Will A Chin Implant Make My Jawline Look More Masculine?

Q: Dr. Eppley, I’m interested in improving my profile with a chin implant (custom or pre-shaped implant – whichever you feel would achieve the best desired results), along with possible injection to my nose. I have always wanted a stronger jawline and chin. I have always felt that I look this way, but in reality I just don’t have that masculine look. By adding a chin implant, will that also improve the jawline since the skin is being stretched further forward? I’ve attached a side-by-side of the results I’m looking for versus my actual face. For my nose, I’m interested in very minimal nose work. I’m fine with my turned up nose as I believe it’s unique, but would like to know if injection was possible to smooth the “slope” to make it appear less concave where the bridge and tip merge?

A: You have demonstrated well the benefits of a chin implant with your prediction imaging. That amount of horizontal advancement is around 9 to 10mm and, when the chin is lengthened, will improve your jawline. The key chin/jawline feature which you have not evaluated yet is how the chin will change in the frontal view and whether it should become more narrow or wider. Such an assessment will help make the determination of whether a preformed stock or custom chin implant will be needed.

From a rhinoplasty standpoint what you are seeking is simple dorsal augmentation. But using an injectable material, even fat, is not going to produce a successful or sustained result. This is going to require the use of either a septal cartilage graft or an implant, both of which can be done through a closed rhinoplasty result. A dorsal augmentation closed rhinoplasty is a fairly minimal nose surgery with a very quick recovery.

Dr. Barry Eppley

Indianapolis, Indiana

How Is Female Chin Augmentation Different Than In Men?

Q: Dr. Eppley, I am interested in female chin augmentation but have some concerns. Many before and after pictures that I have seen show chins that look too strong to me with too much horizontal advancement. I am a 27 year old female and want to do something to improve my weak chin/jawline. Take a look at my attached profile picture and tell me what you think.

A: Female chin augmentation is different both aesthetically and in implant designs that what is done on most men. This side view picture makes it infinitely clear as to your chin concerns. In a female chin that is deficient, the critical question is how much horizontal advancement is desired AND what happens to the width of the chin as it comes forward. In women the chin should become more narrow or triangular as it is advanced forward. This can be done by either a sliding genioplasty or central button chin implant style. I will need to do some computer imaging to see how much chin change you are looking for. In women, less is always more when it comes to chin augmentation in most cases.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Have A Facelift After Jaw Surgery?

Q: Dr. Eppley, if I had maxillofacial surgery, would a chin implant and mini facelift be out of the question for me? Does having had the facial/jaw bones being worked on exclude the possibility of having implants placed on top of the bone or the outer skin lifted like in a facelift?

A: Any type of a facelift and chin implant can be done on someone with a prior history of  orthognathic surgery, whether it was a LeFort 1, mandibular advancement/setback or genioplasty or any combination of them. What is done down at the bone level has no impact on the adjustments of the facial soft tissues along the jawline or on the side of the face. A chin implant can also be done over a previous sliding genioplasty even though there may be some more scar or tissue adhesions around it. To illustrate this point, it is not rare in my experience to place facial implants at the same time as having orthognathic surgery or to do a second stage after orthognathic surgery to place them. Given that the bone is at a completely separate layer than the skin or the SMAS tissues, there is no impact on having any type of a facelift later.

Dr. Barry Eppley

Indianapolis, Indiana

How Can My Chin Implant Be Improved?

Q: Dr. Eppley, I have a chin implant questions/issue.  In my opinion, I have a recessed chin and jaw. Eight years ago, I had a large silicone chin implant inserted, and liposuction below my chin. At my consultation, the plastic surgeon asked if I breathed through my mouth, which I realized I do. Ever since then, I have been on a quest to resolve this issue. I have been to an ENT doctor who said my nasal passages checked out fine. But since I feel that my chin implant did not provide me with enough projection (I am 41 years old but one year ago I had a platysmaplasty for loose skin beneath my chin), and my lips still do not close with out mentalis strain, and as I age I feel that my lack of a supportive jaw is not helping, I would really like to take action. Also, I recently discovered that chin implants have been known to cause bone erosion, which frightens me. I had braces as a teenager, and still have a bit of an overbite, but I do not know where that leaves me as far as options to both improve my appearance and breathing functions. I sincerely appreciate your time and thoughtfulness, as this is quite daunting to me.

Sliding Genioplasty Advancement Dr Barry Eppley IndianapolisA: The chin implant issue that you describe is a common one that I hear about. Between your appearance and breathing issues, your description suggests that your lower face/jawline appearance can be improved. With a naturally short lower jaw, a large chin implant that is still inadequate in projection and a residual mentalis strain, this indicates to me that you need a sliding genioplasty for a chin implant replacement. Besides the limitation of chin implant projection (10mms or less), increasing the chin point by an implant will not improve mentalis muscular function nor any lower lip incompetence should it exist. Your existing chin implant may have also developed some settling into the bone. (often erroneously referred to as ‘bone erosion’ which is not harmful) By removing your chin implant and performing a sliding genioplasty you will improve your chin projection, eliminate the mentalis strain, and also improve your neck profile. I would need to see some pictures of your face to verify these statements but your description is not a rare problem that I see with indwelling large chin implants.

As for your breathing issues, nothing you do to the chin will have any impact on your nasal airway exchange.

Dr. Barry Eppley

Indianapolis, Indiana

 

What Is The Best Face Shape for Jaw Angle Implants?

Q: Dr. Eppley, I am interested in a chin implant, jaw angle implants or both. I believe chin implants/jawline  implants come in different dimensions or sizes? Would it be better to do one procedure at a time? What face shapes are good candidates for this type of procedure?

A: A chin implant and jaw angle implants come in a wide variety of styles and sizes so there is a range of changes that can be done. The purpose of computer imaging is to first see whether these type of facial changes and their magnitude is what someone is looking for. Different implants will create different degrees of change.

When it comes to elective facial surgery, you do the procedure in which you are absolutely convinced is needed. Any procedures in which you are uncertain you wait and see how the first procedure affects the facial area of uncertainty.

The best candidates for chin augmentation is just about any face because it is a ‘edge’ or profile procedure that would improve any face in which the chin is short. Conversely, jaw angle implants work best in thinner faces where their effects enhance or skeletonize the face as opposed to a fuller or rounder face in which it may just make it more bottom heavy.

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

What Are The Best Jawline Implants To Use?

Q: Dr. Eppley, In looking for jawline implants for total jawline enhancement do you think a good combined solution for chin and jaw is the Medpor Matrix system, or do the chin and jaw implants separately? I currently have some hyaluronic acid directly on my jaw angle and line because I did not know about such implants until recently, so I think I should remove that with “Hylase” before determining implant sizes.

My final questions to understand the size and shape of the implants and surgery would be:

a) JAW: The horizontal width of the RZ mandibular angle implants is 11mm (or 7mm respectively) at the LOWEST point of the implant and diminishing gradually to the top – like a triangle, correct? And as you mentioned the  VERTICAL DROP is ALWAYS 10 mm regardless of the horizontal width of 3, 7, or 11mm? (which can be shaved down I guess if necessary?)

b) CHIN: With respect to a chin augmentation:  If, just theoretically, I am satisfied with the length (anterior projection) of my chin length but NOT with the lateral horizontal width and shape (which I want to be SQUARE and 5 cm ranging from one corner of the mouth to the other) – are there available or can you shave down an medpor RZ extended chin implant so that there is NO or only 1-2 mm anterior projection but the same lateral and inferior projection as the medium sized RZ Ext Square chin implant? So practically speaking a customized RZ Square chin implant augmenting only laterally the side parts of the chin (like an implant without or only a 1-2 mm middle part9). An implant which makes the chin look more square and broader, which augments the lateral parts of the chin. (hope I expressed myself properly)

Medpor Chin Implant Dr Barry Eppley IndianapolisMedpor Jaw Angle Implants Dr Barry Eppley Indianapolis

A: If I have to use off-the shelf implants, I generally stay away from Medpor because they are hard to put in, never fit very well to the bone, hard to stabilize to the bone and very hard to revise if that ever needs to be done. (of which the risk is about 25% of that need) I have used them a lot and the more I use them the less I like them. None of their purported benefits are true, other than soft tissue adheres to the implants making them a near nightmare to ever revise. But I will still use them when patients insist and some patients, like you, have an affinity for it.

When it comes to total jawline augmentation with Medpor, I would use a three-piece chin and jaw angle approach and not the Matrix system. The Matrix system is extremely hard to put in and virtually impossible to ever remove or revise due to the features of the material as previously described. Since the chin implant is put in as a two-piece implant with a male-female connector, it is easy to make a square implant but how far or close the two pieces are put together. It is, in essence, and adjustable width chin implant. When in doubt about jaw angle widths with the RZ style, it is always better to go with the biggest size as it can also be reduced during surgery. (but you can’t add to it)

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Right Size Of Jaw Angle Implants For My Face?

Q: Dr. Eppley, first thank you for offering such great jaw angle and chin implant surgery to patients. I have found your website on the internet, as I have been looking for Medpor RZ angle implants and chin implants for years and I definitely intend to do that surgery. Of course a final recommendation can only be done personally in your office, but I would be very thankful for your first indication based on a picture of my current jaw line and chin position attached. 

My initial questions prior to the surgery would be:

1. JAW ANGLES:

a. Which Medpor RZ angle implant size would you suggest to achieve a projection like on the celebrity pictures and my computer animated picture, assuming that I augmented my cheek and cheekbone prior to the jaw implant surgery? 7mm or 11mm or 11mm shaved down to 9mm?

b. What is the horizontal width of the 7mm and 11mm Medpor RZ mandibular angle implants?

2. CHIN: which mm size of the chin implant would you suggest for a masculine chin projection, 6mm or 8mm?

A: In answer to your questions:

1) The vast majority of jaw angle implants rarely need to be more than 7mm. An 11mm implant, when both sides are factored in, increases the bigonial width by 22mm which is considerable. The numbers 3, 7 and 11mms refers to the width or horizontal dimensions of the implant. It is a standard 10mm vertical drop with these style of jaw angle implants.

2) I would have to see your pictures and see what degree of chin horizontal shortness you have, but generally 8mms is going to be a better choice than 6mms for most men.

Dr. Barry Eppley

Indianapolis, Indiana

What Type Of Jawline Enhancement Method Would Make Me Look Better Than Just A Chin Implant?

Q: Dr. Eppley, 1.  Am interested in an overall approach to address my weak jawline/chin and nasolabial folds. I had a smaller chin implant over 20 years ago, but I am certain that advances since that time could provide me with a better overall result.

A: I have received your pictures and done some initial imaging predictions. Knowing that you have a chin implant in place with your high jaw angles indicates how short your lower jaw really is. Substantial improvement can come by changing all dimensions of the jawline, not just the horizontal position of the chin. There are two fundamental approaches. A sliding genioplasty combined with an extended chin-jawline implant overlay with vertical lengthening jaw angle implants is one option. The second choice would be a custom total wrap around jawline implant made from a computer-generated design off of a 3D CT scan. There are advantage and disadvantages with either method. Either approach takes it way beyond what the simplistic approach of ‘chin augmentation’ would achieve by looking at a complete jawline enhancement. As you know, your lower jaw issue is not just a simple isolated chin deficiency.

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