Your Questions

Q: Dr. Eppley, I had this jawline augmentation morph done by a person who claims to do plastic surgery morph predictions, and I was wondering if this really is realistic and if I can look like this by any surgery necessary to achieve it. It is basically my ideal result if I could get it, but I want to know if it really is possible. (if anything, i would like to go even further)

Also, and this may be a bit ‘out there’, but would it even be possible to find a man with great facial bone structure and get him to get the 3D CT scan, then you can match my facial bones and jawline with his to make the implants so I would have a jawline augmentation to look like him afterwards?

A: I do think that type of jawline augmentation result is possible. It can only be done with a custom jawline implant designed by a surgeon who has done a lot of them who would know the dimensions to make that type of ‘extreme’ jawline augmentation result. It is not realistic to use someone else’s 3D CT scan as there are other factors involved in how one looks than just their bone structure. And no one is going to expose themselves to radiation for someone else’s benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jaw augmentation. I want to change my whole jawline to make it like one of the men in my goal photos. Up until this point I was assuming the custom wrap around jawline implants would achieve it, but since I shaved my beard off to see what I had, I am unsure if it will even be enough. Do you think I need any other procedure like lefort, jaw advancement, chin wing etc. Do I have a recessed jaw/chin, or is it just generally underdeveloped? I just don’t know, but I’m willing to get whatever jaw augmentation procedure I need.

I attached the best pictures I could take with my phone, I hope they are good enough. Based on them, can you tell me if any of my goals are possible (and what procedure or combination of procedures I would need). If any of the picture’s quality is good enough, is it possible to have a ‘predict my face’ and get a morph of what is maximally possible with custom implants? I really want to achieve a jawline that of one of my goal pictures.

My ultimate goal is to achieve a front jawline as close to any of those goal pictures as possible. And the side profile to have as much of an L shape as possible (male model look). Currently whenever I am in public I push my jaw out as much as possible and also bite my teeth to flex the jaw, it is a small improvement but is too much effort for me to maintain all day (not to mention I shouldn’t have to resort to that just to look less ‘bad’)

Note: I also plan on having other procedures done (rhinoplasty), but right now I am most concerned about jaw augmentation, as I think that will have the biggest impact, and then get the other procedures.

A: Your pictures do not show an abnormal lower jaw that is significantly underdeveloped or would be in need of major orthognathic surgery. To achieve your aesthetic goals you need jaw augmentation by any of the conventional implant methods. There is nothing more powerful and than a custom jawline implant and that would be the ideal approach for you. But the more economic approach to a more complete jaw augmentation is that of a square chin and jaw angle implants. This could also be effective for you since your jaw shape is not overlying deficient and enhancements at the chin and jaw angle areas would go a long way towards a more defined jawline.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I believe I have an underdeveloped jaw. In 2008 I had a chin implant which I feel was not correct and seems to sit on my face. Also there is a dip where my chin ends. My jaw is very undefined and seems to blend into my neck. Last year I wanted to get it fixed again. And the surgeon was adamant the chin implant was sufficient but he said I really needed a face lift. I have deep lines from my nose to chin which I hate. Within only a few days after surgery including liposuction to the neck the lines reappeared along with the fat along the neck and jaw. I approached the surgeon and sadly he said what’s the problem you look Younger. Although that was not actually what I was looking for. I have already spent a lot of money and looked and felt no better. I have also had huge issues with my teeth when my wisdom teeth grew impacted causing infections and damage to the other teeth. I am currently having all of these teeth removed at my local dentist. I do have an overbite but was never referred to an orthodontist, my dentist simply removed about 6 teeth when I was a child.  I would love to hear your opinion and find out whether you feel there are options available to help balance my face. I am 36 years old and this has really affected my confidence. Many thanks!  

A: Thank you for your inquiry. I am sorry to hear that your plastic surgery experiences were not more favorable. In looking at your pictures and your age, the real facial rejuvenative effect would have come from total jawline augmentation not a facelift. Your lower jaw is very short with still significant chin retrusion and high jaw angles. Even with the chin implant in place, whose size is unknown to me, you are still 8 to 10mms short. I think you would be better served by a sliding genioplasty with vertical lengthening jaw angle implants or a total wrap around jawline implant. The key for real facial improvement would be lower jaw augmentation to bring your lower face into better balance and proportion with the rest of your face. You are not a candidate for orthognathic (maxillary or mandibular osteotomies) due to lack of adequate teeth and the need for significant orthodontic preparation even if you had adequate teeth for the procedure. Plus as an adult it is a long orthodontic preparation process before surgery that can create other dental problems. (e.g.,periodontal recession). This you can not really have your lower jaw ‘corrected’ .Therefore you need to do a camouflage approach to the lower jaw deformity by moving the chin bone forward (sliding genioplasty) and augmenting the deficient jaw angles. (jaw angle implants) This keeps your existing teeth where they are and cosmetically makes the lower jaw more advanced and aesthetically balanced.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jaw angle implants to give my jaw a more flared and more square look. I would like my jawline to look like the attached picture. Would that be possible?

A: The ability to achieve a look very similar to your ideal jawline/jaw angles depends on two specific factors. First, you have to have a very thin face over the posterior jawline. Your model picture has virtually no fat which is why the jaw angle is so prominent and it is concave in front of it. You do not have that same anatomy. Your face is fuller so you could never achieve that exact look. Secondly, you have to have the exact implant design to create that degree of jaw angle flare. No off the shelf pair of jaw angle implants does that so a custom design set would be needed.

Based on your attached picture, you would definitely benefit by jaw angle implants. But you would not get that exact ideal result. The very picture you have shown i have seen dozens of times by different male patients who want that exact jawline look. But fir the vast majority of men who seek it, it is not possible.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I need help in figuring out the best way to enhance facial volume. I have hollowing under my eyes and would like a stronger jawline. I had cheek implants placed two years which have done great so am looking for similar impact on my other facial areas. But I’m not sure what the best way to accomplish this is using either facial implants, fat injections or injectable fillers. 

A: When it comes to facial volume enhancement the surgical debate is always whether it should be done by fat injections or facial mplants. This is no different that the debate would have been about your previous cheek augmentation. There are advantages and disadvantages for either approach but that debate must be assessed more specifically for the facial area that one wants to enhance and whether it is composed of underlying bone, soft tissue or both.

The jawline is primarily supported by bone so any effective augmentation is almost always done by some form of implant placement. You would have to further define what jawline area to which you want changed to better answer what type of implant may best address it. This is identical to your cheeks which are usually most effectively done by implant because they are a bony supported area.

The under eye area is different than the jawline because it is a combined bone and soft tissue area. The lower end of the under eye area is the inferior orbital rim while most of the lower eyelid is soft tissue supported. This usually means that fat injections are needed as an implant only covers the very lower end of the under eye area and placing it requires a lower eyelid incision to do so. So fat injections, even though they are unpredictable, usually win out over any implant augmentation. Their ‘softness’ is kore appropriate for the under eye area than the jawline.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a few questions. Here's history on me I have had a sliding genioplasty in 2010 and a rhinoplasty in 2005 now I’m happy with the outcome but would like to get a more masculine chiseled look. But I would like to stay away from implants such as porex, silicone, goretex, etc. Can bone grafts be used or is there a way of augmenting without the use of implants? I think my jaw line will need some augmenting. Along with slight some in the chin for its narrowness/mild step offs. Maybe some in my supra orbital rims to give a stronger appearance. Thanks.

A: What you are asking for and how you are asking to do it can’t be done. There is no way to achieve those facial skeletal changes without the use of synthetic facial implants. While bone grafts can be done they are impractical for two reasons. First onlay bone grafts will completely resorb for the most part and what will stay, if anything,will be very irregular and unpredictable in shape. Secondly the amount of bone graft needed would be impossible to harvest unless large strips of outer cranial bone were taken from you skull. Thus the concept of bone grafts for significant facial skeletal augmentation is an unwise and ineffective approach to improving your jawline. A more effective autologous material would be cartilage grafts which don’t suffer much resorption when applied as an augmentation material. But I don’t think many patients want to have multiple ribs harvested from the subcostal margins for a cosmetic change. The reality is that what you don’t like (synthetic implants) is the best, easiest and actually safest way to achieve your jawline goals.

Dr. Barry Eppley

Indianapolis, Indiana