Your Questions
Your Questions
Q: Dr. Eppley, I am interested in learning more about jawline augmentation by the wrap around implants, I don’t think I need customs ones however so are there any that have been premade? I currently have a triangular face but aiming for a more U shaped, masculine shape, will this be possible? also what is the cost, i have attached picture of what I currently look like, and another of what results I am aiming for.
A: Thank you for your inquiry and sending your imaged pictures which shows a smooth confluent jawline augmentation effect back to the jaw angle areas. It would require other facial views of imaging to see the full 3D jawline effect that you seek. One view alone does not provide all the information needed.
While your jawline augmentation needs are modest by my standards, that does not mean it is easy to achieve. Getting such a smooth and even effect is always most assured by a custom jawline implant made from the patient’s 3D CT scan. Only by creating an implant that naturally expands the shape of the jaw can such a smooth effect be seen in my experience. Standard chin and jaw angles implants are what is known as spot augmentations which are fine if just the chin and/or jaw angle area needs a specific augmentation. But smooth and confluent jawline augmentation effects do not come from the use of standard implants not specifically made for the patient.
I will have my assistant Camille pass along the cost of the surgery to you on this coming Tuesday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having an otoplasty on my left ear. While I did not find many of these types of surgeries during my research, I would like to ask you a few questions.Have you performed similar surgeries in the past, and if so, could you please send me some before and after photos?
What type of method do you plan to apply for this type of surgery and where will the scars be located? Will I have a small scar on the helix of my ear?
I was thinking about a reconstruction from the upper middle up to the top of the ear with the use of a cartilage graft for support, as I saw in one of your surgeries. Do you think that is the best technique to apply on my ear?
A: Thank you for your inquiry and seeding your pictures. You have a form of a constricted ear as seen by the folded over helix from the middle of the ear (3:00 position) up to the center of the top of the ear. (12:00 position) While some may refer to it as a Stahl’s ear, because of its pointed appearance, it does not have a third crus so it is not a classic case of it. The helix is also setback behind the antihelical fold as part of the overall hypoplasia. Interestingly some helical cartilage can be seen protruding from behind the helical skin almost as if the cartilage is adequate by the skin is deficient.
But I do think that the skin needs more helical cartilage support to both pull the helical rim skin back over it as well as provide some more projection. As you have noted a cartilage graft is needed to do so an the right amount and curve to it comes from a small portion of the subcostal rib #9 or #10.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young male and will be getting angular custom jaw implants, a chin implant and cheek implants next month. When I asked my Dr. about the wrap-around implant you offer, he mentioned he is not a fan of this type of implant because it requires complete degloving of the muscles. I have attached the MRI images showing the custom jaw implant that has been ordered from the implant company. Prior to proceeding with the surgery, I was wondering if I can get the opinion on the type of implants my doctor is proposing. After looking at pictures of the wrap-around implant, I’m concerned that with separate angle and chin implants I’m getting, it will be very difficult to achieve both a smooth jawline and a wider and more projected chin, because the vertical lengthening only exists at the back of the jaw bone, and does not extend to the chin. I would really appreciate if you can provide me your medical opinion on this and whether or not you believe what a better result would be obtained in my case with a wrap-around implant. Many thanks,
A: Thank you for your inquiry to which I can make the following comments:
1) I do not comment on facial implant designs of other doctor’s patients. That is not appropriate for either the patient or the treating surgeon.
2) I would disagree, however, with the concept that a total jawline implant requires complete muscular degloving as that is not based on an anatomic understanding of jawline soft tissue anatomy. The muscles that do need to be elevated are the mentalis (chin) and the masseter (jaw angles), there are no muscular attachments between the two. Interestingly these are the same muscles that must be elevated for separate chin and jaw angle implants. What is elevated in a total jawline implant is the need for complete subperiosteal elevation.
3) I think your aesthetic concerns are well founded which is why the use of separate chin and jaw angle implants has largely been replaced in my practice with the wrap around implant concept. It simply offers a superior aesthetic result that has fewer postoperative complications such as asymmetry. When the jawline is weak or underdeveloped it makes more sense to augment the whole problem as a single unit that it does to add ‘spot’ augmentations to the three corners of the lower jaw for most patients.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am reaching out to you in regards to my son who is an early teen. He had a nevus sebaceous birthmark removed from the crown of his headless year. The plastic surgeon was able to do a primary closure. At first the scar looked great, but at almost a month , the scar widened dramatically. Now we have him scheduled for a scar revision with a different plastic surgeon who wants to do extensive undermining and galeal scoring with vertical mattress suturing. Can you give me some insight?
A: It is perfectly normal and to be expected that all scalp scars will widen with any form of excision. The size of the excision will determine how much subsequent widening will occur. This is an unavoidable phenomena because the scalp is tight and is really skin stretched over a beach ball so to speak. While the scar may look great for a few weeks, the widening will subsequently occur. The extent of the widening will be fully manifest by three months after surgery and no revision should ever be done before them…as the tissues need time to relax. This is all part of the typical preoperative education.
I tell all scalp excisional patients, particularly children and teens, that there will be a likely 100% chance of the need for subsequent scar revision. Most likely the wide scar is less than the original excision so the tension will be less and the scar will be better. The techniques that have been described are appropriate and represent the maximum approach for ‘Plan B’.
There is also the phenomenon of lost hair next to scar which can be confused with a ‘wide scar.’ The scar is actually narrow but loss of hair (hair shedding) makes it look wider than it is. In some scars it may be a combination of a true wide scar and loss of hair shafts. This is another reason to wait to see what impact any hair regrowth will create on the scar’s appearance.
Dr. Barry Eppley
Indianapolis, Indiana