Can Liposuction Give Me A More Defined Jawline?

Q: Dr. Eppley, I have had consultation with three other plastic surgeons and they all just say that chin/neck lipo, or submental lipo or whatever it’s called, is what I need, and 1 said chin lipo + buccal fat removal. I weight 183 lbs and I am 5’10 which put me in sort of the overweight part regarding BMI, but even when I was younger and I wasn’t particularly overweight, there still hasn’t been what I wanted.

Basically what I want is a stronger jawline and sort of make my face less round if you get what I mean.

A: Thank you for sending your pictures. While submental/neck/jawline liposuction has some merit you should expect those changes to produce a minimal to very modest improvement and I would guess that your description of a stronger jawline and a less round face is not going to be achieved. Fat removal alone can simply not produce any significant amount of facial defining change. That is offered to you because that is what almost all plastic surgeons know to do. But the change you ideally seeking will not be achieved by a reductive approach only even though you do not have a classic weak jawline per se. 

You are only gong to change your jawline in any significant way by total jawline skeletal expansion. (augmentation) It does not have to be a lot but some total jawline augmentation is needed with the fat removal to really take you to where you ideally want to go. I will send some computer imaging tomorrow morning to illustrate what I mean which is likely much more in line with your goals.

Dr. Barry Eppley

Indianapolis, Indiana

Will Liposuction Get Rid Of My Jowls?

Q: Dr. Eppley, I’ve always had a round face despite my normal weight. One and a half year ago, I underwent a laser liposuction (submental and lower third face) plus a buccal fat pad removal. And masseter botox, too.

My face shrinked but I’m not happy with the results because I remained with a little over correction in the right side that improved with a hyaluronic acid filler. But the worst for me it’s the hypocorrection of the lower third of my face.

What I looking for is to define just a little bit the lower third creating a less puffy jawline in the front view. I don’t want to creat ea depresssion in that area.

I know there’s a risk in liposuction the jowl area. But Is it possible without creating irregularities, just the necessary amount for creating a more straight line in the lower third jawline.

Thanks

A: Thank you for your inquiry and sending your pictures. While the jowl area can be treated with microliposuction with a low risk of causing irregularities, it is probably unlikely to create a perfectly smooth jawline either. Now that your face has been deflated by fat removal the residual jowl fullness is a lax skin issue. To really create a smooth jawline the skin needs to be pulled back along the jawline with a limited lower facelift or jowl tuck procedure.

Dr. Barry Eppley

Indianapolis, Indiana

How Much Bone Is Removed In Clavicular Reduction Surgery for Shoulder Narrowing?

Q: Dr. Eppley, I am inquiring about clavicle reduction surgery. (shoulder narrowing)  How much reduction can be achieved by your team?  How much bone is removed per clavicle?  Where are the scars positioned? What is your timeframe for recovery? How much does this surgery cost, excluding travel expenses? I am asking both out of personal motivation and interest, as well as to compile information about surgeons willing to preform this procedure for others reference. 

Thank you for your time. 

A: In answer to your shoulder narrowing (clavicular reduction) surgery questions:

1) A 2 cm length of the clavicle bone is removed per side which roughly translates into a one inch shoulder width reduction per side.

2) The 4 cm incisions is placed directly over the osteotomy site at the mid-clavicular level.

3) Recovery and what activities are done are based on clavicle bone repair healing. Such bone osteotomies takes about 6 to 8 weeks to fully heal when one can return to all normal physical activities.

4) My assistant Camille will pass along the cost of such shoulder narrowing surgery to you tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Will Custom Infraorbital Implants Decrease My Scleral Show and Improve Under Eye Hollows?

Q: Dr. Eppley, My goal is a more masculine face with better-defined jaw, chin, and cheek bones. Basically the “male model” look. I’m wondering if Dr. Eppley thinks an infraorbital rim implant would be desirable to provide definition beneath my eyes. I suspect that recessed infraorbital rims cause my under-eye area to look hollow.  Please let me the know the extent to which you think I would benefit from these facial implants. 

Thank you!

A: Thank you for your inquiry and sending your pictures. You do have the type of face that would respond well to infraorbital-malar and jawline implants. That type of favorable face has two main characteristics; 1) fairly lean with not a thick soft tissue layer and 2) reasonable facial skeletal development. This allows implants of modest-moderate size to show through and create better facial definition. This may not make you a ‘male model’ but it will take what you are born with and take it to a more defined angular facial look.

Custom infraorbital implants, if they have enough height, can drive up the lower eyelid and decrease scleral show. How much they improve undereye hollows depends on how much horizontal projection they have as well.

Dr. Barry Eppley

Indianapolis, Indiana

How Much Taller Can I Get With A Custom Skull Heightening Implant?

Q: Dr. Eppley, I am a 24 year old male with height of 165cm (5ft 5inches)),

While I would like to increase my height I consider methods such as  Limb lengthening by osteogenesis distraction (where bones are actually broken and lengthened) to be too extreme especially given my starting height, 1-2 inches will be sufficient for me, (3-4 inches is not necessary).

I saw the article on your website (https://exploreplasticsurgery.com/plastic-surgery-case-study-male-custom-heightening-skull-implant/):

1) With use of a scalp expander first would an increase of 2 inches of height be possible with a custom implant??

2)  What is a rough ball park estimate cost of such a procedure? 

A: Thank you for your inquiry in regards to custom skull heightening implants. Depending on one’s natural scalp elasticity, an immediate insertion of a custom skull implant will create close to an inch of additional height. But it will take a first stage scalp expansion to permit the placement of a larger custom skull implant to get closer to 1 1/2 inches.

I will have my assistant Camille pass along the cost of a two stage custom skull implant process on Tuesday.

Dr. Barry Eppley

Indianapolis, Indiana

Are There Any Premade Wrap Around Jawline Implants?

Q: Dr. Eppley, I am interested in learning more about jawline augmentation by the wrap around implants, I don’t think I need customs ones however so are there any that have been premade? I currently have a triangular face but aiming for a more U shaped, masculine shape, will this be possible? also what is the cost, i have attached picture of what I currently look like, and another of what results I am aiming for.

A: Thank you for your inquiry and sending your imaged pictures which shows a smooth confluent jawline augmentation effect back to the jaw angle areas. It would require other facial views of imaging to see the full 3D jawline effect that you seek. One view alone does not provide all the information needed. 

While your jawline augmentation needs are modest by my standards, that does not mean it is easy to achieve. Getting such a smooth and even effect is always most assured by a custom jawline implant made from the patient’s 3D CT scan. Only by creating an implant that naturally expands the shape of the jaw can such a smooth effect be seen in my experience. Standard chin and jaw angles implants are what is known as spot augmentations which are fine if just the chin and/or jaw angle area needs a specific augmentation. But smooth and confluent jawline augmentation effects do not come from the use of standard implants not specifically made for the patient.

I will have my assistant Camille pass along the cost of the surgery to you on this coming Tuesday.

Dr. Barry Eppley

Indianapolis, Indiana

Do I Need Rib Cartilage For My Left Ear Reconstruction?

Q: Dr. Eppley, I am interested in having an otoplasty on my left ear. While I did not find many of these types of surgeries during my research, I would like to ask you a few questions.Have you performed similar surgeries in the past, and if so, could you please send me some before and after photos?

What type of method do you plan to apply for this type of surgery and where will the scars be located? Will I have a small scar on the helix of my ear?

I was thinking about a reconstruction from the upper middle up to the top of the ear with the use of a cartilage graft for support, as I saw in one of your surgeries. Do you think that is the best technique to apply on my ear?

A: Thank you for your inquiry and seeding your pictures. You have a form of a constricted ear as seen by the folded over helix from the middle of the ear (3:00 position) up to the center of the top of the ear. (12:00 position) While some may refer to it as a Stahl’s ear, because of its pointed appearance, it does not have a third crus so it is not a classic case of it. The helix is also setback behind the antihelical fold as part of the overall hypoplasia. Interestingly some helical cartilage can be seen protruding from behind the helical skin almost as if the cartilage is adequate by the skin is deficient.

But I do think that the skin needs more helical cartilage support to both pull the helical rim skin back over it as well as provide some more projection. As you have noted a cartilage graft is needed to do so an the right amount and curve to it comes from a small portion of the subcostal rib #9 or #10.

Dr. Barry Eppley

Indianapolis, Indiana

Is A Custom Wrap Around Jawline Implant Better Than Separate Chin and Jaw Angle Implants?

Q: Dr. Eppley, I am a young male and will be getting angular custom jaw implants, a chin implant and cheek implants next month. When I asked my Dr. about the wrap-around implant you offer, he mentioned he is not a fan of this type of implant because it requires complete degloving of the muscles. I have attached the MRI images showing the custom jaw implant that has been ordered from the implant company. Prior to proceeding with the surgery, I was wondering if I can get the opinion on the type of implants my doctor is proposing. After looking at pictures of the wrap-around implant, I’m concerned that with separate angle and chin implants I’m getting, it will be very difficult to achieve both a smooth jawline and a wider and more projected chin, because the vertical lengthening only exists at the back of the jaw bone, and does not extend to the chin. I would really appreciate if you can provide me your medical opinion on this and whether or not you believe what a better result would be obtained in my case with a wrap-around implant. Many thanks, 

A: Thank you for your inquiry to which I can make the following comments:

1) I do not comment on facial implant designs of other doctor’s patients. That is not appropriate for either the patient or the treating surgeon.

2) I would disagree, however, with the concept that a total jawline implant requires complete muscular degloving as that is not based on an anatomic understanding of jawline soft tissue anatomy. The muscles that do need to be elevated are the mentalis (chin) and the masseter (jaw angles), there are no muscular attachments between the two. Interestingly these are the same muscles that must be elevated for separate chin and jaw angle implants. What is elevated in a total jawline implant is the need for complete subperiosteal elevation.

3) I think your aesthetic concerns are well founded which is why the use of separate chin and jaw angle implants has largely been replaced in my practice with the wrap around implant concept. It simply offers a superior aesthetic result that has fewer postoperative complications such as asymmetry. When the jawline is weak or underdeveloped it makes more sense to augment the whole problem as a single unit that it does to add ‘spot’ augmentations to the three corners of the lower jaw for most patients.

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Best Approach For A Scalp Scar Revision?

Q: Dr. Eppley, I am reaching out to you in regards to my son who is an early teen. He had a nevus sebaceous birthmark removed from the crown of his headless year. The plastic surgeon was able to do a primary closure. At first the scar looked great, but at almost a month , the scar widened dramatically. Now we have him scheduled for a scar revision with a different plastic surgeon who wants to do extensive undermining and galeal scoring with vertical mattress suturing. Can you give me some insight?

A: It is perfectly normal and to be expected that all scalp scars will widen with any form of excision. The size of the excision will determine how much subsequent widening will occur. This is an unavoidable phenomena because the scalp is tight and is really skin stretched over a beach ball so to speak. While the scar may look great for a few weeks, the widening will subsequently occur. The extent of the widening will be fully manifest by three months after surgery and no revision should ever be done before them…as the tissues need time to relax. This is all part of the typical preoperative education. 

I tell all scalp excisional patients, particularly children and teens, that there will be a likely 100% chance of the need for subsequent scar revision. Most likely the wide scar is less than the original excision so the tension will be less and the scar will be better. The techniques that have been described are appropriate and represent the maximum approach for ‘Plan B’.

There is also the phenomenon of lost hair next to scar which can be confused with a ‘wide scar.’ The scar is actually narrow but loss of hair (hair shedding) makes it look wider than it is. In some scars it may be a combination of a true wide scar and loss of hair shafts. This is another reason to wait to see what impact any hair regrowth will create on the scar’s appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Rhinoplasty, Vermiion Advancement, Cheek Implants, Sliding Genioplasty and Jaw Angle Implant Facial Reshaping Options?

Q: Dr. Eppley, Thank you for responding so quickly! I would like your opinion on what could make my face look more symmetric and give it more definition, if possible. Basically, I would like to look like I have good bone structure. I’m not trying to look like any particular celebrity, but I’ll use their pictures to show what I like. I have several facial reshaping procedures in mind, but perhaps you will suggest something different.

I’m 27 years old, female, had braces to correct an overbite over 10 years ago, a primary closed rhinoplasty and a subnasal lip lift last ye5ar. I’ve tried lip fillers both before the lip lift and after.

Overall, I think my nose is better, but I’m not completely happy with it. As far as my lips go, I like the view from the side much better now, but the front still bothers me. Fillers never did much for me in my opinion.

I think I look drastically different bare-faced. Makeup helps me create some definition and angularity in my face, larger upper lip and a more symmetric nose. Of course, makeup can only do so much. I’d rather get more significant and lasting changes.

Here are my specific questions. I’ll start with what had already been operated on and then get to facial implants.

NOSE

I still have a remaining bump that is visible from certain angles. I wanted a more concave bridge and a tip that’s rotated a bit up to create an effect of a slightly shorter nose. I also think it lacks symmetry from the front and even with makeup I have difficulty making it look straight. My original nose had a bump and a bulbous tip, but didn’t seem crooked to me. My breathing was great before surgery, now it’s a bit worse, but not to the point where it bothers me.

Do you think it would be worth it to operate on it again?

LIPS

I just want my top lip to be close in shape and size to the bottom lip. Unfortunately, the lip lift didn’t give me a top lip. And I don’t like what fillers do to me (too puffy, not enough vertical red lip). So I feel stuck. The surgeon who performed my lip lift told me multiple times that both vermilion advancement and V-to-Y would look horrible because there would be no white roll and my lip would look pasted on, but I just don’t see what other options I have. The only thing he suggested was Botox lip flip to prevent the top lip from curling inwards when I smile and more filler. I am not happy at all with the current state of my lips – still very thin top lip when I look straight on, nonexistent on the sides unless I overline significantly, plus now if I close my mouth completely there’s a visible strain in my chin, that’s why I mostly keep the mouth slightly open – if I close it, my chin flattens.I don’t like how (in my opinion) it makes me look sad or angry.

What can I do?

CHEEKS

I’m interested in a custom model implant that extends all the way back. I’d like the effect of very prominent cheekbones, but I know there are limitations.

Do you think that’s achievable for me?

CHIN/JAW

My goals are: shorter, more protruding chin, and a defined jaw. I’ve always felt my chin is a little too long vertically, but in addition to that after a lip lift when I close my mouth my chin looks recessed. I also carry some fat around my jaw even when my weight fluctuates lower. It’s just never been really defined. I’ve had one surgeon recommend a neck lift, but I don’t know if that will be enough – I’m not sure how good my underlying structure is. I think my face always looked soft.

What would be a good solution here? Sliding genioplasty and a custom jaw implant? Something else?

A: Thank you for sending all of your pictures and detailing your concerns. You are correct in that makeup can make a person look completely different. But it is also helpful because it shows what the patient is trying to achieve.

As I understand it your prior surgeries have included a closed rhinoplasty and subnasal lip lift. Your goals now are to basically have a more defined facial structure and fuller lips. In essence this comes down to the following facial reshaping options:

NOSE  While your initial rhinoplasty provided improvement (reduced the hump) it reflects the more modest changes that typically occur from a closed rhinoplasty and largely left the tip relatively unchanged. You are probably seeking a more complete rhinoplasty to lower the bridge further, reduce tip projection and provide some tip rotation This is the way you are going to get a somewhat smaller and more shapely feminine nose.

CHEEKS You need some defatting underneath them from buccal lipectomies and perioral liposuction to create less fullness between the cheekbones and the jawline. This will also create a bit of a cheek augmentation effect. A custom heel-arch style always provide the best definition .

LIPS. When women draw their lips on and they look better they are basically adjusting the position of the vermilion. While a subnasal lip lift creates more central upper lip fullness it does not address the sides of your lip which is why you like it from the side view but not so much from the front view. This can only be addressed by a vermilion advancement.

CHIN-JAW. Your chin needs to come forward and be narrowed (sliding genioplasty) and some small jaw implants that help create a more visible angle to the back would create a more total jawline effect with the chin.

These are my initial thoughts,

Dr. Barry Eppley

Indianapolis, Indiana