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Posts Tagged ‘jaw angle implants’

Case Study – Four-Piece Total Jawline Augmentation

Sunday, December 20th, 2015

 

Background: The desire for a more pronounced and visible lower jawline exists in both men and women. The surgical methods to do so are more commonly requested by men particularly when it comes to a substantially larger jawline change. Making a jawline more evident focuses on increasing the size and shape at its ‘corners’, that of the projecting chin and the back ends at the bilateral angles.

When creating a total jawline augmentation effect, there are two basic approaches.  The historic and still most commonly used method is a three implant approach of independently placed chin and jaw angle implants. In some cases the chin implant may be substituted with a siding genioplasty. The newer method of jawline augmentation is the fabrication and placement of a one-piece custom made jaw implant that wrap around the chin from angle to angle. It is the preferred method of total jawline augmentation given the preoperative designing of the implant and its smooth one-piece construct. But cost considerations may lead some patients to still undergo the classic three implant method.

Chin and jaw angle implants exist in standard styles and sizes. While for some patients these historic standard chin and jaw angle implant styles will effectively work, newer implants styles offer improved total jawline augmentation results for many patients. Newer vertical lengthening jaw angle implants have allowed for increased visible angularity of the back part of the jaw. When vertical elongation of the chin is needed either newer vertical lengthening chin implants can be used or the historic approach of an opening sliding genioplasty. When significant vertical and horizontal chin augmentation is needed, chin implants and a sliding genioplasty can be combined.

Case Study: This 25 year male wanted a total jawline change. Not only was his lower jaw horizontally short but it was vertically deficient as well. This was evident in the short chin and large overbite which are directly related. When he opened his mouth slightly the improvement in his chin and jaw height could be seen confirming the needed vertical dimension of his chin and jawline.

Chin and Jaw Angle Jawline Augmentation result side viewChin and Jaw Angle Jawline Augmentation result oblique viewUnder general anesthesia, he had an opening sliding genioplasty (7ms done and 7mms forward) with a chin implant overly (5mm horizontal augmentation) done through an intraoral approach. Through posterior intraoral incisions jaw angle implants that added 7mm vertical length and 5mm width were placed.

At one year after surgery the improvement in his jawline could be appreciated. Ideally longer vertical lengthening jaw angle implants would have improved his result and are being considered. The sliding genioplasty and chin implant overlay produced a satisfactory improvement to the front part of his jawline

Total jawline augmentation can be effectively done using a non-custom implant approach. It can require the thoughtful application of newer chin and jaw angle implant styles and the selective use of sliding genioplasty techniques.

Highlights:

  1. Total jawline enhancement consists of front (chin) and back (jaw angle) augmentation.
  2. Preformed chin and jaw angle implants is the historic and standard approach to total jawline enhancement.

3. Vertical chin augmentation in total jawline enhancement can be done by a combined sliding genioplasty with a chin implant overlay.

Dr. Barry Eppley

Indianapolis, Indiana

The Significance of Muscular and Tendinous Attachments in Jaw Angle Implant Surgery

Wednesday, June 17th, 2015

 

Augmentation of the jaw angle (often referred to as jawline augmentation) is becoming an increasingly popular aesthetic facial procedure. The  recognition that the back part of the jaw as similar aesthetic significance as that of the front part of the jaw (chin) creates a more comprehensive diagnostic and treatment approach to lower facial aesthetic enhancement. While often perceived as being a completely male procedure, and it is definitely more common in men, it also has benefits for some women as well.

Jaw Angle Implant Results oblique viewThe use of jaw angle implants is unique in numerous ways. First, they are two separate implants (bilateral) whose symmetrical placement can be challenging due to surgical access and common asymmetries in jaw angle shapes that many patients have. Second the optimal augmentative effect must be considered as having a multidimensional jaw angle impact. (horizontal, vertical and anteroposterior) While many surgeons and patients think of jaw angle implants as having a ‘width only’ effect, this perception is both inadequate and historic. Vertical lengthening of the jaw angle for many patients is just as important or even more important that of a width increase.

masster muscle in jaw angle implantsBut regardless of the jaw implant’s size and shape correct positioning on the bone is a critical element in getting a good aesthetic result. The key step in jaw implant positioning is elevation of the masseter muscle and its attachments off of the bone. This large quadrangular chewing muscle has two heads that run from the zygomatic arch to the inferior border of the mandible. The larger superficial head is what attaches to the jaw angle and anteriorly along its lower border. It is also along the inferior border where it joins as a tendinous attachment to the medial pterygoid muscle on the inner surface of the jaw. (pterygomasseteric sling) The smaller deeper head of the masseter muscle is largely covered by the superficial head and inserts much higher up along the lateral ramus near the coronoid process.

Jaw Angle Tendon (Stylomandibular Ligament in Jaw Angle Implant Surgery Dr Barry Eppley IndianapolisElevation of the insertion of both the superficial and deep heads of the masseter muscle are critically important in making the subperiosteal pocket for jaw angle implants. Inadequate muscle release will have the implants sitting too high or too far forward…making them close to the incision in addition to having an undesired aesthetic result. The muscle must gently elevated off of the inferior border and there are numerous undescribed tendinous attachments that are important to release to adequately do so. This is of paramount importance when placing vertical lengthening jaw angle implants as 1/3 or even 1/2 of the implant may need to be sitting off of the bone (below the inferior border) to make a well defined jaw angle. In making this type of muscular release it is also important to not completely disrupt the pteryogmassteric sling or masseteric muscle retraction can occur with the creation of a high muscle bulge when biting down after surgery.

Stylomandibular Ligament in Jaw Angle ImplantsOne important attachment to release in jaw angle implant pocket dissection is the stylomandibular ligament. This is a very specialized type of fascia/tendon that runs between the styloid process of the temporal bone down to the posterior border of the jaw angle It usually sits just above the jaw angle point. It is often classified as a temporomandibular ligament but it inserts no where near the joint capsule. Failure to release the stylomandibular tendon can prevent the jaw angle implant from sitting as far back along the angle as it ideally should.

jaw angle release for jaw angle implantsSuccessful jaw angle implant surgery requires releases of muscular and tendinous attachments alone the posterior and inferior border of the jaw angle area. (red area in illustration) Failure to do prevents seating of the implant over the jaw angle area which is the fundamental purpose of the surgery. This is the most frequent cause of jaw angle implant malposition and is usually due to blind blunt dissection. Without a headlight and electrocautery to release these attachments the risks of jaw angle implant malposition and asymmetry are significantly increased.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Extreme Jawline Implant Augmentation

Monday, May 11th, 2015

 

Background: The shape and prominence of the lower jaw has a major influence on the perceived characteristic of a male. The more defined and stronger the jawline is the more masculine a man is perceived to be. That may or may not be actually true but the perception remains that it is. At the least men are perceived as more attractive if their jawline makes up a stronger lower third of the face.

Human skull, side view.The jaw or jawline is aesthetically composed of three parts, the chin, the paired jaw angles and the intervening bone that connects them. (technically known as the body of the jawline) While a strong chin is essential for a strong jaw, the real defining feature is actually that of the jaw angles. The jaw angles control the shape of the back of the jaw which is a defining feature seen in the front, side or three quarters of the face.

The most common deficiency of the jaw angles is a vertical one. It is a common misconception that a weak jaw angle is a width issue only. A strong and well defined jaw angle sits well below the earlobe, is vertically higher than that the chin and has a width that can be even with a vertical line dropped down from the cheeks or just slightly beyond that line. (in other words has some evident flare)

Extreme Custom Jaw Angle Design  Dr Barry Eppley IndianapolisCase Study: This 38 year-old male had a prior history of chin and jaw angle implants. While his postoperative course was uneventful, the results did not meet his desired aesthetic goals. To better achieve his jawline augmentation needs, a jaw model was obtained from a 3D CT scan and new jaw angle implants were designed that fit into his square chin implant anteriorly.  This allowed for considerable dropping of the jaw angles in the new implant designs.

Extreme Jawline Augmentation result oblique view Dr Barry Eppley IndianapolisExtreme Jawline Augmentation result front view Dr Barry Eppley Indianap[olisUnder general anesthesia, an intraoral approach was used to remove his existing jaw angle implants and replace them with the new designs. This required doing a careful detachment of the pterygo-masseteric sling from the inferior border of the mandible so masseteric muscle disruption did not occur. The new jaw angle implant dropped the angle down 18mms with a width of 15mms. Due to the size of the implants a single screw for fixation was placed through the intraoral incision.

Extreme Jawline Augmentation result side view Dr Barry Eppley IndianapolisHis postoperative results showed a substantial change in his jawline shape. Because he had a near zero mandibular plane angle due to the vertical increase in the jaw angles, his result is called an extreme jawline augmentation.

Case Highlights:

1) Extreme jawline implant augmentation consists of making changes to the chin and jaw angles that conventional implants can not achieve.

2) Extreme jawline enhancement always requires the use of custom made implants.

3) A significant dropping of the jaw angles and the creation of an almost zero degree mandibular plane angle is the hallmark of an extreme jaw augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Screw Fixation of Jaw Angle Implants

Sunday, May 10th, 2015

 

Width only Jaw Angle Implants Dr Barry Eppley IndianapolisThe placement of jaw angle implants has many unique aspects from other facial implants. It requires dissection in the most posterior part of the face done from inside the mouth making access and visibility challenging. It requires the largest muscle on the face to be lifted off the bone (masseter muscle) to place and position the implant. And certain types of jaw angle implants (vertical lengthening types) require that about half of the implant is not situated on the ramus portion of the mandible.

Because of these unique characteristics the success (and failure) of jaw angle implants are related to proper positioning and stabilization of them. Unlike many facial implants where fixation of the implant to the bone may be viewed as a ‘luxury’, I view fixation of jaw angle implants as a virtual necessity. They can become so easily displaced right after wound closure (push back of the masseter muscle causing them to slide forward) that the only postoperative assurance of implant positioning is to screw them into place.

Jaw Angle Screw Fixation Dr Barry Eppley IndianapolisThere are multiple methods of screw fixation but the simplest and most effective is a percutaneous technique using 1.5mm self-tapping screws. Screws are optimally placed from a perpendicular orientation to the bone and this is of paramount importance when the screw is self-tapping. (not requiring a drill to place a hole in the bone) Using a small 3mm skin incision from the side of the face over the implant allows the screw driver to be inserted through the skin and masseter muscle down to the implant’s surface. The screw is then placed on the screw driver and inserted through the implant to the bone. Usually only a single screw is needed that is no more than 5mms in length. (thus avoiding hitting any tooth or nerve structures that lie deeper)

Percutaneous Screw Fixation Technique for Jaw Angle Implant Fixation Dr Barry Eppley IndianapolisPatients are understandably nervous about a facial ‘scar’. But this nick incision is so small that it heals in a scarless fashion. The initial incision is closed with a single 6-0 plain gut suture.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Flange Fixation of Displaced Jaw Angle Implants

Sunday, October 12th, 2014

 

Jaw Angle Implant Results oblique viewJaw angle augmentation has become an increasingly popular facial implant procedure. While done more in men to enhance an overall weak jawline, it is even done in females who have thin lower faces and lack of any jaw angle width. While historically jaw angle implants only added width to the back part of the jaw, it is now recognized that vertical lengthening of the jaw angles is often needed as well in many patients. This has led to two jaw angle implant types, width only and combined width and vertical lengthening styles.

Regardless of jaw angle implant type, they are usually placed as pairs and their positional symmetry becomes an important part of the aesthetic result. Because the implants are usually smooth (silicone), assuring their position on the bone (and often partly off it to length the angle) is important as any instability can lead to displacement. One simple technique to secure implant position, and the most common one that I use, is single screw fixation. Placed percutaneously, a single 1.5mm screw placed through the implant into just the outer cortex of jaw angle bone is usually sufficient to secure its position.

But in some jaw angle implant cases, particularly those which have suffered implant displacement, an even more secure form of fixation is needed. Jaw angle implant displacement is always superiorly, up and away from its lower desired position over the angle. With healing an enveloping capsule develops around the implant which must be opened or removed to permit it to be positioned in its lower desired position during a revisional procedure This leaves a large upper space into which an unsecured implant can become displaced back into it during the healing phase.

Plate Fixation Jaw Angle Implant Dr Barry Eppley IndianapolisOne absolute secure fixation method for jaw angle implant revision is the ‘flange’ technique using a matrix or grid type fixation plate. By securing the upper end of the metal plate just above the implant with 1.5mms screws, the lower end of the plate overlaps the jaw angle implant essentially pinching against the bone. The upper end of the plate prevents the implant from ever riding up again out of place.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Vertical Lengthening Jaw Angle Implants

Monday, September 1st, 2014

 

Background: A more well-defined jawline has become an aesthetic goal for many men and women today. While twenty years ago it was all about the amount of horizontal chin projection of the front of the jawline (and that is still true today), the back part of the jaw (jaw angles) is also recognized now as significant as well. A more complete approach to jawline aesthetics considers the entire length of the bone from front to back if a better total jawline appearance is to be obtained.

It would be no surprise that if a chin is deficient, the jaw angles may be as well since the development of the lower jaw (mandible) is the same throughout its length.  A short chin will often have a high jaw angle as a result of how the bone naturally develops. The position of the lower end of the jaw angle and the chin creates the mandibular plane angle which is steep in many underdeveloped lower jaws.

Vertical Lengthening Jaw Angle Implants Indianapolis Dr Barry EppleyHistorically, jaw angle augmentation was viewed as a width increase of the jaw angles. While a lateral width increase may enhance the appearance of the jaw angles, this dimensional change is rarely adequate for most jawline enhancement needs. A vertical increase is just, if not more, significant than any amount of jaw angle widening. It becomes important to lower the mandibular plane angle, or rotate the jaw down in the back, to obtain a more aesthetic jaw angle change to improve the overall facial appearance.

Case Study: This 48 year-old male wanted to improve the definition/strength of his lower jawline. While he was happy with his chin projection/shape, he felt the back part of his lower jaw was deficient. He wanted stronger jaw angles but also did not want them too big or prominent. He wanted them to fit well into the overall structure of his face.

Vertical Lengthening Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach using posterior vestibular incisions allowed access to the bony jaw angle areas. Subperiosteal dissection gently lifted off the attachments along the lower border of the mandible back around the jaw angle area onto the posterior border of the ramus. Vertical lengthening jaw angle implants (7mm vertical and 5mms width) were placed, positioning them with the lower half of the implant below the bone. There were secured into position with a single 1.5 x 7mm screw placed intraorally. After antibiotic irrigation, a two-layer closure was done (muscle and mucosa) with resorbable sutures.

Vertical Lengthening Jaw Angle Implants result side view Dr Barry Eppley IndianapolisWhile there will be some swelling of the jaw angles, half of it is gone by ten days and almost all of it by three weeks after surgery. A 7mm vertical jaw angle lengthening does not sound like much, but can create a noticeable change in the jawline that does not have an overly high jaw angle position.

Case Highlights:

1) A posterior jaw angle deficiency more often than not involves a vertical deficiency as much as any horizontal deficiency. (the high jaw angle)

2) Vertical lengthening jaw angle implants provide a downward and outer rotation to the appearance of the back part of the jaw.

3) Vertical lengthening jaw angle implants require careful pocket dissection to avoid avulsion of the pteryomasseteric sling anatomy and retraction of the masseter muscle superiorly.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Vertical Lengthening Jaw Angle Implants

Wednesday, December 25th, 2013

 

Background: One of the emerging areas of facial implant augmentation is that of the jaw angles. While jaw angle implants have been around for nearly two decades, their designs have been exclusively made for increasing jaw angle width. While there are some patients who seek a wider and more flared posterior jawline, a width only approach to the jaw angle in many patients will often lead to just a ‘fat’ jaw angle and a dissatisfied patient.

In today’s aesthetic standards, a strong and well defined jawline is a key male feature. This is not really new as strong jawlines have defined masculinity through the ages. What is new is that it is now more possible to create them than ever before by taking a multidimensional approach to their shape change. The development of new and improved chin styles for the front of the jawline have led to to new styles of jaw angle implants for the back of the jawline which incorporate more than just a simple width increase.

High Jaw ngles Dr Barry Eppley IndianapolisMany underdeveloped lower jaws have a classic jaw angle shape. Rather than being an L-shape with a 90 degree angle at the union of the vertical and horizontal rami, a weakly shaped jaw angle as part of a short overall developed jaw is seen. Thus many weak jaw angles have a high and widely angled shape. (greater than 110 degrees) In creating better jaw angle definition, vertical lengthening or elongation of the jaw angles is needed. They must be dropped and the jaw angle shape change to closer to 95 degrees.

Case Study: This 28 year-old male wanted to improve the shape of his jawline. He had adequate chin projection from a prior chin implant procedure but lacked any jaw angle shape. His jaw angles were high and very obliquely shaped. He wanted lower and more defined jaw angles but not necessarily a much wider jaw angle width.

Custom Vertical Lengthening Jaw Angle Implant desigtn Dr Barry Eppley IndianapolisUsing a 3D CT scan, a mandibular (jaw) model was created. Off of this model, custom silicone jaw angle implants were made that dropped his angles down by 15mms but only added 3mms in width. The jaw angles on the implants were made much sharper at just about 90 degrees with more defined angle points.

Vertical Lengthening Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach using posterior lateral vestibular incisions was used. The bony jaw angles were exposed subperiosteally from the angle point anteriorly to just behind the mental nerve. The tendon over the angle point was released to allow the implant to really drop down the angle area. The silicone jaw angle implants were slide into place and secured into their position with a single 1.5mm titanium screw placed through a percutaneous technique. The incisions over the implants were closed in two layers including a muscle layer directly over the implants.

Vertical Lengthening Jaw Angle Implant results front view Dr Barry Eppley IndianapolisHis recovery was very typical for jaw angle implants. It took a full three weeks for most of the swelling to subside and full mouth opening to return. His after results show considerable jaw angle shape improvement and definition with some slight jaw angle asymmetry. (due to a pre-existing soft tissue asymmetry)

Case Highlights:

1) Jaw angle augmentation must take into consideration the vertical length of the jaw angle and not just its width.

2) Jaw angle deficiences almost always have a high bony angle due to undergrowth of the  vertical component of the mandibular ramus.

3) Vertical lengthening jaw angle implants can drop down the angle region while adding little width.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Female Jawline Implant Augmentation

Friday, October 25th, 2013

 

Background: An underdeveloped jaw or mandible has been historically treated by chin and jaw angle implants. A chin implant enhances the front part of the jaw while jaw angle implants augment the posterior part of the jaw. While these types of facial implants are tremendously effective at augmenting the two obvious prominences of the jaw, they neglect the intervening part of the jawline between the two of them known as the body area.

The mandible is a unique facial bone to aesthetically augment because it is a long curved bone that wraps around the lower face. No off-the-shelf implant currently provides a wrap-around augmentative effect of the entire jawline. Such an aesthetic need exists to make the entire jawline more pronounced and would be of value to make jawlines larger from a side-to-side standpoint. Because silicone is a very flexible material, a wrap around jawline implant could be used for just about any jaw shape and could be inserted through a very small incision.

Case Study: This 33 year-old female was having a skull reshaping procedure and wanted to improve her mildly weak chin as well. She felt her overall jawline was weak and not just her chin area but she did not want her jaw angles to be any bigger or flared. Her horizontal chin deficiency measured only 3 to 4mms in projection.

A new uniquely designed jaw implant was selected for her known as a jawline implant. It is essentially a very long and thin extended chin implant that extended back to the jaw angle area creating a wrap around effect along the inferior border. While the chin projection of the implant was 4mms, it tapered back along the jawline to a 2mm feathered edge. Because of its thin and long design, the stiffness (durometer) of the silicone material was stiffer than that used in other facial implants. That extra stiffness prevents the back tail of the implant from folding onto itself on insertion.

Under general anesthesia, a small 2cm submental incision was made down to the bone. A long extended periosteal elevator was used to make a long and narrow tunnel for the implant back along the lower edge of the jaw (inferior border) to the jaw angles. The implant was folded in half and inserted through the incision with both ends of the implant directed into their respective sides of the tunnels. The implant was easily slide into place and the central chin part of the implant was sutured into place to prevent migration. (although with an implant this long there really could not be an migration or displacement.

The jawline implant offers a new type of jaw augmentation implant that is uniquely different from the chin and jaw angle styles. By making the jawline more distinct and adding some slight width, it makes a more prominent jawline in a subtle but aesthetically pleasing manner. It is not designed to create an overpowering jawline augmentation but a subtle enhancement.

Case Highlights:

1) A more defined and distinct jawline is a desireable feature for both men and women and is the result of a more defined inferior border of the mandible.

2) A jawline implant is different than other jaw implants such as a chin or jaw angle implants as it accentuates the mandibular inferior border from the chin back to the jaw angles.

3) Jawline implants can be used alone to enhance a mildly weak jawline or as an additive benefit to facelift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Strong Male Jawline Enhancement

Wednesday, March 6th, 2013

Background: A well-defined and strong jawline is a desireable male feature. While modern culture and media have made it seem a recent attractive male trait, it has been so for as far back in history as pictures have been drawn and sculptures have been created. A strong lower facial structure provides not only good aesthetic proportions but implies increased masculinity and facial attractiveness.

Total or complete male jawline enhancement can improve the structural shape of the lower jaw by increased chin and jaw angle projection through the use of implants. Since the mandible has somewhat of a parabolic curved shape, the front and back ends of the curve must be changed to give it greater angularity. The chin needs a more square form horizontally and the jaw angles need a more square form vertically as well as more outward horizontal flare.

The amount of ‘strength’ of the jaw line that any particular male wants is a very individual decision. There are some general guidelines as to how much chin and jaw angle flare is aesthetically acceptable. The square width of the chin should stay within a vertical line dropped down from the pupil of each eye. The outward flare of the jaw angles should not go past a vertical line dropped down from the midpoint of the zygomatic arch. The lower vertical edge of the jaw angle should sit above the lowest point of the chin in side view so that the mandibular plane angle is not flat. While these aesthetic jawline guidelines stay within the proportions of the balanced face, some patients may desire a stronger jawline look. To achieve a very strong or extreme jawline enhancement, implants have to be selected that exceed these aesthetic facial boundaries but also stay proportionate.

Case Study: This 50 year-old male wanted to achieve more of a stronger facial look with greater skeletonization and prominence of his facial features. A big part of his desired look was a significant change to his jawline. While his chin was not unduly deficient, his jaw angles were significantly narrow, vertically short and ill-defined. Under general anesthesia, his chin was changed by performing an intraoral vertical reduction osteotomy onto which was overlaid a medium silicone square chin implant to provide width and an additional 3mms of horizontal projection. Jaw angle implants were placed intraorally that added 10mms of vertical lengthening and 11mms of increased width. He also had cheek implants placed to his new jawline did not overwhelm his upper face. He had the typical jawline implant recovery with a first week of significant swelling and trismus. (limited jaw opening) By three weeks after surgery, however, much of his swelling subsided and the outlines of the augmentations were more discernible. By six weeks the final shape of the jawline could be seen. While the time period of three months after surgery is the real final evaluation point, 90% to 95% of the result is evident by six weeks. Strong jawline enhancement requires a square chin and prominent jaw angles. One of the key features to a stronger jawline is to increase the vertical length and flare of the jaw angles. To keep the face proportionate and to stay within its aesthetic boundaries, cheek augmentation may be needed to prevent too heavy of a lower facial look. Case Highlights: 1) Total jawline augmentation involves chin and jaw angle implants. 2) Creating a strong and well defined jawline in men involves a more square chin and a three-dimensional change to the posterior jaw angles. 3) Strong jawline augmentation creates a prominent flair and vertical lengthening of the jaw angles and a square chin that will create more of a square shape to the face. Dr. Barry Eppley Indianapolis, Indiana

Jaw Angle Augmentation: Matching Implant Styles and Jaw Angle Changes

Saturday, February 2nd, 2013

 

A well-defined jawline is a desired aesthetic feature of a male face. A strong lower skeletal profile not only provides a well balanced facial profile but also portrays an image of strength and virility. A strong jawline is created by the horizontal portion of the mandible (lower jaw) and composed of threee main components, the chin and a paired set of jaw angles. Because they come from the same bone and embryologic branchial arch origin, it is not surprising that there is a developmental relationship between them. A stronger chin will usually have better defined and lower positioned jaw angles, a weak chin usually has smaller and more highly positioned jaw angles.

The surgical creation of an improved jawline usually includes chin and jaw angle implants. In a minority of cases, jaw angle implants alone are all that is needed. Isolated jaw angle implant surgery usually occurs when a chin implant was initially done and, although there was anterior jawline improvement, the realization is that jaw angle augmentation is needed as well for a more complete jawline enhancement.

While chin implants come in a variety of styles and sizes, the selection of jaw angle implants is much more limited. With only a few manufacturers, jaw angle implants are available in just two basic styles and a handful of sizes. While this limited selection of implants can actually work for most patient’s jaw angle augmentation needs, it is important to match the right style of jaw angle implant with the patient’s anatomy and their aesthetic desires.

One style of jaw angle implant, and the first that was ever introduced over 15 years ago, is the lateral augmentation design. This implant will make the jaw angle wider, a horizontal increase only. It takes the existing skeletal jaw angle outline and merely adds to it. For the patient who is happy with the position of their jaw angles and wants them to be more prominent or fuller, the lateral augmentation style is ideal. It is the ‘easiest’ jaw angle implant to surgically place as it does not require release of the periosteum from the inferior border of the mandible.

While the lateral augmentation style has been around for a long time, it is actually the least useful as what most patients need (want) is not a width increase only. When the jaw angles are weak they are often highly positioned as well with an obtuse angle shape to them. This type of aesthetic jaw angle deficiency needs a vertical elongation and not just width increase alone. In essence, a new jaw angle needs to be created that is partially below the existing one. This style of jaw angle implant is an inferolateral style that changes the jaw angle to a lower and more acute one. This is the ‘hardest’ type of jaw angle implant to surgically place because the tissues along inferior and posterior portion of the jaw angle must be released. The jaw angle implant must then be properly inserted, without an exact bony guide to the best position, and then secured there by screw fixation.

Jaw angle augmentation today requires an understanding of the patient’s bony anatomy and the style of implant that is best suited to make the desired changes. The inferolateral jaw angle implant is what most male patients need for recreating a lower and more prominent jaw angle that creates a stronger and more horizontal jawline.

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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