Your Questions
Your Questions
Q: Dr. Eppley, I am interested in brow bone reduction. I have a prominent brow ridge and orbital region. The orbital region is particularly prominent. I am not a candidate for coronal incision as I have a receding hairline. I have been told by a couple of surgeons that it is possible to do an eyelid incision to shave down the orbital bone region. Would this be something that is possible at your clinic? Thanks for any help.
A: The transpalpebral (through the eyelid) approach be used if the outer half of the brow bone needs reduced. (tail of the brow bone) But it can not be used for the inner half of the brow and glabellar region due to the location of the supraorbital and supratrochlear nerves, They directly exit the lower end of the brow bone in this area and block access to any type of brow bone reduction. If one was willing to sever these nerves and live with permanent numbness of the forehead and frontal scalp then this approach could be used. But I know few patients who would consider this a good tradeoff. The other option would be to do the procedure through a horizontal forehead wrinkle if you have a prominent one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. I had a chin implant removed after a 7 mm mandibular advancement five years ago. I feel I developed ptosis since the removal of the implant. Also, I have a very long upper lip 21mm and considering this correction as well. How many lip lifts have you performed? I am very happy I found your website!
A: Although you only had a frontal view picture attached, I can see evidence of chin soft tissue sag and some lower lip incompetence at rest. With lip sag an intraoral resuspension technique is usually preferred. For your upper lip, its thinness from one corner to the other suggests that a lip advancement would be a more effective procedure than a lip lift. A lip lift only affects the central aspect of the upper lip. If this is evenly slightly overdone with thin lip sides, it can look unnatural. A lip advancement moves the entire vermilion upward from one corner to the other and makes a very thin lip look more naturally larger…plus it also removes some vertical lip wrinkles that are just at the vermilion-cutaneous border. I have performed well over 200 lip lifts, lip advancements and corner of the mouth lifts over the years.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, when I retire I will do a general over-all facial rejuvenation/enhancement and possibly a slight rhinoplasty tune-up/reduction. Probably fairly aggressive because due to my life situation, there is no need to “look like the same person, just well rested”. Now, is there any logical/preferable order in which to do these things? I had a successful facelift several years ago. I can say that I I don’t care if I spend the first three months looking swollen and feeling pain – the end results are well worth it, plus I am just not a whiner. But I thought I might do the rhinoplasty first/separately, so that the follow-on surgeon can correctly judge the amount of change needed with the “new nose”. Thus the question: how much of the facial implant work can be done all at once?
A: Without knowing what you look like or exactly need, I can not give a very precise answer. In general, I routinely perform all facial procures at one time including any implant work and rhinoplasty. How one facial procedure affects another can really be determined before anything is done by computer imaging. But certainly there is no reason you could not do the rhinoplasty first and then three to six months later do the remainder of any facial reshaping procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, we have talked before and i was trying to get surgery done for flat back of the head in 2011. I had some financial problems that is why I didn’t do it. Back in thoe days we talked about Kryptonite bone cement method which it had minimum scarring but expensive. I’m looking in to doing the procedure sometime this coming October 2015 and I was browsing your websites and I found this new approach that you have called Custom Skull Implants by using 3D CT scan.
My questions are
1- What is the price difference between Krypton bone cement and custom skull implant
2- I know the scar is less in Krypton bone, but how big is the scar for implant
3- Recovery time for the implant?
4- How long it will take to make the implant after CT scan?
5- Infection risks?
Thank you very much
A: In regards to a custom occipital implant, your financial concerns have served you well as this is a far superior method for improving the flat back of the head.
- My assistant will pass along the exact cost of a custom occipital implant to you tomorrow.
- The incision is usually placed very low in the occipital hairline and is usually a horizontal incision of 7 to 9cms. When the incision this low, almost in the upper neck, any scar concerns are significantly diminished.
- Recovery is usually less than a week to return to most normal activities.
- It takes about 3 weeks to design and manufacture the implant after the 3D Ct scan is received.
- While infection is always a concern for any implant in the body, I have yet to see one with a custom silicone occipital implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know how long take scars go away from a fat transfer operation. They got some fat from my tummy and put under my eyes. I had a sleepy look eyes. It looks one side it’s kind of went down but my other eye (I mean under the eye) still all puffed out and doctor says its “scar”. It’s hard and it seems like slowly slowly is going away but I’m 10 months now after the surgery and still hard under the skin,
I would like to know if it will EVER go away that scar or will EVER become soft as the fat suppose to be? And if so WHEN? I’m really desperate. It’s my face and I don’t like that people looking at me like what happened to me. The idea was to look better not worse. :o((
A: Unfortunately you are asking a question about a clinical result that I have not yet seen with facial fat transfer. The biggest after surgery issues with injectable fat grafting is how well it survives and irregularities. (lumps/bumps) I have never seen persistent hard lumps many months after its placement. I would assume that it is fat and may or may not be some scare tissue. Certainly ten months is a long time but as long as there is some improvement in it, patience would still be warranted. I would also consider very dilute Kenalog (steroid) injections into to to encourage additional softening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in scar therapy to reduce the raised scar on the bridge of my nose caused by a racket strike during a game of racketball two months ago. Interested in the recommended procedure and number of treatments/visits, etc.
A: Thank your for your inquiry and sharing a picture of your nasal scar. It is important to realize that it is early after the injury and the scar healing process is active and ongoing. If you want to do everything you can do to ensure optimal scare outcome, I would recommend a single fractional laser treatment followed by the daily application of a scar gel and the night time application of occlusive taping. This sequence of scar therapy You can be pleasantly surprised how much better it can look in 3 to 6 months. It is also important to realize that these recommendations are based on a single picture assessment taken from a side view picture only.
When it comes to topical gels a wide variety of options exists and none has been clearly proven to be better than another. The same applies to the number of occlusive tapes and sheets which exist.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think my eyes are slightly uneven but I doubt anything can be done about that and that’s okay. I would like to change the prominent eyebrow structure from the center of my face extending to the outside supraorbital ridges. (brow bone reeduction) They are also slightly uneven. People often ask me if mosquitoes bit my eyebrows. The other thing that bothers me is my weak jaw line. I push my lower jaw out so its less obvious. (chin augmentation)
I know I will never look like a super model, its not even something that I want. I would just like a more symmetrical, angled, softer looking face. Thank you so much for your time and effort, Dr. Eppley. I hope it’s what you need in order to assess for possible procedures.
A: Thank you for sending your pictures. What they should is considerable brow bone protrusion from the glabella to the outer orbital rim. Even without x-rays I can tell that is due to significant frontal sinus hypertrophy and will require an osteoplastic bone flap setback technique for your brow bone reduction and not just burring alone to get a significant reduction. The brow bone protrusion you have is very similar to what I see in men with two distinct medial brow bone mounds. The slope of your forehead is also fairly retroclined and it would be ideal to augment the upper forehead at the same time to really change the entire shape of your forehead.
From a chin standpoint, it is both horizontal and vertically deficient in regards to being in balance to the rest of your face. While a sliding genioplasty would be the historic solution (due to the need for increased vertical chin height), my newer vertical lengthening chin implant (small size in your case) would work well as it brings the chin both forward and down. (at 45 degrees) This would a very good solution for you that is more cost effective than a sliding genioplasty with a much quick recovery as well.
Now that I know exactly what need to be done, I will have my assistant pass along the combined costs of the procedures to you on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been wanting breast implants for a long time and have been researching a lot of doctors and implants. I would like to speak about the augmentation with you. I have has one consult last year and I really liked the doctor but he only did saline implants and I think I am leaning more towards silicone implants but would like to discuss both with a doctor that does both.
A: Saline and silicone filled implants are both FDA-approved options for breast augmentation. They do share certain similarities, they both create equally effective enlargements of the breasts and are equally safe. Looking at augmented breasts from the outside, it would be impossible to tell what type of breast implants was used. But beyond their external appearance, they do have several very distinct differences. Saline implants are associated eventually with palpable and visible ripples on the bottom and sides of the breasts which does not occur with silicone implants. Most women will say that silicone implants feel more natural as a gel-filled implant feels better than a bag of water. A dramatic difference between the two is in how hey will eventually fail. (they will not last a lifetime and will eventually need to be replaced) Saline implants fail by a dramatic loss of fullness like like that of a flat tire. Silicone implants never lose volume because the gel does not act like a liquid (like a gummy bear candy) and just stays in place and with same volume even if the bag sustains a tear or a hole. For this reason alone, silicone breast implants last longer than saline implants.
The concise version of this story is that there is one and only one reason to ever get saline breast implants….cost. They are the most economic form of breast augmentation because a pair of saline implants costs less to buy than a pair of silicone implants from the manufacturer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 27 year-old male hoping to improve my facial appearance with the use of facial implants. I have a rough idea of the kind of result I’d like to achieve and have attached pictures below of me now and a photoshopped version emulating the improvements I’d like to achieve. I have no idea whether I can use preformed implants or need to have custom facial implants made.
I’m interested in chin, jaw, forehead and orbital rim implants. I actually have no cheekbones whatsoever either forward or laterally which creates a very unusual appearance, but so far I’ve been using filler for correction.
Please let me know about how I can get these changes, estimated costs involved etc. I would really like to come to you for surgery as I know you are one of the best.
Thanks for your time and I really look forward to your response.
A: Based on your own morphing, the jawline change is absolutely that of a single piece custom wrap around jawline implant. That is the only type of jaw implant that can make a smooth jawline from the angle to the chin as you have shown. The lack of cheek and orbital rims (zygomatico-orbital deficiency) can be managed by two separate implants but a single custom made infraorbital-malar implant is the best implant to make a smooth transition all the way across the orbital rim and into the cheeks in the very thin tissue of the lower eyelids and cheek. What I notice in the forehead is increased brow bone prominence. Again a custom designed implant to achieve that change is always best since there are no preformed brow bone implants from which to choose.
I will have my assistant pass along the cost of custom implant surgery that would cover all these facial areas. It is possible to use a variety of preformed implants in most of these areas and some designs that I have used for other patients. But that is more of a piece meal approach that can be used if necessary but less than ideal for these more complex facial implant changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like my silicone butt injections removed. Does the scar tissue contain silicone oil, fat oil or is it just scar tissue? Will this procedure help reduce my butt from being sensitive? Is breaking up the lumps dangerous? Can it travel to other places when it’s broken up?
A: Silicone buttock injections can not be removed per se. They can be treated by liposuction and/or fat injections. These techniques allow for some of the silicone to be removed but what it mainly does is break up any hard tissue lumps (e.g., oil cysts and their surrounding scar tissue) caused by the silicone material as well as place new fat in and around where the silicone material/tissue reactions have occurred. Whether these efforts are worth it depend on what symptoms you are now experiencing. These efforts will not change any outside pigmentation changes in the skin but can help with some visible contour issues such as indents.
Oil cysts means silicone oil cysts. Breaking up the lumps is not dangerous. It is the injection of the material that poses the risk of getting in a blood vessel and traveling to other places.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year old female with flat cheekbones that make my eyes look prominent. I have noticed that whenever I laugh the lower eyelid retraction vanishes and the eyes look quite normal. So I am thinking a fat transfer can considerably correct the problem. But I would like toknow if the maxillary hypoplasia is so severe as to make necessary the use of orbital/cheek implants. Or do you believe in using large volumes of fat transfer to treat such cases. And can fat grafts be used in the cheek eyelid junction too?
A: You have astutely discerned the two approaches to anterior midfacial/lower orbital hypoplasia. The bone can be built up with implants or fat can be added to the soft tissues that drape over the bones. Each has their own distinct advantages and disadvantages and the actual anatomy and severity of the tissue deficiency will play a major role in that treatment decision. It would be very helpful to see pictures of your face to provide a more specific answer to your exact facial concerns.
Having done a lot of both infraorbital and tear trough implants and fat grafting in this area, I am facile with both techniques and my treatment decision rests with what is best to anatomically correct the problem. Anatomic needs should dictate the treatment, not what ay surgeon is most familiar with doing. What I can tell about treating this area in general is that I often use a combination of both implants and fat grafting to get the best result. Implants can only go where the bone is, fat injection grafting can volumize soft tissues where implants can not. (e.g., lower eyelid above the infraorbital rim)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial feminization surgery but for different reasons that the typical facial feminization surgery patient. I am a 27 year-old female but my features have been destroyed by acromegaly making me unable to recognize myself. I want the frontal bossing removed and the overall size of my nose reduced. Have you ever worked on an acromegaly patient before? Do you think these two (generally speaking) procedures will improve my features or will I need a reduction in chin, etc? I had my pituitary tumor removed four years ago and my IGF-1 levels are controlled by medication. I have attached pictures of me both and before the acromegaly developed.
A: You are correct in that you desire/need for facial feminization surgery is rare. I have worked on a few acromegaly patients in my career and making significant changes can be challenging based on how much their face has become ‘overgrown’. You appear to have a favorable starting point where some changes (e.g., frontal bossing, chin and jawline reduction) can be visibly improved given that they result from excessive bony deposition and the bone is likely thicker than normal. There are limits in rhinoplasty because there is often as much skin thickening over the nose as there is bone and cartilage excess. As in any rhinoplasty patient the limits of what can be seen on the outside is partially controlled by how much the skin will shrink over a reduced osseocartilaginous framework. Based on just a frontal view alone, it is hard to assess his much nasal changes can occur. (as well as other areas of the face)
Since your pituitary tumor has been removed and your IGF-1 levels are being monitored/controlled, facial surgery would be reasonable to do as the risk of causing an excessive healing response to tissue manipulations (i.e., overgrowth) has been eliminated. It would be important to get an assessment of your facial skeletal features with a 3D CT scan so bone size/thicknesses can be assessed preoperatively. That can be ordered by me to any imaging facility that you choose where you live. Also please send some cur6rent picture from different angles (non-smiling) for my further assessment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year old female with flat cheekbones that
make my eyes look prominent. I have noticed that whenever I laugh the lower eyelid retraction vanishes and the eyes look quite normal. So I am thinking a fat transfer can considerably correct the problem. But I would like toknow if the maxillary hypoplasia is so severe as to make necessary the use of orbital/cheek implants. Or do you believe in using large volumes of fat transfer to treat such cases. And can fat grafts be used in the cheek eyelid junction too?
A: You have astutely discerned the two approaches to anterior midfacial/lower orbital hypoplasia. The bone can be built up with implants or fat can be added to the soft tissues that drape over the bones. Each has their own distinct advantages and disadvantages and the actual anatomy and severity of the tissue deficiency will play a major role in that treatment decision. It would be very helpful to see pictures of your face to provide a more specific answer to your exact facial concerns.
Having done a lot of both implants and fat grafting in this area, I am facile with both techniques and my treatment decision rests with what is best to anatomically correct the problem. Anatomic needs should dictate the treatment, not what ay surgeon is most familiar with doing. What I can tell about treating this area in general is that I often use a combination of both implants and fat grafting to get the best result. Implants can only go where the bone is, fat injection grafting can volumize soft tissues where implants can not. (e.g., lower eyelid above the infraorbital rim)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was just wondering how much the nipple reduction procedure costs. I have protruding nipples that seem “puffy”. I would love to have them lay flat so that I can quit wearing undershirts and join in on summer activities such as swimming. Please let me know.
A: Thank you for your inquiry. There is a difference between protruding nipples and a puffy areola. While sitting right next to each other, they can be very different and require different approaches to treating. One is a simple office procedure to reduce the length of the nipple. (protruding/raised/long nipple) When men use the term ‘puffy nipple’, they are usually referring to the whole nipple-areolar complex that sticks out which is really a very mild form of gynecomastia. That is treated quite differently by excision of the excessive gland tissue under the nipple through a small procedure done in the operating room. A protruding nipple reduction has no recovery at all while the areolar gynecomastia problem requires several weeks of avoiding strenuous activities such as exercise of swimming.
As you can see, I need a clear idea as to exactly what you are referring to. Sending a picture would be very helpful in making that important distinction between the two conditions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin reshaping. I think my mid face and chin are long (I assume it’s easiest to fix just the chin). I’d like to reduce vertical height by at least a third and increase chin projection. I may also consider some work on my nose. (narrow bridge, hump removal, refine tip).
A: Thank you for sending your pictures. It is far easier to vertically shorten facial height by working on the chin. Midface vertical length can only be reduced by a maxillary impaction surgery which can only be done if one has true vertical maxillary excess. (too much tooth and gum show at rest)
Your chin appears long because of it is horizontally short and rotated backward. A sliding genioplasty can be done to bring it forward and to vertically shorten it at the same. To see how this would look, computer imaging needs to be done. To do this type of computer imaging analysis, I need non-smiling pictures from the front and profile views to get a non-distorted imaging. As beautiful as your smile is, it distorts the soft tissues of the chin and nose. This is the one time where smiling is not helpful!
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a tummy tuck. My questions are:
1. Cost- do you know if insurance pays for the surgery or is it out of pocket?
2. Hospital stay – how long or outpatient procedure?
3. How long off of work?
4. Cost for an office consultation
A: Thank you for your tummy tuck inquiry. In answer to your questions:
1) Tummy tuck surgery is a cosmetic procedure and is not covered by insurance unless one has a large overlying abdominal pannus that has documented medical symptoms that have undergone unsuccessful non-surgical treatments. To be considered for insurance coverage a predetermination process is necessary.
2) Unless it is a very large abdominal pannus and the patient has other medical issues, tummy tuck surgery is typically an outpatient procedure.
3) How much time one would need off work after a tummy tuck depends on what type of work one does. But as a general statement, two weeks for an office for sit down job and three weeks or more for a very physical occupation.
4) As a cosmetic tummy tuck there is no charge for am office consultation.
Dr. Barry Eppley
Indianapolis, India
Q: Dr. Eppley, What is the material used to widen my face at all areas. (especially the area at side from zygoma to lower jaw) Will silicone material be the best ? I have tried fat transfer but it was little volume and only had a temporary effect. I wish to widen my face with permanent and semisolid material. I have attached my photo. Thanks a lot.
A: The best way to permanently widen your face is by using a combined custom facial implants approach with jawline and zygomatic arch designs made from a solid silicone implant material. They will provide an immediate and lifetime change. With a custom design they can be made to match in their upper and lower facial width increases so one is not wider than the other.
Fat injections in you was never going to work. And even if the fat took it would look soft and ill-defined. But most importantly your face is too thin to ever have any fat graft take very well. Fat grafts always work better when there is some natural subcutaneous fat into which they are placed.
The only issue here is that there will be a concavity between the mid- and lower facial widths increases where there is no bone support. I assume this is one of the areas where the fat injections were placed that did not work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in frontal bone reduction. (forehead reduction) What’s the average bone thickness of the frontal bones? How much can you usually take off that will a visible different?
A: Burring is the only effective method for forehead reduction or reduction of frontal bone bossing. Frontal bone thicknesses can range from 12 to 17mms in my experience. The bone can be reduced down into the diploid space. How thick the bone is down into that space (how much can the frontal bone be reduced) is best determined by a lateral skull film or CT scan by which the amount of bone reduction can be measured. In my experience that is anywhere from 5 to 8mms. That may not sound like a lot of frontal bone reduction but when done over the entire surface of the forehead it can create a much greater effect than the numbers alone would suggest.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 35 year old male-to-female transsexual. I feel that although I have a substantial amount of buttocks, when looking straight ahead my waist to hip ratio is like a square/box shape. And it doesn’t help that I have broad shoulders. I’ve used temporary solutions like Styrofoams to enhance my hips. I’ve thought about liquid silicone injections but I know that is illegal in the US and very risky/dangerous. I want something that is legal and a better approach to hip augmentation as much as possible. Is this something that you can help me with? Do you do fat transfer to hips only or do you do hip implants? Where are the scars made? Any and all information will help and would be greatly appreciated. Thank you in advance for your time.
A: Hip augmentation can be done by either fat injections or, occasionally, using actual implants. When possible, it is always best to perform hip augmentation with fat injections if one has adequate fat donor sites to harvest by liposuction. It usually takes about 150cc to 200cc of injected fat in each hip to make a visible difference. For both sides that would make a need for about 400cc of concentrated fat to inject. Given that the ratio of obtained concentrated fat to liposuction aspirate is 25% to 33% one has to have about 1500cc of fat to harvest to make the procedure worthwhile. These are average numbers which will vary up and down based on the body type and preoperative hip size.
Hip implants are made by modifying other types silicone body implants since no true hip implants are available as an off-the-shelf preformed implant. They are made of low durometer solid silicone so they are very soft and flexible. (actually feels squishy) They are placed over the desired hip augmentation area through a horizontal incision below the prominence of the iliac crest under the thigh fascia if possible. Because the hip area is a flexion region (e.g., sitting, bending) it is important to not get the implant too high and anterior in the hip region.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation by fat injections. I have no interest in implants whatsoever. I’ve attached a couple pictures for assessment. Do you think I would get a reasonable breast augmentation result (one to two cup sizes bigger) if the fat was taken by liposuction from just my abdomen and flanks. I just weighed myself this morning and my weight is around 170, but I’m typically 165. I’m approximately 5’7” tall.
A: Thank you for sending your pictures and your inquiry in fat injection breast augmentation. I think you have a low amount of fat to harvest to do the procedure given what your breasts are initially like and what your goals are. They have several unfavorable characteristics including a very narrow breast base with large areolae, breast mounds that are very widely separated and a very wide chest width. It would take more fat than you have to inject your breasts to increase the size of your breast mounds to the level that you are seeking. With the amount of fat needed and the assured loss of 50% of what is injected, your breast augmentation result is not going to meet your goals. If you can accept more modest goals such as a 1/2 cup to maybe one cup size bigger, then you become a better candidate for fat injection breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am struggling with my confidence as a result of having a big head. I have read lots of articles on your webpage, and I would really like to do have something done with my head size. It is basically just big in every dimension. So I would like to do these surgeries:
1. Narrowing of head. (Partly removal of the temporal muscle and burring of bone)
2. Shorten the length of my head from my forehead to the back of my head.
3. I would like to reduce the height of my head. (For instance by burring down the sagittal ridge)
I have always had a quite big head, but I was involved in an accident recently, which provoked a bump on the back of my head. So my questions are, how much would it be possible to reduce the skull in the questioned areas?
A: You have highlighted the five site specific skull reduction locations (front, top, back and sides) where reduction procedures are possible that can have an effect on overall head size. It is hard to put an exact number or percent as to how much head size reduction would result from these collective efforts Since every patient is different with varying amounts of head size protrusions and bone thicknesses, each case has to be evaluated on an individual basis. The question is not whether one can perform all these skull procedures but whether the end result justifies the effort. I would need to see pictures of your head from different angles to provide an answer in your case. Ultimately a CT scan is needed to assess the thicknesses of the bone and muscle which also helps in making that determination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a nasal implant question. I would like to have the very tip of my nose lengthened but have been told that my existing implant must be removed due to the fact that it causes the skin of the tip to harden and in future years the implant will cause problems anyway? During my first rhinoplasty a little cartilage was added to the tip. I didn’t feel that it was nearly enough. I have a blue silicone implant in the bridge, “Flowers” is the brand.
A: If you want to lengthen your nasal tip, placing cartilages on top of the nasal implant in the tip area can be done. (if the implant even goes down over the tip) There is no reason to remove the nasal implant to do so.
By the way, if you have a blue colored implant on your nasal bridge, that is not an actual implant. That is the nasal implant sizer used to try in before placing the real implant. Some surgeons unethically place sizers instead of the real implants because they cost only 10% as much as the real implant. That is why the company colors them blue, to try and prevent surgeons from using the sizers as the actual nasal implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am inquiring about the possibilities regarding slimming down my face. It is just long and wide and does not look proportional to my body at all. What could be done to reduce the size of my face? I obviously see that there are limits of what can be done. Whereas I for instance could have jaw reduction and/or cheek cutting. But what sort of experience do you have here?
A: In facial reshaping surgery, slimming the face can be done by three different approaches depending on the dimensions involved. Normally the face could be vertically lengthened to make it look less wide. The face could also be made less wide (width reduction) without changing the vertical length. Lastly, a combination of vertical lengthening and width reduction can be done which often is the most effective.
Your facial dimensions and concerns (‘long and wide’) leave you with only facial width reduction options as you have noted. Cheekbone narrowing and jaw reduction would be the logical procedures of cboice. Whether this would include vertical chin reduction to help with the long face can be debated since vertical facial shortening works against facial width efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin augmentation and rhinoplasty after our consultation? What are the logistics of the actual procedure…i.e, time needed to recover, possible adverse short and long term effects, are the results permanent or will it need to be altered down the road to maintain its new shape, and are allergic reactions to the implant material common?
Another concern of mine is that I train in jiu jitsu (it’s like wrestling pretty much) so would the implant possibly be jostled loose if I were to get knocked in the chin? If so, would the sliding genioplasty yield similar results or no? I do like the chin implant.. just worried that it could be a potential problem.
A: The combination of rhinoplasty and chin augmentation is a very common facial reshaping surgery because of its dual benefits in changing two important areas of facial prominences. These are outpatient procedures done under general anesthesia. The most significant recovery is the first week when the nose will have a tape and splint dressing and the chin will be the most swollen. After the first week the nasal splint comes off so it is easier to be seen out in public without having had obvious surgery. Most of the swelling is gone by about three weeks after the procedure although it really takes a full three months before one should critique the results.
Both the rhinoplasty and chin augmentation create permanent effects through bone and cartilage modifications (nose) and the placement of a non-degradable implant. (chin) There is no such thing as an allergic reaction to a silicone implant although there is the rare occurrence of the risk of infection (1% or less) The chin implant will be secured in placed by small screws so between screw fixation and the enveloping scar that occurs around any implant, it will never move regardless of almost any degree of physical contact. You would have to break the bone to move the implant.
The biggest risks or need for revisional procedures for either a rhinoplasty or chin implant are aesthetic in nature…how does it eventually look and is the patient satisfied. The overwhelming reason for revision of any facial aesthetic procedure is the patient desire for additional changes/improvement in the shape of the nose or chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was seeking a natural tummy tuck result. But after looking at the picture you provided to me, I now realize that removing the excess skin/tissue across my abdomen is not going to give me the “natural” look I was hoping for. So my questions are:
- What other procedures do I need which will help to reduce the flank areas and outer thigh areas (lipo, lifts, different abdominal procedure?). I am not interested in the inner thigh at this point, but I would like surgery results closer to the “after” picture than what the one procedure appears to be able to provide.
- By adding these procedures how much additional time or what will the total surgery time be? Given my age, do you consider this extended time to be a concern?
- By adding these procedures what amount of recovery time do I need to plan for. (My daughter is getting married in late June and activities are already planned for mid-June.) Will a mid-April surgery date, if available, give me the necessary recovery time to fully enjoy the wedding activites, anticipating no surgery complications?
- Will I need to plan more time off than just the day of and day after surgery?
A: The concept of a ‘natural’ look after a tummy tuck is open to wide intrepretation and is subject to one’s own perception. But in answer to your specific questions:
- It is important to realize that you are not able to achieve the after picture that you saw. Your body is completely different in many dimensions and no amount of additional liposuction will make those type of changes.
- If there is truly a ‘dangerous’ part of abdominal contouring, it is large volume liposuction that may accompany the procedure. It is one thing to do a little flank liposuction as part of a tummy tuck, but major liposuction places certain patients like yourself at increased risks and exposes yourself to some of the greater risks and problems that you have heard with other people. I would not recommend it for you other than some small contouring liposuction at the back end of the tummy tuck incisions.
- When you think of any significant event that someone wants to attend and be truly 100% fully recovered, the minimum time for the surgery before the event would be 8 weeks.
- I would definitely plan for more than just one day after the surgery to return to work. For computer work at least a few days would be in order.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had combination malar submalar implants placed a year ago, but they were too big and I had them removed. I later decided to go with malar implants only, but they got infected and I had to remove them too. I guess you can say that I haven’t had the best of luck with these implants.
Anyway, what I’ve noticed is that there seems to be some sagging in the mid-face from the cheek implant removal, and I seem to have deeper nasolabial folds and some droopiness at the corners of my eyes too. I’m not too happy with this, and would like it fixed.
Would it be possible to explain to me what my options are? Are there any minimally invasive lifting procedures that can be done? I’m still young (mid-20s), so I would preferably like to avoid anything too extensive or invasive.
A: With cheeks implant removal of any style and size, tissue sag is inevitable due to loss of anchoring attachments of the overlying cheek tissues to the zygomatic bone. The only potentially effective treatment would be cheek soft tissue resuspension. There are multiple ways that cheek resuspension can be done from using intraoral, lower eyelid and temporal suspension points of anchorage. One can debate whether any of these techniques are less invasive or extensive than the other, but I would not make much of a distinction between them. It can also be debated as to which of these cheek resuspension techniques is more effective than the other. But that is probably more surgeon dependent than technique dependent per se. Lastly whether they can create the more complete improvement that you seek (midface sagging, nasolabial fold reduction and corner of eye droopiness correction) is asking a lot of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 29 year old female and I am interested in a midface lift in hopes of achieving a cat eye look. I love how my hair looks when pulled back into a tight high pony tail. It gives me Asian eyes and lifts my cheeks.
I notice celebrities are having this look, people refer as the PILLOW… I read they have a lot of fillers and botox but i want something that will last longer.
I once had a temple lift with Endotine and done by endoscopic. I loved the results. It gave me exactly what I wanted…slanted eyes and my cheeks raised. But unfortunately it lasted no more than a month. My skin, just went back to it’s pre-surgery state.
So will a midface lift help achieve this for me? I see other questions you answered involving lateral canthoplasty, would that help as well? Which is preferred? Thank you so much for your time Dr. Eppley!
A: What you have learned from your midface lifting experience is that simply pulling on the skin up and back, like a tight ponytail, is not going to create a sustained result. It simply is not that easy. Such endoscopic temporal lifts alone always fail because skin pulling/shifting alone is not the answer for raising the corner of the eye and keeping the cheek tissue lifted. A direct approach to the corner of the eye (lateral canthopexy vs canthoplasty) is needed in conjunction with a high placed cheek implant and and an excisional temporal lift. Like a strair step approach, lifting and support needs to be added at three levels to get a better and more sustained result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m not able to find any image for a “custom made vertical” chin implant. I’m trying to figure out what a vertical chin implant might look like,where it will sit on the chin bone or where the screws will be fixed.
1. Please can you show an image for a custom made vertical chin implant and where it will sit on the chin bone. Hopefully this type of implant will be able to augment 4 millimeters vertically.I read that extended anatomical gives a more natural fit?)
2. If a patient already has a CT scan (including DICOM) of their current jaw/chin bone in order to design a custom made implant; how many weeks will they have to be in Indianapolis to have the jaw angle/chin implants made plus have the surgery done and be safe before they fly out of indiana back to their country? (4wks,6wks?)
(Just in case the implants may result in any infection, how many weeks should one really stay in Indianapolis and wait until it’s safe to know everything is OK before leaving Indiana/the US? Thank you
A: A custom chin implant can be made any way one wants or needs it to be shaped. It can provide the required vertical increase (4mms in your case) and has a lip or edge that goes up over the lower end of the chin bone so it can be secured into place by screw fixation. No standard or preformed chin implant today (other than my small vertical lengthening chin implant can create this type of chin change)
If one has an existing 3D CT scan that reflects the current jaw shape, it can certainly be used. The CT scan is simply sent to me and the implant design is done from here. There is no need for the patient to be here to have it done. The patient only comes in for the surgery and can return home in a few days. There is no need to stay here any longer. And staying here any longer has notbenefit from an infection standpoint. The infection risk is so low (less than 1%) with facial implants and its occurrence could be weeks or months later if it does occur.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having breast implant replacements surgery one week from tomorrow. I am going to send some photos of myself again and the final pic of what I would like to get close to ( yes I know I’ll never be them or anyone else) just looking to getting close to that result. I also realize you told me I’d have to give up silicone and go with saline overfilled. You had me at 655cc Sientra high profile silicone, but if I need to stay with saline to even go in that direction of a result I understand. Also, I understand you won’t be able to use my previous under the breast incision, but the aerola one. The picture I am sending is close to my stats, although I don’t know exact size I know I was an A before I ever got implants too and I don’t know her bwd measurement. Looks like she has 700 silicone ultra high profile, but then again I have the sag that filters in too. Thank you again for your patience! You don’t know how much it is appreciated.
A: Your breast implant replacements choice is a tough one because there is no ideal solution. Each implant size type choice has its own aesthetic tradeoffs. To get a really round look, it is going to take significant volume. Given that you have roughly 350cc implants in place now, you would have to triple that volume to create a very full round look. Only saline implants will allow that volume by taking 700cc/800cc implant and overfilling them to 900cc to 1000cc volumes. (e.g., Allergan high profile round saline 750cc implants) That will pick up all the loose skin and fill it out but to do so will likely make you bigger than the pictures you have shown. Your natural breasts have a bigger base and a lot more loose skin than any of the ideal pictures you are showing. In addition, it is important for you to realize that even at these volumes your breasts are not going to be lifted per se. They are going to stay where they are and just bigger in that position. In conclusion with overfilled saline implants, it is important that you will have to accept a very large round size that sit slower in your chest wall than you desire. The only way to get around the sagging issues is to have a breast lift first and then six months have new implants placed. But because of the scars this is not on the table for consideration.
If we go with silicone breast implant replacements, it would have to be an ultra high profile implant at 700cc or 800cc volume with base widths of 13.5 or 14.2 cms respectively. (Allergan) In so doing you will get the most breast volume that can be achieved with silicone implants. But whether it will give that very round full look that you desire can not really be known until during actual surgery. It is just hard to predict what the skin will do with the volume. I suspect it will take the 800cc to get the best effect possible with this approach. Again, however, this will not lift up the breasts higher in the chest wall.
Regardless of the implant style and volume chosen, the safest approach in very large breast augmentations is with the areolar incision. This deuces the risk of bottoming out of the implants after surgery because it does not place a ‘weak point’ on the underside of the breast where a lower breast fold incision is placed. It is important to realize the stress of the supporting breast tissues that large implants place.
This should give you enough information to pick which implant type (saline or silicone) and their tradeoffs is most important to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently learned that I have two ruptured disc in my back and pressure on a nerve. I am wanting to know if I was to get a tummy tuck, liposuction, etc would it help with my back pain?
A: Whether a tummy tuck would provide any relief of our back pain would largely depend on the size of the abdominal overhang. Some tummy tuck/abdominal panniculectomy patients do report that they do have improvements in back pain after the procedure due to the loss of an overhanging abdominal pannus or even lesser amounts of skin and fat excess. But whether a tummy tuck would help you can not be predicted and is certainly not a common improvement that occurs after any abdominal reshaping procedure. Unlike breast reduction surgery which causes musculoskeletal symptom improvement in every patient, back pain improvement from a tummy tuck is far less assured. This is evidenced by the fact that no insurance company will approve tummy tuck surgery on the basis as a treatment for chronic back pain with or without ruptured discs and/or sciatic nerve pain.
Dr. Barry Eppley
Indianapolis, Indiana
