The custom jawline implant is the ideal method for creating a more visible an defined lower face. It creates this effect as it builds out a more prominent transition between the face and the neck through skeletal augmentation. One element that determines how profound that effect is is the soft tissue thicknesses both above and below the jawline. The thicker/heavier these tissues are the less defined the jawline will be.
The soft tissues of the neck and cheeks are fundamentally centrally unsupported tissues which hang or sag based on soft tissue laxity and redundancies as well as how thick their subcutaneous fat layers are. Management of the neck is well known and consists of liposuction, submentoplasty for necklift procedures. Liposuction and submentoplasties are often performed in conjunction with jawline augmentation and its benefits are well known for enhancing lower facial definition.
What is less appreciated is the reduction of the soft tissues above the jawline. Think of the cheeks as a trampoline area. It is supported by the cheekbone-arch bone above and the jawline bone beneath it. But between them the soft tissues are unsupported much like a trampoline and that trampoline is affected by the fat that lies within it. The buccal fat affects the upper half of the trampoline area while the perioral mound region affects below it.
The buccal lipectomy cheek contouring procedure is well known but its effect is not over the whole cheek. It does not reach all the way down to the jawline or even close to it. Closer to the jawline is the perioral region, an area whose fullness is affected by the thickness of the subcutaneous fat layer. This fat layer adds to fullness the lies just above the jawline.
While not a conventional area to treat by liposuction the perioral facial region can be aspirated following several basic principles. The size of the cannula must be small, usually 2mm or less diameter. When doubt even use a small fat injection cannula to lessen the risk of irregularities. The entrance point should be from just inside the corner of the mouth through an equally small mucosal incision. Aspiration should be done in a radial from the mouth corner reaching to the upper cheek area and down to the jawline.
It only take a few ccs of perioral fat removal per side to make a visible difference. As a complementary procedure to a custom jawline implant it provides a subtle contour effect that is synergistic, changing a convex soft tissue shape above the jawline to a flatter or more concave one.
Dr. Barry Eppley
Indianapolis, Indiana