Background: While the chin used to be the only part of the jawline that was augmented, such aesthetic changes are now done for the rest of the jawline as well. Standard styles of jaw angle implants exist as well as the most contemporary custom jawline implant which changes the shape of the entire jawline.
The primary dimension that is perceived and done in aesthetic jaw augmentation is in the horizontal dimension. Making the chin come further forward or the jaw angles to be wider are the typical dimensional changes done. While such changes may be adequate for many patients the horizontal dimension alone does not work for all patients. The need for a vertical dimension change is often overlooked or misdiagnosed. Part of the reason for this is that few standard chin and jaw angle implant styles incorporate that as part of the implant design. Thus surgeons think of what can be done as the implant styles that exist.
But when it comes to custom jawline implants there are far less restrictions in the shape and size of the implant designs…other than whether the soft tissues can bear the implant load. The need for some part of the jawline to have a vertical augmentation is one of the many reasons one would go the custom route over a standard implant. While developing the pocket and doing a subperiosteal release along the inferior border is a necessity for the placement of such jawline implant designs, there is also an often unappreciated aesthetic benefit that comes from vertical augmentation of the jawline.
Case Study: This make desired a jawline augmentation with the recognition that the lower third of his face was disproportionate to the rest of his face in the vertical dimension in particular. Using his 3D CT scan a custom jawline implant was designed that increased the vertical length of the jawline from the jaw angles forward to the chin.
Like many vertical lengthening jawline implants the vertical increase was greater at the jaw angles than at the chin in the patient with a truly high jaw angle position. This is the opposite of what is seen when the vertical deficiency in the jawline is greatest at the chin as opposed to the jaw angles.
Under general anesthesia and through the standard three incisional approach for jawline implants, the implant was introduced from the anterior submental incision. The placement technique involves placing one side of the long implant at a time through the very small submental incision.
But besides the insertion technique it is critical important that the tissue releases are done along the inferior border of the jawline for proper implant fit. The internal shape of the jawline implant design shows how the implant wraps around the inferior border of the jawline fora proper fit.
One of the predictable but unappreciated effects of wrap around jawline implants, particularly those that have a significant vertical lengthening effect, is their effects on the neck. Loose submental and neck tissues are picked up by the expansion effect of the increased jawline size.
1) The most common dimensional need in jawline augmentation that is often overlooked is in the vertical dimension.
2) In vertical lengthening the jawline with an implant the entire inferior border of the mandible must be released to allow the implant to fit into proper position.
3) One of the aesthetic benefits of vertical lengthening of the jawline is its neck lifting/tightening effect.
Dr. Barry Eppley
World Renowned Plastic Surgeon