Background: Enhancement of the jaw is historically perceived as a chin augmentation procedure. But the chin occupies less than 1/3 of the jawline and neglects the back part of the jaw which is much larger and makes up a significant part of the lower face. This jaw angle area is having increased recognition as being an important part of an aesthetically desireable jawline, particularly in men.
The jaw angles are uniquely different than the chin, not only in its shape, but because there are two of them. Its shape is created by the intersection of the horizontal lower border of the jaw with the posterior or vertical border of the jaw. This entire area is known as the ramus of the mandible. When the ramus is underdeveloped, it creates a high or obtuse jaw angle that is vertically short. (as judged by its position to the anterior chin) When it is developed more strongly, the ramus is vertically longer and the jaw angle is sharper and more defined. When the ramus is longer it often has a wider flare at the angle point as well.
Of all the facial implants, jaw angle implants are the least commonly done and have the fewest options of styles and shapes to use. It is also the hardest facial implant to place, being deep in the oral cavity and have to disinsert part of the masseteric muscle attachments for proper placement. To ensure implant stability, small screws are usually placed through a percutaneous approach to prevent after surgery displacement from the strong maasster muscle action.
Case Study: This 23 year-old male had a prior history of rhinoplasty and chin and cheek implant augmentation. While he was pleased with these facial improvements, he felt that his jawline was still deficient and wanted more visible and flared jaw angles for a more masculine appearance.
Under general anesthesia, intraoral incisions were made along the ascending ramus of the mandible but leaving a good cuff of tissue away from the teeth. The masseter muscles using subperiosteal dissection was raised over the entire ramus as well as along the inferior and posterior borders of the bone. Medpor RZ angle implants of 7mms width were trimmed, presoaked in a combined antibiotic and betadine solution and inserted into place making sure that their cupped lower border design wrapped around the lower edge of the bone. Once their position was ensured, a 1.5mm self-tapping screw was placed through the skin securing the upper part of the implants to the bone. The intraoral incisions were then closed with resorbable sutures in two layers.
The results of this jaw angle implant surgery showed enhanced angular definition with a moderate amount of increased jaw angle flare. This change fit nicely with the rest of his face and was not too strong a change. (jawline stronger than the upper face)
While jaw angle implants are the hardest facial implant to place, they are also the hardest to recover from due to prolonged swelling. As a general rule, 70% of the swelling goes down in 3 weeks, 90% in 6 weeks and 100% by three months. This prolonged recovery can be difficult for some men who do not understand that the final result is not seen in just a few weeks after surgery.
Case Highlights:
1) Jaw angle implants are often needed to complete a total jawline enhancement.
2) Creating a better defined jaw angle usually means that it must have vertical lengthening that creates a sharper and more visible 90 degree shape.
3) Jaw angle implants are placed from inside the mouth and under the masseter muscle.
Dr. Barry Eppley
Indianapolis, Indiana