Your Questions
Your Questions
Q: Dr. Eppley, I have a deviated nose and feel pressure in my nasal bones. ENT doctor said nasal passage was clear from what he could see and prescribed allergy meds for constant stuffiness and post nasal drainage. Wondering if any chance insurance would cover any of my deviated nose repair procedure to improve how I breathe and the way the nose looks.
A: Insurance can cover internal nasal surgery for breathing issues such as septoplasty and turbinate reductions. These are often done as part of many rhinoplasties and fall under the name of septorhinoplasty when both functional and aesthetic nasal changes are done during the same operation.
Before one can submit to insurance to determine whether coverage is possible, this would require a paranasal CT scan to first be obtained to look at the internal nasal anatomy and see what abnormalities exist. If structural problems exist that block the nasal airway then a predetermination letter can be submitted to insurance to determine whether they would cover the functional surgery to correct it. You can not submit a predetermination letter without a CT scan to document what anatomic abnormalities exist inside the nose.The aesthetic part of the rhinoplasty (any external changes) would not be covered by insurance.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, I have a question about chin augmentation. I am on Remicade for Crohn’s disease and was wondering if you have experience working with patients on Remicade and any recommendations you might have for them when undergoing chin implant surgery.
A: Remicade or infliximab) is a TNF-alpha (tumor necrosis factor alpha) blocker used to treat inflammatory bowel disease. (IBD) It is effective in Crohn’s disease and ulcerative colitis since IBD patients have more TNF-alpha in their systems than people without IBD. Remicade is usually given by infusion every 8 weeks. The best way to reduce the risk of infection or wound healing problems is to do surgery 6 to 7 weeks after their last Remicade infusion. Then have the next Remicade infusion 2 to 3 weeks after surgery. This balances the increased risk of infection versus the risk of a flare up of IBD symptoms.
Since chin augmentation surgery is a fairly small insult on the body, this approach may be unnecessary. But I have used it successfully in the past for cosmetic surgeries far more major than chin augmentation such as tummy tucks and breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheek implants and paranasal implants placed overseas two months ago, but it appears that the ones on the left side have been infected (yellow drainage, mild swelling). My issue is that I do not have the time to get them removed right now. I’m thinking of going to a local doctor to get antibiotics to try and control the infection in the interim. If I do that and wait till year’s end to remove them, will it cause any permanent issues (excessive tissue scarring)?
As for the removal, have you ever had any cases whereby you only removed the infected implants? I understand that this will cause asymmetry, but could I use fillers for the side where the implants were removed to compensate (at least until I get the implants reinserted)?
Finally, would waiting 6 months before reinsertion be enough time for the tissues to heal and for the infection to clear? Or, would you recommend waiting even longer?
Sorry for these questions, but I can’t seem to contact my original surgeon right now, and I was hoping you could just help assuage some of my concerns.
A: This is disappointing that you trusted a doctor to do the surgery and now you can not get a hold of him to answer the most basic of questions when you have a problem that he created.
In short, antibiotics will only keep the problem at bay temporarily with infected cheek implants. Leaving them in, if infected, is just going to cause a lot of scar tissue that could make future surgery problematic. If infected it is in your best interest to have them removed, let it heal and then reinsert 3 to 6 months later. Injectable fillers or fat injections should not be placed into the cheeks after implant removal for a minimum of 6 to 8 weeks after the infection has cleared.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have spoken with you in the past regarding jaw implants and chin implants. Through looking at your case examples, I feel as though custom implants produce the best results. Quite frankly, the results you are getting are incredible.
In looking at your recent example: http://www.exploreplasticsurgery.com/tag/male-custom-jawline-implant
I was hoping you could tell me the dimensions of the implant for the jawline (vertical and lateral) as well as the chin, just so that I could get an idea of what what kind of changes are produced from a given size (though I know it will be different for each person). Also, is the recovery easier with a custom implant as opposed to an “off the shelf”?
A: Your assumption is correct about custom jawline implants on two counts. First, it usually does offer a significant aesthetic improvement over a three-piece jawline enhancement approach. This is not only because that it is one continuous piece, which is very much like the natural jawline, but being able to create the individual dimensions of the chin and jaw angle that best suits the patient can be a huge advantage over standard chin and jaw angle sizes. Second, the jawline dimensional changes that are used for each patient are unique to them. Thus, the implant dimensions used for one patient should not be attempted to be transferred to any other patient and assume they would get a similar result. Since they are no software programs that can tell the surgeon what any dimensional change of a custom designed implant will really look like in the patient, it takes a lot of experience to learn what will work for each patient. Thus I do not provide numbers for jawline implant measurements unless I am actually designing the implant for them.
The amount of tissue dissection for a custom jawline implant or a three-piece standard chin and jaw angle implant approach is really the same. Thus the amount of swelling that results and the recovery should be similar between the two implant approaches.
Dr. Barry Eppley
Indianapolis, Indiana