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Of all the facial areas that can be augmented by implants, the jaw angle is the most treacherous. Between getting the desired jaw angle shape and avoiding a soft tissue deficiency over it remains the unique challenges in any form of isolated jaw angle or custom jawline implant surgery.

Excessive lateral or posterior flare is one type of jaw angle implant deformity. Another type of augmented jaw angle deformity is when an implant extension exceeds the ability of the masseter muscle and overlying soft tissues to adequately cover it. This creates a concave contour deformity over the intersection of the posterior and inferior augmented jaw angle region.

Treating an excessive jaw angle implant shape or lack of adequate soft tissue coverage can be a difficult problem to manage. From an intraoral approach the jaw angle area is the furtherest point from the incision. This makes modifying the shape of a jaw angle implant or custom jawline implant very difficult unless implant extraction and/or replacement is done. An alternative approach is the direct jaw angle incision. A small 1 cm incision can be made at the very back end of the jaw angle. This is a perfectly safe zone for such an incision since the marginal mandibular branch of the facial nerve runs below it.

Through this small incision a custom jawline implant that has a too prominent shape either laterally, inferiorly or posteriorly can be reduced under direct vision. This is done by shaving with a scalpel.

A soft tissue contour deformity of the jaw angle region can be similarly treated though this incisional approach. I have never found that trying to relocate the masseter muscle to be particularly successful. A more effective approach is to either augment the soft tissue at the subcutaneous level or with an overlay implant. Either approach camouflages the muscle/soft tissue deficiency by adding volume. The key to the overlay implant is to get it high enough on the underlying implant away from the jaw angle point. It is secured with a horizontal mattress suture to the underlying implant.

The direct jaw angle incision, besides providing safe access, can also be done under local anesthesia or IV sedation. It heals in an inconspicuous manner that is not visible to the patient as well as to others.

Dr. Barry Eppley

Indianapolis, Indiana

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