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TOTAL FACE IMPLANTS
It is not uncommon that patients will seek more than one custom facial implant to suit their facial reshaping needs. This creates a near unlimited potential for ways to structurally change one’s face. It is best to think of the face as having three levels or horizontal lines of facial augmentation. Level 1 is the jawline, level 2 is the midface (infraorbital -malar-maxillary) and level 3 is the brow bones-forehead area. This is a good way to think about it as that is also how most custom implants are designed…to have a horizontal level of augmentation across the facial bony prominences. (or lack thereof)
Custom cheek implant design for high cheekbone look with small infraorbital extension and custom jawline implant for male facial masculinization effect.
Male Custom IOM and Jawline Implants
Small anterior custom cheek implant design with arch extension combined with a custom jawline implant.
Male Custom Large IOM and Jawline Implants
Strong custom cheek and jawline implant for a male facial masculinizing effect.
Custom cheek (non-infraorbital extension) and jawline implant designs to provide more visible facial skeletal features in a male.
Custom right cheek and jawline implant to improve facial asymmetry.
Custom cheek implants in a male to replace and provide a better cheek augmentation effect than the injectable fillers that were currently present. In addition a large custom jawline implant was palced.
A three level custom facial implant augmentation with custom brow bone, infraorbital-malar and wrap around jawline implants.
Full facial masculinization custom brow, cheeks and jawline mplants.
Combining custom forehead-brow bone and infraorbital-malar-maxillary implants for increasing projection of the upper two thirds of the face and creating more deep set eyes.
Custom brow bone and jawline implants to provide a more significant masculinizing effect to the male face.
An enhanced brow bone and jawline adds projection to the male face for more deep set eyes and a much stronger jawline than a standard chin implant can create.
The most common multilevel custom facial implants are the infraorbital-malar and jawline implants to address the ‘cheeks’ and the lower jaw deficiencies.
The custom infraorbital-malar and jawline implants together augment the mid- and lower facial horizontal lines or levels.
This classic male combination of infraorbital-malar implants with a wrap around jaw implant creates the high cheekbone look with that of a more well defined jawline.
A common use of the custom infraorbital-malar implant which is combined with a custom jawline implant for a male facial masculinization effect.
Custom infraorbital-malar implant with maxillary tab extension combined with a custom jawline implant for augmenting the male face.
Custom Temporal, Brow Bone and Infraorbital-Malar Implants
Custom infraorbital-malar implants combined with custom brow bone and temporal implants.
Custom infraorbital-malar implants combined with custom jaw angle implants after orthognathic surgery.
Custom infraorbital-malar implants combined with custom cleft chin and jaw angle implants.
Custom infraorbital-malar implants with custom jawline implants for a two level facial augmentation effect.
Custom infraorbital-malar implants that raise up the lower eyelids to a more horizontal position combined with a custom jawline implant.
A different but not uncommon approach is to widen the temples along with a jawline implant. This creates a broader/wider forehead to have it match the new lower facial/jawline width.
Custom Infraorbital and jawline implant combined with a sliding genioplasty for a male masculinization effect. The need for a combined opening wedge genioplasty and implant overlay is because the vertical increase needed in the chin was 10mms which is beyond what an implant alone can do.
Female for correction of jaw reduction irregularities/asymmetries with custom jawline implant as well as custom infraorbital-maxillary implants to correct a right vertical orbital dystopia and provide side central midface projection.
Forehead and skull reshaping with a custom suprabrow bone implant to reduce the appearance of prominent brow bones combined with a custom skull implant to augment a narrow appearing head shape due to parasagittal and parietal skull deficiencies.
Male custom forehead-brow bone and jawline implant designs to take a rounder softer face into one with more defined bone structure at the upper and lower facial levels.
Increasing the forward projection of the face occurs most effectively at the upper and lower facial levels. Adding projection to the brow bones and chin produces more anterior projection and an increased masculinization effect.
Custom midface implant for more complete anterior projection of the midface (without adding any cheek width) and custom extended jaw angle implants for correction of asymmetries from prior V line jaw reduction surgery.
Male two level facial implant augmentation after a bony genioplasty with custom infraorbital-malar and jawline implants.
Even in the older male typical facial masculinization implants of the infraorbital cheeks and jawline can enhance facial bone structure as well as pick up loose skin of the neck, jawline and cheeks. It is certainly true that implants that cover a lot of bone surface area can have a bit of a facelifting effect.
Combining a lower level vertical lengthening bony genioplasty with extended custom jaw angle implants with midface level custom infraorbital-malar implants is a unique approach to male facial masculinization.
This now classic approach to facial masculinization provides horizontal augmentation to the lower two levels of the face by wrap around undereye-cheek and jawline implant augmentations. In the thinner face these implants do not have to be big to achieve their desired effects in providing visible enhancements to the five corners of the face. (cheeks, chin and jaw angles)
Prior orthognathic surgery, while improving the occlusion and upper and lower jaw proportions, can not create more defined facial features. It does provide however a solid foundation onto which custom implants can be used to create the more visible cheek and jawline definition.
Male with significant congenital lower jaw asymmetry with some mild undereye hollowing and flatter cheeks who underwent simultaneous custom jawline and infraorbital-malar implants.
Like many male patients the goal is to create a more angular and defined face which is created by augmenting the ‘five corners’ of the face, the chin, two jaw angles and the two cheek areas. This explains the popularity of combining custom infraorbital-malar (IOM) and wrap around jawline implants.
Some males already have strong facial bone features and only need some modest enhancement of them. For the infraorbital-malar (IOM) area this usually means a slightly higher line of bone enhancement from under the eye to across the cheek bones. For the jawline it means modest augmentation of the entire inferolateral border from one jaw angle to the other.
Near complete periorbital augmentation can be done by a combination of custom brow bone and infraorbital-malar implants that connect across the lateral orbital rim. This brings the whole bony projection of the bones around the eye forward.
To create a complete periorbital augmentation the custom brow bone and infraorbital-malar implants must have an interlocking connection across the lateral orbital rim. Like a puzzle piece this connection its built into the implant designs.
While custom facial implants can be designed and placed at multiple facial levels (green color = custom infraorbital-malar and jawline implants), custom implants can also be later and overlaid on existing implants. In this case a custom infraorbital floor-rim implant (teal color)was done secondarily to help raise up the lower eye. It was designed to sit as an overlay on top of the existing right orbital-cheek implant.
The most common type of male masculinization surgery is custom infraorbital-malar and jawline implants. But each patient’s dimensional needs in doing so will be different. In this patient the main dimensional need of the jawline was increased vertical length with some increased angulation at the corners. (chin and jaw angles) A modest high cheekbone look was achieved with 3mm infraorbital-malar implants.
Custom Facial Masculinizing Implants
Because of their wraparound design augmenting the convexities of their edges, the dual effect of the custom infraorbital-malar and jawline implants can have very visible external facial reshaping effects.
Small custom infraorbital-malar and jawline implants put together can make for a good facial enhancement that does not look overdone.
After double jaw orthognathic surgery deficiencies in the jaw angles and cheeks are not uncommonly seen. Combining custom jaw angles and cheek implants can provide a facial augmentation to the middle and lower facial thirds to help take the orthognathic surgery result to an improved aesthetic level. This patient added the custom brow bone implant as an upper third of the face augmentation as well.
It is easy to see in 3D CT scans how jaw angle and cheek deficiencies are unintentionally created by double jaw orthognathic surgery which primarily creates sagittal and vertical changes but not significant facial width increases. Custom jaw angle and cheek implants improve the aesthetic outcome of double jaw surgery in many cases by addressing the bony areas of the lower two thirds of the face that jaw surgery can not.
Multi-level custom infraorbital-malar and jawline implants are often used for more modest facial augmentation changes with improvements in jaw asymmetries.
The classic custom infraorbital-malar (IOM) and jawline implants work very well in two specific types of facial deformities in which this patient had both…the post bimax patient with residual jawline deficiencies and untreated infraorbital-malar recession and the older patient with loose and sagging soft tissues of the cheeks and jawline. The jawline implant provides a definitive 3D shape and angularity to the lower face while the IOM implants provide undereye-cheek volume with a lifting effect.
The high cheekbone look with a stronger more defined jawline is a very effective treatment for the post orthognathic surgery as well as the older male patient with soft tissue age-related changes.
Improving all three thirds of the face can be done by three separate custom facial implants…forehead-temporal, infraorbital-malar and jawline augmentations as in this case of total facial reshaping.
In three level facial augmentations one has to be cognizant of how all three fit together since their combined volumetric effects are going to be more significant than one may realize. One of the ways that custom facial implants usually differ from standard facial implants is that their surface area coverage of the bone is much greater. As a result of this amount of bony coverage the amount of added volume can increase significantly.
The placement of jaw angle implants is the most challenging of all facial implant surgeries, particularly if they are intended to create vertical lengthening and are custom in design. This case illustrates that a custom implant design with screw fixation will still produce undesired results if they are not positioned properly.
A prior unsatisfactory facial implant result is often the stimulus for a secondary approach of using custom facial implants. In this case exchanging a standard square chin implant for a more comprehensive square wrap around jawline implant as well as infraorbital-malar implants for the high cheekbone look was done. Sometimes bad can turn into something really good..
Complete periorbital augmentation can be done in one or two stages. In this patient he initially had a custom forehead-brow bone implant placed. (which is why it has a green color as that is the actual implant placed which appeared in this postop 3D CT scan) He subsequently desired the lower half of the orbit and cheek to be augmented for a near complete augmentation of the orbital rims. (which is why the IOM implants are in a teal color as they are the design)
It is common to see the progression of standard facial implants to custom facial implants due to inadequate/asymmetric/undesired aesthetic results. In this case of standard Medpor chin and cheek implants (cheek implants not seen on the scan but the chin implant in green color was) they were replaced by larger custom cheek and extended chin implant designs.
When standard facial implants have proven to be inadequate the effort was not completely wasted. Their current positioning and shape/size provides invaluable information as how to design something better the next time. As seen in this case of replacement of standard Medpor cheek and chin implants with new custom cheek and extended chin implants. As my implant motto goes…‘when you know what doesn’t work you know how to make something new that will work better.’
As a different variation of more common custom cheek and jawline implant designs, a total midface implant combined with jaw angle ‘caps’ were designed to suit this patient’s aesthetic facial needs.
Pulling out a flatter midface and creating better definition at the jaw angles can be done with custom implants that essentially do what the growth of the bone did not.
The concurrent placement of custom infraorbital-malar and jawline implants is a common multi level facial augmentation procedure often done for pure aesthetic enhancements. In this case it was used to treat deep undereye hollows (due to low infraorbital rims) and congenital jaw asymmetry. (in which a prior surgeon attempted to treat it with an asymmetrically placed chin implant)
Combination of custom infraorbital-malar and jawline implants to lengthen a vertically short face.
Custom left maxillary and jawline implants for congenital facial asymmetry due to plagiocephaly. Also getting at the same time a right temporo-parietal skull implant.
Combining cheek and jaw implants is a very common male combination custom facial implant surgery. Getting the high cheekbone look and/or improving undereye hollows are the motivations for the midface implants. While many men get a wrap around jawline implant for their lower face this patient had a very good chin and only needed jaw angle for a more defined jawline.
Replacing standard cheek and jawline implants with custom designs to achieve an improved effect is often the natural progression when the first set of implants do not produce the desired aesthetic effects.
Getting a good jawline augmentation effect can be difficult with standard implants due to their shapes and often unpredictable intraoperative positioning. Designing a custom jawline implant replacement will produce a better aesthetic outcome as the effects of the current indwelling implants are known both in size, shape and positioning on the bone.
Significant facial augmentation often involve custom infraorbital-malar and jawline implants. But when significant changes are needed in the chin area that are beyond what the soft tissues can tolerate with an implant, the custom jawline implant is combined with a bony lengthening genioplasty. This dual approach lessens the implant load in the chin area. The bony gap seen in the design is filled with an interposiitonal corticocancellous bone graft.
The use of custom infraorbital-malar and jawline implants (with a bony lengthening genioplasty) can completely change the shape of the male face.
in Obstructive Sleep Apnea
Double jaw surgery for obstructive sleep apnea can be curative for many patients and can also provide some aesthetic benefits as well. But it does not a true 3D facial augmentative effect for the jawline and almost always leaves the cheeks ‘behind’. As a result it is not uncommon that secondary custom infraorbital-malar and jawline implants are done to maximum the aesthetic effects and smooth out bony irregularities and defects.
The value of custom cheek and jaw implants after double jaw surgery can easily be appreciated for its 3D skeletal enhancement effects.
Facial asymmetry corrections in particular often need more than one location of skeletal augmentations. As in this case of Parry-Romberg Syndrome where a previous attempt using a modified chin implant did not have a good chance of fully addressing the scope of the facial asymmetry.
A 3D CT scan provides a lot more insight into the scope of the facial asymmetry which allows for a more complete correction than ‘eyeballing’ it with an off the shelf standard implant.
With a previous injectable filler history (Radiesse) the desire was for a permanent cheek augmentation effect. While the location of fillers in the soft tissues does not correlate exactly to augmentation on the bone a cheek-midface implant design was made to create an effect that would be somewhat similar. His lower third of his face was small/narrow so a ‘small’ jawline implant design of 11ccs volume was made.
Custom cheek-midface and jawline implant designs for a small male face that wanted more facial volume but not disproportionately so. The green is existing Radiesse injectable filler for cheek augmentation.
The most common form of male facial masculinization is midface and lower 1/3 of the face augmentations. While many men get a custom wrap around jawline implant in the midface the decision is whether it is just cheeks or a more horizontal infraorbital-malar implant design. In this case only high cheek augmentation was desired/needed.
Even well placed standard facial implants are ineffective if they don’t create the desired facial effect. But you always learn from the use of standard implants and you take those effects, desired and undesired, into custom implant designs. In this case the large standard malar shell cheek implants created too much lower cheek fullness/roundness which led to a high cheek implant design. The smaller standard chin implant prompted the patient to go for a full jaw augmentation effect.
Large standard cgeek and small chin implants replaced by custom implants for a more profound masculine effects.
Subtle/modest augmentation of numerous facial bone areas can create an overall facial enhancement change that looks perfectly natural. Custom implants are often as much about broader areas that they cover than them being thick or large.
Combining midface augmentation of its convex surfaces with ‘corner’ augmentations of the jawline.
Custom forehead-brow bone for upper facial masculinization and a custom jawline implant for contouring the jawline after a prior chin wing procedure.
Combined Custom Forehead and Jawline Implants
Both upper and lower third of the face custom implant augmentations….the forehead having never had prior surgery and the lower jaw had a prior chin wing osteotomy.
Male with three level facial transformation as a combined single surgery. (custom extended temporal, midface mask and jawline implants)
Three custom facial implants for a final aesthetic finish after prior Bimax surgery with PEEK cheek and jaw angle implants. (which needed to be removed for the new implant placements)
Custom IOM (infraorbital-malar) and jawline implants are a classic male facial masculinization surgery as they treat the ‘five corners’ of the face. (cheeks(2), chin (1) and jaw angles (2))
Despite the many benefits of double jaw osteotomies, it is not a true three dimensional operation. To add width and other dimensional increases it takes custom IOM and jawline implant designs to complete the final 3-D facial augmentation effect.
Strong male facial skeletal enhancements require profound 5 corner implant designs cheeks, chin and jaw angles). For those seeking a vertlcal chin cleft, while it can be designed into the implant, there is no guarantee that such a design addition will create the external effect.
Men seeking imprrovement over a ‘failed’ jaw angle implant with a custom jawline implant will often augment the infraorbital-malar area as well.
More than one custom implant for a single surgery is not rare even if it is more for a ‘reconstructive’ problem than purely aesthetic. In this case a custom jawline implant was combined with a right infralateral orbital rim-floor implant to treat vertical orbital dystopia (VOD) as well.
In some multi-level custom facial implants they are done in stages…often times never originally planned that way but an evolutionary process. In this case custom jawline and infraorbital-malar implants were originally done (in green color) and later he returned for custom brow bone and paranasal implants.
When standard chin and jaw angle augmentation methods are inadequate for size or symmetry reasons the custom jawline implant becomes the premiere replacement. Very often in men considering a custom jawline implant they take the opportunity to augment the upper midface as well in which the custom infraorbital-malar implant designs are the most ideal for many men.
In prior standard ‘eyeball’ implants for congenital facial asymmetry optimal correction is never obtained as the extent of the differences between the two sides can never be fully appreciated. As a result any implants used to treat will be inadequate. Custom designed implants have a far better chance of matching the opposite normal side.
