Your Questions
Your Questions
Q: Dr. Eppley, I found your website, and I was wondering if you could offer a suggestion in my case. I had jaw surgery twice several years ago. First, a 2-piece Lefort I, IVRO, and a jumping genioplasty was done. (I was a skeletal Class II with anterior open bite.) The surgery, in every aspect, was poorly done and I had a re-do Lefort I six months later. Again, the outcome was not good, and I underwent re-do 2-piece Lefort I, BSSO, and re-do chin osteotomy about 10 weeks ago (with a different surgeon). In this final surgery, bite correction was achieved, and in most respects, it was a success. But I am still unhappy with the appearance of my chin. I have significant step-offs from the first genioplasty. In the re-do, my surgeon shaved down the bone (no cuts) in the front, but did not address the step-offs. From the ceph x-ray, it seems the bony part of the chin is in the right place, but I have significant soft-tissue protrusion that I am very unhappy with. I believe the success of the re-do was compromised by the technique used by the first surgeon (not sure why he didn’t do a sliding genioplasty, as my chin was not terribly receded in relation to my jaw). I am concerned that a third procedure to “correct” the chin may cause more harm than good, but I am not sure. I am also not sure how much swelling I still have in that area. I did not have this amount of soft tissue in the front of the chin area before the first surgery. It appeared after the first surgery, and only increased with the most recent surgery. The step-offs are clearly visible from the front and side, in addition to my being able to feel them. Thank you for your time.
A: I am very sorry to hear of your very complex orthognathic surgery history. From a chin standpoint you had a jumping genioplasty (I have never liked this chin osteotomy technique) which has it own lateral step-off issues. Then the last genioplasty procedure burred down the front edge of the bone which is guaranteed to create a soft tissue excess issue. All of these genioplasty techniques understandably have left you with step-offs and some degree of soft tissue ptosis/sag. While you aren’t quite three months from the last surgery, I see no reason that your chin issues will improve with time. The best way in my experience to address these chin problems are from a submental approach for your genioplasty revision for chin reshaping. The step-off chin defects can be filled in and the chin sag removed with a submental tuck technique.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I am a woman that has a very square chin with a cleft in the middle. What can I do to make my chin more feminine looking?
A: A bony chin reshaping procedure is needed to both narrow the chin and eliminate the vertical cleft. This is done by filling in the cleft of the bone in the middle of the chin, repairing the overlying split muscle and shaving down the lateral tubercles (sides) of the chin. This would give your chin a more narrow shape without losing projection and get rid of the vertical cleft as well. This is a procedure that is done from the inside of the mouth, although it could be done from a external submental approach as well. Feminizing the chin is a common procedure in facial feminization surgery but is also occasionally requested by a woman who simply has too strong of a chin as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting chin reshaping surgery to get rid of my prominent square chin which is not a good look for a woman. If possible, please give me some indications on the following questions.
1) How long before I could go to work? I don’t mind being a little black and blue. More concerned about pain and my ability to focus on things.
2) How soon could I fly after the intraoral surgery?
3) How soon could I drink liquids? Eat solids?
4) Would I need to bring a companion?
5) I assume you detach and reattach the muscles immediately under the chin.
Also, I wanted to let you know that rather than a smooth curved chin, I would like the square to just be made narrower and the asymmtery in length of chin to be corrected in favor of the shorter side, but no shorter of a chin than that. I think a slight square (albeit narrower) is more interesting than a perfect oval.
A: In answer to your questions:
1) For just the intraoral chin contouring, this is a fairly simple and uncomplicated procedure. There will be sone chin swelling but almost never any bruising. The chin will be more numb that it will be painful for awhile. I certainly think you can be back to work in less than a week. There are no restrictions of amy kind after surgery.
2) You could return home the next day.
3) You can eat and drink immediately after surgery.
4) Most out of town patients come by themselves. We just have to have one of our nurses take you back to your hotel from the recovery room. We can not just push you out into the parking lot on your own right after surgery.
5) No muscles are ever deattached from under the chin. The mentalis muscle is elevated to access the chin bone are to be reduced and then reattached at the end of the bony contouring. This muscles sits in front of the chin not beneath it.
In regards to chin contouring, I would agree that in your case and face that a more narrow but slightly still square chin is better than a perfectly oval shaped chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to reshape my chin. My chin doesn’t stick out, it just looks boxed look especially when I started losing weight. Also my ears don’t stick out, I feel they look big as in length for my small head. What do you recommend? I have a front and side picture for you to see.
A: Thank you for sending your excellent pictures. Your square chin can be contoured fairly simply through an intraoral approach where the square corners are removed (chin ostectomy) and the chin made more rounder as a result. The vertical height of your ears is a more challenging issue. It can be seen that what makes your ears long is that the upper half of the ear is big compared to the lower half. While they can be reduced substantially in height, this necessitates a scar which would run across the outer helix in the upper ear area. I am not so sure this is a good aesthetic trade-off. There is an alternative approach for ear height reduction that is done from behind the ear, which leaves no scar on the outside, but it would only reduce the height of the ear a minor amount. So you can see neither approach is ideal, substantial reduction with a scar or minimal reduction with no scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 52 year-old female and am interested in reshaping my chin. I have always been bothered a bit by the squareness of my chin which is a bit unfeminine.with aging But now that I have developed some jowling, it makes my face look more square. I want to get my chin reshaped to a more narrow appearance and then have a facelift afterwards. How would this be done and how far apart should the chin reshaping and facelift be? I have attached some pictures and have done a ‘homemade’ facelift by pulling up on my skin so you can see the squareness of the chin better.
A: Thank you for sending your photos. Your homemade facelift shows the exact location of the squareness of your chin. Now that I know the location of bony excess, that would be best reduced by an intraoral approach given that it is fairly anterior. It would be reshaped by a saw technique, taking off the wings of the chin. I have done an image showing its reduction result, more can be done but this is a good starting point for discussion. Given its very anterior location and away from the plane of dissection of a facelift, I see no reason why the two procedures could not be done at the same time. The distal tightening effect of the facelift would help any soft tissue slack/swelling that would occur from the chin ostectomy/reshaping.
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 am possibly going to have a chin reduction. Here is my serious concerns. I have a very thin face with hollow cheeks. My forehead is large and my chin is small. The problem is I have a projected or jutted out chin which is very pointy, especially when I smile. I have a very strong jaw line, and I just want to to get rid of the witch’s chin look but keep the exact same frontal look. I cannot afford to have my chin shortened. I want a softer look, but I am terrified that I am in for serious dissapointment. If I did this, I would want to do the submental approach and the burring teqnique because I don’t have a long chin. It seems safer, and by your articles it seems I may be correct. I want a softer, more feminine look without making my face look any thinner, and the projection gone. Is this possible?
A: Thank you for sending your inquiry and your pictures. I would take a slightly different approach to your chin. In the frontal view your chin is very square for a female and it needs tubercle reduction (side chin reduction) to soften it. From the side view, it needs some slight horizontal reduction and soft tissue tightening. I would not do any vertical length reduction. You need the length to fit the rest of your face.
This chin reduction procedure is best done, as you have mentioned, from the submental approach to manage the excess soft tissues that will result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr Eppley, I am an Asian female. I have had an advancement chin osteotomy, 4mm forward and 2mm downward. But the result makes me have a long flat face with wider chin. As it’s not just the tip of the chin move forward but also the wide chin so it’s not good. I am guessing that the chin bone should be trimmed and I was wondering if it can be done in 2 to 3 weeks after the chin osteotomy has been done? It seems the swallow is not yet gone, is it good for immediate surgery again? Also I will do a facelift with fat transfer with other surgeon. I was wondering if I should wait and to have the chin bone trimming and facelift done at the same time, rather than do the bone trimming now? If I can’t do them together, how long should I wait before each of the steps? I look forward to hearing from you very soon.
A: Based on your description, it sounds like your chin osteotomy was just done. Your chin bone movement was very small and I doubt that amount of bone movement would make your chin ultimately look wider. I think what you are seeing is swelling, particularly if it has just been done in the past few weeks. You can not really judge the dimensional changes after a chin osteotomy, particularly width, for several months. I would advise waiting 3 months and then see what you think. There is no reason you can not do some chin reshaping if needed with a facelift and fat transfer later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr Eppley. I am wondering if it is possible to get a variation of genioplasty done.
I am wanting to reposition my chin bone higher up. In reduction genioplasty the chin tip is sawn off, a wedge of bone is removed and the chin repositioned back.Is it possible to saw off the end of the chin, then without removing any bone, reattach the sawn off tip at a higher position? This could help address saggying tissue as the higher position of the bone could help lift the surrounding tissue. This would leave a bony ridge on the chin, however this could be hidden with fillers.Does this type of surgery sound like something you could do? Thank you.
A: That is known in chin surgery as a ‘jumping genioplasty’. That places the cut piece of chin bone on top of/in front of the upper chin segment. However this will bring the chin forward and make it more prominent, although it would lift up sagging chin tissues and shorten its vertical length somewhat.
By your descriptions, I think you may have an erroneous concept of how chin osteotomies are done. It is important that the cut piece of chin bone remains attached to the muscles which provide it with a blood supply, otherwise it will die and resorb away. It is not just moved anywhere else one wants to put it.
Perhaps you could send me some pictures so I could see what type of chin problem you and what may or may not work.
Dr. Barry Eppley
Indianapolis, Indiana