Your Questions
Your Questions
Q: Dr. Eppley, I’ve seen your article about testicular wraparound implants.
It seems to be a very interesting alternative to standard half curved implants that always looks to be a bit easy to detect.
How many patients have you already implanted that kind of implants?
No blood circulation issues or decrease of sperm due to maybe hotter testicle temperature du to implant?
How much did it will cost to have that surgery done?
Thank you in advance and have a nice day.
A: In answer to your custom testicular wraparound implant questions:
1) I have performed six such cases or twelve total implants.
2) Since the testicle is dissected out on its neurovascular pedicle before placing it inside the implant, no circulatory or testicular survival issues would be expected.
3) I can not speak to the issue of sperm counts as that is not a preoperative or postoperative test that is done. In any such patients that have been implanted they have all been older (greater than 50 years of age so viable sperm was not a concern to them)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My height 5’1 weight 102 Ibs. I’m a short torso
want to get rid of hip dips and want to know which procedure is the best for me?
Questions:
1) How long should I stay in Indianapolis?
2.) If I had consultation for first time after that, how long does it take time to customize implant?
3.) Does hip implant and rib removal are the best way to give my body hourglass figure?
Thank you.
A: Thank you for your inquiry and sending your pictures to which I can make the following comments:
1) While it is good to have well defined goals, the ideal images you have provided are not ones that are realistic with your body or can be done in a safe manner. I have attached a realistic imaging prediction based on rib removal and custom hip implants of what can be achieved in the effort to give you more of an hourglass shape.
2) The lead time for manufacturing of custom hip implants is three weeks. What I do is have a virtual consultation with the patients where measurements are shown how to be done from which I develop the implant dimensions based on that discussion.
3) I would say give yourself 10 days to be here before returning home.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, First off, my desired surgery objective is still this: a more symmetrical, fuller, rounder head shape, with no (or very minimal) impact to hair follicles and craniofacial health.
With this aim, here are some questions I’d like to have your views on. I really appreciate your time to attend this email. Thank you Dr. Eppley!
1. About screws
I learned that in most cases, screws are used in order to stably attach an implant to one’s skull. These photos show how they look: https://exploreplasticsurgery.com/wp-content/uploads/2018/09/Screw-Fixation-of-Custom-Occipital-Plagiocephaly-Skull-Implant-intraop-Dr-Barry-Eppley-Indianapolis.jpg
What is the material of the screws, 100% titanium?
Are they screwed into the skull bone?
If so how deep do they go?
Are there chances that the way the screws are drilled does harm to one’s brain in particular, or to one’s health in general?
Are screws detectable when the person is going through a security check/scan, for example, at airport customs or other similar sort of checks in public places?
Is there other attachment methods that don’t use screws?
If using screw is the best option, why?
2. Implant material
In one of your articles, it says “Total skull enlargement and augmentation can be done using either bone cements or a custom implant”
Which method should I choose and why?
Will an implant with either method cause migraine and headache to a patient?
Does the procedure cause hair follicle damage (consequently causing hair loss) post-operation, in short-term or permanently?
Is there things that I can’t do due to having an implant on my skull, for example, some intense sports, pressure massage on the scalp, or other strength and movement placed on the head?
Will either material cause problems or discomfort feelings when I am in hot temperature, for example in a sauna, or tropical summer climate with 40+ degrees, and in icy cold environment, say winter in North Canada?
What is the worst case of side effect caused by implant material?
One of your articles talks about injectable bone cement. https://exploreplasticsurgery.com/product-review-osteovation-injectable-bone-cement-small-skull-contouring/
For my case, is there benefit of using injectable bone cement, compared to custom implant(s)? Why?
3. Pieces of implant
In one of your articles, it says “A large custom skull implant replacement requires a two piece design approach to keep the scalp incision more limited.”
For my case, would you recommend to have 1 or 2 pieces (known as geometric split implant insertion technique?)? Why or why not?
Where is recommended for the incision?
4. Design and desired shape
I could see this case study has some similarities to what my shape issue is and what the outcome could be. I may prefer a rounder shape outcome instead of square shape in this example though.
May I know what are the parts that I will be invovled during the design stage?
I know there requires doing 3D CT scan, discussing on a design, and maybe other parts?
I currently live outside the U.S., but I can consider to come to the U.S. during the design stage, if this is necessary to help create a better design. Do you think this is necessary? Where is it better to do the required 3D CT Scan, in Australia or the U.S.?
5. About first stage scalp expansion
My understanding is that it is very similar (or just the same) to a regular augmentation procedure. The only difference is that by doing it, it is assumed that there will be a second time procedure with the aim to further enlarge the implant size/volume. Therefore, a “first stage scalp expansion” itself is a separate, complete skull reshaping procedure, and after that, whether or not one pursues a second surgery is optional.
Is my understanding correct?
As the ideal scenario is that my shape problem could be solved fully (or to a high level of satisfaction) through one single surgery, so I’d like to find out more specifications of the design during the design stage. I can’t wait to get to that stage : )
6. About potential removal
Are there common reasons that one needs to remove an implant during later stage in their lives?
If needed, can a removal be done, and is there major risk from a removal?
7. Other questions
How long do you suggest me to stay in the U.S., for best catering to the designing stage and recovering from surgery?
What is the earliest procedure date can be booked, if you have information on this?
Is there recommendations on budget accommodations?
Thank you for your attention. I really hope all goes well on your side. Speak soon!
A: In answer to your skull augmentation questions:
1) Screws are made of titanium and are self-drilled into the skull to a depth of about 2mms. They are not detectable by an airport scanner.
2) Custom skull implants made of solid silicone are the superior augmentation method because they are premade based on the patients’s 3D CT scan and can be placed through much smaller scalp incisions than the full coronal scalp incisions that bone cements require. Because they are placed down the bone level they have no adverse effects one the hair follicles or hair growth.
3) A first stage scalp expansion is needed of the patient requires more than a 125 to 150cc volume of implant augmentation.
4) The shape of the custom skull implant can be whatever the patient wants since it is predesigned from a 3D CT scan which the patient gets in their geographic location. All imlpant design planning can be done remotely.
5) Whether a first stage scalp expansion is needed is based on the patient’s aesthetic desires. (how much augmentation do they want and what are they willing to go through to get it)
6) A custom silicone skull implant is easily rempved/reversed if desired.
7) Most patients return home 2 to 3 days after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks again for all your help, Dr. Eppley. I just wanted to update you that I recently had an overnight sleep study. If I have sleep apnea, as the oral surgeon suspects due to my airway, we will move forward with jaw surgery to address the airway and also do a genioplasty. If I don’t have sleep apnea, then only genioplasty. He feels the lower jaw could be extended regardless, but double jaw surgery only if there is sleep apnea.
I just had a question, though, which you’re the expert in. Let’s say I have jaw surgery for the sleep apnea and combine the genioplasty with it. If I’m still not satisfied with the width of my lower jaw, are mandibular angle implants s even possible? I know you recommended a staged approach, but I wondered if it even possible to augment a jaw after it’s gone through jaw surgery. The narrowness of my lower jaw concerns me.
A: Yon can always do mandibular angle implants after BSSO surgery. That is very commonly done and up to 1/3 of jaw angle and custom jawline implant patients have had prior orthognathic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a deformed forehead. My brow bones are sticking out and the bulge is very prominent.I am hereby sharing the photographs
I would like to know if it is possible to shave the brow bone partially through incision below the brows as I don’t want to go for scalp incision due to receding hair line and possible scar formation post surgery
My expectation from this surgery is reduction in the deformity and not to get a perfect look. Also, the bulge above left brow is more prominent than right which looks even worse. I would like to know if that can be shaved off to bring down to the size of right bone.
A: Thank you for your inquiry and sending your pictures. You have major brow bone protrusion. An effective reduction can not be done by just shaving the bone (it is too thin), it will require bone flap removal and setback. The more pertinent question, however, is the surgical access to it if any scalp incision is eliminated as an option. An incision would to be made at the eyebrow level. Whether that is made just at the hairline at the bottom or top edge of the brow bone can be debated but I would prefer the bottom edge of the eyebrow hairs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have differences in the shape of my buttocks with the left being lower than the right. I was told that a buttock lift would be need to improve the asymmetry at the bottom.
How familiar are you with the procedure? I’ve read that trying to fix something like my case is 85% more likely to make the problem worse due to fat distribution. I would just like your professional reassurance as to how you would avoid making the problem worse. Thank you.
A: Your right buttock has a lower infragluteal fold than that of the left. Thus a left infragluteal or buttock tuck is needed to raise the lower side to match better with the higher right side.
I have performed lower buttock tucks for almost 30 years. In so doing I have never seen or would understand how it is likely to create an ‘85% risk of making the problem worse’. That is not a pertinent question or a relevant likely outcome. The real question is whether the fine line scar along the new raised infragluteal crease is a worthy tradeoff in the correction of your buttock asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, If you remove tons of facial bone and end up with sagging soft tissue, is there a limit to how much of that soft tissue you can “clean” up? Would any patient who is motivated and willing enough, eventually able to remove enough of the soft tissue to the point where it would nicely fit the new smaller facial bones?
A: Unlike removing bone, adjusting the soft tissue to fit the smaller bone is not so simple. All that can be done is a variety of facial lifting procedures to try and address it…which may our may not be as effective as one would like after facial bone reduction surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I know you’re one of the top surgeons in the USA for revision. I had my nose job (primary) about 1.5 years ago. I’m satisfied however I notice a bump – ball lump like feeling on the side of my nose tip. I do not know if this is common. I read that it isn’t cartilage coming out as usually does shows after 3-6 weeks post op and not 1 year post up and plus. Do your patients usually get these or have these and is it due to maybe an acne or thick pore build up? What’s the resolution that you would do for this. If I took a photo you wouldn’t see it as when I put my finger on the side of my nose tip I can feel like a small ball. I attached a photo to show the area.
However I’m thinking it could be a epidermoid cyst tip of nose. How do you remove these without any scarring?
A: Just based on this one picture it is more likely that you are seeing the cartilage underneath the skin. It can take 1 or 2 years sometimes after a rhinoplasty for the fine details of the shrink wrap effect of the the tissues to reveal the underlying osteocartilaginous anatomy particularly in the tip area. It would be very unlikely that a dermoid cyst could occur from an open rhinoplasty….not impossible but I have never seen it or heard of it occurring. Undermining the skin would not be a mechanism for its occurrence. Until proven otherwise I would assume this is due to the same of the underlying lower alar cartilage.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think cheekbone reductions is tricky. I would like them a slimmer, but I also would like to maintain the current natural “curve” of the zygomatic body and arch I currently have. I am not intimately familiar with all the various cheekbone osteotomy procedures, but I know the ones popularized in Korea are the L and U shaped oseotomies. I have also attached photos of people I think who have gotten such reductions that reflect the results I would like to achieve. I think my overarching goal there being to maintain the natural “curve” and protrusion of the cheekbones despite the reduction. My questions here:
a) Which variation of cheekbone osteotomy would you recommend so I can do more research? Pointers to any publications would be appreciated!
b) Would your recommended procedure also affect my anterior cheekbone projection?
c) Is there imaging and preplanning here to plan the cuts as to protect the facial nerve?
As for risk factors In my research, the main complications seem to be facial sagging and bone integrity issues (non-union) after cheekbone osteotomy. So my questions here are:
a) As compared to genioplasty, how often do you perform of cheekbone osteotomies?
b) What is the relative complication/satisfaction rate for each?
c) Has the technique for cheekbone osteotomy been changing recently or has it been the same technique used for a number of years? Based on the literature, it seems cheekbone osteotomy is a relatively recent technique that’s constantly undergoing new innovations, which makes me concerned about the stability of the outcomes.
Sorry for all the questions, and thanks again for the time!
A: In answer to your cheekbone reduction questions:
1) In cheekbone reduction osteotomies you never lose the natural curve of the zygomatic arch as the osteotomies are done in front of and behind the curve of the arch.
2) The L-shaped anterior cheek bone reduction osteotomy is the most common osteotomy pattern used.
3) I have performed many cheekbone reduction osteotomy surgeries in both Asian and Non-Asian patients. But by comparison chin osteotomies are more commonly requested and performed.
6) While there are many subtle variations in technique whose clinical relevance can be debated, the fundamental concepts of anterior zygomatic body and posterior arch osteotomies with plate fixation has remained the same.
7) A preoperative 3D CT scan is required before any form of facial bone surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, If we were to impact the maxilla (LeFort 1), I understand the septum would also be trimmed by the corresponding amount. Wouldn’t this result in some shortening at least (perhaps not the full extent of the impacted amount )? Or is this largely variable and dependent mostly on how the soft tissue responds ? Even if post maxillary impaction, there is little or no shortening of the midface (brow to nose tip), if this is followed with rhinoplasty, does this actually increase the amount of shortening the nose can get (frontal view ) since the nasal cavity now is actually a little shorter ? (Septum trimmed by impacted amount and maxilla moved up wards )
Many thanks for your time
A: I am not sure I understand your question as it relates to ‘shortening’ whether this means midface shortening or nose shortening. But assuming it is the latter the nose will not shorten in height or length and make even make the nose look larger/longer. This is because no matter what is done wirh the underlying framework you still have the soft tissue coverage which is not changing. While it is tempting to view these concepts of facial change as a mathematical or from an engineering approach, that is not how the face will respond as it is not a 1:1 correlation. The soft tissue coverage must be accounted for and not being a hard structure its responses are not completely predictable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in custom midface implants, infraorbital malar implants, zygomatic arch process… etc. Whichever best suits my face. My midface is flat, cheeks sit low, and my under eye area is droopy. I want a fuller midface, higher cheeks, and support for my under eye area. A more youthful and prettier heart shaped face.
My questions are:
What is the estimated cost of custom implants like these?
Will they help support my cheeks from future sagging?
How much downtime is needed during recovery?
My age is 24, and I can provide pictures for reference.
Thank you.
A: Thank you for your inquiry. By your description it sounds like you need an infraorbital-malar-maxillary implant design to which I can make the following general responses to your questions:
1) My assistant Camille will pass along the cost of the surgery to you later today.
2) Such an implant will provided enhanced soft tissue support that will help decrease cheek sagging that would otherwise occur more severely without such added support.
3) Downtime from almost any facial surgery is primarily related to the postoperative swelling and its impact on your appearance. Most patients needs at least 10 to 14 days if not longer until they may feel more comfortable being in public. But the total resolution of all significant swelling really takes 6 to 8 weeks to occur at a minimum.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Approximately two years ago I had a rhinoplasty surgery at your clinic and the results are amazing. I love the way my nose now looks. However, a few months after the surgery, the skin around my nose (in all of the spots that sinuses are located) started to become inflamed. Every few weeks the skin becomes inflamed and peels off. I’ve been seeing many different doctors repeatedly and it has left them all baffled. They’ve decided it’s not acne or allergies, have tried treating me for bacterial infections and viruses as well as ran blood work and determined I don’t have HSV. Could my nose/body have possibly healed incorrectly and be causing the issue?
A: Thank you for your long-term followup. Having done many rhinoplasty procedures over the past 25 years, this is a postoperative development that I have never seen or heard of before. Problems in rhinoplasty healing, which is very rare due to the superb blood supply of the nose, affect the nasal skin directly…not off the nose to the sides. The fact that this developed months after the surgery also speaks to that it is not a nose healing issue as such problems would have developed right after surgery and appeared right on the nose. I wish I had a better answer for you that could solve your problem but I am like all the other doctors you have seen….baffled for an explanation as to the cause.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have 420cc silicone implants. I have had them in for 9 years. Before I had them done I was a B cup, I am now a DD/E cup. I am 27 and 5ft 7inches height, I have had one child breastfed for two months. I hate the size and want to go back to my natural breast but my main worry is will I have enough natural breast tissue and will the skin be extremely loose? I have gone from clothes size 8 to 12 over the years.
A: The most important concept to understand is that removal of breast implants in anyone is not going to return you to the breast shape that you had before they were implanted. Going from a B to DD cup and having a child that you breastfed all means that you will have exactly the problems that you fear….loose skin with less breast tissue that you had before these events. There are unavoidable sequelae of the tissue expansion effect created by the implant and having a pregnancy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 21 years old and I have been losing my hair rather dramatically in the last year or so. This wouldn’t bother me that much as I always knew I would, but my head is asymmetrical. The right side of my head above my ear extends further out than the left side, and the right side of my forehead extends forward more than the left. I was wondering what the cost of a temporal reduction surgery would be for just one side, and what surgery you would recommend for the front.
Thanks!
A: By your description the temporal reduction procedures sounds appropriate for the right protrusion above your ears. While the forehead can be reduced by bone reduction, the problem is the need for a more visible scalp[ incision to do so. Whether that is a worthy tradeoff would depend on the magnitude of the right frontal protrusion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently read about masseter muscle reattachment after mandibular angle surgery as one of my own patients has presented with masseter muscle disinsertion on the right side after revision of his mandibular angle implants performed in January of this year.
Recognizing your expertise in jaw implant surgery, I am hoping that you can help me by commenting on whether you are using a similar operative repair technique as what I read in the article and/or or whether you have any additional pearls of wisdom for successfully performing this reconstructive surgery.
In your experience, how often does masseter muscle retraction occur following mandibular angle implant placement and how can I prevent this from occurring in the future?
Have you generally found it necessary to remove the existing implant at the time of masseter muscle reattachment?
How many (and what type of) sutures do you generally place in order to resecure the masseter muscle to the mandibular bone?
Do you augment the repair with Alloderm or temporalis fascia?
Is botox treatment of the retracted masseter muscle a possible alternative to surgery?
A: In answer to your questions:
1) I have not found the masseter muscle reattachment procedure particularly effective. When combined with having to place a neck scar to do so, I rarely ever perform it anymore.
2) I treat the soft tissue jaw angle defect today with either the subcutaneous placement of thick Alloderm, perforated ePTFE sheeting or custom made ultrasoft silicone jaw angle implants. This camouflage approach has proven to be far more effective in my hands. This can be done through a less than 1 cm skin incision right over the angle edge.
3) Some patients may merit treatment of the retracted bulge of the muscle with Botox.
4) In terms of prevention, very careful subperiosteal elevation along the inferior border beginning anteriorly at the body of the mandible back around the angle is needed. This technique is far more gentler than the standard stripping done for a sagittal split osteotomy. This will prevent most masseter muscle detachment issues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My face looks swollen and fatter. How can I achieve a chiseled face look and get better defined facial look. I have attached some pictures of me to review.
A: Thank you for sending your pictures. Compared to many patients with darker skin pigmentation your tissues are not quite as thick as I suspected they would be. What you do have is vertical facial shortening of the lower third of your face with a flat mandibular plane. As a result there are some positive things you can do to your face including vertical chin lengthening and/or total jawline vertical lengthening combined with buccal lipectomies and possibly cheek augmentation. Stretching out the lower third of the face and adding highlights at the ‘five corners’ (cheeks, chin and jaw angles) is what can make a face more angular.
Many men seek a more chiseled face. But surgically achieving it in the way now may want it is often not possible. The men who get closer to a more chiseled face are those that already have a thin face where skeletal augmentation of the cheeks, chin and jaw angles is best revealed. Defatting a face alone rarely if ever achieve much increased definition. Facial defatting should be looked at as a complementary procedure to changing the shape of the facial bones.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’d writing to inquire about a few procedures with Dr. Eppley. I’m wondering if you can tell me the cost of each as well as answer some questions I have. I am transsexual so have to plan these around some other surgeries, both time-wise and financially. I expect I wouldn’t be able to do this probably until early next year, hopefully as my last surgery.
1)Clavicle reduction. How much length can you take off? What is involved with recovery?
2) Rib removal. Can you estimate how much it takes off the circumference of the waist Are there ever issues with soft tissue laxity?
3) Lateral Orbital Rim Reduction. I read on your website this can be done using an intraoral incision. I’ve already had a hairline incision during FFS and one hair transplant with another coming soon so would rather not have a coronal incision on top of it, especially because I would expect shock loss. I’m planning on having fat transferred to my temples soon as they’re very depressed. Do you think this will also reduce the appearance of the lateral orbit? I’ve attached a photo where the light catches it on one side and you can see the silhouette of it on the other.
A: Thank you for your inquiry. In answer to your questions:
1) In shoulder reduction surgery a 2 cm (one inch) segment is taken fro each clavicle. Recovery is somewhat similar to a broken clavicle with the exception that there is two of them.
2) Patients report a 1 to 3 inch reduction in circumferential waistline measurements. No on has ever indicated that it has caused a soft tissue laxity problem.
3) Lateral orbital rim reduction can not be done using an intraoral incision, that requires a more direct eyelid incision. There is always a chance that temporal augmentation can make the lateral orbital rims either diminished or no longer visible.
4) I will have my assistant Camille pass along the cost of these surgeries to you tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m trying to gather information and plan out a few procedures to improve my figure. I would like to inquire about shoulder narrowing, custom hip implants and rib removal.
1. What is the recovery like for shoulder narrowing? I read that full recovery takes 6-8 weeks. But how long would I need to wait before traveling? I live in europe, so I have quite a distance to travel.
2. How long do hip implants last? Will they need to be replaced eventually, or are they considered permanent?
3. Can any of these procedures be combined, i.e. done at the same time?
4. What is the price for these three procedures?
Thank you for your time!
A: Thank you for your inquiry on multiple body contouring procedures. In answer to your questions:
1) In regards to shoulder narrowing surgery, you should be able to fly home a week after the surgery.
2) Hip implants are not like breast implants, they are soft solid silicone that will last forever and never need to be replaced due to device failure.
3) The logical staging of these procedure would be a combination of hip implants and rib removal and doing shoulder narrowing surgery as a separate procedure. Which order these two groupings are done in does not matter.
4) My assistant Camille will pass along the cost of these procedures .
Dr. Barry Eppley
Indianapolis, Indana
Q: Dr. Eppley, I have been doing some research into possible solutions for my area of concern, I have very very deep set eyes that appear quite small in comparison to my face. Do you perform oculoplastic surgery? I have heard of something called orbital implants that act to push the eyes into a more forward position, is this something you have any opinion on, or know of any patients who have had this sort of procedure. I am a young woman in her twenties , I don’t have any issues with loose skin around or above the eyes, just very deep set, an almost beady eye appearance. I have looked into plastic surgery for many years seeking to enhance my facial appearance to look more feminine . My eyes are a really big concern for me.
Thank you in advance for reading
A: For the deep set eye there is no procedures that can physically move the eye forward. It is important to remember that the eye is attached by the optic nerve of a certain length that goes through the apex of the orbit. You can not bring the eye further forward that what the natural given length of the optic nerve is…without risking blindness
The only potential procedure is to reduce the orbital bone that surrounds the eye. Whether this would be of benefit depends on what your periorbital structures looks like ad whether such reduction would make a visible difference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had a titanium jaw implant fitted to my left side and v-line surgery including genioplasty. unfortunately I am feeling very remorseful for shortening my chin it was a bad decision which makes my profile too weak with a terrible double chin. I am 38 years old and the surgery was meant to correct asymmetry issues caused from mandibular advancement surgery from 4.5 years ago.
I have included my before and after X-rays for you to see, please can you tell me if there is a way to reverse the chin via genioplasty, I am not keen on the idea of another implant in my face. I had the plates removed from the advancement surgery which is why there are no plates in the before images I have attached.
I have also included an X-ray of a genioplasty I found on the Internet and one that I have photoshopped my my own chin to ask if this is possible? Another surgeon said this was only possible with a bone graft from my mandible but I am not keen to lose any more bone from my jaw since the recent surgery already removed more than I would of liked. So I am hoping that you might have some ideas.
I have attached images of my side profile and front face and photoshopped versions to show how I would like my face to look. I had to hold the skin on my chin so that you could see the shape of it.
I would be very grateful to hear from you as I am desperate to restore my face. Please let me know if you think this is something that you would be able to achieve.
A: Thank you for your inquiry and detailing your history and sending your pictures and x-rays. From what I can interpret from your photoshopped imaging, your goal is to bring your previous genioplasty down and forward which movements that appear to be about 3mm and 3mms respectively. I see no reason that could not be done and, while an autologous bone graft may be ideal, allogeneic bone particulate or solid graft would also work just fine. The key is the bone fixation used, grafting is of secondary importance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Curious about paranasal or paramaxillary implants. I have poor midface projection and my upper lip doesn’t project as much as I want it to. Would love to discuss this and a chin implant.
A: Thank you for the inquiry and sending your pictures. Based on your pictures you are referring to a paranasal-maxillary augmentation. I don’t think you are referring to a premaxillary augmentation as, besides not being able to project your upper lip any further (the upper teeth are primarily responsible for lip projection), it will also open up your nasolabial angle and push out the base of your nose across the anterior nasal spine, which with a long upper lip I wouldn’t think you would want that type of midface change.
As for your chin I would predict that you need increased anterior projection but with a decreased vertical height and no increase in width. That type of chin change may be better suited for a sliding genioplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my chin burred down and jaw implants put in ten years ago. Worst decision of my life as my face was asymmetrical and the implants accentuated my asymmetry.
Biggest issue is my Chin Ptosis. I ended up with lip incompetence , severe lower teeth show, flat mentolabial fold and droopy chin.
I am in a desperate situation and I feel aging is making things worse. Been very self conscious about my chin for the past 10 years.
Was currently considering going to South Korea to see a maxillofacial who can help me with my asymmetry and Chin Ptosis until I stumbled upon your name several times . I felt it was a sign to contact you first.
Please take a look at my pics.
A: Thank you for sending your pictures and detailing your surgical history. Any time the chin is burred down for reduction, particularly if done intraorally, chin ptosis will always result. It is not a question of whether chin ptosis will occur but how severe it will be.
Correction of chin ptosis in the face of lower lip incompetence must resuspend the soft tissue chin pad upward. But this will not be successful unless there is a ‘ledge’ to help hold it up. Whether that is from the placement of an implant or from moving the chin bone forward, the soft tissue chin pad needs support.
While chin ptosis correction can also be done by a submental tuck from below that risk making the lower lip incompetence worse. That approach should only be used when good lower lip position and competence exists.
Given what you have been through and to be more thoughtful in any further efforts, the next step is to get a 3D CT scan of your lower jaw/face. It is time to see what the actual bony anatomy looks like as well as any implants therein.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I currently have large cheek implants in the front of my face. It gave me projection to my mid face which addressed my 1st concern buh didn’t fulfill my 2nd concern to have a wider more angular face. Can i have a 2nd surgery and get extra large implants to put on the sides of my cheek ( and still keep my large midface implants)?
A: That is probably not the best approach to try and place two cheek implants on top of each other. It would be very difficult to get two separate cheek implants close to each other and have then be stable in position. You are asking standard cheek implants to really do what they are not designed to do. You would be far better to have one unified custom cheek implant design which can more effective address your needs and have much lower risk of malposition and asymmetry than four standard cheek implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a square jaw and wide cheekbones which give me an overall square face look.I am right now seeing who’s the best doc for the job. So far all the maxillofacial that can help me seem to be in South Korea, which I have no problem of going to but if I could find something in the US I would prefer that. Here I will attach a photo. Without me telling you what I want, what would you recommend. I am open to everything as long as the risks of complications are kept minimal.
A: Thank you for your inquiry. In the treatment of your wide cheekbones and prominent jawline, you are correct in that bony reduction of both cheeks and jawline is needed. The cheekbones are straightforward as there is only one way to reduce them…anterior and posterior cheekbone reduction osteotomies. The jaw angles/jawline is different in that there are two procedures, 1) lateral corticotomies (thinning) with mild blunting of the actual jaw angles or 2) jawline angle/jawline amputation for a more radical reduction which eliminates the jaw angle completely. Without seeing a 3D CT scan of your face bones as well as a side and oblique pictures I can not say which may be better in your case.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, First of all it is a great respect and i have to say I admire your facial reshaping surgery work. If one were to do those procedures, what would be the correct order and spacing?
Rhinoplasty
Otoplasty
BSSO and GENIO
Wrap around jaw implant
Cheek implant
Brow ridge and fore head implant
Eyebrow transplant
Lip lift and mouth widening?
And out of those if I were to do the followingwhat will be the cost overall?
Custom Forhead implant
Custom Browridge implant
Custom cheek implant
Custom wrap around implant
Lip lift
Mouth widening
Rhinoplasty
Otoplasty
A: Thank you for your inquiry about facial reshaping surgery. Much like building a house you start first with the foundation…in your case the BSSO/genioplasty. Thereafter you build on that foundation six months later with any facial implant augmentations and rhinoplasty. Then the third and final stage would be any lip procedures since all of the other procedures cause too much swelling to make the sensitive lip area amenable to good scarring.
Since it is not yet clear what actual procedures would be done, for now I will have my assistant Camille quote the facial implants and rhinoplasty as done during the proposed stage 2 of the facial reshaping.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the head/ temple and jaw widening procedure. I know you have designed some jaw angle and temple implants for mass market use. As I would most likely not want to have another CT scan done do to multiple scans within the past few years from an unrelated accident. My timeline for surgery would most likely be mid next year. My questions are as follows :
As I do have hollowed temples, would I need both front and side temporal implants or would the sides cover correctly this ?
What would a ballpark figure be for said surgery with custom vs implantech implants?
I know this may be a lot to ask but numbers do not have to be precise
Thanks and kind regards
A: Thank you for your inquiry. In answer to your questions:
1) Standard temporal implants are for hollowing that exist by the side of the eye in the non-hair bearing area. How that applies to your situation its unknown since I don’t now what you look like.
2) The term ‘jaw widening;’ can mean either just the jaw angle areas only or could be the whole jawline. Like #1 without knowing what you mean exactly I can say whether those goals are achievable with standard or only custom designs.
While my assistant is happy to provide costs of surgery, it is not clear whether standard or custom implants are best in your case. I need more information (pictures and your exact goals) to provide a qualified answer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I suffer from moderate plagiocephaly. My biggest concern is the asymmetry of my face as one side seems to bulge out. In my case the flatness of the back isn’t as severe as the front. Is it possible to have reshaping of the front of my head and brow and maybe to contour my cheeks so it doesn’t looks too severe? My eye is also bulging a little bit out but i don’t think it’s fixable.
A: Thank you for your inquiry and detailing your facial asymmetry concerns. The frontal portion of plagiocephaly can be treated as successfully as the posterior portion, it just involves some more complex topographic assessment and treatment than the more uniform back of the skull contour. Please send me some pictures of your face for my assessment and recommendations. A 3D CT scan is always needed in the assessment of facial asymmetries but pictures would be a good start to the assessment process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a question about my custom infraorbital-malar implant design. I notice that the back end of the zygomatic arch comes to a blunt end with 2mm thickness Why is it this way as opposed to tapering to a feathered edge?
A:To refresh your memory as to this very topic we discussed during the custom infraorbital-malar implant design process, the tail end of the zygomatic arch is not usually tapered to a feather edge for two reasons:
1) A fine feathered edge is very prone to flipping up or rolled over during insertion which is never seen during placement…only to appear later when the swelling goes down as a prominent bump. I have learned that lesson more than once.
2) If it is tapered and the design fades from front to back there will be no visual evidence of an arch component at all.
These are the two reasons I don’t taper the ends. Most of the back ends of the arch component are often much thicker in the 3 to 4mm range as a blunt end.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In regards to forehead horns I have three questions:
1) is it almost always an extra amount of bone, rather than the shaping of the skull? (meaning the skull is shaped rather normally underneath and the excess can be burred off?)
2) if a “safe” amount is taken off, will integrity be sacrificed at all? If I were to play a contact sport or something after reduction, would skull damage be any more likely?
3) is there another name for these? Is it just pretty rare? You’re basically the only surgeon who comes up when I try to look in to this.
A: In answer to your forehead horn reduction questions:
1) The exact origin of forehead horns is nor precisely known. But they are a prominence of the upper forehead that can be burred down if that makes for an aesthetic improvement of the shape of the forehead. In some patients that have an overall greater retroclination to the forehead it may be better to build up the bone around the horns as a method for their ‘elimination’.
2) The amount of bone reduced in forehead horn reduction does not compromise the integrity of the frontal bone.
3) The term ‘forehead horns’ is a well known term for these upper forehead prominences that has been in use long before I ever treated them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I was just wondering, If I got 5cm custom hip implants in really soft implants would they have a risk of folding in the healing process? Because I was told that the normal 5cm implants may cause erosion of the underlying tissues, meaning I would have to have “really soft” 5cm ones, but they may fold whilst healing. Is this same risk with your implants? I just want a second opinion because I’m either going to get my hips done with you or the other place I’ve contacted 🙂 thank you so much.
A: At 5 cm hip implant thickness, even the ultrasoft silicone is going to feel very firm/hard. The thicker an ultra soft solid hip implant is, the more firm it will feel. This is just a function of material thickness. While at 1 cm it will feel very squishy, at 5 cms it will be almost as firm as a brick. Because of this issue and others, I would never place a hip implant that was more than 2.5 or 3 cms thick at most. This is just asking for a complication of some type. Hip implants are unique because they are not in or under muscle but on top of its fascia. This makes for higher rates of potential complications. By a lot of painful experiences i can only pass along this piece of wisdom….’it is far better to have an uncomplicated result that may be only 50% of your aesthetic goal than it is to have achieved 100% of your aesthetic goal with complications’.
Dr. Barry Eppley
Indianapolis, Indiana