I've never been very happy with my profile. I've always had a pretty good overbite and a equally deficient lower jaw. As I hit 40 I noticed that the little bit of lower jaw definition I had begin to give way to family genetics. As much as I exercised or ate lean, it wasn't making much difference in terms of the blob that was becoming my jaw/neck. I found myself holding my lower jaw agape in social situations in an attempt to create a better profile. I noticed that when photos were taken I would always drop and push out my lower jaw so I didn't look so bad. As I hit 44 I decided I had to either change it or accept it.
The search for a surgeon and treatment:
One day, I decided to see what might be done. I set out to learn about every possible option from simple chin implants to jaw advancement. I spent two full years researching and had consults with three plastic surgeons regarding options. Their opinions varied greatly and I was actually shocked to find such variances between surgeons. One advised "jumping genioplasty" the other a single chin implant with smart liposuction of the neck area. I had narrowed the field to one who I felt had communicated a strong sense of what needed to be done and felt confident he could achieve what I wanted. I waited a full three months and did my research into his background before our first appointment. He sold me on a chin implant and submentoplasty. I waited another month then decided to go ahead. We met one more time before the surgery to go over the procedures again... HOWEVER, at this second appointment he completely reversed himself and his opinion of what treatment should be done. He had now decided that I needed jaw advancement instead and needed to go to a orthoganthic surgeon. He additionally told me now that the best I could hope for was a few mm of projection. This reversal shattered my confidence in the surgeon and I decided to look elsewhere.
I found Dr. Barry Eppley's website and started to do my research before contacting him. His site is very informative, and has plenty of before and after photos. The thing that really stuck out to me was the fact that he seemed to welcome the "too hard to do" surgeries with all of the custom implant options he offers. I did not know that custom forehead implants were even a thing, for example. While some Doctors may view this as being too general or not specialized, I viewed it as someone who is confident in his own surgical abilities to perform surgeries others can't or won't.
I scheduled an online Skype session with Dr Eppley after forwarding the photos of my lower face. Within a day or so he had sent me his projections of what he felt confident he could accomplish with surgery. His proposal was thus: 1. Custom wraparound jaw implant. 2. full buccal lipectomy (all buccal fat removed). 3. Submentoplasty (neck tightening) and finally 4. Neck liposuction.
Dr. Eppley stated that the best chance of achieving the projections he sent me required all four procedures however if I couldn't afford all three, the custom wraparound implant would be the best option. A fourth option he offered was using three separate silicon implants: chin and two side angle implants. He said to achieve what I wanted (a strong, full jawline) I really needed to go with the custom wraparound.
So, I went to do more research. I found good and bad reviews on here regarding Dr. Eppley and weighed both in equal measure. I additionally researched custom implants and tried to find as many before and after photos of them in use as possible. Real self reviews played a large part in my final determination to proceed.
I decided I wouldn't book the surgery without flying out to meet Dr. Eppley. While the Doctor assured me that an in person visit would not change his proposed course of treatment, if it made me feel better it would be fine. So, off I went to meet him.
I arrived at his office which is actually inside a local hospital which made me feel good right off the bat.
His office is actually more like a spa and has a staff of several employees who were friendly and professional. I met his nurse who showed me to a waiting area as the Dr was running behind due to other appointments. When we finally sat down he looked at my lower jaw and said he was confident his plan would provide good results. He cautioned me not to be too optimistic, be realistic etc. I liked his frankness and the fact that he told me how bad recovery would be. While some may not appreciate this kind of directness, to me it was great.
After we wrapped up, he asked me if I wanted to see what the design session for a custom implant looked like. He showed me a generic example of a custom implant and how it's created by computed assisted drawing from CT images. It was fascinating and I was glad he took the time to show me.
After mulling it over for a few days upon my return, I decided to do it. I called and made my nonrefundable deposit on the custom wrap around implant and headed to the local imaging center to get a 3d CT image of my skull/lower jaw.
Here we go:
After several weeks Dr. Eppley sent me a .pdf file of the custom implant design. I wasn't really happy with it so we worked together to modify it a bit. One of the best things the Dr told me was this: "You won't get perfect. So, you must decide if it's not perfect, would you rather it be a little to small or a little too big?". For me, this framed the outcome perfectly and I opted for a '...little too big'.
A week or so later, I had an email with the new design. We again spoke and he shared his concern that any bigger the implant might have to be cut at the time of surgery and placed in two pieces. He said the result would be the same but I didn't like the idea of cutting a custom one piece implant so we agreed on the size he recommended. No surprise, the Dr knows what he's doing as the size fit perfectly in my jaw with no modification. He said if we'd gone just a little bit bigger that wouldn't have been the case.
We settled on a date in mid December and I drove out to get it done. The actual surgery was performed at "The Surgery Center" in Indianapolis not far from Dr. Eppley's offices. The staff there were very friendly and helpful and made me comfortable while I waited my turn under the knife. Dr. Eppley eventually came by and we went over the procedures to be performed. After that I was wheeled in to the OR and we got started.
So, let me not sugar coat this. It was rough. I opted to pay the extra to stay overnight in the surgery center. It's not much extra (800 if memory serves) but the advantage is that the nurses are able to give you shots of pain meds as needed..and you'll need them. They help you to the restroom etc and it was just a smoother transition than going back to a hotel room right after, in my opinion.
Dr. Eppley came by very early the next morning to check on me and said the surgery went great, and he couldn't have been more pleased. He released me and I went to my hotel and stayed there for another day (just in case there were any complications) before I headed back home to DC.
As you can see in the photos...MAJOR swelling... of basketball proportions just as Dr. Eppley advised. It was pretty bad. I wondered if there was a jaw under all that swelling someplace. That being said, there were three pretty major procedures done and in the case of the jaw implant, the masseter muscle (the long muscle at the back of your jaw) had to literally be stripped away from the bone and the implant slid under it. Then, it has to grow back over the implant. No small feat. Plus there are now six titanium screws in my lower jaw. I definitely felt the jaw pain from where these were inserted afterwards.
Swelling was enormous. It stayed that way for about four weeks. Then, it subsided but I was still obviously post surgical and had severe bruising in the areas where the buccal fat and lipo was done.
Everything was good until I felt one of the stitch lines in the lower left side of my face pop open one afternoon. My immediate thought/fear was infection. I began to call Dr Eppley and email him photos of the area. Now, here is the problem when you have surgery out of state... there is only so much your surgeon can do over the phone. If it's bad, you have two choices 1. Fly out to see him 2. Go to a local Dr. I ended up opting for the latter. My primary put me on an aggressive course of antibiotics to counter the potential infection. The linear area filled up with white, then green film and I was pretty sure I'd be getting this implant taken back out, cleaned and reinserted.
I have to say, Dr Eppley was super responsive during this process and even returned my emails and calls on Christmas eve which is about the time when it was at it's worst. Again, there is only so much he could do but he definitely didn't ignore me and was replied personally to me. I think if you deal with Dr Eppley you'll find that he generally does most of his own correspondence and I had very little interaction with his nurse or staff for my questions both pre and post surgery. I did like that he was so accessible to me as a patient.
Ironically most reviews on here I read the biggest concern folks have is that it doesn't look right or the implant is somehow misplaced, too small etc. I never had that worry and realized early on that it would take 3-6 months before everything settled down enough for me to see what the final result would be. I credit this to Dr Eppley's counsel that I needed to be patient and not expect too much too soon...it helped me leverage my expectations and kept me patient.
About 1.5 weeks after surgery, I had no real pain and no need for the Rx meds they gave me. My face felt full and swollen so, not comfortable but not really painful either. It was tender of course in spots and I had to sleep sitting up for about a week post surgery. Truth be told, I actually slept that way for a month as I didn't want to chance having my result be compromised by rolling over on my face during night or something.
About three months post, I was able to go out to eat etc without feeling like people were staring. I was still pretty swollen but not obviously post surgical. So, if you have similar procedures done, I'd say 2.5-3 months is the average time it takes for the swelling do go down enough so that you won't be self conscious. Of course everyone is different and Dr Eppley advised me pre-surgery that my tissues were thick naturally and so I'd have more brushing and swelling than someone with thinner skin.
I'm 10.5 months post now and very happy I did it. It was expensive, painful and at times worrisome but I made the right choice in terms of a Surgeon and type of procedure(s). Some days I feel the implant and it tingles in areas but other days I forget I have it at all. I don't believe I can overstate the boost of confidence it's provided me. I didn't want to look like someone famous but just a bit more rugged/masculine and I believe this was achieved through Dr Eppley's skill as a surgeon and the right choice of implant. In closing, I guess the best advice I can give is don't rush. This entire journey took me three years (!) from start till today but I strongly feel had I opted for any other plastic surgeon I would not have been near as happy as I am with this result. Interview several plastic surgeons and get several opinions. Yes consult fees can add up but in the end finding the right one will save you a lot of heartache and money in the long run.
Speaking of long, I didn't mean for this to run on so long. Hopefully by giving you some of the details of the process leading up to finding a good surgeon as well as the procedure is helpful.
If I can answer any questions or be of any help, please don't hesitate to contact me. Good luck to everyone who is contemplating some kind of procedure as it can be intimidating but potentially worth it.