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Posts Tagged ‘jawline augmentation’

Case Study – The Extended Custom Chin Implant in Facial Deformities

Sunday, November 29th, 2015

 

Background: Soft tissue contractures of the face cause a variety of deformities. Even with normal underlying bone structures, loss of overlying soft tissue volume and shape can make the face appear deficient and distorted. This is most classically illustrated by burn patients who suffer the greatest amounts of soft tissue loss and deformity when suffering extensive burns to the face. But there are a variety of other diseases and medical conditions that can also cause soft tissue facial contractures.

The jawline is one of the most notable features of the lower face as it creates a clear separation of the face from the neck. Also because it is the only bone that moves on the face, its projecting prominence helps create a distinct facial profile. A more evident  lower jawline and a nicely shaped chin prominence is valued as part of a proportionate and attractive shape. Distortion of its overlying soft tissue along the bony jawline can create a distinct degree of distortion of its form including the anterior projecting chin and lips.

Case Study: This 46 year female presented with an overall facial deformity caused by a rare medical condition with extensive soft tissue deformities and scars. She had been through dozens of soft tissue procedures of the face, through excision and reconstruction, that led to her present facial state.

Extended Chin Implant design and placement Dr Barry Eppley IndianapolisCustom Extended Chin Implant result side view Dr Barry Eppley IndianapolisShe subsequently underwent a variety of reconstructive procedures including injectable fat grafting, dermal-fat grafts, lip reconstructions and an extended custom chin implant to augment the chin and the jawline behind it. The implant was designed from a 3D CT scan of the patient.

Custom Extended Chin Implant result oblique view Dr Barry Eppley IndianapolisCustom Extended Chin Implant result front view Dr Barry Eppley IndianapolisThe re-establishment of facial volume from contracture and volume loss can be aided by augmentation of the bone beneath it. While this is of value over any of the bony prominences of the face, the extent of the surface area of the jawline makes it most useful in this boundary area between the face and the neck. Such a custom chin implant serves a tissue expander to stretch out the contracted overlying soft tissues.

Highlights:

  1. Chin augmentation can include the entire length of the  body of the mandible back to the angle with a custom designed chin implant
  2. Adding volume and structure along the jawline can expand the overlying soft tissue in cases of contracture and deformity.

3) Adequate chin projection and a straighter jawline improve facial proportions.

Dr. Barry Eppley

Indianapolis, Indiana

Jaw Makeovers for Men and Women

Thursday, January 15th, 2015

 

Strong Male Jawline Dr Barry Eppley IndianapolisThe jaw makeover seems to be one of the newer requested facial cosmetic procedures. Women and men grab their necks and stroke their jawline looking back on the days when it was much tighter and more defined. Men are particularly focused on their jawline feeling that a more prominent one would improve their appearance as well as other aspects of their life. A small hint of this elevated level of interest in the jawline is shown by the increased number of chin augmentation procedures done over the past decade.

The reality is that there is not really one jaw makeover procedure or technique. Rather there is a large number of procedures that can be done that offer some degree of jawline enhancement. They range from minimally invasive procedures like skin tightening ultrasound and radiofrequency treatments, injectable fillers, liposuction, fat injections, standard preformed chin and jaw angle implants and custom total wrap around jawline implants. Conceptually they create a more prominent jawline through either skeletal augmentation or to reshape the soft tissues around the existing jawline.

But it is important to understand that not all jaw makeover treatments are created equal. One should not expect that a little skin tightening and filler or fat injections will create the same jawline effect as chin and jaw angle implants. Of course it all depends on where one starts and how deficient the underlying jawline anatomy is.

Superman Jawline Dr Barry Eppley IndianapolisThe motivation for the increase in jaw makeover procedures is multifactorial. Stronger jawlines have also been desirable for men and dates back to antiquity. Actually there has never been a time when a weak chin or obtuse neck angle has been in demand or shown to enhance one’s appearance. But recent fashion and style does have an impact which leads one to look at the influence of the many recent superhero movies in the past decade or so. These comic book characters now on display on the big screen inadvertently suggest a relationship between a strong jawline and ‘enhanced powers’. It has also long been established that stronger facial features in men (as well as height) have an advantage in the work place and for job advancement.

Strong female jawline Dr Barry Eppley IndianapolisWhile women historically have been aesthetically pleasing with a softer jawline, stronger jawlines through increased definition and angularity has become more popular. This trend of female jaw aesthetics can be seen in contemporary models and some actresses and celebrities. Why stronger jawlines in women are appealing is a matter of debate. But strong skeletonized facial features in a woman suggest strength, fitness and a strong will.

Fillers and skin tightening procedures can create a better jawline but it is important to understand that these results are more modest and are only temporary. A lower facelift unmasks the ‘old’ jawline that once existed and has become obscured with sagging jowl and neck skin. It creates an improved jawline by unmasking the old one. Bone implants create the strongest change in jawlines that are permanent and the most visible. With a stronger push to the overlying skin due to the material, greater angularity and definition can be achieved. Younger jaw makeovers are usually skeletally based while ‘older’ ones incorporate some soft tissue management as well due to aging.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Missing Element in Jawline Enhancement

Monday, October 28th, 2013

 

A strong jawline is a well known perceived desirable facial feature. While an obvious aesthetic asset in men, it is even so in women as long as the chin does not protrude too much. What what makes up a nice and well defined jawline? The jawline comes from the mandible or lower jaw which is anatomically made up of five distinct components that is essentially a paired L-shape curvilinear structure that meets in the middle. Its anatomic components and their aesthetic corollaries are the symphysis (chin), parasymphysis (prejowl), body (middle of the jawline), ramus (angle) and the condyle. (jaw joint which has no aesthetic relevance) Chin implants increase the projection of the symphysis, jaw angle implants increase the width or length of the ramus and prejowl implants increase the fullness of the parasymphysis. But there is no off-the-shelf standard implant for the body of the mandible that would connect whatever is done at the opposite ends of the jawline. (chin and jaw angles) This is the missing piece of aesthetic jawline enhancement, the ability to make a smooth and stronger jawline along the sides. Currently, only custom made implants can do body jawline augmentation. or the wrap around jawline implant which includes all elements of making a well defined jawline.

Dr. Barry Eppley

Case Study: Facelift with Chin-Prejowl Augmentation

Monday, June 17th, 2013

 

Background:  Aging of the face takes on many predictable changes but none is more evident than what occurs along the jawline. The once more discernible and sharp jawline becomes lost as jowls appear and the neck sags. The neck angle becomes more obtuse, the chin may appear shorter, and the transition between the face and the neck becomes obscured. This falling down of the facial tissues over the ledge of the jaw bone into the neck typically occurs due to loss of osteocutaneous ligament support to the skin.

The facelift operation reverses the soft tissue components of this aging process. A facelift is really an isolated neck-jowl procedure that removes fat from the neck, tightens neck muscles (platysma), lifts up the intervening layer of soft tissue between the muscle and the skin (SMAS) on the side of the face, and relocates and removes excess face and neck as it is elevated past the ears.

But often forgotten, and many patients do not see it themselves, is the bony support of the jawline. The strength of the chin and the jawline backs to the bony angles has an influence on how much and how quickly the facial aging process proceeds. Inherently weak chins and a shorter jawline with high mandibular angles indicates a weak system for the prevention of facial tissues from falling over the ‘ledge’ and lack of support to hold the neck tissues up.

As part of any facelift, consideration should always be given to augmenting the jawline. Most commonly, this is seen a simple chin augmentation as weak chins are easy to spot. Chin implant augmentation adds length to the jawline and adds a complementary effect to the restoration of a more acute neck angle. In other cases, an extended implant that incorporates the prejowl area better defines the front half of the jawline.

Case Study: This 65 year-old female wanted to improve her saggy neck and jowls that had been slowly getting worse over the past decade. She was a very thin lady with very little subcutaneous fat. She had rolls of skin over the jowls and into the neck with prominent platysmal bands. Her chin had some horizontal shortness and her jaw angles were extremely high, creating a 45 degree angle to her mandibular plane.

Under general anesthesia, a facelift was performed. Initially, a submental incision was made and skin flaps raised to expose the platysma muscle. The muscle edges were exposed with cautery and a sutured together from under the chin down to the thyroid cartilage. A combined chin-prejowl implant was placed on the chin bone back behind the mental nerve on the lower edge of the bone. Incisions were made around the ears in a retrotragal fashion and long skin flaps raised to connect with those previously made in the neck. Her SMAS tissue was very thin and imbrication by sutures was done rather than raising the flaps. Excess skin was brought back over the ears, the excess removed, and the outline of the ear re-established.

Her recovery was very typical for a facelift and she looked fairly non-surgical in just over two seeks after her procedure. Her jawline was sharp again and the chin had more projection although not overly so. Even the outline of her high mandibular angles could be clearly discerned.

Skeletal jawline augmentation is an underutilized technique in facelift surgery. Its use in patients that have a congenitally short jaw is extremely beneficial and will highly compliment the soft tissue rearrangement. But even in patients that do not have an obvious chin deficiency the jawline can be made more prominent with a prejowl implant that adds minimal horizontal chin projection.

Case Highlights:

1) The woman with a short jaw, as evidenced by a small chin and high mandibular angles, will develop considerable neck and jowl soft tissue sagging as she ages.

2) While a facelift is the standard approach to neck and jowl sagging, adding skeletal support through chin augmentation helps recreate a more visible jawline.

3) Chin and jawline implants can be a valuable addition to lower facial rejuvenation.

Dr. Barry Eppley

Indianapolis, Indiana

Total Jawline Enhancement in Men

Wednesday, June 10th, 2009

One of the most dominant and defining features of the male face is the jawline. While the chin is a part of the jawline, it does not represent the entire dimension of the lower third of the face. It represents only the central third. The dimensions of the jawline follow the curvature of the mandible from one angle to the other. In assessing the desire to improve the lower male face, one has to consider the entire jawline.


Chin implants have really evolved since their introduction decades and the changes in implant design and styles can really be beneficial in male chin augmentation. The most important change has been that they have been extended in their shape rather than just a central ‘button’.  In men, these keeps the chin from getting too narrow from the frontal view. These extended anatomic implants are longer and more tapered at the ends, although they can still be placed through a very small incision right under the chin. Because they extend back further they give an enhanced but still natural appearance to the chin. This is achieved by filling in the jawline between the chin and the back of the jaw, slightly widening the anterior jawline making the overall look more balanced. There is even a square chin style that can make the chin quite square if one desires a strong change.

The sides and back part of the jawline can be enhanced through the use of jaw angle implants. Placed over the junction of the posterior and inferior mandibular borders, the implant’s design and shape can help make the jaw angle’s definition more pronounced. By so doing, particularly when done on both sides, the width of the back of the jawline is increased creating a stronger and more masculine facial appearance.

Total jawline enhancement or augmentation requires a three implant approach, a chin and two jaw angles. The combination of all three can make quite a difference in improving the look of the lower third of the face. The most anterior edge of the jaw angle implant, hwoever, is not long enough to ever reach the back end of a chin implant. So there will always be a gap between the two. I do not think that this is ever much of a problem for most patients as adding width to the middle of the jawline is not that aesthetically significant. But a fourth (and fifth) piece can be added if desired which is best done with a hand-carved piece of Gore-tex block which is fit and screwed in between the two other implants. One will always be able to feel some step-offs and edges when there are this many implants however.

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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