Custom Jawline Implant

Q: Dr. Eppley,  Exploring options as part of the decision making process, I understand an alternative to the custom jawline implant would be a sliding genioplasty along with Gore-tex posterior mandibular angles and a mandibular body piece to go between the angle implant and the chin.  The advantage, I believe, would be a somewhat more natural looking ‘mentolabial sulcus’ (more of an ’S’ than ‘V’ shape) and chin.  

Do you think a sliding genioplasty could give me the chin width shown in my Photoshop image?  I believe the chin can be split vertically and a piece of bone inserted between the halves to increase width.

Do you think the custom wrap-around implant would give me the length, width, and projection I am after, as good as a sliding genioplasty with Gore-tex angles?  

As much as I want to avoid adding complexity to the surgery, I do want the best looking and most natural looking end product/result.

Your thoughts would be greatly appreciated.

A: While there are different approaches to a total jawline enhancement effect, using any form of a three piece approach (chin and two angles… or in your description a five piece approach) is, just frankly, an historic and problematic approach to  achieving the jawline effect you seek. I have done over the past twenty-five years every conceivable method for chin, jaw angle and total jawline augmentation surgery. In almost every case, the custom jawline implant method is far superior to any other method or combination of jawline surgery methods for the following reasons:

  1. An important aspect of the total jawline enhancement look that you are going for is smoothness of the jawline from one angle to the other. A one piece implant can do that. A hodge podge of bone cuts and implants will leave a jawline irregular and asymmetric with absolute certainty.
  2. Every aesthetic surgery has risks of of revision which are cumulative based on the number of procedures done. While a custom jawline implant does have a risk of revision for aesthetic reasons, it is a single risk of around 15% because it is a single implant/procedure. When you combone five procedures together, as you have described, the cumulative risk from that approach will approach 100%.
  3. Gore-tex implants, even if they were available in the right size and thickness (which they are not) are soft and compressible. To vertically lengthen the jaw angles as you desire you need something that not only has the right shape but can push the overlying muscle and skin downward and then maintain it. Gore-tex is not the material for that job.
  4. While a sliding genioplasty can be split in the middle and bone grafted, the inferior edge transitions back along the jawline will not be smooth. Besides that issue you will need a bone graft harvested which must come from either your skull, rib or hip.
  5. The impact of a sliding genioplasty or a custom jawline implant on the labiomental sulcus are perfectly similar. The labiomental sulcus is a fixed anatomic structure whose effects from any procedure below it will remain the same.

Dr. Barry Eppley

Indianapolis, Indiana