Q: Dr. Eppley, I want to improve my face and have attached pictures which show my concerns. For some reason, the selfies make my face look longer than it really is. I have a very square face. I would like very much to have more of a heart shaped face… and to address the skin laxity that is showing my age.  These pics are without makeup and do show a little of the perioral mound that keeps a heart shape away. I am wondering if that needs to be removed or if I would do better with a form of facelift to lift some of the fullness/wrinkles from my mouth area. By the way… I have had an upper bleph (love it!), but do wonder about a little brow lift as well. I have a very short forehead and low brows. It looks quite wrinkly when I try to keep them raised. Thank you.

A: Thank you for sending all of your pictures. Selfies do create facial distortions as your face is certainly not long but vertically short with its more square shape. Your pseudo perioral mounds are really caused by the skin laxity along the jawline. As the skin falls forward it ‘piles up’ against the corner of the mouth creating these tissue mounds. Ideally what you need is a small ‘tuck up’ lower facelift also known as a jowl lift. That will resolve the jowls and eliminate the buildup of tissue in the perioral mound area. To help make you face less square and more heart-shaped some vertical chin lengthening would go a long way in that regard. This can be most simply done by a small vertical lengthening chin implant but also by am opening bony genioplasty as well.

For the brows an endoscopic browlift would be beneficial as it would not only lift the eyebrows but would vertically lengthen the forehead as well.

Dr. Barry Eppley

Indianapolis, Indiana