Posts Tagged ‘chin osteotomy’
Thursday, February 16th, 2012
Q: Dr. Eppley, Hi. My jaw points down and my chin is very weak. I would like my jaw to appear more square shaped. I don’t think this is a problem with the growth of my jaw as my bite is excellent and I wouldn’t want to mess with it anyway. I considered a chin implant but that seem to just make my jaw longer as it would sit on a backward angled segment of bone. Also, my nose has a high bridge, so I am wondering if rhinoplasty might off set the look of the jaw. Right now, my jaw line and the bridge of my nose are almost parallel lines. What is your suggestions?
A: In looking at your pictures, your mandibular plane angle does parallel the dorsal line of your nose. This is not a nose problem as its shape and size looks good. A rhinoplasty you most certainly do not need. You need to reorient the plane of your mandible. This would be best done by a combined chin osteotomy and jaw angle implants. The chin osteotomy would bring the chin forward but would also bring it upward due to the angle of the osteotomy cut. This will actually shorten the vertical length of the face. The jaw angle implants will bring down or lengthen the ramus of the mandible of posterior length of the face. These two procedures together will create a counter clockwise rotation of the mandibular plane angle.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, jaw angle implants
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Tuesday, January 31st, 2012
Q: Dr. Eppley, I am considering a chin osteotomy as opposed to a chin implant for my weak chin. What I am most concerned about, however, is the complications that may be involved (numbness around the area and using titanium plates/screws inside my bod). As I have decided not to correct my overbite, would you still recommend that a sliding genioplasty would be a good option for me? Thank you very much.
A: In my opinion, the sliding genioplasty is and has always been your best solution. It solves all your chin issues at the same time. I would not concern about titanium being implant and in your body for the rest of your life. Titanium is the most biocompatible metal that is known in medicine and will be completely overgrown with bone anyway. I have never had to remove titanium plates and screws from a chin nor have I ever seen it to be a problem. This is the best place for such metal materials in the face because it is has a thick bone and soft tissue cover and is not exposed to the stresses of mastication. While there is always the risk of some feeling loss from chin osteotomies, my experience is that it is very low. The key is to do the osteotomy at least 5mms below the mental foramen if not lower to avoid any risk of permanent loss of sensation to the lip and chin.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eplpey, indianapolis, slifing genioplasty
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Wednesday, January 25th, 2012
Q: Dr. Eppley, I am primarily concerned with the lower third of my face. I think my chin is too long and pointy which contributes to the long, thin face look. Do you think a chin reduction combined with jaw implants or a pre jowls chin implant would do the trick? If so, do you perfom such procedures? Do you have any other suggestions as to how I could improve my facial features? Please do not be afraid to hurt my feelings!
A:Thank you for sending your pictures. Your long thin face is partly the result of a long sweeping jawline with a modestly steep mandibular plane angle. This makes for a lower face that appears vertically long. This is magnified by the observation that your midface (cheek and paranasal areas) is relatively flat/recessed. That combination makes for what you see,, a face that has a greater vertical component than horizontal projection and width.
To address this concern, I would recommend a chin osteotomy which, based on the angle of the cut, allows the chin to become vertically shorter as it comes forward. You need both a mild amount of horizontal increase with an equal amount of vertical reduction. Only an osteotomy can make this bony chin movement possible. In addition,. I would place jaw angle implants that both widen and vertically drop the jaw angles downward. Between the chin and the jaw angle changes, the lower third of your face would become shorter and wider. That will help counter the long thin face look. I have attached some predictive imaging to illustrate these changes.
The other change that would be helpful is cheek augmentation. That would bring the midface more forward, again a manuever that counters the vertical and thin (horizontally deficient) facial appearance. I have attached an image that shows where this cheek augmentation would be. Your pictures are not of a good enough quality to really show what cheek augmentation can do.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, jaw angle implants
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Thursday, January 5th, 2012
Q: Dr. Eppley, I am looking to have corrective jaw surgery for my long face. I don’t have an under/overbite but I do have longer face which I would like to be shortened. What are the options available for doing this? I have attached a picture for your assessment.
A: There are two fundamental approaches to aesthetically shortening the long face. The first is a vertical chin reduction osteotomy in which only the chin length is reduced. (shortening of the lower third of the face) I have attached an imaging picture of what that may look like on you. This would be the simplest technique but it only deals with one area of vertical excess, the chin. A true long face is most people involves the entire face. The second approach, which is usually combined with vertical chin reduction, is a maxillary impaction or shortening. This requires that the patient has a vertical maxillary excess to start with as reflected in having a lot of tooth exposure and/or a gummy smile and lip incompetence. This shortens the middle part of the face which when combined with vertical chin reduction gives the maximal shortening effect. This is a more extensive approach requiring a LeFort I osteotomy and, again, requires that the patient have vertical maxillary excess. Your pictures suggests that you have that to some degree based on your tooth show/lip incompetence at rest. This is a harder area to image given that it is in the middle part of the face.
Which approach is best for any patient depends on how much vertical shortening they need and what one is prepared to got through to get what degree of shortening.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, maxillary osteotomy, shortening the long face
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Saturday, December 31st, 2011
Q: Dr. Eppley, I had a sliding genioplasty four years ago. Everything went well and I like the result. My surgeon told me that he could remove the titanium plates and the screws but it wouldn’t be a problem if they stay inside me for the rest of my life. So I decided to let them stay inside of my chin. Last week I meet another surgeon who said that titanium plates and screws should be removed in younger patients. On ‘House MD’ it has been shown that titanium plates can severely burn soft tissue and skin when an MRI is needed. Is this true? Should my titanium plates be removed because they can lead to bone resorption or other problems in the future?
A: The simple answer to your question is that none of what you have heard or been told is true. Titanium is the most biocompatible metal in the body which is why it is so commonly used. In facial plates and screws it is a nearly pure metal to which bone will bond directly (and often grow over) and it is non-ferromagnetic so it is not affected by the powerful magnetic influence of an MRI. There is no reason whatsoever, therefore, to remove your chin osteotomy plates and screws. Of all the places on the face where rigid fixation is used, the chin is the one area where I have never seen any long-problems such as loosening, irritation, or interference with function. Removing them may be a good exercise for the surgeon but is of no benefit to you at all.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, titanium plates and screws
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Saturday, October 1st, 2011
Q: Dr. Eppley, one year ago I underwent surgery for a medium chin implant and neck liposuction. Though I was initially pleased with the result due to the way the swelling made my chin look, after the swelling had subsided I was very disappointed with the outcome. I feel that my chin and jaw line are vertically short and that my chin is still a little bit horizontally short. Additionally, my jaw line lacks solidity and I think that my chin could stand to be a little wider/fuller. I have attached two photos of what my face currently looks like.
I would like to add roughly a 1/2 inch to my chin/jaw line vertically, as well as 3-5 mm horizontally (from where the current implant ends). I would like my jaw to angle down to my chin, so that the chin is lower than the rest of the jaw. As I previously mentioned, I would also like my chin to be a little bit wider and to add solidity to my jaw line as it gains fat easily.
In order to obtain the results that I desire and keep them long-term, what would be the best procedure for me? The three that I have been looking at are a sliding genioplasty, a geniomandibular implant with Gore-Tex strips or a custom jaw implant. Money is a little bit tight for me, so I’m hoping to avoid the custom jaw implant.
I appreciate your help and eagerly await your response,
A: I have taken a careful look at your photos and your desired aesthetic chin changes. While a custom implant is one method to achieve those changes, it is not the only way as you have pointed out and the cost of it eliminates it from consideration by your own admission.
Between a chin osteotomy and geniomandibular implants, each has its own advantages and disadvantages. A chin osteotomy (keeping the chin implant in front of it) would easily create 10mms of vertical lengthening, about 5mms of additional horizontal advancement and could be sectioned to create 5mms of horizontal expansion as well. It is done from the inside of the mouth and would actually be my preference in your case even over a custom chin implant. Geniomandibular groove implants could also provide up to 10mms of vertical lengthening and 5 to 7mms of horizontal widening as the implants can be placed with separation between the two sides. The problem with these implants is that you would only get about 2 to 3mms of additional horizontal advancement and your existing chin implant would have to be placed on top and in front of it to keep and enhance the horizontal projection that you already have. That is not a big problem, just that you have two implants stacked together. This procedure would need to be done from a submental skin incision from below the chin with a resultant scar.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, custom chin implant, dr barry eppley, geniomandibular implants, indianapolis
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Wednesday, September 14th, 2011
Q: Dr. Eppley, I am interesting in what you refer to as an extreme chin augmentation (osteotomy and an implant). I have a short lower jaw, but unfortunately have been told I’m not a candidate for orthognathic surgery due to the position and condition of my teeth. To help correct this problem, I have had a chin implant placed but the results do not satisfy me as it is not big enough. I am attaching a copy of my ceph x-ray. I do not have a profile picture at this time, but it is pretty clear where my chin is from this x-ray. Can you please comment on having this surgery? I have seen a lot of your before/after pictures on other sites for chin augmentation and am very impressed with your work and the knowledge you seem to have from the questions you answer on your site.
A: Thank you for your inquiry and sending your ceph x-ray. You do an underlying significant lower jaw deficiency as seen on your film. Your current indwelling chin implant provides only 7mms horizontal projection and is positioned just slightly high on the bone. Your true chin deficiency is more in the range of 16 to 18mms deficient. You therefore already have half of an extreme chin augmentation with the existing implant in place. You now need a chin osteotomy done just above your existing implant to advance the bone (carrying the implant) forward about 10 to 12mms with a vertical opening of 2 to 3mms. This will create the most ideal chin projection for you. So doing the previous chin implant was not a wasted procedure. You would have needed it anyway as the bone can only be brought forward so far. i have done some computer imaging and predictive tracings on the ceph x-ray that you have sent me.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, chin osteotomy, dr barry eppley, extreme chin augmentation, indianapolis
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Saturday, September 3rd, 2011
Q: Dr. Eppley, I think that I need my chin lengthened downward. I have a very deep overbite. I have attached a variety of photos as I wanted to show you my face shape when my teeth are closed together (I have a deep overbite) and when they are not. Most of my teeth are bridges and crowns and I have recently been advised to have all of them removed and implants put in place and that would help my overbite and give me a lovely smile. I don’t know if this would help as it is unclear to me if my overbite is dental or skeletal. I am under the assumption that my problem is skeletal as I thought my overbite would be addressed when all my teeth were replaced around 6 years ago but this wasn’t the case. Unfortunately it isn’t really a financially viable option for me to now have all my teeth removed and replaced. I also sought advice a couple of years ago and although I was only 45 at the time, I was advised to have a facelift and nose job to improve my jowling and small chin. I did so but I don’t feel the real problem has been solved. I would appreciate your professional advice on how an improvement can be made.
A: Thank you for sending your pictures. I can see that you have a 100% overbite, which means your lower jaw is over rotated on closure thus shortening the entire lower face. This is a skeletal problem that is manifest by the presence of the occlusal discrepancy. But because of the arc of rotation, the vertical shortening is greatest anteriorly at the chin. As a general rule, the amount of vertical shortening in a 100% overbite can be calculated at the vertical height of the incisor teeth. (crown length) That would be somewhere between 10 and 15mms in most patients. So you are absolutely correct in desiring a vertical chin lengthening osteotomy. That would provide the greatest benefit in terms of improving lower facial height and overall facial balance. I have done some computer imaging which shows the predicted outcomes from that procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, vertical chin lengthening
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Friday, August 12th, 2011
Q: Dr. Eppley, I had a chin osteotomy several years ago but still feel my chin is short. Do you think another chin osteotomy can be done. I do not want an implant for more chin if I can avoid it. I have attached an x-ray so you can see what my chin looks like now.
A: Your x-ray shows that you had a sliding genioplasty fixed together with cerclage wires. What this means and shows is that the back cortex of the chin segment has been brought forward enough to be attached to the front cortex of the mandible. This means that the chin segment has been brought forward as far as it can go. This is an older genioplasty technique that dates back to a time when only wires were available for facial bone fixation. Since the wires can only attach to the cortices of the bone, the chin is brought forward whatever distance the back end of the chin and the front edge of the upper bone will allow as they match together. In today’s genioplasty bone fixation techniques, plates are used that move and hold the chin together at any desired distance horizontally as well as vertically.
In theory, you should not be able to get any more advancement out of the chin segment once a ‘maximal’ bony genioplasty has been performed. But there is one thing that is a bit unusual in the way your chin osteotomy was performed. The x-ray shows that it was cut at a very low horizontal level. This has left a lot of bone height between the lower end of your incisor teeth and the top edge of the bony cut. This suggests that a new osteotomy could be done above the old one, bringing more of the chin forward. This would create a ‘stairstep’ chin osteotomy approach which I have done at the same time but never as a staged procedure which is actually safer. So I do think a repeat chin osteotomy is possible to gain more chin projection. In stairstep chin osteotomies, I do recommend the use of hydroxyapatite granules or demineralized bone to fill in the steps at the end of the procedure for maximal bony healing.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis
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Sunday, July 31st, 2011
Q: Dr. Eppley, I was born with a face that to me looks a little crooked. It seems my jaw line is shorter on one side and it looks like my face is bent in one direction. Would you be able to look at the pictures I am enclosing and please tell me what you think. My face is definitely not even and my chin is crooked. I think it is too big, but is it also receded? I am so self conscious that I hide behind my hair and makeup. Thank you so very much for your time and please, any advice and recommendations would be greatly appreciated!
A: I have taken a look at your pictures and your concerns. I think there is no question that you have facial asymmetry that is almost completely due to the shape of the lower jaw. The differences in the jaw length has resulted in frontal chin asymmetry with the midportion of the chin being deviated to your right side. This can be corrected (straightened) through a chin osteotomy, sliding it over to the left until its midportion is in alignment with that of your nose and upper and lower lips. This may also require some vertical chin adjustment with a reduction of the left side or an opening lengthening on the right side, depending upon which aesthetically looks better. Your side view shows a mild amount of recession which, given that an osteotomy would be done, I would take the opportunity to give more horizontal projection to the chin as well. I have attached some predictive imaging of the potential outcome with this sliding chin osteotomy procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin asymmetry, chin osteotomy, dr barry eppley, facial asymmetry, indianapolis, plastic surgery of the chin
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