Background: Custom facial implants have understandably gone through an evolution that past quarter century…like all technology has. In the 1970s and 1980s, the concept of a custom facial implant was one were the few standard implants that existed was modified intraoperatively by handcarving. Or a solid block of material was hand craved into a specific shape during surgery.
With the introduction of 3D CT scanning in the 1990s, facial models could be printed out of the lower jaw or the entire face. From these skeletal models custom implants surgeons created by a wax, clay or acrylic design by hand. This design was then sent to the manufacturer were the custom implant was created by taking an impression of it from which an implant was created from a poured mold,
Today custom facial implants are done all by computer design from a 3D CT scan. A method which makes an implant that is far more dimensionally accurate, offers corrections for existing bony asymmetries and often covers much larger surface area for greater amounts of bony augmentation.
Case Study: This 60ish year-old male has a prior history of a custom chin implant and standard cheek implants from 1997. While providing a great aesthetic benefit since that time he decided to improve upon existing implant for a complete jawline augmentation effect. A current 3D CT scan showed a custom chin implant in place that was quite considerable in size for its time.
Using the 3D CT scan a total jawline implant was designed that offered more horizontal and vertical chin projection as well as coverage of the jaw angles with vertical lengthening of the entire jawline.
Under general anesthesia his existing submental incision was opened and the old custom chin implant removed. Visual comparison of it to the new custom jawline implant demonstrates how far the concept of custom facial implant designs has come.
Combining the existing submental skin incision with intraoral posterior vestibular incisions permitted the placement of the custom jawline implant as a single piece in a front to back insertion technique.
It is not rare the patients ‘graduate’ from a chin implant to a more complete jawline implant. This case is unique in that the patient will have experienced at two different points of time the custom facial implant technology of the time.
Case Highlights:
1) The concept of a ‘custom jaw implant’ decades ago was a hand carved implant design made from wax on a skeletal model.
2) Today’s custom implants made from a 3D CT scan cover a lot more jawbone surface area in a more precise design.
3) An old custom chin implant helps in both the new design and perspiring the tissue for a more aesthetically complete jaw augmentation effect.
Dr. Barry Eppley
Indianapolis, Indiana