Should I Have My Buttock Implants Incision Stitched Back up?

Q: Dr. Eppley, I had subfascial buttock implants placed three week ago. My doctor wanted to keep the skin stitches in for a long time so that it would heal without coming apart.  I’ve been keeping an eye on my stitches now that I able able to see them better. I am seeing an opening develop that I did not see until now. This opening in the incision worries me. Should I get it restitched to assure that it closes properly when I go in for my one month checkup?

Intergluteal incision Buttock Implants Dr Barry Eppley IndianapolisA:  What you are observing after your buttock implants is very common and, quite frankly, expected. This is why I keep the the intergluteal incisional sutures in for so long. Every intergluteal incision will develop small openings such as you have and they never occur until 2 to 4 weeks after surgery. I do not close them because the sutures will never hold. They need to be allowed to heal in on their own. There are 3 other layers of tissue suturing under that of the skin closure so such small openings are not a concern. I would recommend topical Silvadene dressings which will help the small open area granulate in faster and is a potent antibacterial as well.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Reverse Corner Of The Mouth Lift Be Done?

Q: Dr. Eppley, I have an unusual question. I know you are an expert at the corner of the mouth lift. My lips turn up at the sides too much as it is. Is there  any way you could perform a subtle corner of the mouth ‘drop’…a reverse corner of the mouth lift if you will. This would be a reverse procedure. When I pull my lips down slightly they look as good as possible and being a professional entertainer I could really use this improvement. Also can the lower lip be lengthened slightly– thank u so much for your time!

A: I have to admit that I have never done a ‘reverse’ corner of the mouth lift nor has anyone ever requested it before. But like a traditional corner of the mouth lift, the reverse can be done I am sure. Some lengthening of the lower lip could be done at the same time. Unlike the corner of the lift which is done on the upper lip, a corner of the mouth ‘drop’ would be done on the lower lip.

I would need to see pictures of your mouth to give a more qualified opinion.

Dr. Barry Eppley

Indianapolis, Indiana

Can MIdface Augmentation Create A LeFort Advancement Effect?

Q: Dr. Eppley, I am interested in midface augmentation. I’m 25 years old and I have problems with my facial aesthetics. My forehead is more protruding than my midface and my lower third. This is easily observeable in sunny places, my forehead is highlighted but the rest of the face (except the nose) in shadow. Since my bite is good and my jaw quite strong, I would think a chin implant is a good idea, but is there an really effective method to bring the midface forward without a LeFort osteotomy?

A: As for the chin implant I would need to see pictures to make a helpful comment on its benefits for you. There is a very effective method to bring the level of the face around the nose forward which would create the equivalent of LeFort I osteotomy effect. Combined paranasal/premaxillary- maxillary implants can have a very powerful midface augmentation effect. Cheek implants are also useful but they create a zygomatic augmentation (upper midface) not a maxillary (lower midface) augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Can Temporal Implants Be Placed After Cheek Implants?

Q: Dr. Eppley, I have questions about temporal augmentation. I just got cheek implants and am modestly happy with them. I wanted to know if temple implants can co-exist with cheek implant. My surgeon has explained to me that temple implants are not safe due to a sensitive nerve in that area, and something he does not practice, nor advises. 

A: I am afraid to say that what your surgeon is telling is inaccurate and anatomically incorrect about temporal augmentation. Temporal implants are placed in a subfascial pocket through a small incision in the temporal hairline. There are no nerves in the subfascial temporal plane which is directly on top of the temporalis muscle. Your surgeon is likely referring to the subcutaneous temporal location where the frontal branch of the facial nerve runs. The subfascial is below that location and is perfectly safe.

Cheek and temporal implants can co-exist because they are in completely different tissue pockets even though they are right next to each other. Cheek implants can make the temporal region above it look hollow/deficient and it is not rare in my experience that the cheek implant patient subsequently goes on to have temporal implants.

Dr. Barry Eppley

Indianapolis, Indiana

How Do I Get Rid Of Lumps After Facial Fat Grafting?

Q: Dr. Eppley, I had facial fat grafting six months ago with 30 cc of on each side of the face into the bottom of the cheeks, smiles lines, nasolobial folds and near the mouth! This has unfortunately lead to a very bad new look! Fat lumps develop in the above mentioned areas as fat was injected too superficially. I read a recommendation from Dr Eppley on RealSelf that fat can be surgically excised! Would like to know more about this procedure! is it done from outside the cheeks or from inside the mouth?

A: There are numerous methods to try and reduce excessive fat contours after facial fat grafting. Surgical excision is rarely used unless the fat is located in an area that is easily accessible through a facelift or blepharoplasty incisions. Small cannula or microliposuction is the most effective method near the central face and mouth areas. This is usually done through a small incision inside the corners of the mouth.

Other non-surgical options to get rid of fat grafting lumps include steroid injections (low dose Kenalog) and the use of deoxycholic acid solutions. (originally known as Lipodissolve injections and now under clinical trial investigation as ATX101 by Kythera)

Dr. Barry Eppley

Indianapolis, Indiana

Do I Need A Breast Lift for Improved Breast Symmetry?

Q: Dr. Eppley, I have a breast asymmetry problem. I am 26 years old and the mother of one. During the period of breastfeeding, my child developed a likeness to my left breast which cause it to fill faster with milk and now my breast has stretched to such an extent that my right breast is almost half the size of my left breast, I live in Guyana, but the expertise is not here in this area (plastic surgery) I would like to know which one of the surgeries for the breast would be right for me and also do you deal with clients who may come from another country for plastic surgery.

A: There are multiple approaches to treating breast asymmetries and the choice of procedures depends on the size and shape of each breast and their differences. The first and most important question is…is one of the breasts the size and shape that is desired? In your case that would mean is the right breast the goal to try and make the left one look like again? If so, then a breast lift and/or reduction on the larger left breast may be all that is needed. If neither breasts are ideal or even the  ’better’ one needs improved, then bilateral breast reshaping procedures would be needed.

A unilateral breast lift is a relatively straightforward procedure that could be done as an outpatient under general anesthesia in about an hour of surgery. I will have my assistant Camille, who handles all of my far away patients, contact you later today.

Dr. Barry Eppley

Indianapolis, Indiana

What Are My Options With A Saline Breast Implant Deflation?

Q: Dr. Eppley, I am 70 years old and got saline breast implants forty years ago. Recently my left saline implant ruptured. Need surgeon with your skills. I am  confused about options with my saline breast implant deflation. I saw you on Real Self. Can you help me please? Thank you. 

A: Having saline breast implants that have lasted for forty years is way beyond what one would expect them to last without suffering a deflation. The duration most saline implants are typically expected to last is in the ten to twenty-five year range. I have never heard of a saline breast implant lasting four decades!

With a recent saline breast implant deflation, the simplest and most economically efficient option would be to simply replace the ruptured implant with a new saline implant. Breast implants replacements are easy because there is an established implant pocket already. You could, of course, switch to silicone implants in both breasts if you still want implants and want to eliminate any future risks of an implant deflation. (since silicone implants do to deflate)  As an alternative option, you can simply remove both implants if you no longer desire to have them and wish to most assuredly eliminate any future breast implant concerns.

Dr. Barry Eppley

Indianapolis, Indiana

How Is A Custom Brow Bone Implant Made?

Q: Dr. Eppley, I am seeking a custom brow bone implant. My problem is that my brow bones are very low, typical Asian. My eyelids are protruding.I believe this makes me look too soft, messy in the eye area, sad etc. not manly. I have thought of this for at least five years. My  brow bone is less protruding or equal to eyelid protrusion.

For men the brow bone should be substantially more protruding than the eyelids, almost close to protrusion of upper lip.

What I wish for is a permanent brow bone implant. I want an attractive manly forehead and supraorbital rim area. I want the brow bone to protrude more than eyelids and close to protrusion of upper lip based on analysis of male faces I want to look like.

A: What you are seeking is a custom brow bone implant. Most likely this would have to be a combined forehead brow bone implant to create the best overall effect. This type of custom made implant is made off of the patient’s 3D CT scan. Its final shape requires some artistic design but how much brow bone augmentation is needed can be determined by looking at the difference in the brow-eyelid position in the profile view. Thus type of facial implant would need to be placed through a scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

What Are My Options For Double Chin Correction?

Q: Dr. Eppley, I am interested in double chin correction. Attached you will find some pictures that I took–today during my lunch break! Looking at me straight on, at a flattering angle, you can tell I have a round face but the double chin isn’t noticeable. When I smile widely, laugh, or am viewed from my profile, it is clearly evident. What are my treatment options? Will liposuction alone work as another doctor told me? Let me know your thoughts!

A: Thank you for sending your pictures. While there is certainly some subcutaneous fat to liposuction, that will give you a modest improvement only. Necks like yours almost always have a subplatysmal collection of fat in the midline that will not be changed by liposuction. This requires a submentoplasty technique to maximally tighten the neck angle. You also have a bit of a horizontally short rounder chin. This adds a third factor to the double chin appearance. Adding a small central button style chin implant will add a little more horizontal projection and change the frontal chin shape to more of a tapered chin look.

In conclusion, it is all about the degree of double chin correction you are seeking.Liposuction alone will produce a modest improvement, a submentoplasty (which includes neck liposuction) will make a good change and the final addition of a chin implant will make the best overall double chin correction. As you can see neck liposuction is the most basic approach but does not produce the best double chin correction.

Dr. Barry Eppley

Indianapolis, Indiana

Will Insurance Pay For A New Facelift?

Q: Dr. Eppley, Twenty years ago, I had a facelift done. Until six months ago, all was well. However, for some time, I have noticed that along my hairline, little “slits: appeared followed by something quite hard. Recently, my face has begun to drop dramatically to the point I’m embarrassed to be in public. The comparative pictures are unbelievable. I have Medicare and Tricare for Life. Is there any possibility insurance would cover the repair or for a new facelift? I’m desperate at this point. 

A: Twenty years is a tremendous amount of time to get the benefits of a facelift. Most facelifts have largely degraded and the benefits lost by ten to twelve years after the procedure. I have no idea what the issue is with the ‘slits’ /hard knots in the hairline. Although most plastic surgeons use dissolvable sutures for their facelifts, your surgeon may have placed permanent sutures deep and they may be working their way to the surface after so many years. That would be the only explanation I could fathom for their presentation. No medical insurance is going to pay for facelift surgery. This is a purely cosmetic procedure that is paid for upfront undoubtably just like it was twenty years ago.

Dr. Barry Eppley

Indianapolis, Indiana