Background: A prominent and more defined jawline is a facial feature that has always been in vogue for men and more recently that of women as well. While there are differences between jawline augmentation methods and objectives for man and women, a smooth jawline from front to back is characteristic of both of them.
With few exceptions in my jaw reshaping/augmentation experience, the most assured method of total jawline augmentation is with the use of a custom jawline implant. Using the patient’s 3D scan, a complete wrap around jawline implant can be made of almost any dimensions one wants as along as the overlying soft tissue can accommodate the expansion. (this is really an issue for the chin area only) Its jawline augmentation results are so superior than any other method of jaw augmentation using separate preformed implants should only be done for cost considerations only.
With the emergence of custom jawline augmentation, I have run into a whole host of patients who have had prior surgeries with various forms of implants and other materials placed along their jawline. These include previous sliding genioplasties, silicone and Medpor implants, titanium plates and screws and hydroxyapatite blocks and granules. While in days gone by some of these would have been a surprise, 3D CT scans can pick up what is there and the implants can be designed with their virtual removal or made to fit around them.
Case Study: This 52 year-old male wanted a stronger jawline and had made prior surgical attempts to achieve it. He ha d a prior procedure that included a sliding genioplasty and the placement of a large amount of hydroxyapatite (HA) granules from the chin back to the jaw angles. While this provided some benefit to the chin, it had little success in making a stronger and more defined jawline.
A 3D CT scan showed the sliding genioplasty plate and screws and a large amount of irregular and lumpy radiodense material (green color) along the sides of the jawline back to the angles. To prepare the bone surface for implant design, the HA material was electronically removed showing an irregular jawline bone surface and edges
A wrap around jawline implant was designed to provide 6mms horizontal and 5mm vertical chin increase as well as 7mm vertical and 5mm width increase at the jaw angles. The chin and jaw angles were connected between them with material that made for a very smooth jawline implant.
Under general anesthesia, the mandibular implant pocket as developed through a combined submental and bilateral intraoral incisions. The tissues were very adherent and much of the hydroxyapatite granules had become overgrown and encased with bone. The bone surface was scrapped and rasped to make is as smooth as possible. The custom jawline implant was inserted in one piece through the submental position and its posterior position checked through the intraoral incision. Due to the irregular bone surface the implant was secured with multiple small 1.5mm titanium screws.
Despite prior jaw surgery and implants, a custom jawline implant for augmentation can still be done. A 3D CT scan to make the implant helps identify potential jaw issues and materials. If needed the 3D CT planning can ‘remove’ what will serve as an obstruction and adjust for those bone surfaces changes in the custom jawline implant’s design.
Case Highlights:
1) Custom designed implants are the most effective method for complete jawline augmentation.
2) Prior mandibular surgery and jaw implants do not prohibit or prevent the design and placement of a total jawline implant.
3) 3D CT assessment and designing of jaw implants is essential for an optimal result in the face of altered mandibular anatomy.
Dr. Barry Eppley
Indianapolis, Indiana