Your Questions
Your Questions
Q: Dr. Eppley, I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.
A: In answer to your questions:
1) No.
2) Yes.
3) Yes.
4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some sliding genioplasty questions. I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.
A:In answer to your post sliding genioplasty questions:
1) No.
2) Yes.
3) Yes.
4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a few questions about sliding genioplasty surgery.
1. I had a sliding (osseous) genioplasty last summer, but I still have a decent labiomental crease. I am not experiencing tightness unless I really pull by lower chin down, but it’s not bothersome. My surgeon is suggesting hardware removal (since he says it’s pulling the skin in, and scar tissue accumulates there), some bone shaving, and fat grafting. Hardware removal doesn’t seem promising, and bone shaving seems counterintuitive. Do you think these suggestions will help reduce the fold?
2. Does hardware add any projection, and will removal reduce projection?
3. Does cutting into the mentalis muscle and soft tissue again increase the chance of nerve damage? (Luckily I had no permanent numbness from the first procedure.)
4. Unrelatedly, I’m considering jawline implants, but I am fearful of bone resorption. (This is why I avoided chin implants.) Is this a risk of jawline implants?
Thanks so much!
A: A deeper labiomental fold is not going to be improved by hardware removal or bone shaving after a sliding genioplasty. That is a failure to appreciate the anatomic basis of the problem. This is the resilt of a change in the shape of the chin bone which now has a deeper concavity or stepoff beneath the labiomental fold. This bone area needs to be built up on top of the plate for which a dermal-fat graft works well for this problem.
Numbness comes from injury to the mental nerves which lies way to the sides of the mentalis muscles.
The best way to avoid the remote risk of bone resorption with jaw implants is to not do them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty and jaw augmentation using hydroxyapatite several years ago. The jaw is asymmetric and bumpy, and the chin was moved up instead of just forward. I wanted to have the HA paste along the jaw re-contoured if possible, and the genioplasty revised to give me some more vertical height and more projection too if possible. I also have loose skin on my neck from the massive amount of swelling that I had after the procedure. If you could give me a breakdown of the procedures id be so grateful. (Jaw HA paste contouring/ revision Sliding genio / neck lift/tightening) thanks!
A: The angle of the bone cut on the sliding genioplasty obviously created a vertical shortening effect as the bone was brought forward. Moving the chin back down and out further can be done by a repeat of the sliding genioplasty. The HA granules appear to have been used to try and create a posterior jaw angle augmentation effect. HA onlay application to the bone very often creates an irregular surface contour as it heals and bone grows into it. The HA granules can not be removed per se but they can be contoured (burred) down to create a smoother contour. As for the neck, it is impossible for me to say what may be beneficial since I don’t know what your neck looks like. Real neck tightening comes only from a lower neck/jowl tuck-up. I would assume you are young so this procedure seems a bit aggressive for your age but the problem may warrant it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty after I had braces for 2 years to fix my bite. I thought my chin was large and I wanted it reduced. I did not like the results. I felt like my face looked fatter and as though there is extra tissue/bone under my chin. My oral maxillofacial surgeon told me that if he removed the screws and plate from the previous surgery it would not make my chin look as big and I thought he was going to shave off the bottom part of my chin that appears to stick out but the only thing he did was remove the one screw as he said he couldn’t remove the other one. My chin looks very asymmetric to me and there are indentations and lines that I do not like. I was wondering what your opinion is and if there are any options to improve my appearance. I have more pictures I could send if it would be helpful. Thanks!
A: Thank you for your inquiry. I suspect you originally had a reverse sliding genioplasty to fix a protruding or big chin. This operation is always never a good idea because even though the horizontal projection of the chin may be less, the chin will look wider in the front view and a bulge or increased fullness will occur under the chin. These are the exact symptoms that you developed after your sliding genioplasty. While your surgeon meant well, removing the fixation hardware would not have made any difference in how it looks even if all the plates and screws could be removed.
While I would need to see your after surgery x-rays, the correct treatment now is a submental chin reduction approach to vertically shorten and narrow its width. At the same time, liposuction and a submental tuck needs to be done to smooth out the contour under the chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 19 and have a weak chin which I am beyond self conscious about. It is not extremely weak but it still makes my profile and resting face cringe worthy to me when people take photos of me. I do not feel comfortable getting a chin implant but also can’t afford to get chin fillers to fix the problem every six to twelve months for the rest of my life. I’ve considered fat transfer but would be devastated if the fat didn’t survive or became lumpy. I have come across Dr. Eppley on Real Self and am impressed with his knowledge about sliding genioplasty. I am a petite girl with a skinny face and well defined jawline (5’2 113 pounds). I am wanting a small amount of advancement forward and an even smaller amount if none at all of vertical advancement. However, given my skinny face, I am so incredibly afraid of having a “step off” or notch in my jawline. I am wondering if a 4 to 5mm advancement would create this irregularity in the jawline or if it is preventable. I am also afraid of nerve damage and want to know how common this is. Thank you so much.
A: There is no question that the smaller the amount of chin bone advancement by sliding genioplasty the less chance there would be for a notch or step off along the jawline. In my experience, I have not seen cases that I am aware of that has had permanent inferior alveolar nerve numbness. Just like the notch along the jawline, the smaller the chin advancement the less likely there is of a risk of nerve injury.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty to correct my weak chin and create a longer jawline. I have fullness at my lower half of the jaw which is actually bone even though it looks like jowls. I have a bone notch half way down my jaw where the bone comes out so the jaw looks fuller and looks too masculine for my liking from the front. I’m not sure where the cut from a sliding genioplasty is but if it is quite far forward so this part of the jaw can be shaved down a bit in addition to moving my chin?
A: Your question is a good one as it relates to the width of the jaw behind the chin where the location of the sliding genioplasty is performed. The bone notch to which you refer is actually normal and is known as the antegonial notch. As the jaw bone descends from that area it can sometimes get a little wider. Whether it can be safely reduced depends on the exact location of the width and its relationship to the mental nerve from the bone which exits somewhere close to that area. While to may be aesthetically desired to reduce it you also don’t what to potentially cause permanent numbness to your lower lip and chin either. The bone cut from a sliding genioplasty is a horizontal one and usually goes back behind the location of the nerve. This bone segment moving usually creates a more narrowing effect to the jawline as it becomes longer. In some cases it may be possible to reduce some of the bone behind it but if I think that the mental nerve is at risk for injury I won’t do it. It all depends on where your mental nerve comes out of the bone in relationship to this area of bone width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to get cheek implants, a sliding genioplasty and jaw angle reduction.My question is that I have just had maxilla advancement jaw surgery (LeFort 1 osteotomy) one months ago. Only the maxilla was moved forward. The mandible was not moved. How long is necessary to wait before I can come see you to get these surgery procedures done? I worry the maxilla may be banged in the surgery or after 4 weeks is this not a problem?
A: Since you just had a LeFort 1 osteotomy just four weeks ago, I would wait a full 8 weeks before doing any surgery that would involve re-entering the surgical site (cheek implants) This is not because the maxilla has any change to be displaced. (it is undoubtably rigidly secured into place with plates and screws) but because you want all the swelling to get out of the cheeks so you have a good idea when placing cheek implants so that the style and size of the implants could be best judged. As it relates to the mandibular procedures (sliding genioplasty and jaw angle reduction) the previous LeFort 1 osteotomy has no impact on their execution and vice versa. But waiting until all facial swelling has resolved is still worthy of the wait.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a large chin button and excess soft tissue padding as well. My oral surgeon plans to slid the chin button (sliding genioplasty) during a jaw surgery but can you reduce the soft tissue afterward? Does this sound reasonable?
A: In interpreting your question, I assume you are having a sliding genioplasty done with a sagittal split mandibular advancement osteotomies. Having a large chin button implies that there is a bony knob on the end of the chin. Onto which you are saying there is a large soft tissue chin pad on top of this chin button. Your question then implies there may be an excessive soft tissue prominence of the chin after the sliding genioplasty is done and whether this can be reduced secondarily. While I would think it can that is a statement made without any knowledge of what your chin looks like or what the lateral cephalometric x-ray shows before the surgery. (how thick does the soft tissue chin pad appear) While this would be an unusual sequence of chin procedures (sliding genioplasty followed by secondary soft tissue chin reduction), for now let us assume it is appropriate to be done.
Dr. Barry Eppley
Indianapolis, Indiana
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: Dr. Eppley, I was previously going to have a chin implant with screw fixation. At the time, I was planning to get one and was planning to consult with you. I’ve done a lot of research since that time and have come to the realization that I’d like to address my issues with bimaxillary advancement as my entire jaw region isn’t adequately projected and I have a “fleshy neck” appearance in photos and on video. My airway is also smaller than it should be and obstructive sleep apnea is an issue.To the point – I’m debating getting a sliding genioplasty in conjunction with my bimaxillary advancement to advance the chin horizontally. I want my chin to be closer in line with my lips and I did not know if bimaxillary surgery alone would address this or not. Would a sliding genioplasty be a bad idea (too deep labiomental fold afterward)? Thank you
A: Having done lots of orthognathic surgery, including bimaxillary advancements, the only reason to pursue that course is for the purposes of improving sleep apnea. From an aesthetic standpojnt, bimaxillary osteotomies along would not cure the weaker chin and fleshy neck appearance that is of concern to you. That anterior movement of the mandible, in the range of 6 to 8mms, would help your chin projection but since the upper jaw is coming forward it would not provide the ideal correction. Cephalometric tracings would verify the accuracy of that statement. A sliding genioplasty would still be needed to provide the aesthetic goal of making the chin be closer in line with the lips. The bimaxillary advancement would make the amount of amount of the sliding genioplasty less however. All forms of chin augmentation, including a sliding genioplasty, will make the labiodental sulcus deeper. That is unavoidable but a 4 to 5mm sliding genioplasty advancement would not make it that much deeper or would make for a minimal adverse change in its depth.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very happy with the buccal fat removal and perioral liposuction you did on me a few years ago. I still feel that my face lacks definition though and have been researching lower jaw surgery/sliding genioplasty and vertical lengthening chin implants and wondering if one of those procedures would be beneficial for me to get that angular, taut lower and mid facial structure that a lot of models have. A jaw/chin that has extra projection seems to produce a concavity in the para nasal area that think is really pretty…I know I have an overbite but it’s not severe and I am hoping to avoid having to go through orthodontics and jaw advancement IF a sliding genioplasty and/or a custom chin implant would yield the same results. I have attached some photos of the look I am aiming for (as well as one of myself for reference) and would like to know if you think I could get close to my “ideal” with a genioplasty/implant or if lower jaw advancement is really the best treatment (for aesthetic purposes only). I always feel myself involuntarily jutting my lower jaw forward (it feels more comfortable that way and it also makes my face look better). My face just looks better from ALL angles when I’m projecting my jaw forward. Since I’m already 31 I would like to get started right away, especially if the best choice is jaw advancement since I would have to have braces before and after that.
A: To best answer your question about chin lengthening, I have done imaging based on some old pictures that I have of you of a combination chin lengthening and small jaw angle implants for the more complete jawline effect. You definitely do not need to move the whole lower jaw with orthodontics. That would not produce the same result. The choice is really between a sliding genioplasty vs a custom V-shaped chin implant. Both theoretically could achieve the same longer chin, they are just two different ways to get there. You already have a pretty V-shaped chin and you are young so I am leaning towards the sliding genioplasty because it is more ‘natural’ and would even accentuate the V-shape of your chin. I simply put in the small jaw angles just to give you a little more width and squareness to the back of the jaw…which is what all those models also have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty done two months ago and I think that it has shifted. I am not sure if there is a gap on part of it because of the shift. I would like your opinion and evaluation.
A: Thank you for your inquiry. I understand that you think your sliding genioplasty has shifted. Did you have any x-rays after surgery or any now that would help understand if that is what has happened? It is also possible that as all swelling has finally subsided any asymmetries can become more apparent which are masked for the first 4 to 6 weeks after surgery due to the swelling. Please send me some pictures or anything that shows where you see the chin/jawline asymmetry. It is also more likely than not that the gap you see is the step-off at the tail end of the sliding genioplasty along the jawline behind the chin.
An under appreciated aspect of any sliding genioplasty is that it causes a disruption of the inferior border of the jawline. Depending upon the angle of the bone cut and the amount of forward advancement of the chin, the inferior border disruption may be minimal or significant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty done two months ago and I think that it has shifted. I am not sure if there is a gap on part of it because of the shift. I would like your opinion and evaluation.
A: Thank you for your inquiry. I understand that you think your sliding genioplasty has shifted. Did you have any x-rays after surgery or any now that would help understand if that is what has happened? It is also possible that as all the swelling has finally subsided any asymmetries can become more apparent which are masked for the first 4 to 6 weeks after surgery due to the swelling. Please send me some pictures or anything that shows where you see the chin/jawline asymmetry. It is also more likely than not that the gap you see is the step-off at the tail end of the sliding genioplasty along the jawline behind the chin. This can be more apparent on one side or the other and is more common if the sliding genioplasty movement was significant or the angle of the bone was at least 45 degrees or greater. The bigger the bony movement and the greater the angle of the bone cut, the more likely jawline indentations will appear after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had sliding genioplasty surgery couple of days ago and moved forward 8-9mm.I hate my bottom lip got 1/4 size of my original one! It’s a heart attack and I loved my lips! Did you see any improvement in lip’s size after a while? Should I reverse the surgery?Attached are some picture of before and after 4days surgery. I really liked my bottom lip and I feel the suture are tok high that locked my lower lip and I doubt if it loose even after it heals. The reason might be because of the 8-9mm projection on my chin or the surgent personal desire to balance my lower lip without letting me know in advance. As I know he moved my chin 8mm out and little down. Now I can’t accept new round face and nice bottom lips are gone! What I wanted to have was a little projection! What do you recommend? I am thinking to revise partially before my bone get heal! Although I am worry because it might not give my pervious face and lips back! So appreciated for the help.
A: Thank you for sending your before and after sliding genioplasty pictures. I think it is extremely important to realize that you are just 4 days after surgery and the chin always gets tremendous swelling…which is why your face seems round right now. That will change over the next three weeks as some of the swelling subsides. I see no evidence that your chin is ‘overdone’ or been advanced too far. I think from an augmentation standpoint that you should wait much longer as it takes a good 6 weeks to really appreciate the final result. As for the your lower lip, it is very common that it feels very tight. This will always loosen up much more than it is now.
I think right now you are going through ‘buyer’s regret’ which is not uncommon with all the swelling and tightness and the uncertainty of what will be the final outcome. It is not rare that one yearns for what they look like previously when going through the early recovery period after many forms of facial structural surgery such as a sliding genioplasty.
I would urge you at this point to have more patience and give it two to three more weeks to see how you feel then. The osteotomy can be easily partially or fully reversed even months after the initial surgery date.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am really confused about the types of surgery best suited for me. I do know that my face is too masculine. My cheekbones are too wide, my jaw is angular, and my chin is too long. I have no facial fat or cheeks. I am also wondering about an eye lid and upper and lower lip lift, or some type of lip contouring or mouth reshaping. I like full lips, but my lips seem to protrude and the top lip is really wide when smiling. I don’t know if I need a jaw reduction, chin vertical height reduction, or sliding genioplasty with a reduction in height.I would also like rhinoplasty and possibly a facelift. Overall, my face is just not feminine at all to me and my hair line and forehead looks masculine too. Thanks for your help.
A: Thank you for your inquiry. Based on an assessment of the pictures you sent, let me try and provide you some direction. First of all, let’s start out by eliminating what you don’t need, won’t work or isn’t worth the aesthetic tradeoffs. You would not benefit by a facelift, eyelid lifts or lip lifts. There is nothing you can do about your lip protrusion or how far the upper lip moves when smiling. Your cheek bones are not too wide but they do lack any anterior projection. (fullness) That lack of projection makes you think your cheekbones are wide when they are not. Cheek augmentation here may be beneficial.
Your biggest issue is that your lower jaw is short and angulated downward. This makes the chin horizontally short but vertically long. An intraoral bony sliding genioplasty to vertically shorten your chin and bring it a little forward would be very helpful in getting away from a masculine look.
Your forehead looks masculine to you because it slopes backward. Forehead augmentation to create a more projected and convex forehead shape would make it look more feminine.
In short, your face appears masculine because of its skeletal structure. These are bony issues and changes in the shape of the facial skeleton of the chin, cheeks and forehead would create the appearance of a face that has more anterior projection and less vertical height.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of a sliding genioplasty. I have visited an orthodontist, oral surgeon and plastic surgeon so far. My goal is to improve my profile, solve the mentalis strain and lip incompetence, balance my front face (not a too long or too short chin) and most importantly, not to create more problems. The concern I have now is that how I can improve my profile without making my chin too long. I have a very round face and I will be happy to keep it that way if possible.
A: Thank you for sending your pictures and x-rays in consideration of a sliding genioplasty. Given your young age and your degree of chin deficiency, I think you are a very good candidate for a sliding genioplasty. How much horizontal advancement is yet to be determined but it would be at least 7mmm to 8mm. Such horizontal advancement should resolve your mentalis strain and lower lip incompetence. To maintain the vertical height of your lower face, the angle of the bone cut should be slightly angled backward and the chin vertically shortened as it is brought forward. Unlike a chin implant only a sliding genioplasty can bring the chin horizontally forward and make it vertically shorter at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of a sliding genioplasty to treat sleep apnea. Can a sliding genioplasty be billed to insurance at all?
A: The question that you are asking is whether insurance will pay for your sliding genioplasty as a medical necessity for your sleep apnea. That is not an unreasonable question but one that can only be determined by the submission of a predetemination letter to your insurance carrier. To do this requires the following information to be submitted:
1) Pictures (which you have)
2) Sleep study results that show you have a high AHI
3) X-rays which show a short jaw.
Once I have this information then a pre letter can be submitted. Only the insurance company can make the decision for approval or denial for the sliding genioplasty but they must have all of the required information for you to have any shot at all of potential coverage.
As an aside, I am not aware that a sliding genioplasty is a primary procedure for improving sleep apnea. It may offer some mld improvement but major skeletal advancement through maxillomandibular osteotomies is usually what is required to make a major improvement in severe sleep apnea problems. A sliding genioplasty is an anterior pull procedure while maxillomandibular osteotomies are a push procedure which is more effective for opening the airway.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I underwent an 8mm sliding genioplasty three years ago. Overall I consider it a big improvement for my face, but now instead of lacking a chin, I have a step-off deformity on the right jawline. It is quite visible (you have to look straight to it thought). I could live with it but I’d also be much free from concern if I could get rid of it. Is there any way to fix and unify my jawline, preferably without major surgery? Thank you very much. Kind regards.
A: Step-offs along the jawline after a sliding genioplasty are common particularly the greater the horizontal movement and the more steep the osteotomy cut is. The simplest method to treat these jawline irregularities after a sliding geniplasty is to fill in the defect from an intraoral approach. There are a variety of material options but hydroxyapatite granules or the layering of porous mesh over it is the most common way I do it. It is a surgery but I would not consider it major surgery compared to a sliding genioplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty for functional purposes. I am a 40 year old female with moderate obstructive sleep apnea with an AHI of 24 and 90% oxygen saturation at night while sleeping. I also have a very recessed chin and need a sliding genioplasty to both improve my obstructive sleep apnea and my cosmetic appearance. Maxillomandibular advancement osteotomies is not feasible for me. What type of sliding genioplasty is best, a mortisized genioplasty or a straight horizontal osteotomy? A craniofacial surgeon told me I need the mortisized type with a 4mm advancement.
A: I think what you are referring to is the difference between a straightforward sliding genioplasty and a ‘jumping’ genioplasty. I am not completely sure what you mean by a ‘mortisized genioplasty’ as that would refer to a bony genioglossus advancement only which would have no cosmetic benefit. That choice depends on which will give the greatest amount of chin advancement (which you need for your OSA) and what impact that would have on our appearance. With plate fixation the concept of a jumping sliding genioplasty has less significance than it did when only wire fixation was used. I would need to see pictures of your face and x-rays to best answer your question as to the optimal method of a sliding genioplasty for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in making my chin vertically longer. I consulted a Oral and Maxillofacial Surgeon where he took x-rays and he said that I should probably do jaw surgery because he cannot do a sliding genioplasty of more than 3 mm without any hip bone grafts. Is this true? I definitely do not want to do a corrective jaw surgery because of the high risks. I would be okay with doing a sliding genioplasty but I am concerned with the involved hip procedure. Do you have pictures of patients who have had custom implants for the jaw and chin so i can see the results? Will they be similar results to someone doing a sliding genioplasty? Also how long is each of these procedures and recovery time?
A: It is absolutely not true that a vertical lengthening sliding genioplasty requires a bone graft. While a gap will be created between the two bony chin segments, the use of a synthetic hydroxyapatite block works quite well as the interpositional graft. There is even some debate as to whether this bone gap needs to be treated at all. But certainly a bone graft is not needed in my experience. I have never placed a bone graft in the many vertical sliding genioplasties that I have done.
The vertically opening sliding genioplasty and a custom implant can have very similar effects. The only potential difference is at the jawline behind the chin and how well the bony genioplasty cut blends into it. But from the front view there would be no difference in the chin lengthening effect.
Both procedures requires several weeks for most of the swelling to go down. Recovery will also involve some temporary chin and lower lip numbness. (bony genioplasty only)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a more elongated lower 3rd of my face with less of a square look. I previously had liposuction done underneath my chin but it has never improved. Will the chin augmentation improve this area? Also, approximately how much length in mm is needed to achieve what I am looking for? Thank you!
A: You have a very distinct chin augmentation need. Your square jawline and distance between the base of the nose and the chin indicates that there is a vertical lower facial deficiency. I would not have expected liposuction under the chin to change what is a skeletal issue. There are twi fundamental approaches to managing a vertical lower third of the face deficiency. If it is just located anteriorly a vertical lengthening sliding genioplasty or a custom vertical lengthening chin implant can be used. If one feels the entire jawline is vertically short from front to back only a custom jawline implant that lengthens the entire jawline can be done. In looking at your face my feeling is that a vertical lengthening sliding genioplasty would probably be the best choice. In my experience at least a 7mm vertical increase is usually needed to make a noticeable vertical chin augmentation change. This is done by an open wedge bony genioplasty where the front edge if the bone rotate down while the back edge of the bony cut keeps the bone in the same position. The exact measurement of vertical chin lengthening needed can also be determined by two other methods. One can open their lower jaw to the vertical chin length that looks good to you and measure the created distance between the front teeth. One can also take measurements of their facial thirds and then see how short in millimeters the lower facial third is. I would do both methods to see how well they correlate so you can select the most effective vertical chin augmentation improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jawline reconstruction.I had upper and lower jaw surgery in 2012 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 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 jawline enhancement surgery doing a sliding genioplasty and jaw angle implants. Can the chin surgery be done at the same time as adding jaw angle implants? Would these custom implants be of a material that would be able to last a lifetime? I’m only 25 years old and have already gone through so much with my jaw and teeth that I wouldn’t want to go through with another surgery, but I am very unhappy with the way my face looks currently. I think that a sliding genioplasty with the jaw angle implants would be ideal because I agree that my chin looks rather long and I would rather adjust/fix it than add a chin implant. I know that this isn’t a consultation but what would be approximate cost be for these operations…10-12k or over 15k? I am currently covered under Tri-care but I know that these would be considered cosmetic and probably nothing would be covered with insurance.
A: In answer to your jawline enhancement surgery questions,
1) A sliding genioplasty and jaw angle implants can and should be done at the same time.
2) All facial implants are made of non-biodegradable silicone material which will last much longer than you and I will.
3) I thin the best approach in you would be a sliding genioplasty and vertical lengthening jaw angle implants. The most ideal approach for the implants is to have them custom made because you probably have some degree of asymmetry between your jaw angles given your prior surgery. But in the interest of cost, semi-custom vertical lengthening jaw angle implants can be used.
4) I will have my assistant pass along the exact cost of the surgery to you tomorrow.
5) Unfortunately your assumption is correct in that this would not be considered a medically necessity and would be viewed by TriCare as an elective cosmetic procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve had a chin implant procedure. The photos are of me about a year after the procedure. I am not fully satisfied with the size. Do you think a sliding genioplasty (perhaps while keeping the implant I have) would help? I don’t think I look bad, but I would like to have a more masculine face.
A: Thank you for your inquiry and sending your pictures. I would agree that your chin projection is still inadequate and could be further improved. The question is whether this is best done by a new custom made implant or whether a sliding genioplasty should be done keeping the existing implant in place. The answer to that can not be completely derived from profile pictures. It would be helpful to know the size of your existing chin implant and where it is positioned on the bone. These pics of information you are not likely to know and are best determined from getting a 3D CT scan. That will provide invaluable treatment planning information. It is clear in your profile view that you need at least another 7mms of chin advancement and come vertical lengthening as well. But your front view pictures would also be helpful so see what your chin width is. A sliding genioplasty in the front view will usually make the chin more narrow and not wider so this is an important assessment to make.
Please send a front view picture for my assessment. We can help you get a 3D CT scan where you live. You simply find a facility where you want it done and we will fax the order to them for you to get it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about mentalis resuspension and v-y inner lip plasty. I had a sliding genioplasty and no plate was used during my sliding genioplasty, just two screws which seem to have been placed quite low. Could this be part of why the mentalis muscle is not as high as it was? Thank you.
A: One of the methods in sliding genioplasty bone fixation is that of lag screws as opposed to a step fixation plate and screws. This is undoubtably the two low placed screws that you see. Placing lag screws does require more muscle and soft tissue stripped off of the chin to place them. But I do not think, based on this description alone, as to why you think the mentalis muscle is not as high as it once was. You are likely referring to the depth of the labiodental fold of which the mentalis muscle makes little contribution to it. The labiodental fold is a fixed structure that is an external indicator as to the depth of the vestibular sulcus intraorally. When the chin bone is advanced the depth of the labiomental fold will often appear deeper since its position did not change but the chin projection became greater. This is not usually a reflection of loss of mentalis muscle attachment, it is the natural deepening of the labiomental fold area which will occur despite having the mentalis muscle attached back into its original position. This deepening of the labiomental fold is a natural occurrence in many sliding genioplasty outcomes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty three months ago and now my left lower lip is paralyzed. It affects my smile and when I open my mouth. What surgical procedure can I do to make it better. What type of nerve repair is needed and how is it done?
A:The most common nerve injury from a sliding genioplasty is that of the mental nerve, a sensory nerve that controls the feeling of the lip and chin. Injury to a branch of the facial nerve is different as this is a motor nerve that controls the depressor anguli oris (DAO) muscle which provides a depressor or pull down of the lower lip when smiling.
If you have developed marginal mandibular nerve weakness from a sliding genioplasty (or any other chin surgery), which is a very rare complication from this type of surgery, the only potential resolution is time. This is a monofascicular branch of the facial nerve that has no interconnections with other facial nerve branches so its recovery will be slow. It is not likely that it is cut or torn but stretched. Even if it was inadvertently cut it is too small to find and repair. This is why time is all that can be done with marginal mandibular facial nerve injuries. Many do resolve satusfactorily with time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 32 yo man going for a sliding genioplasty. .I have lip incomptence therefore the surgeon is planning to remove a 5mm wedge of bone and I asked him to move the chin 10mm forward. However I’m a bit afraid of removing that amount of bone. I’ve read that with an angled genioplasty is also possible for height reduction but he seems reluctant because of the notch left on the jaw. I don’t know if these two procedures give the same result. The second picture is approximately what I expect and since I’ve had time I ‘simulated’ it on the x ray. Even though I rely on him, I’m looking for the best result that’s why I’m asking for another thought on it. Thanks for reading.
A:Please send me pictures of your face from the side view. That will be helpful to see how much vertical chin height reduction is needed if any in your sliding genioplasty procedure. If you really need vertical height reduction it is better to do it by a vertical wedge resection than a severely angled bone cut. That is the more assured method of achieving adequate vertical chin height reduction. Ideally seeing pictures of your lateral cephalometric x-ray would also be most helpful.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in your assessment of my jawline issues. and what you would recommend for surgical improvement. I have a weak jaw but a fairly good bite. Had orthodontics as a teenager and they never recommended any surgery. The other issue which may be helpful is that I have obstructive sleep apnea (OSA) and wear a mouth piece at night to push my chin forward. I am tall and thin so I do not fit the ‘typical’ body type for many OSA patients. I have attached pictures for your review. I have been to several plastic surgery consults but each one suggests a chin implant. While that might be somewhat helpful it just seems that it is an inadequate solution for my problem.
A: Thank you for sending your pictures. My assessment is that you have an overall short lower third of our face as evidenced by a horizontal and vertical deficiency of your entire jawline. (mandible) Besides the visually apparent facial third discrepancy, the fact that you have OSA and require the use of nighttime CPAP speaks to the potential contribution of a short jaw as a contributing factor.
The optional treatment for this type of jaw deficiency is a custom jawline implant that can augment smoothly the entire jawline in a wraparound fashion from jaw angle to jaw angle including the chin with tridimensional changes including increased vertical, horizontal and some width changes. (see attached predictive imaging) Having significant OSA, however, throws a variable into such a plan however as it would provide no functional improvement in your airway….and that seems like a shame given its potential lifelong occurrence.
A variation on the custom jawline implant would be to combine a sliding genioplasty to bring the chin down and forward (carrying the anterior attachment of the tongue muscles with it and potentially offering some OSA symptom improvement) combined with a pre made custom implant that would augment the rest of the jaw. This would be the only way to have a completely smooth transition from the posterior edges of the sliding genioplasty osteotomy line to the body and angle of the jaw behind it from an augmentative standpoint. Like the total custom wraparound jawline implant it would need to be made from a 3D CT scan from which the osteotomy and implant design would be done.
The ‘simplest’ option would be to just have a sliding genioplasty with standard off-the-shelf vertical lengthening jaw angle implants. While offering aesthetic and functional jawline improvement, it would not create a perfectly smooth jawline from front to back.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It’s been one month since my sliding genioplasty surgery and I am starting to feel that my results are just getting worse every day. I’ve attached some pictures for you to see. My whole right side of my face looks rotated upwards & even more crooked than before. Is there any chance this is going to get better? I have a dent and now I also have lines on my right side.
A: I think it is important to understand that four weeks, which seems like an eternity when one is the patient, is a very brief time after surgery and many issues have yet to resolve or become clear. In intraoral genioplasties I do not judge the aesthetic outcome and any functional issues for at least six months. When the mentalis muscle is disassembled, the bone cut and moved and the muscle then reassembled, many expected short-term issues will appear. Stiffness and aberrant movements (soft tissue distortions) of the chin pad will initially develop as it heals as one might expect from such disruption of the anatomy. These almost always resolve but it will take time and patience to get there. Until all swelling, numbs and stiffness of the tissues resolve, you are not close to what the final functional outcome may be. The resolution and complete adaptation of the soft tissues down to the bone always takes much longer than any patient thinks. It would be impossible that your face is more crooked than before surgery given exactly what was done. Again the six month time period is when the true final outcome can be determined.
Dr. Barry Eppley
Indianapolis, Indiana