Your Questions
Your Questions
Q: Dr. Eppley, I had a custom jawline implant placed three months ago and I think it is a fine result. However, I would like to make just a few changes to the size and shape of the chin implant portion. Can this be done? Is it a complicated surgery? Recovery time? Can these modifications be made to the original implants or do you believe we need to design a new chin/jaw implant? Thank you and I appreciate all your help.
A: Even with perfect placement and an uncomplicated surgery and recovery, I find that it is not rare that patient’s want to change slightly or modify their custom jawline implant. The good news is that this is a very simple surgery and so much easier than the first time. With an established pocket it is very easy to remove and replace it with very little swelling and no pain. If the initial recovery was a 10, this one will be a 1 or 2. The key question is how to change the implant. It is choice between using the existing one and simply carving it down in the selected areas or making a new one with the new dimensions. Each way has its own advantages and disadvantages being hand carving down the existing one eliminates any new implant cost but requires a good artistic eye to do the changes and keep it smooth. A new implant absolutely ensures smoothness and the exact changes in the right location but incurs the cost of the implant. The difference in the two options is that of the implant cost only.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a custom jawline implant (done by Implantech) placed last year, but there are some areas that haven’t been addressed adequately. Assuming that the design file is still available, can I just check if it would be possible to modify the previous implant design? Also, would it end up costing as much as getting a brand new custom implant made, or will the cost of modification be lower?
Additionally, I’m looking to get my philtrum augmented. Would any existing implant work (Peri-pyriform?), or should I consider fat grafting?
A: This is not the first time I have had a patient inquiry about changing a custom jawline implant to a new or tweaked design. I can assure you that your original design file is still available and the previous jawline implant design can be modified. There is some reduction in a new implant design cost fee which is about 15% from the original pricing. (as per the manufacturer) The other good news is that replacing an existing jawline implant with a new one is substantially easier than the first time with a very quick recovery.
I believe when you refer to philtral augmentation, you mean paranasal/upper lip augmentation. That is what is illustrated in the link you have provided. True philtral augmentation is philtral column augmentation done by placing cartilage grafts or small implants in the philtral columns of the upper lip right under the skin to give enhanced ridge lines. There are advantages and disadvantages to either injected fat or placing implants along the nasal base. (paranasal-premaxillary region) In general, implants are going to give a more assured and permanent augmentation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am debating on a sliding genioplasty vs silicone implant for chin augmentation.. I know that up to 10mms in vertical length can be achieved by a genioplasty, as well as width changes through hydroxyapatite blocks. I would like to get your personal opinion on this. For a male, what would be a normal range of chin length from lowest part of the bottom lip to the end of the chin? What length would the chin need to be for a male in order to warrant a lengthening genioplasty or to declare it unnecessary? I want to add as much size to my face as possible, length and width wise.
A: For chin augmentation, both a sliding genioplasty and an implant can be used to create vertical length for a more profound or dominant chin. However, there is no standard or normal range for how vertically long one’s chin should be. It is more of a ratio to the other vertical facial thirds and how dominant one prefers their lower third of the face. As a general rule in my experience, few patients need the vertical length of the chin increased by as much as 10mm. That would be too long for even many men, particularly when other dimensions of the chin are being added as well.
While a sliding genioplasty is traditionally perceived as being the only method to vertically lengthen the chin, custom designed implants can also be used today. However they may not do it equally well. Because of the limits of the bone cuts of a sliding genioplasty, significant vertical lengthening may look ‘unusual‘ as only the chin of the jawline drops down. In contrast, custom designed implant can vertically lengthen a larger portion or the entire jawline for a more natural blending of the vertical lengthening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jawline implant. As I understand the process of design off of a 3D CT scan, one “see” the skeletal changes butI am having difficulty envisioning the appearance of my jawline outside “with skin on it”. I am very serious about having this procedure done and want definite improvements to both my jawline and my chin/profile, but I also want a final result that looks natural and keeps all my facial features in good perspective with one another. Is there a way for me to “see” the proposed changes from an exterior view? For example, can I take photographs of my face so predictions could be made from them with the designed implant in place?
A: There are several facets of the custom jawline implant process that is important ofr anyone to understand that wants to have the procedure done. While computer imaging can do a great job of making the implant design to perfectly match the bone, the translation of what the bone changes would be to how it looks on the outside is not currently possible. That is because the translation of bone augmentation to an exterior soft tissue facial change is not accurately known. It is assumed that it is a 1:1 relationship and that is probably more true than not. There is also the issue that there is no radiographic method to capture your soft tissue, overlay it on the bone, and then change it based on the underlying bone changes. This would obviously be tremendously beneficial but that technology has not yet make it to this application in any cost efficient manner as of yet. Thus radiographic assessment and implant design processes are still very bone-based.
What all of this means is that I have to design the dimensions of such a jawline implant based on a non-scientific artistic manner. While that sounds very dubious and obscure, it is not. I have a lot of experience designing these custom implants and have a very good feel for whether it will actually fit (having enough soft tissue to cover it) and how it will look on the outside when placed. That is precisely the role that our prior computer soft tissue imaging played before I designed the implant. I was trying to get a feel for the type of jawline changes you were looking for and what you could tolerate. Having done this a large number it times there are some general rules that I following in a wrap around jawline implant design. One of the very first thing one learns in doing these is that it is very easy to make them too big. While you can design anything on the computer you have to take into account the thickness of the overlying soft tissue as that will add to the volume as well. It is always better to slightly ‘undersize’ it as oversizing will always lead to revisional surgery.
The concept of what a ‘natural’ jawline result is can be a very individual one. But again that is the role of the initial computer imaging. That helps me determine how extreme a change any patients wants. And you are correct, you don’t want a jawline change that overwhelms or is out of proportion to the rest of one’s facial features.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 22 year old man who is interested in custom facial implants. I have taken an interest in your practice because of your really detailed and informative website and photos and because of the experience you have with the particular facial implants I want done. I am interested in getting cheek and wraparound jawline/chin implants. I want the cheeks implants because my cheeks are quite small and I would like to have implants put in to make them larger and have a more sculpted face. As for my jawline and chin, it is quite small and narrow and I would like a wraparound jawline implant to give me a stronger wider jawline, a sharper jaw angle in the back, and a larger chin that are seamlessly connected together. I know this will require a custom implant approach to get the best implant symmetry and shape, provide a faster operating time, and provide me with a better chance of obtaining the results I am looking for. I want to know if these two surgeries could be done at the same time? I am really looking for a more masculine sculpted jawline and chin and cheekbones that provide a youthful face as well. I am really interested in you performing the surgery since so far you seem to be the only surgeon I have searched online who has a blog devoted to helping answer clients questions and you have an extremely thorough website.
A: You are correct in assuming that a custom facial implants is the best way to go when one seeks a wrap around jawline implant that is seamless from front to back. While off-the-shelf cheek implants could probably be used, one might as well make the cheek implants custom as well since that would add little cost as the 3D CT scan and software design process is already in place. It would be very common to do cheek, chin and jawline implants together to achieve a comprehensive overall facial enhancement result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in custom facial implant (jawline) revision. One month ago, I had a custom wrap around jawline implant placed which is way too big and disproportionate to the rest of my face. I think that it should be removed or at least reduced in size as soon as possible. Is this possible at just one month after surgery?
A: Let me first provide you with some comments about a custom jawline implant that come from a more objective perspective. I have done many standard and custom implants for young men and there is almost always a fairly standard pattern of postoperative behavior and anxiety in the early postoperative period….many think the implants are too big/asymmetric/not right and want it immediately downsized/revised or even removed. Sometimes this is true but most of the time it is because the patient has does not have an objective perspective and is finding it difficult to go through adjusting to their new look…even if it was exactly what they said that wanted. This is a phenomenon that I call Facial Structural Accommodation. I would urge you to be more patient with your result, not because a great amount of swelling resolution is going to make it smaller, but because you need time to let the result soak in. Oe month is simply not long enough to really know. Doing something now may be very capricious and a decision you may come to regret later. While I obviously don’t know what you looked like before or after this surgery, most men that I have seen in similar situations rarely have an after surgery result that would be objectively viewed as way too big.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jawline implant. Roughly what is the cost of a Custom Jawline Implant and the procedure if I want a very large implant enclosing the entire chin and jawline and angles, adding quite a lot around the angles, increasing chin projection up to 25mms?
A: A custom jawline implant is fabricated from a patient’s 3D scan. From this a completely customized implant is made from one jaw angle to the other. While any dimensions can be made on the model using design software (up to 25mms at the chin), there has to be enough soft tissue along the jawline so that the implant will actually fit into place. Realistically, having placed many custom wrap around jawline implants, a chin enlargement of 25mm horizontal advancement is likely more than the neck soft issues (which is where the skin must come from) can accommodate. This is too much soft tissue stretch when you factor in that the implant wraps the whole way around the jaw. A more reasonable approach is around 15mms or so of horizontal chin advancement. You must also factor in the lower lip position and the depth of the labiomental sulcus which will be severely left behind when the chin comes that far forward. The total cost of such an implant, all costs including fabrication and surgical placement, is in the range of $12,000 to $ 13,000.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, 1. Am interested in an overall approach to address my weak jawline/chin and nasolabial folds. I had a smaller chin implant over 20 years ago, but I am certain that advances since that time could provide me with a better overall result.
A: I have received your pictures and done some initial imaging predictions. Knowing that you have a chin implant in place with your high jaw angles indicates how short your lower jaw really is. Substantial improvement can come by changing all dimensions of the jawline, not just the horizontal position of the chin. There are two fundamental approaches. A sliding genioplasty combined with an extended chin-jawline implant overlay with vertical lengthening jaw angle implants is one option. The second choice would be a custom total wrap around jawline implant made from a computer-generated design off of a 3D CT scan. There are advantage and disadvantages with either method. Either approach takes it way beyond what the simplistic approach of ‘chin augmentation’ would achieve by looking at a complete jawline enhancement. As you know, your lower jaw issue is not just a simple isolated chin deficiency.
Dr. Barry Eppley
Indianapolis, Indiana