Custom chin implants are often necessary when significant vertical elongation of the chin is needed, the implant extension needs to go back further along the jawline than conventional chin implants will allow or there is some significant chin asymmetry. The key surgical point about their placement is the consideration of the placement of the incision when done from a submental approach. The incision may need to be further back than the submental crease as the tissue recruitment from the implant may ‘roll out’ the submental tissues further than one would think of the custom chin implant adds any significant vertical length.
Custom chin implant design for make who desires a square chin with slight vertical elongation.
Custom chin implant design for female who desires to have a modest amount of horizontal and vertical chin augmentation without widening the chin.
Small petite chin implant for female who is also having multiple other custom facial implants done.
Male who wanted a strong wide square chin implant design.
Female with significant chin shortness with class II maocclusion hat needed a large amount of horizontal advancement with needed to keep the chin narrow.
Total male three-piece jawline augmentation with custom square chin and jaw angle implants designs.
Custom chin implant design for female with prior sliding genioplasty to add additional chin projection and to smooth out bone irregularities along the jawline.
Custom cleft chin implant design for male three-piece total jawline augmentation.
Petite custom female chin implant design with an upward tilt to the horizontal projection.
Custom lateral chin implant design for fill in lateral bone defects from prior sliding genioplasty.
Extended square chin and jawline implant design for vertical jawline lengthening in a male.
Female who previously had an anatomic chin implant placed to try and achieve a V-shaped chin appearance…which was unsuccessful. A custom V-shaped chin implant design was more effective.
Trying to hang a standard chin implant design off of the bone to create a V-shape is fraught with potential implant malpositioning issues as that is not what they are made to do. Unique chin reshaping needs require a custom chin implant approach to be more effective.
One often leans from the first chin implant what look they may want better. In this case a male with a standard round extended anatomic chin implant that subsequently desired a more square shape with wings that more assuredly sat lower along the lower edge of the bone.
When design square chin implants for men the shape must be over exaggerated a bit because the thickness of the soft tissue chin pad will obscure some of the detail of the implant design.
The optimal square chin look for men requires a chin implant design that takes the squareness out to the canines and adds a little vertical length to help stretch out the soft tissue chin pad.
Females withMedpor chin implants often find them too bulky and that they add too much width. Replacing them with a custom chin implant assures a more controlled shape with less width and more pleasing feminine shape to them.
A custom chin implant replacement for Medpor implants (invisible) which had a non-smooth coverage of the step off deformity from a prior sliding genioplasty.
Smoothing out a prior sliding genioplasty irregularities, particularly the posterior step offs, is hard to do using standard implant materials. In this case a modified Medpor chin implant was attempted (invisible on the x-rays with the exception of the screws) but had palpable edges and and inadequate result. The Medpor chin implant was removed and replaced by a custom made chin implant
Custom chin implant designed to be asymmetric to compensate for a soft tissue deficiency on the right side which became revealed after the placement of a first custom chin implant. (for removal of a malpositioned standard chin implant)
Asymmetric custom chin implant design for soft tissue chin pad deficiency.
Getting a chin implant to integrate into previously placed jaw angle implants, while reducing the bony height of the chin at the same time, requires the preoperative designing of the vertical bone cut with a custom chin implant design.
Having a smooth flow into the anterior ends of jaw angle implants for a total jawline augmentation effect is most assured with a custom chin implant design.
Custom chin implant design for a female who had an initial submental chin reduction by burring with postoperative regrets. Then wanted to fully reverse it to return to her normal chin shape and projection.
Desire to replace a malpositioned custom jawline implant (decided that the jaw angle part he did not like despite the asymmetry)with a new custom chin implant. He liked what the chin implant did despite its asymmetry. Wanted some more horizontal projection and a more pronounced square chin shape.
When creating a new custom chin implant replacement obtaining a more square shape requires that the implant design have an exaggerated square shape. It is important to remember that the thick soft tissue chin pad acts like a ‘quilt’ in covering the implant so some of the implant’s design becomes obscured.
A initial standard vertical chin implant was used with a good result in this female but she wanted a bit more chin length and with wings that went further back. This takes a custom chin implant design to do so.
In this female one might never chose a custom vertical lengthening chin implant design IF they did not have an initial standard vertical lengthening chin implant first to prove that the vertical change was aesthetically beneficial. Once proven only a custom chin implant design can carry the concept to greater dimensions of change.
An uoside down standard chin implant positioned too low on the bone with an overprojected and too long chin result motivated this patient to seek a custom chin implant design. The goal was no vertical or horizontal augmentation and to only make the chin wider.
It may be unusual to design a chin implant that adds no projection centrally. But if the goal is a wider chin only then only a custom design can achieve that dimensional effect.
For vertical chin lengthening up to 7mms a custom implant design can be effective at correctiung the vertically short chin.
Loss of chin and jaw height can occur from loss of ramus height in reconstructive surgery. A vertical lengthening chin implant can restore loss of anterior lower facial height.
Custom Jaw Angle Implants
Bony jaw angle/jaw angle implant asymmetry and the desire for vertical elongation of the jaw angles are two most common indications for custom jaw angle implants. Asymmetric placement of jaw angle implants is very common and is caused by both placement error and slight but significant differences in natural jaw angle shapes. A little difference in the shape or angular form of the jaw angles can translate into a very visible difference when they are enlarged by implants. Aesthetic augmentation of jaw angles often requires vertical lengthening (dropping down) of the jaw angles which no current form of jaw angle implant provides. While jaw angles are often perceived as just being made wider, the more common aesthetic need for many jaw angle augmentations is create by lowering the jaw angle and not by just making it wider. In some cases this requires the entire jawline from angle to angle to be made vertically longer.
Custom jaw angle implant designs to fill in bony defects and smooth out the jawline after orthognathic surgery. (sagittal split ramus osteotomies of lower jaw)
Custom jaw angle implants designs for back of jaw augmentation after prior sagittal split ramus osteotomies.
Custom jawline implant designs to go with a sliding genioplasty for overall jawline augmentation in a female. (who also had a large custom skull implant done at the same time)
Custom jaw angles implants design to go with a vertical chin reduction intraoral osteotomy.
Custom jaw angle implant designs for a male after V-line reduction sur-gery to restore some of the lost jaw angles.
Male total jawline augmentation with custom extended jaw angle im-plants to vertical and horizontally lengthening sliding genioplasty.
Custom jaw angle implant designs to balance out jawline shape after or-thognathic surgery in a male.
Custom flared jaw angle implants to complete a total jawline augmenta-tion effect after a sliding genioplasty.
Custom jaw angle implant designs to create a more complete male jaw-line effect after a prior sliding genioplasty.
Custom jaw angle implant designs in facial asymmetry with custom left cheek implant as well.
Small custom left jaw angle implant design for correction of lower jaw asymmetry in a female.
Extended custom jaw angle implants for correction of the high mandibu-lar plane angle make patient with accentuated antegonial notches.
Custom right extended jaw angle implant for correction of lower facial asymmetry in a female.
Custom jaw angle implants made to provide a complete jawline augmentation effect in a patient who had an existing chin implant of which he was happy with its aesthetic result.
Custom right jaw angle implant to correct jaw angle asymmetry from prior sagittal split mandibular osteotomy.
Much of the jaw angle asymmetry after sagittal split mandibular osteotomies has a vertical component to it and not just a width issue. This is why standard jaw angle implants often do not work well in this type of jaw asymmetry.
The difference between the jaw angle asymmetry that occurs after a sagittal split osteotomy and how to best treat it is illustrated in this case where a standard jaw angle implant was inadequate and a custom jaw angle implant design showed the amount of bone that needed to be replaced for optimal jaw symmetry.
Sagittal split osteotomies are a fundamental approach to the correction of a significantly deviated lower jaw. While the procedure can re-establish a midline position of the chin it will not correct an underdeveloped jaw angle in the shorter side. (it actually makes it more pronounced) A custom jaw angle implant design is needed to create the final jaw asymmetry correction.
V line surgery has the potential to leave the jawline irregular and asymmetric. Smoothing and improving the asymmetry between the two sides of the jawline is best done using a custom jawline implant design approach.
In designing custom jawline implants after V line surgery the goal is not to restore the original size and shape of the jawline but to make for a smooth and more even shape between the two sides.
When the implant load on the chin may be considered ‘excessive’, a sliding genioplasty can be done combined with custom extended jawline implants that connect up to the advanced chin segment. These custom implants achieve the dual purpose of creating a complete jawline augmentation with the sliding genioplasty as well as covering over the bony stepoffs at the back end of the chin osteotomy line.
Merging the extended jawline implant into the advanced chin bone segment in a male creates a wider chin, which a sliding genioplasty does not, as well as helps to square the chin shape. This combination of bone and implant jawline augmentation is used when significant vertical chin lengthening is needed.
In the custom extended jaw angle implant design it goes to the corner of the chin, to add width, but does not cross over and join in the midline as a complete jawline implant would do. (close but not quite connected)
When replacing unsatisfactory existing jaw angle implants (in this case Medpor jaw angle implants from 20 years ago) a custom jaw angle implant approach is best. While the Medpor material can not usually be seen in a 3D CT scan it does leave a partial imprint on the bone. But not knowing where the existing implant is may not be that important as in the high jaw angle implant patient the shape of the bone os what guides the implant design.
Female with prior sliding genioplasty that felt afterwards her jawline was now incomplete. Custom jaw angle implants were made due to her jaw angle asymmetry and the need for unique vertical augmentation for a female.
When designing female jaw angle implants it is important to know that vertical length is just as important as width and often the most desired jaw angle dimensional change in women.
The high mandibular plane angle patient, by definition, has a vertically short jaw angle and lack of any visible jaw angle show as a result. Such a patient needs vertical jaw angle length but the right amount is usually just enough to make the mandibular plane angle straight…which in this patient was 10mms.
When creating vertical length in a custom jaw angle implant careful attention must be paid to their width. The addition of vertical length adds to the jaw angle width effect as well.
Custom jaw angle implants replacing malpositioned standard jaw angle implants. When unsatisfactory results occur from the use of a standard implant many patients will progress to a custom implant design with the expectation of an improved implant positioning and subsequent aesthetic result.
In certain jaw angle augmentations all that the patient wants is a ‘little’ more defined jaw angles. They are seeking more visible jaw angles and not jaw angles that are a lot bigger. For this aesthetic needs a custom jaw angle implant ‘cap’ can be designed that just fits directly over the jaw angles.
Custom Jaw angle Implant ‘cap’ designs for just a more defined jaw angle only.
A sliding genioplasty, a very good procedure for chin augmentation, can ‘uncover’ an overall lower jaw deficiency. As in this female who liked the chin projection from her sliding genioplasty but felt it worsened an already narrow lower face. She completed her lower facial augmentation by the placement of custom jaw angle implants.
The more narrow lower facial appearance after a sliding genioplasty can be improved by custom jaw angle implants.
Custom jaw angles can be made of any material including titanium metal. Titanium metal offers the same bone biocompatibility that is well known in plates and screws as well as in dental implants. It is the most expensive custom implant material to use but has a useful role to play in the properly selected patient.
Custom jaw angle implants made of titanium has its greatest advantage when the amount of vertical angle lengthening is ‘extreme’, 15 mms or greater.
The use of standard jaw angle implants, if not aesthetically successful, provides valuable information on what changes to make to the implant particularly if the implant is in good position. On this patient’s right side the standard jaw angle implant was well placed but he felt that its projection was too high and far back. A custom jaw angle implant was designed to lower the widest projection point…which technically would have been too far forward in most patients…but that is what worked best for him. As an aside oine overgrowth on top of a jaw angle implant is common and must be removed to do its replacement.
On the patient’s left side, while the standard jaw angle implant would normally be viewed placed too far forward, it was where the patient liked its maximal width position. But the overall side and fullness of the standard implant was too much. In his custom jaw angle implant placement it kept the same width as the standard implant but was made overall smaller.
Attempts at jaw shaving, when the aesthetic results are not satisfactory, often leave an asymmetric irregular jaw angle/inferior border. To restore a matched jawline to the other side only a custom jawline implant can successfully do so.
Inexperienced surgeons with jaw angle implants often make major malpositioning errors by failing to make an adequate posterior dissection. While a custom jaw angle implant design has its benefits getting it into the proper position over the bony jaw angles is still key.
Poor positioning of standard jaw angle implants is often the impetus for a custom jaw angle implant design. Besides removing the existing mapositioned implants, scar capsule and bony overgrowths around the implant site must be removed to get the new custom implants into their designed positions.
Jaw angle asymmetry after sagittal split osteotomies is not rare and the most accurate ‘reconstruction’ of it is with a custom jaw angle implant design.
Desire for combined vertical and horizontal jaw angle augmentation with custom designed implants.
Custom right jaw angle implant for asymmetric jaw angle asymmetry.
Custom Jawline Implants
Currently aesthetic augmentation of the jawline is a very popular use of the custom design process and is the most common aesthetic custom facial implant performed. While there are standard styles and sizes of both chin and jaw angles, there is no standard total jawline implant. A standard jawline implant would be impossible to create as a complete wrap around implant due to the variability in jawline sizes and shapes between people.
Having an implant that connects one jaw angle to the other across the chin is the most powerful method to enhance a jawline. This is of particular interest in men who want to have an overall stronger and more defined jawline. With an implant that covers a large bony surface area, it is important to not oversize it in any one dimension. With a facial implant that covers such a large surface area, it is very easy to oversize it as the influence on the jawline shape is significant.
A custom wrap around jawline implant is inserted through three separate incisions. Bilateral intraoral posterior mandibular vestibular incisions are used to position the jaw angle portion of the implants. An anterior incision, either intraoral or external submental, is used to insert the entire implant and feed it back to the jaw angles in a folded fashion.
Male custom jawline implant designed to replace standard chin and jaw angle implants which are misplaced.
Custom jawline implant designate vertically lengthen a low or flat mandibular plane angle patient.
Female custom jawline implant design which rounded narrow chin and vertical jawline lengthening.
Strong custom jawline implant and cheek implanted designs for maximal male masculinization effect.
Petite custom jaw angle implant design for a female.
Female custom jawline implant design to partially restore jawline after an overly aggressive V-line jaw reduction procedure.
Moderate custom jawline implant and cheek implanted designs for maximal male masculinization effect.
Female custom jawline implant design needed for jawline restoration after V-line jaw reduction surgery.
Custom jawline and cheek implants designs in an older male for a facial rejuvenation effect and filling out of sagging tissues.
Custom jaw angle implant design to change a low mandibular plane angle into a higher plane angle.
Custom left jawline implant combined with a right inferior border osteotomy to treat lower jaw asymmetry.
Large custom non-linear jawline implant design for strong masculinization effect.
Custom jawline implant replacement design for displaced chin and jaw angle implants.
Custom jawline implant design for a smooth linear and increased augmentation effect after a chin wing osteotomy.
Custom infraorbital-malar and jawline implant designs for strong facial masculinization effect.
Male custom jawline implant to restore jawline after V-line reduction surgery.
Custom jawline and right cheek implant designs for correction of facial asymmetries.
Custom jawline implant replacement in a male for unachieved effects from strandard chin and jaw angle implants.
Custom jawline implant design for high mandibular plane angle male patient.
Custom jawline implant design to straighten out a nonlinear and add vertical length to the chin. (replace an inadequate standard chin implant).
Custom jawline and brow bone implants for facial masculinization after prior sliding genioplasty and extended chin implant failed to achieve the desired jawline augmentation effect.
Small custom jawline implant design to enhance a softer and more indistinct male jawline.
Custom jawline implant design to treat a hooked jawline and short chin.
Custom female jawline implant which typically has a smaller overall size, less jaw angle width and more narrow chin shape.
Custom jawline implants for females, while being smaller in size than for males, usually add vertical jaw angle length/shape and come forward with a smooth linear connection to the chin.
Custom jawline implants are often requested for the treatment of facial asymmetry which often involves the lower jaw. The patient will often choose to then just augment the entire jawline for an overall lower jaw augmentation as well as correction of the jaw asymmetry.
Female custom jawline implant for V Line reversal surgery.
When designing a custom jawline implant for V Line reversal surgery consideration is given to whether the patient wants a subtotal or total restoration of their removed jawline.
Attempting to partially or fully reverse a prior V line surgery can not be done very well by using any form of standard implants as illustrated in this case where strips of ePTFE (Goretex) were used. (in green) V line jaw restoration needs a smooth jawline implant that restores much of the vertical length of the jawline that was previously resected.
V line reversal surgery is largely about vertical jawline restoration, which can only reliably be done using a custom implant design approach. Patching together standard implant materials to try and create this unique jawline augmentation effect works poorly as seen with these ePTFE implants. (in green)
Many custom jawline implants start out with a chin implant as their entrance into lower facial reshaping surgery. Either due to an inadequate chin augmentation result or the desire to ‘graduate’ to a complete jawline effect, the existing chin implant serves as a helpful guide as to how to improve the chin as well as that of the rest of the jawline.
A prior chin implant that produces an undesired effect (in this case a chin that became too vertically long) ‘teaches’ one how to make it better when a custom jawline implant is designed for its replacement.
Prior chin implant issues, such as asymmetries, often lead to the consideration of not only improving the chin augmentation, but converting to a total jawline augmentation effect with a custom jawline implant approach.
Many short chins are associated with a high and indistinct jaw angles. Changing from an initial chin implant to a custom jawline implant improves then entire shape of the lower face.
In the high jaw angle or steep mandibular plane angle patient widening jaw angle implants may look acceptable from the front but they accentuate the steep mandibular plane angle from any other facial view. The combination of lowering the jaw angles and shortening the chin usually produces a better overall lower facial shape. Standard submalar implants in a male rarely produce a positive aesthetic benefit. Men usually want a high cheekbone look which can only currently be achieved by a custom cheek implant design.
Replacement of standard cheek and jaw angle implants with custom cheek and jawline implants.
Custom jawline implant design for male who wanted to achieve two simultaneous lower jaw objectives, fix the right lower jaw asymmetry and create an overall stronger lower facial appearance.
A custom jawline implant provides the most effective approach to improving the asymmetric jawline because it identifies and treats the entire jawline deficiency…which is particularly challenging when such deficiency is vertical in nature.
Injectable fillers (e.g., Radiesse which appears in the green color) is often used for jawline augmentation which resides up in the soft tissues. By comparison a custom jawline implant (in teal color) sits down on the bone below the soft tissues. As a result, injectable fillers produce a more rounded jawline effect while a bone based implant is capable of a stronger more well defined jawline look.
While injectable fillers (in green) can have a good temporary effect their soft tissue location limits the jawline definition they are capable of creating for many patients….unlike that of the custom jawline implant. (in teal color)
Female often seek jawline enhancement, not necessarily to make the overall jaw much bigger, but to give it some shape and better definition. This is particularly useful when the lower third of the face is a bit vertically short.
Increasing the mandibular plane angle in a female with a vertically short chin creates the opportunity to make a more tapered jawline with a more narrow chin shape with a custom jawline implant design.
Custom jawline implants can be combined with a sliding genioplasty when the vertical lengthening needed for the chin reaches a critical amount. The soft tissue chin pad is already a tissue area under tension because it wraps around a solitary point. (projecting chin) It can only safely stretch so much so attention must be paid to how much implant volume is placed under an incisional closure. An opening wedge sliding genioplasty can do all of the vertical lengthening more safely and the implant than only needs to add a bit more contour. (projection and width)
The combined vertical lengthening opening wedge genioplasty and custom jawline implant overlay is needed when the dimensional changes to the chin collectively exceed 12. (combined horizontal and vertical chin increases)
The custom jawline implant provides a complete jawline augmentation effect which often is not appreciated is needed until chin augmentation is done. This patient had double stacked chin implants (two separate surgeries to build out the chin) for an 18mm chin augmentation which then revealed to the patient how deficient the jawline was behind it. Also note as chin implants become bigger on a really deficient chin the direction of augmentation is not purely horizontal but adds a vertical lengthening effect as well…which is usually not a desired effect.
The patient’s double stacked chin implants, while providing a positive chin augmentation effect, makes the narrow jawline behind it even more so. The custom jawline implant replacement more comprehensively treats the entire jaw deficiency.
Jaw reduction surgery, often called V line surgery, can create irregularities and asymmetries between the two sides of the lower jaw. A thin custom jawline implant can smooth out the inferior border between the two sides and out back a little jaw structure in those patients that also feel they have been over reduced.
V line partial jaw reduction reversal can be done by a small low volume (3 to 6cc) custom jawline implant.
Custom jawline implants for females are always smaller than that of men. This is because they have a smaller initial jaw size but also because their aesthetic goals are different and more modest in the augmentation dimensions needed.
Female custom jawline implants often focus on the need for vertical elongation of the jaw angle and chin to create a more defined jawline but not substantially increasing their lower facial width.
Replacement of prior separate chin and jaw angle implants which have not produced a satisfactory aesthetic result is a common reason for ‘graduating’ to a custom jawline implant design. The prior implants help provide invaluable information about how to improve the aesthetic result. Unfortunately Medpor implants (jaw angle implants in this specific case) do not appear on 3D Ct scans due to the tissue ingrowth. This poses an inconvenience in custom implant designing as well as removal challenges during the replacement surgery.
While Medpor jaw angle implants can not be seen the bony ingrowth that results around (above) them can easily be seen. This adds to the difficulty in their removal as the implant is partially buried under an overlying layer of bone at its upper edge. But they can still be successfully removed and replaced with a custom jawline implant.
Replacement of three standard misaligned chin and jaw angle implants with a connected one piece jawline implant creates a smoother lower facial look with less risk of implant malposition.
While aesthetic outcomes using a three standard implant approach to total jawline augmentation can be successful, the risks of implant malposition is high because it is essentially three unconnected operations done during one surgery. When an unsatisfactory outcome occurs with this approach a custom jawline implant design takes advantage of what is aesthetically good with the current indwelling implants and adds what they don’t provide in a connected one piece implant design.
When the desired amount of dimensional chin augmentation changes exceed the 12 to 14 number range (combining the horizontal and vertical chin augmentation change) it is safer to use a sliding genioplasty for the chin augmentation part of the jawline and custom implants for the rest of the jawline. This is because an implant in the chin separates the overlying soft tissues from the bone and becomes a spacer between the bone and the implant. This may make a competent incisional closure over a large implant load in the chin questionable. Conversely a bony genioplasty through the middle of the chin bone and keeps the soft tissues attached to its bottom portion. Thus not posing the same potential issue one soft tissue closure as an implant.
A sliding genioplasty with custom extended jaw angle implants. The implants merge into the chin which also covers the inferior border notch deformity which occurs in most bony genioplasties.
A malpositioned or unsatisfactory chin implant result is often the impetus to ‘graduate’ to a more complete jaw augmentation effect using a custom jawline implant design.
Custom extended jaw angle/jawline implant designs for an irregular jawline after V line surgery
It is not uncommon that a custom jawline implant is done after a bony genioplasty. This can be a good two stage approach when the chin needs a significant dimensional change such as vertical lengthening. While the bony genioplasty can not create certain dimensional changes (augmenting the jawline behind it, squaring out the chin) it does ultimately reduce the implant load on the chin area which is sensitive to the demands of implant stretch because of the tight soft tissue chin pad tissues.
As seen in the side view design the first stage vertical lengthening bony genioplasty has done much of the work for the chin area. The chin portion of the jawline implant then merely finishes off some dimensional details needs. (a little bit more horizontal length and squaring out the chin shape) The main work of the custom jawline implant is posterior when the angles and jawline curve are straightened and widened.
Some patients ‘graduate’ from the traditional three-piece jaw augmentation approach to get a more connected and linear jawline look as well as improve the implant dimensions based on the results from the first standard implant procedure.
A linear connection from the jaw angles to the chin is one aesthetic feature that only a custom jawline implant can provide.
A custom jawline implant can be used to complete a prior chin procedure such as a vertical lengthening bony genioplasty. When significant changes are made to the chin the patient often becomes aware afterwards of the now relative deficiency of the rest of the jawline.
As seen in side view the vertical lengthening genioplasty has created a jawline that lies behind it as now deficient for which the custom jawline implant can complete the augmentation.
Getting a smooth and even jawline and any desired enhanced chin and jaw angle projection after sagittal split and sliding genioplasty operations requires a custom jawline implant.
A custom jawline implant can provide the final aesthetic refinements to a lower jaw that has been through prior bony osteotomies as seen in this female Treacher-Collins patient.
A not uncommon patient that presents for a custom jawline implant is the patient who has had prior orthognathic surgery. While the occlusion has been corrected and the lower jaw brought as far forward as the teeth will permit, adding shape, width and more projection to the lower jaw/face requires a ‘finishing’ jawline implant augmentation.
The one dimensional changed to the lower jaw that only a custom jawline implant can make is vertical lengthening. To achieve complete vertical lengthening from one jaw angle to the other requires a custom designed implant to do so.
Larger male custom jawline implants average in the 24 to 28cc volume range. Such implant volume calculations tell more about their effects than any one single thickness measurement.
This custom jawline implant case is a good example of the wrong type of chin implant being used. While the patient needed horizontal chin augmentation he got a vertical lengthening chin implant which, not only did not correct his horizontal chin deficiency, but then made his chin too vertically long. He then proceeded to have a custom implant made to address the entire jawline deficiency.
Asymmetry of the lower jaw is a common request to be treated and no other method works as well as a custom jawline implant. While some patients opt to treat just the shorter/smaller side, many men choose to augment the overall jawline as well with a custom wrap around jawline implant.
In almost all jaw asymmetries the smaller or shorter side has a higher inferior border than the more normal/desired side. It is often a bit wider as well. Thus correction of hypoplastic jaw asymmetries requires a lowering or lengthening of the affected side.
Jaw asymmetries are often more modest in size (a few millimeters) which can be compensated for in a custom jawline implant design. The asymmetry may be most apparent in the chin area where the fusion of the two sides of the lower jaw did not come together perfectly during development.
The steep mandibular plane angle jawline shape often needs to be lowered a bit which involves release of the tightly adherent musculoligamentous attachments of the masseter muscle seen as prominent bumps of bone at the jaw angle area.
Replacement of existing standard chin and jaw angle implants is a common request for a custom jawline implant in which improved dimensions and a connected linear look between the chin and jaw angles can be achieved.
When replacing prior jaw angle implants in particular there can often be significant amounts of bony overgrowth on the top of the implants.
A stronger jawline implant design for most men is usually close to 20ccs in volume or more with evident corners at the chin and jaw angle areas.
Eliminating the antegonial notch of the pre jaw angle region and getting the chin projection past that of the upper teeth are the hallmarks of a bony jawline implant design.
The chin wing osteotomy produces a jawline enhancement restricted to the chin and middle portion of the jawline and adds length and width. But it does not have anypositive change to the jaw angle region. (can not make them vertically longer or wider A custom jawline implant can be designed and placed secondarily to complete the total jawline augmentation effect.
While the chin wing osteotomy may not create a complete jawline augmentation effect, it does provide a good bony platform onto which a smaller custom jawline implant by volume can be secondarily placed with a lower implant load.
Stromger male custom jawline implants will have more prominent chin and jaw angle ‘corners’, substantially denouncing the jawline into a more defined shape.
Some males have fairly well defined jawlines but they are dimensionally deficient vertically. A custom jawline implant can be designed that primarily adds vertical length like in this case with 3mms length at the jaw angles and 6mms length at the chin. It doesn’t sound like much bit when wrapped around the entire inferior border of the jawline it has a much more powerful effect than one would think.
Vertical length combined with some added angularity at the corners (chin and jaw angles) is one type of dimensional jawline change that works well in this type of short lower jaw.
One of the advantages of a custom jawline implant design is that can ‘square out’ the lower face for improved definition. How well such an implant design translates to creating an external effect is highly dependent on the thickness of the soft tissues. The thinner the soft tissue cover the more of the implant design that will be seen.
Some male patients may eventually ‘graduate’ to a more complete jawline augmentation effect by replacing their standard chin implant with a custom jawline implant. About 40% of the custom jawline implant surgeries that I do the patient has had a prior chin implant.
In addition to creating a more complete jaw augmentation effect over a chin implant, it can also add to the amount of chin projection as well as give it a more square (less round) shape.
For a more complete jawline augmentation result a custom wrap around jawline implant offers a more controlled solution than using three standard implants both in result and success in positioning on the bone. But in very large custom jawline implants (greater than 25ccs in volume) it may be necessary to section it into three pieces, insert as such and then reassemble once inside the tissue pockets.
One of the main advantages to a custom jawline implant is the connected and linear look that it creates.
Many custom jawline implant patients have had prior chin procedures including various forms of bony genioplasties. When the chin procedure result is unsatisfactory or creates an incomplete jaw augmentation effect (or both) the custom jawline becomes the definitive method of corrective augmentation.
The hooked jawline shape due to a high jaw angle with prominent antegonial notches combined with lack of good chin projection can only be fully corrected with a custom jawline implant.
Combining a sliding genioplasty with custom jawline implants is a valuable method of jaw augmentation when the dimensional requirements of the chin exceed what an implant is this area can do. As in this case the chin needed to come forward 12mms and be vertically shortened…which are dimensional changes in the chin which an implant can not do.
When designing custom jawline implants to fit into a sliding genioplasty it is important to have them wrap around the advanced chin bone. This allows for intraoperative flexibility in fitting them together. It also allows the implant to cover the back edge of the sliding genioplasty defect as well as can make the chin wider as well if desired.
For some men a major jawline augmentation is not needed. They may have a bit of a smaller jawline but what they really lack are more defined ‘corners’ (chin and jaw angles) and a more connected appearance between them. This is the role of smaller or enhancing jawline implant designs.
Lack of adequate chin projection may be what is most obvious in some patients but adding on a more proportionate look to the rest of the jawline behind it is what a custom jawline implant accomplishes whether it is big or small.
Male who desired a stronger jawline but with existing chin asymmetry. Custom jawline implants do a wonderful of correcting chin and jaw asymmetries. What often confuses patients in jawline implant designs is the flare of the jaw angles which will often look exaggerated in the design. This is often necessary to overcome thick overlying jaw angle tissues and the maximal fullness of the masseter muscle located in the middle of the mandibular ramus above the jaw angle prominences.
When the dimensional needs of the chin are beyond what an implant can do ( in this case 12mm vertical lengthening and 5mms forward projection) total lower jaw augmentation can be done by a combination of a lengthening bony genioplasty combined with custom jawline implants for the complete wrap around effect.
Improving the shape and visibility of a short jawline often means extending its length and angulation. (aka mandibular plane angle) In the patient with a short chin it needs to be vertically lengthened which is often beyond what should be done with an implant. This is the role of bony chin lengthening in custom jawline implant augmentations…make the bone take on much of the load in the tight chin area and let the implant do the rest of the work behind it.
In the short, but long chin patient with a steep mandibular plane angle the chin needs to be advanced BUT vertically shortened. Only a bony genioplasty can achieve that type of dimensionally chin change. In this case a 12mm horizontal advancement was done with 4mms of vertical shortening by osteotomy. A custom jawline implant did the remainder of the jawline augmentation by vertical elongation, producing a major change in the mandibular plane angle.
The combination of bring the chin forward with vertical shortening (sliding genioplasty) and dropping down the jaw angles and body of the lower jaw by custom implants shortens the long face and creates some needed with to the lower face.
The basic objective of many male jawline implant designs is to create greater prominences of the corners of the jawline. (chin and jaw angles) To do so their shapes must be changes to a more square or angular form which is best appreciated in the submental view of the implant design.
One of the most overlooked deficiencies of the chin and jawline is in the vertical dimension. A short looking lower face, flatter mandibular plane angle, deep labiomental fold and an overbite are all indicators of a vertically short chin and/or jawline. Only a custom jawline implant can lower the entire inferior border of the jawline for a complete correction of the vertical deficiency.
Vertically lengthening the jawline and creating a smooth inferior border not only creates a more proportionate lower 1/3 of the face but will often have a bit of a ‘neck lifting’ effect and eliminate loose skin or the appearance of submental fullness.
While making the male chin more square may seem to be achievable with a standard square chin implant what is usually accomplished is it only makes the chin wider not really square. To make a square chin you really don’t need a lot more width than the natural chin bone. BUT the implant must have an over exaggerated square shape due to the thickness of the overlying soft tissues which will blunt the corners of the implant’s shape. Only a custom implant design, like this jawline implant replacement for a standard square chin implant, can create this desired effect.
In congenital hemifacial microsomes the foundational correction is at the bone level with left jaw reconstruction and upper and lower jaw surgery. But these improvements along often still leave the left face deficient. Custom cheek and jawline implants provide the final definitive hard tissue symmetry improvements.,
The jaw deficiency in some hemifacial microsomia patents can leave marginal bone on which to place an implant…but it can still be done. One of the important elements in a jawline implant design with this degree of asymmetry is to not over correct it…which can happen if the implant design is ‘perfect’. Slight under correction of the implant design is preferred.
The wrap around effect of custom jawline implants has a powerful aesthetic effect, meaning sometimes ‘a little bit goes a long way.’ Modest dimensional increases can create good enhancements for greater jawline definition without creating a major increase in the size of the lower third of the face.
,A little more chin projection and a straighter jawline is all that some patients need and want for their jaw augmentations, which is why I refer to these custom implant designs as jawline enhancements.
In the short face the jaw deficiency is primarily in the vertical dimension. A custom jawline implant is then design to lengthen the face while adding as little width as possible. Such lower facial lengthening helps make the face a bit thinner as well.
In the vertically short face the jaw angle width and chin projection needs are minimal and the implant must primarily add vertical length. This requires designing an implant that partially sits under the inferior border of the mandible as well as requires the intraoperative pocket dissection to release the soft tissue attachments inferiorly as well.
In congenital jaw asymmetry leveling the inferior borders can only be done with a custom jawline implant in most cases. (provided double jaw surgery either has been done and a level occlusal plane is achieved but the inferior borders remain asymmetric or the patient does not want to go through double jaw surgery) The asymmetric placement of a chin implant is not a good approach to treat jaw asymmetry and doesn’t usually even make the chin more symmetric. (and most certainly can have no positive effect when it is placed this high)
In congenital jaw asymmetry a custom jawline implant design can extend the higher inferior border the short asymmetric side of the jaw.
In correcting this uncommon type of jaw angle asymmetry (rotated sagittal split osteotomy on one side) it is important to not make the implant design match perfectly with the other side as the muscle has rotated and shortened as well. If the implant design goes back posteriorly it will stick out beyond where the muscle now exists. This will not be an aesthetic problem if the design improve the vertical length and shape of the aw angle…just don’t extend it posteriorly.
Custom jawline implant replacement for prior vertical lengthening chin implant and Radiesse injectable filler along the right jawline for asymmetry.The vertical lengthening chin implant ‘taught’ the patient that anterior chin elongation helped the face look less round/wide.
Radiesse injectable filler is often used as a technique for lower jaw augmentation particularly when jaw asymmetry exists. (one side of the jaw is smaller. A permanent jaw asymmetry fix can come from a permanent custom jawline implant where the jaw asymmetry results in an implant design with different measurements on each side.
A custom jawline implant restores a smoother and more proportionate mandibular plane angle after an 18mm long bony chin lengthening procedure.
With an extreme 18mm vertical chin lengthening by osteotomy and interpositonal bone graft the jawline behind it naturally becomes deficient. A custom jawline implant is the only way to complete the overall vertical lengthening of the lower face in a smooth and even manner.
Custom jawline implants are a common aesthetic followup to double jaw surgery which, while having many benefits, is aesthetically limited primarily to sagittal plane changes. Adding width and shape to the jawline has to be done by an implant approach for a complete 3D jaw shape change.
Sagitta split osteotomies of the lower jaw can sometimes change the shape of the jaw angles, resulting in asymmetries and diminished haw angle shape. A custom jawline implant rebuilds and reshapes the jaw angles as well as creating an overall smoother jaw shape even if no significant chin augmentation is desired.
Patients occasionally request midline clefts put in their jawline implant with the hope of getting an external chin cleft as a result. While this makes sense at the design level this very rarely works as chin clefts are soft tissue based and not in the bone.
Many custom jawline implants have a normally developed jawline and the goals is to provide an enhancement or some additional definition. How well these jawline implant design enhancements are seen on the outside is highly influenced by the thickness of the overlying soft tissues.
Some jawline implant patients have a good chin and their primary goal is for improved jaw angle definition. The purpose of he wraparound implant is to carry the jawline effect anteriorly for a linear jawline look and to square out the chin.
The main effect of the jawline implant is to build out the jawline behind the chin with minimal actual chin augmentation effects other than to square out the chin shape.
One method of total jawline augmentation is three separate chin and jaw angle implants that are not connected. This is done in an effort to create a non-linear jawline look where the chin and jaw angles standout as three distinct ‘corners’.
One common error in chin implant augmentation is to try and make a standard chin implant do what it was not made to do. When you need significant vertical lengthening of the chin AND a square chin shape this is an indication for a custom chin implant design. When combined with custom jaw angle implants a non-linear jawline augmentation effect is created.
Many custom jawline implants patients have a predicate history of a chin implant. Their purpose in ‘graduating’ to a total jawline implant is usually to get an overall jaw augmentation enhancement as an improvement over what the chin implant has accomplished. The chin implant does not need to be removed to design the jawline implant and actually serves an an invaluable guide on the 3D CT scan to help guide the improvements in the chin portion of the new jawline implant.
Some custom jawline implant patients have had injectable fillers done along the jawline as an initial test or short term jaw augmentation effect. When Radiesse injectable filler is used it can be seen on the 3D CT scan since it has a calcium hydroxyapatite composition. The effects of the filler can be used in some instances to help guide the implant design because of their known external aesthetic effects. (e.g., the jaw angle width in this case)
Dramatic facial changes require significant skeletal changes. The dual midface and jawline implant augmentations are a common combination to do so. In this case the patient had a prior vertical chin lengthening by a bone graft as evidenced by the four vertical wires in the chin. The chin bone was moved by osteotomy with a jawline implant overlay across the chin.
The amount of chin augmentation needed could not be done by an implant alone. Thus total jawline implant augmentation was done by a 14mm horizontal chin advancement with 5mm vertical lengthening in which the jawline implant crossed over the chin only to help make not more square.
The combination of the desire to improve jaw asymmetry as well as create improved jawline shape/angularity is one proven benefit of a custom jawline implant.
Facial asymmetry very often is the result of one side of the face not developing as full as the other side which translates into a vertical shortening on the affected side. This deviates the chin to the smaller side as well as causes a less prominent jawline and cheek. The face simply looks more pulled in. To untwist the face the smaller side needs to be vertically lengthened with cheek and jawline augmentations for which custom implants are the most effective method to do so. Many patients opt to do the whole jawline to get a more overall defined jawline as well.
It is easy to see in the submental view the jawline implant design mus add more material to the normal side to adequately straighten the chin and ‘pull’ the jawline over for a better asymmetry correction.
A male can have a well defined jawline, albeit small, and still want it augmented to improve its overall size. This is an overall jaw deficiency for which only a wrap around implant augmentation can be effective. Note the good lateral chin tubercles and what is good jaw angle development as seen in the prominent masseter muscle ligament bone spikes.
In the flat mandibular plane angle male the jaw angles are well developed with a prominent antegonial notch and well defined ligament attachment points at the jaw angles. This is a jawline implant that clearly needs no increase in jaw angle length, just a smoother more linear lawline.
V line surgery, while very effective for many patients, can be overdone with too much bone removal making the patients lower face too narrow. Subtotal or complete V line reversal can only be done by a custom jawline implant design.
In overdone V line surgery a more acceptable or less radical change is done with a custom jawline implant which still keeps a jaw narrowing effect through partial bone restoration.
Patients may be happy with their prior chin and jaw angle implant effects but desire a more connected or linear look between them. This requires a custom jawline implant to do so which may need to be split in half to surgically placed through the now encapsulated ‘mental nerve tunnel’.
A custom jawline implant replacement of prior implants offers the opportunity to not only make a linear connection but also to straighten out any oher implant asymmetries.
While a connected wrap around jawline implant is the most common design for a complete lower jaw augmentation effect, some patients may benefit by not having that connection. This is usually for patients who desire very discrete small changes at the ‘corners’ (chin and jaw angles) and want to avoid any thickness along the sides of the jaw.
The lack of connection between custom chin and jaw angle implant designs requires precise placement as there is no positioning reference between the implants.
The one piece design of a custom jawline implant creates a smooth linear look at the junction of the face and neck which can have a neck rejuvenation effect in some patients.
The female jawline implant is uniquely different from that in men by often being smaller in size, more focus on vertical jaw angle lengthening and less horizontal chin projection needed.
Females with a very narrow lower third of their face may want some jaw angle width but almost always there is a need for vertical jaw angle lengthening.
Many male custom jawline implant paients have indwelling chin implants that may have adequate horizontal projection but have a round shape. In the custom jawline implant replacement a more square chin shape can be achieved.
Chin implants often end up highly positioned on the bone particularly when they are placed through an intraoral approach with no screw fixation. in such high posiitons they lose some of their horizontal projection capabilities. In a new custom jawline implant design the new chin projection can be lowered to its more ideal position on the bone.
Jawline implants are not always primarily about an augmentation effect. After othognathic surgery it is not uncommon to hgave an irregular jawline particularly if a prominent antegonia notch existed prior to that surgery. (A sagittal split advancement will make an existing antegonial notch more prominent if the advancement is significant) In these cases the patient may only desire a smoothing effect along the inferior border from the implant with minimal increase in jawline size and definition.
In the older male who usually has loose facial and neck tissues a jawline implant design often has to be stronger or more exaggerated to overcome the excess tissues which younger patients do not have. It is a great example of how the implant looks in the bone is not the effect you see on the outside particularlywith loose and/or thicker tissues.
Custom jawline implants are a not uncommon secondary procedure after double jaw surgery to optimize the aesthetic result and smooth out the shape of the jawline. While such changes can be appealing to many some may find that such results are greater than they desired. Once you know what is too ‘big’ that allows one to have a much better idea as to the jawline implant dimensions that would work better. (reduced jawline implant dimensions)
An inadequate chin implant result is often the stimulus to consider a more complete jaw augmentation effect particularly using a custom implant design. The existing chin inmplant does provide some useful information in terms of the amount of horizontal projection as well as implant position on the bone.
For females a v-shaped chin of the custom jawline implant, if desired, is a shape that even a standard chin implant can not achieve.
One of the reasons patients seek a custom jawline implant is for a ‘failed’ or inadequate jaw augmentation using standard chin and jaw angle implants. It is far more challenging with a less predictable outcome when three implants off the shelf are used to try and create a uniform jaw augmentation outcome.
Even if standard chin and jaw angle implants were well placed (and in this patient on this side of his face they are) they can not create a connected and smooth jawline appearance. This is not what they are made to do.
About 20% or one-fifth of all patients that present for a custom wraparound jaw implant have a prior history of orthognathic or double jaw surgery. The bone movements set the foundation for the lower half of the face and the jawline implant provides the finishing touches to smooth out the entire jawline and enhance the corners. (chin and jaw angles)
About 40% of custom jawline implants have a prior history of facial implants, most commonly a chin implant. Chin implants are often the ‘starter’ method of jaw augmentation only to learn in some cases, by implant malposition or due to its incomplete effect, that a more complete jaw augmentation is desired. In designing the custom jaw implant the chin implant can usually be seen. (in green)
As successful as double jaw surgery can be in improving many maxillofacial problems/symptoms, it can not address jaw width or shape to any significant degree. A custom jawline after can provode the definitive jaw shape change as well as smooth out any bony irregularities.
In designing a custom jawline implant with an indwelling chin implant the ability to see the chin implant (green) allows the chin part of the jaw implant to have an improved design for a better chin augmentation effect.
Restoration of unnecessary or overdone V line surgery can only be done by a custom made jawline implant to put back the lost bone. Ideally such a custom jawline implant is made from the patient’s pre-V line surgery 3D CT scan if one exists.
Relengthening the jawline back to its original shape after prior V line surgery requires a custom jawline implant design. In many cases a pre-V line surgery scan does not exists which requires some guesswork as to what was removed. In this case, however, such a scan did exist so the replacement design could get very close to what the jaw shape originally was.
The female custom jawlione implant design is uniquely different than that of a malke jawline. Smaller in size (ccs of volume), a more narrow chin and vertical jaw angle lengthening with minimum width are the fundamental key changes to conisder in its design.
In female jawline implant designs that want a tapered triangular chin shape its design must usually look distinctly pointy on the design to overcome the thickness of the soft tissue chin pad.
Many chin implants ‘graduate’ to a custom jawline implant for two reasons. It is either because they want to expand the initial benefits of the chin implant or due to unhappiness with the chin implant results and are now taking the opportunity for an entire lower facial augmentation effect.
If one has en existing chinb cleft a custom jawline implant can be designed to keep or accentuate the existing external cleft appearance. To do so the designed cleft must be exaggerated (deeper and more sharp) to be able to be seen through the thicker soft tissue chin pad.
