Q: Dr. Eppley, I am interested in a custom jawline implant. I have had Radiesse injected in my jawline about six months ago. I am looking into getting a custom jaw implant as I feel the Radiesse has made my face too rounded looking. How long would I need to wait for the Radiesse to go away before getting the implants? I also have a chin implant already, would this present an issue with the jaw implants?
A: It would be best to have most of the Rardiesse dissipate before placing custom jaw angle implants. This would allow a better assessment of your aesthetic jawline needs. When you say a custom jawline implant, I am assuming that you mean a wrap around jawline implant from jaw angle to jaw angle that crosses and includes the chin. Having a chin implant in place is not a problem as the design of the implant will digitally remove the chin implant from the scan so the jawline implant can be designed. In surgery the chin implant is simply removed to make way for the new custom jawline implant.
In theory an injectable filler is a god trial for what a facial implant can do in some cases. But it does replicate the exact effects of what a more firm facial implant on the bone can achieve.
Dr. Barry Eppley
Q: Dr. Eppley, I’m about 6 weeks after placement of a custom jawline implant. To be honest, I’m not too thrilled about the results and would like to possibly schedule a revision surgery with yourself. First off I’d like to tell you the situation with my custom jawline implant. On the positive side, in terms of the added bulk along the jawline, I think it’s perfect. There are two main issues I have which I would love your feedback on how to improve. The first is that I feel the lateral projection/width of the angles is not big enough. At about the 3rd week after surgery, I think it was at the perfect level. But after a few more weeks passed, I lost that added width and and angularity and now the angles blend in with the jaw, giving my face a big U look, rather than adding any angularity or sharpness. The second is that because I lost the added width at the angles, the newly added vertical length of the chin has my face now with a stretched out/elongated look. While the projection of the chin is fine, I feel the length really needs to be shorten about 1.5mms or so.
Can I ask your feedback on what you would recommend on terms of design to rectify these issues? To get better sharpness at the angle, should we increase just the lateral projection or also increase the thickness? How do you think would best to handle the chin? Again, the jawline itself looks much better and defined but I would really like to fix the angle and chin issues.
A: The first thing I would tell any custom jawline implant patient is to wait a full three months before contemplating any revision. It takes time for all of the swelling to subside and the tissues to contract back down around the implant. There is also the accommodation phase of adjusting to a new look. Between all of these factors how one feels at just 5 weeks after surgery may change…I have seen it happen.
That being said, what you have learned is that while computer designing is a great and only way to make a total wrap around jawline augmentation, there is no accurate way of predicting what the final aesthetic result would be. The computer has no innate knowledge of how to make those dimensional changes and that input must come from the surgeon based on his/her experience.
What you do know now is what effect the current design has created. Those dimensions are critically important when contemplating a revision/replacement implant. What would be important to see, and it is of critical importance, is where you started and what you look like now. That information helps gauge how the dimensions of the chin and jaw angles have had an initial impact and will play a critical role in knowing how to change the current implant design.
Dr. Barry Eppley
Dr. Eppley, I’m having a LeFort 1 and bilateral split sagittal osteotomy to widen my upper arch and move it forward and rotate it clockwise and to straighten my lower jaw, and correct an underbite. But since I’m going through the trouble of this surgery and its difficult recovery, I’ve been thinking about how I might as well make the results better. In an ideal world, I’d love to have a more prominent and masculine jaw angle and jaw line. My surgeon is considering combining the surgery with a sliding genioplasty. From what I understand, together these surgeries could improve my chin but not necessarily my jaw angle.
My two questions are: 1) have you had any patients who had a wrap around custom jaw implant (or even just jaw angle implants) done at the same time as a LeFort/BSS osteotomies? and 2) how long would one need to wait after surgery before considering implants? Thanks for your help.
A: It is not advised that a wrap around custom jaw implant be placed at the same time as a sagittal split mandibular ramus osteotomy. Placing a custom jaw implant over a newly made sagittal split osteotomy site may adversely affect bone healing. One should wait six months after orthognathic surgery to consider placing a custom jaw implant.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in jaw augmentation. I want to change my whole jawline to make it like one of the men in my goal photos. Up until this point I was assuming the custom wrap around jawline implants would achieve it, but since I shaved my beard off to see what I had, I am unsure if it will even be enough. Do you think I need any other procedure like lefort, jaw advancement, chin wing etc. Do I have a recessed jaw/chin, or is it just generally underdeveloped? I just don’t know, but I’m willing to get whatever jaw augmentation procedure I need.
I attached the best pictures I could take with my phone, I hope they are good enough. Based on them, can you tell me if any of my goals are possible (and what procedure or combination of procedures I would need). If any of the picture’s quality is good enough, is it possible to have a ‘predict my face’ and get a morph of what is maximally possible with custom implants? I really want to achieve a jawline that of one of my goal pictures.
My ultimate goal is to achieve a front jawline as close to any of those goal pictures as possible. And the side profile to have as much of an L shape as possible (male model look). Currently whenever I am in public I push my jaw out as much as possible and also bite my teeth to flex the jaw, it is a small improvement but is too much effort for me to maintain all day (not to mention I shouldn’t have to resort to that just to look less ‘bad’)
Note: I also plan on having other procedures done (rhinoplasty), but right now I am most concerned about jaw augmentation, as I think that will have the biggest impact, and then get the other procedures.
A: Your pictures do not show an abnormal lower jaw that is significantly underdeveloped or would be in need of major orthognathic surgery. To achieve your aesthetic goals you need jaw augmentation by any of the conventional implant methods. There is nothing more powerful and than a custom jawline implant and that would be the ideal approach for you. But the more economic approach to a more complete jaw augmentation is that of a square chin and jaw angle implants. This could also be effective for you since your jaw shape is not overlying deficient and enhancements at the chin and jaw angle areas would go a long way towards a more defined jawline.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested, I think, in a custom jawline implant.The attached photo includes a Photoshop direction I would like to take with a custom jawline implant. Is this achievable or just very wishful thinking? Also, would you suggest a neck lift or would such an implant eliminate the loose muscle/fat under my chin. I’m looking forward to making a decision on this very soon and moving forward. Thank you very much!
A: What you are demonstrating by your Photoshop effort is pretty much what is possible with a custom jawline implant. It is not wishful thinking. Such a custom implant will pick up all the loose skin in the neck particularly back along the jawline and jaw angle area. It will also do so under the chin as well. How effective it is at ‘eliminating’ this loose skin has a lot to do with the size and dimensions of the implant. It does so because the increased surface area of the implant requires greater soft tissue coverage and it pulls it up from below not downward from the face. A bigger bone surface requires more tissue coverage and it has to come from somewhere. Fortunately for the jawline it comes from the neck.
Dr. Barry Eppley
Q: Dr. Eppley, Exploring options as part of the decision making process, I understand an alternative to the custom jawline implant would be a sliding genioplasty along with Gore-tex posterior mandibular angles and a mandibular body piece to go between the angle implant and the chin. The advantage, I believe, would be a somewhat more natural looking ‘mentolabial sulcus’ (more of an ’S’ than ‘V’ shape) and chin.
Do you think a sliding genioplasty could give me the chin width shown in my Photoshop image? I believe the chin can be split vertically and a piece of bone inserted between the halves to increase width.
Do you think the custom wrap-around implant would give me the length, width, and projection I am after, as good as a sliding genioplasty with Gore-tex angles?
As much as I want to avoid adding complexity to the surgery, I do want the best looking and most natural looking end product/result.
Your thoughts would be greatly appreciated.
A: While there are different approaches to a total jawline enhancement effect, using any form of a three piece approach (chin and two angles… or in your description a five piece approach) is, just frankly, an historic and problematic approach to achieving the jawline effect you seek. I have done over the past twenty-five years every conceivable method for chin, jaw angle and total jawline augmentation surgery. In almost every case, the custom jawline implant method is far superior to any other method or combination of jawline surgery methods for the following reasons:
- An important aspect of the total jawline enhancement look that you are going for is smoothness of the jawline from one angle to the other. A one piece implant can do that. A hodge podge of bone cuts and implants will leave a jawline irregular and asymmetric with absolute certainty.
- Every aesthetic surgery has risks of of revision which are cumulative based on the number of procedures done. While a custom jawline implant does have a risk of revision for aesthetic reasons, it is a single risk of around 15% because it is a single implant/procedure. When you combone five procedures together, as you have described, the cumulative risk from that approach will approach 100%.
- Gore-tex implants, even if they were available in the right size and thickness (which they are not) are soft and compressible. To vertically lengthen the jaw angles as you desire you need something that not only has the right shape but can push the overlying muscle and skin downward and then maintain it. Gore-tex is not the material for that job.
- While a sliding genioplasty can be split in the middle and bone grafted, the inferior edge transitions back along the jawline will not be smooth. Besides that issue you will need a bone graft harvested which must come from either your skull, rib or hip.
- The impact of a sliding genioplasty or a custom jawline implant on the labiomental sulcus are perfectly similar. The labiomental sulcus is a fixed anatomic structure whose effects from any procedure below it will remain the same.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom jawline implant. I have a weak jawline. I have had braces in the past so I do not think it is related to an overbite. My face is vary narrow and I am hoping that I can add some lower jaw width. I really like that you are trained in maxillofacial surgery and your results are beautiful. I have attached some pictures and am open to suggestions and would like to get a quote. I have also attached photos of my aspired look. I look forward to hearing back from you!
A: Your face is narrow and your jawline or lower third of your face is your weakest skeletal feature. It is short in both jawline width and chin projection. The best method to achieve the ideal pictures you are demonstrating is through a custom jawline implant. That is the only method to get the desired facial width and have a smooth shape and transition from the chin back to the jaw angles. Standard chin and jaw angle implants are another option but are suboptimal as their effects will be a bit unconnected and not smooth…which is really crucial to the jawline look you desire. A custom jawline implant is the proven ideal method to improve the balance of the lower third of your face to what lies above it.
Dr. Barry Eppley
Q: Dr. Eppley, I was looking into this procedure to create a more masculine jawline and prominent chin as I feel currently my face has the more oval shape as opposed to a squarer shape that I would prefer due to high jaw insertions and a slightly recessive chin. As you can see in the photos there is some degree of jawline asymmetry present as the left side is significantly more developed than the right, would this asymmetry necessitate the use of a custom implant as opposed to the off the shelf chin and jaw implants. Thanks very much.
A: You would need a custom jawline implant (one piece wrap around type) for the following two reasons. First, the lower facial augmentation effect you are trying to create requires a smooth augmentation from one jaw angle to the angle across the chin. A separate three piece approach (chin and two jaw angle implants) would not have this smooth widening jawline effect. Secondly with the degree of jawline asymmetry that you have, only a custom jawline implant made from your 3D CT scan can be designed to take that into account to get the best jaw symmetry as possible.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom jawline implant. But before making this expensive decision I just want to make sure a sliding genioplasty is not something I should consider and living with a custom chin implant for life is 100% the best for me. I really think vertical length is one of the key factors with my chin being weak. I would appreciate your thoughts before I make this choice. Thanks so much.
A: In looking at your goals by your own imaging, you need chin and jaw angle changes. When it comes to vertical chin lengthening that can be done by either a sliding genioplasty or a custom implant. If you were just doing the chin alone and did not care about the rest of your jawline then the debate of a sliding genioplasty vs. implant has merit. But when you factor in the rest of the jawline for aesthetic improvement, where jaw angle implants would be needed and the only way to get that improvement, then a custom jawline implant makes the most sense. While a sliding genioplasty can be done with jaw angle implants, those areas will remain unconnected and not have a smooth line between them. A custom jawline implant creates all the chin and jaw angle changes one needs and connects them in a smooth wraparound fashion. In my experience this produces a far better result for almost all male jawline enhancements with lower risks of nerve injury/numbness. An even though the implant is more expensive to manufacture up front, it is done in less surgery time (so the costs differences are closed to a wash) with lower risks of revisional surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I had a v-line jaw surgery in Seoul, Korea and feel that it doesn’t suit my face. Is there a way to reverse it? I fear that it will cause me to prematurely age…it has already given me jowls.
A: While V-line jaw surgery can be very effective at making the jawline/chin smaller, it does create the potential for loss of skeletal support to the overlying tissues. Usually in young people this is not a major concern because the have very good elastic properties of the soft tissue which can adequately shrink down to the reduced jawline bone structure. But if overdone or in some older patients a jawline reduction can result in a soft tissue sag most commonly seen in the jowl area. A V-line jawline reduction can be reversed and requires a custom jawline implant to do so. I have done several of these procedures and the implant is designed based on a 3D CT scan. In some patients I have been fortunate enough that the patient had an original 3D CT scan prior to their jawline reduction surgery so the new and old 3D CT scans could be overlaid and an exact replica of their original jawline structure recreated. In other cases no such prior 3D CT scan existed so the custom jawline implant design had to be based on what was believed to be the original jawline bone structure. In one case, a male patent even went as far as augmenting his jawline far further that what his original jawline structure was like before the jawline reduction.
In short, a V-line jawline surgery can be reversed by a custom jawline implant.
Dr. Barry Eppley
Q: Dr. Eppley, I had a question that has made me a bit nervous about a custom jawline implant Originally, i was going to have just jaw implants, but after talking to Dr eppley, I decided to do the full jawline including chin, for a more symmetric look. I was wondering a bit about the implant insertion. With just the jaw, I know that the implants were put in from the inside of the mouth, being placed gently under the muscle. But with the full jawline/chin implant, I didn’t know how it would be inserted and if there are complications. From what I understand, under the chin will be the incision. will the implant be one big piece and slid back on both sides to its final location. Are there any complication with the muscles by inserting this way? Is it easy and safe. Also, is it one piece, or is it 3 pieces that are created together that will be re-attached together at the end (2 jawlines and chin). I’m just looking for a more in depth explanation. Any videos of the surgery you could recommend. Let me know if you have any details you could share for me.
A: A custom jawline implant is put in usually as a single piece implant. But it requires three incisions to properly place…two inside the mouth and a front incision done either inside the mouth or from under the chin. The effects on the mentalis and master muscles are the same whether one has a total wraparound custom jawline implant or three separate implants. (chin and two jaw angles) In either case the same subperiosteal pocket must be made.
Dr. Barry Eppley
Q: Dr. Eppley, I have had custom jawline implant (chin and jaw angle implants) made and placed and I have included my before surgery and after surgery pictures. I am very happy with the chin portion. I also like the jaw portion, but feel like it left me with a sort of puffy look versus the more v shaped jaw i was looking for. I know it isn’t possible to look like Brad Pitt or a male celebrity, but I at least wanted to try and emulate the general characteristics. Just going off of what the implants did, I figured going a few mm more in width and couple mm in posterior drop would be beneficial, but of course I defer to you. I have attached some pictures of the general look I am going for, and would appreciate any comments on what you think would look good for me. Also, in seeing my pictures, do you think I would benefit from the temporal augmentation with implants? Or is it something you don’t think would add much? I have always appreciated your expert and honest advice.
A: Your jaw angle implants did not get close to your desired result because they did not go back far enough and had no vertical drop. Thus they may you look ‘puffy’ but did not add any angularity to the jaw angles and don’t really match the chin that well. Also the inplant design appears to be connected on the left side but not on the right for some reason. Without dropping the entire jawline from chin on back to the angles you will not improve your posterior jaw shape. In essence you need a connected wraparound cusyom jawline implant that is better designed for your objectives.
If you increase your jawline than I would agree that the width of your temporal and lateral forehead region is comparatively too narrow. Extended anterior temporal implants would provide a good balance with a new posterior jawline.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a full wrap around custom jaw implant as it seems to be exactly what I need for the look I am interested in. When making the wrap around it it possible to make the side ends thick to get an end result like I have illustrated in this example but also build in the chin implant on the wrap around to make my chin longer and more aesthetic? With my current chin implant I feel like the chin implant was placed too high and has altered my smile, so fixing it all in one go would be great. I am from around Loa Angeles so could I fly out prior to surgery and get a 3D CT scan and show you exactly the type of implant I wanted? Also would I need to get my wisdom teeth removed before the surgery? I talked to another doctor who required it.
A: The wrap around custom jaw implant is the only way you can get that continuous jawline look that goes from side to side. That jawline implant look (large wide jaw angles) can be designed although many patients would consider the look to which you reference as being excessively wide in the jaw angle area. Vertically lengthening of the chin as part of the design is commonly done for many custom jawline implant proedures.
The 3D CT scan which is needed can be done where you live so there is no need to come here to get that done. The design part is done from afar with you and it takes about three weeks from design to having the implant ready for surgery.
Whether your wisdom teeth should be removed depends on whether they fully erupted or partially or full bony impacted and whether they have ever been symptomatic. (e.g., developed pericoronitis) If they are full erupted and are asymptomatic then it does not matter if they are in place or not. But if they are less than fully erupted they should be removed 3 months prior to the custom jawline implant procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in your assessment of my jawline issues. and what you would recommend for surgical improvement. I have a weak jaw but a fairly good bite. Had orthodontics as a teenager and they never recommended any surgery. The other issue which may be helpful is that I have obstructive sleep apnea (OSA) and wear a mouth piece at night to push my chin forward. I am tall and thin so I do not fit the ‘typical’ body type for many OSA patients. I have attached pictures for your review. I have been to several plastic surgery consults but each one suggests a chin implant. While that might be somewhat helpful it just seems that it is an inadequate solution for my problem.
A: Thank you for sending your pictures. My assessment is that you have an overall short lower third of our face as evidenced by a horizontal and vertical deficiency of your entire jawline. (mandible) Besides the visually apparent facial third discrepancy, the fact that you have OSA and require the use of nighttime CPAP speaks to the potential contribution of a short jaw as a contributing factor.
The optional treatment for this type of jaw deficiency is a custom jawline implant that can augment smoothly the entire jawline in a wraparound fashion from jaw angle to jaw angle including the chin with tridimensional changes including increased vertical, horizontal and some width changes. (see attached predictive imaging) Having significant OSA, however, throws a variable into such a plan however as it would provide no functional improvement in your airway….and that seems like a shame given its potential lifelong occurrence.
A variation on the custom jawline implant would be to combine a sliding genioplasty to bring the chin down and forward (carrying the anterior attachment of the tongue muscles with it and potentially offering some OSA symptom improvement) combined with a pre made custom implant that would augment the rest of the jaw. This would be the only way to have a completely smooth transition from the posterior edges of the sliding genioplasty osteotomy line to the body and angle of the jaw behind it from an augmentative standpoint. Like the total custom wraparound jawline implant it would need to be made from a 3D CT scan from which the osteotomy and implant design would be done.
The ‘simplest’ option would be to just have a sliding genioplasty with standard off-the-shelf vertical lengthening jaw angle implants. While offering aesthetic and functional jawline improvement, it would not create a perfectly smooth jawline from front to back.
Dr. Barry Eppley
Q: Dr. Eppley, I have 2 questions about a custom jawline implant. Recently I tried to find photos of celebrities with similar skull width and face shape as me, but I noticed that among people with similar midface width, the shape of the jawline can be very different. I can basically tell 2 different types, and what I’m trying to achieve is the Type I effect. That is the “long sharp chin” effect while the jawline still looks 3-dimensional. My current chin implant is sharp, but the size of it is too small and still short and the weight of the entire lower face looks very unbalanced (jaw body vertically short and flat). Also my jawline looks very 2-dimensional.
I really don’t like an over-masculine jawline like a “squared jaw” that protrudes in lateral direction like a lot of bodybuilders might request…). I prefer a neutral but a little more “boyish” one as type I. But almost all results of jaw implants I’ve seen are sort of similar to Type II (it’s big and wide), so
1. I just want to ask whether it is possible to achieve Type I effect with a wrapped-around vertical custom jawline implant?
2. Although it’s obvious that they are different, but I can’t tell exactly what contributed to the differences… Can you tell me some differences between Type I and Type II jawlines?
A: The short answer to your question is that the ONLY way to achieve a more vertical jawline enhancement is with a custom implant approach. No standard or preformed off-the-shelf are designed for that effect, they are all width based implants because they are all sitting completely on the bone. That is why you see many ‘type II’ jawline enhancement results and not your desired ‘type I’ jawline augmentation result.
Dr. Barry Eppley
Q: Dr. Eppley, I’m interested in having custom jawline implant with you but I have several questions want to ask. I want to get jawline implant not because I want to be more masculine looking, but instead I think my flat and short jawline makes me look weird in oblique (45 degree) view. I had a chin implant but it didn’t help much. The chin length looks OK in frontal view (in fact I’d say a bit short for a male) and it protrudes enough in lateral view, but in oblique view it doesn’t look very projecting because of the vertically short jaw. It looks like Lindsay Price before she got a chin and jaw surgery. Besides that I don’t have the angle, my jaws go directly up to my ears.
My questions are:
1) Is it possible to get a jawline implant but not make my face wider (no angled & lateral jaw), instead just making the jaw steeper? For example, like Cameron Dallas or Justin Bieber (they have very steep jawline)
2) I have a V-shaped lower face, is it possible to remain the overall V-shape and sharp chin, but just make the overall length longer & steeper? Like my friend on the left, he has very long chin and steep jaw, but still has sharp chin.
3) I now have a chin implant, but I know that for a custom implant you need to design on a CT file. Is it possible to distinguish between the bone and implant, and design on a CT file with a current chin implant? Or I’ll need to take CT after removing the old implant?
4) Is computer simulation possible for jawline and chin implant?
A: By the description of your jawline concerns and needs, you need a custom jawline implant that is made off of a 3D CT scan that wraps around the entire jawline. It can be made with your chin implant in place which is then digitally removed during the the implant’s design process. The implant’s shape and dimensions can be made virtually anyway one wants it to crate their desired jawline shape.
Dr. Barry Eppley
Q: Dr. Eppley, I had a custom jawline implant placed about six months ago by another surgeon. It is not adequate at all and now what the surgeon promised the result would be. Besides its size my other concern is the location of the exterior scar on my face? It seems to be very close to the front of my chin, in fact on some ‘shrugging’ type expressions it seems to roll over to the front. Would this be in a better location upon my custom jawline implant revision?
A: One of the things you learn in placing custom jawline implants or even vertical lengthening chin implants is the typical location for the submental incision will be too far forward if not changed from its traditional submental skin crease location. When the chin is lengthened vertically and comes forward, the typical location of the submental incision is too far forward and will almost end up on the chin point as opposed to being tucked on the underside of the chin. Therefore, the incision needs to be placed further back than most surgeon’s think as the implant rolls it forward. That incision location can not really be changed now.
Dr. Barry Eppley
Q: Dr. Eppley, What is the material used to widen my face at all areas. (especially the area at side from zygoma to lower jaw) Will silicone material be the best ? I have tried fat transfer but it was little volume and only had a temporary effect. I wish to widen my face with permanent and semisolid material. I have attached my photo. Thanks a lot.
A: The best way to permanently widen your face is by using a combined custom facial implants approach with jawline and zygomatic arch designs made from a solid silicone implant material. They will provide an immediate and lifetime change. With a custom design they can be made to match in their upper and lower facial width increases so one is not wider than the other.
Fat injections in you was never going to work. And even if the fat took it would look soft and ill-defined. But most importantly your face is too thin to ever have any fat graft take very well. Fat grafts always work better when there is some natural subcutaneous fat into which they are placed.
The only issue here is that there will be a concavity between the mid- and lower facial widths increases where there is no bone support. I assume this is one of the areas where the fat injections were placed that did not work.
Dr. Barry Eppley
Q: Dr. Eppley, I’m really pleased to know a chin implant can be a solution after my chin and jaw angle reduction surgery which has left my face deformed. I’ve sent pics to show how my chin dips in side profile and how the chin area directly below my lower lip protrudes when I smile. I think this is related to mentalis suspension? Really want to get rid of this protrusion, not normal looking.
- Can vertical chin implant get rid of this protrusion under my lower lip?
- Does a “mentalis resuspension” mean, cut along the gum line and stitch it again with a new stiching line in a different place? What does mentalis resuspension mean?
- What is the risk involved in mentalis resuspension? ( Or could it result in a worse bulge/protrusion or some other complications?) Or should I best leave it, if it’s going to risk resulting in a worse protrusion or some other complications.
- The center that did my CT scans seem to think that my jaw angles have been over cut (surgeon took too much bone off?), it was not cut straight and I have indented jaw angles? Does it look as if my jaw angles have been over cut? ( CT scan attached)
- Is it best I get a chin implant and 2 jaw angle implants? Or is it best to get a one piece implant that goes from one side of jaw angle ,across the chin, to the other side of jaw angle?
- Are there any down sides to having screws in your face bones? How many screws will it take to hold the implant(s)in place?
- I read online that a silicone jawline implant does not give good defined bone shape/anatomy, but acrylic PMMA is able to give that defined bone structure, is there truth in this ?
Thank you so much.
A: Thank you for sending your pictures of you and your 3D CT scan after your jawline narrowing or V line jaw reshaping surgery. In answer to your questions:
1) Vertical augmentation of your chin will help with the protrusion as the origin of the problem is the loss of volume from the previous chin reduction.
2) Mentalis resuspension is an intraoral technique where the mentalis muscle is repositioned higher on the bone.
3) The only downside with mentalis muscle resuspension is in how well it works. It has no other downsides and will not make what you have now worse. I do not think, however, that mentalis resuspension is needed for tour chin problem and implant augmentation alone is a better approach.
4) Your jaw angles do look over cut with a severe 45 degree angle to them. That matches with how you loo on the outside of your face. (the indentations over the angles)
5) Unless you want the side of the jawline augmented (which I do not think you do as there is a reason you had the original surgery…a narrower jawline), I would go with a three piece chin and jaw angle implant approach. They need to be custom made and I would design them as a single attached jawline implant (because it will cost you less to do so) but in surgery I will convert it to three pieces.
6) There are no downsides to have small 1.5mm screws in your jawline for fixation of the implants. They are roughly the size of the screws used in eye glasses.
7) A custom jawline implant, made of silicone, creates the best jawline definition and shape over any other material. PMMA would be the worst material to use since you have to shape it during surgery and achieve any symmetry and good shape between the two sides of the jawline would and be virtually impossible. Anyone who would say so otherwise is inexperienced and ill informed and does not have a contemporary understanding of facial implant materials and how to design and place them.
Dr. Barry Eppley
Q: Dr. Eppley, Here you have some pictures 3 months post op from my custom malar-infraorbital and custom jawline implants. As you can see all (or almost all) of the swelling in the jaw and chin area has subsided. There is still some swelling (or puffiness) under my eyes but that is slowly improving. To this date is a bit better than in the pictures. The scar under the chin is almost imperceptible and I can shave without feeling anything.The blepharoplasty scar at the corner of my eyes are less noticeable. I am happy with the result and I think it definitely is an improvement. I’d like to ask you about your opinion on a second implant advancing my chin still a bit and pushing the jaw angle a bit backwards (I am happy with the width of the jaw but I wonder how feasible it would be to take it a bit lower and backwards)
A: Thank you for the followup. In looking at your before and after pictures, I would agree that there has been overall improvement in both the eye/cheek area as well as the jawline. It looks natural and not overdone. I would also agree that we certainly did not overdo the jawline (which was an initial concern) and there is room for further chin and jaw angle improvement through a redesigned implant. The good news is that a new custom jawline implant is so much easier the second time because there is already a pocket in place so the trauma of extensive soft tissue dissection is over. Also we have the advantage now of knowing what the existing custom jawline implant does and that makes it much more predictable in terms of how to redesign a new one for added augmentation benefits.
Dr. Barry Eppley
Q: Dr. Eppley, I am currently undergoing orthodontic treatment to correct a severe overbite which has also caused a recessed chin and weak jaw. My orthodontist said it may be necessary to undergo orthognathic surgery following my treatment. While I’m perfectly happy to do this, there is a good chance my insurance won’t cover it as it is not causing a medical problem (such as sleep apnea or speech impediments) and the surgery can cost anywhere from $20-50k.
I want to know if a custom wrap around jawline implant could give the same aesthetic effects of the jawline (fix my recessed chin/weak jaw) as orthognathic surgery of the mandible? In other words, can the implant mask the appearance issue of the jawline without actually addressing the functionality issue of an overbite?
A: The simple answer to your question is yes. In reality, a custom wrap around jawline implant offers much more versatility in terms of dimensional facial changes than any form of orthognathic surgery. A sagittal split osteotomy advancement of the mandible can really only supply a horizontal forward movement whose limit is based on the difference between the pre surgical relationship of the upper and lower teeth.
Dr. Barry Eppley
Q: Dr. Eppley, Thank you for taking the time to generate this computer modeling image for me. Although striking, I find the jaw line in the modeling too bold or strong for my liking. Perhaps I need time to acclimatize to the new look. I am more inclined to a long slim straight jaw line with small round (almost but not quite pointy, but not square or large round/oval) chin as in the first attached image.
I understand that you would be making a custom implant from the CT Scan I will provide. But from my limited web research, I have made the following observations. If Implantech implants were used, the back of the jaw would just be built out to appear 1” below the ear as opposed to the modeling of 2” below the ear (using a jaw angle lateral width implant versus an vertical lengthening jaw implant). I understand that the chin implant (such as the vertical lengthening chin by Implantech) would add projection reducing pre jowl sulcus as well as help with the angle under the chin. (See second attached image).
My big concern is with my neck angle in profile. Would a neck lift with removal of playsmal fat banding create a nice sharp neck angle (horizontal as opposed to 45 degree angle)? Would the above mentioned vertical lengthening be appropriate to correcting this problem?
A: The main role of computer imaging is to see what type of changes a patient is looking for. So having thrown that first draft out there, you have provided the direction I was looking for in regards to your jawline shape goals.
When making custom implants, there are different than what standard stock chin and jaw angle implants have to offer. They can be made to any dimensions one desires and would be connected between all three. That is a significant advantage when it comes to addressing any loose skin around the jawline and neck lift as it will pick it up to some degree through a volumizing effect. This effect combined with a small neck lift should address any neck issues and create more of a well defined and sharper cervicomental angle.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in jaw augmentation implants, specifically ones for vertical chin enhancement and lateral jaw angle implants. I have previously had a standard chin implant that only gave projection but did not correct a weak jaw. Your custom implants look like what I need. Do I need a CT scan for these or can I be assessed in person or on Skype?
A: Your story is a very common one, having had a standard chin implant which helped but left one way short of a more complete total jawline enhancement. What you undoubtably need is a more comprehensive approach with a custom wrap around jawline implant. This is designed from the patient’s 3D CT scan which you can get locally. (just let me know were you want it done and an order will be feed to them) In the interim, please send me some pictures of you face (front aide and three quarter view) from which I will do some computer imaging to see what type of jawline changes you are seeking in the vertical, horizontal and width dimensions. We can then have a Skype consultation to review these dimensional choices and discuss the details of the surgery.
I will have my assistant pass along the cost of the surgery and to arrange for a Skype consultation time next week.
Dr. Barry Eppley
Q: Dr. Eppley, I have some questions about custom wrap around jaw implants. Firstly, how secure are the wraparound implants regarding the likely of it becoming displaced or dislodged? What level of force or impact could it withstand without being dislodged? Secondly, when considering the probable chin length projection provided by the implant, is there a means to prevent my labiomental crease from becoming deeper/more exaggerated, as I am already unhappy with its current depth?
A: Wrap around jaw implants are very secure given their custom design and fit and the use of multiple point miniscrew fixation. I could not tell you how much force it would take dislodge a custom jaw implant as that has never been tested. I would imagine that it would be considerable and would have to be of the magnitude that would be enough to break the jaw.
When any portion of the chin is advanced forward, some deepening of the labiomental fold is likely. This is unavoidable in a straightforward horizontal chin increase since the labiomental fold is a fixed point caused by the superior attachment of the mentalis muscle. When the chin is also advanced vertically, any change in the depth of the labiomenal fold will be less. I would use the imaging to be a good test as to what happens to the labiomental fold since it has not been moved with the chin change. Lessening of any labiomenal fold depth increase can be told by simultaneous fat injections to it.
Dr. Barry Eppley
Q: Dr. Eppley, I am very interested in your custom one-piece wrap-around jawline implant but have a few questions.
1. I saw an example of your custom wrap-around implant in an article you published on August 24, 2014 on your website. It was very impressive and exactly what I’m looking for. How difficult is that procedure compared to the standard 3-piece chin/mandible implant?
2. Is the recovery time and swelling reduced in the one-piece wrap-around implant compared to the 3-piece (because it is inserted only under the chin and not inside the mouth as in the 3-piece)?
3. Is the incision under the chin larger in a wrap-around implant compared to just a standard chin implant incision?
4. Apart from cost, what disadvantages do custom wrap-around implants have against an off the shelf 3-piece? (In other words, if cost wasn’t a factor, why would I or anyone ever consider a 3-piece implant?
- If your questions about difficult relates to its surgical placement, it is not more difficult than placing standard chin and jaw angle implants…if one had done it a fair number of times.
- Usually three incisions are still used for a custom wrap around jawline implant because it is critically important to check and ensure that the posterior jaw angle portions are properly positioned on the bone. But the overall swelling and recovery are no different than placing three separate chin and jaw angle implants.
- The incision under the chin is the same for either standard chin implants or a custom jawline implant.
- Good question! They are so superior that cost would be the only reason not to use them…and when the costs are considered for either a standard or custom jawline implant approach the custom implant is not significantly more costly.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in the customized one-piece jawline enhancement. I live in Sweden and have been talking to a doctor in NY who is using implants made of Medpor instead of silicone for the mandibular angles. Medpor is a material that your body grows into therefore the risk of misplacement or jawline breakdown is reduced.
1. Is it possible to have the custom implants to be made in Medpor instead?
2. Could you send me at least 10 before and after pictures of patients who have had jawline enhancement with the custom implants?
3. I know the custom implants varies in price but could you give an approximate price so that I know how much money that I need to save?
4. Can I pay 1000 dollars/month?
5. How soon can I have the surgery done? I would prefer to have it done this month or the next since I have my vacation now.
6. How long do I need to stay if I want the custom implants? I read from the Q&A that it takes 3 weeks to get the custom implants from the 3D-scan. After surgery I need to stay probably another 2 weeks right?
7). As I fly in from Sweden, where can I live during my stay and how much will it cost for 5-6 weeks?
A: In answer to your questions about a custom one-piece wrap around jawline implant:
- A custom one-piece jaw implant can only be made of silicone not Medpor. Even if it could be made of Medpor, it could never be placed as a single piece. That material is too stiff and would need to be sectioned into three pieces to place it…but even that would not be easy. The ingrowth of tissues into Medpor often poses more problems than it ever solves, particularly if you have to revise, replace or try to remove them. A custom implant does not shift because of its precision fit.
- Due to patient confidentiality, we do not distribute patient photos randomly across the internet.
- I will have my assistant Camille pass along the cost of custom jawline implants to you tomorrow.
- Surgery fess must be all paid in advance not in partial payments after the procedure.
- It would take a minimum of three weeks just to have a custom implant fabricated. Thus unless one wants to use a three-piece implant approach with standard implants it can not be done this month.
- The 3D CT scan is done in your country and send here to make the implants. You come here one day before the surgery and return home 48 to 72 hours after the procedure.
- You only need to be here a few days to have the actual procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I have spoken with you in the past regarding jaw implants and chin implants. Through looking at your case examples, I feel as though custom implants produce the best results. Quite frankly, the results you are getting are incredible.
In looking at your recent example: http://www.exploreplasticsurgery.com/tag/male-custom-jawline-implant
I was hoping you could tell me the dimensions of the implant for the jawline (vertical and lateral) as well as the chin, just so that I could get an idea of what what kind of changes are produced from a given size (though I know it will be different for each person). Also, is the recovery easier with a custom implant as opposed to an “off the shelf”?
A: Your assumption is correct about custom jawline implants on two counts. First, it usually does offer a significant aesthetic improvement over a three-piece jawline enhancement approach. This is not only because that it is one continuous piece, which is very much like the natural jawline, but being able to create the individual dimensions of the chin and jaw angle that best suits the patient can be a huge advantage over standard chin and jaw angle sizes. Second, the jawline dimensional changes that are used for each patient are unique to them. Thus, the implant dimensions used for one patient should not be attempted to be transferred to any other patient and assume they would get a similar result. Since they are no software programs that can tell the surgeon what any dimensional change of a custom designed implant will really look like in the patient, it takes a lot of experience to learn what will work for each patient. Thus I do not provide numbers for jawline implant measurements unless I am actually designing the implant for them.
The amount of tissue dissection for a custom jawline implant or a three-piece standard chin and jaw angle implant approach is really the same. Thus the amount of swelling that results and the recovery should be similar between the two implant approaches.
Dr. Barry Eppley
Q: Dr. Eppley, I have some questions about a custom jawline implant.
1) Does having a custom jawline implant that increases chin dimensions of 15 mm or so place undue stress on the bone? Presumably not, otherwise this wouldn’t be discussed as an option.
2) You had mentioned off the shelf mandibular angle implants are two wide in many cases. Would that hold true in my case?
3) Since my previous implant created a pocket, will this be favorable to swelling in that area?
4) What type of lead time do you need when designing this implant prior to surgery? I don’t think I’m as concerned about quantifying millimeters as other patients may as I am with having some broad criteria of the implant not looking overly large and unnatural.
5) You had mentioned getting Voluma prior to surgery would not affect things. There’s a surgeon locally adding this to his practice and providing this for free if I want to slightly accentuate the jaw angles. I don’t know if this issue still holds true with this custom implant option. I would assume in the worst case scenario this product could be dissolved, however, I don’t want to risk affecting this process in the future or perhaps even the 3D scan somehow.
- A larger implant, like the custom jawline implant, distributes its forces (stress) on the bone over a very wide surface area. Thus one does not see the traditional implant settling phenomenon that can occur from an isolated chin implant.
- Most patients, men or women, need a vertical lengthening component to their jaw angles not just width. Most current styles of jaw angle implants only add width and very little if any length to the jaw angles.
- Having an indwelling implant with an existing pocket will tend to create less swelling in that area with a new implant than during the initial implant placement surgery.
- From obtaining the 3D CT scan to having the sterile implant in hand ready for surgery is a three week process.
- Getting a synthetic injectable filler, like Voluma, will not interfere with the images obtained in a 3D CT scan. It will also not interfere with placing any jawline implant.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom jawline implant option and have some questions about it. You have mentioned that this particular implant will be able to address all of the following aesthetic issues of my jawline:
- Address the approximate 10 or 12 mm horizontal chin deficiency
- Address the approximate 5 to 7 mm vertical chin deficiency
- Address vertical and width dimensions of the mandibular angle (curious how this is accomplished if I visualize this as a chin implant with very long wings as this looks quite different than an off the shelf mandibular angle implant)
- Account for any existing jaw asymmetries
- Creation of a continuous jawline from to the chin back to the mandibular angle
I can see that this certainly seems favorable considering the decreased operating room time and relative cost between alternatives involving multiple procedures and implants as you explained.
A: You have thoroughly hit on all of the aesthetic benefits that a custom jawline implant would provide. And it is also the only way you could achieve all of these dimensional jawline changes with a single implant. Such an implant is not really an ‘extension’ of a chin or jaw angle implant. Rather it is an implant that accentuates the entire jawline rather than just being a forward extension of a jaw angle implant or a backward extension of a chin implant.
Dr. Barry Eppley
Q: Dr. Eppley, I exhibit a weak jawline and recessed chin. I have had several consultations with doctors in the Los Angeles area. The most logically sounding consultation seemed to be a custom jaw implant. I see that you do this procedure yet also use off the shelf products as well. My question is…is a custom implant truly superior and does the higher cost justify this type of implant? The doctor made a compelling argument for custom implants however the price was extremely high. Look forward to your reply.
A: The key decision between off the shelf and custom jawline implants is in what you are trying to achieve. Depending upon the nature and magnitude of the dimensions of the jawline changes desired, only a custom implant will work for some patients. In fact, in some of these patients they should not have the procedure at all unless they go a custom fabrication route, For others, a custom implant may have no significant aesthetic advantage and off the shelf implants will work just fine. You would have to supply me with the exact jawline changes you are seeking and some pictures to better answer your question about what will work for you.
When it comes to cost, it is important to realize that custom facial implants today are not significantly more expensive than preformed off the shelf implants. Why? While the material cost of the custom implant is higher than the material cost of preformed implants, they are capable of being surgically placed ini half the operative time. Thus the extra cost to design and fabricate a custom jawline implant is partially offset by the savings of a quicker operation. You also have to consider the risk of revisional surgery, where if it were necessary due to an aesthetic issue, any savings from using off the shelf implants would be completely wiped and exceeded.
Dr. Barry Eppley