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Background: The custom jawline implant is the most complete method of lower facial reshaping due to its 3D expansion effects. Many patients that present for such lower jaw augmentation have a prior history of more limited standard implants for initial lower facial reshaping. Most commonly it is a chin implant that has provided a positive benefit and now the patient seeks more of an overall jaw result. Or the chin  has created an unsatisfactory aesthetic result and the patient now realizes a custom implant approach would be better. 

Whatever the chin implant result it provides valuable information for a custom jawline implant design. By virtue of its indwelling location and known external effects important dimensional implant design knowledge is gained. Does the new chin shape need more horizontal projection, is vertical lengthening of any benefit and does the chin need to be wider, rounder or more of square shape? While how to design the rest of the jawline implant behind it does not have the benefit of a known implant effect the chin part provides a good start.

One of benefits of a custom jawline implant in that expanding the lower third of the face can help to partially change a rounder facial shape into a less round one. Notice that I did not say a rounder facial shape can be changed into a square or much leaner looking face. Such dramatic facial changes are virtually impossible to achieve no matter what procedures are done.

Case Study: This male had a prior history of a square chin implant to provide a chin augmentation of more horizontal and vertical length as well as the hope of a square chin appearance. Despite the implant having good position it is not designed to add vertical length and, in when placing it that way, make its wings go way above the jawline.

In addition the standard square chin implant is fundamentally flawed in its design. It was designed with the premise that chin width is what gives a square chin appearance. All it really does is make the chin wider not square and a part of the widened implant does not even sit on the bone. 

A custom jawline implant was designed that more effectively lengthened the chin, added a little more projection and made it square. The jawline behind was lengthened back to the jaw angles.

To best see the difference between the original square chin implant and the effects of the new jawline implant an overlay method is used.

After uncomplicated surgical removal of the existing chin implant and replacement with the jawline implant.

When seen 4 months postop, his results show better chin and jawline definition and partial derounding of his face.

This case illustrates two key points: 1) to make a square chin effect the squareness of the implant design is what is important not width, and 2) lower facial lengthening improves a round face but rarely provides the ideal leaner more sculpted face that patient’s desire. The thickness of the soft tissues is the limiting factor which is very hard to completely overcome.

Case Highlights:

1) Many custom jawline implants have indwelling chin implants which provide some insights into a new implant design.

2) To make a square chin shape in a a custom jawline implant it takes an exaggerated square chin shape.

3) A custom jawline implant helps deround a face by adding vertical lower facial length and width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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