Background: The shape of the lower face is primarily influenced by the size and dimensions of the mandible or lower jaw. Being the only moveable bone on the face it has a unique shape due to the biomechanical stresses placed on it as well as having to contain up to sixteen teeth that pass loading forces onto the upper jaw. It has three prominences that make up its identifiable tripartite structure, the anterior chin and the posterior jaw angles. While the chin is the mandible’s most recognized aesthetic feature, the jaw angles are really like the paired set of chins on the back part of the jaw.
While chin augmentation has been around for over five decades, jaw angle augmentation is much more recent. Unlike the chin, augmentation of the jaw angles can only be done by implants and doing so is far more complicated than that of the chin. Besides the anatomic fact there are two jaw angles, their location underneath the strong masseter muscles creates considerations of incision location, implant shape and size and its location on the bone and how it may affect muscular position and shape.
While the ideal method for total jawline augmentation is that of a custom made wrap around jawline implant, many patient’s may not need that technology or prefer not to undergo its use. Standard chin and jaw angle implants can work well for many patients and their wide variety of sizes and shapes create a lot of aesthetic jawline augmentation options. But how to mix and match these implant sizes and the challenges of placing three separate implants in their proper bony positions makes getting symmetric and aesthetically satisfying results challenging.
Case Study: This young male wanted a total jawline augmentation with a result that was of a modest enhancing effect. He didn’t want it too strong or to look overdone. His natural jaw was not weak or overtly deficient but had softer highlights of the chin and jaw angles.
Under general anesthesia, a small square chin implant was placed through a submental incision. Through posterior vestibular intraoral incisions, medium square widening jaw angle implants were placed and secured by titanium micro screws.
His after surgery results showed a more defined jawline that had better chin and jaw angle angularity. The implants had acceptable symmetry and were not oversized.
While this patient had a good result using standard chin and jaw angle implants, the risks of revisional surgery with three independent bone areas of augmentation is not low. Between the size and shape of the implants and their proper and symmetric placement on the bone, the average risk of an aesthetic revision for the dozens of influencing and interconnected possible variables is 50% or higher.
Highlights:
- Complete jawline augmentation consists of highlighting the three corners of the jaw, the chin and bilateral jaw angles.
- A wide variety of standard chin and jaw angle implants exist to satisfy many patient’s aesthetic jawline needs.
- With three independent implants along the jawline it is important that patient’s appreciate the relatively high rate of aesthetic revisions that can occur.
Dr. Barry Eppley
Indianapolis, Indiana