Posts Tagged ‘facial implants’
Tuesday, May 21st, 2013
Q: Dr. Eppley, I have a few questions regarding facial implants. I did not see this addressed on your blog so thought I would ask. My question is regarding the known/ suspected long term effects of having facial implants if any. While I understand that for instance solid silicone implants such as the jaw/ chin implants I’m interested in will last a lifetime; however, what does the aging process hold for those that have such implants? Does placing an implant under the largest muscle (of the jaw) have drawbacks as I age. ( only in my 30′s now) Will jowls/ sagging skin etc show up faster since the muscle is now stretched over this new ( larger jaw)? How will chewing be effected if at all due to this as I age. Or will aging and its various processes just march on as if I never had anything done and just as if I was born with this new wider jaw and more pronounced chin? Thanks again for your time.
A: Facial implants, of any location, have no negative impact of facial aging and may actually have the reverse effect. As implants add volume by addition to the bone, they may prevent some tissue sag, or delay it, that will inevitably occur with aging. Jaw angle implants have no negative effect on chewing other than the initial discomfort and stiffness in mouth opening right after surgery that persists for a few weeks.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry epley, facial aging, facial implants, indianapolis
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Sunday, April 7th, 2013
Q: Dr. Eppley, I’ve attached a photo of my side profiles and front. The main issue I have is with my eyes, which effects my self esteem the most. They also protrude quite a bit and I was hoping orbital decompression could be done whilst aligning them? I know it’s a very complicated invasive procedure.
The others issues are my jaw, hairline and eyebrows. I clench my jaw (whilst sleeping) predominantly on the left side resulting in having to get a root canals to subside pain in those teeth. So it’s more function than anything.
If it’s possible to get the alignment sorted out, I would possibly at a later stage want augmentation done on my jaw and cheekbones to balance my face out. What would your opinion be on that? Thanks again, your time is very much appreciated.
A: Thank you for your inquiry. You are making an incorrect eye diagnosis. You do not have true orbital proptosis or bulging eyes. You have pseudoproptosis…meaning the eyes appear bulging because the orbital bones around them (infraorbital rim and cheek bones) are deficient. Thus the eyes appear bulging when in fact the eyeball has a normal position. Thus orbital decompression surgery is an incorrect and inappropriate treatment for you. The correct treatment is to build
up the underlyling bones which are deficient through onlay facial implant augmentation.
In regards to other issues, Botox injections are the ideal treatment for painful masseteric muscle clenching, which can work spectacularly well.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: bulging eyes, dr barry eppley, facial implants, indianapolis, pseudoproptosis
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Sunday, February 17th, 2013
Q: Dr. Eppley, I want to achieve a more masculine jaw line. My face is oval and I want a more square cut lower face. I had a chin implant back in 1990 with a rhinoplasty. Would like to know what my options are and also would this implants just be inserted or are they secured with screws. How many days do I have to stay inIndianapolis before flying back to home. Thanks so much for your fast response.
A: Thank you for sending your pictures. I did some preliminary imaging based on what I perceive as your desire for a more masculine jawline. This was done using a combination of chin and jaw angle implants, the most common approach to make a circumferential change to the jawline. One interesting issue with you is that you already have a chin implant and the change to get you to the imaging result is significant. This raises the question of whether an off-the-shelf (stock) chin implant can really achieve that goal of which I have doubt. This leaves the possibility of either making a custom chin implant or doing a combined sliding genioplasty with a small square chin implant placed in front of it for the square width effect.
All facial implants are always secured by screws for stability of position on the desired bone position long-term.
No matter how it is done, you would be returning home 48 hours after surgery.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: chin implants, dr barry eppley, facial implants, indianapolis, jaw angle implants, jawline enhancement
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Saturday, December 22nd, 2012
Q: Dr. Eppley, In your experience what’s the least expected facial implant material to get infected? Also can maxillofacial bone cements or pastes be able to be used for the chiseled look? Also there’s a procedure where you cut the cheekbone and advanced the bone then added plates and screws can that give masculine cheeks/zygomatic arch look?
And does the bone grow into to the cut cheeks to reattach in case if plates ever needed to be removed? Is there any sort of special maxillofacial bone cut to the jaw to just add width and some drop down? Thank you.
A: While I appreciate the nature of your all of your questions, each one of them represents the same issue…you are searching for non-implant procedures to do what facial implants do. And the answer to all of them is the same…they either do not exist or do not work very well at all. There is only one bone procedure that replicates what an implant does..the sliding genioplasty. Otherwise, every other osteotomy/bone moving method works very poorly…and I know because I have tried them all over the years.
There are many factors that go into how implants can get infected so it is not as simple as one material is necessarily better than the other. If handled well, they all should have th same rate of risk of infectivity. But if I had to pick one just based on the material alone, it would be silicone because of its smooth and non-porous surface. It is harder for bacteria to get a good hold on this type of surface as opposed to a rougher irregular one like Medpor.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry eppley, facial implants, indianapolis
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Friday, December 21st, 2012
Q: Dr. Eppley, I had a few questions. Here's history on me I have had a sliding genioplasty in 2010 and a rhinoplasty in 2005 now I’m happy with the outcome but would like to get a more masculine chiseled look. But I would like to stay away from implants such as porex, silicone, goretex, etc. Can bone grafts be used or is there a way of augmenting without the use of implants? I think my jaw line will need some augmenting. Along with slight some in the chin for its narrowness/mild step offs. Maybe some in my supra orbital rims to give a stronger appearance. Thanks.
A: What you are asking for and how you are asking to do it can’t be done. There is no way to achieve those facial skeletal changes without the use of synthetic facial implants. While bone grafts can be done they are impractical for two reasons. First onlay bone grafts will completely resorb for the most part and what will stay, if anything,will be very irregular and unpredictable in shape. Secondly the amount of bone graft needed would be impossible to harvest unless large strips of outer cranial bone were taken from you skull. Thus the concept of bone grafts for significant facial skeletal augmentation is an unwise and ineffective approach to improving your jawline. A more effective autologous material would be cartilage grafts which don’t suffer much resorption when applied as an augmentation material. But I don’t think many patients want to have multiple ribs harvested from the subcostal margins for a cosmetic change. The reality is that what you don’t like (synthetic implants) is the best, easiest and actually safest way to achieve your jawline goals.
Dr. Barry Eppley
Indianapolis, Indiana
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Tags: dr barry eppley, facial implants, indianapolis, jawline augmentation, male chseled jaw look
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Sunday, November 4th, 2012
Q: Dr. Eppley, I have some skull and face asymmetry from positional plagiocephaly. The main issue is that the right side of my forehead bulges, is it possible to reduce this bulging so my forehead doesnt have such a broad appearance when viewed from one side? Also the left side of my face is less prominent, maybe you could say “weaker” than the right. Would some sort of implant help with the asymmetry and make the left side as prominent as the right?
A: Plagiocephaly produces the exact face and skull asymmetry that you have described. Your right-sided forehead protrusion and smaller left face are common. Although I have not seen any pictures of you, your theory for improvement in facial symmetry would be the correct approach. Reduction of the right forehead bulging and augmentation of the left face, most likely that of the left cheek and jaw angle, could offer visible improvement. I would need to see some pictures of you, particularly a straight-on frontal view, to confirm if this approach would be helpful.
The left facial implants can be placed from inside the mouth so there are no scar trade-offs for those improvements. That can not be said for the forehead reduction in which the scalp scar trade-0ff must be considered very carefully, particularly in the a male patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial asymmetry, facial implants, forehead reduction, indianapolis, plagiocephaly
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Thursday, October 4th, 2012
Q: Dr. Eppley, does the mandibular angle implant bond to the bone through time? Or is it just the screws that hold it in place for the rest of my life?
A: There is no synthetic facial implant materials that truly bond to the bone in the truest sense of the word. Bonding denotes an actual bone ingrowth and attachment to the underlying bone without the interface of scar, much like a dental implant where bone bonds directly to the metal. That does not happen with either silicone or Medpor materials.
What does ultimately stabilize and maintain a facial implant into a secure position is the development of a surrounding layer of scar known as a capsule. This takes several months to form a solid capsule around the implant. So the primary purpose of implant screw fixation is to maintain the desired position until a good capsule forms. Medpor material does develop a more robust capsule formation than silicone but early implant stability can only be completely assured by screw fixation as that still takes time to develop. Medpor material also has a much higher frictional resistance (which is also why it is much harder to insert and usually needs bigger incisions) so this may help a little with early implant stability. But that is not enough for me to rely exclusively on this material property. Silicone has little frictional resistance and pocket development alone does not provide assurance that implant migration/mobility will not happen after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial implants, indianapolis, screw fixation of facial implants
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Sunday, September 16th, 2012
Q: Dr. Eppley, I am a male 35 years old and I am interested in having facial implants. What’s the process to get them? What is the period of time to get healed after the surgery? And how much will it cost?
A: Your questions as posed are both vague and impossible to answer. Facial implants is a broad topic and there are implant possibilities for just about every region of the face. The first place to start is to find what you are trying to achieve with your face and whether facial implants may be needed. I would write me back and tell what deficiences you feel you have in your face, what changes you would like to see, and also send me a few pictures of yourself. With that information, I can determine if facial implants, or other surgeries, may be helpful in you achieving your aesthetic facial goals.
I must first find out what you need before the secondary questions of healing, recovery and cost can be determined. For now, you have the cart in front of the horse so to speak.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial implants, indianapolis
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Monday, September 3rd, 2012
Q: Dr. Eppley, do you feel it is possible to create an aesthetic male face even with my Class 1 hypertelorism? I understand that it can be found to be an attractive feature in women (such as Jackie Kennedy), but I can’t really seem to find any examples of good looking male face with hypertelorism. Do you know of any? Thanks!
A: First degree hypertelorism, as you have been mentioned, can be attractive in females. You have mentioned Jackie Kennedy as an historic example but Uma Thurman would be a more recent illustration. When it comes to men, however, I have never heard it so described and can not think of any example where it is.
The spacing between the eyes can be improved by several facial camouflage strategies. I have not seen a side view of you so I can not say how successful they would be in your case. Building up the bridge of the nose, usually with an implant, is a classic example of decreasing the distance between the eyes. This is best done in patients that have a low or wide nasal bridge. The higher the nasal bridge, the less the eyes look far apart. In addition, widening the lower face can also help camouflage it. Cheek and jaw angle implants in particular help widen a the lower 2/3 s of the face.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cheek implants, dr barry eppley, facial implants, indianapolis, jaw angle implants, nasal implants
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Monday, September 3rd, 2012
Q: Dr. Eppley, I am interested in implants to correct my jaw asymmetry. My jaw angles are very asymmetric and I feel I would be more attractive if my facial asymmetry was corrected. I have always been curious about art with respect to beauty. What is beauty? I’ve concluded that beauty is not only in the eye of the beholder but also in the symmetry of the viewed. When you see a symmetric butterfly, it looks beautiful. When you see the symmetry of a supermodel, it is beauty. So this is something that I have become aware of over the years… and others have as well. In fact, there is now an iPhone app that can rate your attractiveness by measuring your symmetry… and guess what actor ranks the highest… It’s Brad Pitt. His left side of his face is exactly like his right side.
I have read your comment about not being able to reach a perfect match on anyone’s facial asymmetry, but instead improving on it. I like that realistic goal. I personally would be highly satisfied if I used a string that was measured and cut to reach from the corner of my left outer eye to the corner of my left corner back jaw (mandibular ramus) and have that string reach the same distance on the right side of my face as well. It currently does not match. But if it did, I would be a happy man. And I also understand that even if I had this result, the symmetry would not be perfect since the position of the corner jaws may be different in the 3-D x-y-z coordinate system.
A: While I have found that perfect symmetry can be difficult to achieve in facial surgery, that does not mean it is not the goal. There are different methods in trying to achieve that symmetry regardless of the location of the implants. Traditional, and still the most commonly done, method of facial implant surgery is to pick out the implants based on a more or less artistic assessment of the patient’s needs. There is no precise method of matching the implants to the underlying bone shape or knowing exactly what the outward changes will be. As unscientific as that is, it works most of the time when the patient’s facial bones are symmetric and the patient isn’t overly detailed or looking for perfection. When it comes to improving facial asymmetry, however, it is easy to see how an unexact science applied to a variable problem is prone to some degree of a persistent level of asymmetry.
To counter these issues, an ideal approach is to make custom implants off of a 3-D model. When this is economically feasible, it is easy to see why this is better than ‘eyeballing’ it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial asymmetry surgery, facial implants, indianapolis
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