Abstract
A large percentage of patients with microgenia requesting chin augmentation also exhibit an associated component of micrognathia with either narrow or acutely angled mandibular bodies and/or hypoplasia of the gonial angles. Augmentation of the face and mandible should optimally address all regions of deficiency and can now be customized with a high degree of accuracy using software that can be accessed over the Internet. We discuss the advanced capabilities of merging a sophisticated software system (Geometric Freeform® software; Morrisville, North Carolina) and computed tomography (CT) imaging to design precise, total custom mandibular implants over the Internet without the need for physical modeling. In revision cases, this process also allowed for the implant to be removed and replaced within a single-stage procedure. We retrospectively reviewed 34 cases in an outpatient surgical center and described the preoperative evaluation, imaging protocol, customization process, and surgical procedure for custom mandibular and custom total mandibular augmentation. Between January 2004 and June 2015, 25 patients underwent total mandibular augmentation and 9 had custom extended mandibular angle and body augmentation. All patients received solid silicone rubber implants that were customized using virtual or acrylic prototypes digitally designed via real-time video conferencing. This custom process achieved an enhanced level of satisfaction with an improved ability to achieve symmetry based on quantitative measurements during the interactive design process, alloplastic facial implants can be customized with a high degree of accuracy, precision, and fit by combining the capabilities of 3-dimensional CT and advanced computer design software accessed via the Internet.
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