Background: Soft tissue contractures of the face cause a variety of deformities. Even with normal underlying bone structures, loss of overlying soft tissue volume and shape can make the face appear deficient and distorted. This is most classically illustrated by burn patients who suffer the greatest amounts of soft tissue loss and deformity when suffering extensive burns to the face. But there are a variety of other diseases and medical conditions that can also cause soft tissue facial contractures.
The jawline is one of the most notable features of the lower face as it creates a clear separation of the face from the neck. Also because it is the only bone that moves on the face, its projecting prominence helps create a distinct facial profile. A more evident lower jawline and a nicely shaped chin prominence is valued as part of a proportionate and attractive shape. Distortion of its overlying soft tissue along the bony jawline can create a distinct degree of distortion of its form including the anterior projecting chin and lips.
Case Study: This 46 year female presented with an overall facial deformity caused by a rare medical condition with extensive soft tissue deformities and scars. She had been through dozens of soft tissue procedures of the face, through excision and reconstruction, that led to her present facial state.
She subsequently underwent a variety of reconstructive procedures including injectable fat grafting, dermal-fat grafts, lip reconstructions and an extended custom chin implant to augment the chin and the jawline behind it. The implant was designed from a 3D CT scan of the patient.
The re-establishment of facial volume from contracture and volume loss can be aided by augmentation of the bone beneath it. While this is of value over any of the bony prominences of the face, the extent of the surface area of the jawline makes it most useful in this boundary area between the face and the neck. Such a custom chin implant serves a tissue expander to stretch out the contracted overlying soft tissues.
Highlights:
- Chin augmentation can include the entire length of the body of the mandible back to the angle with a custom designed chin implant
- Adding volume and structure along the jawline can expand the overlying soft tissue in cases of contracture and deformity.
3) Adequate chin projection and a straighter jawline improve facial proportions.
Dr. Barry Eppley
Indianapolis, Indiana