Questions about Head Width Reduction, Tear Trough Implants and Jaw Implants

Q: Dr. Eppley, I hope this message finds you well. I understand that you’re very busy, so I apologize if I’m asking too many questions. If answering all of them is too extensive that’s totally understandable. I’m potentially interested in three procedures—head width reduction, tear trough implants, and jaw implants. I’ll address each separately: 

Head width reduction: The area of concern is above my ears until the top of my head. My head is just quite wide and always has been. From reading your blog, my understanding is that the area right above my ears can be reduced by extracting muscle. However, what about the uppermost area on the side of the head? My understanding is that area is made up of bone. Would bone burring and muscle extraction have to be done to narrow the entire sides of my head? Also, if burring were necessary, would the incision have to be made on the side of the head, or can it be made on top? The reason I ask is because a scar or hair loss on top of my head would be easy for me to hide, but not so with a scar on the side. 

Tear trough implants: This is pretty straightforward. My tear troughs are pretty hollow. I’ve tried fillers, but they don’t seem to give me the result I’m looking for. I’m wondering if it can be corrected with custom implants, especially because I have asymmetry where my left under eye hollow is deeper than my right. From my research on RealSelf, it seems some surgeons are not big fans of this approach. Some claim there are complications and that nowadays there are better methods. I guess my question is, do you believe there is any validity to those claims? 

Jaw implants: Although I wouldn’t say my jaw is particularly weak, I’m looking to get a more chiseled, masculine jawline. My own intuition makes me feel that wrap around implants would produce the most natural and best outcome. However, I’m not looking for much of a change to my chin, as I believe the main issue is with my jaw. I may want to advance my chin a mm or two, but that would be about it. Is it possible for a wrap around implant to be designed to mostly augment the jawline but mostly keep the chin the same? I know that implants for only the jaw exist, but based on my own intuition I feel wrap around implants produce the most natural result, as there is a smooth transition around the entire jawline. With just jaw implants I feel that may create a bit of a step off that may not transition smoothly to the chin. Obviously I’m not an expert, so I don’t know if there’s any validity to this. Second, I’m only looking for a slight enhancement of my jawline, but not to completely change it. From my research it seems that patients who are unhappy with jawline implants generally feel they were too wide. To play it safe, I’d look to augment my jaw by only a few mm, may 3 to 5. From your experience, will 3-5 mm have a noticeable effect? Lastly, my jaw is asymmetrical in that it is tilted towards one side and my right side is rounder than my left side. I think this may in part be due to my right cheek being wider than my left cheek. Is this jaw asymmetry something that can be predictably corrected with custom implants? 

A: In answer to your questions:

1) To reduce the very top of the sides of the head, known as the anterior temporal line, an incision would have to be placed somewhere near it. Perhaps closer to the top of the head than the side.

2) Having put in many custom infraorbital rims implants (which work far better than standard tear trough implants) I have observed that this is the far superior method. I would put little stock in any surgeon that has no knowledge or experience in the complete gamut of infraorbital rim augmentation methods.

3) Like all custom implants designs they are based off of the patient’s 3D CT scan. With that skeletal information one can learn a lot about the patient’s natural anatomy, what asymmetries and proportionate relationships exists and now to design the implants to account for those issues.

Dr. Barry Eppley

Indianapolis, Indiana