Should I Do Skull Reshaping Before Or After Hair Transplantation?

Q: Dr. Eppley, I want to ask about the skull reshaping using the bone cement.

1- what are the side effects, honestly?

2- how much will it cost?

3- if i want to do a hair transplant shall i do it before the head surgery or it doesnt matter and i can do it after?

4- can the doctor show me how my head will look in a computer before the surgery?

I really hope I hear these answers from the doctor himself.

A: To properly answer your questions, I would need to see some pictures of you and know exactly what you want to change in your skull shape. But to provide general answers to your questions:

1) Other than some type of scalp incision (scar0 to do the surgery, the only other side effects are how well is the goal achieved, is it smooth and is the result symmetric.

2) I would need to see exactly what needs to be done to give you an accurate cost of the surgery by sending some pictures of your head.

3) You should do any hair transplants AFTER skull reshaping surgery.

4) Pictures would be needed to see potential surgical changes by computer imaging.

Dr. Barry Eppley

Indianapolis, Indiana

 

Will Rib Removal Change My Physique?

Q: Dr. Eppley, I had a botched ear surgery and need to come to you for correction for more prominence. I also want to build up my nose for taller nasal bridge. I know it is best to use rib cartilage for surgery rather than a foreign material like Medpor. My concern is that I am a dancer and have to be shirtless a lot for work. I worry the scar needed for rib removal will be big and also will change my physique? Then I read about rib removal for cosmetic surgery purposes. If this is the case maybe it will give me a more defined figure because rib removal gives a more slender slimmer lower waist? Is that correct? Would you be able to use the same scar? I plan to do the surgery separately, first do ear revision and then few months later do nose. Would they use rib from one side for ears and then rib from other side for nose? Or is there not going to be enough rib? Can they use one scar to remove rib and symmetrically remove rib for each side? 

A: Rib removal, whether it is done for otoplasty correction, augmnetative rhinoplasty or for waistline reshaping, will create a scar. It is not a large scar, usually about 4 cms in length, but it is a scar nonetheless. If harvesting just for the nose or ear, it will not change your physique or cause an indented chest area. The amount of rib cartilage length removed is not that long.

Because of the recovery from rib harvest, it is probably best to do the otoplasty revision and rhinoplasty at the same time. While two separate surgeries could be done the amount of rib cartilage needed for the ears is small and does not seem worthy of a separate surgery to do it.

Rib removal can help define the upper waistline by removing the lower free floating ribs but whether that is worth that effort and the two scars to do it must be considered carefully.

Dr. Barry Eppley

Indianapolis, Indiana

How Stable Are Custom Wrap Around Jaw Implants?

Q: Dr. Eppley, I have some questions about custom wrap around jaw implants. Firstly, how secure are the wraparound implants regarding the likely of it becoming displaced or dislodged? What level of force or impact could it withstand without being dislodged? Secondly, when considering the probable chin length projection provided by the implant, is there a means to prevent my labiomental crease from becoming deeper/more exaggerated, as I am already unhappy with its current depth?

A: Wrap around jaw implants are very secure given their custom design and fit and the use of multiple point miniscrew fixation. I could not tell you how much force it would take dislodge a custom jaw implant as that has never been tested. I would imagine that it would be considerable and would have to be of the magnitude that would be enough to break the jaw.

When any portion of the chin is advanced forward, some deepening of the labiomental fold is likely. This is unavoidable in a straightforward horizontal chin increase since the labiomental fold is a fixed point caused by the superior attachment of the mentalis muscle. When the chin is also advanced vertically, any change in the depth of the labiomenal fold will be less. I would use the imaging to be a good test as to what happens to the labiomental fold since it has not been moved with the chin change. Lessening of any labiomenal fold depth increase can be told by simultaneous fat injections to it.

Dr. Barry Eppley

Indianapolis, Indiana

Is Skull Reduction Surgery Safe?

 Q: Dr. Eppley, I am curious about my options regarding skull reduction surgery. I believe I have a pretty normal skull shape but I’d like to smooth down the bump on the lower back of my head, I believe it to be the occipital although I’m not certain. From where the top of the back of my neck transitions to the skull it seams like a bit more exaggerated of a curve than normal. I was curious if it would be an option to smooth it down, if allowably possible. Let me know if you have any questions or what you would initially require in order to assess. I would be willing to take an X-ray or CT scan if necessary. Thanks.

A: The prominence of the occipital bone can be burred down, usually about 7mms across its entirety based on its inherent thickness. The question is not whether it can be done but whether enough can be safely removed to make a difference. That can be simply answered by a plain lateral skull x-ray which will show how much skull reduction can be obtained by the removal of most of the outer cortex. It is not advised to go past the outer cortex of the trilaminar skull layers.

Dr. Barry Eppley

Indianapolis, Indiana

What Profile Should I Have For My Breast Implant Replacements?

Q: Dr. Eppley, Thanks for speaking with me last week for my breast implant replacement consultation. I am scheduled for breast implant replacement surgery next month and I have a question. On my pre-op papers, I noticed you are recommending a change from my current round 390 cc moderate profile to high-profile 595-655 cc implant. I am familiar with the moderate profile, but not so much the high. I just wanted to make sure the high profile is not going to be the “round ball” look. I am wanting a more natural look. Could you explain the use of the high profile for me? Again, thank you for you time and for seeing me last Friday. Im looking forward to my procedure.

Breast Implant Replacements results front view Dr Barry Eppley IndianapolisA: Your question about the profile of your breast implant replacements is a good one and understandably can be confusing. When comparing saline (your current implants) and silicone (your new implants) implants, the projection/profiles between them are not comparable or 1:1. Saline implants naturally sit higher (have more projection) than silicone breast implants because they are under some pressure or distension from the saline. (particularly if they are overfilled) Silicone is softer and not distended because they really are to some degree underfilled for the bag. (this is demonstrated by looking at a silicone implant sitting on the table and it will have an ‘ashtray’ effect while a saline-filled one will be very round and puffy) Thus a moderate saline implant profile is really comparable to a high silicone implant profile.

There is also the issue that as you go bigger in implant size, you do not want the implant to be too wide. Thus a higher profile silicone implant allows for the increased volume but without adding substantial more implant width.

Dr. Barry Eppley

Indianapolis, Indiana

How Long Does It Take To See The Results Of Lower Leg Liposuction?

Q: Dr. Eppley, I hope you can help me. I am almost 30 and I have had ‘fat’ legs since my early teens. My grandma and mother have the same. When I lose weight my legs still stay fat; I go to the gym regularly and this has gone some way to improve muscle tone but not to achieve any fat loss from my ankles or calves. I would love my legs to look slimmer and more shapely. 

A: Lower leg liposuction can be effective at improving the fuller lower leg from the knees to the ankles and making them more shapely. But it is not done in a circumferential manner as many people think. Rather it is done by treating selective areas to improve their silhouette or profile through inner knee, upper medial calf, and inner and outer lower ankle liposuction. While such lower extremity liposuction can be very effective it can take several months to get to see its benefits. As the lower legs have increased venous pressure and slower lymphatic outflow due to gravity they hang onto swelling for some time after the surgery. It usually takes about three full months to see the final results of the lower leg reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

 

Does Occipital Knob Reduction Relieve Headaches?

Q: Dr. Eppley, I’ve had this large bump on the back of my head y for as long as I can remember.  I think they call it an occipital knob. I would like it removed. I have many questions about the procedure. Here they are

1. How do I get an appointment with you? 

2. Is there a hospital stay for this surgery or is it same day surgery?

3. Have you found that insurance willpay for the operation?

4. Is this skull deformity a common problem?

5. How soon would an operation be scheduled?

I’m very excited about finding a doctor who can help me feel better and not have any more headaches.

A: In answer to your occipital knob reduction questions:

1) We can talk by phone or Skype as soon as you would like

2) This is an outpatient procedure that takes one hour to complete under general anesthesia.

3) This would not be an insurance covered procedure to my knowledge.

4) I can not speak for exactly how common it is but I suspect it occurs in about 1:1000 people.

5) Since it is a relatively short operation, it can be scheduled fairly quickly.

You made an interesting statement about relief of headaches. I am not aware that an occipital knob reduction does relieve headaches although I can see how that might occur. There are tight muscle and fascial attachments at the base of the occipital knob and release of these may provide relief of some occipital-based headaches.

Dr. Barry Eppley

Indianapolis, Indiana

Is Male Liposuction Successful?

Q: Dr. Eppley, After our liposuction consultation last week, I have a few more questions to help me decide about the surgery. (abdominal and flank liposuction) 1. What will be expected for time of discomfort and movement restriction? 2. What are possible complications after Liposuction ? 3. Can you help me with your past customers (males) experiences and were they satisfied with the outcome considering the cost and rehab? I realize that everyone is different, but just need some case history with men similar to my build. 4. Will I be a sleep during the procedure? Thank you.

A: In answer to your liposuction questions:

  1. While I do not place any liposuction patient on any after surgery restrictions, there will certainly be some. The most discomfort of course would be in the first few days but you will remain sore for weeks. It probably takes 2 to 3 weeks to begin moving close to normal again.
  2. The most common complications after liposuction are aesthetic in nature, symmetry of the reduction and how well the skin will lay back down. Men generally have few skin irregularity issues because their skin is thicker and has never been stretched by pregnancy.
  3. I think every male liposuction patient I have ever done has been largely satisfied..but the time to ask them is months later when they have fully recovered. Male liposuction of the body almost always is that of the abdomen and flanks (waistline) and often it is near circumferential. It is a tough aesthetic surgery for most men (depending on the size of the problem) but it can achieve a major change in stomach and waistline contours that can be otherwise hard to achieve.
  4. This is a procedure that can only be done under general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

How Does Profile Affect Breast Implant Replacements?

Q: Dr. Eppley, Thanks for speaking with me last week for my breast implant replacement consultation. I am scheduled for breast implant replacement surgery next month and I have a question. On my pre-op papers, I noticed you are recommending a change from my current round 390 cc moderate profile to high-profile 595-655 cc implant. I am familiar with the moderate profile, but not so much the high. I just wanted to make sure the high profile is not going to be the “round ball” look. I am wanting a more natural look. Could you explain the use of the high profile for me? Again, thank you for you time and for seeing me last Friday. Im looking forward to my procedure.

A: Your question about the profile of the implants is a good one and understandably can be confusing. When comparing saline (your current implants) and silicone (your new implants) implants, the projection/profiles between them are not comparable or 1:1. Saline implants naturally sit higher (have more projection) than silicone breast implants because they are under some pressure or distortion from the saline. (particularly if they are overfilled) Silicone is softer and not distended because they really are to some degree underfilled for the bag. (this is demonstrated by looking at a silicone implant sitting on the table and it will have an ‘ashtray’ effect while a saline-filled one will be very round and puffy) Thus a moderate saline implant profile is really comparable to a high silicone implant profile.

There is also the issue that as you go bigger in implant size, you do not want the implant to be too wide. Thus a higher profile silicone implant allows for the increased volume but without adding substantial more implant width.

Dr. Barry Eppley

Indianapolis, Indiana

What Are The Sizes Of Thigh Implants That Are Available?

Q: Dr. Eppley, I’m largely familiar with the constellation of procedures that comprise Facial Feminization Surgery and Sexual Reassignment Surgery. Procedures that ‘balance’ the lower-body to ensure it’s proportional to the upper body are much less clear. Would you please take a moment to help me understand your thigh and buttock augmentation procedures?

1. What is the vertical & circumferential extend of implants used for lateral augmentation of the thigh (in the region of the greater trochanter)?

2. What are the vertical & lateral dimensions of the buttock implants? My concern here is to understand how these implants, in conjunction with lateral thigh implants, will create a natural curved profile in the waist-to-thigh area (instead of being “localized” augmentation).

3. I have a ‘flat’ area just below the iliac crest. Since this is above the greater trochanter and will likely not change with lateral thigh augmentation, do you have a method (or implant) to fill-in this area for to create an more uniform curvature from waist-to-thigh?

4. How are implants in this area ‘secured’ in their desired location so there will be no dislocation over time?

5. Where are the incision(s) for lateral thigh augmentation?

A: Thank you for your questions. In answer to them:

  1. There are no standard off the shelf thigh implants. They almost all have to be custom made so their dimensions can be largely what one chooses based on measurements of the patient. But one should not think of them as circumferential, they are lateral implants and that is the extent that they cover.
  2. Even when put together at the same time in the same patient, buttock and thigh implants will be localized augmentations. They do not connect nor can they. Their implant pockets are separate.
  3. The trochanteric drop area is best treated by fat injections if possible since it is a flexion area for which implants are not best used.
  4. All forms of body implants are secured only by the pocket that is made for them. They stabilize because the body forms a layer of scar around them (the capsule) this locking them into place.
  5. Lateral thigh implants are placed through a small (4 to 5 cm) incision over the upper thigh.

Dr. Barry Eppley

Indianapolis, Indiana