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Background: Well defined and angular facial features are desired by many men. Some men have it naturally due to their thinner faces and good bone structure. Others achieve it by photographic manipulation. Historic surgical efforts to create it have relied on traditional chin and cheek implants and buccal lipectomies, which help some, but often fall substantially short of the desired facial reshaping outcome.

The more effective and contemporary approach to facial masculinization almost always involves custom implants. Augmenting the length of the cheek (which means the zygomatic arch) as well as expanding all the external circumferential contours of the jawline is what it takes to create improved definition. ‘Spot’ augmentation of the cheek and jawline corners by traditional implants is by comparison understandably creates a more limited and unconnected effect.

Unike custom facial implants which can cover broad surface areas of the bones, facial defatting is much more limited. The goal with defatting is to thin out the face between the cheek and jawline, to create a concave profile between the enhanced skeletal convexities. Traditional defatting means buccal lipectomies which only have a limited defatting effect restricted to right under the cheekbone. This is why additional small cannula fat removal of the surrounding aubcutaneous facial tissues is a helpful addition. How effective such defatting efforts are depends on the natural tissue thicknesses one has.

Case Study:  This young male desired an overall facial masculinization effect. He had a prior history of bimaxillary orthognathic surgery which improved his bite but did not create the desired facial improvements. Using his 3D CT scan custom infraorbital-malar implants were designed fora high cheek augmentation looks well as to treat his undereye hollows. The custom jawline implant was designed to primarily drop the high jaw angles down and then make a smooth connection forward around the chin.

Under general anesthesia the custom jawline implant was placed through a combined external submental incision with paired intraoral incisions. It was able to be placed through as it as designed as an intact one-piece implant due to the flexibility of the jaw angles in a front to back insertion technique. The custom infraorbital-cheek implants were placed through lower eyelid incisions. Buccal lipectomies and perioral liposuction was done through intraoral incisions.

Facial masculinization is a combination of improving skeletal convexities and bony angles. Custom implants provide the mid- and lower face skeletal enhancements. Defatting techniques, though limited, have a complementary effect.

Case Highlights:

1) Masculinizing the male face typically consists of jawline and cheek augmentation combined with facial defatting.

2) Custom cheek and jawline implants are the best approach for facial masculinization.

3) How successful implants and defatting are at creating the desired facial definition is highly influenced by the natural thickness of the tissues.

Dr. Barry Eppley

Indianapolis, Indiana

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