Background: The traditional approach to total jawline augmentation has been the use of standard chin and jaw angle implants. While this ‘three-point’ approach can be effective in the properly selected patient, it is fraught with potential aesthetic sequelae such as implant asymmetries and an inability to achieve the desired jawline shape outcome. This is somewhat to be expected given that it involves the placement of three separate implants and uses implants that have a standard range of dimensional capabilities.
There is also the often encountered outcome that a patient will have a pretty good aesthetic outcome form their standard chin and jaw angle implants but desires some change in the resultant jawline shape or adjustment of some degree of asymmetry.
As a result both patient and surgeon have to accept that jawline augmentation revision using standard implants (or even with custom implants) is a very real possibility and is not rare. No one knows the actual statistics since so few surgeons do this kind of aesthetic jawline work in any quantity to really know an accurate answer. But in my experience the revision rates are at least 33% using three standard chin and jaw angle implants, whether it is an acute issue or one that is broached years later to seek an improved jawline result.
Case Study: This young male initially had jawline augmentation done using standard Medpor chin and jaw angle implants. By 3D CT assessment the implants were all fairly well placed. (it is important to understand that every standard facial implant placement is never perfect and perfect symmetry between bilateral facial implants is never achieved….I have yet to see it in looking at many hundreds of postop 3D CT scans done from surgeons all over the world)
While having a good jawline shape improvement, he sought further aesthetic changes beyond what the standard implants had achieved. Using the amount of jawline augmentation achieved by the indwelling Medpor implants, a connected custom jawline implant was designed.
Under general ansthesia and using his existing intraoral and submental skin incisions, his Medpor chin and jaw angle implants were removed in their entirety including all screws used to secure them to the bone. The size of new custom jawline implant mandated that a geometric split techniques was done placing it in a back to front technique.
Medpor chin and jaw angle implants are difficult to remove but it can be done. Having removed hundreds of them I can say that I have never seen any bony ingrowth into them, it does develop a highly adherent soft tissue capsule around and under it, and bony overgrowth does occur around some of its edges particularly in the ja angle areas. Such dissection does allow for the new and larger solid silicone custom jawline implant to be adequately placed.
Highlights:
1)A three piece approach to total jawline augmentation can fail due to implant malpositions and a lack of connection between the three individual implants;
2) Medpor chin and jaw angle implants can be removed to allow the placement of a custom one piece jawline implant.
3) The indwelling standard chin and jaw engine implants serve as good design guidelines for the design of a custom jawline implant replacement.
Dr. Barry Eppley
Indianapolis, Indiana