Q: Dr. Eppley, I have several questions about the various precedes we had discussed for my skull and nose.
1) For my skull, you are saying you are able to fix and address all my skull irregularities entirely with just that one incision, correct?
2) Will my skull look more symmetrical than my nose? I ask because you have made it clear for my nose to not expect a perfectly straight outcome. Does the same apply to the skull even though it is not a smaller centered human feature?
3) If I do both the skull reshaping and the nose surgery at the same time does that make it easier for you to give me the best symmetrical outcome or does it not make a difference?
4) The only part I am not clear about when it comes to my nose is the curve on the bridge on my nose that I can feel right now when I run my finger down my nose. Once my finger reaches the bridge I can feel the raised right side and the left side cave in and curve and it is no longer flat and straight. Will this remain after surgery or will the bone structure feel straight and even to my hand touch? This is hard to explain with words but it’s what I have been worrying about all along.
5) You did not answer the last time I asked. I am very curious is it possible to see imaging predictions of how a full skull reshape would turn out with the nose job?
A: In answer to your questions:
1) If you are including the forehead as well as the back of the skull as the totality of your skull irregularities then no one single incision, short of a full coronal (ear to ear) incision can address all of them through a single point of entry.
2) Skull symmetry is usually defined a smoothness of shape between the two sides. I would expect it to be a lot better. But perfect asymmetry, like that of the nose, is probably never achieved.
3) The issues with perfect shape and symmetry with any shape changing face or skull surgery are independent variables and are not linked. Each area poses its own challenges which do not change whether they are done together or separately. If you think about the challenges it is one of open access. Through the incisions used for rhinoplasty or most limited incision cranioplasties the surgeon does not have unlimited visual access. If you have no skin on your nose or your skull it would be a different story.
4) While your nasal bone asymmetry will be addressed in your rhinoplasty through osteotomies and nasal bone repositioning, it is not always predictable that the edges will feel perfectly smooth.
5) In regards to imaging, with the right picture angles it may be possible to show some skull reshaping changes with that of the nose.
Dr. Barry Eppley