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The male face typically has more prominent bone development than a female. The seven points of the face (chin, jaw angles, cheeks and brow bones) are more visible in men because these bony areas have undergone more development. There are other facial features that differentiate men from women (e.g., nose) but these skeletal landmarks serve as the guide in male masculinization surgery.

Whether it is for the male that needs a more major change due to skeletal underdevelopment or for the male that has a good bone structure and merely wants it enhanced, the five corner approach of cheek and jawline augmentation can be considered the basic male masculinization surgery. In some men standard cheek, chin and jaw angle implants may suffice to make these skeletal corners more evident.

But to achieve the most effective and reliable result, custom cheek and jawline implants offer results that are usually more significant than standard implants.This is because they are not only made for the individual patient but also because they cover more bony surface area for a connected and linear look.

The custom jawline implant has been used extensively to give men a more defined jaw appearance. Just because it is a custom implant does not necessarily mean it is big or the patient wants a large lower facial appearance. Some do, of course, but an equal number if not more just want a more visible and defined chin and jawline which creates a clear separation between the face and the neck from one side to the other.

While jawline implant designs are fairly well established, cheek implant designs can appear harder to create. The first part of the design looks at whether one needs an undereye (infraorbital) extension or not. Beside having an implant footprint that becomes more horizontal, it also changes the surgical placement. Custom cheek implants can be inserted through an intraoral approach while most infraorbital-malar implants are best put in through a lower eyelid incision.

Most custom male cheek implants have some amount of zygomatic arch extension. But the most critical component of their design is in ‘turning the corner around the main zygomatic body. This part of the design relies heavily on the shape and thickness of the Ogee curve as seen in the oblique view. The Ogee curve is crucial in creating a high cheekbone look which almost all men prefer as opposed to a lower more anterior apple cheek look which is for females.

Custom cheek and jawline implants have the most profound capability of augmenting the five skeletal corners of the mid- and lower face for a masculinizing effect. There is an almost infinite number of combinations of shapes and thicknesses of these implant-covered corners  which must be determined for each individual patient for which there is no absolute science in how to do so. (although there are many learned guidelines) With four of the five incisions needed to place them done from inside the mouth (one small submental skin incision), such a facial effect can be created in an almost scar free manner.

Dr. Barry Eppley

Indianapolis, Indiana

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