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Posts Tagged ‘jawline enhancement’

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

Case Study: Custom Wrap Around Implant for Male Jawline Enhancement

Monday, August 25th, 2014


Male Jawline Dr Barry Eppley IndianapolisBackground: The ideal male jawline is seen as strong and chiseled…at least by most men.  (some women may prefer a softer jawline which creates a more nurturing appeal) For those men that do not have it, implants can be used to create a stronger or more pronounced jawline. While once traditionally seen as simple chin augmentation, today’s facial implants now incorporate jaw angle implant designs to change the back part of the jaw as well for a more complete or total jawline enhancement.

For many men the use of standard chin and jaw angle implants, through a three-point augmentation approach, can create the desired jawline improvement. With a three implant approach, however, the sides of the jawline may remain deficient since there may not be a direct connection between the chin and jaw angle implants. Also three implants placed individually runs the risk of implant asymmetry since they are not connected and their position must be ‘eyeballed’ for placement as they relate to each other. There is also the limitations of jawline changes based on the sizes of existing chin and jaw angle implants.

All of the existing potential problems with standard jaw implants can be overcome by the use of a custom-designed jawline implant. By making a single piece wraparound implant, the entire jawline can be augmented in just about any dimensions that one wants and the overlying soft tissues can tolerate.

Custom Jawline Implant design Dr Barry Eppley IndianapolisCase Study: This 23 year old male wanted to have a more masculine jawline with a stronger chin and jaw angles. By using computer imaging, it could been seen that the look he wanted was more of a total wrap around effect that just augmentation of the chin and jaw angle areas. By using his 3D CT scan, a wrap around jawline implant design was done creating a more square chin, prominent jaw angle flare and a smooth connection between the front and back part of the jaw.

Custom Jawline Implant placement Dr Barry Eppley IndianapolisUnder general anesthesia, a small (2.5 cm) submental incision was made behind his existing skin crease. (accounting for a forward rollout of the incision which will always occur. Subperiosteal dissection was done over the entire chin and back along the jawline to the angle with special long-handed dissectors. This was combined with two posterior vestibular incisions to expose the jaw angle. The implant was folded and tunneled into position from the submental incision. The positioning of the jaw angle sections of the implants was checked through the intraoral incisions to ensure good seating over the jaw angles. A single microscrew was used anteriorly but the fit over the jaw angles was so good no screw fixation was felt necessary.

Custom Jawline Implant result front viewCustom Jawline Implant result oblique viewThis is his result just 10 days after surgery. While these is still some slight swelling and tissue ‘stiffness’, his face/jawline looks very acceptable at this early point that he could pass as not being obviously ‘surgical’. His jawline shows improved definition and now has more of a classic strong male jawline that has much more angularity to it without being too big or overdone.

Male jawline enhancement is optimally done by a custom wraparound implant if one wants a total change to the entire jawline that appears connected throughout the implant. It is also the only implant approach that will work if one has more extreme dimensional needs that standard implants can not achieve. While the cost of a custom jawline implant is more than that of standard implants, the difference is not as great as most would think. The custom aspect of the implant also lowers the risk of revisional surgery as the shape and location of it along the jaw is determined prior to to surgery in the computer designing process.

Case Highlights:

1) Complete jawline enhancement involves a total change to the entire horizontal portion of the lower jaw in a ‘wrap around’ fashion.

2)  A custom jawline implant is made from a patient’s 3D CT scan and incorporates changes to the chin, jaw angles and the jawline between them in the desired dimensional changes.

3) Due to the flexibility of even a large silicone one-piece jawline implant, it can be inserted through a small submental skin incision conbined with two intraoral mucosal incision to check for posterior positioning.

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: 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

Case Study: Jawline Enhancement in the Thin Male Face

Friday, November 2nd, 2012


Background: A strong jawline is perceived as a sign of masculinity and is a commonly desired feature of some men. Using implants is the only way to create a well-defined jawline through the triple approach of chin and jaw angle implants. While these implants are available in different materials from various manufacturers, their most important feature is the style and size that they offer. Picking these implant features for any male patient is a lot more art that it is science.

When picking implants for any facial area, it is important to take into account their facial shape and the overlying soft tissue thickness. Thick faces blunt the effects of implants and may simultaneously benefit from some defatting procedures as well. Thinner faces have less overlying soft tissue and the effects of implants can more easily be seen. These facial characteristics are particularly important at the jawline which is essentially a transition point between the face and the neck. Augmenting the front (chin) and the back part (jaw angles) of the U-shaped jawline can change its appearance dramatically.

The thin face and jawline has the benefit of being more easily skeletonized by implants. But implant size must be tempered lest their effects become too pronounced or big. The lower face must not overpower the upper face by being too wide or extending beyond the upper zygomatic width. It must also not become too square in appearance and still maintain some element of being thin and somewhat narrow, just with a more defined jawline.

Case Study: This 45 year-old male felt that his entire jawline was weak. He had a chin implant placed four years ago and, while it provided some benefit, it was still not satisfactory. As part of the discussion about how to improve his chin, his highly angled jaw angle area was pointed out and it was agreed that jaw angle implants would be beneficial as well. He remembered that his prior chin implant was of mersilene mesh composition and that it was ‘large’ according to his original surgeon.

A square silicone chin was chosen to replace his existing chin implant. At least 9mms of additional horizontal augmentation was needed with a more square frontal shape. Silicone jaw angle implants that dropped the angle border down was also chosen but with a width that was not more than 7mms, keeping in line with the rest of the width of his face. The implants would have some overlap across the body of the mandible but with no augmentation effect in this area, which is common.

During surgery, the chin was approached through his existing submental scar. The mersilene mesh implant was heavily ingrown with tissue and was near the dermis of the skin. Removing it was felt to leave too little soft tissue between the skin and any new implant. It was elected to leave it in place and place the new square silicone implant between the underside of the mesh implant and the bone. The wings of the square chin implant went well beyond that of the mesh implant and had no problem providing a more square shape effect. The jaw angle implants were placed through an intraoral incision behind the molars. Dissection released muscular attachments off the angle and the inferior border so the jaw angle implants could be placed low enough. They dropped the border 5mms and had 7mms width. A single screw secured them in place to keep them low and to the back of the angle.

He had some moderate facial swelling, but like in all thin faces, it resolved fairly quickly within three weeks after surgery. He had a much improved jawline with better definition but a jawline width that stayed in line with his upper facial width.

Case Highlights:

1)      Jawline enhancement in men is most commonly performed by a combination of off-the-shelf chin and jaw angle implants.

2)      The style and size of chin and jaw angle implants must be chosen carefully and with an appreciation of the patient’s natural anatomy and soft tissue thickness.

3)      In the thin male face, jawline implants should not be too wide or over-sized as small implant can produce dramatic effects.

Dr. Barry Eppley

Indianapolis, Indiana

Implant Options in Jawline Enhancement

Thursday, February 17th, 2011

The lower third of the face is dominated by the jawline. The jawline extends from one jaw angle around a convex arch to the other. It is actually the largest surface area of any facial bone prominence. Leading the way is the chin but the jaw angles located at the back play an often equally important aesthetic role. A well-defined chin and jaw angles conveys a stronger facial appearance. Weak chins and jaw angles convey timidity and weakness. While this perception may not always be true (and often isn’t), an ill-defined jawline helps create that impression and often makes the neck appear fuller with an obtuse neck angle. In today’s plastic surgery, newer implant designs and styles opens up the possibilities for a variety of jawline enhancements.

The evolution of chin implants has really evolved over the past decade with many different styles and size options. The most important change has been that they have been extended in their shape rather than just being small central buttons. Having an enhanced chin that flows better into the surrounding jawline is a more anatomic approach for most patients. To have a smooth transition from the chin implant to the side of the jaw, the implant must extend back further to blend into the jawline. These newer implants are longer and more tapered at the ends, although they can still be placed through a small incision right under the chin. Because they extend back further they give an enhanced but natural appearance to the chin. Slightly widening the anterior jawline by filling in this area between the chin and the side of the jaw creates a more balanced look. Chin implants can be placed on the lower edge of the bone to add some vertical length to the chin as well. Square and cleft chin implant styles exist for those that want more chin width or a central chin soft tissue highlight.

Jaw angle implants are one of the newest facial implant options that adds to what the historic chin implant can do for the jawline. A more square and well-defined jaw angle creates a more masculinizing look and can only be created with implants. Jaw angle implants can either widen the back of the jaw, make it more longer and more square, or both. These effects are created by different jaw angle implant style options. They are inserted from inside the mouth so scarring is not a concern.

Combinations of chin and jaw angle implants can create a more complete jawline makeover and are often done together. In some cases, no available off-the-shelf chin or jaw angle implant can create the desired effect due to a patient’s unique anatomy or aesthetic needs. In this situation, a customized ‘wrap-around’ jawline implant can be made from a 3-D CT scan of the patient. These can be made as a single implant or in multiple units that can be inserted in pieces and assembled when next to the bone. This approach is particularly useful when the jawline needs to be vertically lengthened. (implant sitting on the bottom edge of the bone)

Dr. Barry Eppley

Indianapolis, Indiana

Chin and Jaw Angle Implants for Male Jawline Enhancement

Tuesday, September 22nd, 2009

I frequently get e-mailed and asked…’What can I do to get a stronger jawline?’ This is exclusively a male question and usually, but not always, is from a younger patient. In looking at a lot of photographs of male patients with this concern, the most common problem is that the chin is short and the jawline is ill-defined. Some cases are more severe while others are much more mild. In either case, the strong jawline of male models and some famous male actors has set a beauty standard for males to aspire to.

In making a jawline more distinctive, there are three areas to consider improving or highlighting. Anterior projection (chin), posterior lateral width (jaw angle) and inferior border or circumferential jawline are the areas that can be surgically augmented with implants. Other than the chin, there are no bony moving or bone grafting procedures that will work.

From a practical standpoint, the two most common and easiest implants to place are the chin and jaw angle. The available implants are well made with numerous styles (chin) and a good range of sizes that will fit all but the very largest, or most bony deficient, patients. By bringing the chin forward (and more square) and making the back of the jaw (jaw angle) wider, the jawline becomes much more distinctive. This approach will work for the vast majority of male patients.

The use of a chin and jaw angle implant for jawline augmentation does leave a gap in the body of the mandible between the two. Depending upon the type of chin implant used (how far back the wings of the chin implant goes), that gap can be up to several cms. in length. While this may seem unfavorable, it is usually not discernible and the aesthetic benefits of considering ‘filling in that gap’ are not usually worth it in my Indianapolis plastic surgery experience. Having three separate implants (five actually along the entire jaw) is bound to have some irregularities that certainly will be felt.

Implants for the body (middle) of the jaw are not commercially available. No such stock implants exist. That fact should tell you that their need, or more pertinently their importance, is really quite limited. To use such an implant, it has to be hand-carved during surgery. Actually this is not that difficult as the use of Gore-tex blocks or sheets can be easily used and shaped. I have no qualms about the ability to shape or place them but my concerns revolve around the ability to feel them, particularly the transition with the chin implant on the front edge and the jaws angle implant on the back edge. Because of these concerns, there has to be a really compelling reason to use them.

There is an alternative to a piece-meal implant approach to total mandibular augmentation. A one-piece custom implant can be fabricated before surgery off of a 3-D CT mandibular scan of the patient. This is best used when the objective is vertical lengthening of the jawline as this is how it must be placed. It can not be used to provide posterior width like a traditional jaw angle implant.

Barry L. Eppley, M.D., D.M.D.

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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