Your Questions
Your Questions
Q: Dr. Eppley, I am interested in forehead reduction. I have had 3500 FUE strip harvest hair transplants done five years ago. While the grafts have taken well without hair loss I have a remaining large forehead. I still have some elasticity to the scalp and am interested in seeing what a forehead reduction can do.
Q: The key element of a successful forehead reduction (and I assume you mean hairline advancement and not bony reduction) is the scalp elasticity as you have already noted. That scalp elasticity comes from the back of our head primarily and not so much the top when the scalp is advanced. If you have had 3500 transplants that would indicate to me that you have had at least two harvests procedures and a linear scar exists across the back of your head. (unless it was done by Neograft or Artiss) That does not bode well for much scalp mobilization no matter how loose it may seem. (although I can not say for sure about the scalp elasticity just by looking at pictures) Secondly there is also the issue of needing a frontal hairline incision. This is always a little bit more risky for prominent scarring in men as opposed to women. Hair density along the frontal hairline is important so that issue also needs to be considered.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a silicone implant to build up the bridge of my nose for years. I have a few questions for you about it based on your expertise in rhinoplasty, Your feedback is extremely helpful. My skin is thin and I have a medium size implant in my bridge area. ] Do you think that I should be concerned about extrusion? If this starts to extrude later on do you think the area can be filled with fat? I’ve never seen a photo of someone with a medium sized implant removed so I have no idea how deformed it looks. I’ve also heard that revision tip surgery is more difficult with the implant due to the increased chance of infection and hardening of the tip? I’ve also heard that it can take up to 10 years for infection of an implant to show up? Thank you
A: The long-term effects of a silicone implant on the nose depend on several factors including the size and shape of the implant, the thickness of the nasal tissue and how long it has been in place. Many nasal implants when removed after long-term placement will leave the nose looking ‘deformed’ due to the expanded skin over a now smaller underlying framework. While fat could be used to replace a silicone implant, it is not as predictable in terms of survival and smoothness of shape as a cartilage graft replacement. Whether you should remove or keep your nasal implant is impossible for me to say since I don’t know what you look like now and how the bridge of the nose looks and feels. Signs of ominous problems with your imlpant include skin color changes, visible edges of the implant or swelling and redness over the nose. It is understandably hard to get enthusiastic about replacing a nasal implant when it is asymptomatic.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can you elaborate on a question I have regarding the effects of Accutane on hair transplantations? I am on a pretty small prescription of Accutane right now that isnt going to end for a while. I’ m on around 30 to 40mg/week which s considered a very tiny dosage and considered “maintenance”. I actually get some medium depth Jessners chemical and Salicylic Acid peels while I’m on this medication and have had no true healing issues.
I keep hearing that Accutane shouldn’t be taken for 6 months or more after a hair transplant because it can stifle healing but since I’m on such a small dosage would it even matter? I personally would be patient if my wounds did take slightly more time to heal.
I do have other concerns though such as what other problems could arise? Would the expected graft retention outcome be less or is it just a matter of the wounds taking slightly longer to heal. The former would make me want to wait until my dosage is finished but I don’t mind if my grafts took longer to sprout as long or if my wound took slightly longer to heal, as long as the end outcome would be the same. Its the amount of grafts that I retain and the quality of them that is the most important to me and if Accutane does affect this then i would be fine with waiting. Thanks.
A: A hair follicle is an epithelial derived structure. Accutane impacts how epithelium regenerates and heals. Thus it is easy to see that Accutane can potentially adversely affect both the healing and potential take of FUE grafts. Whether a maintenance dose of Accutane would have any effect on hair transplantation at all is speculative. Healing from light chemical peels would suggest that it doesn’t. But given that every transplanted hair follicle is ‘valuable real estate’, why chance it? If you were my patient I would not let you do it whether you wanted to or not.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have 3 procedures I am considering. The breast reduction and/or lift is something I definitely want to do, as I’m very uncomfortable from the weight pulling on my neck. Over the past few year I have noticed facial asymmetry developing. It seems to be from an enlarged masseter muscle and I’m curious what my treatment options are for this. Lastly, regardless of how thin I am, I have always had somewhat of a double chin. My chin is not very pronounced and I’m curious if a chin implant would be a good option to fix this? Do you offer discounts when multiple procedures are done? Anything information you can provide would be greatly appreciated. I can provide pictures. Thanks for your time.
A: The breast reduction surgery is fairly straightforward and the inferior pedicle technique with the anchor scar pattern is well known. Masseter muscle hypertrophy is most commonly treated by Botox injections which can have a profound but often temporary effect. Surgical reduction through electrical cautery reduction is also an option if one happens to be undergoing another surgery. When it comes to the double chin, chin augmentation by an implant ir sliding genioplasty is often done. But often this alone may be inadequate so neck liposuction or a submentoplasty combined with it usually produces the best double chin correction. I would need to see pictures of your chin/neck to give a more educated recommendation for your double chin anatomy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very particular question regarding cheekbone reduction fracture. I had cheekbone reduction abroad where they pushed the sides of the arch of my cheekbones in to make my face narrower. However, the posterior end of the arches somewhat move outward on and off a bit, making my face wider. I was wondering if it was possible to place plates on the posterior ends of the zygomatic arches to keep them in. Thank you.
A: When it comes to cheek bone reduction osteotomies, the posterior end of the zygomatic arch is cut and moved inward. Many times a small plate with screws is placed to keep it positioned inward. This may not be necessary if a larger plate with screws is placed on the anterior cheek osteotomy. But if there is persistent mobility and rocking of the posterior segment, it can be stabilized secondarily. The best fixation method to stabilize it inward is to make a small step plate and secure wit with a screw to the remaining temporal process of the zygomatic arch. The bent step plate is then used to push the posterior end of the zygomatic arch inward and keep it from moving back outward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just recieved otoplasty and earlobe reduction one month ago.I The surgeon did a wonderful job thus far but there is still some minor sweeping and obviously the ears will change shape a bit over next few months. However I don’t believe enough length was removed from the earlobes. My ears still feel long and large. (not protruding) I’ve been through multiple of your surgery photos and reviews and honestly love what you do with the ear anatomy. What I would like to know is if you could take an additional amount from my earlobe to sort of shorten the ear. I would love to do my revision with you. Please let me know if and when and I have attached pictures for your review. I would love to get out opinion. Thank you for your time and I look forward to hearing from you.
A: Earlobe reduction can be done at the same time as an otoplasty or any time afterwards. The blood supply to the earlobe is not affected by any type of otoplasty procedure or even a prior earlobe reduction. The best vertical earlobe reduction technique is the helical rim type which places no visible scar on the outer surface of the earlobe. You probably need another 5 to 7mms vertical reduction. I can not completely tell from your pictures as to what type of earlobe reduction you had done but it does not appear to be of the helical rim variety. Regardless another earlobe reduction can be still be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have few questions about facial implants:
1. how much will it cost approximately to get customized cheek and jaw implants done at the same time?
2. how long does it take to manufacture facial implants?
3. do you personally use screws to secure both cheek and jaw implants in place?
4. lastly, is it possible to get jaw implants just to have defined jawline without the width being added (meaning that i don`t want for my oval shaped face to change into a square shape but i definitely want the very sharp defined jawline) is it possible?
Thank you very much and I look forward to your response.
A: In answer to your questions about custom facial implants:
- My assistant will pass the cost of custom cheek and jaw implats on to you tomorrow.
- From the time of receiving the CT scan until the implants are designed, manufactured, sterilized and shipped, it would be on average about 6 weeks.
- I secure almost all facial implants with small titanium screw fixation.
- Custom implants can be designed just about any way the patient wants as long as the implants can be made to fit and secured on the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a problem with my cheek implants and I need either cheek implant removal or cheek implant revision. I had a severe damage from buccal fat pad removals when I was younger and that left me sagging cheeks, downturned mouth corners, and jowls. Then I got medium sized submalar cheek implants to correct this problem. I looked fine and then I got a facelift which lifted the corners of my mouth and got rid of my jowls. But that has now left me with the cheek implants sticking out like shelves and my face looking like a skeleton. I got your information online that you have helped a patient with similar situation and I would like to get your advice.
Q: Between your previous buccal lipectomies and the pull of the facelift (which can thin out the submalar region by its sweeping effect) cheek implants can be come prominent and create an ‘hourglass’ facial deformity. The best approach would not be to completely get rid of the existing cheek implants as that will likely create a very flat cheek look creating another aesthetic problem. I would recommend downsizing your cheek implants (by at least 50%) and placing fat injection grafts below them to eliminate the ‘shelves’ and create a more natural and smoother facial contour. Cheek implant revision would be preferred.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can micro iposuction remove lumps from fat injections or it can only help removing the natural fat that is already there? The problem in that I have fat lumps (10 lumps n both cheeks varies which vary size between 5-10 mm) mainly found near the mouth, along the nasolobial folds and two lumps in the bottom of the cheeks. If these lumps can’t be removed by micro liposuction, what would be the way to remove them? Does radiofrequency help melting the fat? I already took 3 sessions and will take three more (machine is Endymed, temp used was 40C and 37 Watts) Would it be effective in melting the injected fat whether it’s lumpy or soft?
A: Certainly removing undesired fat collections (lumps) is more challenging than the original fat injection procedure. Any technique for facial fat removal (small cannula liposuction or any energy-based external therapies) are more effective for general fat removal rather than discrete fat lumps. Either surgical and non-surgical methods have their advantages and disadvantages. Small cannula liposuction (aka microliposuction) can access all your involved more central facial areas from small incisions inside the corners of the mouth. It would also be somewhat effective at breaking up the harder fatty lumps and likely removing some of their mass effect. (probably more effective at breaking them up than removing them) Conversely, topical energy-based devices are non-surgical and require no incisions but they will have a heat field effect, meaning they will create an overall fat reduction in the fat not necessarily just the lumpy area. I would be somewhat concerned with these energy-based devices that you might trade off one problem for another.
Another option would be injection therapy right into the fatty lumps if they can easily be felt from the outside. Very low dose steroids and old-style ‘lipodissolve’ (deoxycholic acid) solutions can be effective and I have used them successfully in the past for the exact problem that you have. The better ‘lipodissolve’ solutuion, ATX 101, has recently been FFA approved for facial fat reduction (technically submental/neck fat) and would be the best injectable solution as soon as it becomes commerically available later this year
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in inner inner thigh liposuction. I want to create a space between my inner thighs, a so called thigh gap. How much total fat do you think you could harvest? If I take a big pinch of skin and fat at my inner thighs I can make a visible thigh gap. Would that be a realistic result from inner thigh liposuction. My weight is around 132 to 137lbs at 5’4” if that helps with any part of the assessment.
A: The thigh appearance you are showing, known as a thigh gap, can not be created by liposuction. That is asking liposuction to do more than it is capable of. Many thigh gaps that you see in ads and model pictures have been created by ‘Photoshop liposuction’ or the women are exceptionally thin and have it by genetics. If you don’t naturally have a thigh gap, surgery is not likely to create one.
The inner thigh area is a challenging area for good liposuction results because the skin is unforgiving (poor elasticity) and has little ability to retract and reshape. If one is very aggressive and too much fat is removed there will be contour deformities and indentations as a result…thinner but misshapen. Conversely, if one is more conservative and does not take too much fat, then the resultant change is very modest. This is why the inner thighs are the #1 body area for dissatisfaction from liposuction…the results are often not enough or another aesthetic problem has been created. You have to ‘pick your poison’ so to speak…a modest change with likely smooth skin or a more aggressive volume reduction and a higher risk of contour irregularities and skin dimpling.
Dr. Barry Eppley
Indianapolis, Indiana