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The custom jawline implant is the definitive lower facial augmentation procedure. By wrapping around the entire border of the mandible from one jaw angle to the other, a more defined transition between the face and neck results. How much more evident the jawline becomes is a function of the size of the implant and the thickness of the tissues that overlie it.

One of the main advantages of the custom jawline implant is its connected design. The one piece wrap around shape is what goes a long way in creating a smooth linear jawline that can not be achieved with any three piece standard implant approach. But with this feature comes a potential disadvantage of how can it be placed with minimal scarring as a one piece design or avoid cutting it into multiple smaller pieces to do so.

The ability to place it in one piece requires a material that is semi-rigid. By definition a rigid material can never be placed as a one piece implant through any acceptable incisional size. Semi-rigid means the implant has flexibility, specifically the property of elastic deformation. This means the ability to be bent/flexed with return to its original shape without material damage once the deforming forces cease. Only solid silicone has this property of all facial implant materials.

In one piece custom jawline implant placement the submental incision looks inexplicably small compared to implant size. But from the submental incision a complete subperiosteal release is down over the chin and back along the sides and inferior border of the jawline. The mental nerve is usually well visualized in this initial anterior dissection. From the paired intraoral incisions located on the cheek side of the vestibule opposite the second/third lower molars, the jaw angle dissection is completed  and connected to the previously made anterior dissection. This intraoral dissection is needed as there is no way to do the careful release and elevation of the muscle off the edge of the bone from the remote submental incision.

Once the entire pocket dissection is completed, one side of the jawline implant is insert by passing it through the incision and below the mental nerve. Once one side is in the other side is then similarly placed. This almost always requires that the chin portion is left out beyond the incision until both implant sides have been passed posteriorly.

Once the total implant is inside the pocket, the midline of the chin is established using the marking embossed on the chin and secured with a screw. The jaw angles areas are never positioned and secured without first setting the chin midline of the implant. Closure of the submental incision is done first before closing the intraoral incisions.

This placement technique works for custom jawline implants in the small (under 10ccs volume) to medium (10 to 20ccs volume) sizes. It can also work for many larger implant sizes as well. (20 to 28ccs volume) The limitation arises when the size of the jaw angle part of the implant becomes too risky to safely pass under the mental nerve. In these sizes the split implant technique may needed.            

Dr. Barry Eppley

Indianapolis, Indiana

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