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 35-year-old female patient (left) before facial contouring and (right) four months post-operative. Patient received small, hand-carved facial implants inserted into the chin and mid-face region to add dimension to the profile and balance a dominant mouth. ( Photo credit: Edmund Kwan, M.D.) |
For Manhattan-based plastic surgeon Edmund Kwan, M.D., who specializes in cosmetic surgery in ethnic patients, this goal is the driving force behind his innovative "profileplasty," which is a combination of procedures that together address a number of complaints regularly voiced by his Asian patients.
 Dr. Kwan |
"They see their profile as flattened, with the mouth as the dominant feature. This facial imbalance can be corrected by inserting small facial implants in the mid-face and chin. It's relatively simple, but offers dramatic results."
CUSTOM CARVING Dr. Kwan eschews using the patient's own bone to augment the imbalance and relies instead on custom-carved silicone implants.
"With the profileplasty, we are mainly augmenting the central portion of the face. In order to make the eyes more pleasing on a profile, I build a bridge by placing an implant right across the bridge of the nose," he explains.
"I don't like to use bone because you can have a donor site problem and because bone has variable resorption rates. Instead, I use a silicone implant that I carve for each individual, and I place it through a small incision inside the nose, similar to a rhinoplasty incision," he explains.
Making the nasal bridge taller improves the profile markedly, notes Dr. Kwan, because "you don't see past their bridge to the other eye on profile."
AESTHETIC PROPORTIONS The profileplasty also entails intraorally-placed, mid-face implants that are situated next to the alar base on both sides.
"By pushing that out, the upper part of the mouth actually recedes. Then, I put a chin implant in and a maxillary spine implant right under the columella of the nose. That really shifts the whole mouth into place," Dr. Kwan says.
"There are options; you could do one of two things. You could either shave the nose down and bring it back down to the proportion of the chin, or you could bring the chin out. It's an aesthetic proportionality issue," he explains.
CONTOURING APPROACHES Facial contouring of the cheekbone, jawbone and forehead are also frequently-employed options with Dr. Kwan's Asian patients. Of these, jawbone contouring is the most popular.
"Many Asians have a fairly prominent mandible, and a thick masseter muscle. My approach to that is to examine the patient and see if it's mainly a masseter muscle hypertrophy or if there's also bony enlargement or flaring of the bone that's contributing to this," Dr. Kwan says.
"If it's mainly a muscle problem, my approach is a little different than if it's a bone and a muscle problem."
