V line surgery is a very popular methof of reductive facial reshaping achievwed through mandibular bone removal. But like all forms of facial reshaping (augmentation or reduction) patients may later regret their decision and wish to partially or fully reverse it.
Custom jawline implants are the only effective method to reliably and permanently reverse the aesthetic effects of prior V-line surgery, particularly when the patient’s goal is to restore a stronger, wider, or more masculine lower face. Complete reversal of the underlying bone removal is usually not possible without reconstructive bone grafting, but custom implants can recreate much of the lost contour.
What V-line surgery changes
V-line surgery typically involves one or more of the following:
- Angle ostectomy (removal of the mandibular angles)
- Cortical bone shaving along the lower mandibular border
- T-osteotomy or narrowing genioplasty of the chin
- Chin setback or reduction
- Sometimes masseter muscle reduction
The result is a narrower, tapered lower face. For patients who later desire a broader or more masculine appearance, the challenge is restoring lost width, projection, and mandibular definition.
How custom implants can reverse these changes
A custom implant is designed from a high-resolution 3D CT scan and conforms precisely to the altered mandibular anatomy. Depending on the deformity, it can restore:
- Jaw angle width and prominence
- Lower border height and continuity
- Posterior jaw flare
- Chin width and projection
- Smooth transition from chin to mandibular angles
In many cases, a single wraparound jawline implant extending from angle to angle provides the most comprehensive correction.
What can realistically be restored
Custom implants can:
- Recreate a stronger mandibular angle
- Restore lower facial width
- Improve jawline definition
- Replace contour lost from bone reduction
- Produce a more masculine facial shape when desired
However, they cannot:
- Regrow the patient’s native bone
- Restore masseter muscle that has significantly atrophied or been partially resected
- Correct every soft tissue change caused by the original surgery without additional procedures
When additional procedures may be needed
Depending on the prior V-line procedure, additional surgery may improve the final result:
- Revision genioplasty if chin position is significantly altered
- Fat grafting if there is soft tissue deficiency
- Neck or jawline soft tissue procedures if skin laxity is present
- Treatment of mentalis muscle abnormalities or chin pad ptosis, if present
Why custom implants are preferred
Standard off-the-shelf implants rarely fit the irregular anatomy left after V-line surgery. A custom implant can:
- Match the patient’s altered bone precisely
- Bridge areas of bone deficiency
- Correct asymmetry
- Restore smooth mandibular contours
- Be designed with variable thickness in different regions to achieve a balanced appearance
My experience
Reversal, either partially or in total, after V-line surgery is one of the situations where only a custom implant can do it. The post-V-line mandible often has irregular contours, reduced vertical height, and loss of the normal jaw angle anatomy. A patient-specific implant can be designed to recreate the lower facial framework in a way that is not possible by any other surgical method.
The degree of correction depends on how much bone was removed initially, but in many patients, a custom wraparound jawline implant can restore a substantial amount of the original lower facial width and definition if the exact amount of bone removal was preoperatively known.
Dr. Barry Eppley
Plastic Surgeon