the shelf vertical mandibular implants adds width to you jawline? As much as the lateral ones? Can you explain the difference pls
They both add width (because the vertical ones have width to them) but not as much as the widening implants
Wow thanks for covering this so quick! Did have another question however. With the Stryker implant specifically, you mentioned it cups the gonial angle (which I assume means it slides underneath and around the back of the bone as well), but how would this impact the masseter muscle and where it attaches to the bone? Doesn't the masseter muscle insert/attach on top of the lateral or outside of the mandible? I would think this would tear the masseter or make it impossible for the implant to cup around the bone, as apposed to the implanttech where you mentioned it sorta sits on the bone. So how does an implant like this work when dealing with the masseter? Also is this a procedure you do often and have experience with?
Thanks again for the video and featuring me haha.
The masseter doesn’t really connect to the bone directly. It becomes ligamentous and extends to the backside like a sling. The entire implant is placed underneath that sling without disrupting it. I have experience with this procedure and would like to perform jaw implant surgery more often.
What is the probability of silicone jaw implants moving position over time? I'm a bit concerned about having them screwed in case I don't like them but I also don't know how reliable silicone is. Thanks
Unlikely to move over time. Silicone can easily pull free from a screw but it holds things in place while scar tissue secures the device in position.
Can they be removed?
Yes absolutely
Could this be used to fix jaw asymmetry, for example if one side is bigger than the other? If so what are the best options
Yes to a certain extent- it depends on your bite (occlusion) and other features as well.
If someone does it late 20s how the aging effect will be, do they cause harmony issues with aging?
Probably not as it is simply reshaping the jawline for the better.
Is it possible to just widen and not lower the jaw angle? Even if it’s a little bit, I just want to widen the jaw angle and not to lower it.
Yes, although every widening implant has some impact on length, and vice versa
I had jaw angle implants 2 years ago but I don't like them. Is it possible to remove them? They are titanium material implants
Yes these can be removed and you are not alone
Have you ever done a Jaw implant? I had cancer five years ago that left me without a lower jaw. I am cancer free but at what cost. Talk about quality of life.
Yes but it sounds like you are looking at a total mandibular reconstruction. I am sorry for your loss and glad you are cancer free, at the very least. Let me know if there’s anything I can do to help.
😊hi from Brazil viewer
Hello
Please don't add the soft background music it really adds nothing. I'm sure everyone viewing this is totally focused on what you are saying and it just distracts from this.
Thank you for the feedback - I will change this
Maybe cause is very expensive i read is like $10-15k
Correct
Good to know. Some day, both my daughter and I will schedule a consultation (maybe when we win the lottery 😬). Chins and jaws are almost nonexistent in our DNA. 😒
Dr. are jaw implants an option for me - a sixty year old woman with minor jowling who is losing bone in her jaw in leiu of a facelift? I'm also have teeth bone issues - thanks for your input
You would need to seen. For the dental issues - it may impact the maxilla and mandible relationship but assuming not, you might not need jaw implants given mild jowling and the prospect of deep fat transfer.
Sounds extremely expensive
Finally!
Will tmj clicking worsen
It is possible but I haven’t seen it in my patients