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Of all the facial implants, jaw angle implants are the most challenging to accurately place. Whether it is a standard jaw angle implant or the jaw angle portion of a custom jawline implant getting the corner position of the implant (posterior-inferior angle) in the correct position is not easy or assured. This is so because of a unique phenomenon with their placement…the working end of the implant is the furtherest away from the incision used to place it. (intraoral)

This placement issue becomes magnified when the objective of the jaw angle implant is designed to lengthen it. This means that a portion of the implant is off of the bone which is much harder to accurately position than when the implant only has a widening effect.

Typically a malposition of a jaw angle implant requires re-entry through the intraoral incision for repositioning. This still remains a challenge as the visual access is not improved and the risks of infection and secondary would healing problems is increased going back through prior intraoral incision. While it is usually successful as when you know where the implant s not supposed to be one knows better where it should be….but the infection risk and wound healing risks still exist.

A transcutaneous approach to the jaw angle region through a small overlying incision provides a direct view of the working end of the implant and the back end of the bony jaw angle. This provides an assured repositioning because of the visual access.

In secondary surgery for malposition the implant is most likely screwed into place. These screws can typically be removed by looking though the small incision and passing the screwdriver through a very small skin incision directly over it.

Once the implant is properly repositioned a screw is placed directly though the implant to the very end of the jaw angle bone, ensuring stable implant positioning. 

The small skin incision is closed after putting the split fibers of the masseter muscle back together. This incision in the male heals beautifully due to the beard skin and its location on the backside of the jaw angle.

The direct transcutaneous approach is an underutilized incisional access method for jaw angle implant repositioning. Despite the very small scar most patients would prefer to avoid the intraoral approach with its risks and recovery associated with it. 

Dr. Barry Eppley

Indianapolis, Indiana

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