Your Questions
Your Questions
Q: Dr. Eppley, it looks like I’ll be moving forward with the custom infraorbital-malar and jawline implants next year.
I am seeking temporary improvement before I see you. I find that when I pull my skin in an upwards/diagonal vector, I see large improvements in the nasolabial area and my overall appearance. Would a PDO threadlift (I know its effectiveness is debated, but the nurse I’d be seeing uses a newer thread and had compelling before and afters) be contraindicated given implants with you in May? My understanding is that most of the effects of the threadlift would likely dissipate by May, but there is a chance some of the sutures won’t have completely dissolved.
A: Pulling your skin upward by fingers is not representative of what a thread lift can really do. It will have a much less significant effect than that simulation and will never make the nasolabial folds appear less deep. Such digital manipulations way over estimate what is possible with any thread lifting procedure.
Otherwise any threadlift done now will not impact any custom facial implants planned for next year.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In a previous email you said you wouldn’t drop the jaw angles any further down than 7mms for fear any muscle coverage problems which I understand– purely out of curiosity, is 7mm the maximum you can lower the jaw angles or does it depend on each individual patient?
A: The risk of masseteric muscle dehiscence exists any time you use an implant to extend the existing shape of the jaw angles vertically downward. There is no absolute number which has been determined to be ‘safe or not safe’ to do so. In my experience I have dropped it down 25mms and not seen any muscle problems and have dropped it down 7mms and have seen it. It is not a completely predictable effect. What I can say for sure is that the more it is vertically elongated the more the risk increases What I have also learned over the years is that the amount of vertical jaw angle lengthening that is really needed is often over predicted preoperatively. In essence a little bit goes a long way particularly when there is some width added also. Lastly, like all aesthetic surgery it is a balance between benefit vs risk. One must always be careful in the goal of the ideal result to not incur other aesthetic complications that are hard to fix. (and masseter muscle dehiscence is very hard to fix) It is always better to have 80% of the ideal result with no complications that it is to have 100% of the ideal result with complications.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am strongly considering a temporal reduction in the near future due to my wide head, but i have a few questions.
1. Is this procedure dangerous in any way?
2. Will the temporalis muscle grow back once it is reduced?
3. With my age being only 19, am i too young for this operation?
4. How often do you perform these procedures?
5. Roughly, what is the cost for this procedure?
I hope I am not asking for too much, but a response would be greatly appreciated. Thank you.
A: In answer to your temporal reduction questions:
1) This is a very safe procedure.
2) The muscle will not grow back.
3) Age 19 is not too young for the surgery.
4) I perform Temporal Reduction surgery on a regular basis.
5) My assistant will pass along the cost of the surgery to you later today.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a cartilage chin implant for 13 years and it was ok. A Dr. convinced me to replace it for a silicone implant which I had for 15 years and caused bone loss and chin ptosis. I didn’t want a replacement but no Plastic Surgeon would remove it without a replacement. I had a plastic surgeon replace it with a Medpor which was AWFUL so 3 months later it was replaced with another Medpor chin implant with 4 screws. I have had 2 chin pad resuspensions as well. Now 7 years later I am seeing my chin get pointy and believe it is due to bone loss. My body is not liking this implant. Would you be able to remove this Medpor chin implant without another synthetic chin implant. Do you do cartilage chin implants or is there something else I can do as my chin might look deformed? Thank you.
A: While I don’t know what you look like or the size of your existing chin implant, a synthetic chin implant can be replaced with either autologous (your own tissue) or allogeneic (cadaveric) cartilage or bone grafts if avoiding another synthetic chin implant is the goal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have asked you questions before and I read your boards here and you seem very knowledgable in implants. I had a right cheek implant replaced from silicone to medpor 2 weeks ago. Have medpor in the left side as well. My Dr is well known and well versed in implants but not a good communicator and I really don’t want surgery with him again. My question is about pain. I have some swelling but not significant and some redness but not much, no fever and no heat at the site. However, I have a significant amount of pain. I will do an MRI to look for possible low grade infection. I think this is unlikely but possible. My question is, could things down the road be okay possibly? I mean, could things settle down and this pain be from swelling and tissue/nerve disruption of the infraorbital nerve? It is placed mid cheek (slightly higher) It is very bothersome (obviously). I don’t want to remove it, but also could not live like this the rest of my life either…Thank you for your input.
A: I think the fundamental question you are asking is whether the cheek implant is impinging on the infraorbital nerve…as this would be the only reason to have more than the typical pain associated with cheek augmentation which usually is not very significant. The best way to check cheek implant positioning, or any facial implant positioning, is to get a 3D CT scan. That will answer that question.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, a friend of mine has had large prosthetics and augmentation in his entire forehead region and even supraorbital a while back. He doesn’t care for them now however, and in fact, finds that his forehead is too prominent now and wants them removed. He is wondering what will happen to his upper eye area when this happens. Will his eyes become more hooded and his eyebrows descend? He actually prefers this because he feels his upper eyes at the moment are too hollow and eyebrows are too high at the moment
He is also considering a hairline lowering procedure but was told by a doctor that his scalp was too tough. Would the removal of these implants also make it possible for him to achieve a hairline lowering without the usage if a tissue expansion?
A:I think it is fair today that removing a large forehead augmentation will result in some potential brow ptosis and even upper eyelid hooding….which sounds like what he prefers anyway.
Whether he could get any significant hairline lowering without tissue expansion I can not say given that I have no idea what he looks like or have felt his scalp. Suffice it to say that hairline lowering is most effective when a first stage scalp expansion is done.
Dr. Barry Eppley
Indianapolis, Indiana
Dr. Eppley, Does a custom midface implant or any other implant (significantly) reduce naso-labial lines? If not, what is the best procedure? Am I stuck with continuing to use fillers?
A: Thank you for your inquiry. If you are having success with injectable fillers, it is possible that you MAY benefit from some type of midface implant. It would all depend on your facial anatomy and the depth of your nasolabial folds. I would need to see pictures of your face/folds to determine if underlying soft tissue release and midface skeletal augmentation would be of benefit.
But the concept of building up the bone beneath the nasolabial fold makes sense in terms of pushing the overlying soft tissue outward. The best test to determine if this would work is to have the injectable filler placed down at the bone level….which would verify the effect of a ‘bone push’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a temporal brow lift which I got reversed 3 weeks after the initial surgery as it was VERY aggressive. However though it has been reversed I feel that the surgeon totally messed up the upper third of my face, my forehead/temple and eyebrow shape is no longer feminine and softer. there are dents and bulges in random parts around my temples. gives me an almost masculine look. Can you please suggest what could be done to help regain my old structure back. Thank you.
A: Thank you for sending your pictures. That was an aggressive temporal browlift procedure. Fortunately most of the pleating and tissue irregularities has resolved. Short of further skin release and allogeneic dermal interpositional grafting, I am not sure you can obtain much further improvement other than what more time and healing has to offer. Time and aging will eventually be the most important factor that will reverse most of the effects of an undesired lateral temporal browlift.
Dr. Barry Eppley
Indianapolis, Indiana