Is A Custom Wrap Around Jawline Implant Better Than Separate Chin and Jaw Angle Implants?

Q: Dr. Eppley, I am a young male and will be getting angular custom jaw implants, a chin implant and cheek implants next month. When I asked my Dr. about the wrap-around implant you offer, he mentioned he is not a fan of this type of implant because it requires complete degloving of the muscles. I have attached the MRI images showing the custom jaw implant that has been ordered from the implant company. Prior to proceeding with the surgery, I was wondering if I can get the opinion on the type of implants my doctor is proposing. After looking at pictures of the wrap-around implant, I’m concerned that with separate angle and chin implants I’m getting, it will be very difficult to achieve both a smooth jawline and a wider and more projected chin, because the vertical lengthening only exists at the back of the jaw bone, and does not extend to the chin. I would really appreciate if you can provide me your medical opinion on this and whether or not you believe what a better result would be obtained in my case with a wrap-around implant. Many thanks, 

A: Thank you for your inquiry to which I can make the following comments:

1) I do not comment on facial implant designs of other doctor’s patients. That is not appropriate for either the patient or the treating surgeon.

2) I would disagree, however, with the concept that a total jawline implant requires complete muscular degloving as that is not based on an anatomic understanding of jawline soft tissue anatomy. The muscles that do need to be elevated are the mentalis (chin) and the masseter (jaw angles), there are no muscular attachments between the two. Interestingly these are the same muscles that must be elevated for separate chin and jaw angle implants. What is elevated in a total jawline implant is the need for complete subperiosteal elevation.

3) I think your aesthetic concerns are well founded which is why the use of separate chin and jaw angle implants has largely been replaced in my practice with the wrap around implant concept. It simply offers a superior aesthetic result that has fewer postoperative complications such as asymmetry. When the jawline is weak or underdeveloped it makes more sense to augment the whole problem as a single unit that it does to add ‘spot’ augmentations to the three corners of the lower jaw for most patients.

Dr. Barry Eppley

Indianapolis, Indiana