How Can I Do A Subtle Chin and Paranasal Augmentation?

Q: Dr. Eppley, I am strongly considering a subtle chin and paranasal augmentation procedure. I’ve been genetically gifted with a small jaw and huge cheeks, now that I’m in my mid-30s and the fat pads have decreased, all my sagging soft tissue is hanging out below my jawline. I’ve consulted several doctors, and they advised a full facelift to excise the excess SMAS. I’m looking to achieve a more balanced heart shaped face based on my natural foundation, and prefer permanent methods that will factor in facial bone loss from aging. 1. Should I do the facelift or the structural augmentation first? 2. How long should I wait in between procedures? 3. Would a chin implant or sliding genioplasty be better for my anatomy / situation? approximately how much advancement? I’m ok with my chin’s vertical length and just want to increase its projection. 4. What kind of implant material would be best for my paranasal area? I mainly want to correct how sunken in my nostrils look and soften the appearance of nasolabial grooves. 5. The left side of my face is more structurally sloped than the right, exacerbating the appearance of asymmetrical nostrils. Is it advisable to try to correct for this with paranasal augmentation? Thank you for your expertise.

A:Thank you for your inquiry and sending your pictures. As a general statement you always want to make whatever structural changes are needed first before you manipulate the overlying soft tissues. In some cases the bony procedures hey obviate the need for significant soft tissue changes such as a facelift. Whether that would happen or not cannot be predicted beforehand but I think you always want to address the foundation first onto which the soft tissue envelops.

For the chin I have done some imaging to determine the magnitude of horizontal projection you may find acceptable. As a general rule in females one has to be very cautious about too much horizontal projection and I would estimate what I have image to be about 5 to 6 mm. Whether this is done by an implant or a sliding genioplasty can be debated, and this amount of forward chin  projection can be accomplished by both, but usually moving the bone is better for the submental areas and the contour of the neck to reduce its fullness. One should always do some submental liposuction on the underside of the chin anyway to optimize the result.

For the paranasal augmentation I currently prefer ePTFE paranasal implants which works quite well and the tissues integrate into the implant’s surface. The asymmetry of your nostrils is only partially contributed to by the underlying bone. You also have alar rim retraction which is not going to be solved by paranasal implants.

Dr. Barry Eppley

World-Renowned Plastic Surgeon