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Background: The lower third of the face in men is a very important aesthetic feature. It defines both a more sculpted facial shape but is well known to crate a more masculine appearance. The historic and obvious approach to creating a more masculine face is chin augmentation. While effective it is a limited approach to lower facial augmentation as it is a ‘spot’ augmentation  of the jawline…meaning it only involves 1/3 of the total jawline. The back 2/3s of the jawline remain the same.

While there are some chin augmentation patients who only desire the frontal enhancement of the jawline, for some it is a stepping stone to seek a more complete lower facial reshaping.. Even though a chin implant only provides a limited lower facial change it is fairly straightforward to do and has a more limited recovery since it does not involve the major masticatory muscles. As a result it is not surprising that it is the first step into aesthetic facial surgery for many men.

While it becomes necessary to remove the chin implant when a custom jawline implant is made to replace it, the chin implant has value both before and during the replacement surgery. Contrary to the perception of some, the chin implant does not need to be removed before designing a custom jawline implant. The chin implant is digitally removed off of the 3D CT scan as it is not in the way of the new implant design. Not all chin implants can be digitally seen. (Silicone is best seen while Medpor is rarely seen at all) But when seen on the scan a known cause and effect  relationship exists. That helps in designing the chin portion of the jawline implant. During surgery, even when the a chin implant removal may be difficult (Medpor implants) the removal creates more than an adequate pocket in the chin area.   

Case Study: This male had a prior history of a Medpor chin implant and then a silicone chin implant overlay to provide a further augmentation effect. Despite the improvements in his chin shape he desired a wider more prominent chin and an enhanced jawline to go with it.

A custom jawline implant was designed to achieve his lower facial reshaping objectives. What was gained with the prior chin implants was the determination of  how much more forward projection and width would be beneficial. This can be seen in the overlay of the two using see through imaging.

Under general anesthesia and through his existing submental incision and two new posterior intraoral incisions, the chin implants were removed and the jawline subperiosteal pocket created. Due to the size of the jawline implant and to protect the mental nerves from injury I decided to split it into two pieces and pass it from back to front using the intraoral incision as the point of implant entrance. This ensure that the biggest or widest part of the implant stays behind the location of the mental nerves.

His jawline implant result seen years later shows a significant transformation from his naturally genetically determined lower facial shape. Such lower facial changes can take a younger softer facial shape into a stronger more masculine appearance…provided that is one’s goal.

Case Highlights:

1) A significant percent of patients seeking a wrap around jawline implant have a prior history of chin implant augmentations.

2) The existing chin implant(s) provide a good guide as to what the dimensions for the jawline implant should be in the chin area.

3) In larger custom jawline implants a split implant technique can be used for its placement.

Dr. Barry Eppley

Indianapolis, Indiana

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