Revisional Facial Slimming Surgery
Q: Dr. Eppley, I am in desperate need of revisional facial slimming surgery. Two years ago I had cheek and jawline reduction in Thailand and it has turned out to be a disaster. It has left my cheeks sagging, my jawline has disappeared and I got a deep burn across my chin from a hot instrument during surgery. I have attached before and after pictures as well as x-rays. I do not look anything like I did before the surgery. This has been a nightmare and I need an expert like you to help me!
A: Thank you for your inquiry, sending all of your pictures and x-rays and describing a very unfortunate surgical outcome from a typical facial slimming procedures of cheek bone and jaw angle reduction surgery. My comments are as follows:
1) From a bony standpoint, you have the classic cheekbone reduction sag that occurs when the anterior osteotomies are not fixed by a plate and screws or has an osteotomy design that is self-retaining. While this effectively narrows the cheek bone, it causes a soft tissue sag as the attached soft tissues sink in and down with the bone.
2) Your jaw angles shows a complete amputation of the bony angles at a 60 degree angle. While this will also narrow the lower part of the face, the complete lack of any bony support causes the face to sink in and look prematurely aged. There is also asymmetry between the jaw angle cuts which is common.
3) Your lower lip/chin burn was a 3 degree burn injury undoubtably causing by the heat from the power equipment used to cut the bone inadvertently laying against the skin while in use. Based on its location and angle I would assume this was from the cheekbone cut. Such an extensive burn injury I have not see before from this type of facial procedure. It has gone on to heal with the expectant hypertrophic scar.
My recommendations for revisional facial slimming surgery that may be of benefit at this point:
1) Excision of hypertrophic burn scar and geometric skin closure.
2) Anterior zygomatic bone elevation/repositioning with plate fixation
3) Bilateral vertical jaw angle implants to put back some of the lost bony support.
Dr. Barry Eppley