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Replacing standard jaw implants with a custom jawline implant is not an uncommon upgrade for some patients. While standard chin and jaw angle implants can produce good results in the properly selected patient, their lack of connectivity creates the potential for malpositioning and difficulty with symmetry at the jaw angles. It is important to think of using chin and jaw angle implants as three separate operations …which is what it really is. How they are positioned and even selected beforehand is done as independent entities, not as an overall connected form of jawline augmentation.

Standard chin and jaw angles implants for jawline augmentation can produce undesired results for three reasons. First, there can be suboptimal positioning on the bone of which the most common is that the jaw angle implants being too far forward/too high. Secondly, there can be asymmetry of the implant placements which, while obvious for the jaw angles due to their paired placement, can also occur on the chin. (cockeyed or canted positioning) Lastly the shape and size of the implants simply didn’t produce the result the patient had hoped they would achieve.

Even though the undesired effects of the standard chin and jaw angle implants are unfortunate they do help considerably when it comes to designing a custom jawline implant replacement. The concept is when you know what doesn’t work it helps you better to understand what will work better. Thus in the design process of the custom jawline implant the existing standard implants are used as a guide to help determine the patient’s desired changes. The patient knows what they don’t like about the current appearance and this is correlated with the known position of the implants on the 3D CT scan. Then a new custom one piece jawline implant is designed to improve what the patient doesn’t like. The new design (in teal color) is then placed over the old design (in green color) to preoperatively know what type of external facial appearance changes/improvements will occur.

While custom facial implant designing is not an exact science, working with the knowns of existing implants provide guidance into what type of new implant shape and size changes would work better. So all is not lost in the prior surgery as one would never have known how to get to an implant design that has proven types of facial augmentation changes.

Dr. Barry Eppley

Indianapolis, Indiana

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