Extreme Jaw Angle Augmentation

Q: Dr. Eppley, I am interested in knowing whether I can have an extreme jaw angle augmentation. I will be having surgery to both advance and widen my jaw very soon. However, my surgeon does not use implants. In the attached picture I have a before and (predicted) after for the advancement, but I also morphed it to have my ramus/gonial angle improved and thus increase my facial height solely through my lower 3rd. I wanted to know if you believe the 2nd picture (right side image) is attainable through custom implants. Thanks in advance for looking at this.

A: Such a custom jaw angle implant design is possible as you can make anything of any size or shape in the custom implant design. But from a clinical standpoint such an extreme jaw angle augmentation change would result in masseter muscle dehiscence (the muscle can not follow the implant down and back so far) with resultant implant reveal. The square end of the implant sticking out beyond where the lower border of the muscle will be. (muscle bulge way above the square jaw angle when biting down) In short this is not an advisable jaw angle implant design.

Dr. Barry Eppley

Indianapolis, Indiana