Your Questions
Your Questions
Q: Dr. Eppley,I am seeking a facial profile enhancement. I am not happy with the way my profile looks. I would like your recommendation. I have a deviated septum so a rhinoplasty at the same time might be possible? I also have an overbite and I was wondering what you would recommend for receding chin… orthodontics or cosmetic surgery.
A: It is very common to do a septoplasty and rhinoplasty at the same time, known as a septorhinoplasty. You do have a short chin and treating its deficiency combined with neck liposuction would provide the best result. With an existing overbite the question is how significant it is and whether you are prepared for the commitment of a combined orthodontic-jaw advancement surgery treatment program. (orthognathic surgery) If not then a chin implant or sliding genioplasty would be the cosmetic treatment options. A rhinoplasty, chin augmentation and neck liposuction could all be done at the same time for a significant facial profile change. (facial profile enhancement)
A combination of nose, chin and neck changes can make for the most powerful and significant change in one’s facial profile that is possible. It usually takes at least two changes in one’;s face to create the optimal facial profile enhancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I originally sought rhinoplasty due to great discomfort concerning the projection of my nose. The tip feels enlarged and out of proportion to the rest of my face as well as deviating to one side. However, after speaking with a surgeon, I have come to learn that my jaw is retrusive which makes my nose look larger. I would like to know whether or not you think I would benefit from both jaw and rhinoplasty surgery, or whether you think one or the other would be enough to balance my face. I have attached some photographs in this email.
A: Thank you for sending your pictures. I think it is quite clear that in looking at them that the short chin/jaw is a far greater contributor to your profile concerns than that of the nose. Like many profile concerns, it is really a ratio of the nose:chin in looking at the deficiency and where the greatest improvement may come from what procedure. In your case I would put it at 80:20, jaw:chin. While chin augmentation will make a major difference, a rhinoplasty where the tip is thinned and a bit shortened will make for an even better result.
In many cases of rhinoplasty, the chin augmentation that may be done with it is complementary to the nose changes. But in your case it is the reverse…the rhinoplasty would be complementary to the chin augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a more elongated lower 3rd of my face with less of a square look. I previously had liposuction done underneath my chin but it has never improved. Will the chin augmentation improve this area? Also, approximately how much length in mm is needed to achieve what I am looking for? Thank you!
A: You have a very distinct chin augmentation need. Your square jawline and distance between the base of the nose and the chin indicates that there is a vertical lower facial deficiency. I would not have expected liposuction under the chin to change what is a skeletal issue. There are twi fundamental approaches to managing a vertical lower third of the face deficiency. If it is just located anteriorly a vertical lengthening sliding genioplasty or a custom vertical lengthening chin implant can be used. If one feels the entire jawline is vertically short from front to back only a custom jawline implant that lengthens the entire jawline can be done. In looking at your face my feeling is that a vertical lengthening sliding genioplasty would probably be the best choice. In my experience at least a 7mm vertical increase is usually needed to make a noticeable vertical chin augmentation change. This is done by an open wedge bony genioplasty where the front edge if the bone rotate down while the back edge of the bony cut keeps the bone in the same position. The exact measurement of vertical chin lengthening needed can also be determined by two other methods. One can open their lower jaw to the vertical chin length that looks good to you and measure the created distance between the front teeth. One can also take measurements of their facial thirds and then see how short in millimeters the lower facial third is. I would do both methods to see how well they correlate so you can select the most effective vertical chin augmentation improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think my eyes are slightly uneven but I doubt anything can be done about that and that’s okay. I would like to change the prominent eyebrow structure from the center of my face extending to the outside supraorbital ridges. (brow bone reeduction) They are also slightly uneven. People often ask me if mosquitoes bit my eyebrows. The other thing that bothers me is my weak jaw line. I push my lower jaw out so its less obvious. (chin augmentation)
I know I will never look like a super model, its not even something that I want. I would just like a more symmetrical, angled, softer looking face. Thank you so much for your time and effort, Dr. Eppley. I hope it’s what you need in order to assess for possible procedures.
A: Thank you for sending your pictures. What they should is considerable brow bone protrusion from the glabella to the outer orbital rim. Even without x-rays I can tell that is due to significant frontal sinus hypertrophy and will require an osteoplastic bone flap setback technique for your brow bone reduction and not just burring alone to get a significant reduction. The brow bone protrusion you have is very similar to what I see in men with two distinct medial brow bone mounds. The slope of your forehead is also fairly retroclined and it would be ideal to augment the upper forehead at the same time to really change the entire shape of your forehead.
From a chin standpoint, it is both horizontal and vertically deficient in regards to being in balance to the rest of your face. While a sliding genioplasty would be the historic solution (due to the need for increased vertical chin height), my newer vertical lengthening chin implant (small size in your case) would work well as it brings the chin both forward and down. (at 45 degrees) This would a very good solution for you that is more cost effective than a sliding genioplasty with a much quick recovery as well.
Now that I know exactly what need to be done, I will have my assistant pass along the combined costs of the procedures to you on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin augmentation and rhinoplasty after our consultation? What are the logistics of the actual procedure…i.e, time needed to recover, possible adverse short and long term effects, are the results permanent or will it need to be altered down the road to maintain its new shape, and are allergic reactions to the implant material common?
Another concern of mine is that I train in jiu jitsu (it’s like wrestling pretty much) so would the implant possibly be jostled loose if I were to get knocked in the chin? If so, would the sliding genioplasty yield similar results or no? I do like the chin implant.. just worried that it could be a potential problem.
A: The combination of rhinoplasty and chin augmentation is a very common facial reshaping surgery because of its dual benefits in changing two important areas of facial prominences. These are outpatient procedures done under general anesthesia. The most significant recovery is the first week when the nose will have a tape and splint dressing and the chin will be the most swollen. After the first week the nasal splint comes off so it is easier to be seen out in public without having had obvious surgery. Most of the swelling is gone by about three weeks after the procedure although it really takes a full three months before one should critique the results.
Both the rhinoplasty and chin augmentation create permanent effects through bone and cartilage modifications (nose) and the placement of a non-degradable implant. (chin) There is no such thing as an allergic reaction to a silicone implant although there is the rare occurrence of the risk of infection (1% or less) The chin implant will be secured in placed by small screws so between screw fixation and the enveloping scar that occurs around any implant, it will never move regardless of almost any degree of physical contact. You would have to break the bone to move the implant.
The biggest risks or need for revisional procedures for either a rhinoplasty or chin implant are aesthetic in nature…how does it eventually look and is the patient satisfied. The overwhelming reason for revision of any facial aesthetic procedure is the patient desire for additional changes/improvement in the shape of the nose or chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a weak chin making my side profile look really bad. I think its was because of a overbite. I have been wearing braces but I just want to have a good profile. Can I still get a chin implant? I don’t care about my overbite so I’m not thinking of getting jaw surgery. Will a chin implant with wings be a good alternative?
A: If mandibular advancement (orthognathic) surgery is not going to be done and of that you are certain, then attention can be directed to its aesthetic enhancement or camouflage. Chin augmentation can be done successfully using either a chin implant or a sliding genioplasty. Whether a chin implant is best for you depends on how short your chin is. Off-the-shelf chin implants do not exceed 10 to 11ms in horizontal projection so very short chins in men may be inadequately treated by a standard chin implant alone. I would need to see a front and side view picture of you to determine how successful a chin implant would be in your case. These pictures would be used for computer imaging to determine how much increase in chin projection is needed based on measurements and different changes in chin dimensions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about chin augmentation. I am on Remicade for Crohn’s disease and was wondering if you have experience working with patients on Remicade and any recommendations you might have for them when undergoing chin implant surgery.
A: Remicade or infliximab) is a TNF-alpha (tumor necrosis factor alpha) blocker used to treat inflammatory bowel disease. (IBD) It is effective in Crohn’s disease and ulcerative colitis since IBD patients have more TNF-alpha in their systems than people without IBD. Remicade is usually given by infusion every 8 weeks. The best way to reduce the risk of infection or wound healing problems is to do surgery 6 to 7 weeks after their last Remicade infusion. Then have the next Remicade infusion 2 to 3 weeks after surgery. This balances the increased risk of infection versus the risk of a flare up of IBD symptoms.
Since chin augmentation surgery is a fairly small insult on the body, this approach may be unnecessary. But I have used it successfully in the past for cosmetic surgeries far more major than chin augmentation such as tummy tucks and breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have this grinding type noise when I open my jaw on my right side. I have had orthodontic treatment years ago and have a underdeveloped lower jaw. I consulted my orthodontist about the grinding noise possibly being linked to my underdeveloped lower mandible. He told me that my jaws are lined up correctly and I should do nothing about this grinding noise. At the beginning if my orthodontic treatment a lower mandibular advancement was recommended, however I decided at that time that I would just have orthodontic treatment without surgery. After orthodontic treatment I have a clearly recessive jaw with extra skin around my lower jaw area. As a craniofacial and maxillofacial surgeon I would highly consider your opinion in what my next step should be.
A: Many people have asymptomatic grinding noises which emanate from their temporomandibular joints. This is usually caused by the disc in the joint which may catch on opening as the mandibular condyle comes forward. Underdeveloped lower jaws with Class II malocclusions (orthodontically corrected or not) have a greater propensity for these disc noises. But as long as one is having no pain in the TMJs or any difficulty with opening, there is no treatment indicated. For the recessive jaw and loose skin around it, this can be aesthetically addressed by either a sliding genioplasty or a chin implant. Either approach has certain advantages and disadvantages that must be assessed based on each person’s anatomy and aesthetic desires. The first place to make this determination would require an assessment of pictures from the side and front views.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to know if there was any way to make my mouth smaller. I am 22 years old and I have always been self-conscious about my mouth. It has become a major problem in my life. I want to know what kind of recommendations you might have.
A: To some degree you have a bit of bimaxillary alveolar protrusion which makes your overall mouth area project further out from the frontal plane of your face. This makes your overall mouth look big. Also, by pure measurements, the horizontal width of your mouth from one corner to the other is wide as it exceeds a vertical line drawn down from the pupil of your eyes.
One method to make a mouth look smaller is to narrow its width by bringing in the corners of the mouth. While this can be down, it does leave scars at the corners of the mouth which with your natural skin pigment will probably not be very good scars. Eve if they were good and acceptable scars I do not think that would help that much as your problem is as much a protrusive issue as it is about its width.
An alternative strategy to dealing with a protrusive mouth is to increase projection of other areas of your face to better balance the mouth. You do have a retrusive chin and flat cheek bones. Increasing their projection through chin and cheek augmentation will probably help make the mouth look less protrusive and create better overall facial balance. This is a scarless and safer approach to smaller mouth surgery. The potential benefits of improving these facial areas on the appearance of the mouth could be demonstrated by computer imaging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 26 years old female. I had a chin implant surgery along with a rhinoplasty three years ago. I was happy with the surgery results until I started to see how I looked in pictures. I think that my face looks too long, and in some pictures it looks really especially when I smile. I also dislike my gummy smile, though I can hide it when I try not to rise my lips. I don’t know what the problem is. What would be the most recommended procedure for me? I would like to look more feminine and balanced. Could a smaller chin implant make my face more balanced? are there any risks involved?
Could cheek fillers or implants help? Or should I also consider the possibility of orthognathic surgery, in case the camouflage would yield very limited results..
What other procedure would you recommend for me? The upper part is me before the surgery, and the lower part is me after the surgery. And I also attached my X ray.
A: While both your rhinoplasty and chin implant augmentation produced good results, I see the crux of your facial concerns with the chin area. It is a very large implant which was needed but is also the source of your facial imbalance.
You initially have a very retrusive chin due to an underdeveloped lower jaw. When the chin is so short due to an underdeveloped ramus of the back part of the lower jaw, it is also vertically long anteriorly as the chin rotates downward. With a chin implant used for the augmentation, it does bring it forward but also actually makes the chin vertically longer and with a much deeper labiomental fold. A better chin augmentation would have been a sliding genioplasty. This would also bring the chin forward but it vertically shortens the chin and makes it more narrow, both changes which are more feminine.
Thus I would recommend that you replace your large chin implant with a sliding genioplasty that does not create as much horizontal projection but also vertically shortens it as well. It will also make the chin more of a triangular shape rather than have an obvious square shape to it that it has now from the outline of the implant. You may also consider adding small cheek implants to bring a little highlight to the cheek area, which with the genioplasty, would give your face more of a feminine heart shape to it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a recessed chin (no overbite as orthodontics aligned my bite) and a very deep labiomental crease. My question is, am I a candidate for a chin implant? I feel like I am not a good candidate as an implant would only exaggerate my pre-existing issue. Please see attached pictures.
A: Almost anyone can undergo a chin implant if their chin is deficient enough. The real question is whether someone is a good candidate for the procedure. Since you appear to be using the criteria of any deepening of the labiomental fold as not being a good candidate, then you would likely be correct. If the depth of the labiomental fold bothers you know, then it may bother you more after chin augmentation. Any chin implant procedure changes the pogonion position of the lower chin but leaves the depth of the nasolabial fold unchanged as it is not a bony supported structure. Whether it would be significantly deeper depends on the size of the chin implant, the shape of the implant and whether the labiomental fold is augmented at the same time. Since your chin augmentation needs do not appear to be large, the labiomental fold may not be changed significantly.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an hydroxyapatite chin augmentation several years ago. The hydroxyapatite was semi-solid or loose when implanted- mixed I believe with some fluids, but it was not cut from a block. It was implanted intraorally. Besides not doing much from my chin, it appears that the chin tissues are more loose now and hanging somewhat. I would like to see if we could perhaps fix this problem as much as possible. The tissue also appears more red in color that the rest of my face after surgery. I have attached some pictures of my face for you. I did take them myself from short distance so they do appear a tiny bit distorted, but they give you a good look at the chin and jaw angles in particular. In terms of enhancement to my jaw, I am not necessarily looking for a massively dramatic distal increase in size- just a moderate one to give a sharper look to the lower part of my face and to help with structure as I age.
A: Thank you for sending your pictures. I can’t say that I see any significant soft tissue detachment of looseness per se but the chin is horizontally short. It may feel somewhat looser as the hydroxyapatite granules are not structurally supportive. The hydroxapatite paste put in the chin usually have very little push to it so its augmentative effect is very minimal and often can be very irregular. I am not sure why the chin button area is slightly red as hydroxyapatite is usually very biocompatible. Certainly the hydroxyapatite granules can be removed and other forms of chin augmentation done. A more stouter form of chin augmentation will do a better job of picking up the loose chin tissues as well as providing more of an augmentative effect. At the same time, jaw angle augmentation focusing primarily on vertical length can be done as part of an overall jaw enhancement strategy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 42 year old man who is interested in getting a chin implant. This is something I’ve considered for most of my adult life. I have a very hectic and busy work schedule. My down time is very important to know. I’m concerned on how long I’d be out of it after surgery. Also when I can resume my duties at a 100% level. I’m in very good health and the only vice I have is smoking. Aside from that I have no issues that would stop me from surgery.
A: The recovery from chin implant surgery is more of a social rather than a physical recovery. A social recovery refers to you how one looks after surgery…how much the swelling and chin distortion is and when you feel comfortable returning to the rigors of your work schedule based on your appearance. There are no physical restrictions after surgery and the chin swelling and discomfort is not usually that physically limiting. Thus you can return to work as soon as you feel capable. Depending upon the type of work you do that may be anywhere from 3 to 7 days after surgery. There is nothing you can do to adversely effect the outcome of the chin augmentation surgery short of getting hit or falling on your chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking to have a Chin Implant surgery and I heard a lot about you across the internet from satisfied patients. I have some concerns about the surgery. I grow facial hair (beard) relatively fast like in a week. Will it cause or disturb the stitches made under the chin. and When can I start shaving after the surgery?
A: In the submental approach to chin or jawline implant placement, a skin incision is made under the chin through hair-bearing skin in men. I close the skin portion of the incision with a 5-0 plain suture in a subcuticular fashion (under the skin) so no suture removal is needed later. It is then covered with thin flesh-colored tapea that are glued on. Once get the tapes wet and shave around as soon as one feels comfortable doing so. It is expected that the growth of the beard skin will push the tapes loose in a matter of days. Once can then shave over the incision beginning one week after surgery. This is an incision management strategy that has worked well over the years in chin and jawline implants in men and has never posed an implant infection or hair growth problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I believe I have a mentalis strain, my chin starts to dimple and looks somewhat “bubbly.” My chin looks pretty short and recedes to me , but I am happy with the size my lower jaw except for the receding and the strain. Will my lower jaw have to be wider to fix the problem or can i just simply have my jaw moved forward enough to fix the problem without having to change the size of my jaw?
A: Most mentalis strains are the result of a short lower jaw, a horizontal bone deficiency. This makes the mentalis muscle ‘overwork’ to try and achieve lip competence. Whether this is best treated by a lower jaw advancement or just a chin augmentation depends on many factors including one’s existing occlusion (bite), how horizontally deficient the chin position is and what effort one wants to put in to treating the problem. The width of the lower jaw/chin has no impact on the cause of the mentalis strain or in the treatment of it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin augmentation. I am a 52 year old male in good health with no serious medical conditions. Three years ago I had a platysmaplasty, rhinoplasty, lip lift, and implants in my chin, jaw angles, and cheeks. The chin implant subsequently became infected. The infection resulted in the removal of the chin and jaw angle implants several months later. Only the chin implants remain. My primary concern now is that my chin appears weak. I’m also concerned about the sagging appearance on underneath left side of my chin and the very visible scar below my chin from the previous surgeries. Regarding the jaw angle implants, I understand that my posterior mandible is quite narrow, but my eyes are also narrowly set and jaw angle implants accentuate that feature. I learned this clearly from the very wide jaw angle implants I had from my first surgery. So, jaw angle implants are problematic for me for that reason. Also, the chin and jaw angle implants that I had moved significantly after surgery, which I would also like to avoid with any subsequent implants. Please let me know if you can fix any implants with screws so that they do not move.
A: In reading your history, you have lost the benefits of your chin augmentation due to infection, your implants shifted after surgery and the jaw angle implants were an aesthetic detriment. In addition the submental scar is very wide and there is a little tissue sag on the left side of the chin.
A new chin implant can certainly be done and I almost always secure this in by double screw fixation. This could be put in from your existing submental scar. Your submental scar is wide because it has been placed behind the submental skin crease in the skin of the neck. This is not an ideal location as horizontal incisions in the neck skin tend to widen. The best that can be done with that scar is to excise it completely and hope that it heals more narrow this time. A new chin implant should pick up any loose skin along the jawline.
Jaw angle implants are more than just about widening the jaw angle as you appear to have had lateral widening jaw angle implants used. There are also different styles of jaw angle implants that merely make a pronounced jaw angle without making it wider. You may initially have just had a wrong style implant used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,Is wisdom teeth removal a prerequisite for an osseous sliding genioplasty? Also, how much does your practice charge for an osseous genioplasty (with hospital fees + anesthesia)?
A: There is no correlation between a sliding genioplasty and wisdom teeth, whether they are removed or not. The chin is located on the front part of the jaw while the wisdom teeth (third molars) is on the back part of the jaw. You may be thinking of a sagittal split ramus osteotomy (back of the jaw osteotomy) where having impacted wisdom teeth out six months before the procedure is needed as the embedded tooth roots may interfere with successful splitting of the bone and plate the screw fixation to hold it together as it heals. In fact, wisdom teeth removal can be done at the same time as a sliding genioplasty if necessary.
A sliding genioplasty is done as a one hour procedure done under general anesthesia in a surgery center not a hospital. The usual total fees are around $6500 for all involved costs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a chin augmentation surgery. I have attached a couple of photos in order to get your opinion. You had written that there is a permanent chin augmentation solution where the implants are secured by small titanium screws. Would those screws need to be replaced after ten or more years? Do they set off metal detectors? It seems that screwing the implant in makes more sense. As my chief concern is the security of the implant and its ability to withstand an occasional stiff impact. I do know some chin implants are used without screws. What is your opinion on those types? My feeling was that since they are just placed on top of the chin and not secured with anything the likelihood for them to become dislodged increases. Not sure if that is true though. Assuming that there are different types of chin implants, (some more square, some more rounded) perhaps when you see the attached photos you’ll have a better idea which one would benefit me the most. Finally, I would be remised if I did not say that being your office is in Indianapolis it seems difficult that I would fly from another state for such a procedure. The logistics alone would be difficult to for me to work around. Though being your reputation is excellent, nothing is completely out of bounds. Thanks for your time, it is very much appreciated.
A: Your photos demonstrate that you would be an excellent candidate for chin augmentation. Your chin deficiency, compared to many patients that I treat is relatively mild, but I would agree that more chin projection and a more square chin appearance would have some aesthetic benefits for you. I will do some computer imaging of that and send it to you later today.
In answer to your questions about chin implants and screw fixation, this is a technique that I have always done in the vast majority of chin implants. It is simple, quick and inexpensive to do and assures that for the lifetime of the patient the chin implant is never going to move or become dislodged. I have certainly never seen it in the 25 yeasrs that I have been doing the procedure. The screws are composed of titanium, a pure element that never degrades or corrodes or needs to be replaced. It is a non-ferromagnetic metal, which means it does not set off metal detectors nor affects MRI scans. While placing screws is not standard practice for most surgeons that place any type of facial implants, it really should be.
While being a far away patient may seem unusual, it is standard in my practice as patients fly in from all over the world every week for surgery. It is easier to do than you think and handling the logistics of how to do it efficiently is a common occurrence for my staff and surgery center.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My question is in regards to the safety and security of chin implants. While I firmly believe such a procedure would improve my appearance my hesitation lies in the uncertainty of the implant being a permanent solution. To be specific my job is such that at times is of a physical nature and am worried that the implant could become dislodged. How is it kept in place? And are there certain implants designs that are better then others? Would hard impact to the chin or jaw cause it to become dislodged? Perhaps you know people in the Military who have had this done? My second line of questions are about the health risks of a foreign element placed in the body. Are there long term effects from having a implant inserted and is this something that once done should remain for life? Thanks for your time.
A: Chin implants, almost of any implant placed on the body, are the safest (less likely to have complications) in my long plastic surgery experience. There are a permanent chin augmentation solution as the material will never degrade. The implants are secured in place by small titanium screws so that they will never move or become dislodged. I have yet to have a case where a chin implant became dislodged or displaced because of trauma of any nature, including patients in the military. There are no health risks from performed silicone since it is a molecularly stable material that does not degrade or release any free silicone molecules.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in some facial reshaping procedures. I am 54 and desire more of a heart shape to my face. It is long and not as feminine as I would like. My nose is a bit long and wide on the bridge (from the front esp.) Looking younger would be great, but looking more feminine and therefore prettier is my main goal. Wider temple area/distinct cheekbones, tighter jaw to neck angle, more of a right angle beneath chin-to-neck, and a feminine nose are some ideas I have. My jawbone has reabsorbed somewhat, according to my dentist. But I need YOUR trained eye to tell me how to accomplish my goal of looking more feminine, losing the chub underneath my chin, creating a prettier facial shape in general. Thanks so much for giving me the straight scoop.
A: In looking at your pictures and understanding your facial reshaping goals, I would recommend the following changes.
CHIN A V or triangular shaped chin implant augmentation with the objective or bringing your chin forward, which is short, but making it narrower at the same time.
NOSE An open rhinoplasty to narrow the nose from the bridge to the tip with some slight shortening and elevation of the tip with nostril narrowing.
CHEEKS Cheek implants that produce some a combined malar/submalar (shell) effect. This with the chin helps create more of a heart-shaped face.
TEMPLES Subfascial temporal implant to correct the hollowing and increase the bitemporal width.
EARLOBES I know you did not mention these but these seem a little bit and stick out and reducing them adds a touch of femininity to the sides of the face.
I have attached some computer imaging predictions of how I see these changes affecting your face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in rhinoplasty but think I may need more. I’m trying to find a way to make my side profile look nice and pretty. I hate my nose as its quite large and has a small bump on it therefore I really want rhinoplasty. I also have a small slanted forehead and small chin so it looks like my face goes into a point at my nose. What would be best to change this? Please help, many thanks.
A: By your description, your three main side profile features have an imbalance. Your nose is too big and the forehead and chin is too small, creating the profile that you dislike. In trying to figure out what procedures you may need that creates the best change, it would be important to do some computer imaging. The procedures of rhinoplasty and chin and forehead augmentation must be looked at individually as well as in comboantion to see which creates the best change. It probably goes without saying that all three create the greatest profile improvement but do you really need them all. I suspect that the rhinoplasty and chin augmentation alone may be sufficient and produce the best return on the effort but that remains to be proven by the imaging predictions. Please send me a side profile picture at your convenience to help you make that determination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, At the moment, I am at a complete loss of what to do about my profile. I have had so many consultations now and have advice ranging from ‘do nothing’ to ‘have a neck lift, fat removal and chin implant at the same time’. I need to do something as it’s making me very self conscious and I hate seeing photos of myself from the side.
My problem is that I am only 27 and am apparently not a candidate for neck liposuction alone because of my bone structure. It has to be explained to me that I have a low hyoid bone that is creating a blunted neck angle so that my neck blends into my chin. My teeth do align so it is not a problem with my bite but I do also have a weak chin.
From my own research it seems like a chin implant might provide me with the illusion of an improved neck angle but my concern is how it will impact my face front on and my smile- lots of reviews seem to say their jaw looks to masculine after a chin implant or that they can no longer show their bottom teeth when smiling. At the moment when I smile I show my bottom teeth, which I like, and my chin points slightly in feminine way. I also have a small indent in my chin when I smile and am unsure if a chin implant would make this worse.
Do you have a recommended approach to this sort of problem? Given my age, I don’t want to risk ruining my face with anything too drastic! I do need to do something though as it’s making me really self conscious.
Thanks in advance for your help. I do wish I was a more straightforward case!
A: Quite frankly you are a very straightforward case. The combination of chin augmentation and neck liposuction is the correct approach. The key to a successful chin augmentation in you is to understand that in the profile view there needs to be both a horizontal and vertical dimensional change and in the front view the chin shape needs to stay a triangular shape and not become too round or full which is more masculine. There are two ways to achieve these chin changes. An implant needs to have some vertical elongation and must be more of a central buton style that has no significant lateral wings to it. The other option is a sliding genioplasty which can be brought forward as well as down. (vertical lengthening) Sliding genioplasties will always keep a narrow chin or make one more narrow as it comes forward because it is a U-shaped that is being brought forward. The indent in your chin, whether the augmentation is done by an implant or an osteotomy, will not change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you could answer a quick question for me: Is there a way to perform a sliding genioplasty without having to cut the mentalis muscles? Is it possible to use an extraoral incision under the chin (if the patient didn’t care about small scars) to reduce damage to the underlying muscles of the lips? I am tired of hiding my face but I don’t think I’m brave enough to risk damaging the nerves or musculature of my lower face. How risky is this procedure?
A: Whether you go from inside the mouth or from below the chin, the mentalis muscle has to be cut. Even in a chin implant the muscle has to be cut. In skilled hands, a sliding genioplasty is a very safe and effective procedure with no long-term muscle or lip issues. The key is not whether the muscle is cut but if the surgeon knows how to put it back together.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m trying to achieve a more aethetically appealing face, by whatever means necessary. I’ve noticed my forehead protrudes in respect the level my eyes are at, making them look sunken and my face more masculine. I don’t believe it’s my bossing that sticks out, just my forehead in general, so i’m not sure how much of a result I would see with surgery. I’ve been told my nose is large, so I’m considering rhinoplasty as well. Additionally, my lips appear to almost “hang off” my face. I know this isn’t your forte but do you believe jaw surgery could be a solution? In general, I was just wondering what procedures you would recommend. Thank you for your time and I look forward to hearing from you!
A: Thank you for sending your pictures. I have done some imaging predictions based on the one side profile that you sent. What I have done is a forehead reduction, rhinoplasty and chin augmentation . If you look carefully at those changes, the most dramatic effects come from the rhinoplasty and chin augmentation. The rhinoplasty is key because your forehead and brows look so pronounced because you have a very deep radix. (root of the nose). One of the key manuevers in your rhinoplasty is the buildup of the root of the nose. By doing so that makes the forehead less retrusive in appearance alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, many thanks for your email reply and I have attached some more pictures. Hope they are of the correct type – if you need better quality or closer views I can arrange that. As you can see I’ve taken photos of my profile many times and at varying body weights. The thinner I am the better my jawline looks, obviously, but I find it difficult to maintain the weight that allows this (roughly 50kg) – also I worry about when I get pregnant that I will look terrible with a big double chin.
My main concerns are that, from the front, my lower face looks chubby with jowls just to the right and left of my chin. I feel this makes me look really young but not in a good way!Like a chubby little girl! From a side(but not complete profile) view the jaw line gets hazy-looking about halfway along. In profile my chin just looks really weak which, to be honest, I wouldn’t mind so much but its the fact that this causes my neck structures to be poorly supported and therefore have a double chin. I also feel that my lower jaw is asymetrical and this can be seen from the front? Think that the left side of jaw is shorter making jowls worse on that side?
I have pushed my lower jaw out in some of the pics to get a view of what things might look like if I have a better jaw line/chin but obviously this gives me a horrible underbite and can’t walk around looking like that all day! But thought you might be interested to see the jawline I have in mind and I would hope for.
I included a pic of me at a lower weight to show you the effect of that as well….maybe I just need to knuckle down and lose the weight because currently I eat whatever I want and do NO EXERCISE at all…very bad I know!
Feel that my nose is quite fat looking at the lower portion from the front although I don’t have too much of an issue with the view in profile. Can something be done to make nose less bulbous at the end? This is definitely less of a concern for me the as it’s my chin that I really hate and think about it pretty much every day and am self conscious about it.
Many thanks.
A: Thank you for sending your pictures. What they show and you demonstrate so well is that the chin/jawline is somewhat short. Lengthening the chin by jawline distraction produces a good improvement. This manuever demonstrates to me that a sliding genioplasty would be a better treatment choice than a chin implant. Moving the chin bone forward brings with it the the underlying neck musculature and, as a result, produces a better jawline/neck appearance. One may also consider submental liposuction with the chin advancement to ensure getting the best result possible. As for the jowl asymmetry, the chin bone would be advanced symmetrically and hopefully that will make an improvement in that concern as well.
As for the nose, that would require a straightforward tip rhinoplasty to thin the cartilages and make the tip less bulbous.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had jaw augmentation and a little lipo in the neck area…It was performed 2 weeks ago today….I can’t move my bottom lip in a downward motion which means I can’t smile….I still have a great deal of swelling although significantly less…Is this nerve damage permanent or could the swelling have something to do with it.Your advice would be greatly appreciated as I am very nervous. Thank you. It was performed by a very reputable surgeon but none the less I now bad outcomes can happen to anyone.
A: What you have is weakness of the marginal mandibular nerve branch of the facial nerves. This tiny nerve branch, which supplies the depressor muscle of the lower lips, crosses over the jawline on the side of the chin. It is not really at risk from the jaw (chin) augmentation since that is down at the bone level which is deeper. It is at risk from liposuction of the jowls particularly if liposuction is done at or above the jawline which is exactly where the nerve runs. Nerve injury from liposuction , because it is a blunt instrument, does not cut the nerve but bruises it. This may make it weak for a period of time (unable to lower lip) but recovery almost always occur. Nerve recovery does not parallel swelling reduction, however, and usually takes much longer. In most cases llike yours, full functional nerve recovery can take up to three months or longer. Given that there is no other treatment, patience is all you can do for it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in forehead augmentation and possibly rhinoplasty. I have put together a compilation of my head shots along with some of the “standard” head models. In short, I feel that I have a huge face and no skull. I would like to achieve a better balance between the two. So the procedures I was thinking of are 1) Forehead augmentation and 2) Skull Augmentation to the sides, up and back (if possible of course, sounds like a lot). I am also considering a rhinoplasty to reduce the width of my nose. Please see the attached compilation and let me know what you think. Thank you so much for a prompt response.
A: I have done some imaging based on what I see as the causes of your face:skull disproportion. Your forehead is sloped at a near 45 degree angle with no brow prominence. When combined with a long overprojecting nose and a short chin, your face looks out of proportion to your skull. By doing a forehead augmentation, shortening the nose and bring the chin forward with a central button implant, there is much better balance between your face and skull. I have attached some imaging to show what effects those procedures might have on your appearance. These imaging predictions are just a first pass on the procedures and more or less changes are possible.
Dr. Barry Eppley
indianapolis, Indiana
Q: Dr. Eppley, I really wanted to advance my chin and make my jawline straighter. I know I will need a sliding genioplasty and perhaps bone cement along the sides of my jawline. I was wondering if what I had in mind is possible and have done my own before and after to show you whicih I have attached. I like how the part below my lip and above my chin comes out almost like the jaw was moved forward, along with the the extension of my chin and straightness of the middle part of my jawline. Is all of this possible ? I don’t want to use any kind of implant, just my bone and bone cement. Can you make a custom 3D implant mold and place bone cement in that instead of using an implant ?
A: What you are demonstrating is the classic change that would occur from a sliding genioplasty. There is no need for bone cement or 3D model fabrications to get there. The chin bone (not the jaw bone) is cut and moved forward and plated into position. While silicone synthetic implants can be made from a 3-D model you can not use bone cement to create an implant as it is too brittle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had two chin implants that had various problems so I opted for sliding genioplasty. For this surgery my surgeon drawn some sketches on my x-ray tracing which added 6 mm. I knew my prior implants didn't give vertical length and 6 mm looked fine and he explained about soft tissue draping that it would add some fullness too. I showed him examples of the chin I would like to have. And he said it’s possible. But now I am utterly frustrated as even after talking things through and showing him what I wanted I am stuck with how my chin looked like with an implant with very little added vertical length. Please let me know your thoughts. Should I ask for revision? When I told him my concerns, he said not more than 5-6 mm is possible with sliding genioplasty because that is what the metal plate allows.
A: My only comments are:
The step chin osteotomy plates go out to 10 to 12 mms, depending upon the manufacturer. I am not familiar with a 6mm advancement limitation by the fixation device. In some patients, there may be a bone thickness limitation for the amount of forward movement that can be achieved.
When measuring the chin bone for advancement by a sliding genioplasty, the soft tissue does not add any fullness. It moves in a 1:1 relationship with the bone. Therefore, for example, if you want the soft tissue chin point to move 10mms to get a desired look then move the bone 10mms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My brows and eyes give me a cold look and I’d like to have a softer image. I am consider getting brow reshaping, but what else can be done to improve my appearance. I have attached a front and profile picture to see what you think can be done.
A: Thank you for sending your photos. I would not disagree that your brow bone shape and promience do give your eyes a bit of a harder look. While the brow bones can be surgically reduced, there is always the tradeoff of a scalp scar to do it. That can be a precarious trade-off in men based on their hair pattern, density and potential hairline instability. I am niot ruling it out for you but I think there are other facial issues that I think would be equally, if not more effective, that can be done with no such trade-off. Your prominent nose and short chin create a significant amount of facial imbalance. Their alteration by reduction rhinoplasty and chin augmentation puts your face in better balance and would help to give your face less of a cold look. I have attached some imaging to see what you think of the nose and chin changes.
Dr. Barry Eppley
Indianapolis, Indiana