Your Questions
Your Questions
Q: Dr. Eppley, my face is getting increasingly crooked as I think my implant is displaced. it feels like its sitting on an angle. i would like a video consultation to understand what went wrong and my options now. I feel awful and it doesnt look good. its also hurting a little where the implant sits very high.
A: I assume you are referring to a chin implant since you didn’t specifically say what implant. Based on your preoperative chin recess one can debate whether an implant was initially the best choice. But that being said I think it is clear that it has an asymmetric positioning. If we wanted to have a clear indication of exactly how the implant is positioned a 3D CT scan is needed. But there are several important pieces of information I don’t have. (incision used for placement, implant material, implant style and size)
But as overview there are three secondary chin augmentation options:
1) Reposition the current chin implant
2) Remove and Replace with New Chin Implant
3) Remove current chin implant and Replaced with Sliding Genioplasty
Such decisions would be based on how you feel if the chin implant you have in did not have any asymmetry.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I was wanting to get your opinion if a Large vertical lengthening chin implant (VLC) can help achieve these results.
A: That will not create that imaged effect as that is a square chin result and the VLC implant has a rounded shape. That specific chin shape effect requires a custom chin implant design to get both vertical length and a square chin shape.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, After doing research on real self and looking at my own face, I’ve very open to anything you suggest that I have done! You responded to my question in detail on real self several days back which I really appreciated. The main procedures I would like to take a look into having done has to do with my chin, so possibly a chin implant…fat removal underneath the chin/neck (This is one thing I feel like I’m a great candidate for and really want done), and buccal fat pad removal in the cheeks because I have always noticed I have pretty thick cheeks. I do realize sometimes buccal fat removal isn’t possible based around if the cheek has fat that can be removed or if it is just the way it is genetically. My chin also points slightly to the left and I’m not sure if chin implants can fix that? Like I said I’m very open here! Also my whole life I’ve been able to give myself what looks like a facelift just by “flexing/pulling” back the muscles and skin on my face. Everyone who I’ve showed which has been a lot of people, always say they’ve never seen someone who can do it. Have you ever seen this before and what does it mean? In all the side by side pictures attached, on the left side of every pic is my face totally relaxed. And on the right is me “pulling my face back”. I’ve notice it makes all my facial features stand out more but the one thing I don’t like is it also raises my forehead line which makes my forehead look larger.
A: Thanks for your inquiry and sending your pictures. What happens when you pull the skin back is that you ‘skeletonize’ your face. The skin is tighter and the skeletal highlights (brow bone, cheeks, chin and jaw angles) become more prominent. That is why you like your face better this way. To try and replicate some of that effect you have to do a combination of skeletal augmentation and facial defatting. You will never replicate that loo surgically or naturally on its own but there are several procedures that will help. Chin implant augmentation with buccal lipectomy and neck liposuction are good selections. I would also add that small cheek implants can also help sculpt the midface better and are a complement to that of the buccal lipectomy. You natural chin/jaw asymmetry poses an issue for a standard chin implant as this really requires a custom chin implant to ideally correct but that will drive up the cost of surgery. The most economic approach would be to modify a standard chin implant (reduce the left side and position the right side of the implant lower) and hope for better albeit not perfect symmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had two sessions of Sculptra and one session of Radisse fillers earlier this year in January. In early April of this year, I had a chin implant with an incision in the mouth. After the chin implant, my chin and sides swelled up and hardened. It’s been over a week and can’t seem to bring the swelling down. Could this be due to the Sculptra and Radisse fillers that I had earlier this year? If so, what can I do to bring it down.
A: If I interpret your inquiry properly you had a chin implant placed just one week ago. It is perfectly normal to have considerable swelling after such a chin augmentation procedure that will take up to six weeks after surgery to completely go away. As a general rule, 50% of the swelling goes down by 10 days, 75% by three weeks, 90% by 6 weeks and 100% by three months after surgery. The fact that you have had prior fillers in your face has nothing to do with the swelling that you are experiencing now. There is also nothing you can do to hasten this natural healing process. I would have assumed that your surgeon reviewed the typical swelling and tissue firmness that occurs after any facial implant and the protracted time that it takes to resolve.
Dr. Barry Eppley
Indianapois, Indiana
Q:Dr. Eppley, I believe that many of the surgeries you perform are far more effective and life changing than traditional plastic surgery procedures.
I’m looking into having forehead, temporal/skull, and chin augmentation, and have found there are very few plastic surgeons are experienced in craniofacial surgery for cosmetic purposes.
I know that plastic surgery in Korea focuses very much on altering the bony structures of the face to achieve a prettier and more youthful appearance and for this reason I have been enquiring with some plastic surgeons in South Korea. Ideally I would prefer to travel to the US and have the above procedures performed by you.
I am interested in having forehead augmentation- preferably using bone cement as I understand that implant placement can be difficult, particularly when placed lower on the skull; I feel that my brows/superior orbital rim are quite flat and contribute to some minor eyelid sagging so would like the forehead augmentation to extend to this area, as well as smoothing out the temporal bone area, and reducing the backward slope towards my hairline.
I’d like head widening implants possibly extending to the temporal region to balance my lower face.
Lastly I’d like to get an “anatomical” or “extended” type chin implant which extends into the pre-jowl area which is quite hollow and shadow-y, and makes my lower cheeks look a little droopy.
A: My understanding of your email is that you seek the following procedures which are primarily Forehead Augmentation and Chin Augmentation. Let me provide some initial clarification on forehead augmentation because your assertion that implants are harder to get lower on the brow bone than bone cement is not accurate. Actually it is the exact opposite. Because foreheads/brow bone implants have a preformed shape they can more effectively positioned on the brow bone area through a smaller incision. Bone cements can achieve the same result but they take a full coronal scalp incision to really place as low as possible.
The biggest dilemma in forehead augmentation is management, if need be, of adding the temporal area in the overall augmentation. Bone cements can not be placed past the anterior temporal line onto the adding temporalis fascia as that often creates the potential for edge visibility and/or pain. Some slight blending of the upper temporal region can be done but it can not extend down too far.
The only really effective method for anterior temporal and posterior temporal head widening is with the use of subfascial implant placements which have to be semi-custom made and are designs of which I only have.
A chin implant that extends back more posteriorly would be the anatomical design which has long tapering wings back to the pre jowl area. That is a fairly standard facial implant request.
In conclusion, the most economic approach would be PMMA bone cement forehead and chin implant augmentation. The cost of the temporal implants would, by your own description, be prohibitive.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think I need a chin implant. I have a recessed/weak chin and jaw I am looking to get corrected. I had braces as a kid and my teeth fit together fine. I was hoping a chin implant would help alone but my nose might be too large as well.
A: You have at least a 10mm chin deficiency. The choice between a chin implant or a sliding genioplasty is how you would view it from the front view. A sliding genioplasty will keep the chin at its existing narrow width. (unless an overlat implants put in front of it. Conversely a chin implant can make your chin wider/more squatter from the front view. That is what should principally make the aesthetic decision between the two chin augmentation approaches. Regardless of the method used, your labiomental fold will get deeper, unlike what you are showing by pushing your jaw forward to simulate the chin augmentation effect. (this is because the teeth come forward and help augment the labiomental fold)
A chin implant can also help reduce the appearance of a large nose by making the lower face more prominent. It may not eliminate the need for a rhinoplasty is a very large nose but it can delay or even change how the rhinoplasty surgery is done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have always had a long and narrow face that lacks definition and bothers me. I was also born with a recessed chin. Over the summer I decided to have a chin implant, but after waiting months for the swelling to go down, I don’t feel happy with the results. I feel my chin implant sits too high up (intraoral approach was used) both in looks and in function. I have not been able to close my lips without due strain since the surgery and I could this before the surgery. There’s no swelling or tightness left either. Not to mention they used the smallest implant possible, so it’s not that the implant is simply too large. Because of this I am afraid that the height of the implant and the nature of the oral incision could be to blame? I cannot find any answers online and my surgeon says t hat everything is fine. Thoughts?
A: Intraoral chin implant placement has a known propensity to place the implant too high. If the chin implant does not sit down at the bottom of the chin bone, its aesthetic effect will not only be diminished but it can interfere with mentalis muscle function and a competent lip closure. Just based on the description of your symptoms, I suspect your conclusion about the location of the chin implant is correct. Chin implant revision would consist of repositioning of the implant to the proper position and repair of the mentalis muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about chin implant surgery. I recently had a small central chin implant put in and I am about 3 1/2 weeks post-op. I really dislike the shape and am wondering if an extended chin implant would have been a better option. I have shadows/dents on either side of my chin.
A: There are numerous styles to choose from for chin implant surgery. Obviously selection of chin implant style and size are critical in getting the optimal desired aesthetic chin augmentation effect. While a central chin implant is often a good choice for some women, it does not provide any augmentation effects to the side of the chin since it does not extend past a vertical line dropped down from the corners of the mouth on the bone. Since you are seeing shadows/indents on the side of the chin, this would strongly suggest that this indeed a chin shape or chin style issue. The question is at just under four weeks after surgery whether this is too early to make a final judgment about the outcome of your chin augmentation procedure. I would give it a full three months after the initial surgery date before making a final judgment about the decision to change your chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty and chin implant two years ago. But I am still not happy with shape of my nose, chin and face overall. I wish I can start over. I feel my nose is still too long and pinched and wish it was straighter and more refined. I also want a more angular facial shape with a masculine defined jawline and cheekbones. I think my chin implant has done only so much to help my desires. See my before and after pictures. Are my expectations and desires unrealistic? Can you help? Thanks so much.
A: Thank you for sending your before and after pictures. I think on both counts (rhinoplasty and chin augmentation) you have had good improvement and I would not agree that there would be any benefit to ‘starting over’…even if you could. You have reasonable results from both your rhinoplasty and chin augmentation. Your nose may be just a tad too long but that is a pretty good result. You are not going to be able to make any drastic changes to it other than perhaps some tip shortening. I do not know what you mean by being ‘pinched’. The refinement of any rhinoplasty is controlled by the thickness of the nasal skin. Having thicker skin there is a limit as to how much refinement can be obtained. You are likely as good as it can be. In that regard you probably do have some unrealistic expectations. Your chin implant has provided a substantial improvement and you would not want any further horizontal augmentation. What you are ‘missing’ from a facial skeletal standpoint is a lack of jaw angles and cheek prominence. The nose and chin have helped but they were not the sole solution to a more masculine face.
In short I would recommend some nasal tip shortening and cheek and jaw angle implants. This will then provide a more comprehensive approach to facial masculinization.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin ptosis correction. I originally had a chin implant ten years ago. Following an accident in nine years later the implant moved and it was changed with a new implant last year. This new chin implant was much too large for my face and was removed six months later. Following the removal of the implant I developed chin ptosis with too much lower teeth show when I opened my mouth.
I subsequently had a chin ptosis corrective surgery three months ago with bone anchors. The result from the chin ptosis surgery is substantially the same as before the surgery but now my lower lip goes in on the right side when I smile or I speak or when I open my mouth my lower teeth sees too much. When I talk I have trouble to articulating my words, maybe because of the new position of my mouth. I saw the surgeon again last month for this problem again and he did Artecoll to correct the irregularity of the chin and offered me another surgery to remove the extra skin under the chin and to do Botox to correct the defect of the lower lip.
I did not accept these proposals because I want to have first your opinion and advice. The surgery to remove the extra skin under the chin makes me nervous because now when I open my mouth my lower teeth show too much and I fear that this problem will be accentuated with this surgery. Now I really need your advice and your help. I’m sure you could find a solution to restore my chin. I read your publications regarding chin ptosis and possible treatments could be a small implant or 2 or 3 mm osteotomy for support under the chin could help or neck lift. I have seen before and after pictures on your web site concerning this surgery in which you made all this women much more beautiful. Thank you very much for your answer.
A: The first thing is I would not rush into any surgery immediately. It has just been three months and your tissues are still healing. It would be helpful to see pictures from different angles for a more complete assessment. If too much lower tooth show is the primary concern any type of submental tissue removal would not help in that regard. Given your history of multiple chin implants and now being ‘implantless’, it appears that an important part of getting your lip back up may be the placement of a new smaller implant to help drive the tissues upward. Soft tissue suspension alone appears to have been inadequate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, About 2 years ago I had a chin implant put in during a rhinoplasty revision in Miami. It looks great BUT the lisp NEVER went away. It resolved to about 90% and continues to have good days and bad. The chin implant is a medium size. I’ve spoken to a neurologist as well and he does not feel this could have anything to do with mental nerve irritation as there is no area of numbness. At this point I’m quite frustrated and got a CT hoping to see some gross abnormality or slipping of the implant. The CT shows only a slight periosteal reaction (not-osteo per the radiologist) on the right and a .5cm asymmetry of implant riding posteriorly on the right. Could this be the cause of this? I do notice a corresponding limitation to my ability to retract my lower lip on right. Searching the internet, you seem to have the most facial implant experience so I wanted to get your opinion as general consensus thus far (including a speech pathologist) seems to think replacing it with an implant that projects less would be the answer.
A: This is not a postop problem with chin implants that I have personally seen before. I would not feel that the size of the chin implant nor its position is the problem. There are lots of chin implant patients with gross asymmetry of their implants and they don’t have any speech issues. Conversely there are patients with huge chin implants that don’t have a lisp either. It sounds like there is a mild weakness of the marginal mandibular branch of the facial nerve, which affects the retraction of the lower lip, which can be a source of a lisp. That is a lower lip problem that I have seen before. Recovery of a marginal mandibular nerve weakness, which is a monofasicular nerve, will have reach its potential by two years after surgery. Thus I would have no confidence that any manipulation of your indwelling chin implant would offer any improvement in your current speech issue. You can, of course, prove or disprove that conjecture by replacing the current implant that you have. But the chance of improvement to me would be very unlikely.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am mainly looking to improve my profile and get more projection from my chin although I think I would benefit from slight additional vertical length as well. I have done a fair amount of research about the various options for recessed chin (jaw surgery/ sliding genio/ chin aug) and understand chin aug to be the least invasive of them all. I have an overbite that was made slightly better with braces about 2 years ago, but during the process I had 4 teeth extracted which seems to me has made my jawline/ dental arch narrower(may be just in my head). My dentist has said that my overbite is not too bad but I want to make sure that a chin aug alone would be sufficient for my needs or should I be looking more at orthodontic options.
A: Thank you for sending your pictures. With your amount of horizontal chin deficiency and your dental/orthodontic history, there is on doubt that the origin of your chin concerns is a result of overall lower jaw growth deficiency. While major jaw surgery/orthognathic surgery would more ideally address that problem, it would be a very difficult and long road to go through orthodontics before and after surgery not to mention the actual jaw surgery itself. And you would still need some type of chin surgery done with the jaw surgery. Thus this leaves you with either a chin implant or a sliding genioplasty as more practical treatment options. To really add a vertical increase to you chin as well as a horizontal one, you ideally should have a sliding genioplasty. A chin implant to achieve that same type of result would almost have to be custom made to achieve similar dimensional changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in double chin correction. Attached you will find some pictures that I took–today during my lunch break! Looking at me straight on, at a flattering angle, you can tell I have a round face but the double chin isn’t noticeable. When I smile widely, laugh, or am viewed from my profile, it is clearly evident. What are my treatment options? Will liposuction alone work as another doctor told me? Let me know your thoughts!
A: Thank you for sending your pictures. While there is certainly some subcutaneous fat to liposuction, that will give you a modest improvement only. Necks like yours almost always have a subplatysmal collection of fat in the midline that will not be changed by liposuction. This requires a submentoplasty technique to maximally tighten the neck angle. You also have a bit of a horizontally short rounder chin. This adds a third factor to the double chin appearance. Adding a small central button style chin implant will add a little more horizontal projection and change the frontal chin shape to more of a tapered chin look.
In conclusion, it is all about the degree of double chin correction you are seeking.Liposuction alone will produce a modest improvement, a submentoplasty (which includes neck liposuction) will make a good change and the final addition of a chin implant will make the best overall double chin correction. As you can see neck liposuction is the most basic approach but does not produce the best double chin correction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a facelift to get rid of my neck sagging and jowls. Is there anything else you see in my pictures that you think would be helpful to create a more refreshed and younger facial look?
A: Thank you for your inquiry and sending your pictures. You would do really well with a lower facelift which will redefine your jawline and reshape the neck. You do have a bit of chin ptosis (roll of tissue on the underside of the chin and a small chin implant would be helpful to eliminate that and add to improvement in the entire jawline appearance. You do have a little extra skin on both eyelids (and just a bit of puffiness of the lower eyelid as well due to fat herniation so doing blepharoplasties at the same time (which is very common) would add to the overall facial rejuvenative effect. Your thinner skin and tissues also makes for a good outcome as these tissues show the effects of facial skin redraping the best as opposed to thicker heavier tissues. It is more common to do additional procedures with a facelift than to do a facelift alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m really pleased to know a chin implant can be a solution after my chin and jaw angle reduction surgery which has left my face deformed. I’ve sent pics to show how my chin dips in side profile and how the chin area directly below my lower lip protrudes when I smile. I think this is related to mentalis suspension? Really want to get rid of this protrusion, not normal looking.
- Can vertical chin implant get rid of this protrusion under my lower lip?
- Does a “mentalis resuspension” mean, cut along the gum line and stitch it again with a new stiching line in a different place? What does mentalis resuspension mean?
- What is the risk involved in mentalis resuspension? ( Or could it result in a worse bulge/protrusion or some other complications?) Or should I best leave it, if it’s going to risk resulting in a worse protrusion or some other complications.
- The center that did my CT scans seem to think that my jaw angles have been over cut (surgeon took too much bone off?), it was not cut straight and I have indented jaw angles? Does it look as if my jaw angles have been over cut? ( CT scan attached)
- Is it best I get a chin implant and 2 jaw angle implants? Or is it best to get a one piece implant that goes from one side of jaw angle ,across the chin, to the other side of jaw angle?
- Are there any down sides to having screws in your face bones? How many screws will it take to hold the implant(s)in place?
- I read online that a silicone jawline implant does not give good defined bone shape/anatomy, but acrylic PMMA is able to give that defined bone structure, is there truth in this ?
Thank you so much.
A: Thank you for sending your pictures of you and your 3D CT scan after your jawline narrowing or V line jaw reshaping surgery. In answer to your questions:
1) Vertical augmentation of your chin will help with the protrusion as the origin of the problem is the loss of volume from the previous chin reduction.
2) Mentalis resuspension is an intraoral technique where the mentalis muscle is repositioned higher on the bone.
3) The only downside with mentalis muscle resuspension is in how well it works. It has no other downsides and will not make what you have now worse. I do not think, however, that mentalis resuspension is needed for tour chin problem and implant augmentation alone is a better approach.
4) Your jaw angles do look over cut with a severe 45 degree angle to them. That matches with how you loo on the outside of your face. (the indentations over the angles)
5) Unless you want the side of the jawline augmented (which I do not think you do as there is a reason you had the original surgery…a narrower jawline), I would go with a three piece chin and jaw angle implant approach. They need to be custom made and I would design them as a single attached jawline implant (because it will cost you less to do so) but in surgery I will convert it to three pieces.
6) There are no downsides to have small 1.5mm screws in your jawline for fixation of the implants. They are roughly the size of the screws used in eye glasses.
7) A custom jawline implant, made of silicone, creates the best jawline definition and shape over any other material. PMMA would be the worst material to use since you have to shape it during surgery and achieve any symmetry and good shape between the two sides of the jawline would and be virtually impossible. Anyone who would say so otherwise is inexperienced and ill informed and does not have a contemporary understanding of facial implant materials and how to design and place them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It is said that the Terino extended anatomical chin implant produces a wide appearance to the chin. I want to know whether the wideness would be round and wide (like a half-oval) or flat and wide like a skateboard ramp. I’ve heard that the chin will be similar to Dick Tracy cartoon version, but a Real Self review got me thinking otherwise.
A: Every chin implant merely adapts to the shape of the underlying front end of the jaw. So if the implant is oval shape and the bone shape is oval (which almost all chins are) the resultant chin shape will be both wider but round or oval. Only if the chin implant has a different shape on the outside as opposed to a rounder or oval inner surface (like a square chin implant) will the resultant shape be wider and more square. Certainly no standard preformed chin implant available today is going to make any chin similar to a Dick Tracy cartoon version if that is what one’s final shape objective is. Only a custom made chin implant can achieve that very square look. The Terino extended anatomic chin implant does look more square in its picture but it will not create a square outer look in most cases.
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 came across your web site and would like to ask what would cause a persons chin to recede. I am now in my 50’s and have noticed a distinct change in the lower portion of my face. I am considering corrective action but I have never had surgery. Can a chin implant procedure be done without general anesthesia? Also, what is the usual time required for healing when this type of surgery is done. Thanks for any feedback you can provide. I appreciated the case studies and the beautiful outcomes you shared.
A: The observation that one’s chin seems to be getting smaller as one ages is not rare. But only in exceptional cases does the chin bone actually recede or lose bone structure. Most of the time it is really a change in the neck that creates that impression. As the neck drops or begins to droop, the change in the neck angle can make the chin appear more recessive even though it has not really changed. This effect can be magnified in someone who may have always had a slightly recessive chin but never considered it so until this aging effect appeared.
Chin implant augmentation can be done under local or IV sedation fairly comfortably provided that is the only procedure they are having done. Recovery is really just limited to swelling with no functional restrictions. One can expect about 3 weeks until most of the chin swelling is gone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a chin implant but had radiation for a sarcoma on my chin as a teenager which was over thirty years ago. I have read that you like to inject fat prior to placing an implant in an area that has previously received radiation. But doesn’t the fat just go away?
A: The purpose of the fat injections is not to create the augmentation effect, although it may have some mild benefit in that regard. Their purpose is to improve the blood supply and healing potential of your chin to eventually withstand the effects of placement of a chin implant. Fat injections are well known to help reverse the effects of irradiated damaged tissues through a process known as neovascularization. The fat may indeed partially or completely resorb but it will have improved the blood supply of the tissues through various stem cell and growth factor effects. With your history of facial radiation treatments with the chin as the direct recipient of them, placing a chin implant into these damaged tissues could be fraught with wound healing and infectious problems afterward. At the least, fat injections will help soften the chin tissues in preparation for the stretch effects of what an underlying chin implant will create.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin and maybe jawline implants. Do you favour the intra-oral or extra-oral approach for chin implants? Also, do you use silastic or porous implants? I have attached some pictures so you can see how short my chin is.
A: The first question to decide before one considers how to augment the jawline is exactly what type and degree of changes does one seek. As you can see in the attached imaging, you could just do chin augmentation only (side view prediction) vs. total jawline augmentation of chin back to the jaw angles. (oblique view prediction) Your chin is so short because your entire lower jaw is underdeveloped so your jaw angles are rotated up and backward (high) as well. There is also a debate to be had about your chin as to whether that should be done with an implant or a sliding genioplasty. Therefore, options include:
Chin implant only
Chin and jaw angle implants (performed)
Total jawline implant (custom)
Sliding genioplasty alone
sliding genioplasty combined with preformed jaw angle implants
But when it comes to using jawline implants of any configuration, silicone implants are far superior to Medpor and a submental approach (vs intraoral) is easier with a quicker recovery. The small skin scar is inconsequential.
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 am interested in combining a chin implant and facial liposuction for making a round face thinner. I want to have normal shaped face, but also would like a skinnier face overall if possible? And are results permanent because I can get puffy just by taking a shower, so I am worried that my face is not stable and will that interfere with my surgery results. Thanks for any advice 🙂
A: Your desire for a slimmer face is actually based on a deficiency in your lower face not too much fat. You have little little fat throughout your face as you can see your cheek area is fairly thin and flat. The facial shape problem is that your chin is both horizontally and VERTICALLY short. As you can see in the attached imaging , when the chin is brought forward and lengthened, your face overall looks thinner. Thus making you have a thinner face is not based on liposuction fat removal but a very elongation of the lower face done through either a chin implant (vertical lengthening chin style) or a sliding genioplasty. (opening wedge type)
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 lost of a lot of weight and my face is asymmetrical. I have small jowls and not sure if I need a facelift or just a necklift and if face implants would be an alternative to a facelift. I want to look prettier and have a long, narrow face with high cheek bones but hollow cheeks underneath and nasolabial folds. I have tried to have my own fat injected into the nasolabial folds but it does not last very long. I also have very thin skin. Would you recommend a regular face lift or a smart lift? Thank you
A: In looking at your face and objectives, I see three procedures that would be simultaneously beneficial. Higher cheekbones are only going to be obtained by cheek implants. While chin or chin-prejowl augmentation is not a substitute for what some form of a facelift can do, a small vertically lengthening chin implant can help the jowls somewhat but more importantly contribute towards a longer more narrow face. Facelifts go by many names and their name sometimes indicates the extent of the procedure. You need more of a jowl lift type procedure which often carries the name of short scar facelift, Lifestyle Lift, Smartlift etc. Regardless of the name it is designed primarily to lift and eliminate the jowls. When done together with the chin augmentation your jawline should be fairly smooth.
Improving the nasolabial folds is difficult and fat injections, while worth a try, are rarely successful. The only technique that I have found consistently effective are dermal-fat grafts which are essentially autologous implants but they require a harvest site to use.
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’m interested in improving my profile with a chin implant (custom or pre-shaped implant – whichever you feel would achieve the best desired results), along with possible injection to my nose. I have always wanted a stronger jawline and chin. I have always felt that I look this way, but in reality I just don’t have that masculine look. By adding a chin implant, will that also improve the jawline since the skin is being stretched further forward? I’ve attached a side-by-side of the results I’m looking for versus my actual face. For my nose, I’m interested in very minimal nose work. I’m fine with my turned up nose as I believe it’s unique, but would like to know if injection was possible to smooth the “slope” to make it appear less concave where the bridge and tip merge?
A: You have demonstrated well the benefits of a chin implant with your prediction imaging. That amount of horizontal advancement is around 9 to 10mm and, when the chin is lengthened, will improve your jawline. The key chin/jawline feature which you have not evaluated yet is how the chin will change in the frontal view and whether it should become more narrow or wider. Such an assessment will help make the determination of whether a preformed stock or custom chin implant will be needed.
From a rhinoplasty standpoint what you are seeking is simple dorsal augmentation. But using an injectable material, even fat, is not going to produce a successful or sustained result. This is going to require the use of either a septal cartilage graft or an implant, both of which can be done through a closed rhinoplasty result. A dorsal augmentation closed rhinoplasty is a fairly minimal nose surgery with a very quick recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in female chin augmentation but have some concerns. Many before and after pictures that I have seen show chins that look too strong to me with too much horizontal advancement. I am a 27 year old female and want to do something to improve my weak chin/jawline. Take a look at my attached profile picture and tell me what you think.
A: Female chin augmentation is different both aesthetically and in implant designs that what is done on most men. This side view picture makes it infinitely clear as to your chin concerns. In a female chin that is deficient, the critical question is how much horizontal advancement is desired AND what happens to the width of the chin as it comes forward. In women the chin should become more narrow or triangular as it is advanced forward. This can be done by either a sliding genioplasty or central button chin implant style. I will need to do some computer imaging to see how much chin change you are looking for. In women, less is always more when it comes to chin augmentation in most cases.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if I had maxillofacial surgery, would a chin implant and mini facelift be out of the question for me? Does having had the facial/jaw bones being worked on exclude the possibility of having implants placed on top of the bone or the outer skin lifted like in a facelift?
A: Any type of a facelift and chin implant can be done on someone with a prior history of orthognathic surgery, whether it was a LeFort 1, mandibular advancement/setback or genioplasty or any combination of them. What is done down at the bone level has no impact on the adjustments of the facial soft tissues along the jawline or on the side of the face. A chin implant can also be done over a previous sliding genioplasty even though there may be some more scar or tissue adhesions around it. To illustrate this point, it is not rare in my experience to place facial implants at the same time as having orthognathic surgery or to do a second stage after orthognathic surgery to place them. Given that the bone is at a completely separate layer than the skin or the SMAS tissues, there is no impact on having any type of a facelift later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a chin implant questions/issue. In my opinion, I have a recessed chin and jaw. Eight years ago, I had a large silicone chin implant inserted, and liposuction below my chin. At my consultation, the plastic surgeon asked if I breathed through my mouth, which I realized I do. Ever since then, I have been on a quest to resolve this issue. I have been to an ENT doctor who said my nasal passages checked out fine. But since I feel that my chin implant did not provide me with enough projection (I am 41 years old but one year ago I had a platysmaplasty for loose skin beneath my chin), and my lips still do not close with out mentalis strain, and as I age I feel that my lack of a supportive jaw is not helping, I would really like to take action. Also, I recently discovered that chin implants have been known to cause bone erosion, which frightens me. I had braces as a teenager, and still have a bit of an overbite, but I do not know where that leaves me as far as options to both improve my appearance and breathing functions. I sincerely appreciate your time and thoughtfulness, as this is quite daunting to me.
A: The chin implant issue that you describe is a common one that I hear about. Between your appearance and breathing issues, your description suggests that your lower face/jawline appearance can be improved. With a naturally short lower jaw, a large chin implant that is still inadequate in projection and a residual mentalis strain, this indicates to me that you need a sliding genioplasty for a chin implant replacement. Besides the limitation of chin implant projection (10mms or less), increasing the chin point by an implant will not improve mentalis muscular function nor any lower lip incompetence should it exist. Your existing chin implant may have also developed some settling into the bone. (often erroneously referred to as ‘bone erosion’ which is not harmful) By removing your chin implant and performing a sliding genioplasty you will improve your chin projection, eliminate the mentalis strain, and also improve your neck profile. I would need to see some pictures of your face to verify these statements but your description is not a rare problem that I see with indwelling large chin implants.
As for your breathing issues, nothing you do to the chin will have any impact on your nasal airway exchange.
Dr. Barry Eppley
Indianapolis, Indiana