Background: Total jawline augmentation refers to changing the entire look of the mandible. This could mean that the entire jawline has to be changed that can only be done by a custom wrap around jawline implant. But not everyone needs augmentation of all areas of the jawline. Many patients just need to change the three ‘corners’ of the jaw, the chin and the two jaw angles.
A three-piece approach to total jawline augmentation most typically refers to the use of chin and jaw angle implants. A variety of chin and jaw angle implant styles and sizes now exist that can meet the dimensional needs of most patients. Jawline implants can add width, vertical length and horizontal projection. But the one dimension that no jawline implant can achieve is a shortening effect.
The one dimension in jawline reshaping that requires a reductive approach is vertical chin shortening. Many very recessed chins are actually vertically long because of the backward rotation of the entire mandible due to an underdeveloped ramus. While a chin implant can add the necessary horizontal projection, it can not make it shorter. Placing the chin implant high to try and create this effect will lead a fullness under the augmented chin and will not really make it appear vertically shorter.
Case Study: This 38 year-old male presented for improvement in the shape of his jawline and lower third of his face. He had a recessed and long and a narrow jawline shape.
Under general anesthesia he initially had a sliding genioplasty performed with a 10mm forward movement 5mms of vertical shortening. Bilateral jaw angles implants were placed that primarily added 7mms of width but only 1mms of vertical lengthening.
His result shows the impact of widening his jawline but also shortening it anteriorly. This combination creates a broader and more masculine appearing lower third of his face. While the chin change significantly improved his profile, it is the jaw angles that added the most to his front and three-quarter views.
He had a long chin due to its recessed position. While a chin implant could have been used that would have maintained his vertically long face and would also have required the jaw angles to be vertically elongated as well. To help shorten his overall face a sliding genioplasty is a better choice because it can shorten the lower third of his face on the front part of the jaw.
Highlights:
1) Total jawline augmentation refers to the three corners, the chin and the two jaw angles.
2) A sliding genioplasty with jaw angle implants is a three piece approach to total jawline augmentation.
3) A sliding genioplasty is better than a chin implant when the forward movement of the chin needs vertical shortening as well.
Dr. Barry Eppley
Indianapolis, Indiana