Under I.V. sedation, an incision just under an inch long is made in the crease immediately under the chin. A pocket is made under the lining of the bone (the "periosteum"). Care is taken to follow exactly along the lower border of the jaw and avoid injury to the mental nerves which exit the mandible on either side of the chin. The implant is then selected and customized by trimming it to provide more projection where it is needed and less where it is not needed. For example, the patient may need more filling in along the sides of the jaw and not in the middle of the chin, in which case the middle section of the implant is trimmed. The muscle that has been lifted off the jawline is then used to cover the implant and the skin is closed. Usually, a submental lipectomy is performed immediately before insertion of the implant, through the same incision. Either a single continuous "running" suture or several interrupted sutures are used and these are taken out three to seven days after surgery.

Sometimes patients ask if the incision can be made on the inside of the mouth, avoiding an external scar. Although it is possible, and I have used this approach on occasion in the past, the external approach is preferred. The external approach requires less dissection of the muscle off the bone so there is less risk to lower lip function. Also, the exposure is cleaner than working through the mouth, which is not a sterile field. I usually perform liposuction under the chin and tightening the platysma muscle, procedures that require an incision below the chin, so it makes sense to use the same incision to insert the implant and avoid an unnecessary second incision in the mouth. The scar is kept as short as possible and is usually well-concealed in the crease under the chin.

Jawline Augmentation: Jowl Implants

The jowl implant is much like the chin implant described above, but tapered centrally, in the area of the chin. These patients require filling in of the jawline and very little, if any, increased projection of the chin. In fact, I use the same implants that I use for chin augmentation and simply reduce the central portion in the operating room before inserting the implant. The operative technique, postoperative course, instructions and complications are the same as for chin augmentation.