What Are The Best Facial Reshapiong Procedures For Me?

Q: Dr. Eppley, Thank you for taking the time to look at my case. I am aware these pictures are not the best. Please let me know if the pictures need to be improved upon.

There are a few things I would like to change about my face. Firstly, both of my jaws are recessed which is pretty obvious from the side shots. I am very inesecure about this. I suspect jaw implants would be best to remedy this, but of course you know best. Removing the appearance of recession would be great if possible. Something to consider: I got a CT scan and it revealed that my TMJ/Jaw Joints are pretty rounded & weak so adding weights through the addition of implants might not be possible.

I would also like to address the deep eye lines under my eyes. Even with a lot of sleep the lines stay. I am not sure if there is a possible solution for removing these eye lines.

Thirdly, my cheek bones are also pretty weak, particularly the side with the scar on my face. Cheek bone implants to help this would be very nice.

Please let me know if you need any more information to recommend procedures. I am very interested in improving my appearance and would like to be as helpful as possible to ameliorate this process. Thank you so much!!

A: Thank you for your inquiry and sending your pictures. I can certainly see your very weak lower jaw and lack of lower orbital and cheek skeletal projection.

The first important decision to make is whether you would benefit by lower jaw advancement surgery, or even by bimaxillary advancements. You have significant lower jaw and chin recession and you must first determine whether correction of that by moving the entire lower jaw would be indicated. So if you have not had a complete assessment for the consideration of this surgery by a maxillofacial surgeon, this is what you should do first. This is the linchpin decision as if you need that surgery this is the very first thing that you do. Once that is done then come back for secondary facial reshaping procedures. If jaw advancement surgery not indicated (which I doubt) or you do not want to do it then we can look at what your options are.

But for the sake of discussion in this email, let’s assume that you are not going to have bimaxillary advancement surgery. Then there was no question that you need a sliding genioplasty for your chin given its severe recession and implants may be needed behind that to build out the entire width of the lower jaw. Implants have virtually no weight so that is irrelevant to your TMJ condition. From a midface standpoint you definitely need custom infraorbital-malar implants to address your lack of upper midface skeletal support.

Dr Barry Eppley

Plastic Surgeon