Q: Dr. Eppley, regarding jaw implants is it not true that the large masseter muscle goes a very long way to creating the characteristic model look that patients are seeking? If bony anatomy is not the only factor does this not mean that a patient will fail to achieve an authentic looking result, seeing as the implant augments bony anatomy.
A: The concept of the male model look as it relates to the jawline is a variable one that does not have a specific look per se. While it is about a strong and well defined jawline, the front to back angulation of its inferior border and the height and flare of the jaw angles can be quite variable. I have been provided many desired male model jawline pictures from young men which have many variations.
While an exact male model jawline escapes an exact anatomic description, what is not unclear is that it is created by the bony shape of the mandible. While the masseter muscle can be very thick, it is rounded and lacks any defined or sharp edges. It creates bulk and not definition. It is only relevant in how thick it is as well as the thickness of the overlying subcutaneous fat. These tissue thicknesses can obscure any well defined bony shape or implant augmentative effect of the jawline.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a chin implant, jaw angle implants or both. I believe chin implants/jawline implants come in different dimensions or sizes? Would it be better to do one procedure at a time? What face shapes are good candidates for this type of procedure?
A: A chin implant and jaw angle implants come in a wide variety of styles and sizes so there is a range of changes that can be done. The purpose of computer imaging is to first see whether these type of facial changes and their magnitude is what someone is looking for. Different implants will create different degrees of change.
When it comes to elective facial surgery, you do the procedure in which you are absolutely convinced is needed. Any procedures in which you are uncertain you wait and see how the first procedure affects the facial area of uncertainty.
The best candidates for chin augmentation is just about any face because it is a ‘edge’ or profile procedure that would improve any face in which the chin is short. Conversely, jaw angle implants work best in thinner faces where their effects enhance or skeletonize the face as opposed to a fuller or rounder face in which it may just make it more bottom heavy.
Dr. Barry Eppley
Q: Dr. Eppley, Can Jaw and/or chin implants give me more of a chiseled/angular/square longer lower face? I don’t want to have the procedure if it can not create this kind of look.
A: In the right type of face, chin and jawline implants can indeed create a more angular or chiseled look. The right type of face is a thinner or lean one that can show skeletal highlights better. Fuller or ‘fatter’ face can not get a more chiseled look from facial implants as the soft tissue cover is too thick to show their outlines. This is particularly true of jaw angle and cheek implants which are facial locations that do not jut out like the chin can.
Dr. Barry Eppley
Q: Dr. Eppley, In looking for jawline implants for total jawline enhancement do you think a good combined solution for chin and jaw is the Medpor Matrix system, or do the chin and jaw implants separately? I currently have some hyaluronic acid directly on my jaw angle and line because I did not know about such implants until recently, so I think I should remove that with “Hylase” before determining implant sizes.
My final questions to understand the size and shape of the implants and surgery would be:
a) JAW: The horizontal width of the RZ mandibular angle implants is 11mm (or 7mm respectively) at the LOWEST point of the implant and diminishing gradually to the top – like a triangle, correct? And as you mentioned the VERTICAL DROP is ALWAYS 10 mm regardless of the horizontal width of 3, 7, or 11mm? (which can be shaved down I guess if necessary?)
b) CHIN: With respect to a chin augmentation: If, just theoretically, I am satisfied with the length (anterior projection) of my chin length but NOT with the lateral horizontal width and shape (which I want to be SQUARE and 5 cm ranging from one corner of the mouth to the other) – are there available or can you shave down an medpor RZ extended chin implant so that there is NO or only 1-2 mm anterior projection but the same lateral and inferior projection as the medium sized RZ Ext Square chin implant? So practically speaking a customized RZ Square chin implant augmenting only laterally the side parts of the chin (like an implant without or only a 1-2 mm middle part9). An implant which makes the chin look more square and broader, which augments the lateral parts of the chin. (hope I expressed myself properly)
A: If I have to use off-the shelf implants, I generally stay away from Medpor because they are hard to put in, never fit very well to the bone, hard to stabilize to the bone and very hard to revise if that ever needs to be done. (of which the risk is about 25% of that need) I have used them a lot and the more I use them the less I like them. None of their purported benefits are true, other than soft tissue adheres to the implants making them a near nightmare to ever revise. But I will still use them when patients insist and some patients, like you, have an affinity for it.
When it comes to total jawline augmentation with Medpor, I would use a three-piece chin and jaw angle approach and not the Matrix system. The Matrix system is extremely hard to put in and virtually impossible to ever remove or revise due to the features of the material as previously described. Since the chin implant is put in as a two-piece implant with a male-female connector, it is easy to make a square implant but how far or close the two pieces are put together. It is, in essence, and adjustable width chin implant. When in doubt about jaw angle widths with the RZ style, it is always better to go with the biggest size as it can also be reduced during surgery. (but you can’t add to it)
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in getting a custom chin/jawline implant. I’ve been doing some more research into cheek and chin implants and wanted to ask your advice. Based on my photos do you think a standard chin implant modified to fit just the left side would be adequate? Or is it best to stick with the plan for a custom implant? I know a custom implant would be pretty pricey and since I’ll be needing lots of other work done to correct my Parry Rhomberg syndrome so I’m just trying to figure out the best options. I also wanted to get your thoughts on cheek implants. One surgeon I spoke to thought I only need a cheek implant on the left side and that the right side could be built up with fat or filler. However another surgeon insisted that I needed implants on both cheeks, so now I am confused. Would you suggest a cheek implant just on the left side or both sides to make things as symmetrical as possible? I’ve attached the other surgeons photo simulations of a standard chin implant, fat transfer, and left side cheek implants. Do these simulations seem like attainable results to you? Any feed back would be greatly appreciated.
A: With facial bone asymmetry, it is a given that a custom jawline implant would be superior to any off-the-shelf implant. There is no question about that. The question you are asking, understandably, is there something that would cost less that could do a reasonably similar job as a custom implant. When it comes to any existing standard chin implants I would say no because the bone deficiency extends all the way back to the jaw angle. However, I have been using a new wrap around jawline implant for men and women that I believe would work that is not yet available to the general public. (sold by the manufacturer) I think half of this implant could be added from your left chin back to the jaw angle and would do a great job of building out your deficient chin-jawline. (the custom implant would probably look somewhat similar) This would reduce the cost of the procedure considerably over a custom jawline implant.
As for the cheek areas, go with cheek implants on both sides. The cheek implants would not be the same size of course. But never try to compensate for a skeletal deficiency with unpredictable fat grafts when you are already committing to doing a cheek implant on one side. You may still need some fat grafting but just don’t try to make it work for the bone part of the facial problem when there are more predictable solutions.
When it comes to computer prediction imaging, understand that it is not a guarantee of how the surgery will turn out. It is Photoshop where anything is possible by moving pixels around. It is the surgeon’s estimate of what he/she hopes is accomplished and is the goal to aim for but whether that is completely attainable is determined by the surgeons skill and ability and how realistic the imaging has been done.
Dr. Barry Eppley
Q: Dr. Eppley, I recently had chin and jaw angle implants combined with fat transfer ten days ago. I see that my lower face is much wider than expected. I realize that a lot of this is swelling and that fat transfer is overdone with the expectation that much of it will be reabsorbed. However, if there is a “window” of time that would be possible to remove the jaw implants (the chin is just fine) then I would want to be aware of that.
A: One of the very common early postoperative features of any jawline implants, including the chin, is the amount of swelling that occurs. Suffice it to say it is tremendous and doesn’t signify at all what the final outcome will be. It is actually very common that many patients in the first three weeks want to remove their implants as it just seems too big. While I am always happy to do whatever the patient wants, any judgment now is way premature and doesn’t indicate what the final results will be. As a general rule, the result of any facial implant follows the general guideline of 50% by 10 days, 75% by three weeks, 90% by six weeks and the real result (100%) by three months.
There is also the psychology of facial structural changes. Facial augmentation of natural structure is not like a facelift. In anti-aging procedures, people are psychologically comfortable with the swelling because they are just trying to go back to a place they know. (what they used to look like) Facial structural surgery is more psychologically unsettling because the person is going to a place of which they are not familiar. (a new look) This is tremendously unnerving and there is a natural tendency to want to return from when they came. If most patients can just get past this transition period (which is usually about 3 weeks, when a lot of swelling goes down) then they are usually fine and happy with their new look.
It is important to remember that the jaw angle implants are only 3mms thick, just a sliver of width really. So don’t let this temporary facial look with the swelling remotely think that the final result will look anything like what you see now. When you combine the swelling from the jaw angles with the fat grafting, it ail, temporarily look especially heavy on the lower third of the face.
Dr. Barry Eppley
Q: Dr. Eppley, I have a few questions regarding the chin and jaw angle implant procedure. I know you are very busy as a surgeon but if you had a few minutes of free time, I would appreciate it if you could answer some questions before our consultation. It would probably save time for both of us as well. Regarding the Mandible Jaw Implants, I’ve been researching online that this procedure is riskier than chin implants and that they tend to have a higher rejection rate. I’ve also read that they require a very skilled surgeon who has a lot of experience with this procedure. I’m sure you can understand my concerns, so here are my questions:
1) How many mandible/jaw implants (NOT just chin implants) have you done in the past?
2) How often does infection occur with jaw implants and how often do patients request to have them removed (either from infection or dissatisfaction)?
3) I’m looking for that “Chiseled Look”, or angular looking jawline which you see on many famous actors or male models – not necessarily a massive or fat looking jaw – but a defined/contoured jawline. Assuming one has a low body fat percentage, is this look possible with a jaw and chin implant? Also, will the jaw/chin implants look natural in that they look contoured to the face rather than just a large mass hanging from your lower face?
4) How long does recovery take for both a Chin and Mandible Jaw Implant procedure? I’m starting a new job soon so I’m probably going to give myself 2 weeks in between leaving from my current position and the start date for the new job. Would 2 weeks be enough time? It wouldn’t make the best first impression to walk into my new job on the first day and have a swollen jaw, haha.
5) Are the Mandible Jaw Implants customized for different size faces or are they “One-Size-Fits-All” ? I noticed some doctors use customized ones and some use standard implants. Is there a major difference in looks between the two types?
6) Finally, I noticed there are not a lot of Before and After pictures of jaw implants on the internet. Is this because the results don’t turn out good or it because its just not a common procedure? Would it be possible to see some of your jaw implant work during our consultation?
A: In answer to your questions:
- I have performed over 100 standard or custom jaw angle and jawline implants. (and many more chin implants) You are correct in that it is a harder facial implant procedure to do and is not a mainstream facial implant procedure done by a large number of surgeons.
- The infection risk with jaw angle implants is not higher than any other facial implant although the material of which they are made can affect that risk. (Medpor has higehr risk than silicone) Expect a 10% to 15% risk of revision which is usually for asymmetry or unhappiness with the size. (too big or too small)
- The only male patients that can achieve a ‘chiseled’ look or a male model look are those men that have a lean face where changes in the skeletal contours are most easily seen. With today’s implant shapes and designs there is no such result as the implant looking like it is ‘hanging from the bone’.
- Two weeks is really not enough time to recover from a facial appearance standpoint. Three weeks is more realistic.
- Both standard off-the-shelf implants as well as the option to customize them are available. Which approach a patient takes depends on their aesthetic needs and their budget.
- Since few plastic surgeons do this kind of facial work, it is hard to find many examples of results. My work is fully reviewable on my website at http://eppleyplasticsurgery.com//jaw/ under the patient photo section.
Dr. Barry Eppley
Q: Dr. Eppley, You suggested 10mm of vertical projection for both my jaw and chin. However, when I measured my face with a ruler, I determined that in order to achieve the 1/3 1/3 1/3 ratio, I would need between 15-20mm vertical lengthening. I am hoping we can design a chin implant that has close to 15mm of vertical length. In my experience am more worried about undershooting than overshooting. Is a 15mm vertical chin possible? If so, does it carry increased risk?
2) Can we use computer imaging to figure out the ideal dimensions? My left jaw projects significantly more than my right jaw.
3) With a custom 3-piece chin + jaw set that includes both vertical and horizontal projection, will there be a smooth transition in the space between the chin and jaw(body)
4) In terms of safety, what is the difference between my current Medpor implants and silicone? I heard that silicone breast implants may rupture.
5) Can silicone be flexibly shaped to my jaw contour using hot sterile saline the way Medpor can? And if so, would that mean that the easiest approach is to use a previous patient’s custom implants, and skip the CT scan?
6) How much vertical lengthening do my 7mm Mandibular Matrix jaw and chin implants already have? I can’t find the vertical jaw dimension online.
7) Since my current Medpor implants have been screwed in, how will you remove them? Do you “unscrew” them? I believe there are two screws anchoring each one of the pieces.
8) How many custom combined jaw+chin procedures have you done in the past? Are you the only one who does this?
A: In answer to your questions:
1) The vertical length of the jaw angles can be lengthened in the range of 15 to 20mms. The chin can not be done as much because of the lack of adequate soft tissue to recruit for coverage. A more realistic lengthening in 8 to 10 mms.
2) 2) Computer imaging is great to provide a general concept or trend but it would not be an accurate way to determine the desired millimeters of change. Unless the picture is taken so that the computer recognizes its size, it can not be used for estimating exact changes.
3) One of the main purposes of a custom 3-piece jawline implant system is to have a smooth transition between the chin and the jaw angles.
4) There is no danger is using silicone as a
facial implant material. It is a solid material unlike silicone breast implants. I ma not sure where you would get the concept that a silicone facial implant would rupture.
5) Silicone always adapts better to the bone than medpor. Medpor is a very stiff material that is minimally adaptable using ‘hot water’. This is not necessary with a silicone material.
6) It is impossible for me to say how much vertical lengthening your current implants provide since that is highly influenced by how they were placed in addition to their design.
7) Your current implants have to be unscrewed…that is the easy part in trying to remove them.
8) I have been making custom facial implants for 20 years. I can’t speak for who else may use this approach around the world.
Dr. Barry Eppley
Q: Dr. Eppley, I had the Mandibular Matrix system implanted in 2010 including the two 7cm jaw implants and a 7cm chin implant. However after three years, the two jaw implants have shrunken/settled into my bone so that my jaw corners are around the same size as they were before the surgery. I plan to have my jaw revised. From looking around, I can tell that you are one of the top-experts on male jaw enhancement. Do you recommend replacing the jaw implants or stacking a new implant on top? What are the risks of bone settling and how can I reduce them. Also, how can I schedule a consultation and surgery date? I can send you pictures. Thanks.
A: My first question is whether the jaw implants have really sunken into the bone. That would be very unlikely given how the Medpor material is treated by the underlying bone. The first thing I would do is have a 3D CT scan done and a model made to really look at the current relationship of your existing implants and the jaw bone. It would be impossible to give good advice/recommendations without knowing the answer to this very important question. It may also be likely that any new implants may have to be custom made whether they would be placed on top of or in replacement of your existing implants. Be aware that it would be very difficult to remove your existing implants…not impossible but very difficult.
Dr. Barry Eppley
Q: Dr. Eppley, I had a question what is the difference between the custom implant and the off the shelf jaw implants? I think for my ideal face I would like to achieve is to vertically lengthen my chin only a bit and make it more wide. For my jaw I think just maybe only a little bit widen but more lengthened so I would have a longer smaller looking face. I think for me its not so nice to widen it too much). I want the same face I have now only smaller looking with a better jawline. I have attached a male model’s photo which is what I want to reach is something like that possible for my face?Also I am a bit concerned if something would go wrong, is it being corrected for free then? And how long should I stay in Indianapolis as I don’t want to know people at home.
A: The role of custom facial implants is useful when off-the-shelf implants can not produce the desired effect either due to the size changes needed, a special shape of the implant is required or there is asymmetry between two sides. Another difference is that custom implants cost a lot more and will add $7500 to a surgical procedure such as yours. So you have to have a real good question to go the custom route.
The model photo you have shown can not be exactly achieved on you because only a custom jawline implant can create a perfectly smooth wrap around effect.
If revisional surgery is needed, the patient is responsible for the costs of the operating room and anesthesia costs. No revisional surgery procedure is completely free.
Most jawline implant patients will stay 2 to 3 days before returning home. But if you are not desiring to go home until most of the obvious swelling is gone, then it will be several weeks. (which is a bit impractical for most patients)
Dr. Barry Eppley
Q: Dr. Eppley I´m a 34 year old healthy man interested in enhancing my poor defined jaw line. Have read some awesome reviews of your work and feel really drawn to having this aesthetic implant procedure performed by you. It would be easier and less expensive to go to another country but I really feel you should be the one to treat my case. I would like to know the average cost and the downtime it will require. I´ll be more than greatful for any info you can provide me with.
A: The most important decision in regards to jawline enhancement with implants is whether stock preformed or custom implants would be most beneficial. I can make that determination by looking at some picture of your face from different angles. The critical determinants of whether custom jaw implants are needed are the size of augmentation that a patient desires, whether there is any significant vertical increase needed in the jaw angle (and the chin) and whether a smooth continuity of the jawline from the chin back to the jaw angles is desired. Until that determination is made, it is not possible to give an accurate cost quote. But as general guideline, off-the-shelf chin and jaw angle implant surgery is around $8500 while custom chin and jaw angle surgery will be nearly double that cost. Either way, recovery is the same which is largely about facial swelling which takes about three weeks to go down and look normal again.
Dr. Barry Eppley
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)
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