Q: Dr. Eppley, I am writing to you because I am interested in getting a custom implant made for my jaw/chin to improve my profile. I currently have a chin implant that I am not satisfied with because it only advances my chin horizontally. I am interested in vertically lengthening my chin. I saw on your website the case study of vertically lengthening using a custom implant and I wanted to see if this could help me to achieve the results I desire. Specifically, I want to know if a custom implant can both vertically and horizontally lengthen my chin and front of my jaw. I have attached some pictures of what my face looks like before and after the original chin implant surgery.
A: In looking at your desired chin change, there is no question that a significant vertical lengthening as well as some further horizontal advancement is needed. There is two ways to get there.
1) Custom Chin Implant – There is no off-the-shelf implant that can remotely make this amount of chin change. Based on a mandibular model from a 3-D CT scan, I can custom make an implant to the exact specifications that will work. Your existing chin implant would then be replaced by this new one. This is the ideal implant approach and adds additional costs to the base surgery to make the actual implant and have it ready for surgery. (the CT scan cost would be in addition and is based on the facility fee charge)
2) Chin Osteotomy – Keeping your current chin implant in place, a chin osteotomy is performed above it and the entire chin with implant is brought forward and vertically lengthened with an interpositional hydroxyapatite block used as a graft. This is what I call the extreme chin augmentation approach, combining an implant with an osteotomy.
In looking at your pictures, I think #2 is a viable option but I would need to confirm that by looking at a lateral cephalometric x-ray. (standard orthodontic/oral surgery film.
Dr. Barry Eppley