Your Questions
Your Questions
Q: Dr. Eppley, I have scheduled for paranasal implant surgery in September. Now I would like to ask you a few more questions about it:
- Do you think it will be advisable to stay in Carmel for 1 or 2 weeks after the surgery in case some complications may occur?
- Can I eat normally the days following the surgery or are the any restrictions?
- Is it possible to have another surgery done (some months) after the paranasal implantation? I am thinking about a facelift in early spring of next year. From your medical point of view, would this be a problem after the paranasal implantation? Will the implants affect the feasibility of a subsequent face lifting in any aspect? Is the planned point of time 4-5 months after the paranasal surgery ok or should I wait longer? Would it be even better to have the face lifting done prior to the paranasal surgery?
A: In answer to your paranasal implant surgery questions:
1) One to two weeks stay after surgery is not necessary. Infectious complications, rare as they may be for the midface, won’t occur until 3 to 6 weeks after the surgery.
2) I would be careful about biting off food for a few weeks with the high vestibular incision. This is easily bypassed by using utensils to replace what the front teeth normally do.
3) You could have any form of facelift surgery within weeks or months after the paranasal augmentation. Such central midface implants have no impact on mid- or lateral facelift surgery, whether done before or after.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want a wider head shape with a temple implant. What shape should the implant be?
A: Thank you for your inquiry and sending your pictures. Because it really involves the side of the entire head a wrap around or extended temporal implant style (head widening implant) is needed to create an harmonious change from the side of the forehead back to the posterior temporal region. It doesn’t have to be very thick (5mm max most likely in the center) but it is the footprint of the implant that is most important in achieving the desired effect. You also don’t want to overdo the width of the implant to keep in balance with your thinner face and what appears to be a leaner body shape as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Am I candidate for eyelid surgery that can help with my droopy outer eyelids, which give me a tired and depressed look.
A: Thank you for your inquiry. You would be a candidate for outer corner eye reshaping (lateral canthoplasty with lower eyelid spacer grafts) but that would not be most effective if just done alone. Your outer eye corners turn down for a reason…they mimic the lack of bone support underneath them. You have lack of underlying midface projection which results in a negative orbital vector. ( projection of cornea is at or in front of the infraorbital rim) Such negative orbital vectors are best treated by adding structural support (custom infraorbital-malar implants) with the lower eyelid reshaping procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Good afternoon, is there a procedure that can be done to protect the facial bones? A protective face mask but permanent? To reduce injury,Thank You.
A: I assume your question is about an internal layer of protection for the facial bones. That can be done and would consist of making a thin firm layer of custom implants that cover the facial bones. Custom facial implants do indeed act like bumpers on the bone, adding a layer of protection even if they are only a few millimeters thick.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have lip incompetence and chin ptosis after chin implant removal and soft tissue reduction surgery, all via a submental approach. Can a mentalis muscle resuspension help in my case?
A: Mentalis muscle resuspensions rarely work when done alone. They have a better chance of success when combined with a small implant placed on the chin which encourages soft tissue adhesion like a Medpor or Goretex material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I believe that I have hyperdynamic chin ptosis. My chin appears normal at rest, it is prominent when talking or smiling. It bothers me, especially while talking. I never had any surgery done. What would be my options to correct the appearance of my chin?
Thanks in advance.
A: Hyperdynamic chin ptosis is treated by a submental approach where excessive chin pad soft tissues are removed and the mentalis muscle insertion is tightened down to the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Had a chin implant last year, unhappy with results. It looks too square and I have jowling. I also had buccal fat removal and FaceTite. Would like your expert opinion on what is best for me. Thanks!
A:While I don’t know what you looked like before the chin implant and what style/size chin implant was placed, but it is clear whatever was used does not fit your face. If the horizontal projection provided by the chin implant is significant (more than 6mms) then I would replace it with a sliding genioplasty which will make it more narrow and help thin the thicker tissues above and behind the chin. Whether that bony genioplasty needs to be a mini V line version for maximum chin narrowing effect I can not yet say. You would also benefit by microliposuction treatment of the perioral, jowl and lateral facial areas. These are areas that are not affected by a buccal lipectomy which only benefits the upper cheek area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After I had my son I had fat leftover on my chin pad. I didn’t feel like myself. I didn’t know if I needed bone reduction or chin pad reduction. I had bone reduction but now looking back i think I just needed minimal chin pad reduction without causing a witches chin and skin tightening underneath. Im genuinely not sure. Now I have a scar left from my surgery and I’m not sure if he did what I needed. I’m two months post opt. I would like a consultation. Thank you.
A: Since I do not know what you looked like before, I can not comment on what I would have done then. What I can comment on is where you are now with an existing submental scar. Since you already have the scar there is no longer the consideration of a scar tradeoff for a soft tissue chin pad reduction. That can be combined with submental skin tightening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an endoscopic brow lift 9 weeks ago. I absolutely hate it and it is causing me pain. It actually put so much pressure on my nose that it did damage. I consulted with an ENT today and found out it is true. Can the brow lift be reversed using the same incisions? The left side has sutures and the right has 2 tunnels with sutures.( I was never informed I was getting my scalp drilled) I had this done out of state. I do not want to wait and want the brow lift reversed. Is doing it early better before scar tissue forms? Will everything return as it was before? Will there be any negative complications by reversing the brow lift?
A:I would agree that the sooner the brow lift is taken down (reversed) the more likely the tissues may return closer to normal. I know of no other risks to brow lift reversal other than how successfully will it take you back ‘home’ again.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,Hello I lost my intergluteal cleft because of two times sinus pilondal surgery Is it possible to recreation mine? And how is this surgery ? Is it hard?
A:Intergluteal cleftplasty is most commonly done after pilonidal surgery or the placement of buttock implants that uses a midline incision. In either the sacrocutaneous ligamentous attachments are detached/lost. It is generally successful surgery through excision of midline scar tissue and reattachment of the more normal tissues on the sides back down to the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I contacted you several years ago about a temporal reduction surgery for both sides of my head. I have now time and money to make this operation possible. I have several questions:
– Are there visible scars after the surgery ?
– How much time to go back home after the surgery ?
In advance, thanks for your answers.
A:In answer to your temporal reduction surgery questions:
1) Temporal reduction surgery is done from incisions placed in the postauricular sulcus behind the ear, this there are no visible scars.
2) There are no physical restrictions after surgery. Recovery is really about the swelling and its appearance which takes about 10 days to look more normal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young man who is three months out from a genioplasty (8mm advancement) and suffering with severe lip and upper chin tightness / tissue tugging when I raise my lower lip or move it sideways. It impacts speech and any slight lip movement.
The genioplasty was a revision after two months because the original operation had left significant asymmetry. So there have already been two operations in quick succession.
As well as significant tightness and discomfort, I have a high-riding and overactive mentalis muscle and rely on this muscle to close my lips at rest due to lip incompetence. When contracted the muscle presents a noticeable bulge and introduces the tight / tugging sensation.
When at rest my lower lip sags and exposes my lower incisors.
I have read your literature on scar contracture of the soft tissues into the void created by the chin step and believe I am suffering with this.
I wondered if you could recommend any specialist in the UK who might be able to help with my issues? As I live in the UK this might make more sense rather than making trips to USA.
I am not sure my current surgeon is familiar with this complication and wish to explore options to try and improve the current feeling.
Is there value in treating this sooner rather than later? Steroid injections, fat injections, for example, as first solution?
Appreciate any advice you can offer in the short term ahead of our consultation.
A:Thank you for your inquiry and detailing your concerns. I would not know who, if anyone, in the UK would perform this procedure to treat this type of postop genioplasty problem. But any non-surgical treatment by injection, regardless of the agent, would not be harmful. It may or may not provide some relief but at the least it will not make anything worse. There is no urgency to jump right in and do anything immediately as the symptoms you have will not get worse.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I want a consultation for waist reduction please. I have flared protruded rib on the left side and short torso. Thank you.
A: Thank you for your inquiry and sending your pictures. Waist reduction is a general term that includes conventional primary procedures of ljposuction and tummy tucks as well as the less commonly performed rib removal surgery. I can see that you have had a prior tummy tuck….although it does not appear that procedure has been maximized. I see a lot of room for improvement in terms of secondary abdominal and flank liposuction all the way around to the spine and into the back. There appears to still be room for more abdominal skin removal.
As a general rule I don’t ‘graduate’ to rib removal in waist reduction patients who have not maximized their results with the primary waistline procedures as this does not create good outcomes. Thus I would advise with your body type and current tummy tuck results to have a the mentioned secondary liposuction and tummy tuck procedures through which the left subcostal rib protrusion could be reduced,,,saving you an additional external scar.
Dr Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I tell you my case, I had surgery first with a lobuloplasty doctor for the use of expansions in my large ears.which amputated part of the lobe, I went to a second doctor who performed an otoplasty and joined part of the lobe to my neck. The truth is that I don’t feel good about the results tbecause I feel that my ears are not proportional to the face or my nose. The first photo is of the right ear and the second is of the left ear (I think it is the worst one)
I appreciate your time and my question would be if there is any possibility of lengthening the ear, could it be a graft?
A: While ears can be shortened they can not be lengthened. There is no graft that can be done to lengthen or expand an earlobe.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. I have heard about you through some of my friends. My concern is about orbital rim, premaxillary and infraorbital areas. My wish is augmentation on the infraorbital area, and orbital rim contouring around the eye to correct the hollowness, so orbital rim and premaxillary zone augmentation. I want all of these done with HA- hydroxyapatite.
My question is can HA be used on the infraorbital area, orbital rimm and premaxillary areas. I need to have an idea if HA can used on such area of faceYou can see an image on attachment , drawn the area with red color which I want augmentation using HA.
Thank you
A:When it comes to the use of hydroxyapatite cement that material is going to work better for bony concavities than bony convexities. Thus the paranasal region is a good place for it. The lower orbital is OK but not great and you simply can’t build the material out into space. (upper orbital rim) HA is intraoperatively mixed to create a paste which is then applied and molded into the desired shape and then allowed to set. So the base upon which it is applied is a major determinant of its predictable augmentative effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. I need face reshaping and i want to use cranium bone grafts to augment my retruded midface and floor of orbits. Some surgeons told me that i have to do a 3D CT scan for evaluation. This is important because my doctor left me know that the thickness of the skull bone is different on all patients. So when I do the 3D CT will it show in detail the thickness of my skull in milimeters to understand how much bone grafts can be taken from my head to reconstruct my midface and orbits?
A: While a 2D or a 3D scan will allow the various skull bone thicknesses to be measured it is not really necessary. Short of the forehead and temporal region split thickness cranial bone grafts can be harvested anywhere inside the bony temporal lines of the skull. Since the skull has three distinct layers it is the outer cortical table that is taken for cranial bone grafts, not the full thickness of the bone. Scan or no scan you have plenty of good bone to harvest for orbital and midface augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, so Ive read that you use a bone graft from the fibula in order to fill the gap created during clavicle lengthening surgery.
My question is, will this affect one’s eligibility to get leg lengthening surgery if they are lengthening the tibia and fibula?
A: I no longer use a bone graft for clavicle lengthening. It is now a non-bone graft sagittal split clavicle lengthening procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very interested in decreasing the overall width of my head. I have been reading about both the anterior and posterior temporal muscle reduction procedure and I think both would be a suitable procedure to decrease overall head width. Although I am concerned about thickness of my bone on my forehead which still adds a substantial about of thickness to my head size. Would it be possible to know if I would be a good candidate to have both anterior muscle reduction and forehead recontouring (forehead burrowing) by assessing pictures of my forehead?
A:Your question about head width reduction is a good one since the sides of the forehead and the temporal areas share a similar developmental origin, so often both are involved. The only way to answer that question is with computer imaging to show temporal width reduction without any change to the bony forehead so you can be the judge as to whether forehead reduction is needed as well. (see attached)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to inquire about a small chin/jaw shave. I would like to have a slightly more heart-shaped face and a less prominent jaw. I also have some slight asymmetry. I’ve attached a photo below.
A:Thank you for your inquiry and sending your picture. I am not certain what you mean by a ‘small’ chin/jaw shave. I envision from a jaw angle/jawline standpoint that would mean a literal shave (cortical bone burring reduction) which I think would be effective for your purposes. For the chin usually just shaving is often not that effective. The most effective chin narrowing procedure is a t-shaped osteotomy in which a little extra length could be added as well as narrowing which would create the most effective facial reshaping change. (see attached)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a mid 20s male looking to get custom cheek/midface implants and maybe brow ridge implant as well. My cheeks/infraorbitals have always been VERY flat and give a tired appearance. My face looks chubby because my buccal area sticks out farther than my cheekbones. I have no ogee curve from 3/4 or rear view. Additionally I have always had nasolabial folds thatI hope can be corrected with paranasal implants.
I am also considering a custom brow ridge implant to give a more masculine, deep set eyes look. I am 50/50 on whether I want this however because it seems to be an uncommon procedure and may look uncanny on my face.
A:Thank you for your inquiry and sending your picture. Your observations are spot on as you have an overall flatter midface compared to your nose and upper/lower facial thirds. I have done imaging which provides some insight in the areas of midface augmentation. (see attached) Whether this should be done by a custom IOM implant combined with standard paranasal implants or but an overall custom midface mask implant is for discussion. I would also agree that the brow bone augmentation is of more dubious benefit but certainly would have to be in the smaller size range. (see attached imaging of midface aug + brow aug)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a specific question and i want your opinion. In general i have long face…especially lower jaw.
The problem is that the nerve on lower jaw is ery close to the bottom edges of mandibular body.According to the dr, the CT shows that inferior alveolar nerve is laying very close to the end of lower jaw edges. So it is not possible to reduce lower jaw due to the nerve.
I really want to reduce my face because it is very long especially the lower jaw. Now i wanted to ask you, on your experience, is there any way to reduce lower jaw without injuring the nerve, maybe by making a horizontal resection on the middle of the mandibular ramus and moving the lower jaw upward? I’m confused about what to do and i just wanted an opinion from you if there is any option to reduce (upward) the lower jaw.
A:While that is an operation that can be executed on paper, doing so in real life is a very difficult proposition. Besides that fact that it has to be combined with a LeFort I impaction procedure (which may have undesirable aesthetic effects with loss of all maxillary tooth show) it would be technically very difficult to rigidly fix the bones back together. Thus this is a not a practical procedure.
It would be very unusual, in my experience, to have a naturally low position of the inferior nerve that makes an inferior border shave impossible/unsafe. I would have to see the x-ray on which that judgment was made to provide further insight.
The alternative bony method to shorten a long lower face, at least anteriorly, is a vertical reduction genioplasty…an operation that avoids the nerve issue.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 30 year old male with very pronounced frontal eminences and temporal fossa. I’m guessing that I’ve always had these cranial features and that they have only become prominent as I’ve aged due to fat pad loss and a receding hairline. Although, given my age I’m surprised that these features have become so prominent so quickly and I am slightly concerned it could be due to an endocrine issue (e.g., pituitary tumor). Aside from potential health issues, I was hoping to get an expert opinion on what options I might have to address this cosmetic issue. Would filler help reduce the appearance of these features or would I need surgery? Thanks for your time! You do incredible work!
A:You have classic prominent frontal eminences (aka forehead horns)which are congenital not due to an underlying endocrine disorder. The treatment options are to either fill around the eminences by building up the lower forehead areas (fillers vs surgical augmentation) or to have the forehead eminences reduced. (surgery) When in doubt about surgery one can always try injectable fillers first.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently scheduled for Bilateral Rib Removal, Circumferential Abdominal Liposuction and Fat Injections to the Hips. My integrative medicine Dr. Would like me to start pellet therapy because I have extremely low testosterone. The pellets would be placed in the hip area. Will this cause any issues with the fat transfer to the hip area?
A: Good question and thanks for the heads up. I will assume that the pellet will be in the hip area that will receive the fat injections. Just like the lack of any damaging impact on nerves and blood vessels with fat injections around them it should similarly not harm a hormone releasing pellet either.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I had a chin implant removed after 4 months, its been 3 months since removed and I’m worried it wont go back to how it was before. Its not tremendously bigger, but its noticeable to me. I’m estimating its about 1-1.5 mm bigger all around than it was pre-operatively. I’ve heard that it may take around 6 months to go down as much as possible, but in case it doesn’t, is there something you could do to help me? This is my biggest regret, and its killing me that it may not go back. Thank you.
A: Almost undoubtably the way your chin appears now is what it will likely be. Because of the ligamentous release needed for the placement of a chin implant the ability of the soft tissue chin pad to return to what it was fully before the implant was placed is unlikely. More healing time, of course, will answer that question completely.
But if it does not then a submental tuckup procedure will be of benefit.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young male and I had a chin wing about 1 year ago, which pushed my chin forward by 4mm. Initially I wanted to get my overbite (4mm) corrected with a lower jaw surgery (BSSO) but my surgeon convinced me that a chin wing would be sufficient.
I hate the result and want to get it reversed. I know that getting a full reversal might cause skin sagging. For this reason I might pursue orthognatic treatment/ surgery afterwards, which i wanted in the first place.
Does having had a full chin wing and a second subsequent full reversal surgery, disqualify me from pursuing orthognatic treatment/ surgery for my 4mm overbite in the future?
A: I see no reason why you can not have the chin wing reversed and get a BSSO later if desired. The chin wing has very little impact on the actual ramus so a successful split can still be done later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just found out that you offer a shoulder reduction surgery. Since my broad shoulders have always bothered me, I am basically very interested.
I just read your blog but I still have two questions, I hope you can help me.
You write that patients afterwards are not allowed to sleep on their side. Since I am almost not able to sleep on my back I am wondering if it would be possible to sleep on the stomach?
How long is the waiting period if I decide to make this surgery?
Thank you for the answers and best regards
A: I don’t think sleeping on your stomach is that much better than sleeping on your side. You still have to get on your stomach which involves a maneuver to get there which inevitably involves at some point rolling on your side even if momentarily. It is all about lowering the risk of hardware fixation failure whose risk is greatest in the first four weeks after surgery.
My assistant Camille will be able to answer the waiting list question.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to know if he can help me with a congenital condition I was born with. Unfortunately I was born with Muscular Torticollis where one of my neck muscle are contracted and no longer a ordinary muscle. It’s is shortened and stuff to the point where I have never have a adequate rotation of my neck. I wanted to see if the doctor knows about my current condition and is willing to set up a consultation online for hopefully surgery. I will attach some photos of my neck. Thank you for your time.
A: I have surgically treated tight/short SCM muscles in young children previously from torticollis….but never in an adult. My concern would be that even if the muscle was released that it would have no beneficial effect on your neck range of motion. Even in children such a release and with postop physical therapy the degree of improvement in neck range of motion is underwhelming. This is because the problem is not just in the SCM muscle but often there are vertebral anomalies as well.
I would imagine that in an adult who has had this issue since birth that neck muscle release would produce equally limited improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, A few years ago I had a zygomatic arch reduction. Part of the zygomatic arch in front of the ear was removed so that I no longer had such a wide face when seen from the front. But although the bone mass was reduced, the facial skin in that area (just in front of the ear) did not retract, so this operation had almost no effect. The facial skin in this area is very, very saggy and also very thick. Would it be possible to tighten this skin?
A: While a deep plane facelift approach could be used to treat the excess facial skin the scar tradeoffs and hairline displacement that would result in a male would be a dubious aesthetic tradeoff.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, i recently got a sliding genioplasty and all though the procedure went great, I found a new dent that appeared between my bottom lip and chin and every time i pull my bottom lip it appears, I wanted to know if you can fix it after my genioplasty.
A: The dent to which you refer is the deepening of the labiomental fold which is a natural occurrence in any sliding genioplasty in which significant horizontal projection is done. It can also occur, however, if the labiomental fold tissues/mentalis muscle closure gets sewn down too tight combined with failure to fill in the stepoff bony defect from the sliding genioplasty…which appears to be what your video is showing.
This is treatable but it depends on how far postop you are…which you did not provide your surgery date in your inquiry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I got a buccal fat removal and would please want to do anything to make my cheeks fuller again please help!
A: Buccal lipectomy reversal can be treated by fat replacement done by either cheek fat injections or the placement of a dermal-fat graft directly back into the buccal space.
Dr. Barry Eppley
Indianapolis, Indiana
