Background: For augmenting the lower face there are a wide variety of procedures that are available to do so. From the non-surgical injectable fillers to custom jawline implants there is a spectrum of options that differ in both their aesthetic results and their degree of invasiveness. While the custom jawline implant is the complete and final lower jaw augmentation procedure, and some patients do immediately go right that option, there are an equal number who start with lesser and more commonly performed procedures.
Injectable fillers today are the most performed form of jaw augmentation due to the large number of injectable providers and their non-surgical nature. The chin is most commonly injected for both men and women with the jaw angles injected more frequently in men. While a wide variety of fillers are available the most used historically is Radiesse. (This may soon be rivaled by Volux) The chin implant has been and probably always will be the most frequently perform ower jaw augmentation surgery. (the sliding genioplasty is a distant second) Jaw angle implants, while commercially available for thirty years and with increasing interest today, is done far less than chin implants. This is primarily due to it being a more difficult aesthetic implant procedure and one far less familiar to the vast majority of plastic surgeons.
Thus it should not be a surprise that a significant percent of patients who I see for custom jawline implants, about half, have had prior jaw augmentation procedures. While it may initially seem like the efforts from the prior procedures is going to be lost when a jawline implant is going to be placed, this is not actually the case. These prior procedures provide two very important pieces of information. First they have allowed the patient to see what their aesthetic desires actually are. While they may have started out ‘small’, they may have had to grow into a more definitive and complete jawline augmentation procedure. They have learned or expanded what their lower facial goals are. Of equal importance is that the dimensional changes from the prior procedure provides valuable design information in how to make the custom jawline implant.
Case Study: This male had prior procedures of a vertical lengthening chin implant and Radiesse injectable fillers to the right side of his lower jawline. He had these procedures to vertically lengthen his chin to try and make his face less round as well as to improve a congenital right jaw asymmetry. What he learned from these procedures was that an overall jaw lengthening would be beneficial and the right jaw asymmetry could be simultaneously improved as well without the need for ongoing filler treatments.
A custom jawline implant was designed to vertically lengthen the entire jawline using the existing vertical chin lengthening as a guide. The jaw asymmetry was corrected by making the right side look like the left side once it was created. Total implant volumes was 18ccs.
By using the vertical length created by the existing chin implant its known effect helped guide how much vertical lengthening was needed for the chin, of which he was happy, as well as the rest of the jawline.
Looking at the see-through images of the implant design vs bone the 3D jaw augmentation change could be appreciated. The total implant volume was 20ccs.
Under general anesthesia his vertical lengthening chin implant was removed and the custom jawline implant placed.
Patients have more limited jaw augmentation procedures as that is the easiest, most economical and usually what they are aware of approaches. For many patients this is where they stop as that provides an aesthetic satisfaction point. For others it is an educational process to learn what they ultimately want and what they are prepared to undergo to achieve it. Those prior experiences help guide what the next procedure should be…which for the lower face is the custom jawline implant.
Case Highlights:
1) A significant percent of patients that present for custom jawline implants have had prior chin and jaw augmentation procedures.
2) Chin implants and injectable fillers are the most common pre custom jawline implant treatments.
3) The pre jawline implants treatments provide invaluable information about how to design a custom implant replacement.
Dr. Barry Eppley
Indianapolis, Indiana