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Background: V line surgery is a now well known lower jaw reshaping procedure to help slim the lower face. In its original and still most commonly used technique, a vertical amputation (oblique ostectomy) of the lower jaw is done from the jaw angles forward to the anterior body of the mandible. This is then combined with t-shaped chin osteotomies that almost always have a narrowing effect combined with various horizontal and vertical dimensional changes.

While V line surgery can be very effective at making the lower face slimmer and more shapely, it can have adverse aesthetic effects. This can include soft tissue sagging from loss of bone support, over resection of bone that creates too dramatic of a change and inability to adapt to the new facial appearance even if others see it as an acceptance outcome.

In any form of reversal of V line surgery it is mainly about lower jawbone restoration. In most cases there is really no way to reliably do so other than a custom implant design. Re-expanding most of the jawbone contours that have been removed, doing it in a symmetric and bilateral fashion and achieving the type of change the patient desires (subtotal vs total reversal) requires a computer design approach.

Case Study: This female underwent v line surgery in Korea in an effort to aline her lower face. It ended up as a severely overdone result which gave her a very short lower facial appearance and soft tissue sag. It is an example of a technically well performed surgery…just not appropriate in its extent for the patient’s original naturally smaller lower jaw shape.

A custom jawline implant was designed to partially reverse the effects of the original one removal surgery. One has to presume that there was a reason for the original surgery so the goal was a subtotal reversal rather than a complete reversal implant design. Without an original preoperative 3D CT scan prior to the v line surgery it is impossible to know exactly what would be total or partial bone restoration. But it would be fair to say that implant thickness of 3mms or so would be less than the original bone removal knowing well how that surgery is performed. (v line surgery can almost never be just a small amount of bone removal in the jaw angle area based on an intraoral surgical access)

Because of the numerous inherent asymmetries and irregularities of the jawline bone from v line surgery, only a custom implant design can create a smooth jawline edge from angle to chin.

Under general anesthesia and through an external small submental incision combined with posterior intraoral cheek incisions, the jawline implant was placed in a front to back technique as a single piece intact implant.

Her six months results showed a more proportionate lower facial appearance with better chin projection, some restoration of the jaw angles and a more evident and smooth jawline appearance. It created a more proportionate lower third of the face while also keeping a slim lower facial shape.

V line surgery reversal can be difficult, if not impossible. to adequately correct by any method other than an implant restoration along the entire jawline. These smaller and more petite jawline implants (usually in the 6 to 8cc volume range) 

Case Highlights:

1) V line surgery runs the risk of either being overdone, poor patient selection or patient’s unacceptance of their new facial appearance.

2) Because much of V line surgery involves bone removal, partial or complete jawline restoration requires a custom implant approach. 

3) The design of a custom jawline implant after V line surgery is aided by preoperative x-rays of the original bone shape although this is not always available. 

Dr. Barry Eppley

Indianapolis, Indiana

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