Background: The external appearance of the face is highly influenced by its bony foundation. While the overlying soft tissue also makes important contributions the overall gestalt of the face is framed by its skeletal structure. Such influences are well known by many of the basic gender differences in the male and female face and is why different procedures exist for both facial feminization masculinization surgery
While facial feminization always involve bone reduction procedures, facial masculinization requires a bone augmentation approach. The typical procedures involves linear types of enhancement to the jawline and cheeks. While often not thought of as linear structures the cheek line and jawline represent two levels of the face which create distinct lines…which artists historically create in their drawings of the strong male face.
While standard cheek, chin and jaw angles implants can be used, they usually lack the ability to create the best facial lines because they are either not long enough and augment the right horizontal level (cheeks) or are not connected. (chin and jaw angles) Custom designed cheek and jawline implants are far superior because they cover the right bony surface areas and do in a connected/extended fashion.
Case Study: This male desired to have a strong facial masculinization result. He had a good preconceived notion of the type of change he was seeking and this was determined by overlaying his own imaged pictures on his 3D facial CT scan. (can not be shown here for confidentiality reasons) From this insight strong cheek and jawline implants were designed.
What constitutes ‘strong’ facial implant designs is open to interpretation. But there are dimensional numbers for certain aspects of the implants for which they would be considered strong or of a large size. Using this patient’s implants, 7mms of cheek implant projection, 14mms of jaw angle width and 8mms of vertical chin lengthening are all implant thicknesses/projection which is right on the edge of advisability for most patient’s implant designs.
Despite their larger sizes, placement of such custom implant designs is generally not a problem. When cheek implants dimensions get beyond 6mms of projection tat is often too strong and one has to be prepared to reduce it intraoperatively should it appear excessively large in its facial effect.
Case Highlights:
1) Male facial masculinization surgery consists of skeletal augmentation of the jawline and cheeks.
2) Custom cheek and jawline implants is the best approach for optimal augmentation of the facial bone structure.
3) Strong or ultra facial masculinization requires implant designs that have substantial dimensions.
Dr. Barry Eppley
Indianapolis, Indiana