Q: Dr. Eppley, I am interested in jawline augmentation. I had a chin implant placed several months ago. I have attached my before and after pictures. As you can see, the chin augmentation is an inadequate improvement – I have basically gone from having a recessed chin to having a weak one. I want my chin to line-up with my lower lip. I suspect I would need a genioplasty + implant to attain this.However, I do like the height the implant has given to my chin, it has given me a stomion ratio of 2.00 and this is a feature I would like to retain. I also like the enhanced lateral chin width and the squarer shape. Square chins look better than round chins on men in my opinion. My gonial angle I would like reduced to 115-120° range, I’m unsure whether this is a realistic goal though. What is the maximum possible jaw angle augmentation with implants? I’ve read that it is 12mm.
A: Thank you for sending your pictures of your chin augmentation results.. For a large anatomic chin that is not much of an improvement. Based on your pictures and goals, I can make the following jawline augmentation comments:
1) It is rarely a good idea to combine a chin implant on top of a sliding genioplasty in an effort to substantially increase its width. That works best when the goal is merely to ensure that the chin is more square or to cover the back ends of the osteotomy cuts.
2) A sliding genioplasty may provide the greatest horizontal projection but in doing so will make the chin less square and potentially even more narrow.
3) Based on #1 and #2, the best choice is a custom wrap around jawline implant alone. Your existing chin implant has help to serve as a chin tissue expander which allows for greater horizontal projection than otherwise could have been achieved initially.
4) Vertically lengthening the jaw angles (decreasing the mandibular plane angle) in theory can be done any amount, particularly when it is a custom implant design, and can even be surgically placed. But the greater the implant drops down the jaw angle the risk of the muscle not following the implant edge increases. (masseteric muscle disinsertion) Such an aesthetic complication is very difficult and in many cases impossible to correct secondarily…so it is a problem best avoided. It is impossible to predict before surgery what patient may experience this potential problem. I have dropped jaw angles down 25mm and not seen it…then I have seen it occur in drops as ‘minimal’ as 10mms. As a general rule it is best to not get ‘greedy’ and keep a reasonable amount of vertical jaw angle lengthening in the 8mm to 12mm range.
Dr. Barry Eppley