Augmenting the Prejowl: Deciding between Fat, Fillers, and Implants

Abstract

The prejowl sulcus is a complex anatomic structure that results from several age-related changes in the lower face. These changes include the localized atrophy of a segment of the mandible inferior to the mental foreman, fat atrophy, and dehiscence and laxity of the ligamentous and muscular components of the region. The correction of the prejowl sulcus is rarely accomplished through rhytidectomy alone. Instead, the volume deficit of the sulcus usually requires the replacement of volume. Solid implants, fillers, and fat transfer may be used to improve the contour of the lower face. These can be used in isolation and in conjunction with rhytidectomy. The decision of what method to be used depends on the severity of the deformity, the patient's adjacent anatomy, the patient's wishes, and the skill set of the surgeon.

Keywords

prejowl sulcus - groove - implant - fillers - fat transfer

• References

• 1 Perkins SW, Sandel IV HD. Anatomic considerations, analysis, and the aging process of the perioral region. Facial Plast Surg Clin North Am 2007; 15 (4) 403-407 , v.
• 2 Ridley M, Vanhook SM, Aesthetic facial proportions. In: Papel ID. ed. Facial Plastic and Reconstructive Surgery. 3rd ed. New York, NY: Thieme; 2009: 119-113
• 3 Reece EM, Pessa JE, Rohrich RJ. The mandibular septum: anatomical observations of the jowls in aging-implications for facial rejuvenation. Plast Reconstr Surg 2008; 121 (4) 1414-1420
• 4 Braz A, Humphrey S, Weinkle S , et al. Lower face: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg 2015; 136 (5, Suppl): 235S-257S
• 5 Romo T, Yalamanchili H, Sclafani AP. Chin and prejowl augmentation in the management of the aging jawline. Facial Plast Surg 2005; 21 (1) 38-46
• 6 Mittelman H, Spencer JR, Chrzanowski DS. Chin region: management of grooves and mandibular hypoplasia with alloplastic implants. Facial Plast Surg Clin North Am 2007; 15 (4) 445-460 , vi
• 7 Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg 2009; 124 (1) 266-271
• 8 Fattahi T. The prejowl sulcus: an important consideration in lower face rejuvenation. J Oral Maxillofac Surg 2008; 66 (2) 355-358
• 9 Sherris DA, Larrabee Jr WF. Expanded polytetrafluoroethylene augmentation of the lower face. Laryngoscope 1996; 106 (5, Pt 1): 658-663
• 10 Shire JR. The importance of the prejowl notch in face lifting: the prejowl implant. Facial Plast Surg Clin North Am 2008; 16 (1) 87-97 , vi
• 11 Borodic GE. Use of fillers as adjunct therapy for the treatment of lower face hemifacial spasm. Ophthal Plast Reconstr Surg 2013; 29 (3) 225-226
• 12 Graivier MH, Bass LS, Busso M, Jasin ME, Narins RS, Tzikas TL. Calcium hydroxylapatite (Radiesse) for correction of the mid- and lower face: consensus recommendations. Plast Reconstr Surg 2007; 120 (6, Suppl): 55S-66S
• 13 Verpaele A, Strand A. Restylane SubQ, a non-animal stabilized hyaluronic acid gel for soft tissue augmentation of the mid- and lower face. Aesthet Surg J 2006; 26 (1S): S10-S17
• 14 Chang CS, Kang GC. Achieving ideal lower face aesthetic contours: combination of tridimensional fat grafting to the chin with masseter botulinum toxin injection. Aesthet Surg J 2016; [E-pub ahead of print]
• 15 Metzinger S, Parrish J, Guerra A, Zeph R. Autologous fat grafting to the lower one-third of the face. Facial Plast Surg 2012; 28 (1) 21-33
• 16 Ransom ER, Antunes MB, Bloom JD, Greco T. Concurrent structural fat grafting and carbon dioxide laser resurfacing for perioral and lower face rejuvenation. J Cosmet Laser Ther 2011; 13 (1) 6-12
• 17 Sykes JM, Tapias V, Pu LL. Autologous fat grafting viability: lower third of the face. Facial Plast Surg 2010; 26 (5) 376-384
• 18 Glasgold M, Lam SM, Glasgold R. Autologous fat grafting for cosmetic enhancement of the perioral region. Facial Plast Surg Clin North Am 2007; 15 (4) 461-470 , vi