Chin Widening Surgery

Q: Dr. Eppley, I initially had a very broad, and blunted rectangular face. I desired a more oval face and thus pursued surgery in South Korea. My chin tip was narrowed by 7mm, my jaw angles were amputated and the outer layer of my mandible was also shaven off. 

My face is definitely thinner and longer now, but it’s not the shape I had been hoping for. My face shape went from broad and rectangular, to a heart shaped face. My chin tapers in slightly when I rest my face with no expression, instead of the oval U shaped curve I was wanting. 

What bothers me most now is when I smile. My surgeon failed to alert me that the shape of my smile would be so drastically affected with these surgeries.

Prior to surgery, my face was very round and full when I smiled. Now, when I smile with teeth showing, from the ears down, it is an upside down triangle. The chin is extremely tapered in and I just feel it doesn’t look natural at all. The chin tip is also extremely small and its width is probably less than 3cm wide. 

I really hope you will answer my enquiries because I really don’t know where to start to rebuild my face to what I wanted it to be.

(1) I am looking into chin widening surgery. How much can the chin tip be widened with an interpositional bone graft before a step off is visibly noticeable when smiling/tissues stretched back on the bone? Would this surgery keep the curve to the chin or make it more square (ideally not square.) If I were to reinsert a 6mm bone graft, that would logically create an excess of 3mm on the sides of the chin that do not blend into the jaw line. Would 3mm create a visible dent or step off in the face line when I smile?

(2) Is the extreme tapered-ness of my chin when I smile with teeth from the outer layer shaving of the mandible or from the amputation of the jaw angles?

(3) To be quite honest, I like that my jaw angle now starts from below the ear and do not wish to add any vertical length here. Therefore, what area would I need to augment in order to get a more rounded face when I smile? Would I need to augment the back jaw angle in order to get the oval face shape I desire when I smile?

(4) I said in my previous email that I would ideally like to steer clear of silicone, ideally medphor as well. If nothing else can be used then I would need more time to wrap my head around it and get over these feelings. Can whatever augmentation materials I need be pre-formed implants using acrylic PMMA or hydroxyapatite or any more biocompatible materials?

Attached is a photo of my smile.

A: In answer to your chin widening surgery questions:

1) A 6mm interpositonal graft should not make the chin look too square. If any step-offs occurred to the side of the chin they could be shaved down at the same time.

2) The extreme tapering of your chin when you smile is from the loss of bone from the sides of the chin primarily. There is not enough support for the soft tissues as they retracted upward from smiling.

3) Getting a more rounded face now has nothing to do with the jaw angles. It is what is done to the chin and the bone right behind it.

4) Trying to make bone cements to work for the chin/anterior jaw widening effect is not going to work as well as preformed implants. But the use of hydroxyapatite cements is a possibility. It is not ideally made for this type of onlay facial bone application but an experienced user can do it.

Dr. Barry Eppley

Indianapolis, Indiana