Your Questions
Your Questions
Q: Dr. Eppley, I read your case studies on custom jawline implants and wonders if the same could be performed to avoid jaw realignment surgery? Because the studies featured all men wanting masculine jaws what about Asian women who desires a V-shaped jaw? I had a sliding genioplasty and braces five years ago but I still needs to protract my jaw forward.When I protract my jaw I’m satisfied with my looks but I have a cross bite. If I revert to the proper bite the braces gave me then I look almost jawless/chinless. All surgeons I approached told me I have to go back to braces for several years and redo the jaw alignment. I also have a cobblestone chin appearance which I suspect to be caused by the scar tissue from the sliding genioplasty.
A: While many custom jawline implants are doing in men, there are some women that get them. And they usually do get them to create more of a v-line jawline effect. Please send me some pictures of your jaw at rest and then the look you are trying to achieve with your jaw protracted. I have not doubt that a custom jawline implant can achieve that look from the voluntary jaw protrusion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read about your custom jawline implants (wrap-around style) on exploreplasticsurgery.com and was wondering if these implants can increase the width of the jaw angle as well as the vertical height or is it just the vertical height that these can change? I’m also trying to establish the drawbacks (apart from cost) of these wrap around implants over the separate jaw/chin implants.
A: Custom jawline implants can be made to any dimension that is aesthetically desired in either height, width or shape. The actual cost difference between a custom implant and standard implants is much less than one would think, with only about a 20% cost difference at best. While the cost of the custom implant is higher, it takes only 1/2 of the operative time to do…thus explaining why the cost difference is not that extreme. Having done hundreds of combination chin and jaw angle implants, I now find that single custom jawline implant produces a better aesthetic result with a very low risk of malposition/asymmetry compared to using three separate pieces. (1 chin and 2 jaw angles) In fact, it is virtually impossible to have a malposition of a custom implant because of the precision fit and design.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have recently had a medium Terino style 1 chin implant and medium lateral jaw angle implants, with another surgeon. I wasn’t happy, and I had the jaw implants removed a week later. For some reason the 2 implants didn’t seem to go together, the jaw implants made my chin look like it was recessed again, and the sides of my jowls looked very narrow, even though they improved the back of my jaw. I now wonder if it was the chin implant I should have removed and replaced instead. I wonder if it was the combination of sizing that was the problem, I want to have a strong jaw that flows all the way to the back. I have a thin face and the sides of my chin, near the corners of my mouth, still look very narrow. What could be done to solve this problem? Thanks
A: Standard chin and jaw angle implants rarely overlap and, even if they do, will rarely ever make for a straight jawline from chin to jaw angle. That is beyond what they capable of doing. When a patient agrees to have off the shelf stock implants they should know that is the look they can not achieve. Only a custom-designed one-piece jawline implant will provide a straightline effect from front to back because it is made to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had orthognathic surgery to improve my bite and make my jaw more symmetrical. Even though my bite is better, I now realize that my jaw is too small and narrow. I have been researching to find an implant which is able to make my jaw both longer and wider from the chin all the way back to the angles, but can’t find any. Are there any off-the-shelf implants that can achieve my goal of back to a substantial and robust jawline? Can Medpor or silicone implants be custom made? I am more favourable towards Medpor because of its ability to form on to the bone and become incorporated in it, rather than silicone or any other materials. I really hope you will be able to help me with this jaw problem.
A: It is hard for me to know how much change you really need based on your description alone. But in cases that I have worked in the past who have had similar concerns they almost always have needed custom rather than stock or off-the-shelf implants. Custom made jawline implants off of a 3-D model which can be designed and manufactured in virtually any dimension so their versatility makes them always the most ideal choice for total jawline enhancement. They can only be made in silicone, custom made implants from Medpor is not an option because it is not offered by the manufacturer and they would be virtually impossible to place anyway. It is also a misconception that bone grows in Medpor which it does not really do. Rather fibrous or scar tissue is what grows into the material…which is why they can be very hard to remove later.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have some questions about jawline implants. I work in extreme environments overseas and, in addition, my group trains in hand-to-hand combat as well as boxes. Would I be able to take blunt force to the implants as well as I can without any implants?
A: Obviously you are in the military. That is a good question and, quite frankly, is pertinent to any procedure that you would have done on the chin or jawline that involved any form of an implant. I have had patients who have had chin implants before that boxed afterwards and did not have a problem. I have also had other males in the military who have had chin and jaw angle implants. But I can’t say that I have had a similar situation with full jawline implants. I suspect it would not be a problem but I have not yet run across this situation yet. In other words, if the entire jawline was an implant (two-piece that it would be) could it sustain blunt force to it without causing a problem of displacement? I suspect that they would be fine since I always screw facial implants to the underlying bone. If the force is enough to fracture the lower jaw that is another issue but then surgery is going to be needed anyway. It is also possible in this scenario that the implants may have a protective force, like a bumper, and prevent the bone fracture from occurring. That is a conjecture, of course, but not an unreasonable one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have a much better jawline that I currently have. I have attached a picture which shows the perfect jawline for me as well as a picture of myself. What is the best way for me to get this result?
A: To no surprise, every male who wants a better jawline and chin will show me some male model/actor picture as you have done. That is an ideal male jawline for sure. The only way to get that result are custom jawline implants made off of a 3-D model of the patient’s lower jaw. The ideal jawline look requires a square chin, some prominent jaw angles with flare and the key…a smooth jawline and connection between the chin and the jaw angle area. That can only be achieved by a two-piece implant that is custom made from the jaw angles on each side to the chin and then meets in the middle of the chin where the two halfs are connected.. Short of the custom approach, the only other alternative is a large chin implant/osteotomy and jaw angle implants but they will not have a smooth jawline connection between the two.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in getting chin and jaw angle implants. I would like the chin implant to be lengthened (to the most extent) and squared (to the most extent) being in the category of the latest style available on the market. The jawline height should be lengthened and widened to its proportionate maximum possibly by having a “wrap around” implant and/or separated combination of implants. Do the latest style chin implants stating the above written factors of width and length fit the “wrap around” implant or separate implants more accordantly? Thank You.
A: In answer to your questions about chin and jaw angle implants, here is the following dimensions:
Square Chin implant (Style 2 Terino), Implantech = 6.5mm anterior projection in the middle, 10mm projection on the square portion (transition corner) of the implant, 9cms long (4.5 cms back from the middle on each side)
or
RZ Extended Square Chin, Medpor = 7mm in anterior projection, 11mm projection on the square portion of the implant. Because of the central connector, the implant can be expanded and made more square which also allows for the creation of central cleft
RZ Mandibular Angle Implants, Medpor = 11mm width expansion, 10 mm vertical elongation
These three implants must be put together to create a ‘wraparound effect’ but there will be a depression between the two along the jawline because their edges are feathered where they come together. They were never made to be used to create a completely smooth wrap around jawline effect. What you may really be searching for is a custom one piece wrap-around jawline implant that can be made to almost any shape and dimension.
Dr. Barry Eppley
Indianapolis Indiana