Facial reshaping with alloplastic implants is a dynamic and growing area of facial plastic surgery. Driven by the recent increasing demand for injectable synthetic fillers and fat, facial implants offer a long-term solution for facial contouring that includes rejuvenation, congenital or traumatic deformities, or aesthetic facial reshaping for enhanced facial convexity or refinement. However, the goal of temporary fillers and autologous fat grafting is to primarily augment the facial soft-tissue rather than the skeletal foundation. Facial implant augmentation highlights or enhances the facial bone contours and their various convexities. While injectable fillers and fat for facial augmentation has its benefits, it is not directly comparable to the push of more firm implants off of a bone surface.
Augmentation of the lower face by chin implants has a long history and remains as the initial and still most commonly performed aesthetic facial bone augmentation procedure. But the chin represents only one third of the surface area of the entire jawline that can be augmented. Aesthetic appreciation for the rest of the jawline, primarily the jaw angle areas, has come into focus more recently as an important part of an attractive and youthful face for both men and women.
While jaw angle implants have been commercially available for almost twenty five years, they have largely been neglected both in clinical practices and the medical literature. Newer jaw angle implant styles, a better understanding of the anatomy of the jaw angle region and improvement in surgical techniques allows this type of aesthetic jaw implant to be more successfully used today.
Jaw Angle Aesthetics
The value of a defined and more prominent jaw angle has long been recognized as an attractive male facial feature. By definition a strong male jawline includes a good chin and visible jaw angles and a smooth connection between them. Unlike the chin, where a quantitative assessment of its desired projection and vertical length has long been established, no such specific numerical measurements exist for the jaw angle as it is not a pure profile structure. It is a visible facial landmark that is bounded by the preauricular region in front of it, the submandibular tissues beneath and the retroauricular fossa posteriorly.
But some aesthetic standards are known and certain general facial proportional criteria have been described. A good jaw angle has been defined as one that sits well below the ear, looks long and low in profile and has an angle less than 105 degrees. In the front view its bigonial width should be equal to bitemporal width and just slightly less than bizygomatic width. The soft tissue gonion should be distinctly more lateral than the lateral tissue plane of the neck. And in profile there should be adequate ramus height and a distinct body to ramus transition.
A more recent study has looked critically at desired male jaw angle aesthetics based on survey results and quantitative measurements. Their findings were that the ideal intergonial width in men approximates the inter-zygomatic width. The inclination of the jawline in the frontal view is parallel to a line extending from the lateral canthus to the ipsilateral ala. The jaw angle should ideally be at the height of the oral commissure in the frontal view and no lower than the lower lip border. The gonial angle (formed by the intersection of the posterior and inferior ramus borders) is ideally at 130 degrees. The angle between the posterior mandibular border and Frankfort horizontal should measure 65 to 75 degrees.
While this study establishes some guidelines for jaw angle shapes for men, no such information for women exists or has been similarly studied. It has only been more recent that the aesthetic value of the jaw angles in women has become more significant. This can readily be appreciated by simply looking at some prominent young female news anchors and celebrities as well as women in commercials and ads. The value of a well defined female jawline is an unmistakable presence. The ideal female jaw angle shape and aesthetic goals are, in my experience, somewhat different from men and primarily focus on less jaw angle width. The jaw angle is more defined although not necessarily large. A smooth jawline between the chin and angles is essential.
In the end, however, patients may want jaw angle augmentation that may or may not fall within these aesthetic standards. This is where the role of preoperative computer imaging is critical as every patient has their own view of what looks good on them..
Dr Barry Eppley