Your Questions
Your Questions
Q: Dr. Eppley,I am seeking a facial profile enhancement. I am not happy with the way my profile looks. I would like your recommendation. I have a deviated septum so a rhinoplasty at the same time might be possible? I also have an overbite and I was wondering what you would recommend for receding chin… orthodontics or cosmetic surgery.
A: It is very common to do a septoplasty and rhinoplasty at the same time, known as a septorhinoplasty. You do have a short chin and treating its deficiency combined with neck liposuction would provide the best result. With an existing overbite the question is how significant it is and whether you are prepared for the commitment of a combined orthodontic-jaw advancement surgery treatment program. (orthognathic surgery) If not then a chin implant or sliding genioplasty would be the cosmetic treatment options. A rhinoplasty, chin augmentation and neck liposuction could all be done at the same time for a significant facial profile change. (facial profile enhancement)
A combination of nose, chin and neck changes can make for the most powerful and significant change in one’s facial profile that is possible. It usually takes at least two changes in one’;s face to create the optimal facial profile enhancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, how much would neck liposuction cost? Could you give me an idea of what my realistic expectations would be? If you performed neck liposuction on me on a Monday or Tuesday, would I be able to be back t work the following Monday?
A: The best way to think about results from ‘neck contouring’ is to look at the three surgical methods of doing it….1) liposuction alone, 2) submentoplasty (neck liposuction with muscle tightening) and 3) formal neck lift. These are increasingly progressive neck contouring methods that produce increasingly better results. On a scale of 1 to 10, a formal neck lift would be a 10 as it addresses all three issues that are causing the sagging neck. (extra fat and loose muscle and skin) Everything else need to be compared to that ‘gold standard’ which will create the best neck contour with a sharp neck angle and defined jaw line. Thus liposuction will produce a 4 to 5 on that scale as it depends on the skin tightening up a bit. (halfway between where you are now and what the ideal neck change is) A submentoplasty would produce a 6 or 7 on that scale, better than liposuction but not as good as a real neck lift.
While there may be some swelling from liposuction 5 to 6 days after the procedure I do not see a limiting reason as to why you could not be back to work again in less than a week. The swelling would probably not be worse than the way the neck looks now for the most part. (in terms of size)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in double chin correction. Attached you will find some pictures that I took–today during my lunch break! Looking at me straight on, at a flattering angle, you can tell I have a round face but the double chin isn’t noticeable. When I smile widely, laugh, or am viewed from my profile, it is clearly evident. What are my treatment options? Will liposuction alone work as another doctor told me? Let me know your thoughts!
A: Thank you for sending your pictures. While there is certainly some subcutaneous fat to liposuction, that will give you a modest improvement only. Necks like yours almost always have a subplatysmal collection of fat in the midline that will not be changed by liposuction. This requires a submentoplasty technique to maximally tighten the neck angle. You also have a bit of a horizontally short rounder chin. This adds a third factor to the double chin appearance. Adding a small central button style chin implant will add a little more horizontal projection and change the frontal chin shape to more of a tapered chin look.
In conclusion, it is all about the degree of double chin correction you are seeking.Liposuction alone will produce a modest improvement, a submentoplasty (which includes neck liposuction) will make a good change and the final addition of a chin implant will make the best overall double chin correction. As you can see neck liposuction is the most basic approach but does not produce the best double chin correction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am hoping to set up a consultation with you to discuss the possibility of undergoing chin/neck liposuction for double chin. This is something I am quite self conscious about and have considered off and on for years. I am not overweight, but regardless of my weight over the years, I have always had it. I am actually a nurse at one of the local hospitals where you work and have cared for many, many of your patients! Although I haven’t had the pleasure of meeting you in person, I have worked very closely with your team of residents, fellows, and fellow staff physicians. I spoke at length yesterday regarding the matter with one of the local plastic surgeons. He explained to me the risks and benefits, length of time I would be out of commission, and what to expect with results. He is on board if I am. But with all procedures, especially cosmetic ones, I know that it is important to get multiple opinions. I am just curious to hear what you think as well.
Please let me know at your earliest convenience!
A: When it comes to double chin correction the question is not whether you can undergo liposuction of the submental and neck region, it is just how effective it would be in achieving the goal of reducing/eliminating the double chin. There are numerous components that make up a double chin which include the fat layers (subcutaneous and/or subplatysmal), amount of bony chin/jawline projection and the tightness or laxity of the platysmal and hyoid musculature. Knowing what anatomic elements comprise the problem will allow one to choose the best treatment. If all of the double chin problem is subcutaneous fat, then simple liposuction will suffice. But if there are other elements that contribute to the double chin then the result from liposuction may be less than completely satisfactory.
Without seeing pictures of you, I can not say how any of these anatomic/diagnostic considerations may apply.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, At the moment, I am at a complete loss of what to do about my profile. I have had so many consultations now and have advice ranging from ‘do nothing’ to ‘have a neck lift, fat removal and chin implant at the same time’. I need to do something as it’s making me very self conscious and I hate seeing photos of myself from the side.
My problem is that I am only 27 and am apparently not a candidate for neck liposuction alone because of my bone structure. It has to be explained to me that I have a low hyoid bone that is creating a blunted neck angle so that my neck blends into my chin. My teeth do align so it is not a problem with my bite but I do also have a weak chin.
From my own research it seems like a chin implant might provide me with the illusion of an improved neck angle but my concern is how it will impact my face front on and my smile- lots of reviews seem to say their jaw looks to masculine after a chin implant or that they can no longer show their bottom teeth when smiling. At the moment when I smile I show my bottom teeth, which I like, and my chin points slightly in feminine way. I also have a small indent in my chin when I smile and am unsure if a chin implant would make this worse.
Do you have a recommended approach to this sort of problem? Given my age, I don’t want to risk ruining my face with anything too drastic! I do need to do something though as it’s making me really self conscious.
Thanks in advance for your help. I do wish I was a more straightforward case!
A: Quite frankly you are a very straightforward case. The combination of chin augmentation and neck liposuction is the correct approach. The key to a successful chin augmentation in you is to understand that in the profile view there needs to be both a horizontal and vertical dimensional change and in the front view the chin shape needs to stay a triangular shape and not become too round or full which is more masculine. There are two ways to achieve these chin changes. An implant needs to have some vertical elongation and must be more of a central buton style that has no significant lateral wings to it. The other option is a sliding genioplasty which can be brought forward as well as down. (vertical lengthening) Sliding genioplasties will always keep a narrow chin or make one more narrow as it comes forward because it is a U-shaped that is being brought forward. The indent in your chin, whether the augmentation is done by an implant or an osteotomy, will not change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a double chin that I hate. I am only 32 years old but my neck makes me look much older and heavier than I really am. I am interested in a double chin reduction surgery that I have read about. My question is does the double chin reduction grow back after certain time due to weight, age, etc… Thanks!
A: Most double chins are due to a combination of a full neck in the submental area and a weak chin. The upper bump chin is one’s real chin (short) and the lower bump of the bubble is neck fat and skin. Therefore, double chin reduction surgery usually consists of a combination approach of submental/neck liposuction (reduction) and a chin implant and/or osteotomy (augmentation) to eliminate the double roll. In my experience once this is done it is a long-term sustained result because the anatomy is permanently changed. The short chin bump will never return because it is been permanently brought forward. The neck roll usually stays away unless one gains a lot of weight in the future. This combined approach has a great influence on making the face and neck appear more slim and well-defined. Often when combined with buccal lipectomies (cheek fat removal) the slimming effect can influence the face above the jawline as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a facelift with lipo done two years ago. While the result has overall been very good, I am unhappy with the appearance of my neck under the chin area. I’ve included a few photos so you can get a better idea of my situation. When I don’t lift my chin or move my head things look good, but moving my head or chin around creates a really unattractive situation that distracts from the very nicely done lower facelift. I am thinking these are muscle bands that need to be swen together to fix it. What do you think?
A: In looking at your pictures, I don’t think that the vertical bands you are seeing in your neck are platysmal muscle edges. Notice that there are numerous ones not just two isolated long parasagittal bands. I think what you have is a ‘skeletonization’ effect. This means the there is very little neck fat between the skin and the muscle which can lead to adhesions and scar contractures in the neck which are vertical in orientation and almost always occur primarily in the submental area. They are most evident when the chin is raised and the neck stretched upward. This is prone to occur in thin women when the neck is aggressively liposuctioned as part of the submental management of their facelift. There always needs to be some fat left on the skin otherwise adhesions will result. The question then becomes as to how to manage that issue as further muscle plication may not be the ultimate answer. In my experience, re-elevation of the involved skin (adhesion release) and possible muscle plication if needed is the best approach. In an ideal world, some fat would be put back or a dermal graft placed as an interface between the skin and the muscle but I would go with the simpler skin flap elevation/adhesion release initially.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 38 year-old woman and am bothered by the amount of skin under my chin. I would like a more youthful and tightened neck look. I have read about lot of different neck rejuvenating procedures such as a necklift and a ‘trampoline’ neck lift. the necklift/facelift seems like it is too much for my problem while the reviews I have read on the trampoline lift do not give me much confidence. What would be the best procedure for my sagging neck skin?
A: There are a variety of neck tightening procedures as you have mentioned. In the array of neck improvement options, they have differing effects on neck rejuvenation depending upon what they are designed to treat. Given your relatively young age, it is hard to imagine that you have enough loose skin to warrant the maximal tightening procedure of a full necklift. It may be that simple liposuction, particularly Smartlipo or laser liposuction, may create enough of a skin tightening effect. This would depend on whether you also have enough fat in the neck to warrant it. A so-called trampoline necklift achieves its skin tightening effect from liposuction. The sutures placed are designed to create a sharper cervicomental neck angle not to tighten the skin. A more simplified version of this procedure is the standard submentoplasty where sutures are placed to tighten the platysma muscle above the thyroid cartilage and liposuction is used to reduce fat and tighten skin. I would really have to see pictures of your neck to determine what may be of best benefit to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get liposuction for my heavy neck and jowls but am afraid of potential nerve injury causing a droopy mouth. I don’t want to run the risk of trading off one problem for another. But I just hate my profile. I want a more defined neck. At age 35, I should still have a younger looking neck with an angle not a full fat one wiithout one. What are the chances of nerve injury and how can it be avoided. If it is injured is it ever permanent? Thank you
A: Like all surgeries, even relatively simple neck liposuction has risks. The potential nerve damage to which you refer that is in the area of submental and neck liposuction is that of the marginal mandibular branch of the facial nerve. This tiny single branched nerve supplies some movement to the lower lip, primarily being responsible for the depressor anguli oris muscle which creates downward lip movement. It crosses over the lower border of the jaw at the side the chin. It can potentially be traumatized if liposuction is done too far up around the jowl area where the nerve is. It can be avoided by not trying to be too aggressive with treating the jowl area and staying below the border of the jaw, confining the movement of the liposuction cannula to the neck area only. Even if the nerve is traumatized, the blunt cannulas will not cut the nerve but bruise it. This may cause some temporary weakness but almost never permanent paralysis.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant, neck liposuction and a submentoplasty with fat removed under the platysma muscle one month ago. I am 32 years old and had a double chin that could not be improved by any other method. I wore a neck compression garment faithfully for three weeks after surgery. Despite this, I have very visible lumps and creases which did not exist prior to surgery. Will this resolve? What else can I do to help?
A: A submentoplasty combined with liposuction is a very good but aggressive procedure for neck recontouring. There is no question that it can do a good job of removing fat and tightening muscle, significant anatomic changes to improve a neck profile, but it does not remove skin. Thus it relies on the elasticity of skin to shrink down and produce the final shape. It is not uncommon for this procedure in some patients to end up with skin redraping issues. (irregularities, indentations, creases) That is the one knock on the procedure in my experience. It is still early so some of these skin issues will definitely get better with time. Whether they will completely go away remains to be seen and I doubt if there will be 100% resolution. But this is an issue of time and you will know more by six months after surgery. You would probably benefit by neck treatments such as massage or Exilis treatments which can help with skin smoothing and now is the time to do them before a lot of scar sets in.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need your help as I have no jawline. My chin is very short, the neck seems to be missing and it appears as I almost have no lower jaw. This gives a profile that I am very self-conscious about. I make every effort so people don’t see me from the side. I know you are an expert in facial surgery based on your writings and patient photos so what do you recommend?
A: Lack of a well defined jawline and neck angle can be due to any one or combination of the following; chin/lower jaw bone prominence, fullness/fat in the neck and loose neck and jowl skin. Most commonly, the combination of a chin implant and neck liposuction can make a dramatic difference in the younger patient who often has a short chin and full neck. In older patients the sagging skin factors in significantly and some form of a jowl or necklift may be needed. There are exception to these two categories, such as the early aging facial patient with a good chin prominence who just needs some neck contouring through a procedure known as submentoplasty. But when someone describes themselves as having ‘no jaw’, this would indicate the problem is more than just one of the three anatomic components that make up the neck angle and jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to send some photos so you could tell me the most appropriate surgery to have. I would like a wider face, a less pointy chin, a chin lift and jaw implants. I wore braces to correct an underbite and I had a mandibular osteotomy and genioplasty – the result is a long face. What can I do to bettr improve my overall appearance. I am 39 years old and terribly unhappy with my profile and double chins etc.
A: You have many of the sequeale of orthognathic surgery of the lower jaw which occur from both the surgery and aging. While a sagittal split mandibular advancement osteotomy and genioplasty have undoubtably done wonders for your bite and improved your facial profile, there are some skeletal deficiences from that surgery that have either been created or unmasked with aging that have affected your lower face. Your face has become narrower with that surgery as the jaw angles are usually lost from the ramus osteotomy and the chin becomes more narrower as its u-shape comes further forward. There also appears top be some asymmetry of the lower jaw with the left angular area being more deificient than the right. There is also the effects of aging as the neck has become fuller and dropped down due to soft tissue sagging. Collectively, all of these give you a narrow and longer appearing face with a double chin and obtuse neck angle.
This could be improved by a single procedure combining a chin-prejowl implant, mandibular angle implants, neck liposuction and a limited or short scar facelift. I have done some computer imaging from the front and sides to illustrate what changes may be possible through this approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very weak jawline and some fullness to my cheeks and face. My face is sort of round and not very distinct. I went to one plastic surgeon and he said that a chin implant would change my facial shape. But I have read that many chin implants also have liposuction under the chin as well. This seems to make sense to me but I still don’t see how that will improve my chubby cheeks. What would be your recommendations? I have attached some pictures of me from the side.
A: I think there is no question that you have a short chin and a rounder fuller face. A chin implant will definitely over good improvement of your profile. But to really ‘deround’ a fuller face it is going to take other adjustments. These would include some fat removal as well. Liposuction under the chin would also be a definite plus and, with the chin implant, can dramatically change the jawline. But the cheek area needs thinning by a partial buccal lipectomy with perioral liposuction. Buccal fat removal only affects the upper cheek area below the cheek bone. Perioral liposuction is needed to remove fat from the lower cheek area at the level of the corners of the mouth. The combination of chin augmentation and fat removal from the neck and cheeks can very effectively make a round face have a much more defined shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 31yr old female looking to improve the side profile of my face. I have a lot of fat under my chin and this causes an awful side profile. It also shows from the front. From what I’ve read about neck liposuction this could be a good option. But I’ve also read that chin implants can be useful for improving one’s profile as well. Which one would be best for me or do I need both?
A: Improving the profile of the neck and jawline must take into consideration whether excess fat and loose skin exists and the amount of bony chin projection. Given your age loose skin is not an issue so any consideration of a jawline tuck-up is not needed. The combination of neck liposuction and chin augmentation can be a very powerful changer of one’s profile, assuming one has a weaker chin to start. The best way to answer whether chin augmentation is beneficial is through computer imaging. See what your profile would look like with neck liposuction with and without chin augmentation. Seeing is believing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 48 year old female and have begun to notice some fat under my chin, some jowling and some neck wrinkles. I have had gotten two plastic surgery consultations with differing opinions. One said I needed liposuction of my neck with a submentoplasty and fat injections to the jowls. The other said I needed neck liposuction with a jowl tuck-up. These choices seem so different that I am confused. Both plastic surgeons are board-certified and respected in the community.I don’t know which one is right. Any advice would be appreciated.
A: In reality, both are right and these are just two different options for the same facial aging problem. It is clear that you are what I call a ‘tweener’. Your aging issues are not quite enough for a more extensive facelift (neck-jowl lift) but are more than what liposuction alone can ideally improve. In other words, you have a mild amount of excess skin along the jawline and in the upper neck. As these two options are different in technique, they will also produce different results. I think the right answer for you is defined by how much you want to go through for what result. While neither operation is a big procedure, the liposuction/fat injection approach is less invasive but will not tighten the jowl line as much as a limited facelift with liposuction. (jowl lift) It would help to define what bothers you the most, jowling or neck fat. If it is neck fat go with liposuction. If it is jowling, go with the lift.
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: I had liposuction done on my neck when I weighted 185 lbs with about 15% to 16% body fat. I had a good immediate change in the shape of my neck from that procedure. I am now 170 lbs and about 12% to 13% body fat. The great results from the liposuction have persisted as I would have suspected. What I am wondering is what will happen if I gain weight back to where I originally was around 185 lbs. I am not planning to but I am curious as you never know what the future holds. Does it matter if my weight fluctuates between 170lbs and 185lbs? Will the fat return in my neck if I gain weight back?
A: The long-term results of liposuction on most areas of the body are highly dependent on the stability of one’s weight. The neck may be a slightly more privileged site (resist fat re-accumulation) than the stomach or flanks for example, but fat can definitely return there if one gains enough weight back. I think as long as you stay under your weight at the time of your original surgery, then your neck liposuction result should be unchanged. The percent body fat and weight ranges that you are talking about are not significantly large (170 to 185 lbs) so that change will likely not make much if any difference in the neck. However, it behooves you to keep the weight off as the amount of fat that was originally in your neck was there for a reason…so don’t give it a second chance to come back to an area that it once enjoyed.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have sleep apnea and a very thick fat neck. I was wondering if liposuction of the neck would help my sleep apnea? My thought is that if the fat was removed from my neck it would not be so heavy when I laid down. That way it would not push down on my neck and obstruct my throat as much when I was sleeping/ Does this make any sense? What are your thoughts?
A: While liposuction of the neck may help improve the shape and profile of it, I doubt very highly if it would make any improvement in your sleep apnea. Your logic seemingly makes sense but the flaws in it are that fat doesn’t weigh very much, the thyroid cartilage protects the voice box and lower area with a stout shield of protecive armour and the usual sites of anatomic obstruction are usually higher and are closer to the base of the tongue. While I don’t think liposuction of the neck will have any negative effects, it is not an acknowledged procedure in the surgical treatment of sleep apnea. Procedures such as septorhinoplasty and turbinate reductions to open the nasal airway, maxillary and mandibular advancements to open up the entire posterior oropharyngeal airway, shortening of the soft palate (fading in popularity) and bony chin advancement and genioglossus procedures to bring the base of the tongue forward are well recognized sleep apnea operations. Other non-surgical efforts include weight loss and various dental appliances. Before considering any of these options, one should be fully worked up by a sleep apnea specialist to search for the most effective solution.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, I am interested in getting my fatter face and neck thinned out if possible. I am sending pictures for your review (frontal and profile) so you can see what I mean. I am interested in a buccal lipectomy procedure and submental lipectomy. I have always thought my face has made me look, in pictures, 30-40 lbs heavier than I actually am. I have also looked at people that are obese or considerably heavier than I am in pictures, comparatively, and noticed that my face make me looks extremely heavy which I am not. I would like to have the procedures done if the changes are significant. I would also like to know if the procedures can be done under local anesthesia. Please advise.
A: Thank you for sending the pictures. I can see your concerns with the fuller tissues around the jawline and into the neck. Certainly fat reduction by neck liposuction and buccal lipectomy is all that is appropriate or should be done. The good question is how much improvement will be seen. That is a tough one to answer as the final result is determined by how well the skin adapts and shrinks down. The limiting factor in your result, and in other male patients who look just like you, would be controlled by the subplatysmal fat at the cervicomental angle (it is not all just above the platysma in the neck angle area) and the subcutaneous fat layer around the jaw angle and over the parotid. Subplatysmal neck fat can be removed by direct excision but the jaw angle fullness is more limited because it can not be treated neither by liposuction or direct excision because of the marginal mandibular branch of the facial nerve. While changes will clearly be seen, I would use the term moderate improvement rather than a dramatic change. Because of the variabiity of the result, you should only undergo the procedure if you can accept modest to moderate improvement. If it turns out to be significant or dramatic in your view then that would be a bonus.
To get the best result possible, doing the liposuction and lipectomy procedure under local anesthesia would not be my approach. That limits how much can be done as patient comfort then takes precedence over the extent of the result.
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
Q: Hi Dr. Eppley. I have seen four different plastic surgeons seeking improvement in my facial profile and, so far, nobody can show me or even tell me that by doing “this” or “that” I would get the end result I’m looking for. I’m so scared to have the wrong procedure(s) done, or to chose the wrong size of chin implant, you can’t imagine. I have attached some pictures of myself so you can see my chin and neck problem. After reviewing them s there a way we could communicate by phone? I really need to ask you some questions. I would like to thank you for doing this for me. You are my last hope!!! Please reply, thank you.
A: Quite frankly, I am not sure what the mystery is when it comes to making the facial improvements that you want. Yours is a very straightforward and common problem that I see all the time. It is the classic ‘ying and yang’ problem. The chin must come forward and the neck angle must go back. And how to do that is similarly not a mystery. The chin implant should bring the chin no further forward in a woman than a vertical line dropped down from the edge of the lower lip. In the frontal view, it must be a tapered chin implant so as the chin comes forward it remains with a more feminine shape and not becomes more square or too masculine. From the neck standpoint, liposuction is certainly needed. The only unknown, and I can not tell this from photographs or computer imaging, is what the neck and jowl skin will do. Is it good enough quality skin to tighten up on its own or does it need a little help via a jowl-neck tuck-up from incisions around the ears?
I have attached some predictive computer imaging so you can have an approximation of what the outcome from a combined chin implant and neck liposuction and recontouring procedure would be. It is unfortunate that after four plastic surgery consults, this ‘mystery’ has not become unveiled to you.
I am happy to talk to you by phone or Skype any time. Just let me know your availability and we can work out a time.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am 5’7″ and weigh 128 lbs. Even though I am relatively thin, I have always had a double chin for some reason. But I feel like it has gotten worse since I have given birth to two children and have gained over 40 lbs with each pregnancy. I am interested in knowing what could be done and how much improvement I could expect. Getting rid of this double chin would help me feel more confident. Thank you so much for your time.
A: The cause of a ‘double chin’ is a combination of three anatomic factors; neck fat, neck skin, and chin projection/prominence. Every double chin is made up of differing ratios of all three components. It is always about how much neck fat is there, how much extra neck skin there is, and how short one’s chin may be. While you didn’t state your age, that number also has an influence because it suggests how much neck skin you may have and, most importantly, how elastic it is.
Some double chins can be corrected by as simple a procedure as neck liposuction in someone who is young and with decent chin projection. On the flip side, an ‘older’ severe double chin may require everything including neck liposuction, chin augmentation, and some form of a necklift to help tighten the extra loose skin. Each patient must be assessed individually and a custom treatment plan devised as double chin correction is not a one size fits all procedure.
One surprising aspect to the ideal correction of double chin problems is that of the chin. Many people have short chins that are magnified by this problem. Lengthening the jawline with a chin implant while bringing the angle of the neck back (or making it more defined) is the classic ‘ying and yang’ approach which together makes a better result than either change alone.
Dr. Barry Eppley
Indianapolis Indiana
Q:Dr. Eppley, Can you tell me how to get rid of my pesky double chin? It bothers me tremendously. I am only 43 years old and my neck looks twenty years older! I am too young to look like this. I am at a good weight and haven’t been able to shake these two chins off no matter what I do. What do you recommend?
A: The ‘double chin’ appearance comes from two upside down hump areas. The first is the chin, which everyone has, but in the double chin patient it is often short or set back. This can make it appear that it is part of the neck when it should be a more distinct forward prominence of the jaw. The second hump or sag is the soft tissue of the neck. This may be just a lot of fat but is usually mixed in with some loose skin as well. This is particularly so in older patients who may have overall neck skin laxity. Given your relatively young age, I would envision that the anatomic composition of your double chin is a bony chin shortness and a collection of fat with some mild amount of loose skin in the neck.
Therefore, correction of your jaw and neck contour could be done by a combined chin augmentation and neck liposuction. It may also be beneficial to do a little neck muscle (platysma) tightening at the same time to get the best neck angle. I doubt if you need any removal of skin at your age and we would rely on the natural skin tightening that occurs after liposuction in good quality skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have an inherited double chin that makes me look twice my 46 years of age. Can you make it disappear so I can look younger ??
A: A ‘disappearing’ act is what we do a lot of in plastic surgery. Whether it be liposuction, chin implant, facelift…or some combination….it certainly can be made to ‘vanish.’ I know that your double chin makes you look older….but I doubt if it makes you look 92!
When patients refer to a ‘double chin’, this means there are at least two and sometimes three rolls of skin if you include the chin as one of the rolls. The double chin is often the result of the combination problem of a full neck and a short chin. In the younger patient, this can be improved by doing chin augmentation and neck liposuction at the same time. When you move two different things in opposite directions, the result becomes greater than when only one is done alone. In an older patient with more loose skin, this diametric action may require chin augmentation and a facelift to get the neck going back and up as the chin comes forward.
If the forward position of the chin is adequate, then the neck alone can be treated. Again, age and the amount of loose skin determines whether liposuction (good skin) or some version of facelift (bad skin) is needed.
Correction of a double chin is highly effective plastic surgery adventure and can make for a dramatic difference in one’s appearance.
Dr. Barry Eppley
Q : I had liposuction in December and still have pain in my stomach. Also I have an ugly lump under my chin after my liposuction and facelift. Have you seen such chin lumps before?
A: While liposuction doesn’t look like much from the outside, what goes on inside is quite extensive and traumatic to the fatty tissues. While liposuction can be very effective at fat removal and contouring, full recovery is not quick and really takes time often as long as three months to four months.
As part of this prolonged recovery process, there are some very typical aches, pains, and irregularities which one will experience. While liposuction is not acutely painful, soreness and discomfort persist at different intensities over time. As one gets more active and moves about more, twinges of shooting pain and tightness will occur. This is the stretching out and breaking loose of scar tissue that has formed as a result of the procedure. The skin over any liposuction-treated area will also be numb. Full feeling will return but again will take months. Some of the those shooting pains may also be nerves that are healing and re-establishing feeling.
One of the very common sequealae of liposuction is the temporary areas of lumpiness or irregularities that will be felt. These are collections of dead fat, scar and blood that have accumulated in an area. These feel very firm and painful to manipulate or massage. They are extremely common in the neck area because of the thinner neck skin and being an easy place to accumulate in the center of the neck. With time, they will get softer and eventually go away. The neck can get quite indurated after liposuction and will create fullness that temporarily distorts the good result that was seen at the end of surgery. One can massage the neck area several times a day which will help soften it faster.
The recovery after liposuction is a prolonged process and patience is definitely needed. I would not judge the final outcome until you are six months out after your surgery.
Dr. Barry Eppley