Your Questions

Q: Dr. Eppley, I am interested in jawline surgery. The kind of strong jaw and face I’d like to have is like his model picture that I have attached which shows how her jawline drops and she has very pronounced and positive cheeks which I really like. I want something extremely dramatic, my jawline isn’t anything like the model I showed above. I’m cute, but my face is just so narrow that it takes away from the potential attractiveness that I could have. The debate for me is either a sliding genioplasty and two hardcore flared jaw angle implants OR a custom implant for everything. I hate the side profile view right now, as my nose and philtrum are overprojected and everything else is just weirdly shaped due to my terrible genetic inheritance.

A: Thank you for sending your pictures and providing a detailed description of your jawline surgery goals. While the debate is between a total custom jawline implant or a combined sliding genioplasty with two separate jaw angle implants, for a female and your goals I would choose the latter. The reason is that a total custom jawline implant will make the whole jawline wider from front to back, regardless of the dimensional changes in the profile view of the chin and jaw angles. I don’t think that works well for many female faces. What you want to achieve in the front view is a chin that ends up somewhat more narrow, or at least no wider, as it comes forward, a central jawline that dips in on the way back to the jaw angles and posterior jaw angles that flare out. A sliding genioplasty as it comes forward does make the chin a bit more narrow and it also allows the central jawline to remain narrow. (rather than bow out like a custom jawline implant may create) Your jaw angle dimensional needs is a combination of vertical lengthening and horizontal width for which I already have a variety of jaw angle implant styles to meet those needs.

In the side view you probably needs an 8 to 10mm chin advancement. the jaw angles need a 7mm vertical drop down and a 5 to 7mm width increase.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi. As a baby/kid I had misaligned teeth due to sucking my thumb. I sucked my thumb pretty much up to 15 years old or so. At about 15 years old I went to the orthodontist to get braces. He decided along with the braces to install this thing in my mouth called a “herbst appliance”. Cant find anything about on Google. Maybe it was to push up my chin due to my some what recessed chin due to sucking my thumb? I finally got all the stuff out of my mouth removed last summer. I was always a little self conscious about my jaw line , but the past couple of months i’ve started to notice tremendous asymmetry between the right and left side of my jaw. The right side looks like I have a Brad Pitt Jaw and the left side is nothing, barely a jaw line showing. I’m tremendously discomforted inside due to the straight forward appearance of my face shich is crooked.  What can I do to address and fix this problem?

A: Undoubtably what you originally had was a short lower jaw or mandible. In an effort to help the lower jaw grow during your early teen years, the orthodontist put in a growth stimulting appliance for the lower jaw, known as the Herbst appliance to which you refer. It is a well known device that has been used for several decades now. Now that the device has been removed and you at are the end of your facial growth, the final position and shape of the mandible can now be seen.

When looking at facial symmetry from the front view, the important issues on the centric position of the chin and the amount of flare of the jaw angles.  These three points give the visual impression of the overall jawline appearance.  When one has jaw asymmetry, provided that the teeth are in a good bite relationship, manipulation of these three points can be surgically done.

The chin can be adjusted with an implant or an osteotomy. The jaw angles can be accentuated and lowered through implants. Any combination of these numerous options exist. Which one(s) or combinations can only be determined through photographs of your face, a panorex x-ray, and computer image manipulation of proposed changes.

Between chin and jaw angle surgery, a tremendous improvment can usually be obtained and a much more symmetric and pleasing jawline can be realized.

Dr. Barry Eppley