Q: Dr. Eppley, my face is very unbalanced as my chin is very short. This also makes my neck look fat even though I am at a good body weight. I have attached some pictures for you to tell me what you can do for my really short chin. It looks like the lower part of my face is just missing.
A: Here is a side view prediction based on the combination of a chin bony advancement (sliding genioplasty) combined with an implant. Your horizontal chin deficiency exceeds 15mms which puts you well beyond what any conventional chin implant can do. A chin osteotomy will advance you up to 12mms, which is better, but also not ideal. Therefore, in cases like yours I will put an implant in front of the advanced chin bone as well that will add another 5mms to the projection. The addition of the implant also has the advantage of its extended lateral wings which will fill out the sides, making the chin a little more square. That is an advantage for a male who benefits by a more square chin anyway. In addition, your thicker neck tissues would simultaneously benefit by liposuction under the advanced chin area to try and thin that out a little but.
The combination of a chin osteotomy and implant combined with neck liposuction can make some significant changes as the imaging suggests. This type of ‘extreme chin augmentation’ is necessary to get the best result in larger male chin deficiences like yours.
Dr. Barry Eppley
Q: Dr. Eppley, I am interesting in what you refer to as an extreme chin augmentation (osteotomy and an implant). I have a short lower jaw, but unfortunately have been told I’m not a candidate for orthognathic surgery due to the position and condition of my teeth. To help correct this problem, I have had a chin implant placed but the results do not satisfy me as it is not big enough. I am attaching a copy of my ceph x-ray. I do not have a profile picture at this time, but it is pretty clear where my chin is from this x-ray. Can you please comment on having this surgery? I have seen a lot of your before/after pictures on other sites for chin augmentation and am very impressed with your work and the knowledge you seem to have from the questions you answer on your site.
A: Thank you for your inquiry and sending your ceph x-ray. You do an underlying significant lower jaw deficiency as seen on your film. Your current indwelling chin implant provides only 7mms horizontal projection and is positioned just slightly high on the bone. Your true chin deficiency is more in the range of 16 to 18mms deficient. You therefore already have half of an extreme chin augmentation with the existing implant in place. You now need a chin osteotomy done just above your existing implant to advance the bone (carrying the implant) forward about 10 to 12mms with a vertical opening of 2 to 3mms. This will create the most ideal chin projection for you. So doing the previous chin implant was not a wasted procedure. You would have needed it anyway as the bone can only be brought forward so far. i have done some computer imaging and predictive tracings on the ceph x-ray that you have sent me.
Dr. Barry Eppley