How Can I Get A Jawline Straightening Effect?

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