Your Questions
Your Questions
Q: Dr. Eppley, I’m a man and have very prominent temple lines (superior temporal lines), I think they are called. It causes the arteries at the side of my head to constantly bulge which looks unsightly. Is it possible to flatten, or create a channel in, a small part of each temple line to relieve the pressure on the arteries and thus reduce the swelling/bulging?
A: It is possible and not uncommon to do temporal line reduction as part of forehead reshaping surgery or as a stand alone procedure. However a prominent temporal line is likely not the source of your prominent temporal arteries and I would not expect the bony reduction to solve their bulging appearance. Prominent temporal arteries are treated by a multilevel ligation technique which can be done at the same time as bony temporal line reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The first picture is how I want my nose and the pictures below is my current nose. Is this rhinoplasty result possible?
A: Such a result may or may not the completely possible. It is important to know that no matter what is done to the bone and cartilage support of the nose, how well it will show through depends on the thickness of the skin and how well it shrinks down to the smaller reshaped support. Given your thicker nasal skin such a result as you have imaged but not completely occur. The more realistic outcome is halfway between where you are now and your ideal imaged reshaped nose.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can custom orbital rim implants alter the shape of the eye? For example, making a rounder, droopier eye appear more sharp and narrow?
A: Given that there is a near linear relationship between the shape and level of the infraorbital rim and that of the overlying lower eyelid, you are correct in that custo orbital rim implants that raise the level of the bone can positively alter the shape of the lower eyelid. This is particularly enhanced when other supportive procedures are combined with it such as lateral canthoplasties and spacer grafts if indicated.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about ribcage reduction. Since I remember I had problem with my very prominent rib cages. I always crouch and if I don’t, everyone will notice this disorder. As a result I always have backache, and one disk has slipped. This prominence is worse at upper part of my breasts, and more in the middle, I don’t care about the prominence at the bottom of my breasts. The prominence cause my breasts to fall down and no bra can lift it easily.
Im just asking if it’s possible to have a surgery in the future to narrow the upper part of my ribs by cutting a portion of the bones?
Thank you so much for this helpful website.
A: While I would have to see pictures of your exact problem to provide an informed answer, your description refers to an upper ribcage issue at the level of the breasts/inframammary crease. This is not typically an area of the ribcage that can be modified…but again without a visual understanding of your ribcage concerns this is just a general statement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! I have been considering jaw angle surgery for a while now. But i have one concern in particular. I have read some studies, which are quite out date, that suggest that mandibular angle implants can cause bone resorption.
I was wondering what your experience has been in this regard? Have you had many patients which have presented with bone resorption following jaw angle implants? or are my fears largely unfounded?
A: All facial implants, regardless of their anatomic location of placement will develop some small amount of passive imprinting on the bone. This is a normal biologic reaction that is neither pathologic nor has any clinical significance. The entire concept of bone resorption in regards to facial implants is largely misunderstood and unfounded. In fact, around jaw angle implants in particular, the much more profound biologic reaction is the development of bony overgrowth that typically occurs on their superior border.
Thus the relevant risks of jaw angle implants have nothing to do with any form of bony response to them. Rather the risks of infection, implant asymmetry and malpositioning are the real risks that patients need to be aware as these are the common risks that result in the need for revisional surgery
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in having a hip and butt implants and BBL. I’m very petite with an awkward shape. I’ve got flanks, a big belly and hip dips. I don’t have enough fat to get to the size that I’d like to be which is why I’d like butt and hip implants as well as a BBL. How much would this procedure roughly cost? And if so how should I pay? Hope to hear from you soon.
A: With some abdominal and flank fat available for harvest that is usually applied to the hips as a primary augmentation effort or to contour around buttock implants that are concurrently placed. Buttock and hip implants are almost never done together as that is too hard of a recovery and the risk of infection/seroma formation is very high with four body implants placed in the same anatomic region. Based on your description you would be better served by hip implants (as hip dips rarely get solved by fat injections) and invest all the fat into your buttocks. While the buttock size the fat creates may be inadequate, it would at least better prepare the area for placement of buttock implants later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m writing today with 3 questions about cheekbone reduction surgery.
1) How long of a waiting period is there regarding Botox injections pre and post surgery?
2) How long I should pause laser hair removal treatments on my face pre and post surgery?
3) After viewing the last image Dr. Eppley created exemplifying
the maximum width reduction that can be done I am happy to
state I do not want to go any more narrow than what is done in
the image. I did however have one concern. I made some marks
ion the attached photo and wrote below articulating this concern.
A: In answer to your cheekbone reduction questions:
1) There really is no waiting period for Botox injections after cheekbone reduction surgery. It can be done as close to one week before or one week after the surgery. These are distinctly different anatomic areas.
2) The same answers applies to laser hair removal.
3) In regards to your question on the imaging, I would not over interpret the changes. There is inaccuracies in contour changes that occurs when pushing tissue borders around with Photoshop. What you are alluding to is the risk of bony ‘overcorrection’ which has never been a problem in my experience. As it turns out the opposite is actually relevant. The greater risk is actually undercorrection as there are limits as to how much the bone can be permitted to move inward by the volume of temporal muscle sitting next to it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have attaches photos, showing how my ears look now and how I hope they can look. As this is only a small procedure I only have a few questions.
My questions are:
- How will you perform the procedure? Will you use my own cartilage or some other material to push the outer ear out?
- I am looking to extend the outer ear to be a few millimetres past my ear fold. Ideally the outer ear is visible all the way down my ear. Are you able to control how far this outer ear will protrude?
A: In answer to your otoplasty reversal questions:
1) The procedure is done through an incision on the back of your ears, most likely your original otoplasty incision based on where it is located.
2) Usually cadaveric coastal cartilage is used as an interpositonal graft to hold the ear out once it is released. Most patients do not want to have their one rib cartilage harvested although that can be done.
3) The amount that the ear can be brought back out is highly dependent ion how much graft is put behind it to hold it out. What you are demonstrating is the typical location of the release (middle third of they ear) and with the objective of having it visible beyond that of the antihelical fold in front of int.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having a sliding enioplasty with you next week and I wanted to hear your thoughts on if a chin wing osteotomy would make more sense for my case.
I am not looking to have my jaw gain vertical or width, but would a Chin Wing osteotomy make my results look more natural? It also sounds like there’s more risk or side effects from having the Chin wing so it might not be worth it compared to doing a genioplasty.
Thanks
A: A sliding genioplasty and a chin wing osteotomy are done with some different aesthetic objectives. One chooses the chin wing osteotomy for the purposes of adding vertical height to the chin and front half of the jawline…an objective but your own admission that you are not seeking.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is there any problem if you remove from me the Medpor Midface Rim and replace them with malar and submalar cheek implants, considering the fact that my face is very skinny? I mean will the cheek implants show itself too much under the skin or does the submalar mask the implant show of malar implant?
A: You are referring to whether the implant outlines/edges of midface cheek implants will show through a lean face. That would depend on the type of implant chosen for replacement. This risk is virtually zero in custom implants because of the feather edging of their design and the fit to the bone. The standard malar-submalar implants, known as Midfacial or Combined Submalar Shell implants, generally blend well into the surrounding tissues and have low risk of implant show provided their size is not excessive. The overlying soft tissues, even in lean patients, always add a significant blanketing effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I contacted you a few months ago regarding a custom wraparound jaw implant. You produced a very impressive morph of a predicted final outcome.
I do have an additional question: How much horizontal chin movement is possible with such a custom implant? If my chin is 10-12mm recessed, can I achieve the results in the morph with a custom implant alone? Or, will the custom implant need to be combined with a genioplasty?
In case like mine, is a superior aesthetic usually achieved via a custom implant or a genioplasty combined with custom jaw implants?
A: If one has had no prior chin implant in place (which helps stretch the soft tissue chin pad) then a custom implant that adds 10 to 12mms of horizontal projection is right at the edge of what the soft tissue chin pad can stretch to accommodate it. I like to avoid severely stretching the soft tissue chin pad with a large implant load when possible as this is done with a combined sliding genioplasty to lessen the implant volume right over the chin bone prominence. But in looking at your pictures I suspect you would be alright with the custom jawline implant alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is fat grafting to the deltoid muscles for shoulder augmentation safer than a BBL surgery? (Many deaths have occurred from bbl’s). I’d love to get my shoulders bigger.
A:The risk in BBL surgery in injecting fat deep into the gluteus musculature where large veins exist into which fat can inadvertently enter and become an emboli to the lungs. Such a large vein system does not exist in the deltoid muscles and, as a result, fat emboli are not a risk of occurring. Thus shoulder augmentation by fat injections is a perfectly safe procedure that does not have the risk profile that exists when injecting fat into the buttock region..
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am emailing because I have always noticed an asymmetry in my eye positioning, specifically my right eye being lower than my left. But recently i have noticed it is becoming worse, i noticed you have dealt with similar cases, if you could see the photos attached and advise me on possible solutions for my eye asymmetry and the severity of my case, it would be much appreciated.
Kind regards,
A:You have eye asymmetry which is bone-based and is known as Vertical Orbital Dystopia. By an approximate measurement of the horizontal pupillary line of 7mms discrepancy would rate as severe. Definitive treatment planning would first require a 3D CT scan from which the type of corrective surgery can be determined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard that midfacial implants can be used to add more anterior projection to the maxilla. Do these midfaceimplants advance the upper lip? If so, how is this balanced in the lower lip? Can it be advanced as well?
A: While custom midface implants can add projection from the infraorbital rims down to the maxillary root tips, they will not change the position of the upper lip. The upper lip position’s is controlled by the position of the upper front teeth sitting behind it…which is technically controlled by the projection of the maxillary alveolar bone in which the front teeth from canine to canine reside.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m very interested in clavicle lengthening. I have extremely narrow shoulders to the point where they rest in a rolled position (because of the imbalance) I’m curious if 3cm on each clavicle is possible? 2cm honestly wouldn’t be worth the surgery and money in my case. Just hoping for the best possible result.
A: In clavicular lengthening the need for an interpositional bone graft is needed. Most commonly this is done using allogeneic or cadaveric clavicle or fibular bone ‘dowels’ because they are circular in cross-section and provide the best surface area fit/contact with the cut clavicle bone on each side. Healing is done by bone growth into the interpositional graft using it as a substrate. This is a slow process that can take several months to occur. Obviously the longer the interpositional graft is (amount of clavicular lengthening) the longer this process takes to occur. If one can accept the longer healing period 3cms of lengthening can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m wondering do you think in my case clavicle lengthening should be considered since I’ve had this issue with the loss of my deltoid implants? I think I have come to realize that if I do get deltoid implants again they would need to be smaller than what I used to have. Or have nothing at all if the clavicle could give me a decent change. I’m unsure how much width I could get with the clavicle lengthening. What I do find is that my natural shoulders are naturally square which is the look I’m after. It just lacks muscle however my clavicle at the same time is very narrow in the interior. So I’m unsure if one should be addressed first over the other. I’ve had a clean track record with prior body implants but not with the shoulders. If you find this procedure is too invasive or has long term problems I’ll take your word for it as I know it is not commonly requested.
A: While you have had problems with your deltoid implants, I am not certain I would resort to clavicular lengthening. Unlike clavicular reduction where a bone segment is removed and primary bone healing occurs, clavicular lengthening requires the insertion of a bone graft which takes much longer to heal and has a higher risk of plate/bone fracture during the recovery process. When you factor in that is done to both clavicles the recovery process becomes much more challenging and not a surgery to entertain lightly. I think better deltoid implant selection (smaller and better shaped) would be a more appropriate solution to your shoulder width concerns
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It has been 6 weeks since my custom jaw angle implant and paranasal augmentation with you. Recovery has been smooth and have not experienced any problems. The pre-existing jaw muscle dehiscense from my prior jaw angle implants like we discussed is about the same prior to the wrap around jawline implant placement and has not gotten worse.
Since I have more mandible length and height now my facial hair looks patchy. I am considering in the near future of getting a hair transplant done where the back of my head would be the donor site to fill in bald spots of hair in the inferior and posterior portion of the mandible angle.
I looked up how hair transplants work and really thought about how they would make pin hole incisions on the recipient site to accommodate the donor hair. My only concern is that since that skin area where I have the dehiscence is thin (not having the masseter muscle there), I feel like during the poking process that the needle they would use would come in contact with the implant and would start some process of infection? How likely would that happen? Would the scar tissue encapsulating the implant make it unlikely? Is this something you have dealt with in the past? Thank you in advance.
A: While I have not seen or been reported to about beard hair thinning after jaw angle implant augmentation, I do not personally have experience with hair transplantation in this area. But even without muscle coverage over the jaw angle implant, there is subcutaneous fat and a scar capsule that covers the implant, so I would not have concerns about the small slit that is made in the skin for the FUE insertion…which is actually made with a small blade as opposed to a needle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m considering improving my frontal angle of face. I am happy with my jawline but my cheeks lack definition. To add to this I have very unattractive eyes, which are close together and seem sunken in certain lighting especially the inner area – giving me a lion look. I think a cheek implant should be able to improve my eye area, giving me a more attractive look, but to remove the sunken inner eye area would I need a custom that goes all the way around ? If I crop a models lower face and insert it under mine I look a lot more attractive so I think a cheek implant with buccal fat removal will be able to achieve this. Finally I am extremely unhappy with my laugh from my 45 to 90 degree angle (smile is perfect). My cheeks seem very heavy and protrude out whilst my chin seem to move back (I think) will a buccal fat fix this. Thank you.
A: In answer to your facial contouring questions:
1) To get coverage over any or all of the infraorbital rim area a custom infraonital rim implant design is needed.
2) A buccal lipectomy procedure reduces cheek fullness under the cheekbone in a static or non-smiling facial position. It is not intended or can it reduce the cheek fullness that occurs when the face smiles.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few questions about mouth widening surgery:
1) How wide can you make a mouth, would it be possible to increase with around 6mm on each side?
2) How natural would it look after the surgery, would it be lop sided or titled by any chance or would it look like a regular mouth.
Thank you
A: In answer to your mouth widening questions:
1) The average mouth widening distance increase done surgically is usually 5 to 7mms per side.
2) The postoperative concerns are not whether it will look natural or have asymmetry but how well do the scars do and whether a scar touchup may eventually be needed. In my experience about 50% of patients who have the surgery need scar revision touchup on at least one side.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if hyaluronic acid injectable fillers show up on 3D CT scans? If not, can we work around them? Because I have fillers in place and would really prefer if I don’t dissolve them for the consultation, because of the long wait time between the first consultation and surgery.
A: The only injectable filler seen on 3D CT scan is hydroxyapatite granules (Radiesse) which appears because of the radiographic density due to their calcium phosphate composition. Hyaluronic acid fillers, which are simply sugar molecules, are not dense enough to be seen radiographically.
Even in cases of Radiesse filler being present, the material is digitally removed to do implant designs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Just wanted to check in and Thank You for the Lateral Orbit Rim – Brow Implants, I really enjoy having a broader profile both above and around my eyes!
I also realized I liked having some of the extra swelling on the sides of my eyes that pushed the lateral rim out even further. I wasn’t sure if it was possible to try Fillers on top of the lateral rim implant to try making my appearance even wider around the eyes? (pics below better show my idea)
Is there any concern about infecting the implants when using Injectable Fillers near them? If I did like the temporary Injectable Filler, could Allofill then be used for a semi-permanent effect?
Thank you for any advice!
A: You can have fillers placed above the lateral orbital rim – brow implants in the subcutaneous tissues. Just be sure the injector knows that there are implants underneath and the injector should not try and place the filler down at the ‘bone level’….which is what they would normally do when trying to augment a skeletal structure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I suffered from a orbital floor / medial wall fracture 6 months ago and had the fracture repaired with a silicon implant. However, the repair has resulted in vertical dystopia. My injured eye (left) is now noticeably higher, 1-2mm by guessing, than my right eye. I wanted to ask if this is something that you confidently feel could be corrected. Or, if this is something I should just live with. Thank you.
A: Whether your iatrogenic vertical dystopia could be improved by further surgery is not a judgment that can be made by guessing. A 3D CT scan of the orbit should be done to determine the location and thickness of the orbital floor implant and how the level of the floor compares to the opposite uninjured side. If the thickness of the orbital floor implant is the cause then you would know reliably that thinning it out should lower the over elevated eye.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I have breast implants that have likely outlived their shelf life. I got them implanted in 2001 and since has had a child, plus gained weight. I am having back issues and cannot exercise like I used to due to the breast weight. I really need to do something to get my life back and I believe this is likely one of the first steps. I would like to get a consultation either virtually or in person to see what i’m looking at regarding options and costs. Thank you.
A: Certainly removal of the breast implants with a lift is the equivalent of a ‘breast reduction’ effect…which uniformly resolves the musculoskeletal symptoms of larger breasts that have a sag. Removing the implant is the equivalent of removing breast tissue in a traditional breast reduction procedure. And also like a breast reduction a lift will likely need to be incorporated to manage the loose skin that will become greater as the implant volume is removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in a custom skull implant. In particular, i’d like occipital augmentation to mitigate the mild flat head appearance that I have. I would like to ask, do you use PEEK as material for this procedure or is it only done with silicone. Also, I am considering getting an FUE hair transplant sometime in the foreseeable future. Would having a skull implant reduce the viability of FUE? Finally, I would like to know rough cost range for custom occiput implants. Thank you in advance.
A: 1) I have no particular preference for the material used in skull implants, But the material chosen will have a major influence on the cost of surgery and how small or large the scalp incision needs to be to get it placed.
2) While having a skull implant does not preclude having an FUE harvest later, given the value and limited supply of donor hair, it can be argued that hair transplantation should be done before skull augmentation. But this was more of an issue when the traditional donor harvest of a strip grafts was done. Today with FUE harvest there is less compelling need for the order of a skull implant and hair transplantation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 27 years old male. One year ago I got 5 mm Medpor jaw angle implants but unfortunately, I think they are not big enough for my face. I talked with my surgeon and he said he could inject fat to provide more projection as a permanent filler. I tried HA filler 3 months ago, while it got absorbed fast in two months, I found the projection it provided to be satisfactory. I got 1.5 ml on each side.
My question is, would fat provide a projection similar to the ones that fillers did? From what I’ve seen, fat seems unable to make contours, but if the volume required is small, wouldn’t they still be a good alternative? If not, replacing the implants seems to be my only option as I seem to absorb fillers fast.
Thanks for taking the time and read my mail. I’m looking forward to your reply. I’m attaching a picture; no 1 is the current me and no 2 is what I’d like to have ( I used software to create).
Best regards.
A: While fat injections would be a logical graduation from injectable fillers, it has two aesthetic issues. First fat injection survival in a young man will likely go just like the fillers…it will be absorbed fast with little to no successful survival. Secondly, even if it survived, it will not create your imaged results. Fat is soft and will not create sharper angles..it will just be rounder with no sharpness. Implants can only create that result because they have an assured firm push on the overlying soft tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young male patient with a brief question regarding facial implant work. I noticed that on your website, you have articles that refer to customized male model-style cheek implants. If a patient wanted to undergo surgery to have these cheek implants placed, would they need to undergo a 3D CT scan of their skull to have the implants designed? Or are they manufactured in an “off-the-shelf” sense?
A:Ideally true custom cheek implants are manufactured from the patient’s 3D CT scan. There is an option for special design implants (using other patient’s custom facial implant designs) with the understanding that they are like all traditional standard performed implants…they are made for someone else (a patient or a skull model) and their fit may not be exact or the aesthetic outcome may not be ideal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would to inquire about a possible sagittal crest reduction. The top most (crown) part of my skull is slightly raised in comparison to the rest of my skull, and there is a slight dip toward the front of my head which accentuates the crests prominence, giving it a more ‘bump’ or ‘bruise-like’ appearance.
My questions are:
1) What are the expected costs associated with this type of procedure?
2) How long am I expected to be in the country should I choose to proceed with this procedure?
3) How is this procedure actually done?
I understand this is a lot of questions, although would appreciate a decent answer to each as it is something I am heavily considering following-through with. The severity between the pictures and real life are fairly contrasting, and it may just be that I notice the severity a great deal more than others, although it makes me uncomfortable having it there.
A :In answer to his sagittal crest reduction questions:
1) My assistant Camille will pass along the cost of the surgery to you.
2) You should be able to return in 48 hours after the surgery.
3) Through a small scalp incision at the back end of the sagittal crest the raised bone height is reduced by high speed burring.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you so much for your response. The imaging is definitely an improvement over what I have now. In the model’s picture, the tip of her nose not only projects outward but also somewhat projects a little bit downward so that her nostrils aren’t exposed. Can we achieve this in my case? I also still think that my nostrils look flared (my nostrils look thick) so I am hoping we can do an alar base reduction as well as a weier resection so that my alar lobules (I think this is what they are called) can be significantly thinned to achieve a further slimming effect. Is there any way we can further slim tip and make it more pointed through removing layers of fibrofatty tissue and then using permanent sutures to retain that refinement? I also think that I’ll require osteotomies for each of the third sections of my nose to bring the bones inward because my bones are so wide I’ll provide a picture. I also think that my columella is both retracted and wide so that the angle between my lip and the tip of my nose is very wide. I believe this causes my nostrils to be overexposed. Is there any way to bring the collumella forward as well as lengthening my nose so that my nostrils are much less exposed? I would also like to reduce the width of my entire nasal base. Do you think my alar base should be lowered or highered since the base of my nostrils are lower than my collumella? My ultimate goal is to not only decrease the size of my nose but to dramatically alter its shape. I am looking for dramatic results and an overall more graceful, feminine, and balanced look.
I apologize for all the questions but this surgery means a great deal to me because my nose is the number one feature that detracts from my face. It’s amorphous and I’ve always dreamed of having a nose like that model’s. Here are pictures of the wide nasal bones in the middle of my nose along the nostrils as well as a picture of the scar on my columella which I hope to be fixed.
A: In answer to your rhinoplasty questions:
1) One of the hardest goals to achieve in rhinoplasty is deprojecting the nose. (making it turn more downward) There are gartfmtung techniques to try and do so but it is still hard to achieve much in that regard.
2) Nostril narrowing/thinning can be done but the results are often more narrowing than thinning.
3) In all revisional secondary surgery I always defat the nasal tip and use an only air closure of surgical with kenalog to try and decrease tip thickening due to scar.
4) The nasal bones are only at the upper third of the nose so osteotomies only affect that region.
5) Your columella is retracted and it will take cartilage grafts to bring it out. That may or may not make it more narrow.
6) There his no good method to reliably raise or lower the alar absence. (attachment of the nostril to the face)
7) As I stated previously, while I can appreciate what your ideal nose reshaping goals are, you have to be realistic with what is possible. Every rhinoplasty maneuver can be done but you are not going to have a ‘model’s thin nose, your natural skin thickness is just not going to allow that to happen. A nose is not like clay where you can just make anything out of it. No matter what is done to the bone and cartilage underneath the eventual result is what the skin that overlies these structures will allow to show through.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested I’m a rhinoplasty.. Please find attached my photographs. What I am interested in is a dorsal hump removal. I am 28 years old, and have no medical conditions. I do not take any medications.
My questions are as follows:
- What is the estimated cost of the procedure?
- Would this be done under local or general anesthesia (I prefer local)
- Would i wear a cast after the procedure?
- How long would the cast stay on for?
A: In answer to your rhinoplasty questions:
1) While dorsal hump removal can be done as the only component of a rhinoplasty, it will make the nose look longer in profile (see attached first image) and can make the tip heavier in appearance. For aesthetic reasons it rarely is ever done by itself as you change one element of the nose it always affects how the rest of the nose looks. A more complete rhinoplasty approach has a better overall aesthetic change. (second set of images)
2) Local anesthesia for most rhinoplasties is not how I usually do the surgery. This turns out to be a painful experience for all involved and usually adversely affects the aesthetic outcome by limiting what the surgeon can do when trying to perform a more complete rhinoplasty surgery.
3) All rhinoplasties due to postoperative swelling and in effort to get the skin to stick back down to the bone/cartilage before scar tissues sets in (and makes the nose thicker) is always used. This can be removed by the patient in 5 to 7 days after surgery.
4) Like all my geographically distant patients, a virtual consultation is the next step in the process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I hope this finds you well! I learned that my 3D CT scan copy is received and we will be able to move on to implant design process very soon, which is exciting.
At the same time, I was meaning to find out the following, if you may share your input, that would be great.
1. The following link from your blog shows that this case achieved a 15mm-20mm of augmentation, without a 1st stage augmentation involved. Is this amount of augmentation achievable in my surgery?
Case Study: Flat Back of the Head Correction by Augmentation Cranioplasty – Explore Plastic Surgery – Explore Plastic Surgery – Dr. Barry Eppley – Plastic Surgeon Background: The shape of the skull is affected by numerous factors including genetics, in utero skull pressures, post delivery head positioning and growth of the brain. In general, the skull has an oblong shape that is slightly wider in the back than the front. While there is no uniform aesthetic standard for a pleasing skull Read More… exploreplasticsurgery.com |
2. During the design process, how can we figure out what is the maximal augmentation level that is right below unduly tense (too tight) level while it is at a largest viable stretched amount?
3. For augmentation of the areas on which the head is in contact with a pillow while sleeping, e.g. the back of the head, the sides of the head, what are the chances for the implant be moved or loosened, caused by the weight from my head and neck pressuring on the implant approximately 8 hours a night over many years?
If this is a real concern, can we address to this risk during the design stage?
If implant loosening does occur at some point in the future, due to the weight from the head and neck during sleep, how will we handle it?
4. I highly regard your input in the design process of the implant. I replied Dawn’s email on what surgery outcome I would pursue. Please don’t hesitate to share your advice.
5. After surgery, I may choose to have a shaved head style some point in the future. When there is no any hair bearing for camouflage, will the skull shape still look natural and smooth, especially at the edge area where the implant ends and connects to my original skull area?
What makes a smooth and natural transition at the edge of implant possible?
6. Will the implant cause infection many years after the surgery is done?
7. Is an augmentation implant supposed to last all a life-time long?
If not, in what circumstances does the implant require what form of maintenance in the future?
8. After surgery, will it be ok to receive head massage? E.g. finger pressuring on scalp, which is provided by a regular message therapy store.
9. Will I need an additional revisional surgery? If one is needed, how long after the surgery will this happen?
Thanks for your attention Dr. Eppley : )
A: In answer to his custom skull implant questions:
1) No. That was done with a full open coronal incision which allows for some added expansion due to the mobilization of tissues.
2) There is no exact science as to how to know when the implant is too big or the tissues would be too tight to allow it to be placed and the incision safely closed. My design estimates are based on my experience of placing such implants.
3) Zero. While an understandable question it is never been a postoperative concern., I have never seen a custom skull implant move after surgery.
4) I still need to know what skull areas we are going to cover…back only, front only or both?
5) Due to the feather edging in the design there is a smooth transition from implant to bone.
6) No. Infection risks are in the perioperative period. (up two three months after surgery) Once last this time period the infection risk is negligible.
7) Custom skull implants are made of a solid silicone material which will never degrade or breakdown…thus no need for future replacement due to material failure.
8) Head massages are not needed or advised after surgery.
9) Revisional skull implant surgery would only be needed if you determine you want a bigger implant or a different design later. This is not done until six months after the initial surgery.
Dr. Barry Eppley
Indianapolis, Indiana