Your Questions
Your Questions
Q: Do paranasal implants any effect on the length of the upper lip? Do they lengthen the upper lip, what is common with premaxillary implants, or do the paranasal implants rather lift the upper lip a little bit? In one of your You Tube videos about Advanta PTFE facial implants you soaked these implants in an antibiotic solution before they are implanted. Would you similarly dip the Medpor implants in a antibiotic solution also? I noticed that you use both implant materials – silicone and Medpor – and you obviously know the advantages and disadvantages of both very well. I personally would prefer the Medpor implants because they permit tissue ingrowth. But I often hear that Medpor implants are virtually unremovable once they are incorporated. Have you ever removed an incorporated Medpor implant? Is it true that it is extremely difficult to separate the periosteum from the surface of an incorporated Medpor implant?
A: Paranasal implants will not lengthen or push the lip down like a premaxillary implant. Neither will they lift the upper lip either. They merely provide fullness to the nasal base.
I soak all implanted materials in an antibiotic solution. This is particularly valuable in porous implants where bacteria can become trapped into the pores of the implant and not easily washed or rubbed off. The porous nature of the Medpor material also allows an antibiotic solution to be impregnated into the implant with vacuum infiltration or prolonged soaking.
Tissue incorporation into a facial implant is a two-edged sword. It has a benefit of providing anchoring of the implant to the bone site through tissue fixationalthough that advantage can be gained by screw fixation at the time of placement. Removal is definitely more difficult but by no means impossible, particularly for a small anteriorly located implant under the nose. It is more tedious and more tissue disruption must be done to get them out but it is not that difficult.
Dr. Barry Eppley
Indianapolis Indiana
Q : I have a bad scalp scar from a prior brain surgery that I would like revised. I have read about a product from a company called Acell that says it can make scars heal and look better if put into it at the time of the surgery. I have talked to someone at the company and it sounds very promising. Have you ever heard of it and would you use for my scar revision?
A: The search for ‘pixie dust’ in plastic surgery is both alluring and ongoing. We would love to be able to add something to our surgical wounds and incisions that would make them heal better and scar less. While this is of great interest in plastic surgery, I suspect every other surgical specialty would feel the same.
The company to which you refer is known as ACell, Inc. which has developed an implantable material that exergts its effect through the concept of regenerative technology. The product name is MatriStem which is a bioscaffold derived from porcine tissue. (from their bladders) When implanted into a surgical site or wound, it is resorbed and replaced with normal tissue where scar tissue would normally be expected. It purportedly does this by bypassing the typical inflammatory process of wound healing and inducing the body to heal the wound with tissue that is native to the site rather than just dense scar, It comes in sheets and a powder form (micronized particles). It is this powder form that some may call pixie dust. The product is relatively new and has been used for a diverse range of wounds including partial and full-thickness skin wounds, pressure ulcers, venous stasis ulcers, diabetic ulcers, skin donor sites and grafts, after laser skin resurfacing, burns and traumatic abrasions and lacerations.
The material is certainly easy to place into a wound and could be easily applied at the time of closure of your scalp scar revision. It is also not overly expensive as medical products go. Whether your scar will turn out better as a result of using MatriStem particles is unknown but there is no downside to doing so and it does sound promising.
Dr. Barry Eppley
Indianapolis, Indiana
Q : I am a male. I would like to know if Dr. Eppley can do orbital brow bone shaving and whether this can be done without coronal incision. My goal is to achieve a more feminine smooth forehead.
A: Brow bone reshaping can involve different areas of the brow depending upon what one’s aesthetic goal is. If one is interested in a total brow bone reduction, as one would want for a very prominent supraorbital ridge (brow bone), then a coronal incision is needed. This is because at the inner half of the eyebrow are the supraorbital and supratrochlear nerves which supply feeling to the forehead. They can only be pushed out of the way from above without injuring them. In addition, the inner half of the brows are not solid bone but just a thin bone covering over the air-filled frontal sinus. Total brow bone reduction can not be done by shaving but by taking the outer bone off, reshaping it, and putting it back in place.
The outer half of the brow, however, can be surgically altered by both shaving and without needing a large coronal incision from above. This is because the outer half of the brow is solid bone and away from the frontal sinus. It can be done through an upper eyelid incision. The tail of the brow can be reduced and tapered to create more of a lateral sweep which is associated with more of a feminine look.
Indianapolis, Indiana