Custom Jawline Implant after Chin Wing Osteotomy
Q: Dr. Eppley, I am interested in your surgery expertise and I hope you can help me.
1. I had a “chin wing” osteotomy a couple of years ago. Can jaw implants be placed on top of this? And does it increase the likelihood of post-surgery complications?
2. I’m interested in custom midface implants, specifically to achieve what I refer to as the “high cheekbone” look you see on certain male models. So this targets specifically the zygoma prominence and the zygomatic arch. My question is my cheekbones have been described as medium, when I’ve asked different surgeons whether I have high, medium or low cheekbones, so can your implant raise the cheekbone higher? or can it only be placed simply on top of the existing cheekbone and thus increase lateral and anterior projection but not raise it in the superior direction?
3. What incisions are used exactly for the cheekbones? Lateral canthus? Or something else? Is it scar free or does it leave a permanent mark?
4. I want to reduce scleral show. I’m assuming the correct approach is a custom infraorbital implant in combination with a high cheekbone/zygo arch one?
5. My biggest goal with the jawline implants is to create a highly angular facial lower third when viewed front on. I want a somewhat square chin, that extends downward slightly but blends in with the natural curve of the face. I also want a sharp-ish jaw angle from the side, but not a ridiculous 90 degree one as it looks overly artificial. So I guess my desire is something that looks sharp, angular, well defined but not over sized or fake looking. To stress my biggest desire is the shape of the jaw front on. Tom Cruise in his 30’s had an amazing one in a million dynamite jaw in my opinion – a shape like that is what I want. But I don’t know if my face is too round for that to be achieved. What do you think?
6. What’s the waiting time for procedures?
7. Is custom midface implants too much in combination with jaw implants? Does it increase the likelihood of infection?
A: In answer to your questions:
1) I am very familiar with the chin wing osteotomy and have placed custom jawline implants in patients who have had the chin wing osteotomy procedure done previously numerous times. While the chin wing osteotomy has its benefits, it is not a total jawline augmentation procedure.
2) Custom made cheek implants can be made in any shape and dimensions desired. There are no limits as to how they can be designed. The key, therefore, is to determine what those implant dimensions are given what the aesthetic results the patient seeks.
3) The incisional access to the cheek implants depends on the style and dimensions of the implant. Unless there is an infraorbital component to it they are usually placed from an intraoral approach.
4) While adding support to the infraorbital rim is an adjunct to reducing scleral show, it is not usually completely effective as a stand alone procedure expect in the most minor amounts of scleral show. Usually an interpositional graft needs to be added to the lower eyelid to drive up the lid margin.
5) The aesthetic effect of a jawline implant is highly influenced by the face in which it is put. Thinner faces with smaller amounts of subcutaneous fat get the best results. Without knowing what your face looks like I can not tell you how realistic or unrealistic such facial reshaping results are.
6) Custom implants take about one month to designing fabricate for surgery.
7) Custom midface and jawline implants are commonly done together.
Dr. Barry Eppley