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Archive for the ‘chin implants’ Category

Technical Strategies – Sliding Genioplasty and Chin Implants

Tuesday, November 24th, 2015

 

A sliding genioplasty is a very versatile chin reshaping procedure that has been used for decades. In elective chin augmentations it is the alternative option to the use of a chin implant. Although chin implants are by far more commonly done in a ratio of at least 20:1 if not greater. While chin implants are a simpler procedure they are not appealing to everyone nor are they always the best choice for every type of chin deficiency.

A sliding genioplasty is usually best done for younger patients who have significant chin deficiencies. There also is a much higher tendency to  them at the time of orthognathic surgery when other facial bones are being manipulated as well. In larger chin deficiences moving of the bone has less potential for any long-term problems than does an implant.

The limits of how far forward a sliding genioplasty can move the chin horizontally is a function of the thickness of the chin bone. It is important to maintain some bone contact between the upper and lower chin segments, meaning the back edge of the downfractured chin segment should at least touch the front edge of the chin bone above it. (and be stabilized by plate fixation)

Sliding Genioplasty Chin Implant Combination Dr Barry Eppley IndianapolisBut in some larger chin deficiencies even maximal forward chin bone movement may still leave one with less than an ideal profile change. In these circumstances, whether recognized during the initial sliding genioplasty or afterwards, the solution can be a chin implant. A chin implant can be placed on the front edge of the sliding genioplasty to gain an additional 3 to 5mms of horizontal chin projection. An extended anatomic chin implant is used so that its wings cover the step off area on the back side of the osteotome line. It is critically important that the chin implant is secured by screw fixation to the sliding genioplasty segment.

While chin implants and sliding genioplasties are traditionally thought of as being mutually exclusive, they do not have to be. In need of extreme amounts of chin projection, the combination of a sliding genioplasty with a chin implant overlay can be a useful chin augmentation strategy.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Recycled Medpor Chin Implant in Sliding Genioplasty

Saturday, June 13th, 2015

 

When a chin implant ‘fails’ it may be replaced or revised by a sliding genioplasty. Chin implant failure can usually be defined as an implant that had not met the patient’s aesthetic desires due to design, size or positioning issues. This is most commonly seen when a chin implant is used for larger chin deficiencies whose horizontal and vertical dimensional needs are at the fringe or beyond what a standard performed implant can achieve. Recurrent chin implant problems such as asymmetry and visible or palpable edges are another indication to consider moving from a synthetic to an autogenous or more natural chin augmentation solution.

Medpor Chin Implant Removal Dr Barry Eppley IndianapolisMedpor is a chin implant material, which while used far less than that of silicone chin implants, is a favorite among some patients and surgeons. While it is a biomaterial that does offer good tissue adherence and fixation it can suffer the same chin implant problems that silicone implants do. The material composition does not make it immune to similar aesthetic issues. While many surgeons state that Medpor facial implants are impossible to very difficult to remove that perception is a relative one when they are compared to silicone. I have removed many Medpor facial implants and they all can be removed in their entirety with careful surgical technique. They rarely come out as one piece by rather in multiple smaller sections.

Medpor Chin Implant Removal and Sliding Genioplasty Dr Barry Eppley IndianapolisMedpor Implant in Sliding Genioplasty Dr Barry Eppley IndianapolisWhen a sliding genioplasty is used to replace a chin implant, it is sometimes more prone to having a ‘step’deformity’ than that of an implant. The aesthetic consequence of this step and the merits of filling it in can be debated. But should the surgeon choose to do so, it can be filled in with a wide variety of materials. A cost effective approach of filling in the step deformity of a sliding genioplasty is to ‘recycle’ the removed chin implant material. With a Medpor chin implant this would be placing the multiple pieces of the implant material that became that way from removal. Since this implant material already has tissue ingrowth on it it can be come quickly ingrown with further tissue, thus serving as an ‘autoalloplast’ so to speak.

Having used recycled Medpor chin implants in over a dozen sliding genioplasties no infections have occurred and the step has been aesthetically covered eliminating the risk of a much deeper labiomental fold.

Dr. Barry Eppley

Indianapolis, Indiana

Minimal Incision Chin Augmentation

Thursday, March 12th, 2015

 

Chin Implant Styles Dr Barry Eppley IndianapolisChin augmentation using synthetic materials is both the most historic facial implant procedure and still the most commonly done. This is evidenced in that chin implants have the largest number of styles and sizes commercially available of any facial implant manufactured today. Chin implants are inserted by incisions either from the inside of the mouth mucosa or through the skin under the chin. There are advocates for either approach but successful chin augmentation results can be obtained either way with good attention to their unique technical details.

The placement of chin implants is most commonly done from a submental skin incision. It has the advantages of more limited disruption of the mentalis muscle of the chin, less risk of lower lip numbness and a more assured and sustained placement of the implant on the lowest portion of the chin bone. (where it belongs for its maximal effect) Understandably some patients are concerned about the final appearance of the submental scar. This concern is most significant in patients of intermediate skin pigments.

I have seen many submental chin implant scars and there are often much larger (longer) than they need to be. The use of silicone chin implants, even the longer anatomic or winged ones, allows for the implant to be inserted in a folded fashion, one half at a time. This enables a remarkably small incision to be used despite the length of the chin implant.

Small Chin Implant Incision Dr Barry Eppley IndianapolisThe key is to develop the subperiosteal tunnels along the sides of the chin bone in largely a blinded fashion. Once the incision is made down to the bone, small elevators are used to  made the subperiosteal tunnels along the inferior border of the mandible. It is important to make these tunnels longer than the wings of the implant on each side. By so doing half of the implant can be inserted and slide past its midline to one side. This will allow the opposite wing to be folded and inserted easily and then slide back to the midline.

Small Incision for Chin Implant Dr Barry Eppley IndianapolisOnce the implant is in the tunnels it can be slide back into the midline and secured by whatever fixation method one desires. (in this case of a vertical lengthening chin implant a 1.5mm screw was used)

Minimal incision chin augmentation can be very effectively done through a submental skin incision using preformed silicone implants.

Dr. Barry Eppley

Indianapolis, Indiana

Physiologic Tissue Adaptation to Face and Body Implants

Saturday, January 24th, 2015

 

Synthetic implants  are involved in some of the most common procedures performed in plastic surgery. From the skull down to the calfs, implants allow an instantaneous augmentation effect to be achieved of a variety of sizes and shapes. While rivaled more recently in some procedures by fat injection grafting, implants offers a permanent volume/augmentation effect that is simpler to achieve. (out of a box so to speak)

While implants offer many benefits, they also have their own set of potential complications. Infections, malposition and size issues are amongst the most common no matter where in the face and body an implant may be placed. These are obvious complications that occur in the short-term, within weeks or months after surgery.

But longer term changes which sometimes lead to complications with implants come about from a less obvious source. When a synthetic implant is placed in the body, the implant itself can never change as they are made of materials that do not degrade or change. (e.g., silicone) Rather the body must adapt to it and respond based on the pressure caused by the implant’s volume. Thus tissues change around the implant and these changes are almost always that atrophy. Surrounding tissues thin to varying degrees based on implant size and body location.

Chin Implant Settling Dr Barry Eppley IndianapolisOne of the classic examples of this response is that of the chin implant. Often erroneously referred to as ‘erosion’ (which suggests an inflammatory reaction which it is not) some chin implants can be seen on x-rays of being partially inside the bone. This is a benign but natural process of implant settling. As a response to the pressure of the chin implant, which causes its aesthetic effect by pushing off the underly bone on the soft tissues of the chin, the bone responds to this pressure over time by resorbing under the implant. This allows the chin implant to imprint into the bone. Once a ‘pressure release’ is obtained no further settling into the bone occurs. Interestingly it does not occur in all chin implants and rarely if ever occurs in any other type of facial implant.

Breast Implant Chest Wall Deformity Dr Barry Eppley IndianapolisAn often recognized example but one that is far more common is that of breast implants. The pressure release phenomenon occurs through the dual effect of overlying breast tissue thinning and underlying rib deformation. Every plastic surgeon has seen it in some women who undergo breast implant replacements. When the existing breast implant is removed, the remaining breast mound will look sunken in and deformed. This is one reason some women over time feel that their breast implants no longer look as big. The breast implant has never changed in volume but the surrounding breast tissue has become less and the implant may have settled down into the ribs more.

While this tissue response to chin and breast implants rarely causes any problems, such a response on the nose can be very problematic. Rhinoplasty that uses large implants for nasal augmentation is well known to cause thinning of the overlying soft tissues which is very thin. This can lead to implant exposure and infection.

Tissue atrophy and thinning occurs to some degree around every augmentative implant placed in the body. It usually does not cause any long-term problems but is one compelling reason to avoid very large implants at any face or body location.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Combining Chin Implant and Sliding Genioplasty for Large Chin Augmentations

Friday, October 10th, 2014

 

Chin augmentation can be done by a variety of surgical methods including a chin implant and a sliding genioplasty. Each of these aesthetic chin techniques has a role to play and they have their own advantages and disadvantages. But both have the same limitation…a limit to how much the chin can be horizontally projected. Chin implants are not made with standard thicknesses that are greater than 10 to 12mms. A sliding genioplasty can only be moved as far as the thickness of the bone will allow which can vary between 10mm to 16mms.

The horizontal movements provided by standard chin implants and sliding genioplasties are sufficient for the vast majority of patients with chin/jaw deficiencies. But they can be inadequate for the few patients that have horizontal chin projection deficiencies that exceed 15mm and may be as significant as 25mms.

Sliding Genioplasty and Chin Implant Dr Barry Eppley IndianapolisChin Implant and Sliding Geniplasty in Large Chin Augmentations Dr Barry Eppley IndianapolisCombining a sliding genioplasty with an implant is a novel method to achieve larger amounts of chin projection that I have done for years. Through an intraoral approach, which is needed for a sliding genioplasty, the implant is placed on the chin bone just one would normally do. It does need to be secured into placed by screw fixation otherwise it would easily become displaced. A chin implant with long wings also has the advantage of covering over the bony step-off that often occurs at  the back end of the osteotomy.

Very large chin deficiences can be managed by the creation of a custom implant but combining an implant and a sliding geniplasty may be sufficient in some of these cases. In my experience there has been no higher infection risk when placing an implant on top of a sliding genioplasty than when using a chin implant alone.

Dr. Barry Eppley

Indianapolis, Indiana

Five Things You Didn’t Know About Chin Augmentation

Wednesday, December 18th, 2013

 

Chin Implant Augmentation Indianapolis Dr Barry EppleyChin augmentation is one of the most commonly performed aesthetic facial surgeries and has a long history in plastic surgery. Other than rhinoplasty, in which it is often concurrently performed, it is the most frequently changed facial skeletal structure for cosmetic enhancement. While historically done with bone and cartilage, it is almost always done today by a large collection of preformed synthetic implants that offer a wide range of three-dimensional changes  of horizontal projection, width and vertical length.

While chin augmentation is often perceived as a simple and straightforward procedure, both by surgeons and patients alike, there are numerous issues that must be considered for a successful result.

Chin Augmentation is a Three-Dimensional Facial Enhancement. While the historic assessment of chin deficiency, and the success of chin augmentation, has been based on the amount of horizontal augmentation, this dimensional consideration alone is inadequate. Adequate chin augmentation should take into consideration its width as well as its height or vertical length. These dimensions can be almost as important as horizontal projection when one is viewed or seeing themselves in the frontal and oblique facial views. Many of these dimensions can be changed by contemporary chin implant designs.

The Shape of the Chin Is Different in Men and Women. The shape of the face has some very gender specific differences and the chin is no exception. Men want a stronger chin that can aesthetically have more projection and width. (squareness) Conversely, a woman’s chin can be a little bit weaker (less projection) and should have more of a triangular shape, it should also not be too vertically long. The most frequent aesthetic chin augmentation ‘complication‘  is a chin augmentation result in a women that looks too big, often being too wide.

The Chin Is Connected to the Rest of the Jawline. Deficiencies in the chin almost always reflect other jawline issues since the chin is just an extension of the total mandibular bone and its growth and development. For these reason, short chins will almost always have a high jaw angle. For men this may mean that they may aesthetically benefit by the placement of jaw angle implants with their chin augmentation to really given them a much better shaped overall jawline.

The Path of Chin Implant Insertion Can Affect The Results. Chin implants can be inserted through either inside the mouth or from under the chin. While patients understandably are focused on avoiding a scar under the chin, the intraoral route is associated with a far greater risk of complications and poor implant positioning not to mention recovery…all due to disruption of the insertion of the mentalis muscle. It actually takes much greater technical skill to get a good chin augmentation result when done from the ‘scarless’ method of chin implant placement.

Not All Chin Implants Come Preformed Out Of A Box. While there is a wide variety of styles and sizes of chin implant available today, a performed implant may still not be the most ideal for some patients. If the jawline/chin has asymmetry or the amount of chin augmentation is extreme and may require an extended chin implant, a custom designed chin implant can be the much better way to go. While it does add cost, an unhappy result or revisional surgery may end up costing more later.

Dr. Barry Eppley

Indianapolis, Indiana

The Myth of Silicone Chin Implant Erosion

Monday, October 14th, 2013

 

One of the most commonly performed facial augmentation procedures is the placement of a chin implant. Whether it is done for significant microgenia (short chin) or as a complement in rhinoplasty and facelifts for less severe chin deficiencies, chin implants represent an historic and usually straightforward aesthetic facial procedure. Chin implants date back as far as the 1950s and were the first type of synthetic implant placed in the face. While other materials had been used both before that and since, the use of silicone is by far what makes up the vast majority of chin implants that have ever been placed.

Chin implants have a history and a much talked about issue of potential ‘erosion’ into the underlying chin (mandibular symphyseal) bone. This issue has raised all sorts of concerns from patients considering chin augmentation, fearing that it is a destructive process that eats the bone and ultimately poses other problems. For some potential patients, this is issue is so dissuasive that they will either not have an implant for their chin augmentation or will choose a sliding genioplasty or another implant material because they feel it is safer.

After over 30 years of doing chin augmentation in every way possible and seeing every conceivable implant material used for it, I have never seen what one would consider to be a pathologic or destructive bony process of the chin. This does not mean I have not seen many chin implant indentations and impressions on the bone but this should not be confused with an erosive process.

The  biology of any implant that is placed in the body under pressure is that it will cause some surrounding natural tissue absorption. The implant itself is chemically inert so when it pushes on the overlying tissues, as all augmentation implants do, the body adapts to the pressure of the implant by some natural tissue resorption to relieve the pressure or push of the implant. This is well known, for example, in breast augmentation. Over time, the thickness of the breast tissue between the implant and the overlying skin thins due to the pressure of the implant on it. This is why saline breast implants develop more visible rippling over time and women with any type of implant feels that their breasts are a bit smaller. This is a passive tissue remodeling process not an active inflammatory erosive reaction in response to the composition of the material.

Many, but not all, chin implants will develop a minor amount of adaption of the underlying bone which is best called ‘implant settling’. Usually it is not more than a millimeter or two. It is not uncommon to see the the implant sizing number or other markings of the implant on the bone as part of the settling process. When the implant is properly positioned over the thicker bony cortex of the lower chin, this is about the implant settling one will see. In very large chin implants in very short chins, the amount of implant settling may be a few millimeters more.

However, if the implant is placed too high up on the chin bone (which often happens with an intraoral approach), it sits over the much thinner alveolar bone adjacent to or over the incisor tooth roots. This bone is less thick than the lower cortical bone and is more prone to see deeper implant settling. This can look very dramatic and ominous in x-rays and there probably have been a handful of such chin implant cases where lower tooth sensitivity resulted. It is these type of x-rays that has undoubtably led to many of the descriptions of  ‘chin implant erosion’ and such poor implant positioning was common decades ago.

But the number of true chin problems (tooth root exposure, infection) that have resulted from such radiographically seen cases of implant settling is extremely rare and very few cases have ever been reported in the medical literature. (I actually know of none…but I will assume that there have had to be several in the past fifty years)

In conclusion, the phenomenon of chin implant erosion is a myth. Rather it is the mislabeling of a natural process of tissue adaptation to the presence of an implant. It is neither active, inflammatory or a progressive process. Rather it is a passive tissue remodeling process that is self-limiting and of no aesthetic or biologic concern. It is not exclusive to silicone chin implants and can occur with all chin implant materials. With proper chin implant positioning below the apices of the incisor tooth roots, even this remote possibility of potential impingement is eliminated. Interestingly, such tissue remodeling is not seen on any other facial implantation site other than that of the chin.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Extreme Chin Augmentation with Combined Osteotomy and Implant

Monday, December 3rd, 2012

 

Background: Chin augmentation is a very common plastic surgery procedure that helps bring into balance the lower face with more projecting upper facial features. It is by far most commonly done with synthetic implants that provide varying amounts of increased horizontal projection as well as some width changes. Less frequently, sliding genioplasties (chin osteotomies) are done for chin augmentation when more horizontal projection is needed than implants can provide and/or vertical lengthening is aesthetically beneficial as well.

In more extreme cases of chin deficiencies, neither implants or an osteotomy is really adequate. When the chin is really short, this indicates that the entire lower jaw is underdeveloped and an overlying malocclusion (bite deformity) exists as well. While this type of patient should ideally have orthodontics and subsequent orthognathic surgery for jaw correction, this may not be an option for many so afflicted patients. While one could argue that an implant or an osteotomy is better than nothing, and that is most certainly true, they will fall far short of the needed amount of augmentation.

Extreme cases of chin deficiences require a novel approach to get visible and satisfactory results that often must approach 20mms of increased horizontal projection. Combining an osteotomy with an implant is relatively unprecedented although there is no reason why they can not be done together. The implant can merely be placed on the front edge of the osteotomy which is naturally denuded of soft tissue for the execution of the bony cut. Because there is no defined soft tissue pocket, it would be critical to secure the implant to the bone to avert displacement later.

Case Study: This 35 year-old male presented for chin augmentation. He had seen other plastic surgeons who told him his chin was too small for an implant. He did not want at this point in his life to undergo the orthognathic surgery process. In addition, he did not have the quality of dentition that would support in good health a prolonged course of orthodontics. By measurement in photographs using the Frankfort horizontal plane, his soft tissue chin point was deficient by 29mms from an ideal horizontal position. At this amount of horizontal deficiency, he also had a vertical chin deficiency as well.

Through an intraoral approach, an obliquely-oriented horizontal chin osteotomy was done staying 5mms below the mental foramen. The chin was downfractured and then advanced and held into a maximally advanced position with a step plate secured with screws above and below the osteotomy line. A maximal advanced position is one in which there still remains a small amount of bony contact between the front edge of the upper chin bone and the back edge of the advanced chin segment. The step plate was bent downward to create some vertical lengthening as well.

To get more chin projection than just that of the bone, a 7mm extended synthetic implant was placed on the front edge of the advanced chin bone. It was secured to the chin bone with a screw on each side of the midline. The wings of the implant extended back along the advanced chin bone to ensure that they covered the end of the osteotomy site where a bony notch typically occurs. The mentalis muscle was then reattached and closed in two layers with a single mucosal layer closure.

His postoperative course was typical for any sliding genioplasty patient. There was swelling and bruising along they jawline and neck that persisted for about three weeks after surgery. When seen at three months after surgery, all swelling had resolved and he had no residual mental nerve numbness. He had dramatic improvement in the appearance and shape of his chin, even if it still was mildly deficient. At ten years after his surgery, he has not had any implant or bone healing problems.

Case Highlights:

1)      Severe chin deficiencies are not optimally treated by synthetic implants or osteotomies alone. Neither are capable of increasing the horizontal chin projection more than approximately 15mms.

2)      Combining a sliding genioplasty with an implant in front of it can achieve horizontal projection increases of up to 20mms.

3)      Combining implants with a chin osteotomy requires screw fixation of the implant to the advanced chin segment and long enough wings of the implant to cover the notch at the end of the osteotomy cut.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Implant Concepts For Surgical Jawline Enhancement

Monday, November 26th, 2012

 

‘All societies in history were and are preoccupied with facial beauty’

‘ Facial balance and symmetry are the key features to attractiveness’

‘All people regardless of race, class or age share a similar sense of what is attractive’

‘Square jawed males are viewed as more masculine, gain higher ranks in the military and have earlier and more frequent sex’

‘ A square chin and jawline frames the lower face, making it more symmetrical and defined’

‘Defined jaw points and angles are more attractive in both men and women’

These are just a few of the well known facial facts of beauty that are often quoted and specifically address the merits of a strong and well defined jawline. While some have it naturally, the vast majority of us don’t and must seek a surgical solution. While there are a variety of facial implants for jawline enhancement, there are numerous misconceptions about how they work and how a better jawline is achieved.

‘The jawline consists of three parts, the chin, body and angles, all which can be implanted although not equally effectively or in all dimensions’

The most well known jawline implant is that of the chin. It is the most frequently done of all facial implants and has been surgically implanted for over fifty years. While the styles and size of chin implants have improved dramatically over this time, chin augmentation only affects the front 1/3 of the jawline. While one could argue that this is the most important part of the jawline and has its U-shape provides very visible forward projection, a chin implant provides no change for the posterior 2/3s of the jawline.(body and angles) Even today’s extended anatomic designs rarely provide any augmentation to the body even though the tail of the implants may lay upon it. Today’s chin implants, while providing projection and even square shapes through increased width, can not provide vertical lengthening…an overlooked feature of chin implant designs.

Three-dimensional chin reshaping can be done by a sliding genioplasty which can add vertical lengthening as well as horizontal projection. In extreme chin deficiencies, an osteotomy can be combined with an implant in front of it for a few more millimeters of projection or the implant can serve to fill in the notching that often occurs in the bone in the prejowl area.

Jaw angle implants are the least performed augmentations of any of the facial prominences. (chin, cheek, nose and jaw angles) While jaw angle implant designs have been around for nearly fifteen years, they have not garnered great use because their surgical implantation is more difficult and aesthetic interest is more recent. Current jaw angle implants produce mainly lateral augmentation (width) which actually is indicated for only the minority of patients seeking jaw angle enhancement.  For someone with a favorably low jaw angle point, width alone may produce a satisfactory enhancement.

Jaw angle deficiencies, however, almost always are the result of a high jaw angle which by definition implies a vertical deficiency as well. Getting current implant designs low enough is difficult if the surgeon does not do adequate soft tissue release and the implant does not have a design that can engage the lower border of the jaw angle for positional security. Jaw angle implant designs that provide both horizontal and vertical augmentation (inferolateral) are most useful to a larger number of patients, particularly men, who seek a more defined and prominent jaw angle area.

While chin implants augment the anterior two-thirds and jaw angle implants enhance the posterior two-thirds of the jawline, the missing area is the middle or the body of the jawline.  Sandwiched between the chin and the jaw angle, the body area has not specific implant for it. There is no ‘connector’ implant between the two. For those seeking a perfectly straight line back from the chin to the jaw angle point, this may be an aesthetic problem. While chin implants have extensions that go back and jaw angle implants have a forward reaching design, the two only connect over the body by overlapping their feathered edges if done together. This is why many jawline enhancement patients may have a visible step-off or break in their new surgically created jawline. For some combined chin and jaw angle patients, this body discrepancy is minimal and not an aesthetic issue.

The body gap becomes most manifest when the jawline deficiency has a vertical deficiency component to it, areas that are not optimally augmented with current chin and jaw angle implant designs. When a perfectly straight and well defined jawline is desired, a custom two-piece implant is ideally needed that augments the entire jawline from front to back in a perfectly smooth fashion. These are particularly effective when the lower jaw is vertically short and the implant can be made to extend the entire lower border of the jaw. These ‘wrap-around’ jawline implants can produce some dramatic jawline changes.

The most unique jawline problem that can only be addressed by custom implants is when the entire jawline is vertically deficient, creating a small lower face. This almost always is associated with a lot of overbite of the anterior teeth, indicating that the lower jaw is small and fits partially inside the upper jaw. This creates an overclosing of the lower jaw making it too short vertically. Making a custom implant that fits only on the lower border of the jaw and lengthening it from front to back is the only effective solution.

Jawline enhancement must be assessed carefully in every patient to get the right jawline implant(s) design and size. For many patients, a chin implant may only be needed. For others seeking a three-point prominence change, off-the-shelf chin and jaw angle implants will suffice. Improving implant designs and sizes will make using this implants even more effective in the near future. For those seeking a completely new jawline with existing front to back deficiencies, wrap around jawline implants are designed and custom made for each patient’s specific jaw anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Jawline Enhancement in the Thin Male Face

Friday, November 2nd, 2012

 

Background: A strong jawline is perceived as a sign of masculinity and is a commonly desired feature of some men. Using implants is the only way to create a well-defined jawline through the triple approach of chin and jaw angle implants. While these implants are available in different materials from various manufacturers, their most important feature is the style and size that they offer. Picking these implant features for any male patient is a lot more art that it is science.

When picking implants for any facial area, it is important to take into account their facial shape and the overlying soft tissue thickness. Thick faces blunt the effects of implants and may simultaneously benefit from some defatting procedures as well. Thinner faces have less overlying soft tissue and the effects of implants can more easily be seen. These facial characteristics are particularly important at the jawline which is essentially a transition point between the face and the neck. Augmenting the front (chin) and the back part (jaw angles) of the U-shaped jawline can change its appearance dramatically.

The thin face and jawline has the benefit of being more easily skeletonized by implants. But implant size must be tempered lest their effects become too pronounced or big. The lower face must not overpower the upper face by being too wide or extending beyond the upper zygomatic width. It must also not become too square in appearance and still maintain some element of being thin and somewhat narrow, just with a more defined jawline.

Case Study: This 45 year-old male felt that his entire jawline was weak. He had a chin implant placed four years ago and, while it provided some benefit, it was still not satisfactory. As part of the discussion about how to improve his chin, his highly angled jaw angle area was pointed out and it was agreed that jaw angle implants would be beneficial as well. He remembered that his prior chin implant was of mersilene mesh composition and that it was ‘large’ according to his original surgeon.

A square silicone chin was chosen to replace his existing chin implant. At least 9mms of additional horizontal augmentation was needed with a more square frontal shape. Silicone jaw angle implants that dropped the angle border down was also chosen but with a width that was not more than 7mms, keeping in line with the rest of the width of his face. The implants would have some overlap across the body of the mandible but with no augmentation effect in this area, which is common.

During surgery, the chin was approached through his existing submental scar. The mersilene mesh implant was heavily ingrown with tissue and was near the dermis of the skin. Removing it was felt to leave too little soft tissue between the skin and any new implant. It was elected to leave it in place and place the new square silicone implant between the underside of the mesh implant and the bone. The wings of the square chin implant went well beyond that of the mesh implant and had no problem providing a more square shape effect. The jaw angle implants were placed through an intraoral incision behind the molars. Dissection released muscular attachments off the angle and the inferior border so the jaw angle implants could be placed low enough. They dropped the border 5mms and had 7mms width. A single screw secured them in place to keep them low and to the back of the angle.

He had some moderate facial swelling, but like in all thin faces, it resolved fairly quickly within three weeks after surgery. He had a much improved jawline with better definition but a jawline width that stayed in line with his upper facial width.

Case Highlights:

1)      Jawline enhancement in men is most commonly performed by a combination of off-the-shelf chin and jaw angle implants.

2)      The style and size of chin and jaw angle implants must be chosen carefully and with an appreciation of the patient’s natural anatomy and soft tissue thickness.

3)      In the thin male face, jawline implants should not be too wide or over-sized as small implant can produce dramatic effects.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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