Background: Aging of the face takes on many predictable changes but none is more evident than what occurs along the jawline. The once more discernible and sharp jawline becomes lost as jowls appear and the neck sags. The neck angle becomes more obtuse, the chin may appear shorter, and the transition between the face and the neck becomes obscured. This falling down of the facial tissues over the ledge of the jaw bone into the neck typically occurs due to loss of osteocutaneous ligament support to the skin.
The facelift operation reverses the soft tissue components of this aging process. A facelift is really an isolated neck-jowl procedure that removes fat from the neck, tightens neck muscles (platysma), lifts up the intervening layer of soft tissue between the muscle and the skin (SMAS) on the side of the face, and relocates and removes excess face and neck as it is elevated past the ears.
But often forgotten, and many patients do not see it themselves, is the bony support of the jawline. The strength of the chin and the jawline backs to the bony angles has an influence on how much and how quickly the facial aging process proceeds. Inherently weak chins and a shorter jawline with high mandibular angles indicates a weak system for the prevention of facial tissues from falling over the ‘ledge’ and lack of support to hold the neck tissues up.
As part of any facelift, consideration should always be given to augmenting the jawline. Most commonly, this is seen a simple chin augmentation as weak chins are easy to spot. Chin implant augmentation adds length to the jawline and adds a complementary effect to the restoration of a more acute neck angle. In other cases, an extended implant that incorporates the prejowl area better defines the front half of the jawline.
Case Study: This 65 year-old female wanted to improve her saggy neck and jowls that had been slowly getting worse over the past decade. She was a very thin lady with very little subcutaneous fat. She had rolls of skin over the jowls and into the neck with prominent platysmal bands. Her chin had some horizontal shortness and her jaw angles were extremely high, creating a 45 degree angle to her mandibular plane.
Under general anesthesia, a facelift was performed. Initially, a submental incision was made and skin flaps raised to expose the platysma muscle. The muscle edges were exposed with cautery and a sutured together from under the chin down to the thyroid cartilage. A combined chin-prejowl implant was placed on the chin bone back behind the mental nerve on the lower edge of the bone. Incisions were made around the ears in a retrotragal fashion and long skin flaps raised to connect with those previously made in the neck. Her SMAS tissue was very thin and imbrication by sutures was done rather than raising the flaps. Excess skin was brought back over the ears, the excess removed, and the outline of the ear re-established.
Her recovery was very typical for a facelift and she looked fairly non-surgical in just over two seeks after her procedure. Her jawline was sharp again and the chin had more projection although not overly so. Even the outline of her high mandibular angles could be clearly discerned.
Skeletal jawline augmentation is an underutilized technique in facelift surgery. Its use in patients that have a congenitally short jaw is extremely beneficial and will highly compliment the soft tissue rearrangement. But even in patients that do not have an obvious chin deficiency the jawline can be made more prominent with a prejowl implant that adds minimal horizontal chin projection.
1) The woman with a short jaw, as evidenced by a small chin and high mandibular angles, will develop considerable neck and jowl soft tissue sagging as she ages.
2) While a facelift is the standard approach to neck and jowl sagging, adding skeletal support through chin augmentation helps recreate a more visible jawline.
3) Chin and jawline implants can be a valuable addition to lower facial rejuvenation.
Dr. Barry Eppley