Q: Dr. Eppley, I am interested in numerous facial reshaping procedures including cheek augmentation. I think my chin is too big, my cheeks are flat and my nose could have a better shape. I have attached some pictures for your review. What do you think about these three facial areas in me?
A: Thank you for sending your pictures. From a chin reduction standpoint, it appears you have too much horizontal projection. Your chin can be reshaped by a submental approach where it is horizontally reduced and the sides tapered in so it does not end up looking wider. The cheek look you seek is a classic ‘apple cheek’ look that many females want. You have a very visible submalar concavity, probably due to buccal fat atrophy/deficiency, which gives yours cheeks an hourglass appearance as opposed to a fuller more convex anterior shape. You need a combined malar-submalar shell type cheek implant for your cheek augmentation which places the implants anteriorly to help achieve that type of cheek augmentation look. As to your nose, I would need more information as to what changes you seek as I see no obvious or glaring nasal shape deficiencies.
Dr. Barry Eppley
Q: Dr. Eppley, I have a large chin button and excess soft tissue padding as well. My oral surgeon plans to slid the chin button (sliding genioplasty) during a jaw surgery but can you reduce the soft tissue afterward? Does this sound reasonable?
A: In interpreting your question, I assume you are having a sliding genioplasty done with a sagittal split mandibular advancement osteotomies. Having a large chin button implies that there is a bony knob on the end of the chin. Onto which you are saying there is a large soft tissue chin pad on top of this chin button. Your question then implies there may be an excessive soft tissue prominence of the chin after the sliding genioplasty is done and whether this can be reduced secondarily. While I would think it can that is a statement made without any knowledge of what your chin looks like or what the lateral cephalometric x-ray shows before the surgery. (how thick does the soft tissue chin pad appear) While this would be an unusual sequence of chin procedures (sliding genioplasty followed by secondary soft tissue chin reduction), for now let us assume it is appropriate to be done.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting a chin reduction in the near future. However, I have been considering having lip implants (Permalip) before surgery on my chin. I was wondering if the implants would in any way hinder a chin reduction surgery? Would it also depend on whether an intraoral method was used? Thank you.
A: You are correct in making the connection between lip implants and intraoral chin reduction surgery. If you were having a submental type of chin reduction (an incision done on the underside of the chin) then having lip implants done at the same time would not matter. But if you were going to have the chin reduction done intraorally it would be advised to either do the implants at the time of the chin reduction ( chin reduction first and the lip implants as the second part of the procedure) or afterwards… but not before.
Permalip lip implants can be an effective and permanent method of lip augmentation. But they require careful placement in the lip tissues and should not be disturbed by traumatic stretching after their implantation until well healed. Thus it is best that they be surgically placed after other oral or facial procedures have been performed.
Dr. Barry Eppley
Q: Dr. Eppley, We had previously discussed that a button chin implant would be an option for me if I wanted to make the bottom of my chin appear less squared off. I tried the filler as you suggested and actually really liked the rounder/pointier shape… but since I feel like my face is already long, adding that vertical height to create the pointer shape wouldn’t be my first choice..
1) Would it be possible to do something similar with a chin reduction technique so that the chin becomes somewhat narrower/rounder/more feminine and maybe slightly reduced vertically (vs an implant or filler that would require augmentation to add that shape onto my chin)?
2) Would it be possible to do this from an intraoral incision? I saw examples on your blog using an intraoral approach as well as submental and wasn’t really sure what category I’d fall into…
3) If an intraoral approach is possible, what are common complications/complaints you see or hear the most from your patients? Are any of these permanent?
A: In answer to your chin reduction questions:
- A chin reduction can reshape the chin, making it less square and reducing the vertical height.
- To do it intraorally, it would have to be an osteotomy technique where a wedge of bone is removed from the middle of the chin. This keeps the bottom of the soft tissues attached to the bone so there is not ptosis or sagging afterwards.The submental approach is simpler but does involve the scar on the underside of the chin.
- The intraoral approach will involve a slightly longer recovery and will create some temporary numbness to the chin and lip. Such numbness if not usually permanent in my experience.
Dr. Barry Eppley
Q: Dr. Eppley, I had a chin reduction three weeks ago. My chin always made me feel self conscious because I felt it was too long and wide for my face. Also, I had a dimple in the center of my chin that also really bothered me. My surgeon preformed a sliding genioplasty and shortened by chin 5mm. I was also concerned of the width of my chin after surgery so he tapered the sides of my jaw/chin to create a more narrow appearance.
I understand that there is considerable swelling still but I am so unhappy with how I look at this point I can’t even leave my house. The first thing I noticed was instead of dimple being in the middle of my chin, it’s at the very bottom and looks much deeper. I thought my dimple would be greatly diminished if not gone. This is what he told me. Also, my chin looks incredibly round. I feel like he should have addressed my skin and tissue instead of just addressing the bone alone. The sides where he burred to make it more narrow have this big hard knot or bulge on each side. What is this? When I smile I feel like I look awful. My lower lip looks thinner and is still numb. My lips when I smile look lopsided as well. I absolutely hate everything about my chin. I want a v shape appearance with my dimple gone or at least diminished. Now I feel like he made everything worse.
I want you to preform a revision but how long would I have to wait? I have included some pictures from 2 days ago. I would love to have a skype interview with you ASAP.
I appreciate your time and I look forward to hearing from you!
A: While I lack some specific information about your exact chin reduction surgery (type of osteotomy), I can tell you some very specific information about the recovery process from any type of reductive chin surgery. While three weeks seems like an eternity, the full recovery from chin reshaping takes a full three months, The swelling from chin osteotomies can be massive and, at three weeks, I would expect considerable chin distortion and roundness and it may not even be back to its normal size yet. Between resolution of the swelling AND soft tissue contraction back down to the smaller reshaped bone, it really does take a full three months. Other issues such as hard knots/spots, lip numbness and abnormal lip movement and smile are also normal at this point and will take the three months or longer to completely resolve.
If I am to interpret your pictures correctly, I believe some of them are before surgery (glasses) and the after surgery are those without. Based on these pictures I see a chin that do not considerable abnormally enlarged at this point after surgery.
From a chin dimple standpoint, No bony surgery is going to change the dimple. Its location may change because of the bone reduction but it will not go away. This is due to the fact that a chin dimple has a soft tissue etiology not a bone one. To decrease its appearance requires soft tissue management such as fat grafting.
The type of osteotomy used will determine whether a more v-shape will be the final result. This almost always requires a combined horizontal osteotomy and vertical ostectomy to achieve that change. I obviously have no idea what type of chin osteotomy was done in you although I am suspicious that it may have been a horizontal one only with some shaving on the sides. This does not usually work that well to effect that change. A simple panorex x-ray would answer that question.
Based on the chin osteotomy type and the presence of the chin dimple would determine whether staying the course until complete swelling has resolved would be best or whetehr earlier intervention would be more appropriate.
Dr. Barry Eppley
Dr. Eppley, I am interested in facial asymmetry surgery. I have an an asymmetrical face due to irregular growth of the jaw bone. Will the chin reduction on the right side correct it? I also notice that the right side of my face has less soft tissue so will the jaw angle implant balance out my face? Thank you.
A: Your facial asymmetry correction surgery approach certainly appears to be the correct one. Based on your pictures, the right side of the chin is longer and the width of the right jaw angle is more narrow than those two jawline areas on the left side of your face. So a right vertical chin reduction and right lateral width jaw angle implant should create improved facial symmetry. The only question is whether one wants to make the judgments for the amount of vertical chin reduction an the amount of width needed in the jaw angle up to the surgeon’s aesthetic sense or whether to make a more scientific quantitative assessment of them. That may be best done using a 3D CT scan or, at the least, get a panorex and lateral cephalometric x-rays to make some preoperative measurements.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in chin reduction surgery. Here are my questions:
1. What is your recommended approach for me…burring down vs. cutting the bone, intraoral vs. submental, etc? Just the chin or the jaw also? Changes to the fat/muscle/skin?
2. What can it achieve (can you simulate it with a digital image)?
3. What are its limitations and possible side effects?
4. What are the risks and how do you minimize them?
5. What can I do to ensure the best results possible? Are there limitations on travel?
6. Can you share before/after photos of women who have undergone this surgery?
7. Your site states $6500 for chin reduction – does this include anesthesia, operating room, surgeon’s costs? Does the cost differ by surgical method?
8. How much time to I need to plan to take off work and/or work from home?
9. How many trips would be required? (pre-op, surgery day, post-op/follow up?)
10. Would you recommend doing rhinoplasty and chin reduction at the same time or separately?
11. What are your Care Credit terms (6,12,18 months no interest?)
12. Do you require dental x-rays or some other type of imaging?
13. Would liposuction be effective in achieving a more defined chin/jawline? Is this considered a separate procedure from the chin reduction? Is there enough fat in your estimation that re-injecting it to my cheeks would produce a good result? Would a future pregnancy alter the results?
A: Thank you for sending the detailed questions about chin reduction. My answers to your questions are as follows:
1) If vertical chin reduction is all that is needed than an intraoral wedge bony genioplasty approach would be used (this would include narrowing the chin if desired) But all other chin dimension reductions are best done by a submental approach.
2) Computer imaging is always done before any facial reshaping procedure. Chin reduction is no exception.
3) Scar (if submental approach is used), asymmetries, uneven jawline, soft tissue redundancies are all potential risks and complications from chin reduction surgery.
4) As you can see in #3 the risks are essentially aesthetic in nature. Knowing how to manage the soft tissues in a chin reduction is actually more important than the bony reduction part of the operation.
5) Preoperative choice of the correct chin reduction procedure is the most important step to ensure the best result.
6) Because of patient confidentiality, there are very few before and after pictures that can be shared. And this is coming from someone who has done a lot of them.
7) This is a logistical question for my assistant Camille. Until we know the exact chin reduction procedure she can not give you an absolute number.
8) Recovery is all about the swelling and when you feel comfortable being seen in public. Everyone is different in that regard. It could be one week for some and three weeks for others.
9) One trip for the surgery is all that is needed. All followups can be done electronically.
10) Rhinoplasty and chin procedures are commonly done together. That is a personal choice.
11) Another economic question for Camille.
12) No preoperative x-rays are needed unless one is getting an intraoral bony genioplasty.
13) Liposuction rarely, if ever, can make a more defined jawline. Such changes are a reflection of what happens to the bone not the soft tissues. Any fat injections done would need a harvest site not from the neck. The amount of fat needed exceeds what can be obtained from the neck. Chin reduction surgery will not be affected by pregnancy.
Dr. Barry Eppley
Q: Dr. Eppley, I had a chin and jaw reduction ten days ago. It went well except that I have had worsening swelling each day after surgery. Today, when I woke up with even larger swelling on the left, I went to the ER to check it out and the ER doc after examining me was concerned I had a hematoma or an infection and ordered a CT scan with contrast. When the doc came back to my room he said the CT showed a large abscess on the left and a smaller one on the right and said I needed to get them drained. Then he consulted another plastic surgeon in the ER who looked at the CT and then called my plastic surgeon to consult him. After consulting each other it was determined these were pockets of liquid that can be a complication of surgery and would eventually be reabsorbed so no need for drainage. One determining factor was my WBC was normal however I just finished up my antibiotics yesterday. Also the ER doc sent me home on another week of antibiotics so I am wondering if he isn’t still somewhat concerned about possibility of an infection. So nothing is going to be done about the liquid pockets and the large one on the left is particularly bothersome and really has me concerned not only about the possiblity of infection as well as it is delaying my progress with recovery (worsened the swelling, discomfort, etc).
I know that you do a lot of jaw reduction surgery and would so appreciate to get your opinion re: these pockets. Should at least the large one be drained to reduce chance of infection and speed up my recovery?
A: Since you are within the first few weeks after surgery, these fluid pockets are either blood, serous fluid or a combination of blood. Bone when it is cut can ooze after surgery since it is hard tissue that does not have the capability of soft tissue contraction around the oozing exposed blood ‘channels’ and relies on compression of the overlying soft tissue on the bone (external wrap), an indwelling drain to pull off the fluid or just naturally stopping on its own. (which it may do if the bone removed is fairly superficial) Probably every facial bone reduction procedure gets a little bit of fluid which just naturally resorbs on its own within the first month after surgery.
Large (and it can be debated as to what constitutes large) pockets of fluid do have an increased risk of infection (good bacterial culture medium), can be uncomfortable when big enough and can prolong the recovery of one’s appearance and the final result because of increased resorption time. Draining them by needle aspiration or opening the incision and suctioning the fluid out can provide a prompt resolution to these concerns.
I can not tell you what you should do since you are not my patient for this surgery and that is between you and your surgeon.
Dr. Barry Eppley
Q: Dr. Eppley, I am seeking a sliding genioplasty or chin reduction revision. After a sliding genioplasty 18 months ago and two bone burring operations to reverse it (6 and 12 months after the original surgery) there are still areas of bone, on either side of my chin, that were not shaved back to create my original narrow shape. I am left with a wide bulky chin, the excess skin and tissue have sagged from over the past year. Now, after my most recent operation, I have even more tissue. I am always advised to go back to the trio of surgeons who did it but after this I really do not want to. There is a huge miscommunication and when they discuss things in Spanish, in front of me, I no longer trust them. I just want to have my normal looking chin back. Do you perform this type of revision and reconstruction surgery? How often?
A: While you did not state exactly the method by which your two chin revisional procedures were done, I suspect they were by an intraoral bone burring method. While you should have had the sliding genioplasty reversed by redoing the osteotomy and setting back where it once was, intraoral bone burring was destined to create exactly what you have now…a broader flat chin with soft tissue excess. The proper solution now is a submental chin reduction technique where the chin bone can be narrowed and the excessive chin soft tissue removed.
This is a sliding genioplasty and chin reduction problem that I see and treat regularly. It would be helpful to see some picture of your chin and to know the exact details of all three of your prior surgery.
Dr. Barry Eppley
Q: Dr. Eppley, We are interested in chin reduction for our daughter. She is now 17 years of age. Through her orthodontist we have been told that she wiuld need a chin reduction. We have been to visit a plastic surgeon in our local area who is willing to operate on her but we would like to find someone with your level of expertise. We would like to what your thoughts are on what type of chin reduction surgery should be done. I have attached some pictures of her for your assessment. Many thanks.
A: That you for sending your daughter’s pictures which is extremely helpful. She has an unusual excessive chin problem as it is very horizontally protrusive but also vertically short. This creates a prominent chin ‘knob’ deformity. While I don’t know what the bone looks like underneath (it would be helpful to see a lateral cephalometric x-rays from her orthodontist who undoubtably has one) her excessive chin problem is both a bone and soft tissue issue. Both have to be addressed to produce a satisfactory chin reduction result, removing soft tissue alone will not work. While the bone may be horizontally excessive, her chin is also vertically short. Her entire lower face is actually vertically short compared to the rest of her face. Ideally you would want to convert the excessive horizontal bone to increased vertical chin height. This would stretch out some of the horizontally excessive soft tissue which is just following where the bone is. Then any excessive soft tissue could be removed. While this may be the ideal approach, it would entail two stages to do so. The other approach would be a one-stage submental chin reduction with removal of excessive horizontal bone which would then allow some of the excessive soft tissue chin pad to be removed and tucked under. This would still leave the chin vertically short but would offer significant improvement in a single surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I have along protruding chin and am interested in chin reduction surgery. What is the best way to reduce/reshape it so it looks smaller and more proportionate to the rest of my face?
A: In chins that are both vertically long and horizontally protrusive, there are two surgical approaches. A submental chin reduction technique is done from an incision below the chin where the bony chin can be vertically and horizontally reduced and any excess soft tissue removed. This is the best technique for bony chin reduction but does leave a fine line scar under the chin. That is somewhat of a concern with your ethnicity and skin type. The alternative approach would be an intraoral one where a vertical wedge bony genioplasty is done with horizontal setback. This leaves the question of what happens to any soft tissue excess, which may or may not contract back down but it is an externally scarless surgery.
As you can see, each chin reduction approach as its advantages and disadvantages. It all comes down to how the patient perceives the submental scar and what the risk of a redundant chin pad is after the bone is reduced.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting a chin reduction for the vertical height of my chin as well as making the projection smaller when you look at my profile. I also have a chin dimple right in the center of my chin that I want removed and smoothed out. I am a 23 year old female. What can be done for me to achieve this? Also, I worry about loose skin after the reduction, what can be done to avoid that? I have a very tight jawline and I do not want to lose the definition.
A: Chin reduction can only be done only one of two ways from an incisional standpoint. Either it is done from an intraoral (inside the mouth) or a submental (under the chin) approach. Which is best depends on the dimensions of the bony reduction and how much, if any, excess chin pad tissues may result. I only see a frontal view picture attached and I need a side view picture (non-smiling) to determine what the horizontal reduction needs are if any. Most effective chin reductions are done from a submental approach to address this soft tissue concern.
The chin dimple is best treated simultaneously with fat injections to try and reduce/eliminate it.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 32 year old female who underwent several facial procedures last year. I had a vertical chin shortening and a midface lift. I know feel that my chin is too short for my face. Also the midface lift has caused my eyes to look worse than before with too much scleral show. What can be done for these problems now? Wouldn’t you agree that I really do not look better than before?
A: Whether an aesthetic operation produces a pleasing outcome is for the patient to judge not me. What I can say is that you obviously have concerns/questions about the chin and eye areas so I will make some comments about them. If you just showed me the after result of your chin, I would not say it is too short. But given where you started I could understand why you may feel that it is. The good news is that chin lengthening is more reliable than chin shortening whether it be done by an opening bony genioplasty or a vertical lengthening chin implant.
Your eyes clearly have lower lid retraction, a sequelae of the midface lift, which is unclear to me why that was ever done. Given how your eyes looked and your young age, undergoing a midface lift runs a very high risk of lid retraction because you have no extra skin. Such lower lid retraction most likely will require posterior lamellar reconstruction with palatal grafts to get the lid margins up a few millimeters. Lower lid retraction is a far more challenging problem than vertical chin lengthening.
Dr. Barry Eppley
Q: Dr. Eppley, I would like a shorter, fuller face with softer, more feminine features. I am wondering if I need corrective jaw surgery or could a chin reduction and facial fillers alone achieve the look I want. If there isn’t a great difference in the results of corrective jaw surgery and chin reduction surgery, then I would be more inclined to just get chin surgery because it is less invasive and costly. I do not like the large space between my nostrils and my upper lip. Could rhinoplasty help to shorten that distance? You might not be able to tell from these pictures but as far as my nose. I do not like the hump and I do not like my nasal tip. It is very bulbous and when I smile I feel the span of my nostrils becomes very wide. Finally I feel that I have a very prominent brow bone and feel it makes me look even more masculine. I am wondering if I am a good candidate for brow bone reduction surgery and also hairline lowering in order to decrease the length of my face. Thank you in advance for your help. I look forward to communicating with you soon and seeing the computer facial images.
A: All of the facial fershaping procedures you have mentioned would be helpful in shortening the appearance of your face from hairline lowering, rhinoplasty, subnasal lip lift and vertical chin reduction. It is impossible to comment on whether corrective jaw surgery or chin reduction would be better since that decision requires knowing the state of your bite. (occlusion) If your bite is good, then chin reduction would absolutely be the better procedure.
Brow bone reduction would be helpful to feminize your forehead and would be needed with your rhinoplasty to help bring back the glabellar (central) area of the brow. Otherwise the hump reduction with your rhinoplasty will make a deep nasofrontal angle which is more of a masculine facial feature.
While a subnasal lip lift would be helpful, it can not be performed at the same time as a rhinoplasty due to blood supply concerns to the intervening columellar skin between it and the open rhinoplasty incision.
To properly do computer imaging, I need more than just a lateral or side view. Additional views from the front and even a three-quarter (oblique) view make for a complete imaging assessment of the aforementioned facial changes.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about a possible reduction in the “chin pad” on my chin. I actually previously had an actual chin reduction where the bone was burred down, and I was quite happy with the results of this compared to what it was before.
The surgeon did the reduction via submental incision, and I actually already did have a scar in that area prior to the surgery. (stitches from an old sports injury)
However, even before I had my chin reduction, there was a prominent “fat pad” on my chin, and it is slightly more obvious now (although the overall appearance of my chin compared to before the reduction is significantly better now). I would not consider it to be a classic “witch’s chin” .
I was wondering if it would be possible to discuss what could be done to reduce the fat pad? I am a medical student and did read in a textbook chapter Dr. Eppley mentioned liposuction should not be performed on the face, but also read on a post on realself he mentioned a possible intraoral chin pad thinning. I have attached a few pictures, showing me at the present showing the prominent “fat pad”.
A: Your assessment that treating a full chin pad by liposuction is not a good idea. Liposuction of the chin fad pad is not advised as it will result in irregularities and mentalist muscle distortions. The only way to treat an excessive chin pad is with a submental excision and tuck of the remaining tissue.
Dr. Barry Eppley
Q: Dr. Eppley, Hello! I spoke to you all a while back about considering plastic surgery. I was very pleased with the results of the face prediction and your wonderful, fast replies. However, I have just a few questions:
1. How would I schedule an in person consultation? I would be coming from way across the country and I am willing to fly out to Indiana. The online Skype consultation will not really work because the internet is quite slow where I live and I am worried it’ll be more trouble than it’s worth. Therefore, I’d be more comfortable with an in-person consultation.
2. What is the estimated recovery time for Chin Reduction surgery and Rhinoplasty? Would I have to stay in Indiana for a certain amount of time? Are we talking days, or perhaps weeks?
3. I would be unconscious during the surgery, right? So, do you guys have a licensed anesthesiologist at all of your locations?
4. I see that you have multiple offices to choose from. Which office location would be the best for me and my procedure?
Thank you so much for taking the time to answer my question, and thank you all for your hard work.
A: In answer to your questions about rhinoplasty and chin reduction:
- An in person consultation can be arranged at your convenience. I will have my assistant Camille contact you next week to make those arrangements.
- The concept of recovery after any surgery can mean various things to different people. But to use a simple endpoint of being able to do most functions and looking only moderately swollen, think 10 to 14 days. You should be able to return home in a few days after surgery.
- Rhinoplasty and chin reduction surgery requires a general anesthetic to be both completely comfortable during surgery and to allow the best extent of the surgeries to be done.While I operate at multiple hospitals, aesthetic procedures are done at my private surgery center which is both AAAHC certified and staffed with board-certified anesthesiologists.
- At stated in #3 above, there is only one aesthetic surgery center at which I operate.
Dr. Barry Eppley
Q: Dr. Eppley, I’m interested in chin reduction due to the fact that I feel as if my chin is way too large vertically. When I happen to smile there is also enough loose “bulk” to pinch on to skin or muscle, not sure exactly what you’d call it in the doctor world. Horizontally my profile does not bother me. I’ve been reading a lot about chin reduction lately and have seen pictures on websites of your work. And I would like to know exactly what kind of procedure I would need done for me to obtain the chin that I want. (Included)- are two photos the on of me smiling is a perfect example all together of what bothers me about my chin. In the second photo is what I would want my chin to look like…my dream chin 🙂 by the way thanks for your time.
A: What you are seeking is a vertical chin reduction that is best done through a submental incisional approach. To achieve your goals it is necessary to remove approximately 7mms of vertical chin reduction across the bottom of the chin bone. With this amount of vertical chin reduction, two additional issues need to be addressed. First the lower border of the jawbone behind the chin must be reduced lest you would be left with a ‘bulge’ of bone along the jawline behind the chin. Secondly, This amount of bone reduction will require soft tissue removal as well, known as a submental tuck. All three of these combined procedures fall into the procedure I call a ‘chin and jawline reduction’ operation.
It would be helpful to see a non-smiling front and side view picture for computer imaging as well as a panorex x-ray (usually a dental film) so I can measure the amount of of bone that can be safely removed from the chin and jawline. (location of tooth roots and the mental foramen and path of the inferior alveolar nerve)
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in rhinoplasty and chin reduction surgeries. I am very unhappy with the profile of my face. I feel it looks very masculine. I do have a twisted nose and large tip. I feel my nose doesn’t fit in with my face and looks rather big when I start to turn my face from certain angles. When I use a plastic surgery simulator it makes a big difference when I make my chin and nose smaller. I would like to know what your opinion is and what would you think would help balance my face? I have been wanting surgery for a long time now and over the years wasn’t sure exactly what the problem was with my face but I believe it is do with the angle of my chin and nose.
A: The nose and the chin make up a major portion of one’s profile so it is no surprise that changing these two structures can make for a major facial change and not just in the profile view. I would agree completely with your assessment that your nose is too big in various dimensions and is a major culprit in your facial concerns. But as you have also pointed out, and astutely so, is that your chin is also a little too strong. That would become very apparent when the nose is reshaped and made smaller. Thus doing a concomitant chin reduction with a rhinoplasty would produce the greatest effect in make your face have an overall more feminine/less masculine appearance.
I have done some imaging of the one picture you sent to illustrate those potential changes with a rhinoplasty and chin reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I was interested in a chin reduction surgery, perhaps rhinoplasty (although I really don’t mind my nose). I am very comfortable with my appearance, and don’t mind it much although I find my chin to be too large! I think I would be much more attractive and feminine if I had a smaller, less gaunt/obvious chin. I was wondering if you could possible let me know if I would be a good candidate? I know most doctors suggest a traditional ‘almond’ shape, but I don’t mind my jaw square-ness, I just wish my face were shorter. Thank you, I can’t wait to hear your reply!
A: Your chin reduction request is a bit uncommon as what you have is a horizontally short chin that is vertically long because of its retrusive position. This type of chin reduction would actually be performed by a sliding genioplasty technique where the vertically long but horizontally short chin bone is cut at an angle and moved forward. (with a wedge of chin bone removed in the process) I have attached some imaging to illustrate that type of change. What actually happens is that as the chin bone comes forward it is vertically shortened as it is horizontally advanced.
Dr. Barry Eppley
Q: Dr. Eppley, I’ve read two things regarding facial attractiveness.
1) The middle third and lower third of the face should be roughly equal in size (my middle third is 224 and my lower 216)
2) The lower third can be divided into three sections and the top section, the upper lip, should equal 1/3 of the total area and the bottom two sections, the lower lip and chin, should equal 2/3 of the total lower third height. (my upper lip is 71 and my lower lip and chin combined are 139 so it almost perfectly matches the ideal 1:2 ratio).
According to these measurements, my chin is actually not too long. This surprises me because I was always under the impression I had a long chin and would benefit from a slight reduction in chin height. (vertical chin reduction)
Do you have an opinion on my chin height? I’m trying to approach this scientifically, but I’m not sure I’m succeeding.
A: What you are learning is that facial measurements and ratios are general guidelines and do not always translate directly into perceived attractiveness. Case in point…you felt your chin was too vertically long but the numbers say otherwise. While the numbers may be ‘right’, in the end all that matters is what you think. What you need to do is approach your chin concerns in reverse…so some computer imaging with shortening the chin (vertical chin reduction) and see if it looks better to you.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 32 year old female interested in having chin reduction surgery. I underwent orthognathic surgery in 2011 to correct a class III malocclusion and to straighten my midline with a bilateral sagittal split mandibular setback osteotomy. I am pleased with the way my bite looks as a result of this surgery, but I am still unhappy with the extent to which my chin protrudes. I am very interested in learning what can be done to reduce the size of my chin and to improve my facial profile. I have attached some frnt and side view pictures for you to review.
A: Chin reduction surgery must take into account the extent of bone and soft tissue to determine what technique to use. What I see is a central button of bone on the chin which appears to be the primary culprit. It looks like it could be horizontally reduced by at least 5mms and the bone tapered backward along the jawline a few cms. The real question is whether this should be done by a submental or an intraoral approach. It is tempting to do it from inside the mouth but there is always the issue of what will happen with the overlying skin. As tempting as that seems with a smaller chin excess problem like yours, that is probably a mistake. The submental approach has the added benefit of removing and tucking in any soft tissue excess which complements the bone reduction.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a chin reduction. have always had a unique chin with over-protruding bone, an excessive soft tissue pad and deep labiomental crease. It almost looks like I have a bottle cap lodged onto my chin. I am very curious as to what you feel would the best approach here. I have had a couple consults with other docs who have suggested a sliding genioplasty and was even shown some pictures of expected results, which I loved, but I am worried about a sagging chin pad after the procedure as they confirmed that they would not do anything to the soft tissue. So I am pessimistic of the accuracy of the pictures they offered. I would definitely prefer an intraoral approach if possible, though I know this could be a complicated procedure that could benefit from an approach via under the chin. Your thoughts?
A: Chin reduction is a much different procedure than chin augmentation due to soft tissue consierations. From a chin reduction standpoint, I would agree that the accuracy of those imaging results is suspect. There is no doubt that the bony chin can be moved back that far, but the question and issue that has to be dealt with in every chin reduction is where is the ‘excess’ soft tissue going to go. With a setback sliding genioplasty, it is not sagging of the chin pad that is the concern as the chin pad soft tissues are not overly detached. It is the tissue under the chin, the submental area, that often can become bunchy or redundant. As the chin moves back, the skin under the neck can bunch up. This is why a submental approach to chin reduction is usually more successful as it deals with the soft tissue redundancies. But I can certainly understand why one would want to try and avoid a submental scar. The good news is that you are fairly thin with no substantive subcutaneous fat so perhaps the soft tissue redundancy concern may be overstated. Therefore one could undergo a setback genioplasty with the understanding that the sub mental tissue issue is unpredictable and may have to be dealt with secondarily if it is an issue. It just depends on how one wants to ‘gamble’…risk a scar revision with the sub mental approach or risk the potential need for a secondary submental tuck up with the sliding genioplasty setback.
Dr. Barry Eppley
Q: Dr. Eppley, I was told in a consultation with a local plastic surgeon that I needed cheek implants, chin reduction (just shaving the bone down and removing some fat/skin), and a little off the hump in my nose. That is the basis for my inquiry. Even though those were his suggestions, I still wanted to keep looking because I didn’t see that he had a very extensive client base where he had performed all of those at once…or more than one procedure at the same time.
I normally pose differently and make myself look better in pictures, but my profile is very flat in the cheek area and prominent in the chin. I’d like to get this corrected somehow, but I think with so many things to address at once, I get concerned that the surgery would be very noticeable and I would look like a different person all together…
A: In reviewing your pictures, I could make the following comments:
Your vertically long but non-projecting chin would be best treated by an extra oral vertical reduction ostectomy. (submental chin reduction) A burring technique would not remove nearly enough. You need at least 8mms or more off to really make a difference.
Your flat mid facial profile is ideally treated by a combination of paranasal and malar shell cheek implants. This will help pull out the entire midface. (both the nasal base and the cheeks)
You do have some significant facial asymmetry that actually affects the whole left side of the face. (which is shorter) The chin reduction will help with the lower facial asymmetry. The eye asymmetry, however, will not be improved.
One realization is that these changes will make a facial difference with much better balance…but it will likely be noticeable as your face gets vertically shorter and more horizontally projected.
Dr. Barry Eppley
Q: Dr. Eppley, I have a question regarding chin reduction. Could my chin be reduced in height vertically with out having my chin split into pieces? I think that is too much of a risk and to much time to recover from for me. Is there something else you can possibly do like burr it upwards from underneath as well as backwards because I have what I consider to be a pointed chin. I would like to have it rasp to the point it looks wider, flatter and shorter. Is this surgery at all available? How much is allowed to be vertically shaved off before it reaches into the too much taking off zone? I would prefer the incision inside my mouth being as though I’m a person of color but I’m willing to take that risk to have the chin exposed through the under cut to obtain the result I so desperately desire. I’ll just get my scar revised if that’s what it takes.
A: The type of chin reduction you are referring to is common and is known as a submental chin reduction. While burring is used for some minor shaping, more significant reduction is done by a saw blade cut and the edges then burred. This can make a radical reduction in vertical chin length and definitely can take a pointy chin and make it shorter, wider and flatter. With this much vertical chin reduction, the submental approach is best anyway because it allows the excess soft tissue to be removed and tightened as well to prevent a witch’s chin deformity. The amount of bone reduction that can be done is based on the location of the tooth roots and the exit of the mental nerve which is usually above the 10 to 12mm mark from the lower edge of the chin.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in jawline reduction. I really want to shorten my jawline and chin as I think the lower half of my face is too long I have a picture of me and what I hope to achieve after surgery by using a Plastic Surgery Simulator. I have no bite issues and I ideally want 1.5 cm vertical reduction of height of my jawline and chin producing a more rounder and shorter face overall. Is 1.5cm possible? Thank you
A: Vertical chin and jawline reduction can be done but not at the amount of 1.5 cms or 15mms. There is a good reason why that can not be done…the location of the apex of the roots of the lower teeth and the inferior alveolar nerve which runs through the lower jawbone. At 1.5 cms reduction, the nerve and tooth roots would be injured. There is also the issue of what would happen to the soft tissue that is currently covering your existing height of your jawbone. With that much bone removal, there would be a resultant soft tissue sag even if that much bone reduction was possible.
One issue that is common in facial bone augmentation or reduction surgery is that patients way overestimate how much change in measurements they really need. If you actually took away that much bone vertically, you would have very little jaw left. And the amount of desired in the height of our lower face in the Plastic Surgery Simulator is no where close to 15mms. That would be closer to 5 to 8mms. This is also a safer amount to lessen the risk of any soft tissue sag afterwards. One way you can measure how much bone you can safely remove is to get a panorex x-ray (a common dental film) that lays out the entire mandible like a map so the tooth roots and internal nerve can be seen. Then the vertical bone distance can be measured and actually determined.
Dr. Barry Eppley
Q: Dr. Eppley, When you do a chin reduction, how do you determine beforehand how much bone can be vertically removed. You mentioned about the panorex film (I think this is just a dental x-ray but I could be wrong) I think it is pertinent that I get you a copy so you could realistically tell me how much of a reduction I could likely achieve. This way I will know for sure whether there is a noticeable reduction. I would prefer more of a noticable reduction so it seems like the submental approach is advisable- but what about the scar on my chin, how long will it be and where exactly is it made?
A: A panorex is the ‘wraparound’ dental film that you may likely already have in your dentist’s office. In a submental chin reduction, the incision is on the underside of the chin and the key is to keep it curved (following the curve of the jawline but behind it) and to not have it extend any further underneath the chin horizontally than the distance between vertical lines dropped down from the corners of the mouth.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a chin reshaping/chin reduction procedure. My chin is fairly square and big and I feel very insecure about it. It’s not big to the point where it’s the first thing people notice, but I hate it so much and I think it makes my otherwise feminine face look disproportionate. What can be done to reshape a chin? It seems to be one plastic surgery procedure where very little is written about it and very few plastic surgeons actually do it. How is it done and what is the recovery like?
A: There are numerous option in chin reshaping/reduction surgery. Your chin is wide and square for your face and even maybe a bit vertically long. It does not appear to be to protrusive or horizontally long which is a key feature that affects how chin reshaping is done. .Your chin can be reshaped to be slightly shorter and more narrow through an intraoral genioplasty approach. From inside the mouth, the bone is cut, like a sliding genioplasty, and narrowed and then put back together, thus leaving no external incisional scars. This will create a more tapered chin that is more triangular shaped rather than square as it is now. Any bony chin surgery is associated with a fair amount of swelling that will take about three weeks to enter the benefits phase and a full six weeks to see the final result.
Dr. Barry Eppley
Q: Dr. Eppley, I understand that malar and sub-malar facial implants can be used to add volume, 3-dimension and contour to the face. Initially the imaging you provided showed the malar implants only, I think? I am interested to know if the sub-malar implants can be added as well, and more laterally, to camoflauge the slighly hollow buccal area of my face.
Can you please also explain to me the use of paranasal implants? I understand these are largely popular in Asia.
In your opinion, would they assist in the roundening and softening of my face as a whole?
You mentioned the chin augmentation I did may have produced an extreme result, compared to what is actually achievable? Do you think I would notice a measurable reduction in both the width and length of my chin with the sliding genioplasty?
A: What I previously showed was the use of malar implants in your face. The combination of malar and submalar implants is known as malar shells. That would extend the fullness into the underlying buccal space right below the prominence of the cheek bone.
Paranasal implants are designed to add fullness to the base of the nose or push it out further. They are common in Asians because they naturally have a flatter mid face throughout. I can not tell if they would be of benefit to you without looking at picture of your face from different angles, like the side view and the three-quarter or oblique. Midface augmentation in general requires a more 3D type assessment not just a flat 2D picture from the front view.
As for our chin reduction/narrowing, what you had demonstrated was a bit too sharp and extreme which is not surgically possible. But an osseous genioplasty (not a sliding one) can reduce the height of the chin as well as make it more narrow through vertical and midline bone removal.
Dr. Barry Eppley
Q: Dr. Eppley, I am wondering if chin reduction may be helpful for me. I had a chin implant which I was not keen on so I had it removed. It’s been two months now and the chin is not what it was, it looks more masculine and wider than it was originally. Do you think that this will improve?
A: A chin implant adds volume to the bone as an onlay but do so but stretching out the soft tissues of the chin that is on top of it. Thus, when a chin implant is removed, it requires the overlying soft tissues to shrink back down and readapt to the bone. Whether that can happen successfully is influenced by how large the original implant was, how long it was in and what the surgical approach was to place it. (submental vs. intraoral) I don’t think you can have an absolute certain answer for three to four months after its removal, but in many cases the chin will not return to its original shape. Even though it has only been two months, I would not be optimistic based on how your pictures look. Chin reduction surgery may be beneficial in chin removal cases like yours as it removes and tightens the loose soft tissues and may contour the chin bone as needed for additional chin shape contouring.
Dr. Barry Eppley
Q: Dr. Eppley, I have bilateral implants for my top lateral teeth. I was born without my permanent ones. I had this surgery and the oral surgeon told me my bone was not thick enough for the implants. They did the implant surgery and then did graft work. I had a total of 3 den grafts which my body rejected all three. They said the next step was to use my own bone, by removing it from somewhere or growing new bone from my DNA in a lab and then grafting it. Also, my implants are slightly exposed when I smile big and I am very self conscious about this. I would like this fixed. I am also wondering if I can have this grafting done with bone from my protruding chin. Is there a way they can reduce and graft in one surgery.
A: Your prior maxillary bone graft failures sound like it was allogeneic or cadaveric bone, which is commonly used and can be successful, is never as good as your own bone. Forget about growing your bone cells in the laboratory, use good stock bone grafts harvested from the nest donor source available…you!!
Small bone grafts can be harvested from numerous face and skull areas. Each graft probably needs to be less than 1 x 1 cm so using your chin is a real likely possibility for for a donor source. Depending upon how your protruding chin is reduced would determine how the grafts would be harvested and shaped. Chin reductions (bone graft harvests) can be done from an interpositional intraoral osteotomy or from a submental vertical chin reduction approach. When you are using your own bone, it is imperative that it is harvested and placed during the same procedure.
The more practical limitation of using your chin as the donor source for maxillary grafting is whether your surgeon feels comfortable harvesting and reshaping the chin at the same time.
Dr. Barry Eppley