The custom jawline implant is one of the most effective of all facial implants. By augmenting the entire inferolateral border of the lower jaw the entire shape of the lower face is changed and enhanced. Getting such a large implant into place, however, presents its own challenges. Not the least of which is getting it into proper position once inside the implant pocket.
While positioning the implant onto the lower jaw seems easy when looking at its design on the 3D model, it is not. More revisions of such implants are related to less than good positioning than due to an inadequate design. While patients often think that the wrap around jawline implant will simply ‘snap into place’ due to its custom design this is not true. (although I wish that it was) It is two smooth surfaces (exterior surface of the bone and the inner surface of the implant) that lack any frictional resistance and thus they easily slide off of each other…even if in good position.
To get a custom jawline implant into good position it requires a number of intraoperative techniques. One of them is to initially get the chin portion of the implant into position first. This is the easiest portion of the implant to place because it is seen under direct vision through the submental or intraoral incision. Under dirtect vision getting it positioned in the midline as well as having an even horizontal orientation of the chin is the easiest part of the whole implant to get oriented properly on the bone. Once posiitoned it is then screwed into position.
Like laying carpet setting the chin first allows the longer two sides of the implant to be stretched out to length back along the jaw angles. While this does not ensure that the posterior part of the implant will get into ideal position, it does at least allow the anteroposterior (front to back) length of the implant to likely be successfully postponed. There is still the vertical orientation (up and down) of the back part of the implant that requires placement. This is the hardest part of the implant to position since it can not be well seen.
The placement of a custom jawline implant is challenging and is the hardest facial implant to place given its long length and surface area coverage. Setting the chin part of the implant first is an essential first step and controls what happens further posteriorly on both sides.
Dr. Barry Eppley
World-Renowned Plastic Surgeon