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Archive for the ‘jawline reshaping’ Category

Case Study – Female Custom V-Line Jaw Implants

Sunday, July 23rd, 2017

 

Background: The shape of the jawline has taken on great aesthetic importance in contemporary society. This is not just for men but for females as well. But the desired shape of the female jawline is different from that of men. It is desirous to be more tapered from back to front and have more of a triangular or V-shape. While some women have this jaw shape naturally, most do not.

The well known V-line jaw surgery comes from Asia where it is commonly done. The Asian face often has a bigger lower jaw with larger jaw angles as part of an overall wider and flatter facial shape. Dramatic reductions in the jawline through amputation of the jaw angles and jawline combined with a T-shaped chin reduction creates the V-line effect.

But in many Caucasian faces such reductions of the jaw will not produce the same reshaping effect or can not be done with a smaller jaw size. The opposite approach, augmentation of the jawline, may be needed to create a V-line effect.

Case Study: This 26 year-old female wanted to have a more tapered jawline look. She had a prior chin implant placed but it did not create the desired effect. Her 3D CT scan showed a chin implant sitting high on the chin bone  way above the edge of the chin bone. She also had high jaw angles.

Her 3D CT scan was used to make vertical lengthening jaw angle implants (with minimal width) and a v-shaped chin implant that created a completely central augmentation.

Under general anesthesia, her chin implant was initially removed and replaced through a submental incisional approach. This was to ensure that the implants sat down on the bone as low as it was designed and to place screw fixation. The jaw angle implants were placed through an intraoral approach using posterior vestibular mucosal incisions. Because it was a vertical lengthening implant, where half of the implant sits off the bone, double screw fixation was used.

A more tapered and shaped jawline is not always obtained by bone reduction. In some non-Asian jaws augmentation of the jaw angle and chin points may suffice.

Highlights:

  1. V-line jaw reshaping is classically done by chin and jaw angle bine reduction/reshaping.
  2. In the Caucasian face augmentation of the chin and jaw angles may be needed to create the V-line effect.
  3. Custom chin and jaw angle implants can be designed to create a more tapered jawline shape.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Female Jawline Implant

Sunday, July 9th, 2017

 

Background: The shape of the lower face is defined primarily by the size and dimensions of the lower jaw. While a strong or more defined lower jaw shape has always been desired by men, it has also taken on more significance in women with contemporary aesthetic facial standards. The well defined female jaw shape can be seen today in models, actresses and many other celebrities.

The difference between a distinct male and female jawline is really a function of size in most cases. They share similarities of a linear smooth shape from angle to angle and a visible jaw angle shape. The female chin is less square and more tapered and the jaw angle has less lateral flare. But a visible uninterrupted jawline is the hallmark of a defined lower face in a female. It doesn’t have to be big but it has to be defined.

Case Study: This 35 year-old female wanted a better defined lower jawline. She had been receiving injectable fillers for a chin augmentation effect. but wanted a permanent result that improved the entire jawline. From a 3D CT scan of her a custom jawline implant was designed providing 7mms of horizontal chin projection with 3mms of vertical length and 7mms of jaw angle width with 5mms of vertical length.

Under general anesthesia the jawline implant was placed through three intraoral incisions. (one anterior and two posterior) The front and back jawline pockets were connected by a subperiosteal tunnel under the mental nerves exits on each side.

Her six months after surgery results showed an improved jawline shape that had better jaw angle definition and a linear jawline shape that came together into a tapered chin. One of the key features to her improved jawline shape was the increase on overall vertical length.

Most female jawline implants would be considered more modest in size in comparison to many men. This is, of course, due at least to a body size difference. But it is also relevant to overall implant size compared to that of the jaw size.

Highlights:

  1. Total jawline augmentation, from angle to angle, requires a custom jawline implant.
  2. A linear shape to the jawline requires a single piece implant.
  3. Female jawline augmentation is more about shape and definition than it is about size of the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Defining Implant

Sunday, June 4th, 2017

Background: Augmenting the jawline today is more than just a chin or jaw angle implants. To change the entire jawline from angle to angle in a smooth united fashion, custom jawline implants offer aesthetic results not previously obtainable. Made from the patient’s 3D CT scan they provide a precise fit to the bone as well as smooth transitions into the surrounding bone.

Designing a custom jawline implant allows for any type of dimensions/thicknesses/shape provided that the soft tissue will permit it. What those implant dimensions should be for any specific patient depends on their goals. However, how to translate these aesthetic goals into dimensional numbers is not an exact science. The computer design process can only create what it is told, it does not know how to make anyone look exactly like they want. Such custom facial implants designs remain an art form based on the surgeon’s input at the present time.

Some patients prefer a more subtle or modest change to their jawlines. They want to provide some accents to their jawline not necessarily make it ‘big’ or have any extreme change. Creating more visible jaw angles and chin points and a smooth connection between them is their facial goal.

Case Study: This 35 year-old male wanted a jawline enhancement to create an overall more distinct jawline. He didn’t want it too big or too  noticeable. Using a 3D CT scan a custom wraparound jawline implant was designed with most changes at the chin (2mm forward and 3mms vertical elongation) and the jaw angles. (4mms vertical elongation and 4mms jaw angle width)

Under general anesthesia and through two intraoral incisions and one submental incision, the custom implant was inserted in a subperiosteal plane as a one-piece unit. It was secured with three small screws at the chin and jaw angles.

He had a full recovery at six weeks after surgery. When seen three years later he had a subtle but distinct change to his jawline as would have been expected given the modest size of the implant’s dimensions. A smooth connection existed between the front and back end of the jaw creating a smooth linear jawline effect.

Highlights:

  1. A custom jawline implant augments the entire jawline from angle to angle, hence the term ‘wraparound’ to describe it.
  2. Selecting the dimensions of the implant during its preoperative design is an art form for which there is not exact science.
  3. The implant’s dimensions can be modest to only create a jawline enhancing effect.

Dr. Barry Eppley

Indianapolis, Indiana

Female Jawline Enhancement

Thursday, March 9th, 2017

 

The presence of a discernible chin has always been an important aesthetic feature of the lower face in both men and women. While the desired amount of projection will vary between the genders, it is clear that having some chin projection is better than having little or none.

While the chin has always been perceived as an important facial feature, the perception of the entire jawline has taken on greater aesthetic significance today. This means the shape and projection of the back part of the jaw, known as the mandibular ramus or jaw angle, also gives the lower face a fuller and more pleasing appearance. Just like the chin that projects the front part of the lower face, the jaw angles project the back part of the lower face.

Angelina Jolie Square Jaw Angle Dr Barry Eppley IndianapolisWhile stronger jaw angles have been historically associated with men, it also equally applies to women today as well. This can be seen in many well known female celebrities such as Angela Jolie, Olivia Wilde and Hiliary Swank, to name just a few. They all have a  distinct and well defined jawline because they have a vertically long and almost squared shaped jaw angle. It does not necessarily have to be very wide but it is its vertical length and defined posterior and inferior ramus outlines of the bone that give a ‘cut look’ to the jawline. In essence it makes the jaw stand out distinctly from the neck below it.

mandibular plane angleA strong and defined jaw angle is associated with a low mandibular plane angle. The mandibular plane angle is a measurement introduced in orthodontics many decades ago to assess the steepness of the jaw in relation to the base of the skull. (normal is around 30 degrees) It is the anterior angle formed by the intersection of the Frankfort horizontal plane and a tangent to the lower border of the jawline. (in orthodontics it is the angle formed by the intersection of SN and GoGn) The Frankfort-mandibular plane angle is affected by the vertical development and length of the mandibular ramus.

Vertical Lengthening Jaw Angle Implant sizes Dr Barry Eppley IndianapolisFemale Square Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisFemale Jaw Angle Implants result right side view Dr Barry Eppley IndianapolisThe high and indistinct jaw angle can be treated by a vertical lengthening jaw angle implant. This is a special jaw angle implant that drops down the jaw angle by the lengthening provided by the implant. Most women need the vertical jaw angle implant as opposed to the more traditional widening jaw angle implant. While the implant does not look very big, it is surprising how powerful an effect it can have on the shape of the lower face.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Monday, January 23rd, 2017

 

Background: A more complete jawline augmentation is most commonly done using standard chin and jaw angle implants. With good implant selection and ideal placement on the jawbone, an enhanced and satisfying jawline can be achieved. While numerous options in both silicone and Medpor facial implants exist, the material used is of no biologic or long-term consequence. What matters is the shape and size of the implants used.

While more successful than not, a three implant jawline implant approach is associated with a higher rate of complications than any one single facial implant. With three implants the associated risks of infection, implant malposition and undesired aesthetic effects are…three times higher than that of a single implant. By far, implant malposition (asymmetry) of the jaw angles and undesired aesthetic results make up the vast majority of jawline implant complications and the need for revisional surgery.

When the aesthetic results of standard chin and jaw angle implants are inadequate the most effective approach is to make a new implant using a custom approach. This is particularly relevant if the standard implants were very inadequate for the patient’s desired aesthetic needs.

Before Custom Jawline Implant Dr Barry Eppley IndianapolisMedpor Chin and Jaw Angle Implant Jawline Augmentation Dr Barry Eppley IndianapolisCase Study: This 42 year-old male previously had Medpor chin and jaw angle implants to try and create a more masculine and well defined jawline. While he had no medical complications from his implants and they were placed fairly symmetrically, they did not come close to the desired jawline effect. A custom one-piece wrap around jawline implant was designed from a 3D CT scan and a stone jaw model as a replacement.

Medpor Jaw Implant Removals Dr Barry Eppley IndianapolisCustom Jawline Implant design on model Dr Batrry Eppley IndianapolisUnder general anesthesia, his Medpor chin and jaw angle implants were removed through his existing external submental and intraoral posterior incisions. The jaw angle implants were particularly difficult to remove due to tissue adherence and being wrapped around the bony jaw angles. The implants and their fixation screws were removed in many pieces.

Custom Jawline Implant Replacement of Medpor Implant result front view Dr Barry Eppley IndianapolisCustom Jawline Implant Replacement of Medpor Implants result oblique view Dr Barry Eppley IndianapolisCusytom Jawline Implant Replacement for Medpor Implants result side view Dr Barry Eppley IndianapolisHis new custom jawline implant was inserted and fit perfectly to the bone as designed on the 3D CT scan. His immediate surgery results showed a dramatically different aesthetic outcome from his standard implants with a much more defined jawline appearance.

Highlights:

1) Replacement of inadequate standard chin and jaw angle implants is best done with a custom jawline implant design.

2) Removing Medpor facial implants can be very challenging particularly over the jaw angle region.

3) Placement of a total custom wrap around jawline implant can be done through the same incisions as the original chin and jaw angle implants were placed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Total Jawline Enhancement with Custom Implant

Friday, January 20th, 2017

 

Background:  The approach to improving the shape of the lower face has evolved beyond just chin augmentation. While the projection of the chin still has a valuable role to play in lower facial reshaping, it is not a comprehensive approach to lower facial aesthetics. The shape and size of the entire jawline must be considered.

The single most effective complete jawline augmentation method is by using a custom jawline implant design. While it is made from a 3D CT scan and fits the bone as designed, its effect comes from expanding the entire bony borders of the lower jaw.  Because it covers a broad surface area, its effect can range from a subtle to a dramatic type of facial change.

In some male (and most female) jawline augmentations the patient is seeking a more conservative change. This means that one wants the jawline to be sharper and more angular with modest chin and jaw angle size changes. This is the classic definition of a jawline enhancement as opposed to a major jawline augmentation. To do so the custom jawline implant is often smaller with thin connections between the chin and jaw angles.

male custom jawline implant design Dr Barry Eppley IndianapolisCase Study: This 35 year-old male wanted a stronger jawline but one that was not ‘too big’. He always wore a closely trimmed beard which helped to create the appearance of  stronger jawline. He stated that he would continue to have such a beard after and this had to be factored into the implant’s design and size.

male custom jawline implant design and actual implant Dr Barry Eppley IndianapolisUnder general anesthesia and through a three incisional method (extraoral submental chin and intraoral vestibular incisions), a custom jawline implant was placed. To prevent mental nerve injury it was placed in a midline split two-piece fashion.

Custom Jawline Implant results oblioque view Dr Barry Eppley IndianapolisCustom Jawline Implant result side view Dr Barry Eppley IndianapolisHis after surgery results show a subtle but evident change in the appearance of his lower face. Increased chin prominence was evident as was a more defined jawline heading back to the jaw angles on both sides.

Custom Jawline Implant result front view Dr Barry Eppley IndianapolisTotal jawline enhancement can be done using a custom jawline implant. Keeping the projections at the chin and jaw angle areas more modest with thin connections between these three jawline points can keep the jawline augmentation effect more limited and create a more angular jawline.

Highlights:

1) A custom jawline implant affects the entire jawline in a wrap around implant fabrication.

2) Creating three points of augmentation (chin and jaw angles) that are connected can have a powerful effect on the shape of the lower face.

3) A small custom jaw implant provides an increased angularity to the lower face witout making it too big.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Male Custom Jawline Implant

Friday, November 11th, 2016

 

The best way to change the shape of the jawline for many men is a custom jawline implant. Custom designed from the patient’s 3D CT scan, the implant is usually a wrap around style that augments the entire jawline. Changing the shape of the jaw angles and jawline in a continuous fashion around the arc of the jaw can create a dramatic change if the patient so desires.

While such a jawline implant is custom designed, how to create the exact look that the patient wants from such a designing process remains more of an art form rather than an exact science. Besides the implant design the exterior facial change that is achieved is affected by the overlying soft tissues as well.

male-custom-jawline-implant-dr-barry-eppley-indianapolisHaving designed and implanted many a custom jawline implant I am still always amazed when seeing the actual implant at the time of surgery. When designing such implants I may think they are big or small but seeing them in person is almost always a revelation. The size of all custom jawline implants fits into my relatively small hand.

Inserting such a facial implant always seems daunting given its size and how it compares to much smaller standard cheek and chin implants. But a three-incisional insertion technique allows a safe and effective placement method.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Natural Custom Jawline Implant Result

Monday, November 7th, 2016

 

Background: The lower third of the face is a very important component of the male face. Whether one choices to call it more attractive or masculine, a well defined jawline creates an essential aesthetic feature of the lower face in a man. While fashion and beauty ideals change across various cultures and periods of time, there has never been a time in history where a weak or short jawline in a man was viewed as desirous.

There are numerous methods of jawline augmentation, all of which have a role to play in male facial enhancement. Provided one has a stable and well interdigitated bite (occlusion), most augmentation methods involve some form of implant placement. There is a role for a sliding genioplasty in more severe underdevelopment of the jaw but it is far less frequently done than that of implants.

Jaw implant augmentation consists of either using standard implant shapes and sizes or having a custom jaw implant made. The decision between these two choices comes down to which approach can best create the desired aesthetic result. Or to put it another way…can standard chin and jaw angle implants suffice? Does one have to go as far as having a custom jaw implant made? That answer depends on two dimensional issues; 1) Do the desired chin and jaw angle changes fall within what standard implant shapes can achieve and 2) Does one want a smooth jawline connection between the chin and jaw angle area?

male-custom-jawline-implant-design-dr-barry-eppley-indianapolisCase Study: This 35 year-old male wanted a more defined jawline but he did not want it to look too big or unnatural. In essence he did not want it to be obvious that he had surgery. Thus a relatively modest custom jaw implant was designed to make his chin more square and provide some increased angularity to the jaw angles.

male-custom-jawline-implant-design-and-actual-implant-dr-barry-eppley-indianapolisUnder general anesthesia the custom jawline implant was placed through a three-incision technique. (anterior submental skin and posterior bilateral intraoral mucosal incisions) The implant was placed from front to back through a subperiosteal tunnel under the intervening mental nerves. The one-piece wrap around implant was secured at the chin and jaw angles by a single 1.5mm microscrew at each location.

custom-jawline-implant-results-oblioque-view-dr-barry-eppley-indianapoliscustom-jawline-implant-result-side-view-dr-barry-eppley-indianapolisSix weeks later all of his swelling had resolved and most of the final result could be appreciated. His jawline had a greater chin prominence and a stronger jaw angles. But it looks perfectly natural and still fits his face well.

A custom jawline implant does not have to be big to be effective. Small to modest sized jaw implants can produce a nice improvement to the lower face

Highlights:

1) Having a visible and more defined jawline is a frequent aesthetic request amongst men

2) A more stronger and more defined jawline does not always mean that it is substantially bigger, just more evident chin and jaw angle areas.

3) A custom jawline implant offers the only jawline augmentation procedure that creates a stronger chin and jaw angles with a smooth connection between them.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Split Custom Jawline Implant

Friday, October 28th, 2016

Augmentation of the jawline can be done by a variety of implanted materials. While recent trends in plastic surgery have focused on using injectable fillers and fat for many forms of facial augmentation, this is not a particularly successful treatment strategy for the jawline. Most jawline shape changes, particularly in men, call; for a more defined and angular definition which soft injected materials can not usually create. Such external changes require a firm push from the bone surface using firmer implanted materials.

While jawline augmentation has traditionally been done by preformed chin and jaw angle implants, some patients need greater dimensional changes than three separate implants can provide. This is where the expanding role of custom implants made from the patient’s 3D CT scan has become extremely useful. A one-piece wrap around jawline implant unites changes to the chin and jaw angles for a more complete and smooth jawline effect. Such custom jawline implants can be made into virtually any size and shape although great preoperative consideration must be given to its design for who it may affect the patient’s external appearance and desired facial aesthetic goals.

split-custom-jawline-implant-dr-barry-eplpey-indianapolisSurgically placing a one-piece wrap around jawline implant can be challenging. It requires a three incisional approach, one anterior and two posterior. The anterior incision may be either intraoral or external below the chin. Subperiosteal tunneling is done between the incisions to make a path for the implant to slide into place. I always try to place such  jawline implants in one piece but this is not always possible or advised. The size of the jaw angles on the implant determine whether it can be folded and safely passed under the mental nerve from the anterior incision or not. When the jaw angles are too big it is best to split the implant in half through the chin segment. Then it is passed from back to front so the smaller chin segment can go underneath the mental nerves without too much stretch on them. The implant is then reunited in the midline and secured together with small titanium microscrews as seen in this picture.

While a custom jawline implant may be made as a single piece, this does not mean that it needs it be placed that way. Screw fixation of the implant segments, like a bon fracture, allows it to become once again as a single unit. With only two pieces this is one puzzle that is easy to solve.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Three Implant Jawline Augmentation

Thursday, October 27th, 2016

 

Background: Creating a stronger male jawline can be done by a variety of methods, most of which are done by permanent implants. While many plastic surgeons still think that the approach to a better jawline comes from chin implant augmentation alone, that approach excludes any consideration of the back of the jaw which makes up two-thirds of its structure. A more contemporary treatment approach takes the whole jawline into consideration.

The traditional jawline augmentation approach uses three standard styles and sizes of facial implants. This include a chin and two jaw angle implants. The choices for chin implants are either a more commonly used anatomic or convex implant shape and a more square formed shape style. Jaw angle implants can be either a widening or vertical lengthening style. Historically only the widening jaw angle style was available but newer vertical lengthening styles offers a better option for those patients with high jaw angles.

The advantage of a standard three implant jawline augmentation are economy and time efficiency. Unlike a custom implant which requires a 3D CT scan and a month to design and manufacture, standard facial implants are available off the shelf and at a lower implant cost. The one aesthetic disadvantage is that the implants are not connected so there will be an indentation along the jawline between the chin and the jaw angles. For some patients this may not be an aesthetic detraction and may even be a desired effect.

Case Study: This 25 year-old male wanted a stronger jawline with a more square chin and wider jaw angles.

standard-chin-and-jaw-angle-implants-result-front-view-dr-barry-eppley-indianapolisUnder general anesthesia, a medium square chin implant was placed through a submental skin incision. Widening jaw angles of 7mms were placed through bilateral intraoral incisions.

three-piece-chin-and-jaw-angle-implants-result-oblique-view-dr-barry-eppley-indianapolisthree-piece-chin-and-jaw-angle-implants-result-side-vuew-dr-barry-eppley-indianapolisHis postoperative result showed a satisfied patient with a more defined jawline. The chin was more square and the jaw angles wider. The jaw angles even had a slightly more increased vertical length to them by a few millimeters.

As long as the patient can accept a non-connected jawline look through chin and jaw angle implant augmentation, the use of standard implants can be an effective total jawline augmentation approach.

Highlights:

1) Total jawline augmentation consists of increasing the dimensions of the its three main points, the chin and the two jaw angles.

2) A three implant approach to total jawline augmentation includes the use of a square chin implant and two jaw angle implants.

3) A three implant jawline procedure creates a three point augmentation with an intervening concavity of the body of the mandible.

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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