What Can Be Achieved with Custom Implants in Facial Reshaping Surgery?
Q: Dr. Eppley, Attached is a morph (current is on the left) of what I am hoping to achieve with facial reshaping surgery.
A few years after I had the sliding genioplasty with you, I had a chin implant & fat transfer to the chin done by a surgeon close to me. However, the shape is not smooth or natural. I suspect the fat injection is causing an unnatural contour – specifically, a ridge higher up on my chin. Would it be possible to remove the injected fat possibly by small cannula liposuction? I’ve attached a photo of me smiling where the ridge is more obvious.
I would like some more projection and structure overall. As I understand it, the dorsum can be augmented with an implant but the tip must be cartilage. Is this correct? Would it be simpler to just use rib for the entire nose?
I am okay with a subtle increase in projection. You’ve mentioned that pre-formed brow bone implants are also an option. Is there any advantage to going custom since the jawline will be customized as well?
A: In answer to your facial reshaping surgery questions:
1) The approach to removing some of that fat from the chin would be using a microcannula technique, a 1.5mm cannula. That would have the least risk of causing irregularities.
2) You are correct about using implants in the nose. They should be restricted to the dorsum and cartilage should be used for the tip. Thus usually means that the septum or ear cartilage harvest will suffice for the tip. It would not be ‘simpler’ to use a rib graft since it requires a donor site. The logic of using a rib graft wold be if one wants to avoid the use of an implant in larger nasal augmentations.
3) If you are going to have a custom jawline implant then it would be best to just have the brow bone made custom as well. That is because the design and manufacturing cost is less for the second concurrent custom implant and there would be no economic advantage to using a performed special designed brow bone implant.
Dr. Barry Eppley