Can Custom Facial Implants Be Combined With Osteotomies?
Q: Dr. Eppley, I would like to create a more deep-set look to my eyes. That is, the nose between the eyes is not visible in the profile view. I was thinking of having a custom forehead and brow ridge implant to bring them in front of the eyes, and a Le Fort II osteotomy to bring the nasal bone forward to create a result like so in the after:
Would this be possible? I mentioned the Le Fort II osteotomy since I would like to significantly bring forward the flat mid face, including the base of the nose, which is not done in a Le Fort I osteotomy or paranasal implants.
A: A custom forehead/brow bone implant can be done and would be the most successful approach to augmenting the upper third of the face. However, unless you have a malocclusion which requires a maxillary advancement, and even if you do, a LeFort II osteotomy is not really a great approach for midface augmentation. It is the most difficult of all Lefort osteotomies to perform (getting clean osteotomy lines) and the resultant augmentation above the LeFort I level does not usually justify the effort. (in other words, it is a long slide for a short gain) It would be far better and effective to create a custom midface implant for the entire nasmasomaxillary region even if one is having a LeFort I osteotomy. It is simpler and more effective than trying to move the bone at or below the infraorbital rim/nasal side wall areas.
Dr. Barry Eppley