Can volume along with length be added to the prejowl area?

I had chin and jaw reduction surgery and do not like the results. I now have an asymmetric chin that is too narrow with a prejowl sulcus. I would like to fill in the prejowl area but also lengthen it to make the angle going to my chin less sharp. I now have a "V" shaped chin and I am seeking to make it a little more "U" shaped. I am seeking a permanent solution. I am aware of the prejowl implants but can they also all slightly length in the prejowl area?

Doctor Answers 2

You can use injectable fillers for the prejowls after your surgery, or as a preview before committing to something permanent

Thank you for your question. You submitted a question without a photo,  which is somewhat a limitation with the answer, but I can give you some global understanding of my perception and considerations in a situation like yours. You’ve had chin and jaw reduction surgery, but you’re unhappy with the results. You state you have an asymmetric chin that looks like more of a “V”, which you want to look more like a “U”, and you have some prejowl, a sulcus, and you are aware of things like prejowl implants. Overall, you want a permanent solution.

I can certainly give you some guidance. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Facial aging solutions and facial aesthetics are a significant part of my practice. I can give some overall perspective of based on how I interpret this.

You went through very significant orthognathic surgery, most likely with a maxillofacial surgeon. It’s significant because you most likely had issues with teeth occlusion and facial appearance. Once everything was set, if you have these concerns, my first thought is have you addressed this with your doctor, and does your doctor or surgeons who performed the surgery have an idea of what they can do to help you look a little better? If you are looking for a permanent solution, the surgeons who performed this surgery will have the best idea of what is optimal, and the best permanent solution, whether it’s a bone grafting procedure, or  facial implant surgery, which basically cover the permanent solutions.

If you’re not sure permanent solutions would be right for you, or if you are dissatisfied with them, I would consider doing something not permanent, but will give you a sense of what permanent solutions could look like. We perform a procedure in our practice using thicker hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma called structural volumizing. Structural volumizing means addressing a deficit in areas at the bone level. Traditional filler placement is typically done just under the skin or in the skin, (intradermal, subcutaneous). With structural volumizing, we’re placing these thicker fillers at the bone level, typically in the cheekbone area, jawline, prejowl area, the chin, and in the jaw angle. This combination can have a significant impact on the appearance, and what’s remarkable is you would have minimal bruising, and can see close to the final result almost immediately. There’s a certain amount of swelling that can be part of the initial adaptation process and progression of normal balance, so in about two weeks, you get a better sense of what it looks like.

Given how extensive your surgery was, it’s unfortunate you’re still dissatisfied with the outcome. I suspect you do have a significant improvement globally, and you’re now looking at the fine points of areas you want to see improve. When doing something for the fine points, injectable fillers gives us a lot of flexibility. Even if we’re not just structural volumizing, it can be a combination of structural volumizing, and soft tissue augmentation with fillers. You can consider that, so have this dialogue with your original surgeons about the areas you want improved. It’s an interesting idea to have this procedure, then take some photos and show your surgeons this is what you want long-term, so see if it’s attainable.

Meet with qualified, experienced physicians who are familiar with this method  as most doctors don’t do this. This is a specialized approach in using fillers, so take it from there, and hopefully you’ll get closer to the ideal you’re pursuing. I hope that was helpful, I wish you the best of luck, and thank you for your question.

You can use injectable fillers for the prejowls after your surgery, or as a preview before committing to something permanent

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Thank you for your question. You submitted a question without a photo,  which is somewhat a limitation with the answer, but I can give you some global understanding of my perception and considerations in a situation like yours. You’ve had chin and jaw reduction surgery, but you’re unhappy with the results. You state you have an asymmetric chin that looks like more of a “V”, which you want to look more like a “U”, and you have some prejowl, a sulcus, and you are aware of things like prejowl implants. Overall, you want a permanent solution.

I can certainly give you some guidance. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Facial aging solutions and facial aesthetics are a significant part of my practice. I can give some overall perspective of based on how I interpret this.

You went through very significant orthognathic surgery, most likely with a maxillofacial surgeon. It’s significant because you most likely had issues with teeth occlusion and facial appearance. Once everything was set, if you have these concerns, my first thought is have you addressed this with your doctor, and does your doctor or surgeons who performed the surgery have an idea of what they can do to help you look a little better? If you are looking for a permanent solution, the surgeons who performed this surgery will have the best idea of what is optimal, and the best permanent solution, whether it’s a bone grafting procedure, or  facial implant surgery, which basically cover the permanent solutions.

If you’re not sure permanent solutions would be right for you, or if you are dissatisfied with them, I would consider doing something not permanent, but will give you a sense of what permanent solutions could look like. We perform a procedure in our practice using thicker hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma called structural volumizing. Structural volumizing means addressing a deficit in areas at the bone level. Traditional filler placement is typically done just under the skin or in the skin, (intradermal, subcutaneous). With structural volumizing, we’re placing these thicker fillers at the bone level, typically in the cheekbone area, jawline, prejowl area, the chin, and in the jaw angle. This combination can have a significant impact on the appearance, and what’s remarkable is you would have minimal bruising, and can see close to the final result almost immediately. There’s a certain amount of swelling that can be part of the initial adaptation process and progression of normal balance, so in about two weeks, you get a better sense of what it looks like.

Given how extensive your surgery was, it’s unfortunate you’re still dissatisfied with the outcome. I suspect you do have a significant improvement globally, and you’re now looking at the fine points of areas you want to see improve. When doing something for the fine points, injectable fillers gives us a lot of flexibility. Even if we’re not just structural volumizing, it can be a combination of structural volumizing, and soft tissue augmentation with fillers. You can consider that, so have this dialogue with your original surgeons about the areas you want improved. It’s an interesting idea to have this procedure, then take some photos and show your surgeons this is what you want long-term, so see if it’s attainable.

Meet with qualified, experienced physicians who are familiar with this method  as most doctors don’t do this. This is a specialized approach in using fillers, so take it from there, and hopefully you’ll get closer to the ideal you’re pursuing. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Volume in prejowl area after surgery

Filler can be placed along the jaw line to round it out but I would wait awhile after surgery to allow inflamation to subside.  Alternatively a fat transfer to the area may can be done.  Evaluation by an experienced injector needs to be done for a definitive answer.

Volume in prejowl area after surgery

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Filler can be placed along the jaw line to round it out but I would wait awhile after surgery to allow inflamation to subside.  Alternatively a fat transfer to the area may can be done.  Evaluation by an experienced injector needs to be done for a definitive answer.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.