Q: Dr. Eppley, I have a slight asymmetry that affects most of my face, though the only place I noticed it was in my lower jaw. My chin grew too far to one side, and that side was under developed. I had implants put in to make the developed side fuller, my chin was filed down and capped to make it symmetrical. The problem was that after the surgery the side of my face didn’t have implants put in then looked very small. My dad said I looked like the “Janis” Roman coin with a different face on each side. I saw the same surgeon for a corrective procedure where he took out the chin piece almost entirely and only added a piece to make it symmetrical on that side. The result was a very odd look. I think because the jaw implant was designed to go with the chin implant, when the chin implant was gone it no longer worked. I look like I have constant swelling on one side of my face. This was all five years ago. I didn’t have the heart to ask my parents to pay for another surgery. I have been saving since then and I think that I can afford it now. I recently started orthodontics again and can send you current photos of my face and can send you x-rays that show the implants.
I have several concerns, which you will probably need to see these pictures to answer. The first is, do I have unreasonably expectations. I think that I could expect to have symmetry, and a face I don’t try to grow a beard to hide, but I don’t have your experience. This is a tremendous amount of money for me and I won’t have the money to try again if this surgery is unsuccessful so I would rather not go for it if I can’t expect good results. I imagine the previous implants are grown in, I don’t know what that means for your surgery.
Facing me, my right side is too full, my chin is too weak. I would ideally like to pull out the chin implant that is there now and create a new implant that wraps from (facing me) my left side to the implants on the right side. This would lengthen the chin so I wouldn’t have the fat face effect. It would also add filling to the left side so I wouldn’t have the janis effect. Hopefully, it would be symmetrical. Because my whole face is off slightly I worry that a 3d rendering of my jaw may allow for a perfectly symmetrical jaw, that does not look symmetrical. I am sure you could address that.
A: When you have a significant facial asymmetry that has failed previous attempts at ‘simplistic’ correction (estimating the amounts of augmentation), one can assume that this is partly a function of the planning stage. While one can never predict with absolute certainty as to how any bone surgery will create a change on the outside, it is reasonable however to strive for optimal facial symmetry. This is best done with a 3-D CT scan and model fabricated to properly diagnose the problems and design/fabricate custom facial implants that would best correct them.
Dr. Barry Eppley
Q: I had cheek implants 3 yrs ago which I am looking at having revised. I am tall and athletic and they are just giving me a bony gaunt look to my face which also makes my eyes appear too far apart. What I really wanted in the beginning were midface implants, but wasn’t able to make this clear with the doctor. They are screwed in and I am wondering if they can simply be reduced or shaven down? Also I have jaw implants and am not happy with the square shape that has resulted from their outcome .
A: Facial implants today come in a wide variety of styles and sizes. They are far more versatile than just augmenting the chin, cheeks or jaw angle in a single way. Frequently, I have patients come to my Indianapolis plastic surgery practice that have existing facial implants but did not end up with the result that they wanted. Communication and computer imaging is key in facial bone augmentation with implants.
Both cheek and jaw angle implants can certainly be modified, exchanged, or simply removed. The question for both areas is what is the best strategy to achieve your goals. From a cheek standpoint, you may have been more interested in submalar implants (on the underside of the cheek bone) rather than malar implants which sit on top. They create different looks. With the objective of improving a gaunt looking face, submalar augmentation is preferred. Malar implants will actually make that appearance worse. In jaw angle implants, the size may be too big or their position on the bone may be too high or too low. The style and shape of the implant can also affect how square or sharp the mandibular angle is.
Dr. Barry Eppley