Your Questions
Your Questions
Q: Dr. Eppley, Pursuant to my previous questions on a sliding genioplasty, I have come to the realization that horizontal chin advancement will probably not improve the aesthetics of my profile without concurrent movement of the lower lip and the mentolabial fold. On the face of it, a small BSSO seems like the best bet. However, I’m really reluctant to go ahead with the BSSO due to the issues with repositioning of my bite and the wearing of braces. I really feel at a loss as to what to do in reducing the retrusive appearance of my lower jaw without going ahead with the BSSO. I know that the mentolabial fold can be improved with an implant or fat grafting, and obviously the chin can be improved but I’ve made a morph of my profile with just those changes but I feel like my retrusive lower lip is still pretty glaring. Is there anything you can suggest at all in doing a full BSSO camouflage procedure involving the chin, lower lip and mentolabial fold? Is there any scope for an implant to push the lower lip forward like there is with the upper lip? Also, is there any way for a genioplasty to actually lessen the mentolabial fold if it’s done with that in mind? If there’s anything else that you can suggest, please do so.
A: The simple answer is that without a BSSO you are not going to improve the horizontal position of the lower lip. The horizontal position of the lip is largely based on tooth position. Thus only moving the teeth forward (as in a BSSO) will achieve the ideal morph you have shown. You are in a classic conundrum where you can not get what you want the way you want it. You will have to accept some compromise….get the ideal result with the surgery you would not prefer to go through or get the lesser surgery and accept a lesser result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in pediatric skull augmentation. I have a 2 year old son with untreated brachcephaly and plagiocephaly (assymetric brachcephaly). What are the possible side effects of bone cement or a custom implant? Have you done skull reshaping on any children? If so, how many? What age would be ideal for this surgery and how will the cement or implant adjust/effect him as he grows? Finally what is an estimated general cost of this procedure and what is the recovery time? Also I would be extremely concerned about anesthesia for him at a young age. Would you bring in a pediatric anesthesiologist? Thank you for your time.
A: I have done numerous cases of pediatric skull augmentation (onlay cranioplasties) for occipital skull deformations. The use of hydroxyapatite bone cements seems the most appropriate at this young age since the bone will grow into and around it and it will grow proportionately with the surrounding skull bone. I see no reason to perform his skull augmentation surgery until 4 or 5 years of age when the child is older and the skull is more fully formed. This surgery should be done in a pediatric facility (Children’s Hospital) under the management of a pediatric anesthesiologist. Because of the expenses involved this should be a procedure that is done through insurance which requires a predetermination process for approval.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am ready to move forward with my infraorbital/malar implants, but I have a few questions to make sure I understand the difference between custom and semi-custom facial implants. I am familiar with fully custom because that is what we did with my jawline.
So semi-custom does not use my CT scan, but you still design the implants to fit my face based on a design from someone with similar bone structure? Will I still receive the mock-ups and be able to talk to you about revisions?
Does it matter that one of my eye sockets is lower than the other? (AND can that be fixed?)
As always, Thank for your time,
A: The difference between custom vs semi-custom facial implants is the following:
1) A custom implant is made directly off the patient’s 3D CT scan, the semi-custom is using another patient’s implant design off of their scan.
2) The semi-custom implant almost will always require some intraoperative adjustments for fit.
3) The semi-custom approach works better for some facial areas than others. For example, the infraorbital-malar is really not all that different amongst bony deficient patients so It can work satisfactorily in some cases. A semi-custom implant approach, for example, does not work all for a total jawline implant.
4) The only review of the implant design would be by looking at the other patient’s design file. Samples could be made for review but the company will have a charge for them.
5) If you have any significant facial asymmetry a custom implant approach would probably be better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have 33 years old and am interested in occipital reduction. I feel self-conscious for years due to the shape of my head. The occipital part of my head is elongated. I have seen on your website the results of skull reshaping operations. I would like to know the risks of this type of operation. I would also like to know whether the skull after the operation is weaker or at risk of suffering a fracture. Thank you for your attention.
A: Occipital reduction is a very safe surgery that is performed by burring reduction of the bony protrusion. How effective it would be is a function of the thickness of the occipital bone and the patient’s desired objective. The bone be reduced as much as the outer cortical bone thickness will allow. The bone can be reduced until the diploic space is encountered. This allows the inner cortical layer to be maintained and this does not weaker the skull bone to any degree. Occipital reduction needs to be down through a low horizontal scalp incision usually placed over the center of the occipital prominence. Its length will be anywhere from 8 to 12 cms in length.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Lately I have been following your articles and blogs specifically for jaw chin and cheek implants, and have noticed that the custom facial implants can be made to any size but it is the skin stretch that limits the size one can get. My question is, if the skin can stretch a lot when someone gains weight, then can the skin also be “pre-stretched” to prepare for substantially large facial implants of a size that you would not normally want to insert without having the skin gained some laxity?
A: The issue with soft tissue stretch in custom facial implants is one that is exclusively limited to that of the chin area, specifically the dimensions of vertical and horizontal increases. This is not an issue back along the jawline or along the jaw angle area where the tissues have substantially more laxity. I have learned that when the chin is significantly vertically lengthened (10 to 15mms) the soft tissue chin pad may ‘ride up’ in front of the implant rather than staying at the very bottom where the maximal chin projection should be. It is also theoretically possible that such large vertical chin increases could contribute to lower lip incompetence. This situation is very rare, however, as very few patients would ever need to have this degree of dimensional change in the chin.
In these rare patients, pre-stretching the chin tissues would be accomplished by either placing an initial chin implant or, preferably, doing a sliding genioplasty first to set the stage for the eventual larger implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Pursuant to our presurgical conversion about a custom skull implant, I just had two questions.
I still play hockey, ride bikes etc. How long will it take before the skull implant becomes attached so it can’t move because of wearing a helmet and bouncing around ?
The other thing is more a potentially irrational concern but if there is any question about how much bone to remove I’d error on the side of less bone even if it doesn’t go completely flat. I say that because I’m envisioning a hard crash into the board some day in hockey (albeit I’m pretty slow anymore so probably not a hard crash…) and nervous about having a weak spot.
I am looking forward to having the procedure regardless.
A: The skull implant becomes attached quite quickly. But to be safe I would give it a good six weeks and then you can return to all activities regardless of their rigor. Like I said in the office this is like putting a bumper on your head so it adds protection to the skull and does not makes it more vulnerable to injury or fracture from trauma.
Also the amount of bone removed in a sagittal crest skull reduction is not enough to make the skull more prone to fracture afterwards.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to get a rhinoplasty with you. I want to ask first though is it possible to change the nostril shape only? I want to show more of an upturned nose but I don’t want to make my nose length shorter. I just want my nostrils to have the more open look from the side. Can anything be done to make the nostrils from this closed in first pic to open in the second pic.My nose is same as first pic and does not show much nostril from the side. I want my nostrils to look like the bottom picture.I not want any different in my nose shape but only nostrils more open from side like this. What method can be done to do this? All my thanks.
A: The answer to your rhinoplasty questions comes from understanding the anatomy of the tip of the nose and specifically that of the nostril rims. The location and shape of the nostril rims is a direct reflection of the location of the caudal edge of the lower alar cartilages. (and to some degree the thickness of the nasal tip skin as well) This is well known by how the reverse is created from what you want…a lowering of the nostril rim which is done by cartilage grafting. Thus alar rim retraction, or upward rim repositioning, can be created by a resection of a part of the caudal rim of the lower alar cartilages. This can be done through a closed approach with incisions inside the edge of he nostril rims. This would not change the shape of your nose in any other way.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I would like your opinion on what procedures might help me achieve a more chiseled, rugged and defined face. I have chubby cheeks, my chin I feel is weak, and I would like more definition in my jaw. In my picture I have had filler inserted into my chin about a month ago, however it hasn’t had made the difference I’d hoped for. Overall I’d like to ditch the round, baby faced look in hopes of a more handsome and masculine look. The second picture is an idea of the look I’d like to work towards. Any advice is much appreciated.
A: Thank you for your inquiry and sending your pictures. The first insight that I can provide is that you are never going to achieve the facial look as you have demonstrated in your ideal male face image. You don’t have the right soft tissue overlay (thin fat layer) over your facial skeleton. Your facial soft tissues are thicker and thus they will never look as defined as the male model’s face.
That being said there are some realistic improvements that can be obtained and the approach to do it is based on a combination of the 5 male skeletal highlights and fat reduction surgery. The use of cheek, chin and jaw angle implants combined with buccal lipectomies and perioral and neck/jawline liposuction is the maximum aesthetic facial changes that can be done with the goal of sculpting the young male face that is softer, rounder and less defined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been looking into the aesthetics of the eye area in males and what gives them attractive eyes. I have noticed that there are two trends that male models seem to collectively share.
The first is a high palpebral fissure width-to-height ratio, in other words the width of the eyes is large in comparison to their height.
The second trend is the tendency of male models to have a prominent positive medial canthal tilt (a ‘teardrop’ shaped medial canthus). Bashour and Geist published a study (‘Is medial canthal tilt a powerful cue for facial attractiveness?’) in 2007 in which the eye with such a teardrop shaped medial canthus was preferred 93% of the time in female subjects. Anecdotally the same seems to apply to males given the quantity of male models with the feature.
My questions are twofold:
1) Whether you have any thoughts on the contribution of each feature towards eye aesthetics, and any thoughts on whether the two are at all related?
2) Whether the two features can be worked towards via surgery; and if not, what is the reason behind this?
A: While I would not disagree with the two attractive eyes characteristics that you have cited as being attractive for either men or women, neither feature of the eye can be surgically changed. The width of the eye can not be altered as that is controlled by the dimensions of the orbital bones. The medial canthus is a fixed tendon of the eye whose position and angulation on the inner eye bone can not be surgically altered.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very much interested in getting a skull reshaping procedure done under you. I’ve always been conscious of my head (shape wise) growing up. I’ve noticed I have two flat areas of my skull which is the back and the sides. I’ve done many research on skull reshaping and landed on your website. I have the following questions:
1. What is the cost of the procedure? Is it more expensive to do a custom graft or use bone cement? Can you give me a price quote based on my pictures attached (the images on the right (front view)t/below(side view) is photoshopped to give you sort of an ideal results I’d like to have)
2.Do I get the custom graft via CT scan done same day as when I get the procedure done? How does that work since I’m coming from out of state?
3.What is the downtime for the procedure? When can I go back to work?
Hoping for a timely response. Thank you for answering my questions.
A: Thank you for your inquiry. Based on your pictures and description, I see that your two issues need an occipital augmentation (for back of the head projection) and posterior temporal muscle reduction. (for side of the head reduction above the ears) Your imaging results are right on for the side of the head reduction and about 75% obtainable in the back of the projection increase. A custom occipital implant is always the best approach to the back of the head because it can be placed through the smallest incision low in the occipital hairline. The use of bone cements, which are intraoperatively applied and shaped, requires a ,much longer incision placed across the top of the head. I barely use this approach anymore. The posterior temporal reduction is done from an incision behind the ear.
A custom skull implant is made from a 3D CT scan which the patient can get where they live and then they send it to me. It takes about three weeks to have the implant designed and made.
You should be able to return to work in about one week after the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a brow bone implant. My objective is to create a more deep set/ masculine appearance. One of your before/after galleries shows a young man that had this surgery and looks great-naturally. I also wanted pursue improved symmetry even though I realize not everyone is perfectly symmetric. Would having a previous endo browlift have any effect on the coronal approach for this brow bone implant surgery?
A: With a custom brow bone implant I usually place it endoscopically through the same size incisions and locations that the endo browlift was done. A custom implant can also be placed through upper blepharoplasty incisions. Only the use of bone cement necessitates a coronal incisional approach. The relevance of a prior endo browlift is that it creates more scar and tissue tightness over the brow bone regions so a good release is necessary. But it certainly does not preclude the placement of a brow bone implant.
When it comes to brow bone implants, they can be made custom from a 3D CT scan or a preformed implant can be chosen based on custom designs from other male patients. Because it is preformed this permits it to be inserted through small scalp incisions under endoscopic visualization.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in V-Line jaw reversal surgery. I was transitioning to become a female and had v-line mandible contouring surgery where my jaw was was cut up to my ear and removed. I am now de-transitioning after I realize it is not who I thought I was. Is it possible to attach implants if a lot of the jaw bone is gone? I worry too much bone now is gone so is it impossible to attach implant to jaw now? Can it be done? Please help I want it to be square and manly again.
A: It is no problem to do a v-line jaw reversal surgery. I have done about a half dozen several mandibular contouring or v-line reversal surgeries with custom jawline implants just this year. The custom design process allows the jawline to be restored and the existing scar from the previous surgery is not a problem to release and make the pocket for jawline implant insertion. You have more than adequate bone to attach the implant.
The key question in the custom jawline implant design is what the exact dimensions are to bring you back to your original jawline shape or even make it stronger or even more defined than it originally was.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in brow implants to create a more deep set masculine look. I would first like to trial it with filler. I certainly would need to find an injector who has experience with this as it is not a common request for filler. Is this something you do? Where would the actual filler be introduced. I realize it would take a fair amount. Do you have experience with this procedure? Thank you for your time.
A: I have done brow bone augmentations using injectable fillers, fat injections, bone cements and actual brow bone implants. You are correct in that it takes a fair amount of filler to create a visible brow bone augmentation effect depending upon the filler used, the current size of your brow bones and the amount of brow bone augmentation you desire to achieve.
It is very reasonable to first do a test with injectable fillers. While the result may not exactly replicate the effect of a brow bone implant, it will provide a fairy good idea of what you can expect. I would use a hyaluronic-acid based filler, like Voluma, to get a good push on the brow soft tissues. The filler is placed down at the bone level across both brow bones.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a chin ptosis problem. It started when I was 15 years old and I had a very long chin as my lower jaw was pushed forward and my bottom teeth were pushed in front of my upper teeth. The operation was done from inside of the mouth.The operation was:
1) removed of the bone of the chin
2) moved forward the upper jaw in order to get right biting point
As the bone has been removed from the chin, the soft tissue of the chin started to hang. And since then I have never been the same girl. The second operation I have had when I was 21 years old did not turn out well either. This time the Dr advised me to get a traditional liposuction directly on my chin to which I agreed. This did not help.
So now I’m still not where I wanted to be and this time I’ve decided to get advice from you
Thanks to the Dr’s who ruined my confidence as I can’t smile, laugh or even talk properly because everything below my nose has been destroyed.
Please let me know your thoughts of the pictures attached and thank you very much for your help.
A: Thank you for your detailed history and sending your pictures. You have two distinct and related chin problems. First there is significant chin ptosis (soft tissue overhang) at rest which worsens on smiling. Secondly you have a central lower lip sag which fortunately only appears with smiling and not at rest. While pushing up on the overhanging chin pad corrects both problems, that effect can not be created surgically through intraoral mentalis muscle resuspension. While that sounds theoretically appealing, it just is not that effective at making that much of a ‘chin lift’ . The alternative approach is a submental excision of the chin pad overhang and tuck. That is a definitive solution for the chin tissue overhang. It may be best to leave the lower lip sag alone or combine it with an intraoral muscle resuspension at the same time just to see if any improvement in it can be obtained.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an undereye concern When I am not smiling this is what sticks out from under my eyes. I do not believe it is fat—it is the actual muscle. In certain lights it really sticks out. In a smiling picture, you see the bunching up of the lower eyelid. I am wondering if tear trough implants would help. I am also dealing with uneven eyes–certainly do not want to exaggerate that any further witha procedure. I have had previous eyelid surgery so there is scar tissue to deal with.
A: The bulge that you see below your lower eyelids is infraorbital fat not muscle. The orbicularis muscle is paper thin and does out protrude in that area. Conversely, the roll of skin underneath the lash line when you smile is partly orbicularis muscle that bunches up when contracted. Whether tear trough implants would be beneficial is unknown to me based just on a front view picture. If there is an infraorbital rim deficiency then they would. But if the infraorbital rim is not deficient I would think more about some fat removal of the bulge and direct fat graft placement into the tear trough depression. Either way you are not likely to produce any major lessening in the animation deformity of the lower eyelid.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks for responding to my first inquiry concerning the LeFort III osteotomy. I would like to ask you something else, concerning the orbital rims. I was doing a research on these online and amongst some useful information – I did not know about the existence of orbital rim, infraorbital rim implants- I could get, I came across the following statement :
“Those with recessed infraorbital rims usually have recessed eyeballs too, because a retruded maxilla pushes the eyes back. This creates an unaesthetic upper eyelid area with the upper eyelids drooping backward from the brow ridge. Or lack of hooded eyelids. In order for the eye area to be aesthetic, the eyeballs themselves have to be set forward too. Orbital rim implants won’t fix recessed eyeballs. Only a Le Fort III does because it creates space for the eyeballs to project forward. When the orbital rims come forward, the eyeballs themselves would come forward too.”
Infraorbital rim implants only fixes 25% of the problem as a Le Fort III does to the eye area. It does not project the paranasal area forward. It also does not project the eyeballs themselves forward.”
Is the above statement true at all? Wouldn’t only syndrome patients qualify for a LeFort III osteotomy?
A: To clarify your question, a LeFort III moves the infraorbital rims forward but it does not and can not move the eye forward. The globe (eyeball) is on a fixed tether so to speak. (the optic nerve and the surrounding extra ocular muscles) These critical soft tissue attachments do not permit the eyeball to move forward. That is, essentially, an impossibility. This is well known and observed as a LeFort III corrects the proptosis (bulging eyes) that appear in numerous craniofacial syndromes. By bring the infraorbital rims forward, the static position of the globe will become less proptotic because the eyeball stays in the same position…only the bone moves. This is one of the main reasons (beside the malocclusion) why only syndromic cramiofacial patients have a LeFort III osteotomy because of their orbital proptosis.
I don’t think you really understand the magnitude of a LeFort III operation. It is not simple and clean like it appears in an illustration or diagram. It is a procedure that has a lot of aesthetic trade-offs from the scalp scar down to the bony irregularities across the the nose to the cheeks. It is far from being an aesthetic operation. Because of the scope of the surgery and the numerous other issues that it causes, it is reversed for those patients in whom the magnitude of the problem makes even these aesthetic trade-offs worthwhile. (in other words they have significant functional issues) This is far from the case of a purely aesthetic patient who seeks to just have their eye appearance improved.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you could answer a few questions I have on muscle implants. Are there any pros/cons to cohesive gel male pectoral implants (and bicep implants) for example those made by Polythec, over traditional soft solid silicone in terms of aesthetics, feel or safety. Do you offer both types?
Do you recommend square or oval pectoral implants usually?
If I got multiple muscle implants (pec, delotid, bi/triceps), is there an order that would leave one less disproportionate in between surgeries for a thin 20s male. Thanks for your time.
A: When it comes to pectoral implants, the vast majority of men are better served aesthetically with rectangular style or shaped implants. Most body implants, perhaps with the exception of pectoral implants, are best done with the softest durometer but solid silicone gel material. While they are equally safe and effective, the softest durometer of a silicone material allows for easier insertion through smaller incisions. In addition, body implants are attempting replicate muscle tissue and thus should have a similar feel to them.
Polythec is a German Manufacturer of breast and body implants. I can not speak for their silicone material as I have never used them nor are they allowed to sell in the U.S..
When doing multiple body implant surgeries, one can always have them all placed at the same time if one has adequate recovery both psychologically and the time to do so., But when staging them the practical approach is to do them based on intraoperative positioning. In the supine position, pectoral and biceps implants are placed. In the prone position, triceps, deltoids and trapezius implants are placed. This that is how they would be staged.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, One month ago I had an intraoral chin reduction surgery. This consisted of bone burring on the sides because I have a round face and had a somehow wide chin. I like the results of the chin, but can’t realy enjoy it because I am left with an inverted bottom lip! My surgeon says it takes time for the muscles to get used to the new form of the chin, but for me is not a satisfying answer, as my chin muscles move completley fine and also my lip. Also, from my reasearch, inverted lip seems to happen with chin augmentation, not reduction! Chin does not sag so mentalis muscle seems ok. I do have a tight feeling in the chin, When hand pulling lip up it does not strech as it used to. Is this scar tissue issues? contracted mentalis muscle? Did it attached to low? From what I can appreciate the indentation under my lip is at the same height. It just feel like tightness is pulling everything down and my lip responds by going inside. Would steroids injections work? Ultrasound? D o I need a scar revision surgery ( inside mouth scar seem ok ). Is just the muscle still tighten after the trauma?I am very distresed as I had a beautiful mouth and smile and now it looks so tense and unatural. Please consider answering my questions.
A: Thank you for sending all of your pictures. Mentalis muscle dysfunction is very common after intraoral chin procedures as the muscle must be completely detached to do the procedure. Since the muscle is put back together by sutures, there can be a period of tightness/distortion based on how tight it was put back together. While you may think the mentalis muscle fine, that is the main tissue injured during an intraoral approach. Whether it will have a complete recovery on his own can not be predicted. But the protocol for your recovery is as follows:
1) Stretching/massaging the lip and chin is helpful as you have already demonstrated. Such maneuvers should continue for another month.
2) Do NOT inject steroids as they are a destructive chemical that has unpredictable effects in tissues like muscle and fat. It may ultimately cause a worse problem in the long run.
3) If some improvement continues over the next month, then let natural healing takes its course.
4) If there is little to no improvement in another month, fat grafting either by injection or a small dermal-fat graft into the tight area would be the proper treatment.
You have plenty of time to improve as total healing takes up to six months. You have to be patient with this process. Impatience makes people do things that may not be prudent.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in something similar to a mommy makeover – but I”m not a new mother – actually like 53 yrs old. I’m really thin (which I can’t stand), but I have multiple sclerosis. I’m interested in multiple things, but don’t want to ‘piece them’. For example, lip injections, facial fillers, and I really need to do something about my skinny buttox & breasts.I’ve e-mailed before along with my picture, but I was just told to make an appointment. So I was wondering if you have some kind of package (similar to mommy makeover) for older ladies? If so, may you also give me the cost? Thanks.
A: The age of 53 wold not be considered old for any type of plastic surgery procedure(s). Age is not the issue, your medical history may be. With your multiple sclerosis the question is whether you can safely undergo an anesthetic as well as tolerate from whatever surgical procedures you may undergo. The answer to that question would depend on the cur6rent state of your medical condition, what your own doctors say about such surgery and what procedures you may be having. It makes it impossible to answer any surgical cost questions without all of this information since I don’t know what procedures may be appropriate for you. This is why the suggestion about making some form of consultation would be critical in make these determinations.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came across your practice from RealSelf, and I’m very interested in having some work done on my face.
Basically, I would like to create the male model look facial surgery you talk about in your blog using custom jaw implants and cheekbone implants. I had a few questions, though:
1. At the moment, I’m overweight (225 lbs at 5’9), but I read that the jaw/cheek implants have the desired effect only if the face is thin. So I’m working on dropping about 80 lbs within the next 1.5 years before going ahead with the surgery. My question is, is this okay or even recommended? Will my current body fat skew the implant design in any way? Or can I go ahead and get the implants now, at a high body fat, and then lose the weight: would that have the same effect as losing the weight first and then getting the implants?
2. I’ve attached a front side picture of myself and a jaw x-ray I just had done today while at the dentist (they were looking for wisdom teeth to remove). Is my face structure suited for implants to create the male model look? I know you can’t say for 100% without an in-person consultation, but I thought I’d get an approximate opinion from an expert like yourself.
Also, I know it’s unrealistic to expect to look like someone else, but I’d like to create a facial structure similar to that of young Johnny Depp. How feasible would you say this is? I was thinking of doing jaw/cheekbone work, rhinoplasty, and whatever else is necessary to get the desired look. What do you think/suggest?
Thanks so much!
A: In answer to your questions about male model look facial surgery:
1) You definitely need to be down near you ideal body weight to get the best benefits from Facial Sculptiong/Structural surgery like jaw and cheek implants as well as rhinoplasty (although less so for rhinoplasty)
2) I do not think you will get that close to a Johnny Depp look. He is very thin skinned with low body fat. You have much thicker skin so even a rhinoplasty would not even come close. I am sorry to say that this is not a realistic facial surgery goal for you. I may have a different opinion when you have lost the weight. This is also not to say that the facial procedures you have described would not be beneficial for improved facial aesthetics. It is just that you are not going to get the more sculpted angular facial look like that of Johnny Depp.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had custom jaw angle implants by you last week. I feel at this point that there might be some asymmetry between the two sides. My right side feels like it is not even with the left side. Can we do something about this now?
A: Thank you for the followup. We are now entering the postoperative time period in which the concerns about symmetry in facial implants for most young men occur. So it is important to review some basic points about your specific recovery and the protocol for managing potential facial implant asymmetry concerns:
1) At just two weeks after surgery, only about 50% of the swelling from this type surgery has gone down. But equally relevantly, facial swelling and its subsiding course are never even between the two sides. This would be particularly true in your case where the right jaw angle implant was operated on ‘twice’. As you may recall I shared with you that I closed and then reopened the right side to check and resecure the implant. This is relevant because that means there was twice the trauma to the right and the passage of the screwdriver 6X through the right masseter muscle as opposed to just once on the left masseter muscle. So there is going to be substantial differences in the resolution of the swelling between the two sides of the face as this early postoperative period.
2) That being said, you may well be right about the positioning of the right jaw angle implant…or you could just as equally be wrong. I have seen it occur both ways. There is simply no way to judge as this point by an external evaluation. I can not do it nor can any other surgeon. What I do know about your implants is that they have double screw fixation so the implant can not just be turned our pivoted on itself.
3) Because of this uncertainty it is important then to have a specific postoperative protocol and to understand the wound healing biology and logic behind it.
4) As I said before surgery, one can not get a good feel for the outcome of the surgery including symmetry before 6 to 8 weeks after surgery. This time frame is relevant not only to see what the final outcome of the surgery is but to know how to adjust an implant’s position should that be necessary. If you are going to use an external evaluation to judge how to move an implant then one had better wait to really know where it truly is. But this time frame is also relevant in that re-entry into a surgical wound early on carries with it great risk of secondary wound dehiscence, implant exposure and infection. The tissues are not of good quality until several months after surgery. Re-entry weeks or the first month after surgery places one at great risk for these additional postoperative problems. Patience in surgery truly does have its merits.
5) Whether it is early on or later in one’s postoperative recovery. the best and really only way to know about facial implant positioning is to get a 3D CT scan. This provides an unequivocal picture of the location of the implants. But of equal importance it also tells exactly the type of movements needed to best reposition the asymmetric implant side. Anything short of this information is just guessing in surgery.
In short, my recommendation is to wait until further swelling goes down until at least 6 weeks after surgery. No revisional surgery, if needed, is going to be done before that time period anyway for the reasons previously mentioned. One can get a 3D CT scan now or later but that would not change the time period of management. The 3D CT scan is the better alternative to any other surgeon or even myself making a judgment as to the current state of your jaw angle implants.
Dr. Barry Eppley
Indianapolis, Indiana