Custom jawline implants represent the most complete approach to augmenting a deficient lower third of the face. Wrapping around the entirety of the mandible they expand the inferolateral border creating a more defined jawline in a 3D dimensional fashion. Part of their success lies not only in their design but how well they are placed onto the bone. Matching the intraoperative positioning of the implant to how it was designed on the skeletal images is an integral part of a successful surgical outcome.
While the inner surface of the implant is the negative image of the bone on which it will rest, this does not assure short or long-term stability. The implant has a smooth surface as does the bone. So shifting between the two is possible and can be a reason for postoperative implant malpositioning and facial asymmetries. As a result I always use screw fixation at multiple locations of the implant.
Since most custom jawline implant use an anterior submental skin incision, this is the location of a midline chin fixation point. If it is an unspilt implant a single midline screw is used. If it is a split implant, bilateral midline chin screws are used. Posteriorly a transcutaneous approach is used to placed two screws at the jaw angles. A small nick incision is made in the skin over the jaw angles which permits a direct approach to perpendicular screw placement through the implant. (arrow in image)
Screw fixation of custom jawline implants is an essential step in the multilevel approach of producing a stable and symmetric 3D change to the entire jawline. Design, placement and fixation serves as the cornerstones of a successful custom jawline implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana