Brow Bone Implant
Q: Dr. Eppley, I am interested in a combination of procedures including:
1. Brow bone implant augmentation using a custom made brow bone implant and possibly forehead augmentation as well. As you can see from the attached pictures this area of my face lacks definition. i would like a more masculine look. I had upper eyelid surgery done some six years ago. Unfortunately that was a botched operation, the surgeon operating on me sliced off too much of my left eyelid which has left the eye about half way to a third open when I close my eyes. The left eye is wider than the right when open. I was wondering, since the brow augmentation is performed around this area, would this type of surgery cause my eyes,particularly the left one to open further, thereby leaving the eye completely open when shut or when i am asleep? I guess implanting around this area is bound to pull the upper eyelid area upwards and pressure on the tissue surrounding that area.. I would not consider going ahead with brow bone implant augmentation if this is the case. Your opinion on this is greatly appreciated
2. Lip reduction to lower and upper lips. Just minor reduction to counter drooping which I notice and is probably due to me getting on in age. When at rest I can see the pink of my inner lips showing.
3. Alar base reduction in combination with Weir incisions to reduce nasal side walls and inner nostrils as well. When I smile my nostril flare excessively which bothers me, so I refrain from smiling as much as I can.
4. Finally I would like to raise/heighten my dorsal bridge as well as trim the bony area along the bridge to give definition. In addition I would like the bulbous nasal tip defatted if this is something you can do. Again, I just a subtle change as I do not want it looking to pointy.
5. I have had previous rhinoplasty with a premaxillary implant inserted below nasal base and I want to remove this.
Are these procedures you can do? Can you perform these procedures at the same time? Have you any experience performing all the procedures i have mentioned above on ethnic people like me?
A: Thank you for your inquiry and sending all of your pictures. In answer to your procedural questions:
- When it comes to a brow bone implant it is critically important that the decision for total forehead augmentation be considered using computer imaging. That has to be factored into the implant design. With the slope of your forehead I suspect brow bone augmentation only may only make the forehead look more inclined backward. As for the effect on the eyes, I have not really seen much effect on the eyelid position. If anyway I would think it would push the eyelids down lower and not pulled upward.
- Lip reduction almost produces less of a lip reduction effect than most patients want. So a more subtle lip reduction effect is the more likely one to be achieved as opposed to too much of a reduction.
- Reduction of nostril width changes the outer location of the nostril but has no effect on the inner nostril along the midline columella.
- The height of the nasal bridge can be raised and this can be done by either an implant or a rib graft. Since you may already being having a brow bone-forehead implant, I suspect the implant option would be more appealing. Reducing a bulbous tip in thick-skinned men always produces more of a subtle change and never a dramatic or a pointy one.
- The premaxillary implant can be easily removed.
All of these procedures can be done at the same time (custom forehead implant, rhinoplasty, lip reduction and premaxillary implant removal) The only thing ‘ethnic’ about your procedures is that of the nose and I have done many such ethnic rhinoplasties.
Dr. Barry Eppley