Q: Dr. Eppley,I am interested in facial reshaping of multiple areas. I have some questions:
1) Ideally which order should the following operations be done?
– custom jaw implants
– custom midface implant
– brow bone/forehead implant (mimic deep set eyes with lower brow)
2) Also state which procedures can be done at the same sitting?
3) With the custom midface implant, does it obviate the need for paranasal implants, infra-orbital rims etc
4) Do you do sliding genioplasty? If so do you “deglove” or not while doing genioplasty?
A: In answer to your facial reshaping questions:
- All of these facial procedures could be done at the same time. But if you were to stage them, and I would advise one to do so, then they could be grouped into two operations. (Group I = Genioplasty/Jaw Angle Implants/Rhinoplasty and Group II = Forehead/Brow Bone/Midface) Group II should be done first and they will have some influence on the rhinoplasty both at the radix and nasal base levels.
- A custom midface implant covers the entire midface so it includes the paranasal and infraorbital rim areas.
- I do perform genioplasty surgery. (chin osteotomies) In doing the procedure I strive to main as much periosteal/soft tissue attachments as is possible.
Dr. Barry Eppley