Your Questions

Q: Dr. Eppley, In looking for jawline implants for total jawline enhancement do you think a good combined solution for chin and jaw is the Medpor Matrix system, or do the chin and jaw implants separately? I currently have some hyaluronic acid directly on my jaw angle and line because I did not know about such implants until recently, so I think I should remove that with “Hylase” before determining implant sizes.

My final questions to understand the size and shape of the implants and surgery would be:

a) JAW: The horizontal width of the RZ mandibular angle implants is 11mm (or 7mm respectively) at the LOWEST point of the implant and diminishing gradually to the top – like a triangle, correct? And as you mentioned the  VERTICAL DROP is ALWAYS 10 mm regardless of the horizontal width of 3, 7, or 11mm? (which can be shaved down I guess if necessary?)

b) CHIN: With respect to a chin augmentation:  If, just theoretically, I am satisfied with the length (anterior projection) of my chin length but NOT with the lateral horizontal width and shape (which I want to be SQUARE and 5 cm ranging from one corner of the mouth to the other) – are there available or can you shave down an medpor RZ extended chin implant so that there is NO or only 1-2 mm anterior projection but the same lateral and inferior projection as the medium sized RZ Ext Square chin implant? So practically speaking a customized RZ Square chin implant augmenting only laterally the side parts of the chin (like an implant without or only a 1-2 mm middle part9). An implant which makes the chin look more square and broader, which augments the lateral parts of the chin. (hope I expressed myself properly)

A: If I have to use off-the shelf implants, I generally stay away from Medpor because they are hard to put in, never fit very well to the bone, hard to stabilize to the bone and very hard to revise if that ever needs to be done. (of which the risk is about 25% of that need) I have used them a lot and the more I use them the less I like them. None of their purported benefits are true, other than soft tissue adheres to the implants making them a near nightmare to ever revise. But I will still use them when patients insist and some patients, like you, have an affinity for it.

When it comes to total jawline augmentation with Medpor, I would use a three-piece chin and jaw angle approach and not the Matrix system. The Matrix system is extremely hard to put in and virtually impossible to ever remove or revise due to the features of the material as previously described. Since the chin implant is put in as a two-piece implant with a male-female connector, it is easy to make a square implant but how far or close the two pieces are put together. It is, in essence, and adjustable width chin implant. When in doubt about jaw angle widths with the RZ style, it is always better to go with the biggest size as it can also be reduced during surgery. (but you can’t add to it)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, first thank you for offering such great jaw angle and chin implant surgery to patients. I have found your website on the internet, as I have been looking for Medpor RZ angle implants and chin implants for years and I definitely intend to do that surgery. Of course a final recommendation can only be done personally in your office, but I would be very thankful for your first indication based on a picture of my current jaw line and chin position attached. 

My initial questions prior to the surgery would be:

1. JAW ANGLES:

a. Which Medpor RZ angle implant size would you suggest to achieve a projection like on the celebrity pictures and my computer animated picture, assuming that I augmented my cheek and cheekbone prior to the jaw implant surgery? 7mm or 11mm or 11mm shaved down to 9mm?

b. What is the horizontal width of the 7mm and 11mm Medpor RZ mandibular angle implants?

2. CHIN: which mm size of the chin implant would you suggest for a masculine chin projection, 6mm or 8mm?

A: In answer to your questions:

1) The vast majority of jaw angle implants rarely need to be more than 7mm. An 11mm implant, when both sides are factored in, increases the bigonial width by 22mm which is considerable. The numbers 3, 7 and 11mms refers to the width or horizontal dimensions of the implant. It is a standard 10mm vertical drop with these style of jaw angle implants.

2) I would have to see your pictures and see what degree of chin horizontal shortness you have, but generally 8mms is going to be a better choice than 6mms for most men.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, 1.  Am interested in an overall approach to address my weak jawline/chin and nasolabial folds. I had a smaller chin implant over 20 years ago, but I am certain that advances since that time could provide me with a better overall result.

A: I have received your pictures and done some initial imaging predictions. Knowing that you have a chin implant in place with your high jaw angles indicates how short your lower jaw really is. Substantial improvement can come by changing all dimensions of the jawline, not just the horizontal position of the chin. There are two fundamental approaches. A sliding genioplasty combined with an extended chin-jawline implant overlay with vertical lengthening jaw angle implants is one option. The second choice would be a custom total wrap around jawline implant made from a computer-generated design off of a 3D CT scan. There are advantage and disadvantages with either method. Either approach takes it way beyond what the simplistic approach of ‘chin augmentation’ would achieve by looking at a complete jawline enhancement. As you know, your lower jaw issue is not just a simple isolated chin deficiency.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, At the moment, I am at a complete loss of what to do about my profile. I have had so many consultations now and have advice ranging from ‘do nothing’ to ‘have a neck lift, fat removal and chin implant at the same time’. I need to do something as it’s making me very self conscious and I hate seeing photos of myself from the side.

My problem is that I am only 27 and am apparently not a candidate for neck liposuction alone because of my bone structure. It has to be explained to me that I have a low hyoid bone that is creating a blunted neck angle so that my neck blends into my chin. My teeth do align so it is not a problem with my bite but I do also have a weak chin. 

From my own research it seems like a chin implant might provide me with the illusion of an improved neck angle but my concern is how it will impact my face front on and my smile- lots of reviews seem to say their jaw looks to masculine after a chin implant or that they can no longer show their bottom teeth when smiling. At the moment when I smile I show my bottom teeth, which I like, and my chin points slightly in feminine way. I also have a small indent in my chin when I smile and am unsure if a chin implant would make this worse. 

Do you have a recommended approach to this sort of problem? Given my age, I don’t want to risk ruining my face with anything too drastic! I do need to do something though as it’s making me really self conscious. 

Thanks in advance for your help. I do wish I was a more straightforward case!

A: Quite frankly you are a very straightforward case. The combination of chin augmentation and neck liposuction is the correct approach. The key to a successful chin augmentation in you is to understand that in the profile view there needs to be both a horizontal and vertical dimensional change and in the front view the chin shape needs to stay a triangular shape and not become too round or full which is more masculine. There are two ways to achieve these chin changes. An implant needs to have some vertical elongation and must be more of a central buton style that has no significant lateral wings to it. The other option is a sliding genioplasty which can be brought forward as well as down. (vertical lengthening) Sliding genioplasties will always keep a narrow chin or make one more narrow as it comes forward because it is a U-shaped that is being brought forward. The indent in your chin, whether the augmentation is done by an implant or an osteotomy, will not change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had Medpor chin and paranasal implants placed close to 3 weeks ago. The implants were both placed intraorally.However, I still have issues with stiffness and a little difficulty with lip closure. Can I just check whether these issues are normal at this stage of recovery, or is it something I should be worried about? The stiffness in movement is one that concerns me the most, as it does affect my speech a little. Lastly, if this isn’t typical, would removal of these implants be possible? 

A: What you are experiencing for these types of facial implants is extremely typical. My experience and what I counsel my patients on before surgery is that to expect the following recovery as it relates to swelling, function and aesthetics…50% by three weeks, 75% by 6 weeks and 100% by three months. Thus you are being way premature to even consider implant removal as you have not gotten yet to see what the final result will be. Your perception of what you thought your recovery would be is undoubtably much less than that and this accounts for your concern at this early recovery point. Patients understandably do not appreciate that this is, in essence, very similar to bone surgery even though it is done for aesthetic purposes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 21 years old and I bit unhappy about my profile…I was thinking about doing something on my chin,nose and ears what would you recommend me. I have sent you some recent pictures of me.

A: In answer to your questions, You would benefit by any three of the procedures that you described.

1) Your ears do stick out the left more than the right. A setback otoplasty would be very effective.

2) Your nose is very ‘juvenile’ in shape with a low dorsum and a soft amorphous round tip. An augmentative rhinoplasty to build up the bridge, give the tip more projection but also narrow it would give your nose a more defined structure.

3) Your chin is short both horizontally and vertically. A sliding genioplasty or a combined horizontal/vertical lengthening chin implant would make your profile more balanced and proportionate for a male.

I have attached some imaging which reflects these proposed changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking at augmentation the jaw angles to the side of my chin to make it more horizontal and masculine looking. Would it at all be possible to get a Medpor square chin implant, and angle the wings down a little to achieve that effect, or will I require a customized chin implant for this kind of augmentation?

A: Your question has me a bit confused. A square chin implant does not reach the whole way back to the jaw angles. There are specific jaw angle implants to achieve that area of mandibular augmentation that are different from  chin implants. They are two completely different mandibular (jaw) implant styles. In some cases, a custom jawline implant can be made  that wraps around the jawline and goes from angle to angle including the chin.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested to know what can be done for my very short chin. I don’t know if I just need an implant or whether the jaw bone has to be moved. If you can answer a few questions for me I would appreciate it very much. 1) What is the biggest chin implant in terms of maximal horizontal projection? 2) How much can a sliding genioplasty move the chin forward? 3) Can sliding genioplasty be combined with an implant? 4) Can the entire lower jaw be moved without changing my bite? 5) How do you correct chin deficiencies larger than 10 mm? 6) How do you correct vertical deficiencies? 7) Does the implant feel natural and is there any risk of shifting after surgery?

A:  The person with a very short chin poses challenges that often neither a standard chin implant or a sliding genioplasty can ideally solve. In answer to your questions:

1) The maximum horizontal projection for most chin implants is 12 mms.

2) How much a sliding genioplasty can advance the chin depends on the thickness of the mandibular symphyseal bone. That could translate into a 10 to 12mm chin point forward movement.

3) Yes. An implant can be overlaid in front of a sliding genioplasty to gain more horizontal projection or width.

4) No. The mandibular body and ramus can not be changed without carrying the attached teeth with it also, thus changing the occlusal relationship to the upper teeth. By definition, jaw advancement surgery changes the bite.

5) Options include a custom designed chin implant or a sliding genioplasty with an implant placed in front of it.

6) Vertical chin deficiences require a custom implant and are a component of every horizontal chin deficiency greater than 10mms. When the chin is that short it indicates there is an overall jaw shortness.

7) The implant will feel like bone and is screwed into place to prevent the postoperative risk of shifting.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, for my chin and jaw angle implant surgery I have couple of questions. I had originally mentioned the idea of some liposuction below the Jaw line/ chin and wanted to see if you thought that was still an option( especially if it could be done through the chin implant incision.) Finally, any ideas of a realistic downtime from work? Would 3 weeks be enough to be off work and able to go back without looking extremely swollen? Also can the surgery be done under IV/ twilight sedation?  Thanks again for your time. Thanks again 

A: In answer to your questions:

1) Submental liposuction can certainly be done at the same time with access through the same incision as that of the chin implant.

2) The vast majority of the swelling from this type of surgery is from the jaw angles and you are correct to assume that 2 to 3 weeks is enough time for you to look normal, even though the final details of the result will take months to fully emerge.

3) This is not a procedure that is done under sedation anesthesia. Lifting the large masseter muscles off of the mandible is less than a pleasant experience to place the jaw angle implants. This is a procedure that requires general anesthesia to be done correctly.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I was wondering how much of an advancement in millimeters via either an implant or genioplasty to achieve a more masculine chin and does my deep groove effect the outcome. Thanks.

A: How much chin advancement any patient can obtain depends on their anatomy. For a sliding genioplasty it is usually up to 12mms based on the front to back distance of the thickness of the chin bone. An implant can do more as it is based on how the implantg is fabricated, how much the soft tissue can stretch and the placement of the submental incision to place it. Increases in horizontal projections with chin implants can be done up to 15 to 18mms. In some cases, a coimbination of a sliding geniplasty with an implant overlay can be done with increases up to 20mms.

Any amount of chin advancement, no matter how it will done, does not change the labiomental sulcus and, in cases of significant advancement, will make it deeper. In a genioplasty the ‘step’ in the bone can be filled in to help preventing worsening the depth of the sulcus. In chin implants, the best simultaneous treatment would be fat injections placed directly beneath the sulcus.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, My goals are increased horizontal projection of my chin( no vertical lengthening)and a more square chin. Jaw angles flared out with augmentation of the angle itself and of the ramus but not the body? ( not necessarily a drop down of the angle itself as I think the angle is low enough currently). Rhinoplasty to decrease the hump in the nose possibly decreasing the width of the bony part of the nose when viewed from the front and the tip refined somewhat( picture with red hat)( My morph( lateral view of my nose in the blue shirt) I admittedly got a bit crazy/unrealistic with the tip of the nose. Finally, liposuction below the lower jaw/chin area to get rid of the adipose tissue that has always been there no matter my weight( a good 10-15 mm in various spots under the jaw/chin when I do a pinch test.) Also, wondering if the chin implant can be placed through an existing scar on my chin from my childhood.( picture added of scar 20 mm long and 10 mm long in the 2nd aspect and around 3 mm of width to the actual scar line( the scar is basically a T shape) Attached are some before and after pictures that I’ve done in photoshop as what I’m kind of looking for in general terms. I don’t know if this is even possible / what would be proportional for my face, but thought I would include them as a rough reference since I’m not there in person currently. My overall goals are increased balance in my face as I think the upper 1/3 of my face/ head is much larger then the lower 1/3. Also, I’m looking to do this with IV/ twilight sedation and not general. I’ve had septoplasty (2004) and a hernia operation in the past with just iv sedation(+ spinal for the hernia sx) and prefer this option. Thanks a lot.

A: Thank you for sending your pictures and doing the array of imaging. My review of the imaging matches fairly well with your goal descriptions and I would agree with much of it with the exception of a few minor variations.

For your chin you seek more horizontal projection, a more square shape in the frontal view and no change in its vertical length That would be possible using a square silicone chin implant, probably of at least 7mm to 9mms in thickness placed through a submental incision. It would not be wise to use your existing scar as it is too small, would become more prominent as the chin is pushed forward and would dive through the mentalis muscle in the process. A scar revision can be done on it but it would not be used to place the implant.

Your jaw angles show width expansion, a sharpening of the angles and no vertical lengthening. That could be accomplised by a 9mms silicone lateral augmentation implant placed directly over the existing angles.

The only comments about potential results with these implants is that the angularity of them (point of the angles and sharpness of the chin corner) may or may not be as sharp/pronounced as you have shown. The other issue is the continuity or smoothness of the jawline from the chin back to the angle. While the ends of a square chin and jaw angle implants will overlap, these overlapping areas are not as thick as the other parts of the implants. This it is not clear that the jawline will be as perfectly smooth from front to back as you have imaged.

The nose can be changed through an open rhinoplasty with a hump reduction and tip narrowing and some mild lift. I think those results are very achieveable.

Lastly, this collection of combined facial structura procedures can be done very well under just IV sedation. These are operations that are best performed under general anesthetic to get the best result.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley,I am a 27 year-old man currently looking for the best surgeon to carry out jawline and perhaps chin augmentation. I would love to get rod of this beard which I sue to camouflage my weak lower jaw. I have added you on Skype for a consult and have attached some pictures for your review.

A: I have done some imaging on your pictures. Yo do have a very short chin and high jaw angles. I don’t think a chin implant alone would suffice for the change that I have imaged. The concept of a sliding genioplasty with an overlay small square chin implant can create a 12 to 13mms of horizontal increase and add more squareness to your chin from the front view. Your jaw angles need vertical lengthening only with a minimal horizontal increase. All put together this should create a dramatic change in the jawline that will make you be able to dispense with the beard if you so desire.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I like what I see, much more “chiseled” appearing. Would it be unnecessary to or insensible to increase the length of my chin to make it sort of protruding? I’ve always found that to be appealing/masculine. I know people get chin reductions to avoid that, but I’ve always liked that. If not, I feel that I see some flaw in my chin/jaw line that stands out to me. I’ve always wanted a stronger jaw/chin, maybe overly strong, beyond typical. Maybe it is my jaw? Would you recommend a possible jaw implant along with the rhinoplasty and chin implant? Do you think this would match my desired traits? I desire an angular sort of jaw, with a square appearing and strong chin, and my nose looks great after, but is there a way that it could be made that you couldn’t see the bottom of my nose? Its always made me self conscious that the bottom of my nose has been visible when i am looking at someone. I am sorry I’m asking so much, I just want to make sure that I am 100% pleased with the procedure and I want to get as much done at once as possible by the same person and you seem to know exactly what I want.

A: When it comes to vertical lengthening of the chin, that can not be done with an implant by more than few millilmeters. It would require a chin osteotomy or a custom chin implant to do that which, although can be done, adds to the cost of the procedure. I would just use a square chin implant of 9mms augmentation and position low on the chin bone so that is some degree of vertical lengthening. I believe that will more than suffice.

The trifecta of jaw angle implants and a chin augmentation are the best way to create a chiseled jawline. The key question in jaw angle implants is whether they should just be of the lateral augmentation type (just adds with to the jaw angle) or whether they should be of the vertical lengthening type with variable amounts of width addition. What most men who seek the chiseled jawline look need is the latter, some vertical lengthening and width addition to create a sharper and more defined jaw angle at the back of the jaw.

Your nose is slightly over rotated (tip up too high). The tip could be rotated downard to some degree using septal extension and tip only grafts during your rhinoplasty.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I would like to know which one of the two approaches for chin implant surgery is better, intraoral or submental incision? How do you avoid cutting the branch of the facial nerve. When you do the submental incision and how likely is it to injure this nerve by the submental incision?

A: There are advantages and dusadvantages to each chin implant approach. Neither one is necessarily ‘better’. Both are acceptable chin implant approaches and produce similar results if technically done well. The submental approach avoids the intraoral incision and the need for disinsertion of the mentalis muscle from the bone when coming from above and that may make the recovery process a little bit easier. The submental incision should have virtually no risk of injuring the marginal mandibular branch of the facial nerve. The course of that nerve lies way to the side of where the submental incision is and is in a much more superficial tissue plane than the subperiosteal approach to the chin bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I had previously two chin implants which failed to give the length I desired. So I had an sliding genioplasty two months back with implant removal. As the swelling has gone down I look almost same as I did with implant. My surgeon said he advanced my chin 6 mm downwards and 5 mm horizontally. Is it the maximum advancement possible with sliding genioplasty? Your wise thoughts will be very much appreciated.

A: I have several thoughts about your chin surgery history and your question. Did you and your surgeon have a good understanding before surgery using computer imaging as to your desired chin goals? Changing the chin is one of the most predictable of all aesthetic structural facial procedures as the bone/implant change is 1:1 with the overlying soft tissues. It seems very pecular to me that you could have had three chin surgeries, none of them with large chin changes, and still end up inadequate. The bony genioplasty movement of 5mms horizontally is not very significant and, regardless of whatever size chin implant was in before, I am not surprised that you look no different now. You essentially swapped out the change provided by an implant for that of an osteotomy but no more. (other than some vertical increase) When one trades out an implant for an osteotomy it is because the osteotomy can make dimensional changes that an implant can  not. While chin implants are not capable of providing more than a few millimeters of vertical height increase, they are capable of 9 to 10mms of horizontal lengthening. The amount that a bony chin can be advanced is based on the thickness of the bone but in most cases the amount of lengthening can be 10 to 12mms as the back edge of the downfractured chin segment touches the front edge of the intact upper chin bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 32 year-old male and I would like a well-defined jawline. I have attached some pictures for your thoughts.

A: Thank you for your inquiry. When it comes to improving the 'jawline' that could mean various things to different people. Fundamentally it comes down to whether one wants the front of their jawline (chin), the back of their jawline (jaw angles) or both improved. Those distinctions are obviously important as they involve different procedures.

In looking at your photos, an obvious horizontal chin deficiency exists. That could be significantly improved by either a chin implant or a sliding genioplasty. There are advantages and disadvantages to either approach and, based on what I see so far, I would lean towards a sliding genioplasty which would advance your chin up to 12mms but would also narrow it a bit in the frontal view which may be aesthetically advantageous for you. I have attached some prediction imaging of that potential result from the side view. It is not clear, based on just one photo, that augmentation of your jaw angles would help improve your jawline. I have done some imaging on this grainy frntal photo but it is questionably helpful. Better photos would ultimately be needed to clarify this issue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, First off just to inform you that I have been dealing with this since I was 19 yrs old, I am 46 yeras old now. I was born with a very weak chin. I never told anyone and always wondered why I took horrible pictures. Took me many years to figure it out that my jaw was not there. Been ripped off as one doc did needles in my neck and liposuction in 1991 and still had a turkey neck. Then I had a chin implant in 1996 and still had a turkeyneck after. I am a police officer and when people want a pic with a police officer I turn them down. I hate this. Is there any help? I do weight  train & cardio but nothing changes my neck. I just entered on the computer  about weak jaw for men and your site came up.

A: Thank you for your inquiry and sharing your very personal story. Until I see some pictures of you it is hard to know whether you have a very underdeveloped lower jaw although your description sounds very much like that is so since you have had this issue since you were very young. Your prior chin implant may not have been successful because the volumetric dimensions that it added were way inadequate, not that the concept of it was wrong. Significantly lengthening of the jawline and chin will also provide improvement in the turkeyneck appearance as the jawline becomes longer, a neck angle becomes more apparent. Please send me a front and side view of your face for my further assessment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I think I may have screws up my chuin surgery. I was washing my face and was pushing really hard on my chin but didn't know because it is numb and then something felt different…on the right the implant was in a different location. Then I protruded my mandible forward and it only felt tight on the left of my chin, not on both sides of it anymore. And then I palpated my implant and on the right the implant is completely on the outside of my mandible and on the left it is under it. It is bad. Now it is in a lot of pain. I tried putting it back in place but it is of no use. I will just injure myself. Now the incident is giving me a lot of pain: my whole chin and the new location of the implant. Before this happened I called about having you call in more pain medication to my pharmacy and I mentioned a painful tumor-like lump on the left side of my mandible. It is hard like bone, and round, and inferior to the bone as well as lateral to it. My pain includes pain in this area. However, the area felt different to the touch than other areas. Now, after what I have caused to happen with the implant, I cannot assess it. It is still painful to the touch, although the lump seems smaller and less obvious. It was causing my chin to look shifted to the left, because the right of my chin was flat and the left protruded where the lump was/is. Where the implant was feels like a dent in the bone of my mandible and somewhat looks like one. Now that the implant, out of place, adds width to the right side, my chin looks more centered than before, where it looked shifted to the left. I am also sending a picture of the area where the fat was inserted, just checking if everything looks normal. Both of the areas containing the transplanted fat feel to the touch like I am touching like hard rubbery rubber implants. Just want to know if everything's normal. Thanks.

A: Thank you for the follow-up and sending your pictures. Let me share with some basic concepts about the recovery process from your chin osteotomy/implant and fat injection surgery. It takes a minimum of at least 6 weeks and closer to 3 months to see the final result. It is very normal to have everything that you are feeling and showing at this point, which is very early at just 9 days after your procedure. Besides the swelling, numbness and bruising, every chin osteotomy patient at this point will have hard lumps at the end of the osteotomy cuts on the side of the jawline. That is what you are seeing on your left side and I would not consider that abnormal at this point. While it is possible that could be a malpositioned end of the implant overlying the osteotomy site on that side, it is just as likely that is swelling and a collection of blood from the surgery. I would be a lot more concerned about that issue if this was 4 or 6 weeks but not yet at 9 days out from surgery. I also doubt that you could have malpositioned the implant by rubbing on the outside. The bone and the implant are secured in placed by plates and screws so it would be very hard to displace it. The fat injections into the nasolabial folds will feel and look exactly how they do at this point and that is perfectly normal. It will take 4 to 6 weeks for them to smooth out, blend in and feel normal.

Hang in there as it is still very early in your recovery process.

Dr. Barry Eppley

Indianapolis, Indiana

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, my face is very unbalanced as my chin is very short. This also makes my neck look fat even though I am at a good body weight. I have attached some pictures for you to tell me what you can do for my really short chin. It looks like the lower part of my face is just missing.

A: Here is a side view prediction based on the combination of a chin bony advancement (sliding genioplasty) combined with an implant. Your horizontal chin deficiency exceeds 15mms which puts you well beyond what any conventional chin implant can do. A chin osteotomy will advance you up to 12mms, which is better, but also not ideal. Therefore, in cases like yours I will put an implant in front of the advanced chin bone as well that will add another 5mms to the projection. The addition of the implant also has the advantage of its extended lateral wings which will fill out the sides, making the chin a little more square. That is an advantage for a male who benefits by a more square chin anyway. In addition, your thicker neck tissues would simultaneously benefit by liposuction under the advanced chin area to try and thin that out a little but.

The combination of a chin osteotomy and implant combined with neck liposuction can make some significant changes as the imaging suggests. This type of ‘extreme chin augmentation’ is necessary to get the best result in larger male chin deficiences like yours.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I’m going to ask you a question you probably heard 10000 times. What procedures do I need to perform in order to get “the male model look” and look handsome?  I think(I may be wrong) I need: Skull Reshaping, Cheek Augmentation, Chin Advancement, cheek and chin;jaw/mandibular Implants,  nose rhinoplasty; lip reduction; Neck Contouring; I’ve attached a few photos of me. My face looks fat. That’s because i have about 20 pounds of excess fat. 

A: You are correct in assuming that I have been asked that question a lot….and have subsequently done a lot of male facial sculpting surgery. In getting a better balanced and more defined facial shape in a male, there is a list of procedures to consider most of whom you have mentioned. But each face is different and therefore has different needs to improve its proportions and get closer to a more sculpted look. There is also the issue of priority and the associated cost to do them so making the proper diagnosis as to the anatomic problems is extremely important in surgical procedure selection.

Your most glaring anatomic problem is your severe lower jaw/chin deficiency. A short lower jaw makes the entire lower face both horizontally and vertically short. This is what contributes to your impression that your fat is fat…it is not. It is just that the lower 1/3 of your face is overpowered by the upper 2/3s. This is further accentuated in profile by a moderate nasal hump which makes the facial convexity worse.

Your most important procedure is to get the lower 1/3 of your face in proportion. This is beyond what a chin implant alone can do. You really need a chin osteotomy (sliding genioplasty) combined with a small square chin implant placed in front of it. Removing your nasal dorsal hump would then complement your facial profile. (see attached side profile prediction) These are the two most important procedures. Secondary consideration could also be given to cheek implants. (see attached front view prediction)

While some other procedures may be complementary, this is the foundation for helping you get closer to more of a ‘male model look’.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  my jaw is small, not much of a jaw line, and have a slight receding chin. Wondering if an implant could achieve a balanced/symmetrical look or if I should pursue Orthognathic Surgery. Interested in Rhinoplasty as well. How long would recovery time be? Would the implant be permanent?

A:In looking at your pictures, I see no evidence/reason to pursue orthognathic surgery. Such jaw surgery is only done when there is a major occlusal (bite) problem which I suspect you do not have. Your facial balance could be improved by chin implant augmentation only. Chin implants are permanent and will never need to be replaced. I have done some imaging of that result which is best seen in side profile. You may also benefit from jaw angle implants for increased lower facial width. But I will await your response to what a chin implant alone does for your jawline. From a nose standpoint, your tip and nostril area is larger the rest of your nose. (out of balance) A rhinoplasty that focuses on narrows the tip cartilages and nostrils with a slight dorsal reduction would make a better balanced nose. I have done some imaging of that potential result which is best seen in a front view.

I would anticipate that recovery, from a return to work and not obviously looking like you have had surgery, would be 7 to 10 days. It would take the final shape and form of the nose and chin up to 3 months after surgery to have subtle changes in swelling to resolve and to see the true final result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I would like to have the following done for ssome facial changes:

1) upper lip lift to reduce the distance between the base of my nose and upper lip (lip to nose ratio reduction by more than half my current natural lip to nose ratio) I am a fan of the lip to nose ratio as typically seen in women even on men as well.

2)  I would like also a  reduction in the bottom lip to the size of my top lip

3)  I would like profile surgery, in specific mouth protrusion surgery to westernise the protrusion of my mouth which as you know is commonly seen in Asian and african americans.  I understand there are implants and other methods used to achieve a western profile.

4)I would like a medium chin implant to improve my profile, more projection towards the bottom, when carving the shape of such implant, please note the design of my beard which I purposefully shape especially toward the bottom to almost mimic or complement the shape of my cupids bow along the border of my top lip.  We can obviously discuss this more in detail if there are any misunderstandings as to the shape chin I am going for.  You can best describe such shape as masculine and very edgy.

5) I would like an implant to give more height to my nasal bridge, with a tip that more length and projection without making the nose appear from the frontal view to be more bulky and thicker than its current state.

6) Finally a resection or crescent-shaped or wedge alar flare reduction to address nostril flare.  We can discuss what options would be best, maybe an alar suture cinch procedure or wedge resection.   

7) Remove fat underneath chin area.

8) Please use computer imaging for what potentially can be done as a valuable tool for us to communicate. 

A: Thank you for your inquiry and sending your pictures. Let me respond to your 8 issues/concerns as follows:

1) A subnasal lip lift can reduce the distance between the upper lip and the base of the nose, but not by half. That is too much and would create a very unusual looking upper lip. As a general rule, I reduce it either by 1/4 or up to 1/3 the vertical distance as measured along the philtral columns. This provides reduction but keeps a more natural look without the upper lip looking like a snarl.

2) The lower lip can be reduced by an internal horizontal wedge excision at the wet-dry vermilion line. Most lip reductions can reduce their size by about 1/3.

3) I am not absolutely sure what you mean by ‘westernized mouth protrusion surgery’ but I think you may mean paranasal base augmentation to help improve the concave profile around the base of the nose and the upper lip.

4) Your chin is horizontally deficient and an improved shape could be obtained by a chin implant that provides 7 -9mm increased projection and a more square shape.

5) A rhinoplasty using an implant for dorsal (bridge) augmentation as well as a columellar extension would help improve the nasal height and tip projection. This can also be done with a rib graft and their are arguments for both approaches (implant vs graft) based on their advantages and disadvantages.

6) Without question, the alar wedge resection for nostril narrowing is far superior to that of the alar cinch suture.

7) Submental liposuction for fat removal with the chin implant would be a good benefit.

8)I have attached some realistic imaging to give you an idea of what may be able to be achieved with these procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to improve my profile. I am 53 years old and have always had a round face. But as I have gotten older and gained weight, it has gotten more so. About 20 years ago I had a chin implant placed. It helped a little but the result was not what I was looking for but I have lived with it. Now I would like to rejuvenate myself a little bit and get my jawline looking better. I have attached front and side pictures for your recommendations.

A: Thank you for your inquiry and sending your photos. In looking at them, you have chosen the correct procedures, neck recontouring and chin augmentation. The chin augmentation is straight forward. A forward projecting chin implant of 8mm to 9mms would give much improved augmentation.  This is in addition to the chin implant you already have. I suspect it is a very small inplant that is likely placed too high on the bone. So I would remove it and replace it with one that is bigger, more square-shaped and positioned lower on the bone. Your very full neck (bullfrog neck deformity) is the challenging procedure. This can be approached from three different approaches; liposuction only, liposuction with submentoplasty or a full necklift. I think with your size neck and excess skin that only a full necklift will give you the maximal improvement. Males with thick necks never get as much tightening and cervicomental angle creation as females so the most aggressive approach needs to be done. I have attached a side imaging profile to show what I consider to be a conservative result, meaning the least amount of improvement that I would expect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a transitioning female-to-male transgender individual and my goal is to create a more masculine appearance. In particular, I have a very round, feminine face. I believe chin implants and possible jaw implants/contouring would help a lot, but I am open to hear suggestions as well.  I’m very concerned about price given my student status.

A: When it comes to making a face more masculine, you are correct to first look at the jawline. That is one of the top areas in facial contouring in FTM transgender patients. your photos show a really soft jawline and that it makes priority number one from a surgical altering aspect. The rest of your face, as you have pointed out is round and feminine. From a both a cost and an effectiveness standpoint, I would focus on chin augmentation and buccal and submental fat reduction. In other words, a combined chin implant, submental liposuction and partial buccal lipectomies. This will help your jawline considerably and create improved definition sa shown in the computer imaging that I have done. The only debate about the chin procedure is whether it should be an implant or an osteotomy. Ideally, it should be an osteotomy because of your age  and the need for some vertical chin lengthening as well. But there is a cost difference between a chin implant and an osteotomy and that has to be factored into your treatment decision as well as you mentioned. Jaw angle implants are also an option but are far less important than chin augmentation in your case.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like a straighter more refined nose and a stronger jawline. This may require a chin augmentation but I am not sure what I really need. I just want to look more refreshed and have a more attractive face. I have attached some pictures for you to see and give me your recommendations.

A:  Thank you for your inquiry and sending your pictures. I have taken a look at them and can give you the following thoughts.

Your chin deficiency is as much a vertical one as it is a horizontal one. This can not be treated by a traditional chin implant as they can only provide increased horizontal projection. Vertical increase is very important in your chin augmentation. Either a custom chin implant needs to be fabricated or a chin osteotomy needs to be done. Either approach can be successful and I have done many both ways. There are advantages and disadvantages to either approach and they can be discussed in detail further by phone or by Skype.

Your nose shows a lack of tip projection and definition. The nasal tip is rounded and more ball-like. I do not see the lack of straightness in your nose that you have indicated in your inquiry. This can be improved by an open rhinoplasty with the use of a columellar strut graft alar rim grafts and tip reshaping. 

I have attached some before and after computer imaging to show the potential changes of the nose and chin based on these approaches.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking to improve the appearance of my lips, acne scars, and face contouring. I have very large lips and the upper lip is very full and bigger than the lower one, it gives me a duck lip appearance. The upper lip rests above the lower lip instead if the other way around. What would be the best thing to do about that? I have also attempted to loose weight to slim the face yet there is much fat around the lip area and the cheek bone area which does not go well with the full cheeks. I am attempting to achieve a slim-defined male model type of face as well as diminish the appearance of my acne marks. Somehow my facial features don’t mix well with one another. I believe my face is feminine in a way, is there a way to give it a more masculine look?

A: While many people want to achieve an upper lip size that matches the  lower one, you have an opposite concern. The upper lip can be reduced by an internal vermilion reduction to reduce its size and roll back the pout of the upper lip. That leaves any scar on the inside of the upper lip.

From a face standpoint, I don’t see large buccal fat pads to remove but I could see some benefit by perioral liposuction to reduce the perioral mounds out to the side of the lips. While you did not provide a side profile view, chin augmentation with more width and horizontal projection may be more masculinizing for you. But I would need to see some additional photos to be sure that is of benefit.

Acne scars can be improved by fractional laser resurfacing but it is important first to have the acne eruptions under control. With laser resurfacing the ointments needed afterwards as it heals can cause a lot of pore obstruction and an onset of new eruptions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, here is a some photos of my face from both side angles and front on.  Any suggestions you have on improving my chin / side profile will be appreciated.  I’ve already have a very low fat content in my body, but my jawline is still ill-defined.  I’ve been considering a sliding genioplasty to move my chin forward.  I play a lot of contact sports (boxing, wrestling, soccer), so I imagine a chin implant isn’t a great option as it could shift.  Let me know what you think. Thanks a lot for your time.

A:  Thank you for sending your pictures. It is a little hard to see precisely your chin position due to the amount of facial hair, but I have some projected imaging based on much chin advancement I think you would need. I would estimate from 7 to 9mms forward increase. In addition, I have opened up the osteotomy to give some vertical chin lengthening as well of about 3mms. You are correct in assuming that moving your own chin bone long term is better than using an implant if you do participate in a lot of contact sports. Chin implants can be used and screwed into place so shifting with trauma is not a big concern. But it only makes sense to not unnecessarily expose a protruding chin implant to trauma. Your bone is much better designed to withstand that than an implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I just want to have a strong chin and don’t want to narrow it, I think from side view my chin is receding and weak. Please take a look at my photos and give me some advices, what should I do with my chin , I want to bring it forward as much as possible and in your website I see amazing before and after photos, your work is very artistic. If I were in the US I would have flown to your clinic today but unfortunately I am far away and I can’t afford to come for a surgery. If you know someone in overseas who you think his work is excellent please recommend me so that I perform my chin surgery some months later. I may refer to any doctor based on your recommendation because I have trust and confidence in you. You know finding a good doctor is very important.

A: Based on your photos, your chin deficiency is very mild and you already have good chin width in the frontal view. I would recommend an implant as opposed to an osteotomy. This is the most assured way of getting better horizontal as well as transverse width increase. An osteotomy will bring your chin forward but will also make it more narrow as well. Otherwise, I have no surgeon recommendations for you in your part of the world as I simply do not know any surgeons either professionally or personally.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, because of an accident at an early age I had some weak chin and facial asymmetry on the right side. Four years ago I had a chin implant whichi resulted in horrible deep hollows on the side of the chin. My chin implant was a button type. So I’ve had three fat grafting surgeries to correc the hollows and also using fat to lessen the asymmetry. (underdeveloped right side of my face) The results are not bad but still lots ofasymmetry and the fat is starting to melt unevenly so I am looking for a more radical solution. I want to remove the button type implant and replace with an extended anatomical chin implant as well as jaw angle implants to look more solid. What is yourt suggestion about this? Thanks a lot.

A: I would agree that changing the chin implant to an extended style is much better for a male than a central button style. The jaw angle area could be permanently enhanced by lateral extension jaw angle implants. The only area that will not be filled in as well is the area between the two. But I don’t think in your case that would justify custom implants to be made. Fat has been a good intermediary step to see if the changes are favorable but it is definitely not a permanent solution. The combination of chin and jaw angle implants provides a permanent volume solution to jawline enhancement.

Dr. Barry Eppley

Indianapolis, Indiana