Will A Chin Implant Give Me A Square Looking Front Of The Jaw?

Q: Dr. Eppley, It is said that the Terino extended anatomical chin implant produces a wide appearance to the chin. I want to know whether the wideness would be round and wide (like a half-oval) or flat and wide like a skateboard ramp. I’ve heard that the chin will be similar to Dick Tracy cartoon version, but a Real Self review got me thinking otherwise.

Extended Anatomical Chin Implant Dr Barry Eppley IndianapolisA: Every chin implant merely adapts to the shape of the underlying front end of the jaw. So if the implant is oval shape and the bone shape is oval (which almost all chins are) the resultant chin shape will be both wider but round or oval. Only if the chin implant has a different shape on the outside as opposed to a rounder or oval inner surface (like a square chin implant) will the resultant shape be wider and more square. Certainly no standard preformed chin implant available today is going to make any chin similar to a Dick Tracy cartoon version if that is what one’s final shape objective is. Only a custom made chin implant can achieve that very square look. The Terino extended anatomic chin implant does look more square in its picture but it will not create a square outer look in most cases.

Dr. Barry Eppley

Indianapolis, Indiana

Can Brow Bone Reshaping Make My Inner Brow More Sloped?

Q: Dr. Eppley, I am interested in brow bone reshaping. I am wondering whether it is possible to make the inner corner of my brow ridge-glabellar more sloped. I would attach my photos in order to better address my requests to see if they are achievable. I am also attaching an example of the brow shape I am after as I think his brow ridge shape is very elegant. I found out that the formation of the triangular contour that I desire is formed by the downward slope of brow bone in the inner eye corner. Is it possible to, besides make the ridge-line more prominent, also make it more sloped?

Also, I had a previous glabellar implant (not fixed) which has an undesired shape and bad connectivity with my forehead and brow-ridge. I’m 100% sure that I’ll remove this graft sometimes (if not now, it has to be during my revision rhino), but I’m wondering whether it possible to remove this portion with the same incision of brow implant? I have consulted some doctors and they said the position of this graft is relatively high so it’s easier to remove this from upper incision instead of the incision of open rhino. How do you think?

A: When it comes to brow bone reshaping, the ability for remove bone along the medial supraorbital rim depends on two factors. First, the thickness of the rim bone in that area. you have to remember that the frontal sinus lies immediately beneath it. The bone is undoubtably a few millimeters thick so some change is possible, it is just a question of how much. Secondly, it requires good incisional access to reach down that low. No endoscopic or other more limited incisional technique will work.

Wherever the glabellar implant is located, it most certainly can not be removed through an open rhinoplasty incision. It must come out the way it was put in.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Get This Jawline Look From Jaw Angle Implants?

Q: Dr. Eppley, I am interested in jaw angle implants to give my jaw a more flared and more square look. I would like my jawline to look like the attached picture. Would that be possible?

A: The ability to achieve a look very similar to your ideal jawline/jaw angles depends on two specific factors. First, you have to have a very thin face over the posterior jawline. Your model picture has virtually no fat which is why the jaw angle is so prominent and it is concave in front of it. You do not have that same anatomy. Your face is fuller so you could never achieve that exact look. Secondly, you have to have the exact implant design to create that degree of jaw angle flare. No off the shelf pair of jaw angle implants does that so a custom design set would be needed.

Based on your attached picture, you would definitely benefit by jaw angle implants. But you would not get that exact ideal result. The very picture you have shown i have seen dozens of times by different male patients who want that exact jawline look. But fir the vast majority of men who seek it, it is not possible.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Second Sliding Genioplasty Be Done?

Q: Dr. Eppley, I did the chin advancement at your clinic about three years ago and attached is the current result. The vertical length of the chin is good and my face is now long enough. But I still feel the chin needs to be horizontally moved forward a little bit. You did a very good chin job at that time but my chin was quite short and the advancement was put to the possible limit. My question now is: Is it possible to do another chin advancement?

A: Good to hear from you and thanks for the long-term follow-up. I remember your case well. I do agree that the vertical length is good but it still remains horizontally short. One of the sacrifices for vertical lengthening is that there is a limit as to how much horizontal movement can be obtained. The question now is whether a secondary sliding genioplasty can be done to move it further forward. (or whether only an implant can now be used) Given that it has been three years, good bony fill of the osteotomy gap should have occurred. If there is good bone stock the answer would be yes. But the only way to know that for certain would be to check any x-ray. The best x-ray would be a 3D CT scan. That will definitely answer the question of adequate bone thickness. There is also the question of the indwelling metal plate which could be completely overgrown with bone. It may not be easy to remove to do the osteotomy and that is another factor to consider.

Dr. Barry Eppley

Indianapolis, Indiana

How Can My Jaw Augmentation Be Fixed?

Q: Dr. Eppley, recently I had jaw augmentation and lipectomy. Its uneven and asymmetrical. Obviously nothing is perfect but I expected better. I am interested in your chin augmentations for a better jaw line as well as possible wrap around full custom augmentation. I look forward to speaking with you about these revisions. The liposuction isnt aggressive enough and the implants are sligtly off as I said before. I should have traveled to you first. I am interested in a face time consult with you. As you can see the left jaw angle is different that the right and the liposuction needs to more even and closer around the bone. Hopefully a chin implant and small revisions can accomplish a strong even jawline where the bone line is visible.  I don’t know how the doctor I went to has the credentials he has as he is satisfied with this procedure. I wish I came to see you first. I just wanted a defined jawline and facial definition not an asymmetrical nightmare.  

A: Thank you for sending your pictures and telling your surgical story. I don’t have the advantage of knowing what you looked like before surgery or exactly what implants were placed. You mentioned that you had ‘jaw augmentation’ but that can mean different things. My assumption was that you had chin and jaw angle implants placed separately (three separate implants)?? If this is so one has to realize that a smooth even jawline that connects the front and the back (chin to jaw angles) is never going to be possible as, even if the implant wings overlap, these are the thinnest sections of the implants. Thus there will always be a ‘dip’ in the middle of the jawline. Only a custom wrap around jawline implant which is made to augment the entire jawline can accomplish that effect. That is the one trade-off for having three separate implants.

However, your description of jaw augmentation may also only be that you had jaw angle implants only. Again they only come so far forward so there is going to be a drop off in the jawline as it approaches the chin. The main complication with jaw angle implants is asymmetry. It is very hard to get perfectly symmetric jaw angles with implants. Symmetric placement is difficult and most people do not have symmetric jaw angles initially. That combination leads to a high rate of jaw angle implant asymmetry.

I would need more information as to exactly what implants you have in place.

Dr. Barry Eppley

Indianapolis, Indiana

Will A Lower Buttock Tuck Fix My Deep Fold?

Q: Dr. Eppley, I’m from South America but I’m planning to travel to the US. Because one year ago I had liposuction on my banana rolls and now my butts looks larger and the gluteal fold is very prominent. I have attached pictures. Can you tell me if there’s anything that can be done to correct this? (maybe a lower butt tuck?)

Lower Buttock Lift (Fold Effacement) Dr Barry Eppley IndianapolisA: Thank you for sending your pictures. What you have is infragluteal fold accentuation due to lower buttock ptosis where the buttock skin hangs over the crease. This is a common problem that develops after liposuction of the lower buttock/banana rolls. My assumption is that you would like the fold to be less distinct and the loose skin on the lower buttocks removed. If these are your goals, these can be accomplished by excision of the skin above the fold, making a new fold that is less deep and a smoother transition between the lower buttocks and the posterior thighs. Some people call this a lower buttock lift or a lower buttock tuck. And that would be the name to call it. But what is really being done is that the loose lower buttock skin and the fold are being removed to create a less deep infragluteal fold and smoother transition between the buttock and the thighs. But so doing it may also make your buttocks look a little less full because its roundness is decreased.

Dr. Barry Eppley

Indianapolis, Indiana

Is Calf Augmentation With Fat Permanent?

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Q: Dr. Eppley, I am interested in fat injections to make my calfs and ankles bigger. My understanding is that fat injection is not a permanent solution. So if it is applicable in my case do I have to do it on regular basis?

A: While it is true that the lower legs (calf augmentation with fat) is not the best place for fat to take (due to the pressure of the overlying skin), the fat that does take can become permanent. So it is no true that fat is not a permanent procedure. It can be if enough fat is initially placed. The concept of lack of permanency in fat injections comes from the not rare scenario where a repeat fat injection treatment is done to finally get the desired result. This is not because it does not work, just that only a fraction of what was injected (maybe only 10% to 25% of the fat) survives and more fat injections are needed to get to a better end point. Think of it as adding layers to get to the desired result. In some patients, it is a one time procedure but in others a second procedure may be needed.

Dr. Barry Eppley

Indianapolis, Indiana

Will Platelet Rich Plasma (PRP) Help Facial Fat Grafts To Survive?

Q: Dr. Eppley, I am interested in fat augmentation around my facial implants. My biggest concern is how much fat will survive as the plastic surgeon I saw mentioned that the presence of the implants will make it less likely the injected fat cells will be able to develop their own blood supply and grow. This gives me pause as I’m not too keen on another procedure that might just be an expensive temporary natural filler. I would appreciate your thoughts on this and how to maximize the survival of any grafted fat.  Are there any other options to reduce the noticeability of the implants and fill/round out the cheeks more?

A: Your plastic surgeon did reach out to me and I have discussed your case with him. Fat injections are the only treatment that can be used as the ‘missing’ piece of your face is now not what is on the bone but is where the bone/implants aren’t. It is true that the final take of injected fat is both variable and not completely predictable. But I know of no scientific evidence that supports the supposition that fat grafts take less well over or around facial implants. And where you need the fat is to fill in the areas around and between the implants which is only soft tissue anyway.

One technique that can be done to improve fat graft survival is the use of platelet-rich plasma. (PRP) By mixing PRP with the fat grafts, it optimally enhances fat cell survival through its growth factor effects. It may also have an inducing effect on the stem cells that naturally reside in fat. Given that it is an extract from your own blood, there is no reason not to use this natural fat ‘booster’.

Dr. Barry Eppley

Indianapolis, Indiana

What Type Of Facial Scar Revision Can Improve Dog Ears?

Q: Dr. Eppley, I was left with a depressed facial scar with dog ears as a result of multiple cyst removals on the left side of my face along the smile line by my nose. I have been told by plastic surgeons that my scar condition can be improved with fat injections for the loss of volume and surgery which will expand the current scar even more to address the dog ears. I found your article on the internet on the aesthetic refinement of the dog ear correction very encouraging. I am hopeful that it would work on her scar. Please advise. 

A: Thank you for sending your facial scar pictures. The depressed scar and dog ears are very evident as you have described. Your facial scar revision would initially consist of elevating the depressed scar can be done with either fat injections or an actual dermal-fat graft. Given the need to harvest dermal-fat grafts with a resultant scar, even though they take better, fat injections would be the preferred technique given that its harvest and injection can be done in a relatively scarless fashion. As for the dog ears, the classic teaching is that the scar must be extended to excise them. And given how they look for a small amount of scar length increase that is not necessarily a terrible idea and may be the best solution. An alternative approach is to defat them with limited excision and see how that turns out.

Dr. Barry Eppley

Indianapolis, Indiana

Is A Chin Implant A Good Alternative To Jaw Surgery?

Q: Dr. Eppley, I have a weak chin making my side profile look really bad. I think its was because of a overbite. I have been wearing braces but I just want to have a good profile. Can I still get a chin implant? I don’t care about my overbite so I’m not thinking of getting jaw surgery. Will a chin implant with wings be a good alternative?

A: If mandibular advancement (orthognathic) surgery is not going to be done and of that you are certain, then attention can be directed to its aesthetic enhancement or camouflage. Chin augmentation can be done successfully using either a chin implant or a sliding genioplasty. Whether a chin implant is best for you depends on how short your chin is. Off-the-shelf chin implants do not exceed 10 to 11ms in horizontal projection so very short chins in men may be inadequately treated by a standard chin implant alone. I would need to see a front and side view picture of you to determine how successful a chin implant would be in your case. These pictures would be used for computer imaging to determine how much increase in chin projection is needed based on measurements and different changes in chin dimensions.

Dr. Barry Eppley

Indianapolis, Indiana