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Background: Facial aging is associated with a wide range of undesired effects at all facial levels. Besides the eye area the most common area of facial aging concerns to most patients is the neck and the jawline. As the facial tissues fall and start to ‘slide off of the face’ they drape over the jawline. This is the source of the jowls as the soft tissues descend over the jawline.

But one interesting observation is that the jowls always stop at a certain point behind the chin, as if hitting up against a fixed structure. And indeed that is exactly what is happening which is why the jowls do not continue to overtake the more anterior chin. This fixed anatomic structure is the osteocutaneous ligaments along the jawline behind the chin. This soft tissue fixation contributes to the classic prejowl depression or indentation that is seen in many facial aging patients.

In facelift surgery the pull back and repositioning of the fallen soft tissues may restore a smooth jawline from the chin back to the jaw angles. But this does not occur in all patients particularly those with some degree of chin deficiencies. The osteocutaneous ligaments contribute to the prejowl indentation for which the addition of a chin-prejowl or prejowl implant at the time of a facelift can help smooth out the jawline.

Case Study:  This middle-aged female presented with undesired jowl and neck change consistent with the typical signs of aging. She also had a moderate chin deficiency that lacked ideal horizontal projection.

Under general anesthesia a modified lower facelift was performed. Through the submental incision used for midline neck work a small chin-prejowl implant was placed to provide increased chin projection and fill out the prejowl indentation.

Her early result shows the typical improvements from a facelift along the neck and jawline with effacement of the prejowl depression. The chin-prejowl implant helped to smooth out the jawline through the placement of its posterior extensions. The key in women is to make sure that it does not make the chin too wide in the front view.

Case Highlights:

1) Facial aging is commonly associated with jowls and a prejowl depression behind the chin.

2) A facelift will eliminate the jowls but will not always eliminate the prejowl indentation along the jawline.

3) With a concomitant chin deficiency, a chin-prejowl implant along with the lower facelift with help smooth out the jawline.

Dr. Barry Eppley

Indianapolis, Indiana

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