Q: Dr. Eppley, I am very happy with the buccal fat removal and perioral liposuction you did on me a few years ago. I still feel that my face lacks definition though and have been researching lower jaw surgery/sliding genioplasty and vertical lengthening chin implants and wondering if one of those procedures would be beneficial for me to get that angular, taut lower and mid facial structure that a lot of models have. A jaw/chin that has extra projection seems to produce a concavity in the para nasal area that think is really pretty…I know I have an overbite but it’s not severe and I am hoping to avoid having to go through orthodontics and jaw advancement IF a sliding genioplasty and/or a custom chin implant would yield the same results. I have attached some photos of the look I am aiming for (as well as one of myself for reference) and would like to know if you think I could get close to my “ideal” with a genioplasty/implant or if lower jaw advancement is really the best treatment (for aesthetic purposes only). I always feel myself involuntarily jutting my lower jaw forward (it feels more comfortable that way and it also makes my face look better). My face just looks better from ALL angles when I’m projecting my jaw forward. Since I’m already 31 I would like to get started right away, especially if the best choice is jaw advancement since I would have to have braces before and after that.
A: To best answer your question about chin lengthening, I have done imaging based on some old pictures that I have of you of a combination chin lengthening and small jaw angle implants for the more complete jawline effect. You definitely do not need to move the whole lower jaw with orthodontics. That would not produce the same result. The choice is really between a sliding genioplasty vs a custom V-shaped chin implant. Both theoretically could achieve the same longer chin, they are just two different ways to get there. You already have a pretty V-shaped chin and you are young so I am leaning towards the sliding genioplasty because it is more ‘natural’ and would even accentuate the V-shape of your chin. I simply put in the small jaw angles just to give you a little more width and squareness to the back of the jaw…which is what all those models also have.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a custom chin implant but have some questions about it. I’d like to add significant height and projection to my chin (while avoiding a deep labiomental fold). I’d also like to add some slight width to the jaw while maintaining my well-defined cheekbones. To what extent could a custom chin implant achieve this desired look?
A: A custom chin implant (really a modified jawline implant) is the most effective method for creating the chin projection and slight jawline width that you seek. It is best because one controls the dimensions of the implant in the pre surgical design and allows a smooth jawline to be created from the chin on back to the jaw angles. This is not an effect that any off-the-shelf chin implant design can do.
You will not, however, avoid deepening the labiomental fold (technically the labiomental sulcus) with a custom chin implant. The depth of the fold is a fixed point so any substantial increase in the horizontal projection of the chin, and yours would be considered substantial, will deepen the fold. This can not be avoided short of leaving your chin where it is.
Dr. Barry Eppley
Q: Dr. Eppley, Two years ago I wanted a change and I got a Terino Square Chin implant. While I do think it made my chin look better, I would never wear my face without a full beard now. The implant is huge and I believe it did not address the vertical increase that I needed. The groove under my bottom lip looks way to big to be normal. I have also attached a current photo of myself with the full beard. I believe there were some irregularities under the implant with my chin that have now been pronounced since the implant was not custom.What should I do now? I feel that the sliding genioplasty with an implant) may have been my best option from the start but the recovery time is extremely long. My recovery time from this implant was over 10 days. I do not feel hideous or anything so this is not urgent but I really would like to understand if what I am looking for is even possible.
A: Given what you had hoped to achieve and looking at where you are now, the only option to consider is a custom chin or custom jawline implant. Compared to many patients who have gotten square chin implants your results would not be considered remotely huge or disproportionate. But that is clearly how you feel and that is all that matters. You desired results show a lower and more square chin but the width of the squareness is fairly normal and not at all what the Terino square chin implant can achieve. Only a custom chin implant can make that type of non-standard chin augmentation change. You have also shown on your ideal result some jaw angle changes as well. How important that is to you will determine whether you should have a custom chin implant or a custom total jawline implant.
Dr. Barry Eppley
Q: Dr. Eppley, I found your work through the custom implants work on your site and I’m interested in getting a chin implant, but with a twist…
See, I’ve become aware of new research about the “estrogenic activity” of silicon-based implants. I was wondering, in your expertise, would it be possible to create a chin implant out of stainless steel or titanium instead of silicon or plastics-based materials (and have it be a successful operation)?
I realize this requires a complex answer, but feel free to keep your reply brief 🙂
A: I would be remiss if I did not mention that there are significant chemical differences between standard plastic materials (PVCs) and silicone which is a pure element. (#14 on the Periodic Table) There are no reports of any adverse effects on the body with silicone as evidenced by the extensive 15 year FDA study of silicone breast implants. (which is a gel and not even a solid)
A custom chin implant can be made of titanium although it would be very expensive to do so. (probably around $12,000 to make it) It would also be necessary to make it as a two-piece implant so it could be inserted through a reasonably small incision and ‘assembled’ once in place.
Dr. Barry Eppley
Q: Dr. Eppley, I’m not able to find any image for a “custom made vertical” chin implant. I’m trying to figure out what a vertical chin implant might look like,where it will sit on the chin bone or where the screws will be fixed.
1. Please can you show an image for a custom made vertical chin implant and where it will sit on the chin bone. Hopefully this type of implant will be able to augment 4 millimeters vertically.I read that extended anatomical gives a more natural fit?)
2. If a patient already has a CT scan (including DICOM) of their current jaw/chin bone in order to design a custom made implant; how many weeks will they have to be in Indianapolis to have the jaw angle/chin implants made plus have the surgery done and be safe before they fly out of indiana back to their country? (4wks,6wks?)
(Just in case the implants may result in any infection, how many weeks should one really stay in Indianapolis and wait until it’s safe to know everything is OK before leaving Indiana/the US? Thank you
A: A custom chin implant can be made any way one wants or needs it to be shaped. It can provide the required vertical increase (4mms in your case) and has a lip or edge that goes up over the lower end of the chin bone so it can be secured into place by screw fixation. No standard or preformed chin implant today (other than my small vertical lengthening chin implant can create this type of chin change)
If one has an existing 3D CT scan that reflects the current jaw shape, it can certainly be used. The CT scan is simply sent to me and the implant design is done from here. There is no need for the patient to be here to have it done. The patient only comes in for the surgery and can return home in a few days. There is no need to stay here any longer. And staying here any longer has notbenefit from an infection standpoint. The infection risk is so low (less than 1%) with facial implants and its occurrence could be weeks or months later if it does occur.
Dr. Barry Eppley
Q: Dr. Eppley, I am wondering if I am a candidate for custom chin implant as I want both vertical and lateral projection (as opposed to simply lateral with most implants) Also if I decided to go ahead with a large chin implant would jaw angle implants be needed to add balance?
A: There is now available a type of chin implant that produces a combined vertical and horizontal lengthening to the chin so a custom chin implant may not absolutely be needed. This is a new type of chin implant that provides a vertical length increase to the chin that has never before been part of any chin implant. What size of vertical lengthening chin implant you would need depends on how much of a chin change you were looking for. The largest vertical lengthening chin implant creates a 7mm horizontal advancement with a 7mm vertical lengthening effect, creating a 45 degree angulation to the chin.
If you lengthen the chin to any degree, I would suspect that jaw angle implants would be needed to balance out the new jaw length. That could be confirmed by computer imaging.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested to know what can be done for my very short chin. I don’t know if I just need an implant or whether the jaw bone has to be moved. If you can answer a few questions for me I would appreciate it very much. 1) What is the biggest chin implant in terms of maximal horizontal projection? 2) How much can a sliding genioplasty move the chin forward? 3) Can sliding genioplasty be combined with an implant? 4) Can the entire lower jaw be moved without changing my bite? 5) How do you correct chin deficiencies larger than 10 mm? 6) How do you correct vertical deficiencies? 7) Does the implant feel natural and is there any risk of shifting after surgery?
A: The person with a very short chin poses challenges that often neither a standard chin implant or a sliding genioplasty can ideally solve. In answer to your questions:
1) The maximum horizontal projection for most chin implants is 12 mms.
2) How much a sliding genioplasty can advance the chin depends on the thickness of the mandibular symphyseal bone. That could translate into a 10 to 12mm chin point forward movement.
3) Yes. An implant can be overlaid in front of a sliding genioplasty to gain more horizontal projection or width.
4) No. The mandibular body and ramus can not be changed without carrying the attached teeth with it also, thus changing the occlusal relationship to the upper teeth. By definition, jaw advancement surgery changes the bite.
5) Options include a custom designed chin implant or a sliding genioplasty with an implant placed in front of it.
6) Vertical chin deficiences require a custom implant and are a component of every horizontal chin deficiency greater than 10mms. When the chin is that short it indicates there is an overall jaw shortness.
7) The implant will feel like bone and is screwed into place to prevent the postoperative risk of shifting.
Dr. Barry Eppley
Q: Dr. Eppley, hello, I am 37 yrs old and I have a 100% overbite with a deep labiomental fold. I want to have that fixed and get a better jawline and chin and don’t know what procedure would work for me.
A: In looking at your pictures, I can see the external symptoms of the 100% overbite to which you have described. The jaw is overrotated upward causing a vertically short chin (albeit with a touch too much horizontal projection) and a deep labiomental fold. Thi is what happens when there is not an adequate occlusal stop on jaw closure. (overbite should usually be about 10 to 20%)
Correction can be done by one two approaches. One option is a vertically lengthening chin osteotomy with an interpositional hydroxyapatite block graft. This would need to be at least 1 cm (10mm) of vertical lengthening if not more. This would create more of a prominent chin and would help lessen the visible depth of the labiomental fold as it stretches down the chin tissues downward. I have attached some computer imaging of that potential result. The other option is a custom chin implant that would vertically lengthen the chin as well as back along the jawline. In either case, a labiomental implant could also be used to shallow the depth of the fold although this may not be needed with the chin osteotomy as the fold naturally becomes a little less deep as the soft tissues are moved downward with the bony movement.
Dr. Barry Eppley
Q: Dr. Eppley, I was thinking if I would be a good candidate for a custom implant? I had a chin implant done two years ago but had it removed six months later because it did not look and appeared unnatural and asymmetric. This time, I want the implant to address the asymmetry of my chin and also add length and width to my jawline while also lengthening my chin. I have attached pictures to try and show you what I’m looking at getting resolved. Also, are custom implants significantly more costly? My left side of the chin is about 3-4 mm shorter than my right side. Also when I feel where my chin transitions to my jawline, there is more of a “dip” in the bone on my left side. I would like a more smoother jawline transitioning to my chin and a more prominent jawline on both sides as well. I have outlined the area of jawline I am referring to and that I would like it both extended horizontally and vertically. I have attached the picture of my previous implant to show the increase in asymmetry that the implant caused. I think the asymmetry caused the implant to not fit snug and was also the reason why I was able to move the implant from side to side even months after. And finally I have re-attached the ideal chin and jawline. I think what i’m looking to fix would give me the desired look.
A: Based on your pictures and your good illustrations, the only way you would get that chin result is with a custom chin implant. There is no off-the-shelf chin implant that would have those exact dimensions and shape. Why your first chin implant resulted in that undesired look is not known to me because I don’t know what style and size of chin implant it was. It may have been inappropriate for your chin based on a variety of factor6s including style, size and technical placement of the implant.
That being said, there are three ways to go about getting a ‘custom chin implant’. They are different because of how they are done and their cost.
#1.The least expensive way, because it costs no more than a standard implant, is to select a certain chin implant style and size and custom carve it either before and during surgery based on the illustrations you have shown. The limitation is that it is an approximation of the underlying chin anatomy.
#2 The second way is to get a 3-D CT scan and have an exact mandibular model made. From that model, I can then take an off the-shelf implant and then carve it to shape by placing it on the model. This is better than #1 because we would know the exact chin anatomy. The limiting factor is how close existing chin implants are to your needs. Besides the cost of a 3-D CT scan of your mandible (which your insurance will likely cover) is the cost of having the model made. ($ 1100)
#3 The most ideal way to get a custom chin implant is to take the mandibular model and I will then hand-care out a completely custom implant which will then be sent out for formal implant manufacture. The total additional cost of this approach is $3500
As you can see there are multiple ways to get a custom chin implant. But when it comes to having a chin implant that blends smoothly back along the jawline, a true custom chin implant is the only way to get that result in most cases.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 56 year-old man who has always had a weak chin. While I have always wanted to do something about it, I could just never get the nerve to go in and see a plastic surgeon. My girlfriend has given me the encouragement to now do and I am going to make the move to see what is possible. Could you give me some direction in what you think I need? I think the problem is more than just a short chin, my overall jaw just seems smaller. I don’t want to get a chin implant placed on the end of my jaw if it does not look right or natural. I have attached some photos of me from the front and side for your evaluation.
A: Having a weaker jaw/chin in an older male always raises questions about both bone and soft tissue management since there is some degree of sagging of the jowls and neck. While you would undoubtably be helped along the jawline with a facelift (neck-jowl lift), I am going to pass over that issue for now as dealing with the bony deficiency should always been done first. Since a lower facelift affects the posterior jawline and neck angle the most, it would have its greatest effect on the jaw angle area. Whether you would benefit by jaw angle augmentation or a total jawline procedure is unclear to me at present. (and also unlikely) Therefore for this discussion I am only going to focus on your chin deficiency and submental fullness which are your biggest facial imbalance issues.
What you need is a chin implant and neck liposuction/submentoplasty. The question is whether a preformed or off-the shelf chin implant will work or whether a custom implant is preferred. Both will make positive changes. It is just a matter of degree and how substantial that change is. You do have both horizontal, vertical, and transverse (width) chin deficiency which is common when the chin is very weak. The problem, as you have accurately pointed out, is really an overall jaw growth issue not just a simple short chin. This makes the entire lower face short in every dimension.
I have done some predictive imaging based on both off-the-shelf and custom implant approaches so you can get a feel for how the two type of chin implants differ. A custom chin implant will address all dimensional deficiences. and produce a more profound change..if one finds that look appealing.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a chin implant revision. I had a chin implant about six months ago and the doctor said it would look just like I wanted. Well it hasn’t and he appears to have chosen the wrong implant. What I wanted was a much wider and more square chin look and it doesn’t look that way at all. I have done some imaging on my picture to show you what chin look I am after. What is the best type of chin implant to achieve my desired look?
A: The imaged change that you desire in the width of your chin can not be made by almost any off-the-shelf preformed chin implant. Even square chin implants do not add that much width. If you look carefully, the widest part of the chin goes past a vertical line dropped down from the corners of the mouth. That is beyond the widths of most existing chin implants.
There is however a way to do it with one and only one preformed implant, the Medpor RZ extended square chin implant. It is possible to exceed its natural width because of its central connector. It is actually inserted in two separate pieces and then attached once in place. You can increase the width of the chin by a full centimeter by not snapping it together but by leaving the two pieces spaced apart and made ‘one-piece’ by only the thin bridge of the connector.
The other option is to make a one-piece design out of silicone that contains all the desired dimensions and is placed as a single piece implant. (aka custom chin implant)
Dr. Barry Eppley
Q: Dr. Eppley, one year ago I underwent surgery for a medium chin implant and neck liposuction. Though I was initially pleased with the result due to the way the swelling made my chin look, after the swelling had subsided I was very disappointed with the outcome. I feel that my chin and jaw line are vertically short and that my chin is still a little bit horizontally short. Additionally, my jaw line lacks solidity and I think that my chin could stand to be a little wider/fuller. I have attached two photos of what my face currently looks like.
I would like to add roughly a 1/2 inch to my chin/jaw line vertically, as well as 3-5 mm horizontally (from where the current implant ends). I would like my jaw to angle down to my chin, so that the chin is lower than the rest of the jaw. As I previously mentioned, I would also like my chin to be a little bit wider and to add solidity to my jaw line as it gains fat easily.
In order to obtain the results that I desire and keep them long-term, what would be the best procedure for me? The three that I have been looking at are a sliding genioplasty, a geniomandibular implant with Gore-Tex strips or a custom jaw implant. Money is a little bit tight for me, so I’m hoping to avoid the custom jaw implant.
I appreciate your help and eagerly await your response,
A: I have taken a careful look at your photos and your desired aesthetic chin changes. While a custom implant is one method to achieve those changes, it is not the only way as you have pointed out and the cost of it eliminates it from consideration by your own admission.
Between a chin osteotomy and geniomandibular implants, each has its own advantages and disadvantages. A chin osteotomy (keeping the chin implant in front of it) would easily create 10mms of vertical lengthening, about 5mms of additional horizontal advancement and could be sectioned to create 5mms of horizontal expansion as well. It is done from the inside of the mouth and would actually be my preference in your case even over a custom chin implant. Geniomandibular groove implants could also provide up to 10mms of vertical lengthening and 5 to 7mms of horizontal widening as the implants can be placed with separation between the two sides. The problem with these implants is that you would only get about 2 to 3mms of additional horizontal advancement and your existing chin implant would have to be placed on top and in front of it to keep and enhance the horizontal projection that you already have. That is not a big problem, just that you have two implants stacked together. This procedure would need to be done from a submental skin incision from below the chin with a resultant scar.
Dr. Barry Eppley
Q: Dr. Eppley, I had a chin implant done approximately 10 years ago. I have only mildly been satisfied with the results. I believe the implant was put too far down on my chin bone to lengthen it vertically. Shortly after surgery, the implant slipped off on one side making my chin appear uneven. But it is from the profile view that I dislike my chin the most. My chin and neck are not separated by much horizontal distance. I think I may be a candidate for the vertical lengthening jaw implant that is done with the CT scan. My question is..is there a way to do a consult visit without me physically coming to Indiana? Or is an office visit required to make a determination if I am a candidate for this procedure?
A: When considering lengthening the anterior lower face vertically, the decision is between a chin osteotomy or a custom chin implant. For the sake of this answer, I will assume that the implant choice is the better option for you. Since there are no off-the-shelf chin implants that have any significant vertical component to it, a custom implant will need to be fabricated. This is a process that requires the following steps. First, a 3-D CT scan must be obtained. This can be gotten at most CT scanning facilities in your geographic location. That scan is then sent to a model manufacturer which creates an actual mandibular (jaw) model that is an exact replica of your own lower jaw. I then take this model and hand-carve a chin implant out of a special clay material that matches your exact aesthetic needs. That custom chin implant is then sent to a manufacturer who makes and sterilizes a silicone implant from the clay mock-up. All of this can be done without you ever leaving your home. Your candidacy for any custom facial implant is determined from afar by phone, photographic and Skype video consultations. One only has to appear for the actual surgery.
Dr. Barry Eppley