How Can I Fix My Upper Midface After A LeFort I Osteotomy?

Q: Dr. Eppley, I had a Lefort 1 osteotomy to correct an underbite a few years ago but I’m unhappy with the outcome. I have quite hollow under eyes and flat cheeks with a heavier puffy lower face and no definition. I would like to achieve a more slim and defined feminine look with more prominant cheekbones. I have been researching infraorbital malar implants and also types of fat removal and masseter botox. Would these procedures help me achieve my aim or should I consider something else. Thank you.

 A: As can anatomically happen in some LeFort advancements the under eye and cheek areas get ‘left behind’ as the maxilla moves forward as this is a low midface procedure that does not affect the high midface area. Given that maxillomandibular position is now the foundation of your face it would make sense to augment the infraorbital-cheek areas. This will certainly improve the undereye hollows and augment the cheeks. The only question is whether this will have a slenderizing effect on the face…of which I am suspicious that it would. Some of your facial volume concerns comes from the now increased midface soft tissue fullness that is a sequelae of the midface degloving that is necessary for the Lefort I procedure. This is where buccal lipectomies/perioral liposuction/masseteric muscle thinning may have a positive role to play in your facial reshaping efforts.

Dr. Barry Eppley

World Renowned Plastic Surgeon