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Background: Jaw augmentation can be done by a wide variety of non-surgical and surgical methods. All injectable techniques are temporary and as either a test of the effect or as a short term approach. Implants offer a permanent method and the combined use of standard chin and jaw angle implants can be effective for some patients. But their lack of a significant connection between the three jaw corners results in some limitations of their aesthetic effects.

While the most ‘invasive’ and costly to undergo, the wrap around jawline implant always provides a superior aesthetic effect. This is due to be able to thoughtfully plan a preoperative implant design and that is augments the entire border of the lower jawline. Thus it most closely replicates what bone would do if it had developed in a more desired size and shape.

While a custom jawline implant has tremendous appeal, just because it is custom made doesn’t mean it will achieve the patient’s desired jawline size and shape goals. What the patient’s goals are must first be determined by imaging of the patient’s own face and jawline. (showing desired or ideal jawline shape pictures are  somewhat helpful but what really matters is what can be done with the actual patient’s face) After the aesthetic goals are determined the next step is what dimensions of the jawline implant design will come closest to achieving the imaged goals.

Case Study: This young male desired a jawline augmentation to take his more boyish lower facial shape to a more defined and masculine one. His jawline implant design was planned based on an interpretation of his imaged jawline augmentation goals.  

Under general anesthesia and through a three incisional approach (paired posterior intraoral and midline submental incision) the custom jawline implant was placed and secured with small titanium screws at each jaw corner) All incisions were closed with resorbable sutures.

When seen at 2 weeks after surgery he had enough resolution of his jaw swelling to make him socially passable as appearing non-surgical. (Although it takes 6 weeks for all swelling to fully resolve.

While custom facial implant designing offers many exciting possible facial changes there is no formula or playbook on how to make the implant design. Contrary to popular perception the engineers who make the design happen have no innate knowledge of the implant dimensions needed to have a desired result. They take what the surgeon tells them to do and puts those dimensions into the design. This is understandable since the design engineer has no knowledge of the patient or what their goals are. If the surgeon has not taken the effort to learn what the patient’s goals are through imaging efforts, they also will have little understanding of how to design the implant for each patient. What I do is to take the time to do imaging and from that knowledge use my extensive experience in implant design to create the seven (7)( specific dimensions that must done to create a custom jawline implant.

Case Highlights:

1) The custom wrap around jawline implant is the most effective method for jaw augmentation as it simultaneously treats all three jaw corners in a three-dimensional design..

2) There is no specific formula for how to design a good jawline implant for many specific patient, it takes aesthetic experience to know what will and will not work.

3) The main direction of placement of the jawline implant is through the submental incision with the intraoral incisions to aid in pocket development and implant placement and fixation.

Dr. Barry Eppley

Indianapolis, Indiana

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