Chin-jowl implants enhance aesthetic outcomes

Stanford, Calif. - Chin-jowl implants are a valuable adjunct for optimizing the results of minimally invasive facelift procedures and neck liposuction, says Greg S. Morganroth, M.D., who spoke at "The Next Step: Mastering Cutaneous Outpatient Procedures," a continuing education program at Stanford University.

Even while dermatologic surgeons are becoming more advanced in performing facial rejuvenation techniques and procedures to correct age-related volume loss and skin laxity, there is a tendency to overlook aging processes affecting the chin and mandible, says Dr. Morganroth, one of the course co-directors.

Placement of a chin-jowl or jowl implant addresses those latter changes and enhances restoration of youthful facial proportions in patients undergoing a mini-facelift or neck liposuction.

The implantation procedure can be performed completely under local anesthesia, which is obtained using an intraoral mental nerve block followed by direct infiltration of 1 percent lidocaine with epinephrine along the path of the implant over the mandible. Because all patients are also undergoing neck liposuction or a lifting procedure, the incision (1.5 cm to 2.0 cm) is made in the submental crease. After the skin is retracted up over the chin, the incision is extended through the periosteum.

Then, using a Freer elevator, the surgeon creates two subperiosteal pockets in a bloodless dissection along the inferior margin of the mandible. The pockets must extend far laterally (>5 cm in each direction) and should have a tight fit to the implant.

Avoiding nerve injury "To avoid injuring the mental nerve or marginal mandibular nerve, the dissection should be performed in the subperiosteal plane along the inferior border of the mandible," says Dr. Morganroth, a private practitioner in Mountain View, Calif., and a faculty member of the Stanford University Facial Plastic Surgery Fellowship Training Program.

Once the implant is in place, care is taken to check for symmetrical positioning by aligning a blue marking at its center with the patient's midline. Then, using two 4-0 Vicryl sutures, the inferior aspect of the central portion of the implant is anchored to the inferior edge of the periosteum.

"About two-thirds of the implant is contained within the subperiosteal pocket, and as the periosteum shrinks down quickly after surgery, a properly formed pocket will lock the implant in position. Placing two stitches at the central portion of the implant keeps that exposed region from moving up or shifting horizontally," says Dr. Morganroth, who is also clinical assistant professor of dermatology, University of California, San Francisco, and a clinical faculty member in the Mittelman Facial Plastic Surgery Fellowship Training Program.

Next, the residual periosteum is carefully dissected free and is sutured over the implant with 4-0 Vicryl. The skin closure is also done with 4.0 Vicryl and 6-0 nylon sutures.

With meticulous attention to technique, Dr. Morganroth says he has encountered no problems with infection, implant migration or nerve injury.