The jawline is the defining feature of the lower face. It is quite simple from a structural standpoint being a u-shaped arc and serving as the transition between the face and the neck. But it can have lots of aesthetic problems that are extremely common complaints. A weak chin, a sagging neck, a double chin, jowls, and weak jaw angles are the main jawline issues that manu people have. Whether one is young or old, male or female, these jawline concerns can affect all due either to aging or a congenital structural defect.

The strong or well-defined jawline has become an important component of facial beauty and attractiveness today. With the advent of the internet and other electronic media, a new cultural standard for jawline aesthetics has emerged. Males contact me today and almost always point to the jawline of Brad Pitt and numerous less well known models as to their goal. Women similarly point to actresses like Angelina Jolie or Reese Witherspoon as their desired jawline look.

What makes up a pleasing jawline that conveys both attractiveness and a more youthful appearance? This always refers to a well-defined  and visible inferior border of the mandible that is straight from the jaw angle to the chin. The jaw angles are slightly higher than the horizontal position of the chin and there is a slight flare from front to back. The chin is more square in men than in a women whose chin is more narrow. Soft tissue that hugs the lower edge of the jaw makes for a well-defined neck angle and the absence of any jowls. It can be seen that the bone structure is the key to a good jawline which will also affect how the soft tissue may sag with age off of the bone.     

While I suspect a good jawline has always been a desired facial feature, many recent improvements and advancements in plastic surgery have made it more achievable. But there is not a single jawline technique that will work for everyone. A variety of bone and soft tissue surgical procedures exist and often more than one is needed to get the best result.

Chin and to a lesser degree jaw angle implants have been around for decades. But new improvements in implant shapes have made them more versatile and adaptable to a variety of jawline problems and are available off of-the-shelf. Chin implants that extend posteriorly to cover the prejowl area and those that have increased width to create a more square chin are but a few of the newer options. Better chin implant designs are still needed, particularly those that may allow for increased vertical as well as horizontal projection. Jaw angle implants have largely been in one style, that of adding more lateral fullness. But newer jaw angle designs allow for vertical height increase and stronger lateral flare as well.

But off-the-shelf chin and jaw angle implants can often not make for a completely straight jawline because they are not connected in the middle between the two over the central body of the mandible. Custom jawline implants can now be made that can create a central jawline augmentation that unites the chin and jaw angle areas. Custom designs may also be used when the size of the chin or jaw angles desired has greater dimensions that what off-the-shelf implants can achieve.

Soft tissue techniques for an enhanced jawline include a variety of well known procedures. Fat removal by liposuction, loose skin tightening and removal through differing facelift techniques, and neck muscle tightening can better redrape the soft tissues around the bony jawline. Two uncommon but useful soft tissue procedures are the submentoplasty and the direct necklift. A submentoplasty works best in the younger patient with a full neck where extensive fat removal and muscle tightening are done without skin removal. In contrast is the direct necklift which is for the much older patient who is willing to accept a neck scar for neck wattle removal and platysmal muscle tightening.

Contemporary jawline aesthetic surgery is more than just a chin implant or a facelift. It needs to consider all anatomical elements and combine a variety of bony and soft tissue manipulations to get the best lower facial improvement.  

Dr. Barry Eppley

Indianapolis, Indiana   

Background:

The aesthetic appearance of the lower third of the face is defined largely by the size and shape of the underlying jaw bone. The support that the bone provides in the transition of the face into the neck creates one of the face’s most distinctive features. There are three aesthetic zones to this jawline including the chin, body and jaw angles. Like the chin in the front, the jaw angles provide the definition to the back of the jaw.

There is usually some correlation between the strength of the chin and the prominence of the jaw angles. As the overall mandible becomes weaker or more underdeveloped, the jaw angle area rotates upward. (becomes shorter) Known as the mandibular plane angle, stronger jaws have less of a plane angle than those that are weaker. This makes them vertically longer and slightly more wide.

Thus when evaluating the jaw angle area, it is important to determine if the deficiency is just one of overall width (desire for more flare or prominence) or whether the problem is more three-dimensional. (combination of vertical shortness and width) The clue to that diagnosis is almost always in the forward position of the chin. The weaker the chin, the shorter the jaw angles and the greater vertical deficiency they have.

In patients seeking jaw angle enhancement, the correct diagnosis of the jaw angle anatomy is critical for this controls the style of jaw angle implant selected. While the size of the implant is also important, no good result can be achieved if the proper style is not selected.

Case Study:

This 35 year-old male presented for multiple facial enhancements from the temples down to the jawline. His jawline concerns were that of it being weak. On examination he had a moderate chin deficiency with a mentalis muscle strain evident. His jaw angles were high (1.5 cms above the horizontal chin position) and narrow.

Under general anesthesia, he initally had a large square silicone chin implant placed through a submental incision. The forward projection of the implant was trimmed back to 5mms. This allowed for a more square effect to be seen at the sides of the chin but without too strong of a horizontal change. Through an intraoral approach, jaw angle implants were placed beneath the masseter muscles. Because he needed vertical lengthening, the tendinous attachments of the masseter muscle were released back at the angle area. A vertical lengthening Medpor jaw angle implant was used that was 7mms in width and 10m in vertical length. Once properly positioned, it was secured into place with a single screw on each side.

His postoperative course was typical for every jaw angle implant patient, one of considerable facial swelling and masseter muscle tightness. This took three weeks to look less surgical and six weeks to really look normal and be completely in the ‘benefits’ phase of recovery. While he had good improvement, he felt the jaw angles were too strong and requested some reduction in them. This was done by cutting down the size of the implants in a revisional procedure.

Jaw angle implants can make a dramatic difference in the jawline and be very complementary with chin augmentation. Choosing the right implant style is critical. Size estimation with jaw angle implants, however, remains very subjective and lacks any objective method for selection. Over-correction and asymmetry remains the biggest reasons for revisional surgery with this type of facial implant.

Case Highlights:

• Jaw angle augmentation is a part of overall jawline enhancement and is often done in combination with chin augmentation.

• Jaw angle augmentation can be done either as a two-dimensional change (width and greater angle definition) or three-dimensional. (width, vertical length and angle definition)

• Jaw angle implants are placed through an intraoral approach in a submuscular position. The greatest risks with their use are the aesthetics of symmetry and size.

Dr. Barry Eppley

Indianapolis, Indiana

Mandibular Angle (Jaw) Implants for Facial Enhancement

For those male patients who desire a more square and angular facial appearance, the mandibular angle or jaw angle implant has become a popular facial implant option. By squaring off and extending the junction of the back and lower borders of the mandible (jaw), the appearance of the jaw becomes wider and more square. This type of look is often desired by younger males, particularly those interested in or already in the modeling field. It is also a very helpful procedure for those patients, male or female, with weaker jaw appearances or jaw asymmetry. I have placed as many mandibular angle implants for jaw asymmetries (one jaw side is very different than the other) as I have for bilateral (both sides) cosmetic enhancements.

In my practice here in Indianapolis, I discuss mandibular angle enhancement through the use of these implants. There are no practical bone-moving procedures for cosmetic enhancement of the mandibular angle, so implants are always used.While mandibular angle implants are available in different materials, I prefer the use of solid silicone (rubber) cheek implants, which are by far the most commonly used. They are soft, flexible, and slide easily into place along the side of the lower jaw. A mandibular angle implant is inserted through an incision in the mouth along the bone in the back part of the jaw. This leaves no visible scar. While it can be inserted through a skin incision in the neck, I have never done so. The mandibular angle implant is slide along the side of the back part of the lower jaw into its position over the edge of the bone. Usually a mandibular angle implant is held in place simply by the pocket into which it is placed. Occasionally, I will use a metal screw to secure the implant to the bone. This screw fixation method can eliminate one of the very few complications of mandibular angle implants, that of shifting position after surgery causing jaw asymmetry and loss of the desired .While any implant (foreign-body) has some risk of infection, mandibular angle implant infections are quite uncommon.

Enhancing the jaw angle with an implant is the least performed facial implant procedure, compared to cheek and chin implants. The goal of a mandibular angle implant is to produce a fullness to the back part of the lower jaw, resulting in a more square facial appearance. There are only a few variations in the styles of mandibular angle implants. The most basic differences in mandibular angle implants is in the amount of extension that can occur from the edges of the bone, both in the back edge as well as the lower edge. Also, different width thicknesses are available, dependent upon how much increase in width of the jaw angle is desired.

Mandibular angle implants are usually done alone but I have also performed them in conjunction with chin and cheek implants. The most powerful way to masculinize a male’s face is the combination of mandibular angle, chin, and cheek implants all done at the same time.

Dr Barry Eppley

Indianapolis, Indiana