Custom Facial Implant Revision

Q: Dr. Eppley,I currently have custom made cheek, chin, and jaw implants and I feel they are too big overall and I would like your opinion on replacing them. 

I have had numerous facial procedures over the last 25 years, and I am pretty happy with how they turned out, but the facial implants miss the mark each time and have been re done a few times.  As you can imagine, I am very nervous about potentially going through this again. I think my mistake has been bringing in photo’s of celebrities that look nothing like me and trying to achieve a look that is unrealistic.  I would like to just look like a hot version of myself:)  I have also not been cognizant  enough of each doctors aesthetic, and I have not been hands on enough when the design of the implants have been planned. I’ve just left it up to the doctor to produce them after explaining what I would like.  I would want to be involved in the process and think things through very carefully.  
My specific concerns/questions:

1. I dislike the cheeks the most. While I love the look of high cheek bones, I feel there is too much projection to look natural, and the emphasis is near the sides rather than the apples of the cheeks where I would prefer it. They are submalar which I think make my cheeks look too puffy. I would love a more sculpted, defined look (but not gaunt). My cheeks bunch up when I smile and I have some very slight aching in my face. 

2.  The jaw implants are a little too big.  I would prefer a softer, more feminine angle. 

3. The chin is a bit too large and square.  I would really like to go back to my natural heart shaped face and more delicate chin.

4. Would I need a facelift after removing such large implants?  I’m 49 and that is one thing I have not done.
I have attached photo’s of myself currently as well as my before picture and what my goal face looks like.  I understand you are not a magician, but it gives you an idea of what I would prefer. 

I really appreciate your time.

A: Thank you for sending all of your pictures and images. I would certainly agree that you should approach any further facial surgery with both caution and skepticism. When custom facial implants do not produce the desired result, it is always only due to two reasons… either the design of the implants is inadequate or the end goal was never realistic regardless of the implant design. In looking at your current face and now and what your goal is….that is a smaller and more refined facial look/angularity. I would think taking your face from where it is now to anything close to that desired look is not realistic. It is easy to make a face bigger with implants but it is never easy to make a face much smaller as the overlying thickness of the soft tissues now has a major impact. But to answer your specific questions:

1)  I would agree that your cheek implants are too bit and cover too much of the maxilla. (I am not sure why they ever covered the maxilla at all actually)

2) Your jaw implants are actually relatively small. But they are anteriorly placed and are designed to be a widening style. What you actually need is small vertically lengthening style instead.

3) Your chin implant is very small and thus should not be there at all. If you want a smaller chin you would need to remove the Implant and reshape the bone.

4) I see no benefit to a facelift for you. Loose or sagging skin is not an issue you have.

Dr. Barry Eppley
Indianapolis, Indiana