Custom jawline implants offer the most effective method to reshape/augment the lower face. Covering the entire lower jaw from jaw angle to jaw angle they provide the largest single implant that can be done below the forehead. Its connectivity is one of its benefits in jawline augmentation.
But the size and length of a custom jawline implant is also a drawback when it comes to its placement. To place it intact as a one-piece unit as it was designed it would have to be able to be inserted and properly positioned through the three standard incisions that are typically used. (one anterior -intraoral or submental – and two integral posterior vestibular incisions) The key to placing it intact is to use a front to back insertion method which is only possible because the implant is flexible. Also it is necessary that the jaw angle part of the implant, which is always the largest part of the implant, be able to be folded so it can pass under the mental nerve without risk of injury.
But many custom jaw angle implants have substantial jaw angle components that do not permit them to be passed safely under the mental nerve. In these cases the implant must be placed in a back to front technique where it is necessary to separate it into two pieces. (midline split with two half)
One technique for the midline split of a custom jawline implant is to make a geometric or jigsaw interlocking type of cut. This is done with a scalp blade in a squared off pattern. This allows the most precise re-assembly of the midline of the implant with the least risk of distortion.
Once the implant is passed in two pieces from back to front and reunited, it is secured together and to the bone with multiple microscrews. This brings it back together as if it had never been separated.
Placing a custom jawline implant can seem daunting to the surgeon given the limited access to do so. But temporarily making it into two smaller implants and resembling it inside the patient enables placement with less risk of injury to surrounding vital structures.
Dr. Barry Eppley
Indianapolis, Indiana