In the Asian face wide cheeks with a flatter midface is a common facial skeletal shape. There are well known bone reduction operations that address the wide cheeks but there are no osteotomy or bone moving operations that can address the lack of cheek and infraorbital rim anterior projection. Such increased projections require an implant to do so.
While there are several standard implants that are available to provide some increased midface projection they are small and have limited aesthetic effect. (e.g., paranasal and tear trough implants) They should be considered very localized or spot augmentations not providing significant midface projection increases. To do so an implant has to have a much greater surface area of bony coverage over more of the midface which is the role of custom designed implants.
Because of the unique bony shape of the Asian face there are a variety of upper (brow) and midface implant designs that I have found useful. Infraorbital and anterior malar projections can have many different designs but there are two basic ones that work for most patients. The type 1 design covers the anterior malar, infraorbital and upper pyriform aperture areas. It does not extend all the way down to the paranasal area and because of its more limited coverage should probably be no more than 3mms thick particularly in females.
The type 2 design extends further down into the paranasal area medially and lower in the submalar area laterally. It is also has an increased thickness which is permitted by its greater surface area coverage of the maxilla. Such a design is more appropriate in the male face who may need or can tolerate a greater midface augmentation effect.
In the brow area there are many implant designs that are well known for males but none have ever been proposed for the female Asian face where just a hint of brow bone augmentation is needed. Such female brow bone augmentations look like a ribbon across the brow bones to provide a very subtle effect, just enough to make for a slight separation from the forehead above it.
These silicone elastomer implant designs were made during a consultation with a female Asian patient to review her upper and midface augmentation options…which were done on her actual printed craniofacial model made from her 3D CT scan.Â
Dr. Barry Eppley
World-Renowned Plastic Surgeon