Q: Dr. Eppley, I am inquiring about a possible reduction in the “chin pad” on my chin. I actually previously had an actual chin reduction where the bone was burred down, and I was quite happy with the results of this compared to what it was before.
The surgeon did the reduction via submental incision, and I actually already did have a scar in that area prior to the surgery. (stitches from an old sports injury)
However, even before I had my chin reduction, there was a prominent “fat pad” on my chin, and it is slightly more obvious now (although the overall appearance of my chin compared to before the reduction is significantly better now). I would not consider it to be a classic “witch’s chin” .
I was wondering if it would be possible to discuss what could be done to reduce the fat pad? I am a medical student and did read in a textbook chapter Dr. Eppley mentioned liposuction should not be performed on the face, but also read on a post on realself he mentioned a possible intraoral chin pad thinning. I have attached a few pictures, showing me at the present showing the prominent “fat pad”.
A: Your assessment that treating a full chin pad by liposuction is not a good idea. Liposuction of the chin fad pad is not advised as it will result in irregularities and mentalist muscle distortions. The only way to treat an excessive chin pad is with a submental excision and tuck of the remaining tissue.
Dr. Barry Eppley
Q: Dr. Eppley, Do I need a facelift to correct my chin sagging after being burred? I had a procedure done three months ago where the surgeon burred under and shortened the chin. It was done intra orally and the lower chin and my face is slack and looks like there is a protrusion. In other words it still looks like I have a double chin despite everything. I am not sure which procedure I need but I did include pictures. Also could a slight buccal fat removal be done in conjunction with this?
A: Intraoral chin reduction is almost always associated by loose chin skin afterwards and often fails to make a big improvement in the amount of chin projection. A submental approach to your chin reduction would be more effective. Whether this is addressed only by a submental tuck (submentoplasty) or would be rolled into a lower facelift would depend on where you see the area of improvements needed and whether you want the whole jawline tightened. It is not crystal clear in the pictures and the real test would be what happens when you bend your head down and where the skin rolls appear.
When referring to the buccal area, there is the area right below the cheekbone (the true buccal fad pad area) and the area that lies much lower near the mouth and jowl area known as the perioral mounds. (which is often confused with being the buccal area) I believe you may be referring to the perioral mound area by description and in the pictures. Perioral mound liposuction can be done in conjunction with any submental chin tuckup or facelift procedure
Dr. Barry Eppley
Q: Dr. Eppley, I would like to find out if I am a good candidate for chin ptosis repair. I have been doing some research online and found your name. I am interested in a possible facelift later but wanted to address my chin at this time as it is a problem I have had my whole life. My chin pad just seems to fall off of the end of the chin bone and looks worse when I smile. Thank you.
A: You certainly do have a ptotic chin pad and it is just part of your natural development as you have stated it has been there your whole life. That can be markedly improved or eliminated by a submental technique for chin ptosis repair where the extra and loose hanging chin pad is removed and tucked in from underneath. Yours is not an issue where the chin pad is pulled up but rather pulled under and removed. This leaves a fine line scar in the submental skin crease area. This is a short procedure that can be done under IV sedation that has a very minimal recovery as it appears your chin ptosis repair needs only soft tissue reduction and does not require any bone work.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 25 year female and I am looking for an honest surgeon who can do a chin reduction surgery for my long chin. I am wondering if you can reduce the height of my chin vertically? I am not sure if I also need to reduce the width of my chin. I feel I have a long chin when I look at the front of my face in the mirror. To me what most important are the risks of undergoing this surgery and the outcome. I am not just concerned about nerve damage but I am also afraid of having loose/saggy skin after the chin reduction surgery. Because our skin sag when we get older, will this mean any chin reduction will make the sagging worst when we are like 45 or 56 years old…even if the soft issues was reattached and tighten properly? I look forward to hearing from you.
A: Vertical chin reduction is done by one of two approaches, an intraoral wedge reduction genioplasty and an external submental chin reduction. Which one is best for any patient depends on ow much vertical reduction they need, does width reduction need to be done as well and do they have any pre-existing soft tissue excess or sagging. In either case, the soft tissues are managed with both procedures. In the intraoral genioplasty approach the soft tissues remain attached to the inferior chin segment and and are never detached so they move up with the reattachment of the bony segments. In the submental chin reduction technique, a wedge of soft tissue is removed and tightened after the bone is reduced. In general, the submental approach is more effective at vertical chin reduction than the intraoral wedge genioplasty approach. I would need to see front and side view pictures of your chin (non-smiling) to see which approach may be best for you.
Dr. Barry Eppley
Q: Dr. Eppley, I would like my chin made shorter, smaller, more even and to have fat removed from the chin where a plastic surgeon mistakenly added fat in my chin. I have outlined the fat I want removed in one picture. I also have sort of a balled chin and I believe it is weird and uneven in many ways including a minor balling problem. I want a normal, nondescript chin, as much as possible without putting in another chin implant. You can see that my chin is too long, uneven and overly prominent. In one picture I outlined in brown pencil where another plastic surgeon mistakenly injected fat. I would like to have this fat removed if possible. In another picture you can see my overly long chin in profile. In the last picture you can see me pinching the extra skin that resulted from 3 chin implants that were placed and later removed.
A: Thank you for sending your pictures. You will need a significant reduction of some bone and soft tissue to effect a visible chin change. You do not need an implant but a reduction in tissue volume that is best done from a submental chin reduction approach. The chin bone needs to vertically reduced, transversely reshaped and a large wedge of overlying soft tissue removed as well. The fat that was injected was placed in the labiomental fold area, a difficult if not impossible area to remove. Small cannula liposuction can be done but its effectiveness is uncertain.
Dr. Barry Eppley
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