Augmentation of the entire jawline has become a popular method for improvement of the lower third of the face. While historically lower facial augmentation was focused on the front half of the jaw (chin), a more contemporary approach considers the jaw angles behind the chin for a complete jawline effect. While most people who seek jawline enhancement will do well with a ‘three-piece’ approach (standard chin and jaw angle implants), some patients need a one-piece jawline implant to achieve their aesthetic goals.
A total or one-piece jawline implant requires a custom fabrication method. There are no standard or off-the-shelf jawline implants. Using a 3D CT scan a custom jawline implant is designed and manufactured based on input from both the surgeon and the patient. Despite being custom made by computer design, the dimensions of the implant and how well it can achieve the desired patient results remains an art form and not an exact science.
Beyond the design phase, the primary role of the surgeon is to insert the implant and place it as it was designed on the bone in the 3D CT scan. This may sound simple but the reality is that it is a technically challenging procedure to achieve both a good fit and to do so with minimal incisional scarring and surrounding tissue trauma.
Like all facial implants a custom jawline implant can end up malpositioned or have some external aesthetic asymmetry concerns. It is prudent to wait a minimum of six weeks or longer after implant surgery to ensure that most of the swelling has subsided and tissue adaptation has occurred should either of these implant concerns be investigated.
While in days past surgical exploration and facial implant evaluation was done to determine the problem and attempt to resolve it, that should not be the approach with custom jawline implants in particular. There is too much implant volume and surface contact with the mandible to have an accurate evaluation of the problem. In addition much of the implant can not be seen through the limited incisions that were used to insert and position it.
A postoperative 3D CT scan should be for all custom jawline implant positioning concerns. This provides the definitive answer to where all aspects of the implant are positioned on the bone. It is important to be aware that the implant in the postoperative 3D CT scan will not appear like it does in the design images. In the design images a custom jawline implant will appear very smooth. In a postoperative 3D CT scan the same implant will appear fuzzy and not smooth. This is completely normal and reflects the difference between painting on an implant with a design program vs. an image acquired by radiographic acquisition of a low density material.
3D CT scanning is both a necessary preoperative requirement for a custom jawline implant as well as an ideal postoperative method for evaluating implant positioning concerns. Despite the often non-smooth appearance of the implant in a postoperative 3D CT scan, that does not affect its ability to provide clear insight into how the implant sits on the lower jaw bone.
Dr. Barry Eppley
Indianapolis, Indiana