Custom Cheek-Infraorbital Implants

Q: Dr. Eppley, is it possible to get custom cheek-infraorbital implants done for the aforementioned region with a thickness inferior to the 2mm (like in the 0.5 – 2 mm range)? I am young, but I have a thin face with very little facial fat volume, and I really think that medium sized implants would look already excessive on me. Thank you very much for your attention!

A: Custom cheek-infraorbital implants are made from the patient’s 3D CT scan using implant design software. They can be made as thin as about 1.5mms. Any thinner and it poses manufacturing processing problems. Even if they could be made thinner, there would be no practical reason to do so as a 1mm or less  change on one’s face would not be detectable and this would not be worth the surgical effort.

Dr. Barry Eppley

Indianapolis, Indiana

Breast Implant Removal

Q: Dr. Eppley, I am interested in breast implant removal. I had a breast augmentation done in April of last year by you. I had 375cc round moderate plus silicone implants. I am 5’3 and 105-110lbs. I am considering breast implant removal just because I don’t feel like myself. I was a 32B previously. I haven’t had any issues with them. I love the results and think you did a wonderful job. I just don’t feel like myself and am considering getting them removed. It is faster to contact me through email. Thank you so much! 

A: Thank you for the long-term follow-up on your breast augmentation. I don’t really have much to add to your desires as this is just a personal choice on your part. I would say that it is also important to know that your breasts will not return completely to their presurgical shape due to some tissue stretching. Their preoperative size may return but they will feel ‘looser’ with a little more stretch of the breast tissues. Whether that will be a significant aesthetic issue for you after surgery can not be predicted before their removal.

Ultimately this is a very personal decision and very rare in breast augmentation surgery. But just like in facial implants an occasional patient just not feel or like themselves and undergoes removal of the augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Body Lift

Q: Dr. Eppley, I am very interested in getting a Body Lift. I’m 5’8″ and 115 lbs with not a lot of extra fat. What does the Body Lift include? Would be interested in buttock/breast augmentation, but I’m 50 years old. Very unhappy with my appearance. Thanks!

A: When one uses the term ‘Body Lift’ this typically refers to bariatric patients who have lost a lot of weight and have much loose hanging skin as a result of a general body deflation. Body lift surgery is when much of this hanging skin is removed around the waistline and the body is lifted, much like pulling up one’s pants that have fallen down. At 5’8″ and 115lbs I don’t think you are referring to classic Body Lift surgery.

I suspect what you really mean is that at your very lean weight you do not have much of a figure due to a reasonably low body fat content. Thus you have specifically identified breast and buttock augmentation (breast and buttock implants) to help create some ‘curves’ so to speak. Such body augmentation may indeed create a form of body lift in you. Pictures of your body would help clarify what you exactly need in your quest for a ‘Body Lift’ procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Smartlipo

Q: Dr. Eppley, I’m looking to remove excess fat from flanks, abdomen and pubic area. I’m looking for minimal scaring and  down time. (not looking for traditional liposuction, more like Smartlipo) I have attached some pictures of my areas of excess fat concerns. It would be great if I could have the procedure on Friday and be back to all normal things by the following Monday. 

A: Thank you for sending your pictures. While fat reduction by liposuction can be very effective for your concerns, you are mistaken about how it is done. Any form of liposuction is going to entail the identical recovery and downtime. All forms of liposuction are invasive and traumatic, including Smartlipo, and should never be considered ‘minimal downtime’.  Anything that leads you to believe otherwise is marketing promotion and is misleading by whomever wrote or said it. In short there is no easy way to get rid of a lot of fat. Liposuction surgery is still the most effective way but it is a surgical process with significant trauma to the body and a very real recovery. Smartlipo is not different in this regard no matter how it is promoted or marketed.

Dr. Barry Eppley

Indianapolis, Indiana

Temporal Artery Ligation

Q: Dr. Eppley, I am exploring the temporal artery ligation procedure and wanted to ask a few quick question. 1) How many such procedures have you undertaken? 2) Where is the blood flow diverted to when the temporal artery is ligated? What are the chances that other veins visible on the forehead will swell/dilate in response to increased blood flow? 3) What is the estimated cost to have the procedure done on both sides of the head? Thank you.

A: Temporal artery ligation is a diverse group of procedures whose each number of ligations points will vary per patient. I have done over 50 patients for these type of ligations and each one is unique in some way. I would need to see pictures of your temporal areas that show the visible vessels for an assessment. Ligating temporal vessels at any point along their course does not divert the blood flow. Rather it dampens or eliminates the pulsations and visible arterial course by shutting off flow into that section of the vessel along its prominence. I have not yet seen that such ligations promote dilatation of other surrounding vessels particularly when the ligations are distal to the main trunk of the superficial temporal artery.

I will have my assistant pass along the general cost of the procedure to you tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Glabellar Implant

Q: Dr. Eppley, I’ve been struggling with the depression in my forehead, there’s irregularity like a W where the bones right above my eyebrows seem to be swollen to the outside with a depression in the middle.. It makes me look as if I’m frowning all the time. I’m looking for a permanent solution to my problem. Is there one? Is there such a thing as a glabellar implant?  If so will you please advise me of the price and if insurance would cover even part of the treatment? I have attached 2 pictures, please let me know if they aren’t clear enough.Thank you so much doctor.

A: Based on the pictures you have shown and by your description, this is most consistent with a glabellar bony depression between the medial (inner) ends of the brow bones. This is a much more common lower forehead shape in men than in women. I will assume that you have tried Botox injections so we know that it is not problem that is solved by muscle relaxation.

Assuming that the shape of the underlying bone is the main culprit, your options are two fold. One approach is with fat injections to thicken up the vertical soft tissue indentation. The potential success of this approach can be determined before surgery with simple saline injections. While this is the simplest method of tissue augmentation its ultimate success depends on how much fat takes and persists…which can be unpredictable.

The second approach is the placement of a glabellar implant. Inserted endoscopically through small scalp incisions. Such an implant fills in the depression or hollow between the bony eyebrows. Its volume retention is assured. 

Dr. Barry Eppley

Indianapolis, Indiana

Rhinoplasty Recovery

Q: Dr. Eppley, I have a question about my rhinoplasty recovery. I recently had surgery on my nose for a breathing issue out of the left side of my nostril and am 3 1/2 months post op, I was diagnosed with a collapsed septum and was recommended Septoplasty. I was referred to a local Otolaryngologist from my in network primary care physician and inquired about the surgery. At the time of the consultation I asked if a small spur on the side of my nasal bridge could also be removed (Not the dorsal profile) while they preformed the surgery. I was told it could and envisioned the nose I had without the spur and better breathing functionality, unfortunately now post op I feel my profile has been changed and my nasal tip now seems more lifted and my nostrils are more visible. I also believe my nose has been narrowed and appears wider due to the dorsal line being adjusted. My nose also appears crooked due to the refined definition. Along with that I am experiencing swelling in my top lip and from eyebrow to eyebrow with a tight discomfort in the middle of my head. With all that being said here are a few questions I have:

1: Can I expect my nasal tip to drop as the swelling subsides and when the swelling subsides and the skin relaxes do things expand?

2:Do you personally have any experience with a patient who has experienced tight swelling and discomfort in there forehead and lower lip for that long of a time frame? It’s been present since surgery.

3: In regards to revision surgery after the swelling subsides and if I am still unhappy can the profile be restored?

I have attached a comparison photo.

Thanks In advance.

A: Thank you for your inquiry and detailing your recent nasal surgery. As I have no knowledge as to what was actually done structurally during your nasal surgery I could not remotely comment on what its long-term effects would be. I can, however, make some general statements about rhinoplasty recovery:

1) Whatever nasal tip decent is going to occur, it will most likely have occurred by six months or so after the procedure.

2) The persistent tightness sensations in the forehead are not symptoms that I recall having had a patient mention before.

3) Tightness in the upper lip, however, can be present after surgery and can take months to subside…depending upon what was actually done.

4) Profile restoration and tip derogation can always be done secondarily if needed.

I would give yourself a full six months and then ponder #4.

Dr. Barry Eppley

Indianapolis, Indiana

Jawline Implant Recovery

Q: Dr. Eppley, I have some questions about my jawline implant recovery. In terms of the swelling, it has gone down dramatically and almost feels like it used to before surgery. I also finished my antibiotics, and I no longer take any advil or pain medication (just a little pain when I eat). Since I have been exercising regularly (including cardio) is it possible that the swelling goes down more rapidly then more sedentary folks?

I am looking at my reflection and it looks like the face is a bit longer and leaner looking and has a bit more prominent cheekbones and chin; however, I am already starting to think we might have wanted to go with a more projected, square chin and a bit more flaring jaws to make the face look more masculine. I will reserve final judgement until Memorial day, as you mentioned. Do you think it the shrinkwrap phase will make the face resemble the images we photo shopped as time goes on? Any thoughts about what I’m seeing currently?

A: Thank you for the early progress update. At just three weeks after surgery, it is not possible to have all of your facial swelling to be gone…maybe 70% or so but it not a complete process yet. To help you with some practical milestones, here is what you should be looking for in your jawline implant recovery:

Phase 1 – One month afer surgery – resolution of 80% of swelling, healed incisions with loss of most of the sutures, restoration of completely normal mouth opening and return too full diet, no signs of infections (most infections occur within the first month after surgery.

Phase 2 – Two months after surgery – resolution of 100% of swelling, onset of shrink wrap effect with ongoing presentation of implant definition, normal feeling of most facial areas, no signs of infection (if there is no infection by this time this possibility is very unlikely)

Phase 3 – 3 months after surgery – shrink wrap effect complete, psychological adaptation to new facial appearance complete.

As you can see by this timetable and milestones, this is an evolving process that is to fully complete until three months after surgery. You are only approaching the end of phase 1. How phase 2 and 3 will affect your perception of the result remains to be determined. 

On a final note, as I have mentioned before, how the implant dimensions and the results they will create will turn out is not an exact science. We have made the best guesstimates we could with the over riding design principle that we don’t want the implants to be too big. How successful we are in that regard awaits the completion evolution of the recovery process.

Dr. Barry Eppley

Indianapolis, Indiana

Permalip Implant

Q: Dr. Eppley, I need advice. I want a permanent solution to my thin upper lip. I had braces as a child but still have a toothless-looking, thin-lipped resting expression. When I smile or make sure to hold my mandible apart, I have a nice mouth, and I have had small amounts of restalyne before that did not last long. I want a permanent solution and need to know if implants are the answer or a dental procedure of some kind. Thank you!

A: Thank you for sending your lip pictures. Lip implants work best in patients that already have adequate vermilion exposure…which you do.  The implant needs enough vermilion tissue to be able to safely surround the tissues and to push both out and up. So I think you are a good candidate for a Permalip implant in your upper lip if you are looking for a permanent augmentation method.

Permalip implants, like all facial implants, have their disadvantages of which asymmetry or implant malposition is the most common. Its smooth surface allows for good introduction and passage through the tissues and for uncomplicated removal if needed. But this very smooth surface is also what causes it to short inside the capsule in some patients.

Dr. Barry Eppley
Indianapolis, Indiana

Forehead Augmentation

Q: Dr. Eppley, I am interested in forehead augmentation to create a wider, more masculine forehead with a custom implant. My forehead is very narrow and convex for a male. From my research I’ve come to realise that my limiting factor is the positioning of my anterior temporal lines. They are too close to the centre of my forehead. I know that designing an implant that extends beyond these lines may be aesthetically problematic. Is it possible to design an implant that covers both the temporal and forehead areas to sidestep this issue? How important is the ‘crossing the anterior temporal lines’ issue? Is it a completely preclusive one, or may the patient insist on going through with widening the forehead regardless?

A:When it comes to forehead augmentation, crossing the temporal lines with the traditional use of bone cements was always problematic because it was impossible to get a smooth transition into the the temporalis muscle area. (which is what lies on the outside of the temporal lines) But with the use of today’s custom forehead implants made from a 3D CT scan, where the edges can be made very smooth, such transition concerns are now minimized. This creating a wider or more lateral anterior temporal line demarcation can now be reliable done in an aesthetic manner.

Dr. Barry Eppley
Indianapolis, Indiana