Background: The most common bony changes done to the lower jaw are the sliding genioplasty and the sagittal split ramus osteotomy. (SSRO) Other types of bony changes less commonly done are chin wing osteotomies, v line surgery and TMJ joint replacements. All of these autologous jaw procedures can create very effective lower facialreshaping changes but they are not perfect in terms of bone shape or in creating ideal dimensional changes.
This is where the role of secondary jaw reshaping by a custom implant comes into play….provided an augmentative change is needed for an improved aesthetic outcome. All of these bony jaw changes, regardless of the bony irregularities and metal hardware that now exists within, can have implants placed over and around them. This requires an obvious custom implant design to do so.
One of the most obvious indication for custom implants after a jaw osteotomy is when a bony genioplasty is performed. This subtotal jaw augmentation procedures leaves the rest of the jawline ‘behind’. This may not be so or obvious if the bony genioplasty had a primary horizontal movement. But when the chin movement has a major vertical movement the mandibular plane angle becomes non-linear and dimensionally deficient.
Case Study: This male had a prior history of double jaw surgery followed by a 10mm vertical lengthening genioplasty. Between the jaw surgery and the chin lengthening this left his jawline with an irregular non-smooth shape.
A custom jawline implant was designed to smooth out the entire jawline and and give it a smooth linear connected form. The ‘corners’ were also sharpened. This is really a jawline implant to top off and smooth out the major dimensional changes that had been achieved with the bony procedures.
When looking at the implant thickness the color mapping showed where the greatest need for implant volume was. (antegonial notch and chin corners)
A custom jawline implant isn’t always about creating major dimensional changes to the lower jaw. It is also effective as a secondary procedure after any bony work to smooth out the bone surfaces and add any final augmentation effect.
Key Points:
1) Bony jaw procedures have major reshaping effects but do not always produce smooth contours or achieve optimal aesthetic augmentation effects.
2) A vertical lengthening genioplasty can create a vertically deficiency jawline behind it.
3) Only a custom implant design can concurrently contour and augment in a predictable fashion any facial bone irregularities.
Dr. Barry Eppley
World-Renowned Plastic Surgeon