Background: A variety of mandibular (jaw) implants to improve the shape of the lower third of the face exist. They work very well for horizontal chin augmentation or lateral jaw angle enhancement. When the two are put together, a great improvement in the jaw line and shape can be achieved. But standard implants do not exist for treating an uncommon deficiency of the jaw, that of vertical deficiency. Lengthening of the lower face heretofore could not be done with implant techniques.
Case Study: A 55 year-old male wanted improvement in his ‘weak jawline and chin.’ It could be seen in profile that his chin was not that horizontally short. The lower third of his face was vertically short from front to back. This was the result of a mandibular deficiency which was detected in his bite, he had a complete 100% overbite. (lower jaw sits completely inside his upper) His mandible was overclosing thus giving him a vertically short lower jaw. While orthognathic surgery and orthodontics are the standard approach for this problem, he was understandably reluctant for that treatment at his age and state of his teeth. No standard jaw implant exists for this problem.
Using a 3-D CT scan of his mandible, a wrap around vertical lengthening jaw implant was designed in acrylic. The implant dimensions were based on facial measurements and his aesthetic desires. The acrylic mock-up was then sent to the manufacturer to be formally made and sterilized in silastic. (silicone rubber) This process took three weeks to complete.
The implant was then inserted onto the lower border of his jaw through a submental incision under the chin. There was no need for any dissection done inside the mouth. The soft tissues were elevated off of the bone around the chin and back to the jaw angle. The implant was then slide into place and secured to the bone with titanium screws. This procedure took one hour to complete under general anesthesia.
The increase in lower facial height and chin prominence was immediate. He reported some soreness but very little actual pain. It took about three weeks for all of the swelling to subside. He was ecstatic about the result and the change in his facial appearance was very positive. While this approach cost twice as much as a standard chin or jaw angle implant surgery, they were inadequate for what his face really needed to be in better proportionate balance. (vertical augmentation)
1) There is no standard off-the-shelf implant for vertical shortness of the chin or lower jaw.
2) Custom facial implants can be fabricated off of 3-D CT scans to fit specific bone deficiency needs. A wraparound mandibular implant is one such example of a successful custom facial implant.
3) Vertical lengthening of the jaw line and chin can have a powerful influence on increasing the strength and masculinity of the lower face in men.
Dr. Barry Eppley