Your Questions

Q: Dr. Eppley, I would like to schedule a consultation for chin reduction. My chin is too long and slightly asymmetrical. I am from out of town. If surgery goes as planned how many trips will I have to make to see you in person?

A: Your pictures show a chin that is somewhat vertically long and has some asymmetry with a left-sided deviated chin point. The correct way to shorten and straighten your chin in through an intraoral genioplasty with an asymmetrical wedge removal for shortening and realigning the chin point. This is a procedure that takes about one hour under general anesthesia. You could return home within 24 to 48 hours. Any followups would be done by e-mail or Skype just like you are making this inquiry. Expect some substantial chin swelling afterwards that will take about 4 to 6 weeks to see the final result. Sutures inside the mouth are dissolvable so there is no need for their removal.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can I benefit from cheek implants? I have a long thin face that has always bothered me. I don’t know what if anything can be done to add fullness or reduce length? I always look like I am scowling and as I age…it gets worse. The first picture attached us awful I know but it at least gives you an idea of my situation. The second pic is simply one I have played with to widen my features and wish were possible. Thanks for your time.

A: There are improvements that can be made to a long thin face in terms of both length and width. Facial height reduction options are more limited than those of width and are often relegated to the considerations of vertical chin reduction, upper lip lift (shortening) and in some cases rhinoplasty. Numerous facial width increase options include jawline and jaw angle widening, cheek implants and fat injections between these two skeletal area. (the trampoline facial zone) Which one(s) of these might be most beneficial to your face depends on a computer imaging analysis. Unfortunately your one picture is not adequate to much of anything with due to the poor picture quality. If you could send me a front, quarter and profile views of your face (non-smiling) I would be happy to do that assessment for you. Based on this one picture it does seem that cheek implants may be helpful for more facial width and that could be combined with fat injections for a more blended transition from the implants into the thinner and non-bony supported areas outside of the cheek zone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for someone who can give me realistic advice on how to reduce the size of my chin (mentalis) I heard botox is an option but probably wont have much affect. Are there any other options I could explore? I think there is fat in that area so would laser liposuction be an option? Any help would be great.

A: Thank you for your inquiry. I am not sure what you mean by realistic advice but here are the facts on chin reduction. A large chin is due to too much bone, too much soft tissue or both. Its reduction therefore must involve surgical reduction of either bone, the soft tissue cover or both. If the bone problem is one of too much vertical length, then an intraoral vertical reduction bony genioplasty is needed. If the bone problem is too much horizontal with or without vertical bone excess, then a submental bine burring reductyion needs to be done. All excessive soft tissues problems need a submental excision and tuck unless it is just a mild amount of laxity then an intraoral soft tissue suspension must be done.

I don’t know where the concept of Botox comes from since that is a temporary muscle paralyzer not a soft tissue reduction method anywhere it is applied on the face. No form of liposuction should ever be done on the chin as all it will do is dimple the chin and make it look irregular. The amount of fat in anyone’s chin no matter how big it is is very small and the chin needs it to keep an outer smooth skin contour.

The only way to reduce a large chin is surgery, removing either bone, soft tissue or both.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had some type of chin reduction procedure 10 years ago (maybe burring down the bone?) but my neck and chin actually looks worse afterwards. I have attached some x-rays which show a single butterfly-type device with four screws, visible more so from the profile shots. Do you think the irregular bone shape underneath is contributing to any of this fullness? Or does this not matter? The wedge on the end looks like it is positioned a little high to me. Would something like F in the image below be a better option? I want my labiomental fold effaced more like the after-shot in F. Or could this also be achieved with bone burring? What are you thoughts about all this? I want to get rid of the bulbous shape and having small, short teeth doesn’t help matters out much.

A: Thank you for sending the x-rays. What they demonstrate is that you had a reverse sliding genioplasty for your chin reduction, not just a simple burring of the bone. (like image F in the genioplasty illustrations) That is why there is a 4-hole metal fixation plate and screws. This also explains, as I suspected, the submental fullness that developed and never changed after the procedure.

Repeating the original reverse genioplasty is only going to make your neck/submental area worse…and will not reduce the depth of the labiomental fold. Do not let that illustration fool you, it does not work that way in real life on the effects of the soft tissue above the chin bone. (anything can happen on a drawing)

I do think that the bottom of the chin bone needs to be reshaped (narrowed and reduced in height) but, again, that is not going to change the depth of the labiomental fold. Fat injection grafting is the best procedure to try and make that happen.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I had chin reduction done when I was 13 (intraoral approach), however, there are still problems with it and it never has looked exactly right.  I think it may be soft tissue issues?  It still has a bulbous shape, and ever since the surgery, has this odd-looking submental fullness.  The underneath side of my chin sags and looks very unnatural and strange from the side; it has looked like this every since I had the surgery.  I don’t understand why this is…. is this fat or muscle or why doesn’t it look exactly right?  

Also, my bottom lip positioning is incorrect.  My bottom lip needs to come down and out (more everted), because when i smile my bottom lip goes in over my bottom teeth.  What I am wanting is a more normal-looking profile, less of a labiomental fold with a bottom lip that everts (instead of inverts) like normal, and a more sculpted chin (less fleshy and bulbous on the end and a more smooth profile without all the submental fullness.  

I talked to you before about soft tissue reduction of the chin, but I now have x-rays which might be more helpful.  I have attached my digital pics and the x-rays of my mandible (DICOM files).  Would only a soft tissue reduction/augmentation be able to address my problems?  Or do you think I need something done to the bone?  Another ostectomy or bone burring?  I want to get rid of this fullness underneath and get a more sculpted, normal-looking chin, instead of a bulbous one.  What type of procedure or procedures do I need to fix these problems and improve my profile? Thank you 🙂

A: Good to hear from you and I remember your case quite well. Let me dissect all your issues one by one. First the submental fullness is a soft tissue isseu of too much fat and loose skin, which often  happens from an intraoral approach to horizontal chin reduction particulalry if done by an osteotomy. Just that alone could be corrected by a submentoplasty procedure to flatten out the submental fullness and tuck the tissues under the chin. Secondly, the files of the x-rays you sent me were text and not the images and I have no way of opening them in an imaged format. You will have to send me the x-rays  actual jpeg files. But even without the x-rays I believe you need further chin bone reduction/reshaping to have a more sculpted chin shape. The value of the x-rays for me is to know whether there is any hardware in there and what the bone shape looks like. Thirdly, no chin procedure is going to change the depth of the labiomental fold. That has to be addressed directly by either fat injections or a subcutaneous implant to soften its depth. Lastly, the lip position and how it moves is not something that can be reliably changed by surgery. The only option is to do a v-y internal mucosal advancement to create more eversion but this will not in the long-run move the lip position lower.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve seen a lot of photographs and I’m completely amused by the results of the surgeries you have performed. I’m 20 years old female and I’m very interested in chin reduction surgery as I feel that it makes my face too long and also when I smile or speak the muscle/soft tissue protrudes hence this makes it look even larger. I was wondering if I could send you some photographs of my chin so that you could consult me on what could be done to improve my appearance. I have attached photos of my chin and also the result that I would like ( using photoshop) Could you please tell me if it is even realistic to get such result from a chin reduction surgery and how it could be done.

A: Thank you for sending your imaged pictures of the desired result. Your chin concerns are that the center area if long and include both the vertical length of the bone and a soft tissue underhang. To achieve your result, which in my experience is very possible, requires a submentoplasty approach to your chin reduction. From an incision underneath the chin, the center bone could be burred down and smoothed into the sides and the soft tissue overhang could be removed and tucked up.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I wanted to send you a couple pictures to see what you might suggest. I have a very narrow jaw and a pointy, long chin. I would like to have it reduced in length, though I’m not sure what else would be necessary for my jaw to look proportionate. Thank you for your time.

A: Thank you for sending your pictures. There is no question that a vertical chin reduction osteotomy would be very helpful for your chin. The unique part about your vertical chin reduction, because of your very steep mandibular plane angle, is that the back part of the osteotomy behind the bony cut must be reduced (leveled) as well. Otherwise the chin will be vertically reduced but you will end up with a ‘box’ look to the chin as there would not be a smooth transition along the jawline between the end of the osteotomy and the rest of the jawline as it heads back to the angles. I have done some predictive imaging to show what the potential changes could look like. Based on these predictions I see no need to alter your jaw angle area even though they are high. They could be lowered with implants but I am afraid this will make your entire lower face ‘too heavy’ even though it may be better from a jawline perspective. For now I have not imaged such changes but can if you desire.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 21 year old guy with a big jaw and a long chin. Also my jaw line is low which gives me a long face. What’s the best and the safest thing for me to do? Should I go for a jaw line reduction surgery and a chin reduction surgery as well? Are they safe? I have attached some pictures of my jaw from different angles.

A: Thank you for sending your pictures. You do have a most unusual pattern of jaw hypertrophy that I have ever seen with excessive horizontal chin projection and jaw angle protrusion. It would be very help to see some x-rays (even a panorex would be useful) to confirm that the bulges at the jaw angles are primarily bone and not masseteric muscle hypertrophy. But let us assume that these are all bony protrusions, they could be reduced through intraoral approaches by burring reduction of the chin projection and an osteotomy/saw reduction of the lateral jaw angle protrusions. These are not only safe but the only jaw surgery options you have for their reduction. If the vertical length of the chin is felt to be too long, then a vertical reduction osteotomy could be performed by the horizontal burring reduction. But it would be important to manage the then excessive chin soft tissues that would result from the reduction of the bony support. I would performed suture suspension of the soft tissues to the reduced chin size.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am 6 weeks post surgery today from my chin reduction procedure. I am feeling great, most of the swelling is gone. I know I need another month or two for final result, but I pretty much can see an outcome. My chin looks so much nicer without  that point and loose skin. The straight cut that you’ve done suits my face a lot better. But if it was possible I would still want to go a little shorter (it didn’t go as short yet). Maybe it will shrink a little bit more, but I don’t think the change will be very drastic from this point on, as I can feel where the bone is. That is why I wanted to ask you whether further attempts could be done in the future.

1. Do you think there is room on the bone  for more reduction? Of course it is all in the case it won’t go down to where I want it. One side is slightly longer now, it doesn’t bother me at all, but maybe it can be raised if there is no room on the other side?

2. How risky is it to do it again?

3. When is it normally done, after healing is complete or before it? What are the time frames?

4. Non related question, how long do i need to wait before any dental work? Also,do I need to take more calcium or less?

Thank you very much. 

A: Thank you for the follow-up. In answer to your questions:

1) The way to determine if it is safe to do further chin bone reduction is to get a panorex x-ray. (standard dental film) That will show how much distance remains between the lower tooth roots and the bottom part of the bone. I suspect it is fine to do more but it would be important to know the actual distance left between the apices of the teeth and the bone.

2) see #1.

3) The timing of any further efforts is always on the ‘stable target’ premise. It can be done as soon as one is sure that what they are looking at as settled down and no further changes are going to occur…. and one has psychologically adapted to the change.  When it comes to facial bone work that is usually 3 months.

4) You can proceed with dental work at amy time. Taking calcium supplements won’t make any difference positive or negative.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had surgery in the beginning of December of last year for chin reduction surgery. I just had some basic questions for you that I will ask now. It’s been 2 months and the swelling has gone down quite a bit, I’m curious if there will be any more reduction or is this the extent of it. Also, I’m still feeling a lot of resistance in my chin area. Not numbness just resistance. Is this normal? Is this something that I’ll just have to get use to?

A: Good to hear from you. I generally feel that it takes up to a minimum of 3 months after surgery for maximal tissue settling and complete swelling reduction of any facial bone reduction surgery including the chin. So you are probably about 85% there now. Also the chin stiffness will eventually go away I believe but that will take much longer, perhaps as long as 6 months or even longer. The normal feeling/movement of the chin may even take up to a year for complete softening of the chin tissues.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I have attached a picture of myself so you can see my chin. I do have a “ball” on the chin but I do not know what causes that. Each surgeon seems to have a different opinion about it. One surgeon told me it is caused by soft tissue and the mentalis muscle and that he can spread out the mentalis muscle and remove soft tissue to flatten the ball a little bit. But that worries me as I already have some dimples when I smile. I am afraid it will show irregularities on my chin (bumps, dips). How is it possible to know if it is the bone or the muscle and soft tissue causing this? Another surgeon said it would be best to shave the ball a bit (he thinks it’s caused by the bone); what are my options? and the risks? Thank you so much.

A: The one thing that I can tell you for certain is the ball on the end of your chin is all soft tissue and not bone. That is the confluence of the paired mentalis muscle and subcutaneous fat in the midline of the soft tissue of the chin. It is never a bony-based problem. The only way to reduce it is by intraoral soft tissue excision, there is no such procedure as ‘spreading out’ the mentalis muscle. You are correct in assuming that any deflation of the ball does pose risks of overlying soft tissue irregularities, particularly if fat is removed as this lies closest to the underside of the skin. If some of the deeper muscle is removed and swen down to the bone, this is the safest method of reducing its promienence and avoiding any obvious statis or increased dynamic chin dimpling.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to get the size of my chin reduced but am afraid of pain. Is there any painless way to reduce the size of my chin?

A: What you are asking is not possible. The surgery to do reduce the chin may be painless during the procedure because you are asleep. But after surgery there would be some pain and swelling. Most chin reductions involve bone removal, which by definition, will cause some after surgery discomfort. For the most part, anything painless in plastic surgery also correlates with things that don't work.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am interested in getting my chin narrower as it is too wide from the front view. In addition, it is longer on one side than the other. I know that you can burr or shave down the chin to reshape it. I have some concerns and questions about the procedure.

1.  I want my chin to be narrower by at most 1/4 inch.  I want the same squared shape only narrower from the frontal point of view.  Is that easier to do by cutting out a long narrow vertical strip in the middle of the chin and pushing the sides together thus preserving squareness or is it just better to burr down tubercles of chin on outer edges?  I do NOT want a pointy chin nor an oval chin.  Slight square is better just like it is, but narrower. Don’t know how narrowing would change smile lines as they arise from chin though.  Nor am I clear of how the jawbone to chin transition would change in a burring.  May be difficult to preserve some squareness.  Don’t want too small a chin for my size. I also fear that a subsequent face lift will feature a prominent bony masculine chin.  

2.  I do NOT want my chin profile to be changed.  I think it is fine as is.  Would burring down of sides affect this?

3.  Also want the bottom of the chin to be evened out.  One side is longer than the other.  Hopefully the asymmetry in the rest of my face (the right side is fuller in the cheeks) won’t be accentuated by any chin narrowing.   

4.  Will intra-oral approach allow you to visualize the submental nerve adequately?  Will it increase chance of infection?

5.  Percent likelihood of numbness of chin?  Tongue?  Typical resolution time? Ever seen permanent numbness?

6.  What is most catastrophic thing that could go wrong with a chin reduction? Lower face paralysis or worsening of my already incompetent lower lip?

A: In answer to our questions:

1) It is better to simply burr down the side of the chin for such a small amount of chin narrowing. Technically I actually use a reciprocating saw to remove the bone. That stills keeps it square in the front view, just narrower by the amount removed. I don’t think this would have any great impact on the smile lines nor change the jawline-chin transition…it is just being made slightly smaller/narrower in the frontal view. Also, a facelift does not really pull and shift tissues in the chin area so I don’t think that it will accentuate or create more of a square chin appearance.

2) Taking down the sides of the chin will not affect its horizontal projection. (profile) The most projecting part of the chin bone is not being affected.

3) The longer vertical side of the chin can be reduced as well. The computer imaging done previously should show you what the impact the chin surgery has on the look of the rest of your face.

4) The intraoral approach will allow the mental nerves to be seen completely. Intraoral surgery does nto increase the risk of infection unless an implant is being placed. There is nothing wrong with going from beow the chin through a skin incision, it is just that it is not necessary. (no advantages in doing so)

5) There will always be some temporary numbness of the chin because the mental nerves have been exposed. I have not seen permanent numbness from an isolated chin reduction/burring procedure. No risk of tongue numbness, the tongue is innervated from the lingual on the floor of the mouth which is a long way away.

6) There are no catastrophic events that can happen from this procedure. It is just an issue of aesthetics, how close do we come to the desired aesthetic goal. Lower facial paralysis is an impossibility because the facial nerve the moves the face is back near the ear. If your lower lip is incompetent to some degree I will resposition the mentalis muscle and chin soft tissues to try and improve that problem at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 21 year-old make who is trying to achieve a more dominant facial structure. I like the square face more than the oval shape that I have. I would also like a smaller nose feature and more open eyes. I have attached pictures and am open to your suggestions.

A: In listening to your concerns and looking at your pictures, you have the following aesthetic issues:

1) A long and wide chin. This makes your face appear long and oval. In short, it is too vertically long.

2) Your eyelids show a medial epicanthal fold, which is very similar to that of Asians. This makes your eyes look tired/droopy.

3) Your nasal tip is just very slightly long.

To make the facial changes you desire based on these concerns, I would recommend the following:

1) Vertical Reduction of chin by osteotomy (7mms)  with slight advancement. (2mms) This could be combined with jaw angle implants. Together this shortens your face and make sit more square.

2) Medial epicanthoplasties to get rid of the overhanging eyelid fold.

3) Tip rhinoplasty with shortening and narrowing of domes and nostril width narrowing.

I have attached some imaging to show what changes these procedures may create.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m contacting you regarding my chin. I have looked at many pictures of mine and my conclusion is that its too long, has too much soft tissue at the bottom, my right bottom tip is lower than the left and I think that maybe the bottom half of my lower jaw is a little too narrow and not symmetrical to the rest of my face. Also I think its too round. I have a big head and strong features and want my chin and jaw to look balanced. I noticed that my chin was too long  and pointy when I was 16 so I want to do something about it because I think it detracts from my looks and that I could look a lot better with it corrected. I would like to know what you think and what you would recommend.

A: Thank you for your inquiry and sending your pictures. Your long chin appears to be largely comprised of excessive soft tissue. There may be a slight bony excess but that clearly is not the major component. The ‘proof’ that the soft tissues are a major element of your chin problem is in how your chin looks between the non-smiling and smiling images. When excessive soft tissues are the problem with chin hypertrophy this requires a submental chin reduction approach. Only from below can the tissues be excised, tucked and closed. A small amount of bone can be burred down as well if needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 32 year-female with a chin issue. My chin doesn’t look too bad when I’m not smiling because I have a large nose so it is somewhat in balance.  However when I smile, I have excess soft tissue that almost looks like cellulite on my chin and it then sticks out more.  It is an appearance that is very similar to what I understand is witch’s chin deformity or chin ptosis.  I would like to know what you recommend for this problem and what the cost would be.  From reading your blog, I would presume that you would suggest some chin burring using the underneath the chin approach and soft tissue excision.  My concern of course is the length and visibility of the scar and I wondered what your experience with that has been. What is the average size of the scar? Is it visible from a frontal view and does it fade significantly over time? Also, do you think you can effect significant improvement in my problem or would the change be only minor?

A: In looking at your pictures, I suspect most of your chin issue is a soft tissue problem with a small bone component to it. That makes the submental approach the most effective treatment. The submental chin reduction scar is about 4 cm long and is curved to match the border of the lower jawline. Quite frankly, the effectiveness of the procedure is a balance of how much soft tissue tightening/removal can be done vs keeping the scar as short as possible. The scar is not visible from the front view and the redness of the scar does fade with time. I suspect the final result would be somewhere between a minor change vs a significant improvement. That is probably the best way to think about it. It is going to change, it is just a question of how much.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am investigating the possibility of narrowing my wide chin. I am 55 years old and have noticed the characteristic age-related lower face widening as a result of the increasing tissue laxity. While I am planning a facelift within the next year or so, I think a narrower chin will look nicer, more feminine and less bony once I have the jowls tightened. I have the following questions.

1) Am I a candidate for the submental approach and would this involve just burring down the sides of my chin? (I think my profile is fine and don’t need an implant)
2)  Wait time after chin reduction before a lower facelift could be done. 
3)  Likelihood of complete resolution of any numbness?  And additional risks due to my age?

A: 1) I would have to see pictures to determine your candidacy for the procedure. But usually the submental approach is best due to better access to the bone with a minimal risk of any nerve injury. If side chin reduction is only needed, an ostectomy with a saw for narrowing would be the technique used.

2) If one has to stage it, the chin reduction would be done first with a minimum three month delay before the lower facelift. The two procedures could also be combined.

3) When done from below, the mental nerve is well visualized so permanent injury to it is unlikely. Simple stretching and elevation of the soft tissues off of the bone will likely cause some mild temporary numbness or none at all. Other than the age-independent risk of mental nerve neuropraxia, I can foresee no other significant risks other than achieving the desired chin shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been looking into a chin reduction for quite a few years now, but I have never gone through with it because I’ve always been afraid that the results would be terrifying. I read through your case studies on chin surgeries, and I must say it’s a relief to see someone with as much experience on the subject of chin surgery. Perhaps other Doctors have just as much experience or more, but it’s relieving to be able to read about it instead of them briefly talking about it. My main reason for wanting a chin reduction is because I feel that I look weird when I smile.The other goal is to ensure that the chin surgery doesn’t make me look like I’ve had surgery. I have attached pictures of me (non-smiling) from different angles for your assessment.

A: Thank you for sending your detailed non-animated facial photos. What they show is one of the more uncommon, but more favorable, types of chin hypertrophy. Your chin is distinctly large in one dimension, a central horizontal projection known as an enlarged central chin button. It is not long vertically nor is it too wide horizontally. The chin excess is relegated completely to the central chin pad. This type of chin excess is usually composed of a combination of bone and excess soft tissue. It can be reduced by a chin reduction procedure consisting of shaving down the bone and reducing the soft tissue excess. It can be done from either an intraoral mucosal or submental skin incisional approach but coming from below allows a better management of the soft tissue excess.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dear Dr. Eppley, I consulted with a board-certified plastic surgeon who says he can round the corners of my chin and reduce about 5mms of projection without any ptosis or deformity. I have seen his before and after pictures and they are stunning. Best I’ve seen. Should I still be concerned about sagging. Also he wants to put me on a course of antibiotics, steroids and put a drainage tube in my chin to make sure no fluid collects for several days. What are your thoughts?
A: There is no chin reduction procedure of any significance in which the risk of soft tissue sagging does not exist. By definition when you make the supporting bone structure smaller, you have an excess of overlying soft tissue. With proper soft tissue management and suspension this potential concern can be avoided whether it is done from an intraoral or submental approach. The use of antibiotics and steroids are standard practice. The use of a drain is surgeon’s preference. It is not something that I have ever used for any chin procedure but I know there are some surgeons that do.

Dr. Barry Eppley
Indianapolis, Indiana

Q:  Dr. Eppley, I am possibly going to have a chin reduction. Here is my serious concerns. I have a very thin face with hollow cheeks. My forehead is large and my chin is small. The problem is I have a projected or jutted out chin which is very pointy, especially when I smile. I have a very strong jaw line, and I just want to to get rid of the witch’s chin look but keep the exact same frontal look. I cannot afford to have my chin shortened. I want a softer look, but I am terrified that I am in for serious dissapointment. If I did this, I would want to do the submental approach and the burring teqnique because I don’t have a long chin. It seems safer, and by your articles it seems I may be correct. I want a softer, more feminine look without making my face look any thinner, and the projection gone. Is this possible?

A: Thank you for sending your inquiry and your pictures. I would take a slightly different approach to your chin. In the frontal view your chin is very square for a female and it needs tubercle reduction (side chin reduction) to soften it. From the side view, it needs some slight horizontal reduction and soft tissue tightening. I would not do any vertical length reduction. You need the length to fit the rest of your face.

This chin reduction procedure is best done, as you have mentioned, from the submental approach to manage the excess soft tissues that will result.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, The problem with my face is it’s very skinny when I don’t smile. When I smile I have the biggest fattest face ever! I have these fat pockets around my nose. And instead of a smile I look like I’m sneering. I was in an auto accident and it caused nerve damage to my left lip. I want to fix my smile so its even again and you can see more of my teeth. I also have a brow that I hate and would like to get rid of. I also would like some work done on my chin because I hate the way that looks. And also when I smile I have “jowls” and I’d like to get rid of those and my double chin. My double chin is hereditary and being tall and skinny this looks very strange. I would also like to get a nose job because I have my fathers nose and I think it looks very masculine. Overall what I am trying to achieve is a slimmer face, with more feminine features and a better more applying smile. I don’t feel like my face goes with my personality, and how I feel. Also anything else you see that needs to be done please let me know.

A:  Thank you for sending your pictures. In looking at your face and reading your objectives I would consider the following procedures. A rhinoplasty is needed to make your nose thinner and less wide, particularly in the tip. I would also recommend buccal (cheek) fat pad removal (subtotal) and small cannula liposuction of the fullness above the nasolabial (lip-cheek) grooves. A lip lift (vermilion advancement) done with differential skin removal (left greater than the right) will help with better lip symmetry and overall fullness. A submental chin reduction is needed to decrease the amount of chin prominence and protrusion. Liposuction can be done in the neck and jowls to remove fat in these areas.

Unfortunately, I can only do limited computer imaging because your pictures are inadequate.  Smiling photos make a lot of facial feature distortion.

You mentioned a dislike for your brows but I am uncertain what specifically you do not like about them. Until I know more, I can not make any recommendations on whether they can or cannot be favorably changed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am Asian and interested in making my face more narrow. It is too wide in the cheek area. I also think my chin is too long and would look better if it was shorter. I woud like my face to be more oval and not so wide and square. Do you think cheek and chin reduction will achieve what I want? I have attached a picture for you to see my face from the front and show me what the changes would look like. Thanks!

A:I have done some imaging based on the single photo that you have sent me. It is a partial smiling photo so it is not ideal to use but it is acceptable to give you a general idea of the proposed changes. This predictive image is based on the following two procedures:

1) Cheek Reduction with osteotomies at the zygomatic body (front) and the temporal end of the zygomatic arch. (back) Your frontal facial photo shows a wide or bowed zygomatic arch from the cheek on backwards. This is best treated by total zygomatic arch narrowing as opposed to zygomatic body reduction. One would need a submental (vertex) x-ray before surgery to look at the extent of the bowing and determine how change (inward movement) of it could be done.

2) The chin reduction is a vertical shortening which is what I think you mean by chin reduction. I have no side view of your chin so I can not comment on any horizontal issues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in doing a ” Brow ridge reduction “, at least that is what I think it is. Also I would like a chin reduction. So my questions are; Are these types of surgeriess even possible? How far in advance do I have to schedule them? Have you ever done similar work to this? I have attached some pictures for you to see what I mean. Sorry as they are not the best quality.

A:  Thank you for sending your pictures. Your requests for brow bone and chin reduction surgery is not uncommon and these are established procedures. I am very familiar with doing them and get requests for them all the time. Brow bone reduction (technically frontal sinus reduction since the brow bones are largely sinus cavities not solid bone) is done through a scalp incision. The outer table of the frontal sinus is removed and set back which makes the brow bone less prominent. It is a very effective surgery and the only significant issue in men (which are by far those who request the procedure) is the need for a scalp incision and the resultant fine line scar in the scalp to access the forehead and brow areas. Chin reduction surgery is done different ways based on which dimension of the chin one wants to shorten. If it is a vertical chin shortening that is done by an intraoral osteotomy and bony wedge resection. If both a horizontal and a vertical chin reduction is needed that is usually done by a submental (under the chin) incisional approach and the bone is burred down and the soft tissues shortened and tightened to the smaller bone.

This will give you a general overview of your requests. Both surgeries are possible and are part of cosmetic craniofacial reshaping surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi there, I have researched a tremendous amount on the internet to find what I think I need. Although I am from the UK I am willing to travel to you for good results as you are the only surgeon that has a wide range of procedures I feel I need for my long face. I have had prior surgery to my face including chin reduction and fat transfer to my cheeks. However it’s my facial skeleton I feel that just still does not look right. My eyebrows are hooked which I see you do brow reduction which you may recommend but its the whole chin jaw nose balance I am looking for improvement. I constantly am compared to the actress Sarah Jessica Parker which I hate! So you can sort of understand my facial faults. I am looking for improvement in my facial structure and to achieve better looking eyes. Many Thanks and looking forward to hearing from you.

A: While I will obviously need to see some pictures of your face, the long face look is not uncommon. There are certain features to it that create that look besides the fact that the vertical length of the face is measurably long. Often the face is thin and skeletonized with a prominent chin and a long and narrow nose. This is undoubtably why you have had a chin reduction and cheek augmentation to try and create a counteracting effect. While this has probably been somewhat helpful, those procedures alone may not create enough of an effect. Additional procedures to consider would be rhinoplasty, brow bone reduction, jaw angle augmentation and possibly further efforts at chin reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: My chin is too big and I need it reduced. What is the cost of chin shaving surgery?

A: Thank you for your inquiry. When one mentions ‘chin shaving’, they may really need a submentoplasty with chin burring reduction or they may really need a chin reduction via an osteotomy. It depends on their chin problem as the approach for chin reduction can differ based on the size and shape of their chin bone and the surrounding chin and submental soft tissues. Each method of chin reduction also differs in cost. Therefore, before providing a surgical fee quote please forward to me some photographs of your chin and what specific dimensional changes you want to see.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  For most of my life I have considered myself ugly. I avoid having pictures taken and I most certainly don’t look at them if they have to be taken. I have a total lack of confidence and this has definitely poses problems in my personal relationships. I don’t know what it is about my face but it just doesn’t look right. I am only 29 but I look much older. My eye area looks droopy and old and may face looks thin and distorted. I have attached some pictures for you to see and review. What would you recommend to help me look better ?

A: When someone doesn’t like their face, particularly at a young age, this indicates that the problems are with how it is put together (structural components) not that it is has early aging. This means the underlying structures that make up the shape and highlights of the face which are largely bone and cartilage. In reviewing your pictures, I can see that your face has unbalanced structures which include low hanging brows, a broad and prominent nose, hollow cheeks, and a wide and long chin. The combination of these features creates an overall facial look that you do not like. Procedures such as an endoscopic browlift, rhinoplasty, cheek implants and chin reduction collectively would make a major change in how your face looks. It would lend a softer and more youthful due to a better balance of your facial features. Computer imaging with these changes would demonstrate their potential benefit in changing the shape of your face.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am 30 yrs old and am tried of people telling me that I am in my mid to late 40s. Ugghhh! I usually just walk away and cry and I am tried of crying over this and want to get something done about it. I have had a brow lift and a neck liposuction about 2 yrs ago. I would like to see what it would look like with eyelid lift and filler. Would you also recommend something else? Maybe a chemical peel? Thank you for your help! I really appreciate it!

A: Thank you for sending your pictures. Unfortunately computer imaging is good at changing structures of the face but not very good at soft tissue manipulations such as those that you have asked for. An eye lift can not be done as it distorts the whole eyelid. However, I think there is no question you have upper eyelid hooding and you would clearly benefit by an upper blepharoplasty or eyelid lift. Putting in fillers along the nasolabial fold and lips is also not very accurate and often just distorts the lips in trying to image it. You have reasonable lip size so injectable fillers will make them nicely bigger. As you have suggested, a chemical peel is good for skin texture and brightening the glow of the skin and for fine wrinkles as well.

As for other recommendations, I have done some other changes just to look at how to soften your facial features and make your face more ‘youthful’. These have included the following:revisional browlift to lower hairline (reduce long forehead) and correct existing brow asymmetry, rhinoplasty to make nose look slimmer and more narrow and chin reduction to soften chin point and make softer looking.These are structural facial changes which are different than just anti-aging procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I had a chin reduction a couple of years ago and although I am happy with the new shape of the bone, I now have hanging soft tissue. Needless to say I am not happy with these results. I have visited five plastic surgeons and none of them wanted to fix this problem saying that it was dangerous to cut or reattach the muscles and the ending results could be worse. I am very dissapointed and have attached some before and after pictures for your review. I hope you can help.

A: Your pictures show quite clearly some soft tissue sag or ptosis off of the chin bone. It is most pronounced centrally which is what one would expect given that your chin reduction was most likely an intraoral burring approach done to the central button.  To improve this problem there are two approaches, intraoral muscle resuspension or a submental tuckup. The intraoral approach uses a suture anchor to the bone to reattach the muscle and tighten it back done. This is a scarless approach. The submental tuckup  uses an incision under the chin where the loose skin and muscle is removed and tucked or tightened to the bone. Each has its own advantages and disadvantages. The intraoral approach avoids a scar under the chin but the submental tuckup is a more reliable method.

There is no danger to performing this procedure and there is no chance of making the problem worse. Whoever has said has either never treated the problem or is completely unaware that such surgical correction exists.

Dr. Barry Eppley

Indianapolis Indiana

Q:  Please help me out.  I’m so tired of being called Mrs Leno and hiding my lower face.  I have been married for 6 years to a great man but to this day I cover my face when sleeping so he can’t see me and hide my face when we are in a car or at home.  I can’t take this anymore.  I just want to feel beautiful for once.  Can my big chin be made smaller and more proportionate to the rest of my face? I have attached some photos for you to see my chin concerns.

A: Thank you for sending your photos. I can quite clearly see your concerns. You do indeed have a very large lower jaw which is most manifest in the strong chin protrusion. In studying your photos, I think the best method of chin reduction would be an intraoral vertical reduction osteotomy. That would give the greatest amount of vertical reduction and some horizontal reduction as well. There is always some concern about what will happen to the ‘extra’ skin under the chin area when the bone is reduced by this approach. Which is why I would think about doing a simultaneous submentoplasty (skin removal and tightening of the skin) at the same time. Normally this would not be necessary but your very large chin area poses an uncommon problem even in those who seek chin reduction.

Dr. Barry Eppley

Indianapolis Indiana

Q:  Hello Dr Eppley,  I’m just writing to thank you for the great information you have posted on vertical chin reduction. I’ve always had a long chin and had liposuction on my neck 3 years ago. Afterwards it made my chin longer. I don’t know if it just looks that way or something was done to actually make my chin longer if that makes sense. In any event I’m too afraid to do anything about it, but thank you so very much for providing the great information on your site.

A: The neck liposuction did its job by making the neck less full and improving the neck-chin (cervicomental) angle. But having a long chin to start with by your admission, the improved neck shape has unmasked the chin area and made it look longer. That is actually an optical illusion. But an illusion that aesthetically does not work in your favor. When considering neck changes, it is always important to not overlook the chin area as the two work together to contribute significantly to one’s facial profile. Doing computer imaging would have revealed what neck liposuction alone would look like. It likely would have shown that vertical chin reduction was just as important to an improved facial profile as was the neck fat removal.

Dr. Barry Eppley

Indianapolis Indiana