Is The Facial Changes I Have Imaged Realistic?

Q: Dr. Eppley, I’ve attached two photos — one is my natural frontal resting photo, and the other is a conservative mock-up showing improved symmetry and structural balance. I’m trying to understand whether the changes shown in the edited version are surgically achievable and, if so, what procedures would be required. My primary concerns are: • Mild chin deviation from midline • Slight asymmetry in mandibular angle width/projection • Lower-third rotational imbalance • Desire for slightly stronger jaw definition • Subtle improvement in midface support (infraorbital area) without overfilling In the mock-up, the changes are structural rather than exaggerated — centered chin, more even jaw angles, slightly sharper mandibular border, and improved facial harmony while keeping my natural identity. My questions are: 1. Is this level of correction realistically achievable? 2. Would a sliding genioplasty be more appropriate than a chin implant for centering and projection? 3. Would custom jaw angle implants be necessary for symmetry, or could this be addressed with genioplasty alone? 4. Do you see any true midface deficiency that would warrant infraorbital or cheek augmentation? 5. Based on the photos, do you suspect skeletal asymmetry versus soft tissue asymmetry? I am open to obtaining a CBCT scan and cephalometric analysis if necessary to properly assess structural alignment. Thank you for your time — I’m looking for structural harmony and balance, not over-augmentation.

A:Thank you for your inquiry and sending your pictures let me start out by saying that is not a realistic outcome for you with any type of surgery. Those changes look like a completely different person. That being said let’s break down what the differences between your face in the ideal image one which I think you know it is a generalized midface and brow bone lack of forward projection. This is evidenced most clearly buy your significant negative orbital vector. The major change that the ideal error results shows versus you is much more forward projection and fullness for the brow bones down to the base of the nose. Augmentation particularly in the mid face would be beneficial even though it is not going to be a outcome like your ideal image result.

Your chin and jawline concerns are a different matter. You’re trying to make refinements to its shape but without augmenting it in any significant way. That is relevant in the chin we’re what you are seeking is some vertical lengthening which represents a true bony deficiency. Whether that is done best by a custom chin implant or a vertical lengthening bony genioplasty requires a more in depth discussion. But as for the jawline behind it that is best left alone as any efforts to make changes in that area is just as likely to create an adverse outcome as it is to make it better.

Dr. Barry Eppley

Plastic Surgeon