Your Questions
Your Questions
Q: Dr. Eppley, I’ve been looking into getting cheek implants for a while now, and I came across your helpful blog on my numerous exhaustive searches on the Internet for cheek implants. I was hoping I could get your opinion on one big question that I have- what kind of implants will give me the high prominent cheeks look, but with some fullness in the front of the face too. (The pictures show the look that I’m after) (I’d also like to point out that those pictures are just for reference, I do know that cheek implants won’t turn me into Rosie Huntington-Whiteley) want both, the definition from the side, the high placement and also some frontal fullness. Thank you.
A: While there are many different styles of cheek implants, it is important to realize that the look you are after is not likely to be achieved by standard stock implants. If you translate the look you are after to the type of cheek implants available, it is fairly easy to see that no such cheek implant style exists. (at least none that I would feel comfortable placing hoping to achieve that type of cheek augmentation effect) In my opinion, only custom designing cheek implants can create the style and size you seek. Then there is also the factor of your own cheek bone anatomy and how it may help or hurt the desired look…hence the benefits of a custom designed cheek implant style.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a male that has Scheuermann’s Disease and would like to know if having abdominal liposuction may help relieve some of the discomfort and strain from my back and neck? It makes sense to me since less fat would mean less strain Your thoughts on this?
A: I know of no medical evidence that supports abdominal liposuction as providing symptomatic or preventative benefits with this form of spinal issue. (kyphosis) Having said that perhaps if the abdomen was big enough and the liposuction of sufficient volume that there could be some potential benefit. However, most of abdominal fat in men is intraperitoneal and is not treatable by liposuction extraction. That is a fundamental difference between men and women in their abdominal fat distribution and shape.
Thus I am not sure if liposuction alone would produce an adequate relief of the abdominal ‘load’ that would translate into some form of back pain relief or prevention of further spinal kyphosis. It would make more sense to me that an abdominal panniculectomy would have such back benefits since removing an overhanging and heavy pannus is known to reduce lower back strain due to its size and the pulling on the trunk from hanging down below the waistline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have very heavy looking eyelids. Would I be a good candidate for an endoscopic browlift or an eyelid lift? I have some concerns about making my forehead higher.
A: Your question is not an uncommon one as many people with ‘heavy’ upper eyes do have a combination of some degree of brow ptosis and redundant upper eyelid skin. In looking at your pictures, I think your heavy upper eyelids do fall into this ‘combo’ category and are caused by a combination of slightly low brows and upper eyelids that have too much fat and just a touch of extra skin. The question is whether a browlift alone (pretrichial not endoscopic so your hairline will not only not get longer but can even be lowered if desired), some upper eyelid skin removal and defatting or both would be optimally beneficial.
This type of periorbital decision can be difficult as you do not want to over operate but, by the same token, you do not want to under treat either.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Earlier this year I had my cheek implants removed and I feel a lot better that I did. The only thing is the hollowness that it created under eyes and lower cheek area. I feel that that this is due to the loss of cheek attachments and you have even mentioned so in one of your blogs. Do you know of any method to reattach the tissues to cheek and under eyes?
A: You are correct in that I have written in the past about your exact situation. Like breast implants once the cheek tissues are detached and stretched out for implant placement, they may not recover their original position after cheek implant removal. It is not so much from the tissue stretching but all of the cheek tissue attachments have been stripped off from the bone. Unless there was some specific method to reattach these tissues or lift them at the time of cheek implant removal, they may develop some sag off the cheek.
There are several methods to resuspend sagging cheek tissues. This can include a mitek suture anchor resuspension done intraorally or a suture suspension done through a combined temporal and intraoral approach. It is important to realize that this will help with cheek sagging and will have no effect on undereye hollowness.
An alternative approach is to simply have fat injections done to restore cheek volume and fill in the under eye hollows at the same time. Or resuspend the cheek tissues and save the fat injections just for the under eye hollows.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty done about a year ago to extend and derotate my tip and columnella. In the process I also had a premaxillary implant which was inserted in the nasal spine area through an incision through the inside of my upper lip. All of these were rib cartilages.
Whatever the cause, my smile has been warped for the worst. Before surgery, when I smiled, my upper lip used to be mobile, flip up, and thick and my columnella and tip would also droop down resulting in a nice natural smile that wasn’t tense. Now my smile is frozen looking. My upper lip is thin, tense and my nose tip and columnellar are also wooden looking and do not move with my smile the way it used to. It looks off and disturbing according to many of my friends. I am very upset with this. Is this my tip and columnella rib work that is doing this or is it a result of my premaxillary graft? I would certainly like to remove my premax graft if this will fix my smile. Thank you very much.
A: When you add a lot of rib cartilage grafts to the tip of the nose and the underlying pyriform aperture/nasal spine area, there is the possibility of stiffening how the upper lip moves. While it is possible that it is the combination of the effects of all the cartilage grafts (I have no idea as to teh details of where they were placed exactly and their size), the most likely culprit is the premaxillary graft. Its removal would be a good place to start and would also not affect to any significant degree the rhinoplasty result. Whether it will produce a complete normalization of your smile can not be predicted and it is not known if that could ever be achieved even with removal of all of the rib cartilage grafts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to thank you for the kind and professional treatment by you and your staff during my stay in Indianapolis for my occipital augmentation surgery. My scar on the back of my head is healing nicely! I almost can’t see it when I use a mirror to see the back of my head. Overall, in terms of the shape of the back of my head, I’d say there’s a 60% to 70 per cent improvement. However, as you correctly noted during our visit the day after my surgery, my head is/was really flat in certain areas, and the implant may have not been created with sufficient thickness/volume to create a “rounder” effect. It’s funny, with the CT scan, I’d have thought the outer implant shape would be super-precise. So I am wondering about the possibility of doing a revision. I am grateful for the improvement so far, but I sometimes think that the back could be a bit “rounder”, and hence, I start pondering my options. Do you think it would be worth doing a revision for more occipital projection?
A: Let me provide with some insight as it it relates to a result that has ‘60% to 70% improvement and what a ‘revision’ really means.
First, the computer design process did a very precise job of making the implant perfectly. What the computer can do is to make it fit the bone perfectly, make the implant symmetric based on differences of the shape of the underlying bone and make its outer surface and edging as smooth as possible. That is has done wonderfully. What the computer can not do is to inherently know what the shape and thickness of the implant should be based on aesthetic goals. That is the role that I play and it will only follow the design that I instruct it to do. My job is to design an implant that will fit given the tolerances of the overlying scalp and be able to be placed through the smallest incision possible. Occipital implants that are too big can cause catastrophic problems, such as scalp and incisional tissue necrosis, hair fall out, non healing wounds, infection and the need to do a lot of ‘wittling’ on the implant trying to make it fit. (resulting in irregularities and asymmetries) It is my experience and judgment that allows for these type of problems to be avoided. That is why your implant, like many patients, is not designed to be thicker than 9 to 10mms as this is what I have learned to be a safe implant thickness that will always avoid any of these concerns. Most of the time patients will say down the road that they wish it was a little fuller after they get past the initial euphoria of having some augmentation effect. But it is always better to have a 70% result that has never experienced any complications vs. having the perfect volumetric result that has developed a complication.
When it comes to a ‘revision’, this is often a poor term to use and the incorrect way to think about it. Understandably patients think that ‘just adding a little more’ or ‘making an adjustment secondarily’ is easier than the first time. But the reality is that it is exactly the opposite. It is now harder because the tissue are more scarred and the scalp is less flexible. You may be able to place an implant that is 4 to 5mm thicker but it will likely require a bigger incision, a whole new implant, and will increase the potential for any of the complications that I have previously described. (the risk may be still fairly low but it is higher than the first time). Thus one has to weigh the risk vs. benefit for that extra 20% to 30% gain of improvement that could be achieved.
While I am happy to place a whole new implant, and I have done it many times for patients with many different kinds of skull and facial structural surgeries, it is important to understand that every surgery has risks. Just because it worked perfectly the first time is not a guarantee that it will be so the next time. Manipulating otherwise uncomplicated aesthetic results should be considered carefully if not more so than the first time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheekbone reduction surgery done five years ago and I felt it left me with asymmetric cheeks. CT scan pictures after the surgery show that the cheekbones were probably removed too much and they were placed in different positions vertically. There are ‘gaps’ in the cheekbone area. I wonder if this can be fixed.
A: It is not rare to have some asymmetry in the position of the bones after cheek bone reduction surgery. Besides the fact that most people’s cheek bones are not really symmetric initially, there are always going to be differences in the angle of the cuts and the bone fixation points between the sides since they are not independent of each and can not be view intraoperatively in a simultaneous fashion. That being said you do have external cheek bone asymmetry with the right side being more medial or moved inward that the left. I will assume by your comments that your ‘good’ side is the left one and the side you seek improvement is the right side. That could be improved by either repositioning the anterior end of the right cheek bone or adding a small implant over the osteotomy site.
In regards to the cheek bone gaps seen on the CT scan, that is an early after surgery x-ray. At this point years later, those bone gaps have likely filled in and healed with bone. If not, they have a fibrous union and there is no aesthetic benefit to having those bony gaps ‘fixed’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Does your age such as 60 years old matter on results on liposuction if you are not over weight and have some loose skin but not bad. I’m in great shape and health as this has been my whole life lifestyle so not sure why my age would have anything to do with results. I understand skin changes with age but again I see a 30 year looks like my situation such as same shape or worst. Is this true?
A: Generally speaking, skin does not retract very well at age 60 as compared to age 30. There is an overall loss of skin elasticity as one ages. So liposuction results tend to not be as ‘good’ when one is older. The fat can be removed equally well, regardless of age, but the smoothness of the skin tends to be more irregular and imperfect once the fat has been removed at an older age. As long as one can accept that trade-off, there is no reason one can not have liposuction at age 60. This can also change by the body area being treated such as the flanks will always do better than the thighs for example at any age.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like your input on the possibility of me being a good candidate for an arm lift procedure. I am 28 years old, I have lost 80lbs through diet and exercise, while I still have more weight to lose, I do not think that my arms will see any more of an improvement. I have also had abnormally large arms, as the photo shows, my left is approximately 2 inches larger than my right. Do you believe I could be a good candidate for this procedure? Is liposuction an option? I am concerned about bad scarring given that I am African American.
A: By your pictures which show large hanging ‘bat wings’, you would be an excellent candidate for arm lift. I would agree that the size of your arms is not going to change at all with more weight loss. The biggest issue is the amount of arm skin that you have which can neither shrink nor disappear with liposuction. The only way to get improvement is with an excision procedure where the excess arm skin and fat is removed. This would drop your circumferential arm size down to about half, if not more, than what it is now.
The dilemma that you have is that no change can be done to your arms without the scar. Nothing else will make any difference. You do not have the luxury of having a scarless operation that will work. You have to decide to balance the scar and its associated risks vs. living with your arms the way they are. I can not say I have seen any worse scarring in African Americans with arm lifts than any other patients who have had the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 35 year-old male who is interested in jaw angle implants. It seems to be hard to find surgeons who do this procedure with any regularity or expertise in it. I’ve met many surgeons during the last three years and none seems to be expert in it. I know the distance could be a problem in case of complications, but I’m financially ready and, if I remember well, we talked a couple of years ago on another website about this procedure. I had a rhinoplasty and chin implant back in 2010 (conform extended anatomical chin implant, size large, Implantech) and I really would to go on with the work on my face having jaw angle implants.Do you work on international patients? And are two weeks there enough to fly back safely? I see my face as very vertical, so I think I would only need width and not add further vertical projection.
A: I would certainly agree based on your pictures that you only need width enhancing jaw angle implants and not vertical lengthening ones. While the surgery does cause some swelling I would see no need to be here any longer than 5 to 7 days at most before flying home. Fortunately any serious complications are very rare (e.g., infection) so being at a great distance is rarely an issue.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in possibly getting cheek and chin implants (or starting out with dermal filler) to attain a more chiseled & angular look. I would like to get a well-defined, hollowed-out appearance similar to what many actors have.
I am especially interested in seeing if I can obtain not just the hollowed-out cheeks, but also the well-defined line that seems to run from the cheeks to the chin on both sides of his face (this effect is especially noticeable in the last picture).
I have also submitted two photos of myself; please excuse the eye asymmetry, which occurs occasionally due to an outdoor allergic reaction (I run/jog outside a lot).
Generally speaking, do you think the goals I am trying to achieve are realistic?
A: Based in these pictures and your face, I do not find your facial goals especially realistic. While cheek and chin implants will help create more prominent facial structures, they will not necessarily cause that hollowed look you are seeking. That is caused as much by the lack of any subcutaneous fat over the trampoline area of the face and prominent jaw angles as it is caused by any prominent cheek and chin structure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently undergoing orthodontic treatment to correct a severe overbite which has also caused a recessed chin and weak jaw. My orthodontist said it may be necessary to undergo orthognathic surgery following my treatment. While I’m perfectly happy to do this, there is a good chance my insurance won’t cover it as it is not causing a medical problem (such as sleep apnea or speech impediments) and the surgery can cost anywhere from $20-50k.
I want to know if a custom wrap around jawline implant could give the same aesthetic effects of the jawline (fix my recessed chin/weak jaw) as orthognathic surgery of the mandible? In other words, can the implant mask the appearance issue of the jawline without actually addressing the functionality issue of an overbite?
A: The simple answer to your question is yes. In reality, a custom wrap around jawline implant offers much more versatility in terms of dimensional facial changes than any form of orthognathic surgery. A sagittal split osteotomy advancement of the mandible can really only supply a horizontal forward movement whose limit is based on the difference between the pre surgical relationship of the upper and lower teeth.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can I do to make sure my breasts won’t be too far apart after getting breast implants? I know that breast augmentation doesn’t change where your natural breasts sit and that it only enlarges them. But I simply don’t want my new breasts to be too far apart. What can I tell my surgeon to make sure that my breasts are full and close together?
A: You are both asking a reasonable question abut a common breast augmentation concern and also answering it at the same time. You have correctly surmised that all breast implants do is make your natural breasts fuller. That may or may not necessarily make them somewhat closer together depending upon the size of the implants. But there is no guarantee that they will and there is not anything your surgeon can do to change the natural wide spacing between your breasts. You will need to accept that this is a limitation of breast augmentation surgery and is a function of your anatomy and not your surgeon’s technique or ability. At the least, every plastic surgeon recognizes and understands this implant spacing concern…and usually goes to great lengths to point it out and that your after surgery result is still going to have a sternal gap between the augmented breasts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a very narrow, dolichocephalic skull shape and I would like to increase the width of my head. According to the information on head widening provided on your website there are two options to achieve this:
1. Augmenting the posterior part of the temporalis muscle by injecting fat.
2. Placing an implant under the temporalis muscle above the ears.
I prefer option 1 since I would like to avoid implants. However, if the achievable results of fat injections are unsatisfactory I will gladly consider alternatives.
Thus I have the following questions:
1. By how many millimeters can the head be widened through fat injections to the posterior aspect of the temporalis muscle? Are 5mm per side achievable?
2. How much would the procedure cost if i) only the posterior part and ii) both the anterior and the posterior part of the temporalis were to be augmented?
3. How much does it cost to widen the head using semi-custom-made implants with a thickness of 5mm per implant?
4. Are there any other methods to increase the head without producing visible scars?
Thank you for your time.
A: The short answer to your question about head widening through posterior temporal augmentation is that only an implant is going to consistently work. The first issue with fat that you have to have enough to harvest, process and then inject. In a thin person, which it appears you are, that could be the rate limiting step right there. No matter what is injected only a fraction will survive and what survives most certainly is not likely to be symmetric.
The use of a semi-custom temporal widening implant is assured, can easily increase the side width by 5mms and is placed through an incision that is limited to the back of the ear. (thus being placed in a scarless fashion) Any consideration of fat injection use should be limited to the temporal hollowing located next to the eye area (anterior temporal augmentation) where a more posterior implant does not reach. There are very effective implants for that area as well but they require a more exposed vertical incision in the temporal scalp region.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How long should I wait to have a tummy tuck after having a baby. I delivered my baby three months ago and I am now very close to my before pregnancy weight. I am only about 3 lbs from it at this point. The issue is not the weight but the ton of loose skin that I have. I know that I am not going to have any more children so I am ready whenever a doctor says I should do it. I also have a lot of stretch marks which I really don’t like, will a tummy tuck get rid of all of them? Lastly, what type of tummy tuck should I have… a full or mini tuck?
A: The typical answer from most plastic surgeons is that the earliest that a tummy tuck should be done after a pregnancy is six months. This gives a woman ample time to lose as much as of their pregnancy weight as possible and to be able to take care of a new babcy before embarking on a need for their own recovery. It is also important to remember that this is an elective procedure so any need to rush the decision for surgery is an emotional one not one of medical necessity.
By using the term, ton of loose skin, this implies that a full tummy tuck is needed for the best result. This form of a tummy tuck is also the most assured way of getting off the maximum number of stretch marks. While it does result in a longer scar, the result is always better than when less tissue is removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have several questions about vertical chin lengthening. They are as follows:
1) Given my case of wanting vertical elongation with some minimal horizontal projection, are my needs best served with a chin implant or a sliding genioplasty and which one in your professional opinion would you recommend and why?
2) I am primarily interested in a sliding genioplasty and would prefer to avoid an implant. In my case, would you be willing and able to do a sliding genioplasty on me instead of an implant?
3) Can vertical elongation be achieved with a sliding genioplasty?
4) With a chin implant, can vertical elongation be achieved?
5) I noticed that when I smile, my chin seems to jut out. However, upon closer observation, I noticed that it is because my entire face goes upward when I do smile. Would A chin implant emphasize this jutting out of the chin?
6) What a sliding genioplasty emphasize this jutting out of the chin as described above?
7) Since my chin seems to jutt out when I smile, it is possible for a sliding genioplasty to be done primarily for vertical elongation purposes and minimal forward movement?
8) Do you think I would have mentalis muscle strain with a sliding genioplasty?
9) If a sliding genioplasty is done, is there a chance that my lower lip might not be able to touch upon the top lip and would struggle to close my mouth? Is this is same as mentalis muscle strain?
10) Will the lip curl of my lower lip downward be exaggerated with a chin implant given that a chin implant primarily is done for horizontal projection and not for vertical elongation which is my goal?
11) With a sliding genioplasty, because the bone would be brought down and slightly out, will that create a more v-shape/heart shape look to my lower face?
Thank you so much Dr. Eppley and I look forward to your response.
A: In answer to your specific questions:
1) For pure vertical chin elongation, either a sliding genioplasty or a chin implant can be used. But the chin implant would have to be custom made to achieve a vertical lengthening since they are not manufactured in standard shapes to normally do so. I have done in either way for various patients and their affinity or disdain for an implant will determine the choice. Most, if not all, Asian women that I have treated or discussed this type of chin change are going to opt for a sliding genioplasty approach.
2) Your preference for a sliding genioplasty indicates that is the preferred choice for you.
3) Vertical elongation alone can easily be achieved with a sliding genioplasty.
4) Only a custom chin implant can achieve vertical lengthening.
5) and 6) Neither a chin implant or a sliding genioplasty is going to make this jutting out of the chin change. Whether it would make it worse can not be predicted.
7) A sliding genioplasty can be done in any dimension one wants. While it may be commonly done for horizontal advancement, that does not mean it has to be done for that movement. You seem to be under a misconception that it is somehow unusual or difficult to just move the move for vertical lengthening alone when it is not. That is the easiest movement to make for a sliding genioplasty.
8) Any change in the bone position of the chin runs the risk of creating a mentalis strain. It is not very common but potentially can happen.
9) Lower lip incompetence and mentalis strain are indeed related. Again it is not a very common problem to occur after a sliding genioplasty but is possible.
10) Since you are not interested in a chin implant, this question does not seem applicable.
11) Vertical lengthening of the chin by a bony genioplasty is a well known facial bone technique for making the face more heart shaped. This can be particularly aided by also narrowing the chin bone as it is lengthened.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What I most dislike about my face at this time are the bags/creases under my eyes that make me look tired and old. There are also some fairly “deep” lines in my forehead. I am turning 35 next month, so I don’t think I want any type of surgery yet. I am interested to find out what types of options there are for me and what it might cost. Likely, I would do this in the spring time over school break. Thanks!
A: The earliest signs of facial aging always with exactly what you are seeing. Wrinkle lines on the forehead and/or around the eyes and the development of bags (herniated fat ) on the lower eyelids. Botox injections work well for forehead wrinkle lines. Lower eyelid bags are really best treated by removal. (transconjunctival blepharoplasty) But to those adverse to surgery, injectable fillers can be used to fill in the tear troughs created by the bags. Such injection treatments in my experience are a mixed ‘bag’ since they have a not rare problem of lumps and unevenness due to the thin skin of the eyelids. When they work well they are great but when irregularities develop the filler often has to be dissolved away by hyaluronidase injections.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi. I have about a half inch of bone loss in my parietal regin going all the way to the back of my head and bone loss in my back of my head. I saw that you performed an implant on some with a similar problem with silicon. I wanted to know if there was anything else available because I don’t feel comfortable about putting silicon in my body. Would fat transfer work or would you recommend something else. I have had this problem for years, but hair is thinning out and I am not able to cover it up like I used to. Thank you!
A: There are lots of different materials that can be used for skull augmentation or fill in of defects.The one major issue with all of them is that wide open exposure is needed to apply them to the bone site. In other words, a long scar across the top of your head. The reason that custom silicone implants are one of the most popular forms of skull augmentation is that they can be placed through much small and more discrete incisions and do not run the risk of any contour or edge transition problems. There are no effective injectable methods of skull augmentation. While fat can be injected, its survival is highly unpredictable as well as how smooth it might be. (which it wouldn’t) But there are no adverse effect from using fat other than how well it may or may not work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an extremely pronounced (Stage 4 I think) single glabellar line that was treated with Juvaderm and Botox multiple times back in 2007/2008. The single line is now gone but significant 11 lines that have formed around it. My current dermatologist has a concern with fillers and the glabellar region due to the blindness risk. Do you do Acellular Dermal Matrix Insertion? Is that a viable option? Is it an expensive procedure? What are my options for glabellar implants?
A: I have placed about every conceivable graft material into glabellar lines. Acellular dermal matrix (ADM) is just one example and there are many other options including synthetic implants. The most common form of ADM would be Alloderm, which is an allogeneic cadaveric dermal product which has been around for years. It is placed in the office as a simple office procedure done under local anesthesia. But other implant types, such as synthetic Permalip implants can be used, which has a guaranteed volume retention. And are just as easily placed as any other glabellar graft or implant material.
While blindness is an extremely rare complication from the use of injectable fillers around the eyes, the way to completely negate that concern is a non-injectable implant placement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I spoke to you all a while back about considering plastic surgery. I was very pleased with the results of the face prediction and your wonderful, fast replies. However, I have just a few questions:
1. How would I schedule an in person consultation? I would be coming from way across the country and I am willing to fly out to Indiana. The online Skype consultation will not really work because the internet is quite slow where I live and I am worried it’ll be more trouble than it’s worth. Therefore, I’d be more comfortable with an in-person consultation.
2. What is the estimated recovery time for Chin Reduction surgery and Rhinoplasty? Would I have to stay in Indiana for a certain amount of time? Are we talking days, or perhaps weeks?
3. I would be unconscious during the surgery, right? So, do you guys have a licensed anesthesiologist at all of your locations?
4. I see that you have multiple offices to choose from. Which office location would be the best for me and my procedure?
Thank you so much for taking the time to answer my question, and thank you all for your hard work.
A: In answer to your questions about rhinoplasty and chin reduction:
- An in person consultation can be arranged at your convenience. I will have my assistant Camille contact you next week to make those arrangements.
- The concept of recovery after any surgery can mean various things to different people. But to use a simple endpoint of being able to do most functions and looking only moderately swollen, think 10 to 14 days. You should be able to return home in a few days after surgery.
- Rhinoplasty and chin reduction surgery requires a general anesthetic to be both completely comfortable during surgery and to allow the best extent of the surgeries to be done.While I operate at multiple hospitals, aesthetic procedures are done at my private surgery center which is both AAAHC certified and staffed with board-certified anesthesiologists.
- At stated in #3 above, there is only one aesthetic surgery center at which I operate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 21 year old man and I was looking to have jaw angle implants with you. But first I would like to have your professional opinion if I really should get the implants? And to have better results should the implants be customized? And how much does it cost to have custom jaw angle implants?
A: In looking at the side view pictures that you have provided (which only provides an incomplete and one-dimensional view of the jawline), I see no benefit to jaw angle implants for you. You already have a fairly low mandibular plane angle (linear relationship of the jaw angle to chin line compared to the Frankfort horizontal line) and you would not want to drop it down any further. Whether there is any benefit to width only jaw angle implants requires a frontal view picture to make that assessment.
Jaw angle implants come in two fundamental types, width only and combined vertical and width angle types. The vast majority of patients, male or female, seeking jaw angle augmentation have a high jaw angle or a steep mandibular plane. This requires a vertical lengthening style. Less commonly, the angle position is vertically satisfactory and a more defined shape is needed through width enhancement
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, As the date gets closer I’m just stressing a little. Just want to make sure the plan is clear. I just want to make sure you can make the tip smaller and more symmetrical. Not too pointy and won’t stick out too far. Nostrils smaller as well. I just want it to look pretty and feminine and still fit my face well. I know you are good at what you do and I trust you but just had to write you. Just need some reassurance. Thanks 🙂
A: Any patient considering any type of plastic surgery, particularly rhinoplasty which sits in the center of the face, will have presurgical anxiety. This anxiety stems from the uncertainty of what the outcome will be. This is why presurgical computer imaging is done, to help see if the general changes shown are what one is looking to achieve. Thus, it is fair to say that you will go through the surgery just fine and your nose will have an improved appearance afterwards as most of the imaging predictions shown will largely be achieved.
However, it is also important to understand that few rhinoplasties ever turn out ‘perfect’. There is always going to be some minor imperfections from the ideal desired result. It is also important to understand that the final results of a rhinoplasty take a long time to be realized due to the time needed for the overlying skin to shrink down to the reshaped bone and cartilage framework of the nose.
Point of this discussion is…your nose will look a lot more proportionate, it will still has some imperfections and one has to have patience in the recovery process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am on a search to find the right doctor to fix my facial structure problem. I’ve been very dissatisfied with the worsening of this birth defect as I age and skin becomes more loose. I started to notice it when I was in my early teens but was very skinny at that time in my life. I am average weight and I tried just having chin liposuction which helped a little but is back to where it was and never really was even close to enough to fix my issue. It’s not only completely hinged crooked (bottom jaw bone) but I think the top of my skull is also off balance (which might not be a big deal in the end if not fixable with fillers/botox) I need professional analysis and advice. I don’t know how much bone I have on that side but i basically can only take photos on one side or it looks like i h ave a huge swollen tooth (I get asked, it kills my self esteem). I need to do this now. I can’t keep living my life with the constant reminder and pain that comes with it. Not if it’s something that I know can be fixed at least some. I also have an eye issue that will not be something that has to do with this surgery other than the fact that I think my entire face being on a tilt has caused strain on a muscle or nerve causing my limited vision on one side (luckily for me the way I can look straight with both eyes is also the side that I can pose to camouflage the extreme jaw imbalance). Please help! You have a lot of background knowledge and studies that go beyond most others I’ve seen. I need to know the long term problems etc. This is a risky and major surgery but is becoming more common. I was originally told locally that I would have to have my jaw broken, re-aligned, and all my teeth realigned as well which is not something I’m prepared to endure at 31years old. I’m looking for results that aren’t going to take years of adjustments and cost to fix while suffering through the pain. Let me know if you think you can help. Thank you!
A: What I see just in these two picture you have attached is a craniofacial asymmetry of which appears to be a hypertrophy problem on your left side. The first place to start is to make an accurate diagnosis and determine the extent of the facial bone differences between the two sides of your face. While there are a wide variety of facial procedures to help, careful analysis must first be done. This information can be obtained by getting a 3D craniofacial CT scan. This will allow both a visual and quantitative of your craniofacial asymmetry. With that information, treatment recommendations can then be made.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Love Band eyelid surgery and what to know how it is done. Am I a good candidate for this procedure?
A: The so called Asian Love Band eyelid surgery (also called Youthlites) is conceptually double eyelid surgery for the lower eyelid. The objective of this procedure is to create a fullness below the lashline on the lower eyelid, representing an orbicularis muscle roll that naturally occurs in some eyelids. By so doing, it can make the to make the eye look larger and more open as it creates a lower eyelid that has two visible parts. This is an effect that is not unlike that created by the more well known Asian double eyelid surgery in the upper eyelids.
Some people do not have such a lower eyelid roll because their orbicularis muscle is thinner and more stretched. In my experience, I have seen Asians who naturally have an orbicularis muscle roll who want it removed. Conversely, I have seen other Asian patients who do not have it who want it created. (aka Love band lower eyelid procedure) Whether a skin roll under the lower eyelid lashline is viewed as aesthetically pleasing is a personal decision.
There are multiple ways to create the orbicularus roll effect and it is all about adding some form of a graft or implant to create that volume. A temporary Love Band effect can be created by synthetic injectable fillers as a non-surgical technique. Surgical methods include fat injections or the placement of a thin autogenous dermal, fascial or allogeneic dermal graft. (e.g., Alloderm) By adding volume on top of the orbicularis muscle, an outer visible roll is created. No matter what method is used for orbicularis muscle augmentation, recovery is fairly quick as it is just a limited version of a lower blepharoplasty incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in knee lifts and want to know if I am a good candidate. Also have you done many?
A: Technically, a knee lift is a simple excisional procedure that is done for rolls of skin above the knees. It is a near full-thickness crescent of skin and fat removed along the suprapatellar crease. Because it is done directly where the skin rolls are, it is tremendously effective. But it does at the expense of a fine line scar above the knee in the crease so a prospective patients must be fairly motivated. (sees a fine line scar as a better alternative to the skin rolls) To keep the resultant scar as narrow as possible, it is important to preoperatively mark the amount of suprapatellar knee tissue excision with the leg both fully extended and bent at 90 degrees to prevent excessive excision of tissue and extreme tension on the scar
Knee lifts have very little recovery and are not associated with much discomfort. The only caveat is that one should avoid doing activities that risk bending the knee beyond 90 degrees for the first month after surgery.
Because of the scar concerns, the request for knee lifts is very infrequent, I have performed about a half dozen knee lift procedures in the past few years.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do you do or work with an OB/GYN who will do both the tummy tuck and partial hysterectomy during the same operation.
A: It has been historically common to do a hysterectomy and a tummy tuck at the same time for the obvious convenience of patient recovery and the access that a tummy tuck incision provides for the hysterectomy procedure. I have done it numerous times with various Ob-Gyn surgeons. That is still done today although not quite as commonly due to economic considerations. Now that hospitals are very conscious and diligent about collecting complete fees for the elective tummy tuck portion of the combined procedure (OR and anesthesia costs of which you will be responsible not your insurance) it becomes critical to look at the cost differences of having these procedures done together or separately. Depending upon the facility (hospital) the combined costs may be relatively minor compared to doing them separately or could be thousands of dollars more if done together in a hospital compared to having them staged apart. (tummy tuck done in a private facility)
Having good experience combining these procedures, we do know what that differential can be based on our own private plastic surgery center. I will have my office pass along that cost differential to you so you can see of such a combined procedure makes good economic sense for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in rhinoplasty but have one major question. My appearance changes greatly when I smile, my nose really flattens out and I would like it to be more defined when I smile. When my face is at rest, my appearance is satisfactory. My recent pics show no definition. Will rhinoplasty help solve this concern?
A: The concern about nostril flare with smiling is actually a fairly common question from patients considering rhinoplasty. It is important to realize that rhinoplasty is a static operation, not a dynamic one. It changes the nose structures based on their natural non-moving state. While it will give the nose more definition, particularly of the tip, it will not necessarily prevent the nostrils from flaring when you smile. That is a natural phenomenon of all noses as the facial muscles pull on the non-fixed bases of the side of the nostrils. While the nose will become more refined with the surgery, you should not expect that it will solve the flare of the nostrils that naturally occur from smiling. You should consider to undergo rhinoplasty for the changes you may see from computer imaging with your face at rest.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I see that you are able to narrow the width of the face by osteotomy of the zygomatic arch. In addition to this, I am concerned about the roundness of my cheeks, which have fairly prominent ‘apples’. I have fairly prominent cheekbones (I am of asian descent), so I was wondering if it would be possible to somehow reduce the body of the zygoma to reduce the prominence of cheeks when smiling? Or is it more of an issue to do with the amount of soft tissue? And if so, is there any way to reduce the fat in that area.
A: What you appear to be talking about is the soft tissue fullness of the cheek area rather than the bone. The term ‘apple cheeks’ almost always means an anterior cheek area that is not related to bone. This is an area that will not be affected by any bony repositioning. In some cases, small cannula cheek liposuction can be helpful in reducing this area of cheek fullness. It can be surprising sometimes how much fat can be extracted from the cheek and a few ccs can often be obtained. But it is not always successful and can be associated with some persistent after surgery swelling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am average build. I was a patient a few years ago from a Groupon and received an estimate at that time. I had Smart lipo on my arms last spring, by a dermatologist, but the skin still bags below short sleeve tops, I would like to find out if there is anything that can help with that.
A: Unfortunately, getting liposuction through Groupon is probably not the best way to have any form of plastic surgery. By definition of the way Groupon works, you are going to get liposuction for the problem area (whether it would be effective or not) and are going to get the fastest and cheapest way to do it. It is not really any surprise that you have found the result wanting.
In looking at your pictures, without the benefit of not knowing what you looked like initially, I would say that any form of liposuction never had a reasonable chance to work. What you really needed all along is a formal arm lift. You have too much loose hanging arm skin to think that it could possibly be tightened by laser liposuction. You may not want the scar from an arm lift but that is the only treatment that is worth undergoing if you want a real arm shape change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I previously had hydroxyapatite added along my jawline and my cheeks enhanced via zygomatic sandwich osteotomy. My jawline is somewhat asymmetric and some of the HA in the jaw area closer to my chin needs to be removed/remodeled. I would also like my cheeks enhanced via HA as the augmentation is not adequate and also somewhat asymmetric.
I am not sure if you are familiar with all of these procedures and realize this is not a straightforward case. Essentially I would like the the jaw area remodelled for better symmetry by removing HA and the cheeks enhanced further by adding HA.
I am not sure if you use HA, from reading your website it sounds like you don’t however your opinion as a long standing plastic surgeon would be invaluable to me. I am also not opposed to any ideas you might have or getting the jaw remodelling done by yourself.
Thank you very much for your time and consideration.
A: Thank you for telling your story and sending your pictures. I am very familiar with using hydroxyapatite (HA) block and granules as back in the 1980os and early 1990s that was the way much of facial augmentation was done. I still do it occasionally on patient request. HA has fallen out of favor for many surgeons as the blocks are hard to shape and stabilize and the granules are somewhat unpredictable in shape with healing.
I suspect you had HA blocks put in with your zygomatic osteotomies which is good for width but not so much for projection. HA granule ‘sandwiches’ can be made which helps control the material to some degree for secondary placement on the cheeks for greater projection.
Removal of the HA along the jawline is tedious but doable since it was likely injected intraorally along the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
