Q: Dr. Eppley, Hi, I’m interested in improving vertical chin lengthening. Below are attached pictures of before and after application of 1 and then 2 syringes of Juvederm Volume below my chin to increase vertical projection. I like the result but considering a more permanent option. In my research it seems that most chin implants address mostly horizontal projection. My horizontal projection is fine but I would like to increase vertical projection to get more sharper look in profile. I’m in great shape and don’t think dieting and more exercise would greatly improve my facial profile or remove the appearance of double chin. Would like to get your opinion on options. Thanks.
A: When looking for vertical chin lengthening, there are two options. An opening wedge siding genioplasty would be the autologous option. The chin bone is cut and open vertically downward and then plated in its new vertical fashion. The other option is to make a custom chin implant that mainly adds a vertical dimension increase. The decision between the two would be based on how much vertical increase one seeks. Large amounts of vertical increase are best done with a vertical bony genioplasty since it carries the soft tissue downward with it as it remains attached to the bone. With a custom chin implant it is important that enough chin soft tissue is available to be mobilized over the implant.
Lastly, vertical chin lengthening is not going to be enough to completely eliminate the double chin. Liposuction of the submental region would need to be done as part of the chin procedure.
Dr. Barry Eppley
Q: Dr. Eppley, After doing some more research, I’ve also wondered about the possibility of facial liposuction or a buccal lipectomy with my vertical chin lengthening procedure.. I know that buccal lipectomy has to be done selectively, because it can cause a gaunt look. Do you think that buccal lipectomy or some cheek liposuction would help me? The fullness of my cheeks bothers me a lot and so I thought the genioplasty would help elongate my face to reduce the roundness or fullness. Basically my question is if some sort of facial liposuction may be a better option, or if it should be done in addition to the genioplasty? (I’ve had one other doctor mention that my chin height isn’t really lacking and that not much vertical height would need to be added). I’m interested in getting your opinion on this.
A: It would not be rare to do further facial derounding by a subtotal buccal lipectomy as a complement to other procedures. A buccal lipectomy produces a subtle effect so it alone would rarely create significant facial slimming. As long as it is not done overaggressively, it will not ultimately produce the gaunt look and will reduce some fullness right under the cheekbones.
By aesthetic measurements, you vertical chin height may be fine. But in the spirit of what you are trying to achieve, vertical chin lengthening is needed. Rather than rely on numbers or what looks right to someone else, use computer imaging to see what facial look is created with and without vertical chin lengthening.
Dr. Barry Eppley
Q: Dr. Eppley, I had some facial feminization procedures done not too long ago. I had a sliding genioplasty as one of them. I now have the often present notch on either side of the osteotomy. I expressed concerns about minimizing this with the original doctor. The depressions are fairly evident. Also my infra orbital area is lacking. This lacking does not help with a feminine appearance. Over all I am having trouble determining what needs adjusting on my face because the face is the sum of its parts. I need an opinion so I can decide what to do over the next 12 months. I hope to improve symmetry also. I have to wait at least six months to undergo any further work since surgery was not to long ago. I have attached some pictures which hopefully are helpful although they are just one week after surgery.
A: Based on these even very early pictures, your chin is now too vertically short for your face. You have a longer thinner face and now the lower third (chin height) is too short. That is what is throwing off your facial proportions. Also as part of a longer thinner face, the cheek/infraorbital area is flatter. Thus I would recommend a chin bone lengthening (opening back up the osteotomy), infraorbital rim implants, and a subnasal lip lift. This will bring your face into better proportion and balance.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 25 old year guy and I am really not satisfied with my looks. I am looking to improve upon my face for a more youthful look .I know it’s not wise to compare yourself to others as everyone’s face is unique but I think the most distracting feature of my face is a very big and wide lower face (mandible) that makes my face chubby and more old looking. The last time I inquired you about an outer cortex osteotomy for as such the same problem and you requested my pictures so I did attach them. Now I would be really grateful if you clarify me my following doubts:
1. Is it possible to reduce my lower jaw width and angle to make my face more slimmer and proportionate?
2. If yes, how much is it possible to reduce the bigonial distance and achieve a more ovoid looking face (Front view) in my case?
3. Would chin augmentation be helpful to achieve the same?
4. I also want to have a tip rhinoplasty that would give my nose tip more definition and sharpness. Again, how much is it possible to achieve a nose like the one in the model pictures I have attached?
5. Please suggest any additional improvements in case you notice that would be required for a more youthful appeareance such as brows,cheeks or any other.
A: In answer to your questions:
1) There is not a really good procedure to make your entire lower face more narrow. Even if one could do a lateral corticotomy (remove the outer layer of the lower jaw bone) that would just not make enough of a difference in your face.
2) Certainly the jaw angles can be removed but whether that would make a very visible difference is uncertain. Some of your facial width is soft tissue and can not be reduced. The best way to answer whether this procedyure would be worth it is frontal cephalometric x-ray or facial film to look at how much flare the angles have. If it is significant then it may be worthwhile.
3) Vertical chin lengthening is, by far, a more practical approach to facial lengthening (and narrowing) for you given the more square facial shape that you have.
4) A tip rhinoplasty will definitely help narrow your nose but trying to achieve the very slim noses in the pictures you have sent is unrealistic. You will likely end up halfway between where you are now and those type of results.
5) Some soft tissue (fat reduction) would also be helpful, removing part of the buccal fart pad and thinning out the fat outside of the corners of the mouth.
I would think that a vertical lengthening chin osteotomy, tip rhinoplasty and buccal lipectomy with perioral liposuction would be the three procedures that I would recommend that could make the greatest difference in your facial shape/appearance.
Dr. Barry Eppley
Q: Dr. Eppley, I am considering a jaw and/or chin augmentation procedure. I believe my chin would look better if increased length-wise, but I am unsure if a chin implant is able to achieve this (as opposed to the bone shift procedure). I am attaching some pictures so you can see my face from the front and side. I apologize about the poor lighting–I spent several months cultivating a beard, and these are the only pictures I have without the facial hair.
A:I have taken a look at your photos and feel that you are correct…your chin is deficient both horizontally and vertically. Your facial hair shows the vertical increase already and perhaps, consciously or subconsciously, this is why you grown it. Either a chin implant or a chin osteotomy can create vertical chin lengthening but it depends on what you want the overall dimensions of the chin to be. A chin osteotomy will lengthen the chin but will also narrow it in width by doing so. (unless a simultaneously placed thin extended implant is placed along the bony margin at the same time) A chin implant can make the chin longer and wider (more square) but it would have to be a custom implant. There are no off-the-shelf chin implants that create that effect.
Q: Hello, my problem is that I have a lower anterior face height deficiency. Because of that my total face looks very small. First I didn’t know what the problem was. After examining my face very well I came to see that the lower anterior face height is very small. I have a very little chin and small jawline. I have read your article entitled ‘Case Study: Vertical Jawline Lengthening for a Short Lower Face’, and I think I have the same problem as this girl that is mentioned in the article but a bit worse than that. I have attached some pictures of my face so that you can take a closer look. When I look at the photos I think my lower anterior face height should be longer. Can I do this with a chin and a jaw implant or some kind of other implants? Because I’m not sure what kind of implants the girl in the article had. I think I have the same problem as her but more extreme. I would like to know your professional opinion. I went to a local plastic surgeon but they didn’t understand what I mean or maybe they just don’t have the techniques. They kept saying my chin had the right position. (apart from that my chin). Because my lower anterior height is small my forehead looks a bit big. But it is a normal size forehead, it’s just compared to the lower face it looks big. So I think my face needs to be lengthened vertically and a bit horizontal at the jaw (because when it is only vertically lengthened my face will look long, because I don’t have a wide face). I hope you see what I’m trying to say because I know something is not right.
A: I can see perfectly what your facial concerns are and you have stated them quite accurately. Your lower facial height is proportionately short compared to the upper two-thirds of your face. Your chin needs to be vertically lengthened by 7mms and horizontally advanced 5mms. That can not be done with an implant but requires an osteotomy. There is where the chin bone (not the main jaw bone) is cut and moved down and forward. It is held into its new position by a small plate and screws as it heals. This is done from inside your mouth through a small incision in the vestibule below your front teeth. This is a common chin surgery that I regularly perform which is highly successful at improving your lower facial lengthening.
Dr. Barry Eppley
Q: I want a stronger chin and jawline. I currently have a 7 mm winged chin implant in now (with rhinoplasty last year), but feel the asymmetry lies more in the vertical dimension. I also feel that my mandible does not have enough lateral dimension or width. It seems that my lower face is somewhat deficient in multiple planes and I’m unsure which would be better for me, a chin osteotomy with vertical and horizontal augmentation combined with a widening of chin, or a custom wrap around implant. It might be helpful to see the predicted outcomes of both. And, of course, I would love to hear what you think might be best based on the picturesI have attached. Any other suggestions you might have would be appreciated also.
A: I think factoring in all considerations and looking at some imaging predictions, I would opt for the chin osteotomy. The recovery time is actually shorter with the implant but the photographic projections shows what an osteotomy can do and that seems to be the bulk of where the change needs to be to get your face more balanced. Given your 7mm implant that is already in place, your osteotomy needs to come forward 11mms and down at least 7mms. This will require plate fixation and hydroxyapatite block grafts.
Also I have noted that you could benefit from nostril widening. That parft seems to have been overlooked in your original rhinoplasty as well as some additional tip refinement. I would also consider adding in buccal fat removal for submalar narrowing and this would add nothing to the recovery time.
Dr. Barry Eppley