Your Questions
Your Questions
Q: Dr. Eppley, I am interested in forehead augmentation. My forehead is very round in shape and I believe a forehead implant can greatly impact my profile. I also have a bent nose and want to go through rhinoplasty simultaneously. I just want the tip of my nose to be lifted very slightly.
What im curious to know is that, would it be possible to do nasal augmentation, through a coronal incision, and by doing so completely avoiding any scarring of the nose.
A: Thank you for your inquiry. Please send me some picture of your forehead, particularly from the side view, for my assessment and recommendations.
Whether it is to build up the radix or bridge of the nose to for nasal tip manipulations, you can not do that successfully from a forehead approach. This requires an open rhinoplasty for which the small columellar skin incision to fo do so heals so well it is virtually invisible afterwards. I have never in 30 years of rhinoplasty surgery had a patient request a columellar scar revision which speaks to the issue whether any adverse scarring occurs.
In addition most forehead augmentation proedures that are done with a custom implant do not require a coronal scalp incision to place them. That type of access scalp incision is only needed for bone cement forehead augmentations.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a Medpor jaw angle implant revision. Three years ago I had an operation to improve my jawline using Medpor implants. After the surgery i noticed a degree of asymmetry in lateral projection of my right jaw angle. Recently I went through a 3D CT scan to determine the source of this issue and the doctor stated my masseter muscles are not symmetrical and specifically the right jaw muscle is 1-1.5 mm thinner. I would like to know if I can fix this problem by removing the current Medpor implant on my right jaw angle and replacing it with another implant which can increase the lateral projection of my right jaw and consequently remove the asymmetry between my jaws.Thank you in advance and I will look forward to hearing from you.
A: Thank you for your inquiry and detailing your surgical history. While your indwelling Medpor jaw angle implant can be removed and replaced, the initial critical question is whether this is a true muscle asymmetry problem or one related to the implants. I assume you know this answer because you have seen the scan yourself and you have visual assurance that the implants are perfectly positioned and are not the underlying culprit of the asymmetry.
For the sake of discussion there are numerous ways to do a Medpor jaw angle implant revision for a mild jaw angle asymmetry of 1 to 1.5mms, regardless of whether it is of muscle or implant origin, which would not include having to remove and replace the entire implant. An implant overlay can be placed on top of the existing implant which would be far less traumatic to undergo. Of course the complete implant can also be removed and replaced as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a Medpor chin implant placed several years ago but have never been that happy with it. I have always felt it was not enough and was too short even though the implant was a large. I am thinking of having it removed and replaced with a sliding genioplasty. Is this a reasonable plan?
A: The critical question in your secondary chin augmentation inquiry is whether you would leave the existing chin implant in place and do the cut above it and carry it forward with the sliding genioplasty or take it out and do the whole chin advancement with the sliding genioplasty alone. It depends on how much more your chin needs to be advanced over what you have now, what the thickness of your bone is and whether the bone alone can make the amount of advancement improvement that is desired. That would require a 3D CT scan to help make that determination as well as measurements of how much further your chin need to brought froward to meet your aesthetic goals. If the Medpor chin implant was a large one it may bee doubtful that a sliding genioplasty alone would be able create your ideal chin augmentation result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin augmentation. I am 6 feet tall and somehow my chin does not harmonize with the rest of my face. It’s not that I don’t have a chin, but it just doesn’t seem masculine.
I would be very interested in a chin implant and would also like to have the procedure performed later this year. I would also like my jaw to look more contoured. I had in mind filler + chin implant. Can fillers have the same effect as a jawline implant? In this part I’m not sure yet why a temporary solution would be good but with the chin I’m sure it should be permanent. My eyebrows are pretty asymmetrical, maybe you could fix it parallel. I would be very pleased about a cost calculation and would also like to have the intervention carried out with you.
A; Than you for your inquiry and sending all of your pictures. Doing a chin implant with injectable filler or fat is a good combination when one is uncertain as to the jaw angle effect that they seek or whether it would be what they want. The debate for a jaw angle fillers comes to a synthetic like Radiesse or using one’s own fat. There are arguments to be made on either side.
For the brow asymmetry what can be done is to lift the lower side of the eft inner brow area. It is not possible to lower a higher brow so it would be important to know which type of brow change you seek. I will assume the former for now.
I will have my assistant Camille pass along the cost of the surgery to you later today.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I can’t thank you enough for the time and effort that you put into answering patient enquiries. Although I may not be a direct patient of yours, your blog has helped me tremendously. Thank you for not beating around the bush, as many surgeons on RealSelf tend to do.
I’m a 24 year old recipient of cheekbone reduction surgery and had some mild midface ptosis, although I was happy from a bony standpoint. This week, I’ve undergone a temporal/intraoral incision cheek lift to hopefully alleviate the sagging. From your blog, it seemed like the most logical thing to do to directly address my cheek sagging post-op zygoma reduction.
How long after my subperiosteal midface lift should I be able to start seeing the final results? My surgeon mentioned that my temple area and cheek area would be hard and swollen. This is the case but my left nostril and lateral nose are also completely numb. I can flare my nostrils fine, but should I expect a full recovery in regards to this nerve disruption? My surgeon said a full recovery is likely but I just wanted a second opinion.
A: It is not rare to have some temporary numbness of the infraorbital nerve distribution after a midface lift which has a major access point intraorally. That should fully recover but will take 3 to 4 months to do so. Because of swelling it may be difficult to see the results of the midface lift initially but you should be able to see some initial results right after surgery. But the true and final assessment of the outcomes will be evident by six weeks after surgery.
Dr. Barry Eppley
Indianapolis, Indiana