Your Questions
Your Questions
Q: Dr. Eppley, I see you prefer to secure your chin implants with screws. I’ve searched all over my area for a doctor who does this and can’t find a single one. Do you know why this is? Is it inexperience? Is there some added risk of using screws of which I’m unaware? Do you ever do them without screw fixation? What about those who secure with sutures… what does that even mean? Thanks for your time.
A: Fixation of chin implants is done by various methods by different surgeons. By far the most common technique is the use of sutures where it is passed through the implant and done to the lining on or around the bone. One can have a debate about how secure this makes chin implants but this method highly depends on the size of the implant pocket to control asymmetry caused by a tilt in the left-to-right axis of the implant’s placement. Suture fixation can not control the potential for tilt from a single central point. Screw fixation is the most secure method and is really simple and quick to do…if one is familiar with doing it. Having done craniomaxillofacial surgery for decades this makes the use of screws for chin implants as familiar as using suture to close the wound.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few questions about faclal implants. Can cheek implants be done with local or non general anesthesia? Also I have a short face and need to add lateral width and height but I worry about the big wrap around jaw implants involving the masseter muscle. So can we do a custom chin implant with wide wings extending laterally and vertically as far back posteriorly as possible but not hitting the masseter muscle. I realize there would be a major step off somewhere further down the jaw and the rest all the way around the ramus I would fill in with fat or radiesse. Also could that be done without general anesthesia too?
A: In regards to facial implants, certainly cheek and an extended chin implant can be done under IV sedation or MAC. (monitored anesthesia care) The use of local anesthesia for most facial implants alone would likely be inadequate and that would be doubly true if both cheek and chin implants are done at the same time. Be aware that the use of local or IV sedation does not save any money as the intraoperative time to do facial implants takes twice as long as when done under general anesthesia. So your motivation for the selection of anesthesia for these facial implant surgeries should not be one of saving money.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard that chin implants cause bone resorption. If this is true do they cause resorption under silicone nasal implants too? My nasal implant only extends to the dorsum. Also, how does one know if nasal implants cause scar tissue in the nose bridge? Thanks.
A: Silicone nasal implants do not cause bone or cartilage resorption of the underlying nasal structures. Chin implants settle into the chin bone because of the pressure and contraction of the overlying mentalis muscle. This is not active inflammatory resorption but simple passive settling of the implant a millimeter or two into the bone for a pressure release. It is a self-limiting problem whose concerns about it are way overblown. A nasal implant is placed under the skin and is not exposed to the same pressure phenomenon. In nasal implants the potential is not for bone or cartilage resorption but thinning of the skin over if they are big enough.
All implants placed in the body form scar tissue around them or become encapsulated. This is normal and occurs no matter where or what type of implant is placed, including nasal implants. This is a normal bodily response to an alloplastic (synthetic) material)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in possibly getting cheek and chin implants (or starting out with dermal filler) to attain a more chiseled & angular look. I would like to get a well-defined, hollowed-out appearance similar to what many actors have.
I am especially interested in seeing if I can obtain not just the hollowed-out cheeks, but also the well-defined line that seems to run from the cheeks to the chin on both sides of his face (this effect is especially noticeable in the last picture).
I have also submitted two photos of myself; please excuse the eye asymmetry, which occurs occasionally due to an outdoor allergic reaction (I run/jog outside a lot).
Generally speaking, do you think the goals I am trying to achieve are realistic?
A: Based in these pictures and your face, I do not find your facial goals especially realistic. While cheek and chin implants will help create more prominent facial structures, they will not necessarily cause that hollowed look you are seeking. That is caused as much by the lack of any subcutaneous fat over the trampoline area of the face and prominent jaw angles as it is caused by any prominent cheek and chin structure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to hear your expert opinion on whether a chin implant or a sliding genioplasty or some other thing is more appropriate for my jaw. I have attached pictures from 3 angles of my lower jaw, at a default, relaxed face. Notice my big jowls and rounded face. I have been told (by a few oral/maxillofacial surgeons) that a sliding genioplasty would probably be better than a chin implant because, as one surgeon put it,….an implant usually doesn’t create the angles I would need for the roundness to soften up a bit and for significant loose skin to pull. I don’t mind a slightly round face, I just don’t want to look like a balloon on the lower half of my face.
In your experience, how true is this???
A: A properly designed chin implant can create more angles than than a sliding genioplasty. A sliding genioplasty brings the chin forward but will make it more narrow in doing so. That is fine if that is the frontal change that you want….which usually works well for a female. Most males want a more square chin as it comes forward with a genioplasty which will not create that effect unless the bone is split and widened. But in doing so there will be a dip behind the chin in the jawline. Many bone-based facial surgeons often know how to do one chin approach (sliding genioplasty) but often do not have much experience with the array of chin implants, preformed and custom, that are currently available. Both implants and a sliding genioplasty are effective chin augmentation operations but their effects can be dimensionally different. It becomes imperative to know what each of them can aesthetically do and then apply it to the aesthetic needs of the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have consulted with you in the past in regards to jaw/chin implants, and I just had a few questions for you in this regard.
I have read a lot of things about the difference between Medpor and silicone. The main concern I had was in reference to the issue of bone resorption. I know that there are many opinions out there, and I just wanted your experience and expertise as to what the pros and cons of each are.
I am especially worried about the issue of bone resorption, as I don’t want to cause myself a lot of pain and misery in 10 to 20 years. I read that silicone causes more bone resorption compared to Medpor. However, I also read that fixing the silicone implants with screws eliminates a lot of the pressure of the implants. Furthermore, I had read that bone resorption occurs at the chin. Would any occur with jaw implants as well? I would appreciate any clarity on this issue.
I also wanted to know which material feels more natural (if they do at all) when implanted.
A: The concern about bone resorption around any type of facial implant is overstated, largely clinically irrelevant and biologically misunderstood. It is not an active inflammatory response that is eating the bone away. Rather it is a passive bone remodeling response to the pressure of the implant on the underlying bone caused by the tight overlying soft tissues. It is simply put a biologic response to relieve the pressure of the tension band effect on the implant. This can result in a few millimeters or less of the implant settling into the bone which then stops once an equilibrium of pressure redistribution occurs. While largely reported in chin implants, probably because they are easy to evaluate by panorex and lateral cephalometric x-rays, this normal biologic phenomenon to an implant can occur anywhere in the body. Similar examples including breast tissue thinning with breast implants and gluteal muscle thinning in buttock implants.
You have to remember that putting a synthetic implant into the body is not natural and the tissues have grown and work based upon their natural tissue attachments and thicknesses. Once you introduce an implant into these tissues, the natural tissue volume and balance is altered and it will respond by adapting to it. A little bit of implant settling (tissue loss) is a very small price to pay for whatever aesthetic benefits that an implant may provide.
As for facial implants specifically, the chin seems to be the only location where this biologic response is seen. This is due to the natural tightness of the chin tissues and the thickness of the underlying chin bone. In most cases that I have seen, the chin implant is almost always placed or become displaced higher up on the chin bone over the thinner cortical bone.
I have seen this biologic phenomenon in both Medpor and silicone chin implants, which makes sense since both materials are non-resorbable polymers. It is just less reported with Medpor because the vast proponderence of chin implants done involve silicone materials both historically and currently.
I would not think that screw fixation would affect this biologic response either favorably or unfavorably.
Either Medpor or silicone facial implants can feel natural or unnatural based on their size, orientation on the bone, tissue location, thickness of the overlying tissues and the patient’s perception to them. Their physical characteristics (firm) are similar so their postoperative feel, all factors otherwise being the same, should be no different.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting chin and jaw angle implants.I want to be an actor, and I have always been considered attractive however I feel that I need to have a wider jawline like Brad Pitt or Stephen Amell as well as a chin implant in order to balance out a bit of a weak chin and achieve the male model look. I was wondering, is this something that can be achieved for me and be considered extremely physically attractive? Also, when it comes to recovery, what can I expect? Will I be able to have the same smile and live my life the same way after everything is healed? Is it possible to participate in sports or boxing after a procedure such as this? Have many actors and male models had procedures such as these done to help them get to where they are today?
A: First and foremost, the most important thing to realize is what jawline augmentation (chin implant and jaw angle implants) can physically do for you. You can never look like someone else and you can never have their jawline or other facial features. All you can do is make the most of what you have. I have done some imaging of chin and jaw angle implant augmentation to help you see what that potential change would be on you. Expect three weeks of complete physical recovery and three months to finally see the healed and settled look as well as enough time to psychologically adapt to the facial changes. Chin and jaw angle implants will not affect your smile, facial movement or any other physical activity once fully healed. There is no problem participating in sports afterwards. Whether this type of surgery will make you more attractive or successful in whatever endeavors you do in life is more of an internal issue rather than what is seen exclusively on the outside.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been looking into getting facial implants, specifically chin, cheek and jaw angle implants, now for quite some time. During my time researching these procedures I have come across many reputable sources of information, like yourself, and millions of internet experts professing to know the ‘truth’ of some sort of another regarding facial implants. Nowhere amongst all this are clear and unambiguous answers to some of the most basic questions. Hopefully you can provide these for me. My questions are as follows:
1. If a chin, cheek or jaw angle implant is placed, the surgical wound heals, all is well and the patient loves the result several months after the operation, what is the likelihood that the implant will become infected years or decades later.
2. In your experience, if an implant is placed uneventfully can the patient then go on to live for decades having ‘forgotten’ about the implant, so to speak? I don’t want to have to come back to any implants later in life, I want to have my first cosmetic surgery and then forget about it forever.
3. Is the removal of an integrated Medpor jaw angle implant as difficult as it is said to be? Also, is there a silicone jaw angle implant that can provide the so called drop down effect?
4. There is a lot of confusion regarding cheek implants for men who want their cheekbones to flare out laterally. Do you think it is a deficiency in zones 1 and 2 of the malar-zygomatico complex that needs to be corrected in order to achieve the male model look? If so, are custom cheek implants capable of achieving this in the right individuals
5. Individual implants will not make a person look radically different. Is this something that can happen, for good or ill, when several implants are placed at once?
A: In regards to your questions about facial implants ( cheek, chin and jaw angle implants), my answers are as follows:
1) The risk of implant infection is greatest in the perioperative period (first month or two after surgery) usually as a result of implant contamination during placement. Delayed facial implant infections are very rare. not impossible, but it would require contamination into the implant capsule like from a dental local anesthetic injection. Delayed infection risks are so rare that they are almost case reports for the literature.
2) If one has uncomplicated healing and is pleased with the size and symmetry of the facial implant result, having them will quickly become a ‘natural’ part of one’s anatomy and they will be forgotten as being a synthetic extension of one’s face.
3) Medpor implants,including those of the jaw angle, can be removed and I have removed many of them. They are much more difficult to remove than silicone implants but that is an issue of relativity. Silicone facial implants are so easy to remove that anything that is more adherent seems difficult.
New styles of vertical lengthening silicone jaw angle implants are now available. I designed them to provide a better implant material to that of Medpor. They are much easier to insert and replace/modify if necessary.
4) The concept of getting cheek implants to achieve any type of facial look is more ambiguous and harder to achieve that most would think. The cheek area is a complex four-dimensional structure and the interpretation of what is a pleasing shape is as variable as the anatomy of each person’s cheek bones. It frequently is not as simple as just pulling an implant off the shelf, regardless of its style and size, and the desired look is achieved. Even using custom designed implants is not a guarantee that the desired look can be achieved as the ability to translate a design to what it makes the outside of the face look like is not a mathematical one. Many men seek the so called ‘male model’ look which often but not always means a high angular skeletonized cheek look. You would have to define what cheek look you are after by using model pictures as examples. While all of them are models, many of their cheek shapes are quite different.
5) The more facial implants that are placed, if they are not properly sized, the more different one can look.
The one caveat I would add to all of this is a basic fact based on my very extensive experience with male (almost always young) facial skeletal augmentation surgery…such patients have a remarkably high revisional surgery rate which approximates 50% or greater in the first six months after surgery. These revisions are almost never because the implants have any medical problems but because many young men are impatient of the healing process and often are uncertain if they like the aesthetic outcomes of their procedures even if it is exactly what they thought they wanted. Thus, when you think about getting facial implants this revisional surgery issue is what you need to consider, not all the other concerns that you have mentioned which are fairly irrelevant compared to this consideration.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can Jaw and/or chin implants give me more of a chiseled/angular/square longer lower face? I don’t want to have the procedure if it can not create this kind of look.
A: In the right type of face, chin and jawline implants can indeed create a more angular or chiseled look. The right type of face is a thinner or lean one that can show skeletal highlights better. Fuller or ‘fatter’ face can not get a more chiseled look from facial implants as the soft tissue cover is too thick to show their outlines. This is particularly true of jaw angle and cheek implants which are facial locations that do not jut out like the chin can.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My question is in regards to the safety and security of chin implants. While I firmly believe such a procedure would improve my appearance my hesitation lies in the uncertainty of the implant being a permanent solution. To be specific my job is such that at times is of a physical nature and am worried that the implant could become dislodged. How is it kept in place? And are there certain implants designs that are better then others? Would hard impact to the chin or jaw cause it to become dislodged? Perhaps you know people in the Military who have had this done? My second line of questions are about the health risks of a foreign element placed in the body. Are there long term effects from having a implant inserted and is this something that once done should remain for life? Thanks for your time.
A: Chin implants, almost of any implant placed on the body, are the safest (less likely to have complications) in my long plastic surgery experience. There are a permanent chin augmentation solution as the material will never degrade. The implants are secured in place by small titanium screws so that they will never move or become dislodged. I have yet to have a case where a chin implant became dislodged or displaced because of trauma of any nature, including patients in the military. There are no health risks from performed silicone since it is a molecularly stable material that does not degrade or release any free silicone molecules.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw implants to give me a more defined jawline. I can see from your computer imaging that adding the chin implant to the jaw angle implants really does make a difference. I have a couple questions. Are the implants silicone? Do the size and type of the implants determine how chiseled my face would look? I’m trying to get as close to the ‘male model’ look as possible. I’m not sure if any other procedures would make as much of a difference as these.
A: Chin and jaw angle implants (jaw implants) are made of either Medpor or silicone material and I have used both extensively. However I much prefer silicone because implants made of this material can inserted much easier, shaped intraoperatively much better if needed and are far easier to revise/remove if needed. A good saying about silicone facial implants is…easy in, easy out and easy back in if needed.
The size and the shape of the implants play a major role in the look of the final jawline result, provided one has a fairly lean facial look to start. The thicker the overlying soft tissues are, the less defined the outline of the implants becomes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have recently had a medium Terino style 1 chin implant and medium lateral jaw angle implants, with another surgeon. I wasn’t happy, and I had the jaw implants removed a week later. For some reason the 2 implants didn’t seem to go together, the jaw implants made my chin look like it was recessed again, and the sides of my jowls looked very narrow, even though they improved the back of my jaw. I now wonder if it was the chin implant I should have removed and replaced instead. I wonder if it was the combination of sizing that was the problem, I want to have a strong jaw that flows all the way to the back. I have a thin face and the sides of my chin, near the corners of my mouth, still look very narrow. What could be done to solve this problem? Thanks
A: Standard chin and jaw angle implants rarely overlap and, even if they do, will rarely ever make for a straight jawline from chin to jaw angle. That is beyond what they capable of doing. When a patient agrees to have off the shelf stock implants they should know that is the look they can not achieve. Only a custom-designed one-piece jawline implant will provide a straightline effect from front to back because it is made to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw implants for my weak chin. I would like to know what the implants are made from and how durable they are. I do martial arts and blows to the face are quite common, so I wonder how well the implants will endure against physical trauma? Also do you believe there might be a possibility that corrective orthognathic surgery might help me, both cosmetically and in terms of snoring/breathing issues? Thank you.
A: The chin and jaw angle implants are made from silicone of a firmness slightly less than bone. I screw the implants into the bone that they will never move from their implanted position. It will require a force great enough to break the bone to ever dislodge them. And they might actually be a buffer against traumatic forces, ultimately protecting the bone to some degree. Whether you would benefit by orthognathic surgery instead of jawline implants is not a question I can answer based on the information you have provided the best way to answer that important question would be to get and orthodontic evaluation and see if the process of pre- and postsurgical orthodontics and orthognathic surgery would be a more appealing alternative that at least partially address the underlying bone problem of your weak jawline. You owe it to yourself for the sake of educational completeness to get such an evaluation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had the Mandibular Matrix system implanted in 2010 including the two 7cm jaw implants and a 7cm chin implant. However after three years, the two jaw implants have shrunken/settled into my bone so that my jaw corners are around the same size as they were before the surgery. I plan to have my jaw revised. From looking around, I can tell that you are one of the top-experts on male jaw enhancement. Do you recommend replacing the jaw implants or stacking a new implant on top? What are the risks of bone settling and how can I reduce them. Also, how can I schedule a consultation and surgery date? I can send you pictures. Thanks.
A: My first question is whether the jaw implants have really sunken into the bone. That would be very unlikely given how the Medpor material is treated by the underlying bone. The first thing I would do is have a 3D CT scan done and a model made to really look at the current relationship of your existing implants and the jaw bone. It would be impossible to give good advice/recommendations without knowing the answer to this very important question. It may also be likely that any new implants may have to be custom made whether they would be placed on top of or in replacement of your existing implants. Be aware that it would be very difficult to remove your existing implants…not impossible but very difficult.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in having the following procedures done:
* Ear surgery – ear pinning + fix right ear that sits lower than left ear or fix left ear that sits higher than right ear + improve general appearance of ear cartilage
* Blepharoplasty – lower eyelid of my left eye (when I smile, it creates a prominent bag under the eye – not the case with my right eye though)
* Septoplasty – nose veers a little bit to right (possibly due to deviated septum)
* Rhinoplasty – remove slight bump & also looking to have a thinner nose
* Lip augmentation – improve general appearance
* Liposuction under chin – just to get rid of dreaded dubble chin
* Other possible procedures (if doctor recommend them): cheek implants, jaw implants and chin implant – I would like to have more masculine facial structure
Other possible procedures, if you offer them: tear trough implants, cheek lift
PICTURES:
First pic: how I actually look
Second pic: alterations I made to my face on your website (not perfect, just played around).
A: In answer to the facial procedures:
1) It is possible to raise an ear .5 to .75 cms but it is not possible to lower an ear. Ear pinning or antihelical fold setback can effectively reshape the outer ear cartilage.
2) The ‘bag’ of the left lower eyelid is hard to appreciate in your non-smiling views so I am not sure if it is a skin issue or a fat issue.
3 and 4) A septorhinoplasty is needed to straighten the nose, reduce the bump and have a thinner tip.
5) To make that amount of lip augmentation change, you would have to think about fat injections even though their survival in the lips is anything but assured.
6) Submental liposuction can be done but, more importantly, significant chin augmentation will eliminate that concern on its own. Cheek and jaw angle implants would be complementary to the chin and, in your thin face, would make it very sculpted and angular.
7) Cheek implants will obviate the need for a cheek lift. Tear trough implants can be done to fill out the under eye hollows.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had submitted this question via the website, but never received a response so not sure you received it. I had a sliding genioplasty with you probably close to 2 years ago now. I am interested in further enhancing my jaw and chin. I know the sliding genioplasty was brought forward as much as possible, but I am looking at the possibility of a custom jaw/chin wraparound implant as I a.) want to move it even more forward and b.) want it to appear that the entire jaw has been augmented rather than just the chin. I also want to widen things as I think the sliding genioplasty makes me lower face appear much narrower. I wanted to find out how closely this could resemble my having jaw surgery (I do have a class II malocclusion, but jaw surgery would be more complicated in my case). By this approach, how much further forward could the chin/jaw be brought by an implant? I know it is a much more expensive approach than off the shelf implants, but they are not going to help me I don’t think due to my unique problems. If I sent you a current picture, could you demonstrate to me what this would look like from the front and side?
A: This is the first I have seen your question. To create a wider and more prominent entire jawline, you are correct in that some type of wrap around implant approach is needed. The question then becomes whether it is done best by off-the shelf-implants (square chin and lateral augmentation style jaw angle implants) would suffice or whether a custom chin and jaw angle implant approach is needed. I would need to see some pictures of you currently, do some imaging, and see exactly what type of changes would be satisfactory. Please send me a few pictures at your convenience.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 28 year-old male, fairly thin, with concerns about my facial profile. I feel that I have both a weak chin and jawline and have some concerns with mandibular vertical height as well as width. Any advice would be greatly appreciated. I have attached some cell phone pictures for you to see what I look like.
A: I have taken a look at your photos and can offer the following comments.
1) I do agree that your chin does have some moderate horizontal deficiency as well as a touch of a vertical deficiency as well. (short vertical anterior height)
2) Your jaw angles show good vertical length (posterior vertical height) and no deficiency in that regard. I do agree that there is some width deficiency in the jaw angles however.
Taking these two pieces of information would indicate that the correct surgery would be lateral jaw angle implants and a square chin implant that is positioned as low on the inferior border of the chin as possible to gain a few millimeters of vertical height as well.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I want to achieve a more masculine jaw line. My face is oval and I want a more square cut lower face. I had a chin implant back in 1990 with a rhinoplasty. Would like to know what my options are and also would this implants just be inserted or are they secured with screws. How many days do I have to stay inIndianapolis before flying back to home. Thanks so much for your fast response.
A: Thank you for sending your pictures. I did some preliminary imaging based on what I perceive as your desire for a more masculine jawline. This was done using a combination of chin and jaw angle implants, the most common approach to make a circumferential change to the jawline. One interesting issue with you is that you already have a chin implant and the change to get you to the imaging result is significant. This raises the question of whether an off-the-shelf (stock) chin implant can really achieve that goal of which I have doubt. This leaves the possibility of either making a custom chin implant or doing a combined sliding genioplasty with a small square chin implant placed in front of it for the square width effect.
All facial implants are always secured by screws for stability of position on the desired bone position long-term.
No matter how it is done, you would be returning home 48 hours after surgery.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, thank you for doing the imaging on the predicted changes from chin and jaw angle implants. I am blown away that this can actually be done. This is well beyond my expectations. What size implants would you be using for my jawline enhancement?
A: Quite frankly more extreme changes than those can be done but I kept at the limit of what I see as reasonable and not excessive. (I have attached some results so you can see how extreme it can be made if one wants…although I don’t advise that on you). Your imaged look can be approximated by a combined square chin implant (style II square 9mms) and bilateral jaw angle implants (lateral augmentation style silicone 11mms or Medpor lateral augmentation of 7mm size). If the chin would benefit by vertically lengthening as well, I would do a chin osteotomy for lengthening 5mms and bring it forward 7mm with an overlay of a small square chin implant style II of 3mms.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have a question regarding chin and jaw implants. My question is: if a person plans to have both chin and jaw implants, do they have to be done in one procedure? In other words, is it possible to get jaw implants and then in a year get a chin implant? I’ve heard it’s easier when done together, but I just don’t have the resources to get both of them at once right now, so I’m wondering if it is possible to get a jaw implant this year and then next year a chin implant without complications?
A: There is certainly no reason why chin and jaw angle implants they can not be done separately. Economics is a very good reason why some have to ‘stage’ their overall jawline enhancement. Which one you do first is a matter of personal preference and would depend on what you see as your biggest problem. For many patients that would be the chin because it is the most visible part of the jaw and often displays the most obvious deficiency. For others the chin has a more minor deficiency and the high and weak jaw angles is the most deficient part of the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am much concerned about my underdeveloped jaw and need your expert opinion on it. I am in a phase in my life in which I suffered from muscle wasting. With these pictures, I have few questions that if this is really a serious aesthetic problem? If it can be converted into a square jaw and how?
A: Thank you for sending your pictures. More square jaws are created by a combination of chin and jaw angle implants that create a stronger and more angular jawline through their size and shape. For more standard cases where one does want an extreme change, stock or off-the-shelf implants are used. In cases where the patients want a more extreme change or want to do the jawline in a wrap-around fashion so it is completely smooth from one jaw angle to the other, then custom jawline implants are used.
I would love to show you these examples on your face but your beard would camouflage most of the effects or at least obscure many of the most significant changes. I suspect in looking at your pictures that stock chin and angle implants would work just fine…although the strength and magnitude of anyone's jawline goal is a personal one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to create dimension to my face by making bony features more prominent. I would like to correct my flat midface, drooped nasal tip, recessed chin, flat cheeks and forehead, and create a more prominent bridge to my nose. What procedures would you use and how would you make these changes?
A: To make those facial changes, I would perform forehead augmentation with PMMA, a rhinoplasty using either a synthetic implant or rib cartilage grafts, and cheek and chin implants. I have done a side imaging photo to illustrate what I believe you are after with this compilation of procedures, to pull your face out and provide projection to a face that is naturally flatter and more wide. The only thing that I couldn't properly illustrate in the imaging is the bridge of the projection that would be achieved. Your natural bridge is hidden behind the eye so its profile can not be pulled based on this one photo. Always remember that computer imaging is just a visual way to start the discussion about what changes one wants and how much they want those changes to be. All of these facial changes can be done in varying degrees. Finding the correct amounts when multiple facial areas is being done is the key to a successful result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been reading for quite some time on your website and I found a lot of terrific information. I am looking for what you describe as the “Male Model Look”. Could you please tell by the enclosed photos what procedures you would suggest for my face in order to achieve this look. I have been reading about jaw angle, jaw, implants and cheek implants but would like to know what you suggest for my particular face. What else would you suggest? I am 38 years old. I have already had my ears pinned one month ago. Could you also do a custom facial imaging so that I have an idea how I will look (more or less).
A: Thank you for your inquiry. The so called Male Model Look is really about accentuating some or all of the skeletal highlights of the face. These include the brow bones, nose, cheeks, chin and jaw angles/jawline. One has to not have too thick of facial soft tissues to see the effects of the augmentations. When analyzing your face, you have the right amount of soft tissue cover to show these effects well. You are most deficient in the jawline area (chin and jaw angles) and secondarily in the cheeks. For starters, I have just focused on these three areas as you can see in the attached computer imaging. There would be the 'best value' procedures for your face. The only other thought would be some nasal thinning in the tip area. (but I have not done that so you can focus on the more important areas for now)
Dr. Barry Eppley
Indianapolis, Indiana
Dr. Eppley, I want to undergo chin implant along with lip reduction . I have some doubt in my mind if the result of the chin implant is permanent and will last for the whole life of a person. Also, I do wrestling . Does it not affect the implant if there is a injury to the chin? If there is a problem will I have to visit the plastic surgeon or can it be handled by normal doctor?
A: The chin implant is permanent and will never dissolve or degrade it anyway. The position of the chin implant is fairly assured because I secure it to the bone with screws. In young men who participate in sports, I make it a point of emphasis to screw the implant to the bone in multiple places. In the rare event of a chin implant problem due to trauma, a regular doctor will not be of much help. You need to see a plastic surgeon who is familiar with chin implants.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have been trying to figure out about the chin surgery. I have asked a couple of plastic surgeons about what is the difference between chin filling and chin implants. Will either one give you the same type results?
A: What you are asking about is the difference between use injectable fullers to augment the chin as an office procedure with an instantaneous results versus the use of a chin implant which involves surgery and a recovery. The simple answer is no. The effects they will create are radically different. Injectable fillers to the chin are going to create small temporary augmentation changes while an implant is going to create a larger permanent volume change. Each approach has a role to play in the right patient. But injectable fillers to the chin plays a very small role in the overall number of chin augmentation procedures that are done because the changes are both small and temporary. But if one is looking for just a little augmentation, does not want surgery and is willing to accept that the result is not permanent, then this could be a good treatment. In my experience, I find that this is always a female patient who wants just a little central point augmentation to make the chin more feminine. I use Radiesse injectable filler as it lasts fairly long (one year) and its more thick consistency gives a good push to the overlying soft tissues of the chin as it is placed deep down at the bone level.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I plan on getting a rhinoplasty, chin, cheek and jaw angle implants this summer. It makes sense to me to have them all done at once. I have limited time off from work and only have a few weeks to recover at this time of the year. The one plastic surgeon I saw said he wouldn’t do them all at once as it would be too hard on me. I am not sure what he is talking about as I am young and healthy. I am aware that doing more surgery increases the overall risk of potential problems such as infection, but are there other risks to be taken into consideration, such as blood loss, that I am not aware of? Do you think it is safe and reasonable to have all of these facial procedures done at the same time?
A: In my experience and practice, I routinuely perform three, four, five or more facial procedures at the same time. For the reasons you have mentioned, such as recovery and other considerations such as cost, it is desirous to do a ‘facial makeover’ as a single stage procedure. There are no increased health risks for doing combination facial surgery in an otherwise healthy person. Blood loss is not a concern. With that being said, there is one risk that occurs in multiple facial restructuring procedures particularly those that involve facial implants…an increased aesthetic risk of implant asymmetries and the need for revisional surgery. The more procedures you do, the more risk there is for less than perfect results. Each individual procedure comes with its own aesthetic risks which are increased as more procedures are combined. Patients need to appreciate that the likelihood of the need/desire for revisional surgery is multipled as procedures are combined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been trying to figure out certain things about chin surgery. I have asked a couple of Plastic Surgeons about what is the difference between chin filling with injectable fillers and chin implants? Will either give you the same type results? Also, I would like to have a more pointed chin like that of the feminine version. Which procedure would give me this look, a chin shaving or chin implants?
A: The use of injectable fillers vs an actual implant in the chin creates very different effects. One should not be confused with the other in terms of outcomes obtainable. Injectable fillers create small changes in chin projection and shape that are temporary. Implants create large amounts of chin projection and shapes that are permanent. The only role for injectable fillers in the chin in my practice is a test for some patients who are uncertain about proceeding with the placement of a permanent implant.
As to the best method of creating a more feminine pointed chin, that would depend on whether you are happy with your current chin projection both vertically and horizontally. If the present chin position is satisfactory, then it can be reshaped by lateral ostectomies through an intraoral approach . If the chin position is deficient in any dimension then a chin implant can be used to improve projection as well as shape. To obtain a pointy chin with an implant, a central button style should be used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have a chin implant, I want to ask you is a chin implant with a screw holding it into position a must so that it won’t move? One doctor said screw is not necessary as she said you can extend anteriorly more than 1 cm it and it depends on how the doctor carves out the implant so it won’t move place. Is what she said true and effective?
A: How any surgeon secures their facial implants is a matter of personal preference and experience. I prefer to screw all facial implants into place when possible to get the best aesthetic result (assured position) and never have to worry about them every moving or sliding from where I want them. That is my personal preference and has served me and my patients well over the years. Just because other surgeons make not choose that technique of implant fixation, or any fixation at all, does not make them wrong. That is obviously what works for them.
Dr. Barry Eppley
Indianapolis, Indiana
Q:Hi Dr. Eppley. I will be 17 years old next summer. I’m looking to get some implants as I get a little older. Is there any way of creating a custom jaw/chin implant? If so, would this cost extra? If so, how much? Much appreciated. Also, what is the minimum age requirement if one wanted to get some facial implants? I’d like as much information as possible please. Much appreciated.
A: The timing of chin and jaw implants is based on two factors; the degree of jaw deficiency, one’s bite or occlusion and the near completion of jaw growth. At this age you want to be sure that you do not have a correctable malocclusion by a combined orthodontic and orthognathic surgery approach. If not, then chin and/or jaw angle implants may be appropriate. I certainly would not perform that surgery before the age 18 when jaw growth is closer to being complete in a male. Custom chin and jaw implants can be done and I do them on a regular basis. But whether they are really needed and offer any advantage over stock preformed implants must be determined on a regular basis. It is hard to give any reasonably accurate pricing when I don’t know whether one needs just a chin implant or whether one needs a combined chin and jaw angle implants for total jawline enhancement. In either case, custom implants will double the price of the surgery due to the need for special design and fabrication. For this reason, one has to have a very compelling anatomic need to justify the expense of a custom facial implant process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to achieve a radical but natural look. My main problem is that I was born with a bad bone structure. I want a bigger chin, jaw implants to make my face more square, high cheekbones (but natural i´d like to know if fat grafting would be an option), and I see some irregulaties in the form of my forehead and i like to look uniform. Is it possible to correct it with a natural and safe filler? I also think that some liposuction under my chin will help me to create a better facial profile. I have attached some pictures of myself for imaging these changes. Thank you so much.
A: In reviewing your pictures I see that the deficient bone structure is really isolated to the short lower jaw/chin and a forehead that slopes backward. I would agree that a chin augmentation using a square chin implant, and jaw angle implants that both widen and lower the angle would compensate nicely for the lower facial bone deficiency. The jawline improvement would be enhanced by submental and neck liposuction. From a cheek standpoint you can certainly use fat injections. Another fat alternative is to remove part of the buccal fat pads and use this as a ‘cheek implant’, serving the dual purpose of malar augmentation and some submalar contouring. Fat injections could also be used as a forehead filler as well for any irregularities. The attached imaging illustrates some of these potential facial reshaping changes.
Dr. Barry Eppley
Indianapolis, Indiana