Your Questions

Q: Dr. Eppley,  I have a question about the genioplasty and v-line surgery. ( jaw reshaping) What’s a good prediction of what the recovery will be like two  weeks forward in terms of speech, looks and smile? 

For the genioplasty, I definitely want to reduce the width. I think rather than projecting it forward to slightly bring in some height, I’d rather just lengthen it vertically right where it is. I prefer this because I don’t want dramatic length added so I wouldn’t think I want to do both, and I assume extending my chin bone downward will help change my chin profile from “slumping up” at the chine edge, to a more aesthetic look. 

In other words, I assume bringing the chin forward wouldn’t help change my chin’s profile and hence, moving the bone downward would benefit me best. I think if anything perhaps my chin could be brought forward a millimeter, but again the real thing I’m looking for is to reduce the width and add a little height for the sake of creating a more v-line jaw line.

A: I think your insights into creating more of a V-line jaw shape are correct. (v-linje surgery) Chin width reduction and vertical lengthening will go a long way towards changing the shape of the front half of the jawline.

It will take a good three weeks to have about 75% recovery and a full 6 weeks to show 90% of the result from V-line surgery. This surgery does not affect speech or the ability to eat but is mainly an appearance issue due to swelling and temporal chin distortion. There is no doubt your chin will be very swollen the first 7 to 10 days after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 28 year old female.When I was12 whenever I opened my mouth very wide the left side of my face clicked under my ear. Therefter it became more painful to open and I had great difficulty in eating chewy foods. By the time I was 18 my face looked obviously asymmetric. My jaw is not properly aligned. I have been to an orthodontist and was told that I would need corrective jaw surgery which I can not afford and he also said it may not necessarily make my face look straight even if my jaws were better aligned. What can I do to straighten out my face?

A: Your face is significantly asymmetric due to an underdeveloped left side. That extends from the cheek bone down to the jawline with a significant left chin deviation.Your non-major orthognathic surgery options include a combined procedure by repositioning the chin bone (opening wedge genioplasty), a left cheek implant and fat injections to the left side of the face. These three procedures will help fill out the left side of the face and straighten it by aligning the chin with the midline of the face.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, I saw a doctor for a genioplasty consultation and he is supposedly a guru in the field. I have Class II, deep v shaped labiomental fold and my lower lip is behind my upper and my chin height is short and retruded back. He said a sliding genioplasty to horizontally and vertically lengthen my chin will work, but he also said he wanted to inject some kind of new stem cell bone material on my chin underneath the fold which will create new bone and fill in the valley on my chin, which would push out the soft tissue of the fold. I’ve never heard of this. He said bone augmentation was superior to soft tissue implants or fillers, and that this technique is very new.

A: What you are referring to is the simultaneous management of a deep labiomental fold during a genioplasty. Even though vertically lengthening the bony chin with the horizontal advancement will not deepen the fold any further, it is also unlikely to make it more shallow either. Filling in the bone gap of the osteotomy, while often thought as helping push out the labiomental fold area, does not. It is below the level of the labiomental fold. Thus a soft tissue approach is needed to help fill out the deep labiomental fold. That can be done by a variety of methods from injectable fillers, fat injections, allogeneic dermal grafts, and even silicone rubber (Permalip) implants. So-called stem cell injections (usually just concentrated fat injections) is a hot topic for injectable soft tissue augmentation. It is certainly a safe technique to do but its effectiveness is far from established.

Dr. Barry Eppley

Indianapolis,Indiana

Q:  While I don’t think that I am bad looking, I feel that my jaw line is weak and small. My receding chin greatly distracts from my features and I am hoping a jaw and chin augmentation can help balance my lower face and give me a stronger, more masculine appearance. Ideally I would like to substantially increase my chin size horizontally, to or past my lower lip when viewed in profile as well as add vertical length as my chin is rather short. I also desire to add horizontal width and volume as well as increased vertical length when viewed from the front, or in other words a more “squared” appearance. Along with my pictures, I’ve included a rough depiction of what I am trying to achieve. The altered versions are a “goal” and perhaps you can tell me if they are realistic or not. The problem is I realize extending my chin out this far requires substantially augmentation (probably around 12-15 mm) and don’t really know if my goals are realistic. I’ve been researching your website and understand you do chin osteotomy in conjunction with chin implants. Would this be a possibility? If so are there greater risks in terms of potential nerve damage and bone resorption? Also, with such an invasive surgery, are there any long term complications after say a decade or more?

A: Your own predictive computer imaging is greatly helpful and shows exactly what you want to achieve. I could not have the done the imaging any better myself. Because you desire both horizontal and vertical chin lengthening and are a very young man, I would recommend a chin osteotomy which does a better job of such combined dimensional changes. The chin can probably be advanced about 12mms or so and that should be enough to get that look. The chin can become more squared with an osteotomy by splitting the downfractured chin bone and expanding it apart to create more width. As you mentioned, an implant can also be added to the front of the chin osteotomy to create the same effect. I would have to see intraoperatively which would work the best.

Dr. Barry Eppley

Indianapolis, Indiana

Q:   Dear Dr Eppley. I am wondering if it is possible to get a variation of genioplasty done.
I am wanting to reposition my chin bone higher up. In reduction genioplasty the chin tip is sawn off, a wedge of bone is removed and the chin repositioned back.Is it possible to saw off the end of the chin, then without removing any bone, reattach the sawn off tip at a higher position? This could help address saggying tissue as the higher position of the bone could help lift the surrounding tissue. This would leave a bony ridge on the chin, however this could be hidden with fillers.Does this type of surgery sound like something you could do? Thank you.

A: That is known in chin surgery as a ‘jumping genioplasty’. That places the cut piece of chin bone on top of/in front of the upper chin segment. However this will bring the chin forward and make it more prominent, although it would lift up sagging chin tissues and shorten its vertical length somewhat.

By your descriptions, I think you may have an erroneous concept of how chin osteotomies are done. It is important that the cut piece of chin bone remains attached to the muscles which provide it with a blood supply, otherwise it will die and resorb away. It is not just moved anywhere else one wants to put it.

Perhaps you could send me some pictures so I could see what type of chin problem you and what may or may not work.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi Dr Eppley,  I read a article that you have used a long-lasting injectable filler to lessen the deepness of the chin lip fold? I had a sliding genioplasty and there is a mild stepoff and a bit of a deeper sulcus afetr surgery. I was wondering if you would be able to blend the chin into the jawline like the stepoffs and also lessen the labiomental chin lip sulcus? How long after genioplasty am I able to have the injectabale treatment? Also what complications have you seen with such injectable treatments? Thanks.

A: The first thing to appreciate is the anatomy of the labiomental sulcus (chin-lip groove) and how that has been changed from your bony genioplasty. The depth of the labiomental sulcus is a reflection of your anterior mandibular vestibule. If you put your thumb in the labiomental sulcus and your index finger inside your mouth, you will see the correlation between the two. The fold represents the level of the vestibule but, more pertinently, it is the upper or superior attachments of the mentalis muscle.  Once the chin bone has been slide forward, the labiomental sulcus deepens because the chin point moves forward with the bulk of the mentalis muscle with it. That will deepen thue sulcus because the vestibule has not moved but the chin bone has.

How to treat the deep labiomental sulcus can be done several ways. If one is looking for a permanent solution to the depth of the fold, treat the exact anatomic problem and place a dermal graft and build it up from underneath in the bony step-off. That would be my preferred approach. The other option is to use injectable fillers but understand that they will onlu be temporary and are not long-term solutions.

Dr. Barry Eppley

Indianapolis Indiana