Background
Double jaw surgery (DJS) is a common procedure performed to correct facial skeletal discrepancies. It is often indicated for obstructive sleep apnea or to enhance facial projection. While highly effective in these respects, DJS has one important limitation: it does not address facial width. For patients with naturally narrow faces, this can leave the face appearing even narrower after surgery.
When widening the facial skeleton, autologous options are limited. Injectable fillers can provide temporary volume but require substantial amounts and repeated treatments. Implants, particularly custom designs, remain the most effective and durable option. Unlike standard implants, custom implants can provide seamless, continuous augmentation along the cheeks and jawline, closely following the natural bony contours. This connected augmentation is key to achieving a balanced and natural result.
Case Study
A male patient had previously undergone successful double jaw surgery, which improved his projection but not his facial width. To address this, custom jawline and infraorbital-malar implants were designed to enhance both width and projection. His goal was a natural yet noticeably fuller facial appearance.
Under general anesthesia, a one-piece custom jawline implant was placed using a three-incision approach, while midface implants were inserted through lower eyelid incisions. Healing was uneventful, and at several months postoperatively, the patient demonstrated significant improvement in facial width and overall contour.
Discussion
The combination of DJS followed by custom facial implants is not uncommon. In my experience, approximately 20% of custom facial implant patients have undergone prior orthognathic surgery. This is not indicative of surgical failure but rather of the inherent limitations of DJS. While DJS addresses projection and alignment, it cannot significantly change facial width. For patients seeking multidimensional improvements—or correction of residual contour irregularities—custom implants provide the optimal secondary solution.
Key Points
- Double jaw surgery can leave the face appearing narrower, particularly in patients with naturally slim facial structures.
- Cheek and jaw implants are the most effective method for widening the face.
- 3D custom implant design provides predictable, natural-appearing lateral augmentation of the cheeks and jawline.
Dr. Barry Eppley
World-Renowned Plastic Surgeon