Background: Jawline augmentation today usually refers to enhancement of its three primary aesthetic points, the chin and two jaw angles. There are a variety of standard preformed chin and jaw angle implants to achieve this effect and, with proper implant style and size, satisfactory results can be achieved.
But beyond the challenge of selecting the right implant style and size for three different bony jaw areas, there is the need to place them in the proper bony location to exert their desired external effects. The latter is often taken for granted by the patient but not by the surgeon. Placing three implants at different locations on the jawline without being able to reference one to the other due to the limitations of incisional access makes this part of the operation more difficult than it seems. This is far more challenging than placing a single chin implant or even paired cheek implants.
As a result the incidence of implant malposition and asymmetry is not all that uncommon in a three implant approach to jawline augmentation. This risk is magnified when the patient has pre-existing jaw angle bony asymmtetry which may or may not have been recognized before surgery.
Case Study: This middle-aged male had total jaw augmentation previously with a standard anatomic chin and widening jaw angle implants. While the patient recognized that his jaw was asymmetric after the surgery, his surgeon assured him the implants were in good position. A 3 D CT scan showed that the chin implant was positioned too high and to the left and the jaw angle implants were in completely different positions, neither of which was in ideal position.
Using this 3D CT scan a one-piece jawline implant was designed to correct his asymmetries. The dimensions of his existing implants (projections) served as a good guideline as to the size of the various ‘corners’ of the jawline implant.
Under general anesthesia and using an external submental skin incision combined with bilateral posterior vestibular incisions, his chin and jaw angle implants were removed. The new one-piece jawline implant was able to be inserted as the intact piece by which it was designed. His results with pictures taken years later showed good jawline/lower facial asymmetry and better chin and jaw angle projections.
There are many patients in whom standard chin and jaw angle implants work well. But it is not easy to successfully place three independent jaw implants in a perfectly symmetric fashion. Even with a lot of surgical experience it can still happen. When a three-piece jaw implant approach has not been successful, a custom jawline implant will offer improved results by its ‘one implant’ design.
Highlights:
1) Total jawline augmentation done with standard implants has a relaltively high risk of malposition/asymmetry of at least one of the implants since there are three implants used.
2) A 3D CT scan can confirm standard jawline implant positions as well as be used for a one-piece total jawline implant.
3) Indwelling implants provide dimensional guidelines in designing a custom jawline implant.
Dr. Barry Eppley
Indianapolis, Indiana