Q: Dr. Eppley, I have facial asymmetry of which my left eye area is a big part of why it looks the way it does. I am interested in brow shaving and a canthopexy to improve the eye area. My biggest concern with orbital rim shaving would be losing frontal bossing over that orbital rim. Let me ask you if you have ever performed shaving of the orbital rims for the purpose of better balancing facial asymmetry?
Regarding chin implants. Given your extensive experience with these, especially in ideal jaw surgery candidates who refuse surgery (retrognathic lower jaw), I’d like to ask you if it’s a realistic possibility to recreate the appearance of a jaw when it is in a prognathic position, using a chin implant with wings? What I mean is when I slide my jaw as far forward as I can, creating what is dentally considered mandibular prognathism, I reallylike the aesthetic appearance it has on my jawline, probably because my jawline is retruded by default so when I manipulate my jaw into a prognathic position it actually just ends up looking relatively normal (with the exception of my lower teeth pushing my lower lip forward which is the only giveaway). Basically I’m asking if a chin implant with wings can provide anterior projection to the entire jawline, not only the forward most point of chin but also along the mandibular body of the jaw, bringing most of the jaw (except the mandibular angles) more forward relative to other parts of the face, like what happens when you push your jaw forward in your face.
Also another big question Ive always had about chin implants is how does the placement of a chin implant effects the lower lip? Do chin implants push the lower lip forward at all? And what about augmentation of the chin groove, can this be moved “forward” or augmented at all to avoid the formation of a huge indentation in the chin groove between the bottom lip and chin implant? As it would seem the larger the chin implant you use, the deeper this groove would become.
A: In regards to orbital rim shaving is done through an upper eyelid incision, it removes the bottom portion of the orbital rim not its anterior projection. So there would be no risk of losing frontal bossing which is a horizontal brow feature. Inferior orbital rim shaving is done almost exclusively in cases of facial/brow asymmetry. There would be no other reason to do it. The result is subtle, not dramatic, and is in the range of 3 to 5mms depending upon the degree of superior orbital rim asymmetry.
If you are jutting your jaw forward and getting the desired look, then a chin implant with match that horizontal result. It may be a little thinner at the sides. The most ideal thing to do is to make a custom chin implant which would overcome that issue.
The lower lip never changes position no matter whagt is done to the chin. That can only change with an entire jaw advancement procedure. You are correct in that the labiomental groove will be come deeper as the chin position changes below it but the labiomental groove is not changes by an isolated chin procedure, implant or osteotomy. That can be overcome with a custom chin implant which builts up that area whereas a conventional chin implant does not.
Dr. Barry Eppley