Your Questions
Your Questions
Q: Dr. Eppley, I have some questions about facial asymmetry correction. After finally doing my research I have seen amazing reviews on you and before I make some big decisions, I am asking some help from the surgeon point of view. I have two questions I would like to ask.
1) Every time I take a photo and my phone flips it my face looks very asymmetrical and weird looking. What procedures from the photos I sent do you need to perform to look even?
2) How come when I ask my friends they don’t notice it with my eyes and eyebrows unevenly but in the photos I can notice it extremely.
Also I forgot to mention under my eyes too. Thank you.
A: Thank you for sending your pictures. When it comes to facial asymmetry correction it is first important to identify which facial features are the asymmetric ones. What I can gather from the one front view pictures is that you have significant eyebrow asymmetry. The right eyebrow sits lower than the left. Because a picture freezes the face for a continued assessment most facial asymmetries are easily seen. In real life the position of one’s face is constantly moving and rarely does one talk to someone dead on with a ‘frozen face’ so one can get a good assessment of facial symmetry or asymmetries. The treatment for eyebrow asymmetry would be a unilateral endoscopic browlift. This could be effective provided one has some eyebrow tissue laxity which can be assessed by whether you can manually raise up the eyebrow with your fingers.
Your undereye hollows are the result of deficient inferior orbital rim bone. While this can be treated by fat injections, it is probably best treated by infraorbital rim implants with an overlay of fat injections if needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I’m interested in improving vertical chin lengthening. Below are attached pictures of before and after application of 1 and then 2 syringes of Juvederm Volume below my chin to increase vertical projection. I like the result but considering a more permanent option. In my research it seems that most chin implants address mostly horizontal projection. My horizontal projection is fine but I would like to increase vertical projection to get more sharper look in profile. I’m in great shape and don’t think dieting and more exercise would greatly improve my facial profile or remove the appearance of double chin. Would like to get your opinion on options. Thanks.
A: When looking for vertical chin lengthening, there are two options. An opening wedge siding genioplasty would be the autologous option. The chin bone is cut and open vertically downward and then plated in its new vertical fashion. The other option is to make a custom chin implant that mainly adds a vertical dimension increase. The decision between the two would be based on how much vertical increase one seeks. Large amounts of vertical increase are best done with a vertical bony genioplasty since it carries the soft tissue downward with it as it remains attached to the bone. With a custom chin implant it is important that enough chin soft tissue is available to be mobilized over the implant.
Lastly, vertical chin lengthening is not going to be enough to completely eliminate the double chin. Liposuction of the submental region would need to be done as part of the chin procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty and chin implant two years ago. But I am still not happy with shape of my nose, chin and face overall. I wish I can start over. I feel my nose is still too long and pinched and wish it was straighter and more refined. I also want a more angular facial shape with a masculine defined jawline and cheekbones. I think my chin implant has done only so much to help my desires. See my before and after pictures. Are my expectations and desires unrealistic? Can you help? Thanks so much.
A: Thank you for sending your before and after pictures. I think on both counts (rhinoplasty and chin augmentation) you have had good improvement and I would not agree that there would be any benefit to ‘starting over’…even if you could. You have reasonable results from both your rhinoplasty and chin augmentation. Your nose may be just a tad too long but that is a pretty good result. You are not going to be able to make any drastic changes to it other than perhaps some tip shortening. I do not know what you mean by being ‘pinched’. The refinement of any rhinoplasty is controlled by the thickness of the nasal skin. Having thicker skin there is a limit as to how much refinement can be obtained. You are likely as good as it can be. In that regard you probably do have some unrealistic expectations. Your chin implant has provided a substantial improvement and you would not want any further horizontal augmentation. What you are ‘missing’ from a facial skeletal standpoint is a lack of jaw angles and cheek prominence. The nose and chin have helped but they were not the sole solution to a more masculine face.
In short I would recommend some nasal tip shortening and cheek and jaw angle implants. This will then provide a more comprehensive approach to facial masculinization.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much do you charge for Selphyl? And how many cc’s are included in the Vampire Facelift? I did this procedure over 4 years ago and am interested in getting it done again.
A: You have asked about two similar but slightly different injectable facial rejuvenation procedures.
Selphyl is a kit or system where PRP (platelet-rich plasma) is added to PRFM to create a gel-like matrix for injection. By adding a calcium chloride solution, the Selphyl system converts PRP into an injectable gel. This fibrin matrix serves as a three dimensional scaffold to maintain the platelets at the site of injection. This PRP gel adds both volume to the injected facial areas and serves as a tissue stimulant onto which fibrous tissue can be created. The cost of a single Selphyl treatment is $1500.
The Vampire Facelift takes PRP and traditional hyaluronic-based injectable fillers and injects them separately into the facial areas. The injectable filler serves as the three-dimensional matrix in which PRP is secondarily injected. It is not a kit or system per se and is more of a technique that has been given a branding name. A single Vampire facelift may cost up to $2500 depending upon how much injectable filler is used.
The facial rejuvenative concepts between Selphyl and the Vampire facelift are similar even though their methods and materials are slightly different.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am contacting to find out more info about chin ptosis correction. I am 26 years old and had a chin implant that I strongly regretted. It was removed about six months ago. I notice that my chin has not returned to its original shape and size as I had been told that it would. There seems to be excess tissue underneath my chin and I miss the taut appearance that I used to have naturally. Just curious about what is involved to correct this issue and the potential cost. My incision was made underneath the chin, not intraorally. Thanks a lot for any info.
A: Unless the chin implant was fairly small and removed shortly after insertion, rarely do the chin soft tissues return to their exact shape as before surgery. All face and body implants are, to some degree, tissue expanders and they can create some overlying soft tissue changes no matter how small they may be. The approaches to chin ptosis repair are of two fundamental types, resuspension and excision. Sagging chin tissues can be resuspended, excess chin soft tissues can be removed. Which approach is best depends on the nature of the chin problem. I would need to see some pictures of your chin to make that chin ptosis repair determination. My suspicion is that you have a very small amount of soft tissue sag at the bottom of the chin that can be easily solved with a submental tuckup procedure. As long as the lower lip position is good any soft tissue sag off the chin bone is usually best treated by a chin ptosis repair using excision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had so much filler, including volume (five vials of Sculptra and Juvederm within the past year) and I still feel that my cheeks are not full enough. I had very high cheek bones when younger and I am now 52 years old. I used to do the IPL laser years ago and this thinned my face very much due to fat loss. I would like to have a consistently full face rather than be dependent on these costly fillers. When I do the filler the swelling makes me look fantastic, but once the swelling is over it is deflation all the way. I thought that cheek implants, even the smallest, would give me a foundation that I could be happy with.
A: injectable fillers play a major role in facial voluminization, particularly in the cheek area. But the reality is that it is not a long-term solution to one’s desire for fuller cheeks. Fillers are great long enough until one’s decides that they either want to ‘graduate’ to more permanent solutions or to stop their cheek augmentation efforts. While fat injections are one of the two more permanent options, cheek implants provide an assured method of permanent cheek augmentation. With the wide variety of cheek implants style and sizes, patients and plastic surgeons have a lot of good options to choose from for permanent cheek augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jawline implant. But before making this expensive decision I just want to make sure a sliding genioplasty is not something I should consider and living with a custom chin implant for life is 100% the best for me. I really think vertical length is one of the key factors with my chin being weak. I would appreciate your thoughts before I make this choice. Thanks so much.
A: In looking at your goals by your own imaging, you need chin and jaw angle changes. When it comes to vertical chin lengthening that can be done by either a sliding genioplasty or a custom implant. If you were just doing the chin alone and did not care about the rest of your jawline then the debate of a sliding genioplasty vs. implant has merit. But when you factor in the rest of the jawline for aesthetic improvement, where jaw angle implants would be needed and the only way to get that improvement, then a custom jawline implant makes the most sense. While a sliding genioplasty can be done with jaw angle implants, those areas will remain unconnected and not have a smooth line between them. A custom jawline implant creates all the chin and jaw angle changes one needs and connects them in a smooth wraparound fashion. In my experience this produces a far better result for almost all male jawline enhancements with lower risks of nerve injury/numbness. An even though the implant is more expensive to manufacture up front, it is done in less surgery time (so the costs differences are closed to a wash) with lower risks of revisional surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in forehead augmentation. I have very large brow ridges, and a sloping forehead with a prominent central bump in front of the coronal suture. I suffered a blow to the saggital region as a younger boy, and I have always believed that I suffer from premature suture closure. The saggital region is pointed, and my skull height is reduced. I read your procedure articles about plastic inserts in the forehead region to round the forehead and perhaps make it appear higher and more vertical, as well as similar inserts to widen and heighten the overall head shape. I am 68 years old, and have combed my hair over my forehead since I was a young man because I am embarrassed about my appearance. At my current age, and with thinner, receding hairline, this is becoming impossible. Can you help me?
A: Thank you for sending your pictures. I can clearly see your forehead concerns with a large flat area above your brow bones which slopes backward up into the skull. There is a relatively straightforward solution to our forehead deformity by building up the bone over the area of the depressed forehead region which is fairly well delineated. (forehead augmentation) This could be done using either a custom made silicone forehead implant from a 3D CT scan or using bone cement (PMMA) to do the forehead augmentation.
Dr. Barry Eppley
Indianapolis, Indiana