Sliding Genioplasty and Cheek Implants for Asian Facial Reshaping?
Q: Dr. Eppley, I have a few questions regarding some procedures I am interested in. Right now, I am looking to balance my profile and improve my face shape from the front. The two procedures I am most interested in are the sliding genioplasty and cheek implants. I am hoping the SG can also give me slightly less height to my chin as well as move it forward. Can the SG also reduce my lip protrusion, lip incompetence, and make it easier for me to smile? I also realized I have a slight bimaxillary protrusion and I’d like a reduction in it. (my teeth however doesn’t protrude and I don’t have much of a gummy smile, maybe my gums protrude) I’m hoping I don’t need braces or orthognathic surgery like a double jaw procedure.
For the cheek augmentation, from the front my goal is to have a more V or more heart shaped face based more on Asian aesthetics standards and make my face less elongated. I am also hoping it would further balance out my side profile as my front facing cheeks are rather flat. I am also unsure about paranasal implants; I know it can give me more midface projection so I was wondering if you think its right for me? For the cheeks, do you think a ZSO, a submalar, malar, or combined submalar / malar or even a fat graft (to cheeks and to temples) would be right for me? Also, do you think I would need a custom implant or would a carved one suffice? Finally, I would also like to improve my undereye area and I was wondering if cheek augmentation is sufficient for this (although undereye improvement really isn’t important at all to me). Either way I’m hoping you can answer my questions and suggest treatments you think are right for me. Below I attached unflattering but objective pictures of my face at different angles. I also attached a pic of a cartoon drawing as well as a celebrity whose face shape I find looks ideal (tho obviously I don’t want to look like that I just want a face shape resembling those)
A: Thank you for your inquiry, sending your pictures and detailing your surgical concerns and objectives. In answering your questions:
1) While I can not determine what your bite relationship is, you are not an obvious candidate for orthognathic surgery based on your picture assessment alone. I would agree therefore that a sliding genioplasty to bring your chin forward AND vertically shorten it would be the right procedure. Only a sliding genioplasty can create that exact type of dimensional chin change. In theory bringing the chin forward does improve lower lip incompetence and mentalis muscle strain. This does so in most patients although in some that degree of improvement as no as much as one would like.
2) For cheek augmentation what you are really describing, to no surprise in your case, is Asian cheek augmentation…which can be very different than Caucasian cheek augmentation in terms of dimensional cheek augmentation changes. Given the natural lack of horizontal midface projection that most Asian patients have, what you demonstrating in your examples is a more anterior cheek augmentation rather than a lateral one. (most Asian patients don’t need more lateral cheek or zygomatic arch width)
The real question in the Asian male patient is whether this is best accomplished by the use of standard or custom cheek implants? Given that you don’t want/need an undereye augmentation effect and are ‘soft’ on the need for other midfacial augmentation effects (e.g., paranasal), one can use standard cheek implants. In my experience in some Asian male cheek augmentation patients the use of a standard malar shell cheek implant can work well. But the key is its placement on the bone and its orientation. It needs to be placed more anterior as well as the implant needs to be inverted (turned upside down) to create the desired high anterior cheek augmentation effect.
Dr. Barry Eppley