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.
Surgically 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