Q: Dr. Eppley, I am interested in jaw angle implants and cheek implants. I’m 31 years old and I’ve always felt my cheeks and jawline have been a bit “soft” and chubby despite me being rather skinny, so I was hoping you could give me your opinion. I’ve attached a couple images to the post but I’ve also uploaded a file here which includes multiple angles of my face: I wanted to discuss whether surgery might be appropriate on the following areas, given I’m not at all overweight and I don’t think I could address them via weight loss:
1) You can see there is some fat under my chin towards the back of my neck in the first picture when the camera is tilted upwards (I’m 6’1″ tall so it’s fairly visible in everyday life).
2) You can see from the side views that my jawline is quite “soft” and not well defined in general, particularly towards the back.
3) What I assume is the jowl area (labelled in red on one of the images) also seems quite “chubby” and both hangs down below my jawline and makes my lower face wider and less defined than it would otherwise be. There’s also a pre-jowl “hole” in my jawline in the 3/4 view that may or may not be connected with this.
4) My cheek area as a whole just seems quite flat and undefined when seen from the front. There doesn’t seem to be much shape there, it’s kinda just a large empty space.
I’ve had a chin implant in the past (Implantech Anatomical Chin sized large) and I’m generally content with the new position of my chin, but I was told I had an underdeveloped jaw and I assume that is contributing to these issues. However, as the surgery to fix that issue is such a major undertaking I was hoping it would be possible to address these issues via other methods.
I’m curious as to whether these issues are caused by excess fat or by skeletal deficiency? Would liposuction be a good idea? Are cheek implants a possibility to give my cheeks a bit more structure?
I had cheek implants placed roughly 18 months ago, but I had them removed again 6 months ago as I felt they made my face too wide (and a little feminine), particularly when I was smiling. However, we never really discussed the different areas of the cheek that could be enhanced via an implant before the surgery, so I’m unsure if I was unsuitable for implants in general or if the type of implant was simply poorly chosen.
Thanks for your time and apologies for the long email!
A: Thank you for your inquiry and sending your pictures. For our jawline, I think the fundamental problem is that of skeletal deficiency. By your own admission you had a naturally shorter and underdeveloped jawline that ideally should be treated by orthognathic surgery. But, understandably, you do not want to purse that amount of effort. The chin implant has now provided adequate anterior jawline projection but the rest of the jawline behind it remains deficient and actually now has become more apparent with the chin being corrected. Your jaw angles are high and deficient. This creates a relative soft tissue excess/looseness. While liposuction can be done around the jaw angles and along the jawline, it is not really going to reshape these areas. This is an issue of volume deficiency particularly at the jaw angles. Either preformed or custom jaw angle implants are what you really need to complete the total jawline augmentation effect.
Since you have had cheek implants that were not successful, any reconsideration of them should be done more thoughtfully. I would need to see before and after pictures of your initial cheek implant results and to know exactly what style and size of cheek implants that were used. It is certainly true that a cheek implant is not just a cheek implant. There are different styles of cheek implants and, in my experience, most of the available cheek implant styles are not really made for men. (just like most chin implants do not really work well for most women)
Dr. Barry Eppley
Q: Dr. Eppley, I feel my face is a little weak down around my jawline area. Iwas hoping to have a more masculine jaw with out elongating my face any more… just maybe make it more full. Also as you can see on my photographs, my face is very asymmetrical. My right temple seems sunken in so was researching your page and saw you have a temporal implant, was wondering if I good candidate for the procedure. And last but not least, my nose is also very asymmetrical. If I feel above the nostril I can feel more cartilage on the left side of the nose and my right doesn’t have any. I am open to suggestions please if you can let me know the procedure you believe I will benefit from.
A: From a jawline standpoint, there is a clear chin deficiency but with a slightly long (rotated backwards) chin as well. While an implant can be used and probably not lengthen the chin, the most ideal treatment is an osteoplastic genioplasty where the chin can be brought forward and shortened as well. I have imaged that potential change in the attached profile pictures. In addition, I have also added some small jaw angle implant in the front view to see if widening the posterior jawline is also aesthetically beneficial.
As for your nose, I can see a slight retraction of the alar rim upward creating nostril asymmetry. That would also account for the differences you feel in the lower alar cartilages in the tip of your nose. This could be improved by the addition of an alar rim/onlay graft to the right side of the tip of the nose.
As for the temple areas, I am having a hard time to seeing the amount of asymmetry between the two sides. This may be a function of the photograph. For temple asymmetry, a small subfascial temporal implant can provide a moderate amount of augmentation to the more depressed side.
Dr. Barry Eppley
Q: Hello, I have a rare problem. I think, although I am not sure, I have always slept on the left side of my face. Ad a result, I have an extremely strong left chin and not hardly a right chin at all. I was hoping for implants on the weak side or a reduction on the strong side whichever is best. I’m fine with what ever as long as I can look more symmetric. I have attached some photos so you can see what I am talking about. Thanks!
A: Thank you for sending your pictures. Based on your pictures, you do not have chin asymmetry. Rather you have facial asymmetry. The left side of your face is bigger than your right and this is most evident to you along the jawline and at the jaw angle. That is very evident in looking at your side views where the right side lack the prominence at the jaw angle that is seen on the left. Your chin is actually fairly straight. Usually with such facial asymmetry the chin will swing over to the right and be off midline. But this fortunately has not occurred in you.
You would benefit from a right jaw angle implant augmentation to try and get a better match to that of the left side. The jaw angle implant will both lower the angle and add width to it. The width of the jaw angle implant is actually the most important in your case. This will improve your facial symmetry considerably through this relatively simple jaw implant procedure.
Dr. Barry Eppley
Q: I am tired of looking older. My jowls are getting bigger and my neck is starting to really sag. I hate to consider the thought of a plastic surgery procedure like a necklift but I am going to have to do something in the near future. I don’t mind getting old per se, I just don’t want to look old! I have read that there are different types of facelifting procedures. How do I know which one will work for me?
A: A facelift is a plastic surgery operation that changes the lower third of the face, the neck and jowls only. So it is a good match for the jowl and neck issues which bother you. Like many plastic surgery procedures, there are different ways to do them and they come in different ‘varieties’. No one type of facelift is right for everyone. Your plastic surgeon must ‘match the solution to the problem.’
Fundamentally, a full facelift changes both the neck and jowls and is best for someone whose primary problem is their neck. The jowls get improved as well and get swept alone in the changes that occur far away in the neck. The mini-facelift, aka Lifestyle Lift as called by some, changes the jowls primarily and a little bit of the neck. Any limited improvement in the neck is the result of the changes that have occurred in the jowls. The mini- or limited facelift is best for someone whose primary concern is in their jowls. Since jowling proceeds any significant changes in the neck, one can appreciate why a limited facelift is for younger people who have less signs of facial aging.
Another way to think about it is by looking at the incisional pattern around the ears. Mini-facelifts have use an incision that runs into and around the front the ear. Pulling upward from there only impacts the jowls primarily. A full facelift uses incisions in front of and behind the ear. By moving tissue upward from behind the ear, excess neck skin can be worked out to be cut off behind the ear.
Dr. Barry Eppley