Your Questions

Q: Dr. Eppley, I was hoping to schedule an appointment with you soon for undereye filler. I’ve had this done several times before. I attached a photo, if that’s helpful. I don’t have considerable hollows or wrinkles, but I’ve noticed some flatness since the product has worn off. Is this something you’d recommend correcting with filler? I don’t envision needing a ton of volume, just a little extra plump-ness! It’s been over a year since I’ve had any filler. (Before I had surgery with you, actually!) 

I’m considering fat transfer in the future for more permanency, and I was hoping for your opinion on this? 

A: Good to hear from you. Almost all injectable filler treatments done in my practice are done by my master injector Amanda who has done it full time for 15 years.

If you have had successful filler injections to the undereye area in the past then there would not reason not to have more with the unfortunate understanding that they are not permanent. 

Fat transfer is the other injectable option and some good permanent results can potentially be obtained. However fat transfer is not predictable in terms of survival in thin young patients and is also very prone to irregularities which can be a hard problem to solve. The only assured smooth and permanent results obtainable for infraorbital hollows are custom made implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question regarding wrap around jaw implants. I’m one who always likes to play things safe and I ideally only do procedures that are reversible. With regard to wrap around jaw implants, are they completely reversible? Google searches have not yielded much results for me. While many sites claim such procedures are reversible, I’ve only seen some say that the soft tissue changes, as well as possibly bone changes, after implants may cause permanent changes even if the implants are removed. Is this accurate? And if so, does getting the implant removed early on (day after a couple of months) mitigate it? Of course I would not get implants with the intention of removing them, but I recognize that no result is perfectly predictable, so I’d like to play it safe. 

Thank you.

A: In answer to your questions about custom jawline implants:

1) All such implants are completely reversible, meaning the implant can be removed. But I don’t think that is what you meant by reversible.

2) I believe you are referring to whether you face would completely return to normal shape if the implant were subsequently removed. The answer to that question would depend on how big the implant was and how long it had been in place. While I suspect that for the most part the tissues would shrink back down and return to normal or very close to it, the ‘safest’ answer is don’t have the surgery. That is the most assured method of having he identical face shape you have now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I hope this message finds you well. I understand that you’re very busy, so I apologize if I’m asking too many questions. If answering all of them is too extensive that’s totally understandable. I’m potentially interested in three procedures—head width reduction, tear trough implants, and jaw implants. I’ll address each separately: 

Head width reduction: The area of concern is above my ears until the top of my head. My head is just quite wide and always has been. From reading your blog, my understanding is that the area right above my ears can be reduced by extracting muscle. However, what about the uppermost area on the side of the head? My understanding is that area is made up of bone. Would bone burring and muscle extraction have to be done to narrow the entire sides of my head? Also, if burring were necessary, would the incision have to be made on the side of the head, or can it be made on top? The reason I ask is because a scar or hair loss on top of my head would be easy for me to hide, but not so with a scar on the side. 

Tear trough implants: This is pretty straightforward. My tear troughs are pretty hollow. I’ve tried fillers, but they don’t seem to give me the result I’m looking for. I’m wondering if it can be corrected with custom implants, especially because I have asymmetry where my left under eye hollow is deeper than my right. From my research on RealSelf, it seems some surgeons are not big fans of this approach. Some claim there are complications and that nowadays there are better methods. I guess my question is, do you believe there is any validity to those claims? 

Jaw implants: Although I wouldn’t say my jaw is particularly weak, I’m looking to get a more chiseled, masculine jawline. My own intuition makes me feel that wrap around implants would produce the most natural and best outcome. However, I’m not looking for much of a change to my chin, as I believe the main issue is with my jaw. I may want to advance my chin a mm or two, but that would be about it. Is it possible for a wrap around implant to be designed to mostly augment the jawline but mostly keep the chin the same? I know that implants for only the jaw exist, but based on my own intuition I feel wrap around implants produce the most natural result, as there is a smooth transition around the entire jawline. With just jaw implants I feel that may create a bit of a step off that may not transition smoothly to the chin. Obviously I’m not an expert, so I don’t know if there’s any validity to this. Second, I’m only looking for a slight enhancement of my jawline, but not to completely change it. From my research it seems that patients who are unhappy with jawline implants generally feel they were too wide. To play it safe, I’d look to augment my jaw by only a few mm, may 3 to 5. From your experience, will 3-5 mm have a noticeable effect? Lastly, my jaw is asymmetrical in that it is tilted towards one side and my right side is rounder than my left side. I think this may in part be due to my right cheek being wider than my left cheek. Is this jaw asymmetry something that can be predictably corrected with custom implants? 

A: In answer to your questions:

1) To reduce the very top of the sides of the head, known as the anterior temporal line, an incision would have to be placed somewhere near it. Perhaps closer to the top of the head than the side.

2) Having put in many custom infraorbital rims implants (which work far better than standard tear trough implants) I have observed that this is the far superior method. I would put little stock in any surgeon that has no knowledge or experience in the complete gamut of infraorbital rim augmentation methods.

3) Like all custom implants designs they are based off of the patient’s 3D CT scan. With that skeletal information one can learn a lot about the patient’s natural anatomy, what asymmetries and proportionate relationships exists and now to design the implants to account for those issues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to let you know that I have fillers in both cheeks. They are about a year old and about 1 syringe of Voluma was used.  I do like the fillers and would like to replicate their effects with implants. As for my chin, I would like more projection and length to help add more balance to my face. I also mostly wanted the profile of my cheeks to taper down towards my chin. I would also like my chin to be more symmetrical.

My first major concern is about the longevity of the cheek and chin implants. I was wondering what techniques you use to make sure the implant does not shift at any point after the surgery. 

I have also heard that cheek implants have a high infection rate. I was wondering what techniques you use to ensure the implants do not get infected at any point after the surgery.

Another concern of mine is how symmetrical my face will look after the surgery. I understand that there will still be some asymmetry no matter what. However, I was wondering how you ensure the implants will suit my face and look as proportionate as possible after the surgery. 

Lastly, I was wondering if you can give me a price estimate for both surgeries done at the same time, including surgery fees and implant prices. Do you have any travel or hotel accommodations, as well?

Thank you again for getting back to me. I look forward to hearing from you.

A: Thank you for sending your pictures. In answer to your questions:

1) In addressing your aesthetic chin goals, a chin that needs both horizontal an vertical elongation is best done with a sliding genioplasty not an implant in most cases. (implants do not provide any significant vertical elongation effect) Although in looking at your pictures I do not see the need for much vertical elongation of your chin.

2) In addressing your aesthetic cheek goals, 1cc of filler per side is equal to a small or medium sized cheek implant. Since I don’t know what you looked like before, I can not say what style of cheek implant that filler is creating. 

3) Any type of facial implant is composed of a permanent material that does not degrade, break down or ever need to be replaced due to loss of material integrity. Thus they have a lifetime duration.

4) I am not aware that cheek implants have a ‘high infection’ rate. That source of information is inaccurate. Their infection risk is no higher than any other facial implant.

5) Numerous intra- and postoperative strategies are done to reduce the risk of any facial implant infection. But no strategy can completely eliminate that risk…short of not having the surgery.

6) If you have known facial asymmetry then one can be assured that they will have facial asymmetry after the surgery. Placing implants that have the same size and shape on asymmetric facial bones is guaranteed to create ongoing postoperative facial asymmetry. The only question is how significant will that be. To answer that question it is best to get a 3D facial CT scan before surgery to assess how different the two sides of the face are and whether the use of standard or custom implants offers the best aesthetic outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Unfortunately almost two years ago  I incurred damage similar to that of laser but from retinoids. Then my cat scratched me to make matters worse. Since then I’ve been exploring avenues to repair my compromised deflated skin. I’m looking to do full stem cell face fat grafting, face lift, brow lift and PRP treatments. I’m hoping you can help me get my life back. Thanks for your time. 

A:Thank you for your inquiry. For facial skin rejuvenation/restoration there are a variety of agents that can be mixed in with fat injections including PRP (platelet-rich plasma) and Bioburst rejuv which theoretically may work synergistically with the cells in the fat graft for a stimulatory effect on the skin including the stem cells that naturally reside within the fat graft. Processes stem cells, however, are illegal in the U.S. and are forbidden to use by the FDA. So any so called ‘stem cell’ procedures in plastic surgery really means injectable fat grafting. Otherwise these are marketing terms for procedures which are either approved for clinical use or don’t really represent stem cells at all.

I would need to see some pictures of your face to determine if you might be a candidate for this type of therapy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it a very short sighted decision to get hip implants when in say 20 years they may look terrible or need taking out? My skin now is very good and quite thick, I worry that as I age the implants will start to show?

Thank you.

A: Your question is a good one and I am afraid no one knows that answer because such procedures have not been done with decades of experience. So that risk is really not known. But in speculating about it I would not predict that would be an issue for you because the implant size (load to the tissues) is relatively small and the edges would be very feathered. With the perfusion holes in it is also merges with the tissues rather than just be an unattached object in a smooth tissue pocket. But I would think that might be an issue in patients with much bigger implants, just like large breast implants do in women with little skin coverage/thickness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have recently undergone orthognathic surgery and see the need to progress with jaw implants to address bony irregularities which have occurred from the operation.

Would the titanium plates in place after orthognathic surgery need to be removed to obtain a CT scan for planning and design of the implants?

If so, should the plates in the upper jaw region be removed as well?

I have heard that any metal in the head would distort the CT scan. Therefore, the plates need to be removed beforehand .

Thank you for your time.

A: There is no need to remove any hardware before getting a 3D CT scan and designing implants off of that scan. Such titanium hardware does not interfere or distort the 3D CT scan. So what you have heard is not accurate. That may have been true twenty years ago but not today. It is very common to design implants after orthognathic surgery of which there is hardware over the chin, jaw angles and maxilla. Should there be metal plates and screws which will lie underneath the implant, the design incorporates their negative image on its undersurface.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a genioplasty with you last summer. Since then I have had tightness in the right side of my chin. The tightness was mild and was progressively getting better each month.

A few weeks ago, the tightness was the worse it had been since I got the procedure. And almost every day it gets worse. Today is one of the worse days and the scarring is also more prominent. I also feel dryness in my lips as if I need to moisturize it.

This started the day I did a hard workout for the first time since the surgery. I don’t understand how a cardio workout would cause this so I don’t know if the two are related.

Is there any cause to be concerned?

A: Thank for what is now an eight  month followup. Your description of symptoms (tightness) this delayed after surgery is not one I have heard before nor the correlation with a typical workout. Thus I can not say why you have it and whether it will persist. But what I do know is that much healing has occurred since your sliding geniopaosty surgery including bone healing and I would not have any concerns about any problems with the surgical site in terms of infection or some impairment of the complete healing process. I suspect this tightness will become a self-resolving problem in a matter of a few more weeks or months. If not let me know and we can always check an x-ray to see what it looks like on the inside. It is also possible to inject some steroid intraorally see if it will make it better.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I did more research and noticed that sometimes you use an incision under the eye instead for cheek implants. Myquestions are: 

1) Which approach is more likely to get a symmetrical result?

2) What are the biggest risks of going through the eye lid?

3) Lastly, what is the recovery like when going through the eyelid? 

Sorry for all the questions, but I’m very interested in the eyelid approach in order to virtually eradicate the chance of infection. 

A: The incisions used for surgical placement depend on the actual design of the implant. But if the implant has a significant infraorbital component that saddles the bony rim then a lower eyelid incision is used for its placement. This is also helpful if the zygomatic arch component is very long and extends back to the zygmatico-temporal suture line.

The biggest risk in going through the lower eyelid, like any lower eyelid surgery for any reason, is ectropion or see slight malposition of the corner of the eyelid. But this is very uncommon in young patients who are not having an excisional procedure and the incision is used only for access.

Like all facial implant surgeries the initial swelling will be significant and will take a few weeks to become less disturbing…although the complete facial recovery is a 6 to 8 week process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have some eyebrow asymmetry that I wanted fixed by a browlift. Can this be done through a incision from the eyelid? Also what can eh done permanently remove the deep vertical wrinkles between my eyebrows? I have attached some pictures to provide a clearer understanding of my concerns.

A: Thank you for sending your pictures. When you mention the left eye, I assume the pictures are mirrored images since that is the eyebrow that is lower than the other side.

If that is the case, that degree of brow ptosis can not be well corrected by a transpalpebral approach as that browlift approach only affects the outer half of the eyebrow. All other methods of browifting, which are superiorly based, are more effective. Technically the direct browlift method with an incision at the top of the eyebrow is the most effective but the fine line scar is always a potential aesthetic concern.

Treating frown lines is one thing but they can never be permanently eradicated particularly when they are as deep as the two glabellar furrows that you have. They are so deep that direct excision of them with a broken line closure and dermal graft placement would be need to provide the best and most sustained improvement in their appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some form of a chin reduction. My chin is fine at rest but when I smile it sticks out and looks very unflattering. What do you recommend?

A: Thank you for your inquiry and sending your pictures. I assume your concern is the chin protrusion that occurs when you smile. The chin at rest or non-smiling position shows a normal chin. That is what is known as a hyperdynamic chin ptosis problem. It is an ‘excess’ of soft tissue chin pad that protrudes downward as the chin tissues pull back across the end of the chin bone.

This is a very challenging chin protrusion problem to improve as almost all chin reduction surgeries are designed to treat a static problem and not a dynamic problem. That means that trying to improve a dynamic problem may cause an adverse effect in the static position.

Having treated hyperdynamic chin ptosis cases before, the only effective approach is a submental approach where the end of the chin bine is reduced and some soft tissue chin pad is removed and tucked to decrease the dynamic protrusion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been 5 years using cocaine mainly through the left wide of the nose and that area of my face it is a little bit sunken and the part of the maxilla that makes the lateral shape of the nose it is more retracted than on the other side. Also the right alar sidewall is more elevated compared with the left side. I would like to know if its is possible to make a custom implant to reestablish the shape of my face and nose in a natural way. 

THANKS! 

A: By description it sounds like building up the bone would be helpful in the improvement of your nasal base asymmetry. I would need to see some pictures of your face that show this nasal/midface asymmetry to provide a more qualified answer as to what may be able to be done. But by description you are referring to the medial maxilla or the paranasal region. This can certainly be built up by a customized paranasal implant. While a a custom implant made from your 3D CT scan would be ideal, even a hand carved one made from ePTFE could be done at the time of the surgery and would be of good aesthetic benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For my cheekbone implants, I would like them to be placed high on the cheek and to stretch around the length of my zygomatic (like the implant on the right in the first picture attached) and to create an ‘ogge line’. One thing I’m kind of nervous about though is the possibility of having my cheeks augmented too much and looking very weird as a result. I see a lot of women on the streets who have fillers which make them look ridiculously bloated around the zygomas.

A: The key to having a natural looking cheek augmentation result, regardless of the style of implant used, is to not overdo it in terms of size. The cheek is a very sensitive area in terms of volume and a little bit does go along way particularly in small female faces. But this is an issue I am well aware of and I will know during surgery if such is the case and can make the necessary implant adjustments if needed to avoid that exact problem.

In addition injectable fillers notoriously can make the face look bloated because they are placed in the soft tissues and being a soft material they can make the cheeks look puffy and full. Fillers can not create a well defined cheek in most cases. Bone-based implants are different because they push the soft tissue away from the bone in a defined manner based on the shape of the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a setback otoplasty seven years ago and have been bothered by how far back they were set. My surgeon released the sutures and scar tissue several months after surgery but it did no good. Can a reverse otoplasty help bring my ears partially back out and by his much? Could it be as much as 1 or 1.5 cms?

A: I would estimate you can move the ears back out by 5 to 7mms with a reverse otoplasty.

While it is true you can place any amount of cartilage grafting behind the ear to push them out quite far, large cartilage grafts will result in not being able to close the skin incisions behind the ear used to place them. An often overlooked part of a setback otoplasty, when done in the traditional manner, is that a large segment of skin is removed from behind the ear. This has been an historic part of otoplasty for the past 100 years. It has been proven to be unnecessary, as it does not help create or maintain the setback ear position, but it is still commonly done today. As a result a skin ‘deficiency’ now exists on the back of your ear and this prohibits the amount of cartilage ideally need to be placed to push the ears back to their initial preoperative position.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a few more questions before I make the decision on the custom infraorbital-cheek implants.

1. From my research on silicone implants, I’ve read from one surgeon that they cannot be screwed in because the silicone is too soft and would risk rupture over time. But from my understanding you plan to screw in the implant, so how would it not rupture? is this because we are using “hard” silicone?

2. The same doctor told me that the “pocket” that encapsulates the silicone must be exact, or the implant risks micromoving and eroding the bone due to the friction. Is this because off the shelf implants do not fit exactly? 

3. I’ve also read about capsular contracture with breast implants due to scar tissue forming over time around the foreign silicone. What confuses me the most about this is the prevalence of silicone implants in Asia, especially for rhinoplasty. Seems like a bad idea if it is used so often. Is this an issue?

It’s very confusing getting different answers from every doctor…the medical papers provide me a better understanding but unfortunately they mostly talk about chin implants, but I guess the general concepts apply to all facial implants.

A: In answer to your custom infraorbital-cheek implants questions:

1) There has never been a problem with screwing in silicone implants, I have done so in thousand of silicone implants. Solid silicone facial implants are solid enough that they can be securely fixed with screws. The surgeon making that statement is inaccurate.

2) That is another inaccurate statement that has no biologic basis.

3) Capsular contracture is a unique phenomenon that has relevance to a soft tissue implant that is intended to feel soft and move around. That is obviously the opposite of what facial implants are indented to do….remain firm and not move.

4) In reality the basic concepts and biology of facial implants is not confusing. But most surgeons will little clinical experience except maybe with one type of implant or one specific implantation site make it very confusing by promoting statements that have no sound biologic basis. (as in # 1 and 2 above)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a mentoplasty to shave done a bone (almost spurlike) in order to lessen its size and pointiness. My chin now is a little more square due to scar work, age and tissue. I am interested to see if fillers/botox can soften my jawline with a little less squareness to the chin..

A: The squareness of a chin is not going to be improved by Botox (a muscle relaxant) or injectable fillers which will just make it bigger by adding volume. When you just depoint a chin it will, by definition, become wider…unless the depointing procedure also made an effort to desquare it as well.  Desquaring it secondarily requires tapering the sides of the bone….another surgical procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hope you are doing well! It has been a long while since we’ve talked. A couple of things happened and I would like to inquire with you before finally signing up for my surgery. 

Basically I am using a palate expander, I am hoping it would not be a problem for inserting paranasal implant? 

I also would like to know if you do any incision around the nose area during the fixation of the paranasal implant. I am scheduled for a corrective septoplasty in order to help my breathing in August and I am worried about the prior paranasal implant interfering with that procedure.

A: Good to hear from you. In answer to your questions:

1) The intraoral use of a palate expander has no adverse effects or connection with the paranasal implantation site.

2) The intraoral incision location is different from the intranasal location for a septoplasty. There is no anatomic ccommunication between the two sites and paranasal implants in place are not in the way or restrict access for performing a septoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is there a difference between a diced ear cartilage graft wrapped in a fascial graft and diced ear cartilage graft that us glued together? My surgeon used the glue one. Will it be more difficult to remove than the fascial one? Is there any special techniques required for such removal? Is there any complication associated using the glue in mixing the diced ear cartilage? 

Looking forward to reading your consultation.

A: I don’t see any difference in removing either diced ear cartilage graft to the nose. Both can be removed equally well. Undoubtably what you are referring to as a ‘glued’ diced cartilage graft is one mixed with either platelet-rich plasma (PRP) or fibrin glue which are autologous sealants and can loosely be called a ‘glue’. It would not be a true cyanoacrylate glue which would be toxic to a cartilage graft and would cause it to be absorbed. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting paranasal augmentation with you, but I have one main concern. Basically, I’m worried that if I get paranasal augmentation, it will project too far compared to my mouth area and make my mouth look like it’s sunk backwards compared to my paranasal region. Now I’m not referring to premaxillary augmentation, I’m purely referring to augmentation of the sides of the base of the nose, whilst leaving the premaxillary area as it is.

Am I right in saying that if you augment this area, it can cause this part of the face to stick out relative to the mouth? I’m just confused as to how that would work if the centre of the nose base (the premaxillary) around the anterior nasal spine isn’t moved forward.

I guess I’m asking for your general experience on whether purely paranasal augmentation can negatively affect how the mouth appears, or whether that’s something mostly applicable to moving the anterior nasal spine forward when the nasolabial angle is optimal to begin with? To be clear I’m not asking for specific comments about my own case, but rather your opinion on how this thing works.

A: I think your  potential concern is with premaxillary augmentation which is a central midface procedure. The paranasal region lies to the side of the midline and no matter how much it is augmented it can never make the mouth area look recessed. Unlike the premaxillary area which is a projection or structural convexity, the paranasal region is naturally recessed or has a  concavity surface contour.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m aware we have a virtual meeting soon to discuss a few things regarding the implants. I just had a question that I assume would be easier to answer via email since there are photos involved. I’ve attached an unaltered image of myself as well as an altered ‘morphed’ image similar to the one you provided a few months ago where I’ve extended the cheeks and jaw. I tried to make an after photo of what I could potentially look like following the implants. Would the current implant design achieve this look/size or would the implant need adjustments?

In short, what implant size would most approximately get me from the before to the after photo?

A: While the fundamental question you are asking is very relevant, it is a question which defies a predictable answer. As there is no exact mathematical or precise method to know what any dimensional element of a custom implant will exactly create in one’s external appearance, this remains the ‘art’ form of custom implant design. Fortunately having done many hundreds of custom facial implants I have developed a good, albeit not perfect feel, for what any dimensions of such implants may do. 

In that regard your own morphing is tremendously insightful as to your goals and they would be considered very ‘modest’ cheek and jawline changes to which the initial design draft was intended to create. While this is open to further discussion, your imaged result shows the importance of in your case of a ‘less is more’ implant design approach.

Dr. Barry Eppley

Indianaplis, Indiana

Q: Dr. Eppley, I am interested in butt and hip implants, liposuction to the arms, back, abdomen and inner thighs and possibly tummy tuck and rib removal. I would like to set up a in person or phone consultation. I have attached some pictures for your preliminary review and suggestions.

A: Thank you for sending your pictures. There are several ways to approach your body contouring with the following observations:

1) While the fat harvested from the abdomen, flanks, arms and inner thighs is useful for buttock augmentation it is unclear yet as to what your buttock augmentation goals. While it is most likely would not be enough for your buttock augmentation goals (yet to be defined)it it still useful to place around an intramuscular buttock implant if implants should be needed.

2) I do not see a need based on these pictures for a tummy tuck.

3) Rib removal MAY be useful if one is trying to maximize waistline reduction and wants t make every effort to do so.

4) Implants are the most effective strategy for hip augmentation as fat injections almost never work in that area and you don’t have enough to do it anyway…unless you want to invest all the harvested fat towards hip augmentation.

When you put all of these observations together the following is clear:

1) Liposuction of all involved areas is a foundational body contouring procedure for you.

2) The harvested fat can be placed into the buttocks OR the hips but not both.

3) Combining buttock and hip implants with rib removal is a pretty tough combination and is not advised from a recovery standpoint.

4) You can only combine two of three from #3 so you have to prioritize.

5) You could make an argument for liposuction, buttock implants, fat injections to the hips and possibly rib removal.

Buht as your exact goals are to yet clear, these are just some preliminary thoughts to consider.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had my cheekbone and jaw reduced a few years back. If I was to use bone grafts to push the cheekbone back out…would it be best to wait 6 months to a year before I consider a cheeklift? Or can cheekbone reconstruction and a cheek lift be done at the same time?  Thank you.

A: Since it has been a few years since you had cheekbone reduction surgery, there is no reason to wait any longer if secondary cheekbone reconstruction is desired. Treatment options include an anterior re-osteotomy with an interpositional bone graft, a cheek lift or a combination of both done at the same time.

The question you may be asking is whether you should wait to determine if you need a cheeklift after cheekbone reconstruction. It can not be determined beforehand whether tech cheekbone reconstruction will negate the need for the cheeklift or not. Thus you can argue to have the cheekbone reconstruction first and then see if the cheeklift is really needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, after skull reshaping surgery is the ear asymmetry also corrected?

A: Skull reshaping surgery alone will not correct ear asymmetry. That would need to have a specific ear procedure that can most likely be done at the same time as the skull reshaping surgery. Associated ear protrusions are common in skull asymmetry and can be addressed with otoplasty setback surgery. If, however, the ear issue is that it is set further forward or back on the side of the head from the other ear, that is not a fixable issue. The actual front to back position of the ear on the side of the head is fixed by its cartilaginous attachment to the ear canal. Only ear protrusions or an increased auriculocephalic angle can be improved by setback otoplasty surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I stumbled upon an article on this site regarding removal of Medpor chin implants and I have some questions. I had a Medpor chin implant made nearly 20 years ago, but very shortly after it was done, I changed my mind and decided to get rid of it again. I only had it for three weeks or so before it was removed/explanted. 

Since then I’ve been struggling with severe autoimmune issues and I’ve always felt that there is still something left inside my chin. Something remaining there and every now and then the chin gets a little inflamed. 

I went back to the doctor who performed the surgery and he claims that Medpor always comes out in one piece and never breaks off and that all I can possibly have left inside my chin is some kind of harmless body tissue. 

Is it possible that he is wrong about this? 

Would my body really produce so much tissue in such a short period of time? And shouldn’t that tissue be gone by now then if there’s no implant left to create it? And does Medpor break off easily even if it’s only been inside for a few weeks? 

I would really, really appreciate an answer to this. Thank you so much. 

A: While I obviously have no knowledge of your chin implant and the details of its removal surgery, the easiest time to remove a Medpor chin implant is within the first few weeks after surgery before any significant tissue ingrowth has occurred. Thus it is more likely than not that the implant was removed in its entirety. But that is a general statement based on my surgical experience with the material and not a definitive answer to your specific case in which I had no participation.

While all surgery produces scar, such scar tissue after twenty years would have been completely absorbed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had already double jaw surgery which improved my jawline as well as my chin. I really look good in the side profile. However, my mid face is not sharp. I would like to have model looks i.e., high cheek bones. Is it possible to achieve the look in my face, considering my face is chubby not slim. If cheek implants can be done in my case, can you let me know the cost?

A: Thank you for your inquiry. There are many different types of cheek implants but for the ‘high cheekbone’ look that requires a true custom cheek implants design t that wraps around from under the eye all the way back along the zygomatic arch. That would help create the distinct line of the midface that would be compatible with that of your jawline. If you combine that with buccal lipectomies you would definitely help create a less chubby looking face. I will have my assistant Camille pass along the cost of such surgery to you on Monday.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a question. I found this fantastic site that distributes custom implants and CT-Bone via 3D printing.

I am no doctor but it seemed absolutely amazing to me, and I was wondering if the custom implants you provide would be able to be made with such versatility?

CT-Bone for facial asymmetries (Xilloc)

I am very interested in skull reshaping surgery, and I would love to work with implants that are this customly designed. Would it be possible?

I am not sure how distribution works for implants among surgeons, but this site has impressed me wildly.

A: There is nothing unique in the world of 3D implant designing that this manufacturer does. That is common technology today. The designer and manufacturer that I work with on all my custom skull and facial implants, 3D Systems, has capabilities that exceed the company to which you refer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been doing a lot of research on my procedure with you. Just a reminder. I want a custom made wrap around chin/jaw implant, zygo/cheek implant. I’m thinking about having my forehead reduced aka hairline advancement. I also feel like my forehead has a nice brow bone but feel like my forehead is rounded and not flat. I was curious when you do your hairline advancement where the incisions are placed? Can you also reduce the rounded bones surface to be flatter. I was talking with a surgeon currently. He does a incision horizontally and two vertical incisions at the temple/recision area.  I was curious what your incisions are. Does the scar heal lumpy or smooth? Is the scar “almost” invisible?  I like this guys profile of his brow bone to hairline. 

A: By definition a hairline advancement has to have incisions at the hairline….there is no other place to put them. How far down it extends into and along the temporal hairline is an individual decision. And no hairline incisions heal ‘invisible’ no matter what you are told

But the incisions aside you are not a good candidate for this procedure. You have too far a distance to move the hairline if your goals are the pictures you are shown. You simply can not move your hairline far enough forward to help create a straighter or flatter forehead. In addition you can’t reduce our forehead to make it flatter, it is too round and the bone is too thin. You can only add to the forehead to increase its verticality and flatness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, We had a skull reshaping video consultation two Saturdays ago about my cranial abnormalities resulting in asymmetry and sagittal ridge deformity. I apologize that it has taken me so long to get photos to you as you had requested. Rather than taking new ones, I wanted to rectify that situation as I felt the photos I have attached are indicative of the oddities of my skull.

Thank you for your time that morning. I feel that working with you could pave the way to a brighter future for me.

A: Thank you for sending all of your pictures which show the combination of a sagittal ridge and asymmetry.

With the skull reshaping goal of a smoother rounder head shape you have two options:

1) Sagittal ridge burring reduction and augmentation of the asymmetry….while this is a logical approach the dilemma is that this will requires a significant scalp scar whose aesthetic trade-off may not be worth it.

2) The other option is to make a thin custom implant that covers the ridge and the asymmetry. This is more appealing from a scar standpoint as the incision to do so would be smaller.

As you can see each skull reshaping option has its own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I am a 57 old male with untreated scaphocephaly. Do you operate on old people like me to fix the shape of the head?

A: I have performed skull reshaping surgery for a wide variety of shape deformations on patients well into their seventies. So you are still young at age 57 by my standards for this type of surgery.

Please send me some pictures of your head for my assessment and recommendations.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I am inquiring about revision to my lower buttocks. I had a BBL in 2015 and since then I feel as if some of the fat dissolved. I now have a little bit of saggy skin I never had prior. I am not looking to add more size or fat grafting. (I’d like To avoid that if at all possible) However I am interested in fixing the bottom shape of my rear if possible.

A: Thank you for sending your pictures….that was tricky to do but you did a good job with it!

I can see that you have a very long buttocks and some loose skin at and along the ill-defined infragluteal crease. The only way to improve that area is with a lower buttock tuck which is done by excision of the loose skin and placing the scar along the infragluteal crease line.

Dr. Barry Eppley
Indianapolis, Indiana