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Injectable fillers of various types are widely used today to create enhanced facial volumes. They can specifically be used to enhance the facial skeletal features of the brow bones, nose, cheek, chin and jawline. While such facial bone augmentation results are highly dependent on the type of filler used, the volume placed and the skill of the injector, effective facial enhancement changes can be achieved.

As effective as injectable fillers may be for most patients they are often not a lifelong treatment strategy. The economics of placing larger filler volumes in the face and having to repeat it to maintain the effects will be limiting for most patients. The nature evolution is to seek a permanent solution by using surgically placed implants if the desired effect can be reasonably achieved. 

The largest example of facial filler augmentation is in the jawline. It takes a fair amount of filler for each jaw angle/jawline and the most commonly used Radiesse. The G prime force of Radiesse provides a good push on the overlying soft tissues. It is also the only injectable filler that can be seen radiographically due to its calcium hydroxyapatite component of it. I have seen it many times in patients the present for custom jawline implants as well as other types of facial implants most notably that of the cheeks.

When a patient has a good jawline effect from their injected Radiesse that can serve as a guide as to how to design the jawline implant. It is a bit challenging in that regard as the Radiesse is in the soft tissues and the jawline implant is on the bone. But nonetheless it does provide a general guide. It is also important to calculate the filler volume which can be done from the 3D CT scan. That provides another useful piece of design information although almost any size of a custom jawline implant will have much more volume than the amount of filler present. This is because a greater volumetric effect is needed when the push comes from the bone than when the push is closer to the skin as occurs with filler.

Unlike filler a custom jawline implant is far more likely to create a greater presence of jaw angle or a more square chin. A harder material has a greater capability to create angles and bony definition.

Even when patients want to graduate from fillers to implants, the filler effort was not wasted. The patient learns whether the general augmentation effect is desired and develops a feel for how much they want as well as the exact location of those jawline changes.

Dr. Barry Eppley

Indianapolis, Indiana

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