Your Questions
Your Questions
Q: Dr. Eppley, I am interested in cheek implant removal surgery.What techniques are used in Medpor removal to avoid any tissue sag? Does Medpor hinder the face returning to normal after removal.
A: Any cheek implant removal has the potential for a soft tissue sag thereafter, regardless of the material composition of the cheek implant. It is a simple function of tissue expansion of the overlying tissues and release of the soft tissue attachments. The likelihood of this happening in any cheek implant removal patient can not be precisely predicted and is a function of implant size, implant location and the patient’s inherent anatomy. This raises the question then of whether any type of cheek resuspension/tissue reattachment method should be done at the same time as their removal. This is not an easy decision and there is no method to accurately know if it is really needed. But I think one has to recognize that the face is not going to return completely to its preoperative state. (any more than removing breast implants will return the breasts exactly back to what they were before surgery to make a comparative tissue expansion analogy) If in doubt the best method is to do a soft tissue cheek resuspension through a remote temporal incision. The other more limited option is to use a bone anchoring method through the intraoral incision alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a prominent sagittal ridge on my skull that has bothered me greatly since I began losing my hair several years ago. I’ve viewed your before-and-after sagittal ridge reduction photos, and have a couple questions for you:
As you can see from my attached profile photo, the midline ridge on my skull is prominent not just on top but also extends about half way down the backside of my skull. Is it possible to obliterate the full length of the ridge through just one incision? If so, approximately how long would such an incision need to be?
On a related note, in one of your “after” photos, I noticed that the gentleman has a raised area below the horizontal incision (on the back of his head). Is this raised area simply post operative swelling or is it excess bone that you couldn’t reach with your rotary burr?
Are there any curved burrs or blades that would allow you to more easily work around the curvature of the skull?
Thank you for taking the time to answer my questions.
A: The extent that any sagittal ridge can be reduced is a function of the thickness of the bone (before the inner cortex is encountered) and the length of the incision ‘permitted’ to do the procedure. It is not a function of the rotary burrs or large rasps that are used to do the surgery. They all can more than adequately take down bone at any location. To work around the curvature of the skull, incision location is the key element in sagittal ridge skull reduction. The more it it is located to the back of the head, the further around the skull curvature one can go. Generally incisional lengths will range from 5 to 7 cms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my only child two years ago and since then have lost 50 pounds. Although I am working to lose weight, I am only seeing my tummy continue to sag. As a type 1 diabetic, the saggy skin on my tummy has now gotten to the point I can’t attach my insulin pump. Would a tummy tuck be good for me and will it interfere with my need for insulin through a pump?
A: With a 50 lb weight loss, and the resultant skin overhang that would develop from this amount of abdominal deflation, it is easy to see how a tummy tuck would be beneficial. A tummy tuck will completely get rid of all the tissue looseness/overhang in the abdominal area. While you are at some increased risk due to your type 1 diabetes for some potential postoperative complications (e.g., infection, wound healing issues), a tummy tuck would be immensely helpful and could potentially reduce your insulin requirements. I have performed numerous tummy tucks and other body contouring procedures on diabetics and have not seen these types of complications develop in any significant manner. While you will have to change the location of your insulin pump during the healing phase of the tummy tuck (six weeks), you will be able to use your abdomen again after that recovery period.
Dr. Barry Eppley
Indianapolis, Indiana