Your Questions

Dr. Eppley, For midface augmentation, should I choose paranasal filler (my maxilla is quite forward, my midface is flat and doesn’t point forward as you see in my picture) and cheek filler, or should I get an implant? The second question: how do I change my eye shape? As you see, I got strong dark circles and they are round if you look from the front, do I need infraorbital rim implants to get rid of the circles and more almond eyes (this male model squint look) or can I use filler (upper eye lid for hood look and under the eye for the circles and almond look). Thanks and kind regards.

A: The use of injectable fillers, injectable fat or implants for midface augmentation are all  possible treatment options, each with their own well known advantages and disadvantages. But as a young person the best long-term approach is to have custom facial implants made for a permanent and more controlled facial shape change. Fillers and fat do not produce the same type of augmented facial look and are only going to be temporary. Eye shape change will require a lateral canthoplasty to deround the eye.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in midface augmentation. I’m 25 years old and I have problems with my facial aesthetics. My forehead is more protruding than my midface and my lower third. This is easily observeable in sunny places, my forehead is highlighted but the rest of the face (except the nose) in shadow. Since my bite is good and my jaw quite strong, I would think a chin implant is a good idea, but is there an really effective method to bring the midface forward without a LeFort osteotomy?

A: As for the chin implant I would need to see pictures to make a helpful comment on its benefits for you. There is a very effective method to bring the level of the face around the nose forward which would create the equivalent of LeFort I osteotomy effect. Combined paranasal/premaxillary- maxillary implants can have a very powerful midface augmentation effect. Cheek implants are also useful but they create a zygomatic augmentation (upper midface) not a maxillary (lower midface) augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m an Asian American and I’ve been thinking of a few cosmetic procedures to enhance my flat face and that is rhinoplasty and midface augmentation.I’ve decided to go with the midface first. Being that, I’d like to know your inputs on the area of my midface that needs to be augmented for a more chiselled, three-dimensional look. I know that there a few parts to the midface – premaxillary and maxillary area for the anterior cheek ( I may be wrong on that ). So with that being said, what would you say about having both paranasal and malar implants done together? (for the case that I may need both) Would that cause a great incremental change in my facial projection compared to just one procedure done?

A: In looking at your face, which is not atypical for many Asian males, you might consider a somewhat different approach. The best procedures for ‘pulling your face out’ (increasing midfacial projection is a rhinoplasty combinjed with paranasal implants. It is very difficult to give much definition to broad wide cheeks without burying the rest of the midface behind them. (making the nose look even smaller) Look at the imaging I have attached to see what effect is created by initially pulling the nose and its base out. With your specific facial shape, this is where the real value is in any plastic surgery for you. The cheeks can be enhanced by probably not in the ideal chiselled fashion that you seek, I don’t think that is realistic for your face.

Dr. Barry Eppley

Indianapolis, Indiana