The custom jawline implant provides the most complete 3D changes in shape to the lower jaw. Often called the wrap around jaw implant that is an appropriate name as it provides augmentation to the entire inferior and lateral border of the mandible. Because of its long extended shape and the curved shape of the lower jaw a three corner incisional approach is needed for placement at the chin and jaw angles.
Of the three incision options for custom jawline implant placement are either intraoral (internal) or transcutaneous. (external) At the jaw angle location the intraoral posterior vestibular incisions are usually ‘non-negotiable’. Meaning who there is an external skin approach to the jaw angles the vast majority of patients, unless they have a complicated history of prior jaw surgery, are going to always opt for the intraoral approach. It is the anterior chin incision in which the intraoral vs external approach can have some debate.
There are advantages and disadvantages with both anterior incisional access to the chin. The intraoral approach has as its main advantage the absence of an external scar. Its disadvantages are a higher risk of infection and nerve injury (numbness) as well as potentially an increased difficulty with proper implant placement. The advantages to the external skin approach are exactly the opposite of the intraoral’s disadvantages with the tradeoff of a scar. Given the disparity in the disadvantages between them the raises the question then of how significant is the submental scar.
In my extensive experience in jawline implants and in making the submental incision the key is to limit its length and protect the hair follicles during the dissection and closure. When these basic steps are done the final submental scar can look quite good particularly in beard skin.
Whether it is for the placement of a custom jawline implant or bony chin work the basic principles of making and closing the submental incision apply for as small a scar as possible.
While every incision leaves a scar the only question is how significant is it. Given the advantages of the submental incision there has to be a compelling reason to use the intraoral approach. These would be that the jawline implant is not large (10ccs size or less which gives it good flexibility), its design is for primarily a lateral and not an inferior augmentation and the size of the jaw angle component is not excessively wide or tall. (to safely fit under the mental nerve)
Dr. Barry Eppley
World-Renowned Plastic Surgeon