Your Questions
Your Questions
Q: Dr. Eppley, I just would like to know if you can help me with a procedure. So, I would like to have a silicone implant in my head to grow 2.5 cm for my job and my career. My career requires me to have at least 166, but my size is a 163.5 . I know that this procedure is common in Spain. People do it to grow taller. Please let me know if you can help me. Thank you very much.
A: Skull augmentation with a custom implant can be done to increase your height by 2.5 cms. But this will require a first scalp expansion as no one’s scalp has enough flexibility to permit such a large implant to be placed without it being stretched first.
With the immediate insertion of a custom skull implant one’s height can be increased by about 12mms or 1/2 inch due to the limits of scalp stretch. With a first stage tissue expander the thickness of the implant can be extended to 25 to 30mms (one inch) due to the scalp stretch obtained.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very long face, it’s actually long through out and while i am looking into hairline lowering/hair transplant , and have already had a chin reduction , the mid face and the part of the lower face that is between the lips and the nose appear to be harder to address. Can a Lefort 1/maxillary impaction help to reduce the vertical length of that part of the face between the lips and nose? Also, I am thinking the impact to the mid face (brows to the tip of nose) would be minimal, but some doctors says optically the surgery has the potential to make the mid face look shorter, what are your thoughts?
Also, will shortening the maxilla actually shorten the vertical length of the nose on the frontal view? Or is there any surgical maneuver at all that can reduce the length of the nose (frontal view) when the tip is already at a good position and not drooping? I think we are constrained by the nasal cavity here.
Thanks for your time.
A: In short, there is no effective procedure for reducing the middle third of the face unlike the forehead and chin. No bone shortening procedure shortens the visible midface, it only affects the amount of upper tooth show. A lip lift, which shortens the distance between the base of the nose and the upper lip is the only procedure that provides some vertical midface reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve had decent results from Botox to correct temporal hypertrophy, but the results are always temporary unfortunately, so I’m looking for something more permanent. I have a few questions please .. .1) I think the muscle is thickened in both anterior and posterior aspects, but I think in my case its more an anterior problem, it actually aches in that area at times. I see Dr Eppley’s approach for Anterior is “high temporal release”. Could you please give me a ballpark idea of total cost of that procedure alone. Cost is unfortunately a fairly big issue. So that’s probably a good place to start. 2) Could you please also give idea of cost for posterior approach? 3) The last time I had general anesthesia I had a bad experience from the anesthesia and I swore to never have general again, at most conscious sedation. So, is it at all possible for Dr Eppley to do any of the procedures with local anesthesia/conscious sedation?
A:Thank you for your inquiry. Unfortunately I can not be of assistance in your case. I do not have a reliable way to reduce the anterior temporalis muscle like I do for the posterior temporalis muscle. Furthermore even if I did this is not a procedure that I would do under anything less than general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am searching for a doctor well experienced in sliding genioplasty revision. I had a sliding genioplasty reduction 6 months ago as I wanted to reduce the protrusion of my chin when I smiled. I am happy w the results, the problem is the dynamic ptosis my chin manifests every time I smile. My chin also looks flat and without form when I smile on top of having the tissue/muscle pulled down. I am wonder if this is a matter of mentalis muscle resuspencion or if I can simply have my original surgeon move my chin more forward? Will that fix the hanging tissue or do I truly need a resuspension?
A: Thank you for your inquiry. As expected when you slide the chin bone back for horizontal reduction you are going to develop dynamic chin pad ptosis. (and in some cases submental fullness as well) This occurs because a purely bone-based procedure does not account for the soft tissue excess that is also present. This problem is not going to be solved any any form of muscle suspension as it is a tissue excess probpenm. Your options are to either slide your chin back out to pick up the loose tissue or have a submental chin pad excision/tuck done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been following a lot of your work and you seem to know a lot about computer imaging. I think I will have to go with you for my next procedure because my current doctor doesn’t seem as informed as you.
I had off the shelf cheek implants inserted by a surgeon who put them in asymmetrically ( everyone makes mistakes, not a huge deal ). He wanted to see the asymmetry so he can better know how to fix it during revision, so he ordered an X ray for me, but the X rays only showed us the screws and not the implant.
What type of imaging should we order so we can see the silicone implants and not just the screws? Would a CT scan work? I see in your writing here https://exploreplasticsurgery.com/category/custom-facial-implants/page/11/ that a CT scan works, but do we just order a regular CT scan or do we need to ask for some special CT scan that shows silicone?
Thank you very much for your time.
A: The short answer is that the implant images are in the CT scan, which I assume is a 3D CT scan which is the type of scan to accurately assess facial implant positioning. But if you don’t have special software to pull them out of the data, you will not be able to see them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been thinking about getting custom made jaw implants to compliment my cheek implants, but the ONLY thing that scares me is an infection. I am terrified of infections, which is why I had the cheek implants inserted through the eye lid.
Which brings me to this series of questions:
1. Would it be possible to have the jaw implant inserted from outside my face in order to dramatically decrease the chance of infection?
2. Is this easier or harder on you compared to inserting from inside the mouth? I don’t want to make things harder on you since that increases the chance of things going wrong
3. Are there any risks associated with inserting them from the side of the face that I should know about? Maybe increased chance of nerve damage or something?
4. Have you ever done this before or would I be the first special case like this?
Sorry about all the questions, and thank you for your time.
A: I have done several times both primary insertion of jaw angle implants as well as secondary revisions of them through an external skin approach in men. In answer to your questions in that regard:
1) The external approach is done through a small skin incision right over the jaw angle area. See attached picture of scar.
2) Whether it is harder or easier than an intraoral approach depends on what material and implant style/size of jaw angle implant is being placed. To keep the incision small I would only use a silicone jaw angle implant for an external approach.
3) Other than the scar, the only other remote risk is marginal mandibular nerve injury. But the course of that nerve is lower than the level of the incision.
4) see #1 above.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been carefully considering everything and I think I am going to put off getting calf augmentation and custom infraorbital-malar implants until future procedures, if I choose to do so. I am still interested in the following:
-Custom Jawline
-Buccal Lipectomies with Perioral Mound Liposuction: Bilateral
-Septorhinoplasty
-Fat Grafting to: Labiomental Fold
I have some questions about those procedures and some others I’d like to consider:
1) If I got a custom jawline implant, would it be attached to my jaw bone with screws? If yes, would this affect my ability to have an MRI in the future if I needed one for any reason?
2) Can a custom jawline implant make snoring worse?
3) We talked in my consultation about submentoplasty, you considered it a bad return on investment because it was likely I would get the jawline definition I was looking for from an implant only. I am a little confused about the description of the procedure. Is it just fat removal/liposuction? Do you also tighten the platysma muscles? What I am trying to achieve with submentoplasty is to get a much sharper angle between my neck and my jawline as seen in the before/after picture I have attached.
4) If I’d like to treat the my under eye hollows/bag with fillers instead of implants, what kind of fillers would you recommend? How long do they last, do they deteriorate slowly over time or all of the sudden? How many syringes of filler would I need?
5) I feel like I have some breathing difficulties and I know for certain that I snore loudly and would prefer not to. Do you offer somnoplasty/turbinate reduction? I’d like to get my soft palate/uvula and turbinates targeted to treat nasal obstruction and habitual snoring. If you do offer it, do you perform it often? Is this a procedure that I need some sort of medical evidence/sleep test results to show that I need it?
A: In answer to your questions:
1) All jawline implants are attached within screws. There are titanium so they are non-magnetic.
2) No.
3) A submentoplasty is a combination of liposuction, fat removal beneath the platysma and muscle tightening.
4) The only fillers that should be placed in the thin undereye tissues are hyaluronic acid-based of low viscosity. Most people need at least 0.5ccs per side or at least 1 syringe,may be 2.
5) I perform inferior turbinate reduction regularly and are part of most septorhinoplasties when there is breathing impairment present.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am an international patient and am interested in a custom wraparound jaw implant. I have a few questions:
1. As I am an international patient, will it be possible for Dr Eppley to design the implant just off the 3D ct scans or will i have to physically be present for optimal results?
2. Can a custom wraparound jaw implant add a slight amount of vertical chin length (roughly 4mm)?
3. What would be the rough total cost of such a surgery? I understand this cost may vary from patient to patient but it would be great to get a rough range.
Thank you very much!
A:Thank you for your inquiry. In answer to your custom wraparound jawline implant questions:
1) Most custom facial implants are designed off of the 3D CT scan and picture imaging. The patient does not need to be physically present unless they want to be.
2) Custom jawline implants often add vertical length not which 4mms at the chin is no problem to do.
3) My assistant Camille will pass along the cost of the surgery to you later today.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have really been mulling a facial reshaping procedure for some time.
I am interested in getting a more heart shaped face. High, defined ogee curve – so delicate cheekbones and a V like chin. I am unclear on if I need to touch my chin at all. I am also unclear if my brow bone has anything to do with this.
I have attached my photo and a few photos showing what shape I am aiming for. I do intend to do rhinoplasty next year but first things first. I am seeking definition that photographs well as well as looks nice in real life.
I was really considering fillers to accomplish this look but my issue is I really want it to look like a change in structure, not fullness. I also want it to be permanent.
Questions:
Will weight loss after surgery possibly change proportions in a negative way?
Would implants negatively affect my ability to smile?
Also, are my goals realistic at all? To be clear I know won’t like these models. Rather, is it possible to get closer to my ideal v like face shape without it looking fake? Is it possible for cosmetic surgery to achieve that facial harmony seen on actually attractive faces (as opposed to just placing features that still don’t show that balance?)
Sorry for the lengthy email. I just want to move forward and need to know if I found my solution.
A: Thank you for your inquiry. In trying achieve your facial reshaping changing the correct procedures are cheek implants, mid facial defatting (buccal lipectomies and perioral liposuction) and possible chin lengthening. (although I can not tell based on just a front view whether that is beneficial in your case or not)
The question is not whether these procedures can be done but whether they can remotely achieve the type of facial change you are seeking given your natural facial anatomy with thicker tissues. In other words how realistic are these type of changes? There is no way to really know that answer accurately other than to say I suspect it is more unrealistic than realistic.
And to answer your two specific questions:
1) Weight loss will only help the result not adversely affect it.
2) Cheek implants will not affect your ability to smile normally.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr Eppley, I am interested in custom infraorbital cheek implants. However, I have scleral show and don’t want to run the risk of amplifying it through insertion via the eyelid. Could the custom implant be inserted though the mouth? Thanks.
A: The intraoral route for custom infraorbital-malar implants can be used IF the implant is not designed to saddle the orbital rim and only provides some minimal anterior projection. If it needs to saddle the orbital rim to any degree, and most such custom implants do which is why they are custom, then a lower eyelid approach is needed ensure adequate placement.
Custom infraorbital implants that saddle the orbital rim and add height to the bone are actually an effective treatment for scleral show as they drive the lower eyelid upward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am two days after custom infraorbital-malar and jawline implants. I’m feeling OK, pain is tolerable. However I have significant facial swelling, right face greater than left (I notice that this is far more than what I had my Lefort 1 surgeries).
I have started medrol dose pack. Is this common to see this amount of swelling? Is there anything else that needs to be done? Should I take the bandage off?
A: Your surgery went superbly and your lower eyelids did not have to be disturbed from above. Coincidentally I also drained a large sebaceous cyst in the left cheek area the became more revealed from the perioral liposuction.
What is important to remember about the facial swelling is the following:
1) It will be considerably more than anything you have ever seen before. If you think about it your entire face was degloved off the facial bones with the exception of the nose. That is not remotely similar to anything you have ever experienced previously. So even though you may have been partially ‘prepared’ from our prior surgeries, that is the barometer by which to judge the swelling from this surgery.
2) Swelling will takes 2 days to maximize. So whatever we see today will be worse by tomorrow, this is normal. I would basically expect your face to look like a round pumpkin by tomorrow at the peak day. It is psychologically disturbing, as I mentioned before surgery, and it will take about1days until you feel better by the direction that things are heading….but a good month until things start to look close to what the final facial reshaping effect will be.
3) Even though the surgery was done symmetrically, the same things to both sides, they never swell symmetrically. One side will always swelling more than the other.This is normal.
You may remove the chin strap at any time. It is only there if it provides comfort. It has no role in stabilizing the position of the implants.
You may shower and wash your hair today as normal.
Despite all the thought that goes into these surgeries, this early recovery phase is the hardest for patients as only time, healing and patience are the ingredients for recovery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was thinking about brow bone reduction surgery and I have two questions:
1) Will the screw/plate/etc in my skull interfere with airport security?
2) Is the brow bone reduction surgery something that is often re-done or come with complications? I was a bit startled when the form said 15% of patients want surgeries to be re-done. If something goes wrong, I won’t have time to get surgery redone because I will have to go back to school.
A: In answer to your brow bone reduction questions:
1) The 1 plate and 4 small screws used to hold the bone flap in place as it heals are made of titanium, a non ferromagnetic metal. This will not interfere with airport scanners or having MRIs.
2) It is important to realize that any surgery has a risk of revisional surgery, whose percentage risk varies dependent on the type of procedure performed. The risks that we are mainly referring to are largely aesthetic in nature and are often issues that patients see and are not necessarily medically needed. For example such risks as asymmetry or a slight irregularity here or there. There are other more major risks, such as infection, although tis is to something I have seen in this type of facial surgery.
While revisional surgery in brow bone reduction is not common, it is wise that the patient be aware that it exists and it is a potential sequelae of this or any surgery. Surgery is not like putting puzzle pieces together. The factors of how human tissues respond and heal to surgical manipulation is not a completely predictable phenomenon.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in getting cheek implants after unfavourable results from zygoma reduction surgery. I am very much interested in getting custom implants to get the most desirable results, but this would entail going overseas as no plastic surgeon offers custom implants for aesthetic purposes in my home country.
How often or what percentage of patients get an infection in one or both implants in the immediate post-op period? I have read that implants can get infected up to two or three months after the surgery, and I definitely cannot be overseas for that long. I am worried about getting implants put in and then returning to my home country and then getting an infection.
If you could please provide any insight on your experience, it would be much appreciated. Thank you for your time.
A: In my vast experience with custom facial implants, infection of cheek implants is one of the lowest. So low that I can not recall a prior case in which infection resulted in implant removal. I do recall, however, several that were resolved satisfactorily with antibiotics alone.
Because I have so many international patients, I use a special antibiotic protocol as the stakes of having problems is so much higher when patients are far away.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What type of cheeklift did I have done when my Medpor cheek implants were removed?
A: Cheeklifts are done to either treat a difficult ectropion, as a prevention of ectropion or cheek tissue sagging such as may occur from cheek implant removal, or do a cheeklift for sagging from aging or as a possible substitute for cheek implants. While many different types of cheeklifts have been described, every cheeklift is some form of a subperiosteal technique which only differs by the way they are suspended upward. A direct cheeklift, which is really the most effective as it is done closest to the ‘problem area’ and also lifts the cheeks vertically in the correct vector, does so by attaching the suspension to the orbital rims.
Because it is done through a lower eyelid incision it is not the most common cheeklift technique even though it is the most effective as many younger patients don’t want a lower eyelid incision. But in your case with an already existing lower eyelid incision with ectropion and wanting cheek implants removed, this was by far the most logical and effective approach.
Dr. Barry Eppley
Indianapolis, IndianaC
Q: Dr. Eppley, I am interested in rib removal surgery for waistline reduction. I want to make way since I’m not near you for an in person consult and email should be enough for now.
1: Referencing the picture of the ribs in this reply could you tell me precisely what the surgery entails? Is it just cartilage or the entire rib? Making sure we’re on the same page the primary reason for this surgery is waistline reduction; so completely elective and doing it for myself only.
2: Regarding aesthetics/scars what are we talking here? Where or how will the cut be as I see the people on your site and some scars look fine. I’m used to various elective surgical scars over the years and have come to accept them. It also sounds like there are options in how extensive of a surgery I’m able to choose.
3: How much does this cost and what hospital does it take place at?
4: How’s recovery and should I know anything special regarding flying before/after such as how soon can I return to work or how much pain there’ll be? I’m only a few states away and my current job is very white collar low physical.
5: Will liposuction be performed or can that be done separately later on if I decide that’s something I want to pursue with a local center? I’m mainly interested in the core procedure since I’m already a twig to begin with. Weight gain has never been an issue of mine.
6: Figure I’d throw this out here, but should I bother making a claim to insurance to get it potentially covered in any way?
7: Assuming I’m ok with all this after having time to think some more, do you do a final in person consult before surgery to know precisely how much to take out? We’ve never met in person so you only know what I sent you pictures of.
8: Do you accept payment plans? Some plastic surgery centers offer cosmetic credit cards or payment plans to allow patients to get their procedures sooner and work on paying it off in their own time later.
Thank you.
A: It is not clear to me whether you are referring to anterior or posterior rib removals which are done for different reasons. Posterior rib removals is done for horizontal waistline reduction while anterior rib removals are done for verticals waistline lengthening and/or removal of subcostal rib protrusions. In answering your questions I will assume you are referring to posterior rib removals.
1) In posterior rib removals, the outer calfs of ribs #10,11 and 12are taken. (see attached picture)
2) These are 5 cm obliquely oriented scars on the back. (see attached picture)
3) My assistant Camille will pass along the cost of the surgery to you later today. This is done in my surgery center not a hospital.
4) Recovery is really about comfort and getting back to doing things normal which will take a few weeks. There are no restrictions after surgery. Most people can return to work in ten days after the procedure.
5) Posterior rib removal always includes flank liposuction as well as rib removals.
6) This surgery would not be able be covered by insurance, this is an elective cosmetic procedure.
7) The amount of rib removal is the same one each person, the outer half of the rib is removed back to the erector spinal muscle.
8) My assistant Camille can answer all logistical questions about the surgery.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, I had a Mittleman chin implant three weeks ago via a submental incision. It initially looked to me despite the swelling and had no sigs of infection. I had some lip numbness on both sides and occasional shooting/electric shots on the chin during the second week after surgery. But all of his has been improving but I am still having pain in the right lower lip as if the “lip is split vertically. I also have some occasional drooling from the right from the right corner of my mouth. Pain is worse when I open my mouth.
Do you ever find a CT helpful to confirm good implant placement without nerve impingement? I am willing to wait a little longer but if these symptoms do not improve I would consider removal of the implant, possibly shaving down the right wing to make it more narrow and make sure to free any potential nerve impingement. This could just be a nerve traction injury resolving, but I don’t want to miss true nerve impingement if that needs to be addressed given the asymmetry in symptoms at this point.
Have you experienced this before and how have you handled this?
Thanks for your help and guidance!
A: I believe you have already answered your own question…remove any doubt about the position of the chin implant and get a 3D CT scan. That will unequivocally answer the question of potential implant impingement on the nerve. A Cone Beam scan (CBCT) of the mandible can be obtained at a local dental or oral surgery office (just search under Cone Beam scan and you find where to have it done locally) for less than $200. Such a scan will put both you and the surgeon at ease with whatever the management strategy is determined to be. (time vs implant adjustment)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After my 2nd open heart surgery my sternum never healed. It’s been almost 3 years since my surgery and I’m still in pain. I had my wires removed in 2017, that didn’t resolve my issues. Is the sternal plate rigid fixation something that could help me? My pain management doctor said he doesn’t think it’s nerve related.
A:The critical question is what is the source of pain. If the pain is a result of mobility between the two sternal segments, and a CT scan so demonstrates that such sternal non-union exists, then rigid sternal fixation would seem like a logical treatment choice. If there is no mobility then we would have to assume that it is more related to the overall trauma of the ‘chest splitting ‘ process for which there is no good treatment for it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a jawline reduction surgery five years ago, but I think the surgeon may have trimmed the bone a lot. I don’t like the looks that the jawline is very high on the angle now. I want to have an implant that brings the jawline down just a little but without looking too masculine. I also don’t like bulky jaw angle. I want to have feminine jawline look. I’d like to know what are my options?
I would like to consult with you in detail. I have attached a photo of me and pointed out some problems that I would to fix. Both sides of my jawline are not even. When I had a chin implant, my left jaw always showed more depression then my right side (see the pic). Would the custom jawline make the jawline even again like the photo I photoshopped next to it? I would like to achieve that result.
Some of the questions I would also like to know.
1) what are the risks associated with the custom jawline? What is the longevity of the implant? What happens when I get old and my jawbone shrink, would the implant still be in place?
2) cost. When can I expect the implant be ready?
3) Recovery time
4) can I fly back home after the surgery?
5) how is the procedure performed?
6) is the implant reversible?
A: A 3D CT scan of your face will provide the definitive answer as to whether what you see on the outside corresponds to what the bone looks like on the inside. For the sake of this preliminary discussion we will assume that there are underling bony asymmetries/deformities and that their correction will create the improvements you seek. In answer to your questions:
1) A custom jawline implant is permanent and can not be come displaced from the bone with age. Its risks are the same as any other implant went placed in the body. (infection, asymmetry of placement, over/under correction)
2) It takes 30 days after the CT is received to have the implant ready for surgery. My assistant Camille will pass along the cost of the surgery to you later today.
3) Recovery is one you already know. It would be the same as the recovery from your jawline reduction surgery.
4) Most patients fly home 2 to 4 days after the surgery.
5) The implant is placed through incisions inside the mouth (at least in your case)
6) The implant is easily reversible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, A couple of months ago, I had my masseter muscle trimmed which I totally regretted. Now I have depression on both sides where the muscle was trimmed. I see that the skin is going in a little. How do I fix this problem? Would fat transfer work?
A: In answer to your masseter muscle problem, trimming the masseter muscle is always a bad idea as it leaves soft tissue depressions over the angle. This issue would become magnified of a custom jawline implant is placed to partially restore the jaw angles. Fat injections would be a one reasonable approach to treat it
The restoration of lost volume from a change in the shape of the masseter muscle is not an aesthetic problem that is easily remedied. Whether it is the result of disruption of the pteryomassteric sling (masseter muscle retraction) or masseter muscle reduction restoring its shape can be attempted by various soft tissue strategies. Fat injections is the obvious choice but not the only one. Dermal-fat grafts, allogeneic dermal sheets and even ultrasoft silicone implants can be used. I have done all of these strategies and each had their own advantages and disadvantages.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m contacting your office hoping to set up some sort of consultation for a Chin Augmentation procedure. I’m aware you do quick 10-minute pre-consultations over Skype, so perhaps that would be a starting point? However, I’m more than willing to move forward with a regular consultation if that would be most appropriate. What would you need from me to set up a consultation?
Beyond that, if this initial email might also be used as a launchpad for questions, I’ll include some of the ones I have regarding your office.
1How does your office handle the payments? (Lump/Monthly/ect…)
2What is generally the recovery time for the procedures?
3How bad is the scarring from these procedures?
4Are the implants chosen from a stock set of preexisting implants or are they gathered by some other means?
5Certainly nothing meant against neither you, but I was told to inquire about this–how often do you preform these procedures?
6Are you or can you request to be put under for these procedures? Call me timid, but I’m not exactly experienced going under the knife.
7Kind of a silly question, but from your previous patients, how would you rate the pain before, during, and after?
8I most definitely wish to come in for a consultation fairly soon, how much would that visit cost?
9How far out are appointments made for chin augmentation procedures with your office?
Thank you for your time and I hope to hear back from you soon.
A: Thank you for your inquiry. I will have my assistant Camille contact you today to schedule a virtual or actual consultation time. She can also answer all logistical questions as they relate to your questions #1, 7 and 8. Int answer to the other questions:
2) Recovery is largely about swelling which takes about 3 weeks for most of that to subside. Although it really takes up to 3 months to see all of the details of the final outcome.
3) Submental skin scarring is minimal.
4) The type of chin implant chosen, standard vs custom, depends on the patient’s aesthetic needs and goals.
5) Chin and jawline procedures are performed every week multiple times.
6) Chin implant surgeries are done under general anesthesia.
7) Pain is not a big issue for patients after chin augmentation surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you analyze a patients soft tissue during a consult to tell them if they can achieve the angularity they hope for with facial implants?
A genioplasty and chin implant will have the same amount of angularity then, I suppose, right?
Also, does material matter? Do harder materials like PEEK or more brittle ones like medpor have any benefit?
A: In answer to your questions:
1) There is no preoperative test or method of evaluation that can predict how any patient’s soft tissues will respond to what is changed underneath it.
2) A sliding genioplasty and chin implant will have slightly different aesthetic effects because their resultant shapes are different. But both stretch out the soft tissues.
3) It is a myth that that any of the implant materials used will have an influence on the overlying soft tissue effect. There is no biologic basis for that common misconception.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, When it comes to the “short face syndrome” characterized with a shorter lower third compared to middle and upper third, this is often present without any problems in chewing or overbite / upperbite.
In my case, my maxilla is very forward (almost as forward as the likes of Jordan Barrett) but my jaw is small. It is not micrognathic nor retrognathic but just slightly smaller than average. I mean to say that it is short, narrow, and lacks forward projection (lines up with the hollow of the nose but not further than the lips). My bite is okay (class 1 with one or two crooked teeth) as is my breathing etc my only concern is aesthetic
Would your advice to someone who wants peak esthetic modification to be made to their jaw be to have the orthognatic surgery (cosmetic only, and expensive as hell) to fix this JAW OR
Just be to opt for either a simple osteotomy like a genioplasty, or implants like your big ones that fill up around the jaw and chin.
The other reason I am not too certain on the implant route is because they give a “bloated” look in a lot of cases, although I would not be surprised if it turns out that an orthognathic surgery would do the same thing.
I am curious what makes this procedure look so angular and sharp:
When these ones were still effective but you can see they look a bit “bulkier” and less angular:
http://www.customfacialimplants.com/photos/custom-implants/customimplants36.jpg
One user on a board I frequent (and if you know the website Lookism, you know it’s filled with nonsense) theorized this is because of the material of the implant and that silicone gets “squished” by the tautness of the soft tissue. Others theorized it’s because of the masseter muscle.
What made the implants that I linked in that picture so effective when the others looked “bulky”?
Thanks so much for your time.
A:There are many variables that go into what happens with the external facial appearance after any underlying implant or bone moving procedure. But the most important one is the patient’s natural soft tissue thickness. In short, angular faces end up with greater defined results. Fuller faces do not usually get angular just bigger and fuller. The best analogy I know is lip augmentation. Full lips get nicely fuller with any form of augmentation. Thin lips never get nicely fuller no matter what is stuck in them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty where they lowered my columella and used a premaxillary implant at the base of my nose where the incision was in my upper gum line similar to the way you insert them.
I didn’t care for the premaxillary implant and had it removed. I now notice my upper lip is longer and the red part of my upper lip hangs down lower.
Is this because the premaxillary implant stretched the muscle and skin in my upper lip area?
What can be done to bring my upper lip position back to where it used to be?
Would a lip lift work and if so, doesn’t this only address the skin and not the muscle that was also stretched?
A: Like the method that stretched out the upper lip, you have to do the same to restore it….an intraoral lip tuck to shorten the vermilion and a subnasal lip lift to shorten the vertical distance between the nose and the upper lip. This dual approach would be the most effective approach in lifting the lower lip back up after premaxillary implant removal..
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21year-old male. I had my brow bone shaved because it looked like a Neanderthal. Although my surgeon shaved it too much and now it looks too feminine.My question is can fat grafting make my brow ridge more masculine and how masculine can I achieve? Since I don’t want to have an invasive procedure again.
A: Given your own restrictions (no surgery) you are left only with the options of injectable fat for fillers. How aesthetically successful they can be can not be predicted beforehand. But suffice it to say that ‘soft’ materials like fillers and fat do not create the same effect as stronger augmentation materials like bone cements or implants. While I see little harm in doing injectable fillers, which are reversible, I would try that first before doing fat injections. Perhaps for just a little bit of indistinct brow bone augmentation these softer materials may be effective for your brow bone aesthetic needs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am writing you with my concerns as I have seen you respond to Real Self posts concerning similar issues.
About two years ago I have v-line jaw reduction done (I am transgender and currently 30 years old). I had a fairly broad jaw before surgery. The surgery was fairly good and I’m mostly satisfied with the bone work, but I find I have too much soft tissue now which makes my face appear bottom heavy. I have very very subtle signs of jowls and do have pre-jowl indents. My skin is in excellent shape. I would like to improve my jawline and I’m not sure if some sort of mini lower lift or lipo would be the way to go here. I’d like to hear your opinion.
A: Just by your general description and having seen a lot of patients with your exact soft tissue issue after V-line jaw reduction surgery, only a limited form of a lower facelift can address the now lax tissues which have resulted due to the removal of bone support. This so called ‘tuckup’ lower facelift produces skin tightening right over the jaw angle area which is most affected by the prior jaw reduction surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The crown area of my head is quite flat and I have been doing the hair camouflage technique since I was in my mid teens. This has impacted my life significantly. I am working interested in the bone cement technique to reshape this flat portion. I live in Nevada and cannot find a surgeon who performs this procedure. I would like to do this procedure within the next 12 months and am curious what the cost is so I can prepare.
A: Thank you for your inquiry. Bone cement skull augmentations have largely been replaced with the use of custom skull implants which offer better results with the need for a far less scalp scar. I will assume for now that you would receive an immediate custom skull implant (does not require a first stage scalp expansion) for which I will have my assistant Camille pass along the cost of such surgery to you on Monday.
In he interim please send me some side view pictures of your head for my assessment for this procedure from which I can do imaging to determine whether you need a one stage or two stage skull augmentation procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve already had a 6mm sliding genioplasty in the past so this would be my 2nd genioplasty, effectively making it a 12mm chin advancement. I saw a statement online and I’d like to know if there’s any truth to it.
“Bony changes and skin surface changes are not the same with sliding genioplasty. It is possible to advance the the bone over 10 mms but the skin surface changes are typically 1:1 up to 8mms then about 1:0.6 beyond 8mms advancement.”
Also, some surgeons say beyond 8mm, the step-off becomes apparent.
Thank you very much, Doctor Eppley. Your insight is always very helpful.
A: I would not read too much into those soft tissue change opinions about a secondary sliding genioplasty. While it is probably true that the greater the chin bone is brought forward the soft tissue thins a bit so the changes are not 1:1 at larger augmentations. But at the clinical level this is not really very relevant and would not factor into how the genioplasty procedure was done.
The bigger the horizontal chin advancement the bigger the step off can be. But in a ‘staged’ sliding genioplasty I am to sure now relevant the step off concern is.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been having trouble finding an affordable solution to my neck wrinkles on the East Coast. I’m beginning to think it might be more cost effective to have the procedure done in Indiana even with the extra travel expenses.
One plastic surgeon I consulted recommended a rotational neck lift with incisions around the ear lobes and In the IPI crease behind the ears. The scars are hidden behind the cartilage of the ear and beneath the earlobes. It sounds as though the scars may be less noticeable with the rotational neck lift than a short-scar facelift. Is the rotational neck lift a procedure that you perform?
A: A rotational neck lift is just another name for a variation of a shortscar lower facelift. Either way I can see that a possible effective short or long term solution for neck wrinkles. It would depend on the location and depth of the neck wrinkles as well as your interpretation of how much improvement is needed. One also has to be careful about the scars around the ears to perform the procedure and ‘trading off one aesthetic problem to treat another’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, i wanted to ask you if you think i could have a chin implant done if i have overbite (upper teeths are 4mm more projected that the lower teeths) , i plan to get braces to fix it soon but i would like to have a chin implant because if i pull my jaw forward untill the overbite is gone i am still lacking chin projection! I would also like to know in your opinion if my problem with overbite can be fixed with just braces or would i need also jaw surgery BSSO?
Pd: the las pic is with my jaw pushed forward, i would need 1,1cm more projection to reach the line traced
Thanks and greetings!!!
A: You would be best served in the long-term by having orthognathic surgery to have your entire lower jaw moved forward if you want to fix your overbite. You can, however, undergo a chin implant or a sliding genioplasty if your do not want to go through the combined orthodontic-jaw surgery process. Such an implant placement does not preclude having total lower jaw advancement later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I saw that you had performed the surgeries on Pixee Foxx and seemed very confident in his ability. I tore the cartilage on my last true rib on my left side and it has begun to protrude. I have been misdiagnosed several times and have decide I just want it removed. I hope to hear from you soon.
A: When you speak of the last ‘true’ rib I assume you mean rib #10 as the floating or so called false ribs are #11s and 12. I also assume that by tearing the cartilage you mean a separation off the costochondral junction between the bony and the cartilaginous portion of the rib as it goes around the ribcage before int connects to the subcostal region. This is where the protrusion would occur as a result of the separation. Do you have a CT scan that makes the correlation between the protrusion and the underlying costochondral junction? Certainly the protruding rib portions can be removed through a small incision over it. Excising the bony portion next to the costochondral would presumably alleviate the discomfort from the non-union and motion of the rib segments.
Dr. Barry Eppley
Indianapolis, Indiana
