Background: Male facial augmentation focuses on augmenting the five corners of the face, the cheek, chin and jaw angles. These are all flat to convex surface which are at the ideal locations to provide the most visible external effects. All of these areas can be augmented individually or in any number of combinations based open patient’s choice. The most significant effects, of course, comes from augmenting all five areas during one surgery.
Historically such five corner facial augmentations have been done using standard implants. While that is still occasionally done it is fraught with the increase risk of implant malpositions, given that there are five of them that have no connection to each other. Meaning the placement of one of the implants does not provide any guidance as to the placement of the others. This risk along with the inability to precisely control any implant dimensions has led to the more contemporary use of custom implants.
With custom implants the concept changes from a five corner spot approach to the concept of ‘three horizontal line’ facial augmentation concept. The entire wrap around jawline is the long lower horizontal line and the infraorbital-malar midface areas represents two paired smaller horizontal lines. The concept of the line vs spot augmentation is that custom implants provide greater surface areas of bone coverage with more pronounced facial effects through volume displacements.
Case Study: This male had a prior history of double jaw surgery and a bony genioplasty. He desired a smoother and more defined jawline as well as a stronger cheekbone appearance. Improved facial definition is always more challenging in thicker tissue faces. His 3D CT scan showed the non-smooth jawline from the chin to the jaw angles.
A custom jawline implant was designed to smooth out his jawline irregularities as well as add augmentation to the chin and jaw angles. To complement the lower third of the face custom infraorbital-malarn (IOM) implants were designed to augment the upper midface above the leFort I level.
Under general anesthesia the custom jawline implant was placed through a submental skin and bilateral intraoral incisions. The custom IOM implants were placed through lower eyelid incisions. Buccal lipectomies were also performed to help decrease his fuller soft tissue cheeks.
At his request a uvulectomy (not a UPPP) was performed to remove a low hanging uvula which irritated his tongue when sleeping.
When seen nearly one years later the improvement in his overall facial shape was evident but looked perfectly natural.
Key Points:
- 1) Custom IOM and jawline implants are the most common multi-area facial augmentation surgery.
2) Patients who have undergone double jaw surgery not uncommonly progress to custom facial implants to optimize their facial definition and projection.
3) How well the effects of the custom facial implants are seen is highly influenced by the thickness of the patient’s soft tissues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon