Q: Dr. Eppley, I am interested in multiple facial reshaping procedures. I have a long face with a vertically long chin. The last time you said you would take it back and wouldn’t shorten it. I disagree.I f I set it back I have not enough forward projection, I need to shorten it. My jaw is too long too. I need to change the mandibular angle to make it look rounder it is not soft looking. Next thing is my forehead goes backwards a little, I want it rounder and filled with nothing permanent.
A: Good to hear from you again. I must confess that I do not remember our prior emails. about your desired facial reshaping goals. The projection of one’s chin is open to personal opinion so if you prefer the anterior projection you have then vertical chin reduction should only be done. The jaw angles can be made more round by removing at a 45 degree angle their back end. The only non-permanent method of forehead augmentation would be either synthetic fillers. It can be argued that fat injections may not be permanent but they are best thought of as having some amount of permanent retention. The problem with synthetic injectable fillers is the volume that would be needed to augment a large area like the forehead.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. I am a female and am 25 years old. I really don’t like my face but I don’t know whats wrong with it. My forehead is too small, my cheeks are huge and my jawline doesn’t exist or maybe its my chin. Its like too long and wide and my nose is fat. I just want to know if it is possible to change the shape of my face.
A: Thank you for your inquiry and sending your pictures. Much can be done with your face in terms of overall facial reshaping. Your forehead is small because of the low hairline and it lacks projection and convexity. A forehead augmentation can be done to build out the forehead which will also have some effect on increasing the distance between the eyebrows and the hairline. Cheek reduction can be done by osteotomies to narrow their width and projection. Your chin can be vertically shortened and narrowed. Your nose can also be made thinner/more narrow.
When you put the forehead, nose, cheeks and chin changes all together at once then a facial reshaping change will be seen.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping. I absolutely hate my face and how it looks different on both sides. What would I need done to make myself look more symmetrical. I only like the left side. I hate people even looking at my right side and I wont ever take face forward shots. I attached a picture to show you. I just really hate it and very insecure. I feel like everyone can notice that one side of my entire face is higher than the other and that one eye is bigger than the other.
A: Thank you for sending your picture and expressing concerns. I can clearly see the differences between the two sides of your face and most, if not all, of the asymmetry is in the periorbital region. (around the eye) Because the picture you sent may be inverted (mirror image) I am not sure which is the right or the left. But there is one side where the eye is bigger and the brow bone and cheek bone on that side are more developed. While the opposite side has a smaller eye and a slightly lower brow bone edge and smaller cheek.
When it comes to facial asymmetry and facial reshaping surgery that involves the eye, the bigger eye or higher side can not be lowered. Only the smaller side can be made more open or raised. Thus on the smaller side the brow bone can be shaved to raise it, the cheek augmented to make it fuller, the eyeball raised to make the pupil more even with the other side and the upper and lower eyelids raised to expose more of the white of the eye.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in multiple facial reshaping procedures. I went to a lot of surgeons who usually said that everything was perfect and no surgery needed. But I may see things a little bit more detailed or have a different idea of beauty. Some said my chin has an asymmetry, is too pointy, has too much soft tissue on it. Some wanted to do pre jowl implants. Some said my chin is too long and wanted to shorten it. I see that my chin is too long but I don’t think it is the length that is bothering me. It is the whole jawline what makes my chin look like this. My jawline is too long and narrow and not round enough. I will send you my picture first and the second one will be one picture that I changed with a Photoshop tool and I will explain on the picture exactly what Iwanted changed. Please take your time to understand what I try to tell you.
I want to look softer instead of elegant and have a rounder fuller face. I don’t like my high cheekbones and the spot where my cheekbones end there is nothing but flat. I don’t like my eyebrows they are sticking out to the front too much instead of the eyebrow bone being more flat or far in.I don’t like that my chin sticks out too much too. Can we take it back or should we widen it? I have no Idea. Every surgeon said my nose is perfect but they maybe didnt see that when I laugh it points downwards and I personally think that for my narrow face my nose should be flatter. The tip of my nose has to go slightly up. So you see I like to have a more flat more wide face. Everything in my face sticks out too much. I hope you can understand what I mean.
A: Thank you for your inquiry. I have studied your descriptions and concerns as well as your pictures. My facial reshaping surgery responses would be as follows:
CHIN – It has too much horizontal projection. It should be set back about about 5mms by intraoral reverse sliding genioplasty
JAWLINE – It can be rounded/made wider by a custom jawline implants that extenjd from the jaw angles to just behind the chin.
NOSE – As you have well described it, the tip needs to be shortened and rotated upwards and some reduction of the radix height between the eyes.
INFRAORBITAL RIMS/CHEEKS – These should be augmented with an implant that combines the infraorbital rim and cheek area as a single implant. These would be placed through an intraoral or lower eyelid incisions.
BROW BONE – The tail of the brow bones would be flattened by bone burring through upper eyelid incisions.
All of these procedures could be performed as a single operation.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. I want to change the shape of my face. I have a long and thin face which I do not like. I have attached pictures of model faces that I do like. I can not really tell what is different about them from mine. I just can’t point my finger on what it is or what I need for facial reshaping surgery.
A: Thank you for sending all of your own pictures for consideration for facial reshaping surgery and that of faces that you like. All of the faces you like the same differences from yours…their cheeks are much fuller and wider, the chin is vertically shorter and they have more pronounced jaw angles/width. Your face, attractive as it is (although not to you) is longer and thinner. Your ideal face is wider and shorter. To make your face more like your ideal the following three facial reshaping procedures would be needed. Cheek augmentation using implants to substantially widen and increase the apple cheek effect. Your chin could be made vertically shorter by an intraoral vertical reduction bony genioplasty. Thirdly, jaw angle implants would be needed to widen your jawline. The facial reshaping change you seek is… long and thin to shorter and wider.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a combination of procedures including:
1. Brow bone implant augmentation using a custom made brow bone implant and possibly forehead augmentation as well. As you can see from the attached pictures this area of my face lacks definition. i would like a more masculine look. I had upper eyelid surgery done some six years ago. Unfortunately that was a botched operation, the surgeon operating on me sliced off too much of my left eyelid which has left the eye about half way to a third open when I close my eyes. The left eye is wider than the right when open. I was wondering, since the brow augmentation is performed around this area, would this type of surgery cause my eyes,particularly the left one to open further, thereby leaving the eye completely open when shut or when i am asleep? I guess implanting around this area is bound to pull the upper eyelid area upwards and pressure on the tissue surrounding that area.. I would not consider going ahead with brow bone implant augmentation if this is the case. Your opinion on this is greatly appreciated
2. Lip reduction to lower and upper lips. Just minor reduction to counter drooping which I notice and is probably due to me getting on in age. When at rest I can see the pink of my inner lips showing.
3. Alar base reduction in combination with Weir incisions to reduce nasal side walls and inner nostrils as well. When I smile my nostril flare excessively which bothers me, so I refrain from smiling as much as I can.
4. Finally I would like to raise/heighten my dorsal bridge as well as trim the bony area along the bridge to give definition. In addition I would like the bulbous nasal tip defatted if this is something you can do. Again, I just a subtle change as I do not want it looking to pointy.
5. I have had previous rhinoplasty with a premaxillary implant inserted below nasal base and I want to remove this.
Are these procedures you can do? Can you perform these procedures at the same time? Have you any experience performing all the procedures i have mentioned above on ethnic people like me?
A: Thank you for your inquiry and sending all of your pictures. In answer to your procedural questions:
- When it comes to a brow bone implant it is critically important that the decision for total forehead augmentation be considered using computer imaging. That has to be factored into the implant design. With the slope of your forehead I suspect brow bone augmentation only may only make the forehead look more inclined backward. As for the effect on the eyes, I have not really seen much effect on the eyelid position. If anyway I would think it would push the eyelids down lower and not pulled upward.
- Lip reduction almost produces less of a lip reduction effect than most patients want. So a more subtle lip reduction effect is the more likely one to be achieved as opposed to too much of a reduction.
- Reduction of nostril width changes the outer location of the nostril but has no effect on the inner nostril along the midline columella.
- The height of the nasal bridge can be raised and this can be done by either an implant or a rib graft. Since you may already being having a brow bone-forehead implant, I suspect the implant option would be more appealing. Reducing a bulbous tip in thick-skinned men always produces more of a subtle change and never a dramatic or a pointy one.
- The premaxillary implant can be easily removed.
All of these procedures can be done at the same time (custom forehead implant, rhinoplasty, lip reduction and premaxillary implant removal) The only thing ‘ethnic’ about your procedures is that of the nose and I have done many such ethnic rhinoplasties.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. I would like to make a great change on my odd facial appearance. I would like to have a facial reshaping on my interpupillary distance (IPD) and innerouterintercanthal distance (IOICD) because I think I got hypertelorism. I have 4.5cm telecanthus, 3.6cm intercanthal distance, 3cm orbit, 7.5cm interpupillary distance (IPD), around 14.5-15 cm facial width and around 19.5 cm facial length. What surgery should I do at this stage? Decrease interpupillary distance (IPD) by Facial bipartition or increase bitemporal distance and by custom implants? Thanks for your time. I am looking forward to your reply!
A: Thank you for inquiry and sending your pictures. For your facial concerns no major craniofacial surgery such as a hypertelorism or facial bipartition repairs would be appropriate. These are major intracranial surgeries with some significant risks that would not be justified for a cosmetic issue such as type 1 hypertelorism or mild increased intercanthal distances. Instead you want to think of other smaller facial reshaping procedures that can help improve that appearance. You have a low nasal bridge and epicanthal folds. Reducing the epicanthal fold appearance and augmenting the height of the nasal bridge (augmentation rhinoplasty) are well known manuevers that will help make the eyes looks somewhat closer. Making the adjoining areas wider (temporal augmentation) is another option to consider also. When you put all three of these facial procedures together they will do a lot to decrease your perception of the eyes being too far apart.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. Can I get a longer and slimmer face with strong jawline and cheekbone through the facial reshaping procedures? If no, what type of procedure will I need and how much will the total cost be . I feel like I can trust Dr Eppley for these life changing procedures.
A: In looking at your pictures, I can recommend several facial reshaping procedures that would make your face longer and slimmer. These procedures include vertical chin lengthening (vertical lengthening chin implant vs. open sliding genioplasty), cheek implants, buccal lipectomies and perioral mound liposuction. The effect of these procedures is created because multiple hard and soft tissue changes are occurring in different dimensions. When all are combined the effect of increased vertical facial height (real facial change) and decreased facial width (more of a visual facial) occurs.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about the possibilities regarding slimming down my face. It is just long and wide and does not look proportional to my body at all. What could be done to reduce the size of my face? I obviously see that there are limits of what can be done. Whereas I for instance could have jaw reduction and/or cheek cutting. But what sort of experience do you have here?
A: In facial reshaping surgery, slimming the face can be done by three different approaches depending on the dimensions involved. Normally the face could be vertically lengthened to make it look less wide. The face could also be made less wide (width reduction) without changing the vertical length. Lastly, a combination of vertical lengthening and width reduction can be done which often is the most effective.
Your facial dimensions and concerns (‘long and wide’) leave you with only facial width reduction options as you have noted. Cheekbone narrowing and jaw reduction would be the logical procedures of cboice. Whether this would include vertical chin reduction to help with the long face can be debated since vertical facial shortening works against facial width efforts.
Dr. Barry Eppley
Q: Dr. Eppley, I would like a shorter, fuller face with softer, more feminine features. I am wondering if I need corrective jaw surgery or could a chin reduction and facial fillers alone achieve the look I want. If there isn’t a great difference in the results of corrective jaw surgery and chin reduction surgery, then I would be more inclined to just get chin surgery because it is less invasive and costly. I do not like the large space between my nostrils and my upper lip. Could rhinoplasty help to shorten that distance? You might not be able to tell from these pictures but as far as my nose. I do not like the hump and I do not like my nasal tip. It is very bulbous and when I smile I feel the span of my nostrils becomes very wide. Finally I feel that I have a very prominent brow bone and feel it makes me look even more masculine. I am wondering if I am a good candidate for brow bone reduction surgery and also hairline lowering in order to decrease the length of my face. Thank you in advance for your help. I look forward to communicating with you soon and seeing the computer facial images.
A: All of the facial fershaping procedures you have mentioned would be helpful in shortening the appearance of your face from hairline lowering, rhinoplasty, subnasal lip lift and vertical chin reduction. It is impossible to comment on whether corrective jaw surgery or chin reduction would be better since that decision requires knowing the state of your bite. (occlusion) If your bite is good, then chin reduction would absolutely be the better procedure.
Brow bone reduction would be helpful to feminize your forehead and would be needed with your rhinoplasty to help bring back the glabellar (central) area of the brow. Otherwise the hump reduction with your rhinoplasty will make a deep nasofrontal angle which is more of a masculine facial feature.
While a subnasal lip lift would be helpful, it can not be performed at the same time as a rhinoplasty due to blood supply concerns to the intervening columellar skin between it and the open rhinoplasty incision.
To properly do computer imaging, I need more than just a lateral or side view. Additional views from the front and even a three-quarter (oblique) view make for a complete imaging assessment of the aforementioned facial changes.
Dr. Barry Eppley
Q: Dr. Eppley, I am curious as to whether it would be possible to increase the distance between my eyes. Generally I feel this is the most significant weakness in my face! Alternatively, to shorten my midface area vertically would also be a very positive change, or failing that, any procedure that could give that *impression*
Final thing, and this is a bit obscure, but when I wake up, my face generally seems quite puffy, but it looks better in that state. My eyes seem wider, thiner, more masculine and postiively titled. I can’t think of any cause of this he beyond a gathering of fluid from my sleeping position during the previous night – which surely, it is in theory possible to replicate with fillers/injections. Any chance you do this/could do this in the near future?
A: I am afraid that the three things you are asking in terms of facial reshaping are not possible to achieve. There is no procedure, even a camouflage one, that will make your eyes look further apart. There is also no procedure that can vertically shorten your midface, short of a maxillary impaction which will bury your teeth under your upper lip. Only if you have a gummy smile would this operation be aesthetically beneficial. In some cases increased midface projection can create that illusion but that would depend on your natural facial profile. Lastly, adding facial volume (as occurs in your morning temporary facial edema) can not be replicated with synthetic injectable fillers. It may be possible that fat injections in selective area could be beneficial but not in an overall facial effect.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in making some changes to my face and I would value your expert opinion on what needs to be done for this type of facial reshaping. My face does not seem very proportioned and I can’t completely put my finger on why or how to change it. I have attached some pictures of my face from various angles to help you in this assessment.
A: I have taken a look at your pictures and have some changes to the following facial features based on what I see are their disproportions/imbalance.
1) Forehead = high hairline with forehead that slopes backwards at a severe angle. Treated with hairline advancement and upper forehead augmentation to shorten and round out the forehead.
2) Nose = high bridge, protruding tip and bifid tip (wide with split and separated dome cartilages) Treated with open rhinoplasty to lower bridge, deepen nose/forehead junction, shorten and narrow tip, and decrease nostril width.
3) Chin = vertically short chin, protrusive chin pad and deep labiomental fold. Treated with vertical lengthening bony genioplasty.
Attached are some predictive images of all of these potential facial changes put together for their overall composite facial reshaping effect. Together they make for a significant change.
Dr. Barry Eppley
Q: Dr. Eppley, Can you tell me what the cost of jaw surgery would be to shorten and recontour the face? I attached photos which show my face length.
A: The concept of facial shortening by double jaw surgery is based on whether you have vertical maxillary excess and a gummy smile. If one does not, then shortening the lower facial bones is going to bury your teeth under your upper lip which has a very negative aesthetic outcome. The pictures you sent do not show you smiling but I suspect you do not have true vertical maxillary excess as, even with non-smiling, one would have an open mouth posture or show evidence of mentalis muscle strain when the lips are together. Without true vertical maxillary excess, one has to look at a variety of other compensatory facial procedures like vertical chin reduction, subnasal lip lifts and rhinoplasty (that shorten the facial look) and potentially procedures that increase facial projection. (e.g., cheek augmentation) To determine the potential impact of any of these procedures on your face I would need to see some better pictures for computer imaging. (front and side views that are non-smiling)
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping surgery. I am a female with a recessive lower chin and a minimal jawline. I have had orthognathic surgery twice now, which has improved my teeth but not the balance of my face. I still have a very convex facial profile with an extremely long vertical jaw angle. Here are some images of my face. I hope these will help you to assess my situation. My last surgery was 11 months ago in which my upper and lower jaw were brought forward to correct an overbite and an open bite. I do feel that my upper jaw (between nose and upper lip) is more elongated than before. As you will see from the photos it is difficult for me to close my lips. I realize that this cannot probably be fixed, however I would like my face to look less long and narrow and my jaw line more defined. My jaw is rather vertical in angle. Any advice very much appreciated.
A: The forward positioning of the maxillomandibular complex has placed a strain on your lip closure as this was not the bony relationship that your lips were ‘designed’ to function over. Along with the upper lip lengthening, these are not rare changes that occur with such maxillomandbular forward movements. In addition, loss of the jaw angle can occur with sagittal split ramus osteotomies (SSRO) of the mandible particularly when the lower jaw moves forward. This can be accentuated in females who may already have a thin and slightly high vertical has angle position initially.
The way to make your face look less vertically long and not so narrow is through a combined sliding genioplasty and jaw angle implants. Small vertically lengthening jaw angle implants (7mm vertical length and 3 to 5mms width) will create more defined jaw angles but not over power the upper face. A sliding genioplasty of the movements of 3mms forward and 6mms vertical reduction would shorten the chin length and also help push up the soft tissue chin pad. This may provide some potential benefit also to reducing the lip strain through a better lower lip position at rest.
Dr. Barry Eppley
Q: Dr. Eppley, I am 28 year-old Asian make who is very interested in having cosmetic surgery performed for overall facial reshaping. As you offer a wide range of procedures which may be relevant to my goals, I hope to receive advice on the achievability of my goals.
First of all, I am very conscious in photos of the roundness and wideness of my face. (especially when smiling, at which point my cheeks appear very round and prominent) In addition, I would like to reduce the fullness of my lower face and make it thinner.
Secondly, I was wondering if a sliding genioplasty was advisable, as my chin appears to be relatively normal sized. I wish to make my jawline less round, and increase the vertical dimensions of my face to alleviate the aforementioned wideness.
Thirdly, I was wondering if procedures were available to create a more ‘deep-set’ look for my eyes. This, in addition to rhinoplasty to reduce the hump and raise the nose bridge, to reduce the ‘flatness’ of my face in profile.
I realize that not all of my expectations will be realistic nor all procedures advisable, so thanks for your time and expertise in advance.
A: A wide collection of procedures are available for facial reshaping as you are aware. In addressing all four areas of your facial concerns from top to bottom, I can make the following initial comments as they relate to your face.
1) I am now using performed or custom brow bone implants to build up the brow ridges. They can be placed through a limited incision endoscopic technique. That is the most effective way to create a more deep-set look to your eyes.
2) Your rhinoplasty would include a humor reduction, radix augmentation and some slight increased tip projection.
3) Cheekbone narrowing is the only way to provide some reduction in the mid-arch bizygomatic distance of probably 4 to 5mms per side.
4) I would consider paranasal augmentation, I have a new paranasal implant that I am really happy with that can not be felt and adds about 5mms projection to the nasal base.
5) I do think that a vertical lengthening genioplasty (which may have to be widened in a male) will help narrow the jawline. You do not need a horizontal advancement but when opening the vertical distance of the chin it does rotate it back a few millimeters so I would do a small advancement as well.
These are some initial thoughts. Computer imaging needs to be done to see how such facial reshaping procedures would look on you.
Dr. Barry Eppley
Q: Dr. Eppley, I am interesting in a variety of facial procedures to create an overall facial reshaping effect. I have done a lot of research and have concluded that I would like the following done:
1) Corner of Mouth Lifts
2) Upper Blepharoplasties
3) Tail of the Brow Lift (Transpalpebral Browlift)
4) Fat injections to the Lower Eyelids/Infraorbital Rims and Upper and
5) Cheek Implants
6) Chin Implant
7) Jaw Angle Implants
9) Brow Bone Augmentation
10) Temple Implants
Do you think the result could still appear natural with so much procedures? Can they all be performed at one time?
A: I would not disagree with you that this list is a lot of facial reshaping surgeries although I have performed such a list before on a handful of patients. While a large number of skull and facial procedures can be combined in a single operation, whether that can and should be done is based on the practical issues of cost, extent of recovery, will the objective of overall facial reshaping be achieved and whether so many facial changes will look natural.
When it comes to looking natural from extensive facial changes, the key is that no single one of the components of the procedure should be ‘overdone’. The more aesthetic operations in proximity that you do, the changes they make will be cumulative and more obvious. Thus each element of the plan should be done conservatively to not look out of proportion or distorted later.
While many facial procedures are done as an outpatient, this collection of procedures would require that the patient stay overnite after surgery. You must also consider how long your face will be swollen and when you will be presentable for work or other socially scrutinizing activities of daily life.
Cost is almost always what pares down a very long list of desired facial procedures to the most practical or those procedures that produce the greatest value or facial change per investment. A good exercise to do is to rank all of your chosen procedures in order of importance to you from the most important to ‘it would be nice but I can live without it.’
Putting the issues of recovery, a natural look and cost together will determine for you whether this number of facial surgeries can be done in one operation.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping/liposuction for my son. For several years my 16 year old son has expressed concerns with excess fat in the cheek/chin/neck area. He has a genetic double chin that upon weight loss did not help and did not go away. In tears, my son asked if he could do what I did (lower face lift/liposuction) While I do not feel it would be necessary for him to go as extreme, I told him I would research his options. In my own experience, I know it’s not something that diet and exercise alone can help with. As a parent though I am conflicted regarding the risks/ psychology etc. of a surgery for cosmetic purposes at his age. Thank you in advance for your help and information!
A: When it comes to facial reshaping via fat removal, there are several specific areas in the face where fat extraction can be very helpful. This includes the neck (liposuction), buccal fat pad (buccal lipectomy) and the perioral mounds. (liposuction) All three areas would be of benefit to your son based on his pictures. That may not necessarily completely deround is face or give him a thin face but would make a substantative improvement.
When it comes to plastic surgery in teens, the major consideration is their level of expectations. Being less mature and often being guided by information that they find on the internet, their sense of realistic expectations and the necessary recovery process until they truly see the final results is often not accurate. But from a physical standpoint, there is no greater risk of these facial procedures in a teen ager than in an older adult.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some facial reshaping procedures. I am 54 and desire more of a heart shape to my face. It is long and not as feminine as I would like. My nose is a bit long and wide on the bridge (from the front esp.) Looking younger would be great, but looking more feminine and therefore prettier is my main goal. Wider temple area/distinct cheekbones, tighter jaw to neck angle, more of a right angle beneath chin-to-neck, and a feminine nose are some ideas I have. My jawbone has reabsorbed somewhat, according to my dentist. But I need YOUR trained eye to tell me how to accomplish my goal of looking more feminine, losing the chub underneath my chin, creating a prettier facial shape in general. Thanks so much for giving me the straight scoop.
A: In looking at your pictures and understanding your facial reshaping goals, I would recommend the following changes.
CHIN A V or triangular shaped chin implant augmentation with the objective or bringing your chin forward, which is short, but making it narrower at the same time.
NOSE An open rhinoplasty to narrow the nose from the bridge to the tip with some slight shortening and elevation of the tip with nostril narrowing.
CHEEKS Cheek implants that produce some a combined malar/submalar (shell) effect. This with the chin helps create more of a heart-shaped face.
TEMPLES Subfascial temporal implant to correct the hollowing and increase the bitemporal width.
EARLOBES I know you did not mention these but these seem a little bit and stick out and reducing them adds a touch of femininity to the sides of the face.
I have attached some computer imaging predictions of how I see these changes affecting your face.
Dr. Barry Eppley
Q: Dr. Eppley, will a buccal lipectomy make a noticeable difference in the shape of my face? I am trying to get a shadowing effect below my cheek bones so I will have more of a male model look.
A: While the buccal lipectomy procedure has a controversial side as to its long-term facial aging effects (creation of the gaunt face), it is also importanbt to look at their upfront effectiveness as well. In most cases, a buccal lipectomy is a complementary facial reshaping procedure whose magnitude of effects differ based on one’s facial make-up. In a thinner and more skeletonized face, its effects are more visible but this is also the patient who is most predisposed to have sunken in cheeks later in life. In a heavier rounder face, buccal lipectomies often have a more minor effect and other procedures must be done around it to create a more visible facial reshaping effect. These are also the same patients that will not have a sunken in cheek look later in life. Opting for buccal lipectomies in facial reshaping must take into consideration the balance of early facial shape improvement versus potential detrimental long-term facial shape changes.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in some form of facial freshaping. I have some issues regarding a long face, and more importantly a long midface. It’s just been seriously bothering me for years to the point where it is causing problems. If you could take a look at these pics and just figure out what is so wrong with it, i would really appreciate it.
A: While I would not disagree that your face is a little long and the guilty component is your midface, there are other facial structural issues that are magnifing that impression. A horizontally short chin and a long nose with an acute nasolabial angle make the midface loo longer than it already. When you combine that with a very skeletonized face (little facial fat), the effect becomes even more so. There really are no true midface shortening procedures other than a maxillary impaction which is only used for vertical maxillary excess that has a gumkmy smile. (which does not apply to you) But what you can do is change some of the other factors that are accentuating the midface elongation effect. This includes a sliding genioplasty to bring the chin forward, a rhinoplasty to rotate the tip and decrease its length and submalar cheek augmentation to procide some more width to the midface. Together, these facial structural procedures can help shorten a long midface appearance.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial reshaping. I am a 27 year old Asian-American female who, through some weight gain and with late puberty, have developed to me what is a foreign look which has caused me great distress. My objective with plastic surgery is to look all-American. I want a natural look, I don’t want it to look like I got plastic surgery at all. I noticed that my eyes grew higher on my head and slightly closer together. I grew a slight bump on my nose and my cheekbones grew flatter and higher on my head. I have gained weight intentionally to fill out of my face because I felt I looked too hollow. The changes have been about a mm but it bothers me considerably. I feel like I am in someone else’s face and it has changed my life for the worse. I am attaching some photos of the way I look now as well as a couple of photos of the way I looked before when I was in college. I am also attaching photos of how generally how I want to look. The biggest objective is that I want to look American, because I am. I am thinking of having my eyes and cheekbones literally moved lower and wider to give it a feminine and youthful look. I have noticed that male to female surgeries don’t look believable if the distance is still too long between the eyes and mouth. Please let me know what procedures you recommend. I am thinking of cheek implants, nose job, and eyelid surgery too? I really need plastic surgery for the life I want to live.
A: I would to make a few general comments about your facial surgery objectives. First you are going to need to set some realistic objectives. There is no plastic surgery that is going to make you look ‘All-American’. You have Asian features, and while there may be some room for softening, you are always going to look Asian. Secondly, you have thick tissues and thick skin. Every American female face pictures that you have shown has much thinner skin and softer features due to a completely different facial bone structure.. While I realize those may be examples, I do not want you to think your facial features can ever be as refined as theirs…you simply have different tissue thickness which only allow for some moderate changes at best.
While there is some facial changes that can be done, those have to be understood in the context of what may be achievable. This issue up front is more more important than what procedures to do…for within lies the key element of whether any patient will be happy after their plastic surgery operation. Some facial reshaping changes can be made but they will not have a facial transformation effect. They will only improve upon the basic appearance of your face.
Dr. Barry Eppley
Q: Dr. Eppley, I want more angularity to my face. I want high cheekbones, a stronger jaw, an enhanced chin, and possibly removing fat from around my mouth. Do you this will give me what I want? I have attached pictures so you can show me what this may look like after.
A:I have done some imaging on the photos you have sent. Your photos are not the best quality for imaging (poor resolution, fuzzy) but I think they will illustrate the point.
To improve your facial shape, I believe you have correctly identified the structures to consider changing. Your face is somewhat vertically short and lacks keys points of angular definition. From a chin standpoint, you need vertical lengthening as well as increased horizontal projection. Unless one uses a custom implant, the chin can only be lengthened by a sliding genioplasty, it can be brought forward at the same time. I am estimating that you need 7mms of vertical lengthening and up to 9mms of horizontal projection increase. You may also benefit from jaw angle augmentation but your pictures are not good enough to do useful imaging for that evaluation. You would also benefit my higher cheekbones using implants and some perioral liposuction to remove some fat around your mouth area. I Have attached some imaging of these potential results, keeping in mind the limited nature of the quality of the original photographs.
Dr. Barry Eppley
Q: Dr. Eppley, Can I have a full facial surgery at the same time starting from the skull then eyes,nose and ears? I am interested in having my forehead and brow area built up but then I also want a nose job to get rid of my hump and fat tip as well as cheek and chin inplants with facial liposuction, all at the same time. Is this possible?
A: Yes you can. It is not rare to do more complete craniomaxillofacial skeletal remodeling from the skull down to the jawline. In addition to skull and forehead procedures, often facial implants are used in conjunction with open rhinoplasties. These more complete aesthetic craniofacial procedures can take 6 to 8 hours to perform, requiring a patient to be in good health,, relatively young, and ready to sustain a significant recovery from a facial swelling standpoint. These composite procedures are often done for major facial reshaping, facial feminization surgeries, and extensive male masculinization makeovers.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to have the following done for ssome facial changes:
1) upper lip lift to reduce the distance between the base of my nose and upper lip (lip to nose ratio reduction by more than half my current natural lip to nose ratio) I am a fan of the lip to nose ratio as typically seen in women even on men as well.
2) I would like also a reduction in the bottom lip to the size of my top lip
3) I would like profile surgery, in specific mouth protrusion surgery to westernise the protrusion of my mouth which as you know is commonly seen in Asian and african americans. I understand there are implants and other methods used to achieve a western profile.
4)I would like a medium chin implant to improve my profile, more projection towards the bottom, when carving the shape of such implant, please note the design of my beard which I purposefully shape especially toward the bottom to almost mimic or complement the shape of my cupids bow along the border of my top lip. We can obviously discuss this more in detail if there are any misunderstandings as to the shape chin I am going for. You can best describe such shape as masculine and very edgy.
5) I would like an implant to give more height to my nasal bridge, with a tip that more length and projection without making the nose appear from the frontal view to be more bulky and thicker than its current state.
6) Finally a resection or crescent-shaped or wedge alar flare reduction to address nostril flare. We can discuss what options would be best, maybe an alar suture cinch procedure or wedge resection.
7) Remove fat underneath chin area.
8) Please use computer imaging for what potentially can be done as a valuable tool for us to communicate.
A: Thank you for your inquiry and sending your pictures. Let me respond to your 8 issues/concerns as follows:
1) A subnasal lip lift can reduce the distance between the upper lip and the base of the nose, but not by half. That is too much and would create a very unusual looking upper lip. As a general rule, I reduce it either by 1/4 or up to 1/3 the vertical distance as measured along the philtral columns. This provides reduction but keeps a more natural look without the upper lip looking like a snarl.
2) The lower lip can be reduced by an internal horizontal wedge excision at the wet-dry vermilion line. Most lip reductions can reduce their size by about 1/3.
3) I am not absolutely sure what you mean by ‘westernized mouth protrusion surgery’ but I think you may mean paranasal base augmentation to help improve the concave profile around the base of the nose and the upper lip.
4) Your chin is horizontally deficient and an improved shape could be obtained by a chin implant that provides 7 -9mm increased projection and a more square shape.
5) A rhinoplasty using an implant for dorsal (bridge) augmentation as well as a columellar extension would help improve the nasal height and tip projection. This can also be done with a rib graft and their are arguments for both approaches (implant vs graft) based on their advantages and disadvantages.
6) Without question, the alar wedge resection for nostril narrowing is far superior to that of the alar cinch suture.
7) Submental liposuction for fat removal with the chin implant would be a good benefit.
8)I have attached some realistic imaging to give you an idea of what may be able to be achieved with these procedures.
Dr. Barry Eppley
Q: Dr. Eppley, I am would be interested in some procedures that could help me improve upon my face, in terms of structure, proportion, balance and profile. Please see my attached photos and let me know what can be achieved in terms of improving my facial structure. To highlight some areas I would be seeking improvement, I would like a more defined, less saggy neckline and a more contoured, defined, less square like face with a narrower facial shape, upper half of the face broader in relation to the lower face. By playing with some photo editing software I got some results that looked interesting (see before and after picture). I am curious what is achievable in reality. What procedures would you recommend to achieve the results I need?
A: Thank you for your inquiry and sending your pictures. Essentially what you would like to achieve is to make some changes so that your face has more definition and less of a round and indistinct shape and contours. From that perspective, there are a variety of procedures that can be done to help achieve that overall goal. Given that it is a more total facial metamorphosis, there is no one single procedure that will achieve it. Rather it is a combination of smaller skeletal and soft tissue procedures that need to be done.
I would recommend some soft tissue contouring by neck, jaw angle and perioral liposuction combined with partial buccal lipectomies. In conjunction i would do some small cheek implants and a small more central chin implant to provide some better skeletal highlights. (narrower chin and more V-shaped face from front view) As you can see, this approach uses a combination of soft tissue reduction and skeletal augmentation to obtain a face that has more overall definition.
I have attached some imaging to demonstrate that potential outcome.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in having multiple facial changes done by you and want to look as attractive as possible. I am a 22 year-old male whose face is a little out of balance and proportion. I have taken the golden ratio mask picture of which I am sure you are familiar and applied it to my face. It shows clearly where my facial imbalances and deficiences are. I know you would do what is best for one’s face but would you go for different results if you were masculine or feminine. The one I used was the female golden pic and there’s a male one as well. Of course I would much rather go for the male look. How close can you come with surgery to achieving these golden ratio mask results?
A: I am very familiar with the golden ratio masks and you are not the first person that has presented it to me. They are very interesting for assessing facial beauty and do provide at least a measureable target for which to aim. They can help surgical planning and, for those who may not be experienced in assessing faces and making the diagnosis by examination of where the deficiences are, they can provide a sort of blueprint to follow. What I do not like about them is that they can create unrealistic or artificial goals for patients as surgery is not like Photoshop nor can it create that degree of precision or change. Perhaps worse, those patients that use them before surgery are going to assess their after surgery results with them. This is a near certain setup for disappointment and an initiator of the need for revisional plastic surgery.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to achieve a radical but natural look. My main problem is that I was born with a bad bone structure. I want a bigger chin, jaw implants to make my face more square, high cheekbones (but natural i´d like to know if fat grafting would be an option), and I see some irregulaties in the form of my forehead and i like to look uniform. Is it possible to correct it with a natural and safe filler? I also think that some liposuction under my chin will help me to create a better facial profile. I have attached some pictures of myself for imaging these changes. Thank you so much.
A: In reviewing your pictures I see that the deficient bone structure is really isolated to the short lower jaw/chin and a forehead that slopes backward. I would agree that a chin augmentation using a square chin implant, and jaw angle implants that both widen and lower the angle would compensate nicely for the lower facial bone deficiency. The jawline improvement would be enhanced by submental and neck liposuction. From a cheek standpoint you can certainly use fat injections. Another fat alternative is to remove part of the buccal fat pads and use this as a ‘cheek implant’, serving the dual purpose of malar augmentation and some submalar contouring. Fat injections could also be used as a forehead filler as well for any irregularities. The attached imaging illustrates some of these potential facial reshaping changes.
Dr. Barry Eppley