Your Questions
Your Questions
Q: Dr. Eppley, I am a 27 year old female who underwent facial slimming surgery. It’s a long, complicated story but a few years ago, I went to South Korea to just get a sliding genioplasty because I’ve always had a weak chin and I was told they were the best in the world for that sort of thing so I spent all my savings to fly there and get it done. They did that successfully. However, I am not sure if something got lost in translation before surgery or what happened, but without my permission, they also lowered my cheekbones (they actually shaved and broke the bones and I now have screws in my face) and cut a part of my jawbone. Now I have sagging skin, weak cheekbones, and jowls due to this. This whole thing has been a nightmare and I desperately need help. I am not sure what surgeries I need. I miss my high cheekbones and I hate the sagging skin and jowls. I would do anything to fix this mistake as it’s been really hard on me. Thanks
A: What you had was the classic Asian surgery of facial slimming including cheekbone reduction, jaw angle reduction (amputation) and a sliding genioplasty. This is a very common surgery in many Asian patients to try and change a wide face into a more narrow one. While it can be appropriate for some Caucasian patients, it is far less commonly needed. I suspect nothing got lost in translation. That was just what they were going to do and your aesthetic desires were secondary or irrelevant.
That being said your facial issues are loss of soft tissue support of the cheeks and jaw angles. Re-establishing the jaw angles is fairly straightforward using vertical lengthening jw angle implants. Whether they would be standard or custom implants is matter of debate. For the cheeks it is a bit more of a complex decision. The cheekbones would be refractured and brought back out or cheek implants could be placed to create the augmentation and re-establish cheek support.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in adult skull reshaping surgery. I am 26 years old and just realized that I have a scaphocephaly. My head looks more or less normal from front view but extremely terrible, big and large from the side. My parents refused the surgery when I was a baby. I have always been complemented by this malformation.
Today I want to know if the surgery is still possible? I thank you in advance for your reply.
A: Congenital craniosynostoses, like sagittal or scaphocephaly, is commonly treated as an infant where the bone is removed and rehabbed. This works well as an infant because the bone is very thin, easily removed and can be reshaping after surgery by the growing brain. That window of opportunity for that type of surgery passes with in the first two years or so life. As an adult scaphocephalic skull shapes are treated by sagittal ridge reduction and a custom implant to build up the deficient parasagittal areas. I would need to see some pictures of your head to determine if this might be an effective skull reshaping approach for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking orbital dystopia correction. Having seen some of your earlier work regarding orbital surgeries I think you are the best one to know what my options are. I am a male, 25 years old. For as long as I can remember I’ve really been disliking my orbital asymmetry. I don’t know if it’s become worse with age/time but my left “bigger” eye is constantly focusing lower down than the right “smaller” eye. The pupils are never aligned. This phenomenon was a tricky one for me for many years, because it almost mimicks “ptosis” because the lid and the right eyebrow sag down on the same side. But as the pupillary distance is vertically different (1-2mm) that must mean that my eyes are set differently as well. I am so depressed by this discovery that I don’t know how to approach people or even look people in the eyes without wanting to look the other way. The right eye also seem to have a slight slant. When I put my chin to my chest, eyes straight up in the ceiling, the right eye always goes higher up than the left.
It seems my right eye is set further back, thus looking smaller and also makes the lid sag more. But could this be enophthalmos (sunken globe)? Notice the right eye in a few pictures with my head tilted back.
Here in my country, I get zero help from opthalmologists or other specialists, despite having done a lot of research and presented to them. Either they don’t understand the underlying problem or they think I shouldn’t worry or exaggerate it. So my chances of help over here are pretty much limited. So that is why I am contacting you.
A: Thank you for your detailed inquiry and sending your pictures. As you may or may not recall you have previously submitted and inquiry with pictures (which I still have) so I am familiar with your case. The best way to confirm and quantify your orbital dystopia is with a 3D CT scan. It will no doubt confirm that the right orbit is lower than the left. It will also establish by what amount. Beyond the diagnosis the greatest value of the 3D CT scan would be when planning for surgery in the creation of how thick an orbital floor implant would need to be. But an orbital floor implant alone will be inadequate. It has to be combined with a right browlift and upper eyelid ptosis correction. Otherwise all you do is bury the elevated eye up under the eyelid.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a skull reshaping procedure which is likely to be an extensive procedure. My head is very angled and flat and would likely require implants to achieve the desired shape. Some questions I have regarding the procedure include:
As I currently live in Australia, what would be the required or recommended duration for me to stay close to the hospital post surgery?
What type of risks are associated post surgery as I age? Eg would there be any limitations on physical activity, will there be any need for adjustments?
These are the main questions that pop into my head for now (pun intended) regarding the surgery. Appreciate any feedback.
A: Since I don’t know what your particular skull reshaping needs and procedures may be, I can only make general comments to your questions.
1) There is no reason to ‘stay close to a hospital’ during or after the surgery. This is aesthetic skull surgery, not neurosurgery. There are no neurologic risks from undergoing the surgery.
2) There are no limitations on physical activity after the surgery.
3) I am not aware of any age-related risks from skull reshaping surgery.
I hope this is helpful,
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in the mouth widening surgery known as lateral commisuroplasty and I’d also like to pursue a lower lip reduction surgery.
As you can see on the photo below, my lips are pretty narrow and so my mouth is barely any wider than my nose. If I were to undergo a lateral commisuroplasty and a lower lip reduction procedure could I achieve a mouth appearance very similar to these? How much would the two lip procedures cost?
Also, I looked up photos of jawline augmentation on Google Images and one of them was this Did this patient have a lateral commisuroplasty procedure? I notice that his lips are wider in the after image as there are also some noticeable scars on his mouth corners.
A: It is possible to do a lower lip reduction and lateral commissuroplasties (mouth widening surgery) at the same time. In looking at your pictures and those of your ideal goals, that is not an achievable mouth widening goal.Realistically you could probably achieve about 1/2 to 3/4 of where you are now compared to ideal mouth width. In the jawline picture that is not my patient so I can not say what procedures he had done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am suffering from a too narrow/small head. I hated my hairstyle every day, physical complexes, missing self-confidence. In addition to the external phenomena (daily struggle with the hair, the hairdresser, always looking in the mirror without anyone noticing), it is more the internal psychological phenomena, which destroy my self-confidence more and more (no self-assured occurrence, doubt, fear in meeting new people, afraid to present things at work or speak up). I am now at an age where I would like to change this before it will further destroy my self-confidence. Please could you take a look at my pictures and let me know if there are treatment options?
A: The narrow head, signified by a a straight or convex profile above the ears, is a deficiency of the posterior temporal region primarily. This can be very effectively treated by the placement of submuscular temporal implants. These would need to be custom made based on the dimensions of your temporal region and the extent of coverage/augmentation that is needed. The typical thickness would be around 1 cm above the ear region. These implants are placed through incisions on the back of the ears.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How to improve my undereyes? Can a chin augmentation be done that doesn’t simply just push the bottom tip of the chin forward ?(but fills in below the lower lip as well)
A:In regards to your chin augmentation question, the depth of the labiomental fold (under the lower lip) can never be changed by any form of chin augmentation and it will always end up a little deeper with any form of increased chin projection., That is because the labiodental fold represents the attachment of the mentalist muscle above the chin bone. The attachment of the muscle can not be changed or removed for the obvious functional reason. That being said it can be treated at the same time as a chin augmentation by either fat injections (externally) or a dermal-fat graft. (internally) The latter is more effective at reducing the labiomental fold than the former.
Your lower eyelids show classic pseudo fat herniation due to recession of the infraorbital rims. This can be improved by a lower blepharoplasty that takes the bulging fat and repositions it over the bony infraorbital rim bone to create a smoother lower eyelid contour into the cheek.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would a tummy tuck work on me. I have a protruding abdomen. reason I have contacted you is because of an article that you wrote about the fat in the upper abdomen and being realistic about what a tummy tuck can do. I would really like to avoid the dangers and the scars of this type of operation. So please find attached my photos and I look forward to your advice on what sort of procedure would be best for me.
I am 5 feet 2. And weigh 156pounds. I have had a c section twenty years ago. And my appendix removed.
A: Thank you for sending all of your pictures. While you definitely need a tummy tuck, the question is how you prefer to ‘stage’ it. As you have read in my articles the upper abdominal fat is a challenge to ideally manage at the time of a tummy tuck. If you aggressively liposuction fat in the upper abdomen at the time of a tummy tuck, there are increased risks for causing wound healing problems of the tummy tuck incision. To prevent this potentially devastating complication, it is safer to do some upper abdominal liposuction at the time of a tummy tuck conservatively knowing that a complete flattening of the upper abdominal area will not result. This is why I tell many tummy tuck patients that it may require a second procedure six months after the tummy tuck to come back and liposuction the rest of the upper abdomen to reduce the upper abdominal bulge. The other approach is to do aggressive liposuction of the full abdomen, flanks and waistline first and then come back six months later to so the ‘completion’ tummy tuck which now will not require liposuction. Ss you can see, either approach to your abdominal contouring will involve two stages…it just depends how one wants to approach it. The second approach (liposuction first, tummy tuck second stage) is how most BBL (buttock augmentation by fat injection) procedures are done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty revision. I have previously had a sliding genioplasty with 5mm advancement and liposuction to the neck. I still have fullness under the chin that I feel could be improved through further chin or a jaw advancement to enhance my side profile and align the chin with the bottom lip. I feel an additional 5mm would suffice.
The first option I am considering is a sliding genioplasty revision that would provide the desired 5mm projection for better alignment. This would also assist by making the muscles and skin more taut to decrease the fullness in the neck region. Is there any structural risks advancing another 5mm in performing another genioplasty. Is my chin bone thick enough to support another 5mm?
The second option; braces to the lower teeth to shift the teeth back 5mm and then performing lower jaw surgery and advancing the jaw by 5mm.
The third option; platysma plication to tighten the muscles and/or shaving the digastric muscles, submandibular glands or lifting the glands up via suture support.
I have attached a photo highlighting the area of concern and an x-ray; you will see my teeth are already fairly aligned and bite is fairly good.
I have also had a CT scan which shows no chin fat as a concern and the submandibular glands are not abnormally large.
I would greatly appreciate your opinion as to the most suitable surgical option to move forward with. Also, based on aesthetics alone; is a lower jaw advancement compared to a genioplasty more pleasing to the eye? Do they bring forward the same muscles?
I look forward to your opinion and greatly appreciate your thoughts and time.
A: Thank your for sending your facial pictures and images. In answer to your questions:
1) You have enough bone to allow for another 5mm increase and 2-3 mms vertically down for your sliding genioplasty revision. Your chin still remains dimensionally short, 5mms was an inadequate movement from an aesthetic standpoint.
2) Your submental fullness can be further improved by direct supraplatysmal defatting (liposuction always leaves behind more than one thinks), direct subplatysmal defatting, platysmal muscle plication and partial resection of the anterior bellies of the digastric muscles. Collectively this is known as a submentoplasty procedure. In my experience the common use of just neck liposuction is often inadequate for many men as it only addresses what lies above the muscle which is often just half or less of the anatomic reason the submental fullness exists. The thicker tissues of men usually require a more aggressive approach.
3) Your outline of what can be achieved by a more thorough neck contouring approach is not realistic. The back half of your drawing is on the jawline and not on the neck. I have provided a more accurate representation of the actual zone of submental/neck improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in surgical tattoo removal by excision. I was asked to provide a picture of the tattoo I wish to have excised. (I’m having to go this route since laser will take too long before my new job will be starting). I do realize that there will be a scar created in this process and I’m absolutely fine with that. As you can see, the tattoo is on my hand, and the skin there is not taunt as it is on many others, so I’m hoping that will work out in my favor.
Thank you so much for looking into this and I look forward to talking with you about this tattoo removal procedure.
A: The surgical tattoo removal approach to your dorsal hand tattoo would not be excision and linear closure. It is simply too big to be done that way, there is not that much loose skin on the back of the hand…or just about anywhere on the body for that matter. For a single-stage surgical approach the tattoo could be excised completely and skin grafted. Skin grafts on the back of the hand take and heal very well. It will create a patch-like appearance since there will always be some color mismatch between the skin color on the back of the hand and the donor site. (usually the outer thigh) But as long as the ‘patch’ is better subjectively than the tattoo then this would be a favorable trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in an upper lip lift. I have plenty of upper and bottom lip, however, my upper lip seems thin. My concern is not just aesthetic. My upper lip sags right along my teeth, which makes smiling not as automatic for me as for some people (if that makes any sense). For my teeth to show in a smile, my smile has to be genuine and pronounced and extend to the muscles on the upper half of my face. I’m actually a pretty content/happy person, but people seem to think I’m not. To complicate matters, I have a medium olive skin tone and scar easily. Is it possible for me to have this surgery without scarring?
A: Thank you for your inquiry. An upper lip lift will shorten the distance between the nose and upper lip and will have a more limited effect on showing more upper teeth. In some cases I perform a horizontal mucosal line at the smile line at the same time to create more of a tooth show effect. In my experience with patients with more significant skin pigments, I have not see the sub nasal lip scar from a lip lift to be an aesthetic problem. BUT all lip lifts create scar, there is no such outcome as no scarring. It is all about how well that scar will look.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a few questions occur to me about my upcoming zygomatic arch reduction surgery.
First, lowering my zygomatic arch seems like I could be creating a weak spot that could fail under pressure. I live an active life and would hate to have it crushed in during a snowboard fall should the hardware fail. Do you feel this is an issue? You mentioned you couldn’t get to the zygomatic arch to grind it down. I’m not sure what this means other than get to it without leaving a scar. I think I might prefer a small scar than a weak point. From the original CT scan it appeared to my untrained eye as much more bone than the opposing side and possible to grind down.
Let me know your thoughts.
A: In answer to your zygomatic arch reduction questions:
1) In regards to the zygomatic arch, it is not being lowered. Rather it is being medialized, meaning moved inward not down. This is a very stable position when secured with plate and screws. I would have no concerns about how it would respond to a traumatic event later.
2) You can’t get to the zygomatic arch to burr it down because of the size of the incision needed for that exposure plus the risk of injury to the frontal branch of the facial nerve which crosses over its middle portion at the highest point of its arc.
3) Also burring down the zygomatic arch is not an option because the bone is too thin to do so. One would simply have nothing left when even burring it down a few millimeters.
4) To do zygomatic arch reduction (aka cheekbone reduction osteotomies) this is done through a combined intraoral and small external incision (1 cm) in the sideburn hair.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in having a custom jaw implant to have a wider, more symmetrical and defined jawline.
I, however, don’t live in Indianapolis so am unsure as to the process of getting this done. Do I need to come to Indianapolis more than once? Or can I just send the CT scan that I have already done, have Skype consults and only come in once?
In terms of timing I have a tight schedule with uni. Ideally I would be hoping to get this done in January but am unsure if this is realistic with your schedule and time required for everything to be ready? How long does it take for the designing and the printing of the implants? When would your next availability for such surgery be?
If everything works out, what is the next step to move forwards with the implants?
A: I have many patients from all over the world who come in for custom jaw implants. Except for the surgery, all related matters can be handled by email, phone and Skype. You can get the 3D scan that is needed for implant design and fabrication where you live and I can order it for you.
It usually takes 3 to 4 weeks for the implant to be designed, fabricated and shipped for surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in buttock augmentation by fat injections. I have attached pictures to see if I am a good candidate. I would like a nice round booty if you think it would be possible.
A: Thank you for making the effort in sending your pictures. You have several issues of relevance to your desire for buttock augmentation. The overall amount of fat that you have to harvest is adequate but marginal. The fat alone would produce a modest buttock augmentation result but certainly not a large result…or as you have desired a ‘nice round booty’. You simply don’t have enough fat to do it.
You also have a lot of extra and loose abdominal skin and you really need a tummy tuck and not just abdominal liposuction alone. Ideally the best approach in our situation is to do a combined BBL surgery with a tummy tuck and use the tissue removed from the tummy tuck as buttock implants. That tissue is placed into the buttock muscle and then fat is injected in the buttock tissues above the muscle. All together this will give you the best buttock augmentation result combined with major abdominal/waistline reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in learning more about laser lipo to attain a more defined jawline.
I have attached photos from a frontal, side angle and profile view for you to better assess if my request is a good approach to achieving my jawline goals. I am specifically trying to target the skin under my chin to prevent further aging that would require a more in depth surgery later down the road.
A: Thank you for sending your pictures. I can clearly see your jawline concerns and what is masking your jawline is thicker soft tissues, not necessarily an underlying bone deficiency. I do not believe you can achieve your ideal goals by laser lipo jawline surgery but you can certainly obtain improvement. To do so you are going to have to do a maximum soft tissue reduction approach. This would include jawline and submental liposuction, buccal lipectomies, perioral lipsouction and masseter muscle reduction. This is the most soft tissue reduction you can do around the lower facial skeletal structures and is what I call a facial derounding technique.
In addition I would not get infatuated with laser liposuction. It sounds like it is better than traditional liposuction but in my experience it offers no significant improvement or recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In the past you have spoken about the “chin wing” surgery procedure and conveyed you are not a big fan of it
On some surgery forums however, it has come out in the wash that the procedure being described by European surgeons to treat problems of jaw width is not the “chin wing” as is traditionally described in the literature but rather would be more aptly described as a “side wing” where instead of making a cut and sliding forward, the focus is on widening the mandible and then fixing in place I believe.
Have you heard of anything like this and what is your opinion on such an approach? Its my understanding the augmentation of such an approach is very limited at what can be achieved in one operation, but can also be enhanced by widening the chin at the same time.
A: My opinion about any bone procedure that tries to augment the entire jawline is that it conceptually flawed. It is simply not possible to move the jawline around, regardless of the dimensions, to have a profound jawline augmentation effect. It simply will not be effective for most patients. I certainly understand the appeal of using our own bone. But when the aesthetic result can not be achieved, and bony stepoffs result, the use of one’s own bone becomes an irrelevant advantage. When one compares what any bone procedure can do versus a custom jawline implant…there is no comparison.
But it also depends now what type of jawline augmentation one wants to achieve. For some limited improvement, like chin advancement and widening, such bone procedures are useful. Just not for an entire jawline effect.
The conclusion is I am a big fan of what works and not a big fan of procedures that don’t.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a big masculine jawline implant, plain and simple. It’s bothered me for years. It’s a little concerning that there isn’t a lot of before and after examples of people who have had with this procedure. I’ve been looking for over a year and i came across your site. You have far more examples then most doctors.
A: Thank you for sending your pictures. The difference between your jawline and that of your classic examples is you have a high jaw angle, short chin and lack of angularity at either location. You are correct in that only a custom designed masculine jawline implant can make those desired changes. It is also relevant to point out that every example you have shown has a very thin face with little fat. (which is one reason they have jawline and facial angularity) Conversely your face has thicker tissues. So while you can achieve a major jawline improvement it would not be realistic to assume your new jawline will look exactly like that of your examples. But there is no question that you can achieve a much stronger lower facial appearance with a masculine jawline implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is there any possibility that a facial implant could become infected years after it’s put in? I’m guessing that if one were to have any kind of further surgery on the mouth (e.g., dental implants) then there would be a risk, but in general is there an infection window? The idea of wondering each day whether an infection could suddenly appear makes me uneasy. Especially as financial positions change down the line.
A: Any time you have a facial implant there is always a lifelong risk of creating an infection from one historic source….dental treatments. If the dentist is unaware that an implant may be below the tissues the injection of local anesthetic could inadvertently enter the implant capsule and innoculate the implant with bacteria. This is very rare but there have been a few documented cases of this occurrence. This risk is actually higher with cheek implants than any chin or jaw implant because where the needle would be placed to create local anesthesia is closer to where the implant resides. (maxillary vestibular infiltration) It is a consideration in a jawline implant but it is so exceedingly rare I am unaware of a single reported case.
Today’s aesthetic world has also created an additional risk for needle penetration into the implant capsule…injectable filler injections. This is more relevant in cheek and infraorbital rim implants because of the thinner tissue cover over them and being a frequent location for injectable soft tissue augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some questions about skull reduction surgery.
1) If you reduce the total of my head, (back and between the temporal lines) will the results come slower than if you just reduced a small area?
2) How will the swelling feel like, is it like bone, or can I feel difference?
3) After how long after the surgery will the result be final and when will the result be 25%, 50, 75%?
4) If i had an accident years ago, on my skull, will it be possible that my body naturally responds with forming bone?
5) Or can bone form at all after such a surgery?
6) Will the scalp be normal after procedure, it will not be thicker?
A: In answer to your questions about skull reduction surgery:
- Larger areas of skull reduction will have a longer recovery period than smaller or spot reductions.
- Scalp swelling will feel somewhat softer than the feel of skull bone.
- It takes a full 2 months after surgery to appreciate the final result. The swelling goes down at a rate of 50% by 10 days, 75% at three week, 90% at 6 weeks and 100% at 8 weeks after surgery.
- Trauma to a portion of the skull that has been previously reduced will not cause it to form bone.
- New bone is not known to form after skull reduction surgery.
- There will be no appreciable change to the thickness of your scalp after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in lip augmentation. I have very thin lips with no upper lip shape at all. I have tried fillers but they don’t make enough change. I think lip implants may be a better choice. I have attached pictures of my lip to you can see what I mean by having no upper lip shape.
A: Thank you for sending your pictures. When you have lips as thin as yours, with no Cupid’s bow shape at all, no type of volume addition is going to create a pleasing outcome. Lip implants will fare no better than that of injectable fillers. This is how patient’s end up with so called ‘duck lips’, where the volume just pushes outward but not upward. You need more vermilion exposure or enhancement. The only effective procedure for your thin lips is a vermilion advancement lip augmentation procedure. This is where the red part of the lip is moved upward by skin removal, increasing the size of the upper lip and changing its shape permanently. This also allows for a nicely shaped Cupid’s bow to be created which is the hallmark of a pleasing upper lip appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had skull reduction done twice now by two different doctors and both times the result which was promised didn’t come. Do you know why this could happen? Is it possible to form bone after such a procedure? After what Ive understood it is only the scalp that swells and in the early stages post-op I could feel that the scalp was soft, so I could push it down a couple of mms.
But after a while when the swelling was supposed to be gone, my head didn’t look any different at all! Prior to the second surgery I had a CT and it showed I had some mms of bone in the outer layer, which then again was removed, but as well this time I could tell no difference.
I know this for sure sounds impossible, I could see the mms removed the second time after the surgery, and I had a drain and dressing placed, which was removed after two days. Is there any way possible to avoid the swelling after the procedure at all? Have you encountered such after any skull reduction procedures? What really stumbles me is that some places actually has become smaller, while some is as big as it was. So there has become sort of “plateaus”, where some areas are much higher than the surrounding area. I just don’t understand this at all
A: These are questions for the doctors who performed the procedures since they know what they actually did. If you really want to know how much bone has been removed and where it was done at, get a 3D CT scan of your skull which will show those changes.
While there are limits as to how skull bone can be removed, an unsatisfactory aesthetic results comes from only two potential issues: 1) the patient did not have a realistic expectation of what the operation could achieve (expected more than what could be safely done), or 2) the surgeon performed a subpar skull reduction procedure.
While I can appreciate your concerns, I did not do your surgery, don’t know what you look like and never had any pre surgical discussions with you. Your questions should be addressed by those surgeons who you entrusted to do the surgery. That is their responsibility and your obligation to follow up with them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision. Attached please find two pictures – one is very old and is before the chin implant but shows my chin and smile. The other was taken about two years ago. The chin implant looks rounded and it looks even wider and rounded the more I smile. My teeth are not very visible also and the implant makes that even more apparent. I was wondering if you trim down or re-shape implants or remove them. The implant was inserted fourteen years ago from under my chin. It was a rounded, Gore-tex chin implant. I was very determined to have the procedure done at the time – but did not realize the way it would look when I smiled. Thanks very much for reviewing.
A: Thank you for sending your pictures. I would agree with your assessment that some reduction of the chin implant would be a good chin implant revision approach. The chin implant is undoubtably having some aesthetic benefit and you would hate to forego all of it. The traditional Gore-tex chin implant is a very round one and the material is easy to modify. Through your existing submental incision the implant could be removed, reduced in size and shape and reimplanted. This should have a fairly minimal recovery/swelling since you have a existing implant pocket. At the least it should be a better recovery than the initial implantation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently consulted with an orthodontist to improve my smile,I was told that I will need maxillofacial surgery secondary to deficiency in upper jaw/maxilla relative to my bottom jaw/mandible…I have a significant underbite.I am interested in improving my facial appearance,possibly with facial implants,I want to achieve my ultimate “phi”.I am wondering if the upper jaw surgery is necessary and if so should it be done prior to progressing with facial implants or other cosmetic procedures?
A: If you have a significant underbite and you would like that corrected, then you should address that first. Whether a maxillary advancement is a good option depends on numerous factors including one’s age, willingness to participate in a protracted course of orthodontics and how much midface advancement is needed. But if one opts for a maxillary advancement, that should always be done first before considering the placement of facial implants. A maxillary bone advancement should always be done before any effort at facial implant augmentation.
In some cases, facial implants that are custom made can create the identical or better midface result than that of a LeFort I osteotomy as they cover a broader surface area of the midface.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been researching plastic surgeons who specialize in custom facial implants and was particularly interested in finding a specialist who uses 3D technology to create the implants custom for their patients. I came across Dr. Eppley’s website while researching and was pleasantly surprised to find that he uses this in his practice.
I am looking for something very specific. I have no serious issues with my face, rather I am simply looking to enhance my attractiveness through creating more symmetry and creating angles that fit within the Marquardt mask beauty dimensions.
My goal is to have a 3D scan of my face done. (I do understand this requires a CT scan) Then have the Marquardt mask/dimensions superimposed onto my existing facial structure. Then from the mask application combined with measurements and the surgeons expertise see where implants would be needed and exactly the measurements and dimensions each implant should be in order to achieve this level of heightened symmetry and beauty.
As the face is asymmetrical I anticipate each implant would be customized to created the most natural balanced look. Then through the same 3D technology be able to see how I would look after the implants were put in.
I am looking for a natural and subtle look as the outcome.
A: I do many custom facial implants in my practice which involves the use of a 3D CT scan and designing software/engineers through a company known as 3D Systems. While the 3D process is the ideal way to make facial implants and augment the face, you do have some common misconceptions about the implant designing process.
First, the implants are designed from the 3D CT scan using very sophisticated designing software. This is a bone-based design, not a soft tissue one. The Marquardt beauty mask is based on soft tissue measurements, not bone. Thus it can not be used to overlay on the bone to determine the implant designs.
Second, the design of custom facial implants is an art form. The computer does not tell the surgeon or the engineer how it should be designed, it is the reverse.The surgeon tells the engineer how to make the implant design. The computer makes sure it then fits the bone perfectly, is symmetric if there are paired implants, has smooth contours and feather edge transition into the surrounding bone. But as of yet there is no software application where the ideal facial bone structure or a beauty mask can be used in the design process.
Lastly, regardless of the implant design, the computer can NOT then show what they will look like on the external face. There is no software yet to be able to make that prediction.
In short, custom designed facial implants are always better than using standard ones off the shelf, particularly in cases of asymmetry. But the shape and dimensions of the implants and what the postoperative result may be currently remains part of the art of custom facial implants.
Dr. Barry Eppley
Indianapolis, Indiana