One of the main motivations for men to undergo a custom jawline implant is to have stronger or more defined jaw angles. Such jaw angles, like that of the chin, is a three dimensional structure of which its width, vertical length and profile shape must be considered in the design. Many patients erroneously think that creating more defined jaw angles means that the jaw angle actually looks square or very square-like. Besides being aesthetically inaccurate such a design approach can lead to unexpected although predictable adverse aesthetic outcomes.
When designing the jaw angle area of custom jawline implants it is important to appreciate the natural bony shape of the angle area and its muscular attachments. The natural profile shape of the bony jaw angle is curvilinear and not square. Even in men with square looking jaw angles they are still curvilinear in shape. The lower the mandibular plane angle is the closer it gets to being square. But even then there is a curvilinear shape to the corner of the angle area.
With this bony jaw angle shape is the masseteric muscle attachment whose inferior extent parallels the edge of the only jaw angle. Like the bony jaw angle the muscle at this location has a curvilinear length/attachment shape. While the edge of this muscle can be elevated and become lengthened with implant extension, the muscle can not achieve a more square shape no matter what the implant does.
As a result implant designs that attempt to square out the jaw angle area as it is vertically lengthened will result in what is known as ‘implant reveal’. Some interpret this as masseteric muscle dehiscence which is somewhat similar but not exactly the same. Implant reveal is when the masseteric muscle attachments remain intact but the implant is sticking out specifically at the angle area. This is a function of the implant design not muscle dehiscence. The masseteric muscle has no ability to widen or extend back more posteriorly than it naturally does. So custom jawline implants should avoid this type of jaw angle designs and keep a more curvilinear shape in the profile view.
While some male patients insist on having a more square shape to the very end of the jaw angle area of their custom jawline implant, I urge them to avoid this implant design mistake. As it always results in the implant sticking out beyond the muscle creating a skeletonized or implant reveal look.
Dr. Barry Eppley