Background: The prominence of the lower face, known as the jawline, has great significance for men. The size of the jawline is defined by its three points of the chin and the two jaw angles. Due to the way the jaw develops and its unique shape, a small or weak chin is also associated with high and indistinct jaw angle. While augmentation of the chin has been done for decades, increasing attention is being paid to the jaw angles that lie behind it.
While newer and better designed jaw angle implants are now available to be used alone or in conjunction with a chin implant for a total jawline effect, aesthetic complications such as asymmetry or lack of adequate or well placed augmentation can occur. Creating a one piece single implant that encompasses both jaw angles and chin obviates many of the concerns of a ‘three piece’ jaw augmentation approach.
Custom wraparound jaw implants are designed and made today using a 3D CT scan of the patient. While the computer can make a beautiful design that fits the bone well and is smooth and well connected along the entire jawline, it has no innate knowledge as to what dimensions the custom jaw implant should be to create the patient’s desired effect. Such information must be provided by the surgeon and is gathered from a thorough discussion with the patient and through the use of computer imaging.
Case Study: This 40 year-old male wanted to improve his entire jawline but wanted to do so in a more ‘modest’ fashion. He did not want to be too noticeable or be too ‘strong’. In working with him, a custom jaw implant was designed from a 3D CT scan of him.
Under general anesthesia, a three incisional approach was used for its placement. (external submental and two intraoral incisions in the back of the mouth) The implant was inserted through the submental incision and threaded into placed under direct vision from the intraoral incisions to correct placement over the jaw angles. Microscrew fixation was done at the chin and jaw angle portion of the implant.
His postoperative results at one year after surgery show a modest bur visible change in his jawline. The chin was augmented by 7mm horizontally while the jaw angles were vertically lengthened by 5mm and 7mms width.
Custom jaw implants can create a very powerful effect on the lower face due to the surface area that it covers. The most common error in designing them is to create an implant that is too big and oversized. It takes considerable experience in designing and placing custom jaw implants to develop an appreciation of what effects it can potentially create. In addition, custom jaw implants can have their biggest effects, whether they are small or big in size, in faces that are lean and not round and full.
Highlights:
- The best method for enhancement of the entire lower face is a wraparound jaw implant made from a 3D CT scan.
- Increasing the prominence and angularity of the lower jaw from angle to angle across the chin creates the most harmonious and united jawline effect.
3. Smaller custom jaw implants can be designed for more modest improvements in the shape of the entire jawline.
Dr. Barry Eppley
Indianapolis, Indiana