Background: The original aesthetic lower facial reshaping procedure is chin augmentation. Whether it was done with an implant or a sliding genioplasty, this was the first skeletal facial augmentation procedure (excluding the nose) that changed the basic structure of the face. Whether done in isolation typically in younger patients or combined with facial rejuvenation (e.g., facelift) procedures in older patients, it has served as a foundational plastic surgery procedure that is widely known and performed.
As an extension of augmentation of the front part of the jaw, it naturally led to efforts at augmentation of the back of the jaw (jaw angles) as a more complete jawline enhancement effect. Jaw angle implants have been around for several decades but their implementation and use is dramatically different from chin implants. As common as chin implants are, jaw angle implants are far less performed for a variety of reasons. Patient demand is less, they are technically more challenging to perform, and the comfort zone of most plastic surgeons is far lower with them. But with new jaw angle implant designs and more educational opportunities available both them, both demand and surgeon familiarity is increasing.
Because of increasing patient demand and awareness, an overall jawline or lower facial reshaping change is becoming requested. To no surprise many chin deficiencies are associated with overall structural jaw weakness. Not infrequently the more complete jawline effect is sought by someone who has already had a chin augmentation procedure. Whether it be a chin implant or sliding genioplasty they have seen the initial benefits, or are desiring even further benefits over what they have initially achieved, and now seek a more complete jaw augmentation. Whether it is inadvertent or were using the chin augmentation as an initial foray into aesthetic surgery, they are now ready to ‘graduate’ into the full lower facial reshaping benefits.
Case Study: This male had a history of a prior sliding genioplasty (9mm horizontal advancement) which was uncomplicated and offered good aesthetic improvement. Thereafter he sought further horizontal chin increase as well as a more complete jawline augmentation effect.
Using his 3D CT scan a wrap around jawline implant was designed. In creating such designs there is always aesthetic judgments about what dimensional numbers will come close to creating the desired effect. With an existing sliding genioplasty in place this provides a good basis for knowing how to establish the chin dimensions. (projection, height and width) While this does not necessarily tell how to design the remaining two-thirds of the implant, knowing at least one-third is better than no thirds!
The imprint of the sliding genioplasty plate could be seen on the back side of the jawline implant design. The internal wedges on the inside of the jaw angle portion are to aid a front to back one-piece implant placement technique.
Under general anesthesia and through a three incision method the custom jawline implant was successfully placed and secured.
Of all custom jawline implant patients that I have seen over the past ten years, over half have already had prior jaw surgery. This could include chin implants, sliding genioplasties, jaw angle implants, jaw angle and V-line jaw reductions, orthognathic surgery and even previous custom jawline implants. For some of these patients getting a custom jawline implant is an aesthetic graduation from a prior more limited procedure. For others they have such an implant to jawline deficiencies left behind from the prior surgery.
Case Highlights:
1) Some form of chin augmentation, such as a sliding genioplasty, is often an unknown first step towards a custom jawline implant.
2) The changes created by the initial sliding genioplasty provides invaluable insight into how to design 1/3 of the custom jawline implant.
3) The sliding genioplasty plate can often be used as an implant positioning guide for the overlay jawline implant in the chin area.
Dr. Barry Eppley
Indianapolis, Indiana