Your Questions

Q: Dr. Eppley, I am interested in a jawline implant I am a 50 year old male in good shape. I had liposuction under my chin for the first time at age 35. About ten years ago I had a neck lift and liposuction under my chin. At 50 years of age, I am interested in a Jawline implant and tightening of the platysma muscles which seem to be sagging. Additionally, the skin under my neck is just a bit saggy. I would like a 90 degree cervico-mental angle, similar to Rob Lowe without the protruding chin. I would rather get this done while I am younger so it won’t look so dramatic after the surgery? Can anyone tell that one has had jaw implants?

A: I need to know whether you mean jaw angle implants or a total jawline implant. I believe you may be referring to a total wrap around jawline implant which can be combined with a submentoplasty procedure for the optimal jawline-neck shape change. Such jaw implants are not detectable unless they are overdone or look obviously disproportionate to the rest of the face. They require a preoperative 3D Ct scan for their custom fabrication.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had upper and lower jaw surgery in 2011 where I was referred by my orthodontist and convinced that I needed it. However, they ruined my face and my bite has subsequently shifted. I would like a sharp jawline. Is it possible to get jaw angle implants? Now, I cannot close my mouth properly and I have a weak chin.

A: While I do not know what you looked like previously, I can see now that you have a very steep mandibular plane (high jaw angles) and a recessed chin. From a jaw angle standpoint, vertical lengthening jaw angle implants are needed to drop the angle down and provide a more square angle shape. (not really square but closer to 110 degrees) Given that you have had prior jaw surgery (and I assume a sagittal split mandibular osteotomy, SSRO), your jaw angles are likely asymmetric and scarred. Custom jaw angle implants would be the ideal method for these unique jaw angle shapes.

For the chin the options would be either a sliding genioplasty or an implant as part of a total jawline implant which includes the jaw angles. Initially I would favor a sliding genioplasty because the vertical height of your chin needs to be reduced. But a custom implant may be designed this way also.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting jaw and cheek implants, but I am waiting until there is a more natural choice. I want implants that integrate with the bone so I won’t have to worry about shifting. I’ve read online that some doctors have been able to 3D print bones that integrate with the bone. How long until this is applied to cosmetic surgery?

A: If your primary concern about cheek and jaw implants is that they will shift, there is a far simpler technique available today that ensures that will not happen…known as screw fixation. Securing the implant to the bone with small titanium screws ensures that it will never move and is a technique of implant fixation that I do to just about every facial implant that I place. I have used that implant technique for over twenty years and I have yet to see a facial implant that has yet moved from where I placed it.

When it comes to 3D printing of any human tissue, this topic has been in the news of late and is a technology that is quite early in its development. All the recent press releases demonstrate that it can technically be done. But that is far cry from being able to do it in humans for real surgery. I do believe that one day such technology will be available for surgical use but, at a minimum, it will be 10 to 15 years due to FDA regulations and the clinical approval process which is involved in getting it through those hurdles. This does not take into account the economics of the process in which a company has to invest millions (or tens of millions) to get it through that regulatory process. And a company will only do that if the market in which they are developing their product for justifies that expense. The facial implant market would not be considered such a market by today’s standards.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jaw implants to give me a more defined jawline. I can see from your computer imaging that adding the chin implant to the jaw angle implants really does make a difference. I have a couple questions. Are the implants silicone? Do the size and type of the implants determine how chiseled my face would look? I’m trying to get as close to the ‘male model’ look as possible. I’m not sure if any other procedures would make as much of a difference as these.

A: Chin and jaw angle implants (jaw implants) are made of either Medpor or silicone material and I have used both extensively. However I much prefer silicone because implants made of this material can inserted much easier, shaped intraoperatively much better if needed and are far easier to revise/remove if needed. A good saying about silicone facial implants is…easy in, easy out and easy back in if needed.

The size and the shape of the implants play a major role in the look of the final jawline result, provided one has a fairly lean facial look to start. The thicker the overlying soft tissues are, the less defined the outline of the implants becomes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jaw implants for my weak chin. I would like to know what the implants are made from and how durable they are. I do martial arts and blows to the face are quite common, so I wonder how well the implants will endure against physical trauma? Also do you believe there might be a possibility that corrective orthognathic surgery might help me, both cosmetically and in terms of snoring/breathing issues? Thank you. 

A: The chin and jaw angle implants are made from silicone of a firmness slightly less than bone. I screw the implants into the bone that they will never move from their implanted position. It will require a force great enough to break the bone to ever dislodge them. And they might actually be a buffer against traumatic forces, ultimately protecting the bone to some degree. Whether you would benefit by orthognathic surgery instead of jawline implants is not a question I can answer based on the information you have provided the best way to answer that important question would be to get and orthodontic evaluation and see if the process of pre- and postsurgical orthodontics and orthognathic surgery would be a more appealing alternative that at least partially address the underlying bone problem of your weak jawline. You owe it to yourself for the sake of educational completeness to get such an evaluation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had prior jaw surgery which hasn’t gone so well. I was just wondering if you can have jaw angle implants put over a metal plate that was left in my face? I have bone scans which I can send to you to have a look at.

A: I suspect what you are referring to is a jaw angle/inferior border deformity after an orthognathic surgery procedure. I have placed jaw angle implants over metal plates in the mandibular ramus area numerous times. It is not rare to have mandibular ramus notching and bone resorption around healed sagittal split osteotomy sites. This problem may be severe if one developed a non-union or infection after the procedure. These deformities may be able to be improved by implant augmentation. Even though fixation hardware (plates and screws) exist on the outside of the bone and considerable scar tissue will be present, and pocket dissection is not easy, jaw angle  implants can be successfully placed. I shall look forward to reviewing your bone scans and photographs.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 20 year old male and have what I would describe as a long and narrow jaw. I am wanting to get my face/jaw to be wider and more masculine to that of a square jaw type face and understand this can be done via mandible implants? I want to know would these implants last forever as I hear a lot of stories that the implants get infected or shift. I wouldn’t want to have them for say 25 years then on the 26th year something goes wrong. I could have a wife and kids then and would be a whole new person. Are these implants successful?

A:  All facial implants, including any used in the mandible, are made of synthetic materials that do not degrade or resorb. Thus the implants are permanent, will not wear out and will last the rest of one’s life. This does not mean that they can not have problems as any implant surgery in the body may have. In facial implants, the risk of infection is an early one related to the time period around implantation. Once well healed, the risk of infection is very rare. Shifting of one’s implants can occur over time but can be completely prevented if the implant is secured into position by the use of bone screws. Well placed, well secured facial implants have a very low risk of any long-term problems. To be most successful, like any plastic surgery, choose your surgeon carefully as implantation technique has the greatest influence on long-term prevention of potential problems.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to send some photos so you could tell me the most appropriate surgery to have. I would like a wider face, a less pointy chin, a chin lift and jaw implants. I wore braces to correct an underbite and I had a mandibular osteotomy and genioplasty – the result is a long face. What can I do to bettr improve my overall appearance. I am 39 years old and terribly unhappy with my profile and double chins etc.

A: You have many of the sequeale of orthognathic surgery of the lower jaw which occur from both the surgery and aging. While a sagittal split mandibular advancement osteotomy and genioplasty have undoubtably done wonders for your bite and improved your facial profile, there are some skeletal deficiences from that surgery that have either been created or unmasked with aging that have affected your lower face. Your face has become narrower with that surgery as the jaw angles are usually lost from the ramus osteotomy and the chin becomes more narrower as its u-shape comes further forward. There also appears top be some asymmetry of the lower jaw with the left angular area being more deificient than the right. There is also the effects of aging as the neck has become fuller and dropped down due to soft tissue sagging. Collectively, all of these give you a narrow and longer appearing face with a double chin and obtuse neck angle.

This could be improved by a single procedure combining a chin-prejowl implant, mandibular angle implants, neck liposuction and a limited or short scar facelift. I have done some computer imaging from the front and sides to illustrate what changes may be possible through this approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q:Hi Dr. Eppley. I will be 17 years old next summer. I’m looking to get some implants as I get a little older. Is there any way of creating a custom jaw/chin implant? If so, would this cost extra? If so, how much? Much appreciated. Also, what is the minimum age requirement if one wanted to get some facial implants? I’d like as much information as possible please. Much appreciated.

A: The timing of chin and jaw implants is based on two factors; the degree of jaw deficiency, one’s bite or occlusion and the near completion of jaw growth. At this age you want to be sure that you do not have a correctable malocclusion by a combined orthodontic and orthognathic surgery approach. If not, then chin and/or jaw angle implants may be appropriate. I certainly would not perform that surgery before the age 18 when jaw growth is closer to being complete in a male. Custom chin and jaw implants can be done and I do them on a regular basis. But whether they are really needed and offer any advantage over stock preformed implants must be determined on a regular basis. It is hard to give any reasonably accurate pricing when I don’t know whether one needs just a chin implant or whether one needs a combined chin and jaw angle implants for total jawline enhancement. In either case, custom implants will double the price of the surgery due to the need for special design and fabrication. For this reason, one has to have a very compelling anatomic need to justify the expense of a custom facial implant process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my jaw grew asymmetrically from birth. I had a surgery when I was 18 years old where they shaved off part of the chin, and added implants around much of my jaw. However, when it was done I thought my face looked too full. I had a second surgery to remove some of the implants. The result was better, but I am still not satisfied. I don’t need to look perfect, but I don’t enjoy having one side of my face be fuller than the other. Would it be possible to do surgery and simply shave off a little of the implant? I don’t want it out, because it needed to be in there, it is just too large.

A: Onlay augmentation of the jaw with implants is a common method to improve jaw asymmetry. This is a good treatment option when an osteotomy and occlusal adjustment is not needed or desired. There are numerous types of implants used in the jaw including silicone, Medpor (porous polyethylene) and Gore-Tex. (polytetrafluoroethylene) Each has their own advantages and disadvantages but they all share one similarity…they are relatively easy to carve and shape with a scalpel. Even though you did not say and may not even know what type of material that was implanted, it should be able to be pared down to a smaller size without the need to remove it first. Jaw implants are usually fairly easy to modify once in place.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dear Dr. Eppley, I am about to undergo a third surgery for my short mandible. My first surgery consisted of bone grafts to the jaw angles with  a sliding genioplasty for my chin. I then had a second surgery in which silastic jaw angle implants were placed as the bone grafts had resorbed.  For my upcoming third surgery, a medpor chin implant is going to be used which will extend back to the jaw angle. My doctor is concerned, however, about placing the medpor implants over the indwelling silastic implants (to improve the angle still) because of issues with bonding medpor to silastic. I assume it will take some method to secure the two implants together. He is concerned with slippage of the two implants placed on top of each other. Do you have any suggestions as to how to fix these two implants together? Your comments will be very appreciated. Thanks.

A: Commenting on another surgeon’s operative plan or method of surgery is not really appropriate from my perspective. I am certain that your surgeon would not really appreciate it and, if he needed help in the planning, he would have his own reference sources to ask. In addition, the details of exactly what has been previously done and the specifics of this next proposed surgery are lacking in your brief description of the issues. I wish you the best in this upcoming surgery and hope that your desired final aesthetic goals from your jaw reconstruction will be successfully met.

Dr. Barry Eppley

Indianapolis Indiana