Your Questions
Your Questions
Q: Dr. Eppley, I have an overbite that I’ve been told (by a couple of orthodontists) can only be fixed with jaw surgery. And due to the overbite I have a pretty recessed chin and my nose appears bigger.
However, jaw surgery is a major surgery and I don’t have the type of support system needed to help me with the length of recovery required. Also, it would take a long time before I could even have the surgery because of braces, etc.
So I’ve decided to instead check into improving the cosmetic aspects of my recessed chin for now instead of the underlying problem. I’m thinking a sliding genioplasty would help a lot. Maybe I would need an implant too. But that is what I am contacting you for, to find out what you recommend. My nose might still be proportionately too big also, even after improving my chin.
When I was younger I found a plastic surgeon and had a chin implant and rhinoplasty. This was before the internet and I really didn’t know what I was doing. I had never heard of sliding genioplasty. The surgery did result in an improvement, but really not a big change.
I’ve seen before and after photos from you and other surgeons for sliding genioplasties, and they are amazing! It wouldn’t address my underlying problem, but it would make my profile look so much better!
I also don’t like the size of my nose but I don’t know how it would look if my chin looked better. And I’m noticing my face getting a little saggy around my mouth/chin due to age, but maybe the chin surgery would make that less noticeable?
Anyway, I would love to know what you recommend. Attached are some pictures I took as well as a x-ray from my more recent orthodontist.
A: Thank you for your inquiry and sending your pictures and x-rays. As you know you have an entire short lower jaw and Class II occlusions for which jaw advancement surgery is ideal…but we know the effort to do that at this point in your life is not acceptable. Thus a sliding genioplasty is the procedure you need for cosmetic camouflage because you have both a horizontally and vertically short chin for which an implant does not do well for those combined movements. (the chin implant you have is very small and is positioned too high to have much of an effect) I have done some imaging looking at bony chin movements of 7mm forward and about 5mm vertical as a starting point. While this will help with some of the loose tissue under the chin , the submental area should be ideally treated with liposuction at the same time for best contouring. By the imaging you can see that the nose looks smaller as the lower face comes into better balance. But I also did some imaging looking at nasal tip reduction as well for you to see the combined effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I do have a few questions. The first are related to the temples:
a.) If Dr. Eppley were to use filler this time around, would that show me pretty much exactly what an implant would look like?
b.) What is the price differential?
c.) If I went with the implants, would open me up to the possibility of visible scarring or bruising? How about the filler? (I’m thinking about the fact that I have to be back at work four days after surgery.
A: In answer to your temporal augmentation questions:
1) Fillers will have some under approximation of what an implant will do as they are not comparative volumes. A standard temporal implant, for example, is the equivalent of 2.7cc of filler per side. Most patients are not going to invest 5 syringes of filler to ‘see what it looks like’.
2) Temporal implants are gong to cause some swelling which will not be gone by four days after the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it normal for gluteal implants placed intramuscularly to flip? And is that something that will become less common with larger implants? If not can anything be done to ensure it doesn’t happen?
A: Buttock implants placed in the intramuscular pocket have a much tighter compression against the implant and often have a wider implant base as well. s a result, It would be very rare for a buttock implant to flip in the intramuscular pocket as there is less pocket relaxation that exists than in the subfascial pocket. I have never seen it or heard of it occurring. That is the same regardless of implant size which is often less also because of the tighter pocket. Such flipping is a potential subfascial pocket concern where often lager implant sizes are used that have higher profile to base width ratios.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering how close you could get me to looking like this guy. (link attached)
I’ll attach some photos of myself and explain what I’d want to change to try and match the male model look.
I want to know about forehead implants and how to go about getting my forehead to look as similar to his as possible. My forehead slopes back so I want it looking flat and a defined eyebrow ridge.
I also want to know about jaw implants and how to make my jaw as angular as absolutely possible and much wider.
I really want that sucked in cheek look as well so I want high cheekbones but I’ve read that cheekbone implants aren’t very effective, is this true?
(like this guy in the leather jacket)
Look forward to hearing your assessment on how I could best go about looking as much like this guy or just a male model that might suit my face better.
Kind regards
A:Thank you for your inquiry and sending your pictures. While it is good to have goals, all you can do is take the face you have and see how its proportions and shape can be changed. In that regard that means a forehead-brow bone implant, high infraorbital-malar implants with buccal lipectomies and a jawline implant is how you would reshape your face.
Traditional or standard cheek implants will not create the high cheekbone look, that is true. It requires custom infraorbital-malar implants to create it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have four to six ribs removed. I am also planning on extra large breast tissue expanders to reach a goal of 5000cc to 6000cc in each breast. Given that would it be safe to remove four ti six 4-6 floating ribs if I have 6000cc saline in my breasts? I am 1.75 cm tall and weigh 54kg. Thanks.
A: I have done rib removal in numerous women who have had breast implants well in excess of 1000ccs. I have no experience in rib removal in women with breast volumes as you have or are going to get. However, I presume your question is based on that such large breast implants would not be supported by a ribcage that has been modified? I don’t see any correlation between implant/body support and a modified lower ribcage. The strength to support that breast weight/size comes from muscle support not a fully intact ribcage.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, several years ago I had a buccal lipectomy. I never liked the result and am searching for a “reversal”. In your blog I have read about the possibility to place a dermal fat graft in the buccal space. This is my preferred option since a dermal fat graft creates more assured volume than fat injections and is a solid graft. I don’t mind having a scar somewhere on the body to harvest the graft. Am I correct in assuming this solid graft would not absorb but replace the lost volume I had pre-buccal fat removal? How many of these procedures have you done in the past to correct buccal fat removal?
Could you please tell me how much would that approximately cost? Is general anesthesia needed?
I look forward to hearing from you.
A: In answer to your Buccal Lipectomy Reversal questions:
1) It would seem logical that the type of fat graft tor replacement of a previously removed buccal fat pad would be a solid fat graft. As the buccal fat pad is an encapsulated fat pocket of around 3ccs, its replacement could similarly be a solid fat graft of similar volume.
2) While the volume retention of the implantation of a solid fat graft or fat injections can be debated, and never really proven either way on a truly comparative basis, it is more about what the patient wants to go through. Do they prefer having a body harvest site for a likely one time fat grafting procedure (solid fat graft) or do they prefer having less surgery but likely to have to repeat it more than once. (fat injections)
3) My experience in buccal space fat grating has been primarily that of the HIV facial lipoatrophy patient (type 4 and 5) and not a cosmetic buccal lipectomy patient. Although the results should be similar if not better given a more normal ‘fat state’ in a non-HIV patient..
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in hairline lowering. Would I need scalp expansion to do so? I can’t tell how loose my scalp is and whether it can move a lot or not. It seems sort of flexible but I am not sure how much looseness is needed.
A: Whether your frontal hairline can be lowered without scalp expansion depends on how much forward movement the hairline needs to come and how much scalp laxity you have. The latter is more difficult to accurately answer by email but the former can be answered by sending me a picture which shows the hairline marked where you would like it to be.
But it is fair to say that scalp expansion makes every hairline lowering better and more effective but removing all doubt about the needed scalp laxity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to ask you about how to decide the correct size for jaw angle implants. For reference my bigonial width is 9.8cm without soft tissues and 11cm counting them, my bizygomatic width is 13.6cm. Thanks for the help and greetings.
A: The reality is there is no exact science as to how to select jaw angle implant style and size. X-rays and measurements on them are not really helpful anymore than a chest x-ray is helpful in selecting breast implant size for women. What is the most useful thing to do is computer imaging, looking at various changes in jaw angle shape and size and then seeing how you interpret those changes. From that assessment jaw angle implant styles and size is determined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been suffering with rib pain for over 2 years now. I can’t walk or do activities without burning pain in my left side. I believe the worst are ribs 11 and 12, possibly 10. I saw that you’ve done surgery for the bottom ribs hitting the iliac crest. I am not sure if thats what happening to mine or not, but I am in a lot of pain. Are all CT scans 3d? I had a CT scan (with contrast) in 2017 when this first started but they did not find anything. I’ve also had a thoracic MRI but nothing found. I am running out of options and not sure wha to do.
A: I obviously can not say for certain whether #11 and #12 rib removals would be the cure for your symptoms. In costo-iliac syndrome the long lower ribs (or shortened waist on the affected side) can impinge upon the iliac crest. This can be a source of pain that occurs or exacerbated when one bends over onto that side and the ribs actually touch the iliac crest. Otherwise all x-ray studies would usually be negative as they are done in the upright position. This is typical pain that occurs when one bends over but is relieved when one stands straight.
Whether any of this applies to you I can not say. You would certainly not want to got though such rib removals and end up with no relief of your symptoms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have two large dents (step-offs) and a large bony bulge (on left jawline) that resulted from a bad sliding genioplasty done in 2009. I just want my straight jawline back but concerns over someone not experienced in bone work, particularly in what I’ve been told is a complicated repair, have resulted in my waiting years. However, it’s time to do something and from what I’ve seen and read of your work you have performed these types of repairs before. I have pictures that will show the deformities and happy to send. Would you be willing to discuss my situation? Thank you very much for your time.
A: A 3D CT scan is needed to have an accurate assessment of both the bony stepoffs and the bony bulge. I suspect the bony bulge is due to a shift of the sliding genioplasty resulting in one wing that sticks out. This also contributes to a larger bony step off on the opposite side than would otherwise exist. This would ned to be burred down. The bony setoffs from a sliding genioplasty can be treated with an overlay implant. For the sake of absolute accuracy I would prefer to make custom implants to fill in the defects which can be designed off of your 3D CT scan.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if it was possible to widen or enlarge my head, it is small. That along with a jawline augmentation. Is it possible to do simultaneously. How much would that cost?
Also are there any long term side effects of placing implant on the skull? Such as headaches, or increased chances of other complications?
A: In answer to your head widening and jaw widening questions:
1) It is possible to concurrently widen your head (temporal augmentation) at the same time as widening of your lower face.(jawline augmentation)
2) Both head and jaw widening will require custom implants to do so.
3) I have never had a patient who has developed any problems with headaches after any form of skull augmentation. This is an extracranial procedure that has no effect on the brain.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in ear reduction surgery. As you can see from the photo, I already had this surgery done but I would like to achieve better results.
1. Could you please tell me what would be the total price of the surgery (incl. medication, preparation etc.)
2. Will you be using dissolvable stitches?
3. Could you use small bandages (patches) instead of big ones that go around the head?
I took a measures and it turned out that the reduction should be around 5 mm.
A: In answer to your ear reduction questions:
1) Whomever did your original ear reduction used an inappropriate technique resulting in significant notching of your helical rim in a too high superior position.
2) But you are stuck now with using that location for the back cut across the helical rim. Although I believe I can make the helical rom smoother with a secondary ear reduction.
3) I will have my assistant Camille pass along the cost of the procedure to you on Monday. It can be done under local anesthesia.
4) Dissolveable sutures will be used.
5) Only antibiotic ointment is used as a topical dressing.
Dr. Barry Eppley
Indianapolis, Indiana