Does My Mentalis Strain Need Chin Or Jaw Advancement?

Q: Dr. Eppley, I believe I have a mentalis strain, my chin starts to dimple and looks somewhat “bubbly.” My chin looks pretty short and recedes to me , but I am happy with the size my lower jaw except for the receding and the strain. Will my lower jaw have to be wider to fix the problem or can i just simply have my jaw  moved forward enough to fix the problem without having to change the size of my jaw?

A: Most mentalis strains are the result of a short lower jaw, a horizontal bone deficiency. This makes the mentalis muscle ‘overwork’ to try and achieve lip competence. Whether this is best treated by a lower jaw advancement or just a chin augmentation depends on many factors including one’s existing occlusion (bite), how horizontally deficient the chin position is and what effort one wants to put in to treating the problem. The width of the lower jaw/chin has no impact on the cause of the mentalis strain or in the treatment of it.

Dr. Barry Eppley

Indianapolis, Indiana

Can Chin Augmentation Use Screw Fixation?

Q: Dr. Eppley, I am interested in chin augmentation. I am a 52 year old male in good health with no serious medical conditions. Three years ago I had a platysmaplasty, rhinoplasty, lip lift, and implants in my chin, jaw angles, and cheeks. The chin implant subsequently became infected. The infection resulted in the removal of the chin and jaw angle implants several months later. Only the chin implants remain. My primary concern now is that my chin appears weak. I’m also concerned about the sagging appearance on underneath left side of my chin and the very visible scar below my chin from the previous surgeries. Regarding the jaw angle implants,  I understand that my posterior mandible is quite narrow, but my eyes are also narrowly set and jaw angle implants accentuate that feature. I learned this clearly from the very wide jaw angle implants I had from my first surgery. So, jaw angle implants are problematic for me for that reason. Also, the chin and jaw angle implants that I had moved significantly after surgery, which I would also like to avoid with any subsequent implants. Please let me know if you can fix any implants with screws so that they do not move.

A: In reading your history, you have lost the benefits of your chin augmentation due to infection, your implants shifted after surgery and the jaw angle implants were an aesthetic detriment. In addition the submental scar is very wide and there is a little tissue sag on the left side of the chin.

A new chin implant can certainly be done and I almost always secure this in by double screw fixation. This could be put in from your existing submental scar. Your submental scar is wide because it has been placed behind the submental skin crease in the skin of the neck. This is not an ideal location as horizontal incisions in the neck skin tend to widen. The best that can be done with that scar is to excise it completely and hope that it heals more narrow this time. A new chin implant should pick up any loose skin along the jawline.

Jaw angle implants are more than just about widening the jaw angle as you appear to have had lateral widening jaw angle implants used. There are also different styles of jaw angle implants that merely make a pronounced jaw angle without making it wider. You may initially have just had a wrong style implant used.

Dr. Barry Eppley

Indianapolis, Indiana

Do Wisdom Teeth Need To Be Removed Before Having A Sliding Genioplasty?

Q: Dr. Eppley,Is wisdom teeth removal a prerequisite for an osseous sliding genioplasty? Also, how much does your practice charge for an osseous genioplasty (with hospital fees + anesthesia)? 

Sliding Genioplasty Indianapolis Dr Barry EppleyA: There is no correlation between a sliding genioplasty and wisdom teeth, whether they are removed or not. The chin is located on the front part of the jaw while the wisdom teeth (third molars) is on the back part of the jaw. You may be thinking of a sagittal split ramus osteotomy (back of the jaw osteotomy) where having impacted wisdom teeth out six months before the procedure is needed as the embedded tooth roots may interfere with  successful splitting of the bone and plate the screw fixation to hold it together as it heals. In fact, wisdom teeth removal can be done at the same time as a sliding genioplasty if necessary.

A sliding genioplasty is done as a one hour procedure done under general anesthesia in a surgery center not a hospital. The usual total fees are around $6500 for all involved costs.

Dr. Barry Eppley

Indianapolis, Indiana

Are Screws Used In Chin Augmentation?

Q: Dr. Eppley, I am interested in getting a chin augmentation surgery. I have attached a couple of photos in order to get your opinion. You had written that there is a permanent chin augmentation solution where the implants are secured by small titanium screws. Would those screws need to be replaced after ten or more years? Do they set off metal detectors? It seems that screwing the implant in makes more sense. As my chief concern is the security of the implant and its ability to withstand an occasional stiff impact. I do know some chin implants are used without screws. What is your opinion on those types? My feeling was that since they are just placed on top of the chin and not secured with anything the likelihood for them to become dislodged increases. Not sure if that is true though. Assuming that there are different types of chin implants, (some more square, some more rounded) perhaps when you see the attached photos you’ll have a better idea which one would benefit me the most. Finally, I would be remised if I did not say that being your office is in Indianapolis it seems difficult that I would fly from another state for such a procedure. The logistics alone would be difficult to for me to work around. Though being your reputation is excellent, nothing is completely out of bounds. Thanks for your time, it is very much appreciated.

A: Your photos demonstrate that you would be an excellent candidate for chin augmentation. Your chin deficiency, compared to many patients that I treat is relatively mild, but I would agree that more chin projection and a more square chin appearance would have some aesthetic benefits for you. I will do some computer imaging of that and send it to you later today.

In answer to your questions about chin implants and screw fixation, this is a technique that I have always done in the vast majority of chin implants. It is simple, quick and inexpensive to do and assures that for the lifetime of the patient the chin implant is never going to move or become dislodged. I have certainly never seen it in the 25 yeasrs that I have been doing the procedure. The screws are composed of titanium, a pure element that never degrades or corrodes or needs to be replaced. It is a non-ferromagnetic metal, which means it does not set off metal detectors nor affects MRI scans. While placing screws is not standard practice for most surgeons that place any type of facial implants, it really should be.

While being a far away patient may seem unusual, it is standard in my practice as patients fly in from all over the world every week for surgery. It is easier to do than you think and handling the logistics of how to do it efficiently is a common occurrence for my staff and surgery center.

Dr. Barry Eppley

Indianapolis, Indiana

How Safe Are Chin Implants?

Q: Dr. Eppley, My question is in regards to the safety and security of chin implants. While I firmly believe such a procedure would improve my appearance my hesitation lies in the uncertainty of the implant being a permanent solution. To be specific my job is such that at times is of a physical nature and am worried that the implant could become dislodged. How is it kept in place? And are there certain implants designs that are better then others? Would hard impact to the chin or jaw cause it to become dislodged? Perhaps you know people in the Military who have had this done? My second line of questions are about the health risks of a foreign element placed in the body. Are there long term effects from having a implant inserted and is this something that once done should remain for life? Thanks for your time.

A: Chin implants, almost of any implant placed on the body, are the safest (less likely to have complications) in my long plastic surgery experience. There are a permanent chin augmentation solution as the material will never degrade. The implants are secured in place by small titanium screws so that they will never move or become dislodged. I have yet to have a case where a chin implant became dislodged or displaced because of trauma of any nature, including patients in the military. There are no health risks from performed silicone since it is a molecularly stable material that does not degrade or release any free silicone molecules.

Dr. Barry Eppley

Indianapolis, Indiana

What Procedures Do I Need To My Facial Reshaping Goals?

Q: Dr. Eppley, I am interested in some facial reshaping procedures. I am 54 and desire more of a heart shape to my face. It is long and not as feminine as I would like. My nose is a bit long and wide on the bridge (from the front esp.) Looking younger would be great, but looking more feminine and therefore prettier is my main goal. Wider temple area/distinct cheekbones, tighter jaw to neck angle, more of a right angle beneath chin-to-neck, and a feminine nose are some ideas I have. My jawbone has reabsorbed somewhat, according to my dentist. But I need YOUR trained eye to tell me how to accomplish my goal of looking more feminine, losing the chub underneath my chin, creating a prettier facial shape in general. Thanks so much for giving me the straight scoop.

A: In looking at your pictures and understanding your facial reshaping goals, I would recommend the following changes.

CHIN A V or triangular shaped chin implant augmentation with the objective or bringing your chin forward, which is short, but making it narrower at the same time.

NOSE An open rhinoplasty to narrow the nose from the bridge to the tip with some slight shortening and elevation of the tip with nostril narrowing.

CHEEKS Cheek implants that produce some a combined malar/submalar (shell) effect. This with the chin helps create more of a heart-shaped face.

TEMPLES Subfascial temporal implant to correct the hollowing and increase the bitemporal width.

EARLOBES I know you did not mention these but these seem a little bit and stick out and reducing them adds a touch of femininity to the sides of the face.

I have attached some computer imaging predictions of how I see these changes affecting your face.

Dr. Barry Eppley

Indianapolis, Indiana

What Else Besides Rhinoplasty Will Make My Profile Look Better?

Q: Dr. Eppley, I am interested in rhinoplasty but think I may need more.  I’m trying to find a way to make my side profile look nice and pretty. I hate my nose as its quite large and has a small bump on it therefore I really want rhinoplasty. I also have a small slanted forehead and small chin so it looks like my face goes into a point at my nose. What would be best to change this? Please help, many thanks.

A: By your description, your three main side profile features have an imbalance. Your nose is too big and the forehead and chin is too small, creating the profile that you dislike. In trying to figure out what procedures you may need that creates the best change, it would be important to do some computer imaging. The procedures of rhinoplasty and chin and forehead augmentation must be looked at individually as well as in comboantion to see which creates the best change. It probably goes without saying that all three create the greatest profile improvement  but do you really need them all. I suspect that the rhinoplasty and chin augmentation alone may be sufficient and produce the best return on the effort but that remains to be proven by the imaging predictions. Please send me a side profile picture at your convenience to help you make that determination.

Dr. Barry Eppley

Indianapolis, Indiana

Should I Have Chin Augmentation With My Neck Liposuction?

Q: Dr. Eppley, At the moment, I am at a complete loss of what to do about my profile. I have had so many consultations now and have advice ranging from ‘do nothing’ to ‘have a neck lift, fat removal and chin implant at the same time’. I need to do something as it’s making me very self conscious and I hate seeing photos of myself from the side.

My problem is that I am only 27 and am apparently not a candidate for neck liposuction alone because of my bone structure. It has to be explained to me that I have a low hyoid bone that is creating a blunted neck angle so that my neck blends into my chin. My teeth do align so it is not a problem with my bite but I do also have a weak chin. 

From my own research it seems like a chin implant might provide me with the illusion of an improved neck angle but my concern is how it will impact my face front on and my smile- lots of reviews seem to say their jaw looks to masculine after a chin implant or that they can no longer show their bottom teeth when smiling. At the moment when I smile I show my bottom teeth, which I like, and my chin points slightly in feminine way. I also have a small indent in my chin when I smile and am unsure if a chin implant would make this worse. 

Do you have a recommended approach to this sort of problem? Given my age, I don’t want to risk ruining my face with anything too drastic! I do need to do something though as it’s making me really self conscious. 

Thanks in advance for your help. I do wish I was a more straightforward case!

A: Quite frankly you are a very straightforward case. The combination of chin augmentation and neck liposuction is the correct approach. The key to a successful chin augmentation in you is to understand that in the profile view there needs to be both a horizontal and vertical dimensional change and in the front view the chin shape needs to stay a triangular shape and not become too round or full which is more masculine. There are two ways to achieve these chin changes. An implant needs to have some vertical elongation and must be more of a central buton style that has no significant lateral wings to it. The other option is a sliding genioplasty which can be brought forward as well as down. (vertical lengthening) Sliding genioplasties will always keep a narrow chin or make one more narrow as it comes forward because it is a U-shaped that is being brought forward. The indent in your chin, whether the augmentation is done by an implant or an osteotomy, will not change.

Dr. Barry Eppley

Indianapolis, Indiana

How Risky Is A Sliding Genioplasty?

Q: Dr. Eppley, I was wondering if you could answer a quick question for me: Is there a way to perform a sliding genioplasty without having to cut the mentalis muscles? Is it possible to use an extraoral incision under the chin (if the patient didn’t care about small scars) to reduce damage to the underlying muscles of the lips? I am tired of hiding my face but I don’t think I’m brave enough to risk damaging the nerves or musculature of my lower face. How risky is this procedure?

A: Whether you go from inside the mouth or from below the chin, the mentalis muscle has to be cut. Even in a chin implant the muscle has to be cut. In skilled hands, a sliding genioplasty is a very safe and effective procedure with no long-term muscle or lip issues. The key is not whether the muscle is cut but if the surgeon knows how to put it back together.

Dr. Barry Eppley

Indianapolis, Indiana

What Can Be Done About My Protruding Forehead, Big Nose And Small Chin?

Q: Dr. Eppley, I’m trying to achieve a more aethetically appealing face, by whatever means necessary. I’ve noticed my forehead protrudes in respect the level my eyes are at, making them look sunken and my face more masculine. I don’t believe it’s my bossing that sticks out, just my forehead in general, so i’m not sure how much of a result I would see with surgery. I’ve been told my nose is large, so I’m considering rhinoplasty as well. Additionally, my lips appear to almost ”hang off” my face. I know this isn’t your forte but do you believe jaw surgery could be a solution? In general, I was just wondering what procedures you would recommend. Thank you for your time and I look forward to hearing from you!

A: Thank you for sending your pictures. I have done some imaging predictions based on the one side profile that you sent. What I have done is a forehead reduction, rhinoplasty and chin augmentation . If you look carefully at those changes, the most dramatic effects come from the rhinoplasty and chin augmentation. The rhinoplasty is key because your forehead and brows look so pronounced because you have a very deep radix. (root of the nose). One of the key manuevers in your rhinoplasty is the buildup of the root of the nose. By doing so that makes the forehead less retrusive in appearance alone.

Dr. Barry Eppley

Indianapolis, Indiana