Would Jaw Angle And Cheek Implants Soften My Face?

Q: Dr. Eppley, I am looking for an opinion regarding correction of my steep jaw line. I had orthognathic jaw surgery in 1998 to correct an underbite, but over the years I feel that the angle of my jaw has gotten steeper, giving my profile a “harsh” look. A doctor has suggested jaw angle and cheek implants to balance out my chin and soften my face. I am hesitant to go under general anesthesia and am concerned with the risks of the procedure and, most importantly, whether it will improve my look. I was told that another option is filler in the jaw line, but that an implant would provide more correction.What would you recommend for me? Do you think that jaw angle implants would improve my look? Do you think I could achieve good results with just filler? After going through orthognathic surgery, I was hoping to have achieved a better result and I feel self conscious about my jaw line. I have attached some pictures for you to review.

A: Based on the viewing of your side profile, your jawline is characteristic for someone who has had a mandibular setback osteotomy for a Class III malocclusion due to an original mandibular prognathism. This can adversely shorten the jaw angle and increase its plane angle. I can understand the proposal of jaw angle and cheek implants to give your face more skeletal balance. The real questions are, however, will it make a positive change and is it worth undergoing surgery for it.

There are two ways to provide insight to those questions. First, computer imaging should be done with jaw angle implants alone and then combined with cheek implants. While computer imaging is an estimate and not a guarantee, I have always found it very helpful for prospective patients. I have done that for you and it is attached. These are based only on a side view. The front view you have provided is not good for imaging because you are smiling and it doesn’t show the jawline/angle all that well. The three-quarter or oblique view is the next most helpful view to evaluate. Secondly, injectable fillers can be an alternative to see if the concept of implants would be appropriate. When placed next to the bone they can provide some bone augmentation. But they will never produce the same effect as adding implants because of the sheer volume differences. Injectable fillers are never a comparative substitute for facial implants but they may provide some insight into whether bony augmentation is the right concept. If one is not absolutely certain that implants are the right answer, try fillers first.

Dr. Barry Eppley

Indianapolis, Indiana