While injectable fillers were initially not intended to be a facial bone augmentation method, it is now commonly done. The development of injectable fillers that have higher viscosities with stronger soft tissue displacements effects have led to their use for chin, jawline, cheek, midface and brow bone augmentations. Many of these fillers have longer lasting effects due to their compositions which is an added benefit.
As a result it is not uncommon today to see patients present for jawline implants that have either had or still have in place injectable fillers. The fillers have either served as an initial test or they have done such injections numerous times before and now desire to graduate to a permanent implant method.
The prior use of injectable fillers in custom jawline implant patients has several benefits. First, it helps to determine if an augmentative change is desirable. In essence it is a reversible trial of chin or entire jaw augmentation. Even though fillers don’t have the same augmentation effect as implants, they do give a general idea of the concept. Their effects are not directly comparable as fillers are placed in the superficial soft tissues and not on the bone like implants. Being closer to the skin and softer than any implant their effects are more of a rounded fuller shape particularly around the jaw angle areas. This is best illustrated when looking at 3D CT scan of Radiesse filler placed for a jawline augmentation. Since this filler is in the subcutaneous tissues it shows how far away from the jaw bone it really is. The filler does not have distinct edges or form.
Secondly, fillers provide insight into the type or magnitude of a desired jaw augmentation effect. Where they are placed and the dimensional changes that result help guide what a custom jawline implant design should or should not be. This is particularly relevant in determining if vertical chin and jawline lengthening is needed/desired.
One typical question with fillers in jawline implant patients is should I get the fillers dissolved to prior to surgery. I generally do not advocate that fillers need to be removed prior to surgery. They do not interfere with the implant design as they can either not be seen in a 3D CT scan (Radiuses is the only fuller seen in x-rays because of its calcium composition) or can be digitally removed in the design process. They do not interfere with surgical placement of the implant as the implant is down on the bone while the fillers are up in the soft tissues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon