Rejuvenation of the Aging Jawline: A Comprehensive Approach
Patrick K. Sullivan, MD, Erik Hoy, MD, Johnny T. Chang, MD.
Brown University, Providence, RI, USA.
BACKGROUND: Much literature in the field of facial rejuvenation has focused on the midface, brow/forehead, and neck. Equally important is a well-defined and harmonious cercivofacial region, which provides a frame for the inferior portion of the face and has profound effects on perceived attractiveness, youth, masculinity, and femininity. Though some authors have focused on rejuvenation of the jawline, a comprehensive approach to the jawline is lacking and would aid the clinician in addressing the complexities of the jawline. This includes 1) reversing soft tissue descent with an effective lifting procedure, 2) removing volume excesses, 3) releasing ligamentous mandibular attachments, and 4) filling deficient areas with fat injections deficits. We present the senior author’s 10-year experience, and draw from that experience a comprehensive algorithm for jawline rejuvenation.
METHODS: A retrospective review of the senior author’s patients over ten consecutive years was undertaken. Four major portions of the jawline rejuvenation procedure are described and analyzed: 1) extended SMAS suspension rhytidectomy, 2) fat grafting and 3) fine canula liposuction, and 4) release of mandibular and submental retaining ligaments. Patient demographics were compiled, along with fat grafting locations and volumes. The fat grafting techniques for jawline rejuvenation focused on three major areas of concern: the posterior jawline, prejowl sulcus, and chin. Critical anatomy encountered during cervicoplasty is presented, in particular the location of the vessels encountered in releasing the mandibular retaining ligaments. Histologic evidence of mandibular and submental retaining ligaments that contribute to predictable age-related skin creases is demonstrated. Comparisons of male and female jawline rejuvenation procedures are made to emphasize gender differences. In addition, representative photographs are presented.
RESULTS: We identified 589 patients over the 10 years included in the study. Females comprised 452 of the patients, whereas there were 37 male patients. Average fat graft volumes in female and male patients respectively were as follows: 2.77 and 3.14 cc’s in the posterior jawline, 1.76 and 1.94 cc’s in the prejowl sulcus, and 2.97 and 2.80 cc’s in the chin. During the cervicoplasty portion of the procedure, critical vasculature that can result in significant hemorrhage and hematoma were consistently found 3.3-4.1 cm from the midline. Histologic sections of the mandibular region revealed clear evidence of retaining ligaments that coincide with significant skin creasing. No infections associated with fat grafting were noted. Of the female patients, 2% required a secondary grafting procedure for increased augmentation, not for asymmetry; this was the case with 4% of males.
CONCLUSIONS: The jawline is a key contributor to overall facial aesthetics, and should be addressed in a systematic and algorithmic manner. We present an approach based on the senior author’s experience with 589 patients over 10 years that will aid the surgeon in addressing the unique needs of individual patients seeking facial rejuvenation.
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