What Are The Best Implants To Improve My Facial Convexity?
Q: Dr. Eppley, I had my upper and lower jaw advancement done 7 months ago and was not too happy with the results. I recently had chin and jaw implants together with a rhinoplasty done. I have also had some facial fillers placed under the lower eyelids and on the upper cheeks. Regardless, I still feel like my mid-face is flat and would like to know what can be done (if any) to make it more convex.
A: While I do not have the advantage of seeing any pictures of your face, I will assume by your description that you have either a malar or a combined orbito-malar skeletal deficiency from an aesthetic standpoint. This may or may not include a maxillary-paranasal deficiency as well although your recent maxillary advancement surgery may have improved that concern. Knowing which of these areas needs augmented is obviously important. But for the sake of completeness let me review all three areas.
Cheek implants are probably very familiar to you but there are four basic styles to consider that augment different areas of the cheek. To improve facial convexity, the cheek implant must provide anterolateral projection, with more anterior than lateral. This can be placed through the mouth like most traditional cheek implants. If a concomitant infraorbital deficiency exists, an orbito-malar implant can be used which is placed through a lower eyelid (blepharoplasty) incision. When a deficiency around the nasal base exists, paranasal or a premaxillary implant can be used. The difference is that one pushes out the base of the nose on the sides (paranasal) while the other pushes on the base of the columella (premaxillary) to open up the nasolabial angle.
Without seeing pictures, I could not tell you which type of midfacial implant(s) would be appropriate for you.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.