Does The Design Of A Custom Jawline Implant Take The Facial Soft Tissues Into Consideration?

Q: Dr. Eppley, I am interested in a custom  jawline implant. As I understand the process of design off of a 3D CT scan, one “see” the skeletal changes butI am having difficulty envisioning the appearance of my jawline outside “with skin on it”. I am very serious about having this procedure done and want definite improvements to both my jawline and my chin/profile, but I also want a final result that looks natural and keeps all my facial features in good perspective with one another. Is there a way for me to “see” the proposed changes from an exterior view?  For example, can I take photographs of my face so predictions could be made from them with the designed implant in place?

A:  There are several facets of the custom jawline implant process that is important ofr anyone to understand that wants to have the procedure done. While computer imaging can do a great job of making the implant design to perfectly match the bone, the translation of what the bone changes would be to how it looks on the outside is not currently possible. That is because the translation of bone augmentation to an exterior soft tissue facial change is not accurately known. It is assumed that it is a 1:1 relationship and that is probably more true than not. There is also the issue that there is no radiographic method to capture your soft tissue, overlay it on the bone, and then change it based on the underlying bone changes. This would obviously be tremendously beneficial but that technology has not yet make it to this application in any cost efficient manner as of yet. Thus radiographic assessment and implant design processes are still very bone-based.

What all of this means is that I have to design the dimensions of such a jawline implant based on a non-scientific artistic manner. While that sounds very dubious and obscure, it is not. I have a lot of experience designing these custom implants and have a very good feel for whether it will actually fit (having enough soft tissue to cover it) and how it will look on the outside when placed. That is precisely the role that our prior computer soft tissue imaging played before I designed the implant. I was trying to get a feel for the type of jawline changes you were looking for and what you could tolerate. Having done this a large number it times there are some general rules that I following in a wrap around jawline implant design. One of the very first thing one learns in doing these is that it is very easy to make them too big. While you can design anything on the computer you have to take into account the thickness of the overlying soft tissue as that will add to the volume as well. It is always better to slightly ‘undersize’ it as oversizing will always lead to revisional surgery.

The concept of what a ‘natural’ jawline result is can be a very individual one. But again that is the role of the initial computer imaging. That helps me determine how extreme a change any patients wants. And you are correct, you don’t want a jawline change that overwhelms or is out of proportion to the rest of one’s facial features.

Dr. Barry Eppley

Indianapolis, Indiana