Your Questions
Your Questions
Q: Dr. Eppley, I’m unhappy with my face. I think the horizontal projection is very poor and the jawline is weak. Just starting to look into options and I would be happy to hear any ideas you have. My first thought was that chin implants might be helpful. I’m hoping to create a face that Asian and white women will find very attractive and projects warmth while also commanding respect in a business setting. I have attached a profile picture for your thoughts.
A: I am not sure what Asian or Caucasian women would necessarily find attractive or what facial appearance projects warmth while commanding respect in a business setting. But in looking at your side view pictures, I would agree that your chin is weak and out of proportion to the rest of your face. Having a more proportionate chin would give your face better balance and is what I think you would give you an improved facial appearance that may be considered more attractive as well as casting an image of greater masculinity. I have done some imaging on your side picture to see if you agree. The chin augmentation, which could be done by either implant or a sliding genioplasty, would benefit by concomitant neck liposuction as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m unhappy with my asymmetric face and would like to have a nose job and chin implant to correct it. Would it be possible to correct it with standard Medpor chin implants? Which chin implant it would suit to me better to correct it and can I get a view how would I look after these changes to my face.
A: Thank you for your inquiry and sending your pictures. I have done some imaging on your nose and chin. Your rhinoplasty is straightforward, meaning that tip shortening with narrowing and a little lift and dorsal line straightening with narrowing of the upper nose with osteotomies would be done. Your chin is severely short and I could argue that an implant is not the best choice given the limits of how much horizontal advancement can be obtained with off-the-shelf implants. (only up to 10mms) But I have imaged what I think the most that a chin implant can achieve. When it comes to chin implant type, there are advantages and disadvantages to either silicone or Medpor materials. While some surgeons and patients get focused on their theoretical biological differences, I have never found them to be distinctly different in that way. I am more interested in what styles and sizes of chin implants the various manufacturers offer. In your case, I would likely choose a two-piece square chin Medpor implant of 11mms horizontal projection.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 56 year-old man who has always had a weak chin. While I have always wanted to do something about it, I could just never get the nerve to go in and see a plastic surgeon. My girlfriend has given me the encouragement to now do and I am going to make the move to see what is possible. Could you give me some direction in what you think I need? I think the problem is more than just a short chin, my overall jaw just seems smaller. I don’t want to get a chin implant placed on the end of my jaw if it does not look right or natural. I have attached some photos of me from the front and side for your evaluation.
A: Having a weaker jaw/chin in an older male always raises questions about both bone and soft tissue management since there is some degree of sagging of the jowls and neck. While you would undoubtably be helped along the jawline with a facelift (neck-jowl lift), I am going to pass over that issue for now as dealing with the bony deficiency should always been done first. Since a lower facelift affects the posterior jawline and neck angle the most, it would have its greatest effect on the jaw angle area. Whether you would benefit by jaw angle augmentation or a total jawline procedure is unclear to me at present. (and also unlikely) Therefore for this discussion I am only going to focus on your chin deficiency and submental fullness which are your biggest facial imbalance issues.
What you need is a chin implant and neck liposuction/submentoplasty. The question is whether a preformed or off-the shelf chin implant will work or whether a custom implant is preferred. Both will make positive changes. It is just a matter of degree and how substantial that change is. You do have both horizontal, vertical, and transverse (width) chin deficiency which is common when the chin is very weak. The problem, as you have accurately pointed out, is really an overall jaw growth issue not just a simple short chin. This makes the entire lower face short in every dimension.
I have done some predictive imaging based on both off-the-shelf and custom implant approaches so you can get a feel for how the two type of chin implants differ. A custom chin implant will address all dimensional deficiences. and produce a more profound change..if one finds that look appealing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very weak jawline and some fullness to my cheeks and face. My face is sort of round and not very distinct. I went to one plastic surgeon and he said that a chin implant would change my facial shape. But I have read that many chin implants also have liposuction under the chin as well. This seems to make sense to me but I still don’t see how that will improve my chubby cheeks. What would be your recommendations? I have attached some pictures of me from the side.
A: I think there is no question that you have a short chin and a rounder fuller face. A chin implant will definitely over good improvement of your profile. But to really ‘deround’ a fuller face it is going to take other adjustments. These would include some fat removal as well. Liposuction under the chin would also be a definite plus and, with the chin implant, can dramatically change the jawline. But the cheek area needs thinning by a partial buccal lipectomy with perioral liposuction. Buccal fat removal only affects the upper cheek area below the cheek bone. Perioral liposuction is needed to remove fat from the lower cheek area at the level of the corners of the mouth. The combination of chin augmentation and fat removal from the neck and cheeks can very effectively make a round face have a much more defined shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 31yr old female looking to improve the side profile of my face. I have a lot of fat under my chin and this causes an awful side profile. It also shows from the front. From what I’ve read about neck liposuction this could be a good option. But I’ve also read that chin implants can be useful for improving one’s profile as well. Which one would be best for me or do I need both?
A: Improving the profile of the neck and jawline must take into consideration whether excess fat and loose skin exists and the amount of bony chin projection. Given your age loose skin is not an issue so any consideration of a jawline tuck-up is not needed. The combination of neck liposuction and chin augmentation can be a very powerful changer of one’s profile, assuming one has a weaker chin to start. The best way to answer whether chin augmentation is beneficial is through computer imaging. See what your profile would look like with neck liposuction with and without chin augmentation. Seeing is believing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I’d like to get a more feminine face. I would like to reshape my heavy jawline and brow, correct the weak chin, do liposuction under chin and I would also like to correct any small asymmetries that would improve the appearance of my face. I have attached a front and side for your assessment of what can be done.
A: Thank you for sending your pictures. In looking at our face what is most striking are two things. First, you have a very strong facial structure as seen in your prominent brow bones and cheekbones. This upper part of your craniofacial skeleton is also broad as reflected in the wide base of your nose and its wide tip. Secondly, and in contrast, your lower jaw (mandible) is actually short both in the horizontal and vertical dimensions. This gives you the impression that your jawline is heavy, when in fact, it is really short which makes it wider than it is tall.
I have done some computer imaging projections based on what I think would make the most significant changes towards a more feminine face. These include brow bone reduction, rhinoplasty and chin augmentation. (both horizontally and vertically) One of the key components of this approach is that your lower face (jaw) needs to be vertically lengthened to change the shape of your face from square to more of an angular or triangular shape. Combined with reduction of the brows and thinning of the nose, your face will become softer and more feminine.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I went in recently for a consultation from an Indianapolis rhinoplasty surgeon. During the consultation he recommended a chin implant with my rhinoplasty surgery. While he seemed very honest in this suggestion, I was completely floored as I never thought I had any chin problem. I certainly didn’t think that I had a weak chin. Having had the idea settle in for awhile, I am now more comfortable that maybe I do need one. I like the way my face looks in every way except for my profile which is why I want my nose done. What I am concerned about is that the combination of a rhinoplasty and chin implant will change my face too much. I have attached a profile picture of me for your thoughts. What would you do if you were me?
A: It is not uncommon to perform a rhinoplasty and chin implant together and it can be a powerful changer of one’s profile. But whether it is aesthetically beneficial can actually be determined by you. Make sure that you have done a series of predictive computer imaging. Have shown to you how your profile would look both with and without a chin implant with your rhinoplasty prior to actually undergoing surgery. These images will answer your question better than anyone simply telling you one way or the other. One cautionary note, if you opt for chin augmentation your plastic surgeon needs to be careful about the style and size that is selected for implantation. You have a retruded but long chin. It would be easy to end up with too strong a chin appearance afterwards if the right chin implant is not chosen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some questions about chin augmentation for me.Here is a picture that I myself adjusted (I included the original). I actually like my front but as you can tell from my profile, my chin is weak. If you adjust my chin, it really doesn’t do anything to make me look better. My question is after a chin augmentation what can I do to achieve better symmetry in my profile and make me look better from the front (cheek reduction?). It’s quite odd because I look good from the front and correcting my chin doesn’t seem to make me any better looking. In before and afters online you can clearly see how it makes people look remarkably better. Perhaps this is as good as it will get for my chin. Do you think it will dramatically change the way I look from the front? I am interested to hear your professional opinion because I’m puzzled, I was thinking this procedure would make me better looking.
A: Thank you for sending your pictures. What you are perceiving is absolutely correct. While from a profile view, bringing your chin forward increases its prominence and is better by facial proportions measurements, it does not necessarily improve your overall appearance. The reason that more chin prominence does not fit in ‘better’ with the rest of the shape of your face is due your ethnicity in which your facial shape is broader, wider and flatter. You do not have an angular thinner face in which more chin prominence helps make the rest of the face look better as well. (balance) You have to be careful in your facial type that increasing your lower facial prominence does not make it look heavier and too prominent. The only way that chin augmentation would be a benefit is that from the frontal view the chin becomes more tapered rather than wider. This requires more of a central button implant and not the typical anatomic chin implant with long wrap-around wings.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have facial asymmetry of which my left eye area is a big part of why it looks the way it does. I am interested in brow shaving and a canthopexy to improve the eye area. My biggest concern with orbital rim shaving would be losing frontal bossing over that orbital rim. Let me ask you if you have ever performed shaving of the orbital rims for the purpose of better balancing facial asymmetry?
Regarding chin implants. Given your extensive experience with these, especially in ideal jaw surgery candidates who refuse surgery (retrognathic lower jaw), I’d like to ask you if it’s a realistic possibility to recreate the appearance of a jaw when it is in a prognathic position, using a chin implant with wings? What I mean is when I slide my jaw as far forward as I can, creating what is dentally considered mandibular prognathism, I reallylike the aesthetic appearance it has on my jawline, probably because my jawline is retruded by default so when I manipulate my jaw into a prognathic position it actually just ends up looking relatively normal (with the exception of my lower teeth pushing my lower lip forward which is the only giveaway). Basically I’m asking if a chin implant with wings can provide anterior projection to the entire jawline, not only the forward most point of chin but also along the mandibular body of the jaw, bringing most of the jaw (except the mandibular angles) more forward relative to other parts of the face, like what happens when you push your jaw forward in your face.
Also another big question Ive always had about chin implants is how does the placement of a chin implant effects the lower lip? Do chin implants push the lower lip forward at all? And what about augmentation of the chin groove, can this be moved “forward” or augmented at all to avoid the formation of a huge indentation in the chin groove between the bottom lip and chin implant? As it would seem the larger the chin implant you use, the deeper this groove would become.
A: In regards to orbital rim shaving is done through an upper eyelid incision, it removes the bottom portion of the orbital rim not its anterior projection. So there would be no risk of losing frontal bossing which is a horizontal brow feature. Inferior orbital rim shaving is done almost exclusively in cases of facial/brow asymmetry. There would be no other reason to do it. The result is subtle, not dramatic, and is in the range of 3 to 5mms depending upon the degree of superior orbital rim asymmetry.
If you are jutting your jaw forward and getting the desired look, then a chin implant with match that horizontal result. It may be a little thinner at the sides. The most ideal thing to do is to make a custom chin implant which would overcome that issue.
The lower lip never changes position no matter whagt is done to the chin. That can only change with an entire jaw advancement procedure. You are correct in that the labiomental groove will be come deeper as the chin position changes below it but the labiomental groove is not changes by an isolated chin procedure, implant or osteotomy. That can be overcome with a custom chin implant which builts up that area whereas a conventional chin implant does not.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in two facial procedures and I believe you are the right doctor to do them. I already have a chin implant in place but it is not ideal. I would like to have a sliding genioplasty to correct my underbite and have a slightly more balanced chin. Also I want buccal fat removal. I have a heavy lower face with full cheeks that I would like to look slightly more sculpted.
A: Based on the procedures you desire and your objectives, I would make the following comments and clarifications.
A sliding genioplasty is an alternative, and is sometimes better than a chin implant for more severe cases of chin deficiency. It will not, however, correct any occlusal problems as it is a chin procedure and not a total jaw advancement. The correction of one’s underbite requires a sagittal split ramus osteotomy jaw procedure (done in the back part of the lower jaw) which moves the tooth-bearing portion of the jaw bone. This requires pre- and post-surgical orthodontics. It fixes the bite as well as produces an amount of chin augmentation in millimeters that matches how far the lower teeth have moved to fit better to the upper teeth. Do not confuse a sliding genioplasty and a sagittal split mandibular osteotomy.
A buccal lipectomy removes fat and its associated fullness right under the cheek bone (submalar region) It does not create any slimming effect below this area. Most patients envision the entire cheek area done to and past the corner of the mouth when they refer to making their face less full. For this reason, many buccal lipectomies (done from a small incision inside the mouth) are combined with small cannula liposuction of the perioral mounds. (mound or fullness to the sides if the mouth or lower cheek region) This combination creates a better overall slimming effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am committed to undergoing chin augmentation with an implant but I am a little anxious. I just have a few questions. What do you see as the risks involved with a chin implant procedure, if any? Do your predictive photos mirror actual results? Thanks for taking the time to answer my nervous questions.
A: In answer to your presurgical jitters:
1) There are always some risks with any surgery and chin implant augmentation is no exception. Fortunately those risks with chin implants are few and very low. The ones that I have observed are infection (1% to 2%) and asymmetry of the wings of the implant. (2% to 3%) Both are very correctable, albeit with a revisional surgery. There is always the risk of too little or too much chin augmentation with an improper size implant but that is not a very common problem in my experience.
2) Computer imaging is an estimate and not an exact predictor of the final outcome from any plastic surgery procedure. Its predictive ability varies based on the type of procedure being performed. Of all the facial cosmetic procedures, chin augmentation is one of the more accurate in terms of predicting the outcome as it is a profile or silhouette facial feature.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant done approximately 10 years ago. I have only mildly been satisfied with the results. I believe the implant was put too far down on my chin bone to lengthen it vertically. Shortly after surgery, the implant slipped off on one side making my chin appear uneven. But it is from the profile view that I dislike my chin the most. My chin and neck are not separated by much horizontal distance. I think I may be a candidate for the vertical lengthening jaw implant that is done with the CT scan. My question is..is there a way to do a consult visit without me physically coming to Indiana? Or is an office visit required to make a determination if I am a candidate for this procedure?
A: When considering lengthening the anterior lower face vertically, the decision is between a chin osteotomy or a custom chin implant. For the sake of this answer, I will assume that the implant choice is the better option for you. Since there are no off-the-shelf chin implants that have any significant vertical component to it, a custom implant will need to be fabricated. This is a process that requires the following steps. First, a 3-D CT scan must be obtained. This can be gotten at most CT scanning facilities in your geographic location. That scan is then sent to a model manufacturer which creates an actual mandibular (jaw) model that is an exact replica of your own lower jaw. I then take this model and hand-carve a chin implant out of a special clay material that matches your exact aesthetic needs. That custom chin implant is then sent to a manufacturer who makes and sterilizes a silicone implant from the clay mock-up. All of this can be done without you ever leaving your home. Your candidacy for any custom facial implant is determined from afar by phone, photographic and Skype video consultations. One only has to appear for the actual surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am trying to make my face symmetrical. My jaw is not aligned, making my mouth and smile crooked and my nose is wide with a pronounced bump. I have attached some pictures for you to evaluate, image, and give me recommendations as to what to do. Thanks!
A: An analysis of your pictures shows that you do have a deviated nose with a hump and a wide tip. But in addition, you have left facial hypertrophy. This is the origin of why you feel that your jaw and smile is crooked. The left side of your face, from the orbit down to the jaw angle is bigger and wider. This creates your facial imbalance/crookedness. I have done some imaging of your rhinoplasty, with and with adjustment of the left facial enlargement. In facial asymmetry it is always a question as to whether to build up the smaller side or reduce the bigger side. In your case, I think it is better to try and make the larger side smaller through cheekbone and jaw angle reduction. This is shown in your rhinoplasty front view imaging, both with and without it being done. From a side view, I have also added a small chin augmentation as your profile shows some mild horizontal chin deficiency.
I think the combination of rhinoplasty, cheekbone and jaw angle reduction and chin augmentation can make for a more symmetrical and balanced face. This will not change the asymmetry in your smile as that is soft tissue-based and can not be adjusted like the underlying harder facial structures.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am 38 years old and I need some changes to my face. It is a very round face without much definition or highlights. From a side view, I think my profile would be much improved with chin augmentation and fat removed from under my chin.. I do not know if my chin augmentation would benefit more from an implant or osteotomy. From a frontal view, I would like the distance between my upper lip and nose shortened. It is too long and I have a thin upper lip as well. I am attaching some picture for you to image to show me what could be done with plastic surgery.
A: Thank you for sending your photos. I have done some computer imaging based on your desired changes. I think you are correct in predicting that chin augmentation (implant not an osteotomy) with submental liposuction would make a nice change. The combination of the two can completely change the profile of your lower face. From a lip standpoint, your upper lip is very long and a subnasal lip lift would help shorten that distance. I have also added a buccal lipectomy to help slim your cheeks which would provide a good thinning complement to the proposed fat reduction in your neck.
The combination of all four of these changes would help make your face more proportioned and balanced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr Eppley, I am a boxer and wanted to get a sliding genioplasty. I am recessed by about 10mm’s and was wondering if I would be able to box after this chin surgery. If so, how long after surgery can I do so? Thanks for your time.
A: For your chin deficiency, a sliding genioplasty is probably a more wise decision than an implant given your boxing avocation/occupation. A chin implant may have also worked as long as it would be secured with 3 to 5 screws. It would have a quicker recovery and return to boxing (1 month if contact to face may occur, training part doesn’t matter) but there is always the potential for some implant related problem long-term if struck on the chin. (which I assume is common on boxing) For a chin osteotomy, the return to contact boxing should be 3 months at least although training could occur at any time one felt comfortable. You could argue that the bone is not really healed in a big advancement (10mms) for up to 6 months so this is a more conservative estimate. With the osteotomy in your case, I would secure it with more than the traditional chin plate (step plate) and 4 screws. I would probably add a small plate on each side of the sliding genioplasty for the extra security of the bone position.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in getting a chin implant to make my weaker chin look better. It seems like a fairly simple procedure but this bone resorption underneath the implant sort of scares me. Why does this happen? Is there any way to avoid this bone reorption if I get a chin implant?
A: The phenomenon of bone resorption under a chin implant is a much talked about finding for many decades. One of the reasons that it occurs is due to a pressure issue with the implant sandwiched between the soft tissues and the bone. While the implant pushes the soft tissue out, causing more visible chin projection, the soft tissues do apply a small amount of pressure or recoil back over time. Since the implant is not going to resorb because it is an inorganic synthetic material, that leaves the underlying bone to accomodate and relieve this pressure.
This pressure situation is really magnified with implants that are placed too high on the chin bone. This happens when chin implants are placed from inside the mouth and are not secured down to the lower edge of the bone. It can also happen from a submental chin incision approach but is much less common because it it easer to keep the pocket of the implant low. The observation that it does not occur with more contemporary anatomical chin implants is because the wings of the implant keep them from riding up higher, acting like lateral stabilizing bars. From either approach, if the implant ends above the basal bone of the chin (which is thick cortical bone) it rests on bone with a much thinner cortex. This is where bone resorption will be seen with chin implants. It is a function of bone position and is not an actual feature or result of the implant or its material composition per se. This bone resorption phenomenon (which is largely benign and not of any great signfiicance) can be completely avoided by proper implant position on the lower edge of the chin bone. This will also maximize the benefits of the horizontal projection that the chin implant provides, some of which is lost if it gets malpositioned higher as it slides up and back.
Dr. Barry Eppley
Indianapolis Indiana
Q: I would like a normal chin size without cutting or moving bone. Just with a chin implant or injectables. is it possible? I´m not interested in a major surgery such a sliding genioplasty. It seems that I have overbite but my dentist says that my bite is ok and I don’t need any orthognatic procedure. I ´d like to have neck liposuction too. I have a little extra fat below my chin and round the neck. The truth is that I don´t want to go under a major surgery but I also want a stronger chin. Can I achieve this result? I want it to look like a good male chin and not weaker or like a girls´s chin. I have looked at different projections of chin implants and I think that an 8 mm implant would work. I think that an implant with some little liposuction would be ok. I want it to be bigger but maybe more than 8mms kwill make my chin to look like very big. Please tell me what you think?
A: When it comes to chin implant size, there is a fine balance between too much vs too little. For a male, the chin position should ideally be even with the most protrusive part of the lips when see in a side view. While this is a classic anthropometric measurement, and one that is historically espoused in the concept of male beauty, that does not mean it is the most ideal aesthetically for any individual. Some men prefer their chin to be stronger than this measurement suggests while others prefer it to be a little shorter. When trying to decide between two chin implants sizes of a few millimeters difference ask yourself this question…would I prefer to ‘error’ on the side of having the chin turn out to be a little too strong or a little too weak? Obviously you want it perfect but knowing that choice will help make the decision between those two implant sizes.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi Dr. Eppley, I am interested in nose and neck surgery. In the front view the tip of my nose is too fat. My nose profile shows that my bridge projects too much and the line from my top of forehead down through the bottom of my nose is too straight. I wish to have these things changed by a closed rhinoplasty. Also my neck and jowls is sagging and I would like liposuction to tighten them up, I am 49 years old. Additionly I don’t wear face makeup so I wish for no visible scars to show. Thank you for your time and I really enjoying reading all your info on the web and hoping you can improve my nose and neck. I have attached some pictures for you to review.
A: Thank you for sending your pictures. I have some computer imaging on them and those are attached. Here are my comments based on your stated desires and what is realistic.
Your rhinoplasty would be best done open. You have thick nasal bones and cartilages and to effect those changes you would get a better result through an open visual approach. (less chance of need for revision) You have thick nasal skin so there is no risk of having your nose ‘overdone’ or looking like it is too small or has an operated look. Thick nasal skin always make a rhinoplasty result less rather than more in appearance.
You have too much loose jowl and neck skin to just do liposuction alone. That will just make the skin look loose and have more sag. You need a tuck-up neck-jowl lift with liposuction to get the result that you are after. Again, the thickness of your skin and it looseness work against a fat removal only procedure. Your skin quality and amount in the jowl and neck area makes it necessary for a more aggressive approach to get a good result.
One additional thought is that of your chin. It is horizontally short and that works against you getting an improved jaw line and neck appearance. A chin augmentation would really complement the neck-jowl lift.
Dr. Barry Eppley
Indianapolis Indiana
Q: I would like an opinion by a plastic surgeon. I would like to get rid of the hump on my nose and for it to be smaller and not so wide. My nose is especially wide underneath my eyes. I would like a chin implant to help with my side profile. These are the two procedures that I’m for sure ready to have done immediately. I eventually would like enhance the size of my lips. I had Juvaderm administered to my upper lip about two years ago and did not have good results. My primary focus right now is my nose and chin and would really like to see what I would generally look like after a Rhinoplasty with a chin implant. Thank you so much!
A: The combination of a rhinoplasty and chin augmentation is very common and highly successful. This is particularly true in one’s s profile view even though that is not how one usually sees themselves. (even though most of the world knows you more this way) In this what I call the ‘ying and the yang’ procedure, reducing prominent areas on the nose (hump reduction, shortening or de-lengthening the nose) and bringing a recessed chin forward can make for a significant change in one’s side view. And because two areas are being changed in different directions, it does not take large changes in either the nose or the chin to make a real visible difference. This can be demonstrated before surgery (and always should be) by computer imaging. Rhinoplasty and chin augmentation are two procedures that can be both easily and accurately demonstrated by computer imaging manipulation.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have had a beard for years and now I have a job that will not allow facial hair. This has made my insecurities over my chin to resurface. I am especially interested in a chin implant. After review a lot of before and afters you have seemed to me to do the best work. What is the best type of chin implant ti use?
A: Facial hair on men provides uniqueness to one’s facial appearance and is often a fashion statement. Many times, however, facial hair serves as either a distraction or camouflage technique. This is especially true for upper lip and chin concerns in men. A beard or a goutee adds at least 5 to 8mm of pseudoprojection of the chin depending upon how long the hair is allowed to grow.
When it comes to chin implants, there is no one single style or type of material used that is the best. There are over a dozen chin implant styles, which initially seems confusing, but that allows for a chin implant style that goes best with a wide variety of chin concerns and objectives. Chin implants should be looked at as more than just providing horizontal projection. The frontal view of the chin and jawline should also be taken into consideration in term of vertical height and width of the chin area. It is important to go over all chin dimensions with your plastic surgeon so the best chin implant style is chosen for you. When it comes to different materials of chin implants, there are certainly advocates for each type. I personally find the material composition of chin implants largely irrelevant and am more interested in making sure the style and the patients desires match the best.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am 5’7″ and weigh 128 lbs. Even though I am relatively thin, I have always had a double chin for some reason. But I feel like it has gotten worse since I have given birth to two children and have gained over 40 lbs with each pregnancy. I am interested in knowing what could be done and how much improvement I could expect. Getting rid of this double chin would help me feel more confident. Thank you so much for your time.
A: The cause of a ‘double chin’ is a combination of three anatomic factors; neck fat, neck skin, and chin projection/prominence. Every double chin is made up of differing ratios of all three components. It is always about how much neck fat is there, how much extra neck skin there is, and how short one’s chin may be. While you didn’t state your age, that number also has an influence because it suggests how much neck skin you may have and, most importantly, how elastic it is.
Some double chins can be corrected by as simple a procedure as neck liposuction in someone who is young and with decent chin projection. On the flip side, an ‘older’ severe double chin may require everything including neck liposuction, chin augmentation, and some form of a necklift to help tighten the extra loose skin. Each patient must be assessed individually and a custom treatment plan devised as double chin correction is not a one size fits all procedure.
One surprising aspect to the ideal correction of double chin problems is that of the chin. Many people have short chins that are magnified by this problem. Lengthening the jawline with a chin implant while bringing the angle of the neck back (or making it more defined) is the classic ‘ying and yang’ approach which together makes a better result than either change alone.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am considering getting involved in martial art training and was wondering if having a chin implant would pose a problem with that activity. I have a porex chin implant and I’m afraid it will shift if struck. Have you ever seen a porex implant shift from blunt trauma? Is there a difference in potential shifting between porex and silicone implants. Please let me know so I will know whether or not to proceed with martial arts training.
A: I would not personally refrain from martial arts training, or any other contact-related sports activity, if I had an indwelling chin implant. The risk is always there that a good blow to the chin could cause a problem such as shifting of the implant but that risk to me seems very low. There is an equal, if not greater risk, of breaking one’s nose or having a tooth knocked out. Such are the orofacial risks of any contact sport.
The potential advantage of a porex (medpor) chin implant over a silicone one in terms of shifting in the face of trauma is theoretical. Because the porex implant has greater tissue adherence and even some amount of tissue ingrowth, one would assume that it is more resistant to movement after surgery over a purely non-ingrown encapsulated silicone implant. But blunt trauma to the jaw with enough force can easily fracture the bone so the potential for implant movement, regardless of its composition, is always a low occurrence possibility.
Dr. Barry Eppley
Indianapolis Indiana
Q: Can a chin implant be done after a sliding genioplasty?
A: The premise of this question is that the result of the bony chin advancement did not produce the desired amount of horizontal chin projection. That could be because the bony chin was not moved forward enough or that the amount of chin advancement needed exceeded how much the bone could be safely moved forward.
Either way, an implant can easily be added onto the front of the chin bone. This is best done through a submental incision under the chin as would be done traditionally. Placing the implant on the front edge of the chin bone does not disrupt the healed chin bone and disrupt the blood supply to the bone. While it can also be placed through the same intraoral incision as the of the sliding genioplasty, this causes a lot of extra tissue disruption going through an area that is already scarred from previous surgery.
Gauging the amount of chin advancement needed is one of the most predictable forms of facial computer imaging. Since the chin soft tissue moves on a 1:1 basis with how the bone position changes, side view predictions can quite easily show how much movement is needed. In doing a sliding genioplasty, if one notes beforehand on the computer prediction imaging that it remains still horizontally deficient, an implant can be placed on the front of the chin at the same time as the chin bone is moved forward. I have done this successfully several times and it works to get 3 to 5 mms of chin projection if needed.
Dr. Barry Eppley
Indianapolis Indiana
Q: I hope you can help answer some questions about chin/jaw implants please? I have a weak jaw line in that my bottom jaw is slightly further back than that of my front, if you follow. I was wondering if I would be a candidate for a chin/jaw implant and if you believe this would assist in aligning my jaw whilst avoiding a lower jaw construction which I would rather not go through?
A: Small horizontal chin deficiencies are usually the result of lack of bone growth in the chin area only. (symphysis) More significant chin deficiencies, however, are a problem with the growth of the entire lower jaw (condyle, ramus and body), meaning that the whole jaw is short not just the chin. This can be clearly evident by how one’s teeth comes together. In a jaw deficiency, the lower teeth are offset behind the upper teeth by a 1/2 to full tooth. (known as a Class II malocclusion) Chin augmentation, whether done by an implant or cutting just the chin bone, improves the projection of the chin and the facial profile but does not align the entire lower jaw.
Aligning the lower jaw, by bringing the entire jaw forward that contains the teeth, provides chin enhancement but also improves one’s bite (occlusion) as well. This is most commonly done by a sagittal split osteotomy of the lower jaw which is performed in the ramus of the mandible. It is clear to see that jaw alignment and chin augmentation are the not the same thing. Jaw alignment by bone advancement will simultaneously give chin augmentation but chin augmentation alone will not create a lower jaw alignment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am considering having augmentation for my short chin. I am confused as to whether to use an implant or move the bone. Doctors seem to recommend both ways and it is not clear as to which way may be best for me. Can you help me decide?
A: Your two main choices for chin augmentation are either an implant or a sliding osteotomy. Both will work and each has its own disadvantages and advantages. An implant is simpler, has a quicker recovery and can make the chin wider as it comes forward. (if you want to change your v-shaped chin in frontal view to a more round or even a more square shape) There are even square chin implants to help create that look. The only disadvantage is that it is an implant…although I don’t really see any lifelong problem with having an implant in the chin. That is a very safe place for a facial implant and it is not likely to ever cause any problems requiring its removal. The osteotomy involves moving the chin bone instead of an implant. It is a ‘bigger’ operation, requires a plate and screws and thus there is more expense. It’s main advantage over an implant is that it is better at increasing the vertical length of the chin should that be needed. An implant can not do that very well at all. Also in big horizontal advancements (8 to 10mms or more) in a young person, moving your own chin bone forward is probably better than having a big implant on the end of the chin. An implant can deepen the labiomental sulcus whereas an osteotomy can keep it from getting deeper than where it started. This means that it may look more natural in the long run for big chin advancements.
In the end, you have to look at the anatomy of your chin deficiency and determine whether an implant or osteotomy can correct it the best and the most natural. Other important consideration are your age and the economics of the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have looked into chin implants and, a local plastic surgeon with whom I shadowed in town, felt that a simple chin implant would only bring the skin forward in the front and not actually give me the square, fuller jaw, and more forward chin, I was looking for to balance the face. So my question would be, is chin and jaw augmentation the same thing or are they different procedures? If they are then would “chin” augmentation be my best bet?
A: Chin and jaw augmentation are different but related. Chin augmentation refers to building out the front part of the chin or jaw, otherwise known as the anterior prominence. Jaw augmentation most commonly refers to jaw angle implants which accentuate the size and prominence of the posterior jaw prominence. While they are often done separately, it is not rare to have them both done at the same time to get a total jawline enhancement effect. A chin deficiency is frequently part of an overall ‘weaker’ jawline, so the three point augmentation approach (one chin, two jaw angles) can create a better defined and more masculine lower third of the face.
While jaw angle augmentation exclusively uses implants, chin augmentation can be done with implants or by moving the bone known as an osteotomy. Whether one is better served by a chin implant or a chin osteotomy, and the size and style of jaw angle implant needed, requires a careful facial assessment and the use of computer imaging to make those determinations for each individual patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q : I have a medpor chin implant as part of some cosmetic surgery 4 years ago. The implant is eroding the bone and my oral surgeon says it must come out. He doesn’t want to replace it. I am in no pain and I like the way I look. Do I have to have this surgery to remove it?
A: Medpor chin implants have a uniquely porous material of which they are composed. One of the purported benefits to its material is that it will cause less bone erosion underneath when it is placed in the chin area. The phenomenon of the implant settling into the chin bone is known as pressure resorption. This unique chin implant phenomenon has been recognized for decades. It is a natural phenomenon and is very similar to what is seen in breast implants. When breast implants are replaced many years later, the underlying rib cage will often have a concave surface or bowl where the implant sat. Such bone resorption is what happens when the soft tissue is stretched by an implant, it pushes back just a little bit over a long time. Since the synthetic implant is a solid non-resorbable material, the underlying bone relieves itself of the pressure by some resorption. ..and the implant settles or erodes to some degree into the bone.
While you may have some chin implant settling into the bone as evidenced on an x-ray, it is not a problem in my opinion. You have no symptoms and you are satisfied with your existing chin projection. Surgery to replace your chin implant seems to be an overreaction to a non-problem.
Indianapolis, Indiana
Q: Can a chin implant be an alternative route to mandibular advancement? I went to the orthodontist today for my overbite and excessively gummy smile and was told that my options are to get the Lefort maxillary surgery (or place 2 screws on my upper jaw and have wires pull my teeth-in sections via braces- upwards to reduce the gummy areas) and mandibular advancement. Read about LeFort and mandibular advancement and don’t think I want to go through all the pain and side affects so I looked into chin implant and I am entertaining the idea of a chin implant and the 2 screw method to pull my teeth upwards….. any suggestions?
A: Both chin augmentation and mandiibular advancement will have similar effects on the chin…bringing it further forward. How much each approach will bring it forward is more adjustable with a chin implant as different sizes can be chosen. In mandbular advancement, the chin will only be brought forward as far as the jaw comes forward and the teeth still fit together properly.
Chin augmentation is certainly a far easier and more efficient choice if the primary motivation for the surgery is the aesthetics of the chin. But it will not obviously change one’s bite so there may be some functional chewing and temporomandibular joint tradeoffs if the lower jaw is significantly short.
Mandibular advancement is a commitment both in orthodontic preparatory time and in surgical recovery. Therefore the amount of jaw shortness and how well one is able to chew and bite comes into play as to whether this effort is worth the risks.
Indianapolis, Indiana
Q: have a older button style chin implant and would like to replace it with a new one. I want a chin implant that creates a more masculine look with lateral fullness in the mandible area and a more squared off appearance to the chin. I would also like to have a lip reduction to rebalance my facial proportions so that the jaw line is more prominent and the lips less so. Let me know if this is something you can do all at the same time.
A: Older style chin implants were much smaller in size and ‘non-anatomic’ in shape. They usually just fit over the central part or button of the chin, providing only central horizontal augmentation. While such chin augmentation shape can be acceptable in some patients (usually females), it does not provide the best chin shape in most males. It makes the frontal chin shape too triangular. In men, squaring of the chin shape produces a much more pleasing facial change. While profile views shows good horizontal advancement, patients do not usually see themselves that way and using that view as a judgment of the final result can be deceiving.
Today, chin implants come in a wide variety of styles and shapes that can achieve more than just a simple gain in profile lengthening. Men, in particular, often want a more masculine chin look which means a more square frontal shape and one that blends into the side of the jaw without an obvious transition. In addition, some increase in vertical length is often aesthetically desireable.
Chin implants can easily be exchanged in styles and size, regardless of whether they were placed from under the chin (my preference) or through the mouth. Pocket size and positioning may need to be altered but this does not usually involve the extent of dissection and postoperative discomfort that occurred from the first chin implant placement procedure.
Lip procedures can easily be done at the time of chin augmentation, particularly if the path of implant insertion is done from under the chin. (submental incision)
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have an inherited double chin that makes me look twice my 46 years of age. Can you make it disappear so I can look younger ??
A: A ‘disappearing’ act is what we do a lot of in plastic surgery. Whether it be liposuction, chin implant, facelift…or some combination….it certainly can be made to ‘vanish.’ I know that your double chin makes you look older….but I doubt if it makes you look 92!
When patients refer to a ‘double chin’, this means there are at least two and sometimes three rolls of skin if you include the chin as one of the rolls. The double chin is often the result of the combination problem of a full neck and a short chin. In the younger patient, this can be improved by doing chin augmentation and neck liposuction at the same time. When you move two different things in opposite directions, the result becomes greater than when only one is done alone. In an older patient with more loose skin, this diametric action may require chin augmentation and a facelift to get the neck going back and up as the chin comes forward.
If the forward position of the chin is adequate, then the neck alone can be treated. Again, age and the amount of loose skin determines whether liposuction (good skin) or some version of facelift (bad skin) is needed.
Correction of a double chin is highly effective plastic surgery adventure and can make for a dramatic difference in one’s appearance.
Dr. Barry Eppley