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Archive for the 'jaw implants' Category
Background: A variety of mandibular (jaw) implants to improve the shape of the lower third of the face exist. They work very well for horizontal chin augmentation or lateral jaw angle enhancement. When the two are put together, a great improvement in the jaw line and shape can be achieved. But standard implants do not exist for treating an uncommon deficiency of the jaw, that of vertical deficiency. Lengthening of the lower face heretofore could not be done with implant techniques.
Case Study: A 55 year-old male wanted improvement in his ‘weak jawline and chin.’ It could be seen in profile that his chin was not that horizontally short. The lower third of his face was vertically short from front to back. This was the result of a mandibular deficiency which was detected in his bite, he had a complete 100% overbite. (lower jaw sits completely inside his upper) His mandible was overclosing thus giving him a vertically short lower jaw. While orthognathic surgery and orthodontics are the standard approach for this problem, he was understandably reluctant for that treatment at his age and state of his teeth. No standard jaw implant exists for this problem.
Using a 3-D CT scan of his mandible, a wrap around vertical lengthening jaw implant was designed in acrylic. The implant dimensions were based on facial measurements and his aesthetic desires. The acrylic mock-up was then sent to the manufacturer to be formally made and sterilized in silastic. (silicone rubber) This process took three weeks to complete.
The implant was then inserted onto the lower border of his jaw through a submental incision under the chin. There was no need for any dissection done inside the mouth. The soft tissues were elevated off of the bone around the chin and back to the jaw angle. The implant was then slide into place and secured to the bone with titanium screws. This procedure took one hour to complete under general anesthesia.
The increase in lower facial height and chin prominence was immediate. He reported some soreness but very little actual pain. It took about three weeks for all of the swelling to subside. He was ecstatic about the result and the change in his facial appearance was very positive. While this approach cost twice as much as a standard chin or jaw angle implant surgery, they were inadequate for what his face really needed to be in better proportionate balance. (vertical augmentation)
Case Highlights:
1) There is no standard off-the-shelf implant for vertical shortness of the chin or lower jaw.
2) Custom facial implants can be fabricated off of 3-D CT scans to fit specific bone deficiency needs. A wraparound mandibular implant is one such example of a successful custom facial implant.
3) Vertical lengthening of the jaw line and chin can have a powerful influence on increasing the strength and masculinity of the lower face in men.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
I frequently get e-mailed and asked…’What can I do to get a stronger jawline?’ This is exclusively a male question and usually, but not always, is from a younger patient. In looking at a lot of photographs of male patients with this concern, the most common problem is that the chin is short and the jawline is ill-defined. Some cases are more severe while others are much more mild. In either case, the strong jawline of male models and some famous male actors has set a beauty standard for males to aspire to.
In making a jawline more distinctive, there are three areas to consider improving or highlighting. Anterior projection (chin), posterior lateral width (jaw angle) and inferior border or circumferential jawline are the areas that can be surgically augmented with implants. Other than the chin, there are no bony moving or bone grafting procedures that will work.
From a practical standpoint, the two most common and easiest implants to place are the chin and jaw angle. The available implants are well made with numerous styles (chin) and a good range of sizes that will fit all but the very largest, or most bony deficient, patients. By bringing the chin forward (and more square) and making the back of the jaw (jaw angle) wider, the jawline becomes much more distinctive. This approach will work for the vast majority of male patients.
The use of a chin and jaw angle implant for jawline augmentation does leave a gap in the body of the mandible between the two. Depending upon the type of chin implant used (how far back the wings of the chin implant goes), that gap can be up to several cms. in length. While this may seem unfavorable, it is usually not discernible and the aesthetic benefits of considering ‘filling in that gap’ are not usually worth it in my Indianapolis plastic surgery experience. Having three separate implants (five actually along the entire jaw) is bound to have some irregularities that certainly will be felt.
Implants for the body (middle) of the jaw are not commercially available. No such stock implants exist. That fact should tell you that their need, or more pertinently their importance, is really quite limited. To use such an implant, it has to be hand-carved during surgery. Actually this is not that difficult as the use of Gore-tex blocks or sheets can be easily used and shaped. I have no qualms about the ability to shape or place them but my concerns revolve around the ability to feel them, particularly the transition with the chin implant on the front edge and the jaws angle implant on the back edge. Because of these concerns, there has to be a really compelling reason to use them.
There is an alternative to a piece-meal implant approach to total mandibular augmentation. A one-piece custom implant can be fabricated before surgery off of a 3-D CT mandibular scan of the patient. This is best used when the objective is vertical lengthening of the jawline as this is how it must be placed. It can not be used to provide posterior width like a traditional jaw angle implant.
Barry L. Eppley, M.D., D.M.D.
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Facial asymmetry exists whenever one side of the face does not match the other in size and shape. The most common reason this occurs is due to different development patterns of the underlying facial bones and is most commonly seen in people who have some facial bone development issues such as cleft lip and palate and other craniofacial birth defects. Sometimes it may just be soft tissue only and the facial bones are fairly symmetric. But aside from these types of patients, some people merely have a light or mild facial asymmetry of which the cause is not obvious or will ever be known. In essence, it is just you.
In many cases of facial asymmetry the most common finding or cause is that the lower jaw is different between the two sides. Because the lower jaw is moveable (the only facial bone to do so) and has an L-shape in the back above which the jaw joint hinges, it is the one facial bone that is most prone to having differences between the two sides. Most commonly, these differences are back at the angle area and along the jawline that comes forward. This can create a very visible difference between the jawlines when looking straight forward. It is the most common type of facial asymmetry that I see. Sometimes I will see someone who has a crooked chin, where the chin point if offline, but the origin of the crooked chin usually comes from differential jaw growth between the two sides.
In cases of facial asymmetry it is initally important to make sure that the jaw asymmetry is not best corrected by actually moving the whole jaw and putting the teeth into a better bite relationship. If one is young and the jaw asymmetry is significant, how the teeth come together will determine if this is the best long-term solution. But assuming that jaw bone movement is not a good solution, the more common approach is to correct it with the placement of implants.
Jaw angle and jawline implants can be fairly simple methods of improving jaw asymmetry. These implants are almost always placed through inside the mouth. Off-the-shelf jaw angle implants exist but there is no off-the-shelf jawline implant. Jawline implants have to be fashioned at the time of surgery, usually out of a block or thick sheet of semi-soft material. (Gore-tex or SAM is what I prefer) The key to success with implant augmentation is to be certain of exactly where the jaw asymmetry is. Implants will do little good if they aren’t in the area of bone deficiency or asymmetry. Sometimes this is obvious by feel, other times it may be better to get a 3-D CT scan and have an exact skeletal image to work off of. In rare cases, I have even had a 3-D model made from the CT scan and custom-fabricated the shape of the implants prior to surgery. This is the most exacting method but also the most costly.
When having implants placed for any type of facial asymmetry it is important to walk into surgery with the understanding that the outcome will be better…but not perfect. Surgical facial augmentation with implants is as much an art as it is an exact science.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
The use of facial implants for male face enhancement is common and the traditional areas include the chin, cheeks, and jaw angle areas. Every now and then, I get a request or see a patient who really enhancement in a different area of the jaw….the vertical dimension. Making the jawline longer in the vertical dimension to increase lower facial height and put the face in better overall balance. Most of these unusual cases exhibit an underlying jaw deficiency problem, often with a significant overbite relationship at their teeth, indicating a jaw that is both short in the front-back dimension (horizontal development) and in the up and down dimension. (vertical development at the ramus)
In correcting this type of jaw problem, the ideal solution for most of these patients is a course of orthodontics followed by traditional orthognathic surgery. While this may be ideal, most of these patients are beyond their teenage years and do not want to make the multi-year investment of time to make a formal anatomic correction based on the bone. A ’short-cut’ solution is to augment the deficient areas with a synthetic implant. While the actual procedure is not difficult to do, the problem is in finding a commercially-available implant that will match the patient’s problem. When it comes to vertical lengthening of the mandible from one side to the other (wrap-around), there is no such off-the-shelf implant option.
Sometimes a standard chin implant, combined with a jaw angle implant, that is positioned low on the bone below the native bone edge may suffice. But there will be a gap between where the chin implent ends and the jaw angle begins. In some cases, it may work but it is a piecemeal approach that is fraught with problems such shifting of the implants after surgery. (in this case , the jaw angle implant)
A better solution is to have a custom wrap-around implant made off of a computer-generated model. A 3-D CT scan can be done from which an exact replica of the jaw (mandible) can be created. Then a mock-up of the implant (by me) can be done in acrylic to create a one-piece wrap-around jaw implant that sits on the inferior border of the jaw, lengthening it throughout. The acrylic mock-up is then sent to a manufacturer where they make a formal silicone rubber implant. While a lot of work is done on the front end, the implant is easily placed through a small incision under the chin. (it is flexible so it easily folds on itself to be easily inserted through a small incision) It is fixed with a single screw underneath the chin so it does not ever move. It really is nothing more than a long extended chin implant that runs from one jaw angle to the other, but is on the bottom edge of the bone.
I have done this procedure several times over the years and found it to be quite successful. There is some significant cost upfront fron the CT scan, jaw model, and final implant (around $5,000, surgery costs are additional) but it is the best way to go when one is looking for this type of jaw implant)
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis
Mandibular Angle (Jaw) Implant in Indianapolis by Dr Barry Eppley
Author: barryeppley
Mandibular Angle (Jaw) Implants for Facial Enhancement in Indianapolis
For those male patients who desire a more square and angular facial appearance, the mandibular angle or jaw angle implant has become a popular facial implant option. By squaring off and extending the junction of the back and lower borders of the mandible (jaw), the appearance of the jaw becomes wider and more square. This type of look is often desired by younger males, particularly those interested in or already in the modeling field. It is also a very helpful procedure for those patients, male or female, with weaker jaw appearances or jaw asymmetry. I have placed as many mandibular angle implants for jaw asymmetries (one jaw side is very different than the other) as I have for bilateral (both sides) cosmetic enhancements.
In my practice here in Indianapolis, I discuss mandibular angle enhancement through the use of these implants. There are no practical bone-moving procedures for cosmetic enhancement of the mandibular angle, so implants are always used.While mandibular angle implants are available in different materials, I prefer the use of solid silicone (rubber) cheek implants, which are by far the most commonly used. They are soft, flexible, and slide easily into place along the side of the lower jaw. A mandibular angle implant is inserted through an incision in the mouth along the bone in the back part of the jaw. This leaves no visible scar. While it can be inserted through a skin incision in the neck, I have never done so. The mandibular angle implant is slide along the side of the back part of the lower jaw into its position over the edge of the bone. Usually a mandibular angle implant is held in place simply by the pocket into which it is placed. Occasionally, I will use a metal screw to secure the implant to the bone. This screw fixation method can eliminate one of the very few complications of mandibular angle implants, that of shifting position after surgery causing jaw asymmetry and loss of the desired .While any implant (foreign-body) has some risk of infection, mandibular angle implant infections are quite uncommon.
Enhancing the jaw angle with an implant is the least performed facial implant procedure, compared to cheek and chin implants. The goal of a mandibular angle implant is to produce a fullness to the back part of the lower jaw, resulting in a more square facial appearance. There are only a few variations in the styles of mandibular angle implants. The most basic differences in mandibular angle implants is in the amount of extension that can occur from the edges of the bone, both in the back edge as well as the lower edge. Also, different width thicknesses are available, dependent upon how much increase in width of the jaw angle is desired.
Mandibular angle implants are usually done alone but I have also performed them in conjunction with chin and cheek implants. The most powerful way to masculinize a male’s face is the combination of manidbular angle, chin, and cheek implants all done at the same time.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis