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 shape of the neck is an important aesthetic structure of the face. When it is well defined with a sharp angle definition (between 90 to 120 degrees in profile), it makes the chin and jawline more prominent and flattering. When the neck angle is obtuse or completely open (straight), the jawline becomes obscured and less aesthetically pleasing. The neck can be seen to have a major influence on how the entire lower third of the face looks. As one begins to age, the neck tissues become loose and begin to sag. For some, even at a young age, they have a naturally full with an obtuse angle due to a thicker fat layer and a lower positioned hyoid bone.

While genetics, gravity and time work against a shapely neck with a good angle, there are a number of plastic surgery procedures to improve the aesthetic appearance of the neck. First, however, a few comments on non-surgical reshaping methods. While creams and exercises are touted to improve the shape of the neck, none have been proven effective for making noticeable changes. Some modest changes can be made in the appearance of jowls and neck skin sagging in those who have good skin elasticity with various transcutaneous energy therapies. (e.g., BBL or Skin Tyte) These are not to be confused with surgical results but there can be visible improvement. Injectable Botox can also be used to treat prominent vertical platysmal neck bands. These are best viewed as treatments neck for those that don’t have enough of a problem to justify surgery or for those who do but prefer to try a non-surgical approach first.

Full thicker necks with good skin can be treated solely by liposuction. Removing fat allows the skin to shrink and tighten up to reveal the shape of the underlying platysma muscle. While traditional liposuction is effective, the additional use of a laser-assisted technique can help improve the results. Smartlipo, which uses a fiberoptic laser probe, creates heat which not only helps melt fat but can create a skin tightening effect as well. While neck Smartlipo is ideal for younger patients due to their better skin quality, I have seen a few older patients with impressive neck changes as well.

The next level beyond neck liposuction is a submentoplasty. This is a neck tightening operation that not only removes fat by liposuction but tightens the platysma muscle as well. It is performed through a submental incision in which some small amount of loose upper neck skin can also be removed. Also known as a submental tuckup, it can be effective for the very beginnings of neck sagging in younger patients with good skin. It is also historically used after a facelift when some submental skin sagging develops (rebound relaxation) in the first year after surgery.

Facelifts are the primary procedure that can create the most effective change for the aging neck. Facelifts, also called necklifts, can be thought of as being two fundamental types either a limited and full type. Both use incisions around the ear but the length of the incisions and what effects they create in the neck and jowls is different. A limited facelift, which goes by a lot of marketing names (Lifestyle Lift, Quicklift etc), has as its main effect the smoothing out of sagging jowls with a more limited effect in lifting neck skin. It is best used in patients whose primary complaints are about their droopy jowls and not their necks. Full facelifts are used when the neck problem is more significant and its improvement is the main objective of the surgery. It is the most powerful changer of both the neck and jowls and usually also incorporates liposuction of neck fat and tightening of the platysma neck muscles. Chin augmentation with a facelift can also be helpful in giving a more defined jawline.

One other approach to the sagging neck is that of the direct necklift. Unlike facelifts in which the incisions and the direction of skin lifting is based around the ears, the direct necklift removes loose neck skin by excising it down the center of the neck…directly if you will. This is a simpler approach to a necklift and is a very powerful reshaping method of the neck but it does so with the trade-off of a midline neck scar. This can be a preferred procedure for older men (greater than age 65) who prefer the least recovery and have large hanging neck wattles. Male beard skin heals remarkably well and I have not found the neck scar to be a visible concern after it heals.

The last area of neck reshaping, which has nothing to do with age, is the prominent Adam’s apple or thyroid cartilage. For those that have too strong of a neck bulge caused by the strength of the paired cartilages of the 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 end up with a completely smooth neckline.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

A lower facelift, technically a neck-jowl lift, is the standard approach for improving an aging neck or an obtuse cervicomental angle. This has been historically true but as the average age of people seeking neck and jawline improvement continues to lower, some altered approaches are needed. Younger people do not want a ‘facelift’or an extensive procedure but seek something less invasive with a quicker recovery. In the properly selected patient, liposuction of the neck or a submentoplasty may just be what they are looking for.

These minimally invasive neck procedures are usually best done for patients in their 30s and 40s, although I occasionally have treated older patients as well with them. The key is the quality and amount of neck skin and how much fat there is. This can be determined by feeling the neck, pinching the neck skin and having the patient swallow. Full necks or those with an obtuse cervicomental angle usually have fat both above and below the platysma muscle. Knowing whether the removal of fat is needed below the muscle is important in determining whether liposuction alone or a submentoplasty is needed.

What is the difference between liposuction and submentoplasty? Liposuction is well recognized and exclusively removes fat through a small skin nick under the chin. It can effectively remove supraplatysmal fat in the central neck, jowls and out close to the anterior border of the sternocleidomastoid muscle. A submentoplasty incorporates liposuction but goes further. Through a larger submental ckin crease incision, a skin flap is raised with facelift scissors after liposuction has been initially done. The platysma muscle is then opened down the middle with a ‘cautery clamp’ technique. Subplatysmal fat is then removed and the muscle edges put together with sutures. (others have described their method of submentoplasty, this one is the way I prefer to do it)

Like liposuction, a submentoplasty ultimately shows its degree of improvement by the contraction of the overlying skin. This is why the thickness and elasticity of the neck skin is so critical in determing how successful these procedures will be in improving neck and jawline definition without a lot of irregularities. This is also why the use of neck compression through circumferential garments (facelift bra) is important during the first week after surgery.

With any neck reshaping procedure, it is important to look at chin projection as well. Many full neck with an obtuse cervicomental angle have a weaker or poorly projecting chin. The use of a chin implant can make a dramatic improvement, in some cases as significant as the improvement in the neck angle. This ‘ying and yang’ approach, bringing the chin forward as the neck comes back, can have a very rejuvenating look to the neck.

While neck liposuction or a submentoplasty do not replace the need for a lower facelift, they can produce significant change in the right patient. Age (less than 50 years old) is one of the best indicators of whom these procedures work best in but not exclusively so.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  One of the most bothersome facial features in late middle-aged and older men is the droopy neck or neck wattle. The skin of the jowls and neck eventually develops some sag due to its weight and loss of underlying attachments. This will be magnified in those men who have fat collections that have developed in the neck and often have a bit of a body weight issue.

The sagging neck in older men always has a significant component  of extra skin that has lost some amount of its original elasticity. This means that the best treatment is a procedure that addresses both loose skin and too much fat. The well known name for that procedure is a lower facelift or necklift. It is tremendously effective because it both removes the extra neck skin and lifts it as well. However, many men would prefer to avoid a facelift for a variety of understandable reasons including cost and recovery issues.

Short of a facelift, the only other neck treatment option is liposuction. If significant neck fat is present, liposuction will offer some improvement. The key question is how much? And does the result justify the effort? While no result can be predicted with absolute certainty, one predictor is the quality of the neck skin. Is it thick or thin? Does the neck feel tight or does it feel loose? Does it feel like there is a significant fat layer between the skin and the muscle. These are all signs that liposuction may offer a promising improvement in the profile of one’s neck.

Case Study:  A 68 year-old male wanted improvement in his hanging neck wattle. On eyeing his neck in a conversation from across the room, I initially thought that only a necklift could offer any improvement. But on examination, his neck felt very firm and the skin was taut. This indicated that there  was a fair amount of fat in the neck. This was consistent with the rest of his body being clearly overweight. Liposuction was also a good option because he was not about to undergo any form of a necklift procedure.

Under IV sedation, the neck was initially infused with a lidocaine and epinephrine solution using a small stab incision under the chin. Then a Smartlipo probe was used to treat the neck just anterior to the sternocleidomastoid muscles and down to the prominence of the thyroid cartilage with 7,500 joules of laser energy. Using a small cannula, 25cc of fat aspirate was removed by liposuction with minimal blood seen. He was dressed with a snug chin strap after the procedure.

He wore the chin strap for five days and showered daily. Even at two weeks after surgery, he had a significant improvement despite some light swelling and bruising. By six weeks after the procedure, he had his final result as the neck felt surprisingly soft although a tad tender on squeezing the skin. This tenderness went completely away by 8 weeks after surgery.

It is hard to know precisely what role laser liposuction had in getting such a good result. In my opinion, it clearly provides some benefit just hard to know whether it is significant compared to traditional liposuction alone. Heating the subcutaneous tissues of the neck prior to fat extraction seems like a beneficial step to do and may help in decreasing bruising and improving the quality of the skin retraction. While this result should not be confused with what a necklift can do, it was more than satisfactory for his expectations.

Case Highlights:

1)      The traditional approach for fixing a neck wattle in an older male is a necklift. (facelift) In some cases, liposuction may make enough of an improvement to avoid any type of skin removal or lifting.

2)      The success of liposuction in improving the sagging neck in an older male depends on the elastic quality of the neck skin and the expectations of the patient.

3)      Smartlipo (laser liposuction) offers an edge in neck liposuction by potentially improving the retraction of the overlying neck skin, which is essential to avoid skin that is loose and rippled.

Dr. Barry Eppley

http://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

Unhappiness with the shape of one’s neck is a common cosmetic concern. It is important to differentiate between a full neck, which is a fat problem, from that of a neck wattle which is more of a skin issue than that of fat. Usually a neck shape that is due primarily to fat is associated with thicker, more elastic skin and the patient is often younger. (under age 50)

The use of liposuction to shape up a fuller neck is a very simple and effective procedure. A surprising amount of fat can be suctioned from some necks. Liposuction in this lower facial area can be divided into submental or neck liposuction. This distinction reflects the amount of area that can be suctioned. Submental refers to the area just under the chin. Neck liposuction covers a broader area which includes the submental and out into the sides of the neck. Neck liposuction is done between the jugular veins and the anterior border of the sternocleidomastoid muscles. Crossing these boundaries  could result in laceration or rupture of  a jugular vein, an event to be avoided. For this reason, patients should not expect as much improvement in the side of the neck as occurs under the chin.

A common concern amongst many patients is what will happen to the neck skin after the fat is removed. As long as one has reasonably elastic skin, it will contract and ‘stick back up’ without a problem. If you can roll the skin between your fingers without a significant amount of fat between them (less than ½ an inch), then a smooth skin result may not occur.

One expected outcome that patients do not consider when undergoing neck liposuction is how the area will temporarily feel and look after surgery. While an immediate and sometimes dramatic result can be seen immediately on the operating table, swelling and bruising will occur later. While the use of neck straps and dressings is helpful to reduce this inevitable reaction, there is no way to get good sustained compression without pressing on your airway. In addition, patients do not like to wear neck straps very long as they are socially restrictive.

As a result of swelling, bruising, and lympedema, the liposuctioned neck will go through a temporary phase of some deformity. This means it will feel hard, stiff, and will have some swelling and soreness.. This will persist for up to six weeks after surgery until it softens and the final result is more apparent. While before and after photographs of neck liposuction look great, patients need to realize that recovery is a process. Judgment of neck liposuction should not be passed until the neck feels soft again and is no longer sore.

While this process occurs in all forms of liposuction, I have found in my Indianapolis plastic surgery practice that laser liposuction seems to have less of this reaction. It may be that the heat generated in performing it causes less inflammation and lymphatic leak. When neck liposuction is being performed as a stand alone procedure, it can be very comfortably done under local anesthesia using the laser probe and small suction cannulae.

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis

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

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

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

A sharply defined and tight neck is associated with a youthful and healthy appearance. Loss of a good neck angle certainly does occur with age as the neck skin loosens and jowling along the jawline develops. However, poor neck shapes and an obtuse neck angle occurs in the young as well but for different reasons. Necks with a lot of fat above the platysma muscle, with or without a short chin, creates a neck appearance that is full and ill-defined.

A very effective ‘cure’ for this type of neck problem is the combination procedure of chin augmentation and neck liposuction. Submental and neck liposuction can be very effective at thinning out a full neck. As the fat is removed, the skin contracts up and back above the thyroid cartilage (adam’ s apple),  decreasing the wide open neck angle and creating more visible horizontal and vertical neck lines in profile.  Bringing out the chin, ,if short, will make the horizontal part of the neck line longer both in appearance and in actuality.

Neck liposuction and a chin implant is another example of a ‘ying and yang’ plastic surgery procedure. The neck angle becomes sharper and the jawline becomes longer. Each procedure alone produces an improvement, but together the effect of each is even better. This is easy to see before surgery through computer imaging. See the results of each procedure separately and then together.  You will convince yourself if one or both is better.

The other benefit of combination neck liposuction and chin augmentation  is that they are done through the same incision. Right under the chin in the submental skin crease, a small stab incision is made and the neck liposuction performed through it. The stab incision is then lengthened to about an inch through which an implant is introduced in front of and on top of the chin bone.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www/ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Fat in the neck and jowl area would certainly classify as a Type 1 LipoDissolve problem. I find that LipoDissolve injections in the neck to be a particularly effective treatment, probably the best use of an injectable fat reduction method. It works in this area for one good reason, the neck has a small surface area to it and therefore the fat problem is likewise limited. It fits in well with my concept of the ‘hand’ evaluation method to determine LipoDissolve candidacy. If the area fits into the size of my hand (size 6 ½) then it is reasonable to treat with LipoDissolve. In many necks that I have treated, the results with LipoDissolve can be close to that of liposuction.

The concept to grasp about LipoDissolve is that it is an inefficient method of fat treatment, albeit non-surgical. Unlike liposuction, fat injections require months of treatments to achieve its final results. So while it can be effective, it is not efficient. Liposuction surgery achieves its results in less than 30 minutes, albeit through a surgical process. Generally, the inefficiency of LipoDissolve would not be an issue if the treatment was hidden and not socially obvious. However, in the neck and jowl area, the effects of LipoDissolve treatment are for all to see and I am not just talking about the final results. After each LipoDissolve treatment session, the injected area will immediately swell and stay that way for about five days. And when I mean swell…think of doubling in size! Yes I did say double in size, you will have a bullneck. And this swelling process must be repeated each time that a treatment session is done, generally around three treatment sessions are needed to get the best result. For many patients, this neck swelling and how to explain it is enough for them to choose liposuction over LipoDissolve. For others, the importance of not having to go to surgery, and the additional expense, is worth the temporary neck swelling.

Besides the neck swelling, the other consideration is if the neck fullness is an isolated problem. LipoDissolve makes no sense if you are having other procedures anyway. The whole purpose of LipoDissolve is to avoid a surgical procedure. If you are getting on the operating room table anyway, then opt for liposuction and enjoy the benefits of the efficiency of surgery. One final consideration is how much much loose skin you have in the neck. While LipoDissolve can tighten some skin, do not think of it as an alternative to other truly neck tightening procedures such as a facelift. In older patients with more loose skin, these procedures are likely better and neck liposuction is part of every facelift (necklift) anyway.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Not infrequently I get requests from patients for the desire to transform a round face into a more shapelier one. One cause of a round face is that the patient is overweight. A full neck, round cheeks, and a lot of subcutaneous fat throughout the face creates a generalized fullness that creates a fat and round face. These patients know full well that they are overweight and some liposuction of the neck and buccal lipectomies may make some difference. But weight loss will probably make the most difference in these cases. And these procedures should not be performed until some weight loss has been achieved.

 
But the overweight patient is not what usually makes up the ’round face’ patient. Most commonly these are younger patients that are not significantly overweight and are usually closer to being more height and weight porportionate. They may have some mild fullness in the cheeks and neck but often their bony prominences (cheeks, chin, or jaw angles) may be somewhat deficient. The approach to these patients must deal with both hard and soft tissues issues to be effective at improving the face’s angularity and definition.

 
In addition to the fullness of the cheeks and neck, the next most important consideration in facial shape improvement should look at the chin. Often it may only be midly short in the horizontal dimension but the width of the chin is also important, particularly in the male patient. Chin implants today can provide more projection as well as width in many different sizes. Placed through a small incision under the chin bone, a chin implant can lend more definition and squareness to the lower face from subtle to dramatic results.

 
Upper facial fullness, more specifically midfacial fullness, can be achieved through cheek implants. Placed into position by incisions inside the mouth under the upper lip, cheek implants can provide good highlights through three-dimensional enhancement of the bone as it wraps around the area below the eye. An amazing aray of cheek and midface implants is available to provide a lot of enhancements around this important facial landmark. When paired cheek implants are combined with a chin implant, an upside down triangle of change is created that directly opposes a more round or oval facial shape.

 
Jaw angle implants are always a possibility but these are rarely needed in most really round faces. They can produce some lateral facial fullness but this is not usually helpful in ‘de-rounding’ the face.
The procedures of buccal lipectomies, neck and jowl liposuction, chin and cheel implants make up the usual plastic surgery tools for facial rehaping. Which one or combination of procedures is most helpful for improving facial definition is best determined by careful computer imaging study between the patient and their plastic surgeon.

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