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Q: Dr. Eppley, I had a surgery to correct my inverted nipples ten years ago and it did not work. It just left me with scarring. I read some reviews on your success with the surgery and wanted to get more information about how I go about scheduling a surgery living out of state.
A: I have found the best method for inverted nipple correction is to do a release and simultaneous placement of an interpositional graft. (e.g., stacked Alloderm wafers, dermal-fat graft) Whether that would be effective now for scarred down inverted nipples of long duration after a prior effort can not be predicted before surgery. It could only really be known by doing it. A prior procedure and scarring makes it more difficult than it would otherwise be. One test that could be help is whether you can manually make the nipple come out by gently squeeing on it. If so that is a very positive sign whether you have had prior surgery or not. I suspect, however, that yours does not even your prior surgery. That does not mean, however, that subsequent surgery may not be more successful.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have two questions for you:
1. I will be getting jaw surgery in order to advance both my maxilla and mandible. Would it be a good idea to let my surgeon know that I plan to see you afterwards for both custom jaw as well as midface (orbital and zygos) implants? Or would it not matter? I planned on telling him to give me the best aesthetic result he can from jaw surgery before I came to you with implants.
2. How much forward growth can be obtained from custom midface implants (orbitals and zygomas)?
A: It is irrelevant what you are going to do with your face after orthognathic surgery, custom facial implants not withstanding. That has no influence on how the orthognathic surgery is planned or done,
The amount of forward midface augmentation (not growth) that can be done with custom facial implants is in excess of whatever anyone’s aesthetic needs are.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to ask in general if it is okay to do a chin implant and cheek implant prior to jaw implant if I am considering a jaw implant as well. Or rather would it be better if all 3 implants are done at once (cheek + chin + jaw implant). Last question if a drill hole canthoplasty is done say 10 to 20 years later I wanted to do a revision are drill hole canthoplasties can it be done again does the orbital bone that’s drilled initially heal over time where another drill hole can be done again or would the previous drill hole still be used for future canthoplasty revisions. Thank you
A: Presuming we are talking about three separate implants (chin, jaw angle and cheeks), I don’t think the order matters. It is all a personal preference as well as which procedures have the highest aesthetic priority. When they are separate implants they can be placed at any time.
Most drill home lateral canthoplasties are done as high up on the lateral orbital rim as possible. So once it is done it can never be moved higher as there is nowhere else to go.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am considering having a large skull augmentation. And am considering no where or no one else in the world to do it other than you and your brilliant team!
I have uploaded the photos of the shape of my head to WeTransfer.I have taken a shot from each angle, to give a thorough idea of what my head shape is like, to give the best possible idea of what I may need. I have a long birthmark running along the top of it, and asymmetric ears which might make it hard to tell the true shape. I also have quite a few asymmetries over my whole head in different areas which I would like to be corrected with whatever method I choose for a perfectly smooth outcome from all angles.
I have also attached a few photos where I have outlined the areas I want volume to be added to. I have also attached photos of the look I am going for which is one similar to the shape of Amber Rose’s and ideally Jorja Smith’s head.
I have quite prominent facial features, and adding more volume to my head area, wether its through hair or the use of a hat, always takes the focus away from that, and balances it all out.
I have a few questions to ask before, so that I know I am clear on as much as possible before I move forward with important decision making. And also so that I can reference back to the answers whenever I need to.
1) Ideally, I would prefer to use a material such as PMMA instead of a custom fit implant, due to my assumption that it will require smaller incisions.
However if an implant is more suitable, will it be necessary to fly out to design the implant, and then back again for the date of the surgery? Or is it possible to design the implant without me being present, by sending over some sort of scan of my skull?
And if not would it be possible to make the implant within days or the same week as the date of surgery?
2) From the pictures, the shape of my skull and my desire for it to be, as an estimate how much can I expect this to cost?
3) How long after the surgery date would I be able to fly back home? And then resume casual non strenuous work?
4) What solutions for reducing the visibility of scars are there? Are there any good creams or treatments?
5) How long after (and if at all), before I can return to dancing how I usually do, which is very fast, energetic and involves a lot of head banging and sudden head and neck movement?
Thank you Dr. Eppley for taking the time to read this email, and answer my questions, I really do appreciate it.
You are the best! And I look forward to moving through with all of this!
A: Thank you for your skull augmentation inquiry and sending all of your pictures. To answer your questions:
1) Only a custom skull implant can provide such a large area of skull augmentation in a smooth manner with a smaller scalp incision. PMMA bone cements require a full coronal scalp incision for placement and such material can not be placed over any muscular skull areas…which much of your desired skull augmentation does. PMMA bone cement is not a skull augmentation options for you.
2) Based in the total amount of skull augmentation it most likely would require a first stage scalp expansion procedure.
3) Such custom skull implants are designed are from a 3D CT scan of he patient which can be done in a remote or virtual manner.
4) It takes an average of 30 days from the receipt of the 3D CT scan to got though the design and manufacturing process to have to ready for surgery.
5) My assistant Camille will pass along the cost of the surgery to you in a day or two.
6) Most patients fly home in one to two days after other surgery.
7) Scalp incisions can heal remarkably well and the most important component in how well they heal is in how they are surgically made and closed. The use of scar creams after surgery never hurt but they are not magical.
8) They are no physical restrictions after surgery, patients return to any physical activity as they feel fit to do. I suspect it will be a few weeks, however, before any ‘head banging’ sounds or feels appropriate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in shoulder widening surgery by lengthening the clavicle bone. How does the scapula move after the procedure and how much change can there be in shoulder width.
About the widening, does the scapula widen in conjunction with the clavicle ? Does the bi-deltoid width increase and by how much? Also why is there such little research on this topic across the internet.
A: The scapula moves normally since the AC joint is not involved in the clavicular bony lengthening.
A 2 cm mid-clavicular osteotomy and interpositoinal bone graft is done roughy increasing shoulder width almost 1 inch per side.
The scapula bone does not widen per se, its angulation changes slightly to accommodate the change in the lateral clavicular and AC joint positions.
There is an an approximate 80% correlation between the linear lengthening of the clavicle and the increase in the outer contour of the deltoid soft tissues. Thus about 2 cms per side.
Clavicular lengthening surgery is a rare aesthetic treatment for shoulder widening given that there are already two other treatments methods which are less invasive. (fat injections and deltoid implants) Thus it is rarely requested and is done by very few surgeons around the world leading to a paucity of any information about it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I hope you’re well. I am loving my rib removal results. I would like to know if complete buttock hip augmentation can be done if my current buttock implants are intramuscular? Can the size of my buttock implants be increased at the same time? How common is hip implant shifting and malposition? How much hip Augmentation can be achieved with custom implants? And my last question is have you done thigh augmentation with quadricep muscle implants?
A: Good to hear from you and I am glad to hear that the rib removal surgery has been successful. In answer to your questions:
1) I am not completely sure what you mean by complete buttock-hip augmentation but I assume you mean a confluent augmentation as the buttocks cross into the hip area. Having hip and buttock implants in the same tissue plane is really only most relevant to very thin individuals with little subcutaneous tissue for implant camouflage. Thus I think you are alright in that regard and a hip implant that extends back over the lateral buttock area, even with intramuscular buttock implants, will work just fine.
2) Secondary buttock implant enlargement can always be done as the first implant acts like a tissue expander. As a general rule up to 50% volume increase can secondarily be done.
3) For hip augmentation a maximal thickness over the defined central projection point can be 2.5 to 3 cms per side. But don’t let that number fool you as the surface area hip implants cover is much greater than buttock implants and thus their effects are more impactful than that linear number alone would suggest.
4) I have done thigh augmentation numerous times and have a specific thigh implant design to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I would be prescribed any pain medication for the post surgery aftercare for lip advancements while the stiches dissolve and while the incision closes up ? As my skin is very sensitive I’m worried I will be very irritated around the area and really don’t want to feel the need to itch the incision, feel too uncomfortable or harm the work you have done.
How long will it take for the incision to properly close up and for the chance of infection to pass?
Will it be possible to wear a pollution mask while I am out in public as I would prefer to cover up the incision while the stitches are in if possible
And how long will it be till I am able to wear lip stick /cover up around the area ?
And how long will it be till I can do exercise again?
Thank you
Sorry for the overload of questions
And if you have any recommendations for aftercare please let me know!
See you very soon!
A: In answer to your lip advancement questions:
1) Pain medication will be provided for yourafter surgery needs, although lip advancements are not particularly painful afterwards
2) Lip incisions heal well in about three weeks after surgery.
3) Lipstick can be worn in one week after the procedure.
4) You can exercise immediately after surgery.
5) You can wear a pollution mark any time after the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Overall, my aim is to have a more chiseled face but also want it to look very natural – currently have c. 2-2.5ml of fillers- done last year and I am happy with results. Might get 2ml more fillers for minor improvements in upper cheeks and jaw. Can the fillers be dissolved pre surgery?
Only started noticing a more droopy/chubby face after I turned 30
Looking for a more sort of a makeover (but natural) from Dr Eppley, happy to consider multiple minor improvements
Unhappy with my resting face (seems tired/angry at times) and smile (which is quite unattractive – as per all my friends)
Have had multiple filler since past 4 years for tear trough. Would tear trough implants be a good long term solution? Is the insertion via lower eye lid?
What sort of cheek implant would you recommend? I have attached a pdf of a result from Real Self which i really like. Can this sort of an implant be combined with a tear trough implant?
I am also intrigued by a the full jaw + chin implant i saw on your website. What is the typical downtime post such a surgery? Is the implant placed above the masseter muscle?
Assuming I go for cheek and jaw implants, would the temples then look hollow? In my opinion, they already look hollow but i can somewhat hide this when I have longer hair. They are really exposed when I have short hair.
Do I need ptosis surgery? Had an email exchange with an oculoplastic surgeon who said it will help for upper eyes after looking at few of my pictures. I am just scared of overcorrection in this sort of a surgery.
Rhinoplasty to reduce bulbous tip – not looking for anything significant, just a minor reduction, should look natural. If it goes well, may think of a more significant revision in a year.
Buccal fat removal? Will it help for a more chiseled look? Can you remove Buccal fat if I have a low fat body? I am aiming to reduce body fat to 15% in the next 3 to 4 months.
Double chin – This has been really bothering me since 2 years now. I visited two aestheticians regarding this, one suggested ultherapy because it was saggy skin and other suggested fat dissolving injections. I underwent ultherapy. I can see the jaw looks better now, still far away from the chiseled look I desire
Less curved/more straight eyebrows – hair transplant or any other options? An aesthetician told me Botox to lower central forehead may help, but I am not sure if that is correct, I haven’t seen/read anything about it online
Can something be done about lip asymmetry?
A:In answer to your facial reshaping questions:
1) All hyaluron-based injectable fillers can be dissolved before surgery.
2) Tear trough or infraorbital rim implants are usually inserted through a lower eyelid incision.
3) Combining a tear trough implant with a cheek implant is commonly done in my practice and is known as a custom infraorbital-malar implant.
4) All custom jawline implants, like standard jaw angle implants, are placed on top of the bone in a subperiosteal pocket underneath the masseter muscle.
5) Ptosis surgery will open up your eyes a bit. The technique used will determine how much upper load shortening is obtained. You probably just need a mullerectomy for a 1 to 2mm change.
6) Rhinoplasty surgery can help narrow a bulbous tip. Your thick skin would prevent any type of change from being too narrow or looking overdone.
7) For facial derounding/slimming you need buccal lipectomies and perioral and submental/neck liposuction.
8) Any change in the shape of your eyebrows os one of hair management strategies, not a surgical or Botox treatment.
9) Your left upper lip asymmetry is of less vermilion show on the left upper lip. To correct it that requires a vermilion advancement on that side by a few millimeters to match the right sided vermilion show.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am hoping to replace the standard mandibular implants and chin implant with a custom wrap around vertical lengthening implant. I am a little over 3 months post op and still have a lot of swelling. The doctor that did my procedures told me that he thinks that the right mandibular implant has shifted forward. After the procedure, he told me that he didn’t use screws. He offered to do a revision and said that he would put the mandibular implant back in place and shave it (if necessary) as well as bring it as far back to my ramus as possible. Being the result I wanted was a strong (drop down) vertical lengthening to my jawline. He also “repositioned” a previous botched chin implant that had migrated and shifted upward on my chin and had caused bone resorption. He was actually supposed to replace the old chin implant with a new one (that was more squared) But, unfortunately I was told after I awoke from anesthesia, that he had decided to just use the old one I had and just repositioned it more downward. Needless to say, I’m very unhappy with this result. I’m hoping and praying that you can help me!! I have attached some pictures of the RESULT/GOALS I’m aiming for. Do you think that a custom wrap around vertical lengthening implant will get me close to my desired result? Also, would you recommend a larger more square implant, and or a sliding genioplasty?? Any recommendations by you is greatly appreciated!!
Thanks again so very much.
A: Thank you for detailing your surgical history and your current situation. First and foremost, whether it was your original surgery or any revision thereof, your desired goals based on your model pictures were never realistic. That is not going to happen with any standard or even custom jawline implant. You don’t have the facial anatomy for it. That requires a very thin face that is already skeletonized to achieve that degree of facial definition. Your original surgeon or any subsequent surgeon should have provided realistic computer facial imaging that could show what is possible with YOUR face. You can’t get someone’s else facial shape…which is basically what showing those type of ideal facial shapes is trying to achieve.
Secondly most facial implants revisions or replacements require a 3D CT scan in my experience so the exact placement of the implant can be known. From that better implant positioning can be obtained ad/or new implants made that will have an improved facial result. You don’t guess or eyeball facial implant revisions/replacements…that is a recipe for just creating ongoing aesthetic problems.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I got hip augmentation with implants but i’m not happy with them. The doctor has his hip implants, and although i got the largest, it’s pretty clear they were made for someone smaller (i’m 6’1″ and about 180lbs.) I was doing a bit more research and came across some pics that you posted:
These are much closer to what i am looking for and if they could be scaled for my tall stature…(!!!)
i’ve also got some ideas that i was curious what you’d think….
first the easy stuff: for reference here is one of the pix i sent you post op:
Would my current hip augmentation be similar to breast augmentation, where the first pair stretches the skin a bit so that a larger implant could replace it? in other words, could the fact that I have already had hip implants and that area has already been stretched a bit, mean there is a possibility that I might be able to get implants with a ‘higher superior profile?” I’ve always admired pear shaped women, or women with thick thighs. I am black and there is a lot of emphasis on thicker lower body shapes, so i’m hoping this is the case. I’d love it if i could have a shape similar to Ely Ivy (or as close as we could get to it):
I’d prefer something longer rather than shorter because of my height, if possible. I know you can’t go as high up as the following illustration, but wherever the start, ideally I’d love it if they’d taper at mid thigh like drag queen pads. I’d absolutely love it if they could have the upper thigh curve of the second pic below (and maybe some of the booty shaping on the left side of both pads?)
Speaking of the height of the implant, is there any way to make a small pocket above the implant to make it go up a bit higher? i know usually surgeons make one pocket, then slide the implant in, but i was wondering if something more like a envelope pillowcase would work.
Instead of there just being one pocket there would be two, a smaller one above the incision, and the main one below. This way the implant could be just a little above the incision line. would that work or is it still impractical?
You had some questions about my prior hip implant surgery so i’ll include those with the answers below (to the best of my knowledge):
1) Where are the incisions for the hip implants?
Below the top of the hip. if you look at the pix, you can see the white of the bandages.
2) What type of material for the hip implants?
The same used for butt and calf implants; soft, semi solid silicone.
3) What type of implants were used since there are no standard hip implants?
It was a specific rounded corner triangle shaped implant made specifically for hip augmentation. It is placed downward pointing underneath the fascia, below the top of the hip.
4) What is the tissue pocket for the implants?
It is placed downward pointing (the shortest side of the triangle at the top) underneath the fascia, below the top of the hip. i do know he keeps it at a certain weight to prevent any migration. because i am looking for something longer, that adds to the total thigh thickness as well as hips, i am hoping that a pocket can be made beneath muscle or another implant could be placed beneath his implant and muscle.
So my questions:
- What is the approx. cost of your hip implants (including room, anesthesiologist, etc) I know i’ll need a consult, but to plan, i need a ballpark estimate. 🙂
- Like breast augmentation, would my first implants allow me to replace them and get bigger hip implants with you, since the skin has been stretched by them?
- Do you think we could get anything close to Ely Ivy’s pear shape?
- Is implants that go down to mid-thigh be possible, with my question #2 in mind?
- Would the double pocket envelope pillowcase idea work?
A: In answer to your secondary hip implant questions:
1) Having existing hip implants is both beneficial and a disadvantage. Stretching the tissues out is the helpful part as that would allow for a greater implant size increase. The negative is that the existing implants have created a scarred capsule which makes extending the tissue pockets, a necessity for larger surface area implants, more difficult, Not impossible but the bottom part of the pocket, which is the furthest away from the incision, is a hard place to reach. But given that you would need a new tissue pocket above the fascia makes your existing implant pocket irrelevant.
2) For your goal standpoint, given where you are now and what your pictorial goals are, I do not think that is surgically achievable in a single operation. Realistically it would likely be about closer to halfway between the two.
3) Going higher with new hip implants is not an issue, it is how far down the thigh one can go that is always the greater challenge. But clearly you have to and can go longer down the hip/thigh that where you are now. Hip implants are unique in that they need to cover a lot of surface area to create their effect. They are not rounder mounds like buttock or breast implants.
4) The incision would be at the same location that you are already have. They may be longer, however, although I don’t know/can’t see how long yours are now.
5) Hip implants in my practice are all made custom out of ultrasoft solid silicone.
6) To cover the larger surface areas of most hip augmentation patients the implants need to be on top of the TFL fascia, not underneath it or in the muscle. Those pockets are much tighter and more restrictive.
7) While you have the general shape of the implant design, the illustration is too big and thick.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Attached is a morph (current is on the left) of what I am hoping to achieve with facial reshaping surgery.
Jawline:
A few years after I had the sliding genioplasty with you, I had a chin implant & fat transfer to the chin done by a surgeon close to me. However, the shape is not smooth or natural. I suspect the fat injection is causing an unnatural contour – specifically, a ridge higher up on my chin. Would it be possible to remove the injected fat possibly by small cannula liposuction? I’ve attached a photo of me smiling where the ridge is more obvious.
Nose:
I would like some more projection and structure overall. As I understand it, the dorsum can be augmented with an implant but the tip must be cartilage. Is this correct? Would it be simpler to just use rib for the entire nose?
Brow bone:
I am okay with a subtle increase in projection. You’ve mentioned that pre-formed brow bone implants are also an option. Is there any advantage to going custom since the jawline will be customized as well?
A: In answer to your facial reshaping surgery questions:
1) The approach to removing some of that fat from the chin would be using a microcannula technique, a 1.5mm cannula. That would have the least risk of causing irregularities.
2) You are correct about using implants in the nose. They should be restricted to the dorsum and cartilage should be used for the tip. Thus usually means that the septum or ear cartilage harvest will suffice for the tip. It would not be ‘simpler’ to use a rib graft since it requires a donor site. The logic of using a rib graft wold be if one wants to avoid the use of an implant in larger nasal augmentations.
3) If you are going to have a custom jawline implant then it would be best to just have the brow bone made custom as well. That is because the design and manufacturing cost is less for the second concurrent custom implant and there would be no economic advantage to using a performed special designed brow bone implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question/concern about my jaw implant revision coming on on the 14th of this month.
I initially raised a concern that the left implant seemed too low. While there is definitely an asymmetry/difference, I was wondering if the right could also possibly be too high? The reason is the right jaw angle does seem quite high compared to the design, image predictions, etc.
I previously assumed it would be almost impossible for an implant to be too high, since the implant appears to wrap around the bone in the design. But on the other hand I’m not sure if this part is trimmed during insertion? Is it possible that the right is also too high?
A: In answer to your custom jaw angle implant revision questions:
1) In 3D CT reconstructions of implants, they will not look like implant design drawings. The very thin edges of the implant are often missing as there is not enough material information present to be ‘seen’ in reconstructed images. That is also why they look fuzzy and irregular unlike the smooth and confluent design they have both in the design drawings and in real life. Thus I would not over interpret the finer details of the scan.
2) What counts at this point is what it looks like on the outside and not the inside. In other words treat the patient and not the x-ray.
3) The most successful facial implant asymmetry corrections comes from taking the ‘bad’ side and trying to match it to the ‘good’ side. When you try and move both implants you dramatically increase the risk of ongoing facial asymmetry…just of a different kind. This applies to custom as well as standard implants.
4) I would be very hesitant at trying to lower the right implant because of two potential risks: 1) infection. (you double your risk of infection by operating on both sides) You just got away with it the first time on one side. I would be very cautions at spinning the ‘roulette wheel’ the second time. 2) Masseteric muscle dehiscence. You have to break though the surrounding capsule as well as do further release of these soft tissue attachments. It is hard enough to avoid it the first time. But releasing the scarred capsule which is attached to the thin muscle layer at the inferior border makes that more precious the second time. The latter risk is one you don’t have on the lower side because it is an upward release and movement, not a downward release and implant movement.
In summary, implant surgery is all about the benefits to be obtained vs the risks involved in doing so. While this is true of all surgery, the stakes in implant surgery are much higher since it is an unnatural implant being used rather than just using one’s natural tissues. The balance of those two issues is much more precarious on your right side than it is on the left. I have seen far too many patients with overall good results, and in the pursuit of a small incremental benefit, incur the downsides only to look back and wish they had left their ‘90% good result’ alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very impressed with the work that Dr. Eppley does. I am a college student (male 19) who has a weak brow bone which makes me look feminine. But I want to look like my father, he is german and has very deep set eyes with a prominent brow brow comparing to Brad Pitt, Leo Dicaprio, Chris Hemsworth, Mark Wahlberg, etc. They all commonly have a very similar looking prominent brow bones that I very much desire. My questions are; can you create a brow bone that is very similar looking to the listed people I mentioned. For whatever reason I’m not satisfied with the result, can it be removed?
A: Thank you for your brow bone augmentation questions. The tightness of the brow skin and the degree of brow bone hypoplasia are factors in how much brow bone augmentation can be achieved. So what your brows look like now compared to your goals is key in determining how much change is possible. I would need to see some pictures of your face/brow bones to make that determination. It is also important to recognize that the position of the eyebrows can be very difficult to bring down with brow bone augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, So i did get a jaw and chin implant surgery from a different surgeon in the end of October 2018 but I’m not happy with the results because its too big and asymmetrical. I did consult another surgeon in my area and he did agree thats it’s big for my face. Im considering getting a custom made jaw/ chin implant instead. Would Dr Eppley be able to make a custom implant even though I have the existing implants. Does he have to remove it first before he can measure the dimension of the custom implant?
Thank you
A: Having existing chin and jaw implants in place is actually very helpful in designing a custom jawline implant because you know how to better design a new implant. By taking what is disliked with the indwelling implants it helps guide how to make a new implant better. About 1/3 of custom jawline implants patients I see have chin and/or jaw angles in place.
The 3D CT scan used for custom implant designing will show the existing implants, which are then digitally removed to design the new ones, and then digitally overlaid back over them for comparison purposes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think I’m definitely wanting them done. would you like me to send pictures of my hips? Last questions.. how long do they last, do they need replacing after a certain timeframe? Would they last 10 or 20 years or more? Is there risk of contracture like breast implants? Would they ever shift? If you for whatever reason in the late future you aren’t available anymore, not saying you would but If you did for example.. do you think there would be a way to get custom implants redone with anybody else, say if I was much older and something happened to the implants and I needed them redone.. just thinking about the future as well because they aren’t my own fat this time, they’re implants. But I’m very keen to get it done because the fat transfer has gone away in my hips, and I really want the hourglass shape in my hips. I’m happy with my butt, it’s just the hips I would love to be round and hourglassy. So i think I’ll definitely go ahead with the hip implants if you think I’m a good candidate after you see my hips.
Thank you
A: Please send me some pictures of your hips.
Hip implants are made from a solid silicone material so they would never need to be replaced due to implant ‘failure’…since they don’t fail like breast implants can and do.
While custom hip implants may be uncommonly done by few surgeons today, like everything else in life progress continues and what was once uncommon becomes more commonly done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How Much Bone Erosion Should I Expect for Mersilene Mesh Nose Implant removal That Was Taken Place almost 7 Yrs Ago?
I had a double layered of Mersilene Mesh implant inside my nose to augment the nasal dorsum implant inserted 7 yrs ago. I’m planning to remove it soon due to health problem and because I prefer the original me over the implant. However, I have some worrisome about the bone erosion that is brought by the nose implant as well as collageneous built up capsule formation after mesh removal, Will I be swollen for a long time because of that capsule?will I have saddled drooping tip after mesh removal since I used to have a small nose? And if so, how to prevent this from happening? Will I be able to get back to the pre-op nose? Many thanks!
A: There is not going to be any bone erosion from a Mersilene marsh nasal implant removal. The scar tissue that is created from the implant largely goes away with time.
Like all implants placed anywhere on the face or the body, their removal does NOT take one back to their exact preoperative shape or form.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I got revision surgery with Medpor cheek implants and chin implant (through the mouth) five weeks ago. As my surgeon lives in a different state, I was very paranoid about the possibility of getting an infection. For the first post op month, I put myself on a very strict diet of liquids and no chew foods (e.g. porridge) so no food got stuck in the incisions. I had taken oral antibiotics post surgery and bought myself a gargle even in fear of getting an infection.
Now at 5 weeks, I fear the worst has happened. The left cheek implant and chin implant are very sore and painful and red. There is also some slight pus that oozes when I press on the areas. I contacted my surgeon and was told 5 weeks out of surgery the infection was probably caused by myself, rather than the surgery itself. He told me that if the infection was from the surgery itself, it would’ve been apparent in the first week to three weeks post op.
From your experience of implants, what would be the reason why an infection occurred so late. How common is it to have an infection appear suddenly beyond the first month?
A: This is not a late infection, this is exactly when it happens. Most facial implant infections do not occur before 3 weeks after surgery and can develop as late as 8 weeks after implantation. This is why I always tell patients that the risk of infection is not 100% past until three months after surgery.
All such infections occur because they got either got inoculated during surgery or got contaminated after surgery due to a wound opening. Either way it is not the patient who can cause an infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have setup a virtual consultation for temporal reduction. I should note that I think both the anterior AND posterior portions have too much convexity for me. It starts to bulge just a couple millimeters before my hairline begins. When I look at my face in the mirror, the anterior portion is what stands out the most; in fact, if I open my mouth as far as possible, the bulge/muscle seems to migrate down the side of eyes, creating a fairly flat side. I can show you when we chat. I think removing portions of the temporal muscle from both the anterior and posterior would be ideal for me — though I’m not sure if this is regular part of the procedure or not.
A: Thank you for providing that information. All temporal muscle regions look smaller/flatter when the mouth is opened because the muscle is elongated as the lower jaw pulls it downward as it opens. While the posterior temporal muscle can undergo a dramatic reduction due to surgical access, the anterior temporal muscle can not be so significantly reduced as there is no direct access to it without undue scarring. Thus no surgical reduction efforts of the anterior temporal muscle can approximate the effect that opening one’s mouth does.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty about 14-months ago. The procedure left me with lower lip incompetence and a pulling down tightness of the lip. I tried to have the surgeon reverse my genioplasty in the hopes of relieving my symptoms but he was fearful the bone would split/crack with the removal of the plate screws. So, instead he shaved the bottom portion of my chin bone to release some soft tissue tension. Though the surgery did relieve some tension, I still have all the same issues and now the muscle that runs the front length of my chin now protrudes, as if it is not attached to the bone. When I push down on this muscle with my finger, it releases the tension in my lower lip, but when I remove my finger from pressing down on the muscle, the muscle flexes and immediately pulls down my lip. So, I have two questions; can this muscle be reattached to the bone and keep it from protruding/flexing, and my second question is, how many mm of bone can be safely shaved from the bottom of my chin? The surgeon who shaved my bone said 3-4 mm was removed and I am wondering if more can be taken? Thank you in advance Dr. Eppley.
A: Thank you for your inquiry an detailing your sliding genioplasty history. Why your chin was subsequently shaved instead of the whole bone being move back (sliding geneoplasty reversal) is baffling. It makes no surgical sense at all that the bone would fracture if it is recut and move back. I have done that many times and have never seen it to be a problem. The problem with shaving is actually what you are experiencing….lax soft tissues. You should have had the sliding genioplasty reversal procedure and not shaving. Shaving and a sliding genioplasty reversal does not have the same soft tissue effects.
Whether you should just have the bone cut and moved back depends on how much your chin was initially advanced and what your chin bone looks like now in a lateral cephalometric x-ray. Either way the soft tissues appear to need resuspension.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting to get a non-surgical nose job in the next few weeks. Also interested in getting some filler in my upper lip as it is kind of flat and smaller than the bottom lip. Just wanting to know if I am a good candidate and an estimate on cost. I know there are a couple different fillers, but not sure what is best for this sort of procedure.
A: An injectable rhinoplasty works by adding volume so its use is restricted to a few specific types of nasal deformities, In looking at your pictures, I assume what has drawn you to this approach is to fill in the ‘depression’ above your hump….which is the type of nasa shape issue which an injectable rhinoplasty works the best. While this does smooth out the dorsal line in profile, it also makes the bridge look higher. But as long as one can accept that tradeoff, it will make get rid of the hump.
This approach to your nose reshaping is a good short-term treatment. In the long run we know that surgical reduction of the hump with rhinoplasty surgery is best. But this is often an easy and good starting point for some patients.
Like the lips, the best fillers to put into the nose are any of the hyaluronic-acid based materials. (e.g., Juvederm, Restylane etc)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would the “shape” of what i guess is my ramus be a problem for attaching jaw angle implants? All the x-ray that I find on Google seems to have a L or two straight lines form so I don’t know if this is normal. I hope that the attached pics explain better what i mean.
A: Everyone’s bony jaw angle is not square, it is round. Thus to make a more square or pronounced jaw angle it takes a special designed implant, usually a vertically lengthening implant, to be precisely positioned over the bone so that some of the implant is not on the bone to create the new jaw angle shape. That is not easy to do and get it perfectly positioned for symmetry between the two sides. That is the challenge in many standard jaw angle implant placements and accounts for why asymmetry is the number one aesthetic issue in jaw angle implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks for explaining custom hip implants to me. I think I will go ahead with it 😊. Can the scars be hidden by underwear or bikini bottoms? Does it look natural when seated or in different positions, and is it hard or soft? How long is the recovery period. Will I fly over for a consult to measure and get them made weeks before my surgery?
A: In answer to your custom hip implant questions:
1) I would have to see pictures of your hips (front, back and sides) to both determine your candidacy for the procedure as well as to mark the location of the incisions.
2) In my experience whether any edging is seen depends on your natural tissue thickness. In very thin females this can be a potential issue.
3) The custom hip implants are made of a very soft (low durometer) solid silicone material.
4) The recovery period depends on how you choose to define recovery but I would most patient return to fill activities within a month after the surgery.
5) Measurements for the implants are done using patient’s marking on their hips where they want the surface area coverage (foot print of the implant), the location of maximum projection and an estimate of how much this maximum projected area should be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, As for the cheek implants, I was running on my deck last month and slipped- hit my brow (split it open, now a scar) cheek bone and some rib cracks- landed on the brick, hit so hard and fast it knocked me out for almost a minute! just starting to heal from that, what concerned me was if it had the cheek implants, what would have happened to the screw in there- it would have been jammed into my bone or broken off.
A: Your question is a good and not uncommon one…what would happen to my facial implants in the event of trauma? Despite having placed thousands of facial implants over 30 years, and certainly some of those patients have had facial trauma, the actual clinical situation or complications has never occurred to my knowledge.
I would hypothesize that nothing adverse would happen because the implant is ‘locked’ into place by the surrounding scar tissue. (capsule) The screw at that point is not what is holding it into place. The purpose of the screw is to merely hold it into the desired position long enough so that the scar tissue grows around it and secures it into place. The scar tissue or capsule has a shrink wrap effect on the implant. The scar has not purpose at that point and is a passive device at that point. These are screws are very small son they are neither going to break off or become displaced into the bone.
Conversely, I have always argued that implants have a protective effect on the bone because they are softer than it is. Like a piece of firm rubber you can’t break them, like bone or glass, and they merely allow the force to be displaced (deflected) outward…protecting the underlying bone much like a bumper guard.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need your consultation. I’m a female and I had three previous rhinoplasties. In the last nose job in 2012, my nose was implanted with double grafts of mersilene mesh on dorsom. I have a lot of side effects because of the mesh implant. The mersilene mesh shows through the skin and makes it red as well as difficulty breathing at night; the mesh is attaching my immune system causing me a lot of diseases osteopenia, high Rheumatoid factor, unable to digest food, pain, cramps, etc. Besides, I hate the look cause it looks bigger with hump and deformities and does not make me breath well while sleeping and I hate everything about the change of my nose and would like to undo everything, remove all those implants. What is the complications and risks of nose mesh removal specifically after 7 years and is it possible to revise the nose at the same time removing the mesh implant? Can you perform such complicated surgery? Please advise
Looking forward to hear from you.
A: While mersilene mesh allows tissue ingrowth and is harder to remove than some implanted materials, it is not impossible to remove and it can be done so. Because the mersilene mesh removal will result in some soft tissue loss and tissue thinning, it is important to realizer that the tissues over the dorsum will not return to what they were before they were implanted. Thus you should probably consider having a thin allogeneic dermal graft (0.5mm thickness) placed in its replacement to compensate for the thinning of the overlying skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, You are correct in saying my soft tissues are lax after an intraoral shaving chin reduction. At the bottom of my chin, the skin is loose and has not contoured around my chin bone. When I push up on this lax skin under my chin along the bone, it resolves my lip incompetence issues. The function of my mouth improves, as well as the appearance when I push up on this sagging skin. It is approximately a quarter of an inch sag. I know you mentioned resuspension in your response and was wondering if that means attaching this soft tissue in place somehow? In my mind it seems to be an easy fix of my symptoms, because it resolves with a simple push with my finger. Is it a much more complicated surgery to get the same effect internally?
Thank you
A: While an intraoral soft tissue chin pad suspension can be performed, it is fair not say that it may not completely replicate what you are doing with the ‘simple push of your finger on the lower loose chin pad. That is not always a completely 1:1 correlation in my experience between the preoperative ‘test’ and what surgery can create.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just had a question regarding the masseter muscle and the buccal fat injections to the jaw angles.
1, Will the buccal fat injections look defined or just fat/bloated?
2. How much do you think my masseters would shrink from botox injections, would I be able to chew gum without them revealing themselves?
I’ve seen some dramatic results from botox injections in the masseters so I’m hoping I would be able to achieve a result where they are virtually non detectable, if you’d make a guess, do you think that’s possible?
3. Let’s say the buccal fat injections does not provide enough augmentation to the angles of the jaw, is it possible at a later time to inject fillers there to augment it even more?
Thanks again!
A: In answer to your questions:
1) Fat injections will not create a sharp or defined bony look. They create a softer effect as is is a soft material that pushed out on the tissues.
2) How much the masseter muscles will shrink depends on the dose/units of Botox injected. I am not sure that will ever shrink enough to not be visible when maximally working them like in chewing gum….but it may be possible.
3) You can always add synthetic fillers after fat injections, that is not a problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was surfing the web to check about my illness. After spending a lot of time, I somehow got lucky to find this article on your website. I believe I have the same problem. (Zygomatic Bone Arch Tumor). I have the same little bony bump on my left side of the face exactly as shown in the xray on your webpage.
Since, I don’t live in the country where you live, So unfortunately I wont be able to get treatment from you. But I have some questions, which I believe you could answer to in order to help me.
My questions are as follows:
1. Does this surgery leave prominent scars on face?
2. If yes, Can these scar be made go away?
3. Does this surgery help in making the face asymmetrical to symmetrical?
I hope to get a good and quick responce from you. Your cooperation will be highly appreciated.
A: In answer to your Zygomatic Arch Tumor questions:
1) Depending upon the location of the bony tumor on the arch would determine the method of surgical access. Since I have done several cases if this type of bony tumor I am not certain where in the arch it is located in your case. But as a general rule surgical access is done intraorally so there is no external facial scar.
2) The best way to make the diagnosis is with a 3D CT scan which I assume you have since you appear to know were the bony tumor is located.
3) If the bony tumor is a source of facial asymmetry then its removal will help to improve facial symmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to address three outstanding concerns.
1. I understand the Superolateral OR forms the top and side protrusion of the brow bone. However, I wanted to ensure that this top area would remain untouched, as the concern is not so much brow protrusion, but rather the thickness along the side and at the base of this (near the zygomaticofacial foramen) to provide the angularity desired. In fact, I would rather appreciate having has much “side brow protrusion” as possible, so I wouldn’t want this “top” area reduced. I attach a picture (skull) to illustrate this concern: I would rather leave the protrusion provided by the superolateral rim alone (region A) and rather focus on shaping the angularity of the circled region. Perhaps you could provide some clarity on this.
2. Another issue of great concern is the procedure itself. Is it truly necessary to peel forward the face to achieve the aesthetic result? It seems this is drastic (in terms of exposure of the surface area, infection risks associated, shaving the head, healing time, among many others) and I was hoping there would be an endoscopic alternative or lateral incisions that could be made along the temporal region or at the base of/along the rim itself.
3. Finally, I wanted to make sure that we were in agreement with regards to the aesthetic result. I would like to ensure that the cheekbone area/zygoma remain intact in its width and protrusion. The simple changes I wish to make are essentially a small indentation along the temporal region (see attached photo face example, region A) to result in an indentation between the brow and zygoma (region B). I do not wish to drastically change my face by any means. It is important for me to know if you believe from your professional perspective if this procedure will produce a significantly aesthetically pleasing result in terms of facial balance and angularity, or if you believe this would simply satisfy a request to change a proposed anatomical irregularity. I attach two final photos (a before and after) with an example of the intended aesthetic result. I am interested in what you think.
Many thanks for all.
A: In answer to your questions:
1) The zone of bone reduction is decided and marked before surgery so there is not confusion as to where to go and not to go.. I think as you have described it is pretty clear that any aspect of the brow bone is not part of the lateral orbital rim.
2) While perhaps a full coronal incision does make it a bit easier to do, I would need think that effort and scar tradeoff would justify that approach. This leaves us with three incisional options, either alone of done in time combination, upper eyelid, lower eyelid and intraoral. The outer half of the upper eyelid incision would be the most practical with possibly an intraoral component as well.
3) You are specifically referring to a lateral orbital rim reduction, which lies between the tail of the brow bone superiorly and the main body of the cheek (zygoma) inferiorly. That would create an indentation between the brow and cheek bones. As for the anesthetic outcome I can only comment on its aesthetic effectiveness based on your own description and imaged illustrations…if that is what looks good to you then can say this procedure is what can do it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, People starring all the time at me. I dont know if its cause of my unnatural look or cause of my lips. I had 6 month ago a underlip reduction. Me for myself i see the shape and all of my complete lip as not beautiful. I would like now to know with this last email what you suggest me to do that people stop starring in a bad way to me. I have taken a pic in the sunlight. It would be nice if you would be honest to me and my situation. I had a lot of surgeries and i dont want to make it more worst so what you suggest me now to do?
Thank you
A: I can not comment on what other people do or why you have the feeling they are staring. Whether they are or not and, if they are, why do so I can not say.
What I can say as a general statement is that people’s perception of other’s, contrary to what most patient’s think, is usually never one specific facial structure or area. People see more the overall facial picture (gestalt) rather than specific facial features. The analogy would be in art….you may know a work of art by its overall perception of what it creates (e.g., farmer standing in a field) but most don’t see or remember the details. (e.g., was there a cow in the field, what was the color of the farmer’s pants etc)
The face may be made up of numerous individual features, which the person themselves knows very well in detail, but someone else does not see it that way. They just know the overall impression or look that all of these individual features creates. (the composite image)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have a complete facial feminization surgery.
Do you take a more subtle conservative approach, or would you do something more aggressive if I wanted to? I have a very big dysphoria about my face, and I want a radical change.
A: In FFS surgery the first step for me is to determine which of the numerous procedures has the greatest facial effects. From there computer imaging is designed to try and determine what is the extent of change from each procedure that the patient seeks. My goal is to find try and deliver the type of change the patient wants as well as educate the patient beforehand as to what is and is not realistic.
It is important to remember that the amount of facial change that is possible with surgery also depends significantly on the patients natural facial shape…which may or may allow the radical change hat you seek.
Dr. Barry Eppley
Indianapolis, Indiana
