‘All societies in history were and are preoccupied with facial beauty’
‘ Facial balance and symmetry are the key features to attractiveness’
‘All people regardless of race, class or age share a similar sense of what is attractive’
‘Square jawed males are viewed as more masculine, gain higher ranks in the military and have earlier and more frequent sex’
‘ A square chin and jawline frames the lower face, making it more symmetrical and defined’
‘Defined jaw points and angles are more attractive in both men and women’
These are just a few of the well known facial facts of beauty that are often quoted and specifically address the merits of a strong and well defined jawline. While some have it naturally, the vast majority of us don’t and must seek a surgical solution. While there are a variety of facial implants for jawline enhancement, there are numerous misconceptions about how they work and how a better jawline is achieved.
‘The jawline consists of three parts, the chin, body and angles, all which can be implanted although not equally effectively or in all dimensions’
The most well known jawline implant is that of the chin. It is the most frequently done of all facial implants and has been surgically implanted for over fifty years. While the styles and size of chin implants have improved dramatically over this time, chin augmentation only affects the front 1/3 of the jawline. While one could argue that this is the most important part of the jawline and has its U-shape provides very visible forward projection, a chin implant provides no change for the posterior 2/3s of the jawline.(body and angles) Even today’s extended anatomic designs rarely provide any augmentation to the body even though the tail of the implants may lay upon it. Today’s chin implants, while providing projection and even square shapes through increased width, can not provide vertical lengthening…an overlooked feature of chin implant designs.
Three-dimensional chin reshaping can be done by a sliding genioplasty which can add vertical lengthening as well as horizontal projection. In extreme chin deficiencies, an osteotomy can be combined with an implant in front of it for a few more millimeters of projection or the implant can serve to fill in the notching that often occurs in the bone in the prejowl area.
Jaw angle implants are the least performed augmentations of any of the facial prominences. (chin, cheek, nose and jaw angles) While jaw angle implant designs have been around for nearly fifteen years, they have not garnered great use because their surgical implantation is more difficult and aesthetic interest is more recent. Current jaw angle implants produce mainly lateral augmentation (width) which actually is indicated for only the minority of patients seeking jaw angle enhancement. For someone with a favorably low jaw angle point, width alone may produce a satisfactory enhancement.
Jaw angle deficiencies, however, almost always are the result of a high jaw angle which by definition implies a vertical deficiency as well. Getting current implant designs low enough is difficult if the surgeon does not do adequate soft tissue release and the implant does not have a design that can engage the lower border of the jaw angle for positional security. Jaw angle implant designs that provide both horizontal and vertical augmentation (inferolateral) are most useful to a larger number of patients, particularly men, who seek a more defined and prominent jaw angle area.
While chin implants augment the anterior two-thirds and jaw angle implants enhance the posterior two-thirds of the jawline, the missing area is the middle or the body of the jawline. Sandwiched between the chin and the jaw angle, the body area has not specific implant for it. There is no ‘connector’ implant between the two. For those seeking a perfectly straight line back from the chin to the jaw angle point, this may be an aesthetic problem. While chin implants have extensions that go back and jaw angle implants have a forward reaching design, the two only connect over the body by overlapping their feathered edges if done together. This is why many jawline enhancement patients may have a visible step-off or break in their new surgically created jawline. For some combined chin and jaw angle patients, this body discrepancy is minimal and not an aesthetic issue.
The body gap becomes most manifest when the jawline deficiency has a vertical deficiency component to it, areas that are not optimally augmented with current chin and jaw angle implant designs. When a perfectly straight and well defined jawline is desired, a custom two-piece implant is ideally needed that augments the entire jawline from front to back in a perfectly smooth fashion. These are particularly effective when the lower jaw is vertically short and the implant can be made to extend the entire lower border of the jaw. These ‘wrap-around’ jawline implants can produce some dramatic jawline changes.
The most unique jawline problem that can only be addressed by custom implants is when the entire jawline is vertically deficient, creating a small lower face. This almost always is associated with a lot of overbite of the anterior teeth, indicating that the lower jaw is small and fits partially inside the upper jaw. This creates an overclosing of the lower jaw making it too short vertically. Making a custom implant that fits only on the lower border of the jaw and lengthening it from front to back is the only effective solution.
Jawline enhancement must be assessed carefully in every patient to get the right jawline implant(s) design and size. For many patients, a chin implant may only be needed. For others seeking a three-point prominence change, off-the-shelf chin and jaw angle implants will suffice. Improving implant designs and sizes will make using this implants even more effective in the near future. For those seeking a completely new jawline with existing front to back deficiencies, wrap around jawline implants are designed and custom made for each patient’s specific jaw anatomy.
Dr. Barry Eppley
Indianapolis, Indiana