Your Questions
Your Questions
Q: Dr. Eppley, I am seeking an ‘enhanced’ cheek dimple surgery. I already have one existing dimple on my right cheek. Can cheek dimple surgery enhance it and make it more prominent?
A: An existing cheek dimple already has the anatomic features that make it visible, an underlying defect in the buccinator muscle and a tethering of the skin down towards it. To enhance an existing cheek dimple (make it deeper and more pronounced) it is just a matter of removing some tissue between the dimple skin and the underlying muscle and placing a percutaneous suture to bring the skin further in to make it more deeper or more indented. This is a procedure that can be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested on finding out if a browlift I had done can be reversed or a brow lower ing procedure be done. About one year ago I had an aggressive endoscopic browlift done in which afterwards has lifted my eyebrows way too high. I only had a minor brow sagging problem beforehand and was borderline for the procedure anyway. My surgeon told me they would eventually drop but have not done so and if they have it is clearly not enough. I look like the proverbial ‘deer in the headlights’ look compared to what I looked like before surgery. Can this overdone browlift be fixed in your experience?
A: Excessive brow elevation from an from an overdone browlift can be treated by observation for 3 to 6 months or a brow lowering procedure. Most overlifted brows will usually relax to an acceptable level. But if not, a brow lowering procedure can be done with a subgaleal dissection release combined with an intraoperative tissue expansion manuever. Using a small tissue expander placed in the mid-forehead, it is inflated to its maximum volume to aid with the subgaleal release. Done together, a browlift can be reversed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am about two months after double jaw surgery and sliding genioplasty to correct an open bite and weak chin. Everything is healing nicely, however since day one of my genioplasty, I have noticed that when I raise my lower lip or close my mouth, there is a “shelf” that forms from the mentalis muscle pushing up. It looks like a very deep labiomental fold, however it protrudes enough for me to be able to literally grab onto the muscle that is sticking out. This has been causing me to be tremendously depressed to the point where I’ve gone back to my surgeon and requested a revearsal of the genioplasty. I’ve been hearing about ptosis problems associated with chin augmentations, however mine seems to be the opposite. It looks fine with my mouth is open, however when closed, the muscle seems to be contracted too much and pushing out of my face. All of the doctors I’ve seen at my surgeon’s office seem to think that it will resolve with time, and that the incisions need to mature before the muscles can fully relax. However, it hasn’t shown any improvement. I was told if it doesn’t resolve by April, then it can be addressed, although I hate to wait that long. What I want to know is, what exactly is causing this, what is it, and by which method can it be fixed?
A: In a sliding genioplasty, the chin bone is brought forward and brings with it all of the attached soft tissue. Depending upon the angle of the bone cut of the genioplasty, the amount of bony advancement, the shape of the chin soft tissue pad before surgery, and how the mentalis muscle was sewn back will all influence how the chin soft tissue pad now looks and moves. What you are describing and demonstrating in your picture is a dynamic muscular deformity of the chin pad. (a roll becomes present when smiling, OK at rest) What I would do is first have some Botox injections done into this chin roll to determine if this is aesthetically helpful. If it improves with Botox then it becomes a later question of a mentalis muscle release and repositioning. (this also buys you some time without having the chin pad deformity as well ) If it does not improve with Botox injections then the only improvement is going to come from undoing the genioplasty to some degree. The interesting question in this regards is how much did the chin bone move forward and as it vertically shortened at the same time. In larger sliding genioplasty movements, the chin bone may come forward but may also get vertically shorter. This may cause some soft tissue bunching when one smiles as there is now an ‘excess’ of tissue.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial liposuction. I am slim but hate my chubby cheeks. Whatever I do they don’t go away. I tried buccal fat removal with little luck. Problem is the round bit of fat in malar pads which always goes very high on my apples of my cheeks when I smile. Can the cheek malar pads be removed completely? I want like male models so it looks like no fat at all on cheeks and so When smile it is just skin that raises up instead of the fat malar pad. I dont need malar lift, I just want it to be gotten rid of for good. Can it be completely removed and sucked out even if this may leave some sagginess of the skin. After that maybe I can have midfacelift if needed but I really want this malar pad gone. It is not buccal fat that I want gone, it is malar pad which rests on top of cheekbone. I don’t want a malar lift to redistribute fat on to higher position, just complete removal. Is it possible?
A: I understand perfectly as to what you are referring to and it is no surprise that a buccal lipectomy would have no effect. The buccal fat pad is in a lower anatomic location. The tissues that you are referring to are over the malar region but to describe them as the malar ‘fat pad’ is not anatomically accurate for what you are trying to achieve. The malar ‘fat pad’ is not like the buccal fat pad, it is not an isolated and thus easily extractable type of fat. Rather it is fat mixed in with other tissues giving it a more fibrofatty quality to it. Thus it is not amenable to excision (like the buccal fat pad) and is more resistant to small cannula or microliposuction. This does not mean it can not be treated, it is just a question of how effective it would be and that disrupting these tissues will cause it to sag as the suspensory ligaments would be traumatized. But when it comes to complete removal of the malar fat pad fullness, I do not believe that is surgically possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need some skin care advice. I was using both Task Essential Serum Revitalisant 02, 02 Revitalizing Serum in the morning, Task Essential Treatment Regenateur 02,and 02 Regenerative Treatment at night. After my operation, switched to Cetaphil. Do you think Task Essential are the best products to use? And is Task Essential New Skin Exfoliant the best scrub to use on my face? Also is Task Essential Pure Mask Instant the best mask to use on my face? And what is the best sunblock to use for my skin? By-the-way, when I use Cetaphil Cream on my face, should I use a lot. And should I use a lot on my nose and instead of rubbing it into my skin should I let sit sit on my nose overnight?
A: When it comes to skin care products, there are literally thousands of product options. In reality there is no one single product or product line that is the ‘best’ or is the best for anyone. Probably hundreds of these thousands of product options would be effective for most people. What is important about any facial skin care product line is that one finds it non-irritating and comfortable to one’s skin as the benefits of any topical skin treatment is based on regular and sustained use. In short, neither of the two products you have chose is better than the other. Use the one you like the best.
The same issue applies to sunblock. Most moisturizers today contain sunblock and as along as it is at least SPF 30 in strength that is all that matters.
Your goal with any skin care product application is to use the least that works. Using more does not make it more effective, that only allows you to go through more product faster.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of breast implant replacements. I had breast augmentation in 1991 and it appears one of my implants must have ruptured and has deflated. I need to explore my options.The original surgery was done by using implants with a silicone shell with outer saline fluid.
A: Your original breast implants by description were what was known as Becker implants. They were a double lumen ( 2 bags) implant with an inner bag that contained silicone and an outer bag that contained saline fluid that was filled at the time of surgery. The logic of that old style breast implant was that it helped control silicone gel ‘bleed’ which had a known effect of causing high rates of capsular contracture at the time. (breast implant hardening) Those implants have not been manufactured for over 20 years although some few patients still exist with them in. Like a completely saline-filled breast implants, rupture and partial deflation (remember there js still an inner bag that has intact silicone gel) was inevitable. Getting 23 years of service out of these breast implants means you have done well. This day was eventually coming and it now appears that it is here. The only real significant question with breast implant replacements is whether you want to go with a completely saline-filled or silicone gel type breast implant and whether you want a similar size in volume with these replacements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal implants but I have a twist to my need. I am bald and can’t regrow hair so I keep my head shaved. In addition I had a direct browlift last year so there are healed incisions right above my eyebrows. My question is can these implants be placed by going through the brow incisions? I hate that I would need temporal scalp incisions which would be very visible in someone like me.
A: While temporal implants may be aesthetically beneficial for you the question is how to get them in there in a ‘scarless’ manner in someone who shaves their head. This is a unique male question and not one that is seen in females. As you have read, the approach for temporal implants is from a 3 to 4cm incision just above the ear. While that approach makes it very easy and simple to do, the concept of a fine line scar in shaven scalp skin does give me pause. Your question of whether a temporal implant can be placed through a direct brow lift incision is an interesting one and the presence of a scar in that area poses a unique ‘opportunity’. The eyebrow incision for temporal implants is one I have never done and I doubt if it has ever been done anywhere in the world to date. By its proximity your eyebrow scars provide direct access to the area of temporal hollowing but the attachment of the temporal fascia to the lateral orbital bone is quite stout and would have to be released to gain entrance to the subfascial temporal plane. (having done a lot of craniofacial surgery I am very familiar with doing surgery in this area) The simple answer to your question is that it is theoretically possible and if one was doing some adjustment of your direct brow lift anyway there is no reason not to try. If it becomes too difficult to do, one can always then switch to doing fat injection into the muscle and on top of the fascia to create a temporal augmentation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am interested in some form of forehead reshaping. I have two hard-like horns or lumps on my forehead. They have been there since I was a teenager. Now that I am in my early twenties it bothers me greatly. They feel like really hard like bones. They really affect me and bring my self esteem down. I’ve been to my family doctor and I was told it was really nothing. I am hoping you can help me. I have attached pictures from different angles for your assessment.
A: One of the most minor forms of forehead reshaping is reduction of prominent bulges. Your pictures show a very classic example of them and how protuberant they can be. Thank you for sending your pictures. They are the type of forehead bulges/osteomas/horns that I have seen many times. They are common excess growths of the forehead bone and are almost always on both sides.They are benign and normal but obviously not aesthetically desireable. They can be burred down to make for a more smooth confluent forehead contour. Depending upon the shape of the rest of your forehead and how much they can be burred down, it is sometimes also helpful to build up with bone cement around the area to get a really smooth forehead shape. That shaping consideration aside, the only other issue to consider is one of surgical access. You have to have an incision somewhere to gain access and this would be back in the scalp. Thus one has to accept a very fine line scalp incision to do it. Fortunately even in men with thinner or thinning hair cover, the scalp incision heals well with very minimal scar.
Dr. Barry Eppley
Indianapolis, Indiana