Background: Facial asymmetry is common and not surprising given the complex embryologic development of the face. It occurs in a tremendously diverse range of presentations of which the vast majority causes more aesthetic concerns than functional issues. While it is commonly said that every face has some degree of asymmetry and this is normal that does not mean that those so affected feel that it is irrelevant or adds to their facial attractiveness.
One of the most common forms of facial asymmetry affects that of the lower third of the face and is a direct result of some degree of growth differences between the two sides of the lower jaw. I choose to define aesthetic facial asymmetry as when differences between the two sides of the lower face is not associated with a malocclusion or any lower jaw movement restrictions. Such lower facial asymmetries are almost always caused any bony differences although there is some degree of overlying soft tissue differences as well.
Lower facial asymmetries can be categories into two types based on whether a chin asymmetry is present. When chin asymmetry exists there is bilateral jawline asymmetries as well. When the chin is midline the bony asymmetry only exists on one side.
Case Study: This female was bothered by a right lower facial asymmetry. She had a midline chin position. Using her 3D CT scan a width deficiency could be seen on the right jawline from the corner of the chin back to the jaw angle. A right custom jawline implant was designed by making a mirror image of the left side to the deficient right jawline. The volume of the designed implant was 4.5ccs. The maximal width of the implant was 4.5mm at the jaw angle area.
Under general anesthesia and through a completely intraoral approach (two incisions), the custom right jawline implant was placed and secured with titanium screws.
Aesthetic jawline asymmetries are not uncommon. While the tendency is to simply pull an implant off the shelf and eyeball its dimensions and placement this approach is more likely than not to just create a different form of the jaw asymmetry. Conversely fat injections are another treatment option for jaw asymmetries and it has merit. (simplicity, minimally invasive) But beyond how well the fat may survive there is a risk of creating a rounder/fuller/indistinct look. A custom jawline implant provides the definitive treatment for what the actual primary problem is…a bony deficiency.
Case Highlights:
1) Aesthetic jaw asymmetry can occur in isolation but is more commonly seen as a component of a larger facial asymmetry.
2) Jaw asymmetry is typically an issue of underdevelopment or deficiency on one side, with or without chin asymmetry.
3) A 3D CT scan is the best method to define the extent of the jaw asymmetry and design a custom implant to augment it.
Dr. Barry Eppley
Indianapolis, Indiana