Your Questions
Your Questions
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
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have my lower jaw length reduced and a more tapered shape (lean 40 year old male). Is this possible without ending-up with an excess of soft tissue? I believe a big difference could be made with minor over-all length reduction, but especially a tapering of the front at the chin where my jaw is currently just a broad, rounded mass. I would also like to have otoplasty.
A: It would be helpful to see some pictures of your face for a more definitive assessment. But your concern about potential soft tissue excess is always relevant when losing some bony support. Whether that would actually be a real problem depends on three factors; 1) how much bony, 2) the technique used for the bone reduction and 3) whether soft tissue resuspension is employed. (for the chin) But in looking at your pictures, I believe you are right on the money in regards to what you need. This could be achieved by an intraoral vertical reduction genioplasty (7mms) and lateral chin tubercle ostectomies done concurrently to reduce the vertical height of the chin and make it less square. An otoplasty could be done at the same time. I have attached a predicted image of what I envision the result to be from these procedures. Lastly, I see no concerns about loose skin after this procedure as muscle and soft tissue tightening would be done at the same time as closure of the intraoral incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very long chin that completely throws off the rest of my features. I live in Arizona and can’t seem to find a good MD in the California/Arizona area. I wanted to know if you could recommend someone for the procedure, or if not, suggest the feasibility of going out there for the procedure. What would be the downtime/ballpark costs for vertical reduction in the chin length? Thank you for your help.
A: Thank you for your inquiry. It sounds like you need a vertical reduction wedge chin osteotomy. As a ballpark range, the cost of a chin osteotomy is around $6500. We have many patients that come in for surgery from all over the world so this is a common experience for us. You may also feel free to send me some pictures of your face for my assessment to determine your suitability for this procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been researching within the fields of plastic surgery for a while, searching for the ideal solution for my somewhat elongated facial appearance. I’ve ultimately concluded that I would probably benefit quite significantly from a chin reduction – shortening my vertically long chin.What I’m looking for, is to give my lower face a more angular and masculine look, whilst decreasing the length of my face. I’ve been very impressed by your work, and have decided to contact you first and foremost for an opinion or two on my appearance. I have a couple of pictures for you to look at, if you have the time.My front profile in original, compared with my photoshop-altered front profile to give you an idea of what I’m roughly considering. All I did, was reduce the vertical length of my chin. As you can see, doing so greatly improves my facial balance (At least that’s my interpretation). I hope you’ll take a look at these and give me your take. I’d like to know if you find my expectations realistic.
A: In reviewing your pictures and imaging, I would agree completely that your vertical chin reduction goals are very realistic. That is probably a 5 to 7mm vertical chin reduction by osteotomy and ostectomy and, as you have shown by your own imaging, it makes all the difference. It can be surprising how one simple change like vertical chin length can make a difference in how the whole face is perceived.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, five years ago I had a sliding genioplasty to increase the projection of my chin. The titanium plates and screws are still in place. Although I am very happy with the new projection of my chin, I would like to have a decrease in the vertical length of my chin. Is it possible to simply cut out the bone below the titanium screws (below the red line on my x-ray pic) My surgeon told me that there are special muscles attached to this area and for this reason this wouldn´t be possible. This would lead to a droopy chin. He told me that vertical reduction of the chin could only be achieved by cutting out a horizontal slice of bone between the chin. What is your opinion on this?
A: To decrease the vertical height of the chin, if you are using an intraoral approach, it would be better to redo the horizontal osteotomy for the sake of keeping the soft tissues attached to the underside of the chin bone. The challenge in repeat sliding genioplasties is not the bone cut or removing the needed amount of bone but getting the old plate and screws out. Sometimes this can be next to impossible particularly if more than one screwheads sheers off. It is for this reason that removing a wedge of bone on the underside of the chin is appealing. Knowing how to reattach the muscles (mentalis muscle resuspension) is the key to successfully using that approach for vertical chin reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi Dr Eppley, I have read your article about chin reduction. I am a female and I have a long chin and my self-confidence is affected by it. I have attached some pictures for you to see what can be done about it. By the way, I wear a full lower dental denture (one original tooth left) and I have partial upper denture. Most of my remaining teeth has been root canaled. Thank you and looking forward to hear from you.
A: In reviewing your pictures, you undoubtably have a very long chin. But, equally relevant, is that your face has a great imbalance between your upper jaw (maxilla) and your lower jaw. Your midface is very flat and recessed, partly because of your ethnicity but also because it is underdeveloped. This is magnified by your loss of teeth which contributes to your maxillary atrophy from a horizontal projection standpoint. Your lower jaw is very long with a high jaw angle. This combination has created a significant maxillary-mandibular mismatch (short maxilla, long mandible) and is a major contributing factor to your appearance of a ‘long chin’. One of the missing pieces of information is what your bite (occlusion) is like. With these facial bone relationships, you may also have a Class III malocclusion or underbite.
From a corrective standpoint, the ideal approach is to move the entire lower jaw back and the upper jaw forward. This would ideally solve this long chin appearance. But that may be more than you want to do, although having most of your occlusion done by dentures, it is not so far fetched. Short of orthognathic surgery, the other combination would a vertical chin reduction osteotomy and possible paranasal augmentation of the midface. This would not make as big of a change as orthognathic surgery but it would be a noticeable difference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Is it possible to have a vertical chin that points downward as a result of fleshy tissue and not bone? My chin is vertically too long for my face and projects downward especially when I smile. I’d hate to have complications from having the bone burred down on the tip but would also hate to have titanium plates & screws in my chin from a wedge of bone being cut out to reduce the chin. I live in Texas and I don’t’ know any surgeons here that are properly certified and experienced in chin reductions. Please let me know. Thanks.
A: A long vertical chin can be the result of too much bone, too much soft tissue, or a combination of both. In most cases, vertical chin excess is a combination of both. By definition, a chin that is too long because of bone must have extra soft tissue to go with it. Making the proper diagnosis helps one correct the right chin reduction procedure. Not properly addressing the right problem, or inadequately treating it, is the reason so many chin reductions have unsatisfactory results.
A physical exam can usually tell which component make up the vertically excessive chin. In some cases, a simple panorex dental x-ray can also be helpful. The observation that your chin soft tissues pull downward when you smile is common and indicates that it a combined bone and soft tissue problem.
Chin reductions can be done by bone only reductions (intraoral horizontal reduction osteotomy) and bone and soft tissue reductions. (extraoral submental bone burring reduction and soft tissue resection and tightening) Because these two procedures are so different, one can see the importance of making the correct diagnosis of excessive tissues.
Dr. Barry Eppley
Indianapolis Indiana