EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Archive for the ‘chin augmentation’ Category

Case Study: Sliding Geniopasty with Indwelling Chin Implant

Sunday, May 3rd, 2015

 

Background: Horizontal chin augmentation can be done using either a synthetic chin implant or a sliding genioplasty. There are advantages and disadvantages with either approach and they must be considered in an individual patient basis. The decision in any patient ultimately depends on their perception of an alloplastic vs. an autogenous approach, the risks of the procedure and its recovery and what other dimensional changes of the chin that are needed beyond just that of the horizontal change.

But the use of a chin implant does not always produce the desired amount of chin augmentation change that every patient desires. This may be due to inadequate implant selection, the chin implant settling into the bone thus losing some horizontal projection, chin implant malposition or an accommodation to the initial chin augmentation result.

When further improvement is desired after an initial chin implant augmentation, the options are either a larger implant or to convert it to a sliding genioplasty method. A larger implant is usually done as this is the simplest revisional approach provided that a new implant can create the desired horizontal change. When a larger chin implant offers but a modest additional augmentation (e.g., 5mms or less) the the sliding genioplasty option becomes a consideration. It would be either that or have a custom chin/jaw implant made.

Chin Implant Settling (Erosion) Dr Barry Eppley IndianapolisCase Study: This 26 year-old male wanted additional chin augmentation after having a prior chin implant placed several years previously. He always felt that is lower jaw was smaller. His original chin implant provided 7mms of horizontal projection but it could be seen that it had settled into the bone a few millimeters. He opted for a sliding genioplasty as he felt that would more reliably give him long-term augmentation.

Sliding Genioplasty with Chin Implant intraop Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was used to access the chin. The chin implant was easily identified and it was nestled nicely into the bone. A horizontal osteotomy cut was made above it from side to side and the bone downfractured. The chin segment was then advanced 12mms and stabilized with a step plate and screws. The chin implant was never moved from its original position during the procedure.

Sliding Genioplasty with Chin Implant result Dr Barry Eppley IndianapolisSliding Genioplasty with Chin Implant 3D CT scan Dr Barry Eppley IndianapolisA sliding genioplasty can be successfully done with an indwelling chin implant. It can be argued that this is a good technique to take advantage of some of the prior procedure (and investment) and gain additional horizontal augmentation. Whatever implant settling has occurred into the bone has already reached its peak and no further inward change would be anticipated.

Case Highlights:

1) An unsuccessful chin implant result can be improved by a sliding genioplasty.

2) It is not always necessary to remove an existing chin implant when doing a sliding genioplasty.

3) A sliding genioplasty can be performed by making the osteotomy cut above the chin implant and moving both forward simultaneously.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty for Lower Facial Elongation

Tuesday, April 14th, 2015

 

Background: A sliding genioplasty is a well known and historic procedure for changing the shape of the chin. It was originally described in the 1940s but has evolved considerably due to the use of rigid fixation using plates and screws. While once clever osteotomy designs and wire fixation methods were used for stabilization of the bone segments, which limits how much the chin position could be changed, plate and screw fixation now makes virtually any bony chin change possible.

Sliding Genioplasty Indianapolis Dr EppleyFor chin augmentation, the chin implant is often compared to the sliding genioplasty as creating similar effects. But the reality is that this is only partially true and they are only comparable when it comes to pure horizontal movements as seen in the profile view. Vertical and width (narrowing) changes can not be done with an implant. (although newer vertical lengthening chin implants have recently become available)

The real benefits for a sliding genioplasty are when vertical elongation of the chin is needed and when the amount of chin advancement desired exceeds that of which standard implants can achieve. This would be particularly useful in women who can aesthetically tolerate a more narrow chin as it comes both forward and down. The other benefit for a sliding genioplasty in these more substantial chin changes is that it ‘carries’ the soft tissue of the chin pad with it and does not create a devascularizing effect due to maintaining most of the soft tissue attachments (and resultant perfusion) to the bone.

Case Study: This 26 year-old female had a short chin in both horizontal and vertical dimensions. Her lower facial height was disproportionate to the rest of her face. As a result, she appeared to have a full neck/double chin.  She knew she wanted her chin augmented but was just not sure how it should be done.

Sliding Genioplasty result side viewSliding Geniop[lasty result oblique viewUnder general anesthesia, she underwent an intraoral sliding genioplasty. A low horizontal bone cut was done and the chin was advanced 16mm forward and 8mms downward. This was the maximum amount of chin bone movement that could be done while still maintaining some bone contact between the segments. Rigid fixation was achieved by a titanium step plate and screws. The bone gap (step between the upper and lower bone segments was filled with demineralized bone particles. The mentalis muscle was resuspended at closure.

Sliding Genioplasty result front viewThe vertically opening sliding genioplasty can help make the lower face more proportionate by making bringing it forward and down. This will make the jawline have more of a V-shape and will also help get rid of a double chin problem due to lack of bony projection.

Case Highlights:

1) A sliding genioplasty is historically the only chin procedure that can provide both horizontal and vertical elongation of the chin. (custom made implants can now do that also)

2) A vertically opening sliding genioplasty with horizontal advancement will make the chin more narrow as a result of these bony movements.

3) Unless the bony chin movements are extreme, bone grafting of the interpositional gap between the chin segments is not necessary. Even when needed demineralized bone substitutes can be successfully used.

Dr. Barry Eppley

Indianapolis, Indiana

Minimal Incision Chin Augmentation

Thursday, March 12th, 2015

 

Chin Implant Styles Dr Barry Eppley IndianapolisChin augmentation using synthetic materials is both the most historic facial implant procedure and still the most commonly done. This is evidenced in that chin implants have the largest number of styles and sizes commercially available of any facial implant manufactured today. Chin implants are inserted by incisions either from the inside of the mouth mucosa or through the skin under the chin. There are advocates for either approach but successful chin augmentation results can be obtained either way with good attention to their unique technical details.

The placement of chin implants is most commonly done from a submental skin incision. It has the advantages of more limited disruption of the mentalis muscle of the chin, less risk of lower lip numbness and a more assured and sustained placement of the implant on the lowest portion of the chin bone. (where it belongs for its maximal effect) Understandably some patients are concerned about the final appearance of the submental scar. This concern is most significant in patients of intermediate skin pigments.

I have seen many submental chin implant scars and there are often much larger (longer) than they need to be. The use of silicone chin implants, even the longer anatomic or winged ones, allows for the implant to be inserted in a folded fashion, one half at a time. This enables a remarkably small incision to be used despite the length of the chin implant.

Small Chin Implant Incision Dr Barry Eppley IndianapolisThe key is to develop the subperiosteal tunnels along the sides of the chin bone in largely a blinded fashion. Once the incision is made down to the bone, small elevators are used to  made the subperiosteal tunnels along the inferior border of the mandible. It is important to make these tunnels longer than the wings of the implant on each side. By so doing half of the implant can be inserted and slide past its midline to one side. This will allow the opposite wing to be folded and inserted easily and then slide back to the midline.

Small Incision for Chin Implant Dr Barry Eppley IndianapolisOnce the implant is in the tunnels it can be slide back into the midline and secured by whatever fixation method one desires. (in this case of a vertical lengthening chin implant a 1.5mm screw was used)

Minimal incision chin augmentation can be very effectively done through a submental skin incision using preformed silicone implants.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – The Reversal Sliding Genioplasty

Monday, February 16th, 2015

 

Sliding Geniop[asty intraop technique Dr Barry Eppley IndianapolisBackground: Chin augmentation can be done by using either an implant or actually moving the chin bone.  A chin implant is by far the most common genioplasty method because it is simpler, less invasive and easily reversible. While the sliding genioplasty method can be done alone, it is almost always used when other facial bone surgery is being done. (i.e., orthognathic surgery) Its use is also highly influenced by the training and specialty of the treating surgeon.

Sliding Genioplasty result side view Dr Barry Eppley IndianapolisWhile a sliding genioplasty can provide a variety of dimensional changes to the chin, such changes do not always produce a pleasing outcome. Just like chin implants, the new chin can be unsettling because of an unfamiliarity of the ‘new’ face. Preoperative computer imaging can help reduce this risk significantly but it can rarely still occur. A sliding genioplasty can also cause a cascade of symptoms from numbness and tightness of chin tissues that did not exist before surgery. While such symptoms usually resolve within months of the surgery, for some they may not go completely away and their persistence may eventually become intolerable.

Reverting the chin back to its original preoperative position, or to just make it less advanced or lengthened, can be done through a reversal sliding genioplasty procedure. This is merely repositioning the chin bone by making a new osteotomy cut. But in considering to do so, it is important to look at the type of indwelling fixation hardware used (by x-ray) and what soft tissue impact may ensue. These factors along with how likely the aesthetic outcome may be achieved will determine whether a reversal sliding genioplasty is worth it.

Case Study: This 52 year-old male had a sliding genioplasty done seven years ago as part of a mandibular osteotomy to fix a malocclusion. He never really liked how it changed his chin and he had numerous persistent soft tissue symptoms from it including a tight chin and a lower lip sag from it. In addition, he could feel the notch in the jawline at the back end of the original osteotomy lines were the cuts went through the inferior border. After much thought he finally decided to have it reversed.

Sliding Genioplasty Reversal result oblique view Dr Barry Eppley Indianapolis IndianaUnder general anesthesia, an intraoral approach was done using his original vestibular mucosal incision. The chin bone was exposed and the lower end of a metal fixation plate and screws were removed. (the upper end of the plate was grown over with bone) An osteotomy cut was made with a saw at the obvious stair step shape in the chin bone.  Once the bone was downfractured it was able to be pushed back until the outer shape of the chin was flush across the osteotomy. After securing with 1.5mm plate and screws, a mentalis muscle resuspension was performed as well as V-Y mucosal lower lip advancement/closure.

A reversal sliding genioplasty is performed similarly to the original advancement. Preoperative attention needs to be paid to what type of original bone fixation hardware was used to ensure it will not be problematic to remove or is in the way of the new osteotomy cut. Since the chin tissues are stretched forward what happens to the attached soft tissues along the jawline and in the central neck needs to be considered.

Case Highlights:

1) A sliding genioplasty is one method of chin augmentation that creates a natural effect by moving the chin bone below the level of the front teeth.

2) While a bony genioplasty usually leads to a significant chin augmentation effect and a satisfied patient, some can find the effect too much and may yearn for a return to their former self.

3) A sliding genioplasty can be reversed months to years later by recutting the original osteotomy line and setting/sliding the bone back.

Dr. Barry Eppley

Indianapolis, Indiana

Jaw Makeovers for Men and Women

Thursday, January 15th, 2015

 

Strong Male Jawline Dr Barry Eppley IndianapolisThe jaw makeover seems to be one of the newer requested facial cosmetic procedures. Women and men grab their necks and stroke their jawline looking back on the days when it was much tighter and more defined. Men are particularly focused on their jawline feeling that a more prominent one would improve their appearance as well as other aspects of their life. A small hint of this elevated level of interest in the jawline is shown by the increased number of chin augmentation procedures done over the past decade.

The reality is that there is not really one jaw makeover procedure or technique. Rather there is a large number of procedures that can be done that offer some degree of jawline enhancement. They range from minimally invasive procedures like skin tightening ultrasound and radiofrequency treatments, injectable fillers, liposuction, fat injections, standard preformed chin and jaw angle implants and custom total wrap around jawline implants. Conceptually they create a more prominent jawline through either skeletal augmentation or to reshape the soft tissues around the existing jawline.

But it is important to understand that not all jaw makeover treatments are created equal. One should not expect that a little skin tightening and filler or fat injections will create the same jawline effect as chin and jaw angle implants. Of course it all depends on where one starts and how deficient the underlying jawline anatomy is.

Superman Jawline Dr Barry Eppley IndianapolisThe motivation for the increase in jaw makeover procedures is multifactorial. Stronger jawlines have also been desirable for men and dates back to antiquity. Actually there has never been a time when a weak chin or obtuse neck angle has been in demand or shown to enhance one’s appearance. But recent fashion and style does have an impact which leads one to look at the influence of the many recent superhero movies in the past decade or so. These comic book characters now on display on the big screen inadvertently suggest a relationship between a strong jawline and ‘enhanced powers’. It has also long been established that stronger facial features in men (as well as height) have an advantage in the work place and for job advancement.

Strong female jawline Dr Barry Eppley IndianapolisWhile women historically have been aesthetically pleasing with a softer jawline, stronger jawlines through increased definition and angularity has become more popular. This trend of female jaw aesthetics can be seen in contemporary models and some actresses and celebrities. Why stronger jawlines in women are appealing is a matter of debate. But strong skeletonized facial features in a woman suggest strength, fitness and a strong will.

Fillers and skin tightening procedures can create a better jawline but it is important to understand that these results are more modest and are only temporary. A lower facelift unmasks the ‘old’ jawline that once existed and has become obscured with sagging jowl and neck skin. It creates an improved jawline by unmasking the old one. Bone implants create the strongest change in jawlines that are permanent and the most visible. With a stronger push to the overlying skin due to the material, greater angularity and definition can be achieved. Younger jaw makeovers are usually skeletally based while ‘older’ ones incorporate some soft tissue management as well due to aging.

Dr. Barry Eppley

Indianapolis, Indiana

The Step-Off Deformity in a Sliding Genioplasty

Monday, December 1st, 2014

 

The sliding genioplasty is a well known chin reshaping procedure. Unlike its cousin, the chin implant, it has a much greater versatility than simply increasing horizontal projection alone. It can be done to create a multidimensional effect from increasing or shortening vertical height, increasing or dereasing chin width and in some cases even moving the chin backwards for horizontal shortening.

The sliding genioplasty is a pedicled bone flap that maintains muscular attachments from the tongue and neck muscles which keeps the bone alive. While some perceive that it is a free bone graft,. it is not nor would it work if it was. Any bone gap created by the cut bone movement heals because the bone is alive and can make new bone to heal the gap without the need for bone grafting.

Sliding Genioplasty step off front view Dr Barry Eppley IndianapolisThe basis premise of the sliding genioplasty is that it is created by a horizontal full-thickness bone cut through both cortices. The angle of the horizontal bone cut historically controlled how the bone could move since it was wired together and had to maintain some degree of bone contact. But with today’s titanium plate and screw fixation techniques, the angle of the bone cut is less important.

Sliding Genioplasty step off Dr Barry Eppley IndianapolisBut no matter how the bone is cut, the back end of the bone cut goes through the inferior border of the mandible. This usually occurs somewhere behind the level of the mental foramen in the mid body of the mandible. Since the cut chin bone is usually moved forward to some degree, this creates a step-off or inferior edge deformity. The more the chin moves forward, the more than an inverted V step off deformity may be felt. Depending on the patient’s soft tissue thickness, such a step off may even been seen along the edge of the bone.

While step-offs in sliding genioplasties are common, the question is whether they should be managed at the time of the initial surgery. In most cases it is not necessary as the bone remodels over time and their prominence will become less or even completely become non-existent with enough healing time. There is also the issue that their management may potentially cause as many problems as it is intended to solve. Trying to fill the defect at the time of the initial genioplasty with some type of filler (e.g., hydroxyapatite granules) could result in a lump or clump of material that would be just as bothersome as a bone indent may be.

Dr. Barry Eppley

Indianapolis, Indiana

Sliding Genioplasty Modification for Jawline/Lower Facial Reshaping

Sunday, November 9th, 2014

 

In facial reshaping surgery, it is important to appreciate the differences between a Western vs an Asian type face. While a strong jawline is attractive by Western standards, a more narrow lower face that makes an oval or a v-line look is preferred. To achieve this Asian form of mandibular contouring surgery, various forms of sliding genioplasties and lower border mandibular ostectomies have been developed.

The greatest variance amongst the various forms of mandibular contouring has been that of the chin. And the chin also makes the greatest contribution for most patients to the lower facial shape. Reducing the horizontal width of the chin through a central segment bone resection is the most common technique used with a horizontal sliding genioplasty. However this method does not specifically reduce the height of the chin unless a horizontal wedge resection of bone is done at the same time.

In the October 2014 issue of Plastic and Reconstructive Surgery Global Open issue, the article entitled ‘Inverted V-shape Osteotomy with Central Strip Resection: A Simultaneous Narrowing and Vertical Reduction Genioplasty’ was published. In this paper, the authors introduce a simple but very effective method to reduce the chin width and length simultaneously with an inverted V-shaped osteotomy and central segment resection instead of a horizontal osteotomy and central segment resection. Over a three year period, nearly 550 patients (75% female) underwent mandibular contouring surgery of which over 300 were treated with this narrowing and vertical reduction genioplasty technique. No significant complications occurred other than about 1/3 of the patients experienced transient mental nerve numbness which went on to full recovery.

While there are different ways to change the bony shape of the chin, this ingenious method is a clever geometric modification of a traditional linear approach to a sliding genioplasty.The square and long face can be effectively changed into a more slender oval shape as the chin is similarly changed. It also requires a minimal amount of plate and screw fixation and appears very stable for optimal healing.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Combining Chin Implant and Sliding Genioplasty for Large Chin Augmentations

Friday, October 10th, 2014

 

Chin augmentation can be done by a variety of surgical methods including a chin implant and a sliding genioplasty. Each of these aesthetic chin techniques has a role to play and they have their own advantages and disadvantages. But both have the same limitation…a limit to how much the chin can be horizontally projected. Chin implants are not made with standard thicknesses that are greater than 10 to 12mms. A sliding genioplasty can only be moved as far as the thickness of the bone will allow which can vary between 10mm to 16mms.

The horizontal movements provided by standard chin implants and sliding genioplasties are sufficient for the vast majority of patients with chin/jaw deficiencies. But they can be inadequate for the few patients that have horizontal chin projection deficiencies that exceed 15mm and may be as significant as 25mms.

Sliding Genioplasty and Chin Implant Dr Barry Eppley IndianapolisChin Implant and Sliding Geniplasty in Large Chin Augmentations Dr Barry Eppley IndianapolisCombining a sliding genioplasty with an implant is a novel method to achieve larger amounts of chin projection that I have done for years. Through an intraoral approach, which is needed for a sliding genioplasty, the implant is placed on the chin bone just one would normally do. It does need to be secured into placed by screw fixation otherwise it would easily become displaced. A chin implant with long wings also has the advantage of covering over the bony step-off that often occurs at  the back end of the osteotomy.

Very large chin deficiences can be managed by the creation of a custom implant but combining an implant and a sliding geniplasty may be sufficient in some of these cases. In my experience there has been no higher infection risk when placing an implant on top of a sliding genioplasty than when using a chin implant alone.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty for Obstructive Sleep Apnea Improvement

Sunday, September 7th, 2014

 

Background: Chin augmentation with a sliding genioplasty is a well known aesthetic technique. It is not done as commonly as a chin implant but in the right patient has its own advantages. One of its benefits is that it brings the chin forward with its attached tongue-side musculature as well as lengthening the jawline. By so doing it can help smooth out the neck better than an implant which just pushes out the soft tissue chin pad and has no direct effect on the neck muscles behind it

genioglossus and geniohyoid muscles attached to the chinThe main muscles that a sliding genioplasty pulls forward is the genioglossus and geniohyoid. The genioglossus is a fan-shaped tongue muscle which comprises most of the tongue. Its origin is the spine on the back side of the chin bone and inserts into the hyoid bone and the bottom of the tongue. Its contraction enables one to stick their tongue out as well as enlarges the upper airway behind the base of the tongue. The geniohyoid muscle lies below the genioglossus but above the mylohyoid muscle. It runs from the back of the chin down to the hyoid bone and its contraction dilates the upper airway as it pulls the hyoid bone upward and forward.

Because of the attached muscles that accompany a sliding genioplasty, it could have an effect very similar to a direct muscle procedure used to treat obstructive sleep apnea. A genioglossus muscle advancement is an intrachin procedure where the genioglossus muscle is brought forward by using a window of bone in the chin. It is usually part of other obstructive sleep apnea procedures and is rarely done alone since obstructive sleep apnea almost always involves various structures at different areas of the airway. It is limited to a forward muscle movement that is no further than the thickness of the chin bone.

Case Study: This 46 year-old male presented with symptoms of obstructive sleep apnea and a short lower jaw.  He wore CPAP at night. He had a class II malocclusion and an overall heavy face appearance. He was overweight but certainly not obese. He had significant daytime sleepiness. A sleep study showed multiple apneic episodes greater than 10 seconds and a drop in oxygen saturations to 84%. His apnea-hypopnea index (AHI) was 25. He did not want a maxillomandibular advancement.

Sliding Genioplasty Technique for Obstructive Sleep Apnea Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral approach was used to deglove the chin. A mid-level near horizontal osteotomy bone cut was made through the chin keeping the muscles attached to the lingual side of the chin. The chin was brought forward 16mms and stabilized with central step plate as well as two side plates due to the magnitude of the movement.

Obstructive Sleep Apnea Sliding Genioplasty result sidew view Dr Barry Eppley IndianapolisAfter surgery he had a significant increase in chin horizontal position and an improved facial profile. Despite the very large chin movement, his chin projection was not excessive. He had improvement in his sleep apnea symptoms but not a complete cure of it as was expected before surgery. His sleep study numbers improved to an AHI of 15.

Obstructive Sleep Apnea Sliding Genioplasty result front view Dr Barry Eppley IndianapolisFor a genioglossus movement to be effective, its forward movement must be considerable. (greater than 15mms) This is not usually possible with the traditional technique of moving the genial tubercle alone. This sliding genioplasty was beneficial for this patient’s sleep apnea symptoms because of the magnitude of its movement. His initial lower jaw retrusion permitted a large sliding genoplasty movement.

Case Highlights:

1) One type of occipital skull deformity is that of the prominent nuchal ridge which forms a raised horizontal ridge across the back of the head.

2) The prominent nuchal ridge should not be confused with the occipital knob which is a raised button of bone at the center of the nuchal ridge.

3) Nuchal ridge reduction is done through a small horizontal incision over the central part of it.

4) Some patients with a prominent nuchal ridge have intermittent occipital headaches due to tight neck muscle attachments.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Chin Narrowing Surgery By Lateral Ostectomies

Saturday, June 7th, 2014

 

Background: The chin has a major impact on the appearance of the lower face. While most think of it as only from a horizontal projection perspective, its frontal shape has a major influence on the gender identification to whom it is attached. Men often have strong more square chin shapes in the front view while it is usually perceived as more feminine to have a narrow and or heart-shaped chin.

It is not rare for either a women or in male to female facial feminization surgery to make an effort to narrow the chin. There are a variety of methods to accomplish the bone removal needed, either by direct lateral bone reduction (ostectomies) or by an osseous genioplasty technique. (wedge reduction) Each has their own advantages and disadvantages but the more extensive genioplasty approach is usually indicated when there are other dimensional changes needed in the chin as well. (vertical and horizontal)

Case Study: This 31 year-old male to female patient was having a variety of facial feminization procedures from brow bone reduction to rhinoplasty. One of the changes that was requested was a narrowing of the jawline to reduce a square chin to a more narrow and softer one.

Chin Narrowing Technique Dr Barry Eppley IndianapolisUnder general anesthesia, an intraoral high vestibular incision was made and the chin bone exposed by muscle and periosteal elevation. A vertical bone cut of 4 to 5mms was made from the mid-body of the mandible to a point just lateral to the center of the chin, protecting the mental nerve on both sides. This removed along strip of bone along the sides of the chin and anterior jawline. Some additional bone smoothing was done with a burr to smooth out any rough edges. The narrowing effect was immediately apparent when the the first side of chin was done.

Chin Narrowing result front viewRecovery from chin narrowing surgery does involve a fair amount of swelling that takes a full four to six weeks to completely resolve. One can tell when all swelling is gone when the feeling in the chin is norma again and it feels soft and supple again.

Chin Narrowing result oblique viewNarrowing of the wide chin or the desire to have a more narrow chin can be done by a by lateral ostectomy technique if no horizontal or vertical changes are needed. This type of ‘bony’ chin procedure is different from the sliding genioplasty as bone is removed rather than cut and relocated. It can be remarkable how a small amount of bone removal can change the shape of the chin in this narrowing technique.

Case Highlights:

1) The wide chin can be narrowed for either a softer jawline or to help feminize a face.

2) The width of the chin can be narrowed without a genioplasty by lateral tubercle ostectomies.

3) The intraoral approach for chin narrowing ostectomies leaves no scar but takes a while to see the final result due to prolonged swelling.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

Read More


Free Plastic Surgery Consultation

*required fields


Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits


Categories