Can Temporal Implants, Zygomatic Arch Implants and Vertical Chin Reduction Be Done At The Same Time?
Q: Dr. Eppley, I have questions about temporal implants, zygomatic arch implants and vertical chin reduction. Are you pretty confident that you can produce a significant improvement and that you would not have to go in again and that the result would last several years.
With the temporal implant
With the cheek implant
With the chin
If it’s not enough augmentation, and fillers can make up the difference, then I might as well do fillers. But I believe you said on the net the fat can be used to effectively deal with that.
( I’m confused—-Since you are in there and you see the anatomy and you can custom carve the implant- I had the clear impression that you can see what you would get before the swelling takes place , and that eliminates the guesswork. ) In the last letter you’re saying that it is tricky to know if it’s too much or too little..
Are most patients happy with a significant difference, (and that maybe you can see it as well). we have agreed that my face is long and that in your opinion the temporal area definitely needs augmentation and I do have a long chin. I realize that I make the ultimate decision but how you and others experience my visual is important .
Like The experiment with the chin reduction, is there anything I can do to produce some type of visual of what it would look like with the midface implants? Also, and importantly, I want to be able to estimate the length of the widening in the midface area so I can tell you how much, right? and I wonder that’s since the skin will be somewhat stretched in that area if that would have a secondary effect of slightly pulling out the corners of my lips.
You have the panorex Of my chin area along with other films that showed all of the screws ——-that I provided on my first consultation. Could you please take a look at that and tell me the amount you can safely take it out? That would make my final decision about the chin area. also the soft tissue swelling that is present underneath the anterior aspect of my chin makes it look long as well and that is not part of the bone. And when I press that then that helps some.
Am I underestimating the noticeable benefit of reducing 7 mm? If you feel fairly confident that you can cut out the soft tissue underneath the anterior aspect of the chain +7 mm, I will do it, 10 mm would be great, but if only 5 mm plus the soft tissue then I would have to think about it. I sent you the pictures of the actor with the width of his face and short length of the chin from the bottom lip. is there a good chance that I could get fairly close to this?
Where is the Incision and scar with midface implants? In front of the year? Is the scar noticeable to the untrained observer?
How many days out before the scars are no longer noticeable or can’t be covered up with make up or skin coloured tape ?
Hoping that this will offer me clarity, and again thanking you for your time.
A: In assure to your temporal implant, zygomatic arch implants and vertical chin reduction questions:
1) All such augmentations of the temples and cheeks are done with implants so we know they will last forever. Their only question is the magnitude of the change…how much is enough, too little, or too much? This is a judgment call to which no one can accurately predict what you will see as too little, enough or too much. In surgery I have to pick an implant size and see what looks goods to me as you are not there to help me with the implant size selection. The biggest fear in implant size selection is in being too big….which is a %100 assurance of a revisional surgery to change.
2) When it comes to a reductive change like that of the vertical chin reduction, the fear is the opposite of that of implant augmentations….there is no risk of doing too much as it more of trying to make sure enough is done to make it worthwhile. This is where the anatomy has more control than that of just making a choice as to how much bone to remove. The limitations of the tooth roots and the mental nerve exit from the bone control where the upper bone cut is made and how much bone can be removed. (you have to stay at least 5mms below them to ensure they are not damaged) This is why I know that at least 7mms can be removed centrally and possibly up to 10mms centrally. A preoperative x-ray measurement will provide more insight which I will do when I am permitted to get back into the office.
3) It is a normal thought and every patient thinks the you can really see what an implant looks like in surgery because significant swelling has not yet occurred….but that is not true. What is overlooked is that in creating the tissue pocket all of the overlying tissues are elevated from their attachments. (that is what making an implant pocket means…creating an open space for the implant underneath the tissues) So when you put in an implant what really occurs is that the released tissues are floating above the implant and are not rigidly stuck down around it…which is what will eventually happen when full healing occurs. So much like having the sheets floating above the mattress on your bed, if you put a small or larger ball on the mattress underneath these floating sheets would you know what size the ball is or even that is was a ball??) This is what makes implant size selection so difficult on the face where a few mllimeters either way can make a big difference to the patient.
4) There is no question you have a long chin and there is no doubt that a diametric widening effect of the temples and zygomatic arches (lateral cheeks) works in concert with the vertical chin reduction to both create a shorter and wider appearing facial shape. Other than computer imaging there really is no other test to preoperatively determine the effects of the temporal or lateral cheek augmentations.
5) For vertical chin reduction I plan on removing both a wedge of bone intraorally as well as a wedge of soft tissue from underneath the chin.
6) Zygomatic or lateral cheek implants are placed through intraoral incisions. But they can also be placed through an external skin incision on the backside of the sideburn over the posterior zygomatic arch.
7) Since the only external scar you would have for all of these procedures is the one you already have (submental), the recovery and outcome for that scar is one you already know.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.