There is no substitute for what a custom jawline implant can do for reshaping the lower third of the face. By virtually expanding the outer corner of the entire jawline a true 3D expansion/reshaping of the face results. Unlike the use of more standard chin and jaw angle implants which are smaller, the question arises as to how these single piece larger facial implants are placed.
The answer to the question is to not cut them into several pieces to place them like smaller standard chin and jaw angle implants. While that can be done it will disrupt the designed linear connections between the front and back parts of the implant. While the implant can be ‘reassembled’ when inside the pockets, healing and tissue contraction may result in implant displacements. Thus every effort needs to be done to get the implant into place intact.
A front to back insertion technique, done through either an external submental skin incision or an intraoral incision, is the fundamental concept. The implant is essentially threaded into place into the created total jawline pocket. But doing requires that the jaw angle part of the implant be folded onto itself to pass under the narrowest part of the subperiosteal tunnel. This protects the mental nerve from injury. This is not a problem to do when the jaw angle portion is not too big/wide. (7 or 8mms or less)
But when the jaw angle is wider it is not possible to create an adequate material fold. This problem has been partially overcome by the design innovation of horizontal grooves on the inner surface of the jaw angles. By so doing material resistance is lessened and more complete jaw angle implant folding becomes possible.
To date I have used this design technique and up to 14mms of jaw angle width have been able to be implanted successfully in the front to back single piece technique. It currently remains unclear to what jaw angle implant size will exceed this capability and a midline split back to front technique insertion technique will be needed.
Dr. Barry Eppley
Indianapolis, Indiana