Uncategorized
Uncategorized
Q: Dr. Eppley, Can you design a custom hydroxyapatite forehead implant? I need a bio scaffold type implant.
A: That can not be done in a satisfactory aesthetic manner (will have a lot of visible edging since HA can not be made with 0.2mm feather edges) nor can it be surgically placed unless a full coronal ear to ear scalp incision is made.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am from Poland and I am interested in rib removal surgery. I read about different methods and wanted to ask which one you recommend in my case. I am 29 years old and a woman, but I have always had a very boyish body type. In addition, I have mild scoliosis. I’ve had two breast implant surgeries, but they still separate slightly from side to side. The doctor said it was the chest.
It is also important for me to know what the scars look like before I decide to undergo surgery – can you send photos? and the price of the treatment.
Please let me know what you recommend in my case.
I also saw hip implants in your offer, which made me curious because I had never heard of it – would you recommend it in my case? Is it safe? What do the scars look like?
My hip circumference is only 80 cm
A: 1) I would need to see pictures of her body to do some imaging to have her see what type of waistline reduction change is possible.
2) I would go to www.exploreplasticsurgery.com and search under rib removal where extensive informatiomn about rib removal surgery can be found in over 100 writings on the topic, including the incisions used and scars.
3) But the attached two pictures are representative outocomes from the incisions used for Type 1 rib removal surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I get custom jaw angle implants after failed jaw angle implants after V line surgery?
A: In my experience with V line surgery correction the ostectomy lines on each side are rarely symmetric and more commonly asymmetric. Given that what is really missing is vertical length from the amputation of the jaw angles it is best to use a custom implant approach to get a stable and symmetric result. While your initial effort at that resulted in a wound dehiscence and subsequent implant removal without custom implants the aesthetic result may have ended up unsatisfactory anyway.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am in need of a custom skull implant. How much time do I need for this process and recovering? Do you think 3 weeks are enough? Also, If I come to USA, how long it will take to prepare a skull implants for me..
I took some pictures. It is almost impossible to understand unless you touch it. I had fillers before. In my researches at that time, that doctor was the only onewho did skull filling in Turkey. He was terrible. He used kind of bone powder I guess.. I It was a dough and he inserted it under my head skin and the dough has hardened. But he couldn’t succeed. Failed to place the filling evenly on my head. In the pictures, everything looks normal but in reality it is not. There are a lot of depressions on my head and it hurts me when I sleep, brush and touch my head. I marked the that areas with red pen in the pictures.
Thank you so much for your attention!
A: This appears to be a classic attempt at croewn of the skull augmentation using bone cement which, besides the limited result, often ends up very irregular and uneven in shape. The bone cement should be evident on thje 3D CT scan but teh images attached are of limited views so it is not seen.
What you are now seeking is a better skull augmentation method using a custom skull implant. To answer your logistical questions:
1) Custom skull implants are made off of the 3D CT scan so I will need the actual disc of that scan. Such implants are made well in advance of the surgery as that process takes about 3 months to complete. You come here only for the surgery, appearing one day before the surgery. Your implant design would be very similar to that which is attached….likely just a bit smaller in size of the implant footprint.
2) Your stay here would be short, returning home no more than 4 to 5 days after the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to inquire about the best approach for reversing a cheekbone reduction procedure given my situation. Could you please inform me about the costs associated with Cheekbone Reduction Reversal surgery?
Additionally, could you provide an overview of potential solutions in the event of an infection, whether it pertains to my custom jawline implant surgery or the cheekbone reduction reversal surgery, and give a rough estimate of the total cost for revision surgery in case of an infection?
A: Cheek bone reduction surgery could consist of an implant overlay or a reverse cheekbone osteotomy with interpositional graft. Eachj has their advantages and disadvantages and the aesthetic outcomes between the two are slightly different. This is a personal choice so I would have to know which you prefer.
In the infrequent occurrence case of an implant infection I remove it at no charge and as soon as possible. Most implant-based infections do not resolve otherwise.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I be like someone by getting facial reshaping implants (celebraty). Indeed, there is a similarity between us, but I want to be a copy of him. The celebrity is Zayn Malik.
A: No one of course can be made to look like someone else….unless they re very close initially and the feature differences are structural in nature.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had been perusing through your impressive website about cosmetic and reconstructive facial implants. Some of them seem rather large.
If you have time, would you be able to give me feedback on these topics that your plastic surgery website inspired?
1) For your larger complete mid-face “mask”, how do you secure each piece to minimize movement, migration and possible extrusion?
1.5) In the case of customized implants – for any part of the face – how is the height of each part of the implant measured to ensure that the lift or elevation afforded by the implant is optimal but also not too exaggerated. Is there a biometric baseline used? Every face is different; men and women, people of different ethnicity, people who are middle-aged or very advanced in age and some people are heavily affected by social media’s standards about what is trending or currently considered “hot” which means they have different facial surfaces and want different potential results. How does the customized implants production account for all these factors in determining the most ideal heights, surface relief, etc.?
2) With such a large silicone implants, how does the inner skin tissue (above implant) and the bone underneath deal with this interruption in the strata of delicate tissues that the implant(s) now wedge between and the wedging encompasses a significant surface area? Even if a capsule is formed from the natural immune system trying to isolate this large foreign object, doesn’t the significance interruption between health inner skin and muscle/bone interface over a large surface create other complications?
3) Do these large implants cause restrictions for future cosmetic facial procedures? Take the mid-face mask with or without cheekbones involvement in the implants. Would a future plastic surgery such as a deep plane face lift or rhinoplasty, for example, be made impossible to do or with severe compromised aesthetic results?
4) I read in several medical journals that the mid-face, especially the region where the cheeks meets the mid-nose and the piriform apertures – suffer the most wearing away of the bone with the natural aging process. It makes individuals in their 60s and 70s look very gaunt and deflated in the face. (But it’s natural, so I am not implying that Father Time is evil.) So if a man or woman gets anyone of your customized implants in these vulnerable areas, with time, wouldn’t the foundation on which the implants sit on be so fragile when the patient reaches age 70 or 80 that it might fracture the natural aged bone foundation underneath? The bone tissue thins out over time but the implant remains hard, unyielding and applying a downward force and tension/stress on the bone underneath.
Help educate me in the event I might invest in your artistic and technical precision at Eppley Plastic Surgery or just to help me because more information about these exciting elective procedures. If you do not have time, that’s okay. Any clarification or education will be warmly appreciated.
Thank you for your time.
A: In answer to your custom facial implant questions:
1) All facial implants are secured with titanium microscrews.
1.5) The design of any custom facial implant is an artistic endeavor more than some scientific measurements which don’t exist for it. Experience is another major factor knowing the effects of a implant design to its external aesthetic effecvts.
2) It does not. It merely sits there passively.
3) They do not.
4) That is not a risk. That theoretical biologic sequelae is not a reality.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I received a custom brow/forehead implant as well a total midface implant four years ago. Ever since the surgery, my left temple has always felt a little different than my right. Closer to the time of surgery, I would occasionally get sharp twinges of discomfort around the left edge of the implant. I haven’t felt that discomfort in a long time, but that area will sometimes briefly itch for seemingly no reason. That area also feels a little more sensitive than the same spot on the right side, even years later. All of these sensations can be traced back to the time of surgery. The left side was also the side that experienced more significant bruising.
This is not a serious issue by any means, but I want to check in to know if there might be anything I should keep in mind going forward. I am extremely happy with my implants and want them to stay healthy for the rest of my life.
A: Good to hear from you after our surgical adventure from 2020. Those left-sided symptoms suggest a more neurologic basis as abnormal sensations from one of the lateral branches of the sensory supraorbital nerve which could have been more stretched form the greater swelling/bruising on that side. That is what itching would indicate as opposed to a problem with the implant. Such small terminal branches of a sensory nerve are either trying to recover or just exhibit an abnormal sensation from time to time given the stretch injury. When we look at the rather ‘extreme’ nature of the augmentation (implant surface area) and the periorbital incisions needed to do it it is probably surprising that is the only relatively minor sequelae from the surgery. Whether that will ever change over time remains to be seen.
Attached is an endoscopic picture from your surgery showing the left supraorbital nerve and vessels as they exit from the brow bone and the dissection needed to make the space for the brow bone implant. So it is easy to see how small nerve branches can get severely stretched.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I have a question. I want to do shoulder width reduction. And that I want my shoulders to be lower and more droopy like these two examples. It is possible ?
A:In clavicle reduction osteotomies it pulls the shoulders inward and down a bit…which I believe is what you mean by ‘droopy’. How significant that effect is depends on the patient’s individual shoulder shape. I don’t know the specific examples to which you refer but they probably are representative of the general effect of the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I got mandibular angle implants and now have masseter dehiscence. I have no outward projection, and the sunken angles have made my face look round from the front. My masseter is noticeably high up. This is the opposite of what I wanted. I find almost nothing when I research this, but nearly everything I do see is from Dr Eppley. As of now, is the surgery to reattach the masseter still likely to fail? I really do not want to use filler, so what would be my best course of action?
A:This is classic masseteric muscle dehiscence in which you have correctly assumed that actual muscle repositioning usually is unsuccessful. The most effective approach I have found is a graft (Alloderm,- cadaveric dermis) or soft tissue implant augmentation method done through a small direct incision (1 cm) right behind the jaw angle area.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in Hamstring implants, perhaps 1 in each back muscle or 1 big one.I was thinking of it as an implant like you would do with a butt implant: intramuscular.
A: A hamstring implant would not be submuscular due to the sciatic nerve proximity and it would not be intramuscular as it is a thin longitudinal muscle in which it would be permanently injured and end up atrophic. The gluteus maximus muscle of the buttocks is a very thick muscle that has the space for an intramuscular implant in which even it ends up with some muscle atrophy.
Thus any hamstring implant would be subfascial, like most longitudinal extremity muscle augmentations and the biceps femoris would be the best candidate since it is the largest of the hamstring muscles.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was just thinking about the role of the buccinator muscle with smiling. When I smile it typically has 12 teeth show, but i notice that there is something inside the cheek that pushes against my 2nd molar preventing a 14 tooth smile, apparently this is the buccinator muscle I think. I was curious if a buccinator mucosal myectomy would actually result in a 14 tooth smile or if theres simply too much muscle contracting to make a difference with the surgery. Thanks a lot for reading my question.
A:I don’t think it would make any difference as the smile is a horizontal movement while a buccinator muscle resection removes it horizontally not vertically… which is what would be needed to debulk it enough to allow more horizontal movement if possible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Quick question about cheek implant revision. If the first cheek implants were screwed is it ok if the revision surgeon doesnt screw them in? Im nervous that the pockets will be too big and the implant will shift in the preexisting pocket since im going for a much smaller implant the second time around.Is there any way to prevent this?
Thank you
A: If you are placing a smaller cheek implant into a larger implant pocket then they would absolutely need to be secured with screws. It is more important this time around than the first time since there is an established capsule.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What is the realistically largest size for the wrap around jaw implant method?
A: The size of a custom jawline implant depends on many factors of which the most important is the tissue’s tolerance for implant displacement. That must be determined on an individual basis.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 32 years old male which for the bigger part of my life I’ve been very uncertain about my skull shape, mainly driven by the laughs and giggles at school when I was young. Especially with buzzed hair, the shape of my skull is noticeably visible. By growing older, and the balding process getting started, I’m afraid everyone will look start looking again at my skull. I’d like to ask whether you’ve come across someone with a skull shape like mine, and if you think there is anything that can be done to make it look more normal. I’m attaching a RAD picture, taken last year to verify whether a certain dizziness was coming from my head (which wasn’t after all).
A: While I don’t know exactly what you look like in person the side profile of your x-ray shows a flat upper back of the head with a compensatory elevated crown of the skull. This is not a rare skull shape concern in my experience and it is treated by a crown of the skull bone reduction (red in diagram) with a custom skull implant augmentation. (green in diagram)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am transsexual and have a very boxy torso as seen in the pictures attached, I have read through Dr. Eppley’s numerous blog posts and seen some amazing improvements, however, I am worried that my torso may not be able to be sufficiently feminised. Along with the usual 12, 11 and 10 rib and latissimus muscle strip removals, would it be possible to remove ribs 9 and 8 as well? I’m unsure if its the 9th or 8th rib primarily contributing to my boxy torso but its one of them. I’m aware of the complexities of rib removals while trying not to disrupt nerves and as Dr. Eppley mentioned, the pleura; could Dr. Eppley shave down rib 9 or 8 or both completely in order to remove them instead of using the traditional cutting methods used for the other ribs? I know in the blog posts its been mentioned that rib 9 has been shaved, I understand it wasn’t completely shaved to the point it was removed, though I could be wrong.
I am not particularly concerned with scars and am willing to go the extra mile to fix my body.
A: It is not prudent to remove 5 levels of the ribcae of which a portion of the rib rejmoval lies directly over the lower 1/3 of the lung. However ribs #8 and #9 could be shaved thin with removal of the overlying LD muscle which would be safer and provide some benefit.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I got my medpor jaw angle implant procedure over 2 years ago. One year ago I had one side of the implant shaved down to make my face look more symmetrical. But, the second procedure caused a mandibular nerve injury, which has impacted my smile and caused a dimple in my chin. My smile and chin are improving, but very slowly. I’m confident that my smile and chin will heal eventually on its own.
If I go ahead and get these implants removed by Dr. Eppley, what are the chances of getting another nerve injury? I was planning to get a 3D CT scan soon, which would probably help Dr. Eppley see where my nerves are and if it’s possible to safely remove my implants?
A: You are referring to an injury to the marginal mandibular branch of the facial nerve. A nerve that is not seen on a bone scan unlike the inferior alveolar nerve that runs through the bone which is a sensory nerve not a motor nerve. It is not clear to me how that nerve got injured if the jaw angle implants were placed intraorally. It could have occurred if they were placed externally through a skin incision near the jaw angle but not intraorally.
There is a good motto to remember about recurrent surgical risks….past history predicts future behavior.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My son is now 7 years old, he developed Plagiocephaly just two months after he was born. I was a young new mom with severe postpartum with no help and knowledge on soft skulls of babies. I noticed his head being oddly shaped. I informed his doctor at the time and he said do more tummy time and didn’t really express the issue as something abnormal. I was under the impression that it rounds out as he gets older. As time went on, after tummy time, rotating his head, etc, it never rounded out at all and once I realized I needed to help him, it was too late. Everyone including family members, the doctor and my husband just brushed it off. It wasn’t until my friend who was a doctor who saw him when he was 9 months and said it was bad and he needed a helmet, by that point it was too late and my husband at the time still didn’t think much of it. Since that time I haven’t had a day of regret and depression over it. I feel sad, upset and resentful! for I feel let down and hurt by the doctor who didn’t treat it as a medical issue! Dr. Eppley is my only hope! I researched for hours and hours and cried for hours trying to find a solution for this. Please let me know if there’s any hope for him, my prayers will be answered.
A: I don’t treat plagiocephaly as an external skull augmentation technique until the skull has come closer to full maturity. (aka 16 years of age) It is an effective approach but one with un known long terms risks in the developing skull.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.
A: In answer to your questions:
1) No.
2) Yes.
3) Yes.
4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I think the cheek and infraorbital rim implants that I had placed in 2014 ended up moving upward from the orthognathic surgery I had in 2017. I just noticed this by comparing their current position to the position they were supposed to be in according to the original design, which I’m attaching. I think they are intruding upon the infraorbital cavity and causing some symptoms consistent with nerve compression. I’m worried that they are damaging the optic nerve. Could we have a consultation to talk about this? I think the implants might need to be repositioned surgically.
A:I have seen the IOM implant positions previously. They would not have moved upward from the effects of the LeFort osteotomy, that is just how they were placed. Custom implant placements rarely look exactly like the designs, close but never identical. One of the ‘downsides’ to see a postop scan is that patients can become aware of these discrepancies which exist in every case. The impetus for surgery should be what it looks like on the outside not what it looks like on a scan. It has been almost 10 years since those implants were placed and they would not cause any orbital compression being out of the orbital cavity and only sitting on the infraorbital rim. The optic nerve is located 35mm to 45mms behind the infraorbital rim so this is not an issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Are you doing shoulder augmentation for women as well ? My shoulders are too narrow and I want to change that. I included the pictures here for you see what I would like to make , could you confirm if it’s possible? And maybe you could send me more pictures similar surgery?
I hope you understood me correctly, I want to increase my shoulders so that the body proportions are looking more right, but naturally not a fake , hope you know what I mean
Thank you so much !
A:I have never done shoulder lengthening on a female so I can not say whether such a change is possible. But if I borrow from my experience in men I would say such a change is not possible. What I learned from men is that the amount of shoulder lengthening by osteotomies is more limited than desired because of the strong shoulder soft tissue attachment to the scapula and surrounding tissues. Whether in females this is less of an issue due to less strong soft tissue attachments can only be speculated.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is there a surgery I could get to reduce my temple width so glasses can fit without looking too small? My temple width is 165mm and I’d like to reduce at least 5mm per side. I’ve heard that removing the temporalis muscle can do, but when I press against my temple I barely feel muscles, but bones. So is there a surgery to reduce the width of my temporal bones? Or maybe it’s normal to not feel the temporalis muscle by pressing the temple, and muscle removal would work just fine?
A:The temporal muscle on the side of the head is quite thick often being up to 10mms in thickness just above the ear. Everyone says the same thing about the feel of the side of their head…it feels more like bone than muscle. The reality is that there is more muscle thickness than bone. But the muscle is soft and its backing (bone) is firm and that creates the illusion that there is not much muscle there. Muscle removal works just fine for reducing temporal width.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I see that you do thigh implant surgery (do you know how hard that is to find :-p) I was wondering, though, if you would do Hamstring implants, perhaps 1 in each back muscle or 1 big one.Thank you in advance for any of your help, have a great day!
A:In regards to thigh implants they are placed in the quads or the front of the thigh (adductor magnus and vastus lateralis) usually as one single implant with the option for an additional small implant for the vastus medialis. You mention the ‘hamstring muscles’ which refers to back of the thigh (semimembranous, semitendinous and bicep femoris) for which I have not yet placed such thigh implants nor am I familiar with anyone who ever has. It is theoretically possible to do so but it has not yet been performed to my knowledge.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, my face is getting increasingly crooked as I think my implant is displaced. it feels like its sitting on an angle. i would like a video consultation to understand what went wrong and my options now. I feel awful and it doesnt look good. its also hurting a little where the implant sits very high.
A: I assume you are referring to a chin implant since you didn’t specifically say what implant. Based on your preoperative chin recess one can debate whether an implant was initially the best choice. But that being said I think it is clear that it has an asymmetric positioning. If we wanted to have a clear indication of exactly how the implant is positioned a 3D CT scan is needed. But there are several important pieces of information I don’t have. (incision used for placement, implant material, implant style and size)
But as overview there are three secondary chin augmentation options:
1) Reposition the current chin implant
2) Remove and Replace with New Chin Implant
3) Remove current chin implant and Replaced with Sliding Genioplasty
Such decisions would be based on how you feel if the chin implant you have in did not have any asymmetry.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have attached some images for potential hip reduction surgery. I would also like to say that I’ve had liposuction before, it was a quick fix but the issue is the structure of the bones.I will also attach an image of when I’m at my thinnest, the hips are quite prominent.
My hips are wide everywhere to me. They’re wide at the top and wide at the bottom. Widest area is probably at the bottom, at the hip joints, I’m aware that nothing is really possible at this area without potentially damaging the joints.
The upper hip area gives me lots of dysphoria.
When I had my liposuction, the operator said that one of my hips is more prominent/ protruding outward more than the other side.
I’d just like smaller more masculine hips/pelvis in any way, shape or form. Whatever is possible medically.
A: As you have astutely pointed out there is no surgical remedy for the lower hip fullness due to the width of the greater trochanter of the femur as it is a movable joint. However the iliac crest of the upper hip area does allow for some reduction. In your earlier leaner pictures you have a prominent anterior crestal area. Such iliac crest reduction offers benefits close to the attached imaging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Im a 32 year old transgender Man. I am wondering if it’s possible to make hip bones smaller or more narrow by shaving/removing bone from my pelvis? It’s something that I think about constantly and it bothers me a lot. Please let me know if there is anything available like this that could help narrow the pelvis.
A:The only surgical method top narrow the hip bones is an iliac crest reduction procedure. (see attached image) Whether this would be effective for you would require seeing some pictures of your hips and where you see them as the widest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is there a surgery I could get to reduce my temple width so glasses can fit without looking too small? My temple width is 165mm and I’d like to reduce at least 5mm per side. I’ve heard that removing the temporalis muscle can do, but when I press against my temple I barely feel muscles, but bones. So is there a surgery to reduce the width of my temporal bones? Or maybe it’s normal to not feel the temporalis muscle by pressing the temple, and muscle removal would work just fine?
A:The temporal muscle on the side of the head is quite thick often being up to 10mms in thickness just above the ear. Everyone says the same thing about the feel of the side of their head…it feels more like bone than muscle. The reality is that there is more muscle thickness than bone. But the muscle is soft and its backing (bone) is firm and that creates the illusion that there is not much muscle there. Muscle removal works just fine for reducing temporal width.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Are you doing that for women as well? Mmy shoulders are too narrow and I want to change that.
I included the pictures here for you see what I would like to make , could you confirm if it’s possible? And maybe you could send me more pictures similar surgery? I hope you understood me correctly, I want to increase my shoulders so that the body proportions are looking more right, but naturally not a fake, hope you know what I mean.
Thank you so much!
A:I have never done shoulder lengthening on a female so I can not say whether such a change is possible. But if I borrow from my experience in men I would say such a change is not possible. What I learned from men is that the amount of shoulder lengthening is more limited than desired because of the strong shoulder soft tissue attachment to the scapula and surrounding tissues. Whether in females this is less of an issue due to less strong soft tissue attachments can only be speculated.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I think the cheek and infraorbital rim implants that I had placed in 2014 ended up moving upward from the orthognathic surgery I had in 2017. I just noticed this by comparing their current position to the position they were supposed to be in according to the original design, which I’m attaching. I think they are intruding upon the infraorbital cavity and causing some symptoms consistent with nerve compression. I’m worried that they are damaging the optic nerve. Could we have a consultation to talk about this? I think the implants might need to be repositioned surgically.
A:I have seen the IOM implant positions previously on your 3D Ct scan. They would not have moved upward from the effects of the LeFort osteotomy, that is just how they were placed. Custom implant placements rarely look exactly like the designs, close but never identical. One of the ‘downsides’ to see a postop scan is that patients can become aware of these discrepancies which exist in every case. The impetus for surgery should be what it looks like on the outside not what it looks like on a scan. It has been almost 10 years since those implants were placed and they would not cause any orbital compression being out of the orbital cavity and only sitting on the infraorbital rim. The optic nerve is located 35mm to 45mms behind the infraorbital rim so this is not an issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some sliding genioplasty questions. I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.
A:In answer to your post sliding genioplasty questions:
1) No.
2) Yes.
3) Yes.
4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.
Dr. Barry Eppley
World-Renowned Plastic Surgeon