Background: There are numerous methods of performing aesthetic jaw augmentation. While some interpret jaw enhancement as chin augmentation that is an antiquated concept. While in the past the only known method of ‘jaw augmentation’ was a chin implant or a sliding genioplasty, jaw augmentation today means either isolated jaw angle implants, a chin procedure with jaw angle implants or a custom total jawline implant.
In the face of an adequate chin, either naturally or from a surgical procedure, jaw angle implants can complete the total jawline augmentation effect. But without any prior procedures and if the goal is a complete lower facial augmentation then the custom jawline implant is the best way to go from the beginning. It offers preoperative control of the chin and jaw angle changes, augmented the entire inferolateral border of the lower jaw and can address any asymmetries which are present.
Bit there are limits to what the dimensions of a custom jawline implant can safely accomplish which is most manifest in the chin. The tight soft tissue chin pad has a limited ability to stretch and can only tolerate so much implant without incurring a high risk of complications. This consideration becomes relevant in two specific situations; 1) when the vertical chin lengthening needed exceeds 7mms with the need of some horizontal chin augmentation effect as well, and 2) additional vertical and horizontal augmentation is desired when a chin or jawline implant already is in place. This is where the role of combining a bony genioplasty and a custom jawline implant is needed.
Case Study: This male has a prior history of a custom jawline implant placed several years previously with a successful aesthetic outcome. While it was a good result he decided that some more augmentation of the chin and the jaw angles would be an aesthetic improvement.
Because of the increased demands of the soft tissues of the chin it was decided that a bony genioplasty should be performed instead of a larger implant in the chin. Thus a bony geniopasty was done with a new custom jawline implant wrapping around it. This second jaw augmentation produced further enhancements of the entire jawline from the chin back to the jaw angles.
Like all custom facial implants, the final aesthetic target can change over time. What was once a good result may leave one wanting for more later on. Like any implant exchange/replacement there is always risk in doing so. Such risks are magnified when one already has a good result. (doesn’t matter whether one is going bigger or smaller)
Excessive implant in the chin area can be particularly problematic due to the tight and limited soft tissues at the more anterior projection area of the jawline. While osteotomies and implants seem incompatible the reality is that a bony genioplasty and custom implants for the jawline work very well with the benefits of reducing implant load through a limited but aesthetically effective procedure.
Case Highlights:
1) Jaw augmentation in some patients can be a progression of procedures until the patient achieves their maximal desired result.
2) Graduating from a custom jawline implant to a larger size design may be limited by how much change is desired at the chin.
3) When implant size increases at the chin exceed what the tissues may safely be able to tolerate it needs to be changed to a bony genioplasty combined with a jawline implant that fits around it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon