Q: Dr. Eppley, many thanks for your email reply and I have attached some more pictures. Hope they are of the correct type – if you need better quality or closer views I can arrange that. As you can see I’ve taken photos of my profile many times and at varying body weights. The thinner I am the better my jawline looks, obviously, but I find it difficult to maintain the weight that allows this (roughly 50kg) – also I worry about when I get pregnant that I will look terrible with a big double chin.
My main concerns are that, from the front, my lower face looks chubby with jowls just to the right and left of my chin. I feel this makes me look really young but not in a good way!Like a chubby little girl! From a side(but not complete profile) view the jaw line gets hazy-looking about halfway along. In profile my chin just looks really weak which, to be honest, I wouldn’t mind so much but its the fact that this causes my neck structures to be poorly supported and therefore have a double chin. I also feel that my lower jaw is asymetrical and this can be seen from the front? Think that the left side of jaw is shorter making jowls worse on that side?
I have pushed my lower jaw out in some of the pics to get a view of what things might look like if I have a better jaw line/chin but obviously this gives me a horrible underbite and can’t walk around looking like that all day! But thought you might be interested to see the jawline I have in mind and I would hope for.
I included a pic of me at a lower weight to show you the effect of that as well….maybe I just need to knuckle down and lose the weight because currently I eat whatever I want and do NO EXERCISE at all…very bad I know!
Feel that my nose is quite fat looking at the lower portion from the front although I don’t have too much of an issue with the view in profile. Can something be done to make nose less bulbous at the end? This is definitely less of a concern for me the as
it’s my chin that I really hate and think about it pretty much every day and am self conscious about it.
A: Thank you for sending your pictures. What they show and you demonstrate so well is that the chin/jawline is somewhat short. Lengthening the chin by jawline distraction produces a good improvement. This manuever demonstrates to me that a sliding genioplasty would be a better treatment choice than a chin implant. Moving the chin bone forward brings with it the the underlying neck musculature and, as a result, produces a better jawline/neck appearance. One may also consider submental liposuction with the chin advancement to ensure getting the best result possible. As for the jowl asymmetry, the chin bone would be advanced symmetrically and hopefully that will make an improvement in that concern as well.
As for the nose, that would require a straightforward tip rhinoplasty to thin the cartilages and make the tip less bulbous.
Dr. Barry Eppley
Q: Dr. Eppley, I have a very long chin that completely throws off the rest of my features. I live in Arizona and can’t seem to find a good MD in the California/Arizonaarea. I wanted to know if you could recommend someone for the procedure, or if not, suggest the feasibility of going out there for the procedure. What would
be the downtime/ballpark costs for vertical reduction in the chin length? Thank you for your help.
A: Thank you for your inquiry. It sounds like you need a vertical reduction wedge chin osteotomy. As a ballpark range, the cost of a chin osteotomy is around $6500. We have many patients that come in for surgery from all over the world so this is a common experience for us. You may also feel free to send me some pictures of your face for my assessment to determine your suitability for this procedure.
Dr. Barry Eppley
Q: Dr. Eppley, My face needs a vertical augmentation about 8mm and a horizontal one about 5mm or so. Yesterday I met a doctor in our area, he told me that with an Osteotomy surgery he can give it a nearly 2 to 3mm of vertical projection and about 3 to 4mm of horizontal projection, and above that level is impossible. He described that they cut a piece of my chin from its below, with a triangle section (kinda similar to a wedge I guess) and slide it forward and downward. I wanted to get your advice
about how the surgery could be more efficient for me and how I can reach my desirable face.
A: You are referring to a sliding genioplasty procedure. The dimensional movements to which you have been told are far below what is possible. While I don’t know what your chin looks like, I would see no reason why you couldn’t have an 8mm vertical elongation and a 5 to 6mms horizontal advancement. Such movements are possible because of the use of specially designed chin plates that can be adjusted for a wide variety of chin movements to hold the bone in the desired position. I have no idea why you have been given those small chin movements as being what is possible. But to say that 8mm of length and 5 to 6mms of horizontal increase are impossible is not accurate.
Dr. Barry Eppley
Q: Dr. Eppley, I have a couple of questions about doing a genioplasty to reduce the length of my chin. First of all a vertical shortening of the chin would require an intra-oral approach, correct? Or could it be done via submental approach? Where would you rank this procedure in terms of potential risks and permanent negative outcomes? Als, how is it with European patients? Have you had people fly over from Europe before? And if so, how is the process concerning consultation, surgery and post-surgery follow-up? Is it possible to fly over for a consultation followed by surgery on the same, or one of the next few days? Or is an online consultation enough for you to assess the patient? Maybe an x-ray exam. is required for a procedure like the one I'm heavily contemplating?
A: In answer to your questions:
1) A vertical chin reduction osteotomy needs to be performed intraorally. The only risk of this procedure, besides have we achieved the aesthetic goal, is some temporary lip and chin numbness from the mental nerv
e which will be exposed in doing the procedure. While some permanent sensory loss is possible, that is not something that patients have reported to me.
2) We have many far away patients from all over the world so we are very familiar with how to manage them. As we are now doing, all of the details of diagnosis and treatment planning can be done by e-mail. My assistant will arrange for a Skype consultation as it is always good to talk, if possible, face-to-face from afar although this is not absolutely necessary. Surgery is arranged and then the patient arrives the day before and then we can meet in person at that time. Surgery is performed the next day and you should be able to return home within 48 hours. There are no sutures to remove and no real physical restrictions after surgery. Follow-up is done just as we are doing now by e-mail. From a chin osteotomy, expect some significant swelling for a few weeks after surgery but usually no bruising.
3) The only preoperative test that I would need is a lateral cephalometric x-ray so I can take measurements and see how much chin bone can be safely removed/reduced.
Dr. Barry Eppley
Q: Dr. Eppley, I’m unhappy with my face. I think the horizontal projection is very poor and the jawline is weak. Just starting to look into options and I would be happy to hear any ideas you have. My first thought was that chin implants might be helpful. I’m hoping to create a face that Asian and white women will find very attractive and projects warmth while also commanding respect in a business setting. I have attached a profile picture for your thoughts.
A: I am not sure what Asian or Caucasian women would necessarily find attractive or what facial appearance projects warmth while commanding respect in a business setting. But in looking at your side view pictures, I would agree that your chin is weak and out of proportion to the rest of your face. Having a more proportionate chin would give your face better balance and is what I think you would give you an improved facial appearance that may be considered more attractive as well as casting an image of greater masculinity. I have done some imaging on your side picture to see if you agree. The chin augmentation, which could be done by either implant or a sliding genioplasty, would benefit by concomitant neck liposuction as well.
Dr. Barry Eppley
Q: Dr. Eppley, my face is very unbalanced as my chin is very short. This also makes my neck look fat even though I am at a good body weight. I have attached some pictures for you to tell me what you can do for my really short chin. It looks like the lower part of my face is just missing.
A: Here is a side view prediction based on the combination of a chin bony advancement (sliding genioplasty) combined with an implant. Your horizontal chin deficiency exceeds 15mms which puts you well beyond what any conventional chin implant can do. A chin osteotomy will advance you up to 12mms, which is better, but also not ideal. Therefore, in cases like yours I will put an implant in front of the advanced chin bone as well that will add another 5mms to the projection. The addition of the implant also has the advantage of its extended lateral wings which will fill out the sides, making the chin a little more square. That is an advantage for a male who benefits by a more square chin anyway. In addition, your thicker neck tissues would simultaneously benefit by liposuction under the advanced chin area to try and thin that out a little but.
The combination of a chin osteotomy and implant combined with neck liposuction can make some significant changes as the imaging suggests. This type of ‘extreme chin augmentation’ is necessary to get the best result in larger male chin deficiences like yours.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in neck liposuction, revision rhinoplasty, and cheek augmentation. I want to get rid of neck fat, define my jaw and neck line, straighten nose-one side of nose is bigger, and add volume in mid- and lower cheeks and under eyes. I have attached pictures for your review and assessment.
A: In looking at your pictures and your areas of interest, I can make the following comments/recommendations:
1) You jawline is ill-defined because your chin is both horizontally and vertically short. This makes your lower face look very deficient and creates a lack of any jawline definition. What you would ideally benefit from is a vertical-lengthening chin osteotomy which adds lower facial height and creates a more obvious jawline. This will also improve the appearance of a fuller/fatter neck although some submental liposuction done with the chin procedure would complement that improvement.
2) Your nose shows numerous secondary rhinoplasty issues. I do not have the benefit of knowing what you looked like before but I see issues relating to lack of upper dorsal height, tip asymmetry/thickness, nostril asymmetry and a deviated columella.
3) The need for volume in your cheeks and lower eyes is a bit perplexing to me. I see no benefit to lower eyelid volume augmentation. Perhaps with the chin lengthening, more volume in the lower cheeks (submalar implants) may be aesthetically beneficial to you. I have left those areas unimaged so you can see the other more important areas of facial change first.
Dr. Barry Eppley
Q: Dr. Eppley, I’ve had two procedures done 20 yrs ago. I don’t know the name of the procedure but I had a large amount of gums showing when I used to smile. They cut my upper jaw and raised it up, so I didn’t have the “gummy” smile. I then had my chin moved forward 11mm. I believe I have some underlying scar tissue from my upper jaw surgery underneath my cheeks. When I smile, my cheeks stand out and my face looks disproportionate. Can this be improved? Also my chin is still somewhat horizontally short. Can it be moved further forward again?
A: Your original surgery was a LeFort I or maxillary impaction to shorten the upper jaw and a sliding genioplasty to move the chin forward. The fullness that you have/feel in your cheeks is not really scar tissue per se. It is due to the release of the facial tissues made during the vestibular incision for your maxillary osteotomy. This causes some of the tissues and their muscular attachments to retract out to the sides into the cheeks, creating increased cheek fullness and what I call a ‘LeFort Look’ which is classic. This has long been recognized and is why at the completion of the maxillary bone surgery the vestibular incision is closed in a V-Y fashion to restore the midfacial tissues position. At this point in time after surgery, these tissues can not be respositioned. It may be possible to remove some of the buccal fat pad to reduce this fullness.
From a chin standpoint, osseous genioplasties or chin osteotomes can be repeated. The only complicating factor could be the fixation hardware used to secure the bone from the original surgery. Whether it was wires or plates and screws, these devices often get covered by bone healing and can be difficult to remove, hence blocking a good bone cut. Depending upon the indwelling hardware, it may be preferable to consider an implant rather than a repeat osteotomy. Whether chin implant or osteotomy should now be done can be determined by a simple x-ray, like a panorex, so the type of hardware in place can be seen.
Dr. Barry Eppley
Q: Dr. Eppley, I have a long chin that goes straight down as apposed to sticking out a little bit. I would like to have my chin shaved down so it’s shorter and somehow have it stick out instead of going straight down. Another reason this problem is so severe is because I have an extreme-overjet, but I’m going to a dentist to try to find a solution to that problem.
A: Based on your description of your aesthetic chin concerns and desires, what you actually need is a chin osteotomy (bony genioplasty) not a chin bony burring. A chin osteotomy removes 5 to 7mm of vertical bony height AND can move the chin forward whatever number of millimeters is desired. This procedure gives you both a vertical chin reduction and horizontal chin projection. This is the only chin procedure that can make those changes, which sounds exactly like what you are looking for. If you send me a front and side picture, I can do some computer imaging to show you what those chin changes would be like.
In regards to your occlusal overjet, that dental bite problem may be a contributing factor to your horizontal chin shortness but does not affect the chin being too long. In looking at the one picture you have sent, I do not see any evidence that whatever overjet you have would represent a severe mandibular deficiency. You should have an orthodontic work-up but I do not think it likely that there is major orthognathic surgery in your future.
Dr. Barry Eppley
Q: Dr. Eppley, there is an overall lack of definition to my face (flat cheeks and very prominent and long chin) which you will notice here. It’s my belief that with some cheek contouring and possibly jaw as well, I may look as beautiful as I feel. When I smile and when the lighting is even I have a much more appealing appearance as it seems to round out my face if you know what I mean. When I’m not smiling and when the light is harsh (as it usually is unless one is in a photography studi0 and manipulating light!) I feel like my face is a sliver- very long with nothing to break it up or draw the eye up. I look forward to hearing what you think!
A: In looking carefully at your facial features, there are three areas that could be altered to help make the transition from a long flatter face to one with better proportion and angularity. As you have mentioned, your cheeks/infraorbital areas are flat, your chin is long and slightly retruded and your nose is slightly prominent and a little deviated. Changing all three would make the greatest change but I just want to focus on your cheeks and chin for now. Cheek implants with anterolateral augmentation and a chin osteotomy that vertically shortens the chin and brings it forward is the best way to help vertically shorten your face and ‘pull’ it outward. I have demonstrated that on the attached imaging pictures in the side and front views. I think a reductive rhinoplasty would also be very helpful to shorten and deproject the nose, which would make the midface look more full, but the pictures you have sent are not of good enough quality to do the rhinoplasty imaging justice. But these initial images will give you some good material to think about.
Dr. Barry Eppley