Background: One of the most powerful facial implants is the custom jawline implant. It gets its substantial effects because of its large surface area coverage as well as its critical location at the junction of the face and neck. It is becoming increasingly requested by patients and used by a growing number of patients because off its profound aesthetic effects.
While some patients request the custom jawline implant as a primary facial augmentation procedure an equal number of patients have had prior aesthetic chin and jaw surgery. One of the most common precursor surgeries is the standard chin implant. This is no surprise given the history of chin implants and their familiarity with patient and surgeon alike. The deeper issue that most surgeons still view lower facial augmentation as restricted to the anterior projection of the chin only.
Some chin implant patients are satisfied with their chin implant result and merely want a more complete jaw augmentation effect. Others were never that keen on the result and are looking for an opportunity to make a major aesthetic lower facial change. But regardless of the reason the indwelling chin implant offers valuable information when planning the custom jawline implant replacement.
Case Study: This male had a prior chin implant which provided some modest aesthetic benefit but left him wanting a more complete and effective jaw augmentation cange. His 3D CT scan showed an extended anatomic silicone chin implant of 5mms projection that was fairly well placed.
A strong and angular jawline implant was designed that added 5mms more chin projection and significant jaw angle lengthening and width addition. The implant volume was 19.5cc, a revelation of its medium-large size.
Under general anesthesia and through his submental scar the indwelling chin implant was removed. It was also necessary to remove all the bony overgrowth around the chin implant to allow for an unimpeded placement of the new jawline implant. (in green is the bone overgrowth that needs to be removed)
With the aid of additional posterior vestibular intraoral incisions to complete the subperiosteal dissection along the jawline the custom implant was inserted as a one piece implant rom the submental incision and positioned back along the jaw angles. The chin part of the implant was secured with a single 15mm midline screw. The jaw angle portions of the implant with small percutaneous screws secured to the bone.
At four months postop the change in the appearance of the lower face was apparent with a larger and more defined jawline. in large part due to the lowering of the high jaw angles and connecting it to the chin.
In side profile the high mandibular plane angle has bee corrected by the implant design.
In many jawline implant designs they can seem too angular in shape and patients undestandably fear they will look so on the outside. But the thickness of the soft tissues as a dampening effect on the design so this does not actually occur. For this reason it is sometimes important to exaggerate an implant design to achieve a desired effect.
Key Points:
1) About 1/3 of patients that present for custom jawline implants have a prior history of chin surgery.
2) The existing chin implant provides useful dimensional information as to how to design the front end of the custom jawline implant.
3) The real power of the custom jawline implant is at its effects at the jaw angles and not connects to the chin.
Dr. Barry Eppley
World-Renowned Plastic Surgeon