Your Questions
Your Questions
Q: Dr. Eppley, i have an occipital fold that I would like removed. I am a 62 year old (hx Type II, obesity) I have a large protruding skin fold at the occipital part of my scalp. I find it extremely bothersome. I’m not sure there is a bone protrusion or just a fold of skin cause I can grab the darn thing between two fingers. I want to get rid of it. I have photos that I can email separately (took them myself and aren’t great quality, but you’ll get the idea).
A: Thank you for sending your excellent quality pictures of the scalp roll on the back of your head. This is a common location for such a scalp skin roll. It can certainly be excised with the aesthetic tradeoff of a fine line scar as its replacement. (occipital skin fold excision) This can be performed as an outpatient procedure with minimal recovery. In the properly’ motivated’ patient it could even be performed under local anesthesia. (although it does not have to be)
Occipital skin fold excision is done by cutting out the redundant skin fold and putting the scalp back together in a more flattened contour. When performed well it can be done with a fairly minimal scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a flatness in the occipital area of my head which is very pronounced, especially with short or wet hair. I have x-rays with a little outline of the augmentation I wish to accomplish. If I were to proceed with an augmentation procedure I would prefer a custom occipital implant. With today’s technology, how big of an incision should I look forward to, and where would this incision be made? Can a custom occipita implant be fabricated using the x-rays I have or is there another form of imaging technology that needs to be used? There is also a slight bump on the top left side of my head. If I wanted to try an shave that down a bit, how much would the incision size change, and can that same incision be used to insert a custom implant for the occipital portion?
A: A custom occipital implant is made from a 3D CT scan, no other form of x-ray will suffice due to inadequate imaging data. A custom occipital implant is usually placed through a low horizontal scalp incision on the back of the head. Unless the skull bump is very near the location of this incision, it would not be able to be reduced through it and another scalp incision closer to it would be needed. There is also the alternative of making a higher scalp incision where the custom occipital implant could be placed and the skull bump could be reduced through the same incisional access.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a tear trough implant. I had a four lid blepharoplasty performed ten years ago followed by an inappropriate injection of Radiesse to both lower lids. Granulomas subsequently developed and were excised a year later but this left me with a depression and mild ptosis of the right lower eyelid. I have had this lower eyelid depression treated with hyaluronic acid fillers for years by a dermatologist, but the depression needs more stable support, especially as I age. I am Interested in consulting with you due to your extensive experience with facial implants. I have attached pictures of my lower eyelids for your review.
A: Thank you for your inquiry and sending your pictures. I can clearly see the depression along the medial half of the right infraorbital rim. As you probably know there are a variety of materials to build up the infraorbital rim. Since the deficiency is really caused by a soft tissue problem (due to the excision of tissues) one could argue that either fat injections or the actual placement of a dermal-fat graft would be the most appropriate technique give the source of the problem. With your history, injections would understandably not be appealing. This leaves the choice then between he dermal-fat graft and a tear trough implant. Each one has their own advantages and disadvantages. But certainly the main advantage of a tear trough implant is its volume stability moving forward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think I need a chin implant. I have a recessed/weak chin and jaw I am looking to get corrected. I had braces as a kid and my teeth fit together fine. I was hoping a chin implant would help alone but my nose might be too large as well.
A: You have at least a 10mm chin deficiency. The choice between a chin implant or a sliding genioplasty is how you would view it from the front view. A sliding genioplasty will keep the chin at its existing narrow width. (unless an overlat implants put in front of it. Conversely a chin implant can make your chin wider/more squatter from the front view. That is what should principally make the aesthetic decision between the two chin augmentation approaches. Regardless of the method used, your labiomental fold will get deeper, unlike what you are showing by pushing your jaw forward to simulate the chin augmentation effect. (this is because the teeth come forward and help augment the labiomental fold)
A chin implant can also help reduce the appearance of a large nose by making the lower face more prominent. It may not eliminate the need for a rhinoplasty is a very large nose but it can delay or even change how the rhinoplasty surgery is done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was in your office a few weeks ago originally for a consultation about liposuction. However after speaking with you, you informed my that the best procedure for my goals would be the extended male tummy tuck. I’m still considering this procedure however, I’m getting a bit nervous as while I have had surgical procedures before, this would be the very first one that is considered “elective”. While I have a few more questions about this procedure and your practice.
I’m not sure if I should email you these questions or if I should schedule an appointment to meet with you. Therefore, I figured I would try email first and if you recommend me coming in, I’m willing to do that as well. Please see the below:
1. I was looking through your website and while I see some of the procedures you have done with respects to this procedure with women, I didn’t see any regarding men. Are there significant differences between performing this procedure on men then women? Also, if I can ask, how many of these procedures have you performed on men?
2. What would be my realistic outcome should I have this procedure done? I realize that you would have to remember speaking with me regarding this question. However, in the event you do I figured I would ask in this email. I have looked online and have seen many success stories regarding this procedure. However, I have also seen many not so successful stories where the outcome had’t met the patients expectations.
A: In answer to your questions:
1) About one-third of extended tummy tucks that are done (usually due to weight loss) are in men. I have done many. What prospective patients fail to appreciate about any plastic surgery website is that any photos shown are just a small fraction of what has been done and are only there to provide a general idea of the procedure. Also plastic surgeons can only post pictures that patients will allow to be posted and that is often a very low percentage of patients…men are the most restrictive in this regard.
2) There is nothing in men that make any form of a tummy tuck harder than in women.
3) Every tummy tuck patient, men or women, achieves great improvement. I don’t ever recall any patient that has ever said it was not worth it or did not have significant improvement. This is particularly true in weight loss patients who have no other mechanism to get rid of their resultant loose skin or tissues. That being said, that does not mean that in some cases a secondary revision may be done to help some solve residual issues (e.g., dog ears, scars, contour asymmetry) No plastic surgery procedure, particularly one that covers such a large surface area, ever produces a perfect result. Whether any remaining or more minor aesthetic issues are bothersome enough for the patient to undergo a touch up or revision procedure will vary for each patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an active depressor septi muscle in a way my upper lip is very shortened during smiling. this muscle has been partially cut during a nose job and it was perfect, but after a few months it has reattached.
Therefore, i would like a permanent outcome… a complete cutting of the muscle. Can you do the incision from inside the mouth? Can you explain to me please the process of the surgery?
A: Since the depressor septi muscle can not grow back or reattach itself after surgery, the temporary improvement you saw was due to swelling and temporary muscle inactivity from the rhinoplasty surgery. Once the muscle recovered from the surrounding surgery, it recovered to full motion like that prior to the nasal procedure.
The depressor septi muscle can be cut from inside the nose or from inside the mouth. I find the intraoral approach to be the most assured at getting a complete release of the muscle. This also allows the best view of the muscle from its origin at the incisive fossa of the maxilla to its insertion on the nasal septum. By electrocautery the muscle can be visualized and released in a controlled fashion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom skull implant.I have a flat back of the head, that I hide every day as much as I can with my hair (no hair loss). I am interested in the skull reshaping procedures using custom implants described in the page: http://eppleyplasticsurgery.com//skull-reshaping/. I am particularly interested by the computer designed flexible implants, and the example photographies of a skull with/without implant in the middle of the section ‘custom skull implant’ matches quite closely my situation. I believe that an additional 50cm3 volume would be largely sufficient to get the desire ’rounding’ effect, after testing with plasticine, however I do not know if this volume would fit under my scalp.
I have listed below my questions (I have a lot, but I am considering very seriously this surgery), I hope you can answer them either by mail or a scheduled interview, as you see fit (however I’m more comfortable writing english than speaking it):
1) what is the volume range of the implants that can be inserted?
2) what is the material used to 3d-print the implant? How long is it supposed to last?
3) what would be the size and position of the scar necessary to insert the implant?
4) can you give me the necessary details of the 3D imagery you need, so that I can already schedule the skull scanner in a nearby laboratory?
5) what would be the cost of such an intervention?
6) If the implant has to be removed, even a few years later. Iis the removal a simple process? Can the screws be removed?
Thank you for your time.
A: In answer to your questions about a custom occipital implant:
- I do think of skull implants in terms of volume. Rather I think about their maximal thickness and how the scalp can stretch to accomodate it. In general, a custom occipital implant of 10 to 12 mms thickness can be tolerated by most patients regardless of the surface area that it covers.
- The implants are made of solid silicone and will last forever.
- The implant is inserted through a low horizontal scalp incision on the back of the head.
- A high resolution (.1mm thocknes slices) skull 3D CT scan is needed.
- My assistant will pass along the cost of the surgery to you tomorrow.
- The implant can be easily removed later. I no longer use screws for implant fixation as they are not needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty to correct my weak chin and create a longer jawline. I have fullness at my lower half of the jaw which is actually bone even though it looks like jowls. I have a bone notch half way down my jaw where the bone comes out so the jaw looks fuller and looks too masculine for my liking from the front. I’m not sure where the cut from a sliding genioplasty is but if it is quite far forward so this part of the jaw can be shaved down a bit in addition to moving my chin?
A: Your question is a good one as it relates to the width of the jaw behind the chin where the location of the sliding genioplasty is performed. The bone notch to which you refer is actually normal and is known as the antegonial notch. As the jaw bone descends from that area it can sometimes get a little wider. Whether it can be safely reduced depends on the exact location of the width and its relationship to the mental nerve from the bone which exits somewhere close to that area. While to may be aesthetically desired to reduce it you also don’t what to potentially cause permanent numbness to your lower lip and chin either. The bone cut from a sliding genioplasty is a horizontal one and usually goes back behind the location of the nerve. This bone segment moving usually creates a more narrowing effect to the jawline as it becomes longer. In some cases it may be possible to reduce some of the bone behind it but if I think that the mental nerve is at risk for injury I won’t do it. It all depends on where your mental nerve comes out of the bone in relationship to this area of bone width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision or removal. I had my initial chin implant placed about one year ago. Immediately I know it was too big. The doctor talked me into a revision and now it’s pointy and not the shape of areal chin. I Only wanted subtle chin projection. Now I wish I never had it done at all. I am worried about chin ptosis if it is removed especially after reading your info online and I don’t know what to do.
A: I think you have two chin implant revision or removal options:
1) Downsize the chin implant to a much smaller one with intraoral suspension. This still leaves some soft tissue support and has the lowest risk of chin ptosis, or
2) Remove the chin implant entirely and do an intraoral suspension and hope for the best. There is still a chance you may be able to avoid the chin ptosis problem. It is not always a 100% guarantee that it will always happen when a chin implant is removed. The risk is high but it is not 100%. There are successful ways to manage chin ptosis even it occurs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My knowledge about Smartlipo is limited. I have watched many tutorial videos and read information that has been posted on doctors websites. I understand that it is a procedure that uses a laser to help extract the fat. It seems to have less bruising, less downtime and less time one has to wear the compression garment than traditional liposuction.
Maybe Smart lipo is not the best procedure for the unwanted fat on my abdomen, flanks, back bra area, thighs and let’s throw in the chin area for good measure. But that is the reason for the consultation….for you to advise me on options that will best fit my needs.
A: The reason I ask about your perspective on Smartlipo is that it is highly misunderstood…which is not the patient’s fault. Many doctor’s marketing of it is false…or at the least a but understated. Smartlipo is not different in terms of invasiveness, amount of bruising, recovery or downtime than any other form of liposuction. It is just a different way to loosen up the fat to remove it but it is still a very invasive procedure just like every other form of liposuction.
Dr. Barry Eppley
Indianapolis, Indiana