Your Questions
Your Questions
Q: Dr. Eppley, Thank you for taking the time to generate this computer modeling image for me. Although striking, I find the jaw line in the modeling too bold or strong for my liking. Perhaps I need time to acclimatize to the new look. I am more inclined to a long slim straight jaw line with small round (almost but not quite pointy, but not square or large round/oval) chin as in the first attached image.
I understand that you would be making a custom implant from the CT Scan I will provide. But from my limited web research, I have made the following observations. If Implantech implants were used, the back of the jaw would just be built out to appear 1” below the ear as opposed to the modeling of 2” below the ear (using a jaw angle lateral width implant versus an vertical lengthening jaw implant). I understand that the chin implant (such as the vertical lengthening chin by Implantech) would add projection reducing pre jowl sulcus as well as help with the angle under the chin. (See second attached image).
My big concern is with my neck angle in profile. Would a neck lift with removal of playsmal fat banding create a nice sharp neck angle (horizontal as opposed to 45 degree angle)? Would the above mentioned vertical lengthening be appropriate to correcting this problem?
A: The main role of computer imaging is to see what type of changes a patient is looking for. So having thrown that first draft out there, you have provided the direction I was looking for in regards to your jawline shape goals.
When making custom implants, there are different than what standard stock chin and jaw angle implants have to offer. They can be made to any dimensions one desires and would be connected between all three. That is a significant advantage when it comes to addressing any loose skin around the jawline and neck lift as it will pick it up to some degree through a volumizing effect. This effect combined with a small neck lift should address any neck issues and create more of a well defined and sharper cervicomental angle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am about three months post op sliding genioplasty to advance my chin forward 6mm. The surgery made my lower part of face more narrow with a clear step off in my jaw line which was not there before and I still have mentalis strain. Actually I like my face before and I didn’t want it to change in the frontal view, just wanted a little projection to improve my profile. My surgeon told me nothing will change in front but now I see dramatic changes. I’m thinking of reversing the surgery and I have questions regarding that option. In case of full reversal am I going to regain my old look and the step off will go away? Risk of skin sagging? And when I can use injectable after surgery? Thank you.
A: When the chin is moved forward by sliding genioplasty there are almost always two aesthetic ‘side effects’ of the procedure. It is not a question of whether they will be there but how much and how noticeable will they be to the patient. First, as the chin comes by bone movement the front end of the jawline will appear more narrow. This is a simple principle of a U-shape that is being extended, the U will become more like a V. Secondly, the back ends of the sliding genioplasty will leave some degree of step-off along the inferior border of the jaw. The bigger the bony chin advancement the bigger these step-offs may be.
In a sliding genioplasty reversal, it is important to recognize that you probably will never be 100% exactly like it was before. The bone may be perfectly repositioned back but how the soft tissues, which have been traumatized and stretched, will respond is unknown but to be 100% like you were before can not be guaranteed. If you are young there should be no residual chin soft tissue sagging and the bony step-off should be gone. Most of the time the issue will be how the lower lip responds with a two-time mentalis muscle disruption/repair.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in chin reduction due to the fact that I feel as if my chin is way too large vertically. When I happen to smile there is also enough loose “bulk” to pinch on to skin or muscle, not sure exactly what you’d call it in the doctor world. Horizontally my profile does not bother me. I’ve been reading a lot about chin reduction lately and have seen pictures on websites of your work. And I would like to know exactly what kind of procedure I would need done for me to obtain the chin that I want. (Included)- are two photos the on of me smiling is a perfect example all together of what bothers me about my chin. In the second photo is what I would want my chin to look like…my dream chin 🙂 by the way thanks for your time.
A: What you are seeking is a vertical chin reduction that is best done through a submental incisional approach. To achieve your goals it is necessary to remove approximately 7mms of vertical chin reduction across the bottom of the chin bone. With this amount of vertical chin reduction, two additional issues need to be addressed. First the lower border of the jawbone behind the chin must be reduced lest you would be left with a ‘bulge’ of bone along the jawline behind the chin. Secondly, This amount of bone reduction will require soft tissue removal as well, known as a submental tuck. All three of these combined procedures fall into the procedure I call a ‘chin and jawline reduction’ operation.
It would be helpful to see a non-smiling front and side view picture for computer imaging as well as a panorex x-ray (usually a dental film) so I can measure the amount of of bone that can be safely removed from the chin and jawline. (location of tooth roots and the mental foramen and path of the inferior alveolar nerve)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a kidney transplant six years ago. My transplant team believes I could have a procedure to diminish the abdominal-flanks area. The side where the kidney is is larger. I weight 195 lbs and am 5’11”. I dislike being lopsided and have exercised (I am in pretty good shape). I was interesting in you because of your experience with a few transplant patients. There are great surgeons where I live but I trust you more.
A: I can see in your picture the protrusion/lop sidedness of the left side. That is the same side as your kidney transplant as can be seen by the location of the oblique abdominal scar. However, the bulge that is sticking out I doubt is where the kidney is. Generally that would be under the incision away from the bulge sitting on top of the abdominal fascia. Thus I do think that the protrusion could be reduced by a combination of liposuction and skin excision. (tummy tuck) The skin excision could extend across the whole abdominal incision as there may be skin excess there as well.
You would be on some level of immunosuppressive medication currently and we compensate for that by giving ‘stress steroid’ dosing at the time of surgery. Any other considerations/needs based on your transplant doctors input is also important.
I would estimate that you would need to be here no more than three to five days based on whether the placement of a surgical drain is needed. (which I would work towards not using.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw augmentation implants, specifically ones for vertical chin enhancement and lateral jaw angle implants. I have previously had a standard chin implant that only gave projection but did not correct a weak jaw. Your custom implants look like what I need. Do I need a CT scan for these or can I be assessed in person or on Skype?
A: Your story is a very common one, having had a standard chin implant which helped but left one way short of a more complete total jawline enhancement. What you undoubtably need is a more comprehensive approach with a custom wrap around jawline implant. This is designed from the patient’s 3D CT scan which you can get locally. (just let me know were you want it done and an order will be feed to them) In the interim, please send me some pictures of you face (front aide and three quarter view) from which I will do some computer imaging to see what type of jawline changes you are seeking in the vertical, horizontal and width dimensions. We can then have a Skype consultation to review these dimensional choices and discuss the details of the surgery.
I will have my assistant pass along the cost of the surgery and to arrange for a Skype consultation time next week.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wondering if you could perhaps further explain how exactly a cheek lift lasts – and by that I mean how it permanently elevates the cheeks? I am confused on how it works. You mentioned that the tissues are elevated and suspended. Are the sutures used always dissolvable, or are they sometimes permanent?
It is assumed that during the months following the cheek lift, the tissues reattach to the bone in a higher position. Is this inevitable and natural for the body because of the sutures lifting the tissue or can it ever “not” happen ? Do some of the tissues ever not reattach in the upright position over that period?
After the sutures dissolve over a period of time (assuming dissolvable sutures are used), what ensures that the tissues just do not fall back down? What if some did not attach before the sutures dissolved?
The second doctor I consulted with stated that since in his experience he has never re-done a patient’s cheek lift and he has been doing them for thirteen years, it should last me a minimum of ten years. He stated that I will age at a natural rate after the cheek lift. However, I have read dissimilar answers on Realself where other doctors have stated that it can last a mere 3 years! What is your general estimate on longevity? Would I age any faster or would my tissues fall faster having had the cheek lift done or are the effects of aging unknown?
A: The exact lifespan of any cheek lift can not be precisely predicted and is dependent on why it was done, age of the patient, how they genetically age and the technique used. Thus no average number of years can really be accurately stated for cheek lifts.
A cheek lift is a subperiosteal tissue elevation and resuspension. (which makes it quite different than that of a facelift for example and ore similar to that of a browlift) In theory, its initial stability is held by the sutures but the healing of the tissues is ultimately what holds it elevated. Therefore the use of permanent sutures offers no advantages long term over dissolveable sutures and runs the risk of suture reactions later if non-resorbable sutures are used.
Once the cheek tissues have healed, how they age is going to be reflective of the natural aging process of the patient and how the cheeks may have aged (dropped) had the procedure not been done. Think of a cheek lift as restorative to what you were before the cheek implants. How the cheeks may age could be better than had nothing ever been done since they would be further elevated than had the cheek implants never been placed.
Dr. Barry Eppley
Indianapolis, Indian
Q: Dr. Eppley, I would like to know if you do Artefill or Radiesse injectable filler in the legs?Because I have skinny lower legs and I would like some volume. Also do you do butt injections for lift. Thanks!
A: Injectable fillers are never used to provide volume for such large body areas as the lower legs. Besides that fact that they are only temporary, the sheer volume of injectable fillers needed would cost $25,000 to $50,000 to create the desired effect. All of which would go away in less than six months. Injectable fillers are only used in the face where smaller volumes can have a more profound effect.
The correct injectable filler to be for augmenting any body area, including the legs and the buttocks, would be your own fat. Fat injections are the most common method used for buttock augmentation, known as the Brazilian Butt Lift. They could also be used for the legs such as in calf augmentation. Whether you have enough fat to harvest to have a successful buttock or leg augmentation procedure is the key question and is the rate limiting step in any patient considering a fat injection augmentation procedure. That could be determined by seeing some pictures of your body.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a bimaxillary correction surgery last year. After the surgery I’ve lost my jaw angle.My jaw angle was near 90 degree.I have before-surgery-x-rays and want it back,but I’m worried if that doesn’t look good on me. I heard that you prefer silicone with a 3D custom implant fabrication. Would that be slippery? (compared to medphors) In my case,I only need a verical lengthning (a lot).
A: It is not rare that orthognathic surgery, specifically sagittal split ramus osteotomies, change the shape of the jaw angles. This can be due to an actual change in the jaw angle bone shape with advancement movements, loss of masseter muscle mass or both. It can also occur in short jaws where the jawline and chin move forward but the jaw angle position remains high, thus causing an illusionary change in the jaw angle shape. Regardless of the cause, restoration of the jaw angle can be done using jaw angle implants. You specifically have pointed out the dimensional change needed which is vertical lengthening. Of the available off the shelf preformed jaw angle implants, vertical lengthening styles are available in either silicone or Medpor materials. Either type of vertical lengthening jaw angle implant is secured into position by a screw which is important when half of the implant is placed below the level of the bone. Depending upon asymmetry issues, which may occur after mandibular advancement surgery, a custom implant approach may be preferred to create the most optimal symmetry between the jaw angle sides. If one is concerned about how lower and more prominent jaw angles may look, computer imaging can be done to help with that assessment. I would need to have some pictures of your face to do that computer imaging assessment.
Dr. Barry Eppley
Indianapolis, Indiana