Your Questions

Q: Dr. Eppley, I`m interested in jawline reduction, and I have some questions regarding this procedure. I have read that there is a risk of damaging the facial nerve during this procedure. How high would you say that this risk is? And should it happen, will it be possible to repair the damage afterwards? Is the risk smaller if the reduction doesn`t involve the angle, but the bone between the chin and the angle?

A: The nerve that is at risk for potential injury during jawline reduction is not the facial but the mental nerve. The facial nerve is a motor nerve which controls facial movements while the mental nerve is a branch of the trigeminal nerve which is responsible for feeling of the lower lip and chin. It is at risk for injury, not during jaw angle reduction, but in reducing the bone between the chin and the angle. This is where the nerve exits out of the bone at the mental foramen. The nerve is most frequently injured due to it being stretched which can largely recover on its own. This causes some numbness of the lip and chin which may be  temporary or some of it could be permanent.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in chin reduction due to the fact that I feel as if my chin is way too large vertically. When I happen to smile there is also enough loose “bulk” to pinch on to skin or muscle, not sure exactly what you’d call it in the doctor world. Horizontally my profile does not bother me. I’ve been reading a lot about chin reduction lately and have seen pictures on websites of your work. And I would like to know exactly what kind of procedure I would need done for me to obtain the chin that I want. (Included)- are two photos the on of me smiling is a perfect example all together of what bothers me about my chin. In the second photo is what I would want my chin to look like…my dream chin 🙂 by the way thanks for your time.

A: What you are seeking is a vertical chin reduction that is best done through a submental incisional approach. To achieve your goals it is necessary to remove approximately 7mms of vertical chin reduction across the bottom of the chin bone. With this amount of vertical chin reduction, two additional issues need to be addressed. First the lower border of the jawbone behind the chin must be reduced lest you would be left with a ‘bulge’ of bone along the jawline behind the chin. Secondly, This amount of bone reduction will require soft tissue removal as well, known as a submental tuck. All three of these combined procedures fall into the procedure I call a ‘chin and jawline reduction’ operation.

It would be helpful to see a non-smiling front and side view picture for computer imaging as well as a panorex x-ray (usually a dental film) so I can measure the amount of of bone that can be safely removed from the chin and jawline. (location of tooth roots and the mental foramen and path of the inferior alveolar nerve)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jawline reduction. I really want to shorten my jawline and chin as I think the lower half of my face is too long I have a picture of me and what I hope to achieve after surgery by using a Plastic Surgery Simulator. I have no bite issues and I ideally want 1.5 cm vertical reduction of height of my jawline and chin producing a more rounder and shorter face overall. Is 1.5cm possible? Thank you

A: Vertical chin and jawline reduction can be done but not at the amount of 1.5 cms or 15mms. There is a good reason why that can not be done…the location of the apex of the roots of the lower teeth and the inferior alveolar nerve which runs through the lower jawbone. At 1.5 cms reduction, the nerve and tooth roots would be injured. There is also the issue of what would happen to the soft tissue that is currently covering your existing height of your jawbone. With that much bone removal, there would be a resultant soft tissue sag even if that much bone reduction was possible.

One issue that is common in facial bone augmentation or reduction surgery is that patients way overestimate how much change in measurements they really need. If you actually took away that much bone vertically, you would have very little jaw left. And the amount of desired in the height of our lower face in the Plastic Surgery Simulator is no where close to 15mms. That would be closer to  5 to 8mms. This is also a safer amount to lessen the risk of any soft tissue sag afterwards.  One way you can measure how much bone you can safely remove is to get a panorex x-ray (a common dental film) that lays out the entire mandible like a map so the tooth roots and internal nerve can be seen. Then the vertical bone distance can be measured and actually determined.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, I am an Asian female who is 27 years old and want to have a more narrow face. I’m interested in jaw reduction, chin reduction(v-line) and cheekbone reduction surgeries. What are the possibilities of side-effects such as nerve damage and sagging skin? Is it possible to do all 3 surgeries at once?

A: As you undoubtably know, narrowing of the Asian face by bone reduction is a common request and collection of procedures. All three facial bone reduction procedures are commonly done together including cheek bone reduction and jawline narrowing.  The most common side effect, albeit not a complication, is the protracted facial swelling (4 to 6 weeks) until you see the beginnings of the results of the procedure. Generally permanent nerve damage (sensory nerves, infraorbital and mental nerves) does not occur although there will be a period of some lip numbness. The bigger risk is with the mental nerve as the jawline reduction goes right beneath it and some stretch on the nerve does occur. Sagging skin is also not usually an issue either and this is more of a concern in the cheek area rather than the jawline.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in getting a jaw reduction surgery done. I am a 25- yr old female with a jawline significantly wider than cheek bones area. My jawline alone is wider, adding to that strongly developed mandibular muscles makes my lower face evidently out of proportion.

1) Do I need anything additional done besides the jaw reduction surgery?
2) For how many days would I ave to remain hospitalized?
3) I live out of state, so how could the follow up appointments happen?
4) how many follow up examinations does Dr Eppley usually do? And what is their time frame?
5) what is the approximate cost I would be looking at (including hospital stay)?

Thank you!

A: In answer to your questions:

1. I would need to see some pictures of your face to determine what, if anything, else make be helpful in achieving your goal of a more narrow lower facial width.
2. This type of facial surgery is done as an outpatient procedure. There is no reason to be hospitalized for jaw angle/jawline reduction surgery.
3. As a general rule, my out of state/country patients follow-up by e-mail, phone or Skype. There are no regularly scheduled in-person follow-up examinations needed. When it comes ti changing appearance what matters is how things look and that can be discerned with modern technology from afar.
4. as per #3 above
5. I will have my assistant pass along that information later today or tomorrow. Although be aware that this is a cost estimate for a procedure on a face that I have not yet seen.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 35 year-old transgendered woman who is interested in more of a feminine face. I do believe that my jawline and chin is what needs to be changed and would be the most beneficial to me. I have been living full-time as a woman since my gender transition eight years ago. At this time, other than having two teeth extracted and dental work, I have no other facial surgery or injuries. As a woman, I do have occasional passability problems. I feel that my face currently absolutely needs improvement and will boost my self-esteem and self-worth.

A: In looking at your pictures, I do agree that your jawline from the chin back to the jaw angles, is the most masculine appearing part of your face. Softening your jawline would be a beneficial step towards your aesthetic facial goals and is a potential part of many facial feminization surgeries. Reducing the entire jawline is never as easy as making it bigger but there are procedures that can help your its prominence. The jawline angle can be reduced by angular ostectomies where the sharpness and prominence of the angles are reduced along with some width reduction. This is done through an intraoral approach where a saw is used to removed the bony jaw angles (makes them less square) and taking the outer cortex of the mandibular ramus to make it thinner as well. Your chin needs to be vertically reduced and narrowed combined with lateral prejowl ostectomies to make the whole front part of the jaw more narrow. This also is done from inside the mouth where the chin bone is downfractured, shortened and narrowed and put back together. Then behind the chin osteotomy the body of the jaw is then narrowed by outer corticotomies. I have attached some predictive imaging of those potential jawline reduction results.

Dr. Barry Eppley