What Type Of Structural Jawline Enhancement Do I Need?

Q: Dr. Eppley ,I’m interested in a consultation regarding structural jawline enhancement using custom implants.

I have mandibular retrusion with an overbite and I’m looking for a patient-specific solution rather than a standard chin implant. Specifically, I’m interested in a custom wraparound mandibular implant (chin + mandibular body) to improve projection and jawline definition in a balanced way.

My goal is to avoid an isolated chin projection and achieve a natural result from both side and front views.

A:Thank you for your inquiry and sending your pictures. First, when you have a known mandibular retrusion with an overbite, which causes a deep labiomental fold, the ideal structural jaw procedure should be an advancement sagittal split ramus osteotomy +/- sliding genioplasty. Besides normalizing the position of the lower troll and chin it will also soften the deep labiomental fold as the lower teeth come forward.

Undertaking implants in a lower jaw that has a significant structural deficiency is reasonable provided the patient is aware that is not the ideal structural jaw treatment. I am going to assume for now you are well aware of this option and I have researched it out and decided that you would like to seek an alternative to a lower jaw osteotomy.

With a chin that is both vertically and horizontally short with the deep labiomental fold the better treatment is a sliding  genioplasty to make this type of chin projection change. The bony genioplasty will also help lessen the depth of the labiomental fold. While a chin/jaw implant can be used for the same type of dimensional chin change it will likely deepen the labomental fold rather than improving it.

However the chin is treated it still requires an implant behind it to augment the rest of the jawline.

In conclusion you have to two approaches to a non-orthognathic structural jaw enhancement:

1) a custom wrap around jawline implant which will likely deepen the labiomental fold, or

2) a sliding genioplasty combined with the wraparound jawline implant which will either not make the depth of the fold worse or may actually lessen it somewhat.

Dr. Barry Eppley

Plastic Surgeon