Multiple Facial Reshaping Questions

Q: Dr. Eppley, I have some facial reshaping questions and I’ve done some crude arrows with correlating numbers to try and illustrate what I mean in the attached pictures.

1) Would it be possible to achieve a lower vertical mandibular angle or would it not be appropriate for me?  

2) Will there be any paranasal adjustment to give more projection of the nose and reduce this fold? Or is this a weight loss/buccal fat removal thing?

3) Would I also benefit from a forehead/brow ridge implant in order to lift up the edges of my eyebrows and make them straight and the forehead more prominent?  

4) As mentioned in the email from from your assistant you said that “Mouth widening surgery should not be done at the same time as any form of intraoral surgery.” After I get the jaw and midface implant, is it possible to come back in a year or two and get the mouth widening surgery/ fix my lips?

5) Is there any solution to fix my droopy upper eyelids?

6) Is there any solution to reduce my upper eyelid exposure? Is a fat transfer or something possible?

7) Would I benefit from buccal fat reduction to get more defined cheeks or should this also be done at a separate time to any intraoral surgery?

A: In answer to your facial reshaping questions:

1) Some vertical jaw angle lengthening would be appropriate for you.

2) The paranasal area requires direct augmentation and is not affected by buccal fat removal.

3) Whether brow bone augmentation would be beneficial would require some eventual computer imaging to assess its effect. But in general brow bone augmentation does not make the tail of the brow bone become straight, it merely pushes out what you have.

4) Mouth widening surgery should be delayed at least 3 months after the other surgeries.

5) I believe when you use the term ‘droopy upper eyelids, you may be referring to ptosis correction which raises up the level of the eyelid to expose more iris of the eye.

6) You are correct that a fat graft is needed to fill in the more deficient fullness of the upper  eyelids.

7) Buccal lipectomies and perioral liposuction are common strategies to try and reduce tissue fullness between the bony cheeks and the jawline.

Dr. Barry Eppley

Indianapolis, Indiana