Q: Dr. Eppley, I am interested in custom jaw implants. I had a chin wing osteotomy done three months ago and I am happy so far with the result, but not with the width of my jaw and the asymmetry. Is it possible to get this procedure done after a chin wing osteotomy? When could I get the surgery this year? How much will it cost? How long do I have to stay?
A: It is possible to do a custom jaw implant after a chin wing osteotomy. I have done numerous such cases. The chin wing osteotomy provides no facial width, no posterior jaw angle vertical lengthening and often ends up asymmetric/irregular. I would wait until six months after the chin wing procedure to be certain you known exactly the dimensional jaw changes you want to achieve. A custom jaw implant will require a 3D CT scan for implant design. You have a very good knowledge of the recovery based on your chin wing osteotomy experience. It would be similar to that although the amount of swelling may or may not be less.
The cost of a custom jaw implant will be greater than that of the chin wing due to the design and fabrication of the implant.
Dr. Barry Eppley
Q: Dr. Eppley, Thank you for your amazing job you do as a surgeon and to inform all the patients online. I know (as read on your site) custom implants would be my best choice. However, i really do not want implants, there’s a 0% chance of me getting implants. A friend of mine had a “zygomatic osteotomy” and a “chin wing osteotomy” and I think his results were very good. Do you perform these surgeries? Do you use some bone grafts? Why would you, or why wouldn’t you recommend the following procedures’?
A: When one tries to compare different facial reshaping operations it is important to carefully investigate up front what dimensional changes they can actually make. I have perform many zygomatic osteotomies (for cheekbone narrowing and cheekbone widening) as well as the chin wing osteotomy. The zygomatic osteotomy provides width and width only to the zygomatic arch and the very posterior aspect of the zygomatic body. It can not provide any anterior projection to the cheek as that is not the direction that the bone moves. The interpositional gap created by the zygomatic expansion osteotomy can be grafted by bone or an hydroxyapatite block. The chin wing osteotomy is useful for two types of jawline changes. It is primarily useful in creating a sliding genioplasty effect where the entire jawline is moved as the chin comes forward and downward. It can also be used to vertically lengthen the entire jawline.
The only reason I ever do these types of facial osteotomies is when the patient wants to do a ‘natural’ operation as opposed to the use of custom facial implants for a very specific type of facial dimensional change as outlined above.
Dr. Barry Eppley
Q: Dr. Eppley, I was wondering if you did the ‘chin wing osteotomy’ surgery which is different from a genioplasty where they move the jaw forward ? I saw your response to someone else asking the same question on Real Self and you said you’ve done it before and I was interested. Not a genioplasty or a chin implant which I can get done where I live. I’m not sure if there’s other names for it but that’s what it’s called on other surgeons websites who do it. I’m assuming it’s called a chin wing osteotomy.
A: I am very familiar with the chin wing osteotomy, having performed it numerous times. Quite frankly I think it is not a very good procedure for the problem that it is designed to treat. It is technically difficult to perform and is prone to a high rate of complications. Iy requires a long bony cut back from the chin to the jaw angles underneath the mental nerve foramen and the path of the inferior alveolar bone as it courses through the bone.
It is really an historic procedure for which there are more effective procedures today. It is far easier, has less complications and a better result is obtained using a custom made jawline implant when attempting to obtained total vertical jawline augmentation.
Dr. Barry Eppley