How Realistic Are My Photoshopped Desired Facial Changes?

Q: Dr. Eppley, I have attached the facial pictures you have requested for assessment for my facial surgery. I did my own Photoshop of the desired changes.

A: When a patient does their own imaging they are showing me what they would like to visually accomplish so that is tremendously helpful in two ways: 1) it allows me to say what it and is not possible and 2) for what is possible I now know what their flavor or degree of change they desire. In regards to your imaging I can make the following comments:

1) Consistently in all three views I see forehead and crown of head skull augmentation with periorbital changes consistent with what is known as almond eye surgery. (aka lateral canthoplasties or elevated outer corners of the eyes)

2) There is high cheekbone augmentation in all views.

3) For the lower third of the face the chin has been brought slightly forward and up which only a sliding genioplasty can do. While the jaw angles have been brought down (side and oblique views) for a more defined jaw angle appearance the front view is showing an inaccurate change. In the front view the jaw angles will not stay high and narrow but will drop down and look a bit wider making the face more boxy/wider….so I would be cautious about this change. Everyone overlooks what happens in the front view when considering jaw angle surgery.

Thus all of your requested procedures seem applicable (Custom Forehead/Skull Implant, Custom Bilateral Infraorbital Malar Implants, Standard Jaw Angle Implants, and Sliding Genioplasty) with the one exception of the jaw angle augmentation.

As a final comment about imaging I would read the following statement about it and its role in facial structural surgery:

‘The purpose of computer imaging is frequently misunderstood by patients. Computer imaging is done to help determine what the patient’s aesthetic goals are. It is a method of interactive visual communication to help your surgeon understand what your specific facial reshaping goals are. It is not necessarily a completely accurate predictor of the final outcome but rather what the patient’s goals are. By knowing the target it then allows the surgeon to comment on how realistic it is and how close or far from an actual outcome then result may fall from the target based on the surgeon’s experience.’

The point being imaging, whether done by the surgeon or the patient, sets the desired aesthetic targets. This does not mean they are always precisely surgically achieved but what I do know is that you can never hit a target you do not have.

Dr. Barry Eppley

World-Renowned Plastic Surgeon