Your Questions
Your Questions
Q: Dr. Eppley, you performed a 12mm sliding genioplasty advancement (with a Gore-tex implant in the step-off, jaw angle implants, and infraorbital-cheek implants two days ago. My face is very swollen and appears lopsided. I am concerned that something is wrong. Please tell me that the facial swelling will go down very soon.
A: I will repeat what I extensively reviewed before surgery which are my six principles of facial implant surgery recovery:
1) The swelling from theses types of facial reshaping surgeries will be horrendous and very distorting…and psychologically troubling. You will not recognize yourself and will wonder if something is wrong or whether you should have done the surgery at all.
2) The resolution of swelling will go down in a very typical progression…50% by 10 days, 75% by 3 weeks and 90% by 6 weeks. It will take a full 3 months before the final result will be seen.
3) With the swelling there will be typical differences between facial sides which is very common as no two sides of the face will swell the same.
4) I do not critique/judge the result myself for a full three months…nor should you.
5) I never consider any changes or revisions to the surgical outcome until a full resolution of all facial swelling has resolved and the tissues have shrunken/adapted back down the changed skeletal framework.
6) When asked at any time period doing this full recovery period about the result or any concerns, I will repeat the aforementioned five principles.
Wbile it is hard, patience is paramount. You are only at day 2 which is the peak of the facial swelling. (it takes two days for facial swelling to maximize)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m looking to have an angle jaw implant procedure done this summer. I However am not interested in adding too much width nor am I looking to add any length (Nothing vertical length). My goal is to gain some width but mainly I’d like to get a sharp (not round angle like) from the front as well as profile, Brat Pitts Jaw sort of thing but less wider and more natural looking. I was thinking about the lateral angle jaw angel implant until I came across this new implant on implanttech the other day that looks very promising in terms of what I’m looking for which is adding some width as well as a sharp/chiseled angle. It’s called Conform™ Mandibular Angle implant, On the description it states that it’s Evolved from years of feedback by leaders in the field and creates the magazine-model jaw angle desired by many patients. Its patented grid backing readily adapts to the gonial angle, while its extended design easily enables optional screw fixation. Fine anterior edges ensure a smooth implant transition.
I’d really like to hear your opinion about this since you are an expert in this particular procedure. Have you used this implant on any of your patients, and if so do you have any before and after picture available?! In your professional opinion does this new Conform™ Mandibular Angle implant deliver a chiseled angular projection to the jaw (Brad pitt alike, both from the front and side) rather than a round look?
Looking forward to hearing back from you very soon.
A: Thank you for your inquiry. I have intimate knowledge of every jaw angle implant that exist or will exist in the near future. The new Conform Mandibular Angle Implant is exactly the style of jaw angle implant that I wouldn’t use. It has a very rounded jaw angle shape that is situated about the mandibular angle point by a considerable amount. This will create a rounder/fatter looking jaw angle not the sharper more well defined jaw angle shape that your desire. It does not in my experience create the ‘magazine model jaw angel shape’. The newer widening jaw angle implant is better in that regard because it has a more defined angle shape and its point of maximum projection is directly at the lowest angle point. This jaw angle implant style has a much better chance of succeeding with that desired outcome.
The other way to be most assured of the optimal jaw angle shape is to have them custom made in exactly the shape you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty after I had braces for 2 years to fix my bite. I thought my chin was large and I wanted it reduced. I did not like the results. I felt like my face looked fatter and as though there is extra tissue/bone under my chin. My oral maxillofacial surgeon told me that if he removed the screws and plate from the previous surgery it would not make my chin look as big and I thought he was going to shave off the bottom part of my chin that appears to stick out but the only thing he did was remove the one screw as he said he couldn’t remove the other one. My chin looks very asymmetric to me and there are indentations and lines that I do not like. I was wondering what your opinion is and if there are any options to improve my appearance. I have more pictures I could send if it would be helpful. Thanks!
A: Thank you for your inquiry. I suspect you originally had a reverse sliding genioplasty to fix a protruding or big chin. This operation is always never a good idea because even though the horizontal projection of the chin may be less, the chin will look wider in the front view and a bulge or increased fullness will occur under the chin. These are the exact symptoms that you developed after your sliding genioplasty. While your surgeon meant well, removing the fixation hardware would not have made any difference in how it looks even if all the plates and screws could be removed.
While I would need to see your after surgery x-rays, the correct treatment now is a submental chin reduction approach to vertically shorten and narrow its width. At the same time, liposuction and a submental tuck needs to be done to smooth out the contour under the chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in female skull augmentation. I have hated my small head for as long as I can remember. I am finally looking into this and didn’t know there was really any options. I have a flat, small head and small, flat occipital area. Would like to know what may be the best option for me and what price range I’d be into. I feel like an implant type thing would be best (to cover a couple of problem areas) but not sure. I can send a photo but would like to hear back first.
A: All cases of women who want a bigger head involve augmentation of multiple skull areas. (female skull augmentation) That is almost always in the back over the crown and around the sides. Because of most women’s goals in this type of skull augmentation procedure, the scalp has to be expanded as a first stage procedure to get in the bigger skull implant that is needed to try and get this effect. Having done many of such skull augmentation cases my experience has been that usually only about 75% to 80% of the ideal skull enlargement goal is achieved even with scalp expansion. The limiting factor is how much of the scalp can be stretched safely to cover a larger skull implant…with emphasis on safety first and the amount of skull augmentation second.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Does a breast reduction include them being lifted? Is there a way to make my areola smaller? Will my stretch marks go away if they are lifted? Is a reduction what you suggest or just a lift? I am only 19 and I feel like my breast look like Im 40 and have had kids already.
A: Thank you for your inquiry. I would agree that for a young women that is too much breast tissue with a lot of sag for you to carry around as well as from an aesthetic standpoint. You are an dial candidate for a breast reduction and your questions about such surgery are common. Let me clarify some basic concepts about breast reduction. Every breast reduction includes a full breast lift. While a breast lift can be done with a reduction, a breast reduction can not be done without doing a lift. In almost every breast reduction the diameter of the areola is reduced significantly, usually done to 40mm to 44mm diameter. Stretch marks that lie within the excised skin of the breast lift are removed. Any stretch marks that lie outside of that zone remain but often look better because of the lifting effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley I am interested in more information regarding the extended zygomatic cheek implants you describe here:
http://exploreplasticsurgery.com/extended-cheek-implants-high-cheekbone-look/
1) Can you share any before-after pictures of people who have had this done (specifically with zygomatic arch extension)?
2) Where would the scars be and what size?
3) Do you anchor these to the bone in any way to prevent shifting?
4) What percent risk is there of damage to the infraorbital nerve during placement and what would be the usual result (ie. numbness, sagging, pain) if such damage occurred?
Thanks
A: Thank you for your inquiry in regards to extended cheek implants. In answer to your questions about them:
- Due to patient confidentiality, I can not release patients across the internet without their explicit permission. No such extended cheek implants patient has ever agreed to do so.
- The implants are placed from inside the mouth so there are no external scars.
- I always secure every type of cheek implant with a single small titanium microscrew.
- There is no greater to the infraorbital nerve from extended cheek implants as opposed to standard styles of cheek implants. The implants are placed to the side of the nerve so it is not in the path of dissection for their placement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping surgery. I am a female and am 25 years old. I really don’t like my face but I don’t know whats wrong with it. My forehead is too small, my cheeks are huge and my jawline doesn’t exist or maybe its my chin. Its like too long and wide and my nose is fat. I just want to know if it is possible to change the shape of my face.
A: Thank you for your inquiry and sending your pictures. Much can be done with your face in terms of overall facial reshaping. Your forehead is small because of the low hairline and it lacks projection and convexity. A forehead augmentation can be done to build out the forehead which will also have some effect on increasing the distance between the eyebrows and the hairline. Cheek reduction can be done by osteotomies to narrow their width and projection. Your chin can be vertically shortened and narrowed. Your nose can also be made thinner/more narrow.
When you put the forehead, nose, cheeks and chin changes all together at once then a facial reshaping change will be seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had two sessions of Sculptra and one session of Radisse fillers earlier this year in January. In early April of this year, I had a chin implant with an incision in the mouth. After the chin implant, my chin and sides swelled up and hardened. It’s been over a week and can’t seem to bring the swelling down. Could this be due to the Sculptra and Radisse fillers that I had earlier this year? If so, what can I do to bring it down.
A: If I interpret your inquiry properly you had a chin implant placed just one week ago. It is perfectly normal to have considerable swelling after such a chin augmentation procedure that will take up to six weeks after surgery to completely go away. As a general rule, 50% of the swelling goes down by 10 days, 75% by three weeks, 90% by 6 weeks and 100% by three months after surgery. The fact that you have had prior fillers in your face has nothing to do with the swelling that you are experiencing now. There is also nothing you can do to hasten this natural healing process. I would have assumed that your surgeon reviewed the typical swelling and tissue firmness that occurs after any facial implant and the protracted time that it takes to resolve.
Dr. Barry Eppley
Indianapois, Indiana
Q: Dr. Eppley, I am interested in custom jaw implants. I had a chin wing osteotomy done three months ago and I am happy so far with the result, but not with the width of my jaw and the asymmetry. Is it possible to get this procedure done after a chin wing osteotomy? When could I get the surgery this year? How much will it cost? How long do I have to stay?
A: It is possible to do a custom jaw implant after a chin wing osteotomy. I have done numerous such cases. The chin wing osteotomy provides no facial width, no posterior jaw angle vertical lengthening and often ends up asymmetric/irregular. I would wait until six months after the chin wing procedure to be certain you known exactly the dimensional jaw changes you want to achieve. A custom jaw implant will require a 3D CT scan for implant design. You have a very good knowledge of the recovery based on your chin wing osteotomy experience. It would be similar to that although the amount of swelling may or may not be less.
The cost of a custom jaw implant will be greater than that of the chin wing due to the design and fabrication of the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve tried doing research about chubby cheeks and cheeks sticking out of the face when smiling, and I can’t seem to find anything about it. I don’t think it’s something common that people have. I’ve seen pictures of people generally having chubby cheeks but not the way mine are. My cheeks stick outward of my face when smiling. I have a whole bunch of extra fat on the side. My hair is always worn down to cover that extra patch. I get very self conscious to wear my hair up and reveal my cheeks. I’ve noticed that whenever people smile, their cheeks align with their forehead and my cheeks do not do that. The shape of my face is very chipmunk-like when I smile. My cheeks expand further than the rest of my face/forehead. I really want to get rid of that extra fat and not having to be self conscious about my chipmunk cheeks when smiling. Have you ever seen anything like this before? What do you suggest.
A: This is not the first time a patient has expressed your same concerns/desires to me about the chubby cheeks that appears when they smile. In reality, this is not an adviseable problem to treat for the following reasons. First, plastic surgery on the face is almost never performed because of an animation/smiling concern. Facial structures/tissues are changed/modified because of how they look in a static or non-animated because that is how surgery is usually performed…with the face still and not moving. Secondly, changing facial structures for how it looks when one is smiling will almost inevitably cause an undesirable effect when one is not smiling. (face now too thin or droopy because of loss of support) Lastly, what is making your chubby cheeks look like that has do with the skin and subcutaneous fat that lies over the cheekbones. These are not tissues that are amenable to surgical reduction due to the facial nerves that cross in them. Your chubby cheeks are not caused by too much buccal fat or other fatty areas that can be safely surgically reduced. This cheek bunching effect is the result of normal tissues being pulled up and over the cheekbones.
The conclusion is that chubby cheeks is an unsolveable cheek problem and any effort to try and treat it will likely cause other problems…that may be more undesireable that what you have now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question regarding chin implant fixation. I’m still having trouble deciding whether to travel to get my implant done by a surgeon who will use screw fixation, as it would obviously increase the costs. Do implants secured with screw fixation cause additional issues over unsecured implants if infection occurs? For example, would screw-fixated silicone implants be more difficult to remove than non-fixated? Would they require special attention since infections could spread into the bone tissue via the holes used for the screws or anything like that?
A: Your concerns about screws in chin implant fixation are unfounded. Chin implants secured by screws are no more difficult to remove than those that are not. A screw is not a source of infection into the bone should the rare incidence of infection occur after chin implant placement. Some of your thoughts about screws are probably based on the misconception of their size. Screws used for skull and facial implants are 1.5mm in diameter, roughly the same size as screws used in a pair of eye or sunglasses. When the screw is placed on a penny, it is only as big as Lincoln’s jaw.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Have a saggy butt and slightly saggy inner thighs also. Would a buttock lift incision in the infragluteal fold(under buttock)while pulling up the inner thigh slightly be realistic. I donr think a radical upper buttock lift would be necessary as it is more radical and the inner thighs would have to be done separately. Also could my extra tissue cut off be used as an implant to improve the form of the buttocks.What concerns me is the scar in this operation. Is it eventually not too conspicuous as when wearing a bathing suit esp. when bending over. There is a surgeon close to where I live who would do it that way, as he feels a higher buttock lift would flatten my buttock as it is just slightly saggy with a banana roll. Please give me your opinion.
A: Thank you for your inquiry. I would need to see some pictures of your buttocks to best answer your questions. But I do know the following without seeing any pictures.
1) A direct approach to the lower buttocks and thighs is needed. No far away or upper buttock procedures will work.
2) Buttock lift and inner thigh scars I never consider great in many patients. One just has to choose which aesthetic liability they would like better. (scars vs tissue sag)
3) Any buttock or thigh tissue removed is not going to be enough volume to be successfully used as an implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty revision.I had a sliding genioplasty in Feb 2014 moving my chin forward around 8.5mm. From the start it looked like the result was asymmetrical. 2 years later this is definitely the case. From my attached photos you can see that the left side is sticking out of the face slightly when viewed from the front and there is also a step off when viewing from the side. I’d like to know what my options are.
A: Most asymmetries after a sliding genioplasty comes from differences in the angle and length of the bone cuts on the two sides. Even subtle differences become really apparent when the horizontal movement become bigger. This creates asymmetry from the appearance that the chin is rotated (which it may well be) but often it is just two different lengths of the bone cuts.
In correction of your chin asymmetry, the first piece of information that would be very helpful is to know exactly what the bone looks like. This is where a 3D CT scan can be enormously helpful in understanding your existing chin shape as well as planning what to do about. Fundamentally it comes down to either reduction of prominent bone wings or augmentation of bone wing deficiencies…or some combination there of. You appear to need this exact combination by both your picture and your description of the chin asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have questions about a custom skull implant My son wants to be a few cm taller. He said doing skull augmentation will let his total height longer by measurement by a few cm. He is about 5 ft 5 inches tall. Is it safe to do skull augmentation? Is the material used safe? Can the material or implant be removed if complications arise later? Will it affect hair growth after the implant or filler inserted? Please explain the steps and procedures a bit. Also the risks, if any. Please suggest and reply as I don’t know what to do. Thank you.
A: I do not see that a custom skull implant is an approach to be used for ‘heightening’. It is ideally used to correct a flat top of the head. It is a perfectly safe procedure which is done using a custom silicone skull implant made to fit the patient from their own 3D CT scan. As single stage procedure the most height that could be obtained would be 12 to 15mm due too the limits of how much the scalp can stretch. As a two stage procedure with first stage scalp expansion, the amount of skull augmentation could be close to 25mms. Placing an implant on the bone will not affect hair growth. The implant is relatively easily inserted and removed secondarily if necessary. In my vast experience with this type of aesthetic skull surgery, I have not experienced any major problems. But the key is to stay within the limits of what the overlying scalp can accommodate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in custom jaw implants. I had a chin wing done 3 months ago and I am happy so far with the result, but not with the width of my jaw and the asymmetric. Is it possible to get this procedure done after a chin wing osteotomy? When could I get the surgery this year? How long do I have to stay after surgery?
A: It is possible to do a custom jaw implant after a chin wing osteotomy. I have done numerous such cases. The chin wing osteotomy provides no facial width, no posterior jaw angle vertical lengthening and often ends up asymmetric/irregular. I would wait until six months after the chin wing procedure to be certain you known exactly the dimensional jaw changes you want to achieve. A custom jaw implant will require a 3D CT scan for implant design. You have a very good knowledge of the recovery based on your chin wing experience. It would be similar to that although the amount of swelling may or may not be less.
I will have my assistant Camille pass along the cost of a custom jawline implant to you tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jaw implant. I have always felt my mandible is very under developed and I am starting to think my neck and jowls are slowly swallowing the thing. I just turned 35 and I look like I’m about 21 years old. I feel this is mostly because my mandible hasn’t grown much since I was a teenager. As a male, I feel like I project slight weakness because of my insecurity. I thought for a long time I would outgrow my dissatisfaction but unfortunately that has not been the case. I have also been hopeful that my face would eventually full out, but that too has not occurred.
I read countless reports about chin implants and jawbone expansion techniques, etc. your website had the most comprehensive descriptions of what I feel is “wrong” with my ever slimming face. I like your description of how the jawline can be lowered as well as widened with specific implants. I want to keep my “shape”, but I want it to be lowered and widened. Does that make sense?
A: Thank you for sending your pictures. What I see is an entire lower jaw that is both vertically and horizontally short. This makes it disproportionate to the upper two-thirds of your facial structures. This is the ideal anatomic deficiency for which a custom jaw implant works so well to correct and put the face in balance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard about temporal reduction and I know you are an expert at it. I was wondering if its possible to reduce the size of a WIDE head from the front view. I realized also when I fully open my mouth my head looks smaller compared to when my mouth is closed. I hate my head and was wondering how long is the down time for this surgery?
A: Temporal reduction is an interesting aesthetic skull procedure that few patients or surgeons have ever heard of. Your description of seeing head width improvement when opening your mouth is due to the thinning of your temporal muscles on the side of your head. They lengthen and narrow when opening one’s mouth widely. Thus you would need reduction of both the anterior and posterior bellies of the temporal muscles. The posterior temporal muscles can be surgically reduced from an incision behind the ear in the postauricular sulcus. Th larger anterior temporal muscles can not be surgically reduced but often respond well to Botox injections. Complete head widening by total temporal reduction is done by a combined procedure of surgical posterior temporal reduction and anterior temporal muscle Botox injections. This procedure surprisingly has very little if any downtime.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am after a very large chin implant (actually, probably a custom wraparound implant, but my question is in relation to the chin). I would like a vertical lengthening of 2cm to achieve a huge looking chin that i desire. I would likely get a vertical lengthening genioplasty at an earlier stage but I will still need the implant to get the rest. In addition to the large length increase, i’d like it to be very wide and square. But I’m aware the skin cannot stretch this much in the chin. Is it possible to use a tissue expander in the chin before the implant, much like you use in the scalp for large skull implants?
A: In relation to achieving such a large vertical increase for a large chin implant, you would need to take a three step approach. First, A vertical lengthening genioplasty needs to be done of about 8mms. Three to six months later, a vertical lengthening chin implant needs to be placed from a submental approach. These two together will approach a vertical chin increase and chin pad soft tissue expansion of 13 to 15mms. Then a custom wrap around jawline implant could be used to complete the maximal vertical chin increase.
While a tissue expander could be placed in the chin, there are multiple problems with its use in this anatomic location. The incision for its placement would be right over the expander and that is a recipe for wound breakdown and exposure of the implant during the expansion process. There is also the problem of where to place the remote port to inject fluid to expand it as it is not practical to have it handing down from the chin or sticking out into the mouth.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What if anything can be done for my orbital and overall facial asymmetry? Its clearly affected the entire side of my face not just my eye. I have to tilt my face for pictures and even then its way off. Thoughts? The second pic is with my head tilted…I am tired of having to do so and has really hindered my confidence my entire life.
A: Thank you for your inquiry and sending your picture. Eye asymmetry (orbital dystopia) rarely occurs in isolation and is often part of an overall facial asymmetry. The brow bone, cheek, nose and even the jawline may be lower or deficient on the ‘lower eye’ side. Tilting the head helps ‘lift’ the deficient side to make it more even. The key is this type of facial asymmetry is to pick the procedures that would make the greatest difference. The hardest choice is deciding what to do with the eye as this is the most important part of the facial asymmetry correction. The eye must come up as well as the outer corner of the lower eyelid. One caution here is to keep an ‘eye’ on the position of the upper eyelid so the raised eye does not get buried under the upper eyelid creating a pseudoptosis appearance.
Vertical brow bone reduction, cheek augmentation and jawline reduction/widening and a straightening rhinoplasty are all other options to consider in facial asymmetry correction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you very much for responding about lower buttock lifts. Very rare doctors take that much interest. I do have a few more questions though, if you could again answer. 1) Is there anyway the scar in the lower buttock crease (infragluteal) can be made less conspicuous? (less wide or by tattooing after) 2) If a surgeon uses the buttock tissue removed to implant as a graft will it cause problems? (e.g., infection , circulation) Will it not add a bit more volume to my buttocks? 3)When you do the incision in the infragluteal fold do you tuck the extra tissue inside/under or cut it off? 4) Are there different ways of doing this operation. 5) Is there not a risk that there is no crease /projection left—in other words—does it create a flat butt? 6) It seems like an operation lasting more than 3 hrs. Do most patients do well–as I am a little scared–I prefer twilight sedation–seems like it is not the method used for this surgery. 7) If the saggy inner thigh skin is pulled up at the same time, will the scar descend with time to become visible within the groin area?
A: 1) Tattooing is not an effective form of scar camouflage anywhere on the body.
2) The thin strips of skin and fat are worthless as grafts because of their very low volume. And placing such a graft always runs the risk of causing an infection. This is not a good benefits vs risk proposition.
3) In a lower buttock lift in my hands, it is a combination of tissue removal AND the recreation of an infragluteal fold. (aka tuck)
4) The number of ways to do a buttock lift seem rather limited…but I can not speak for what other surgeons may or mat not do with this uncommon body contouring procedure.
5) If an attempt is not made to recreate an infragluteal fold and too much tissue is taken, the result cold very well be a flat lower buttocks contour.
6) How long it takes a surgeon to do any procedure is highly variable. Whether your buttock issues makes this 3 hour time long or appropriate I can not say since I don’t know what your buttocks look like. Because a lower buttock lift is done in the prone position, the only acceptable anesthetic is most cases would be a general with a controlled airway.
7) Many thigh lift scars can descend downward. Whether that occurs or not is both a function of how much tissue is removed and how the procedure is performed. (e.g., incision location, use of fascial fixation)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came in about a week ago to discuss breast augmentation. I am confused about breast implant profiles. I’m about five one and 100lbs. Right away I knew I wanted silicone due to them having a softer feel and I also was leaning towards moderate Plus due to the pictures that I have liked. They seem to look more natural well as natural as you can get with implants. Though right away you said high profile I’m sure it’s due to my small frame. My question is this afterwards will the high profile give me that two very round balls on my chest? Or will they hang a lil and have some side boob like real ones do? I just don’t want to look like I have balls on my chest though with my small frame will the high profile give me the boob look I’m looking for the noticeable though somewhat natural look. That the moderate Plus would give if I was a little wider? Could you help explain a little more the difference and looks please. I’m very interested I just want to be 100% with my decision. I understand with my small frame my options are limited. I believe I decided with 400cc round high profile silicone.. Thank you.
A: Your primary question about breast augmentation is in understanding the difference between high profile and moderate plus profile implants. To some degree, the size of 400cc in your body size is never going to look ‘natural’. Larger breast implants placed in smaller tight chested skin can not really avoid having a rounder/fuller look. That is more a function of the patient’s anatomy that it is being placed in and much less to do with the implant’s profile. There is also the very relevant issue of what happens with time (e.g., 6 months after surgery) as the tissues relax and settle after being so dramatically expanded in such a short time. Meaning implanted breasts that look high and round will always settle into a more natural shape over time. But the key issue is time and one has to be patient.
To better understand breast implant profiles, a high profile implant is less wide than the moderate plus. (even though they have similar 400cc volumes) This type of implant profile is often used in smaller women who are getting ‘bigger’ implants so the implant does end up too wide or too far to the side of the chest. (in the way of the swing of the arms) The tradeoff for that choice may be that they will slightly more round in the upper part of the breast. A moderate plus profile implant is more wide and slightly less high. It will have slightly less upper pole fullness but at the expense of more implant to the side. At the end of the day one has to choose which aesthetic tradeoff they prefer….a slightly rounder looking breast (high profile) or one that is a bit too far too the side. (moderate plus)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jawline implant. One year ago I had jaw surgery and a sliding genioplasty. I had a receding chin and an overbite so it was recommended o have my jaw brought forward and have a sliding geniplasty instead of a chin implant. The surgery was certainly not fun and I was very swollen for many months. Six months after the surgery I was happy with how my face looked but as the swelling further reduced my face became more narrow and asymmetrical. I ended up with a very narrow asymmetric face and a very pointy chin. This was devastating for me as this was not how I envisioned I would look. I thought I would get a stronger more chiseled jaw and mandible as this is what the surgeon told me! But I ended up with a very long and narrow looking face.
I consulted another surgeon to ask about getting implant/implants to fix the asymmetry but he didn’t recommend it. He recommend fillers or a fat transfer. I ended up getting fillers but the asymmetry was so much (and the volume loss on the right side) that I had to have six treatments. It was expensive and I still wasn’t happy with it. I’m looking for a permanent solution.
A: Thank you for your inquiry and detailing out your surgical history and current concerns . While moving the chin and mandible forward does enhance anterior skeletal projection, it almost always does so at the expense of width. (A U-shaped structure that comes forward in two places will be more narrow….this is magnified when the surgical trauma and swelling causes soft tissue atrophy) While an effort at injectable treatment was worthy of the effort, to prove to yourself what the results would be, it never was a long-term solution. In addition, no form of fillers or fat can create skeletal highlights or angularity, all they can do it makes things puffy and round which is why they rarely are effective for jawline augmentation.
It would seem by your concerns and pictures that custom jaw implant would create the missing chin and jaw line dimensions. This is done using a current 3D CT scan. This is also an excellent method for improving any bony asymmetries since the computer design process can make those adjustments done to the 1mm level.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have asymmetric eyes, the left eye is 3 millimeter lower than the right. I do not have double vision. Can I have the surgery to move my left eye up and into a more correct horizontal position? I really thank you for answering my question. I have attached a picture which shows the difference between my two eyes.
A: Thank you for sending your picture. Your entire orbital ‘box’ on the left side is shifted downward, otherwise known as orbital dystopia. This is a more challenging problem to fix that it initially seems because of the existing ptosis (sagging) of the upper eyelid. The brow bone above will need to be vertically shaved (raised)and the orbital floor augmented. The problem is that this will raise the eye upward but it will become more ‘buried’ under the upper eyelid than it is now. This will require either a simultaneous upper eyelid ptosis repair or have the ptosis repair done as as second stage procedure 3 to 6 months later. The problems with ptosis repair at the time of other orbital procedures is that the eyelid adjustment is being done when everything else is being changed. It would be highly unlikely that the upper eyelid position would be correct or ideally located on the newly elevated eyeball.
Thus while there can be major improvement in your left orbital dystopia, I would not think of it as only a one-stage operation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a flat head from behind. It has been that way since my childhood since I always slept on my back and never changed positions. I came across your procedure while looking for ‘flat head treatment’ on the Internet. I have a few questions.
- I wish to know how much improvement I can expect with the treatment. Can I get a completely round head?
- I also wish to know how exactly it feels after the implant is placed under the scalp. When I touch the back of my head would I feel like there’s something there or would it feel like bone?
- About the material, can it be carcinogenic or can it possibly cause any allergic reactions?
- Would the material completely adhere to my skull and not float around between the scalp and the skull?
- Can the procedure be done under local anesthesia?
Thank you in advance for your reply.
A: In answer to your questions about flat head correction using a custom implant:
- Only with a two-stage (first stage scalp expansion) can you get a fairly round head. one-stage occipital implant on the back of the head will produce about of that ideal result.
- The implant will feel like bone.
- A silicone implant os not carcinogenic nor will it cause any allergic reactions.
- The implant will not float around and will adhere to the underlying bone and the overlying scalp.
- The procedure can NOT be done be done under local anesthesia, it requires a general anesthetic.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 19 and have a weak chin which I am beyond self conscious about. It is not extremely weak but it still makes my profile and resting face cringe worthy to me when people take photos of me. I do not feel comfortable getting a chin implant but also can’t afford to get chin fillers to fix the problem every six to twelve months for the rest of my life. I’ve considered fat transfer but would be devastated if the fat didn’t survive or became lumpy. I have come across Dr. Eppley on Real Self and am impressed with his knowledge about sliding genioplasty. I am a petite girl with a skinny face and well defined jawline (5’2 113 pounds). I am wanting a small amount of advancement forward and an even smaller amount if none at all of vertical advancement. However, given my skinny face, I am so incredibly afraid of having a “step off” or notch in my jawline. I am wondering if a 4 to 5mm advancement would create this irregularity in the jawline or if it is preventable. I am also afraid of nerve damage and want to know how common this is. Thank you so much.
A: There is no question that the smaller the amount of chin bone advancement by sliding genioplasty the less chance there would be for a notch or step off along the jawline. In my experience, I have not seen cases that I am aware of that has had permanent inferior alveolar nerve numbness. Just like the notch along the jawline, the smaller the chin advancement the less likely there is of a risk of nerve injury.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have questions about Brazilian Butt Lift surgery. What is the average percentage of the fat transfer that stays on the buttocks? After the surgery are the buttocks firm? I have not had children yet, when i have children if I would like to go forward with the procedure again if I lose the fat from mybuttocks afterwards will that be dangerous to go through another procedure?
I am very interested in this procedure and would like the best results. Do you have a way to show patients what the body will look like after surgery before the actual procedure?
A: On average the amount of fat that persists in most Brazilian Butt Lifts (BBL) is around 50% to 80% in my experience. But any fat transfer is not completely predictable and every patient will have varying degrees of fat retention. Initially the buttocks are firm from the immediate volume full but that softens quickly in the first month. Fat transfers do not create the firmness that comes with buttock implants. The buttocks will end up bigger but they will still feel soft. There is no harm or danger in the future to having another BBL procedure.
The key question is whether what one wants to achieve with BBL surgery can be done based on one’s goals and what they look like now. To determine whether BBL surgery has a reasonable chance to achieve your goals, I would need to see pictures of your buttocks/body now and what your buttock augmentation goals are.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin implant removal surgery. I had cosmetic surgery last year for cheek and chin implants. I was pleased with the experience and I am very happy with the cheek implants. However, I do not like the chin implant. The chin implant was very uncomfortable for the first few months and it took about 7 months for the swelling to completely go away. After the swelling had gone, I still did not like the look or feel of the implant. I decided to wait a few more months to see if the situation would change but it has not. I think it looks too bulbous and it still feels quite stiff.
The implant was put in from the chin. I would want to leave it out. Please find pictures attached how my chin looked before the implant (one year ago) and with the implant (now). Just to keep you in the picture, the reason for the chin implant was to help balance my face as I have quite a large overbite. After getting the implant, I don’t think that it really does balance my face and I have since been informed that this is because I would actually need a jaw surgery to improve the look of the overbite, not an implant. So, after the implant is removed, I will plan to get the jaw realignment surgery needed to correct the overbite.
A: Thank you for sending your pictures and providing the details of your surgical experience. From the submental incision the Medpor chin implant and any screws used to secure can be removed. Be aware that there may be some adverse aesthetic sequelae from its removal. Not that the chin tissues have been stretched out with the implant (which I would bet is not a small one), they will not retract back down completely. Thus you will likely develop some soft tissue chin sagging. (ptosis) To avoid this after chin implant removal problem, the soft tissues of the chin will need to be tightened back down to the bone at the time of the implant removal. (chin ptosis repair) This is not a problem that will be solved later by jaw advancement surgery since that affects the teeth position by the whole mandible coming forward. Such a bone movement will have no impact on the chin bone-soft tissue relationship even though the chin comes forward as the whole jaw moves forward.
I will have my assistant Camille pass along the cost of the surgery to you by tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for an otoplasty reversal surgeon who can offer the best possible result for an undesirable otoplasty result in my left ear so. I have attached a picture showing my ear before the otoplasty and a second picture where i had undergone a revision where the sutures and scar tissue was removed in the hope the ear would look how it was before. It shows the antihelix being thick and overfolded in the lower part and the upper part has lost roundness. I appreciate my ear will never look the same as before I had the original procedure but what are your experiences in an antihelix deformity such as this and do you feel you could make a significant difference using any type of revision (cartilage/skin graft, scar release etc).
Thank you for taking the time to read this and I look forward to your response.
A: Thank you for sending your pictures which are very helpful in showing the otoplasty problem. This appears to be an overfolding of the helix, causing a deformity of the antihelix which lies in front of it. The correction would obviously lie in reversing how the otoplasty was done…getting the helical rim to unfold back out. This will not be achieved by releasing any tissues alone as the cartilage is now ‘deformed‘ and has a new shape. The release must be supported by an interpositional graft of which I have used cadaveric rib/bone and the patient’s own small rib graft to achieve a stable otoplasty reversal result. In my experience, this graft technique is essential for the procedure’s success as you have learned that releasing the scar/sutures alone is unsuccessful. (unless it is done within a few weeks/months after the procedure)
Dr. Barry Eppley
Indianapolis, Indiana
Q:Dr. Eppley, I believe that many of the surgeries you perform are far more effective and life changing than traditional plastic surgery procedures.
I’m looking into having forehead, temporal/skull, and chin augmentation, and have found there are very few plastic surgeons are experienced in craniofacial surgery for cosmetic purposes.
I know that plastic surgery in Korea focuses very much on altering the bony structures of the face to achieve a prettier and more youthful appearance and for this reason I have been enquiring with some plastic surgeons in South Korea. Ideally I would prefer to travel to the US and have the above procedures performed by you.
I am interested in having forehead augmentation- preferably using bone cement as I understand that implant placement can be difficult, particularly when placed lower on the skull; I feel that my brows/superior orbital rim are quite flat and contribute to some minor eyelid sagging so would like the forehead augmentation to extend to this area, as well as smoothing out the temporal bone area, and reducing the backward slope towards my hairline.
I’d like head widening implants possibly extending to the temporal region to balance my lower face.
Lastly I’d like to get an “anatomical” or “extended” type chin implant which extends into the pre-jowl area which is quite hollow and shadow-y, and makes my lower cheeks look a little droopy.
A: My understanding of your email is that you seek the following procedures which are primarily Forehead Augmentation and Chin Augmentation. Let me provide some initial clarification on forehead augmentation because your assertion that implants are harder to get lower on the brow bone than bone cement is not accurate. Actually it is the exact opposite. Because foreheads/brow bone implants have a preformed shape they can more effectively positioned on the brow bone area through a smaller incision. Bone cements can achieve the same result but they take a full coronal scalp incision to really place as low as possible.
The biggest dilemma in forehead augmentation is management, if need be, of adding the temporal area in the overall augmentation. Bone cements can not be placed past the anterior temporal line onto the adding temporalis fascia as that often creates the potential for edge visibility and/or pain. Some slight blending of the upper temporal region can be done but it can not extend down too far.
The only really effective method for anterior temporal and posterior temporal head widening is with the use of subfascial implant placements which have to be semi-custom made and are designs of which I only have.
A chin implant that extends back more posteriorly would be the anatomical design which has long tapering wings back to the pre jowl area. That is a fairly standard facial implant request.
In conclusion, the most economic approach would be PMMA bone cement forehead and chin implant augmentation. The cost of the temporal implants would, by your own description, be prohibitive.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal artery ligation. My right temporal artery is considerably larger than the one on my left. Although both are unsightly and bothersome. I have become very self conscious of them. And the are affecting my daily life. At normal rest they are slightly visible. They become increasingly larger and more noticeable when I exercise, when its warm, and when I consume alcohol. And not much alcohol either ! Just a few sips of beer or wine. They even enlarge when I’m talking a lot.
A: Your description of prominent temporal arteries is classic. Prominent temporal arteries can be successfully reduced, and some times completely eliminated, by temporal artery ligation. The secret is to locate the pattern of flow into the visible artery and do ligations both anterograde and retrograde. This is a bit of an art form and, while every temporal artery ligation procedure shows immediate improvement, the real test of the effectiveness of the procedure is what it is like 3 to 6 months afterward.
Temporal artery ligation is a procedure done under local anesthesia in an office setting. Each small access incision for ligation is about 5 to 7mms in length. There is no bruising afterwards with minimal swelling.
Dr. Barry Eppley
Indianapolis, Indiana