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 implants’ Category

Case Study: Extreme Chin Augmentation with Combined Osteotomy and Implant

Monday, December 3rd, 2012

 

Background: Chin augmentation is a very common plastic surgery procedure that helps bring into balance the lower face with more projecting upper facial features. It is by far most commonly done with synthetic implants that provide varying amounts of increased horizontal projection as well as some width changes. Less frequently, sliding genioplasties (chin osteotomies) are done for chin augmentation when more horizontal projection is needed than implants can provide and/or vertical lengthening is aesthetically beneficial as well.

In more extreme cases of chin deficiencies, neither implants or an osteotomy is really adequate. When the chin is really short, this indicates that the entire lower jaw is underdeveloped and an overlying malocclusion (bite deformity) exists as well. While this type of patient should ideally have orthodontics and subsequent orthognathic surgery for jaw correction, this may not be an option for many so afflicted patients. While one could argue that an implant or an osteotomy is better than nothing, and that is most certainly true, they will fall far short of the needed amount of augmentation.

Extreme cases of chin deficiences require a novel approach to get visible and satisfactory results that often must approach 20mms of increased horizontal projection. Combining an osteotomy with an implant is relatively unprecedented although there is no reason why they can not be done together. The implant can merely be placed on the front edge of the osteotomy which is naturally denuded of soft tissue for the execution of the bony cut. Because there is no defined soft tissue pocket, it would be critical to secure the implant to the bone to avert displacement later.

Case Study: This 35 year-old male presented for chin augmentation. He had seen other plastic surgeons who told him his chin was too small for an implant. He did not want at this point in his life to undergo the orthognathic surgery process. In addition, he did not have the quality of dentition that would support in good health a prolonged course of orthodontics. By measurement in photographs using the Frankfort horizontal plane, his soft tissue chin point was deficient by 29mms from an ideal horizontal position. At this amount of horizontal deficiency, he also had a vertical chin deficiency as well.

Through an intraoral approach, an obliquely-oriented horizontal chin osteotomy was done staying 5mms below the mental foramen. The chin was downfractured and then advanced and held into a maximally advanced position with a step plate secured with screws above and below the osteotomy line. A maximal advanced position is one in which there still remains a small amount of bony contact between the front edge of the upper chin bone and the back edge of the advanced chin segment. The step plate was bent downward to create some vertical lengthening as well.

To get more chin projection than just that of the bone, a 7mm extended synthetic implant was placed on the front edge of the advanced chin bone. It was secured to the chin bone with a screw on each side of the midline. The wings of the implant extended back along the advanced chin bone to ensure that they covered the end of the osteotomy site where a bony notch typically occurs. The mentalis muscle was then reattached and closed in two layers with a single mucosal layer closure.

His postoperative course was typical for any sliding genioplasty patient. There was swelling and bruising along they jawline and neck that persisted for about three weeks after surgery. When seen at three months after surgery, all swelling had resolved and he had no residual mental nerve numbness. He had dramatic improvement in the appearance and shape of his chin, even if it still was mildly deficient. At ten years after his surgery, he has not had any implant or bone healing problems.

Case Highlights:

1)      Severe chin deficiencies are not optimally treated by synthetic implants or osteotomies alone. Neither are capable of increasing the horizontal chin projection more than approximately 15mms.

2)      Combining a sliding genioplasty with an implant in front of it can achieve horizontal projection increases of up to 20mms.

3)      Combining implants with a chin osteotomy requires screw fixation of the implant to the advanced chin segment and long enough wings of the implant to cover the notch at the end of the osteotomy cut.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Implant Concepts For Surgical Jawline Enhancement

Monday, November 26th, 2012

 

‘All societies in history were and are preoccupied with facial beauty’

‘ Facial balance and symmetry are the key features to attractiveness’

‘All people regardless of race, class or age share a similar sense of what is attractive’

‘Square jawed males are viewed as more masculine, gain higher ranks in the military and have earlier and more frequent sex’

‘ A square chin and jawline frames the lower face, making it more symmetrical and defined’

‘Defined jaw points and angles are more attractive in both men and women’

These are just a few of the well known facial facts of beauty that are often quoted and specifically address the merits of a strong and well defined jawline. While some have it naturally, the vast majority of us don’t and must seek a surgical solution. While there are a variety of facial implants for jawline enhancement, there are numerous misconceptions about how they work and how a better jawline is achieved.

‘The jawline consists of three parts, the chin, body and angles, all which can be implanted although not equally effectively or in all dimensions’

The most well known jawline implant is that of the chin. It is the most frequently done of all facial implants and has been surgically implanted for over fifty years. While the styles and size of chin implants have improved dramatically over this time, chin augmentation only affects the front 1/3 of the jawline. While one could argue that this is the most important part of the jawline and has its U-shape provides very visible forward projection, a chin implant provides no change for the posterior 2/3s of the jawline.(body and angles) Even today’s extended anatomic designs rarely provide any augmentation to the body even though the tail of the implants may lay upon it. Today’s chin implants, while providing projection and even square shapes through increased width, can not provide vertical lengthening…an overlooked feature of chin implant designs.

Three-dimensional chin reshaping can be done by a sliding genioplasty which can add vertical lengthening as well as horizontal projection. In extreme chin deficiencies, an osteotomy can be combined with an implant in front of it for a few more millimeters of projection or the implant can serve to fill in the notching that often occurs in the bone in the prejowl area.

Jaw angle implants are the least performed augmentations of any of the facial prominences. (chin, cheek, nose and jaw angles) While jaw angle implant designs have been around for nearly fifteen years, they have not garnered great use because their surgical implantation is more difficult and aesthetic interest is more recent. Current jaw angle implants produce mainly lateral augmentation (width) which actually is indicated for only the minority of patients seeking jaw angle enhancement.  For someone with a favorably low jaw angle point, width alone may produce a satisfactory enhancement.

Jaw angle deficiencies, however, almost always are the result of a high jaw angle which by definition implies a vertical deficiency as well. Getting current implant designs low enough is difficult if the surgeon does not do adequate soft tissue release and the implant does not have a design that can engage the lower border of the jaw angle for positional security. Jaw angle implant designs that provide both horizontal and vertical augmentation (inferolateral) are most useful to a larger number of patients, particularly men, who seek a more defined and prominent jaw angle area.

While chin implants augment the anterior two-thirds and jaw angle implants enhance the posterior two-thirds of the jawline, the missing area is the middle or the body of the jawline.  Sandwiched between the chin and the jaw angle, the body area has not specific implant for it. There is no ‘connector’ implant between the two. For those seeking a perfectly straight line back from the chin to the jaw angle point, this may be an aesthetic problem. While chin implants have extensions that go back and jaw angle implants have a forward reaching design, the two only connect over the body by overlapping their feathered edges if done together. This is why many jawline enhancement patients may have a visible step-off or break in their new surgically created jawline. For some combined chin and jaw angle patients, this body discrepancy is minimal and not an aesthetic issue.

The body gap becomes most manifest when the jawline deficiency has a vertical deficiency component to it, areas that are not optimally augmented with current chin and jaw angle implant designs. When a perfectly straight and well defined jawline is desired, a custom two-piece implant is ideally needed that augments the entire jawline from front to back in a perfectly smooth fashion. These are particularly effective when the lower jaw is vertically short and the implant can be made to extend the entire lower border of the jaw. These ‘wrap-around’ jawline implants can produce some dramatic jawline changes.

The most unique jawline problem that can only be addressed by custom implants is when the entire jawline is vertically deficient, creating a small lower face. This almost always is associated with a lot of overbite of the anterior teeth, indicating that the lower jaw is small and fits partially inside the upper jaw. This creates an overclosing of the lower jaw making it too short vertically. Making a custom implant that fits only on the lower border of the jaw and lengthening it from front to back is the only effective solution.

Jawline enhancement must be assessed carefully in every patient to get the right jawline implant(s) design and size. For many patients, a chin implant may only be needed. For others seeking a three-point prominence change, off-the-shelf chin and jaw angle implants will suffice. Improving implant designs and sizes will make using this implants even more effective in the near future. For those seeking a completely new jawline with existing front to back deficiencies, wrap around jawline implants are designed and custom made for each patient’s specific jaw anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Jawline Enhancement in the Thin Male Face

Friday, November 2nd, 2012

 

Background: A strong jawline is perceived as a sign of masculinity and is a commonly desired feature of some men. Using implants is the only way to create a well-defined jawline through the triple approach of chin and jaw angle implants. While these implants are available in different materials from various manufacturers, their most important feature is the style and size that they offer. Picking these implant features for any male patient is a lot more art that it is science.

When picking implants for any facial area, it is important to take into account their facial shape and the overlying soft tissue thickness. Thick faces blunt the effects of implants and may simultaneously benefit from some defatting procedures as well. Thinner faces have less overlying soft tissue and the effects of implants can more easily be seen. These facial characteristics are particularly important at the jawline which is essentially a transition point between the face and the neck. Augmenting the front (chin) and the back part (jaw angles) of the U-shaped jawline can change its appearance dramatically.

The thin face and jawline has the benefit of being more easily skeletonized by implants. But implant size must be tempered lest their effects become too pronounced or big. The lower face must not overpower the upper face by being too wide or extending beyond the upper zygomatic width. It must also not become too square in appearance and still maintain some element of being thin and somewhat narrow, just with a more defined jawline.

Case Study: This 45 year-old male felt that his entire jawline was weak. He had a chin implant placed four years ago and, while it provided some benefit, it was still not satisfactory. As part of the discussion about how to improve his chin, his highly angled jaw angle area was pointed out and it was agreed that jaw angle implants would be beneficial as well. He remembered that his prior chin implant was of mersilene mesh composition and that it was ‘large’ according to his original surgeon.

A square silicone chin was chosen to replace his existing chin implant. At least 9mms of additional horizontal augmentation was needed with a more square frontal shape. Silicone jaw angle implants that dropped the angle border down was also chosen but with a width that was not more than 7mms, keeping in line with the rest of the width of his face. The implants would have some overlap across the body of the mandible but with no augmentation effect in this area, which is common.

During surgery, the chin was approached through his existing submental scar. The mersilene mesh implant was heavily ingrown with tissue and was near the dermis of the skin. Removing it was felt to leave too little soft tissue between the skin and any new implant. It was elected to leave it in place and place the new square silicone implant between the underside of the mesh implant and the bone. The wings of the square chin implant went well beyond that of the mesh implant and had no problem providing a more square shape effect. The jaw angle implants were placed through an intraoral incision behind the molars. Dissection released muscular attachments off the angle and the inferior border so the jaw angle implants could be placed low enough. They dropped the border 5mms and had 7mms width. A single screw secured them in place to keep them low and to the back of the angle.

He had some moderate facial swelling, but like in all thin faces, it resolved fairly quickly within three weeks after surgery. He had a much improved jawline with better definition but a jawline width that stayed in line with his upper facial width.

Case Highlights:

1)      Jawline enhancement in men is most commonly performed by a combination of off-the-shelf chin and jaw angle implants.

2)      The style and size of chin and jaw angle implants must be chosen carefully and with an appreciation of the patient’s natural anatomy and soft tissue thickness.

3)      In the thin male face, jawline implants should not be too wide or over-sized as small implant can produce dramatic effects.

Dr. Barry Eppley

Indianapolis, Indiana

Options in Neck Contouring – 2. Hard Tissue Procedures

Saturday, August 25th, 2012

 

While the soft tissues dominate the surface area of the neck, they are not the only elements that give it its shape. Several hard tissue components comprised of bone and cartilage also make a contribution. The form of the jawline is on the upper edge of the neck and is the superior suspension point for most of the neck’s soft tissues. The thyroid cartilage sits in the midline of the lower neck and is barely noticeable unless it sticks out too far. The prominence of the thyroid cartilage also has gender significance in helping to define a male vs a female’s neck.

While manipulation of the hard tissues of the neck does not change the all-important cervicomental angle, it does help influence how that angle is seen. The stronger and more defined the jawline is, the greater is the perception of more youthful neck due to a longer upper limb of the cervicomental. If the thyroid cartilage is too prominent, the lower limb of the angle is disrupted creating an undesireable bump in the neckline. While for men this bump may be fine and even attractive, it is not so for women.

Chin Augmentation The jawline separates the neck from the face and is defined by both its length and it anterior projection. The chin is the most forward part of the jawline and its strength or weakness can help or hurt the appearance of the neck.  The horizontal projection of the chin can be easily increased using a variety of implant styles and sizes. Chin implants can be placed through either the mouth or from under the chin. For many patients, putting the implant in from under the chin assures proper positioning on the most forward part of the chin bone. Chin augmentation can be a very useful adjunctive procedure with any of the neck contouring procedures, particularly isolated liposuction and facelifts.

Tracheal Shave  The prominence of the thyroid cartilage often has little to do with one’s age. The size of the cartilages are genetically imprinted and not age-related. The one occasional exception is that seen after a facelift when the profile of the thyroid cartilage can become unmasked as the neck skin is tightened and pulled back. For those that have too strong of a neck bulge caused by the strength of the paired thyroid cartilages (more commonly known as an Adam’a apple), this can be reduced by shaving the prominence down. This is done through a small horizontal neck incision directly over the prominence. It is a virtually painless procedure with no recovery and a result that is immediate. Most patients obtain results where the size of the bulge is dramatically reduced and a few will get a completely smooth neckline in profile.

Tracheal Augmentation In rare cases, a more dominant or even an evident thyroid cartilage bulge is desired. This masculinizing neck procedure requires the placement of a specially-shaped implant on top of the thyroid cartilage to build out its projection where the paired cartilages meet in the midline. When combined with a submentoplasty above it, a more prominent tracheal bulge can be created.

Dr. Barry Eppley

Indianapolis, Indiana

The Rise In Chin Augmentation Surgery

Tuesday, April 24th, 2012

The chin has a prominent role in defining facial shape and its aesthetic look. Whereas a strong prominent chin has been associated with strength and increased masculinity, a short chin portrays the opposite appearance of weakness. As a result, cosmetic chin augmentation with an implant has been done in plastic surgery for more than four decades. It is as common to be done by itself as often as it is combined with other facial procedures to improve one’s profile.

While having been done for a long time, chin augmentation surgery has undergone a surge in the numbers of procedures performed. In 2011, a 70% increase in chin augmentations was reported compared to the previous year according to statistics published by the American Society of Plastic Surgeons. News outlets have picked on this increase in chin augmentation surgery and have credited it to such recent electronic device interactions such as Skype on the internet and Facetime on the iphone. It is theorized that seeing one’s face on web cameras and smartphone pictures has increased awareness of chin deficiencies.

While this explanation is intriguing and a bit trendy, it likely has little to do with why more chin augmentations are being done. There are better explanations that make more sense and are reflective of a variety of different factors. First, there are more chin implant options today than ever before. Most of them are made of silicone which makes it easy to create new styles and sizes. Go to any facial implant manufacturer and you will see that there are more chin implant options than almost all other facial implants combined. One of the more popular facial implant manufacturer has 14 different styles not to mention different sizes within each style. One may argue how really different many of these implant styles are but they give surgeons a lot of options. When more options are available, more procedures end up being done.

Another major driving force is the rise in two other specific facial procedures, rhinoplasty and facelifts. Both are being done by an increasing number of surgeons but facelifting treats a problem that eventually affects all of the population. The rise of numerous types of limited or less invasive facelifts has spurned a lot of attention in the younger patient with earlier signs of aging. This has drawn a lot more attention to how one’s face looks as it ages. Since facelifts focus on the shape of the jawline and the neck, any chin deficiency will be quickly recognized. Chin augmentation adds length to the jawline which helps in improving the smoothness of the jawline and the sharpness of the neck angle.

There may also be some influence, as had been suggested, that more people are seeing themselves than ever before. Whether by digital camera, smartphone or on Facebook, people are having to see more of themselves particularly in profile. When combined with an ever increasing desire to remain competitive in the workplace, change in social circumstances such as divorce and an ever increasing emphasis in society on looking and feeling younger, all types of facial rejuvenation procedures are increasing.

Put together, there are many reasons chin augmentation is increasing. But the main reason it continues to grow is because it is works. It is one of the most significant structural changes of the face, whether it is a small increase to complement a facelift or a major change to improve a naturally short jaw.  

Dr. Barry Eppley

Indianapolis, Indiana   

Plastic Surgery’s Did You Know? The Rise in Chin Augmentation

Wednesday, April 18th, 2012

The fastest growing cosmetic plastic surgery operation in 2011 was…chin augmentation. Done primarily with an implant, enhancing one’s profile by improving the projection of the chin increased over 70% last year. The rise in chin augmentation has been linked to the increasing use of Skype and FaceTime, applications where you are forced to look at yourself while talking to others. The distortion of webcams rarely improves one’s appearance and often makes the face look fatter. More likely the increase is due to new chin implant sizes and styles and the growing number of different types of facelifts which are often combined with chin implants to create a more defined and smoother jawline and neck angle.

Surgical Facial Changes for the Male Model Look

Wednesday, August 3rd, 2011

Almost anyone in the world is aware of the recent tragedy in Norway with the mass killings of an incomprehensible number of Norwegian teens and young adults. The murderer Anders Breivik appears to have acted alone, driven by his white supremacist and anti-Muslin views. What has caught my attention as a plastic surgeon, however, is comments that have been written about his facial appearance.

 

According to the head of Norway’s intelligence agency, it is believed that he had undergone plastic surgery in the past to look more “Aryan.” The agency’s head has stated that “You do not have that Aryan look naturally in Norway”…”Hitler would have had him on posters. He has the perfect, classic Aryan face. He must have had a facelift.”

 

While I am not an expert on Norwegian facial structure, I do know that he would not have had a facelift to change his facial appearance. That is not what a facelift does. A facelift is what I call ‘anti-aging facial surgery’, where one is trying to return to one’s prior appearance. This does not change your face but rather makes it look rejuvenated and less tired like it did 10 or 15 years ago. But you still look like you, just a better you.

 

Rather he would have undergone ‘structural facial surgery’, where the foundational components of the face are altered. That can and often does change one’s appearance. Foundational facial procedures are done at the bone or cartilage level, not just the skin and soft tissues. This includes plastic surgery procedures such as rhinoplasty and facial bone augmentations. (forehead, brow, cheek, chins and jaw angles) According to reports, he supposedly underwent nose and chin surgery at age 21. This would make more sense as these can change the structure of the face and definitely can make one more Aryan in facial appearance, particularly if certain elements of the face are already there.

 

This raises the question of what is an Aryan facial appearance and why does it look so? The word Aryan, at least as it was perceived and used in Nazi Germany, specifically refers to being white, blond-haired and blue-eyed. But there is not necessarily a specific set or arrangement of facial features that are ascribed to an Aryan face. People talk about it and one would know if they saw it but may not be able to describe the details of it.  But what it undoubtably refers to is a strong and well-chiseled face. For a male this would be highlighted by well-defined facial bony prominences of the brows, cheeks, chin and jaw angles. The nose would have a strong and high dorsal line with a balanced ratio between the three nasal thirds.

 

The concept of an Aryan face continues to exist today but it is better known as the ‘Male Model Face’. Most young male models in any advertisement today almost all have this type of facial appearance. Whether they have it by genetics, plastic surgery or the use of good lighting and/or Photoshop, the strong and desireable male face has these consistent features.

 

Plastic surgery techniques today can help many men undergo these type of structural facial changes. Rhinoplasty, anatomical cheek implants, square chin implants, vertical lengthening jaw angle implants and occasionally select fat removal below the cheeks and in the neck can create a face that has more well-defined angles and is more masculine in appearance. For some men, this ‘Male Model Surgery’ can be very effective provided they don’t have a lot of facial fat and not an overly round face.  

Dr. Barry Eppley

Indianapolis, Indiana

The Removal Of Medpor Chin Implants

Sunday, May 15th, 2011

The most common method of chin augmentation is to use a synthetic implant. While there are a large number of chin implant sizes and styles, the compositions of them are more limited. The two most commonly used materials for chin implants are silicone elastomer and porous polyethylene. (Medpor) Each has their own merits and surgeon advocates but both can work well with good placement technique.

One of the highly touted advantages of Medpor implants is that they develop some degree of tissue ingrowth due to its semi-porous material property . This is opposed to the completely smooth surface of silicone implants which develop a surrounding scar capsule instead. While this tissue ingrowth is advantageous for long-term implant stability, it also makes the removal of Medpor facial implants difficult.

The difficulty with removing Medpor facial implants is well chronicled, particularly across the internet. Despite this purported difficulty, I have not had the same experience. Over the years, I have had the opportunity to remove or remove and replace numerous Medpor implants, most commonly those of the chin. While they are more difficult to remove than silicone implants, which literally slide right out, that difference in difficulty is only a comparative one. They are not impossible to remove nor are they ‘extensively destructive’ to the surrounding tissues to do so.

Many times in their removal it is easier to remove them in pieces as they fragment fairly easily. Here is a recent case I did where another surgeon secured a chin implant in with 8 screws! While I am a fan of screw fixation  for facial implants, the reason for 8 screws in a single chin implant is  unclear. With so many screws, the Medpor chin implant needed to be removed in pieces to access all of the screws.

A new Medpor chin implant, of a different size and style, was inserted and secured with two new screws. The underlying bone showed no resorption and the overlying soft tissues had but a thin capsule. There was nothing abnormal about the revised chin implant site.

Medpor facial implants should not be viewed as overly difficult or destructive to remove should they need be. The material easily fragments helping preserve the tissue quality of the recipient site.  

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Chin Augmentation Revision with Implant Exchange and Repositioning

Monday, January 10th, 2011

Background:  Chin augmentation is the original and the most common area of facial skeletal enhancement. As a projecting edge of bone that is fairly easy to access, placing a chin implant is understandably perceived as a very simple and near error-free facial implant procedure. Despite this commonly-held belief, however, chin implants do have problems and need to be revised, replaced, or even removed.  

There are two common chin implant problems, malpositioning and implant selection. Malpositioning of a chin implant can occur in two different ways. Superior or upward migration of the implant usually occurs if it is placed from inside the mouth. While the intraoral approach avoids an external incision, its path of dissection provides an avenue for the implant to slide up along the bone afterwards. Lateral or wing malpositioning is actually the most common problem and is a result of the newer styles having thin and more floppy wing extensions which can easily fold onto themselves. Chin implants can also have size (undersized, oversized) and style (too wide, too narrow) problems which is a preoperative diagnosis and selection issue.

Case Study: This 40 year-old male was unhappy with the result of his chin augmentation. He had two prior chin implant procedures. They were done from an intraoral incisional approach. He felt that his chin was still not defined and prominent enough. He wanted a more masculine chin appearance. He had a record of his indwelling chin implant which was silicone in composition,7mms in projection, with limited lateral wings.

To improve his chin result, two different approaches were discussed for a revisional surgery. First, use a submental skin incision to remove the existing implant and replace a new one at the lowest position on the bone. Secondly, a different implant style would be used that had greater lateral extensions to add more lateral chin fullness and width.

During surgery, the submental incision was done but no implant was found at the inferior border of the chin. Located 14mms above the chin border, an implant was found and removed. There was 2 to 3mms of bone resorption underneath the implant when it was removed. Pockets  were dissected out along the  lower border of the jaw from the midline about 4.5 cms per side. A new chin implant style, a chin-prejowl design, was then inserted. Pulled down to the lower edge of the bone, the implant was secured with a single 12mm long titanium screw.

The immediate results of this chin implant exchange and repositioning can be seen just one hour after surgery. The chin had more lateral fullness and better horizontal projection, particularly at the low edge of the chin bone which is the most important point of increasing its projection.  

Case Highlights:

1)      Chin augmentation requires proper placement of the implant on the bone. Intraoral chin augmentation is prone to superior implant migration and malpositioning.

 

2)      Replacement of a highly positioned chin implant is best done from a submental approach with screw fixation.

 

3)      In the male chin augmentation, consideration needs to be given to an implant design that provides more lateral fullness and extends back further towards the body of the mandible.

Dr. Barry Eppley

Indianapolis, Indiana

 

 

  

 

Getting Rid of the Double Chin Deformity

Saturday, April 11th, 2009

The double chin is not truly two chins in the classic sense. Rather it is one upper chin (true chin) that is bony in nature and a lower chin that is really an accumulation of fat. (false chin) The development of fat accumulation can occur quite easily beneath the jawline in some people. For those predisposed, the double chin can develop even when one is not particularly overweight. Short necks, low hyoid bones, and underdeveloped jaws are all anatomic factors that can lead to the appearance of a double chin.

Some try exercise and diet to lose the double chin but with little success.  Double chin exercises, chin exercisers, and devices such as ‘chin gyms’ can improve platysmal (neck) muscle tone and make it more firm.  But the collection of fat on the upper neck or under the chin will remain, no matter what exercises are done.  You simple cannot exercise neck fat away.

Liposuction double chin surgery is very effective for eliminating and getting rid of excess fat and or loose or sagging skin of the upper neck area.  With the newest small cannula and Smartlipo (laser lipolysis) liposuction techniques, neck fat can be very effectively removed. With fat removal, chin and neck skin tightens as part of the healing process, getting rid of the false chin and improving the neck angle in profile. 

Liposuction of the neck is part of all double chin corrections and most low-hanging neck issues. (e.g., facelifts) Through a tiny skin incision under the chin under local anesthesia, a fiberoptic cable for Smartlipo or small liposuction cannulas are used, both of which are usually less than 2mm in diameter and are not much larger than the lead from a #2 pencil. I really like to use the laser energy from Smartlipo as the heat generated melts fat as well as has a positive effect on neck skin tightening.

How large the double chin is and how tight or loose the neck skin is determines whether liposuction alone will be sufficient. Skin that is not too excessive or is thick will likely tighten fairly well. A lot of neck skin or skin that is thin and wrinkly will not likely do well with liposuction only. Other accompanying procedures such as a face or necklift may be needed in these cases.

In double chins, it is also important to look at the true chin and see if it is far enough forward in the facial profile. Some double chin corrections can really benefit by chin augmentation as well. In a deficient bony chin (too short), the combination of a chin implant (bigger true chin) and the reduction of the false chin by liposuction can make a really dramatic change.  

In my Indianapolis plastic surgery practice, most patients take 2 to 3 days from work after chin liposuction surgery.  But they are easily able to undergo light to moderate activity during that time.  There is minimal to moderate swelling and bruising which rapidly subsides. After liposuction for double chin, a special garment is worn for a few days.  It is an elastic strap, kind of like an enlarged chin strap.  The purpose of the garment is to provide a little gentle pressure for a few days.  After that, no special care is needed.

 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