Background: A custom jawline implant made from a 3D CT scan is becoming recognized as the most definitive method to modify the shape of the lower jaw. Because it is a unified one-piece implant and can be preoperatively designed to whatever dimensions the surgeon and the patient desire, it is hard to argue with the potential changes it can create
But the reveal of a custom jawline implant is dependent on more than its design. The overlying soft tissues play a major role in how the jawline implant augmentation will look like on the outside. Thick overlying soft tissue of the face and neck can make even the most sharply and dramatically designed jawline implant design appear round and indistinct. Thus each patient and their anatomy must be carefully considered to determine if the large surface area of a custom jawline implant would be aesthetically beneficial.
The thick or short neck always poses a challenge in custom jawline implant surgery. It must be dealt with concurrently at the time of implant placement to get the best result. Liposuction is always helpful and may be all that is needed in many patients. But to get the best jawline and neck angle show a more aggressive procedure, a submentoplasty, should be considered.
Case Study: This 46 year-old male wanted to improve the shape of his jawline and neck. He recognized that his chin and jawline was vertically short as well as horizontally deficient. A custom jawline was designed to provide more vertical lengthening than horizontal projection in the chin and a substantial vertical drop down at the jaw angles. The jawline implant design flared out from front to back.
Under general anesthesia, the custom jawline implant was placed through an external submental skin incision and two posterior intraoral incisions. It was positioned and screwed into place. Through the submental incision, the neck was treated by liposuction above the platysma muscle, subplatysmal defatting in the midline and midline platysmal muscle plication by sutures.
His postoperative results showed a more distinct chin and a better defined neck angle. His jawline back to the angles was lower and more distinct but did not have the sharpness or definition that we both ideally desired.
A surgical strategy for the neck must occasionally be considered in conjunction with a custom jawline implant. Liposuction and a submentoplasty procedure are the options. The decision between the two is based on the thickness of the neck tissues and current slope of the neck from the chin down to the adam’s apple area.
1) A custom jawline implant can change all dimensions of one’s existing jawline. How to design it for an external effect still remains an art form.
2) The effects of jawline augmentation can be masked by a full neck and lax platsymal muscles.
3) Combining a custom jawline implant with a submentoplasty neck procedure offers the best possible reveal of the new lower facial shape.
Dr. Barry Eppley