Background: Jawline augmentation has become a popular surgery today as patients seek a stronger and more well defined lower facial shape. Augmenting just the front of the jaw (chin augmentation), while still commonly done, often overlooks a more complete jawline change. The addition of jaw angle implants to that of the chin creates a total jawline change.
While an effective jawline augmentation approach for many patients, the use of three preformed chin and jaw angle implants has a relatively high potential for implant malposition. While any single facial implant always has its own risk of malpositioning, that risk increases three-fold when three implants are used. Most jawline augmentation malpositions occur back in the jaw angle area where implants are hard to place well and can suffer from visible asymmetry.
In cases where the three implant jawline approach has aesthetically ‘failed’ due to implant malpositions, a custom jawline approach should be considered. This changes three implants into a single wrap around implant that is predesigned using computer software. This lessens the likelihood of implant malposition considerably since it is a single implant that is made to fit the jawline precisely.
Case Study: This 30 year-old male had a prior history of unsatisfactory jawline implant augmentation using three implants. The surgical outcome was unsatisfactory as the patient desired a strong angular jawline which he did not achieve. A 3D CT scan showed anteriorly displaced widening jaw angle implants and a cleft chin style implant that was positioned low on the chin bone.
A new one-piece jawline implant was created making the chin and jaw angle changes that would more effectively create a more defined and angular jawline. This required a significant vertical elongation at the jaw angles (15mms) and a more pronounced horizontal and vertical change change. The changes in the one-piece implant design were compared to his indwelling inplants in an overlay fashion.
During the surgical procedure where the original three implants were removed and replaced by the new custom jawline implant, they could be compared in a side by side fashion. The replacement operation required making a subperiosteal connection between the chin and jaw angles to properly seat the new implant.
While a custom jawline implant does cost more than three preformed implants, there is less control over their shape and position. Should a revision be necessary because of implant malposition the cost will then exceed that of a custom implant. In total jawline augmentation the potential benefits of a custom approach need to be strongly considered. initially.
Highlights:
1) Jawline augmentation using three preformed chin and jaw angle implants can be effective but also has an increased potential for implant malposition.
2) A 3D CT scan will reveal the location of chin and jaw angle implants which can help in the new custom jawline implant design.
3) A custom jawline implant has a lower risk of implant malposition since it is a one piece implant that is made precisely for the patient’s bone shape.
Dr. Barry Eppley
Indianapolis, Indiana