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Archive for the ‘jawline reshaping’ Category

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

Choosing Jaw Angle Implant Styles

Saturday, October 22nd, 2016

 

The development of new jaw angle implant styles has finally allowed augmentation of the back part of the jaw to get caught up with that of the chin. The jaw angles have been overlooked for a long time as implant styles and sizes of the chin have progressed. With the chin and jaw angle implant styles that are now available the entire jawline can be augmented in the properly selected patient.

widening-jaw-angle-implants-design-dr-barry-eppley-indianapolisWith newer jaw angle implant styles, it is important that the indications for their use are clear. Traditionally jaw angle implants really only provided width to the mandibular ramus. They were designed to sit on the bone on its natural shape, thus increasing its lateral projection. Making the jaw wider is an effective aesthetic strategy provided the mandibular plane angle is not too high. If the jaw angles are within 2 cms or lesss from the earlobe they would be considered high jaw angles. A high jaw angle that is made wider can potentially make the face look too full or chunky and not create a more defined and stronger jawline.

widening-jaw-angle-imlpants-3d-ct-scan-dr-barry-eppley-indianapoliswidening-jaw-angle-implants-in-high-jaw-angles-dr-barry-eppley-indianapolisThis is a 3D CT example of this exact mismatched jaw angle implant problem. This patient has very high jaw angles and a steep mandibular plane angle. While these widening jaw angle implants are reasonably well placed over the rami the patient developed an undesired facial appearance as the enhanced jaw angles remained too high.

vertical-lengthening-jaw-angle-implants-design-dr-barry-eppley-indianapolisNewer styles of jaw angles help vertically lengthen the lower border of the mandibular ramus to treat the high jaw angle patient. This is a very unique facial implant style as a portion of the implant sits off of the bone to create its effect. As much as one third of the implant does not sit on the bone. In lowering the jaw angle it becomes more visually defined and the lower face appears more filled out in the front view. Vertical lengthening of the jaw angle is the most assured way to create a more visible back part of the jaw as it effectively corrects a bone ‘deficiency’. (missing part of the jaw) However one must be careful to not over lengthen the mandibular ramus as it can also make the lower face look too heavy in the patient who has a normal mandibular plane angle.

vertical-lengthening-jaw-angle-implants-dr-barry-eppley-indianapolisThis is a 3D Ct example of jaw angle implants that provide vertical lengthening. A portion of the implant design is off the bone to both lower and make more prominent the jaw angle shape at the back of the jaw. This is the appropriate jaw angle implant style for the high jaw angle patient.

Jaw angle implants today come in both widening and vertically lengthening styles. Each style does add some of the opposite dimension as well. Widening angle implants can add a little vertical length based on how they are positioned. Conversely the design of the vertical lengthening implant has built in width that increases the more it lowers the jaw angle

custom-jaw-angle-implant-design-dr-barry-eppley-indianapolisLike all facial implants not every standard shape and size works well for every patient. Significant jawline asymmetry, postoperative orthognathic surgery bony changes of the ramus and aesthetic dimensoonal needs beyond standard sizes are all reasons to consider custom jaw angle implant designs.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Monday, October 10th, 2016

 

Background: Jawline augmentation has become a popular surgery today as patients seek a stronger and more well defined lower facial shape. Augmenting just the front of the jaw (chin augmentation), while still commonly done, often overlooks a more complete jawline change. The addition of jaw angle implants to that of the chin creates a total jawline change.

While an effective jawline augmentation approach for many patients, the use of three preformed chin and jaw angle implants has a relatively high potential for implant malposition. While any single facial implant always has its own risk of malpositioning, that risk increases three-fold when three implants are used. Most jawline augmentation malpositions occur back in the jaw angle area where implants are hard to place well and can suffer from visible asymmetry.

In cases where the three implant jawline approach has aesthetically ‘failed’ due to implant malpositions, a custom jawline approach should be considered. This changes three implants into a single wrap around implant that is predesigned using computer software. This lessens the likelihood of implant malposition considerably since it is a single implant that is made to fit the jawline precisely.

malpositioned-chin-and-jaw-angle-implantsCase Study: This 30 year-old male had a prior history of unsatisfactory jawline implant augmentation using three implants. The surgical outcome was unsatisfactory as the patient desired a strong angular jawline which he did not achieve. A 3D CT scan showed anteriorly displaced widening jaw angle implants and a cleft chin style implant that was positioned low on the chin bone.

custm-jawline-implant-dimensions-dr-barry-eppley-indianapoliscustom-jawline-implant-replacement-design-dr-barry-eppley-indianapolisA new one-piece jawline implant was created making the chin and jaw angle changes that would more effectively create a more defined and angular jawline. This required a significant vertical elongation at the jaw angles (15mms) and a more pronounced horizontal and vertical change change. The changes in the one-piece implant design were compared to his indwelling inplants in an overlay fashion.

custom-jawline-implant-replacement-surgeryDuring the surgical procedure where the original three implants were removed and replaced by the new custom jawline implant, they could be compared in a side by side fashion. The replacement operation required making a subperiosteal connection between the chin and jaw angles to properly seat the new implant.

While a custom jawline implant does cost more than three preformed implants, there is less control over their shape and position. Should a revision be necessary because of implant malposition the cost will then exceed that of a custom implant. In total jawline augmentation the potential benefits of a custom approach need to be strongly considered. initially.

Highlights:

1) Jawline augmentation using three preformed chin and jaw angle implants can be effective but also has an increased potential for implant malposition.

2) A 3D CT scan will reveal the location of chin and jaw angle implants which can help in the new custom jawline implant design.

3) A custom jawline implant has a lower risk of implant malposition since it is a one piece implant that is made precisely for the patient’s bone shape.

Dr. Barry Eppley

Indianapolis, Indiana

3D CT Scanning of Custom Jawline Implants

Monday, September 12th, 2016

 

Augmentation of the entire jawline has become a popular method for improvement of the lower third of the face. While historically lower facial augmentation was focused on the front half of the jaw (chin), a more contemporary approach considers the jaw angles behind the chin for a complete jawline effect. While most people who seek jawline enhancement will do well with a ‘three-piece’ approach (standard chin and jaw angle implants), some patients need a one-piece jawline implant to achieve their aesthetic goals.

custom-jawline-implant-dr-barry-eppley-indianapolisA total or one-piece jawline implant requires a custom fabrication method. There are no standard or off-the-shelf jawline implants. Using a 3D CT scan a custom jawline implant is designed and manufactured based on input from both the surgeon and the patient. Despite being custom made by computer design, the dimensions of the implant and how well it can achieve the desired patient results remains an art form and not an exact science.

Beyond the design phase, the primary role of the surgeon is to insert the implant and place it as it was designed on the bone in the 3D CT scan. This may sound simple but the reality is that it is a technically challenging procedure to achieve both a good fit and to do so with minimal incisional scarring and surrounding tissue trauma.

Like all facial implants a custom jawline implant can end up malpositioned or have some external aesthetic asymmetry concerns. It is prudent to wait a minimum of six weeks or longer after implant surgery to ensure that most of the swelling has subsided and tissue adaptation has occurred should either of these implant concerns be investigated.

While in days past surgical exploration and facial implant evaluation was done to determine the problem and attempt to resolve it, that should not be the approach with custom jawline implants in particular. There is too much implant volume and surface contact with the mandible to have an accurate evaluation of the problem. In addition much of the implant can not be seen through the limited incisions that were used to insert and position it.

custom-jawline-implant-3d-ct-scan-result-front-view-dr-barry-eppley-indianapoliscustom-jawline-implant-3d-ct-scans-side-view-dr-barry-eppley-indianapoliscustom-jawline-implant-3d-ct-scan-result-top-view-dr-barry-eppley-indianapolisA postoperative 3D CT scan should be for all custom jawline implant positioning concerns. This provides the definitive answer to where all aspects of the implant are positioned on the bone. It is important to be aware that the implant in the postoperative 3D CT scan will not appear like it does in the design images. In the design images a custom jawline implant will appear very smooth. In a postoperative 3D CT scan the same implant will appear fuzzy and not smooth. This is completely normal and reflects the difference between painting on an implant with a design program vs. an image acquired by radiographic acquisition of a low density material.

3D CT scanning is both a necessary preoperative requirement for a custom jawline implant as well as an ideal postoperative method for evaluating implant positioning concerns. Despite the often non-smooth appearance of the implant in a postoperative 3D CT scan, that does not affect its ability to provide clear insight into how the implant sits on the lower jaw bone.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Three-Piece Total Jawline Augmentation

Tuesday, September 6th, 2016

 

Background: Total jawline augmentation refers to changing the entire look of the mandible. This could mean that the entire jawline has to be changed that can only be done by a custom wrap around jawline implant. But not everyone needs augmentation of all areas of the jawline. Many patients just need to change the three ‘corners’ of the jaw, the chin and the two jaw angles.

A three-piece approach to total jawline augmentation most typically refers to the use of chin and jaw angle implants. A variety of chin and jaw angle implant styles and sizes now exist that can meet the dimensional needs of most patients. Jawline implants can add width, vertical length and horizontal projection. But the one dimension that no jawline implant can achieve is a shortening effect.

The one dimension in jawline reshaping that requires a reductive approach is vertical chin shortening. Many very recessed chins are actually vertically long because of the backward rotation of the entire mandible due to an underdeveloped ramus. While a chin implant can add the necessary horizontal projection, it can not make it shorter. Placing the chin implant high to try and create this effect will lead a fullness under the augmented chin and will not really make it appear vertically shorter.

Case Study: This 38 year-old male presented for improvement in the shape of his jawline and lower third of his face. He had a recessed and long and a narrow jawline shape.

Total Jawline Augmentation result front view Dr Barry Eppley IndianapolisUnder general anesthesia he initially had a sliding genioplasty performed with a 10mm forward movement 5mms of vertical shortening. Bilateral jaw angles implants were placed that primarily added 7mms of width but only 1mms of vertical lengthening.

Total Jawline Augmentation result side view Dr Barry Eppley IndianapolisTotal Jawline Augmentation results oblique view Dr Barry Eppley IndianapolisHis result shows the impact of widening his jawline but also shortening it anteriorly. This combination creates a broader and more masculine appearing lower third of his face. While the chin change significantly improved his profile, it is the jaw angles that added the most to his front and three-quarter views.

He had a long chin due to its recessed position. While a chin implant could have been used that would have maintained his vertically long face and would also have required the jaw angles to be vertically elongated as well. To help shorten his overall face a sliding genioplasty is a better choice because it can shorten the lower third of his face on the front part of the jaw.

Highlights:

1) Total jawline augmentation refers to the three corners, the chin and the two jaw angles.

2) A sliding genioplasty with jaw angle implants is a three piece approach to total jawline augmentation.

3) A sliding genioplasty is better than a chin implant when the forward movement of the chin needs vertical shortening as well.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant in a Thin Face

Saturday, August 27th, 2016

 

Background: A well defined and angular jawline has become a desired facial feature for many young men. (and some young women as well) While the strength of the male jawline has never gone out of style, the influence of the internet, social media and smart phones has made it more desirous than ever.

Improving a weak jawline has traditionally focused on chin augmentation. But in today’s contemporary plastic surgery jawline enhancement has evolved to be much more. The evolving styles of jaw angle implants ha enabled the back of the jaw to be augmented to go alone with chin augmentation. Total jawline augmentation is now possible with the use of combined chin and jaw angles implants. Their numerous styles and sizes allow a wide range of jaw enhancement effect.

But the use of preformed implants in a three-piece approach has its limitations. Because the implants are not connected a smooth transition from one implant to the other may not occur. This also limits any significant vertical lengthening effect of the complete jawline. Any jaw asymmetries will be also unlikely to be improved.

The fabrication of a custom jawline implant from a 3D CT scan has a valuable role to play in achieving a lower facial effect that even the best preformed chin and jaw angle implants can not. Because it is custom designed and made it is the best implant approach to have a smooth jawline effect with distinct angularity to it.

Custom Jawloine Implant design Indianapolis Dr Barry EppleyCase Study: This 25 year-old male wanted to improve the shape and definition of his jawline. He wanted  some overall augmentation but more pertinently wanted a well defined and smooth jawline shape. A 3D CT scan was used to make a one-piece jawline implant that provided vertical length along the lower jawline as well as greater squareness to the chin and the jaw angles.

Under general anesthesia the jawline implant was placed through a combined external submental incision and bilateral intraoral incisions. It was able to be inserted as a single piece implant. (although not all custom jawline implants can be) It was secured with three point screw fixation.

Custom Jawline Implant result oblique view Indianapolis Dr Barry EppleyCustom Jawline Implant result Indianapolis Dr Barry EppleyCustom Jawline Implant result side view Indianapolis Dr Barry EppleyHis one year long-term result shows a much more distinct jawline shape with smooth connections from angle to angle. It is important to recognize that not all men, even younger men, can end with such a new jawline shape. One has to have thin facial tissues to show the full effects of the implant. This is evident in almost any face that has a distinct jawline….limited fat and loose skin to allow the shape and size of the lower jawbone to be seen.

Highlights:

1) Creating a well defined and crisp looking jawline requires a thinner face with little subcutaneous fat to see the outlines of the implant.

2) Only a custom jawline implant that wraps around the edge of the bone can create a smooth lower facial contour.

3) The dimensions of the implant are influenced by how much chin projection and the vertical and width increase of the jaw angles.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Jawline Implant After Surgery Swelling

Monday, February 1st, 2016

 

Facial implants of any type of dimensions will always cause some temporary swelling and bruising. Both types of performed jaw implants, chin and jaw angles, cause a predictable amount of facial swelling that will most certainly be viewed as significant by the patient. Typical facial swelling takes two days to reach its peak and the swelling resolves on a predictable downward projectory. I tell my patients that 50% of the swelling will be gone by 10 days, 75% by 21 days and 95% by six weeks after surgery. Final critique of the facial result should await a full three months.

Female Custom Jawline Implant design Dr Barry Eppley IndianapolisA custom jawline implant, will cause the greatest amount of facial swelling than any other type of known facial implant. It combines the postoperative swelling seen in isolated chin and jaw angle implants into one single jawline enlargement. It probably causes more swelling than these two facial implants combined because the entire jawline is dissected free from angle to angle in a subperiosteal plane.

Sequential Custom Jawline Implant swelling front viewSequential Custom Jawline Implant swelling right oblique viewA custom jawline implant can create some dramatic changes to the lower face. But the patient needs to be aware of the magnitude of the swelling and bruising that will occur as it can be very unsettling. As is typical for any facial implant, the swelling from a custom jawline implant will not be ‘bad at all’ the first night after surgery. But by the next day some significant swelling will have developed. It is the second day after surgery when the true magnitude of the swelling will be appreciated. While normal, it is always more than most patients anticipate. This patient example shows the progression of swelling in a three picture sequence of before surgery, day 1 and then day 2 after surgery.

Sequential Custom Jawline Implant Swelling submental viewWith the face naturally ballooned up several days after surgery, patients naturally wonder if something is wrong. Some patients may even question to themselves if having this surgery was the right decision. With the face so distorted, the patient is halfway across the ocean…having left home with a face that was very familiar but far from arriving at their new look. (final destination.) Sitting between these two sides can understandably make patients feel very uncomfortable. But patience and time will resolve the facial swelling. It usually takes about three weeks before one feels like they are becoming more normal and they start to see the benefits of the planned jawline change.

What causes much of the swelling after placement of a custom jawline implant is the disruption of the masseter muscles off the bone. The masseter muscles are the largest muscles on the face and their disruption is the source of much of the facial swelling and the temporary stiffness of jaw opening.

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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