Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

The term, glass chin, has been around for a long time. It is typically used in combat sports, such as boxing and martial arts, to describe a fighter who is susceptible to being knocked out or hurt by a punch to the front part of their jaw. Since the chin is a protruding facial structure that is the easiest part of the face to hit, a fighter’s chin casts an image as to their ability to tolerate physical trauma to the face. This is why a fighter with a good chin, aka granite chin or iron chin, is viewed as having the ability to absorb punishment without being knocked unconscious.

While this is interesting commentary on sporting lingo, it normally would have no relevance to plastic surgery. (unless I had to fix a broken jaw in a fighter) That is what I thought until just a week ago. During a surgical procedure to remove and replace a man’s chin implant, I came across a true glass chin.

I had an out of town patient who, amongst other procedures, wanted his existing chin implant removed. He said he never really thought he needed it anyway and was bothered by its very hard feel. It also made his chin feel stiff up under his lower lip. Through a submental incision, I dissected down through his chin tissues to the patient’s indwelling chin implant. Because it had been placed elsewhere through an intraoral approach, I knew it would be in a high position on the chin bone. It was at least a centimeter above the lower edge of the chin bone when I encountered the implant capsule.

On cutting through the capsule with a cautery, the underlying implant felt unusually hard. Even though it was clear, a sign that it would normally be made of silicone, it was instead hard. So hard that tapping on it made it sound like glass. Unlike a silicone rubber chin implant, which folds on itself and makes it easy to remove, the implant was rock solid. It required the entire implant capsule to be opened for its removal.

On its removal, it could be seen that it not only was made of a hard and inflexible plastic (glass??) but it was also a cleft chin style. I have never seen or even heard of a manufacturer who would make a facial implant out of this hard material. Nor can I envision why anyone would. It not only was hard and poorly shaped, it was very short in horizontal dimension. It was very hard and diminuitive compared to traditional silicone chin implants.

I can now say that I actually have seen a patient who truly had a glass chin.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: The desire for a stronger jaw appearance is sought by many younger men. Part of a strong jawline is the size and angularity of the jaw angle. Located under the masseter chewing muscles, the right or left angle of the back part of the jaw is one of the largest areas of the lower jaw. Unlike the chin, the jaw angle is not a profile structure of the face and is most evident in the frontal and oblique views.

A well defined jaw angle has visible vertical and horizontal edges, some degree of outward flare, and sits above the level of the lower edge of the chin. This allows the profile of the jawline to be seen to angle back and outward from the frontal view, creating a V-shaped configuration. There is no aesthetic consensus on how much flare is best or the vertical relationship of the angle to the chin.

Implants are the only plastic surgery option for creating increasing the prominence of the jaw angle. There are no osteotomy or bone moving procedures that can enhance its shape. Jaw angle implants come in two basic styles, one for lateral augmentation (pushing out the existing bone shape) and inferolateral augmentation. (creating a lower and wider jaw angle partially below its existing shape) Selection of the proper implant style for the patient’s anatomy is critical to get an improved jaw angle definition result

Some men, however, desire a jaw angle change that simply can not be obtained with current implant styles. Or have had prior jaw angle implant surgery, and while finding it provided some improvement, was not satisfied with the result. In these cases, only custom jaw angle implants will suffice.

Case Study: A 35 year-old male had prior chin and jaw angle implant surgery. While there was visible improvement, he wanted a much stronger chin and jaw angle augmentation with an overall more defined jawline. Given the size of his current implants, larger off-the-shelf implants would still fall short of his goals. Therefore, a custom implant approach was used.

An initial 3-D CT scan of the mandible was obtained and a polymer-based mandibular model created. Jaw angle implants were fashioned out of clay and hand-carved to the desired size. They were also made to connect with the largest off-the-shelf silicone square chin implant available. Once created, the implant mock-ups were sent to a manufacturer where they were made into silicone implants and sterilized.

During surgery, his old chin implant was removed and a new larger square chin implant placed. To get even more horizontal projection of the chin, the back section of the old implant was placed behind the new one using a wafer technique. The two stacked chin implants were then screwed together down to the bone. Then his old jaw angle implants were removed and replaced with the new custom ones. The back end of the chin implant wings was sutured to the front edge of the jaw angle implants as initially envisioned on the model during their creation.

He reported that his postoperative recovery was less much severe than his first chin and jaw angle surgery. This was presumably due to the presence of pre-existing pockets from his prior surgery. Although the jaw angle implant had to be significantly lowered and extended to accommodate the size of the new implants. This custom implant approach satisfactorily achieved his aesthetic jawline appearance goals..

Case Highlights:

1) Prominent jaw angles are a desired feature for many men to create a more angular and visible jaw line. Jaw angle implants are the only surgical method available to augment this part of the lower jaw.

2) Current off-the-shelf styles of jaw angle implants may not create a strong enough change for some men. For these patients, custom jaw angle implants may need to be made.

3) Made off of a jaw model from a 3-D CT scan, custom jaw angles implants are manufactured from a silicone material. They can be made with any desired height and width and can make a dramatic change in the angle of the jaw’s appearance.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Chin augmentation is a great way to enhance one’s facial profile if the lower facial prominence is recessed. The use of a chin implant is the most common method to make this facial change. It is typically perceived as a horizontal change or increasing the most anterior soft tissue point of the chin in the side view. This is of value in both men and women but, particularly in men, where a stronger chin creates a more masculine appearance.

But perceiving chin augmentation as just a horizontal change overlooks that it can also impact the frontal appearance of the chin as well. Its vertical length and horizontal width are other important dimensions of the chin that are frequently overlooked. These can also be changed by the type and size of implant selection.

In men, a strong chin can be a favorable facial trait. In the frontal view, one of the determinants of a strong chin feature is its width. Chin implants today can make significant width increases by their design. The square chin implant is one specific style that is intended to make a wider and less rounded chin. It is almost exclusively requested and used in male chin augmentation.

Square chin implants are designed so that there is a frontal ‘bumper’ or block square segment of material across its front. Rather than being rounded as it curves around the edge of the chin, it is squared off and then makes more of a right angle change into the side of the implant. Currently, there are several commercially-available square chin implant designs. In silicone materials, two styles of square chins exist with one having more square width than the other. In porous polyethylene (Medpor), an adjustable square chin is available. This is not only because it has an inherent square front shape but because there is a central connector tab between the two implant halfs. The amount of insertion of the tab between the two halfs allow for some degree of extra widening of the implant, up to an extra 10mms. (this also provides an opportunity to make a vertical chin cleft as well)

When it comes to a square chin, how much is enough? What is the aesthetically pleasing amount of ‘squareness’ that a chin should have if one so desires to make this change? As a general rule, a pleasing and balanced square chin should not exceed a vertical line dropped down from the corners of the mouth. The measurement of the width of the mouth from one corner to the other can be transferred to the width of the square component of the implant. When the right angle of a square chin goes beyond this line, it will cause a noticeable dip or divot to appear along the side of the jawline as it transitions backward. This creates an uneven and unnatural looking jawline.

Smaller versions of square chin implants can be made from any of the many larger non-square or round chin implants. The rounded front edge of an implant can be shaved down or made flat during surgery so the front edge of the implant is more square. How much horizontal augmentation needed must be carefully calculated so that in making the chin implant more square, the amount of desired horizontal increase is not dimnished. Custom square chin implants can also be made to allow for more extreme chin width increases.

Square chin implant augmentation is an aesthetic option for those men who want a stronger appearing chin in the frontal view. Whether this is a good option and looks reasonably natural depends on the shape of the rest of the face and that the implant is not oversized.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

One recent high profile facial change reported in the media is that of Bristol Palin. At a dinner in Washington in late April, she was reported to be unrecognizeable. Something was very different about her face. She had a distinctly more angled jaw and sharpened chin. It was speculated that she had a facelift, fillers or even implants in her cheeks.

What did she have done? According to the 20 year-old reality star, she had corrective jaw surgery. While she acknowledged that it changed her look, the surgery was done for medical necessary reasons. She underwent the procedure so her lower jaw and teeth could align properly. In essence she had a pre-existing malocclusion (underbite) that was treated by a mandibular (jaw) advancement. (sagittal split ramus osteotomy, SSRO) It is impossible to know how big of a jaw advancement she had done, but judging by her preoperative profile pictures, probably in the range of 4 or 5mms at best. But this procedure alone would not account for her new profile and jawline.

She likely may have had the additional cosmetic procedures of neck/submental liposuction and a chin or genioplasty procedure. What type of chin reshaping she had can only be speculated, but it likely was a chin osteotomy as opposed to a chin implant. It is very common to do a chin osteotomy as a complementary procedure to a jaw advancement osteotomy. This is because the same equipment is used for both procedures and if you are asleep for one bone cutting procedure, it makes sense to cut and move the chin bone as well. This is also a good opportunity to perform a natural bone moving procedure that will heal and never pose any problems in the future in a very young patient, unlike the risks (albeit very low) of having a synthetic chin implant.

The other giveaway that it might be a chin osteotomy is the shape of the new chin. The chin is more narrowed, almost a bit pointy, and there is a slight inward indentation as the chin moves around into the side of the jaw. This is a look that a chin osteotomy (osteoplastic genioplasty) can create as the end of the chin bone moves forward. It frequently will create a more narrow chin as the u-shape of the chin bone moves ahead of the rest of the arc of the lower jaw. A chin implant usually does not create as much chin narrowing and makes the sides of the chin wider not more narrow, unless a central chin button style implant is used.

Because she had jaw surgery, she may well have lost some significant weight in the 6 week recovery phase. As one can not eat or chew normally for this period of time, all patients will lose some weight. A 10 or 15 weight loss could account for her overall thinner face, regardless of whether neck liposuction was done.

This conversion of her round face to one that is more oval occurs because of the triple effect of three changes; a more prominent chin, a trimmer neck profile and a more narrow submalar (below the cheeks) area. While Bristol Palin achieved this result by jaw and chin bony advancement and neck liposuction and/or surgically-induced weight loss, the more common ‘facial derounding’ surgery uses a slightly different approach. The more traditional approach uses chin implant augmentation, neck liposuction and buccal lipectomies.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The lower third of the face is dominated by the jawline. The jawline extends from one jaw angle around a convex arch to the other. It is actually the largest surface area of any facial bone prominence. Leading the way is the chin but the jaw angles located at the back play an often equally important aesthetic role. A well-defined chin and jaw angles conveys a stronger facial appearance. Weak chins and jaw angles convey timidity and weakness. While this perception may not always be true (and often isn’t), an ill-defined jawline helps create that impression and often makes the neck appear fuller with an obtuse neck angle. In today’s plastic surgery, newer implant designs and styles opens up the possibilities for a variety of jawline enhancements.

The evolution of chin implants has really evolved over the past decade with many different styles and size options. The most important change has been that they have been extended in their shape rather than just being small central buttons. Having an enhanced chin that flows better into the surrounding jawline is a more anatomic approach for most patients. To have a smooth transition from the chin implant to the side of the jaw, the implant must extend back further to blend into the jawline. These newer implants are longer and more tapered at the ends, although they can still be placed through a small incision right under the chin. Because they extend back further they give an enhanced but natural appearance to the chin. Slightly widening the anterior jawline by filling in this area between the chin and the side of the jaw creates a more balanced look. Chin implants can be placed on the lower edge of the bone to add some vertical length to the chin as well. Square and cleft chin implant styles exist for those that want more chin width or a central chin soft tissue highlight.

Jaw angle implants are one of the newest facial implant options that adds to what the historic chin implant can do for the jawline. A more square and well-defined jaw angle creates a more masculinizing look and can only be created with implants. Jaw angle implants can either widen the back of the jaw, make it more longer and more square, or both. These effects are created by different jaw angle implant style options. They are inserted from inside the mouth so scarring is not a concern.

Combinations of chin and jaw angle implants can create a more complete jawline makeover and are often done together. In some cases, no available off-the-shelf chin or jaw angle implant can create the desired effect due to a patient’s unique anatomy or aesthetic needs. In this situation, a customized ‘wrap-around’ jawline implant can be made from a 3-D CT scan of the patient. These can be made as a single implant or in multiple units that can be inserted in pieces and assembled when next to the bone. This approach is particularly useful when the jawline needs to be vertically lengthened. (implant sitting on the bottom edge of the bone)

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The shape of one’s neck has a profound influence on the appearance of the face that sits above it. The neck is bordered by the jawline, which consists of the chin and the horizontal length of the jaw, and the outline of the neck skin The outline of the neck should be the intersection of horizontal and vertical lines which intersect at an angle point just above the thyroid cartilage. (adam’s apple) A more youthful neck angle is usually in the range of 100 to 120 degrees.

Aging of the face is usually associated with loss of a good neck angle. At fat accumulates in the neck and the skin becomes more loose and saggy, the neck angle changes. In profile, it opens up to a neck angle which can be as big as 180 degrees. When this occurs, there is no neck angle and a straight line runs directly down from the chin to the sternum.

Reshaping of the neck angle, technically known as the cervicomental angle, takes three basic approaches. The approaches often use a combination of neck tissue reduction and tightening and/or chin augmentation. How short the chin is and how much loosed skin there is in the neck determines whether a Type I, II, or III neck recontouring is done.

In the type I neck deformity, the neck problem is a moderate collection of fat but there is not an excess of neck skin or it is not overly lax. In addition, the chin projection is adequate. Correction here consists of liposuction alone. In many instances, the liposuction can be done under local anesthesia. I currently prefer the use of Smartlipo because of its potential skin tightening benefits.

In the type II neck deformity, the neck problem is still a moderate amount of submental and neck fat with reasonably tight skin. At the least, the skin has good elasticity and feels like it can tighten up fairly well. The chin, however, is horizontally short. The combination of chin augmentation with an implant and Smartlipo to the neck produces a much sharper neck neck angle.

In the type III neck deformity, all three neck components are deficient. The chin is short, there is a good amount of fat in the neck, and the neck skin is loose and non-elastic. The neck liposuction and chin implant is complemented by a facelift. The facelift tightens all of the neck skin and produces a very well defined neck angle again.

The surgical strategy to improve a poor neck angle must consider the bone (chin), the amount of fat, and the one real key…how much loose skin is there. Unlike the younger neck where the tightening of the neck skin is more likely, this is a missing element in the other neck.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

The chin and neck angle relationship is one of the most significant facial markers that has a significant influence on the age of one’s appearance. A well defined chin point and a contoured neck angle are what most of us had in the first three to four decades of life. Aging changes the neck angle and, combined with even a slightly weaker chin, creates that loss of youth look.

The combination of neck liposuction and chin augmentation is one the most effective and relatively simple facial procedures. The best patients are generally under the age of 55 (average range 35 to 50 years old) who do not significant neck skin looseness or laxity. The neck skin may have some wrinkling and sun damage but one should not be able to pinch more than an inch of loose skin. (not bunching up fat, just loose skin) The key is patient selection for a good result. If significant loose skin exists, some form of a necklift (facelift) is needed.

Candidates for this combination often seek out or have already had non-surgical treatments like Thermage or SkinTyte. These minimally invasive neck and jowl treatments do not have the capability to really change facial contour. While they do create a minor amount of skin tightening and wrinkle reduction, they often leave patients disappointed. They are not capable of removing a double chin or a jowl sag.

For patients with a good chin profile, neck liposuction alone is all that is needed. I prefer the use of Smartlipo as it can be comfortably and effectively be done under local or sedation anesthesia. With Smartlipo, a 1mm fiber is threaded through a small stainless cannula for insertion under the neck skin. The cannula keeps the fiber from bending and breaking. The tip of the fiber sticks out beyond the cannula just a bit to deliver the heat energy to the fat. The fiber has an aiming beam so one can always see the laser point under the skin and know exactly where the laser is. The key to laser lipolysis is that it is performed with temperature monitoring so the neck tissues do not get too hot. The wavelengths of the laser has three beneficial effects. Its effect on hemoglobin seals off blood vessels which results in less bruising. The heat is very effective for breaking down and melting fat. Additionally, by heating the underside of the skin significant tissue tightening will result. While there is debate about how much skin tightening occurs after laser liposuction, it is fair to say that it is greater than that which is achieved by liposuction alone.

The recovery after Smartlipo of the neck is a maximum of ten days. Often it is within just a week. In some cases, the addition of simultaneous skin resurfacing can be done if there is any pre-existing wrinkles. This will not increase the recovery time at all as less than 50 micron depths are used.

The potential benefit of a chin implant with neck liposuction must be looked at carefully. Many neck contour changes can be enhanced by some more chin projection. Rarely does one need an implant of any significant size, 3 to 5mms of increased horizontal projection can be enough. With flexible silicone implants, they can be placed through the same under the chin incision used for neck liposuction, just slightly larger. Incision lengths less than 15mms are all that is needed.

For the right patient, Smartlipo of the neck with or without chin augmentation provides a very visible neck change, is cost effective, and does not have a long recovery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Chin augmentation is one of the best values in facial surgery because it is both simple and tremendously effective for many patients. Changing the projection of the chin affects one’s profile and balance of facial proportions Because of its relative simplicity, it is widely performed by cosmetic surgeons at all levels of experience and training. It is the chin implant’s apparent simplicity, however, that can led to surgical mishaps and unhappy patients. Surgeons often offer chin implants as a relatively minor procedure, offering them as part of a rhinoplasty or facelift.

A chin implant is essentially a space-occupying mass that pushes out the overlying soft tissue. Within this soft tissue envelope lies the mentalis muscle, which must not only have one end lifted off the bone to insert the implant but will also end up stretching out the muscle as well. While some chin implant problems are related to the position or size of the implant, the most troublesome ones to correct are the result of what has happened to the  overlying soft tissues.  

One of the most common causes of chin implant problems is when an intraoral approach is used. Disrupting the upper attachment of the mentalis muscle can be risky. If the muscle is  not properly put back of during closure, the muscle will contract and pull the chin soft tissues downward. (chin ptosis) If there is sufficient contraction, the lower lip will be pulled down  and excess lower teeth will show. It only takes but a few millimeters of downward lip movement for patients to notice. Correction of chin pad ptosis requires re-entering through mouth, freeing up of the muscle, and re-suspension back up on the bone. Or when an indwelling implant, back up over it and secured to the bone. The whole corrective operation depends on the method of securing it to the bone. I have successfully used both small metal screws and resorbable bone anchors. The bone anchors are the easiest to use and two or three of them work quite nicely.

To avoid this potential problem, chin implants should be placed from below with a submental incision. It is much a more assured way to get the wings of the implant properly placed, has less risk of nerve injury, and the mentalis muscle can be easily sutured back together. Any scar concerns are misplaced as submental scars almost always turn out excellent. Intraoral chin implant surgery is not ‘less invasive’ than an extraoral approach.  

Chin implant removal invariably causes soft tissue problems. In addition to inducing chin pad ptosis, the pocket where the implant used to reside can contract or even fill with fluid, leading to subsequent visible deformities and irregularities of the skin of the chin. To ideally avoid these difficult problems, consider replacing the implant with a smaller one (so the space does not completely collapse) or an advancement osteotomy. If one is possessed about having no implant or considerably less chin projection, one should consider doing a submental tuck-up from below where the expanded soft tissues can be reduced and tightened.

Because of the location of the mental nerves, some chin implant placements can develop neuropathies or numbess of the lower lip afterwards. A little tingling of the lower lip is one thing which almost always resolves in a matter of weeks after  surgery. More significant changes in lip/chin sensation is a different matter. Profound numbness of either side must be dealt with early to avoid permanent nerve damage. The pressure of an impinging implant can cause resorption of its axons which may not regenerate. If lip numbness presents beyond 2 weeks, the implant needs to be adjusted. At the least, re-operation is necessary to ensure that the wing of the implant is sin the proper place. The risk of this potential problem can be assessed by looking at a panorex film and see if the canal lies lower than normal. Greater than 1 cm. of distance between the canal and the inferior border of the mandible is a good safety margin.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis Indiana

Chin augmentation using an implant is a very common and highly successful procedure.With easy access to the front of the lower jaw (mandible) and few anatomic structures in which to be concerned about injuring, changes in the chin are quick and predictable. As a stand alone procedure or in combination with numerous other facial changes, chin implants provide a great tool for structural facial enhancement.

But like all implants used anywhere on the body, they are not complication-free. Mishaps and untoward outcomes do occur and secondary surgery is occasionally needed. Most of these problems are eminently improveable by implant adjustment or replacement and/or soft tissue modification.

Unhappiness with chin projection or shape after augmentation is a function of implant selection. There are now over seven styles of chin implants that offer more than a set amount of horizontal advancement. How far the implant goes back along the jawline and how much fullness to the side of the chin that is created can be altered by chin implant options that are now currently available. By comparison to the original operation, replacement with a new chin implant is a relatively easy operation since a pocket already exists. In some cases, a chin implant may have been asked to do too much. If the amount of forward chin movement needed is greater than 10mms, one may consider an osteotomy instead for such large chin changes. It will be prone to less potential complications.

Chin implants can shift as they are placed along a curved bone surface. Such shifting can occur horizontally or vertically. Most commonly, an implant that has shifted to the right or left is easy to spot as the central chin point is off-center. The center of the chin and its underlying implant should be along a vertical line drawn down from the center of the lower lip and through the midline between the mandibular central incisors. To prevent shifting during initial placement, a centrally-placed screw through the implant to the bone can be used. Similarly, correcting a deviated implant uses the same approach.

Vertical malposition (up too high) is usually the result of the implant being placed through an intraoral (inside the mouth) approach. With an open path from which it was inserted, it can easily slide up from the inferior border of the chin. It is more important to use a screw with the intraoral approach than from an incision under the chin where upward migration is limited by the  superior extent of the pocket dissection during placement.

One of the newer complications of contemporary chin implants (anatomic designs) is lateral wing malposition. While it is usually a benefit to have the implant extend back further along the jawline, it is necessary to have these wings tapered to blend into the bone as the implant ends. This makes the wings very thin and extremely flexible. It is quite easy for them to fold or bend at the back end of the pocket during placement. This can be felt as a bend or fold along the jawline at the implant-bone transition. The implant must be removed, the pocket extended and the implant re-inserted.

One of the well known chin augmentation problems does not involve an implant at all. When a chin implant is removed for whatever reason, the expanded soft tissues may not shrink back down. If they do not, and the larger the original implant the less likely they will, the chin soft tissues fall creating the classic witch’s chin deformity. This can be corrected by refilling the collapsed space with a new implant or an advancement osteotomy.  Another option is to remove the lax tissues and tighten them from underneath the chin. (a submental tuck-up)

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

A full or fat neck is most commonly treated by liposuction, particularly if one is fairly young. The results from neck liposuction are significantly influenced by the quality of the overlying skin. Good taut or thick skin will respond by shrinking and adapting upward to a less obtuse neck-jaw angle. Loose or inelastic skin may shrink somewhat but it will be irregular with band and cords apparent to the eye. When neck skin is loose, the liposuction procedure must be combined with some type of facelifting procedure. Whether it is more of a limited or full facelift will depend on how much loose skin exists.

One often overlooked consideration in neck liposuction is that of the chin. Should the chin be brought forward or is its projection adequate where it is currently? In the spirit of what one is trying to achieve by removing fat from the neck…a more evident jaw and neck line…the chin should not be forgotten. In some cases, it can be a good complement to the look that liposuction creates.

One effect that neck liposuction does create is the illusion that the chin is a little more prominent. As the neck-jaw angle, technically known as the cervicomental angle, become less obtuse and positioned back somewhat, it can look like the chin is a little more prominent. That is easy to understand as the chin may look more forward because the neck has moved back. In some cases, changing the shape of the neck may be all that is needed to improve what one thinks is a short chin.

In other cases, neck liposuction should really be combined with a chin implant. The problem is not just too much fat in the neck but the chin is really short as well. This is a much more prevalent issue in men than it is in women. Men can aesthetically tolerate a more prominent chin anyway, women must be more careful about de-feminizing their appearance. A combined neck liposuction-chin implant procedure is a classic ‘ying-yang’ facial procedure where movements in opposite direction create a better overall effect than either one alone.

Whether a chin augmentation is an additive benefit to neck liposuction can be determined easily prior to any surgery with computer imaging. Imaging profile structures, where the skin is in contract to the background, is very accurate and predictive of what surgery can really achieve. One can have themselves imaged with neck liposuction alone, combined with a small chin implant, and then combined with a larger chin implant as well. Looking at all three changes can really help one decide what is best for themselves.

The shape and appearance of the neck is partially influenced by the forward position of the chin. In many ways, the chin is an extension of the horizontal vector of the neck. As with any neck reshaping procedure, the chin should not be forgotten in surgical consideration and planning

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis