Explore Plastic Surgery

Not infrequently I get requests from patients for the desire to transform a round face into a more shapelier one. One cause of a round face is that the patient is overweight. A full neck, round cheeks, and a lot of subcutaneous fat throughout the face creates a generalized fullness that creates a fat and round face. These patients know full well that they are overweight and some liposuction of the neck and buccal lipectomies may make some difference. But weight loss will probably make the most difference in these cases. And these procedures should not be performed until some weight loss has been achieved.
But the overweight patient is not what usually makes up the ’round face’ patient. Most commonly these are younger patients that are not significantly overweight and are usually closer to being more height and weight porportionate. They may have some mild fullness in the cheeks and neck but often their bony prominences (cheeks, chin, or jaw angles) may be somewhat deficient. The approach to these patients must deal with both hard and soft tissues issues to be effective at improving the face’s angularity and definition.
In addition to the fullness of the cheeks and neck, the next most important consideration in facial shape improvement should look at the chin. Often it may only be midly short in the horizontal dimension but the width of the chin is also important, particularly in the male patient. Chin implants today can provide more projection as well as width in many different sizes. Placed through a small incision under the chin bone, a chin implant can lend more definition and squareness to the lower face from subtle to dramatic results.
Upper facial fullness, more specifically midfacial fullness, can be achieved through cheek implants. Placed into position by incisions inside the mouth under the upper lip, cheek implants can provide good highlights through three-dimensional enhancement of the bone as it wraps around the area below the eye. An amazing aray of cheek and midface implants is available to provide a lot of enhancements around this important facial landmark. When paired cheek implants are combined with a chin implant, an upside down triangle of change is created that directly opposes a more round or oval facial shape.
Jaw angle implants are always a possibility but these are rarely needed in most really round faces. They can produce some lateral facial fullness but this is not usually helpful in ‘de-rounding’ the face.
The procedures of buccal lipectomies, neck and jowl liposuction, chin and cheel implants make up the usual plastic surgery tools for facial rehaping. Which one or combination of procedures is most helpful for improving facial definition is best determined by careful computer imaging study between the patient and their plastic surgeon.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the most straightforward and most satisfying procedures is plastic surgery is chin augmentation. Enhancement of the deficient chin can make a dramatic difference in one’s facial profile. Like the nose, although not as well appreciated, the position of the chin not only plays an important role on the silhouette of the face and neck but helps form an impression (accurate or not) on one’s character. A well-defined chin that is in proportion to the rest of the face suggests strong character traits and portrays an image of strength. Conversely, a recessed or weaker chin can cast quite the opposite image.
The decision (need) to perform chin augmentation is dependent on an assessment of the chin as it sits relative to the rest of the face. This is done exclusively by a profile assessment where a straight line is dropped down from the junction of the nose and forehead with the face looking straight forward and as level as possible. Where the most projecting point of the chin rests relative to this vertical line determines whether chin augmentation is beneficial, and how much, to one’s facial profile. If it rests anywhere behind this line, then chin augmentation will be helpful. How much it sits behind this line in millimeters also helps one choose the amount the chin must be brought forward. This number determines the thickness in millimeters of the chin implant or how much the chin bone must be advanced.
The most common method of chin augmentation is with a silicone rubber (silastic) implant. Implant placement is very simple and uncomplicated. Through a small incision under the chin, the implant can be inserted onto the bone and screwed into place. This direct approach makes it easy to place a chin implant of any size or shape, of which there are numerous styles and thicknesses from which to choose. The extended (anatomic) styles are my personal favorites as they blend into the surrounding jawbone the most naturally. The results from chin implant augmentation are instantaneous although there will be some temporary swelling (no bruising) from having to lift up the chin muscle to put it into place.
Complications from chin implants are quite few. The most common would be implant asymmetry but I avoid this problem by using a small screw to hold the implant in proper position so it can never move after surgery. Implant shifting around the pocket is the cause of this complication. Bleleding and infection, while possible, I have yet to see. Sometimes, the chin and lower lip will ‘move funny’ for awhile afterwards due to temporary swelling and the muscel being manipulated. In other words, the chin area will seem quite stiff after surgery which does impact on how the lower lip may move. This is a self-solving problem as the swelling goes away.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

How is a Chin Implant done?
Short chins (both in height and in length) are good indications for what we call alloplastic mentoplasty, otherwise known as a chin augmentation using a synthetic implant. Chin implants are by far and away the most common method for enlarging one’s chin. Its principal advantage is that it is simple and quick to do, allows for a rapid recovery, and the result is very predictable with a high patient satisfaction rate.
A wide variety of synthetic materials have been used in the chin but the standard over time continues to be solid silicone. It is well tolerated, flexible, easy to insert and remove, can be easily manufactured in an endless number of configurations and sizes, and is inexpensive. Its flexibility allows even large extended implants to be placed through small incisions. As of this writing, porous polyethylene (Medpor) is the lone alternative and good results can be achieved with its use although it is more expensive, requires greater intraoperative time and effort for fashioning and placement, and is more difficult to remove should that ever be necessary.
The chin implant is almost always put in through a small incision on the underside of the chin in the submental crease. This provides a direct approach for placement of the implant (shortest distance to the bone) and allows liposuction and neck tightening procedures to be done through the same incision. The chin implant is slide into position on the bone after a pocket has been made that will accomodate its size. Once in place, it is either sewn or screwed into place and the tissue closed over it. While a chin implant can also be placed through the mouth (a common approach done by many oral surgeons), placing it this way disrupts the main chin muscle and the risk of having the implant riding too high on the chin bone after surgery unless the implant is secured by screws to the bone.
The chin implants used today are quite different from those used in the past. Today’s chin implants are better by having ‘wings’ that extend out further to make a smoother transition to the bone on the side of the chin out on the jaw. This allows for the creation of increased width to the chin and improved blending into the lateral body of the mandible without irregular transition zones. The size and style of chin implant chosen is done by pre-surgical imaging of the face and chin and looking at how the different sizes change one’s profile.
Chin implants are a very safe procedure that has few complications if done well. Infection after surgery is rare but the implant could be salvaged by antibiotics alone if it occurs in the early postoperative period. Thereafter, implant removal is usually required for resolution. Some temporary lower lip numbness can occur but this resolves quite quickly after surgery.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Chin, Cheek, and Jaw Implants for Facial Augmentation in Indianapolis by Dr. Eppley

In the pursuit of improved facial balance and shape, the use of solid facial implants is a simple and proven method. While there are facial implants made from different materials that can be used, the use of solid silicone (rubber) chin, cheek, nose and jaw implants are by far the most commonly used. They are soft, flexible, and slide easily into place on top of facial bones. These type of facial implants are placed deep to the skin down at the bone level. Since they are solid, not gel-filled, there is no risk of implant leakage or breaking. All facial implants can be inserted through very discrete incisions that often leave no visible scars on the face. While any implant (foreign-body) has some risk of infection, facial implants infection is quite uncommon.

Enhancing the chin with an implant is the most commonly performed facial implant procedure. With a small incision under the chin, a chin implant can be easily put into place, bringing the chin forward so that it is in balance to the nose and lips. Unlike the old style ‘button’ chin implant, there are many different styles of chin implants today. From curved styles to a more box shape, to those chin implants with a central dimple, there are many options to custom tailor a chin implant to fit most patient’s faces. Usually the chin implant is sutured into place, a metal screw can be driven through the implant to the bone. This screw fixation method can eliminate one of the very few complications of chin implants, that of shifting or changing position after surgery causing chin asymmetry. Chin implants are commonly in conjunction with other facial procedures including rhinoplasty, neck liposuction, and facelifts.

Cheek implants also have a variety of styles, allowing fullness to be gained over the prominence of the cheekbone, filling out the hollow underneath the cheekbone, or allowing more fullness to be gained up to the side of the nose. By going through the mouth under the upper lip, there is no facial scarring. Cheek implants help bring fullness to a flat cheeks, help camouflage a prominent nose, or restore facial fat atrophy lost in HIV disease. Metal screw fixation seems to be of particular importance as the cheek implant is really sitting ‘on the side of the cliff’ so to speak and, therefore, is more prone to the risk of moving out of place after surgery.

Jaw implants of the mandibular (jaw) angle are relatively new. Jaw implants are designed to ‘square’ the face at the jaw angle for a more masculine look or to correct facial asymmetry if jaw development is different between the two sides of the face. Swelling and recovery after jaw angle implant placement is greater than with chin and cheek implants as the big chewing muscles must be lifted up to put the jaw angle implant in place. This causes some soreness in opening the mouth for several weeks after surgery.

In some cases, the use of different implants in the same patient, such as a chin and jaw angle implants in a male, can provide dramatic changes in one’s facial appearance. Facial implants are a powerful tool, that is simple and usually uncomplicated, to achieve facial enhancement.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Customized Double Chin Correction

Whether it be the younger patient who has always had a fuller neck or the older patient who has developed a neck ‘waddle’, the double chin appearance is an undesired facial look. It can be caused by either too much neck fat, loose neck skin, or a short chin or jaw. In the young patient, it is usually a result of too much fat and a smaller chin. In the older patient, the issue of loose neck skin becomes more prominent.

Surgically changing the double chin look is a highly successful procedure that usually has a fairly dramatic change in one’s appearance. This is most evident in profile or side views, the view that most people see us as but one we rarely perceive ourselves in. There are three plastic surgery procedures that address the double chin deformity; neck liposuction, chin implant, and a neck lift. Which one(s) are used in each patient depends on their age and what is the anatomy of the underlying problem. Sometimes only one procedure used, in other cases all three may be necessary. To help me match the right solution to the problem, I classify double chin patients as follows:

Type 1 Young patient, fat neck, normal chin = neck liposuction only

Type 2 Young patient, fat neck, short chin = neck liposuction + chin implant

Type 3 Middle-age, full neck = neck liposuction, limited or full facelift

Type 4 Middle-age, full neck, short chin = neck liposuction, chin implant, facelift

Type 5 Older, neck waddle = full facelift, chin implant, +/- neck liposuction

This treatment planning algorithm helps me think through what is best for each patient to create that well-defined jowl and neck profile. All procedures are done as an outpatient under sedation or general anesthesia. Surprisingly, there is very little discomfort with these procedures but there is some social recovery (appearance of swelling and bruising) Once corrected, the results last a long time. In most cases, there will never be a complete return to the original look….ever.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis