Dr Bryan Mendelson In Melbourne - Hydroxyapatite Augmentation (Attention K Couture)

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  1. Hi K Couture,

    I have read a few of your posts concerning your surgery with Dr Bryan Mendelson, and am quite fascinated. :smile:

    If you could please answer a few questions, it would be GREATLY appreciated.

    Possibly others on this forum may also be interested, but if you prefer to respond to me privately via message, then that is also ok….

    1. Did you achieve a significant lift of the soft tissue of your cheeks with your concentric malar lift? (ie. did your cheeks look fuller & higher after surgery)?

    2. Did you also have augmentation done with the hydroxyapatite of your orbital rim? I have been advised hydroxyapatite can also be used to address under eye hollowness.

    3. Did you also have hydroxyapatite added to your temples? If so, what was the point and are you happy with the results?

    4. Did you suffer any complications or need for revision surgery (lower eye lid becoming droopy and retracted, nerve damage or numbness, asymmetry of your cheeks, lumpiness of the hydroxyapatite, etc).

    5. How was your post-surgery recovery? (i.e. how long until you were out and about? How long until you felt the swelling/bruising and all issues related to your surgery was well behind you and that you were able to move on with your life?)

    6. Do you feel Dr Mendelson listened to your wishes, and gave you the surgical result that you actually wanted?

    7. Did your surgery make your cheeks look more model-like glamorous and jaw-dropping, or was it a more “subtle” improvement?

    8. On a scale of 1 to 10, how happy are you with the results of your hydroxyapatite cheek augmentation/concentric malar lift? Would you recommend it to others?

    Thank you kindly. :ty:

    Also anyone else who has had any experiences with Dr Mendelson, you are more than welcome to post your story... :biggrin:
  2. 1. I achieved a very significant lift. They looked fuller and higher. Looking back at old photos, my jawline was less defined because of the soft tissue sitting in the area, He basically took soft tissue from the side cheek and lower jaw area and moved it to the center.. Then he used hydroxy to further define the shape in the mid cheek an anterior projection.

    2. I never use it for my orbital rim.

    3. I never ued it for my temples either. Mine was concentric malar lift plus hydroxy in the midface and anterior projection area. Also had it for chin to replace a dodgey implant that was causing me pain. He also added some along the jawline too to give me definition

    4. I had no complications. But because of the concentric malar lift, i am unable to get lateral canthoplasty. Back when i got it done 5-6 years ago, Dr Mendelson would approach the mid facial bone from the lower lid. While i do not have any complications, the fact that my lower lid had an incision there from a previous surgery didn't allow me to get the lateral cantho since the muscle there is weaker now. Should i get a lateral cantho then there is a chance the red in my eye may show. However, i spoke to Dr Mendelson 2 months or so ago and he actually has now come up with a different technique to do it through the mouth.so that's not an issue anymore.

    5..recovery wasn't easy. It was as bad as when i had my jaw reduction. Felt like crap for 5 days then it was fine. One eye was red for a week as the incision was from the lower eyelid. Vision is fine tho nothing damaged or anything. But like i said now he does it through the mouth. Should have waited 6 years for him to come up with a new technique lol!

    6.He got me as close to what i wanted. Admittedly i had very unrealistic expections. I actually showed him pictures of a model (who looked nothing like me lol) i would like to look like. In my younger days i was rather dillusional but now i acknowledge that a surgeon can never make you look like someone else, but rather enhance your features according to what available structure you may have. Dr Mendelson is very patient orientated, and is the exact reason why i always go back to him for advice over any surgeries i have. He is also the most knowledgeable surgeon i have come across. My respect for him is due to the fact that should he feel there is another surgeon who can do a better job than him on a procedure, he will not hesistate to refer you elsewhere. Which is what happpened when i asked him to fix my nose. He said anything with facial bones he is very confident, but because my nose is complicated he feels there are other surgeons who are more skilled in that speciality than him.

    7. Mine was subtle but significant at the same time. Its not like i wasn't recognizable, but people noticed the definition and commented on it.

    8. Im very happy with it.Whether i would recommend depends on the person and what they are looking for. If you are a young asian, with thicker skin and a fuller face do not get that procedure. It might make the side of your face slim down signficantly, but it will make your mid face way too full like you had too much fillers. This procedure is very good for caucasians or asians with thinner skin and faces which are not fulll as it not only slims down your side it gives you significant projection.
  3. #3 Apr 26, 2014
    Last edited: Apr 26, 2014
    Thank you so much for your help K Couture. :smile:

    I myself am caucasian and want the apples of my cheeks to be fuller and elevated much higher. Furthermore I want the classic chiseled high cheekbones visible on the outer corners of the face.

    May I ask by lifting your cheeks, did it also soften/reduce your nasolabial folds on the outer corners of your mouth/nose?

    And BTW - since having the surgery so many years ago, have you felt the hydroxyapatite has reduced/absorbed (is it truly permanent?), or that your cheeks from your concentric malar lift have dropped back down whatsoever/fullness of your cheeks has lessened - because I have heard cheek lifts can in fact relapse?

    Also apparently the scars under the eyes will heal to be invisible. Do you agree or are you finding yourself still possibly having to cover up the scars with make-up?

    Personally, my key concern with the surgery is (a) lower lid retraction in which the lower lid pulls down (don't think going through the mouth will be an option for me, as I need the hydroxyapatite also in the orbital rim), and (b) the thought of spending the rest of my life with any residual discomfort in my face.

    When I mean discomfort, I mean numbness/loss of sensitivity to the cheeks/lips for instance, tension/tightness/pulling sensations when for instance smiling/talking or blinking my eyes, dry or sore eyes, motor nerve issues, etc...

    Can I ask if you ever considered fat grafting/transfer as an alternative to this surgery?

    For me personally, i'm not sure i'm comfortable with the idea of traditional plastic implants (and spending the rest of my life with pieces of plastic inside of me that can get infected and need removal at ANY TIME until the day that I die), but the idea of fat grafting/transfer is promising....

    Though I have heard it may end up looking uneven/lumpy, the possibility the results won't be permanent, and that some people look bloated/puffy/fat-faced after undergoing fat grafting/transfer to the cheeks.

    If you know of anyone in Australia (or even overseas) that does quality fat grafting/transfer to the cheeks, feel welcome to tell me...;)

    I just want to ensure I don't make a costly and time-consuming (and possibly even life ruining...after all it's surgery) mistake by undergoing the wrong cheek augmentation procedure.

    Dr Bryan Mendelson is likely the best in Australia and I love the idea of using coral to augment the cheeks, but I have considered exploring the idea of travelling to the United States and seeing maybe Dr. Michael Yaremchuk (then again, he uses traditional plastic implants which I am not sure I feel comfortable with).

    I think I recall reading you did something similar in that you also travelled around to meet with surgeons and learning their techniques, before settling on Dr Bryan Mendelson? (apologies if I am mistaken).
  4. did dr mendelson tell you that you cannot go through the mouth? The scar on the lower lid was dissolved with kenacort injections. However, while it is not visible, the texture on the rim of the lower eyelid has become somewhat smooth and slippery so i cannot use pencil eyeliner as it does not stay on. I use liquid now lol.

    My procedure did soften/reduce my nasolabial folds and i have not experienced my cheeks dropping back down. Whether the hydroxy got reabsorbed, im sure some of it did. Its meant to. Mendelson actually will put more than you require for that reason as some of it always gets reabsorbed. How much gets reabsorbed i do not know unfortunately. All i can say is i have not noticed any difference since i have gotten the procedure years ago.

    Also if you can concerned about discomfort, ask Dr Mendelson the chances of nerve damage and if any of his patients have experienced it. He will give you an honest answer. He is very upfront and emprical when it comes to statistics. I actually can't remember the answer at this point in time since we discussed these issues a while ago but he provided me with percentile chances of a)temporary motor nerve damage b)temporary sensory nerve damage c)permanent sensory nerve damage d) permanent motor nerve damage. The latter two are really important ones to consider but i recall the likelihood is less than 1% for the motor nerves so i wasn't too phased by it;

    I never considered fat transfer as an alternative, at least not for the cheeks. For me beauty is a slim angular and defined face. I personally find the asian doll face aesthetic very unattractive because as an adult, i feel that there is nothing sensual or sexy about looking cute or adorable. The fat transfer will give the look of fuller cheekbones, not higher and sharper features which is what i consider beautiful.

    Here's the pros and cons tho. Concentric Malar Lift is permanent. Which means it is also irreversible. This is because once the procedure is done your soft tissue ends up fusing to the new position whilst healing. Not to mention the nature of the procedure would be too unpredictable when attempting to reverse it. It is impossible to control and be exact on how much soft tissue to put back into place and in what place as they were all taken from the cheek, lower jaw area etc and lifted to ONE AREA. That being the mid face. Reversing it would thus be impractical.

    The hydroxy fuses with the bone and is readily accepted by your body. But in instances where a patient wants to remove it, they will have difficulty removing it unless it is Dr Mendelson who is the one doing the job. Reason is because this form of implant and technique is only mastered by very few surgeons, and Dr Mendelson is the one who invented it. Many other surgeons would not be able to differentiate the nerves and the hydroxy within facial tissue where there's been prior internal scarring.

    The good thing about silicone implants is that it can be easily removed. Bad thing is there's a chance for it to deviate. Some surgeons may insert titanium screws to hold the implant in place, but then should it need to be removed it wouldn't be that easy either. Also unlike hydroxy, the volume and shape required cannot be moulded to suit your bone structure.

    I travelled overseas to meet surgeons for rhinoplasty revision. With the malar lift i was set on Dr Mendelson after seeing several surgeons in locally in melbourne only. Chris Moss, Peter Dixon were just some of them. None of them are anywhere close to Dr mendelson's skill or experience.

    If you are planning to Korea i hope you make it very very very clear that you absolutely do not want to look like an asian doll lol. I think if you fail to specify that, they will shove what they feel is their standard of beauty onto you.
  5. #5 Jul 30, 2014
    Last edited: Jul 30, 2014
    Hi K Couture,

    So sorry for the late response but THANK YOU so much for your above post. I can’t tell you how grateful I am, because as you probably know – finding someone to ask questions about hydroxyapatite augmentation is virtually impossible on the internet as it is such a rare surgery.

    In regards to having a concentric malar lift/hydroxyapatite cheek augmentation performed via an oral incision, apparently it isn’t an option for everyone – as some people need to have the surgery performed with an incision under the eye if there is hollowness that needs to be corrected in the lower eye area. :sad:

    I'm a little confused - have you had your hydroxyapatite from your cheeks removed? I recall reading somewhere that you had the hydroxyapatite removed because of too much projection/elevation?

    I am just petrified, because I have heard any such surgery via an under-eye incision could cause lower lid retraction. I know you stated in another post that following the surgery, your eyes now look “slanty”. Could you please elaborate on that? Is it really bad? Do your eyes look wonky or asymmetrical?

    I am also petrified at the idea of my eyes looking smaller after surgery. I don’t know if it’s true or not, but I have heard that when someone has surgery around the eyes – it can result in the eyes looking smaller (which would be horrible for me personally because I already have small eyes). Do you think your eyes look smaller after surgery or that I may be at risk of it happening to me?

    A part of me just wants to go down the avenue of fat transfer to bypass such complications – but i’m not sure if fat transfer to the cheeks can elevate and lift the apple of my cheeks and also create high glamorous cheekbones - or instead if it’s just going to make my face look fat and round (and not produce high, sharp and defined cheeks like I want). :confused1:

    Do you really believe a combination of a concentric malar lift/hydroxyapatite cheek augmentation can create high & chiselled mode-like glamorous cheekbones with a higher & fuller anterior projection of the apple of the cheeks? Furthermore – did you have a fluid test where Dr Mendelson injects a fluid into your cheeks that for a short period of time helps visualise what the surgery results would look like (do you feel your fluid test if you indeed had it done – accurately represented your final surgical outcome?).

    What is your opinion of this surgery as a whole K Couture, as somebody who has undergone the procedure? I am really serious about the surgery and I know it is expensive – but just a tad nervous.

    BTW – just want to reconfirm you don’t have any lingering motor nerve/sensory nerve damage (like inability to move parts of your face properly or numbness), on-going pain, or general discomfort/problems in your face since your recovery?

    Thank you so much again K-Couture! :smile:
  6. lol so many questions. I'll try to answer them all. Forgive me if I miss a question or two.

    About the incision site, I'm not sure if there are limitations to do it intraorally. I was simply told by Dr Mendelson a couple of years later he know has refined a technique to do it through the mouth.

    I had some hydroxy removed at my anterior projection. Because when i first got the surgery, i kinda photoshopped myself in a ridiculous way and when i showed it to dr mendelson he said "oh you want it that high and sharp?" And i said yes lol.....few years later i felt my anterior projection was a bit too high so i removed the hydroxy in that region. However, he left the hydroxy in the hollowed mid face area as the projection and volume there is ideal for my facial structure. So my advice to you is be conservative unlike me who went the extreme at first then had to tweak it later on.

    Correct it can cause lower lid retraction. Which is why i was quite glad to tell you that he could do it orally. I never got lower lid retraction tho. Dr Mendelson is very skilled after all. However, procedures like mid face lifts have a tendancy to cause some slantiness if the lift is too much. Mine was very minor and is mostly because of the anterior projection which i have since removed. Now the eye is close to the original state because there is no longer an implant in that region pushing the tissue upwards as that region is closest to the edge of the eye. Like i said be conservative is always ideal.

    Fat transfer creates a softer more volumized look, while hydroxy creates a more defined look. Id go with hydroxy since the latter is your preference.

    I never had the saline injected. I was given the option but as for the results i was looking for was more than mere volumizing, i was looking for a very angular look so his placement of hydroxy for me differed to other patients. The way he performed the concentric malar lift differed too because i had pre mature sagging from my jaw reduction. So he concentric malar lift reversed that effect completely. I also have zero nasiolabial folds because of it. As you can tell i love the concentric malar lift for what it had done for me. I hear people complaining of discomfort from parasnasal surgery and i realized how lucky i was that I am able to remove the sagging and creases I previously had without the use of uncomfortable implants.

    I am very glad i had this procedure done. The concentric malar lift went perfectly. Only thing is i wished i was more conservative with the hydroxy at first, not for the hollowed part of my mid cheek bone but at the anterior region. My advise to you is also to consider your tissue density. Do you have very thick skin? If so you may either want to forgo the concentric malar lift or do a minor lift. People with thicker skin who do too much of a lift can end up with those mariah carey chipmunk cheeks. Hence it is really more ideal for caucasians i believe as caucasians tend to have thinner tissue.

    Hope that helped :smile: