Q: Dr. Eppley, I currently have separate Medpor chin and jaw angle implants. I also understand that you do custom facial implants using a person’s CT scans. My question is, assuming that I would like them replaced with a custom one-piece total jawline implant further down the road, would I have to remove the current implants before proper modeling can be done, or will you still be able to customize the jawline implant with the current implants still in place? Also, would the removal of these Medpor implants be possible? I’ve been to your blog and I understand that you’ve always stated that Medpor removal is possible, but hearing many other surgeons claim that it is impossible makes me a little afraid. Anyway, my preference would be to have the removal of the existing implants and placement of the new implants done together, as it would mean one surgery only. Regardless. kindly let me know what my options are.
A: The answers to your questions are as follows:
1) You can have CT imaging done with your Medpor implants in place. Medpor implants are not picked up especially well by CT scans and they do not appear in the images.
2) Your Medpor implants can be successfully removed, I have done it many times. They are not nearly as easy as silicone to remove but far from impossible to do so.
3) Removal of your existing jaw implants and their replacement would be done during the same surgery.
Dr. Barry Eppley
Q: Dr. Eppley, how much do jaw implants cost roughly? If someone already has a decent jawline but would like to enhance it would that cost be less as opposed to someone who needs a lot of work done?
A: The main difference between the cost of jaw implants, and I will assume you mean combined chin and jaw angle implants, is whether off-the-shelf implants can be used or whether custom ones have to be designed and made. Since you already have a decent jawline and ‘only need a little work’, I will assume standard chin and jaw angle implants can be successfully used. There are differences in these types of implants and the materials from which they are made and this also affects cost. But I will make the assumption that silicone chin and jaw angle implants can be used. Using those inmplants, the total cost of chin and jaw angle augmentation would be around $ 6500.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 28 year old male. I would like to have Restylane injected under my eyes in order to reduce the appearance of my eye bags/dark circles. Is this something that you would do often at your clinic? Am I a suitable candidate? I would also like to increase the definition of my jawline/chin. Have you ever made a more male, square, enhanced jawline/chin by using fillers alone, such as Radiesse? Or would I need to get jaw and chin implants? Do you do this procedure often? I don't like the way there is a slight double chin at certain angles, as you can see in the photo, would fillers get rid of this or would I need a chin implant? The last three photos are of jawlines that I would like mine to be more like.
A: When you look at all of your facial issues combined, they have a similar theme…an underlying bone deficiency. In the words, you are structurally weak. This is particularly relevant in the lower eyelid area where the problem is a recessed infra-orbital rim and cheek bones. That is why you have this appearance at such a young age. The chin and jawline issue is not as weak as it is just your desire for a much stronger one.
As for injectable fillers, they are a poor treatment for the under the eye area and are absolutely a contraindicated treatment for the chin and jawline. While injecting Restylane under the eyes can be done, I have never been that impressed with its results for your particular problem and it is only a temporary fix at best. Irregularities are very common in this area with injectable treatments that will persist as long as the filler lasts. You would be much better served by a combined infra-orbital/malar implants in this area which would correct the entire problem from the rim to the cheek and be permanent. From a jawline perspective, every young male shows me male model/actor pictures just like the ones you have shown. Those type of results are only obtainable with chin and jaw angle implants, ideally custom made ones that connect the chin and jaw angles in one smooth line.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 25 year old man with a normal mandible angles but a slightly weak chin that has a little steeper angle then the rest of my jaw. Anyway I have been considering a square wrap-around or extend chin implant to slightly increase the width and moderately increase the forward projection of my chin But I am concerned that a chin implant will make my jaw angles appear greater so I was thinking a combination of a chin implant with jaw angles might be right for me. So my question is generally speaking do you think that those people who undergo chin augmentation would benefit from jaw angle implants that increase the vertical height of the ramus decreasing the angle.(for me I think part of the reason my angles seem so square is because my chin is undersized and the angle is about 90 degrees but then after the groove increases to about normal dimensions) And then my second question do you have an photos that demonstrate the depression that is formed when off the shelf chin and jaw angle implants are used together?
A: There are no general statement that can be made about the influence of the chin on the appearance of the jaw angles. Each patient’s jawline and facial anatomy is unique and must be considered individually. The best way to answer your question is through computer imaging…change the chin without the jaw angles and see what it looks like. That is the best way to answer that question. You are correct in assuming that most standard chin and jaw angle implants do not meet in the ‘middle’ (body of the mandible) and, even if they do, these are thinnest and most tapered aspects of the two implants. Thus it is possible the jawline might not be perfectly straight from the chin back to the jaw angles and usually isn’t. But whether that occurs or not and is aesthetically significant depends on each patient’s jawline anatomy and the implants used.
Dr. Barry Eppley
Q: Dr. Eppley I´m a 34 year old healthy man interested in enhancing my poor defined jaw line. Have read some awesome reviews of your work and feel really drawn to having this aesthetic implant procedure performed by you. It would be easier and less expensive to go to another country but I really feel you should be the one to treat my case. I would like to know the average cost and the downtime it will require. I´ll be more than greatful for any info you can provide me with.
A: The most important decision in regards to jawline enhancement with implants is whether stock preformed or custom implants would be most beneficial. I can make that determination by looking at some picture of your face from different angles. The critical determinants of whether custom jaw implants are needed are the size of augmentation that a patient desires, whether there is any significant vertical increase needed in the jaw angle (and the chin) and whether a smooth continuity of the jawline from the chin back to the jaw angles is desired. Until that determination is made, it is not possible to give an accurate cost quote. But as general guideline, off-the-shelf chin and jaw angle implant surgery is around $8500 while custom chin and jaw angle surgery will be nearly double that cost. Either way, recovery is the same which is largely about facial swelling which takes about three weeks to go down and look normal again.
Dr. Barry Eppley
Q: I am 22 year old male who is seeking multiple procedures because I really do have numerous facial structures that need improvement as clearly evident in my pictures (attached). My concerns and procedure desires are as follows:
1. Rhinoplasty: I’d like nasal hump reduction, narrowing of wide nasal bridge, and nasal tip contouring. I’d like my nasal tip to be more forward and slightly downward projecting.. I believe forward projection of my nasal tip will make it slightly pointed and thus give my nose a forward direction (rather than being bulbous and appearing as if it is just sitting on my face without direction). Also, all the parts of my nasal tip (i.e. the middle part and two sides) are curvy, and I believe increasing forward projection of my nose will stretch and thus straighten out all the curvy parts (For your reference, the vision I have for my nose is reflected in the nose of David Duchovny, the actor.)
2. Septoplasty: I’ve severely deviated & tortuous nasal septum that is almost completely obstructing airflow in my left nostril and also causing my nasal tip to be asymmetric and bulbous.
3. Lip enhancement: As evident in the picture, my upper lip is feminine-like because most of the visible lipular (pink) tissue is in the central part of the upper lip and sides have almost no visible lipular tissue. I’d like my upper lip to have even visibility of the lipular tissue.
4. Lip reduction: Also evident in the picture, my lower lip is quite large and droopy/bulky and I’d like to reduce it perhaps by at least 50 percent.
5. Chin and jaw/jawline implants: Also evident in the pictures, my jaw is really small in all dimensions. I’d like big chin implant and other jaw implants to increase the vertical height and width of the jaw in order to have more masculine look.
6. Buccal lipectomy: I also feel that I’ve lot of fat on my cheek bones that is more evident when I smile. I’d like to remove this and possibly place cheek implant for more masculine look.
7. Zygomatic arch reduction: At last, my zygomatic arches are curved (rather than straight, which is Caucasian feature) giving my face broad and round appearance. Jaw implants would help balance this by widening my lower-face so it matches my wide mid-face, but I’d like to explore possibility of reducing my zygomatic arches.
A: Thank you for sending your pictures. In many ways, what you are really after is what I call the ‘male model face makeover’. You are trying to structurally change your face to be more and attractive and masculine. By definition, this involves numerous combined facial procedures. I have done some imaging and will answer your numbered comments as follows:
1) Septal and Rhinoplasty surgery is done together and is known as a Septorhinoplasty. The concepts of lowering the dorsal hump and narrowing the tip and nasal bones are standard. Your concept of lengthening the nasal tip and bringing it down is not how the tip becomes more refined and is not the movement you want the tip to go. The tip is narrowed and defined by how I change the shape of the tip cartilages. If anything, the tip is already too long and down too low. It actually needs to be slightly shortened and lifted to have more of a defined narrow tip. Also, it is not a good idea to use other people’s noses as targets. You have a completely different anatomy than that mentioned person (your skin is much thicker and your cartilages are much bigger) and you can not get that nose. You can only work with and modify what you naturally have, not make it look like someone’ elses nose.
2) Septal straightening and turbinate reduction is done at the same time as the rhinioplasty.
3) You would benefit by a subnasal lip lift to create more vermilion show but that can not be done at the same time as an open rhinoplasty.
4) Your lower lip can not be reduced as much as 50%, that is not realistic. Perhaps 10% – 30% reduction can be achieved.
5) A square chin implant and inferolateral jaw angle implants will make your jaw and lower face more balanced o your upper face.
6) Small cheek implants will a buccal lipectomy will enhance your cheeks. These are very difficult to image so those results can not be visually predicted very well.
7) I would leave your zygomatic arches alone. They are fine and only look big because of the smaller size of your lower face.
Dr. Barry Eppley
Cosmetic plastic surgery has long been unintentionally gender-biased. Since the field began, the vast majority of patients who seek cosmetic enhancements, albeit it surgery or office-based treatments, have been women. Men have always made up less than 10% of most plastic surgery practices. Hollywood would lead you to believe otherwise but it just isn’t so. The only rare exception to that has been the more recent popular treatment of laser hair reduction. When it comes to hair removal, men make up about half of the patients seen with the hairy back and shoulders being the prime targets.
But more men are finding their way into the plastic surgeon’s office in the past few years. Besides a steady increase in male numbers, what is noteworthy is the change in what what men are requesting. While there remains some traditional procedures that have always been of interest, technology, societal trends, and younger men have opened up new areas of the face and body for change and improvement. Here are four of the most popular younger male (teenage to early 40s) procedures today.
Liposuction still remains the most requested male procedure. The culprits are always the same, the stomach and love handle areas. But most men that want liposuction are not fat and many are not even overweight. To the contrary, they are lean but have fat collections at the side of the waist and flanks. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques can even give that ‘six-pack’ look for those leaner men that are not opposed to a little surgical cheating.
Chest recontouring is the one male plastic surgery procedure that is really on the rise. Male breast enlargement, known as gynecomastia, has always been an issue. But with increasing teenage weights and the present young male aesthetic for a completely flat and smooth chest, improvement in the male chest is sought out like never before. Even small nipple protrusions can be bothersome for the teenage male. Obvious man boobs are not desireable at any age.
Nose reshaping (rhinoplasty) has always been a popular male operation and that has not changed. It is the one procedure of the face that young men are not afraid to change. Noses that are big with prominent humps and wide nasal tips are bothersome and distracting to an otherwise balanced face. Sports and recreational activities make the young male nose a good target for injury causing twisted and deviated noses that often pose problems for breathing as well.
One set of procedures that is really new and undoubtably influenced by movies and models is structural facial reshaping. Creating that chiseled and angular face is what some young men aspire to achieve. A good jawline in particular is associated with enhanced masculinity. While one perceived just as making a strong chin with an implant, modern plastic surgery implants can be extended all the way to the back of the jaw. With the development of jaw angle implants, the jaw line can become more defined than just with a chin implant alone.
A new generation is redefining male plastic surgery. Have a lean body, flat chest, and a nose and jaw line that creates a well defined face has probably never been out of style. But modern surgical developments make them more attainable than ever before.
Dr. Barry Eppley