High dose ion implantation of heavy elements in Ge induces a rough surface and profile distortions when measured with secondary ion mass spectrometry. In the case of Sb large subsurface holes are also induced by the implantation. The formation of these subsurface structures starts abruptly at a dose between 5.10(14) and 10(15) at/cm(2). The addition of a SiO2 capping layer on top of Ge prevents the formation of the surface roughness, but has limited impact on the void formation. These voids originate from vacancy clustering during the implant process. Anneal studies show that it is impossible to remove these structures by annealing, limiting the usefulness of high dose Sb implants in Ge for junction formation. In the case of As implantation a similar surface roughness is seen but no void formation. Adding a cap layer removes the surface roughness in this case and improves the secondary ion mass spectroscopy profiles. (c) 2006 American Vacuum Society.