What Is The Best Method For VLine Surgery Reversal?

Q: Dr. Eppley, I had jaw reduction surgery along with a sliding genioplasty however, the surgeon over reduced my lower jaw and I developed step-off deformity from sliding genioplasty. The lower half of my face is over reduced and smaller than the upper part making my face look off-balanced. I would like to rebuild my entire lower jaw. Would I need jaw and chin implants or would I have to get a custom jawline implant? Would bone cement be okay for an implant or is silicone better? Would bone grafting work? What are the pros and cons of bone cement/silicon implants and bone grafting?

A: Over reduction from vline surgery is actually very common and is just the nature of how that surgery has to be done. When it comes to rebuilding the inferior border of the lower jaw (which is what is now missing and is what is the cause of the notch deformity from the sliding genioplasty) this can only be done with a custom implant approach. Bone cements, standard implants and bone grafts are not going to work and will just make matters worse. Besides the fact none of these can stick and create a new extended jawline border out into ‘space’ they will be associated with a very irregular/asymmetric jawline result…which will be worse aesthetic problem than what you have now.

One can have debate about the use of silicone or Medpor custom jawline implants (PEEK is not commercially available in the US for jawline implants) but economics will end that debate for a custom silicone jawline implant in most cases.