Zygomatic Arch Widening

Q: Dr. Eppley, I have been following you for quite a long time and am impressed by the exhaustive list of procedures you are capable of performing well.

I am a 25 year old male who is interested in increasing all three of the bony dimensions of my face for a more masculine and attractive appearance. I have a decent base to start with and have already undergone eye reshaping procedures (bilateral canthoplasty, lower lid retraction, tear trough implants, and orbital decompression). For this reason I am very happy with the shape of my eyes and am concerned that any extensive procedures I am about to undertake may remodel them.

Anyway, I would be very interested in knowing whether you’d be able to widen, project forward, and increase the height of my facial skeleton to my happiness with implants/cement/genioplasty/fat alone, or whether any of the procedures I’m going to undertake can be done better with an osteotomy. 

I would like to explore getting with you a jaw implant that lowers the ramus quite a bit, flares out the gonion, and lowers/flares the entire jawline, with a genioplasty (or combination of genioplasty and implant, deferring to your expertise when we meet) that lowers the chin, expands its width slightly, and gives anterior projection. Is this capable of changing my mandibular angle? How about my gonial angle?

Furthermore, I will potentially be pursuing a zygomatic sandwich osteotomy and zygomatic arch osteotomy where for the latter procedure 2/3rds of the arch will be moved laterally. Are either of these procedures capable of being pursued with just implants? I am hoping for 4 mm of lateral facial width at the arch (a total of 8 mm). Perhaps the arch is better done with an implant as well? 

This is where it gets tricky. I would also like my zygoma and infraorbital rim (along with the orbital floor on the left eye for asymmetry) raised. I know the orbital floor can be done with an implant, but I’m wondering whether there is a way to give the appearance of a zygoma and infraorbital rim that is higher on the face and closer to the orbit?

Afterwards I’d pursue a midface lift to redrape the soft tissue that is already slightly saggy and bloated looking on my face, and an extended midface implant not already covering areas of the face (mostly the maxilla and lateral orbital rim). I’d pursue skin tightening, buccal and perioral fat removal, micro lipo, etc in case my lower cheek still looks bloated or chubby.

Lastly, an extended implant, cement, or fat (deferring to you on this) for the temporal/forehead region to also widen this part in line with the rest of the face. Whether the onlay needs to go as high as the parietal bone to give a normal skull shape is up to your experience, though I’d expect it does.

There are two additional procedures I’m exploring that id like to ask about. 1: Is there a way to increase the width of my supraorbital ridge, perhaps by also placing an implant or cement on the very lateral side of my ridge/forehead? 2: is there any way to widen the maxilla above the lefort 1 line, or at least give the illusion of a wide maxilla (I don’t want to have wide facial width with a narrow maxilla as it may look funny). Perhaps by creating some kind of illusion with the way the implant is placed on the cheekbone?

I suspect I need one surgeon to carry out these procedures so my extensive surgical plan can be analyzed and understood accordingly. Please let me know what you think. Thank you very much.

A: All of the facial procedures that you have described can be done with various forms and designs of facial implants. This includes the zygomatic arch widening which can be done simply and effectively with an implant vs am osteotomy.

Dr. Barry Eppley

Indianapolis, Indiana