Extreme Facial Reshaping
Q: Dr. Eppley, I am interested in extreme facial reshaping. I want a well defined chin and jawline with high cheekbones and sucked in cheeks between them. I have taken my pictures and did some computer imaging for the facial changes I am seeking. What are your thoughts?
A: Thank you for supplying your imaged results and a very detailed analysis of your desired outcomes. I can see that you have put a lot of thought into these changes. For this type of extreme facial change, and it is appropriate to call it an extreme change (from a surgical standpoint not a personal one), I can make the following comments:
1) You are correct is assuming that only a custom jawline and cheek implants can ever approximate this type of facial change.
2) It would be fair to say that your imaged results are not a completely realistic outcome for a variety of reasons including soft tissue tolerances and the inability for a 1:1 correlation between the implant design and the exterior desired outcome.
3) Having done over 500 custom facial implants, I can tell you there is no current technology that can take a photoshopped image and translate that into an implant design that will guarantee that outcome. Implants are designed on the 3D CT scan (bone) and it has to be estimated what type of implant shape, thickness and contours might create an outcome that would come close to the patient’s desires. Custom implant designing remains an art form and not an exact science.
4) The extreme indentation between the cheeks and the jawline is not realistic. While the size of the implants and your thin face will help a lot in that regard (and even buccal lipectomies will help also), it would be unlikely that such a contrast between the augmented skeletal contours and the unsupported soft areas between them will be that substantial in contrast.
5) By far and away the most common need for a revision in custom facial implants in general and in such extreme facial changes in particular is high. To not be subtle about this possibility, presume it is 50% or greater. This is particularly true in the patient who before surgery has done a vey detailed analysis and has a very specific facial outcome in mind. This is not a personal statement about you, as I have many such facial patients of which many are men, it speaks more to the imprecision and limitations of the surgical process. (Anything can be done on photoshop which may or may not be translated to the patient’s outcome) It is important to point out that patients assess their after surgery outcomes with the same zeal and analysis that they did before surgery. As a result it would be extremely unlikely that the patient’s exact aesthetic target will be achieved most of the time.
6) Your biggest risk of aesthetic ‘complications’ is in the jawline. Dropping down the jaw angle that much with such widening poses a real risk for masseter muscle disinsertion and retraction with ‘implant reveal’ over the jaw angle area.
7) While infection is the dreaded complication of any facial implant, that risk is fairly low. (< 5%) The real complications, as noted above, are aesthetic in nature.
8) Recovery from any form of facial reshaping surgery, such as implants, takes a lot longer than any patient thinks. You will look reasonable by two weeks or so after surgery but it takes up go two months after surgery to see the true final outcome.
Dr. Barry Eppley