Should A Rhinoplasty Be Done During Or After A Custom Midface Mask Implant?

Q: Dr. Eppley, I’m interested in a consultation with for custom midface implants. Background: I am of SAsian descent. I had a LeFort I advancement ten years that successfully corrected my malocclusion, but my upper midface remains noticeably recessed. The LeFort I advanced the dentoalveolar segment, but everything above the osteotomy line — the infraorbital rims, paranasal area, and cheekbones — was left untouched. 

Mt current concerns: – Significant infraorbital hollowing and a prominent nasojugal groove bilaterally – Flat midface appearance with recessed infraorbital rims – The nose appears flatter than it may actually be due to the lack of surrounding midface projection – Overall midface recession that the LeFort I did not address 

Goals: I’m interested in a custom infraorbital-malar implant (possibly with maxillary extension) to correct the residual upper midface recession. I’ve reviewed Dr. Eppley’s published case studies involving post-LeFort patients receiving custom IOM implants and believe my situation is very similar. I’m also considering rhinoplasty but would like to assess after the midface implant settles whether the improved midface platform reduces or eliminates the need for dorsal augmentation, potentially leaving only a tip refinement.

A:Thank you for your inquiry and sending all of your pictures. Your post LeFort I osteotomy concerns are not uncommon and you are understandably interested in an augmentative effect above the LeFort I level. I think your concept of IOM implants with maxillary extensions, otherwise known as an upper midface mask implant, is appropriate based on your pictures and the prior LeFort I osteotomy. A relevant question, which you have already noted, is what happens to your nose when this augmentation is done around it. This raises the question of whether an augmentation rhinoplasty should be done at the same time or deferred to a secondary basis.

These are all great questions that we can discuss during a virtual consultation.

Dr. Barry Eppley

Plastic Surgeon