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JAW IMPLANTS

Custom Chin Implants

Custom chin implants are useful when significant vertical elongation of the chin is needed, the implant extension needs to go back further along the jawline than conventional chin implants will allow or there is some significant chin asymmetry. The key surgical point about their placement is the consideration of the placement of the incision when done from a submental approach. The incision may need to be further back than the submental crease as the tissue recruitment from the implant may ‘roll out’ the submental tissues further than one would think of the custom chin implant adds any significant vertical length.

Custom chin implant design for make who desires a square chin with slight vertical elongation.
Custom chin implant design for female who desires to have a modest amount of horizontal and vertical chin augmentation without widening the chin.
Small petite chin implant for female who is also having multiple other custom facial implants done.
Male who wanted a strong wide square chin implant design.
Female with significant chin shortness with class II maocclusion hat needed a large amount of horizontal advancement with needed to keep the chin narrow.
Total male three-piece jawline augmentation with custom square chin and jaw angle implants designs.
Custom chin implant design for female with prior sliding genioplasty to add additional chin projection and to smooth out bone irregularities along the jawline.
Custom cleft chin implant design for male three-piece total jawline augmentation.
Petite custom female chin implant design with an upward tilt to the horizontal projection.
Custom lateral chin implant design for fill in lateral bone defects from prior sliding genioplasty.
Extended square chin and jawline implant design for vertical jawline lengthening in a male.
Female who previously had an anatomic chin implant placed to try and achieve a V-shaped chin appearance…which was unsuccessful. A custom V-shaped chin implant design was more effective.
Trying to hang a standard chin implant design off of the bone to create a V-shape is fraught with potential implant malpositioning issues as that is not what they are made to do. Unique chin reshaping needs require a custom chin implant approach to be more effective.
One often leans from the first chin implant what look they may want better. In this case a male with a standard round extended anatomic chin implant that subsequently desired a more square shape with wings that more assuredly sat lower along the lower edge of the bone.
When design square chin implants for men the shape must be over exaggerated a bit because the thickness of the soft tissue chin pad will obscure some of the detail of the implant design.
The optimal square chin look for men requires a chin implant design that takes the squareness out to the canines and adds a little vertical length to help stretch out the soft tissue chin pad.
Females withMedpor chin implants often find them too bulky and that they add too much width. Replacing them with a custom chin implant assures a more controlled shape with less width and more pleasing feminine shape to them.

Custom Jaw Angle Implants

Bony jaw angle/jaw angle implant asymmetry and the desire for vertical elongation of the jaw angles are two most common indications for custom jaw angle implants. Asymmetric placement of jaw angle implants is very common and is caused by both placement error and slight but significant differences in natural jaw angle shapes. A little difference in the shape or angular form of the jaw angles can translate into a very visible difference when they are enlarged by implants. Aesthetic augmentation of jaw angles often requires vertical lengthening (dropping down) of the jaw angles which no current form of jaw angle implant provides. While jaw angles are often perceived as just being made wider, the more common aesthetic need for many jaw angle augmentations is create by lowering the jaw angle and not by just making it wider. In some cases this requires the entire jawline from angle to angle to be made vertically longer.

Custom jaw angle implant designs to fill in bony defects and smooth out the jawline after orthognathic surgery. (sagittal split ramus osteotomies of lower jaw)
Custom jaw angle implants designs for back of jaw augmentation after prior sagittal split ramus osteotomies.
Custom jawline implant designs to go with a sliding genioplasty for overall jawline augmentation in a female. (who also had a large custom skull implant done at the same time)
Custom jaw angles implants design to go with a vertical chin reduction intraoral osteotomy.
Custom jaw angle implant designs for a male after V-line reduction sur-gery to restore some of the lost jaw angles.
Male total jawline augmentation with custom extended jaw angle im-plants to vertical and horizontally lengthening sliding genioplasty.
Custom jaw angle implant designs to balance out jawline shape after or-thognathic surgery in a male.
Custom flared jaw angle implants to complete a total jawline augmenta-tion effect after a sliding genioplasty.
Custom jaw angle implant designs to create a more complete male jaw-line effect after a prior sliding genioplasty.
Custom jaw angle implant designs in facial asymmetry with custom left cheek implant as well.
Small custom left jaw angle implant design for correction of lower jaw asymmetry in a female.
Extended custom jaw angle implants for correction of the high mandibu-lar plane angle make patient with accentuated antegonial notches.
Custom right extended jaw angle implant for correction of lower facial asymmetry in a female.
Custom jaw angle implants made to provide a complete jawline augmentation effect in a patient who had an existing chin implant of which he was happy with its aesthetic result.
Custom right jaw angle implant to correct jaw angle asymmetry from prior sagittal split mandibular osteotomy.
Much of the jaw angle asymmetry after sagittal split mandibular osteotomies has a vertical component to it and not just a width issue. This is why standard jaw angle implants often do not work well in this type of jaw asymmetry.
The difference between the jaw angle asymmetry that occurs after a sagittal split osteotomy and how to best treat it is illustrated in this case where a standard jaw angle implant was inadequate and a custom jaw angle implant design showed the amount of bone that needed to be replaced for optimal jaw symmetry.
Sagittal split osteotomies are a fundamental approach to the correction of a significantly deviated lower jaw. While the procedure can re-establish a midline position of the chin it will not correct an underdeveloped jaw angle in the shorter side. (it actually makes it more pronounced) A custom jaw angle implant design is needed to create the final jaw asymmetry correction.
V line surgery has the potential to leave the jawline irregular and asymmetric. Smoothing and improving the asymmetry between the two sides of the jawline is best done using a custom jawline implant design approach.
In designing custom jawline implants after V line surgery the goal is not to restore the original size and shape of the jawline but to make for a smooth and more even shape between the two sides.
When the implant load on the chin may be considered ‘excessive’, a sliding genioplasty can be done combined with custom extended jawline implants that connect up to the advanced chin segment. These custom implants achieve the dual purpose of creating a complete jawline augmentation with the sliding genioplasty as well as covering over the bony stepoffs at the back end of the chin osteotomy line.
Merging the extended jawline implant into the advanced chin bone segment in a male creates a wider chin, which a sliding genioplasty does not, as well as helps to square the chin shape. This combination of bone and implant jawline augmentation is used when significant vertical chin lengthening is needed.
In the custom extended jaw angle implant design it goes to the corner of the chin, to add width, but does not cross over and join in the midline as a complete jawline implant would do. (close but not quite connected)

Custom Jawline Implants

Currently aesthetic augmentation of the jawline is a very popular use of the custom design process. While there are standard styles and sizes of both chin and jaw angles, there is no standard total jawline implant. A standard jawline implant would be impossible to create as a complete wrap around implant due to the variability in jawline sizes and shapes between people.

Having an implant that connects one jaw angle to the other across the chin is the most powerful method to enhance a jawline. This is of particular interest in men who want to have an overall stronger and more defined jawline. With an implant that covers a large bony surface area, it is important to not oversize it in any one dimension. With a facial implant that covers such a large surface area, it is very easy to oversize it as the influence on the jawline shape is significant.

A custom wrap around jawline implant is inserted through three separate incisions. Bilateral intraoral posterior mandibular vestibular incisions are used to position the jaw angle portion of the implants. An anterior incision, either intraoral or external submental, is used to insert the entire implant and feed it back to the jaw angles in a folded fashion.

Male custom jawline implant designed to replace standard chin and jaw angle implants which are misplaced.
Custom jawline implant designate vertically lengthen a low or flat mandibular plane angle patient.
Female custom jawline implant design which rounded narrow chin and vertical jawline lengthening.
Strong custom jawline implant and cheek implanted designs for maximal male masculinization effect.
Petite custom jaw angle implant design for a female.
Female custom jawline implant design to partially restore jawline after an overly aggressive V-line jaw reduction procedure.
Moderate custom jawline implant and cheek implanted designs for maximal male masculinization effect.
Female custom jawline implant design needed for jawline restoration after V-line jaw reduction surgery.
Custom jawline and cheek implants designs in an older male for a facial rejuvenation effect and filling out of sagging tissues.
Custom jaw angle implant design to change a low mandibular plane angle into a higher plane angle.
Custom left jawline implant combined with a right inferior border osteotomy to treat lower jaw asymmetry.
Large custom non-linear jawline implant design for strong masculinization effect.
Custom jawline implant replacement design for displaced chin and jaw angle implants.
Custom inferior border jawline implant design for lower facial vertical lengthening.
Custom jawline implant design for a smooth linear and increased augmentation effect after a chin wing osteotomy.
Custom infraorbital-malar and jawline implant designs for strong facial masculinization effect.
Male custom jawline implant to restore jawline after V-line reduction surgery.
Custom jawline and right cheek implant designs for correction of facial asymmetries.
Custom jawline implant replacement in a male for unachieved effects from strandard chin and jaw angle implants.
Custom jawline implant design for high mandibular plane angle male patient.
Custom jawline implant design to straighten out a nonlinear and add vertical length to the chin. (replace an inadequate standard chin implant).
Custom jawline and brow bone implants for facial masculinization after prior sliding genioplasty and extended chin implant failed to achieve the desired jawline augmentation effect.
Small custom jawline implant design to enhance a softer and more indistinct male jawline.
Custom jawline implant design to treat a hooked jawline and short chin.
Custom female jawline implant which typically has a smaller overall size, less jaw angle width and more narrow chin shape.
Custom jawline implants for females, while being smaller in size than for males, usually add vertical jaw angle length/shape and come forward with a smooth linear connection to the chin.
Custom jawline implants are often requested for the treatment of facial asymmetry which often involves the lower jaw. The patient will often choose to then just augment the entire jawline for an overall lower jaw augmentation as well as correction of the jaw asymmetry.
Female custom jawline implant for V Line reversal surgery.
When designing a custom jawline implant for V Line reversal surgery consideration is given to whether the patient wants a subtotal or total restoration of their removed jawline.
Attempting to partially or fully reverse a prior V line surgery can not be done very well by using any form of standard implants as illustrated in this case where strips of ePTFE (Goretex) were used. (in green) V line jaw restoration needs a smooth jawline implant that restores much of the vertical length of the jawline that was previously resected.
V line reversal surgery is largely about vertical jawline restoration, which can only reliably be done using a custom implant design approach. Patching together standard implant materials to try and create this unique jawline augmentation effect works poorly as seen with these ePTFE implants. (in green)
Many custom jawline implants start out with a chin implant as their entrance into lower facial reshaping surgery. Either due to an inadequate chin augmentation result or the desire to ‘graduate’ to a complete jawline effect, the existing chin implant serves as a helpful guide as to how to improve the chin as well as that of the rest of the jawline.
A prior chin implant that produces an undesired effect (in this case a chin that became too vertically long) ‘teaches’ one how to make it better when a custom jawline implant is designed for its replacement.
Prior chin implant issues, such as asymmetries, often lead to the consideration of not only improving the chin augmentation, but converting to a total jawline augmentation effect with a custom jawline implant approach.
Many short chins are associated with a high and indistinct jaw angles. Changing from an initial chin implant to a custom jawline implant improves then entire shape of the lower face.
In the high jaw angle or steep mandibular plane angle patient widening jaw angle implants may look acceptable from the front but they accentuate the steep mandibular plane angle from any other facial view. The combination of lowering the jaw angles and shortening the chin usually produces a better overall lower facial shape. Standard submalar implants in a male rarely produce a positive aesthetic benefit. Men usually want a high cheekbone look which can only currently be achieved by a custom cheek implant design.
Replacement of standard cheek and jaw angle implants with custom cheek and jawline implants.
Custom jawline implant design for male who wanted to achieve two simultaneous lower jaw objectives, fix the right lower jaw asymmetry and create an overall stronger lower facial appearance.
A custom jawline implant provides the most effective approach to improving the asymmetric jawline because it identifies and treats the entire jawline deficiency…which is particularly challenging when such deficiency is vertical in nature.
Injectable fillers (e.g., Radiesse which appears in the green color) is often used for jawline augmentation which resides up in the soft tissues. By comparison a custom jawline implant (in teal color) sits down on the bone below the soft tissues. As a result, injectable fillers produce a more rounded jawline effect while a bone based implant is capable of a stronger more well defined jawline look.
While injectable fillers (in green) can have a good temporary effect their soft tissue location limits the jawline definition they are capable of creating for many patients….unlike that of the custom jawline implant. (in teal color)
Female often seek jawline enhancement, not necessarily to make the overall jaw much bigger, but to give it some shape and better definition. This is particularly useful when the lower third of the face is a bit vertically short.
Increasing the mandibular plane angle in a female with a vertically short chin creates the opportunity to make a more tapered jawline with a more narrow chin shape with a custom jawline implant design.
Custom jawline implants can be combined with a sliding genioplasty when the vertical lengthening needed for the chin reaches a critical amount. The soft tissue chin pad is already a tissue area under tension because it wraps around a solitary point. (projecting chin) It can only safely stretch so much so attention must be paid to how much implant volume is placed under an incisional closure. An opening wedge sliding genioplasty can do all of the vertical lengthening more safely and the implant than only needs to add a bit more contour. (projection and width)
The combined vertical lengthening opening wedge genioplasty and custom jawline implant overlay is needed when the dimensional changes to the chin collectively exceed 12. (combined horizontal and vertical chin increases)
The custom jawline implant provides a complete jawline augmentation effect which often is not appreciated is needed until chin augmentation is done. This patient had double stacked chin implants (two separate surgeries to build out the chin) for an 18mm chin augmentation which then revealed to the patient how deficient the jawline was behind it. Also note as chin implants become bigger on a really deficient chin the direction of augmentation is not purely horizontal but adds a vertical lengthening effect as well…which is usually not a desired effect.
The patient’s double stacked chin implants, while providing a positive chin augmentation effect, makes the narrow jawline behind it even more so. The custom jawline implant replacement more comprehensively treats the entire jaw deficiency.
Jaw reduction surgery, often called V line surgery, can create irregularities and asymmetries between the two sides of the lower jaw. A thin custom jawline implant can smooth out the inferior border between the two sides and out back a little jaw structure in those patients that also feel they have been over reduced.
V line partial jaw reduction reversal can be done by a small low volume (3 to 6cc) custom jawline implant.
Custom jawline implants for females are always smaller than that of men. This is because they have a smaller initial jaw size but also because their aesthetic goals are different and more modest in the augmentation dimensions needed.
Female custom jawline implants often focus on the need for vertical elongation of the jaw angle and chin to create a more defined jawline but not substantially increasing their lower facial width.
Replacement of prior separate chin and jaw angle implants which have not produced a satisfactory aesthetic result is a common reason for ‘graduating’ to a custom jawline implant design. The prior implants help provide invaluable information about how to improve the aesthetic result. Unfortunately Medpor implants (jaw angle implants in this specific case) do not appear on 3D Ct scans due to the tissue ingrowth. This poses an inconvenience in custom implant designing as well as removal challenges during the replacement surgery.
While Medpor jaw angle implants can not be seen the bony ingrowth that results around (above) them can easily be seen. This adds to the difficulty in their removal as the implant is partially buried under an overlying layer of bone at its upper edge. But they can still be successfully removed and replaced with a custom jawline implant.
Replacement of three standard misaligned chin and jaw angle implants with a connected one piece jawline implant creates a smoother lower facial look with less risk of implant malposition.
While aesthetic outcomes using a three standard implant approach to total jawline augmentation can be successful, the risks of implant malposition is high because it is essentially three unconnected operations done during one surgery. When an unsatisfactory outcome occurs with this approach a custom jawline implant design takes advantage of what is aesthetically good with the current indwelling implants and adds what they don’t provide in a connected one piece implant design.
When the desired amount of dimensional chin augmentation changes exceed the 12 to 14 number range (combining the horizontal and vertical chin augmentation change) it is safer to use a sliding genioplasty for the chin augmentation part of the jawline and custom implants for the rest of the jawline. This is because an implant in the chin separates the overlying soft tissues from the bone and becomes a spacer between the bone and the implant. This may make a competent incisional closure over a large implant load in the chin questionable. Conversely a bony genioplasty through the middle of the chin bone and keeps the soft tissues attached to its bottom portion. Thus not posing the same potential issue one soft tissue closure as an implant.
A sliding genioplasty with custom extended jaw angle implants. The implants merge into the chin which also covers the inferior border notch deformity which occurs in most bony genioplasties.
A malpositioned or unsatisfactory chin implant result is often the impetus to ‘graduate’ to a more complete jaw augmentation effect using a custom jawline implant design.
Custom extended jaw angle/jawline implant designs for an irregular jawline after V line surgery
It is not uncommon that a custom jawline implant is done after a bony genioplasty. This can be a good two stage approach when the chin needs a significant dimensional change such as vertical lengthening. While the bony genioplasty can not create certain dimensional changes (augmenting the jawline behind it, squaring out the chin) it does ultimately reduce the implant load on the chin area which is sensitive to the demands of implant stretch because of the tight soft tissue chin pad tissues.
As seen in the side view design the first stage vertical lengthening bony genioplasty has done much of the work for the chin area. The chin portion of the jawline implant then merely finishes off some dimensional details needs. (a little bit more horizontal length and squaring out the chin shape) The main work of the custom jawline implant is posterior when the angles and jawline curve are straightened and widened.
Some patients ‘graduate’ from the traditional three-piece jaw augmentation approach to get a more connected and linear jawline look as well as improve the implant dimensions based on the results from the first standard implant procedure.
A linear connection from the jaw angles to the chin is one aesthetic feature that only a custom jawline implant can provide.
A custom jawline implant can be used to complete a prior chin procedure such as a vertical lengthening bony genioplasty. When significant changes are made to the chin the patient often becomes aware afterwards of the now relative deficiency of the rest of the jawline.
As seen in side view the vertical lengthening genioplasty has created a jawline that lies behind it as now deficient for which the custom jawline implant can complete the augmentation.
Getting a smooth and even jawline and any desired enhanced chin and jaw angle projection after sagittal split and sliding genioplasty operations requires a custom jawline implant.
A custom jawline implant can provide the final aesthetic refinements to a lower jaw that has been through prior bony osteotomies as seen in this female Treacher-Collins patient.
A not uncommon patient that presents for a custom jawline implant is the patient who has had prior orthognathic surgery. While the occlusion has been corrected and the lower jaw brought as far forward as the teeth will permit, adding shape, width and more projection to the lower jaw/face requires a ‘finishing’ jawline implant augmentation.
The one dimensional changed to the lower jaw that only a custom jawline implant can make is vertical lengthening. To achieve complete vertical lengthening from one jaw angle to the other requires a custom designed implant to do so.
Larger male custom jawline implants average in the 24 to 28cc volume range. Such implant volume calculations tell more about their effects than any one single thickness measurement.
This custom jawline implant case is a good example of the wrong type of chin implant being used. While the patient needed horizontal chin augmentation he got a vertical lengthening chin implant which, not only did not correct his horizontal chin deficiency, but then made his chin too vertically long. He then proceeded to have a custom implant made to address the entire jawline deficiency.
Asymmetry of the lower jaw is a common request to be treated and no other method works as well as a custom jawline implant. While some patients opt to treat just the shorter/smaller side, many men choose to augment the overall jawline as well with a custom wrap around jawline implant.
In almost all jaw asymmetries the smaller or shorter side has a higher inferior border than the more normal/desired side. It is often a bit wider as well. Thus correction of hypoplastic jaw asymmetries requires a lowering or lengthening of the affected side.
Jaw asymmetries are often more modest in size (a few millimeters) which can be compensated for in a custom jawline implant design. The asymmetry may be most apparent in the chin area where the fusion of the two sides of the lower jaw did not come together perfectly during development.
The steep mandibular plane angle jawline shape often needs to be lowered a bit which involves release of the tightly adherent musculoligamentous attachments of the masseter muscle seen as prominent bumps of bone at the jaw angle area.