Will These Facial Changes Give Me More Of A Square Facial Shape?

Q: Dr. Eppley, I am a 25 year old male and I am interested in facial cosmetic surgery. My previous history of cosmetic surgery is otoplasty, rhinoplasty and a chin implant. I would like a more balanced face and more of an oval/square shape. 

Frontal/anterior view:

-Is it possible to augment more on the weaker side (jaw and cheeks) to balance asymmetry?

-On the cheekbone I would like to augment both the temporal process and the zygomatic bone, augmenting both the sides and front of the cheek bone (particular more augmentation on the right side to balance the weakness)

-On the mandible, i would like the Ramus more laterally augmented (a more square jaw) (also particularly more augmentation to balance the weakness on the right side)

-On the nose, a narrower and more defined tip

Left and right profile views:

-augmentation of the cheekbone (both the temporal process and the zygomatic bone)

-more square mandible angle

-slight de-projection of the nasal tip, lower and upper cartilage*

*Tip projection is more pronounced in the photos of the oblique smiling views. 

I am sending pictures of anterior view and right oblique smiling view. If you could please send me altered photos with your expected results explaining the procedures you have added and why you feel so.

Thank you for your time and consideration

A: Thank you for your inquiry. Unfortunately the images you have sent me are inadequate for imaging. Only the front view is useful. A NON-SMILING oblique and side views are needed to get a more complete analysis.

Other issues:

1) It is not clear if the images are flipped or not. As I see them, the left side of your face is the smaller or weaker side.

2) The concept of oval and a square face are contradictory. As a male I will assume you mean more of a square facial shape is what you desire.

3) While the temporal hollows can be augmented, the bony zygomatic arch and its temporal process  which lies below it can not.

4) Correction of facial asymmetries is difficult even using differently sized implants for each side. Improvement may be obtained but do not expect perfect symmetry as that will not happen.

5) Since you have already have a rhinoplasty, what was done to the tip of the nose initially? What tip changes ere already done and didn’t achieve your goals? It is now a scarred tip and a review of the previous operative note would be helpful to know what now lies underneath and whether cartilage grafts were harvested from your septum. You also have a right middle vault collapse, a step-off at the osteocartilaginous junction, significant nasal deviation and nostril retraction/asymmetry. These and the desire for tip de-projection are going to require cartilage grafts.

All this being said, I have done some imaging based on the one useful frontal view that you have provided with jaw angle, cheek and temporal implants as well as revisional rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana