JAW ANGLE IMPLANTS | Why doesn't anyone talk about them?

thank you all so very much for being loyal followers and um being so receptive to a previous video I made about facial implants just scratching the surface literally on a whole world of options and opportunities and possibilities in facial plastic surgery um so today I want to expound upon this topic because one viewer Michael hi Michael asked me about going your angle slash jawline implants and this is sort of a topic that's kind of a no man's land in our specialty but it's not to me and if you want to know more about jaw angle implants stay tuned [Music] [Applause] woman [Applause] [Music] hi everybody I'm Dr Jonathan zelken a board certified plastic surgeon in Newport Beach California facial plastic surgery plastic surgery to the body is my specialty regardless of what you are looking to do I consider myself a jack of all trades in that sense but I have a particular interest in reshaping the face and facial sculpting and part of this practice that's becoming ever more popular is facial implants facial implants versus Alternatives like fat grafting and even uh fillers are a superior option because it's a it's generally a one and done procedure that's more predictable if the operation is executed well and does not need to be replaced for example every year or so the other thing about it is you are directly augmenting the part of your Anatomy that you want to augment rather than trying to simulate it with fillers or fat graft fat Graft in my hands is a great way of enhancing another procedure such as a facelift or even a facial implant as a standalone procedure I do think there are important limitations for facial fat grafting but it happens that one of my favorite places to Fat graft is the gonial angle what is the gonial angle what is the jaw angle this is the part of your face that separates your cheek from your neck and it's really important to create a nice shadow under that if you have too much weakness of this area for example it's going to accentuate the jowls it's gonna in men for example it'll it'll sort of emasculate the face of a little bit in women it can take away from an attractive feminine jawline regardless of gender age whatever the jaw angle when well defined is a very attractive feature because it casts a desirable Shadow so today I want to talk about one really popular option for jaw angle enhancement and that is the jaw angle implant now in the past video we talked about different flavors of implants be it silicone versus porous polyethylene both of them are great options because they are ductile meaning that you can cut them and so this is an example of a cut specimen of a silicone implant and what you can see here is that it's not like there is a liquid on the inside silicone behaves as a solid more so with facial implants for example than breast implants where you have a more gel like silicone this is a firm and uh State form stable material that is both ductile and malleable meaning you can you could bend it into position and you can cut it so you can customize it and it's really important to know this because a lot of people do ask for custom Solutions whereas this is an implant that is very straightforward to cut with a knife this is also true for porous polyethylene implants and it's really important to recognize that just like silicone porous polyethylene is a ductile material meaning that you can cut it as well and you can craft it both materials again are ductile only the silicone devices are malleable that means silicone devices can be squeezed through small spaces and potentially allow for smaller incisions but the porous polyethylene allows for better ingrowth in response to my previous video Michael asked a really good question he said why aren't more surgeons posting material about jaw angle implants and I think it's because not many surgeons offer this operation unlike chin implants or cheek implants the jaw angle implant is a nuanced procedure that has a higher complication profile than other facial implants be it infection be it implant malposition or just the desire for some sort of revision this operation does require technical expertise which isn't something that can be learned in a weekend for example it's something that requires a deeper understanding of lower facial anatomy and experience at the very least in craniofacial reconstruction so surgeons who do you know osteoplasty or sagittal split osteotomies by maxillary surgery things like that might have more comfort with this area because there's a lot of things that you need to consider one of the first things that you need to consider is that a jaw angle is thought to look like this and this bony spur or tubercle is what connects to the masseter muscle and the masseter muscle is what helps you cleanse your jaw and if you have a really strong acid or muscle you're going to get some um secondary overgrowth or bony out cropping of the angle of your mandible this would be a very attractive mandibular angle and I do see angles that flare outward for example in a lot of Asian patients interestingly enough on this model this is more of a unilateral phenomenon on this uh this model skulls right side it seems to be a little bit more of a normal presentation where the back of the jaw angle actually comes inward a little bit typically you don't get a flaring outward of the jaw angle it usually comes inward a little bit and Striker sent me this model skull based on a real patient and you can see this actually even more so you can see on this patient's left jaw angle that it actually comes inward a little bit this is really important to understand because when you do a jaw angle implant you think you reach the end of your dissection you create a pocket that looks and feels like an implant that's intended for the patient should fit back there but it's actually too far forward and oftentimes especially with a squeeze of the masseter over this implant you can get implant malposition so because it's hard to do because of a higher level of complications including malposition and infection and because a lot of people don't know about this operation jaw angle implants are sort of an underrated option just like the piriform aperture implant that I talk about in other videos and love so much so today for the rest of this video we're going to talk about a porous polyethylene variation the original poster asked about implant Tech options implant Tech does make all sorts of implants but usually the implants that I order from that company are silicone not porous polyethylene there's two flavors of those there's the kind that make your jaw wider and there's the kind that make your jaw taller based on your goals do you want to widen the width of your jaw or do you want to make it longer because it comes too high up re based on your decision we can choose an implant for you even the ones that are designed to widen the uh the jaw angle will lengthen it a little bit and vice versa if you want to implant that is designed to lengthen the jaw angle it will have a secondary widening effect um but I do have a device that was sent to me by Striker and this is a porous polyethylene device and the device that they're using happens to have both of an augmentation quality as far as width and length and when you're lengthening it there's almost a cup to the implant I don't know if you can see it here but if you look inside it is uh designed to almost cup the bottom Edge or the posterior edge of the jaw angle so it fits really nicely in this model and when you get a custom implant like this for example from Striker you can rest assured that implant placement should be fairly precise and stable even without screws this is pretty stable and it stays put because it's really designed to cup the posterior and inferior edge of your job silicone options will be more have more of an on lay effect and so pocket creation and fixation of that device is imperative still even if this is form stable it's really important to get this into the right position and to screw it with one or two screws there are alternatives to using screws but in my practice I do prefer to use screws to fix these implants into position and what you'll notice is even as I'm doing this under direct visualization with pre-drilled screw holes it's not very easy to get a screw in there so this challenge is one of the nuances of jaw angle surgery you've got to have a great assistant and in most cases it requires a small stab incision in the side of the cheek to get through the soft tissue envelope directly on at a 90 degree angle to make sure that you're not either skiving a screw or moving the implant to get the screw in somewhere to get some purchase in the bone when you get the implant in perfect position then and only then should you go in at a 90 degree angle and put a screw in they do make right angle screwdrivers I've received estimates from these from my reps and they're very expensive and I do have some concerns that you don't have that much control when you're putting a screw in this way from this approach also if you're going through the mouth you can imagine that you're always going to be going at a 45 degree or more acute angle which is not a very favorable angle so this small trade-off of a tiny stab hole that heals really well in the cheek is totally validated but because of the challenges of pocket development implant placement implant fixation and higher risks of complications not many surgeons do offer this procedure especially when fillers do a pretty good job and at least in my facelift practice I'm pretty happy with the results of just fat grafting into there so there's so many options available here but because not many surgeons do this and not many surgeons on top of that are YouTube URS and on top of that not many patients can send to photo use it's uh it's a just it's a combination of ingredients that makes it hard to access this information so I do hope that this video sheds some light on the availability options and practicalities of jaw angle implant placement and I'm here to discuss this with you in person if you want to talk about doing surgery or if you have any additional questions please do subscribe please do write your questions and comments below and as Michael will know I do my best to respond I can't answer everybody's question with a video but I will certainly do my best thank you so much for watching this it really does mean the world to me I've been very inspired by your prior commentary and the increase in my subscriptions tell a friend about this Channel and if you want to discuss this more you can access me in a virtual consultation or in person in Newport Beach California thank you so much for your time have a great day [Music] [Applause] [Music]

Channel: Jonathan Zelken, MD

Views: 7,221

Keywords: Newport Beach Plastic Surgery, Plastic Surgery, Celebrity Plastic Surgery, Beverly Hills, Sony a7s iii, Sony FX3, s-log, DIY, tutorial, premiere pro, after effects, jake paul, elon musk, subscribe, facelift, buccal fat, lip fillers, botox, botched, medspa, med school, youtube, casey neistat, new york plastic surgery, jawline, gonial angle, jaw angle, chad, implantech, stryker, facial implants, implants, medpor, silicone, snatched, jaw line, chin implant, brad pitt, eppley, binder, goneal

Id: JixsqWiD1lM

Length: 11min 53sec (713 seconds)

Published: Fri Sep 08 2023