Q: Dr. Eppley, Hello. I had a chin implant removed after a 7 mm mandibular advancement five years ago. I feel I developed ptosis since the removal of the implant. Also, I have a very long upper lip 21mm and considering this correction as well. How many lip lifts have you performed? I am very happy I found your website!
A: Although you only had a frontal view picture attached, I can see evidence of chin soft tissue sag and some lower lip incompetence at rest. With lip sag an intraoral resuspension technique is usually preferred. For your upper lip, its thinness from one corner to the other suggests that a lip advancement would be a more effective procedure than a lip lift. A lip lift only affects the central aspect of the upper lip. If this is evenly slightly overdone with thin lip sides, it can look unnatural. A lip advancement moves the entire vermilion upward from one corner to the other and makes a very thin lip look more naturally larger…plus it also removes some vertical lip wrinkles that are just at the vermilion-cutaneous border. I have performed well over 200 lip lifts, lip advancements and corner of the mouth lifts over the years.
Dr. Barry Eppley
Q: Dr. Eppley, when I retire I will do a general over-all facial rejuvenation/enhancement and possibly a slight rhinoplasty tune-up/reduction. Probably fairly aggressive because due to my life situation, there is no need to “look like the same person, just well rested”. Now, is there any logical/preferable order in which to do these things? I had a successful facelift several years ago. I can say that I I don’t care if I spend the first three months looking swollen and feeling pain – the end results are well worth it, plus I am just not a whiner. But I thought I might do the rhinoplasty first/separately, so that the follow-on surgeon can correctly judge the amount of change needed with the “new nose”. Thus the question: how much of the facial implant work can be done all at once?
A: Without knowing what you look like or exactly need, I can not give a very precise answer. In general, I routinely perform all facial procures at one time including any implant work and rhinoplasty. How one facial procedure affects another can really be determined before anything is done by computer imaging. But certainly there is no reason you could not do the rhinoplasty first and then three to six months later do the remainder of any facial reshaping procedures.
Dr. Barry Eppley
Q: Dr. Eppley, we have talked before and i was trying to get surgery done for flat back of the head in 2011. I had some financial problems that is why I didn’t do it. Back in thoe days we talked about Kryptonite bone cement method which it had minimum scarring but expensive. I’m looking in to doing the procedure sometime this coming October 2015 and I was browsing your websites and I found this new approach that you have called Custom Skull Implants by using 3D CT scan.
My questions are
1- What is the price difference between Krypton bone cement and custom skull implant
2- I know the scar is less in Krypton bone, but how big is the scar for implant
3- Recovery time for the implant?
4- How long it will take to make the implant after CT scan?
5- Infection risks?
Thank you very much
A: In regards to a custom occipital implant, your financial concerns have served you well as this is a far superior method for improving the flat back of the head.
- My assistant will pass along the exact cost of a custom occipital implant to you tomorrow.
- The incision is usually placed very low in the occipital hairline and is usually a horizontal incision of 7 to 9cms. When the incision this low, almost in the upper neck, any scar concerns are significantly diminished.
- Recovery is usually less than a week to return to most normal activities.
- It takes about 3 weeks to design and manufacture the implant after the 3D Ct scan is received.
- While infection is always a concern for any implant in the body, I have yet to see one with a custom silicone occipital implant.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to know how long take scars go away from a fat transfer operation. They got some fat from my tummy and put under my eyes. I had a sleepy look eyes. It looks one side it’s kind of went down but my other eye (I mean under the eye) still all puffed out and doctor says its “scar”. It’s hard and it seems like slowly slowly is going away but I’m 10 months now after the surgery and still hard under the skin,
I would like to know if it will EVER go away that scar or will EVER become soft as the fat suppose to be? And if so WHEN? I’m really desperate. It’s my face and I don’t like that people looking at me like what happened to me. The idea was to look better not worse. ((
A: Unfortunately you are asking a question about a clinical result that I have not yet seen with facial fat transfer. The biggest after surgery issues with injectable fat grafting is how well it survives and irregularities. (lumps/bumps) I have never seen persistent hard lumps many months after its placement. I would assume that it is fat and may or may not be some scare tissue. Certainly ten months is a long time but as long as there is some improvement in it, patience would still be warranted. I would also consider very dilute Kenalog (steroid) injections into to to encourage additional softening.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in scar therapy to reduce the raised scar on the bridge of my nose caused by a racket strike during a game of racketball two months ago. Interested in the recommended procedure and number of treatments/visits, etc.
A: Thank your for your inquiry and sharing a picture of your nasal scar. It is important to realize that it is early after the injury and the scar healing process is active and ongoing. If you want to do everything you can do to ensure optimal scare outcome, I would recommend a single fractional laser treatment followed by the daily application of a scar gel and the night time application of occlusive taping. This sequence of scar therapy You can be pleasantly surprised how much better it can look in 3 to 6 months. It is also important to realize that these recommendations are based on a single picture assessment taken from a side view picture only.
When it comes to topical gels a wide variety of options exists and none has been clearly proven to be better than another. The same applies to the number of occlusive tapes and sheets which exist.
Dr. Barry Eppley
Q: Dr. Eppley, I think my eyes are slightly uneven but I doubt anything can be done about that and that’s okay. I would like to change the prominent eyebrow structure from the center of my face extending to the outside supraorbital ridges. (brow bone reeduction) They are also slightly uneven. People often ask me if mosquitoes bit my eyebrows. The other thing that bothers me is my weak jaw line. I push my lower jaw out so its less obvious. (chin augmentation)
I know I will never look like a super model, its not even something that I want. I would just like a more symmetrical, angled, softer looking face. Thank you so much for your time and effort, Dr. Eppley. I hope it’s what you need in order to assess for possible procedures.
A: Thank you for sending your pictures. What they should is considerable brow bone protrusion from the glabella to the outer orbital rim. Even without x-rays I can tell that is due to significant frontal sinus hypertrophy and will require an osteoplastic bone flap setback technique for your brow bone reduction and not just burring alone to get a significant reduction. The brow bone protrusion you have is very similar to what I see in men with two distinct medial brow bone mounds. The slope of your forehead is also fairly retroclined and it would be ideal to augment the upper forehead at the same time to really change the entire shape of your forehead.
From a chin standpoint, it is both horizontal and vertically deficient in regards to being in balance to the rest of your face. While a sliding genioplasty would be the historic solution (due to the need for increased vertical chin height), my newer vertical lengthening chin implant (small size in your case) would work well as it brings the chin both forward and down. (at 45 degrees) This would a very good solution for you that is more cost effective than a sliding genioplasty with a much quick recovery as well.
Now that I know exactly what need to be done, I will have my assistant pass along the combined costs of the procedures to you on Monday.
Dr. Barry Eppley
Q: Dr. Eppley, I have been wanting breast implants for a long time and have been researching a lot of doctors and implants. I would like to speak about the augmentation with you. I have has one consult last year and I really liked the doctor but he only did saline implants and I think I am leaning more towards silicone implants but would like to discuss both with a doctor that does both.
A: Saline and silicone filled implants are both FDA-approved options for breast augmentation. They do share certain similarities, they both create equally effective enlargements of the breasts and are equally safe. Looking at augmented breasts from the outside, it would be impossible to tell what type of breast implants was used. But beyond their external appearance, they do have several very distinct differences. Saline implants are associated eventually with palpable and visible ripples on the bottom and sides of the breasts which does not occur with silicone implants. Most women will say that silicone implants feel more natural as a gel-filled implant feels better than a bag of water. A dramatic difference between the two is in how hey will eventually fail. (they will not last a lifetime and will eventually need to be replaced) Saline implants fail by a dramatic loss of fullness like like that of a flat tire. Silicone implants never lose volume because the gel does not act like a liquid (like a gummy bear candy) and just stays in place and with same volume even if the bag sustains a tear or a hole. For this reason alone, silicone breast implants last longer than saline implants.
The concise version of this story is that there is one and only one reason to ever get saline breast implants….cost. They are the most economic form of breast augmentation because a pair of saline implants costs less to buy than a pair of silicone implants from the manufacturer.
Dr. Barry Eppley
Q: Dr. Eppley, I’m a 27 year-old male hoping to improve my facial appearance with the use of facial implants. I have a rough idea of the kind of result I’d like to achieve and have attached pictures below of me now and a photoshopped version emulating the improvements I’d like to achieve. I have no idea whether I can use preformed implants or need to have custom facial implants made.
I’m interested in chin, jaw, forehead and orbital rim implants. I actually have no cheekbones whatsoever either forward or laterally which creates a very unusual appearance, but so far I’ve been using filler for correction.
Please let me know about how I can get these changes, estimated costs involved etc. I would really like to come to you for surgery as I know you are one of the best.
Thanks for your time and I really look forward to your response.
A: Based on your own morphing, the jawline change is absolutely that of a single piece custom wrap around jawline implant. That is the only type of jaw implant that can make a smooth jawline from the angle to the chin as you have shown. The lack of cheek and orbital rims (zygomatico-orbital deficiency) can be managed by two separate implants but a single custom made infraorbital-malar implant is the best implant to make a smooth transition all the way across the orbital rim and into the cheeks in the very thin tissue of the lower eyelids and cheek. What I notice in the forehead is increased brow bone prominence. Again a custom designed implant to achieve that change is always best since there are no preformed brow bone implants from which to choose.
I will have my assistant pass along the cost of custom implant surgery that would cover all these facial areas. It is possible to use a variety of preformed implants in most of these areas and some designs that I have used for other patients. But that is more of a piece meal approach that can be used if necessary but less than ideal for these more complex facial implant changes.
Dr. Barry Eppley
Q: Dr. Eppley, I would like my silicone butt injections removed. Does the scar tissue contain silicone oil, fat oil or is it just scar tissue? Will this procedure help reduce my butt from being sensitive? Is breaking up the lumps dangerous? Can it travel to other places when it’s broken up?
A: Silicone buttock injections can not be removed per se. They can be treated by liposuction and/or fat injections. These techniques allow for some of the silicone to be removed but what it mainly does is break up any hard tissue lumps (e.g., oil cysts and their surrounding scar tissue) caused by the silicone material as well as place new fat in and around where the silicone material/tissue reactions have occurred. Whether these efforts are worth it depend on what symptoms you are now experiencing. These efforts will not change any outside pigmentation changes in the skin but can help with some visible contour issues such as indents.
Oil cysts means silicone oil cysts. Breaking up the lumps is not dangerous. It is the injection of the material that poses the risk of getting in a blood vessel and traveling to other places.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 32 year old female with flat cheekbones that make my eyes look prominent. I have noticed that whenever I laugh the lower eyelid retraction vanishes and the eyes look quite normal. So I am thinking a fat transfer can considerably correct the problem. But I would like toknow if the maxillary hypoplasia is so severe as to make necessary the use of orbital/cheek implants. Or do you believe in using large volumes of fat transfer to treat such cases. And can fat grafts be used in the cheek eyelid junction too?
A: You have astutely discerned the two approaches to anterior midfacial/lower orbital hypoplasia. The bone can be built up with implants or fat can be added to the soft tissues that drape over the bones. Each has their own distinct advantages and disadvantages and the actual anatomy and severity of the tissue deficiency will play a major role in that treatment decision. It would be very helpful to see pictures of your face to provide a more specific answer to your exact facial concerns.
Having done a lot of both infraorbital and tear trough implants and fat grafting in this area, I am facile with both techniques and my treatment decision rests with what is best to anatomically correct the problem. Anatomic needs should dictate the treatment, not what ay surgeon is most familiar with doing. What I can tell about treating this area in general is that I often use a combination of both implants and fat grafting to get the best result. Implants can only go where the bone is, fat injection grafting can volumize soft tissues where implants can not. (e.g., lower eyelid above the infraorbital rim)
Dr. Barry Eppley