Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘plastic surgery of the chin’

A Narrowing Genioplasty for Making The Square Face More Slender

Monday, April 25th, 2011

The perception of a square face usually has much to do with the shape of the jaw. A square lower face is largely influenced by the width of the jaw from the chin back to the jaw angles. This may or may not be associated with a horizontally short jaw as well. While this is a common aesthetic facial concern in Orientals, it may also be seen in other ethnic groups as well. In those seeking a change from this appearance, their goal is a more narrow and slender appearing face which changes the shape from square to an oval.

The traditional approach to narrowing a wide or square lower face is jaw angle reduction surgery. An outer cortex ostectomy technique is preferred over complete angle amputation. While this can have a narrowing effect, the results are limited exclusively to the posterior part of the face where the jaw angles exist. This may not make a face appear slender as the chin and anterior jawline area unchanged. For some patients, this is an important area to combine with jaw angle reduction and is often overlooked in the surgical planning of facial slimming.

Chin osteotomies can have a significant influence in changing the frontal appearance of the lower face. The traditional forward movement of the downfractured chin segment gives a measureable narrowing effect as its u-shape is brought forward. When combined with some vertical elongation, this effect can be further maximized. But not every face needs visible horizontal or vertical movement of the chin and it may not be asesthetically advised.

Chin osteotomies can also be done just for narrowing its width. By removing a central bone segment (up to 1 cm) from the mobilized chin segment, it can be brought back together in the midline and secured together. This is a far more effective method of width reduction than burring. This is because the effect of burring is limited by the location of the mental nerves. Once the chin segment is narrowed, smoothing of the bone edges along the osteotomy lines is needed to prevent step-offs that can later be felt through the skin.

One caveat about bony chin narrowing is management of the attached soft tissues. When you have less bone support, soft tissue prolapsed and redundancies are possible. This can occur in the jowl areas as well as the floor of the mouth muscles. The genioglossus muscles must be resuspended to the chin as they are detached with central chin bone resection. The mentalis muscle should also be securely reattached to prevent any sagging of the jowls or chin pad. As it turns out, both muscles are sutured to the same place…the plate and screws used to secure the chin osteotomy in the midline.

The entire jaw contributes to a wide and square face for some patients. A narrowing sliding genioplasty can be a valuable addition to a jaw angle reduction in the goal of making a more slender jawline that has more of an oval appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Camouflaging the Weak Chin – Goatee Facial Hair vs Implant

Saturday, March 26th, 2011

The wearing of facial hair at one time in history represented a matter of convenience, the man didn’t want to bother with the nuisance of shaving. Men wearing facial hair today, however, is done much more often for style reasons and to create a specific facial look. This is evidenced by the observation that many facial hair styles require daily work to keep them in good shape. This is most evident in the manicuring required of a goatee.

A weak chin can throw off the symmetry of an otherwise attractive face, making the nose seem larger, the neck look fuller and even creating the appearance of jowls. It is well known that wearing facial hair can help camouflage a weak chin without resorting to surgery. A weak chin can use a fuller beard to hide and balance that area with the other areas of the face. If you have a diamond-shaped face, a full beard will add girth to the jawline and chin. A goatee is the most common facial hair pattern that I see in men who come in for chin augmentation. The goatee not only adds horizontal projection to the chin but also makes it look wider as well, giving the chin a more square and dominant look.

But for those men who want to lose the facial hair and the daily grooming, chin augmentation can save one hundreds of hours over years. One of the more simpler and less complicated of all the facial implant procedures, it requires just one hour or less of surgery to get the chin you always wanted. Through a small incision of just one inch or inch and a half  under the chin (the incision is often less than 25% of the total chin implant length), an implant can be slide in and along both sides of the  jawline and centered over the midportion of the weaker chin bone. The subsequent scar under the chin heals in an inconspicous manner.

Chin implant styles for men can easily mimic what a goatee can do. This is because they can provide more than just a one-dimensional effect of horizontal projection. Chin implants come in more square-shaped designs than can make for a wider chin as well as one that just juts out further. Square designs exist that even have a central groove for those that desire an enhancement feature of a central groove or cleft. If properly positioned on the lower end of the chin bone, an implant can add some vertical length as well.

To improve the shape and strength of the male chin, external facial hair or an internal implant can be used. Each approach has its own advantages but the chin implant eliminates the need for any daily care and maintenance.  

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Correction of Chin Clefts

Wednesday, July 8th, 2009

Midline clefts of the chin are both a desired as well as a disliked facial feature. For some patients who have these chin clefts naturally, they would like the depth of the cleft softened or even completely removed.  Such a procedure, chin cleft reduction, is possible.


Contrary to popular perception, clefts of the chin are not primarily caused by an underlying cleft or defect in the chin (mandibular symphysis) bone. While some chin clefts do have a notch or indentation in the underlying bone, most do not. The cleft in the skin is caused by a separation or dehiscence of the paired mentalis muscle as it comes together over the chin. Technically, it is not a true separation but a failure of the muscle to come together during development as occurs in non-cleft patients.


The depth of the chin cleft is a reflection of the magnitude of the muscular split. In complete muscle separations, the chin cleft can be quite deep or indented with the edges of the skin completely turned in with little subcutaneous tissue between the cleft and the underlying bone. This understanding has relevance to how it may need to be corrected. Less deep chin clefts do not have such severe skin indents or inturning as the muscle is split less completely and more tissue exists between the cleft and the underlying bone.


Correction (reduction) of chin clefts is done through an incision inside the mouth just above where the lower lip starts from the depth of the vestibule. The muscle is elevated off of the bone down to the underside of the chin bone. One can see the actual separation of the mentalis muscle. Muscle is freed up on both sides of the cleft and is sewn together across the muscle separatikon with dissolveable sutures. It is important to overcorrect or give it a little pucker as there will be some relaxation after surgery. This maneuver will certainly soften and reduce the depth of a chin cleft but may not completely get rid of it.


I have found that the best chin cleft corrections come from simultaneous chin bone manipulations as well. Whether it is a chin implant placement or a chin osteotomy, changing the shape of the underlying bone (advancements or vertical lengthening) has a positive effect on the outcome of chin cleft correction.


When the chin cleft quite deep, some consideration may need to be given to doing external skin incisions as well. Incising along the edges of the chin cleft, with or without a dermal-fat graft placed underneath, and bringing the external skin edges together gives the best correction. But at a price of an external scar…which may or may not be worth it. Some patients would argue that a fine line scar that is less indented is not as problematic as a very deep chin groove.


Conceptually, it is best to think about chin cleft surgery as a reduction of it, not a complete elimination. In my Indianapolis plastic surgery practice, this is a concept that I emphasize about this surgery. Some chin clefts will nearly disappear, the deepest ones are merely reduced. (unless one is willing to accept an external skin scar.  


Dr. Barry Eppley

Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana



Chin Reduction Surgery for Horizontal Excess

Monday, December 22nd, 2008

The chin represents one of the five main prominences of the face, also including the nose, brow ridges/forehead, cheeks, and jaw angle.  It is the defining feature of the lower face. Augmentation or enhancement of a recessed or weak chin is a common plastic surgery procedure that is made fairly simple through the placement of a synthetic implant. Correction of a large or too prominent of a chin, however, is not only less commonly done but is more difficult to do successfully.

A prominent chin has both excess hard and soft tissue. This means that the bone not only has to be reduced but the muscle and skin must be shortened and tightened as well.  If the soft tissue of the chin is not properly addressed in a reduction, it will sag off of the reduced bone after surgery resulting in what is known as a ‘witch’s chin’ deformity.

Chin implant surgery is traditionally done through an incision under the chin in the submental crease. But in a chin reduction procedure, this incision should be moved back a bit accounting for the removal of some submental skin at the end of the procedure. Once the chin bone is exposed, the excess chin is burred down the amount estimated beforehand. Usually it takes at least 6 to 8mms to make a significant difference. It is important to make sure that the bone removed extends far enough to the sides and is tapered to keep the chin from being too square. Once the bone is removed, excess mentalis muscle is removed and this muscle flap is sutured to the underside of the chin to the platysma muscle. Making this a tight muscle closure is important. Redundant overlying submental skin is then removed and closed as well. The soft tissue closure is just as important as the bone removal.

This approach works well for a horizontal chin excess. A vertical chin excess or a long chin, however, requires an intraoral approach with an interpositional wedge osteotomy for its correction. This is a completely different operation with removal and repositioning of bone rather than a simple burring down technique.

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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