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Background: A custom jawline implant is the most powerful augmentation method  of the lower third of the face. Its wrap around design changes the entire jawline in an angle-chin-ange distance. In essence the entire outer cortical border of the mandible is expanded. It is not surprising that its effect is more significant than three separate ‘spot’ augmentations of the jawline.

In designing a custom jawline implant there is no mathematical formula to use to create the patient’s desired aesthetic outcome. We do not yet have the technology to create an implant design knowing what its exact external effects will be. Therefore the surgeon must create the implant’s dimensions based on experience. (and it takes a lot of implant experience to learn the many nuances of such implant design effects) But this design imprecision is not the only variable that can affect the aesthetic result. The other wild card in the outcome is the patients themselves….how will they interpret the effects? Until a patient ‘wears’ an implant for awhile even they do not how they really feel about it.

As a result it is not uncommon that a patient will want to change their jawline implant to a new design.  It will have healed perfectly and there are not obvious asymmetries to it but it will either have had an unpredicted aesthetic effect or they feel they know how to make it look even better. The following case provides such an example.

Case Study:  This middle-aged male had a custom jawline implant placed one year previously. While it provided good improvement he denied after a while how to make it look even better. He requested three specific changes; 1) a wider chin that also added some vertical length, 2) increased jaw angle width and 3) more narrow connections between the chin and the jaw angles. A helpful tool in the design process is to overlay the new design over the previous design to see the differences. (green is the previous implant and bone is the new design)

Under general anesthesia and through his existing submental and intraoral scars, the old implant was removed and the new one put in using an implant-split approach in back to front technique. The geometric midline split was brought together and secured in the midline with sutures and screws.

The current dimensional predictions of today’s custom facial implant designing ensures that some patients will not achieve the best aesthetic outcome that their soft tissue will allow. This remains not completely avoidable. But knowing what the previous implant design achieved provides major guidance as to how to make the next implant design even better.

Case Highlights:

1) It is not rare that patients replace their custom jawline implant with a new one for aesthetic reasons. (desire for further aesthetic improvements)

2) The previous jawline implant serves as an invaluable guide for how to design a new implant for an improved aesthetic outcome.

3) New larger custom jawline implants may require a midline splint approach for placement due to an established tight capsule.

Dr. Barry Eppley

Indianapolis, Indiana

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