Can My Hydroxyapatite Facial Augmentation Be Revised?

Q: Dr. Eppley, I previously had hydroxyapatite added along my jawline and my cheeks enhanced via  zygomatic sandwich osteotomy. My jawline is somewhat asymmetric and some of the HA in the jaw area closer to my chin needs to be removed/remodeled. I would also like my cheeks enhanced via HA as the augmentation is not adequate and also somewhat asymmetric. 

I am not sure if you are familiar with all of these procedures and realize this is not a straightforward case. Essentially I would like the the jaw area remodelled for better symmetry by removing HA and the cheeks enhanced further by adding HA. 

I am not sure if you use HA, from reading your website it sounds like you don’t however your opinion as a long standing plastic surgeon would be invaluable to me. I am also not opposed to any ideas you might have or getting the jaw remodelling done by yourself.

Thank you very much for your time and consideration.

A: Thank you for telling your story and sending your pictures. I am very familiar with using hydroxyapatite (HA) block and granules as back in the 1980os and early 1990s that was the way much of facial augmentation was done. I still do it occasionally on patient request. HA has fallen out of favor for many surgeons as the blocks are hard to shape and stabilize and the granules are somewhat unpredictable in shape with healing.

I suspect you had HA blocks put in with your zygomatic osteotomies which is good for width but not so much for projection. HA granule ‘sandwiches’ can be made which helps control the material to some degree for secondary placement on the cheeks for greater projection.

Removal of the HA along the jawline is tedious but doable since it was likely injected intraorally along the jawline.

Dr. Barry Eppley

Indianapolis, Indiana