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Posts Tagged ‘jawline implants’

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

Options in Aesthetic Jawline Enhancement

Sunday, May 13th, 2012

The jawline is the defining feature of the lower face. It is quite simple from a structural standpoint being a u-shaped arc and serving as the transition between the face and the neck. But it can have lots of aesthetic problems that are extremely common complaints. A weak chin, a sagging neck, a double chin, jowls, and weak jaw angles are the main jawline issues that manu people have. Whether one is young or old, male or female, these jawline concerns can affect all due either to aging or a congenital structural defect.

The strong or well-defined jawline has become an important component of facial beauty and attractiveness today. With the advent of the internet and other electronic media, a new cultural standard for jawline aesthetics has emerged. Males contact me today and almost always point to the jawline of Brad Pitt and numerous less well known models as to their goal. Women similarly point to actresses like Angelina Jolie or Reese Witherspoon as their desired jawline look.

What makes up a pleasing jawline that conveys both attractiveness and a more youthful appearance? This always refers to a well-defined  and visible inferior border of the mandible that is straight from the jaw angle to the chin. The jaw angles are slightly higher than the horizontal position of the chin and there is a slight flare from front to back. The chin is more square in men than in a women whose chin is more narrow. Soft tissue that hugs the lower edge of the jaw makes for a well-defined neck angle and the absence of any jowls. It can be seen that the bone structure is the key to a good jawline which will also affect how the soft tissue may sag with age off of the bone.     

While I suspect a good jawline has always been a desired facial feature, many recent improvements and advancements in plastic surgery have made it more achievable. But there is not a single jawline technique that will work for everyone. A variety of bone and soft tissue surgical procedures exist and often more than one is needed to get the best result.

Chin and to a lesser degree jaw angle implants have been around for decades. But new improvements in implant shapes have made them more versatile and adaptable to a variety of jawline problems and are available off of-the-shelf. Chin implants that extend posteriorly to cover the prejowl area and those that have increased width to create a more square chin are but a few of the newer options. Better chin implant designs are still needed, particularly those that may allow for increased vertical as well as horizontal projection. Jaw angle implants have largely been in one style, that of adding more lateral fullness. But newer jaw angle designs allow for vertical height increase and stronger lateral flare as well.

But off-the-shelf chin and jaw angle implants can often not make for a completely straight jawline because they are not connected in the middle between the two over the central body of the mandible. Custom jawline implants can now be made that can create a central jawline augmentation that unites the chin and jaw angle areas. Custom designs may also be used when the size of the chin or jaw angles desired has greater dimensions that what off-the-shelf implants can achieve.

Soft tissue techniques for an enhanced jawline include a variety of well known procedures. Fat removal by liposuction, loose skin tightening and removal through differing facelift techniques, and neck muscle tightening can better redrape the soft tissues around the bony jawline. Two uncommon but useful soft tissue procedures are the submentoplasty and the direct necklift. A submentoplasty works best in the younger patient with a full neck where extensive fat removal and muscle tightening are done without skin removal. In contrast is the direct necklift which is for the much older patient who is willing to accept a neck scar for neck wattle removal and platysmal muscle tightening.

Contemporary jawline aesthetic surgery is more than just a chin implant or a facelift. It needs to consider all anatomical elements and combine a variety of bony and soft tissue manipulations to get the best lower facial improvement.  

Dr. Barry Eppley

Indianapolis, Indiana   

Facial Implants Instead of Orthognathic Surgery

Thursday, December 8th, 2011

While facial implants are commonly used to highlight the convex bony prominences of the cheeks, chin and jaw angle for purely cosmetic purposes, they have applications to other facial regions and problems as well. They can be very useful in bony deficiencies as well such as midface and mandibular hypoplasias as an orthognathic surgery alternative.

In these orthognathic deficiencies, the face is deficient in the cheek, paranasal and jawline regions but their occlusion is perfectly normal…or has already been orthodontically corrected. This obviates the use of maxillary and mandibular osteotomies to correct the facial appearance. But the use of implants can be used to simulate what would otherwise be achieved through bony movements.

Chin implants are the most well known example of  an orthognathic surgery alternative. Bringing the bony prominence of the chin forward can virtually replicate the identical lower facial change to that of mandibular advancement osteotomies. While a mandibular osteotomy can only bring the chin forward as far as the distance that makes the occlusion fit, implants are much more versatile. Not only differing in the horizontal thickness of the implants, they also can add width and different shapes to the central chin. (square to more angular) If custom implants are used, the chin can also be vertically lengthened as far back as to the jaw angles.   

Some elements of midface or central facial deficiencies are the result of a very concave pyriform aperture shape. This makes the nose undersupported making it appear flat with wide or even flared nostrils. This can also extend onto the base of the nose under the columella where it is supported by the projection of the anterior nasal spine. A short spine or near absent spine allows the columella to be recessed and one have a 90 degree or less nasolabial angle. Augmentation of the paranasal region (pyriform aperture) can simulate the effect of a LeFort I maxillary osteotomy using either paranasal, premaxillary or both implant types. This helps pull out the nose and its base with increased central projection and less flattening.

If one goes above the level of the maxilla, most people quickly think about flat or weak cheek bones. As a general rule, if the cheeks are flat the entire midface below it will also be. But cheek flatness usually also involves the infraorbital rim medial to it as well. This zone is one of the least appreciated areas of midfacial skeletal deficiency. A variety of midface implants are available for the cheek and infraorbital rim that create the visual effect of a LeFort III osteotomy. When the bony deficiency extends across the cheek to the nose, cheek implants alone may accentuate the existing infraorbital rim recession.

Implants can be used to simulate the appearance of facial skeletal osteotomies in patients with either normal or orthodontically corrected occlusions. Often a combination of facial implants is used, particularly in the midface, to create the overall effect of increased skeletal projection.   

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

The Wrap-Around Jawline Implant for Men

Tuesday, April 29th, 2008

The use of facial implants for male face enhancement is common and the traditional areas include the chin, cheeks, and jaw angle areas. Every now and then, I get a request or see a patient who really enhancement in a different area of the jaw….the vertical dimension. Making the jawline longer in the vertical dimension to increase lower facial height and put the face in better overall balance. Most of these unusual cases exhibit an underlying jaw deficiency problem, often with a significant overbite relationship at their teeth, indicating a jaw that is both short in the front-back dimension (horizontal development) and in the up and down dimension. (vertical development at the ramus)

In correcting this type of jaw problem, the ideal solution for most of these patients is a course of orthodontics followed by traditional orthognathic surgery. While this may be ideal, most of these patients are beyond their teenage years and do not want to make the multi-year investment of time to make a formal anatomic correction based on the bone. A ‘short-cut’ solution is to augment the deficient areas with a synthetic implant. While the actual procedure is not difficult to do, the problem is in finding a commercially-available implant that will match the patient’s problem. When it comes to vertical lengthening of the mandible from one side to the other (wrap-around), there is no such off-the-shelf implant option.

Sometimes a standard chin implant, combined with a jaw angle implant, that is positioned low on the bone below the native bone edge may suffice. But there will be a gap between where the chin implent ends and the jaw angle begins. In some cases, it may work but it is a piecemeal approach that is fraught with problems such shifting of the implants after surgery. (in this case , the jaw angle implant)

A better solution is to have a custom wrap-around implant made off of a computer-generated model. A 3-D CT scan can be done from which an exact replica of the jaw (mandible) can be created. Then a mock-up of the implant (by me) can be done in acrylic to create a one-piece wrap-around jaw implant that sits on the inferior border of the jaw, lengthening it throughout. The acrylic mock-up is then sent to a manufacturer where they make a formal silicone rubber implant. While a lot of work is done on the front end, the implant is easily placed through a small incision under the chin. (it is flexible so it easily folds on itself to be easily inserted through a small incision) It is fixed with a single screw underneath the chin so it does not ever move. It really is nothing more than a long extended chin implant that runs from one jaw angle to the other, but is on the bottom edge of the bone.

I have done this procedure several times over the years and found it to be quite successful. There is some significant cost upfront fron the CT scan, jaw model, and final implant (around $5,000, surgery costs are additional) but it is the best way to go when one is looking for this type of jaw implant)

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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