Custom jawline implants are in the properly selected patient the most powerful changer of the lower facial support structure. Creating a more distinct separation between the face and neck is a more extended version of what a standard chin implant does at the front of the jawline. Because the amount of surface area and volume of a jawline implant is so much greater than any standard form of facial implant, a custom design is always needed.
The design process of a custom jawline implant is both fascinating and intriguing for patients. Unlike almost another other form of plastic surgery, the ability for the patient to see and participate in the design of what is to be placed in them is engaging. While I have always felt that patient awareness and participation in these custom implant designs is vital, it also leads to a false sense of simplicity. Creating any implant design on the computer is easy and always look symmetric….surgically placing such a large custom jawline implant however is not as simple as designing it looks.
Surgical placement of a custom jawline implant is typically done through three small incisions….the exterior submental skin and the paired intraoral posterior vestibular mucosal incisions. Each incision length is roughly 3 cms equalling about 10 cms of access and direct mplant visibility. A custom jawline implant is roughly 30 cms in length and when you consider it has three sides (upper, lower and outer side) that is 90 cms of implant to get properly positioned. This results in actual intraoperative visiibility of around 20% or less of the total implant surface area. (when you also factor in some side visibility of the implant from these incisions)
Unfortunately and contrary to the perception of some patients, custom jawline implants do not just ‘snap’ into place. I wish they were like Lego blocks but it simply does not work that way. It is one smooth outer bone surface onto which a smooth inner implant surface is applied, all dine through a narrow subperiosteal tissue tunnel and pockets, It can simply slide in any direction and, in implants which cover a large surface area, any slight malposition to how it looks on the design becomes magnified. A few millimeters of side to side asymmetry at the chin, for example, becomes more than just a few millimeters way back at the jaw angles. And the very material feature that allows such a large implant to be remarkably placed through such small incisions (implant flexibility) is exactly what can also allow it to become malpositioned/misaligned when viewing such a small part of the implant through the incisions.
Thus it should be no surprise that the most common aesthetic complication in custom jawline implants, like even standard chin and jaw angle implants, is implant asymmetry. While a custom jawline implant design allows one to achieve an augmentation effect not possible with preformed standard implants, a custom design by itself does not eliminate that risk.
The good news is that multiple features can be built into a custom jawline implant design that helps with its surgical placement. Orientation tabs at the external oblique line of the jaw angles, vertical midline markers or combined vertical and horizontal compass markers at the chin and mid-body connectors are extremely helpful aids in reducing the risk of postoperative implant asymmetry. And surgeon experience with custom jawline implants also plays a valuable role. But there is no assured way in any patient to eliminate this maposition risk completely.
Dr. Barry Eppley
Indianapolis, Indiana