Is The Mandibular Retaining Ligament Released in Wraparound Jawline Implants?

Q: Dr. Eppley, I’ve noticed that with many wraparound jaw implants (implants that extend along the mandibular body), the final visible contour often doesn’t match the implant design because the soft tissue doesn’t drape tightly enough over the new hard-tissue shape. For an aesthetic lower third, I think soft-tissue tightness and angularity from the antegonial notch through the chin corner is critical. Beyond the obvious masseter dehiscence problem, I’m specifically concerned about the mandibular retaining ligament. In a wraparound dissection, this ligament sits over the inferior lateral mandible where the implant typically lies, so it may be released/detached. My concern is that releasing it without any compensatory/restorative reattachment or pocket control can leave the soft-tissue envelope too loose, allowing bridging/sagging so the implant shape isn’t expressed. When you place this type of implant, do you perform any form of periosteal/soft-tissue resuspension, reattachment, or other technique to recreate the stabilizing effect of that ligament and ensure tight drape? Or do you mainly rely on added volume to stretch the tissues to achieve angularity—and if so, is that only reliable with very large-volume implants?

A: Adequate subperiosteal dissection and the creation of the implant pocket is critical and, by definition,  implant placement is about ligamentous releases. The ligament to  which you refer is released all the time without any adverse aesthetic effects that I have ever seen. There is no known method to restore it even if one desired to do so.

Dr. Barry Eppley

Plastic Surgeon