Q: Dr. Eppley, I had a few questions. Here's history on me I have had a sliding genioplasty in 2010 and a rhinoplasty in 2005 now I’m happy with the outcome but would like to get a more masculine chiseled look. But I would like to stay away from implants such as porex, silicone, goretex, etc. Can bone grafts be used or is there a way of augmenting without the use of implants? I think my jaw line will need some augmenting. Along with slight some in the chin for its narrowness/mild step offs. Maybe some in my supra orbital rims to give a stronger appearance. Thanks.
A: What you are asking for and how you are asking to do it can’t be done. There is no way to achieve those facial skeletal changes without the use of synthetic facial implants. While bone grafts can be done they are impractical for two reasons. First onlay bone grafts will completely resorb for the most part and what will stay, if anything,will be very irregular and unpredictable in shape. Secondly the amount of bone graft needed would be impossible to harvest unless large strips of outer cranial bone were taken from you skull. Thus the concept of bone grafts for significant facial skeletal augmentation is an unwise and ineffective approach to improving your jawline. A more effective autologous material would be cartilage grafts which don’t suffer much resorption when applied as an augmentation material. But I don’t think many patients want to have multiple ribs harvested from the subcostal margins for a cosmetic change. The reality is that what you don’t like (synthetic implants) is the best, easiest and actually safest way to achieve your jawline goals.
Dr. Barry Eppley