Your Questions
Your Questions
Q: Dr. Eppley, I am a 23 year old male with an indentation on the back left area of my skull. It has been there as long as I can remember. It is made worse by the the fact there is a slight bone protrudence to the right of the indent. I have no idea if it is congenital or not. This is clearly visible when my hair is cut short and I am looking to get it fixed. I have attached pictures so you can take a look. I have done a little research and discovered kryptonie, the bone cement and was wondering if that would be an option, or would you recommend something else? I have seen a plastic surgeon in where I am from but he’s not too sure if he could even help. I stumbled across your website and from your previous work, I am very interested in your opinion and setting up a consultation/procedure. I would much rather prefer to make only one trip if possible. I would like to know what are your thoughts on my skull and have you ever dealt with a case like mine before? Would a large incision with scarring be the only way to go about fixing this? Also, what is a rough estimation to what it would cost? Thanks so much for taking the time to read my email.
A: Your pictures show a skull indentation directly over the original site of the posterior fontanelle. This is where the back soft spot was as a baby that did not develop enough skull bone thickness as that of the surrounding skull when it fused. That indentation has probably been there since you were one or two years of age. That is why you have it and I have seen it and treated it before. Basically it is a simple indented skull area that can be built up and smoothed out. The key question is what is the best way to do it. It can be made absolutely smooth and level through a longer open incision but that is understandably not desirous due to your close-cropped hair. That leaves the other options of a minimal incisional approach (maybe 1 to 2 cms) which would allow the indented scalp soft tissues to be adequately elevated from the bone and through which some material could be used inserted. Understand that an injectable technique does not mean incision free, it means that the material as the ability to flow through tubes (not needles) and thus only a small incision is used to place it. This is best thought of as a ‘minimal incision cranioplasty’. Kryptonite as an ‘injectable’ material is no longer commercially available to do this so that leaves us with two other options, PMMA or OsteoVation. There are minor advantages and disadvantage to each material which can be discussed later. Both are liquid and powders that are mixed into an initially runny material which allows it to be pushed into a pocket by syringe created over the bone indentation after the release of the attached soft tissues.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I would like to get rid of my facial wasting due to HIV. I am interested in cheek implants and fat fillers for lipodystrophy. I have attached a picture of my face for your evaluation.
A: In looking at the one picture you sent, your greatest area of lipoatrophy is in the temples and secondarily in the submalar regions. Compared to many patients that I see, your degree of facial lipoatrophy is fortunately more moderate in severity. Given that you have existing lipoatrophy, and I assume you are on antiviral medication, this makes the use of injectable fat survival precarious at best. For this reason, I make an effort to use permanent synthetic implants when possible for its treatment. These would be applicable to the temporal, submalar and even the nasolabial fold areas. But facial implants do not cover all facial lipoatrophy areas and are at best thought of as building blocks from which to fill around with fat injections as needed. Even though fat injection survival is unpredictable, it is the best filler to use for broader facial areas. And since it is not the only method of treatment that is being done, any survival that is achieved is a bonus to the underlying implants.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 27 year old male. I am in good shape and workout all the time. I have lipomas all over my body and have had four surgeries to remove them. I have always had excision. I now have near 100 scars and would like to figure out another option for myself. I have read about your practice and wondering if you could help. I have done a little research on fat dissolving injections. I would prefer not to have as many scars as I do now, but I know that surgery is the best option. So far I have had four surgeries and have removed about 90 small lipomas. I don’t understand why I get them as I am very healthy and in good shape. I exercise regularly and eat a well balanced diet. I would prefer the injections if you feel it is worth my time and money or a possible liposuction technique. I’m not against excision but would prefer no more scars. Thank you for getting back with me.
A: The condition that you have is known as familial lipomatosis. There is where someone, like you, develops recurrent and new subcutaneous lipomas all over their body. It has nothing to do with your weight, diet or exercise habits. It is a genetic condition where these lipomas develop and no one understands the cause and how to control it. All that can be done is selective removal of the most problematic lipomas. While surgical excision is the established and most definitive treatment for lipomas, it can certainly be taxing to undergo recurrent surgeries for them. Lipodissolve is a generic name for the injection of a known fat dissolving solution that contains phosphatidycholine, deoxycholic acid or various combinations of both. This is a compounding pharmacy injection not an FDA-approved drug. (although it is currently under current phase II clinical trials by Kyphera for neck fat reduction) This approach for fat reduction achieved notoriety in the mid-2000s when it was widely used across the U.S. for cosmetic body contouring and fat reduction. Its use collapsed when the company promoting it collapsed and the FDA stepped in and stopped its widespread use as an unregulated cosmetic treatment.
When it comes to the use of these injections for lipomas, I have used them in numerous patients with reasonable success. It does shrink them by fibrosis and scarring. It may take more than one injection session to get the maximal reduction. The lipomas may or may not regrow based on their original size and how much reduction is obtained.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’ 5” and weigh 172 lbs. I am considering a tummy tuck to get rid of my belly that is hanging over my pant line. I am not completely sure I am done having children but I want to go ahead and have a tummy tuck anyway. I am tired if carrying around this belly. My question is can I have a tummy tuck under local or something less than general anesthesia? Also if I should have another child in the future will I be able to get by without changing the look of the tummy tuck?
A: To get the best result from a tummy tuck, it really needs to be done under a general anesthetic. A tummy tuck is one cosmetic operation where the option of a local or IV sedation is just not practical and would not even be considered. Any pregnancy that goes to full-term is going to affect the results of any tummy tuck procedure. It is just a question to what degree will the tummy tuck change and how much loose abdominal skin will result. While it is likely that it will not create a complete return to the way you look now with a significant abdominal overhang, some new skin rolls will likely result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a question what is the difference between the custom implant and the off the shelf jaw implants? I think for my ideal face I would like to achieve is to vertically lengthen my chin only a bit and make it more wide. For my jaw I think just maybe only a little bit widen but more lengthened so I would have a longer smaller looking face. I think for me its not so nice to widen it too much). I want the same face I have now only smaller looking with a better jawline. I have attached a male model’s photo which is what I want to reach is something like that possible for my face?Also I am a bit concerned if something would go wrong, is it being corrected for free then? And how long should I stay in Indianapolis as I don’t want to know people at home.
A: The role of custom facial implants is useful when off-the-shelf implants can not produce the desired effect either due to the size changes needed, a special shape of the implant is required or there is asymmetry between two sides. Another difference is that custom implants cost a lot more and will add $7500 to a surgical procedure such as yours. So you have to have a real good question to go the custom route.
The model photo you have shown can not be exactly achieved on you because only a custom jawline implant can create a perfectly smooth wrap around effect.
If revisional surgery is needed, the patient is responsible for the costs of the operating room and anesthesia costs. No revisional surgery procedure is completely free.
Most jawline implant patients will stay 2 to 3 days before returning home. But if you are not desiring to go home until most of the obvious swelling is gone, then it will be several weeks. (which is a bit impractical for most patients)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a combined forehead augmentation and rhinoplasty. Please see the file attached for my thoughts on how I want to look on the front of my face. Please forgive the crudeness of the drawing, I only have Windows Paint on my computer to play with, which is very limited in abilities ;-). It should give you a general idea however. One of my questions is will the forehead augmentation result in a possible simultaneous hairline lowering? Also, how long would the recovery period be?
A: That is actually a very good drawing as it is always important to understand what the patient actually wants. Any forehead augmentation procedure requires a scalp incision which is almost always placed way behind the hairline and does not really result in hairline lowering. That raises the other possibility of making a hairline incision (what we call pretrichial) to do the forehead augmentation and then try to bring the scalp forward to lower the hairline. This would obviously place the incision at the hairline. Just an additional thought although I always feel it is better to have the incision way away from where the cranioplasty material is placed.
When it comes to recovery from a combined forehead augmentation and rhinoplasty (which is actually not a rare combination in my experience), you would expect to look pretty reasonable in about 10 to 14 days. (although all swelling takes about 6 weeks and final refinements up to 3 months after surgery) It is not really a physical recovery but one of appearance.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, Hello! I have a scar on my forehead indented with a small amount of tissue over and it is same color as skin. Any options for improvement? Here is a picture of what it looks like. I am just particular about it and cover it with makeup daily:) My brother thought Juvederm would work, but I am looking for something a little more long term. Thank you so much.
A: When evaluating scars it is first important to evaluate its physical characteristics. That is the key to determining the best treatment for its potential improvement. Your vertical glabellar (between the eyebrows) scar has one feature that makes it the most visible…it is wide with a depressed gap between the skin edges. When you have a depressed scar the only chance for improvement is excision and reclosure to level out the skin edges and make the scar more narrow. In addition to prevent recurrent collapse of the scar line, the closure should not be a straight lone closure but that of a broken line or geometric closure like a w-plasty pattern. Your small forehead scar revision could be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, Could one have a custom made implant for the chin based on a facial casting to set up a mold for a bone paste like kryptonite. The theory here is that if the implant is a perfect fit then the paste will be a fit perfect too. To clarify… The paste would need to be pressed into the custom mold to set up the shape and then inserted into a ready pocket created with the help of the solid implant. You would avoid the blind aspect of shaping from the outside and complete the critical portion within the 4 minutes allotted to hardening.
A: Your thoughts are good ones but is limited by one major factor. Kryptonite is no longer commercially available (for reasons I do not know) and this is the only calcium-based bone cement that has the biomechanical properties to be molded and inserted similar to a solid implant. The other issue is that bone cements, even if preformed, are not flexible so intimate adaptation to the underlying bone may not occur. This could create some rocking and movement of such a custom made chin implant afterwards.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have been bullied for a number of years over the shape of my skull and I am looking to do something about it as it’s ruining my life. The width is an abnormal shape and above the ears it sticks out quite a bit. I have read some of the questions on the website and seen Doctor Eppley’s answers which seem like it would be something that can assist me. Am I right in saying Doctor Eppley is the only person in the world who performs skull reduction surgery? I have spoken briefly with someone over email where I live but I am not sure the procedure they suggested is what I am looking for. I need to find the right procedure as I feel it is a necessity to have it done to be able to enjoy my life at all. I’m so depressed about it and I’m really searching for someone to help me before I get myself in to a bigger hole with the depression.
I have attached a picture. Are you able to say whether I can be helped or not please?
How long would I need to be in hospital for and when could I travel back home?
I’m worried about the strength of my skull after the surgery, I will be able to live a normal life afterwards won’t I, like play football etc??
I really appreciate your help and you taking the time to read this I understand you are very busy. Another question is that my ears are quite pointy/large and if I was to undertake this surgery I’m worried they will stick out even more, can anything be done with them so this doesn’t happen and they look a bit more normal?
I’m so sorry for so many questions. Whereabouts on my head would the incisions be? Would they be behind the ears and would they be quite deep scars?
I had thought about hair transplants at some point in the future because my hair seems to be disappearing rather quickly but I do prefer the shaved look if I’m honest. Do you think this would be a major problem?
I have to admit it has put a smile on my face knowing that you can possibly help. From the picture do you think the 5mm-7mm you mention in your questions section on the website will be enough to make my head look more normal in terms of shape?
Thank you so much for getting back to me.
A: Thank you for your inquiry and sending your pictures. From what I can see in this one picture (which is the most helpful view), there is temporal skull/muscle protrusion as well as ears that stick out a bit. This could be improved by a combination temporal muscle/bone reduction cranioplasty combined with a setback otoplasty.
This is a procedure that is done as an outpatient and one could return home in 48 hours. There would be no worries about the strength of your skull and you would not have any restrictions after surgery.
The most relevant issue is that an incision is needed on both sides to do the surgery and this is always a concern when it is a male who shaves his head or a has a close cropped hairstyle. We just have to be careful to not ‘trade-off one problem for another’.
To be certain we are looking at the same thing, I have done some before and after imaging to see if the changes that are possible is in line with what your objectives are. This is probably what a 5 to 7mm reduction can achieve.
The incisions would be vertical in the hairline just behind the ears and extending upward about 6 to 7 cms. They are not deep or indented scars but rather just fine lines.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 42 year old male and I am interested in a Chondrolaryngoplasty. (adam’s apple reduction) I am just very self conscious about my large adam’s apple and I am just tired of being harassed about it. I have heard that the cartilage turns to bone at a certain age so at 42 can I still have this procedure done?
A: While it is true that many cartilage areas in the body get partially calcified as one ages, and the thyroid cartilage is no exception, this is not a concern for you at age 42. At this age the thyroid cartilage is still mainly cartilage and it does not change the ability to shave it down. The reality is that even if you were older and the thyroid cartilage was more calcified, it could still be reduced and would be burred down by a machine-driven rotary drill as opposed to shaving. Thus, you should feel completely comfortable being able to have a successful adam’s apple reduction (chondrothyroplasty) at any age regardless of whether the cartilage is uncalcified, partially calcified or even completely calcified.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in the procedures of jaw enhancement, facial fillers, and nosejob. I would like to achieve a more defined and symmetrical jaw line. I want a more filled out face. Perhaps cheek fillers or cheekbone reduction also? I am not sure which approach would be best to give me a fuller face. I want facial features more similar to Brad Pitt.
A: I can see your concerns in regards to a fuller face. You have a very skeletonized face with virtually no fat between the prominent cheek bones and your jaw line. I have done some imaging based on the procedures of jaw angle implants to widen the lower posterior face, a rhinoplasty and fat injections to the sides of the face below the cheekbones down to the jawline. This combination appears to give you better facial proportions and also demonstrate that the cheekbones are not really so prominent. It is the lack of soft tissue fullness (fat) that is why you have your current facial appearance. While cheek bone reduction is an option, I used fillers just to see how the face would look without changing the width of the cheekbones. This confirms their benefit over cheekbone reduction.
The pictures are not of good enough quality to reveal what a rhinoplasty can really do but I made my best effort.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 57 year old male in good health, who exercises regularly and watches what I eat. Over the last couple of years, my temporal artery on the right side of my forehead has become more pronounced. I visited a vascular surgeon, who said there was no medical reason to do anything. The vessel is very noticeable and I wanted to know if there was anything that could be done to hide it. I am concerned because the surgeon said its removal could cause other issues (eyelid drooping).
A: Ligation of the branches of the superficial temporal artery (STA) can be done to reduce its prominence. The main trunk of the STA lies in the temporal hairline and is far removed from any branch of the facial nerve. But reduing anterograde (forward flow) of the STA is usally not eough to reduce its visible pulsatile appearance. Retrograde (backward flow) from the STA from its distal extension in the forehead must also be done. (two-point ligation) This is done through a small stab incision somewhere on the forehead where the tail of the visible artery can be seen. This also has a very low risk of injury to the frontal branch of the facial nerve which supplies the forehead and upper eyelid closure.
Dr. Barry Eppley
Indianapolis, Indianapolis
Q: Dr. Eppley, I am interested in forehead augmentation and possibly rhinoplasty. I have put together a compilation of my head shots along with some of the “standard” head models. In short, I feel that I have a huge face and no skull. I would like to achieve a better balance between the two. So the procedures I was thinking of are 1) Forehead augmentation and 2) Skull Augmentation to the sides, up and back (if possible of course, sounds like a lot). I am also considering a rhinoplasty to reduce the width of my nose. Please see the attached compilation and let me know what you think. Thank you so much for a prompt response.
A: I have done some imaging based on what I see as the causes of your face:skull disproportion. Your forehead is sloped at a near 45 degree angle with no brow prominence. When combined with a long overprojecting nose and a short chin, your face looks out of proportion to your skull. By doing a forehead augmentation, shortening the nose and bring the chin forward with a central button implant, there is much better balance between your face and skull. I have attached some imaging to show what effects those procedures might have on your appearance. These imaging predictions are just a first pass on the procedures and more or less changes are possible.
Dr. Barry Eppley
indianapolis, Indiana
Q: Dr. Eppley, I had mandible angel jaw reduction(removal of square bone at the posterior part/not the front or anywhere towards the frontal part of face) about 5 months ago. Dissolvable stiches were used. The stitching on the inside was fine. The stitches on the outer/upper part of the gum on both sides were dissolved in about 8 days. I had this done in Asia and had to travel back home, realising the stiches on outer/upper gum were dissolved. No infection. The problem now is that both sides of my gum have a gap/opening and I have to gargle after I eat because food bits get into these openings,flap in the gum.
1. WOULD THIS AFFECT THE SWELLING OF THE GUM TO GO DOWN COMPLETELY?( THERE’S NOW A FLAP/OPENING)
2. CAN IT BE STITCHED AGAIN? TO CLOSE THE OPENINGS ON BOTH SIDES OF SURGERY SITE.WHAT COULD BE DONE TO RESOLVE THIS PROBLEM?
Another thing I’m realising. It looks like the jowl area is protruding, it looks round? The square jaw is gone but now there is protruding of something (fat?skin?tissue? I don’t know)around the jowl area? Age is 41.I tried to suck the inside of my cheek in and I think it helps get rid of the round, bulge on jowl area. Therefore, I’m thinking that a buccal fat removal will help get rid of this bulge.
3.Please see pics attached and advise what you can do to take care of this bulge, jowl area?. ( Is it fat? skin? tissue or muscle?)
One more thing I’ve been comtemplating is the nose. Tip augmentation and trimming the fat on the tip area for better definition?
4. I’m not sure what it is that should or could be done to improve the nose. Perhaps there are other things that I am not seeing. Please let me know what you see , what you would suggest doing to improve the nose.
ALSO,LOOKS LIKE DESCENDING FAT BELOW THE EYES, AROUND THE CHEEKS AREA, CREATING A FOLD NEAR BOTTOM PART/SIDE OF NOSE.
5. Is there any method for this descending fat be removed? Im thinking I’d be better off without them.
Hope to hear from you soon.
A: In answer to your questions:
1) I am not completely sure what this issue is in regards to your gum tissue. Normally the incisions for mandibular ramus surgery are done far away from the gum line in the mandibular vestibule leaving at least 1 cm cuff of tissue from the incision to the attached gingiva. When done in this way there never is any issue with gingival (gum) retraction or healing issues. Because you have these concerns now makes me wonder if your incisions are not either very close to the gumline or actually went through the gumline for access. At point, gargling is the best way for oral hygiene and to let the tissues heal further. (although at 5 months after surgery things should be fairly well healed. Whether improvement is possible is hard for me to say as I obviously can not see where the flap is in the tissues.
2) As above. Most likely, the gingivomucosal flaps can be re-raised and closed.
3) Jowling is always an issue of loose skin and descended fat. It has nothing to do with the buccal fat pad and its removal will not be helpful for eliminating jowls. It has probably become more apparent and has ‘developed’ now that the bony jaw angles have been removed. (loss of bony support) Jowls can only be treated by either spot liposuction or a jowl lift.
4) I would agree with your assessment of your nose that further tip projection and definition would be aesthetically beneficial. A tip rhinoplasty with a columellar strut and a double stack tip graft with possible nostril narrowing is how that could be accomplished. I have attached some imaging of that potential result.
5) The fat around the nose at the level of the nasolabial fold can be treated by very small cannula liposuction if desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I fractured my cheekbone about a year ago, and I definately have noticed a change in it’s appearence compared to the other side, however I believe the break occured on a natural fault line so to speak and I’ve noticed that the bone has not yet joined, I can actually move it out and it will resume close to its normal appearence but the muscles on my face work to pull it back in. I think it’s fixable if I can get some kind of bonding agent to hold the bone in place so it can join. Look forward to hearing from you!
A: Most cheekbone fractures occur along very predictable fracture lines that involve the maxillary sinus and the eye bones. Cheek bone fractures almost always fall downward and inward into the maxillary sinus. It would be highly unusual to still have a mobile fracture a year out from injury…but I have heard of occasional reports of it occurring. To stabilize the fracture in place microplate and screws can be placed from a small incision inside the mouth to stabilize the downward pull of the masseter muscles that you are experiencing That is the best way to stabilize a displaced and mobile cheekbone fracture. There are no bonding agents or glues that are available to hold facial bones in place.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my goal is a harmonious and ideal ‘male model’ look profile via rhinoplasty and possibly horizontal and vertical chin augment if rhinoplasty is not enough. I want to have rhinoplasty done to correct my deviated septum, hanging columella, raise my tip slightly and smooth a slight nasal hump. I’m wondering if I can get away with rhinoplasty alone to enhance my profile? I feel my chin is a little weak (I have an overbite ~ class II). I did orthodontics/braces to correct my crooked teeth only, but not my bite. I don’t want jaw surgery because I’m OK with my bite function.
Concern: My deep labiomental fold that is between my lower lip and chin. Will a chin augmentation hurt, help or not effect this crease? I don’t want to make this crease worse, I either want it unchanged or improved.
Questions: Chin
Which procedure is recommended to produce an ideal result. Implant, genioplasty or doing nothing?
If implant, how big and what type should be used?
If genioplasty, what kind of cut would be done horizontal?
Will a chin augmentation hurt, help or not not effect labiomental crease??
A: In answer to your questions;
1) You absolutely can not get away with just a rhinoplasty alone to improve your profile. Your chin position is just too short. For your profile and overall facial aesthetics, chin correction is actually more important than the rhinoplasty.
2) Your chin correction should ideally be done by a sliding genioplasty because you have both a horizontal and a vertical chin deficiency.
3) The vertical component of the sliding genioplasty will allow the depth of the labiomental sulcus depth to remain unchanged as the chin comes forward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, is it possible during a tummy tuck to injure one’s bowels? I am afraid to have a tummy tuck because I don’t want to suffer a major medical problem just because I want a flatter stomach. How close are my bowels to where a tummy tuck is done?
A: While it is common to have some constipation after a tummy tuck, there is no risk of any long-term gastrointestinal tract issues. Only skin, fat and muscle is manipulated during a tummy tuck and there is no chance of inadvertent injury to the large or small intestines. The bowels lies on the opposite side of the abdominal muscles. Repairing a hernia at the time of a tummy tuck poses some risk for those concerns but it is no greater than any other hernia repair. Since pain medication will be needed after a tummy tuck, and that has a known slowing effect on gastrointestinal mobility, women should drink plenty of fluids during their recovery and take a daily stool softener starting a week before surgery as well as continue it afterwards. In short, a tummy tuck may require some significant recovery time but it is not a dangerous surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to deliver my third and final baby next month. I already have a c-section and will be getting another c-section for this final delivery. After the delivery of my second child, I saw how much loose skin and stretch marks I had and that never really went away afterwards. I am wondering if I can get a tummy tuck at the same time as my c-section. It just seems like a logical time to do it, kill two birds with one stone so to speak. Is the hardest part getting two doctors to do it at the same time or can my Ob-Gyn just do it?
A: While loose stomach skin can be removed at the same time as a c-section delivery, it is not the best time to do it. The uterus is swollen and prevents muscle tightening and there is still considerable water weight present. In addition, being under an epidural limits how much overall abdominal reshaping can be done. It is far better to wait six months after delivery and try to lose as much weight as possible before having a tummy tuck…the result will be so much better. While there is nothing wrong with having a little loose skin removed during the c-section but that shouldn’t be confused with a real tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to have a tummy tuck but I have a question about how the belly button is made. Where does it come from? Is made from skin thrown away from the tummy tuck or is it somehow carved out from the stomach wall? Can you explain it to me how you do it?
A: The belly button is nothing more than a remnant or stalk of scar tissue from the skin down to the abdominal wall. It is never removed during a tummy tuck but rather the skin around it is. The stalk of the belly button is always preserved, it is the loose skin around it and any extra length of oys stalk that is removed. The shortened stalk of the belly button is simply put back by bringing it through the abdominal skin that has been brought down and tightened over it. Reshaping of the belly button is almost always done whether it is shortened or not. The key to a good looking belly button result in a tummy tuck is to shorten it so that the outer skin dips in, the surrounding scar is on the inside, and it has more of a vertical rather than a round shape.It is always better to have a smaller belly button than a larger one as a result of a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question regarding chin and jaw implants. My question is: if a person plans to have both chin and jaw implants, do they have to be done in one procedure? In other words, is it possible to get jaw implants and then in a year get a chin implant? I’ve heard it’s easier when done together, but I just don’t have the resources to get both of them at once right now, so I’m wondering if it is possible to get a jaw implant this year and then next year a chin implant without complications?
A: There is certainly no reason why chin and jaw angle implants they can not be done separately. Economics is a very good reason why some have to ‘stage’ their overall jawline enhancement. Which one you do first is a matter of personal preference and would depend on what you see as your biggest problem. For many patients that would be the chin because it is the most visible part of the jaw and often displays the most obvious deficiency. For others the chin has a more minor deficiency and the high and weak jaw angles is the most deficient part of the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wonder if my deep set eyes can be treated by the same procedure which is done for enophthalmos? I heard from a doctor that cartilage can be implanted behind the eyeball. Is that possible?
A: Building up the orbital floor with any form of a graft works in enophthalmos because there exists expanded intraorbital volume and the graft is merely returning the intraorbital space to normal. The eyeball can be oushed up and out because there is space for it to go. where it was once was. In a normal or non-enophthalmic eye, there is normal intraorbital space and lessening that with a graft runs the risk of putting pressure on the eyeball. In other words, you are not going to push the eye out by putting in a graft without the potential risk of visual impairment.
Dr. Barry Eppley
Indianapolis, Indiana