Your Questions

Q: Dr. Eppley, I was wondering what cosmetic surgeries would be needed to achieve this look. I edited the photo on the left to balance the facial features to appear far more graceful from the side: 

Substantial reduction of the nose bridge and depreciation of nasal tip. I realize the reduction shown is drastic and apparent, however I feel that my nose is far too large from the side and this is the best correction. In addition, correct misalignment and deviated septum to improve overall breathing as well. 

Slight chin augmentation to gain slightly more pronounced and remove the “tucked” in profile. 

Straightening of the jawline. Vertical shortening of the jaw bone to obtain the “straight” profile rather than the rounded profile( seen in the pictures). Note: This is the one that is troubling me the most. I am not sure what needs to be done for the jaw in combination with the chin. Some surgeons have commented that jaw shaving is an option. Some have said that fat grafting is the way to go as well but I am having my doubts about this one. Would appreciate your help and thoughts. Thanks:).

A: Thank you for your inquiry and sending your morphed images to which I can make the following comments:

1) As you have suspected that degree of nose reduction is not possible. The large skin envelope controls how much size reduction is possible. Even if it were possible you would likely not be able to breathe through it. A more realistic outcome is halfway between the size of the nose you have now and the unachievable small nose size you have imaged.

2) The modest chin augmentation effect is certainly able to be obtained.

3) Your jawline straightening effect is achieved by an inferior border removal between the jaw angle and chin. That is a very difficult operation to do intraorally and places the mental nerve both in the bone and at its mental foramen exit at some risk. A 3D CT scan would be needed to look at the jaw anatomy and determine exactly where the nerve runs through the bone and see how that correlates to the amount vertical bone reduction that needs to be done.

4) The alternative approach to the jawline, and one with far less risk, is to augment the jaw angle to eliminate the prominent antegonial notch which is the cause of your non-straight jawline in profile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently removed a mandible angle implant and had a retraction in the masseter, I would like to know about the effectiveness of the masseter muscle reattachment surgery.

A: Reattachment of the masseter muscle, once it has been lifted off the bone and retracted, is very difficult with a low rate of success in my experience. A camouflage approach by building up the soft tissue deficit is more effective, again in my experience..

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to know what the options are regarding shortening the nose and midface. I have yet to see actual nasal shortening described anywhere, rather people focus on tip manipulation for the illusory appearance of a truncated nose, or altering radix position. Post-op from a lefort 1 with counter clockwise rotation or impaction (during which the skeletal housing for the nose would be shortened which begs the question, what happens to the cartilage afterwards?) could a “slice” of the soft tissue nose be excised? Skin, cartilage, and septum. Following this, the nose is then simply adjusted up (the entire structure would slide up) and sutured back together. If there was no excessive gum show prior to the Lefort 1, this would accomplish shortening the nose and midface without inducing any inappropriate levels of tooth/gum exposure. Patient would be left with a small external scar across their nose. 

If this cannot be done, may I ask why? I can only imagine the limiting factor to be blood supply and not wanting a major risk of necrosis, but could the entry point be strategically placed to avoid this? Or perhaps lifting or stretching the artery to gain access without traumatizing it? 

Any help is greatly appreciated.

A: You are asking a classic midface shortening question for which, short of a LeFort I impaction in vertically maxillary excess (which really only shortens tooth show) or a subnasal lip lift (which only shortens the upper lip), there are no other effective procedures for doing so. You are understandably viewing external midface shortening as a structural/geometric exercise…which it is not. The midface soft tissues are not going to shrink or become less so with any underlying vertical structural reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 32 year old female and I have a short and chubby face. I’m considering a custom jaw implant primarily for vertical face lengthening but also a defined jaw line. Attached is a pic of my profile and another pic of someone with the jaw appearance I would like. I would appreciate your expert opinion. Thank you! 

A: Thank you for your inquiry and sending your pictures. You are spot on with your diagnosis of a vertically short lower face. While your thicker facial tissues are never going to be as defined as the ideal picture you have shown no matter what you do, vertical jawline lengthening with facial defatting (buccal lipectomies and perioral liposuction) will produce the most effective result in that regard. Elongating the skeletal structure of the lower face and defatting what lies above it is the most you can anatomically change. (technically you can also do high horizontal cheek-arch augmentation as well to create a skeletal line above it)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a more enhanced, attractive and masculine face.This also goes beyond just the custom jaw wrap around implant that I first enquired about. I am interested and willing to consider other potential enhancements to the face such as in the zygomatic areas – cheek bone implants and other possible recommendations. In short,  I want a rather significant makeover to maximize my full potential.

This issue is I have is that I put on a significant amount of weight within the last two years due to some negative personal incidents in my life – leading to the neglect my health and well being. However 2021 is a new year, and it is time to focus on my health, appearance and happiness. I have a BMI of around 35 and an estimated body fat level of 40% – classifying me as obese. 

My plan over the next 8 months is to lose about 35 – 40 kilos.  And attain a body fat % level of at least around 15%. This should provide a more reasonable analysis of my “natural facial” features.

My question is,  should I do my consultation now – However – significant fat and bloat are covering my facial features – which may impair any analysis and influence any potential recommendations. 

Or 

I have attached four photos to this email. Would you recommend any orthognathic surgeries. I know this is extremely difficult to assess just from a few random photos but an initial opinion would be appreciated ) However I would rather prefer implants or other corrective options if it could be an effective alternative.

I look forward to hearing your feedback and suggestions.

A: Thank you for your inquiry and sending your pictures. Given that weight loss would be of tremendous benefit and I need to see what the ‘real’ facial shape is when it comes time to plan and undergo male facial masculinization implant surgery, it would be better to wait until you have achieved at least 75% of your weight loss goals. At that time better facial assessment, imaging and treatment planning can then be done.

Based on the pictures provided, I do not see any indication of the need for orthognathic surgery. But that is said with the caveat that an informed opinion in that regard requires x-rays and a dental/occlusal assessment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have unique problem perhaps you can help fix.I had silicone injection in my chin many years ago and had them removed last year. It was a ball of scar tissue. After the removal  my lower lip has fallen due to loss of support. I’ve  had two previous failed surgeries where Drs tried to re-suspend the mentalis muscle. But the mentalis muscle seems to be intact and surgeries to re-suspend it higher have not worked.

Have you ever encountered a similar problem and been able to fix it I would like an appt. I presently have a chin implant but that has not helped. Perhaps something higher might fill in the gap and add support.  I am a 60 yr old transgender women and in my youth silicone injection were quite common.

A: Thank you for your inquiry and sending your pictures. You have to go back to what caused the lip to look like it does now….excision of soft tissue (scar and silicone mass). This is a soft tissue volume deficiency problem with subsequent tissue contraction into the removed tissue area which will pull the lip down. This is not a mentalis muscle problem or a skeletal chin deficiency. 

Thus to any chance of reversing it you have to add soft tissue back in through a release and dermal-fat graft….as you have suggested.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The top of my skull is completely flat and from a side view it looks really bad like if looking at a nail. I have a lot of hair, so you can’t really tell the shape of my head from a photo, but I found 2 pictures that would give a good representation of what I have going on. I was teased a lot as a child and am deathly terrified of going bald. It’s had a huge impact on my life and I just want to know if it’s possible to fix so that I can be confident in how I look and greatly decrease my social anxiety. 

A: Thank you for your inquiry and sending your representative pictures of the flat top of your head. It appears that you would like to have the top of your head augmented to a more convex shape rather than flat. That is best done by a custom skull implant which can be placed on a one hour surgery with a remarkably short recovery period.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have vertical orbital dystopia. My left eye sits lower than my right. I was hoping you could teach me more about what sort of procedures I would need to correct it.

A: Thank you for your inquiry and sending your picture. Like in all cases of vertical orbital dystopia (VOD) it is important to recognize that as the eyeball is raised what lies around it must be changed as well, particularly the position of the eyelids which will not move up with the eyeball as they have separate attachments. Thus most VOD cases consist of a custom orbital floor-rim cheek implant (made from a 3D CT scan) and upper lid lifting (ptosis repair) and lower eyelid raising. (lateral canthoplasty with spacer graft)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I was just wondering if you can have fillers on the temporal muscles as implants seem risky. I was checking if there are any non surgery ways of doing this I will attach a photo of the temporal muscles.

A: Temporary injectable filler or fat injections can be used for temporal augmentation and is good starting point to see the effects. Ultimately temporal implants offer the only permanent augmentation method and are actually the safest method as they sit in either a submuscular or subfascial position depending upon what temporal area is being augmented.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I did surgery after suffering a brain aneurysm. After the swelling had gone down I noticed this indentation in left temple. How can this be improved?

A: The indentation you have is due to loss of the temporal muscle volume as it retracted from the craniotomy procedure. Since it is a soft tissue issue it should be replaced by soft tissue. Fat grafting for your temporal augmentation would be the logical choice. While the fate of injected fat can never be accurately predicted, and it may require more than one session for the best result, it is a good approach. The other option would be to place layered ePTFE sheeting to build up the temporal depression which would be placed through your existing craniotomy incision line.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley could an orthognatic surgery help to shorten my midface?

A: No as that will make no change on the outside and will only bury your teeth under your upper lip. You can’t shorten the external midface without removing soft tissue…which is not possible in any significant amount. (only a subnasal lip lift in the patient who has a long upper lip)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I was googling whether I should have facial surgery or dental work done first and came across an answer left by you. I looked at many before and after photos and am interested in getting information and hopefully getting work done with you in the future. I understand a thorough consultation is necessary before any procedure. With that in mind, I am curious if it would be suggested I get dental work done or facial surgery first. I feel like one side of my face is completely different than the other. They are very subtle in all areas but when I look at pictures of myself I can absolutely tell. Or when I am video chatting with someone. Because my teeth are the same (one side is straighter and symmetrical, the other side has very crooked teeth and is set farther out.) I am concerned that after I get that taken care of, it may assist in making my face look symmetrical because part if the asymmetry in my face is in my cheek/jaw area.

A: To provide an informed answer I would need to see facial pictures. But as a general rule, orthodontic alignment has no impact on improving facial bone asymmetries or shapes. Orthodontics moves teeth and reshapes upper and lower jaw alveolar bone, not the basal bone which creates the external facial shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I Am interested in an abdominal panniculectomy. Am I a good candidate? I have attached some pictures for you to review. 

A:Thank you for your inquiry and sending your pictures. While resection of overhanging abdominal tissue would be of benefit your abdominal tissues are too thick as they are right now to get the best result. You would either have to lose significant weight first or go through a first stage abdominal/flank liposuction procedure to decompress the tissues and make them more moveable before the tummy tuck/panniculectomy. Otherwise doing the procedure on you now is going to result in much more limited amount of abdominal reduction improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would in my situation a lip lift + lip reduction work for this purpose? I know that my Philtrum isn’t long. I’d like, however, keep my lips “male” Thank you!

A: What makes a lip look more feminine from a lip lift is the change in the shape of the cupid’s bow….which will not be affected by a lip reduction done at the lower edge of the lip. Effeminate lips are more about shape than the size of the vermilion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Upon doing some research I am very interested in temporal reduction surgery. I am 22 years old and have been losing my hair for the last couple of years. I have always had quite a wide head but when I tried shaving my head I was shocked at how big it looked. It was shaped like a lightbulb, a smaller face with getting wide above the ears. My head has always been noticeably round and big but when shaved it looks huge. Before I heard about this surgery I had contemplated getting some kind of skin tightening procedure done because when I would pull the skin on the sides above my ears, it would give my head the appearance of a much more straight look and the change was rather dramatic. I have included a photo of me with hair. When shaved the head looks significantly wider. 

A: Thank you for your inquiry and sending your picture. You have correctly surmised that temporal muscle removal surgery is the only method that can address your side of head shape/width concerns. Skin tightening/lift is not an effective solution for it no matter what you can demonstrate with your hands. Whether temporal muscle reduction surgery can be effective can be partially demonstrated by widely opening your lower mouth/lower jaw and see what happens to the width at the side of your head above the ears.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, As you see the cheek that I left a red mark on is way bigger/rounder which makes my left part of my left cheek / under eye area look fuller and bigger which makes it look asymmetrical.I know it looks like its mainly fuller/more fat but its really the bone. When i feel that area and compare it to my right side its fuller, bigger, rounder and there are more bone on my under eyes, What can be done for this? My right side contour is slimmer / more lifted because the bone is not so round/big like the left side. I hope you understand me. Fillers or fat are not a option because i want it to look like the right side which is the slimmer/better contoured side.

A: Thank you for your inquiry and sending your picture. You are in need of cheekbone reduction surgery of which the only question is what would be the best reduction technique for its size/shape. I would need toa 3D CY scan of your cheeks to best make that determination but most likely it would be an intraoral cheekbone wedge osteotomy to help narrow it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Here are the photos, I’m not exactly sure which surgery I want. I just want a normal looking forehead. If you can look at the photos and give me suggestions on what you believe is the best option for me that would be appreciated. Thank you.

A: Thank you for your inquiry and sending your pictures. First we have to define what constitutes a normal forehead for you which by your description is one of reduction. Whether that is the forehead above the brow bones or includes the brow bones needs to be clarified. I have attached some side view imaging just to get a feel if this is the type of forehead change you may be seeking. Secondly, regardless of the change desired, you have a major aesthetic concern with any type of forehead surgery as all men who shave their heads do (and even in many men who don’t)…there is no favorable location to put a scalp incision to do the surgery. I would aesthetically question the tradeoff of a scalp scar for a forehead contour change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to have my forehead augmented using PMMA bone cement. I understand a coronal incision may be needed but I believe bone cement is my best option for permanent results. Silicone has a long term risk of infection. The sides of my forehead have an indented look which makes the middle part look more prominent. I would like to fill in the side part only too make my forehead one even shape (not my temples but my forehead). I’ve spoken to another doctor and he said he’d do it so I would like to know if you feel comfortable doing it. In the pictures below I would include a picture of me in a lighting where you can see what I’m talking about. I also will circle the area I will like to have filled in, it won’t take a large amount of bone cement. Thank you.

A: In answer to your forehead augmentation questions:

1) The incisional approach to your forehead augmentation would be your existing frontal hairline incision not a coronal scalp incision. It would take a long ear to ear coronal scalp incision to access the forehead as it is way far back. It is more direct and safer to use the existing frontal hairline incision.

2) I believe you are looking to augment the sides of the forehead or the bony temporal lines which you have indicated and I have as well. (see attached) This is the transition zone between the bone and the muscle and the actual area you are trying to augment is not bone but largely muscle fascia. Understanding this anatomic concept is extremely important when determining how to augment it.

3) Trying to put any form of bone cement on muscle fascia is an aesthetic complication waiting to happen. That is an unstable surface to which bone cement will not bond to. For that relatively small area that is almost all muscle fascia I would use a soft tissue augmentation material like ePTFE (Goretex) A 2mm piece cut to the size of the defect with the edges feathered and placed through the hairline incisiion would be what I would do. The hardest thing to achieve along the bony temporal line with any material is an edge transition that is not visible on the outside. ePTFE gives one the best chance to do so.

4) In reality a custom premade silicone implant from a 3D CT scan is the best method to augment this area (I have never seen an infection with them in 30 years) but for cost reasons I think ePTFE is a good alternative option.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know if I could replace my actual 530cc biconvex buttock implants for 1050cc buttock implants on the same pocket?

 Also can I then put the 530cc implants out on the side high hip area?

So i would like to put the 530cc biconvex on the lateral depression area of the buttocks.

A: These are not buttock implant procedures that can be done:

1) you can’t double the size of an existing buttock implant

2) you can’t place implant in the ‘lateral depression’ buttock area

Both are types of implant procedures that exceed what the tissues can tolerate and will have a 100% assurance of complications of attempted.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, Hello, I do have a small lower jaw in general (midpoint of lips to end of chin 3.6cm) and wanted to ask if its possible to vertical lengthen the lower third by approximately 2 to 2.5cm (whether it involved jaw surgery and or/genioplasty/custom implants – or a combined approach) or is a increase that high not doable? 

Thanks

A: I assume when you are referring to lengthening the lower jaw you mean the entire lower jaw from angle to chin. Changes in the range of 2 to 2.5cms are not possible particularly at the chin area as the soft tissues will note permit that type of stretch…and I have yet to see someone who really needs that much lengthening. Patients understandably overestimate the degree of change they need because they can not factor in the effect of what happens at the bone levels to the changes seen in the overlying soft tissues.  Vertical jawline lengthening more in the range of 1 cm is more realistic.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, recently I had buttock implants and although they look nice, my butt now looks too big for my legs. I read in one of your replies where you mentioned that thigh implants are available to be used for behind the buttock area. 

A: Thigh implants are for the anterolateral thigh area known as the quads, not for the back of the leg or the hamstring area.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a sliding genioplasty 7 years ago and have had tightness for years and recently figured out I have adhesions under my chin. I had an area of hair loss under my chin in the beard where there are adhesions. However, with massage of the area for the last few days I’ve noticed the adhesions seem to be improving and also the beard hair is growing back (after years!). Is there any utility in PRP/steroids/5-fu or is just continuing to massage the area best. I also was going to look into surgery but think now perhaps that’s not necessary.

Appreciate your help.

A: There is certainly no harm from massage or any injectable therapy around or into the sliding genioplasty site. Time will answer the question about their long term effectiveness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a forehead, supraorbital implant, how do you prevent the raising of the eyebrows that occurs with this augmentation? 

Ive had a brow bone implant and took it out because it made my eyebrows very high due to the lift and push up and out effect. 

Is there anyway to fix this?

A: That is not an eyebrow effect that I have ever seen from a custom forehead-brow bone implant. That sounds like a placement/implant design issue. Unless one has a lot of experience it is very easy to get a brow bone implant placement too high (inadequate supraorbital release) or have an implant design that does not get the brow bone effect low enough.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a moderately recessed chin and my bite is class 1. What I noticed on my lateral cephalogram (and by felling the chin) is that my soft tissue pad is very thin. The bone is more or less normal size, but the thin soft tissue and thick lips make it look recessed even more. 

Is it possible to bulk up the mentalis muscle a bit to give the impression of a stronger chin? Or would it produce counter results – I read a study that found using Botox to relax the mentalis muscle actually made the chin look horizontally stronger. 

Thank you and kind regards

A: There is no surgical or non-surgical method to make any muscle of facial expression bigger in size. I can not imagine the biologic mechanism by which Botox (which causes muscle atrophy) would make the mentalis muscle bigger nor make the chin look stronger by muscle relaxation. But I know one way to find out…do it and see what happens.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am now three weeks after my sliding genioplasty and jaw angle implants. I have more questions as I am starting to be able to chew and I’m stretching my mouth multiple times throughout the day.

My mouth feels dry all the time is that why my sutures haven’t fallen out yet? Should I constantly swish water around my mouth?

As I’m starting to eat more food I’m cautious to eat anything that could get stuck around the sutures. Could that cause an infection? 

Is it possible to stretch my mouth so hard I mess up a suture? 

Is there an estimate when my mouth will open up normally? I’m fitting about 1.5 fingers in currently.

Will my normal smile return? Is there an estimate time frame of that happening?

Can I chew mastic gum to strengthen my jaw back to normal?

Can I get a tattoo?

Can I resume allergy shots?

Can I start light exercises(push-ups, pull-ups, abs)

When can I start lifting heavy weights?

A: In answer to your post surgery sliding genioplasty and jaw angle implant questions:

1) There is no correlation between mouth dryness and sutures dissolving.

2) You are rightfully cautious about food getting stuck in the sutures in the first month after surgery.

3) Wide mouth opening does pull on the sutures in the lower vestibule.

4) Keep working on stretching and it will eventually return to a normal range of motion.

5) A full smile will return when the tissues in the chin heal and relax. This a function of tissue stiffness/stretch that is temporarily affecting a normal smile movement.

6) Now is not the time to be chewing gum.

7) A tattoo anywhere other than the face is fine.

8) You may resume allergy shots.

9)You can start light exercise any time.

10) I would wait to resume heavy weight lifting until one month after the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Could you please check my case and tell me the best technique to reduce my ear size also and the expected vertical length after surgery nothing that the current length is 70 mm also I want to know the probability of both ears will not be identical after the surgery.

Thanks

A:Thank you for your inquiry and sending your picture. There are only two techniques for reducing ear size (vertical ear reduction), the scaphal flap for the upper half of the ear and earlobe reduction for the lower half of the ear. Maximal vertical ear reduction occurs when both are done together, if indicated, which in your case they are not. You have a normal earlobe size which means only the scaphal flap technique would be used. As a general rule your vertical ear height would be reduced from 70mm to 63/64mms maybe more.Provided that the ears are not significantly different in shape/size now I would expected there not to be any significant asymmetry afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have always been super self conscious about the width and size of my back. I lost weight and my back is just huge and I’ve realized no weight loss will create a feminine look of my back. I’ve always wanted a smaller back and didn’t know if there are surgeries to reduce the width and size of my back. My broad shoulders look beautiful in the front because I am 5’7” 131 pounds. Just in the back it makes me look chunky and less feminine and very boxy. I just want to be able to have to have a smaller frame and more delicate look. I always get confused because I take pictures like this and my back looks massive and makes me look large and I take other pictures and it looks like my back is super skinny and contoured. Through other people taking my picture I have seen more that my back is just super wide and i just am looking for a way to reduce that upper and mid section of my back I feel like my arms stick out like a triangle. I hate this and would love to fix it at some point. 

A: Thank you for your inquiry and sending your picture. There are not any surgeries specifically for reducing the width of the back. The only operation that may affect the width of the back is shoulder reduction combined with upper liposuction but i don’t think that would have much effect on where your specific concerns are. (see attached imaging)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a double jaw surgery with genioplasty and rhinoplasty six weeks ago. My lower and upper jaws were advanced and my chin was made too pointy (width was decreased in an attempt to make it V-shaped) and increased vertically as well. I don’t think there’s any way to increase the width of my chin anymore, but I want to at least reduce the vertical height and also slide it a bit back. It was advanced 15mm vertically and 10mm horizontally. I want it reduced full 15mm vertically (or at least 10mm) and 5mm horizontally too. How long should I wait for that ? Considering I also had double jaw surgery and rhinoplasty in my surgery. Also, is it possible to increase the width by placing the bone in the space so created in genioplasty, and thus aligning it with the bones of previous chin. I feel that if it is done now maybe the width can be regained if complete reversal of genioplasty is done.

A: While I would have to see some postop x-rays to answer your question in a more fully informed manner, the chin bone movements as you have described seem plausible but a bone graft would be needed for the widening effect. (the vertical reduction is not going to create the graft needed as that is just a space that is not filled in with bone). You make these chin changes when you are certain that they needed to be done…which most patients know when they are 6 weeks out from surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’d like to know if this kind of facial look could be achieved through osteotomies and/or fillers. Or maybe osteotomies plus fillers. I’m a bit scared about the implants infections. The first two photos are about me, the third photo the model look I’d like to achieve, augmenting jawline and zygos (ogee curve). I’d like also ask if my face/midface could be shortened.

A: Since you have provided only a front view the most major change appears to be that of the jaw angles. Short of implants temporary injectable fillers would be the only option to widen your jaw angles or augment the cheeks areas. Short of a subnasal lip lift (which you do not need) there are no midface shortening procedures.

The one caveat would be that of the zygomatic sandwich osteotomy (ZSO) for the cheeks. But there is no osteotomy to widen the jaw angles.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr Eppley, Attached are before and after photos of me having received chin filler. I am seeking a permanent solution and I am possibly interested in setting up a virtual consultation and traveling to you as it seems you specialize in this procedure. Could you provide me information on your pricing?Do you feel I would need just a chin implant or if there is a different procedure you’d recommend? How long I would be out of town for? And would I have to wait for my filler to dissolve before getting treatment? My desired results are those from the first screenshot with the pink blush. 

Thank you! I look forward to hearing from you.

A:Thank you for your inquiry and sending your pictures. By looking at the chin filler change that appears to be about a 5 to 6mm horizontal advancement change. I even did my own imaging of what the type of chin augmentation change I think you are looking to achieve. Given this modest amount of change I would go with a chin implant as opposed to a sliding genioplasty. You would not have to dissolve your filler before having the procedure.

Dr. Barry Eppley

Indianapolis, Indiana