Is A Custom Midface Implant A Better Option As An Adult That A LeFort III Osteotomy?

Q: Dr. Eppley, I wanted to ask for your thoughts on what you believe would be the best treatment option for me. I have always had a very ‘flat’ face with lack of forward projection. I am 26 now and previously had braces aged 16 to correct a slight crossbite, and also my upper and lower teeth ‘met’ instead of the upper coming over the lower. I now notice mid-face concavity, deep nasolabial lines and I feel my chin juts too far forward. my cheekbones are flat and there is no projection at all in the apple cheek region. There is also a lack of bone support in the infra-orbital area which I feel pulls my eyes down at the outer corners/ gives me a negative tilt. After much reading online I think I have a recessed upper jaw but I don’t feel its significant enough to undergo orthognathic surgery as I imagine that’s quite a traumatic procedure! I was thinking facial implants may be a good option, but I am unsure which type, or where would be most effective. Ideally id love to achieve a more sculpted, ‘forward-grown’ face, with more defined cheek ‘bones’, forward projection, more apex in the nasolabial area and get rid of the bottom jaw ‘jutting’ out appearance. A stronger overall facial structure with more light and shade/ definition. I will add some pics for your reference! 

I greatly appreciate you taking the time to read my message and I look forward to hearing back from you at your earliest convenience.

A: With an overall midfacial hypoplasia and I assume a reasonable occlusion (bite) the most effective treatment to ‘pull’ your midface forward is a custom midface implant. (see attached) Augmenting the infraorbital rim and downward across the face of the maxilla, it will add total midface fullness without adding any facial width. The custom midface mask implant has the advantage of being a single piece. There are standard implant options to consider (infraorbital, cheek and premaxillary-paranasal implants) which can be put together to try and create a similar effect but i would only consider placing unconnected implants in the midface only of that were the patient’s preference.

Dr. Barry Eppley

Indianapolis, Indiana