Your Questions
Your Questions
Q: Dr. Eppley, I noticed a post inquiring about testicular enlargement, but the reply just explained the difference between implant & enhancement. I was wondering if you perform this procedure. I’ve been on testosterone replacement therapy for a while and have experienced severe testicle atrophy. The only surgeon I’ve found so far is in Beverly Hills. Any assistance you can provide would be greatly appreciated.
A: I do perform testicular enlargement surgery and the options are either place testicular implants in front of the existing testicles or use wrap around implants to enlarge the existing testicles. Both are viable options of which the simpler approach is to place 6cms to 6.5mc implants and displace the smaller natural ones which become ‘lost’ behind the much larger implants in front of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much more difficult is a Medpor chin replacement vs a virgin implant? Should I be concerned that 90% of doctors seem to say it is impossible?
Should I consider replacing it with silicone instead of Medpor?
How long do I need to wait? If we replaced the exact implant, could we expect very similar results to what I had? I am done with surprises.
Thanks in advance for info. Your website is helpful.
A: In answer to your chin implant replacement questions:
1) While Medpor facial implants are more challenging to remove than non-adherent silicone facial implants, they can always be successfully removed. Any surgeon that would say otherwise is either inexperienced, lacks an understanding of implant biology or both.
2) You have to replace your current implant with an implant material of which you feel most comfortable. But what your facial implant experience has shown is that ease of reversibility of what is put in the face is an important implant feature that is often under valued. Since one can never be completely assured of any aesthetic outcome, the ability to easily modify or change it is important. Tissue ingrowth into an implant would be of great value if one knew that the need for secondary surgery on it again for any aesthetic reason would never be needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Will I be normal after doing a skull reshaping surgery, and will it not affect my memory. Will skull reshapping restrict me from going to extreme weather conditions. How long does it takes for 100% recovery.
A: If I interpret your picture correctly your skull shape concern is the bump on the back of your head to which I can provide the following answers to your skull reshaping questions:
1) Such skull reduction has no effect on brain function and thus will not affect memory or any other cognitive skill.
2) There are no restrictions after surgery whether it be sports or going out in any type of weather.
3) Recovery is very quick. 100% recovery will take just a few weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve undergone jaw angle implants one week ago and, as many patients, I am worried about the implants’ size. I’ve used the 10mm Terino’s lateral implants. This picture of myself is the pre-op front view m in order for you to know what I was like before and judge better.
I know it’s very early to judge but I think the implants are little bigger than I expected. I am worried about the outer line of my face and the gonial angle shape which is slightly outer from the cheekbones right now.
According to your experience do you think the outline of my angles will be shrinked to come slightly inside (OR at least match the cheekbones) in the final result? (according to the pro-op image)
Thank you.
A:If you are just one week after surgery every patient will think they are too big. You have less than 50% of the swelling that has gone done which takes a full 6 weeks for most of it to resolve and a full three months before the tissues fully shrink down and wrap around the implants to see the true final effect. Thus no feeling that you have now is an accurate indicator of the final result. No one can predict the final result now, this is a function of time and patience. Your surgeon should have fully advised you of the length of the recovery process until the final results is evident.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in silicone cheek implants (with screws) not only for appearance but also in the hopes that it will help my breathing obstruction on my right side of my nose which is alleviated by the skin stretching that would be enacted by the cheek implant (see last photo). I am interested in the implant being purely in the Zygomatic Arch. Is this something that is possible? My submalar space is already full enough I don’t want it to be more full.
A: Thank you for your inquiry. What it appears you are seeking is a custom design cheek implants that covers the high malar area and goes back along the zygomatic arch. You did not mention the infraorbital area, which is deficient with your negative orbital vector relationship, so I will assume for now that is not part of the implant design. That can certainly be done and is a common custom implant design in my experience. While it can provide the aesthetic benefits you are seeking, I would not go as far as to say it would provide a functional breathing benefit as the finger maneuver to lift the cheek tissues creates a more powerful effect that what almost an implant on the bone can do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in reducing scleral show and raising my lower eyelid, from what I’ve read from your articles the best solution is usually a combination of an infraorbital rim implant combined with a lateral canthopexy. I’ve included some pictures to show if you think this would address these issues.
A:You have correctly surmised that in the presence of infraorbital rim bony deficiency the placement of an infraorbital rim implant or a combined infraorbital rim-malar implant to build up the bone is needed to reduce scleral show. There is a linear relationship between the lower lid margin and the shape and height of the infraorbital bone…which is no an anatomic surprise.
Integrated into the placement of an infraorbital rim implant or infraorbital rim-malar implants are soft tissue procedures such as a cheek lift and lateral canthoplasty which when all combined help drive up the lower eyelids and reduce scleral show.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21 years old and I have noticed that I have a dent on my crown and its mostly on one side like it is missing bone. I noticed about two years ago when my mom was massaging my scalp. At that moment I was like I don’t care. But now i really care about it because it is so ugly. I have lucky to have a lot of hair. My question is can it be filled with bone? Or some other things to make it normal? Im really unhappy and I hope u guys can help me. I can send photos too in email if u guys send me a email Ican send them. I saw some great results in your website and I don’t care about distance or what ever as its about my confidence!
A: The good news is that a dented skull area can be completely fixed using a variety of techniques. From bone cements to custom skull implants the area of the skull that lacks contour can be augmented. If the skull area of concern is not that large and is back in the hair-bearing scalp area the use of bone cements may be the preferred augmentation method. But most of the time a custom skull implant approach is best. Please send some picture for my assessment and more qualified recommendation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had custom infraorbital-malar implants placed for significant malar hypoplasia. Unfortunately I was underwhelmed with the anterior projection the surgeon designed as it was a just 4.5mm at its point of maximum projection. highest.
In your professional opinion, what is the maximum anterior projection in mm for infraorbital-malar implants that would look natural yet prominent in stature? I already had tear trough implants in the past and was underwhelmed by how little it affected the frontal view of my cheek area.
A: I do not have the advantage of knowing what you looked before surgery, what your overall implant designs looked like nor any of the thought process that went into the design of them. But as a general statement custom facial implants designs are always a bit of a ‘guess’ as to what will meet the patient’s aesthetic goals. No surgeon or patient can ever accurately predict what aesthetic outcome a first time custom facial implant will do. The design technology does not yet exist as to know after surgery what the exact aesthetic outcome will be. That is undoubtably why, in my extensive experience, that about 1/3 of all custom facial implants undergo revision or replacement surgery for under- or over correction issues.
That being said, you now have the insight of precisely knowing what the effects are of the implants dimensions that were chosen. That is a tremendous advantage in designing implant replacements. Speaking specifically about horizontal projection at the infraorbital-malar transition area, I have seen patients who ultimately required up to 10mms of projection. The key in having greater projection in this area is that the footprint of the implant would likely need to be greater to allow a smoother transition into the surrounding bone. (aka a natural look) Otherwise a shelf effect is created which would definitely look unnatural.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a man and have very prominent temple lines (superior temporal lines), I think they are called. It causes the arteries at the side of my head to constantly bulge which looks unsightly. Is it possible to flatten, or create a channel in, a small part of each temple line to relieve the pressure on the arteries and thus reduce the swelling/bulging?
A: It is possible and not uncommon to do temporal line reduction as part of forehead reshaping surgery or as a stand alone procedure. However a prominent temporal line is likely not the source of your prominent temporal arteries and I would not expect the bony reduction to solve their bulging appearance. Prominent temporal arteries are treated by a multilevel ligation technique which can be done at the same time as bony temporal line reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The first picture is how I want my nose and the pictures below is my current nose. Is this rhinoplasty result possible?
A: Such a result may or may not the completely possible. It is important to know that no matter what is done to the bone and cartilage support of the nose, how well it will show through depends on the thickness of the skin and how well it shrinks down to the smaller reshaped support. Given your thicker nasal skin such a result as you have imaged but not completely occur. The more realistic outcome is halfway between where you are now and your ideal imaged reshaped nose.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can custom orbital rim implants alter the shape of the eye? For example, making a rounder, droopier eye appear more sharp and narrow?
A: Given that there is a near linear relationship between the shape and level of the infraorbital rim and that of the overlying lower eyelid, you are correct in that custo orbital rim implants that raise the level of the bone can positively alter the shape of the lower eyelid. This is particularly enhanced when other supportive procedures are combined with it such as lateral canthoplasties and spacer grafts if indicated.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about ribcage reduction. Since I remember I had problem with my very prominent rib cages. I always crouch and if I don’t, everyone will notice this disorder. As a result I always have backache, and one disk has slipped. This prominence is worse at upper part of my breasts, and more in the middle, I don’t care about the prominence at the bottom of my breasts. The prominence cause my breasts to fall down and no bra can lift it easily.
Im just asking if it’s possible to have a surgery in the future to narrow the upper part of my ribs by cutting a portion of the bones?
Thank you so much for this helpful website.
A: While I would have to see pictures of your exact problem to provide an informed answer, your description refers to an upper ribcage issue at the level of the breasts/inframammary crease. This is not typically an area of the ribcage that can be modified…but again without a visual understanding of your ribcage concerns this is just a general statement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! I have been considering jaw angle surgery for a while now. But i have one concern in particular. I have read some studies, which are quite out date, that suggest that mandibular angle implants can cause bone resorption.
I was wondering what your experience has been in this regard? Have you had many patients which have presented with bone resorption following jaw angle implants? or are my fears largely unfounded?
A: All facial implants, regardless of their anatomic location of placement will develop some small amount of passive imprinting on the bone. This is a normal biologic reaction that is neither pathologic nor has any clinical significance. The entire concept of bone resorption in regards to facial implants is largely misunderstood and unfounded. In fact, around jaw angle implants in particular, the much more profound biologic reaction is the development of bony overgrowth that typically occurs on their superior border.
Thus the relevant risks of jaw angle implants have nothing to do with any form of bony response to them. Rather the risks of infection, implant asymmetry and malpositioning are the real risks that patients need to be aware as these are the common risks that result in the need for revisional surgery
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in having a hip and butt implants and BBL. I’m very petite with an awkward shape. I’ve got flanks, a big belly and hip dips. I don’t have enough fat to get to the size that I’d like to be which is why I’d like butt and hip implants as well as a BBL. How much would this procedure roughly cost? And if so how should I pay? Hope to hear from you soon.
A: With some abdominal and flank fat available for harvest that is usually applied to the hips as a primary augmentation effort or to contour around buttock implants that are concurrently placed. Buttock and hip implants are almost never done together as that is too hard of a recovery and the risk of infection/seroma formation is very high with four body implants placed in the same anatomic region. Based on your description you would be better served by hip implants (as hip dips rarely get solved by fat injections) and invest all the fat into your buttocks. While the buttock size the fat creates may be inadequate, it would at least better prepare the area for placement of buttock implants later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m writing today with 3 questions about cheekbone reduction surgery.
1) How long of a waiting period is there regarding Botox injections pre and post surgery?
2) How long I should pause laser hair removal treatments on my face pre and post surgery?
3) After viewing the last image Dr. Eppley created exemplifying
the maximum width reduction that can be done I am happy to
state I do not want to go any more narrow than what is done in
the image. I did however have one concern. I made some marks
ion the attached photo and wrote below articulating this concern.
A: In answer to your cheekbone reduction questions:
1) There really is no waiting period for Botox injections after cheekbone reduction surgery. It can be done as close to one week before or one week after the surgery. These are distinctly different anatomic areas.
2) The same answers applies to laser hair removal.
3) In regards to your question on the imaging, I would not over interpret the changes. There is inaccuracies in contour changes that occurs when pushing tissue borders around with Photoshop. What you are alluding to is the risk of bony ‘overcorrection’ which has never been a problem in my experience. As it turns out the opposite is actually relevant. The greater risk is actually undercorrection as there are limits as to how much the bone can be permitted to move inward by the volume of temporal muscle sitting next to it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have attaches photos, showing how my ears look now and how I hope they can look. As this is only a small procedure I only have a few questions.
My questions are:
- How will you perform the procedure? Will you use my own cartilage or some other material to push the outer ear out?
- I am looking to extend the outer ear to be a few millimetres past my ear fold. Ideally the outer ear is visible all the way down my ear. Are you able to control how far this outer ear will protrude?
A: In answer to your otoplasty reversal questions:
1) The procedure is done through an incision on the back of your ears, most likely your original otoplasty incision based on where it is located.
2) Usually cadaveric coastal cartilage is used as an interpositonal graft to hold the ear out once it is released. Most patients do not want to have their one rib cartilage harvested although that can be done.
3) The amount that the ear can be brought back out is highly dependent ion how much graft is put behind it to hold it out. What you are demonstrating is the typical location of the release (middle third of they ear) and with the objective of having it visible beyond that of the antihelical fold in front of int.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having a sliding enioplasty with you next week and I wanted to hear your thoughts on if a chin wing osteotomy would make more sense for my case.
I am not looking to have my jaw gain vertical or width, but would a Chin Wing osteotomy make my results look more natural? It also sounds like there’s more risk or side effects from having the Chin wing so it might not be worth it compared to doing a genioplasty.
Thanks
A: A sliding genioplasty and a chin wing osteotomy are done with some different aesthetic objectives. One chooses the chin wing osteotomy for the purposes of adding vertical height to the chin and front half of the jawline…an objective but your own admission that you are not seeking.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is there any problem if you remove from me the Medpor Midface Rim and replace them with malar and submalar cheek implants, considering the fact that my face is very skinny? I mean will the cheek implants show itself too much under the skin or does the submalar mask the implant show of malar implant?
A: You are referring to whether the implant outlines/edges of midface cheek implants will show through a lean face. That would depend on the type of implant chosen for replacement. This risk is virtually zero in custom implants because of the feather edging of their design and the fit to the bone. The standard malar-submalar implants, known as Midfacial or Combined Submalar Shell implants, generally blend well into the surrounding tissues and have low risk of implant show provided their size is not excessive. The overlying soft tissues, even in lean patients, always add a significant blanketing effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I contacted you a few months ago regarding a custom wraparound jaw implant. You produced a very impressive morph of a predicted final outcome.
I do have an additional question: How much horizontal chin movement is possible with such a custom implant? If my chin is 10-12mm recessed, can I achieve the results in the morph with a custom implant alone? Or, will the custom implant need to be combined with a genioplasty?
In case like mine, is a superior aesthetic usually achieved via a custom implant or a genioplasty combined with custom jaw implants?
A: If one has had no prior chin implant in place (which helps stretch the soft tissue chin pad) then a custom implant that adds 10 to 12mms of horizontal projection is right at the edge of what the soft tissue chin pad can stretch to accommodate it. I like to avoid severely stretching the soft tissue chin pad with a large implant load when possible as this is done with a combined sliding genioplasty to lessen the implant volume right over the chin bone prominence. But in looking at your pictures I suspect you would be alright with the custom jawline implant alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is fat grafting to the deltoid muscles for shoulder augmentation safer than a BBL surgery? (Many deaths have occurred from bbl’s). I’d love to get my shoulders bigger.
A:The risk in BBL surgery in injecting fat deep into the gluteus musculature where large veins exist into which fat can inadvertently enter and become an emboli to the lungs. Such a large vein system does not exist in the deltoid muscles and, as a result, fat emboli are not a risk of occurring. Thus shoulder augmentation by fat injections is a perfectly safe procedure that does not have the risk profile that exists when injecting fat into the buttock region..
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am emailing because I have always noticed an asymmetry in my eye positioning, specifically my right eye being lower than my left. But recently i have noticed it is becoming worse, i noticed you have dealt with similar cases, if you could see the photos attached and advise me on possible solutions for my eye asymmetry and the severity of my case, it would be much appreciated.
Kind regards,
A:You have eye asymmetry which is bone-based and is known as Vertical Orbital Dystopia. By an approximate measurement of the horizontal pupillary line of 7mms discrepancy would rate as severe. Definitive treatment planning would first require a 3D CT scan from which the type of corrective surgery can be determined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard that midfacial implants can be used to add more anterior projection to the maxilla. Do these midfaceimplants advance the upper lip? If so, how is this balanced in the lower lip? Can it be advanced as well?
A: While custom midface implants can add projection from the infraorbital rims down to the maxillary root tips, they will not change the position of the upper lip. The upper lip position’s is controlled by the position of the upper front teeth sitting behind it…which is technically controlled by the projection of the maxillary alveolar bone in which the front teeth from canine to canine reside.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m very interested in clavicle lengthening. I have extremely narrow shoulders to the point where they rest in a rolled position (because of the imbalance) I’m curious if 3cm on each clavicle is possible? 2cm honestly wouldn’t be worth the surgery and money in my case. Just hoping for the best possible result.
A: In clavicular lengthening the need for an interpositional bone graft is needed. Most commonly this is done using allogeneic or cadaveric clavicle or fibular bone ‘dowels’ because they are circular in cross-section and provide the best surface area fit/contact with the cut clavicle bone on each side. Healing is done by bone growth into the interpositional graft using it as a substrate. This is a slow process that can take several months to occur. Obviously the longer the interpositional graft is (amount of clavicular lengthening) the longer this process takes to occur. If one can accept the longer healing period 3cms of lengthening can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m wondering do you think in my case clavicle lengthening should be considered since I’ve had this issue with the loss of my deltoid implants? I think I have come to realize that if I do get deltoid implants again they would need to be smaller than what I used to have. Or have nothing at all if the clavicle could give me a decent change. I’m unsure how much width I could get with the clavicle lengthening. What I do find is that my natural shoulders are naturally square which is the look I’m after. It just lacks muscle however my clavicle at the same time is very narrow in the interior. So I’m unsure if one should be addressed first over the other. I’ve had a clean track record with prior body implants but not with the shoulders. If you find this procedure is too invasive or has long term problems I’ll take your word for it as I know it is not commonly requested.
A: While you have had problems with your deltoid implants, I am not certain I would resort to clavicular lengthening. Unlike clavicular reduction where a bone segment is removed and primary bone healing occurs, clavicular lengthening requires the insertion of a bone graft which takes much longer to heal and has a higher risk of plate/bone fracture during the recovery process. When you factor in that is done to both clavicles the recovery process becomes much more challenging and not a surgery to entertain lightly. I think better deltoid implant selection (smaller and better shaped) would be a more appropriate solution to your shoulder width concerns
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, It has been 6 weeks since my custom jaw angle implant and paranasal augmentation with you. Recovery has been smooth and have not experienced any problems. The pre-existing jaw muscle dehiscense from my prior jaw angle implants like we discussed is about the same prior to the wrap around jawline implant placement and has not gotten worse.
Since I have more mandible length and height now my facial hair looks patchy. I am considering in the near future of getting a hair transplant done where the back of my head would be the donor site to fill in bald spots of hair in the inferior and posterior portion of the mandible angle.
I looked up how hair transplants work and really thought about how they would make pin hole incisions on the recipient site to accommodate the donor hair. My only concern is that since that skin area where I have the dehiscence is thin (not having the masseter muscle there), I feel like during the poking process that the needle they would use would come in contact with the implant and would start some process of infection? How likely would that happen? Would the scar tissue encapsulating the implant make it unlikely? Is this something you have dealt with in the past? Thank you in advance.
A: While I have not seen or been reported to about beard hair thinning after jaw angle implant augmentation, I do not personally have experience with hair transplantation in this area. But even without muscle coverage over the jaw angle implant, there is subcutaneous fat and a scar capsule that covers the implant, so I would not have concerns about the small slit that is made in the skin for the FUE insertion…which is actually made with a small blade as opposed to a needle.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m considering improving my frontal angle of face. I am happy with my jawline but my cheeks lack definition. To add to this I have very unattractive eyes, which are close together and seem sunken in certain lighting especially the inner area – giving me a lion look. I think a cheek implant should be able to improve my eye area, giving me a more attractive look, but to remove the sunken inner eye area would I need a custom that goes all the way around ? If I crop a models lower face and insert it under mine I look a lot more attractive so I think a cheek implant with buccal fat removal will be able to achieve this. Finally I am extremely unhappy with my laugh from my 45 to 90 degree angle (smile is perfect). My cheeks seem very heavy and protrude out whilst my chin seem to move back (I think) will a buccal fat fix this. Thank you.
A: In answer to your facial contouring questions:
1) To get coverage over any or all of the infraorbital rim area a custom infraonital rim implant design is needed.
2) A buccal lipectomy procedure reduces cheek fullness under the cheekbone in a static or non-smiling facial position. It is not intended or can it reduce the cheek fullness that occurs when the face smiles.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few questions about mouth widening surgery:
1) How wide can you make a mouth, would it be possible to increase with around 6mm on each side?
2) How natural would it look after the surgery, would it be lop sided or titled by any chance or would it look like a regular mouth.
Thank you
A: In answer to your mouth widening questions:
1) The average mouth widening distance increase done surgically is usually 5 to 7mms per side.
2) The postoperative concerns are not whether it will look natural or have asymmetry but how well do the scars do and whether a scar touchup may eventually be needed. In my experience about 50% of patients who have the surgery need scar revision touchup on at least one side.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if hyaluronic acid injectable fillers show up on 3D CT scans? If not, can we work around them? Because I have fillers in place and would really prefer if I don’t dissolve them for the consultation, because of the long wait time between the first consultation and surgery.
A: The only injectable filler seen on 3D CT scan is hydroxyapatite granules (Radiesse) which appears because of the radiographic density due to their calcium phosphate composition. Hyaluronic acid fillers, which are simply sugar molecules, are not dense enough to be seen radiographically.
Even in cases of Radiesse filler being present, the material is digitally removed to do implant designs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Just wanted to check in and Thank You for the Lateral Orbit Rim – Brow Implants, I really enjoy having a broader profile both above and around my eyes!
I also realized I liked having some of the extra swelling on the sides of my eyes that pushed the lateral rim out even further. I wasn’t sure if it was possible to try Fillers on top of the lateral rim implant to try making my appearance even wider around the eyes? (pics below better show my idea)
Is there any concern about infecting the implants when using Injectable Fillers near them? If I did like the temporary Injectable Filler, could Allofill then be used for a semi-permanent effect?
Thank you for any advice!
A: You can have fillers placed above the lateral orbital rim – brow implants in the subcutaneous tissues. Just be sure the injector knows that there are implants underneath and the injector should not try and place the filler down at the ‘bone level’….which is what they would normally do when trying to augment a skeletal structure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I suffered from a orbital floor / medial wall fracture 6 months ago and had the fracture repaired with a silicon implant. However, the repair has resulted in vertical dystopia. My injured eye (left) is now noticeably higher, 1-2mm by guessing, than my right eye. I wanted to ask if this is something that you confidently feel could be corrected. Or, if this is something I should just live with. Thank you.
A: Whether your iatrogenic vertical dystopia could be improved by further surgery is not a judgment that can be made by guessing. A 3D CT scan of the orbit should be done to determine the location and thickness of the orbital floor implant and how the level of the floor compares to the opposite uninjured side. If the thickness of the orbital floor implant is the cause then you would know reliably that thinning it out should lower the over elevated eye.
Dr. Barry Eppley
Indianapolis, Indiana
