MIdface Augmentation after Orthognathic Surgery

Q: Dr. Eppley, I am interested in midface augmentation efforts. First of all, thank you for your fast reply. So my first problem is the malar and midface area after my double jaw surgery, which I underwent about a year ago. The skin and soft tissues in this area used to be “tight”, in other words: They sticked to my skull. But after the surgery the skin around my nose became loose, droopy and puffy and it has not improved to this day.

I’ve already asked some doctors on Real Self if there is any proper procedure to tighten the skin. Some of them mentioned fillers and some others talked about facelifts and laser lypolisis. To be honest I’m really desperate because I’m looking for the male model look. I heard about your custom made implants and that’s the main reason I’ve decided to get in contact with you.

My cheekbones are not pronounced they are flat, but I want them to be wider, more prominent, chiseled and high set. Espacially the zygomatic arch is very importnant to me.

Nevertheless as I’ve already mentioned I think the first problem we need to solve to get the best results, is to treat my midface area first. I guess when the skin is too droopy and heavy we won’t get the desired results.

I’ll send you some pictures before and after my double jaw surgery and also some pictures of a few examples so that you can get an idea of what I want.

Please feel free to judge and give me your honest opinion about my situation and also tell me if it is achievable in my case or not.

Thank you very much Dr. Eppley for any type of help

A: Thank you for sending your picture and detailing your surgical history. When the entire midfacial tissues are degloved to perform a maxillary osteotomy there will be some permanent soft tissue changes induced by the surgical swelling and the disruption of the ostecutaneous attachments. There is no form of soft tissue tightening or surgical lift that is going to solve that aesthetic concern. 

You are correct that midface augmentation is the only effective method to fill out the loose midface tissues. You are also correct in that custom designed implants are the only implant design to try and accomplish the type of facial reshaping change you seek. However you may not be correct in that the final facial result will look like the male model picture you have shown as that is not a realistic outcome with any form of facial augmentation. You have to have a ultrathin face with little facial fat to achieve that type of result…which is not your natural facial shape.

Dr. Barry Eppley

Indianapolis, Indiana