Your Questions
Your Questions
Q: Dr. Eppley, I was wondering what I could do to get a defined, sharper chin that projects downward more. I would like a more heart/diamond shaped face.
I am content with my jaw definition/angles, but I want to project the chin and make it sharper like the model’s.
I don’t think i would need an immensely dramatic chin implant, but I’d like to know what you think could achieve the result I desire.
I’ve reviewed my options of a pre-made chin implant and a custom one, and I’m still not too sure what would suit me the most.
Could the results I desire be achieve with an off-the-self chin implant? I also wanted to know what a semi-custom chin implant is, and what is the cost of custom and semi-custom chin implants. How many millimeters of projection are ample for this result?
I’m really eager to hear what would work best for me. I appreciate you taking the time out of your day to respond!
Thank you
A: In answer to your chin implant questions:
1) The dimensional needs of bringing your chin forward and down with a square shape can only be achieved with a custom implant design. Most likley this is a 45 degree projection of 5mms forward and 5mms down. No standard chin implant style can achieve these type of dimensional chin changes.
2) A semi-custom implant design is using another patient’s custom implant design that may (or may not work) well for someone else.
3) My assistant Camille will pass along the cost of such surgery to you later today.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been following for website for years now. I think you are the right person that I should go to. I am looking for forehead implant, more masculine forehead, more brow bone projection, less backward vertical slope of forehead, more typical handsome male model forehead and more deep set eyes. I am an Asian male so I have very little browbone (flat) and small frontal air sinuses. I have sent my pictures.
I have some questions:
1) How long does the swelling and bruises last? I would like to have this done may be early September so it will give me 6-7 weeks after surgery before my cruise.
2) How much does it cost for Forehead implant?
If we can not get this procedure done in early September then it has to be in February 2020.
Thank you and I would love to hear back from you.
A: In answer to your forehead augmentation questions:
1) Most forehead augmentation patients will have resolution of their bruising and the major part of their swelling by three weeks after surgery.
2) Given that it takes up to a month after receiving the 3D CT scan to have the forehead implant designed and manufactured, the earliest surgery date would be mid to later September.
3) My assistant Camille will pass along the cosy of such surgery to you later today.
4) I have also attached one type of forehead augmentation change that could be achieved in you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very interested in hip implants and rib removal/rib resection surgery for a smaller waist and longer torso done by you. A few questions regarding rib removal surgery.
1. Can one reproduce after such surgery?
2. What are the most common risks/long term side effects associated with such surgery?
3. Can one resume physical activities such as yoga, working out, swimming and rock climbing after they are fully recovered?
4. Are the organs still protected, are they at more risk of being damaged after such surgery? Can one still breathe properly for the rest of their life after such surgery?
A: Thank you for your inquiry and your very good questions to which I can say the following:
1) Rib removal surgery does not interfere with one’s ability to get pregnant.
2) The most common risks really come down to two issues, 1) acceptance of small back scars to do the surgery and 2) unpredictability of how much waistline reduction can be achieved.
3) There are no physical activity restrictions when one is fully recovered.
4) Since rib removal is subtotal there is no loss of organ protection or risk of organ injury as well as there is no short or long-term pulmonary dysfunction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am still contemplating getting fillers for jawline augmentation. it has been awhile since I contacted you. Is there any new filler that is a injectable solid or implant so I don’t have to worry about migration or accidentally injecting into an artery since it would stay one piece. I read somewhere there was one in development that injects as a liquid but immediately becomes a solid? Is there a bone paste that can be injected also that can be injected along the jawline? Anything else new that is in production I am looking for augmentation in my jaw and chin, perhaps cheeks and nasolabial too? Is the jaw and chin the least likely to have a accidental injection into an artery and you go blind, any reports of this? Is there any type of imaging that can show where the actual arteries are in the face to stay clear of while you are injecting?
A: 1) I know of no new injectable fillers that have any of the properties that you describe/desire.
2) Do not confuse so called injectable bone cements with that of injectable fillers. They have very different properties and are not used the same way.
3) There is no type of imaging that exists to avoid arteries doing injections….that only currently exists for veins around the eyes..
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Qn about staging multiple surgeries I intend to have rhinoplasty with another surgeon. In particular issue is the transition between glabella augmentation and brow bone augmentation (deep set eyes effect)
However I am considering doing the following with you:
– forehead/brow implants (brow bone augmentation for deep-set eyes effect, more square from front, reduce slope)
– custom midface implant
– custom jaw implant
Questions:
1) Which order should be done from first to last (rhinoplasty/glabella augmentation & 3 implants)?
(Issue is the transition between glabella augmentation & brow/forehead augmentation)
2) Can all 3 implants above be done on same day or does it need to be staggered on different days? If so, what is priority order of the 3 implants?
3) Will brow bone implants change the shape & height of the upper eyelid crease?
Regards
A: In answer to your custom facial implants questions:
1) All three implants can be done at the same time.
2) I would think the rhinoplasty would be done second as how the nose is set may be influenced by all of the other facial changes.
3) Brow bone augmentation would not typically be thought of as changing the upper eyelid crease…although the short term swelling may make one think so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Some surgeons say pectoral implant on male chest lasts life time while other are saying it will last about 10 years. May I know what you think about the life expectancy of the implant? Thanks!
A: This is a question to which there should not be a mystery or any point of confusion., Pectoral Implants are made of a solid soft silicone material which will last a lifetime barring any unforeseen trauma. They should not be confused with breast implants, which are gel-filled devices, which will not last a lifetime. While there may be some places in the world tat may use gel-filled type pectoral implants, here in the U.S. only solid silicone pectoral emplace devices are manufactured and implanted.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, When I initially chose to do a genioplasty it was a decision based on genioplasty and rhinoplasties often being two procedures that complement each other. But I think because I never had any real concerns with the chin itself is the reason why I have been left disappointed with the result both from an aesthetic point of view and functional as per our earlier conversations. Moreover when I spoke with a maxillofacial surgeon at my hospital this week he said the horizontal deficiency was so minimal at baseline that a genioplasty should never have been done.
When I think back prior to having any surgeries my concerns with my face were fixated on a hooked nose from the side view and an upper/mid face that looked simultaneously angry/coarse and recessed. I’ve never been able to pin point exactly what it was that I didn’t like and I have never gone into detail about these concerns with any surgeon in the past which is why I think previous surgeries may have been premature and perhaps unnecessary.
The genioplasty was done last yeaer, and I had an open rhinoplasty done the year before. The rhinoplasty itself I think the side view is certainly an improvement from baseline however I also think it does look a bit too feminine while the front looks a bit unappealing and unnatural at the tip area.
I am wondering if we could perhaps have a detailed consultation to discuss if further surgeries are warranted (in addition to reversing the genioplasty) and if so, would this consultation perhaps best be done in person as opposed to over Skype.
My end goal is still to look like me, just a more balanced version that looks natural. I am hoping for a very honest conversation about what is in my best interest as I have worked hard to reach the career point that I am in and am a bit ashamed with myself that my body image issues have suddenly become this big of a problem for me
Attached are my preop photos before any surgeries were done and my current photos taken this week. I would appreciate any honest suggestions you may have.
A: My short comments are:
1) You have very nice results from you rhinoplasty and sliding genioplasty. I think those are very good improvements and almost all patients would be happy to have those changes.
2) The statement that your sliding genioplasty ‘should have never been done’ is completely off base and misinformed. You had a vertically and horizontally short chin for which the sliding genioplasty was a perfect treatment for that type of aesthetic chin deficiency.
3) If these type of changes are largely unsatisfactory I would be very concerned that any revision of them will end up any better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you again for you prompt response, and please find the previously mentioned photos attached below.
*Please note I’ve included the frontal photo me smiling that is when I feel my area of concern is most pronounced
The green on Area of Concern photo indicates bone that I would like brought ‘in’ to reduce width of face. This is on the sides of my face starting parallel to the corner of my eye and goes down for 4cm.
The purple/pink indicates the area starting under my eye sockets and going down 3cm to the bottom of my nose where I would like to reduce the extent to which the bone comes forward from my face.
A:Thank you for sending all of your pictures and a good description of your concerns and objectives to which I can say the following:
1) The cheek area you have highlighted in green can be reduced in width and is done so by anterior and posterior cheekbone osteotomies…which moves the zygomatic arch width inward which is the primary source of facial width increase in that area.
2) The area you have highlighted in purple, however, is not going to be reduced by any form of bone reduction. This anterior cheek area thickness is comprised of soft tissue which becomes exacerbated (bunches up ) when you smile. (This is a very common facial concern in smiling) The underlying bone is actually concave in contour (not convex like the zygomatic arches) and this is not a bony protrusion that can be reduced. Any further bone reduction in this area, besides not having the eternal desired effect, will expose the maxillary sinus which lies immediately beneath it.
3) The purple cheek area is a facial region for which no effective soft tissue reduction is possible. Cutting out the soft tissue is not an option as permanent injury to branches of the facial nerve will occur. Liposuction of this fibrofatty tissue in this area is ineffective. I have tried its many times and it never produces any improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have viewed your custom facial implant results and you have mentioned that attractive results depend on the soft tissue. I’m not sure if mine is thick or thick but is there a way to thin or reduce the soft tissue to make my face looked more defined with the implant. Also say if I have thick soft tissue would PEEK material give me more angularity and stretch than silicone? Thank you
A: In answer to your facial reshaping and custom facial implants questions:
1) There are a limited number of fat reduction procedures of the face (buccal lipectomy, perioral liposuction) that can be performed. Thus the results of trying to reduce the soft tissue thickness of the face are very limited.
2) It is a fallacy that one type of biomaterial over another offers superior show of a facial implant through the tissues. This makes no biomaterial property sense despite the it is a common misconception that is frequently stated. This might be true if the silicone material as like a breast implant (soft) but it is solid silicone which is quite firm.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in abdominal panniculectomy surgery. I have a question about what is the best way to cut into the groin region so a female person having this procedure does not end up with a femoral nerve being cut? I do no want a numb thigh or leg if I have a panniculectomy done. I wish I could get an answer from a great surgeon such as you. Please email me a response and explain it this can be done with no nerve damage to my leg. Thank You it would be much appreciated.
A: An abdominal panniculectomy does not enter the femoral triangle which is a subfascial space in the upper thigh. Thus femoral nerve injury is not a concern with this procedure. The nerves that are at risk is the lateral and anterior cutaneous branches of the iliohypogastric, the lateral femoral cutaneous and the ilioinguinal. While their risk of injury or entrapment is low, they can still be responsible for chronic pain and numbness. But this does not entail a risk of ‘nerve damage to the leg’.
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 lower buttock lift is needed to raise the lower side to match better with the higher right side.
I have performed lower buttock lift surgery 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, 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 1 or 2 years sometimes 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, Thank you for the quick turnaround and spending the time to morph my pictures, much appreciated. Some feedback and follow-up questions:
1) I agree with the chin, I definitely wanted more projection both vertically and horizontally, and your initial morph there I think is very close to what I would like (I might have to play with it myself a bit to allow my mind to adjust to the drastic change haha). My questions here:
a) Do you know about how many millimeters of a movement that would predicted to be?
b) Is the width of the chin also changing here or just a chin movement? This questions is mostly to understand if the body of the chin needs to be change as I know I have some asymmetry there.
2) I think the cheekbones are a little trickier. 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 oseoteomies. 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 (name in the literature) 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?
3) As for risk factors: I know genioplasty is a relatively more common and well-practiced/studied procedure. It is also performed rarely, especially here in the states, as the procedure seems more nuanced. 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 questions:
1) I would estimate the chin movements as 7mm horizontal and 5mms vertical.
2) Chin width never increases with sliding genioplasty. If anything it may become slightly more narrow.
3) 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.
4) The L-shaped anterior cheek bone reduction osteotomy is the most common osteotomy pattern used.
5) 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, First off, thank you for all your posts and answers which have put out for free on the web. I have found them to be an invaluable source of information.
I am a 25-year-old male looking for some advice. I am grateful to have been blessed with a decent facial bone structure but I am looking to take things to the next level aesthetically. While my jaw is quite strong and wide, I feel I have a relatively flat mid-face. I would like to augment and strengthen this feature, particularly my zygomatic arches, for that hollow, chiseled male model look you have written about so extensively. As I understand it, this would also serve as a preventative measure against mid-face sagging as I age, while also providing under-eye support.
What do you think of this plan? And if possible, could you also provide a rough estimate of the anterior and lateral projection that would suit my particular case?
In addition, to achieve a significant outcome in my case, would fillers be sufficient? Or would I need to go with customized silicone cheek implants? Finally, would you recommend any augmentation to the lower third, such as the chin to balance everything out?
Thank you for time.
A: Thank you for your inquiry. In answer to your questions:
1) In looking at your pictures, you do have a lean/thin face which is always the most favorable to create definition from any form of facial implant augmentation…which is particularly important in trying to achieve the type of midface look you have described.
2) I can not provide numerical estimates for infraorbital-malar implies just based on pictures and an email response.
3) You can certainly try fillers but they an not create the same effect. Fillers are like injecting jello which is adequate to create indistinct volume but is not the same as putting a firmer material that pushes off of the bone. The latter can create an angular skeletal look was opposed to the former which creates an indistinct mass effect.
4) I could see the benefits of chin augmentation in the spirit of some additional facial masculinization effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’d like to ask if can enhance and get sharp, well defined jaw while I have some asymmetry there? I mean if its possible with custom implants or something else would be needed?
Best wishes.
A: A custom jawline implant is always the best approach for maximizing the effect and improving any bony asymmetries of the lower third of your face. Whether you would be able to see the type of result you desire is affected by one other factor…the overlying soft tissue and its thickness. Patients who get the best results have the thinnest tissues and leaner faces which enables whatever is put beneath them to show through the best.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What is the maximum scalp expansion possible? I think I would like to spend at least 4 months and maximum of 5 months in the first stage scalp expansion. This is because i would need a pretty big augmentation, and my case is a bit of an outlier. Perhaps something similar to this photo. Is it possible? I have the time to spare.
A: Based on the picture you are showing no form of skull augmentation would require a scalp expansion to that degree. That is from a reconstruction case due to scalp loss and the scalp flap would be covering normal vascularized tissue one the tissue expander was removed not an implant.
But I am all for a nice slow scalp expansion in which more could be achieved than in the typical six week period commonly used in most two-stage skull augmentations.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was interested in the perioral and buccal lipectomies as well as a revision sliding genioplasty to add just a tiny bit more projection (3mm or so), as well as a platysmaplasty to refine the jawline. I was wondering if the chin were to be advanced more, could we fill in part of the labiomental fold with HA paste to prevent a deep crease there? Thanks!
A:Typically I would fill in the step of a sliding genioplasty with allogeneic bone particles which will ultimately become ingrown with bone. HA paste, an older form of bony augmentation which is synthetic, has largely been relegated to historical significance given the lack of manufacturers who make the particles. HA bone cements are also an option but due their high cost and lack of bony ingrowth would be inferior in my opinion to allogeneic (tissue bank) bone particles.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, I have noticed patients gaining shoulder width on each shoulder by 3cm using implants.
1) Do the implants stay in place during your entire life?
2) what happens when you gwt the implants done and then start exercising afterwards and start gaining muscle on the deltoids? will that not arise problems?
A: You are referring to deltoid implants, also known as shoulder widening implants, of which the most common widths are 1.5 cms or less per side. In answer to your questions:
1) Like all implants placed in the body, deltoid implants become surrounded by scar tissue (encapsulated) which holds the implant in position lifelong.
2) Like all muscle implants, most of which sit on top of the muscle and under its fascia, they are carried outward in an uncomplicated fashion with any increase in the size of the muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have make bimaxillary and sliding genioplasty orthognathic surgery and you can see in the photo the final result.
When mouth is closed I can accept it, when I open the mouth and the TMJ work its like I don’t like my surgery result as it immediately appears with a double chin, superior lip have problem specially in the attachment with the nose, inferior lips don t have the necessary bone support and give me stupid expression, finally even the cheeks are floppy.
Thank you.
A: Thank you for sending your pictures and x-rays. As best as I can tell from them and reading your concerns, you have aesthetic satisfaction with the mouth closed but not with opening.This is completely normal as orthognathic surgery is done for the static closed mouth position as this helps set the jaws in alignment. Surgery is not done for how it may look in opening as the facial soft tissue changes with that movement. This is not abnormal nor is there anything wrong. You may benefit by other soft tissue procedures which were not meant to be done at they same time as your orthognathic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can I ask three questions about temporal reduction surgery? I have wide head.
1: Can you scrape the bones under the muscles of the temporal region? I learned temporal muscle reduction surgery by reading your articles as it will work for making head width more narrow.
https://exploreplasticsurgery.com/anterior-vs-posterior-temporal-reduction-for-head-width-narrowing/
To be honest my case is so severe that I wonder if scraping the bone as well as anterior and posterior muscle reduction is needed.
My back head (especially right side) is flat so here is needed to insert an implant. This is why my face bone is totally weird, not only back but also side,around the top of the head as well.
2. Can I take consultants with you face to face? I know I can take it with virtually but I hope I can take face to face consultation with you.
I never mind extra fees.
3: Do you use plastic surgery simulator for computer?
A: In answer to your temporal reduction questions:
1) Bore reduction can be done as well as muscles reduction but to do so that will change the location of the incision from behind the ear to the side of the head.
2) I will have my assistant Camille contact you to schedule an office face to face consultation time.
3) I always use computer imaging to try and demonstrate potential results.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Recently, I did a V line jaw reduction – an osteotomy and shaving of the mandible and a genioplasty. I had a fat graft to my temples too! However, I’ve been breaking out quite a bit. I was hoping to take Accutane to alleviate this. It has been almost a month since my surgery. I was wondering when it is safe for me to take it? I’m also really really afraid my bones are going to grow back after the jaw reduction as I’m very young.
Also, I’m interested in an Asian blepharoplasty + ptosis correction and an undereye fat graft with you. How long should I wait after I finish Accutane?
A: It is perfectly fine to take Accutane one month after such facial hone surgery. I would wait until you are off Accutane for three months until proceeding with the blepharoplasty and fat grafting procedures. While Accutane primary affects the healing of epidermal wounds (and the evidence for this effect is questionable) in theory it does not affect they healing of tissues such as muscle, fat and bone. But it is always better to be conservative particularly in regards to elective facial surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in reshaping my face with you making it more attractive and add angularity. I’ve been told I have thick soft tissue resulting in weak contours so I was wondering if I can thin the soft tissue. The side of my face is convex but I want more of a concave side, as shown in the picture because I heard the implant stretches the tissue. Would this be achievable with a jaw implant alone if widening the gonials. Thank you
A: Unless your face has that concave look initially, no form of jaw implant is going to have that effect. The tissue stretching effect of a jawline implant is on that of the neck not the face. That is where the pull off the soft tissues is affected. It may help a loose or saggy beck as it pulls the neck tissues up as the lower and outer border of the lower jaw is expanded.
Similarly any ability to get a more concave face requires direct defatting of it and some form of cheek augmentation above it to have any chance of that type of facial reshaping effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I saw your website allows free consultations/questions about plastic surgery. And I was curious about a singular calf implant.
I was born with club foot but after correction the mass in my right leg developed different from the left. It was much smaller but over the years I have made major progress but I know it will never be equal. I am in my mid 20’s and live a very active life. And wanted to know if a calf implant can handle such a lifestyle. From hiking, wakeboarding, marathons and mixed martial arts and things like of that nature; without risk of popping or shifting. I’ve read there are different types of implants such as soft and solid silicone etc and which would be better suited for activity.
I know the recovery time can be a little long but I would be willing to wait as long as possible to guarantee results.
A: Thank you for your inquiry. Clubfoot is the most common reason for the use of a unilateral or solitary calf implant. A calf implant is composed of an ultrasoft but solid silicone that will last a lifetime and can withstand any type of physical exertion or trauma.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in undergoing a full skull reshaping procedure that would include brow reduction and forehead reshaping (with potentially a hairline advancement as well) as well as back of the skull implants for a flat back of the head. I would need to fly in for this procedure so I was wondering if the entire surgery from consultation to procedure could be done in one trip? If so, how many days would I be flying in for and when would appointments be available for the surgery? I was hoping I could get an overall cost estimate as well for the procedures I listed if possible. Thank you.
A: Thank you for your inquiry. I will have my assistant Camille contact you to schedule a virtual consultation time to review some basic concepts about your skull shape needs and how to achieve them.
The concept of a hairline advancement with any form of skull augmentation is contradictory. Hairline advancements base their success upon having the scalp mobility to shift the hairline forward/lower. Conversely occipital augmentation needs scalp to allow it to be expanded from underneath. Thus you can’t do both at the same time. To do all that you have mentioned would require a two stage approach with all frontal procedures done first and any occipital augmentation done later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had a lower jaw advancement but it did not change my chin like I thought it would. Can you look at my pictures and records and tell me what you would recommend for further facial/chin improvement.
A: Thank you for sending your records. What that show me is the following:
1) You have a Class II bite relationship with a horizontal and vertical lower jaw deficiency for which the lower jaw advancement (BSSO) was an indicated procedure.
2) While the BSSO brought the lower jaw forward it was unable to correct the vertical deficiency at the chin.
3) While you did not state what your aesthetic concerns were with the outcome my assumption is that that you feel the chin stick out too far and has bunched up the soft tissue chin pad. This is because the vertical shortness of the chin remains unaddressed.
4) I would think the correct approach would be to vertically lengthen your chin which would improve your facial balance, setback the chin back a bit and unravel the bunched up soft tissue chin pad. (vertical lengthening bony genioplasty)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am considering custom jawline implant with you that wraps around the whole including chin. I am wondering if widening my mandible would stretch the soft tissue and make my cheeks appear slightly hollow. Could you look at my photo and the model to see if my goal is possible with the jawline implant alone. Thank you.
A: That is an easy question to answer…which is no. A custom jawline implant by itself will not make the cheeks more hollow. Even with every cheek procedure that is available (buccal lipectomies and perioral liposuction) such a cheek effect is not going to happen in you. That is not a realistic goal with your natural facial shape. What those models have that you don’t have is cheeks. You have to have the facial defatting procedures and the addition of cheeks to get close to that type of facia shape change.
Dr. Barry Eppley
Indianapolis, Indiana