How Can I Straighten My Crooked Chin And Face?

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

What Is The Best Way To Improve The Profile Of My Chin?

Q: Dr. Eppley, I would like to see if it is possible to improve 3 areas around my chin. The areas I want to improve are my jawline. I would like it better defined. I would also like to create a better angle on neck underneath the chin for better profile. I would also like to create better balance and harmony on my chin. Maybe lengthen it to try and release some of the mental crease. I’m not quite sure what will work. It’s a pretty deep crease. I was born with it. Feels like a huge step below my lower lip. I have attached a front and side view of me for you to see what I mean.

A:  What you have is a classic issue of an overall short lower jaw. Your lower jaw is short in both horizontal and vertical dimensions which is most manifest in the chin area. While I can not see your occlusion (bite), I suspect it is a Class II malocclusion where your lower teeth are somewhat behind your upper teeth and do not meet in an edge-to-edge fashion. That is also why you have a deep labiomental crease. The lower lip is not well supported by the retropositioned lower teeth so the crease deepens while the lower lip rolls forward. What you need for correction is a vertical lengthening chin osteotomy that also brings the entire chin bone forward. I would estimate that it must be vertically lengthened by 8mm and brought forward 10mms. A hydroxyapatite block needs to be added to the step-off in the osteotomy to help build out the labiomental crease or at least prevent it from becoming even deeper. Lengthening the chin will actually help soften the depth of the crease as it pulls the soft tissue of the lower chin down and forward.

Dr. Barry Eppley

Indianapolis, Indiana

Which Is Better To Make My Chin Longer – An Implant Or An Osteotomy?

Q:  I want to make numerous changes to my chin as I think it will make my face look better. I am looking to decrease the horizontal dimension of my chin as well as increase the vertical dimension. I think this will create a more angular jawline as my lower face is very rounded. My chin feels like it pushing my bottom lip upwards so I wanted the lower lip to be brought down slightly, would this be at all a possible? I would also be wanting a rhinoplasty, however at the moment, I will be focusing on the chin. Would these chin changes be best done with an implant or an osteotomy? I really hope you can help Dr. Eppley. Thank you for time.

A: That type of chin change can only be done by an osteotomy. With the chin pushing up on the lower lip, this suggests that it is too vertically short. A chin osteotomy can easily increase its vertical length by making an opening wedge that is held apart by a special chin plate and four screws. Lengthening the bony chin will always make it look thinner, but its bony width can also be narrowed by a midline ostectomy of the  downfractured segment at the same time.

As the chin is lengthened, it can create a slight lower lip lowering effect as the mentalis muscle is also lengthened. As the upper attachment of the mentalis muscle does extend to just below the lower lip, its lengthening as it is carried down with the bone should make the lower lip less pushed up.

Dr. Barry Eppley

Indianapolis, Indiana

Will Intraoral Chin Reduction Cause a Witch's Chin Deformity?

Q: I was wondering if an intraoral chin reduction could be successful if I don’t have much soft tissue. I know if the mentalis muscle is disturbed it can cause sagging but if it is properly tightened back together could this still happen? What is the likelihood?

A: When the chin bone is shortened from inside the mouth, the muscle is not only detached but now an excess amount of soft tissue results. In other words, there is too much soft tissue for the amount of bone left. That is what creates a chin soft tissue sag or witch’s chin. While tightening up the muscle back to the bone is effective for very small chin reductions (that aren’t noticeable), such muscle tightening will not work for more visible chin bone reductions. The extra amount of soft tissue must be shortened (removed) as well as tightened. So the answer to your question is that intraoral chin reduction is usually a bad idea no matter how well the muscle is retightened. Only a submental (under the chin) approach can adequately remove and tighten the loose soft tissue that is created from chin bone reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Is A Chin Osteotomy The Right Procedure For Me?

Q: I have recently consulted with a maxillofacial surgeon who has recommended performing a chin osteotomy procedure. He intends to remove a 3mm wedge (for vertical reduction) as well as a 3mm advancement, with the osteotomy performed at a slight upward angle. I seem to have the unique situation of anterior mandibular vertical excess with a very flat labiomental fold (which would be enhanced by the advancement) What are your thoughts on the success of this procedure?

A: Without looking at photos and x-rays, it would be impossible for me to comment on whether this is a good procedure for your concerns or not. That is a technically sound chin osteotomy procedur and is very straightforward to do. The only question I would raise about it is that these bony movements (3mms) are fairly small. Such small movements are unlikely to make much of an external visible change, albeit a very modest one. To take down the chin bone by osteotomy for this amount of bony movement seems like a ‘solution that is bigger than the problem’. For a horizontal advancement of 3mms, an implant would be far less invasive. For a vertical reduction of 3mms, there is no other solution than osteotomy and bone removal. This makes it a difficult decision in my mind as to whether the problem justifies this degree of surgical effort.  I would look at your chin concerns carefully and would reconsider carefully the potential benefits and risks of this type of chin surgery.

Dr. Barry Eppley

Indianapolis Indiana

Would A Chin Implant or A Chin Osteotomy Be Better For My Desired Chin Appearance?

Q:  While I don’t think that I am bad looking, I feel that my jaw line is weak and small. My receding chin greatly distracts from my features and I am hoping a jaw and chin augmentation can help balance my lower face and give me a stronger, more masculine appearance. Ideally I would like to substantially increase my chin size horizontally, to or past my lower lip when viewed in profile as well as add vertical length as my chin is rather short. I also desire to add horizontal width and volume as well as increased vertical length when viewed from the front, or in other words a more “squared” appearance. Along with my pictures, I’ve included a rough depiction of what I am trying to achieve. The altered versions are a “goal” and perhaps you can tell me if they are realistic or not. The problem is I realize extending my chin out this far requires substantially augmentation (probably around 12-15 mm) and don’t really know if my goals are realistic. I’ve been researching your website and understand you do chin osteotomy in conjunction with chin implants. Would this be a possibility? If so are there greater risks in terms of potential nerve damage and bone resorption? Also, with such an invasive surgery, are there any long term complications after say a decade or more?

A: Your own predictive computer imaging is greatly helpful and shows exactly what you want to achieve. I could not have the done the imaging any better myself. Because you desire both horizontal and vertical chin lengthening and are a very young man, I would recommend a chin osteotomy which does a better job of such combined dimensional changes. The chin can probably be advanced about 12mms or so and that should be enough to get that look. The chin can become more squared with an osteotomy by splitting the downfractured chin bone and expanding it apart to create more width. As you mentioned, an implant can also be added to the front of the chin osteotomy to create the same effect. I would have to see intraoperatively which would work the best.

Dr. Barry Eppley

Indianapolis, Indiana

How Can My Long Chin be Made Shorter?

Q: Hi Dr Eppley, I have read your article about  chin reduction. I am a female and I have  a long chin and my self-confidence is affected by it. I have attached some pictures for you to see what can be done about it. By the way, I wear a full lower dental denture (one original tooth left) and I have partial upper denture. Most of my remaining teeth has been root canaled. Thank you and looking forward to hear from you.

A: In reviewing your pictures, you undoubtably have a very long chin. But, equally relevant, is that your face has a great imbalance between your upper jaw (maxilla) and your lower jaw. Your midface is very flat and recessed, partly because of your ethnicity but also because it is underdeveloped. This is magnified by your loss of teeth which contributes to your maxillary atrophy from a horizontal projection standpoint. Your lower jaw is very long with a high jaw angle. This combination has created a significant maxillary-mandibular mismatch (short maxilla, long mandible) and is a major contributing factor to your appearance of a ‘long chin’. One of the missing  pieces of information is what your bite (occlusion) is like. With these facial bone relationships, you may also have a Class III malocclusion or underbite.

From a corrective standpoint, the ideal approach is to move the entire lower jaw back and the upper jaw forward. This would ideally solve this long chin appearance. But that may be more than you want to do, although having most of your occlusion done by dentures, it is not so far fetched. Short of orthognathic surgery, the other combination would a vertical chin reduction osteotomy and possible paranasal augmentation of the midface. This would not make as big of a change as orthognathic surgery but it would be a noticeable difference.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Jumping Genioplasty Be Done After A Prior Chin Osteotomy?

Q:   I have a question about jumping genioplasty. I am curious, if you have had previous chin surgery with indwelling plates and screws as well as possible internal scarring of the muscle that causes creases in your chin when you smile, can you still undertake a jumping genioplasty? Or would the scar tissue and plates and screws from the previous ostetomy prevent this? I understand this makes surgery more difficult to carry out. I was just wondering if it is still possible.

A:  While you are correct in that it is more difficult, it is not impossible and sometimes is fairly uncomplicated. The only limiting factor is the plates and screws used from the first osteotomy and how easy they are to remove. The typical osteoplastic genioplasty, if the chin has been advanced, is a step titanium plate with 4 or 6 screws. As long as bone had not completely grown over these metal devices, they are often fairly easy to unscrew and pry out the step plate. But if bone has completely covered these devices, their removal can be very difficult and destructive. Fortunately, complete bony healing over the plate and screws is not common. Once the devices are removed, the osteotomy is straight forward and the prior chin surgery actually makes it easier to complete a secondary bone cut.  

Dr. Barry Eppley

Indianapolis, Indiana

How Do You Correct A Witch's Chin Deformity?

Q: I am an 18 year old looking to correct “witch’s chin” deformity or chin ptosis. I do not know of any doctors in my area who have experience with this procedure, so I am seeking your advice and hopefully you can educate me a bit more about my case. The problem is that I have a lot of extra soft tissue in my chin that folds under and looks very awkward when I smile. I had a consultation with a plastic surgeon who said he would scrape out some of the fat and pull the skin back. He also said that he would cut the muscle. I know he has not seen this case before and that is why I have not confirmed the surgery with him. How exactly is this surgery performed and what are the different ways to go about it? How complicated is the procedure? What are the risks of going to somebody who has not done it before and how high is the risk of causing a deformity? I have attached some photo of me smiling and not smiling from both a front and side views. Your insight is very much appreciated! Thank you.

A: Based on your photos, you are correct in that you do indeed have a witch’s chin deformity. The smiling view magnifies the redundancy of muscle and skin and pulls it down abnormally over a pointy bony chin. In the truest definition of a witch’s chin, it is a deformity that occurs after some form of bone chin manipulation. Your case is different in that this is a developmental/congenital problem and not an iatrogenic or surgically-caused one. In these non-surgical cases, the bony chin is also protrusive and that can be seen at rest in your profile view. So the actual anatomic proboem is one of ‘too much chin’ from all tissues involved.

Surgical correction is done from an incision underneath the chin, what is known as a submental approach and the overall procedure can be called a submental chin reduction. From below the chin bone is shaved down and excess muscle, fat and skin is removed. The chin is then reshaped by adapting the shortened soft tissues over the reduced bone. This is not a complex procedure but must be done carefully and all chin tissues musts be reduced and tightened. The trade-off is a scar under the chin. I have attached a patient example of the procedure for you to see the results and the scar.

Dr. Barry Eppley

Indianapolis Indiana

What Is The Cost Of Chin Shaving Surgery?

Q: My chin is too big and I need it reduced. What is the cost of chin shaving surgery?

A: Thank you for your inquiry. When one mentions ‘chin shaving’, they may really need a submentoplasty with chin burring reduction or they may really need a chin reduction via an osteotomy. It depends on their chin problem as the approach for chin reduction can differ based on the size and shape of their chin bone and the surrounding chin and submental soft tissues. Each method of chin reduction also differs in cost. Therefore, before providing a surgical fee quote please forward to me some photographs of your chin and what specific dimensional changes you want to see.

Dr. Barry Eppley

Indianapolis, Indiana