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