Your Questions
Your Questions
Q: Dr. Eppley, I am seeking a sliding genioplasty or chin reduction revision. After a sliding genioplasty 18 months ago and two bone burring operations to reverse it (6 and 12 months after the original surgery) there are still areas of bone, on either side of my chin, that were not shaved back to create my original narrow shape. I am left with a wide bulky chin, the excess skin and tissue have sagged from over the past year. Now, after my most recent operation, I have even more tissue. I am always advised to go back to the trio of surgeons who did it but after this I really do not want to. There is a huge miscommunication and when they discuss things in Spanish, in front of me, I no longer trust them. I just want to have my normal looking chin back. Do you perform this type of revision and reconstruction surgery? How often?
A: While you did not state exactly the method by which your two chin revisional procedures were done, I suspect they were by an intraoral bone burring method. While you should have had the sliding genioplasty reversed by redoing the osteotomy and setting back where it once was, intraoral bone burring was destined to create exactly what you have now…a broader flat chin with soft tissue excess. The proper solution now is a submental chin reduction technique where the chin bone can be narrowed and the excessive chin soft tissue removed.
This is a sliding genioplasty and chin reduction problem that I see and treat regularly. It would be helpful to see some picture of your chin and to know the exact details of all three of your prior surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in rib removal surgery to reduce my protruding ribcage. How risky is this procedure? What are the complications/healing time? What would the results look like? How much, on average, would this cost? What other medical issues would be affected by the surgery? Sorry so many questions! Also, I live in Idaho how do you work with out-of-state patients?
A: Rib removal is not a dangerous surgery but, like any surgery that involves rib manipulation, it does cause some considerable discomfort. This is magnified when both sides of the ribcage are operated on at the same time. The best method of postoperative pain management I have found is the use of Exparel injections as intercostal nerve blocks done during the surgery. This is a local anesthetic that lasts for 72 hours after its placement. One could expect that it would take up to month after surgery until one has fully recovered. There will be a scar for the incision needed on both sides which would be about 6 to 7 cms long. The goal of the surgery is to remove ribs number 8 and 9 to reduce the subcostal protrusion.
My practice has many patients from all over the world for various types of plastic surgery. Patients usually come in the day before the surgery to have a face to face consultation and have surgery the next day. Whether you would stay overnite in the facility depends on whether you are traveling alone or with someone. I would anticipate your stay here to be no more than 2 or 3 days after rib removal surgery before returning home.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. However I’m terrified of losing sensation in my boobs and not be able to breast feed. What are the chances I will lose sensation? Also I’m worried my implants won’t look symmetrical, what are the chances this will occur. Because of these concerns that’s why I’m trying to find a doctor that I know cares about my results and does the best job that they possibly can!
A: Breast implants are placed in a partial submuscular position which means there is no chance of any interference with the ability to breastfeed. Loss of nipple sensation, while a risk of breast augmentation surgery, is very uncommon in my experience and only patient in the past twenty years has reported it to me. The biggest reason for revision in breast augmentation surgery in my experience is implant asymmetry. That risk is about 5% to 7% and is highly influenced by how much breast asymmetry one has initially and whether there is any existing breast ptosis. (sagging)
An important consideration in having breast implant surgery is that there are risks like any surgery and one should have a full understanding of them before undergoing the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a Mentor saline-filled testicular implant for approximately three years. While the implant has been relatively trouble-free, I do have some issues with it. I tend to get some occasional soreness due to the hardness of the implant. Also, as you might imagine, it is somewhat akin to having a nerd ball on one side and a superball on the other. Additionally, the implant, even though it was the largest size available, is perhaps one-third to one-half the size of my natural one. In other words, it’s far from a matched set. What options are available to me? Thank you very much for your help.
A: Soft silicone testicle implants feel a lot more natural than saline implants for sure. As for size I obviously do not know exactly what size your existing saline implant is by dimensional measurements. (saline is done by volume instillation) But the largest silicone testicle implants is 4.5 x 3.5 cms which would seem to be more than adequately large. It would be hard to imagine you would need a testicle implant bigger than that. (although custom ones can be made of any dimension) The pocket for the silicone implant replacement will need to be bigger than your current pocket but it should be no problem expanding the existing scrotal capsule.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a necklift to get rid of my turkey waddle. What would be the best surgical option to do so? I have attached a side view picture of my neck so you can assess the waddle. What type of recovery would be needed?
A: Thank you for sending your picture. Your turkey neck poses a bit of a challenge given your hairstyle. Normally a more traditional lower facelift (neck-jowl lift) would be the preferred treatment. But with no hair cover around your ears, this makes it challenging for incision placement to get the optimal neck contouring which is needed most in the center of the neck. This leaves us with the alternative option of a direct necklift with a fine line neck scar down the center of the neck between the underside of the chin and the adam’s apple. You situation is actually common in today’s world as so many men now just shave their heads.
A direct necklift has a much simpler recovery than a more traditional lower facelift as the loose neck skin is excised directly rather than being loosened and being shifted to another location (ears) for removal. One can look pretty good in a week after surgery other than a healing neck scar.
Dr. Barry Eppley
Indianapolis, Indiana