Your Questions
Your Questions
Q: Dr. Eppley, I had a sliding genioplasty four weeks ago (8mm forward and 2mms vertical) and initially it looked just perfect. But as the swelling has gone down I now know I really want more augmentation. I told the surgeon I would rather have too little than too much augmentation so I probably made the surgeon be too conservative. What are my options now?
A: The not uncommon patient preoperative phrase, ”I would rather have too little than too much’, is an abstract one that may change when looking at actual physical changes. This is not rare. An 8mm forward movement of the chin would not be considered conservative but it all depends on whom it is on, what their initial chin looked like and their interpretation of what looks good to them. But like all facial bone reshaping surgery one never knows how the patient will feel about a ‘new look’ until they actually have it done.
The approach to take depends on how much more horizontal augmentation is needed. (it is all about the millimeters)
Given his original amount of advancement and maintaining bone contact, there is probably only a few more millimeters to go by moving the bone further forward. (changing the plate to a 10 to 12mm plate) In other words maybe another 2 to 4mms with the chin for sure becoming a bit more narrow in the front viewing the notching in the side a bit more palpable..
The other approach is to add an implant on top of the advanced chin bone from a submental approach. This is a more versatile dimensional approach as the amount of horizontal augmentation is greater with added width to the chin as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 20 years old and I noticed witches chin developed a few years ago. I have attached a photo. What type of procedure would you perform?
A: Thank you for your inquiry and sending your profile picture. While most true ‘witch’s chins’ occur from prior surgery or from aging, ir can occur less commonly naturally or congenitally. By definition a witch’s chin deformity is when there is s mismatch between the soft tissue chin pad and the underlying bone support. This is most manifest by some degree of apparent sagging of the soft tissue pad and an underling prominent submental skin crease.
What differentiates an iatrogenic/aging witch’s chin from a congenital one is the tightness of the soft tissue chin pad and the degree of bone development of the underlying chin bone. If one has a deficient bone then any form of chin augmentation will solve it as the soft tissue chin pad is stretched out. If the chin projection is adequate, which yours is, then a soft tissue submental tuck is needed in a ‘vest over pants’ technique.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, the things I wanna improve is my center part of the face which is like dented from the side, but I look okay from the front. I think it also because of my chin shape but I think the risk of having orthognathic surgery is too high. Therefore, I want to consult to see what is the best way for improving it.
A: Thank you sending your picture and detailing your facial concerns. Like many Asian patients there is a general mid facial profile concavity appearance which is manifest both in the nose and midface as well. Since you have specifically mentioned rhinoplasty I will focus my comments just in this facial area.
An augmentative approach to rhinoplasty is the standard procedure in the Asian face. Such augmentation efforts, unlike many Caucasian rhinoplasties, requires significant augmentation efforts which always comes down to using rib grafts vs implants. (and when I refer to implants I mean thee contemporary use of ePTFE implants not the older use of pure silicone implants) This is a classic discussion in the Asian rhinoplasty patient for which there is no perfect answer as either can be used successfully and I have done many with both augmentative approaches. It really comes down to the patient understanding their different risks and choosing which risk profile is more appealing. Such an implant vs autologous graft discussion is well chronicled and comes down to:
RIB GRAFT
- advantages = low to negligible risk of infection, natural material that will never cause any problems long-term once well healed, adequate graft material for all aspects of the rhinoplasty including tip without teh need for sept or ear graft harvests
- disadvantages = donor scar, longer recovery, graft warping/asymmetry
ePTFE IMPLANT
- advantages = no donor scar, more assured straight result as the implant is straight
- disadvantages = higher risk of infection, will still need ear or septal graft for tip augmentation as an implant is never placed across the nasal tip area
As can be seen neither a rib graft or implant approach to significant rhinoplasty augmentation in the Asian nose is perfect, each has their own advantages and disadvantages.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want temporal implants as I have very narrow sides of my head. I think the implants need to be customized as I also have very small brow bones. I want to widen my brows as well. I have attached a front view picture of my head so you can see what needs to be done.
A: Thank you for sending your picture. Based on this information you are in need of a total temporal augmentation (the entire side of the head) procedure which means both anterior (by the side of the eye) and posterior temporal zones. (hair bearing area all the way back to almost the back of the head) This can be done by two different implant methods, a one piece total temporal implant placed at the deep subcutaneous plane (see attached implant example) or a two piece implant approach with a standard extended anterior implant placed in the subfascial plane with a custom posterior temporal implant placed in the deep submuscular plane. There are arguments for either complete temporal augmentation approaches and that permits further discussion.
But since you have also mentioned the need for lateral brow augmentation as well the best approach would be a one piece custom total temporal implant placed in the deep subcutaneous location so the lateral brow area can be included as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had fat grafting to my cheeks and for the first six weeks I was really impressed how good it was looking and it added to my feminine look. But after 6 weeks most of the fat has gone away so I was thinking how can I make that permanent and i was thinking to do cheek implants. I have drawn the area and also send you another pic how i looked directly after the fat graft. So I don’t really want to widen my cheeks. I want more a layer that not makes my face so flat. Will that be possible? If yes I would also like to see those cheek implants before the operation.
A: Thank you for sending your pictures and illustrating your fat grafted areas. The areas you have outlined are not really ‘cheek implant’ areas but are infraorbital-maxillary midface areas. Even the most lateral part of your drawing is barely on the anterior cheek area. This is consistent with the general area of augmentation when patients want to pull their midface forward but not widen it and this is most commonly down with either hand carved ePTFE block implants or custom midface implants. (standard cheek implants do not have a good shape to use in tis area)
While you are correct in that implants offer a permanent solution to the unpredictable volume survival of fat injections, they also differ in the facial areas that ca be augmented. While fat grafts can be placed anywhere on the face, implants must largely occupy bone-based areas. Thus an implant augmentation can only cover the half or two-thirds of the outlines areas you have made. Anything below the horizontal lines I have drawn on your marked areas will not be able to be augmented by implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would lip implants need to be removed before undergoing mouth widening surgery? Will they cause limitations in how much the mouth corners can be widened? That seem to have made my mouth corners tighter.
A: No they would not as the soft tissue movements would be done lateral to them. It may be possible that the tail of the implants may need to be trimmed if they extend completely to the mouth corners but this is not problematic for the procedure. However doing mouth widening surgery on a patient who have indwelling lip implants is not a clinical situation I have yet seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had custom medpor infraorbital / cheekbones implants put in, but did not like the results as they emphasised the asymmetry of my cheekbones. I had them removed very shortly afterwards. Now three months later it seems that the procedure has caused some drooping of my cheeks creating nasolabial lines and an unnatural eye appearance. Would a midface lift be a solution to this issue? If so how soon can I get this done considering it’s only been three months from the time of surgery and I still likely have a bit of swelling / numbness.
A: Between the volume expansion created by the implants and the ligamentous detachments of the soft tissue to the bone needed to place them, it would be expected that some cheek sagging would result with their complete removal. The ideal time to have done any type of midface lift would have been concurrently with implant removal knowing this would have been the expected sequelae. But it can still be done secondarily and at nearly three months after surgery it can really be done at anytime as the inflammatory response of the tissues has subsided and the residual numbness, in and of itself, is not a gauge of time for surgical re-intervention. The question now is not whether a midface lift would be appropriate but how effective it would be at correcting the soft tissue sag without incurring any new problems.(e.g., ectropion)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is only skin trimmed during a standard facelift or both skin and muscle? If so, what do you do if you have excess muscle? Thank you!
A: It is common that patients confuse what occurs under the skin in a facelift. Muscles are manipulated in a facelift but only in the central neck through the submental incision. The platysma muscle may be tightened and is some cases even resected (trimmed) and released out laterally. But on the side of the face no muscle exists that can be manipulated. They deeper masster muscle is what occupies the side of the face and can never moved or manipulated as has no role in facial aging. Rather it is the tissue layer above the muscle, the SMAS layer, is what is lifted and repositioned that along with skin removal creates the rejuvenated lower facial appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, On a moment at the beach I was photographed like this. In this moment I was smiling and the photo was spontaneous. I would like to know why I look so good when I smile and I don’t look good when I don’t smile or laugh ?
Is it possible to make my face as beautiful as in this photo while smiling, but to look as good as in the photo even without smiling ? What implant or implants can bring such a beauty to life?
A: Like in all people that smile, two specific facial changes occur…the cheek area gets fuller (which looks better in a thin face) and the upward movement of the corners of the mouth occurs. (smiling…which is always a more pleasing appearance than a horizontally oriented or downturned mouth corners)
When patients like the appearance of their cheeks when they smile (fuller) one has to be careful what happens when that surgical change is done to what they then look like when their face is in the static or non smiling position. There will be tradeoffs between the desired dynamic vs static resting effect. In other words while cheek implants will make your cheeks fuller at rest, that may make them too full when smiling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been reading your articles about various surgeries on your website for many years, and has been a huge fan. And I recently saw your article on a surgery to correct webbed neck, through the photo of the patient, her neck was greatly elongated after surgery.
I have a pretty short and stubby neck, and it’s been a great concern for many many years, I do not have a webbed neck, however I do have quite large trapezius muscles that makes my neck even shorter.
I have tried Botox, with no luck on correcting the problem. And is wondering if a similar surgery like the attached correction of the Webbed Neck With Posterior Excision and Fascial Plication would help with my situation.
Looking forward to your reply.
A: Thank you for your thoughtful and interesting inquiry. By your description of a normal but short/thiick neck I have never done a webbed neck/neck reshaping procedure on such anatomy. The typical true webbed neck (Turner’s syndrome) has loose skin and more normal trapezius muscular thickness which helps explain the often good results in them. The only corollary to your situation that may apply is in a handful of mosaic Turner’s’ patient who has less webbing but wider necks. In these patients neck reshaping/thinning has often proven to have disappointing results. Perhaps more aggressive trapezius muscle reduction would have better results but I would not say that it could create a dramatically thinner and elongated neck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 45 year old male and the back of my skull has a 45 degree angle shape. I’m interested in correctly this abnormality but cost, success rate and recovery time are my concerns. Would my medical insurance cover this?
A: Thank you for your inquiry which I can provide the following back of head augmentation answers:
1) Such a correction of a sloped back of the head is typically done with a custom skull implant. Although to be certain I would need to see a side profile view of your head.
2) My assistant Camille will pass along the cost of such surgery to you. We do not participate in medical insurance.
3) The success rate of custom skull implant is very high with vert low rates of any complications. It is just a question of how much augmentation is needed and how much the scalp will stretch ti accommodate that need.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I read on one of your forums that 3.5 cms on each clavicle is possible through lengthening… I would be very interested in that! I’m narrow to the point where I have poor range of motion and my shoulders rest rolled over, which keeps me slumped (back training never fully helped) I’d be willing to put in the extra effort with after care/ therapy if this is possible!
I read an article entitled ‘Congenital Forward Shoulder With Clavicle Hypoplasia: Surgical Lengthening By Intercalary Graft Positioning And Plate Fixation.’ I haven’t been diagnosed but this article seems relates to my issue.
A: Lengthening the clavicle for shoulder widening can be done. It is the converse of shoulder width reduction by clavicular bone resection. The differences are that a bone graft needs to be placed as well as longer plate fixation. The critical question is how long the bone graft can be to still support eventual full bony healing. I don’t think enough cases have ever been done to answer that question accurately. Thus I prefer at this time to limit the bone graft length to 2.5cms which results in an inch of shoulder width increase per side. Because of the unique shape of the clavicle lengthening it causes the shoulder to roll outward a bit.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to remove the bulging bone on the back of my head. (occipital knob)I have a few questions about the occipital knob reduction procedure.
- How long does the procedure take?
- What is the recovery time?
- Is the anesthesia local, general or sedation?
- What is the scar size? I am bald.
Thanks in advance
A: Thank you for your inquiry and sending your pictures. In answer to your occipital knob reduction questions:
1) The procedure takes 90 minutes under general anesthesia.
2) Recovery time is really minimal as there are no restrictions after surgery.
3) The attached image shows the location of the incision in the upper horizontal neck crease.
4) My assistant Camille will pass along the cost of the surgery to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, To what degree can infraorbital implants affect the shape of the lower eyelid? My lower lid is just a touch of roundness to it with the inferior sclera visible to a small degree.
Can a custom infraorbital implants create a narrower eye with a more angular lower eyelid?
A: There is no question that custom infraorbital-malar implants can help drive up the lower eyelid level. Whether that is enough on its own to create a ‘more angular lower eyelid’ depends on the current shape of your eyelids. Most likely it would require some eye inner adjustment as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a low set brow ridge that conceals most of my upper eyelid. Even so, it leaves a small semicircular sliver of the upper eyelid exposed. Is it possible to use fillers to conceal this portion of upper eyelid and create a more straight and angular looking upper eye in the process?
A: The best way to know if upper eyelid filler can be effective at reducing the upper eyelid show is to have it done. With an HA filler if it is not as successful as one would like it can always be reversed or let resorb over time on its own. I believe it will help conceal the upper eyelid bit whether it creates a straight or angular looking upper eye is not as clear.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in learning about forehead reduction via forehead bossing and a procedure that can flatten spots on the top of my head from Dr. Eppley:
Could these two procedures and temporal reduction be safely done together?
What would be the individual and total cost of these three procedures?
Are there any video recordings of these procedures? If so, is there anyway that I can view and show these videos to family members?
Could Dr. Eppley please explain or link a recent article about the full operation of these two procedures?
Are there any risks associated with any of these procedures? If so, what is the probability of these risks?
What is the typical duration of recovery from these procedures?
Have prior patients experienced any problems occurring weeks, months and years after surgery?
A: In answer to your skull reshaping questions:
1) Forehead bossing and skull reduction can be done together with temporal reduction surgery.
2) My assistant Camille will pass along that information to you.
3) I am not aware that I have ever shot any videos of these surgeries.
4) Any information on any of these procedures can be found by going to the following: www.exploreplasticsurgery.com and placed in the search box on the hope page the specific procedure name. It will pull up any articles and case reports I have written on the searched topics.
5) Any skull reshaping procedure has the set of risks which vary based on the type of skull reshaping procedure being performed….incision/scar, contour irregularities/asymmetry and over/unercorrection.
6) Recovery from any skull reshaping procedure is largely that of swelling of which the worst of it has usually past by 10 to 14 days after surgery.
7) Other than some minor aesthetic issues I am to aware of any medical sequelae from these procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hey so I’ve contacted before about clavicle lengthening.. something I’m very interested in!! Now, I’m hoping to make the best out of one procedure… is it possible to lengthen each clavicle by 35-40mm? My shoulders are so narrow that they rest rolled over.. and from a cosmetic point of view, I’m hoping to look significantly broader!! Also, was wondering if it’s possible to inject renuva or radiesse into the hands to add volume and thickness to both the back and side of the palms, along with adding thickness to fingers!!
A: In answer to your clavicle lengthening questions:
1) Since clavicle lengthening is done by an interpositional bone graft, and not distraction osteogenesis, a distance of 30 or 40mms is too excessive. The distance of 20 to 25mms per side is more realistic is terms of an improved chance for more rapid and complete healing.
To get to 40mms it would take a combination of clavicle lengthening and deltoid implants.
2) Radiesse or fat are common injection materials for added volume to the back of the hands. Fingers are not injected because of the risk of vascular occlusion due to their tight tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am extremely happy with the outcome of all the surgical procedure Dr. Eppley performed. I had no infections, no complications, and I am more than pleased with the results. I am running 5 miles per day with no pain or complications. I am happy with the professionalism and attention to detail provided by Dr. Eppley’s nurses and staff.
Everything went so well I now wish I had gotten even bigger implants:
-Now the skin has stretched out, would it be possible to upsize the implants?
-if so, how long would I have to wait until the next surgery?
-if so how big could I go?
A: Given the natural stretch of the tissues that occur with time, you could graduate from your 6.5cm testicle implants to 7.5cm testicle implants. As long as you are six months out from the last surgery, your scrotum should be able to handle the additional 20% volume increase.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am writing to you seeking some advice about my teenage son. When he was a baby (approximately 6 months) we noticed the back of his head was flat. We took him to our family Dr and he said make sure you get him to sleep on his side and rotate him regularly. He also gave us a wedge to try to enforce the side sleeping. To make a very long story short, the little one refused to sleep on anything but his back and nothing we did, helped.
Today he regularly comments on his head shape and how much he hates it. He refuses to cut his hair short because it shows his head shape. I would greatly appreciate some information on the corrective procedure (prep, duration of surgery, recovery time, potential impact on his cycling and costs).
Thank you for your time and consideration.
A: Thank you for your detailed and heartfelt inquiry and detailing your son’s head shape concerns. By your description it appears he has a form of brachycephaly or a flat back of the head. The question is not whether the back of his head can be build out with the placement of a custom skull implant but how much augmentation does he needs to get him to a more self-confident state. I would need to see a side view picture of his head with the recognition that hair is a good camouflage of the extent of the problem. With hair the best way to get a good view of the extent of the flatness is to take a side view picture with his hair wet and combed down.
Once I see a picture of head profile I will do some imaging to convey what I think the placement of a custom skull implant can do. (without tissue expansion first) While a first stage scalp expansion always permits the greatest amount of augmentation there are obvious practical travel considerations that we need to consider.
The custom skull implant is made from a 3D CT scan of his skull. The surgery to place it is a 90 minute procedure under general anesthesia. Given his young age such patients usually stay overnite int the facility in most cases Recovery is mainly about swelling which may or may not make its ways into his face. Such swelling is usually resolved by about 10 days after surgery. Once recovered there are no physical restrictions as such a casual implant is really an inadvertent form of skull protection which can make it much harder to fracture (if not impossible) over the area that it covers.
Dr. Barry Eppley
Indianapols, Indiana
Q: Dr. Eppley, In one of your blog posts you state: “many models display a very strong or exaggerated brow bone appearance. It borders on being an almost angry appearance but is better anatomically described as an ultra low brow bone projection with near complete coverage of the upper eyelids. While I frequently get requests for such a brow bone augmentative change, I have to advise such requests that is almost always not possible. This is due to the fact the soft tissues of the eyebrows is very tight and can not be driven down below the existing brow bones unless these tissues have been first expanded before a brow bone implant is placed”
I assume what is meant by this is that lowering the solid prominence brow ridge is possible, but it will not move the eyebrows into a lower position, creating the angry looking appearance many patients desire.
Are you saying that it is rarely possible to create a lower set, bony prominence, or are you saying that it is rarely possible to get the eyebrows to move along with the prominence when creating a lower set brow ridge.
It seems like if a patient wanted to pursue a lower set brow ridge, without significantly moving the eyebrows, then the soft tissues of the brows would not be a limiting factor in that sort of augmentation.
A: Your understanding of the brow bone and eyebrow movement issues is correct. While brow bones can be augmented such that the inferior level of the supraorbital rim is lowered, and this is regularly done, there is no guarantee that the overlying eyebrows will follow down with it. At least not to the extent that some patients desire it to do so. But for the patient where downward movement of the eyebrows is not important, lowering the horizontal projecting level of the brow bones can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m happy with the outcome and feel that you did a really good job with the overall look of the forehead. There’s still a somewhat noticeable protrusion on the right side of the forehead where the implant meets the skull unlike the left side which blends perfectly but it’s not something I’d want to undergo a corrective surgery for. I’m attaching some pictures for your files and did have a couple of questions to ask regarding some symptoms I’ve experienced following the surgery.
The first has been heavy hair fallout along the scar line, which you can see in the last two pictures. Is this normal to experience and if so, could I expect the lost hair grow back eventually?
The second have been sharp daily pains along my right temple and above my right brow. The pain usually doesn’t last very long but comes on strong and seemingly out of nowhere. It feels like a needle poking sensation. This happens maybe 3-5 times a day, and rubbing the forehead usually helps subside the pain. Is this a common occurrence 2+ months out and is it temporary?
A: In answer to your brow bone reduction recovery questions:
1) Hair shedding is not atypical along the incisions line and is a reaction to the trauma of surgery. Some et very little while others get more. Shedding should not be confused with with hair loss or death of the follicles. I would expected most of the shafts that have been shed too exhibit regrowth which unfortunately is a slow process given the .1mm per day hair growth that occurs once the follicles reactivate. A helpful aid is to apply Rogainje along the incision line nightly. That can expedite the hair regeneration since that has largely a vascular enhancing (vasodilator) effect.
2) The dysesthetic nerve symptoms that youare feeling is undoubtedly related to the sensory nerves that are affected in brow bone reduction surgery, most commonly the supraorbital nerves which supply feeling to the forehead. As these nerves regain feeling they typically come back which a variety of abnormal sensations such as shooting pains, itchiness, etc. This is also why they feel better when you rub the forehead (like shaking your hand when you burn or hit it), it causes other story fibers to fire which over ride the and abnormal sensations. At the least I expect much more nerve recovery than you now which can take up to a year for maximum to full recovery…which many patients do experience. So yes at this point this is normal part of the recovery process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in perioral lipo due to bulges around my mouth. I wondered why in your notes it says it should be continued to the jaw line? Surely for a man removing fat from the Sulcus and jawline will be aging and weaken the jaw? It seems most people beyond a certain age are having volume added to this exact area to improve the jawline.
A: While the line of perioral liposuction access can be all the way back the jaw angle, that doesn’t mean it needs to be. It all depends on each patient;s aesthetic desires. Most people that have buccal lipectomies and perioral liposuction do so for a complete cheek concats effect which enhances the cheeks and jawline. But for the patient with just true perioral mounds that is not necessary.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How can I lower my brows? Can brow bone reduction help? I found them too high on the face, not close enough to my eyes! Is eyebrow lowering possible?
Thanks
A: I am not aware of a 100% reliable method for eyebrow lowering. Brow bone reduction topically does not cause the eyebrows to ‘fall’ or lower even in large brow bone reductions. Eyebrows maintain their position because of the length of the forehead skin/soft tissue rather than the bone structure underneath it. Tissue expansion of the forehead skin could be done and the the eyebrows released from the brow bones secondarily to attempt to have drop them down, thus creating more forehead skin. This makes theoretical/anatomic sense but I can to speak to its clinical effectiveness as I have never have forehead tissue expansion for this aesthetic purpose…even though you are to the first person got have asked me about it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Will the soft tissues slid around over silicone facial implants since the tissue do not adhere to them? I am worried that my soft tissues will move around and fall off the implants and look funny if there is no direct tissue adherence to them.
A: While the overlying soft tissues do not directly adhere to the silicone facial implant’s surface (unless perfusion holes are placed in them which is why I almost always do them), a firm capsule of scar develops around a silicone facial implant to which the overlying soft tissues are attached. Thus the importance of soft tissues adhering directly to the implant is really overstated/unnecessary and why soft tissues do not slide around over even a silicone implant. It is all about the biology of the capsular formation and understanding what it does.
The answer to this question is actually also known using another far more commonly done and familiar silicone implant, breast implants. While breast implants are not solid implants the encapsulation process keeps the soft tissue from moving excessively over and around the implants. This makes the implant feel like it is integrated or adhered to the soft tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, When using tissue expanders and brow bone implants to lower the prominence of the brow ridge and eyebrows, what degree of control do you have over the shape of the eyebrows?
If a person wanted a lower, straighter brow ridge, with lower straighter eyebrows to match, would that be achievable using implants and tissue expanders?
A: In the design of custom brow bone implants one has complete control of the shape of the bone bones. However, how the soft tissues respond to tissue expansion and the driving force of the implant can not be as precisely predicted. To no surprise hard tissue augmentation is more predictable than the response of the overlying soft tissues
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Quisiera saber donde ubico la clinica, como es el procedimiento para una rinoplastia, cuanto es el tiempo de recuperacion. Y el aproximado de el costo. Gracias
A: En respuesta a sus preguntas sobre rinoplastia:
- Mi práctica se encuentra en Carmel, Indiana, EE. UU.
- Mi asistente Camille pasará el costo aproximado de la cirugía de rinoplastia. Un costo exacto requeriría una evaluación de imágenes de su nariz.
- 3) La cirugía de rinoplastia se realiza bajo anestesia general en mi centro de cirugía de forma ambulatoria.
- La recuperación de la cirugía de rinoplastia demora una semana hasta que la férula nasal se desprenda, luego de lo cual la inflamación desaparece lentamente en los próximos meses.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in facial asymmetry surgery, specifically fixing my cheek asymmetry. I had a few syringes of Bellafill to try and help my cheek asymmetry but at the time I did not know surgery was an option. Most importantly the filler has not improved the problem even in the slightest. I visited the provider who performed the injections last week and asked him to remove the syringes in order for the CT scan to show my true facial structure. He informed me the only way to remove Bellafill is through surgery. I certainly hope this will not have a negative effect on the CT scan or the surgery..
Since this did not improve anything, can we still proceed with the surgery? I know eventually the Bellafill will wear off, and I am not sure how that would work with a cheek implant. I am a 99.9 percent sure the Bellafill did nothing to improve the asymmetry. Its only effect has been a slight bump in my cheek area
This is an important issue to address before I proceed with the CT scan and cust4om cheek implant surgery.
A: Having Bellafil in the tissues does not preclude you from having surgery, particularly since it had no external aesthetic effect. The material may be able to see seen on the CT scan but likely will not as the PMMA beads are translucent. We may be able to locate and colorize them as part of the implant design to see how they relate, if at all, to the implant design. Regardless I do not see it as any impediment for designing or placing a custom cheek implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a custom jaw wraparound implant placed in September but now when I flex my jaw, the masseter muscle bulges higher up than the gonial angle. Will it heal automatically? Do you offer any procedures that fix it?
A:You have masseter muscle dehiscence, also known as ‘implant reveal’, where the muscle has become disinserted and retracted up over the implant. While it causes no functional jaw movement issues it is an aesthetic deformity. This is a difficult problem for which there are no easy solutions. Repositioning the muscle back over the implant is the biologic approach but that is very difficult to do and requires an external neck incision to do so. Alternatively trying to fill in the soft tissue defect with injectable fillers, fat injections or subcutaneous implants are all camouflage options.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been reading a lot about temporal implants. My temples have gotten deflated in the last few years and the sides of my skull are already narrow. During research, I am reading that doctors claim that temple implants usually show a “groove” on the side of the face with aging – therefore, they are noticeable in negative way. Is this true? Also, I read that infections are very common with these implants (especially skull). Finally, I have read that revisions are needed in a high % of patients. Is this true?
A: In answer to your temporal implants questions:
1) Today’s temporal implants are designed to be applied under the temporalis fascia in top of the muscle, thus implant edging is not seen. You are likely referring to what can happen when temporal implants are placed right under the skin…over time their outlines become apparent. This is why this historic pocket location is a poor choice.
2) Temporal implants, like all skull implants, have very low infection rates. So low that I have yet to see one.
3) Like all implants placed anywhere in the body, revisional surgery may be needed for size, position or asymmetry issues. But it is no greater for temporal implants than any other skull, face for body implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am a 25 year-old trans-woman. I’ve recently been shopping around for quotes for a breast augmentation as I have not had much growth over the years. I have also been following clavicle shortening over the past few years, as I have naturally broad shoulders and I believe it could help my case. Would these two surgeries be able to be preformed simultaneously?
A: Yes both breast augmentation and clavicle reduction surgeries would the able to be performed together. The real recovery is from the clavicle shortening and the breast augmentation doesn’t add much to the recovery.
Interestingly both breast augmentation and clavicle reduction surgery can be done in the same operative field. And also because of the visual closeness of the two anatomic areas one complements the effects of the other. (upper body feminization surgery)
Dr. Barry Eppley
Indianapolis, Indiana