Facial Implant Revision Surgery

Q: Dr. Eppley, I am interested in facial implant revision surgery and fat grafting.Three months ago I underwent surgery with the following facial concerns/objectives, a weak chin (needed more projection and wanted in squarer in appearance), a weak jawline (wanted very strong, defined jaw line), hollow eye area and wanted slightly wider mid face. For those concerns I had a Terino Square – Style I chin implant, buccal fat reduction and fat grafting to under eye area and temples. 

Although I can see an improvement in the projection of my chin in side profile I would have liked the chin to be wider. The chin implant alone has not provided me with the jaw line enhancement I wanted – disappointed with the results. The fat grafting carried out in the eye and temple region was very conservative and provided minimum results/very subtle improvements and my understanding is that the areas treated could further diminish as the fat reabsorbs. However I am happy with the buccal fat reduction.

After evaluating the outcome of my procedures and completing extensive research (including your website and case studies) I feel I have a much better understanding of what I want to achieve and treatment options available. I I would like my chin to be slightly wider in front view and feel that the going up a size (Terino Square Chin – Style I – large) could achieve this effect. I would like a much stronger and more defined jaw line. I feel my jaw angle is very high and that I have a vertical deficiency.  I am very interested in the Vertical Mandibular Angle implant.  I am open to custom implants if it will provide me with a better outcome – I am seeking a straight line back from the chin to the jaw angle point and after reading some of your articles understand that the potential dipping between implants needs to be considered. I would like to add more volume and increase width slightly through implants or fat injections. For the temples, I feel my head is narrow and would like it to be fuller and wider (smooth surface with gentle curves).  I think further fat injections could help.

A: Thank you detailing your recent lower facial surgery history as well as your objectives. In reading through them I can make the following comments:

1) A Style 1 square chin implant lacks adequate width (45mm) for  most men that seek a more square chin look. It almost has to be out to 50 to 55mms to have a more square effect.

2) A chin implant by itself is never going to create a jawline effect as the chin is but one-third of the total jawline.

3) Fat grafting in younger men of average or thin body frames rarely has much persistence and, at best, produces subtle/minimal results. 

4) The only way to have a straight line from the chin back to the jaw angles is with a custom jawline implant.

5) I would have little confidence in fat grafting to the temples. It is a broad area and requires a lot of fat just to have just a little result and would not likely ever end up ‘fuller and wider’. Temporal implants are far more effective and have an assured volume augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana