Chin Implant

Q: Dr. Eppley, After doing research on real self and looking at my own face, I’ve very open to anything you suggest that I have done! You responded to my question in detail on real self several days back which I really appreciated. The main procedures I would like to take a look into having done has to do with my chin, so possibly a chin implant…fat removal underneath the chin/neck (This is one thing I feel like I’m a great candidate for and really want done), and buccal fat pad removal in the cheeks because I have always noticed I have pretty thick cheeks. I do realize sometimes buccal fat removal isn’t possible based around if the cheek has fat that can be removed or if it is just the way it is genetically. My chin also points slightly to the left and I’m not sure if chin implants can fix that? Like I said I’m very open here! Also my whole life I’ve been able to give myself what looks like a facelift just by “flexing/pulling” back the muscles and skin on my face. Everyone who I’ve showed which has been a lot of people, always say they’ve never seen someone who can do it. Have you ever seen this before and what does it mean? In all the side by side pictures attached, on the left side of every pic is my face totally relaxed. And on the right is me “pulling my face back”. I’ve notice it makes all my facial features stand out more but the one thing I don’t like is it also raises my forehead line which makes my forehead look larger. 

A: Thanks for your inquiry and sending your pictures. What happens when you pull the skin back is that you ‘skeletonize’ your face. The skin is tighter and the skeletal highlights (brow bone, cheeks, chin and jaw angles) become more prominent. That is why you like your face better this way. To try and replicate some of that effect you have to do a combination of skeletal augmentation and facial defatting. You will never replicate that loo surgically or naturally on its own but there are several procedures that will help. Chin implant augmentation with buccal lipectomy and neck liposuction are good selections. I would also add that small cheek implants can also help sculpt the midface better and are a complement to that of the buccal lipectomy. You natural chin/jaw asymmetry poses an issue for a standard chin implant as this really requires a custom chin implant to ideally correct but that will drive up the cost of surgery. The most economic approach would be to modify a standard chin implant (reduce the left side and position the right side of the implant lower) and hope for better albeit not perfect symmetry.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant

Q: Dr. Eppley, I had two sessions of Sculptra and one session of Radisse fillers earlier this year in January. In early April of this year, I had a chin implant with an incision in the mouth. After the chin implant, my chin and sides swelled up and hardened. It’s been over a week and can’t seem to bring the swelling down. Could this be due to the Sculptra and Radisse fillers that I had earlier this year? If so, what can I do to bring it down.

A: If I interpret your inquiry properly you had a chin implant placed just one week ago. It is perfectly normal to have considerable swelling after such a chin augmentation procedure that will take up to six weeks after surgery to completely go away. As a general rule, 50% of the swelling goes down by 10 days, 75% by three weeks, 90% by 6 weeks and 100% by three months after surgery. The fact that you have had prior fillers in your face has nothing to do with the swelling that you are experiencing now. There is also nothing you can do to hasten this natural healing process. I would have assumed that your surgeon reviewed the typical swelling and tissue firmness that occurs after any facial implant and the protracted time that it takes to resolve.

Dr. Barry Eppley

Indianapois, Indiana

Forehead Augmentation

Q:Dr. Eppley, I believe that many of the surgeries you perform are far more effective and life changing than traditional plastic surgery procedures.

I’m looking into having forehead, temporal/skull, and chin augmentation, and have found there are very few plastic surgeons are experienced in craniofacial surgery for cosmetic purposes.

I know that plastic surgery in Korea focuses very much on altering the bony structures of the face to achieve a prettier and more youthful appearance and for this reason I have been enquiring with some plastic surgeons in South Korea. Ideally I would prefer to travel to the US and have the above procedures performed by you.

I am interested in having forehead augmentation- preferably using bone cement as I understand that implant placement can be difficult, particularly when placed lower on the skull; I feel that my brows/superior orbital rim are quite flat and contribute to some minor eyelid sagging so would like the forehead augmentation to extend to this area, as well as smoothing out the temporal bone area, and reducing the backward slope towards my hairline.

I’d like head widening implants possibly extending to the temporal region to balance my lower face.

Lastly I’d like to get an “anatomical” or “extended” type chin implant which extends into the pre-jowl area which is quite hollow and shadow-y, and makes my lower cheeks look a little droopy.

A: My understanding of your email is that you seek the following procedures which are primarily Forehead Augmentation and Chin Augmentation. Let me provide some initial clarification on forehead augmentation because your assertion that implants are harder to get lower on the brow bone than bone cement is not accurate. Actually it is the exact opposite. Because foreheads/brow bone implants have a preformed shape they can more effectively positioned on the brow bone area through a smaller incision. Bone cements can achieve the same result but they take a full coronal scalp incision to really place as low as possible.

The biggest dilemma in forehead augmentation is management, if need be, of adding the temporal area in the overall augmentation. Bone cements can not be placed past the anterior temporal line onto the adding temporalis fascia as that often creates the potential for edge visibility and/or pain. Some slight blending of the upper temporal region can be done but it can not extend down too far.

The only really effective method for anterior temporal and posterior temporal head widening is with the use of subfascial implant placements which have to be semi-custom made and are designs of which I only have.

A chin implant that extends back more posteriorly would be the anatomical design which has long tapering wings back to the pre jowl area. That is a fairly standard facial implant request.

In conclusion, the most economic approach would be PMMA bone cement forehead and chin implant augmentation. The cost of the temporal implants would, by your own description, be prohibitive.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant

Q: Dr. Eppley, I think I need a chin implant. I have a recessed/weak chin and jaw I am looking to get corrected. I had braces as a kid and my teeth fit together fine. I was hoping a chin implant would help alone but my nose might be too large as well.

A: You have at least a 10mm chin deficiency. The choice between a chin implant or a sliding genioplasty is how you would view it from the front view. A sliding genioplasty will keep the chin at its existing narrow width. (unless an overlat implants put in front of it. Conversely a chin implant can make your chin wider/more squatter from the front view. That is what should principally make the aesthetic decision between the two chin augmentation approaches. Regardless of the method used, your labiomental fold will get deeper, unlike what you are showing by pushing your jaw forward to simulate the chin augmentation effect. (this is because the teeth come forward and help augment the labiomental fold)

A chin implant can also help reduce the appearance of a large nose by making the lower face more prominent. It may not eliminate the need for a rhinoplasty is a very large nose but it can delay or even change how the rhinoplasty surgery is done.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implants

Q: Dr. Eppley, I got my chin implant because it looked receded in the profile view . But i think it looks large when you look at it from the front and it looks boxy and square from its width. As i grow older, i’m afraid that my chin will stand out where as the rest of my face thins out.   I was thinking about a smaller implant but also considering genioplasty. I still want projection but not the width that the implant adds.

Chin Implants Dr Barry Eppley IndianapolisA: While chin implants provide good lateral projection in a wide view, they also add width in the front view. That will happen no matter what size chin implants is used because of the extended lateral wings on them. While this provides a smooth and more natural blending into the jawline behind the chin, it do so by adding some width to the chin.

The choice is to either remove the wings in your existing implant or remove it and replace it with a sliding genioplasty. A sliding genioplasty as it brings the chin forward will not add any width and, based on how much forward movement is done, may make the chin sightly more narrow.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant

Q: Dr. Eppley, I have always had a long and narrow face that lacks definition and bothers me. I was also born with a recessed chin. Over the summer I decided to have a chin implant, but after waiting months for the swelling to go down, I don’t feel happy with the results. I feel my chin implant sits too high up (intraoral approach was used) both in looks and in function. I have not been able to close my lips without due strain since the surgery and I could this before the surgery. There’s no swelling or tightness left either. Not to mention they used the smallest implant possible, so it’s not that the implant is simply too large. Because of this I am afraid that the height of the implant and the nature of the oral incision could be to blame? I cannot find any answers online and my surgeon says t hat everything is fine. Thoughts? 

A: Intraoral chin implant placement has a known propensity to place the implant too high. If the chin implant does not sit down at the bottom of the chin bone, its aesthetic effect will not only be diminished but it can interfere with mentalis muscle function and a competent lip closure. Just based on the description of your symptoms, I suspect your conclusion about the location of the chin implant is correct. Chin implant revision would consist of repositioning of the implant to the proper position and repair of the mentalis muscle.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant

Q: Dr. Eppley, I have a question about chin implant surgery. I recently had a small central chin implant put in and I am about 3 1/2 weeks post-op. I really dislike the shape and am wondering if an extended chin implant would have been a better option. I have shadows/dents on either side of my chin.

A:  There are numerous styles to choose from for chin implant surgery. Obviously selection of chin implant style and size are critical in getting the optimal desired aesthetic chin augmentation effect. While a central chin implant is often a good choice for some women, it does not provide any augmentation effects to the side of the chin since it does not extend past a vertical line dropped down from the corners of the mouth on the bone. Since you are seeing shadows/indents on the side of the chin, this would strongly suggest that this indeed a chin shape or chin style  issue. The question is at just under four weeks after surgery whether this is too early to make a final judgment about the outcome of your chin augmentation procedure. I would give it a full three months after the initial surgery date before making a final judgment about the decision to change your chin implant.

Dr. Barry Eppley

Indianapolis, Indiana

Rhinoplasty

Q: Dr. Eppley, I had a rhinoplasty and chin implant two years ago. But I am still not happy with shape of my nose, chin and face overall. I wish I can start over. I feel my nose is still too long and pinched and wish it was straighter and more refined. I also want a more angular facial shape with a masculine defined jawline and cheekbones. I think my chin implant has done only so much to help my desires. See my before and after pictures. Are my expectations and desires unrealistic? Can you help? Thanks so much.

A: Thank you for sending your before and after pictures. I think on both counts (rhinoplasty and chin augmentation) you have had good improvement and I would not agree that there would be any benefit to ‘starting over’…even if you could. You have reasonable results from both your rhinoplasty and chin augmentation. Your nose may be just a tad too long but that is a pretty good result. You are not going to be able to make any drastic changes to it other than perhaps some tip shortening. I do not know what you mean by being ‘pinched’. The refinement of any rhinoplasty is controlled by the thickness of the nasal skin. Having thicker skin there is a limit as to how much refinement can be obtained. You are likely as good as it can be. In that regard you probably do have some unrealistic expectations. Your chin implant has provided a substantial improvement and you would not want any further horizontal augmentation. What you are ‘missing’ from a facial skeletal standpoint is a lack of jaw angles and cheek prominence. The nose and chin have helped but they were not the sole solution to a more masculine face.

In short I would recommend some nasal tip shortening and cheek and jaw angle implants. This will then provide a more comprehensive approach to facial masculinization.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Ptosis Repair

Q: Dr. Eppley, I am interested in chin ptosis correction. I originally had a chin implant ten years ago. Following an accident in nine years later the implant moved and it was changed with a new implant last year. This new chin implant was much too large for my face and was removed six months later. Following the removal of the implant I developed chin ptosis with too much lower teeth show when I opened my mouth.

I subsequently had a chin ptosis corrective surgery three months ago with bone anchors. The result from the chin ptosis surgery is substantially the same as before the surgery but now my lower lip goes in on the right side when I smile or I speak or when I open my mouth my lower teeth sees too much. When I talk I have trouble to articulating my words, maybe because of the new position of my mouth. I saw the surgeon again last month for this problem again and he did Artecoll to correct the irregularity of the chin and  offered me another surgery to remove the extra skin under the chin and to do Botox to correct the defect of the lower lip.

I did not accept these proposals because I want to have first your opinion and advice. The surgery to remove the extra skin under the chin makes me nervous because now when I open my mouth my lower teeth show too much and I fear that this problem will be accentuated with this surgery. Now I really need your advice and your help. I’m sure you could find a solution to restore my chin. I read your publications regarding chin ptosis and possible treatments could be a small implant or 2 or 3 mm osteotomy for support under the chin could help or neck lift. I have seen before and after pictures on your web site concerning this surgery in which you made all this women much more beautiful. Thank you very much for your answer. 

A: The first thing is I would not rush into any surgery immediately. It has just been three months and your tissues are still healing. It would be helpful to see pictures from different angles for a more complete assessment. If too much lower tooth show is the primary concern any type of submental tissue removal would not help in that regard. Given your history of multiple chin implants and now being ‘implantless’, it appears that an important part of getting your lip back up may be the placement of a new smaller implant to help drive the tissues upward. Soft tissue suspension alone appears to have been inadequate.

Dr. Barry Eppley

Indianapolis, Indiana

Chin Implant

Q: Dr. Eppley, About 2 years ago I had a chin implant put in during a rhinoplasty revision in Miami.  It looks great BUT the lisp NEVER went away.  It resolved to about 90% and continues to have good days and bad.  The chin implant is a medium size. I’ve spoken to a neurologist as well and he does not feel this could have anything to do with mental nerve irritation as there is no area of numbness.  At this point I’m quite frustrated and got a CT hoping to see some gross abnormality or slipping of the implant.  The CT shows only a slight periosteal reaction (not-osteo per the radiologist) on the right and a .5cm asymmetry of implant riding posteriorly on the right. Could this be the cause of this? I do notice a corresponding limitation to my ability to retract my lower lip on right.  Searching the internet, you seem to have the most facial implant experience so I wanted to get your opinion as general consensus thus far (including a speech pathologist) seems to think replacing it with an implant that projects less would be the answer. 

A: This is not a postop problem with chin implants that I have personally seen before. I would not feel that the size of the chin implant nor its position is the problem. There are lots of chin implant patients with gross asymmetry of their implants and they don’t have any speech issues. Conversely there are patients with huge chin implants that don’t have a lisp either. It sounds like there is a mild weakness of the marginal mandibular branch of the facial nerve, which affects the retraction of the lower lip, which can be a source of a lisp. That is a lower lip problem that I have seen before. Recovery of a marginal mandibular nerve weakness, which is a monofasicular nerve, will have reach its potential by two years after surgery. Thus I would have no confidence that any manipulation of your indwelling chin implant would offer any improvement in your current speech issue. You can, of course, prove or disprove that conjecture by replacing the current implant that you have. But the chance of improvement to me would be very unlikely.

Dr. Barry Eppley

Indianapolis, Indiana