Need feedback on implant designs for jaw, cheeks, brow.

roguedisc

roguedisc

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40yo having Eppley do custom jaw, malar / orbital / brow implants, as well as double upper & lower bleph & canthoplasty & corrugator removal in a few months. We are currently in the design phase and I would like to get some feedback, and I'll post any scans / photos you want. I've had a Qoves facial assessment done to do the cephalometric measurements as well for identifying failos (eyes, VOD, weak orbitals, cheek bone asymmetry, gonial width, narrow chin, narrow mouth.)

The reason I'm having the eye surgery is because i have mild vertical orbital dystopia of a few mm that is effecting my night vision. So we will use this opportunity to improve everything. Two months after the implants I have a rhinoplasty scheduled, and then going out of country to have some PLACL threadlifts done to wind the clock back ten years on my nasolabial folds, so feel free to give all the feedback.

I had a le forte 1 surgery about 20 years ago because my bite wasn't fitting correctly on my back teeth. The LF1 was preceded by 5 years of orthodontics to get the teeth and palate into place. Now my bite and teeth are perfect as far as i'm concerned, except perhaps the palate could use maybe a little more expanding to get from 4.5 to 5 teeth show and the lips could use widening. I have zero interest in lip lifts and commisuroplasty until they figure out how to effectively do it without insane scars. Also when they did the LF1 they apparently did a buccal fat removal as well as I found out last year while I was getting lipo and submentoplasty. Also had bellafill & dysport to eliminate my forehead lines. Also was a norwood 2 and had 6500 FUE grafts to rebuild hairline and have 1500 more donors available for a final round.

This one will be a little difficult because I have extra facial fat right now, so I'll give you pics of my 25yo self so you can see what we are working with. I'm down 28 pounds in 9 months, and i have another 28 to go, and I will hit 15% bodyfat by the time of surgery so that the canthoplastys are as good as you can hope for. For those wondering my natural gonial angle is 129', which is apparently in the male "ideal" range of 125 - 130 according to the Ideal Male Jaw publication attached below and Qoves Studio, but I'm not sure I buy into that.

Below what is not shown is the brow bone implant that will fully wrap all the way to the malars, just a generic zorro mask looking thing, as we aren't there yet but I could use some input as there seems to be a lot of brow bone variability such as if it is just on the orbitals or if it goes across the T zone.

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Do you have any side profile pictures with soft tissue?

I mean if soft tissue is around or in front of this line I dropped from the forehead it might be ok. However I am curious because your nasal bone does look rather large meaning more projected jaws (meaning jaw surgery) might work better with your face.

Fff3
 
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Ok also based on this nasolabial angle, it looks like you could do with maxillary advancement. The angle is too wide.

Lip


Personally I think custom jaw implants on recessed jaws do not work so well because of occlusion, but it depends on the individual. Sometimes it looks decent on borderline cases.
 
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Ok what, I just read you already had a Le Fort? In that case I guess you should only do implants from here. It also looks like Eppley has not added much to the chin projection so that is good and will not make your lips look lost.
 
Do you have any side profile pictures with soft tissue?

I mean if soft tissue is around or in front of this line I dropped from the forehead it might be ok. However I am curious because your nasal bone does look rather large meaning more projected jaws (meaning jaw surgery) might work better with your face.

View attachment 1671572
Profile
Ct scan
I don't have any pics of profile soft tissue without beard. Those skull models are all tilted, and I think the CT is showing you the philtrum ridge, or i have a subliminal cope.
 
Ok what, I just read you already had a Le Fort? In that case I guess you should only do implants from here. It also looks like Eppley has not added much to the chin projection so that is good and will not make your lips look lost.
I think it would look excessive to have 7mm of forward projection on the chin, maybe 4mm. thoughts?
 
View attachment 1671584 I don't have any pics of profile soft tissue without beard. Those skull models are all tilted, and I think the CT is showing you the philtrum ridge, or i have a subliminal cope.
Ok yeah, it looks like everything is probably in a decent place and it is not worth doing more jaw surgery. It doesn't matter about any skull rotation because the Frankfurt plane is drawn from above the ear canal and through the orbital. Many jaw surgeons would have brought things into the position you are in now, excluding some who prioritise extreme forward growth (Coceancig). You can probably get decent results with implants. I would say keep a moustache through if your upper lip really falls down so sharply, although it doesn't look so bad in pic.

Side orof


I think it would look excessive to have 7mm of forward projection on the chin, maybe 4mm. thoughts?
Yes it would, however I don't think Eppley has done that. He has widened your chin (good) and maybe added 1-2mm more projection?
 
He added 7mm of forward projection on the chin. I've told him to dial it back to 4mm, and then additionally widen the implant by 4mm further to steepen the angle (B) in the figure below to get closer to the angle of a line from the alar to lateral canthus. Further I've requested to bring in the alars for the rhinoplasty and fissure the lateral canthus on the canthoplasty to widen the eyes.

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Oh gotcha, yeah the 7mm wasn't shown in the original pics. I think it might be too much because typically you want the chin to be at the same projection as the lips (when correct rotation of skull)
 
I'm especially trying to figure out what is the ideal for brow bone, I can't find any literature on it, especially relating to creating hunter eye effect.
 
If you had better side profile shots I could probably try some morphs. But I think hunter eye effect depends on the positioning of the supraorbital bone (i.e. the bit under the brow) which is basically very hard to augment with implants and looks pretty bad.

However you can augment the brow bone to create bossy brow boning, which is a masculine trait:

Ffff3


You have a decent forehead shape to do this, and Eppley does this a bit.

One other thing related to hunter eyes is also the under eye support, which can be augmented using custom infraorbital implants, which I morphed roughly here:

Epple


I believe Eppley does these, and the real effect is noticed from the front profile. However they do give a more youthful appearance and reduce any dark hollowing under the eye.

If you want to be a complete psycho, another tweak is fixing the negative canthal tilt with a canthoplasty.
 
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Dm me how much this shit is I want to do it. Also dude 5k grafts for Norwood 2? Who the fuck did that.
 
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We are doing the brow bone and malar implants for full orbital support, and the canthoplasties. I'm curious about the shape of the brow bone and how it is facilitated in hunter eyes other than being lower and extended out further to recess the appearance of the eyes.

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Dm me how much this shit is I want to do it. Also dude 5k grafts for Norwood 2? Who the fuck did that.
Two different sessions. I started out as a norwood two, did 2500 grafts, thinned out further did another 4000 grafts 5 years later. Also the total cost is about $60k for the canths, malar implant, jaw implant, brow implant, and surgery fees. Another 10k for the rhino with a different doctor.
 
Two different sessions. I started out as a norwood two, did 2500 grafts, thinned out further did another 4000 grafts 5 years later.
Oh okay so you fixed the Norwood 2 but bladed past the hairline and had to fix that? Okay makes sense
 
We are doing the brow bone and malar implants for full orbital support, and the canthoplasties. I'm curious about the shape of the brow bone and how it is facilitated in hunter eyes other than being lower and extended out further to recess the appearance of the eyes.

View attachment 1671609View attachment 1671612
Okay gotcha, ideally Eppley can show you some before and afters of this specific brow/infra implant to see what will work best.

As for hunter eyes, as I said it's difficult to replicate surgically but you can probably get to a good result with this anyway. Don't obsess over hunter eyes because they tend to only occur with other features naturally.
 
Okay gotcha, ideally Eppley can show you some before and afters of this specific brow/infra implant to see what will work best.

As for hunter eyes, as I said it's difficult to replicate surgically but you can probably get to a good result with this anyway. Don't obsess over hunter eyes because they tend to only occur with other features naturally.
Hunter eyes: I don't get blackpilled on any of this shit, I honestly didn't know I had a lower eye issue until I started trying to understand what my vision issue was and why i looked like a stroke victim. Almond eye outcome is good, I just don't like the excess fat hanging from the supraorbital of hunter.
 
Hunter eyes: I don't get blackpilled on any of this shit, I honestly didn't know I had a lower eye issue until I started trying to understand what my vision issue was and why i looked like a stroke victim. Almond eye outcome is good, I just don't like the excess fat hanging from the supraorbital of hunter.
Good under eye support from infraorbital implant is enough for most people. It will make your eyes look much better. Also based on the second pic of the infraorbital he does put them in the eye socket floor to make eyes symmetric if need be. That is good.
 
How do they do corrugated removal? Is it to eliminate glabella lines for life?
 
Oh okay so you fixed the Norwood 2 but bladed past the hairline and had to fix that? Okay makes sense
IMG 0525
this is where we started on the hair. that may be a bit more than norwood 2, it's like i'm bald with two racing stripes.
 
How do they do corrugated removal? Is it to eliminate glabella lines for life?
Yes, remove the corrugator muscle and no more 11 lines ever again. standard procedure in most brow lifts.
 
Yes, remove the corrugator muscle and no more 11 lines ever again. standard procedure in most brow lifts.
Where is incision? And yes 4500 graft or whatever makes sensw
 
Where is incision? And yes 4500 graft or whatever makes sensw
Depends how big the brow implant ends up. If it is big they will go in through the scalp behind the hairline. If it is small, they will cut a lateral fissure while doing the malar implants and go upwards I think.
 
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Good under eye support from infraorbital implant is enough for most people. It will make your eyes look much better. Also based on the second pic of the infraorbital he does put them in the eye socket floor to make eyes symmetric if need be. That is good.
Yeah the orbital floor is raised with the malar implant to match the height of the other socket.
 
How many MM of anterior and horizontal projection are you getting for cheeks?
 
3mm & 3mm, going to extend the anterior further back with 1.5mm projection for "longer" cheekbones
 
When you gonna have the surgery?
 
August
 
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Amazing thread @roguedisc
Good luck with your surgeries and please keep us updated!
 

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