Are Buttock Implants In Men Different Than Women?

Q: Dr. Eppley, I am a very very thin Asian male that is looking for buttocks enhancement to get more of a Hispanic or Afro looking buttocks that is more perky and with a lot of volume. Because I am thin I know that fat grafting is obviously not an option so from what I know, implants are my best bet. I am looking for more of a shelf with augmentation in the upper buttocks area but as well as more outward projection to the entire thing…protrusion up and out. I would like to go for bigger implants if possible (that are within reason). I do a lot of physical activity such as dancing, running, biking, you name it. From my understanding placement can be from most superficial to deepest, subcutaneous, subfascia, intragluteus maximus or under the gluteus maximus. I have heard that intramuscular is best for augmentation towards the top but for more actual outwards projection, subfascia is better because the space is larger and because intramuscular would make it close to the sacral nerve which is dangerous. My questions therefore are as follows:

What would you agree is the best placement for somebody of my build with my goals? 

I understand that this is based on softness of the implant, but why would anybody want to have a harder implant over a softer one?

Because I’m trying to aim for more of as a shelf as well as projection additionally, is it possible I might need different implants placed in different spots?

What would be the max size you would put in somebody of my thin male Asian build?

What kind of buttock implant shape is best?

A: Thank you for your thoughtful inquiry and insightfiul questions. A male getting buttock implants is uncommon but certainly not unheard of. There is no question that the best long-term results for buttock implants is in the intramuscular position. (never completely submuscular as this is where the sciatic nerve lives) This follows a general rule that the deeper an implant is placed and the more well vascularized soft tissue cover is over it, the better it is for the implant and the fewer complications that can ensue. But when looking at your aesthetic goals, an intramuscular implant can not achieve the buttock size and projection that you seek. Thus, only a subfascial implant placement will work. This will allow for a larger buttock implant size and it will have more lateral and posterior projection. A round shaped buttock implant is what you want to use. (oval implant can rotate in the subfascial plane which can create an obvious problem)

It is hard to know without seeing you and taking measurements as to the maximum implant size that you should get. But certainly I would not think bigger than 450cc to 500cc

Buttock implants are made of a very soft gel elastomer which feels very much like muscle. There is no reason to use a harder implant durometer.

You never want to place more than one implant for any body area, the buttock region notwithstanding.

A primary concern in any buttock implant patient is that they take teh required time to allow the tissues to properly encapsulate the implant befire beginning any strenuous activities. It would be well advised to wait at least four to six weeks before doing so. Seroma formation is the number one complication in buttock implants and a primary cause is too early physical activity.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Have A Subnasal Lip Lift With Braces On?

Q: Dr. Eppley, I’m wearing braces and the distance between my upper lip and nose is short maybe 1.2 cm now. But I know that if I take off the braces the distance will increase to 1.4 or 1.5cm. I don’t want to do lip augmentation. I want the lip lifting procedure and I want to do it wearing braces. Is that possible?

A: Having orthodontics appliances in place does not impede the ability to do a subnasal lip lift. The question is whether one can tell how much to remove so as not to end up with an overdone result. Subnasal lip lifts that have had too much skin removed have no recoverable strategy…you can’t put back the skin that was removed without a very visible graft under the nose. If your calculations are correct you would do a 3mm skin resection for your subnasal lip lift. If you have do do the lip lift before your braces are removed just make sure it is a conservative amount of skin removed. Removing your braces ma result in the lip lengthenng a few millimeters. But since you have not done that test (remove your braces and measure it), assume that maybe no change in lip length will occur.

Dr. Barry Eppley

Indianapolis, Indiana

Should My Revision Rhinoplasty Be Done Open Or Closed?

Q: D. Eppley, I am contacting you because you are the only surgeon I found that discusses Medpor implants extensively on your blog. I had a rhinoplasty with a tip rotation/refinement using Medpor in my columella topped with ear cartilage. I was healing well; the nose seemed narrowed/slightly more projected. But I was injured and the nose seems to have swollen, derotated, and healed unnaturally. It is more swollen on the left and the entire tip is bulbous.

I’ve consulted two local surgeons with board certification. One suggested revision with a septal onlay graft. Another said that based on the softness and shape of the nose, he could work around the implant in a closed rhinoplasty. He said he could reset the “wings” of the implant that is intended to pinch the sides of my nose closed, remove excess cartilage, and remove “soft tissue”.  

I’m seeking a revision because after the injury the nose changed shape. The tip/dorsum is higher, rounder, and tilts leftward due to prolonged swelling and possible shifting of ear cartilage). I have what appears to me to be pollybeak, especially on the left. Instead of sloping down, the nose sticks out/is projected in a ball away from my bridge. In other words, the tip is an overprojected bulb following the injury–like the pre-op nose with a ball of tissue projected by the implant in my columella. The tissue is soft but fibrous and based on everything that happened I feel I am looking at scar due to prolonged swelling, not curving ear cartilage. The skin on the “injured” parts of the nose is whiter and oiler than the “healed part of the nose which went through no trauma. I make this comparison because there isn’t a surgeon I’ve consulted that sees scar tissue, but I know how the nose was shaped and oriented before injury and don’t know that scar can be removed in a closed rhinoplasty.

Any advice on whether a closed rhinoplasty is really likely to help would genuinely be appreciated. I am caught between the appeal of not going through another open rhinoplasty and the thought that I will pay a hefty price for something that will not actually help much at all.

A: While I have not examined your nose, the question for your revision rhinoplasty is what is the source of the tip problem and what is the best way to solve it. Between the implant and the scar, it is hard to know the bigger source of the problem but in my opinion but need to go. This is best accomplished with an open rhinoplasty with replacement of the implant with a septal cartilage graft.

Dr. Barry Eppley

Indianapolis, Indiana

What Can Be Done For the Big Acne Scar On My Face?

Q: Dr. Eppley, I am interested in surgical scar revision for my box car acne scar. I have undergone microdermabrasion, fractional laser resurfacing, and TCA peel to the area but none of them have had any beneficial effect. It seems like something deeper will need to be done or perhaps just cutting it out. I don’t know as I am not a doctor but none of these other doctors seems to know either.

A:  As you have discovered, none of these superficial treatments are going to work for your type of facial acne scar. This is a problem of tissue atrophy/loss not one of just a more simple surface contour irregularity. Your acne scar surgery options include either excision and geometric scar rearrangement or scar adhesion release and injectable fat grafting. You can first test out how well fat grafting may work by having some injectable filler or even a trial of saline injections done to see if the scarred area will lift up by adding volume by injection underneath it.

Give its size, total excision and a geometric closure is also a consideration. What needs to consider how much tolerance one has for the healing and maturity of a scar on one’s face vs. whether one wants to first try an injection approach before embarking on a ‘bolder’ excisional approach.

Dr. Barry Eppley

Indianapolis, Indiana

Do I Need A Corner Of The Mouth Lift After My Lip Lift?

Q: Dr. Eppley, I recently had a subnasal lip lift which I am pleased with the lift in the center of my lips. Now however, it seems to accent the thin corner of my liplips. Aesthetically to balance out the look, I think this is something that should have been done too. Can a corner lip lift be done with local anesthesia?

A: The subnasal lip lift in the right patient is a very effective lip augmentation procedure but it will only affect what lies within the skin excision pattern. By dropping down a vertical line from the sides of the nose to the lip, the lip area improved will only lie within. In essence, it shortens the amount of vertical skin between the base of the nose and the upper lip and only provides accentuation of the cupid’s bow of the upper lip. It would not be rare to a have a lip lift patient turn their focus to the sides of the lip and the mouth corners thereafter.

Corner of Mouth Lift in Indianapolis Dr Barry EppleyThe key question about changing what was not improved by the lip lift is defining the exact area of outer lip deficiency. This could be either an isolated corner of the mouth lift or an extended corner of the mouth lift that extends further up along the sides of tails of the upper lip. This distinction is critical to understand. An isolated corner of the mouth lift will just change the angle of the corner of the mouth and will not make it thicker. A extended corner of the mouth lift or an outer lip advancement will make the sides of the lip fuller.

I would need to see a picture of your lip to help you decide what is the correct lip augmentation procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Am I A Good Candidate For A Pinch Lower Blepharoplasty?

Q: Dr. Eppley, I’m interested in a pinch lower blepharoplasty and am seeing if I am a candidate for the procedure. I took the picture smiling because the wrinkles aren’t as noticeable when I’m not smiling. I have seen a few plastic surgeons about my options. I do have a little fat under my eyes that I’ve been told could be fixed by filler or moving the fat around. That doesn’t bother me as much as the loose skin, and I’m hoping that tightening the skin will help. I will be fifty in November, but I lead a very healthy lifestyle with regular chemical peels.  If I did the recommended procedures, what is the recovery time?

Pinch Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisA: The difference between someone who needs a pinch lower blepharoplasty technique versus a full lower blepharoplasty is a function of numerous factors. How much loose skin is present, is there an orbicularis muscle roll, presence of any fat herniation and how much loose wrinkled skin do they have. In addition, the age of the patient and how much facial aging they have is also relevant…as pinch blepharoplasties are generally reserved for early signs of periorbital aging. (less than 50 years of age) Your picture is a smiling one so that obscures some of this anatomic information. But clearly you are young and do not have much herniated fat. Thus based on this one picture, I would say that a pinch blepharoplasty combined with a 35% TCA peel for the rest of the lower eyelids and 8 units of Botox for the orbicularis muscle activity per eye would be beneficial. You can’t get rid of all your lower eyelid wrinkles with any procedure, particularly when one smiles, but this would provide a major improvement with limited downtime. Expect one week or less of a ‘cosmetic’ recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Should My Revision Rhinoplasty Be Done Open Or Closed?

Medpor Nasal Implants Dr Barry Eppley IndianapolisQ: Dr. Eppley, I need help in determining what type of revision rhinoplasty I need. I had a tip rotation/refinement using Medpor in my columella topped with ear cartilage. I was healing well; the nose seemed narrowed/slightly more projected. But I was injured and the nose seems to have swollen, derotated, and healed unnaturally. It is more swollen on the left (especially in the tip) than on the right side; the entire tip is bulbous.

I’ve consulted two local surgeons with board certification. One suggested revision with a septal onlay graft/overlay graft in the dorsum. Another said that based on the softness and shape of the nose, he could work around the implant in a closed rhinoplasty (referred to it as a septorhinoplasty). He said he could reset the “wings” of the implant that is intended to pinch the sides of my nose closed, remove excess cartilage, and remove “soft tissue”. 

I’m seeking a revision because after the injury the nose changed shape. The tip/dorsum is higher, rounder, and tilts leftward due to prolonged swelling and possible shifting of ear cartilage (not excess). I have what appears to me to be a pollybeak, especially on the left. Instead of sloping down, the nose sticks out/is projected in a ball someplace away from my bridge, underneath where the tip used to be before it “dropped” filled out due to injury or naturally, like a tube. In other words, the tip is an overprojected bulb following the injury–like the pre-op nose, with a ball of tissue where the nose used to simply droop down flat. That “ball” is projected by the implant in my columella. 

The tissue is soft but fibrous and based on everything that happened I feel I am looking at scar due to prolonged swelling, not curving ear cartilage. The skin on the “injured” parts of the nose is whiter and oiler than the “healed part of the nose which went through no trauma. I make this comparison because there isn’t a surgeon I’ve consulted that sees scar tissue, but I know how the nose was shaped and oriented before injury and don’t know that scar can be removed in a closed septorhinoplasty.

Any advice on whether a closed rhinoplasty is really likely to help would genuinely be appreciated. I am caught between the appeal of not going through another open rhinoplasty and the thought that I will pay a hefty price for something that will not actually help much at all, will have a period at least as stressful, and will cause the same problems in the tip. 

A: The short answer to your revision rhinoplasty dilemma is…have an open rhinoplasty and get the Medpor implant out and replaced with your own cartilage if it is still needed. This is the only to ensure that you can get the best result long-term. A synthetic implant in the tip of the nose may or may not be part of the problem…but I doubt it will be part of the cure. With scar tissue in a revisional nasal tip surgery, visualization and removal of all scar tissue with cartilage reconstruction is the only way to successfully reshape the bulbous and overprojected nasal tip consistently.

Dr. Barry Eppley

Indianapolis, Indiana

Does A Cleft Lip Repair Include Correction Of The Nose As Well?

Q: Dr. Eppley, my one month old son has cleft lip and palate on the left side. It is due to be repaired in another few months. Besides the cleft lip, the nose is also very distorted and wide set. Can his nose also be corrected at the same time as that of his cleft lip repair?

A: The initial cleft lip repair is usually done around the age of three or four months after birth. During a primary cleft lip repair, efforts are always made to reshape the distorted nostril and tip of the nose. Some of the nose improvements are natural as the lateral lip element is one and the same with the base of the nostril. So the base of the nostril naturally gets better as the two sides of the lips are brought together and united. But one should not think of this nose effort as a definitive rhinoplasyt or a complete correction. The lower alar cartilages of the nose are still deformed and remain small in development. They are far from completely formed and these initial nasal correction efforts at the time of the cleft lip repair are mainly to improve the width of the nostril base. The nose must undergo further development and additional nasal work will be needed during the early school  and teenage years to more extensively reshape the deformed tip cartilages and correct septal deviations and other nasal abnormalities.

Dr. Barry Eppley

Indianapolis, Indiana

What Type Of Midface Implants Do I Need?

Q: Dr. Eppley, I am interested in midface augmentation using malar shell implants but I have not yet had the procedure because of certain concerns. I am concerned about the submalar fullness which I had noticed in photos of female patients who have had the submalar cheek implants placed. Although I definitely have the concavities in the submalar area which would benefit from some augmentation, I did not want “apple” or “cherub” cheeks. (Check out Barry Manilow’s face now). This type of fullness can look artificial and certainly looks better on females than males. I know that the implant can be modified by removing some projection from the underneath side of the submalar portion of the implant.  Of course, a lot would depend upon how much fullness is already present in the submalar area. I am also unsure of whether the implant would make my face look wider and somewhat “chubby” rather than more sculpted (more attractive on males).  I have a round face lacking in strong structural features. But I was not so sure about what the midface augmentation would accomplish .  In addition, the lower eyelid area concerned me.  Actually, I thought that if the midface implant were placed high on the bone close to the orbital rim, it  would have the nice collateral benefit of minimizing the tear trough area, but I did not know how much an improvement this would be, given the design of the implant. 

A: In looking at your face and all the current styles of performed midface implants, none would be appropriate for what you are looking for. You are correct in assuming that your face would get wider  and would dimensionally change you in the wrong direction. What you need is more anterior or forward projection across the orbital rims and down onto the face of the maxilla. This is actually the ‘missing’ zone of facial augmentation in regards to current implant designs because it is concave facial area and not a convex one.

What you really need is an orbito-maxillary facial implant that improves midface projection but not malar width. This can only be properly designed through a custom implant approach based on a 3D CT scan.

Dr. Barry Eppley

Indianapolis, Indiana

How Many Body Contouring After Weight Loss Procedures Can I Have At One Time?

Q: Dr. Eppley, I am interested in numerous body contouring procedures since I have lost 130 lbs. But I did not achieve this weight by bariatric surgery so would it be possible for me to have multiple procedures in one day? I have a lot of loose skin from my arms to my thighs so I need a lot of work done and the quicker I can get it off the better.

A: The origin of one’s weight loss has little impact on how any number of body contouring procedures are done in a single operative event. Actually extreme amounts of weight loss achieved by non-bariatric means, diet and exercise, are ‘safer’ since there are no metabolic issues to consider. (unlike a gastric bypass) There really are few differences between body contouring after weight loss and bariatric plastic surgery considerations when it comes to the type of body reshaping procedures considered and how they are put together. The key issues in doing multiple  body contouring procedures is the length of time to do the surgery and what period of recovery time does the patient have. As all body contouring involves considerable trauma to the body if you just consider the size of the body surface areas being treated.

Dr. Barry Eppley

Indianapolis, Indiana