Your Questions
Your Questions
Q: Dr. Eppley, I have been researching for a long regarding the application of custom implants and the techniques proposed by many were undertook a ‘one suits all’ outlook which for me is the hallmark between an average and leading figure in his field. The attention to detail and to attending each case differently is what yields a high probability of results that achieve the correct look for both the surgeon and the patient. The technique/s, implant design and photos illustrated below in the link below are what I had in mind for years and upon seeing & this reading the link, I can honestly I feel like this long and eternal stretch of a search is finally over.
Plastic Surgery Case Study – Custom Infraorbital-Malar Implants for the High Cheekbone Look
A: Thank you for your inquiry and sending your picture. I would agree that the IOM (infraorbital-malar) implant concept is appropriate for what appears to be your aesthetic facial needs. (see attached) The basic footprint of the implant design, while changing somewhat with each patient, what really varies is the various thicknesses/topography of the implant design amongst each patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a couple more questions. How tall is your highest rib cartilage for nose bridge augmentation? How tall is your highest rib cartilage for brow bone implants? In millimeters. I have a flat ethnic nose bridge and a low brow bone.
A: The upper end of most brow bone implants is in the 7 to 8mms range. Rib grafts to the nose are in the 7 to 8mm range also. Both are somewhat controlled by the tolerance of the soft tissues to stretch to accommodate what is placed beneath them.
Given the need for brow bone and nasal bridge augmentation one consideration is a one piece brow bone-nasal implant design. You can’t make a brow bone implant out of cartilage.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Since it’s been a couple months since this case-study was posted, I was curious if the plates and screws are meant to be removed eventually? Or will they have to be kept on forever? If they are kept forever do the plates/screws cause issues when going through air-port security? Also will people be able to feel them if they touch my shoulders?
A: The fixation hardware used in clavicle reduction surgery can be left in forever or removed as soon as 6 months after the surgery. Their removal is a personal choice. To date after five years of doing this type of surgery only one patient has requested hardware removal. Their titanium composition does not cause problems with airport security or in MRI studies. I can not speak to whether someone else would be able to feel the presence of the hardware as no one has mentioned that as an issue to date.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How long does it take for the dermal fat graft to level out/settle?I am 3 weeks post op, approximately how much more will it shrink?If it is too big after the healing time is complete, can it easily be made smaller/more leveled out?mI think he told me this, but I can’t remember and haven’t been able to find these answers online.
A: In answer to your labiomental fold dermal-fat grafting questions:
1) 6 to 8 weeks for dermal-fat graft settling to occur.
2) The grafts can also be reduced secondarily but I have never yet seen someone request to do so. In the long run it often is the opposite issue….I would like some more
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Should I have rib removal before a plasma liposuction / tightening procedure or after it?
A: Ideally you would do it before because….what you are hoping is that the effect of the plasma liposuction makes the need for rib removal surgery unnecessary. You use rib removal as the last ditch effort to achieve what every other procedure can not do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My main chin augmentation goal is increased width, with some minor increased horizontal projection, and little to no vertical increase. I’m now leaning towards a Terino Square Style II (size small). From what I gather, the dimensions for that specific implant would be 4cm in width across the chin, a total of 7.8cm in width along the chin and jawline (thanks to the wings), and 4.7mm of horizontal projection. Do I have this correct?
A: I find both style 1 and II square chin implants very aesthetically unsatisfactory. They were designed 30 years ago and custom implant designing has taught me how poorly designed they are by comparison. Neither make the chin more square in appearance as the corners are very round. Style II is way too wide as no patient ever needs 40mms in width, 35mm is usually the maximum. They are too skinny in height and end up looking like a rail across the front of the chin. The back wings of the implant for unknown reasons are tilted upwards rather than continuing with the shape of the jawline going posteriorly. When ‘forced’ to use them I choose a more projecting implant and cut off the front edge to make it more square as well as trim off the top part of wings to keep them from going too high along the jawline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a man and I am 20 years old. I do not have any relevant disease, except allergic rhinitis. I have a question about my brow ridges. I notice them a little big, but I have consulted with doctors and they have told me that they are normal. My dad has it similar. I have also noticed that my left superciliary arch is a little larger than the other one. I suffered a strong blow to my left eyebrow when I was around 5-6 years old. I am not planning to undergo any surgery, I would just like to know if my superciliary arch is normal. I am from Latin America and I really do not have the economic means to undergo surgery. Thank you very much
A: The size of the brow bones is a reflection of the development of the underlying frontal sinuses which creates them. Since the frontal sizes are often paired and the two sides are separate asymmetric development of them is not uncommon particularly in men whose natural frontal sinus development is more pronounced than in women.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read your informative post about Bullhorn Lip Lift.
My operation was about 7 weeks ago and i think i have the problem with the distortion of the nostril 🙁 The nostrils are much wider than before the surgery. Im very sad about this.
Can you tell from the pictures and the scar whether this is a residual swelling and whether the nostrils are getting smaller?
My doctor told me that a Bullhorn lift will not change the nostrils and from the internet i only found your statement in that direction 🙁
Thank you for your answer and your opinion !
A:Presuming your before and after pictures are taken at the same focal length, measurements do not show any appreciable nostril widening. (see attached) They actually measure identical linear lengths. While they visually appear so that is not what a measurement shows. I believe they appear so because with the vertical lip shortening the linear width of the mouth is now closer to the nasal base….creating the illusion that the nostrils are actually wider.
At 7 weeks after surgery there is no appreciable swelling present nor would I expect the nostrils to shrink down in size.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi. I am looking forward to proceeding with buttock implants. I just had a few questions, thank you so much in advance.
Would it be possible if I could get a Euromed implant that we could use that for the buttock implants?
What would be the difference between a buttock implant and a breast implant for buttock augmentation?
I’ve heard of the dual plane method, that it can project the top part of the glutes. What would be the benefits of that method vs completely under the muscle?
My goals are to try to keep the implant less visible. And for the implant to be softer. But what would be the advantages and disadvantages of having a breast implant vs soft silicone implant placed under the muscle? As far as long-term ect.
Also does the breast implant project the same as a silicone implant?
I noticed online you have an implant that you place holes in it to allow the tissues to grow into the implant. Is that method used under muscle as well? Does that make the implants stay in place better long term?
Will I be able to train squat etc the same in the gym after?
Would I be able to see the implants when I bend over?
I did get a fat transfer over 3 weeks ago to see how it would look and I love it but, I feel that I do still need an implant, to give more upper pole fullness projection, and I trust you for this type of procedure. You are amazing!! I am excited!!! How soon can I proceed with getting buttock implants? My fat transfer was almost a month ago, therefore what would be a recommended timeline to proceed with buttock implants? I would like to book a date for the procedure. I would like to also book a brief consultation beforehand if possible. Thank you!!
A:In answer to your buttock implant questions:
1) In the U.S. we can only use FDA approved implant devices. Medical devices from other countries that don’t have FDA approval can not be imported into the country.
2) The dual plane method refers to breast implants. In buttock implants the implant is either on top of the muscle (subfascial), partially in the muscle (intramuscular) or under the muscle. (submuscular) There are no deliberate dual plane methods although some intramuscular buttock implants do end up as ‘dual plane’ as the muscle thins over them and the central part of the implant ends up projecting through the muscle.
3) An ultrasoft solid buttock implant is fairly soft but not as soft as a breast implant…how different these are can be debated. Long term what you know is that a solid buttock implant will never rupture or need replacing. Another approach is to custom make the buttock implant and have it made in the softest solid silicone possible…which puts its feel pretty close to a breast implant.
4) Breast implants and buttock implants project the same.
5) The placement of perfusion holes in an implant is not done in buttock implants as the intramuscular pocket holds it adequately into place.
6) You would be able to squat train after buttock implants.
7) You would not see the implants in the intramuscular or submuscular pocket position when you bend over.
8) Given that you are 3 weeks out from fat transfer now and given the time to get the procedure scheduled you can get to work on that now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,Hello, I have been a big fan of your work for years and have gone through your Q&A’s to answer a lot of my own questions. Last July, (10 months ago) I got a sliding genioplasty. My chin looks fantastic, however, I do have lots of tightness at the incision area. I would say that there has been no change in the tightness since November. Everything else has been healing nicely. My bottom teeth/gums are no longer numb, flossing is pretty much back to normal etc. Although my bottom lip feels tight, I would say I have 98% of my movement back. So all really looks and feels pretty good, minus the tightness. The tightness feels more severe than it looks. I feel sometimes like I may look like my lip is stiff while I am speaking, but it actually looks pretty normal. The tightness feels like a combo of it being pulled and like having a lot of food stuck in that area. Not sure if that makes sense. Its not painful, but feels very uncomfortable yet still pretty much works the same as before the surgery. Based on all of my internet research, I am thinking that my chin was pulled so far out (doctor said 13mm), that my tissue is most likely falling into that new empty space where my chin was extended. I love the way that I look and do not want to change it, but I also am slightly miserable with this tightness. I read that you do intraoral release and place of dermal fat graft. Not sure if that is relevant to my case, but if it were, how might that change what my chin looks like and what is the general cost for something like that? I am attaching before and after photos so that you have an idea of how much my chin was moved forward. Thank you for being quite the online resource.
A:Your diagnosis and the treatment for it would be the corrective approach. The bone has been expanded but the soft envelope remains the same. In essence you now have a bone shape that is beyond what the soft tissues were designed to contain.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to inquire aabout if 30mm of clavicle lengthening per side is possible.
A: One of the major limiting factors in clavicle lengthening is how much resistance is met by the shoulder girdle tissues. When lengthening the clavicle you are pushing out against the AC joint and all of its surrounding bony and soft tissue attachments. As a result, once the bone is cut (sagittal split completed) the shoulder does not unfortunately just fall to the side. (lengthen) This is quite different than in clavicle reduction where upon removing a segment of bone it does indeed fall inward. It requires a fair amount of force to get the bone lengthened due to the shoulder girdles tissue whose resistance must be overcome. This is why it is a challenge to just get 20mms of lengthening…and even that can be a struggle. This is why I thing there is merit in shoulder stretching exercises preoperatively to try and ‘loosen up’ the soft tissue attachments.
The other limiting factor is the length of the clavicle plate. The longest 10 hole clavicle plate is only going to permit three screws per side even up to a 25 mm lengthening.
Thus for anatomic and fixation plate restrictions a 30mm increase in any patient is not a technical possibility. I wish it were as more is always better but we are asking the body to do something beyond what it was designed/developed to be. As a result it does pose limitations sometimes from our ideal aesthetic goals.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in knee and thigh Lifts. I have a few questions:
1. On the site i saw picture of the knees after knee lift surgery ( see attachment). To get such a thin scar is there a special surgical technique or are products for scars enough?
2. after how many days I can fly after knee lift surgery?
3. How long I will be not able to bend my knees?
4. Does yo do a mini thigh lift?
5. in case of both procedures ( knee lift and thigh lift) after how many weeks I can fly back home oversea? It is long flight, about 12-14 hours.
Thank you very much for your reply.
A: In answer to your knee lift questions:
1) The key to having an acceptable knee lift scar is to avoid over resection and do the preoperative excisonal markings taking both the extension and flexion of the knee into consideration. A multilayer closure is done with subcuticular suturing for the skin.
2) You should be able to fly home within 48 hours after the surgery.
3) You should avoid bending the knee more than 45 degrees for 4 weeks after the surgery.
4) Please define your thoughts on what a mini-thigh lift is.
5) Even with a combined knee and mini-thigh lft procedure you should be able to fly home within 72 hours after the procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I am a trans woman. I am extremely interested in your work on shoulder reduction surgery and I find myself consistently returning back to the few photos you have of before and afters online.
I have two questions for you, which I hope can be answered:
1. Are there more photos of before and after results from further away than just the shoulders available so i can get a better idea of what results will be like with respect to the entire body? Your case study post on the trans woman was exceptionally enlightening, but I would like to see a few more in order to decide if it’s something i actually want. I am curious how this surgery improves the shoulder to hip ratio and whether it can help shift patients from a more triangular body type to one more hourglass or pear shaped. Below is the case study i am discussing. Being able to see how she looked in the mirror helped quite a bit, but I think the most enlightening pictures would show full body shots.
https://exploreplasticsurgery.com/plastic-surgery-case-study-outcome-assessment-of-transgender-male-to-female-shoulder-narrowing-surgery/?doing_wp_cron=1650927706.0061049461364746093750
2. Have you had any experience getting this procedure covered by insurance? I have Blue Cross Blue shield, which recently updated its policy to cover breast augmentation for trans women, as well as a few other affirming procedures, but I know as this procedure is relatively new it may be some time before we ever see it formally implemented into insurance policies. If any individuals you have seen previously for this surgery have managed to get it covered somehow, I would love to hear some anecdotes about their experience and how they may have accomplished this.
As of now, this procedure is really one of the only things i’ve ever wanted, and would relieve years of painful dysphoria I’ve experienced as a result of my shoulders. Its effected me to the extent I find it progressively harder to focus and has impaired me in school and my social life because it has followed me wherever I go. If I could relieve this I can imagine my life would improve significantly.
Anything you could do with respect to above would be absolutely fantastic! Please let me know when you can.
A: In answer to your shoulder narrowing questions:
1) In respect of patient’s privacy I am limited as to the views I can show. In addition since all of my patients are not local, there is no return for an actual in office followup. All such followups are done in a virtual manner by Zoom.
2) I do not participate in insurance so I can not comment on whether shoulder narrowing surgery would be so covered.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I just found out that there is a possibility to change the shape of the skull and searched a bit about the ways to do so. When you use bone cement how much of the result can it show, dose it only change the shape or can it also get a bit bigger?
A: The use of bone cements for aesthetic skull augmentation is a near historic procedure. The use of custom skull implants is the contemporary method which adds 3X the volume, has an assured shape and can be placed through smaller scalp incisions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in 3d printed glabellar region implant. The result I want is natural and minimal. Currently I have has chin implant, check bone implant, temporal region implant and nasolabial implant. They all looks natural and conservative.
A: By your description you are most likely seeking a glabellar forehead implant similar to the concept as seen in the implant design attachments. To keep it as natural as possible I wold definitely stay under 3.5mm in thickness.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Also, want to double check that, given the clavicle(s) have had adequate time to heal, I should be able to resume heavy weight workouts–I am benching and rowing above 200 lbs multiple times per week, definitely not power lifting, but also potentially putting more strain on the clavicles than is standard. Not sure if these particular exercises would even be the ones I ought to be concerned about, but yeah, wondering if its possible to get some reassurance that this operation shouldn’t limit my ability to workout (again, assuming adequate time is allowed to heal the clavicle(s))
Thanks!
A:Provided adequate time is given for full bone healing, there should be no restrictions for those activities after clavicle lengthening surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in consulting about getting chin and jaw implants. When I was six I had cancer and extensive radiation delivered to my facial region resulting in a stunt of growth in my mandible.
Q:Thank you for your inquiry and sending your pictures. With the history of radiation in the area we have to be very cautious about treatment selection as that affects the involved tissues lifelong and their ability to respond to trauma and exhibit normal healing from it may be compromised. (at the least it has a higher risk of infection) I will need to see a 3D CT scan of your lower face (jaw areas) to have a better appreciation of the bony anatomy. With the history of radiation a custom wrap around jawline implant is out as the infection risk is too high. Thus, for now, I am thinking a bony genioplasty (you need mainly vertical lengthening anyway and jaw angle implants. The bony genioplasty will be fine, it is the jaw angle implants in the back we have to assess very carefully.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Here are some of my desired results from rib removal.
Waist: 28-30
Hips: 40
Inseam: 32
I really want that golden ratio of a .6 waist to hips. I think that a 26-27 inch waist with a 42-44 inch hips is a buffer. Here are photos of what I would like, I will attach photos of myself currently, with as little fat and showing abs for best results.
A:Thank you for your inquiry and sending your pictures. I think with your lean body frame the only way you are going to have a more narrow waist is with rib removal surgery. How much waistline reduction you can achieve with this surgery is never completely predictable so I would not specifically provide a waist measurement number for what can be achieved. The only outcome aspect of rib removal surgery that is assured is that once this is done there are no longer any further anatomic reductions that can be done. Rib removal surgery is the last stop on the waistline narrowing train.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is such a skull implant possible for women with no effect on hair color and heat on it ??
A:Correct, the implant material only changes shape/breaks down at 375 degrees F.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Questions about how to correct a sloping forehead with a very strong low brow bone with temporal hollowing.
A: That would be done with a custom forehead implant (minus the brow bones) that has temporal extensions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I live in Sweden and I’m interested in cheek augmentation for the high cheek bone look. The thing is I’ve done an operation with cheek augmentation here in Sweden (intra-oral) but I didn’t get the high cheek bone result.
Is it possible doing this operation , going through the lower eyelid as shown?
A: There is no standard form of cheek implant that can achieve the high cheekbone look…which is largely a horizontal augmentation along the zygomatic body and arch. Whether that would also include the more anterior infraorbital rim is determined on an individual case basis. Most of the time the preferred method of accurate implant placement/positioning is through the lower eyelid.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I was looking into forehead contouring surgery to reduce frontal bossing and had a few questions that I hope you can answer:
What is the average cost for forehead contouring to reduce frontal bossing?
How are nerves and expressions affected after the surgery?
Does the hairline look natural after patients are fully healed and what’s the recovery time?
When you start shaving the bone, are you making the bone super thin and is that dangerous? Or does frontal bossing create a thicker layer of bone that can be shaved down to a normal thickness. If that could be explained, I’d like to know.
I’m looking for information to get started, but there’s not much to go off of online, and all the info varies greatly. Any help would be appreciated. Thanks
A: In answer to your forehead contouring questions:
1) My assistant Camille will pass along the cost of the surgery.
2) Some temporary numbness of the front part of the scalp and forehead stiffness will occur right after the surgery…all of which resolves in a month or two later.
3) The key question in approaching the upper forehead is whether a hairline incision is used or whether it is placed behind it. But most hairline incisions heal well and look natural provided one has a good initial hairline density.
4) To determine how thick the forehead bone as it relates to the frontal bossing a preoperative x-ray is taken to determine its thickness and see how much bone can be safely reduced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,Also I got a rhinoplasty and chin implant and lipo done several days ago. But I would like to do more lipo (I believe you call it a buccal myectomy) and custom implants that might replace the existing chin implant if required. How long should I wait before getting another procedure done?
A:Three months after the last procedure would be sufficient. If a custom chin implant is needed for a replacement for the standard chin implant just done now would be a good time to get started since that will take 3 months to design and have ready for surgery.
Dr. Barry Eppley
Indianapols, Indiana
Q: Dr. Eppley,Hello. I love your work. It is so wonderful to see a surgeon that is so talented and passionate about the outcomes of every procedure.
I wanted to ask in regards to a sliding genioplasty in your experience what is the risk of severe bleeding during and post operatively on a healthy patient that does not take any medications.
Thank you.
A: Of the potential risks and complications of a sliding genioplasty, severe bleeding during surgery or a postoperative hematoma is not one of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I know after shoulder narrowing surgery patients are released for full activity after 12 weeks but what is your recommendation for returning back to work? (more range of motion at weeks 5 and 6).
A:That is probably not unreasonable. Given the type of work a dental assistant does the range of shoulder motion at one month after the surgery should be adequate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, So as you can see i have a certain eye area that looks nothing like my desired result (below), and i would like to know the best and most efficient surgeries and augmentations that would take me from what i have to something with the same characteristics as the model below. (a Fair amount of Hooding, 0 sclera exposure and positive canthal tilt). Also it might not be visible in the photo, but i also have a negative orbital vector that is especially striking whenever i squint or lift my eye.
A:I would say the major difference between you and the model eye look is that you need a lateral canthoplasty, spacer grafts to the lower eyelids and infraorbital-malar implant augmentation for the lower orbital area. The upper orbital area needs filling of the supratarsal area with some form of a fat graft. (fat injections or an en bloc fat graft) Your brows seem to be sufficiently low.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty done 5 years ago to correct the contour of the sides of my nose. While the surgery made a very significant improvement, the left side is still a little curved from front view, while the right side is straight. I met with a different surgeon recently about whether or not a non-surgical liquid filler could correct this issue, and they said they wouldn’t recommend injecting a filler after a previous surgical rhinoplasty, as it’s “a little dangerous”.
I’m not sure what the danger is they’re alluding to, but if it’s the vision loss I’ve read about, and the risk is high enough, it might not be worth it. If the risk is very low, though, maybe it would be worth it.
A: If the goal is to augment the flatter side of the nose to better match the curved side, then the use of injectable fillers is a reasonable non-surgical approach.
When it comes to the use of injectable fillers in the nose the risk to which is being referred is that of an ischemic event. This means the pressure of the filler causes a compression of the blood supply to the overlying skin resulting in an area of necrosis or eventual skin loss. In the scarred nose (prior rhinoplasty) this risk is higher due to this scar tissue. How significant that risk is can be debated but I can’t fault the surgeon from passing on doing it as for him/her the reward:risk ratio is just not worth it. Its occurrence may be uncommon but it would create a deformity worse than the original aesthetic problem.
Dr. Barry Eppley
Indianapolis, Indianapolis
Dr. Eppley, Do you perform mouth widening surgery and do you feel it can be done with acceptable scarring. Conversely is there an alternative surgery that can achieve this. My goal is to widen my mouth and smile.
A: Mouth widening is a procedure that I essentially developed from an aesthetic standpoint. Whether the scarring is acceptable is a matter of individual interpretation. What is an issue not open to interpretation is that the need for scar revision in mouth widening surgery is 50% or greater.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I hope you are well. I have a few questions regarding the clavicle lengthening procedure I have scheduled with you in June and was hoping you’d be able to help.
The first thing is regarding a potential complication. It appears I may have either a Type 1 or Type 2 acromioclavicular joint injury (I’ll attach pictures). I don’t recall any particular trauma, and it may have just been caused from weightlifting over time, or by something that I didn’t think was painful enough to seek out medical attention or suspect an injury. Either way, this was taken a few months ago and it appears to be the same (no further healing). From what I’ve read (but I may be incorrect of course), it seems that if a few months has passed and the injury persists, it likely will not heal on it’s own. I’m curious if you think this is any reason to be concerned when planning lengthening of the clavicles.
Although it is not causing me trouble now, I’m not sure if it may need to be corrected by surgery if it gets worse (or possibly now to prevent it from getting worse). If you think clavicle lengthening is still feasible, would you think it may cause any complications to a potential A/C joint repair in the future? I ask because I wonder if this is something best corrected now, or if it can probably wait until later (if needed at all) after a recovery from clavicle lengthening. I just wanted to make you aware of this before my X-rays the day before surgery, and to get your opinion.
The second question is regarding exercises and preparation for surgery. Since the lengthening procedure will stretch some muscles, I would imagine it would be beneficial to stretch affected muscles as much as possible beforehand. Would you think this is a good idea, and if so, would you be able to provide a list of muscles that I should be stretching?
Thank you for your time and insight.
A: In answer to your questions:
1) I am not an AC joint authority but I don’t see the correlation between a lengthening osteotomy done on the inner third of the clavicle to whatever injury exists at the distant outer joint. The clavicle bone is of good bone stock so I see no reason why it would have any trouble healing.
2) The reverse question seems more pertinent….how does a lengthened clavicle affect an injury at the AC joint? That is a question outside my field of knowledge but I would think important to know. This would have to be answered by an Orthopedic Shoulder Surgery specialist.
3) I would certainly see no harm in any shoulder strengthening or stretching exercises before surgery…although I can say they are absolutely essential. The amount of clavicle lengthening achieved in the surgery is not going to be limited by the natural flexibility of the tissues. But I think it is always a good idea to ‘train’ for body surgery almost regardless of what that surgery is.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had orbital floor surgery on my right side for a fracture. I do some acting but feel I lose parts because my eyes are no where symmetrical. I think the surgery was rushed leaving my replacement floor on my right higher than my left. Thoughts?
A: While I don’t know what you looked like before the injury and before the surgery, and your face is a bit tilted in this picture, the eye asymmetry is obvious. (see attached) It is clear the right orbital floor reconstruction is higher then the left unaffected side. That can be remedied but a 3D CT scan should be done first to have a precise measurement of the different orbital floor heights. That would then be matched with the differences in the external horizontal pupillary levels. (which presumably is 1:1 with the differences in the level of the orbital floors. Do you know what material was used to reconstruct the orbital floor?
Dr. Barry Eppley
Indianapolis, Indiana
