Archive for February, 2012
Wednesday, February 29th, 2012
Q: Dr. Eppley, I have had injectable fillers placed along the back side of my jaw to give me more of a sharper angle appearance. It was Radiesse and it took two full syringes to get a modest effect. The result was good but I wished it was stronger and more pronounced. I have heard that if you keep getting the fillers they will build up overtime and you will get a permanent effect. Is this true? If it is not, then do you think jaw angle implants will give me what I want?
A: There are no synthetic injectable fillers currently approved in the U.S. that are permanent. So it is not true that repeat treatments of any injectable filler will lead to a long-lasting build up of any facial bone site. Most certainly injectable fillers are not a substitute for the volume and permanency that can be provided by jaw angle implants. What your injectable filler treatment has done is to demonstrate that augmentation of the jaw angle region is aesthetically beneficial for you. That can be very helpful when uncertain if such a facial change is worthwhile. This should give you the confidence of proceeding forward with this implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, jaw injectable fillers
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Sunday, February 26th, 2012
Q: Dr. Eppley, I am very unhappy with the result of a rhinoplasty that I had done two years ago. It was a closed rhinoplasty and I wanted to have a more refined and pretty nasal tip. It has ended up, however, being just a balled up fat tip with nostrils that now look bigger. What type of rhinoplasty do I need now to fix it? And can it be fixed?
A: Thank you for sending your pictures. What appears to have happened is that you have lost cartilaginous support of the tip due to overresection of the lower alar cartilages and the caudal end of the septum. The thick overlying tip skin has now just contracted inward without adequate support, resulting in a ball-like tip with excessive nostril show. Your nasal problem most definitely can not be fixed by any closed rhinoplasty method. It will need a rhinoplasty revision using an open approach and cartilage grafting to restore support for the tip to create a more natural shape and decrease nostril show. You will need a columellar strut graft and alar rim grafts to help correct the retraction as well as tip reshaping. These type grafts are best placed through an open rhinoplasty, particularly in the face of a nose that has scar from prior surgery. Presumably these cartilages grafts can be harvested from the septum and the ear.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty revision
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Saturday, February 25th, 2012
Q: Dr. Eppley, I had a chin implant, neck liposuction and a submentoplasty with fat removed under the platysma muscle one month ago. I am 32 years old and had a double chin that could not be improved by any other method. I wore a neck compression garment faithfully for three weeks after surgery. Despite this, I have very visible lumps and creases which did not exist prior to surgery. Will this resolve? What else can I do to help?
A: A submentoplasty combined with liposuction is a very good but aggressive procedure for neck recontouring. There is no question that it can do a good job of removing fat and tightening muscle, significant anatomic changes to improve a neck profile, but it does not remove skin. Thus it relies on the elasticity of skin to shrink down and produce the final shape. It is not uncommon for this procedure in some patients to end up with skin redraping issues. (irregularities, indentations, creases) That is the one knock on the procedure in my experience. It is still early so some of these skin issues will definitely get better with time. Whether they will completely go away remains to be seen and I doubt if there will be 100% resolution. But this is an issue of time and you will know more by six months after surgery. You would probably benefit by neck treatments such as massage or Exilis treatments which can help with skin smoothing and now is the time to do them before a lot of scar sets in.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, neck liposuction, submentoplasty
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Saturday, February 25th, 2012
Q: Dr. Eppley, I have a question about Kryptonite bone cement. Can it be used to build up the jawline. I was born with hemifacial microsomia and my jaw on one side is short not very full. My bite has been corrected by a jaw osteotomy previously but the overall side of the jaw is still small and too thin. Would this be a good use for this type of bone cement material? Also what would happen it is got infected after surgery?
A: Kryptonite bone cement is FDA-approved for all craniomaxillofacial bone applications whether it is as an inlay, onlay or any combination thereof. Therefore, it is appropriate to use it as an onlay augmentative material for the mandible or any other facial bone for either reconstructive or cosmetic indications. So it could be safely used for jaw onlay augmentation.
Having 20 years experience as a craniofacial plastic surgeon with a lot of experience in biomaterials in the craniofacial region, Kryptonite has a very steep learning curve with its use. It handles completely different than every other bone cement material used in craniomaxillofacial surgery. It would also be a challenge in getting into a site with difficult access such as the jawline. What I have learned in complex cases like yours is to first get a 3-D craniofacial model made from a CT scan. Then use that either to premake the desired implant for other synthetic materials or use it sterilized during surgery to custom make an implant intraoperatively out of Kryptonite. This will help tremendously in getting the best contour shape and in its placement.
Once an implanted material gets infected, Kryptonite or otherwise, antibiotics will not usually solve it. The material must be removed to cure the infection. The material is simply inoculated, particularly a porous material, and you can’t get rid of the bacteria with drugs alone. They will only provide a temporary amelioration of the infection which will return as soon as the antibiotics are stopped. Clearly this is a problem to be avoided which is why I always mix in antibiotic powder with any bone cement material in the preparation process.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw augmentation, kryptonite bone cement
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Saturday, February 25th, 2012
Q: Dr. Eppley, I am 22 years old and am bothered by my small lower jaw. It is small with about a 1/2 inch discrepancy between my upper and lower teeth. I really dislike my profile. I had an appointment with an orthodontist last week and he recommended getting braces and then having a lower jaw advancement. This sounds too extreme to me. I was wondering if I can just get a chin implant if I’m that unhappy with my looks. If you were me what would you do?
A: Your dilemma is a classic one and the decision is ultimately affected by a patient’s age, whether they have any masticatory functional symptoms, the magnitude of the jaw discrepancy and what they are willing to go through. From a long-term standpoint at your young age, both functionally and aesthetically, you should have the combined orthodontic and jaw advancement surgery. It is most certainly not extreme and is a routinue maxillofacial surgical procedure. A chin implant, while comparatively simple and providing an immediate aesthetic benefit, would offer no functional improvement for your bite, jaw function and TMJ health.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, dr barry eppley, indianapolis, jaw advancement
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Saturday, February 25th, 2012
Q: Dr. Eppley, I have a problem from a previous closed rhinoplasty. I am very unhappy with the tip of my nose. It has been lifted too high and this has exposed my nostrils unfavorably. It also makes my face look flat. What I want is correction through a closed rhinoplasty. Will that work for me and my nose problem?
A: When the nasal tip becomes too shortened after a rhinoplasty, it will produce a set of classic aesthetic issues including an obstuse nasolabial angle with excessive nostril exposure. It can be corrected through tip lengthening/de-rotation through cartilage grafting. This is not best done through a closed rhinoplasty. The grafts would be hard to place and secure through such limited visualization. An open rhinoplasty would provide much better exposure to accurate place tip grafts and/or septal extension grafts to create a de-rotation effect. The one exception to this approach is if the amount of tip lengthening needed is small. Then the placement of limited tip grafting could be done through a closed approach. I would need to see photos of your nose to determine which rhinoplasty approach may work for your revisional surgery. The only question I would ask is what is the basis for your deference to an open rhinoplasty? The scar is inconsequential and the results are more consistent and superior.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty revision
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Saturday, February 25th, 2012
Q: Dr. Eppley, I am a 27 year old man and I’m thinking to have a surgery to reduce the size of my brow bone. My question is if the look of my eyes would change. Because I have read in other forums that such surgery might change the deep of my eyes of which I love their appearance. I would appreciate very much your esteemed opinion to my concern. Is it justified or not? Thank you very much.
A: It has not been my experience that the depth of one’s eyes appears any different after brow bone reduction surgery. This is because brow bone reduction in men, in particular, is about changing the bulge or convexity of the anterior table bone of the frontal sinus. It does not change very much the lowest edge of the brow bone or reduce it posteriorly which would make the eyes look less deep. I would have to see some pictures of you, particularly from the side view, to make that determination more specifically however.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, indianapolis
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Saturday, February 25th, 2012
Q: Dr. Eppley, I am having a tummy tuck later this spring and look forward to a beach vacation this summer with my new body! My question is how soon after surgery can I begin tanning? If I have my surgery in May could I get into the ocean by July? How much time should I allow between surgery and these activities? I don’t want to do them too soon and affect my results but I know I will be anxious to do them.
A: The answer to both questions resolves around the tummy tuck scar and making sure it is healed enough to not be affected by these activities. Getting into ocean water, which will have organisms in it that do not occur in chlorinated water, should be deferred until 6 to 8 weeks after tummy tuck surgery. At this point, you should be well healed including any small areas of potential suture extrusions. The effects of tanning and sun exposure on your tummy tuck incision, however, is a much different concern. Both tanning bed and sun rays can adversely effect how the scar may eventually look so such exposure should be deferred until it is well healed for at least three months after surgery. If you must use the tanning bed, I would cover the tummy tuck scar with tape until then to block these undesired rays.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tanning after a tummy tuck, tummy tuck
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Friday, February 24th, 2012
Q: Dr. Eppley, I have saline breast implants placed under the muscle now 11 years ago. I have been very happy with them and have had no problems at all. I was originally told by my plastic surgeon that they will last anywhere from ten to twenty years. Now that I am past the ten year mark, I am wondering if I should just have them replaced now since a deflation could happen anytime now.
A: It is important to realize that breast implants are not life-long devices. They will eventually fail, which means the containment bag will develop a leak. With saline this means the fluid is coming out and the implant will deflate with an external flattening of the involved breast. How long saline breast implants will last and when they will deflate can not be accurately determined. While your breast implants are living on borrowed time, I see no reason to preemptively just replace them. You might as well get the value out of them for as long as you can. While this will someday result in a breast implant ‘emergency’, it can be replaced within a matter of days with no significant recovery. (unlike the first time)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, saline breast implants deflation
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Wednesday, February 22nd, 2012
Q: Dr. Eppley, I need your help as I have no jawline. My chin is very short, the neck seems to be missing and it appears as I almost have no lower jaw. This gives a profile that I am very self-conscious about. I make every effort so people don’t see me from the side. I know you are an expert in facial surgery based on your writings and patient photos so what do you recommend?
A: Lack of a well defined jawline and neck angle can be due to any one or combination of the following; chin/lower jaw bone prominence, fullness/fat in the neck and loose neck and jowl skin. Most commonly, the combination of a chin implant and neck liposuction can make a dramatic difference in the younger patient who often has a short chin and full neck. In older patients the sagging skin factors in significantly and some form of a jowl or necklift may be needed. There are exception to these two categories, such as the early aging facial patient with a good chin prominence who just needs some neck contouring through a procedure known as submentoplasty. But when someone describes themselves as having ‘no jaw’, this would indicate the problem is more than just one of the three anatomic components that make up the neck angle and jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, dr barry eppley, facelift, indianapolis, neck liposuction, submentoplasty
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