Q: Dr. Eppley, I am interested in facial reshaping surgery.I just wanted to make an enquiry about possibly having some cosmetic surgery with you in the coming months. I’ve been to a few plastic surgeons here in my country but I am having difficulty finding the right surgeon to operate on me. Having looked through your website I was very impressed with the before and after pictures of his patients and am now considering flying to America to have the surgery.
I noticed he seems to offer a lot of different types of facial implants which I am most interested in. I’m just wondering is there a limit on the amount of procedures that can be carried out at one time? I would be looking to enhance and refine several features on my face and finding a surgeon that can perform a lot of the procedures I’m interested in in Europe is very difficult.
I was hoping that you review some photographs i’ve edited myself and let me know if he thinks the result I’m looking for is possible. My goal is to install more classical features onto my face and to create a more chiseled, symmetrical bone structure with the most natural result possible so as to avoid a ‘surgery look’.
A: Thank you for your inquiry. One can have done any number of facial procedures at one time, albeit bony change or soft tissue. Even with doing a large number of procedures simultaneously, the concern is not usually looking overdone but whether enough change has occurred to satisfy the patient’s aesthetic goals. The concern about being overdone is largely relegated to anti-aging facial surgery not the type of facial reshaping surgery that younger people undergo such as you are considering. In the spirit of expectations, let me go over your morphed facial images to review what is and is not possible. You have illustrated the following changes on your face:
1) Hairline Advancement – what you have shown is reasonable although be aware that the greatest forward movement in the hairline is in the center and not in the temporal areas. Once can expect about a 1cm forward movement in males which is about what you are showing.
2) Rhinoplasty – dropping the dorsal line and shortening and rotating the tip is an achievable goal as you have shown.
3) Submalar Hollowing – removing the buccal fat pads with perioral liposuction will help but it needs to be combined with a zygomatic arch augmentation to have an effect that goes further back on your face.
4) Upper Lip Advancement – this procedure can set the vermilion-cutaneous border where you want it so that outcome can be obtained.
5) Jawline – In trying to achieve a more defined jawline (stronger chin and prominent jaw angles) you are showing the type of change that is not possible. What you have done is to vertically shorten the entire jawline and create a degree of jawline sharpness that can not be done. You just can’t vertically shorten the middle portion of the jawline like you have shown. While the squareness and greater projection of the chin is possible and well as the vertical elongation of the jaw angles, the vertical height of the middle portion of the jawline can not be changed. Either a custom three piece jawline implant (chin and two jaw angles) or a custom one-piece jawline implant (with a thin connection between the chin and jaw angles) would create a much improved definition of the jawline albeit not as vertically short or quite as sharp as you have morphed.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. I can not figure out what my face needs to look better. I’d really appreciate you taking your time for this. I have been given different surgery options from doctors here in Australia. However my opinion is that the best doctors are located in America, especially for facial surgery. It has been recommended to me that I have cheek implants, buccal lipectomy and a chin implant. But I want to know your opinion since you are regarded as one of the best surgeons in the world for facial reshaping surgery.
A: In looking at your pictures, your facial reshaping/restructuring goal would be to shorten your longer face and provide some more central projection. You have a more flat paranasal/midface and thus you have to be careful with how you change things to not look worse. I would recommend the following:
1) Chin augmentation but by sliding genioplasty as your chin needs to come forward but should become vertically shorter not longer. (implants tend to make the chin longer or at least neutral in vertical length)
2) Malar/Submalar implant augmentation with emphasis on providing with anterior projection not so much width
3) Avoid a buccal lipectomy. That would be one of the worst things you can do to a face that already lacks projection and could easily end up looking gaunt.
4) Paranasal augmentation to build out the base of the nose and the maxilla. This complements what the dimensional changes of the cheeks and chin and avoids ‘leaving the area between the two behind’.
Dr. Barry Eppley