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Background: Augmenting the entire jawline in a smooth and continuous fashion provides the most comprehensive and significant result in lower facial reshaping. It bypasses anything standard chin and jaw angle implants can do with their three corner spot augmentation approach. This effect is more than just about dimensions and as much about surface coverage.

While the custom jawline implants have some obvious and serious aesthetic advantages when seen in designs on 3D CT scans, what is not obvious and just as important is how is it going to be placed. It is one thing to look at it on a skeletal model but such large implants are unprecedented when it comes to surgical insertion and placement. Despite what they can aesthetically do unattractive large incisions/scars or high risks of permanent nerve injuries are not acceptable.

The key to such implant placement is two-fold; three small incisions and the flexibility of the implant to pass through them. For men it is almost always preferred to have a small submental skin incision combined with intraoral incisions. Ideally the implant can be passed through the external skin incision and positioned at the jaw angles through the intraoral incisions. Because the implant can only be partially seen in limited amounts through the incisions, ensuring its placement on the bone as desired requires aids built into the design to do so.

Case Study:  This young male desired total jawline augmentation with moderate horizontal chin projection and vertical jaw angle lengthening for his developmental short lower jaw with a high mandibular plane angle. Using his 3D CT scan a jawline implant was designed that achieved his jaw augmentation objectives. His goals were relatively modest and he realized that he was not going to have a model jawline look after surgery. He had prior infraorbital rim implants which is seen in his scan.

In his implant design several very important design elements were added to aid midline and symmetric placement. (A = chin midline marker, B = jaw angle orientation tabs along external oblique line, C = internal jaw angle wedges for folding)

Under general anesthesia a three incisional placement technique was used. (submental skin and bilateral intraoral posterior vestibular mucosal incisions) The submental incision is used for implant introduction and pass underneath the mental nerves by folding the jaw angle portions onto itself. Because the implant augments the lateral and lower border of the jaw it is critical to release any ligaments along the subperiosteal dissection of which multiple ones are known to exist on the sides of the chin.

Once inserted and positioned the implant is secured to the bone with 2 screws at each triangle point. (chin and jaw angles) In many patients the immediate effect on the chin area can be appreciated.

Case Highlights:

1) Custom jawline implants have numerous elements incorporated into their design that aids in their surgical placement through limited incisions.

2) In men the submental skin approach allows small to moderate sized implants to be introduced and safely passed under the mental nerves.

3) One-piece or intact implant placement is always one of the primary surgical goals if possible.

Dr. Barry Eppley

Indianapolis, Indiana

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