Your Questions
Your Questions
Q: Dr. Eppley, I was born with a face that to me looks a little crooked. It seems my jaw line is shorter on one side and it looks like my face is bent in one direction. Would you be able to look at the pictures I am enclosing and please tell me what you think. My face is definitely not even and my chin is crooked. I think it is too big, but is it also receded? I am so self conscious that I hide behind my hair and makeup. Thank you so very much for your time and please, any advice and recommendations would be greatly appreciated!
A: I have taken a look at your pictures and your concerns. I think there is no question that you have facial asymmetry that is almost completely due to the shape of the lower jaw. The differences in the jaw length has resulted in frontal chin asymmetry with the midportion of the chin being deviated to your right side. This can be corrected (straightened) through a chin osteotomy, sliding it over to the left until its midportion is in alignment with that of your nose and upper and lower lips. This may also require some vertical chin adjustment with a reduction of the left side or an opening lengthening on the right side, depending upon which aesthetically looks better. Your side view shows a mild amount of recession which, given that an osteotomy would be done, I would take the opportunity to give more horizontal projection to the chin as well. I have attached some predictive imaging of the potential outcome with this sliding chin osteotomy procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to see if it is possible to improve 3 areas around my chin. The areas I want to improve are my jawline. I would like it better defined. I would also like to create a better angle on neck underneath the chin for better profile. I would also like to create better balance and harmony on my chin. Maybe lengthen it to try and release some of the mental crease. I’m not quite sure what will work. It’s a pretty deep crease. I was born with it. Feels like a huge step below my lower lip. I have attached a front and side view of me for you to see what I mean.
A: What you have is a classic issue of an overall short lower jaw. Your lower jaw is short in both horizontal and vertical dimensions which is most manifest in the chin area. While I can not see your occlusion (bite), I suspect it is a Class II malocclusion where your lower teeth are somewhat behind your upper teeth and do not meet in an edge-to-edge fashion. That is also why you have a deep labiomental crease. The lower lip is not well supported by the retropositioned lower teeth so the crease deepens while the lower lip rolls forward. What you need for correction is a vertical lengthening chin osteotomy that also brings the entire chin bone forward. I would estimate that it must be vertically lengthened by 8mm and brought forward 10mms. A hydroxyapatite block needs to be added to the step-off in the osteotomy to help build out the labiomental crease or at least prevent it from becoming even deeper. Lengthening the chin will actually help soften the depth of the crease as it pulls the soft tissue of the lower chin down and forward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want to make numerous changes to my chin as I think it will make my face look better. I am looking to decrease the horizontal dimension of my chin as well as increase the vertical dimension. I think this will create a more angular jawline as my lower face is very rounded. My chin feels like it pushing my bottom lip upwards so I wanted the lower lip to be brought down slightly, would this be at all a possible? I would also be wanting a rhinoplasty, however at the moment, I will be focusing on the chin. Would these chin changes be best done with an implant or an osteotomy? I really hope you can help Dr. Eppley. Thank you for time.
A: That type of chin change can only be done by an osteotomy. With the chin pushing up on the lower lip, this suggests that it is too vertically short. A chin osteotomy can easily increase its vertical length by making an opening wedge that is held apart by a special chin plate and four screws. Lengthening the bony chin will always make it look thinner, but its bony width can also be narrowed by a midline ostectomy of the downfractured segment at the same time.
As the chin is lengthened, it can create a slight lower lip lowering effect as the mentalis muscle is also lengthened. As the upper attachment of the mentalis muscle does extend to just below the lower lip, its lengthening as it is carried down with the bone should make the lower lip less pushed up.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I was wondering if an intraoral chin reduction could be successful if I don’t have much soft tissue. I know if the mentalis muscle is disturbed it can cause sagging but if it is properly tightened back together could this still happen? What is the likelihood?
A: When the chin bone is shortened from inside the mouth, the muscle is not only detached but now an excess amount of soft tissue results. In other words, there is too much soft tissue for the amount of bone left. That is what creates a chin soft tissue sag or witch’s chin. While tightening up the muscle back to the bone is effective for very small chin reductions (that aren’t noticeable), such muscle tightening will not work for more visible chin bone reductions. The extra amount of soft tissue must be shortened (removed) as well as tightened. So the answer to your question is that intraoral chin reduction is usually a bad idea no matter how well the muscle is retightened. Only a submental (under the chin) approach can adequately remove and tighten the loose soft tissue that is created from chin bone reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have recently consulted with a maxillofacial surgeon who has recommended performing a chin osteotomy procedure. He intends to remove a 3mm wedge (for vertical reduction) as well as a 3mm advancement, with the osteotomy performed at a slight upward angle. I seem to have the unique situation of anterior mandibular vertical excess with a very flat labiomental fold (which would be enhanced by the advancement) What are your thoughts on the success of this procedure?
A: Without looking at photos and x-rays, it would be impossible for me to comment on whether this is a good procedure for your concerns or not. That is a technically sound chin osteotomy procedur and is very straightforward to do. The only question I would raise about it is that these bony movements (3mms) are fairly small. Such small movements are unlikely to make much of an external visible change, albeit a very modest one. To take down the chin bone by osteotomy for this amount of bony movement seems like a ‘solution that is bigger than the problem’. For a horizontal advancement of 3mms, an implant would be far less invasive. For a vertical reduction of 3mms, there is no other solution than osteotomy and bone removal. This makes it a difficult decision in my mind as to whether the problem justifies this degree of surgical effort. I would look at your chin concerns carefully and would reconsider carefully the potential benefits and risks of this type of chin surgery.
Dr. Barry Eppley
Indianapolis Indiana
Q: While I don’t think that I am bad looking, I feel that my jaw line is weak and small. My receding chin greatly distracts from my features and I am hoping a jaw and chin augmentation can help balance my lower face and give me a stronger, more masculine appearance. Ideally I would like to substantially increase my chin size horizontally, to or past my lower lip when viewed in profile as well as add vertical length as my chin is rather short. I also desire to add horizontal width and volume as well as increased vertical length when viewed from the front, or in other words a more “squared” appearance. Along with my pictures, I’ve included a rough depiction of what I am trying to achieve. The altered versions are a “goal” and perhaps you can tell me if they are realistic or not. The problem is I realize extending my chin out this far requires substantially augmentation (probably around 12-15 mm) and don’t really know if my goals are realistic. I’ve been researching your website and understand you do chin osteotomy in conjunction with chin implants. Would this be a possibility? If so are there greater risks in terms of potential nerve damage and bone resorption? Also, with such an invasive surgery, are there any long term complications after say a decade or more?
A: Your own predictive computer imaging is greatly helpful and shows exactly what you want to achieve. I could not have the done the imaging any better myself. Because you desire both horizontal and vertical chin lengthening and are a very young man, I would recommend a chin osteotomy which does a better job of such combined dimensional changes. The chin can probably be advanced about 12mms or so and that should be enough to get that look. The chin can become more squared with an osteotomy by splitting the downfractured chin bone and expanding it apart to create more width. As you mentioned, an implant can also be added to the front of the chin osteotomy to create the same effect. I would have to see intraoperatively which would work the best.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi Dr Eppley, I have read your article about chin reduction. I am a female and I have a long chin and my self-confidence is affected by it. I have attached some pictures for you to see what can be done about it. By the way, I wear a full lower dental denture (one original tooth left) and I have partial upper denture. Most of my remaining teeth has been root canaled. Thank you and looking forward to hear from you.
A: In reviewing your pictures, you undoubtably have a very long chin. But, equally relevant, is that your face has a great imbalance between your upper jaw (maxilla) and your lower jaw. Your midface is very flat and recessed, partly because of your ethnicity but also because it is underdeveloped. This is magnified by your loss of teeth which contributes to your maxillary atrophy from a horizontal projection standpoint. Your lower jaw is very long with a high jaw angle. This combination has created a significant maxillary-mandibular mismatch (short maxilla, long mandible) and is a major contributing factor to your appearance of a ‘long chin’. One of the missing pieces of information is what your bite (occlusion) is like. With these facial bone relationships, you may also have a Class III malocclusion or underbite.
From a corrective standpoint, the ideal approach is to move the entire lower jaw back and the upper jaw forward. This would ideally solve this long chin appearance. But that may be more than you want to do, although having most of your occlusion done by dentures, it is not so far fetched. Short of orthognathic surgery, the other combination would a vertical chin reduction osteotomy and possible paranasal augmentation of the midface. This would not make as big of a change as orthognathic surgery but it would be a noticeable difference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a question about jumping genioplasty. I am curious, if you have had previous chin surgery with indwelling plates and screws as well as possible internal scarring of the muscle that causes creases in your chin when you smile, can you still undertake a jumping genioplasty? Or would the scar tissue and plates and screws from the previous ostetomy prevent this? I understand this makes surgery more difficult to carry out. I was just wondering if it is still possible.
A: While you are correct in that it is more difficult, it is not impossible and sometimes is fairly uncomplicated. The only limiting factor is the plates and screws used from the first osteotomy and how easy they are to remove. The typical osteoplastic genioplasty, if the chin has been advanced, is a step titanium plate with 4 or 6 screws. As long as bone had not completely grown over these metal devices, they are often fairly easy to unscrew and pry out the step plate. But if bone has completely covered these devices, their removal can be very difficult and destructive. Fortunately, complete bony healing over the plate and screws is not common. Once the devices are removed, the osteotomy is straight forward and the prior chin surgery actually makes it easier to complete a secondary bone cut.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am an 18 year old looking to correct “witch’s chin” deformity or chin ptosis. I do not know of any doctors in my area who have experience with this procedure, so I am seeking your advice and hopefully you can educate me a bit more about my case. The problem is that I have a lot of extra soft tissue in my chin that folds under and looks very awkward when I smile. I had a consultation with a plastic surgeon who said he would scrape out some of the fat and pull the skin back. He also said that he would cut the muscle. I know he has not seen this case before and that is why I have not confirmed the surgery with him. How exactly is this surgery performed and what are the different ways to go about it? How complicated is the procedure? What are the risks of going to somebody who has not done it before and how high is the risk of causing a deformity? I have attached some photo of me smiling and not smiling from both a front and side views. Your insight is very much appreciated! Thank you.
A: Based on your photos, you are correct in that you do indeed have a witch’s chin deformity. The smiling view magnifies the redundancy of muscle and skin and pulls it down abnormally over a pointy bony chin. In the truest definition of a witch’s chin, it is a deformity that occurs after some form of bone chin manipulation. Your case is different in that this is a developmental/congenital problem and not an iatrogenic or surgically-caused one. In these non-surgical cases, the bony chin is also protrusive and that can be seen at rest in your profile view. So the actual anatomic proboem is one of ‘too much chin’ from all tissues involved.
Surgical correction is done from an incision underneath the chin, what is known as a submental approach and the overall procedure can be called a submental chin reduction. From below the chin bone is shaved down and excess muscle, fat and skin is removed. The chin is then reshaped by adapting the shortened soft tissues over the reduced bone. This is not a complex procedure but must be done carefully and all chin tissues musts be reduced and tightened. The trade-off is a scar under the chin. I have attached a patient example of the procedure for you to see the results and the scar.
Dr. Barry Eppley
Indianapolis Indiana
Q: My chin is too big and I need it reduced. What is the cost of chin shaving surgery?
A: Thank you for your inquiry. When one mentions ‘chin shaving’, they may really need a submentoplasty with chin burring reduction or they may really need a chin reduction via an osteotomy. It depends on their chin problem as the approach for chin reduction can differ based on the size and shape of their chin bone and the surrounding chin and submental soft tissues. Each method of chin reduction also differs in cost. Therefore, before providing a surgical fee quote please forward to me some photographs of your chin and what specific dimensional changes you want to see.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr Eppley, I am an Asian female. I have had an advancement chin osteotomy, 4mm forward and 2mm downward. But the result makes me have a long flat face with wider chin. As it’s not just the tip of the chin move forward but also the wide chin so it’s not good. I am guessing that the chin bone should be trimmed and I was wondering if it can be done in 2 to 3 weeks after the chin osteotomy has been done? It seems the swallow is not yet gone, is it good for immediate surgery again? Also I will do a facelift with fat transfer with other surgeon. I was wondering if I should wait and to have the chin bone trimming and facelift done at the same time, rather than do the bone trimming now? If I can’t do them together, how long should I wait before each of the steps? I look forward to hearing from you very soon.
A: Based on your description, it sounds like your chin osteotomy was just done. Your chin bone movement was very small and I doubt that amount of bone movement would make your chin ultimately look wider. I think what you are seeing is swelling, particularly if it has just been done in the past few weeks. You can not really judge the dimensional changes after a chin osteotomy, particularly width, for several months. I would advise waiting 3 months and then see what you think. There is no reason you can not do some chin reshaping if needed with a facelift and fat transfer later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a chin implant done on 2/1/2011. It was a 7mm projection Mettleman style. The right side looks wonderful and I cannot feel the implant really at all. On the left side, however, the implant traces nicely along the edge of the jawbone until aproximately the last 8mm of the wing. At that point it swings upward at about a 40 degree angle. The wing can be felt intraorally with my finger near the bottom of my mouth on that side. Aesthetically, on that same side, there is a jowling effect. I do not know if this is due to the free floating wing or if the wing has pushed other tissue upward and created a lump or ball. My surgeon has suggested that we wait 6 weeks and then go in intraorally and either “tuck” the wing back under the periosteum or simply snip it off IF it is beyond the point of the pre-jowl sulcus, thus accomplishing the pre-op goal of filling in that area. He described it by saying that that what is now the “floor” of the pocket where the wing is malpositioned will be the “ceiling” if we tuck it back under the periostium. I believe he would suture the ceiling so as to ensure the wing doesn’t communicate with the previous pocket and again migrate north. Does this sound like a reasonable plan to you?
A: With today’s extended chin implants, exclusively those made out of silicone, the most common complication is wing malposition. The ends of the silicone implant wings are very thin and easily bent or folded onto themselves if the pocket made during surgery is not fully developed and extended enough to accommodate the full length of the implant. Because you can feel the end of the implant in the vestibule at the side of your mouth,it is bent up in that direction which also causes an implant to create a bulge in the jowl area. There are several approaches to fixing the malpositioned implant wing. The intraoral approach is one and is the easiest. The implant can also be removed, the pocket extended and replaced but involves ‘more surgery’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a chin reduction by bone burring 2 months ago. Not only do I see no change in the size of my chin, but I now have a witch’s chin/double chin due to the scar under my chin. I feel like I should wait to address this, but I am in a very public position and need to fix this as soon as possible. It is affecting my work and my self-esteem. Is it too soon to do a revision?
A: With the story of a recent chin reduction by burring, you almost certainly had an intraoral (inside the mouth) approach to your chin procedure. When this is attempted, two results happen after surgery. First, little to no change is ever seen in the amount of chin projection as just the very edge of bone has been work on which is inadequate. Secondly, and a much worse problem, is the chin ptosis or sagging that can occur due to the disinsertion of the mentalis muscle and the degloving of the chin soft tissues. The intraoral approach requires a very careful reapproximation and resuspension of the muscle if this is to be prevented.
The best time to correct a chin ptosis/witch’s chin is earlier rather than later. The more time that passes allows more scar tissue to form and can make a good correction more difficult. There are several different methods of correction depending upon the end goal and tolerance to an external scar. The chin soft tissues can be resuspended from an intraoral approach which will leave no visible scar but will not make for any chin reduction. The other approach for chin ptosis repair is from under the chin where both bone and soft tissues can be reduced, solving two problems, but leaving a submental skin scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: For most of my life I have considered myself ugly. I avoid having pictures taken and I most certainly don’t look at them if they have to be taken. I have a total lack of confidence and this has definitely poses problems in my personal relationships. I don’t know what it is about my face but it just doesn’t look right. I am only 29 but I look much older. My eye area looks droopy and old and may face looks thin and distorted. I have attached some pictures for you to see and review. What would you recommend to help me look better ?
A: When someone doesn’t like their face, particularly at a young age, this indicates that the problems are with how it is put together (structural components) not that it is has early aging. This means the underlying structures that make up the shape and highlights of the face which are largely bone and cartilage. In reviewing your pictures, I can see that your face has unbalanced structures which include low hanging brows, a broad and prominent nose, hollow cheeks, and a wide and long chin. The combination of these features creates an overall facial look that you do not like. Procedures such as an endoscopic browlift, rhinoplasty, cheek implants and chin reduction collectively would make a major change in how your face looks. It would lend a softer and more youthful due to a better balance of your facial features. Computer imaging with these changes would demonstrate their potential benefit in changing the shape of your face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a sliding genioplasty just one month ago in January 2011. It was advanced 8mm and I feel it was too much. I do not like how my chin looks. It is not a natural look. I also lost almost 2/3 of my lower lip which make the chin even bigger. It really has changed me a lot. I was wondering what can be done to recover the fullness of my lip. I am even considering a reverse genioplasty to bring it back to 5mm even though the cephalometric analysis says that I am short 9 mms. How long should I wait for a revision and any further interventions?
A: Now that you are roughly 6 weeks out from your initial chin surgery, most (but not all) of the swelling should have subsided. While there is some final swelling and stiffness of the chin that needs to go away in the next few months, that will only change the chin projection by maybe 1 to 1.5mms. Therefore if you feel the chin is too strong at this point, then it is and your decision to set it back some more is reasonable. A change from 8mm to 5mm is reasonable since it takes at 2 to 3mms to really see any difference. The time to make that change is NOW. The bone is not yet healed and it is a relatively easy plate and screw exchange to do the revision.
When you say you have lost ‘2/3s of my lower lip’, I am assuming you mean that you have a drooping lower lip otherwise known as lip incompetence or sag. Unlike chin swelling where time will make some of it go away, time will not lift up a sagging lower lip. This is a function of the mentalis muscle position/resuspension on the chin bone. To imrpove that situation, the muscle need to be lifted up higher in the bone and secured. This will help the lower lip get back to a more normal position. The sooner this is done the better as muscle scarring is occurring. So again, NOW is the time to revisit this with your surgeon and have these discussions.
Reversing/revising the effects of a sliding genioplasty are best done early before complete bone and soft tissue healing has occurred.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dear Dr Eppley. I am wondering if it is possible to get a variation of genioplasty done.
I am wanting to reposition my chin bone higher up. In reduction genioplasty the chin tip is sawn off, a wedge of bone is removed and the chin repositioned back.Is it possible to saw off the end of the chin, then without removing any bone, reattach the sawn off tip at a higher position? This could help address saggying tissue as the higher position of the bone could help lift the surrounding tissue. This would leave a bony ridge on the chin, however this could be hidden with fillers.Does this type of surgery sound like something you could do? Thank you.
A: That is known in chin surgery as a ‘jumping genioplasty’. That places the cut piece of chin bone on top of/in front of the upper chin segment. However this will bring the chin forward and make it more prominent, although it would lift up sagging chin tissues and shorten its vertical length somewhat.
By your descriptions, I think you may have an erroneous concept of how chin osteotomies are done. It is important that the cut piece of chin bone remains attached to the muscles which provide it with a blood supply, otherwise it will die and resorb away. It is not just moved anywhere else one wants to put it.
Perhaps you could send me some pictures so I could see what type of chin problem you and what may or may not work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, I had submental chin implant revision surgery and lipo under the chin. The incision was made in my natural crease and is extremely apparent. Also, it seems as though after the surgery, I have jowls that I have never had before. People think I lost a lot of weight. Is there anything that can be done to correct either situation reasonably? Thank you for your time.
A: The placement of a submental (under the chin) incision for chin augmentation is a fairly simple and straightforward consideration. Most people have a skin crease on the underside of their chin and this is a logical incision location. But depending on the location of this crease and the size of chin implant to be placed, this may not always be a good location. The chin skin stretched forward due to the push of the implant and what was once a hidden location may become more visible. For this reason, I often move the incision location slightly behind the submental skin crease to avoid any potential that it may become visible. Once the incisional scar location is set, there is no way to relocate the scar.
The development of jowls after chin augmentation may be the result of the wings or sides of the chin implant. Chin implants today are more anatomic in design and often will have long extensions that go back from the sides of the chin into the body of the jaw. If these wings get folded unto themselves and are not fully extended due to a pocket dissection that was short, the folding of the implant’s wings could create the look of jowls. If this is the problem, it can only be resolved by revisional chin implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I read your article where you speak about chin implants and you say: “Lateral or wing malpositioning is actually the most common problem and is a result of the newer styles having thin and more floppy wing extensions which can easily fold onto themselves” . I would be most grateful if you could advise on the best way to correct misplaced wings on the side of the jaw.
A: Unlike chin implants of old, most contemporary chin implant styles are more anatomic in design and shape. This means that rather than having a simplistic button or oval shape that just sits on the very end of the chin bone, they are longer and wrap around the bone to flow more confluently into the body of the mandible. This gives them long wings or lateral extensions along their sides. With silicone chin implants, these wings have thinner material thicknesses that end in minute paper-thin extensions. Because silicone is flexible, this makes them prone to fold upon themselves or buckle if the implant pocket is not dissected far enough back. Also they can ride upward or downward based on the angulation of the pocket dissection. Either way, these implant wing malpositions will be felt or seen as a lump or bump along the jawline. With Medpor chin implants, these wing malformations do not occur as the material is much stiffer and not flexible so the ends do not bend.
With chin implant wing malformations, the only way to correct them is to do an open revision. The implant is removed, the pocket checked and dissected further if needed and the implant then re-inserted. In some cases, the fine ends of the wings are removed as they serve no volume or contour purposes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr Eppley, I am a boxer and wanted to get a sliding genioplasty. I am recessed by about 10mm’s and was wondering if I would be able to box after this chin surgery. If so, how long after surgery can I do so? Thanks for your time.
A: For your chin deficiency, a sliding genioplasty is probably a more wise decision than an implant given your boxing avocation/occupation. A chin implant may have also worked as long as it would be secured with 3 to 5 screws. It would have a quicker recovery and return to boxing (1 month if contact to face may occur, training part doesn’t matter) but there is always the potential for some implant related problem long-term if struck on the chin. (which I assume is common on boxing) For a chin osteotomy, the return to contact boxing should be 3 months at least although training could occur at any time one felt comfortable. You could argue that the bone is not really healed in a big advancement (10mms) for up to 6 months so this is a more conservative estimate. With the osteotomy in your case, I would secure it with more than the traditional chin plate (step plate) and 4 screws. I would probably add a small plate on each side of the sliding genioplasty for the extra security of the bone position.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in having a cleft put into my chin. Can you tell me how this is done, how successful it is, and is there any visible scarring as a result. Thank you for your time.
A: There are chin clefts and chin dimples. I assume you are very specific about a vertical chin cleft. They can be created anywhere from a hint of a cleft to a very prominent one but the techniques to do so are different. A subtle to moderate chin cleft (most natural) is done by notching the bone internally, removing a wedge of mentalis muscle and fat, and then sewing the underside of the skin down towards the bone with suture anchors. Very deep chin clefts can be created but that requires a vertical incision in the outer chin skin which would only be acceptable in those desiring a very deep cleft almost down to the bone. This is more unnatural looking in my experience. The most commonly done chin cleft surgery is performed from inside the mouth where no external scarring is created. It is a highly successful procedure which will initially look a little deep or overdone but some relaxation of the depth of the cleft will occur to create a more natural look.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have been attempting to learn the pros and cons of chin surgery. I really want my chin longer and want to know in your opinion if it would stretch my lower lip and expose too much of my lower teeth when I smile? In addition, if I had a chin implant could a widening chin implant be used to square my jaw and length it?
A: Lengthening of the chin usually means increasing the vertical height of the bony chin. Some may use lengthening in terms of a horizontal increase or projection. I am assuming by your question that you mean a vertical increase. Whether the vertical height is increased by an osteotomy with an interpositional graft or an implant, neither approach will stretch your lower lip and expose any more tooth show. That simply doesn’t happen with vertical chin lengthening and is not a concern. But there are differences, however, in how much vertical lengthening can be achieved by the two techniques. An implant can only lengthen the chin by being placed on the edge of the bone, creating a lengthening of maybe 2 or 3 mms. In contrast, an osteotomy can lengthen a chin up to 10 or 12mms which is a significant difference.
Square chin implant styles do exist but they will have only a minimal, if any, vertical lengthening effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a chin reduction a couple of years ago and although I am happy with the new shape of the bone, I now have hanging soft tissue. Needless to say I am not happy with these results. I have visited five plastic surgeons and none of them wanted to fix this problem saying that it was dangerous to cut or reattach the muscles and the ending results could be worse. I am very dissapointed and have attached some before and after pictures for your review. I hope you can help.
A: Your pictures show quite clearly some soft tissue sag or ptosis off of the chin bone. It is most pronounced centrally which is what one would expect given that your chin reduction was most likely an intraoral burring approach done to the central button. To improve this problem there are two approaches, intraoral muscle resuspension or a submental tuckup. The intraoral approach uses a suture anchor to the bone to reattach the muscle and tighten it back done. This is a scarless approach. The submental tuckup uses an incision under the chin where the loose skin and muscle is removed and tucked or tightened to the bone. Each has its own advantages and disadvantages. The intraoral approach avoids a scar under the chin but the submental tuckup is a more reliable method.
There is no danger to performing this procedure and there is no chance of making the problem worse. Whoever has said has either never treated the problem or is completely unaware that such surgical correction exists.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in getting a chin implant to make my weaker chin look better. It seems like a fairly simple procedure but this bone resorption underneath the implant sort of scares me. Why does this happen? Is there any way to avoid this bone reorption if I get a chin implant?
A: The phenomenon of bone resorption under a chin implant is a much talked about finding for many decades. One of the reasons that it occurs is due to a pressure issue with the implant sandwiched between the soft tissues and the bone. While the implant pushes the soft tissue out, causing more visible chin projection, the soft tissues do apply a small amount of pressure or recoil back over time. Since the implant is not going to resorb because it is an inorganic synthetic material, that leaves the underlying bone to accomodate and relieve this pressure.
This pressure situation is really magnified with implants that are placed too high on the chin bone. This happens when chin implants are placed from inside the mouth and are not secured down to the lower edge of the bone. It can also happen from a submental chin incision approach but is much less common because it it easer to keep the pocket of the implant low. The observation that it does not occur with more contemporary anatomical chin implants is because the wings of the implant keep them from riding up higher, acting like lateral stabilizing bars. From either approach, if the implant ends above the basal bone of the chin (which is thick cortical bone) it rests on bone with a much thinner cortex. This is where bone resorption will be seen with chin implants. It is a function of bone position and is not an actual feature or result of the implant or its material composition per se. This bone resorption phenomenon (which is largely benign and not of any great signfiicance) can be completely avoided by proper implant position on the lower edge of the chin bone. This will also maximize the benefits of the horizontal projection that the chin implant provides, some of which is lost if it gets malpositioned higher as it slides up and back.
Dr. Barry Eppley
Indianapolis Indiana