Jaw Angle Implants

Q: Dr. Eppley, I’ve also been looking into custom jaw implants to add some vertical length to my ramus and chin. However I’ve noticed that in the vast majority of these cases the results tend to look unnatural and often times asymmetric. Whilst I was confused about seeing the asymmetry in several of these custom implants (surely the designing process would have attempted to avoid any asymmetry?), this is less of a concern for me as some of the results I have seen are symmetric and thus I think with the right planning that can be avoided. However, what is bugging me is the synthetic ‘afters’ of most of these custom jaw implants. I don’t know how to describe it other than that it sometimes looks very ‘plastic’ which of course it is. Also I’ve noticed that a lot of these cases look very ‘bloated’, almost as if they have bruxism caused masseter hypertrophy. But why do the silicone implants create this unnatural looking effect through soft tissue? Even where augmentation isn’t extreme, the really sharp mandibular border that the implant creates doesn’t seem to look real. Is there anything to be said here about eliminating this effect?

A: Jaw angle asymmetry is the norm in jaw angle implant surgery not the exception. Whether the degree of asymmetry is significant or bothersome to the patient will vary widely. I have seen patients with small amounts of asymmetry have multiple surgeries to try and make it perfect while other patients with larger amounts of asymmetry are perfectly content with it. My experience is that if you are a young male you will fall into the former category and will not rest unless it is near perfect. While making custom jaw angle implants definitely helps decrease the risk of postoperative asymmetry, it does eliminate it completely. There is the implants design and then there is the actual placing the implant. I have an enormous experience with jaw angle implants and even I have a 10% to 20% risk of jaw angle asymmetry particularly when it comes to implants that create any vertical lengthening of the jaw angle.

Most people that seek jaw angle enhancement need vertical lengthening and not just width. All current commercially available jaw angle implants create width only and are inadequately designed in my experience. But that is what is available to almost all surgeons so that is what gets used. This wide rounded angle implant creates a fatter jaw angle not a more defined one in most cases. I am to sure what you refer to as ‘really sharp jaw angle implants’ since no such style of jaw angle implant is currently available to my knowledge. I have my own line of vertical jaw angle implants and often will custom design them to get a sharper  and not rounded jaw angle look. That begin said, not every face can end up with a more defined jawline look. The heavy the face or the one with thicker tissues will never get a very defined jawline/jaw angle effect from any type implant.

Dr. Barry Eppley

Indianapolis, Indiana