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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘jaw angle implant’

Case Study – Jaw Asymmetry Correction

Sunday, September 27th, 2015


Background: Facial asymmetry is not uncommon and can occur from multiple causes. One of the most common is that from plagiocephaly where the entire craniofacial skeleton rotates or twists around a central axis resulting in a classic pattern of skull and facial bone asymmetries. But most facial asymmetries do not have such well identified causes and are usually idiopathic….it is just the way the face developed.

Jaw or mandibular asymmetries are one of the most common and identifiable anatomic causes of facial asymmetry. The size of the lower jaw and the importance of the chin and jaw angles on facial appearance can make even small jaw asymmetries very noticeable. Jaw asymmetries come in a wide variety of types but most commonly it presents when one side of the jaw has either overgrown or one side has under developed. This results in a twisting of mandible such that the chin is deviated either towards the smaller side or away from the overgrown side.

Many jaw asymmetries are associated with a malocclusion (bite that is off) which is best treated by a combined orthodontic and jaw surgery combination. But when the bite is acceptable or the patient does not want to undergo orthognathic surgery, aesthetic correction of the jaw asymmetry can still be done.

Jaw Asymmetry 3D CT scan front view Dr Barry Eppley Indianapolis Jaw Asymmetry 3D CT scan Dr Barry Eppley IndianapolisCase Study: This 22 year old male has lower facial asymmetry with a smaller right side, a chin deviation to the right and a more pronounced left jaw side/angle. A 3D CT scan shows that the right mandible was shorter and the left  mandible was longer. This created the chin deviation to the right of the facial midline.

Cin Osteotomy for jaw Asymmetry Dr Barry Eppley IndianapolisUnder general anesthesia he had a left jaw angle reduction, a right jaw angle implant placed (width only jaw angle implant) and a leveling chin osteotomy. All jaw procedures were done from an intraoral approach. Reduction of the left jaw angle accounted for a 5mm narrowing of the jaw angle flare. A 7mm wide lateral jaw angle implant was placed on the right. The intraoral chin osteotomy consisted of an asymmetric wedge  removal and shifting of the chin bone back towards the midline.

Jawline Asymmetry Correction result front view Dr Barry Eppley IndianapolisJawline Asymmetry Correction result oblique view Dr Barry Eppley IndianapolisHis jaw asymmetry correction surgery showed a good improvement. In an ideal world I wish just reducing the larger jaw on the left side of his face would straighten it but that almost never can happen by itself. The reason is that you can not reduce the larger bone enough to make a big difference. (there are teeth and nerves in the bone so that is a limiting factor as to how much bone can be reduced) For these reasons this is why most jaw asymmetry corrections must employ a ‘three point’ approach. This means all three points of the jaw (chin and two jaw angles) are treated. Reducing the left jawline, straightening the chin and augmenting the right jaw angle in this case provides the most comprehensive approach to jaw asymmetry correction. Even with this approach perfect lower facial symmetry is not usually possible. But it is usually the best approach to mask the lower facial disproportion which now exists.


1) Jaw and lower facial asymmetry is a developmental deformity that usually affects the entire jawbone from angle to angle.

2) It is rare that just treatment of one side of the jaw asymmetry will result in a very good correction.

3) Jaw asymmetry correction is best done by treating the three points along the jawline, the chin and both jaw angles.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Jaw Angle Augmentation in Facial Asymmetry Correction

Saturday, September 21st, 2013


Background: Facial asymmetry can occur from a wide variety of bone and soft tissue deficiencies or even, more uncommonly, overgrowths. (hypertrophy) One of the most common components of facial asymmetry occurs in the jawline of the lower face. Growth abnormalities emanate from the rami of the mandible, the meeting point of the vertical and horizontal bony limbs of the lower jaw.

Developmental or growth abnormalities always alter the rami or jaw angle shape in a variety of dimensions. Given that the jaw angle actually has four dimensions (height, length, width and degree of angulation) even subtle changes in development can create visible facial changes. These would be seen in the amount of flaring of the jaw angles, evenness of the jawline as it comes forward and the centric position of the chin as seen from the direct frontal view.

In correction of lower facial asymmetry, the first decision is whether the chin has a midline position. If so then correction can focus on the jaw angle region exclusively. If not then the treatment plan must incorporate a combined jawline approach that augments the chin back to the jaw angle area.

Case Study: This 35 year-old female presented with concerns about asymmetry of her face. She felt that the left side of lower jaw was not the same size as her right side. It was flatter and did not have as sharp a jawline or angle shape. The remainder of her face was symmetric and without concerns.

Under general anesthesia, a width only (3mm) jaw angle implant was placed through an intraoral retromandibular incision. It was situated only over the bone with the intent of adding a small amount of jaw angle width and definition.

The usual significant jaw swelling occurred that was largely gone by three weeks after surgery. By six weeks after surgery the full result was seen with nearly symmetric jaw angle prominences and a significant improvement in her facial asymmetry.

In using a jaw angle implant for correction of a lower facial asymmetry, it is unusual that only width expansion is needed without some vertical component. As most jaw angle deficiencies involve a component of retraction (vertical shortening) as well as lack of width development.

Case Highlights:

1) Jaw asymmetries frequently originate from the rami or angle regions and can affect both the vertical and horizontal dimensions of the lower third of the face.

2) Jaw angle augmentation is a frequent need for correction of lower third facial asymmetry.

3) Jaw angle implants are put in through an intraoral incision and different styles and sizes allow for either width expansion, vertical lengthening or both.

Dr. Barry Eppley

Indianapolis, Indiana

The Myth of Facial Liposuction

Saturday, November 28th, 2009

Liposuction is a very effective method of fat removal. While it can be used in almost any location of the body where there is fat, it does have limitations. And when applied to certain fat areas, it may even have the opposite effect of an undesired result.

The face is one such area where the concept of liposuction is largely more theoretical than practical. While the face does have fat below the skin, it is not easily removed like that in the trunk or extremities. Facial fat is more fibrous and has branches of the facial nerve lying deep to it. There are few very discrete collections which can easily be removed with the exception of the buccal fat pad and some of its numerous extensions.

Plastic surgeons frequently advertise and perform neck liposuction. And while the neck is part of the face, most patients do not think of the neck when they envision the concept of facial liposuction.

When you combine what is contained in the buccal space with the subcutaneous tissues in the neck, these are the only two facial areas where contouring can be done through fat removal. The neck can be liposuctioned while the buccal fat pad can be directly extracted through a small open incision. Removal of any other facial fat areas through liposuction  is not only ineffective but can cause a lot of tissue trauma and prolonged swelling.

When liposuction first became widely used in the 1980s and 90s, facial liposuction was both advocated and written about. It was used to try and reduce facial fullness in the lateral face and even reduce the prominent mound of tissue that develops above the nasolabial fold with aging. It was proven to be ineffective and has since become largely abandoned as a treatment for facial fullness.

For those seeking to reduce their ‘fat’ face or to deround their facial appearance, liposuction is not the answer. It simply can not do what can be done for the circumference of the thigh or the waistline. One cannot deflate the face so to speak.

Improving the shape of a very full and round face does include some fat removal which is accessible, the buccal and neck fat. But fat removal alone is inadequate as it can only change some of the contour. If a full neck is all that bothers someone, then liposuction alone is a good treatment. But for more total facial sculpting and definition creation,  it must be combined with other procedures that bring out or highlight facial prominences such as the chin, cheeks, or jaw angles. Using implants in these facial convexity areas can help bring shape to an otherwise amorphous face.         

Dr. Barry Eppley

Indianapolis, Indiana


Jawline Implants in Men

Tuesday, July 7th, 2009

There is no doubting the influence that a strong jawline has on the appearance of the male face. From a well-defined chin back to the jaw angle, a straight and strong jawline creates a favorable lower third of the face which is aesthetically important in men. But creating a good jawline for those who don’t have one is not as simple as it may seem.


What makes up the jawline? It is a single bone of the mandible (lower jaw) that incorporates three distinct aesthetic regions. These include the chin, the body, and the jaw angles. The combination of all three ideally create a well-defined line (at the lower border of the jaw) that runs smoothly from the chin back to the jaw angle. It is broken up into three areas based on how it must be surgically approached. The use of chin implants for the front and jaw angle implants for the back are well known. But it is the central zone, the body, that poses the most challenging area to aesthetically augment.


If the body area is augmented with an implant, this poses three potential problems. First, there is no standard implant that is available or pre-fabricated for this application. As a result, one has to custom carve during surgery the shape and length of implant needed. Secondly, placing a body implant in between a chin or jaw angle implant creates a three-piece jawline implant that has the real potential of being able to feel the transition zones between them. This is particularly true at the back end of a chin implant and the front end of the body implant. Lastly, the purpose of most jaw body implants is to provide more projection to the edge or bottom side of the jawline. This makes placing it and holding it in place after surgery a potential challenge.


For these reasons, I feel that a custom fabricated one-piece jawline implant is almost always best. This requires preoperative modeling and an implant design which certainly adds to the cost of the operation. But if one is looking for a more vertical elongation to the entire jawline, this is definitely the way to go. One-piece implants, regardless of size, are always easier to place and will have less potential for postoperative problems.


When lateral jawline augmentation is desired, then the three-piece approach is more reasonable. The body and jaw angle implants can be placed inside the mouth while the chin implant is placed through an incision underneath the chin. Screw fixation is used for all implants as this is best way to prevent shifting or migration of the implant.


Every jawline patient must be looked at individually and a specific implant approach used for each depending upon their goals and aesthetic desires. The concept of jawline augmentation with multiple plastic surgery options intermingles a variety of factors that defies one standard approach.


For the older male, creating a stronger jawline must take into account the development of jowling from aging and gravity. A facelift (neck-jowl lift) would be a necessary part of the plan. The use of one or two implants, at the chin and jaw angle, may be all that is needed to recreate a more well-defined jawline prominence.


Dr. Barry Eppley



Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana


Improving the Shape of the Face by Bony Augmentation and Fat Reduction

Thursday, October 9th, 2008

Making a face more square or angular can be done through bone augmentation, fat reduction, or both. I have found that there are two types of patients who come because they want a more defined facial look. First is the male patient (usually younger)who does not necessarily have a full or fat face but wants more definition at the defining points of the face. In some cases, I call this seeking the ‘male model look’. The second type of patient is male or female who does have a fuller face and simply wants to be ‘less round’. Their goals are not quite so precise as the first patient. Usually they are younger as well but can be middle-aged also.

The defining bony points of the face are the cheeks, chin, and jaw angles. Facial fat points are the cheeks and neck. Those searching for the ‘male model look’ are usually looking at the trio or combination of cheek, chin and jaw angle implants.  The thinner the face is, the more profound the result will be with this triple implant approach. When you are placing three implants, or simultaneously changing three facial prominences, it is always best to not to overdo it. Large implants in all three places can create a very unnatural or artificial look. Cheek implants never look too good if they are too large.  Subtle cheek changes are more natural.The proper size of a chin implant is easier to know because the amount of chin deficiency can be measured in profile. Most men should consider a more square chin implant style as that is often what this type of patient is trying to achieve. Jaw angle implants can rarely be too large as they are manufactured small anyway and the jaw muscles and thickness of tissue over the jaw angles can camouflage a great deal of the implant.

Those trying to deround a face must use a different approach. Fat removal in the neck (liposuction) and in the cheeks (buccal lipectomies) are an important element of derounding and is often done with a chin implant. In rare cases, cheek implants may be considered but they should be small as buccal fat removal will create the visual impression of some minor cheek augmentation as the area below the cheek moves inward. This type of facial derounding is more subtle than squaring a face with the most dramatic changes occurring in the neck and less in the cheek and side areas of the face.

Careful analysis of the face prior to surgery through computer imaging can be invaluable in this type of surgery. Changing multiple areas of the face at one time, with the objective of changing one’s facial look, requires good insight and understanding between the patient and their plastic surgeon.

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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