Q: Dr. Eppley, I am interested in facial reshaping surgery. Can I get a longer and slimmer face with strong jawline and cheekbone through the facial reshaping procedures? If no, what type of procedure will I need and how much will the total cost be . I feel like I can trust Dr Eppley for these life changing procedures.
A: In looking at your pictures, I can recommend several facial reshaping procedures that would make your face longer and slimmer. These procedures include vertical chin lengthening (vertical lengthening chin implant vs. open sliding genioplasty), cheek implants, buccal lipectomies and perioral mound liposuction. The effect of these procedures is created because multiple hard and soft tissue changes are occurring in different dimensions. When all are combined the effect of increased vertical facial height (real facial change) and decreased facial width (more of a visual facial) occurs.
Dr. Barry Eppley
Q: Dr. Eppley, I think that I need my chin lengthened downward. I have a very deep overbite. I have attached a variety of photos as I wanted to show you my face shape when my teeth are closed together (I have a deep overbite) and when they are not. Most of my teeth are bridges and crowns and I have recently been advised to have all of them removed and implants put in place and that would help my overbite and give me a lovely smile. I don’t know if this would help as it is unclear to me if my overbite is dental or skeletal. I am under the assumption that my problem is skeletal as I thought my overbite would be addressed when all my teeth were replaced around 6 years ago but this wasn’t the case. Unfortunately it isn’t really a financially viable option for me to now have all my teeth removed and replaced. I also sought advice a couple of years ago and although I was only 45 at the time, I was advised to have a facelift and nose job to improve my jowling and small chin. I did so but I don’t feel the real problem has been solved. I would appreciate your professional advice on how an improvement can be made.
A: Thank you for sending your pictures. I can see that you have a 100% overbite, which means your lower jaw is over rotated on closure thus shortening the entire lower face. This is a skeletal problem that is manifest by the presence of the occlusal discrepancy. But because of the arc of rotation, the vertical shortening is greatest anteriorly at the chin. As a general rule, the amount of vertical shortening in a 100% overbite can be calculated at the vertical height of the incisor teeth. (crown length) That would be somewhere between 10 and 15mms in most patients. So you are absolutely correct in desiring a vertical chin lengthening osteotomy. That would provide the greatest benefit in terms of improving lower facial height and overall facial balance. I have done some computer imaging which shows the predicted outcomes from that procedure.
Dr. Barry Eppley
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
Q: I need a chin augmentation because my chin is definitely short. I know there are two ways to do it, either with an implant or an osteotomy. I would ultimately prefer the implant over an osteotomy. Is it possible to get some vertical lengthening with an implant, maybe in the range of 2 or 3 mms? Is it possible to get an implant without making the labiomental indentation deeper?
A: When significant vertical lengthening of the chin is needed, an osteotomy is really needed. But when the vertical height increase needed is small, a chin implant can achieve that dimensional change. It is necessary to place the implant as low as possible on the chin bone, almost as if it was on the edge of the bone. To maintain that position, I prefer to place a single metal screw into the bone to secure it. That way there is no risk that it can move upward even a single millimeter.
The labiomental sulcus or groove is located below the lip and really represents the location of the mandibular vestibule inside the mouth where the mentalis muscle attaches to the bone. Because of its superior fixed location, it will usually become a little deeper after chin implant augmentation. This is because it doesn’t change but the soft tissue of the chin moves forward, making it look a little deeper. When the amount of chin advancement is significant (8 to 10mms), the labiomental fold will get deeper in most patients. That effect will be lessened when the implant is placed on the lower end of the chin bone with vertical lengthening as the push underneath the labiomenal fold is less due to the lower position of the implant.
Dr. Barry Eppley