V-Line Reversal Surgery (Custom Jaw Angles Implants After Jaw Angle Reduction)
Q: Dr. Eppley, Last year, I went to South Korea for a simple chin narrowing genioplasty. I consulted for a mini-vline surgery, which is what they call chin-narrowing surgery without the jaw bone shaving.
I don’t know if things got lost in translation or if my surgeon just didn’t understand what I wanted. But my jaw angles did end up getting cut off. I strictly did point out I wanted my jaw angles left alone but when I saw the before/after CT scans, I was absolutely mortified. Only later did I find out, the Korean word for jaw and chin are literally the same.
In fact, a lot of my jaw bone was amputated off. I wanted a slimmer look but I didn’t want that egg-shaped face that Koreans strive for. I think around 2cm or slightly less of vertical bone was amputated.
Now I find that my face is severely disproportional at the side view and the 45 angle view. And I can pinch a lot of excess skin and fat around the bottom/back area of my jaw.
I am looking for solutions to remedy my botched surgery of which it appears only custom implants can successfully achieve V-line reversal.
(1) Would it be ‘dangerous’ to try to restore my original jawline contour with a 2cm vertical implant. Or would I have to compromise and go for a smaller increase such as around 1cm? Ideally I would like to get my original contour but if the risks of complete masseter sling disruption are higher with a larger increase, I would rather opt to compromise. Are the risks of complete disruption high when my masseter muscle is scarred and contracted? My understanding is that the muscle can contract and be shortened, but it cannot be lengthened.
(2) What would be the risks of using a harder material such as PMMA or PEEK to rebuild my jawline contour? Even if it requires larger incisions, if a person’s jawbone can be taken out, hypothetically, it can also be put back in?
(3) How long would I have to stay in the US for this procedure to safely rule out the possibility of an infection? Is it possible to get a delayed infection aside from needle penetration from fillers or dental anaesthetic?
(4) Would it be possible to have the implant extend into the pre-jowl area to give that area width?
I apologize for the long list of questions. I am quite distressed about the situation and really do look forward to your take on my situation
.A: I have heard your jawline surgical story many times. It is not really a language barrier, it is more of a cultural issue. They are simply going to do what they want to do. There is no such thing as customizing or doing an individual treatment approach. Regardless of language issues, it is seemingly hard to confuse a chin procedure with one where the jaw angles are completely removed.
In answer to your V-line reversal surgery questions:
1) Making custom jaw implants to restore your jawline is the only effective treatment approach for it. How much you should attempt to restore it is a matter of personal preference. It is very likely that the massteric muscle sling may already been disrupted as there is no emphasis in its preservation in a bone shortening operation where the muscle needs to contract anyway. That being said it is true that the greater the vertical jaw angle lengthening is after jaw angle reduction that risk is increased. But there is no known actual number of lengthening where the risk substantially changes. I would say that 2 cms is probably too much.
2) When it comes to the material used for custom jaw angle implant restoration, the body doesn’t care what the material is. That will all work the same. And the stiffness of silicone (durometer) can be made to almost match that of Medpor or PEEK. What matters most is whether any of the material can be designed appropriately, placed without trauma and incisional length and can be manufactured at reasonable cost.
3) Infection does not occur until 3 to 6 weeks after implant placement. So no one is going to stay here until that time has passed. The goal is to get home as soon as you can, often between 2 to 4 days after surgery. One does have to be vigilant ab outany injections therapies around the implants. (didn’t inject down into the bone) Such needle tract-induced infections are very rare but they have been known to occur.
4) The implant design can be made to what surface and dimensions one wants including a forward extension out to the prejowl area.
Dr. Barry Eppley