Q: Dr. Eppley, I want to achieve a better face shape with a wider and higher jawline, higher cheek bones, a wider upper face and a less ‘pear shaped’ face. I have attached two pictures. In the second picture I tried to draw the changes I want to make, if possible. Thank you.
A: Thank you for sending your pictures. Your highlighting the changes you desire makes it very helpful to know exactly what you are looking for. Based on your face and those highlighted changes, I can make the following comments. These are said with the acknowledgement you have some significant facial asymmetry as seen most prominently in your jawline and eyebrow areas.
1) Your eyebrow asymmetry poses challenges as a high eyebrow can not be brought down. Only the lower eyebrow can be elevated to a more symmetric level to the higher one. Whether that is done by a unilateral endoscopic browlift or a hairline procedure that elevates the right brow and overall shortens the vertical length of the forehead depends on your other foreheads objectives.
2) Temporal implants can easily augment and widen the temporal area.
3) Your drawn concept of a lower eyelid lift is to raise the horizontal level of the lower eyelid. That is quite different than a typical lower blepharoplasty that removes excess skin but maintains the existing horizontal eyelid level. Raising the low horizontal lower eyelid with too much sclera show is not easy nor always predictable. To do so requires adding a spacer dermal graft in the internal lining (lamella) of the lower eyelid and tightening the lateral canthal tendon. It may be possible to raise the eyelid but not more than a few millimeters at best.
4) Your cheek implants are positioned on the underside of the cheek, indicating that submalar implants would be most beneficial.
5) Your nose changes shows expansion of the middle vault with spreader grafts, tip narrowing and shortening, and nostril narrowing. This can be done through an open rhinoplasty.
6) Your lip drawings show upper and lower lip vermilion advancements but I am not sure whether those fine line scars would be acceptable. But only vermilion advancements can produce the results you are showing.
7) Your jawline poses a bit of a challenge. It is not possible to make it as smooth from the chin back to the jaw angle as you have drawn. You can place lateral jaw angle implants, the right being bigger the left, to widen the lower face.
When it comes to changing the overall shape of one’s face, multiple procedures need to be done at the same time. Your composite drawings illustrate that well.
Dr. Barry Eppley