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Archive for the ‘jaw angle implant’ Category

Case Study – Three-Piece Total Jawline Augmentation

Tuesday, September 6th, 2016

 

Background: Total jawline augmentation refers to changing the entire look of the mandible. This could mean that the entire jawline has to be changed that can only be done by a custom wrap around jawline implant. But not everyone needs augmentation of all areas of the jawline. Many patients just need to change the three ‘corners’ of the jaw, the chin and the two jaw angles.

A three-piece approach to total jawline augmentation most typically refers to the use of chin and jaw angle implants. A variety of chin and jaw angle implant styles and sizes now exist that can meet the dimensional needs of most patients. Jawline implants can add width, vertical length and horizontal projection. But the one dimension that no jawline implant can achieve is a shortening effect.

The one dimension in jawline reshaping that requires a reductive approach is vertical chin shortening. Many very recessed chins are actually vertically long because of the backward rotation of the entire mandible due to an underdeveloped ramus. While a chin implant can add the necessary horizontal projection, it can not make it shorter. Placing the chin implant high to try and create this effect will lead a fullness under the augmented chin and will not really make it appear vertically shorter.

Case Study: This 38 year-old male presented for improvement in the shape of his jawline and lower third of his face. He had a recessed and long and a narrow jawline shape.

Total Jawline Augmentation result front view Dr Barry Eppley IndianapolisUnder general anesthesia he initially had a sliding genioplasty performed with a 10mm forward movement 5mms of vertical shortening. Bilateral jaw angles implants were placed that primarily added 7mms of width but only 1mms of vertical lengthening.

Total Jawline Augmentation result side view Dr Barry Eppley IndianapolisTotal Jawline Augmentation results oblique view Dr Barry Eppley IndianapolisHis result shows the impact of widening his jawline but also shortening it anteriorly. This combination creates a broader and more masculine appearing lower third of his face. While the chin change significantly improved his profile, it is the jaw angles that added the most to his front and three-quarter views.

He had a long chin due to its recessed position. While a chin implant could have been used that would have maintained his vertically long face and would also have required the jaw angles to be vertically elongated as well. To help shorten his overall face a sliding genioplasty is a better choice because it can shorten the lower third of his face on the front part of the jaw.

Highlights:

1) Total jawline augmentation refers to the three corners, the chin and the two jaw angles.

2) A sliding genioplasty with jaw angle implants is a three piece approach to total jawline augmentation.

3) A sliding genioplasty is better than a chin implant when the forward movement of the chin needs vertical shortening as well.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Jaw Angle Implants after Mandibular Osteotomy

Thursday, August 25th, 2016

 

sagittal split manidbular osteotomyBackground: The sagittal split mandibular osteotomy (SSRO), most commonly used for lower jaw advancement, is one of the most ingenious of all the craniomaxillofacial osteotomies. Splitting the ramus of the mandible longutudinally into two vascularized bone segments is a technical marvel. It allows the distal tooth-bearing portion of the lower jaw to be moved forward while leaving the proximal TMJ-containing bone segment in place. This maintains good bone contact that is fixed together and heals without creating a bone defect.

While the bones segments of a sagittal split mandibular osteotomy do maintain the shape of the jaw angle during the procedure, the jaw angle shape can adversely change as it heals. Some bony resorption of the jaw angle is not rare as the proximal bone segment not only becomes thinner afterwards but probably suffers some degree of devascularization in some cases. This resorption pattern can make the back of the jaw look thinner with a higher jaw angle shape externally.

Such jaw angle shape deformities after a mandibular osteotomy is more prone in thin jaws, inadvertent fracture patterns (aka ‘bad splits’) and repeat sagittal split procedures. The best diagnosis of the jaw angle shape is a from a 3D CT scan where the two sides can be compared in both frontal and side views.

Case Study: This 22 year-old female had a history of orthognathic surgery consisting of a LeFort I, mandibular sagittal split osteotomies and a sliding geniplasty several years previously. She felt that her lower face was too thin and lacked any definition as well has still had inadequate chin projection.

Vertical Lengthening Jaw Angle Implants after Sagittal Split intraop Dr Barry Eppley IndianapolisUnder general anesthesia she had a total jawline augmentation done using standard implants. An anatomic extended chin implant of 8mms projectionwas placed through an intraoral incision. Then using new preformed vertical lengthening jaw angle implants (7mms lengthening and 5mms width), they were inserted intraorally through her previous incisions. The jaw angle implants were placed below the existing bone plates used to secure the mandibular osteotomies and posed no problems for their placement. The jaw angle implants were screwed into placed with a percutaneous screw fixation technique.

Simulated Vertical Jaw Angle Implant effects oblique view Dr Barry Eppley IndianapolisSimulated Vertical Jaw Angle Implant effect Dr Barry Eppley IndianapolisThe goal of the jawline enhancement was to create a more visible jawline both at the front and back of the jaw. By bringing the chin further forward and rotating the jaw angles downward a more distinct lower jaw shape is created as seen in this preoperative predictive imaging.

Highlights:

1) Loss of the jaw angle shape can occur after sagittal split osteotomies due to bone resorption.

2) Jaw angle implants can either restore or augment the shape of the jaw angle.

3) Whether the jaw angle implants should be standard or custom made depends on how much bone resorption has occurred and the amount of bony asymmetry.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jaw Angle Implant after BSSRO Surgery

Sunday, July 17th, 2016

 

Background: The most common method of corrective lower jaw surgery is the sagittal split ramus osteotomy. (BSSRO) While initially described over half a century ago, it remains the cornerstone of lower jaw repositioning surgery. It is an incredibly clever oseotomy design that I still consider a marvel of craniofacial bone surgery and remains technically challenging to perform even after having one the operation for decades.

sagittal split manidbular osteotomyLongitudinally or sagittally splitting the mandibular ramus into proximal and distal segments allows the toothbearing portion (distal segment) to be moved independently of the proximal (jaw joint containing) segment. Once the teeth are set into the desired bite, the overlapping proximal and distal segments are put back together allowing for maximal bone contact to expedite bony healing.

But the proximal mandibular segment, which provides the shape to the jaw angle, is largely stripped of its soft tissue attachments in the execution of a BSSRO. This partially devascularizing effect can cause the shape of the bone to undergo some postoperative remodeling. This can cause the shape of the jaw angle to change. While it doesn’t always occur it is probably an under reported aesthetic bony change.

Case Study: This 35 year-old female had a prior history of a mandibular osteotomy to correct a malocclusion accompanied by a sliding genioplasty. While this gave her a good bite it left her with facial asymmetry which was most pronounced at the jaw angle areas. She did have treatment with liposuction and fat grafting into the right jaw angle but this did not improve her facial asymmetry adequately.

Custom Jaw Angle Implant for Asymmetry Dr Barry Eppley IndianapolisIt was decided to perform bilateral jaw angle surgery with liposuction to the right jaw angle (to remove the injected fate) and augment the left jaw angle with a custom jaw angle implant. A 3D CT scan was used to both evaluate and design the left jaw angle implant.

Jaw Asymmetry Surgery result front view Dr Barry Eppley IndianapolisUnder general anesthesia the right jaw angle soft tissues underwent small cannula liposuction from an incision behind the earlobe. The custom jaw angle implant was placed in the left side through an intraoral incision and secured with a single 1.5mm microscrew. The combination of the right jaw angle liposuction and the left jaw angle implant improved her facial symmetry.

Deformations of the jaw angles can occur from the BSSRO procedure. The bone may heal perfectly but there can still be a change in the shape of the jaw angle due to bony resorption. Restoration or enhancement of jaw angle shape can be done with an implant. Whether the jaw angle implant would need to be custom or not depends on the degree of  bony jaw angle deformity.

Highlights:

1) Jaw angle deformation and asymmetry is not rare after sagittal split mandibular osteotomies.

2) Asymmetry of the jaw angles is best assessed by a 3D CT scan to develop an accurate appreciation of their bony differences.

3) A custom jaw angle implant is the best method to correct bony angle asymmetry.

Dr. Barry Eppley

Indianapolis, Indiana

Jaw Angle Implants vs Injectable Fillers Volume Effects

Saturday, July 2nd, 2016

 

Jaw angle implants have become more recently recognized as an essential part of jawline augmentation. While much focus has historically been on the front protruding part of the jaw through chin augmentation, it is now recognized that the chin represents just a part of the total lower facial effect.

While jaw angle implants have been around for several decades they have been limited to an implant style that only provides width to the ramus of the mandible. While this has a beneficial role in some patients, many jaw angle deficiencies are as much vertical if not more so than just width. Lengthening the jaw angle and creating a more obvious angularity to the back part of the lower jaw has some major aesthetic benefits.  This has been remedied today with more vertical lengthening jaw angle implants. Injectable fillers have also been used to create this effect with variable success. But it is an accepted ‘trial’ method for some patients to determine if such changes would be perceived as beneficial.

When it comes to jaw angle augmentation does an injectable filler really create the same effect as an implant? And if it does how does it compare volumetrically?How does the volume of an injectable filler compared to the displacement effect caused by a solid implant? In other words, how much injectable filler does it take to create the same effect as that of an implant?

Comparing facial implants and injectable fillers is done using volumetric displacement. Based on the Archimedes principle of displacement, volume of displaced water would be equal to the volume of the implant. Using newer vertical lengthening jaw angle implants of its three available sizes, their weights in grams and volume displacement were as follows:

JAW ANGLE IMPLANTS

Small              3.65 grams     1.6 ml

Medium        7.54 grams     2.7 ml

Large            14.98 grams    4.2 ml

Jaw Angle Implants vs. Injectable Fillers Dr Barry Eppley IndianapolisThe volume displacement of all injectable fillers is on the syringe so the comparison to jaw angle implants can be directly done. It shows that a 1cc syringe of any of the hyaluronic acid-based fillers (e.g., Juvederm) would be equal to less than half of a small jaw angle implant. Larger jaw angle implants more directly compare to more than two to three 1.5cc syringes of Radiesse.

Volume alone, however, is not the complete story of any material’s external facial augmentation effect. Besides volume there is the issue of how well the material pushes on the overlying soft tissues to create their effect. This is known as G Prime Force or the elastic modulus. By feel it is obvious that implants are stiffer than any liquid material and would have a higher resistance to deformation. (thus creating more outward effect given a similar material volume) It is therefore probable that comparing volume displacements alone overestimates the effect of injectable fillers compared to implants.

Dr. Barry Eppley

Indianapolis, Indiana

Bony Overgrowth of Jaw Angle Implants

Sunday, June 26th, 2016

 

Jaw angles implants are becoming increasingly popular for their jawline augmentation effects. Different styles of jaw angle implants allow for a variety of posterior jawline effects from widening, lengthening and combinations thereof. Like a chin implant they are placed in the subperiosteal submuscular position at the back of the jaw.
The difference in jaw angle implants, compared to almost any other site-specific facial implant, is their size. They are comparatively large and are placed under the largest muscle in the face, the masseter muscle. It is also a muscle that has a lot of repetitive activity as it is responsible for both its chewing effects as well as aiding in moving the lower jaw.
Bone Overgrowth Jaw Angle Implants Dr Barry Eppley IndianapolisJaw Angle Implant Bony Overgrowth Dr Barry Eppley IndianapolisHaving done many jaw angle implants and seeing 3D CT scans of their position on the bone, I have noticed a very interesting finding. Many jaw angle implants will have developed bony overgrowth over their edges. It does not matter whether the implant is composed of silicone or Medpor material, it occurs on both materials. It is a frequent finding on 3D CT scans over jaw angle implants or the jaw angle portion of a total wrap around jawline implant.
The bony overgrowth that develops is very thin and has the consistency of an eggshell. It easily flakes off the implant and is similarly easily removed from its attachment to the side of the jawbone from where it grew. it is interesting that it develops even on smooth silicone implant surfaces.
Bony overgrowth is seen in other facial implants and is a well observed finding in chin implants. It is commonly seen in chin implants that have developed some passive settling into the bone with new bone growing up along its side. While such implant settling is seen in chin implants I have not observed in jaw angle implants.
The source of the bone growth is undoubtably from the periosteum on the underside of the large masseter muscle’s inner surface that has been raised up off of the bone. This is a potent source of bone stimulation and growth.
Dr. Barry Eppley
Indianapolis, Indiana

Case Study – Female Jaw Angle Implants

Sunday, June 12th, 2016

 

Background: A strong and well defined jawline used to be an exclusively male trait. And the pursuit of a stronger jawline through implant surgery used to be only pursued by the young male patient. But that has changed in recent times as now women often desire a stronger jawline as well.

When patients, men or women, seek a stronger jawline they are usually referring the back part of the jaw known as the jaw angles. The chin at the front of the jaw may also be part of the desired jawline effect. But stronger jawlines almost always refer to a stronger and more defined jaw angle region even if the chin is adequate.

Brad Pitt JawlineAngelina Jolie jawlineBut a stronger jawline has slightly different connotations for men vs. women.  Men often want a square and wider jawline such as that seen in Brad Pitt or Tom Cruise. Women, on the other hand, often long for the jaw-dropping effect that vertically lengthens the jaw angle as it defines it such as Tyra Banks or Angelina Jolie. Understanding this difference in jaw angle shapes between men and women is critical in selecting the right jaw angle implant.

Case Study: This 32 year-old female desired  stronger and more defined jaw angles. She had a thin face with little facial fat. She had a good chin but high and narrow jaw angles.

Vertical Lengthening Jaw Angle Implant sizes Dr Barry Eppley Indianapolisvertical lengthenign jaw angle implant style dr barry eppley indianapolisUnder general anesthesia she underwent the intraoral placement of vertical lengthening jaw angle implants. This style of jaw angle implant drops the level of the jaw angle downward while only adding enough width for the implant to adequately engage the mandibular ramus bone This style of jaw angle implant is unique because half of the implant is not on the bone. This design is necessary to create the vertical lengthening effect.

Female Square Jaw Angle Implants result frnt view Dr Barry Eppley IndianapolisFemale Square Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisHer result at three months after surgery showed much more defined angle that was both lower and wider. This helped ‘square off ‘ her face to some degree and created increased facial angularity.

Female Square Jaw Angle Implants result side view Dr Barry Eppley IndianapolisJaw angle implants historically were one style that only widened the jaw angle and often did not create much jaw angle definition. But with increased patient demand for jawline augmentation, newer jaw angle implant styles are needed. Vertical lengthening of the jaw angles is often needed much more than width for many patients. This is particularly true in females where the strength of the jawline comes from greater angle definition than increased jaw angle width.

Highlights:

1) Women today often seek a stronger jawline with more defined jaw angles.

2) Most women need vertical lengthening jaw angle implants as opposed to a jaw angle widening style jaw angle implant.

3) Female jaw angle implants aim mainly to create a well-defined jaw angle.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jaw Angle Implants

Sunday, April 10th, 2016

 

Jaw Angle Reduction Surgery Dr Barry Eppley IndianapolisBackground: Jaw angle reduction is a well known surgery that is most commonly performed in Asian patients to narrow a wide lower face.  The historic approach for this operation, and still one that is commonly performed, is that of an amputation technique of the jaw angle bone. By cutting off the jaw angle, the lower facial protrusion is eliminated and the lower face narrowed.

But jaw angle reduction surgery is not without its complications. Adverse aesthetic effects may develop such as overcorrection, asymmetry and loss of support of the jawline soft tissues. Patients may also develop surgical regret and wish to return to the original jaw angle shape.

Jaw angle implants would be the logical method to restore the bony anatomy from prior jaw angle reduction surgery. But standard jaw angle implants do not provide vertical jaw angle lengthening, a critical element in jaw angle restoration.

Jaw Angle Reductions with Medpor Impplant Reconstruction Dr Barry Eppley IndiianapolisCustom Jaw Angle Implants for Jaw Angle Restoration right side Dr Barry Eppley IndianapolisCustom Jaw Angle Implants for Jaw Angle Restoration left side Dr Barry Eppley IndianapolisCustom Jaw Angle Implants for Jaw Angle Restoration front view Dr Barry Eppley IndianapolisCase Study: This 40 year-old Asian male  had his jaw angles removed over ten years ago. He tried to reverse the surgery six years later with standard Medpor jaw angle implants. They failed to create the effect he desired leaving his jaw angle still vertically and horiontally defiicient. Custom jaw angle implants  were designed off of an original presurgical panorex x-ray where the jaw angle reduction surgeon had marked the lines of bone resection. A 3D CT scan was used to create the implant designs. The 3D CT scan can not visualize the Medpor material although the three metal screws used to secure the implant could be seen.

Remove and Replace Jaw Angle Imkplants intraop implants Dr Barry Eppley IndianapolisUnder general anesthesia, his original intraoral incisions were reopened and his jaw angle implants exposed. The Medpor jaw angle implants were removed in pieces and the screws were chiseled out of the bone. The custom jaw angle implants were inserted after lower border capsulotomies to release the scar tissue. The new implants were secured with two 1.5 x 5mm screws placed with a percutaneous technique.

Jaw angle restoration from prior jaw angle reduction surgery is usually best done with custom made implants. This case illustrates that inadequate results are usually obtained using standard jaw angle implants. Vertical lengthening of the surgically altered jaw angles is the key to an adequate jaw angle restoration. New vertical jaw angle implants that will soon be available may work for some patients but it is hard to beat what custom jaw angle implants can do.

Highlights:

1) Jaw angle reduction surgery often amputates the jaw angles creating a vertical shortening and loss of soft tissue support.

2) Jaw angle restoration is frequently inadequate using standard jaw angle implants.

3) Custom jaw angle implants is the ideal method for jaw angle restoration after jaw angle reduction surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Female Jaw Angle Implants

Tuesday, April 5th, 2016

 

Background: Strong jawlines are historically associated with men as a desired masculine facial feature. While this is certainly still true today, women now desire stronger jawlines as well. But a strong jawline does not mean exactly the same thing for men and women. They are subtle gender differences in what makes up a good looking jawline.

strong female jawlineMen often desire strong chin and jaw angles that are angulated with greater width and prominence. This may mean more of a square shape to the chin and jaw angles that have more lateral flare or width and more of a square shape to them. Conversely women usually want a straight jawline with a more narrow chin and defined but vertically elongated jaw angles with minimal lateral flare.

Vertical lengthening of the jaw angles has historically been impossible because there was simply not an implant available that could create that effect. Vertical jaw angle lengthening is a different type of change that what traditional jaw angles create which is only width. A width only or lateral  jaw angle implant for women is almost never a good choice as they have often have a high and obtuse jaw angle shapes. (steep mandibular plane) What they desire is more of a defined jaw angle shape but with little additional width.

Case Study: This 33 year-old female wanted to have a ‘strong’ jaw angle shape to her jawline. She had a thin face with good chin projection that was adequately narrow. What she lacked was a more defined jaw angle which required vertical lengthening and the creation of a more 90 degree angle shape.

Under general anesthesia, vertical lengthening jaw angle implants were placed through posterior intraoral incisions. The implants added 7mms of vertical length to the back of the jaw angle, 3mms width and a more defined jaw angle shape. The implants were secured into placed with one small microscrew on each side.

Female Jaw Angle Implants result oblique view Dr Barry Eppley IndianapolisFemale Jaw Angle Implants result side view Dr Barry Eppley IndianapolisFemale Jaw Angle Implants result front view Dr Barry Eppley IndianapolisHer six months after surgery results showed a marked improvement to her jaw angle shape and definition. From the front view the implants added a small amount of lower facial width and fullness.

Vertical lengthening jaw angle implants add new possibilities for aesthetic jawline enhancement. Unlike traditional jaw angle implants that only add width, vertical lengthening of the jaw angle enables a change that many jawline enhancement patients really need to reach their aesthetic goals. This is certainly true for the vast majority of women that seek augmentative jawline enhancement.

Interestingly, and as a side note, the patient eventually returned to have even stronger jaw angle implants placed.

Highlights:

1) Female jaw angle implants are designed to create a more defined posterior jaw angle prominence.

2) Vertical jaw angle lengthening is usually what most females desire for a better jawline.

3) A vertical lengthening jaw angle implant requires adequate muscle release and screw fixation for a stable postoperative result.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Jawline Implants for Women

Wednesday, January 27th, 2016

 

Jawline enhancement or jawline augmentation is where various dimensions of the lower facial skeleton are built up. Unlike chin augmentation, jawline augmentation refers to both chin and jaw angle for a more overall effect. Such a jawline effect is typically thought of as being exclusively for men. And while that is true most of the time, there are an increasing number of women who are undergoing the procedure.

Women who benefit by jawline enhancement  fall into several types. The first are those women who have an overall shorter jaw by development or genetics that is seen in the chin area as being both horizontally and vertically short. This also means that the jaw angles are higher and indistinct in shape. Another deficient jawline in females is that created by the well known V line surgery. Some women once having it want to reverse it and return back to their naturally normal jaw shape.

Female Custom Jawline Implant design Dr Barry Eppley IndianapolisFemale Custom Jawline Implant thickness Dr Barry Eppley IndianapolisThe best method for total jawline enhancement in females is a custom jawline implant. Covering the entire jawline from angle to angle creates a vey powerful effect on the lower face. For this reason, many female custom jawline implants in women are made smaller than for most men.

Custom Female Jawline Implant intraoperative insertion 2 Dr Barry Eppley IndianapolisThe smaller size of most female custom jawline implants makes them fully capable of being inserted through incisions inside the mouth. The smaller flare and thickness of the jaw angles makes their passing under the mental nerve in a subperiosteal tunnel uncomplicated. The usually more modest amount of chin augmentation allows for good mentalis muscle closure over the implant intraorally.

Female Custom Jawline Implant early result front viewCusytom Female Jawline Implant early result oblique viewEven though they are smaller that does not mean that the early jaw swelling after placement of a custom jawline implant will not be significant. It takes a full six weeks before the vast majority of the jawline swelling has gone away. It is important for women to be patient as the jaw can look too big as these one week after surgery pictures show.

 

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Four-Piece Total Jawline Augmentation

Sunday, December 20th, 2015

 

Background: The desire for a more pronounced and visible lower jawline exists in both men and women. The surgical methods to do so are more commonly requested by men particularly when it comes to a substantially larger jawline change. Making a jawline more evident focuses on increasing the size and shape at its ‘corners’, that of the projecting chin and the back ends at the bilateral angles.

When creating a total jawline augmentation effect, there are two basic approaches.  The historic and still most commonly used method is a three implant approach of independently placed chin and jaw angle implants. In some cases the chin implant may be substituted with a siding genioplasty. The newer method of jawline augmentation is the fabrication and placement of a one-piece custom made jaw implant that wrap around the chin from angle to angle. It is the preferred method of total jawline augmentation given the preoperative designing of the implant and its smooth one-piece construct. But cost considerations may lead some patients to still undergo the classic three implant method.

Chin and jaw angle implants exist in standard styles and sizes. While for some patients these historic standard chin and jaw angle implant styles will effectively work, newer implants styles offer improved total jawline augmentation results for many patients. Newer vertical lengthening jaw angle implants have allowed for increased visible angularity of the back part of the jaw. When vertical elongation of the chin is needed either newer vertical lengthening chin implants can be used or the historic approach of an opening sliding genioplasty. When significant vertical and horizontal chin augmentation is needed, chin implants and a sliding genioplasty can be combined.

Case Study: This 25 year male wanted a total jawline change. Not only was his lower jaw horizontally short but it was vertically deficient as well. This was evident in the short chin and large overbite which are directly related. When he opened his mouth slightly the improvement in his chin and jaw height could be seen confirming the needed vertical dimension of his chin and jawline.

Chin and Jaw Angle Jawline Augmentation result side viewChin and Jaw Angle Jawline Augmentation result oblique viewUnder general anesthesia, he had an opening sliding genioplasty (7ms done and 7mms forward) with a chin implant overly (5mm horizontal augmentation) done through an intraoral approach. Through posterior intraoral incisions jaw angle implants that added 7mm vertical length and 5mm width were placed.

At one year after surgery the improvement in his jawline could be appreciated. Ideally longer vertical lengthening jaw angle implants would have improved his result and are being considered. The sliding genioplasty and chin implant overlay produced a satisfactory improvement to the front part of his jawline

Total jawline augmentation can be effectively done using a non-custom implant approach. It can require the thoughtful application of newer chin and jaw angle implant styles and the selective use of sliding genioplasty techniques.

Highlights:

  1. Total jawline enhancement consists of front (chin) and back (jaw angle) augmentation.
  2. Preformed chin and jaw angle implants is the historic and standard approach to total jawline enhancement.

3. Vertical chin augmentation in total jawline enhancement can be done by a combined sliding genioplasty with a chin implant overlay.

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.

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