Q: Dr. Eppley I had a chin implant placed over a year ago. While I like the amount of projection the implant gave me, I feel that my chin would look better if it was also longer. I suggested to my doctor that a chin osteotomy would be a good idea so that the chin is angled downward as well as brought forward. He felt that it would make my face too long and discouraged me from it. While I respect his opinion, my artistic sense of my own face disagrees with that assessment and I strongly feel that my small and round face would look better with some lengthening. I have attached a side picture for you to give me your opinion.
A: The debate of whether one facial change or another is better can be largely answered by computer imaging. This is particularly true in a profile facial structure such as the chin which is one of the most accurate areas for predicting facial bone to soft tissue alterations.
There are two ways to get create vertical lengthening of the chin. One way is to position or reposition a chin implant lower on the bone so that it is just not sitting exclusively on the front edge. If the implant is moved down to be between the front and lower edge of the bone, some mild vertical lengthening of chin and lower face can be achieved. (2 – 4 mms) The implant has to be secured in this position by screws for stability as you can’t rely on the containment of the soft tissue envelope only. The other option which you have already mentioned is a chin osteotomy which can make for more significant vertical lengthening of 6 to 8mms.
By making these chin changes on the computer, you can visually determine whether your belief for more vertical chin lengthening is correct.
Dr. Barry Eppley