Mandibular angle implants or filler to create a more angled wider jaw? Female (Photo)

Question

I'm torn between getting fillers or Mandibular angle implants. My worry about filler is that it will move, or end up being umsemeyrical. I've been doing my lips with juviderm since I was 19 & I like them however they have never been 100% perfect or semeyrical with no lumps after Injections. The down side to the Mandibular angle implants is longer recovery and I work in intertainment and am heavily booked for shoots so it's hard to get time off. But I want the best results.

Michael P. Morrissette, DDS, FACS · Answer

You have a beautiful facial features and structure. I would most definitely not recommend mandibular angle implants for your face. You already have what is considered the "triangle of beauty". Mandibular angle implants would distort that appearance. In order to enhance your beauty, I would recommend trying filler treatment to your lateral cheek region to increase the youthful and contoured appearance. As far a lip fillers go, you should not have a lumpy experience following the injection of lip fillers. Good luck

Bao L. Phan, MD · Answer

Hi, Amaple.  The 2 options you are considering to augment the angle of your mandible (tissue fillers and implants) have their pros and cons, which you have so astutely listed. While tissue fillers may cause some lumpiness, asymmetry and move on you, if carefully done by an experienced and skillful board certified plastic surgeon, they can help achieve the effect you are looking for with less risks and less downtime.  I particularly like Radiesse when enhancing bony features of the face such as the cheeks, chin and jawline.  It usually has to be placed a little deeper than the hyaluronic acid based fillers because it's more firm but by doing so it's there is less chance of it being lumpy.  Also since Radiesse is more firm, it tends to not move on you as much.  But, because it's not as pliable and moldable, it has to be placed more precisely and a little bit at a time (better to under- fill and come back again for touch up than placing too much as it is more difficult to remove/ dissolve than HA fillers).  Downside of fillers is that they don't last as long as we would all like and so you have to get it re- injected, which could get very expensive over time and especially with the much larger volume required for the large surface area of the angle of the mandible (which makes this a very cost- prohibitive option for most patients).  Mandible angle implants, as you have pointed out, have the major disadvantage of much longer recovery and much greater risks (bleeding, infection, nerve injury, migration/shifting/asymmetry of the implants and most of all- palpability of the implant).  They hardly ever feel very natural.  I definitely do not feel you need to go that route as you already have a very attractive face with very nice proportions already so don't ruin it.
If you really desire more enhancement of your jawline and want to consider another option that has more longevity than tissue fillers but less risks and downtime than mandible implants, I think you would be a great candidate for fat transfers.  The recovery is much, much quicker (less than a week usually before you feel  comfortable enough showing your face in public without scaring anyone) with much less surgical risks than implants, and it's all natural so you never have to worry about the potential problems of implants.  It has the potential to last much longer than tissue fillers which most are guaranteed to go away within 6- 12 months.  The challenge with fat grafting is the variability of graft survival.  We cannot guarantee exactly how much of it will "take" but usually 20- 40% of it will not survive the transfer process, depending on the quality of fat you have, how much volume you need to graft and most of all- the experience and technique used by your surgeon.  Fat grafting is just one of those techniques that requires a lot of experience and good technique to be successful at.  Not all surgeons have the same of either one. The more experience surgeons with more refined techniques can usually get better graft take and with less complications.  If not done properly, it can be lumpy and/ or too much of it will go away.  I think the jawline is a safe area to augment with fat though.  If successful, the grafted fat can be with you for many many years and even decades, depending on how young you are to begin with.  The other great thing is that if too much of it goes away with the initial transfer session, you can repeat it to get more volume to take.  When it works, it's a beautiful thing.
I recommend you see several board certified plastic surgeons with lots of experience with fat transfers who can show you lots of good case results.  Best wishes.

Regina Rodman, MD · Answer

Thank you for sharing your photos and questions.
You are stunning!  Anything you do, I would recommend doing something subtle and reversible.  I see the photos that are your goals, and they are also beautiful women.  However, our idea of beauty changes over time and trends change.  
Currently, I am doing many "V-line" surgeries to help women get rid of the sharp angle of their jaw and to have a heart shaped face.  Many women pay lots of money for surgery to have your face shape!  
If you want to try something, I would recommend Restylane lift or Voluma at the angles and see how you like it.  You can always do an implant later.
Best of luck
Dr Rodman

Chase Lay, MD · Answer

Girl, come on!  Obviously you're young and beautiful so I'd say leave it alone BUT we've all got goals.  I'm guilty of injecting my own chin from time to time to give it a more prominent look.  HOWEVER, you've got great features so don't mess it up.  My advice would be to use fillers first as this is temporary and often easily reverse if you use HA fillers like Voluma or Restylane Lyft.  Implants would be a big commitment and certainly has some risk.  I do like and occasionally place angle of mandible implants but take smaller steps.  What's worse?  Having a beautiful face that isn't 100% the way you want it to be or permanently changing your look in a way you do not like?  Also, it would make a bit more sense to do this later in life as it will help you age better by giving the mandible body and structure an will hold the soft tissue up.Chase Lay MD

Val Lambros, MD, FACS (retired) · Answer

the most natural way to get this done would be to adhere to a very chewy diet with nuts grains and a lot of raw foods.  Chew gum a lot. Do jaw clenching exercises. within a few months your jaw muscles will get big and you will have a natural amplified jawline that will be perfectly smooth and wonderful. You could do some fillers along the way, but you will need many syringes. there will be no shortage of people who want to operate on you, so be careful.  Your face is a jewel and you don't want to mess it up.

David Alessi, MD - Account Suspended · Answer

The safest way is to use fillers.  For deeper corrections, asymmetry is less of an issue.  Also, Voluma (which is the best for this) is reversible.  Angle implants would define the angle better but, as you indicated, require surgery and a recovery time.  Typically, the recovery is about 2 weeks before the swelling is down enough to do photos.  Overall, I would encourage you to do fillers first.  If you like it, then do the implants later.  However, either choice is fine.  Best wishes.

Gerald Wittenberg, MSc, DMD (retired) · Answer

Your view is certainly reasonable. The use of fillers is possible but less ideal over time since one has to repeat it and the absorption/as it dissolves; may not be even. The most ideal is customization of implants at surgery to fit your specific goal and facial balance. That is the main choice for persons in the public view as well. The recovery is longer, but so is the long term benefit and effect.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  From the photos, the back portions of your jaw line are weak as is your chin compared to the photo examples that you provided.  The back portion of your jaw line is a bit weak and can be augmented, without making your face appear masculine, using precise placement of a dermal filler (I prefer using Restylane Lyft).
 I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.
Hope this helps.

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