Your Questions
Your Questions
Q: Dr. Eppley, interested in removing excess sagging around belly button and what the cost and procedure would be.
A:Thank you for your inquiry and sending your picture. With loose skin around the umbilicus there is no good direct way to remove it. (i.e., vertical excision or periumbilical excision) Such scarring is just as bad as the loose skin if not worse. The effective method is a horizontally-based tummy tuck where a new belly button can be made through a fresh skin site. Whether the lower tummy tuck is viable depends of what the rest of your abdomen looks like as well as your tolerance for a lower tummy tuck scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin Implant 3 years ago when I had a rhinoplasty done. I never wanted a chin implant however the surgeon recommended so I got it. Nine months after I decided to get it removed because I felt it made me look masculine, too much projection. However my skin began to sag after removing it and I don’t like it. I feel like my chin looks so long. What do you recommend should be done to fix this. My skin sags more when I smile. Please advise. Thank you I appreciate your time!
A:Thank you for your inquiry and sending all of your picture. What you have is very common after chin implant removal, the stretched soft tissue chin pad does not shrink down and go back to its preoperative state/position. Rather it sags/drop due to the two sides of the capsule not adhering. The most effective strategy for its surgical managment is a submental tuck to remove the overhang. An intraoral resuspension seems logical but works inconsistently my experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! While I’m in no place to afford a cosmetic cranial implant right now, I was wondering if I could see results in the future. I’m a 5’9″ male with a cranial circumference of 53 cm. So extremely small, and I absolutely hate my head. Can a cranial implant make my head look normal? My forehead is slanted backwards and the back of my head is flat.
A: A custom skull implant can be designed to improve the slope of the forehead and the flatness of the back of your head. If improving those areas is what constitutes a more normal head shape then it will be a successful procedure for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, for my hyperdynamic chin ptosis, if it is treated by a submental technique where the excessive soft tissue chin pad is reduced/tucked. Will this cause my chin to have dimples, or orange like texture to my chin? Or make my mentalis muscle weak and worsen?
A:Good questions and the answer would be no on both of them. Since the surgery tucks from underneath there are contour alterations in the soft tissue chin pad. Most of the excised submental tissue is skin and fat and not muscle so no mentalis muscle dysfunction will occur.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello I have a flat head and I’m struggling alot with my skull’s shape. Can i know how much the scull reshaping costs?
A:The term ‘skull reshaping’ is a very broad term and does not specify the problem being treated or the specific procedure need to treat it. Without a detailed description of your head shape concerns accompanied by pictures to support that description I can not provide an informed answer to your question(s).
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking a rhinoplasty and chin implant. I am transgender and looking to enhance how masculine my face appears as well as improve it aesthetically. I’ve considered buccal fat removal or cheek implants, even liposuction to my chin/jaw area, so I was wondering if you agreed with that assessment. (that it would improve my appearance aesthetically)
A: Thank you for your inquiry and sending your pictures. I have done imaging looking at chin and nasal dorsal augmentation for their potential facial masculinization effects. In terms of achieving those changes the debate is between implant vs rib graft for the nose and implant vs sliding genioplasty for the chin. I would certainly agree that the defatting procedures of buccal lipectiomy,, perioral/facial and submental liposuction would be of benefit in facial slimming/contouring and would be complementary to the nose and chin augmentation efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for a skull as well as heel implants to make myself few inches taller as I am only 5-3 and because my Career is at stake. I tried to reach to few plastic surgeons but could not figure out where I can get the surgery . With a lot of hope I am texting you just to find out if such a surgery is available with you ….Please kindly help.
A: While I can perform a custom skull implant that cam make your head up to one inch taller, I do not perform heel implants or am not aware that it is even a viable surgical procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cosmetic hip implants done in Los Angeles — twice, actually. The second was to upsize.
Unfortunately I’m not terribly pleased with the result — while the “width” is roughly what I was going for, the widest point is definitely higher than I would have liked, and the placement of the implants appears uneven when comparing both sides.
I am just curious if you would consider doing such a remove/replace following a different surgeon’s work, especially knowing that your approach would likely be a bit different (including carving out a larger pocket). If this is something you’d consider, please let me know and I’ll send pictures.
A: Thank you for your inquiry and detailing your hip implant history. I have no restrictions about performing secondary/revisional surgery on other surgeon’s work as I do it all the time. My only criteria for such surgeries is whether I have a high confidence that what I can do with actually improve the patient’s concerns.
In that regard the critical issues are the shape of the hip implants and their current asymmetrical positioning. The former is the most assured to improve as that is a function of their shape/design of which your exact concerns I have seen numerous times. While I would need to see the design file for your current hip implants, most likely it is that the maximum projection is in the upper third of the implant. Many patients desire the maximum projection area to be lower.
Hip implant asymmetry, however, is a different matter and is not so easily improved. The incisional access to hip implants is remote from the actual encapsulated pocket and visual access is very limited to pocket manipulation/change. While the implant can be lowered through a small incision at its inferior end, raising up a low hip implant is almost impossible to do in my experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I really would like a ball park estimate of forehead masculization before taking the next step. I want to make sure I have enough saved. Thank you.
A: Thank you for your inquiry and sending your picture. When you speak of forehead masculization you are most likely referring to a combined forehead-brow bone augmentation using a custom implant design concept as shown in the attached images. While brow bone augmentation can be done alone many men that lack brow bine projection have foreheads that slack backward. I can tell whether this exactly applies to you without seeing a side view picture.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a custom jaw implant by another surgeon in 2019, at first it looked good even though it was very swollen. But as swelling subsided, the implant lost all its angularity and Ive been left with a round looking facial shape, which is convex downwards at the mandible. In addition, the masseters detached causing asymmetry and since the doctor didn’t fill the first hole on the mandible with a screw, some soft tissue had filled it and now a small circle of my skin is attached there. If I undergo revision, are you able to fix these problems, especially the convexity /angular-less shape. How will you change the implant design from my current one which I have attached? including the prediction of the final result vs the actual. can I achieve the prediction?
A: Thank you for your inquiry and sending your picture. One of the advantages of having a jawline implant design and knowing the exact aesthetic outcome allows one to know with greater confidence on how a design change would be better. For me I could see in the original design that the jaw angles were too rounded and there is way too much material in the body of the mandible and could have predicted the lower facial shape outcome you have now. A linear jawline implant design may look good on an skeletal model but that design shape is not good for everyone.
But implant design improvements at the jaw angle, however, are going to be compromised now because you have masseteric muscle dehiscence. This implant-soft tissue contour mismatch is not going to be improved by a new implant design and would likely appear worse when the angles have greater angularity.
I have not seen great results with trying to bring back down the retracted muscle once it is scarred/shortened. In my experience it requires a soft tissue contouring method and would eventually consider soft tissue angle implants placed through a very small back of the angle skin incision. This would provide the most assured correction of the angle contour issue and great increased angularity at the same time.
But since you have to replace the implant anyway because of its rounded bowed shape, you might as well change the jaw angle area as well. But don’t expected a new design to solve the soft tissue jaw angle issue. That would have to he addressed secondarily as previously mentioned.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if it is possible to reduce the width of hips by shaving the great trochanter. Is it possible to narrow the great trochanter? I am thin ( I don’t really have extra fat) but the bone of the great trochanter sticks out a lot. It makes my hips look very weird. I cannot dress because my silhouette looks strange. It bother me lot! I would just like the great trochanter to be in continuity with the rest of my body. Is there any surgery to make that possible? It really the great trochanter that cause all my issues.
I would really like to have an answer. Thanks a lot
A: The greater trochanter of the femur has numerous important muscular attachments to it that are essential for walking and hip stability. Thus it is not possible to reduce its width for aesthetic purposes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve had extended infraorbital implants with SOOF lift but unfortunately there have been nerve complications with a permanent change in sensation most likely relating to the infraorbital nerve, My upper lip is worst off with a sharp painful feeling when stretched or pressured. The lip is a bit numb but also very sensitive to sharp stimuli like when I bite it. The left side is much worse than the right and a part of it gives off a strange feeling including increased sensitivity to cold and heat. The rest of the areas controlled by the infraorbital nerves, the frontal midface, side of the nose, lower eyelids etc. are numb with occasional weird sensations that come and go. Again the left side is much worse and reacts weirdly with temperature often spreading throughout the area.
What could cause this, might it be pressure from the implants, scar tissue or perhaps I was unlucky and the nerves have been permanently damaged somehow? Can I hope that this might be treated or are these symptoms telling you that the damage is permanent?
Thank you.
A: As you have correctly surmised these are infraorbital nerve symptoms. Whether they are due to compression from the implants or from the dissection in placing them is impossible to know by description. You did not say how long ago the surgery was or what the trajectory of change has been since surgery, if any, has occurred. If there has been no improvement since surgery your options would include removal/adjusting the implants to be certain they are not compressing the nerve (a 3D CT scan looking at implant placement would be extremely helpful) and wrapping the nerves with fat grafts to help them heal/recover would be the action steps indicated.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have what you call a (lightbulb) appearance from head shape to narrow jaw. I believe what I need is head width narrowing by temporal reduction.
I want to know what you charge for this, as well as are there complications with this surgery, or has it been a success every time?
Thanks
A: Thank you for your inquiry and sending your picture. Posterior temporal reduction in my experience has been uniformly successful and has experienced no complications.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, There is this recent study published by you: https://exploreplasticsurgery.com/plastic-surgery-case-study-custom-infraorbital-maxillary-malar-implant-as-secondary-midface-augmentation-after-a-lefort-i-osteotomy/?doing_wp_cron=1612719980.9635739326477050781250
“….a custom implant design allows for a smooth augmentation effect that can blend in with a previous underlying LeFort I osteotomy.” Is it better and more controlled to place such implants after healing from a LeFort 1 or high LeFort 1 or is it better to place them while performing a LeFort 1?
Thank you.
A: That is a good question whose answer would be influenced by the exact LeFort movement. If a horizontal advancement was involved (and I suspect that is to what you may be referring) then I would wait and do it secondarily because you would then have an implant exposed to the wide open maxillary sinus cavity below it….increasing the risk of infection. And if it as a ‘high’ Lefort osteotomy that osteotomy line is a bit more uncontrolled. Thus the match between what superior augmentation is needed and how the augmentation would blend in to the repositioned bone below it is not precisely known.
In short wait 6 months after the LeFort osteotomy and use a new 3D CT scan to make a precise implant fit that has less risk of infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering because I have heard and noticed all surgeons do the bicep/tricep implant insertion differently. Some state that under the muscle can look better and hold better in place but there is the risk of nerve damage going underneath the muscle. I have heard that placing it on top of the muscle/underneath the fascia is much more safe but the implant is more noticeable and can even be felt and one could tell it is an implant?
Is that true? What are your thoughts on that? My goal is to have implants stay tight and not be noticeable or felt. If someone could feel my arm and tell an implant was there, then I think it would make more sense to place it under the muscle as it would hide better.
A: I think everything that you are stating about the two different pocket locations for upper arm is largely accurate with these 3 caveats.
1) Under the muscle (on the bone) implants will not be as big or noticeable due to the need to use smaller implants.
2) There will be a more visible scar with under the muscle arm implants due to the need for a medial arm incision location.
3) Most of the subfascial implant visibility issues are circumvented with a custom implant design approach where the edges are feathered and not round like in standard implants.
4) Potential injury to the musculocutaneous nerve does exist with under the muscle implants. This is a motor nerve to the forearm and hand. While rare it is an issue to consider.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, hello one of my cheek is more receded making it look flat is is possible to bring one of my cheek forward.
A: If you are referring to building out the flatter cheek using an implant then yes. if you are referring to cutting the cheekbone and bringing it forward (rather than width expansion) then no.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I horse back ride 5 days a week. Would there be more risk for when I fall off my horse if I had those ribs removed?
A: Since the inner half of ribs 10, 11 and 12 remain I do not see ant increased should you fall from a horse. But when in doubt there is the rib osteotomy procedure where the ribs are fractured, but left intact, and are molded inward after surgery by corseting.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, “Good morning doctor, I have some questions about Permalip, is smoking a problem? the lips remain hard? thank you”
A: I am not aware that smoking increases any risks from lip implant surgery. The lips will soften as they heal after implant placement. One may be able to feel the implant but it is not because it remains hard.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. My testicles have become smaller due to testosterone replacement ( I don’t abuse it. My level was 34 !). Are the testicle implants still really firm ? Know a guy who has them and they felt unnatural to the touch. Thanks !
A: You are likely referring to the common use of saline testicle implants which are both small and very hard. Ultrasoft silicone testicle implants, which I use, feel much softer and natural to the touch.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a problem with the length of my nose. The length of my nose takes a large part on my midface. Is it possilble to reduce the wings of the nose and the tip? My wish is to get a reduction of the length of my nose from the eyes to the tip of the nose. I send you a picture where you can See the Red mark that should be reduce. Thank you for your time and help.
A: The only way to shorten a nose by rotating the tip upward…not excising any of the actual tip skin. While I think this would help a little bit, it would probably not be to the degree of change that you seek.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, in the future I want to get skull reduction surgery. My neurocranium is rather large and I understand the reduction is limited. My three main questions are will this lower the hairline sightly because of excess skin, will it raise my eyebrows, and what kind of scarring is left behind and can the scar heal permanently ? As male, I like the positioning of my eyebrows, close to my eye, and I do not want the eyebrow position to change. And I have always had a high hairline, and getting forehead reduction surgery is not option because I might go bald when I’m older. So I was wonder if this surgery does the trick. I saw a picture of a women undergoing this treatment on your website and her hairline lowered. So I was wondering if she got a forehead reduction from the skull reduction surgery?
A: In answer to your skull reduction questions:
1) I have not seen the frontal hairline lowered in skull reductions. I am not sure to which patient you refer.
2) I have not seen the eyebrows raise from skull reductions, that is potentially an issue in large skull augmentations.
3) The incision used and the resultant scarring left behind depends on what type of skull reduction procedure it is.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m looking for a surgeon who can make my hips as wide, or close to my shoulders. I noticed you said America only uses soft implants, I was wondering if you could order and use hard implants. Titanium or mesh implants to place on the crest. I do not believe I will ever have enough fat to make my hips wide enough, or that my body won’t burn it.
A: Thank you for your inquiry and sending your pictures. I assume when you say making your hips wider you are referring to the wing of the iliac crest and not the hip region below it. There are no standard iliac crest implants so they have to be custom made. Whether they are made of ultrahard solid silicone or titanium is patient preference and cost related.
The company to which you refer (Ostymeditech), although apparently US-based, does not return phone calls or emails, for reasons unknown to me.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 32 year old man. I want a customized implant to provide forward projection to my infraorbital rims. Uniquely, I want this implant to move the frontal process of the maxilla forward. Here, I am referring to the point at which the infraorbital rim meets the frontal process. This would typically be a portion of the face moved by the Le Fort 2 osteotomy. I want to raise my infraorbital margin too. I want this implant to extend onto the zygomatic arch to provide a small amount of lateral projection there. I want no lateral movement of the zygomatic body, because I dislike cheekbone mass.
The key objective for me however, is to widen the perceived appearance of my orbital complex. I’ve noticed that this is an under appreciated and core aspect of beauty that most male models possess. I believe that this is possible by widening the brow bone, the lateral orbital rim and the zygomatic arch.
I have so many questions on the theory of this, but I will limit them to 4 questions for your blog, and for now I will ignore the brow bone aspect. And then maybe send another email for a further round of questions. I hope this is ok with you.
1) Is it possible to widen the bones that surround the side of the eye, to achieve this ‘broad eye area’ look? I believe that the answer is yes, but I’m unclear how to preserve harmony with the anterior temporal area. My concern is that making the lateral orbital rim project laterally, will create an unnatural ratio between the width of the lateral orbital rim and the width of the anterior temporal zone.
In your experience, is this easily resolvable by extending a lateral orbital rim implant into the anterior temporal area to widen it to the same degree? And most importantly, does this look completely natural and not too ‘egg’ shaped?
2) Regarding raising the infraorbital margin – my concern is that if I’m simultaneously raising and pushing forward the infraorbital rim – would this not create an unnatural appearance by making the infraorbital margin sit well above the lower border of the obicularus oculi? Obviously in its natural form, the infraorbital margin and the obicularis oculi have a high degree of correlation in their vertical positions. I am concerned about pushing the rim forward, too high above the natural position of these muscles. Might we do a SOOF lift with lower eyelid retraction surgery to resolve this problem?
3) I’m also aiming to get a few other eye procedures: cosmetic orbital decompression for bulging eyeballs, a canthoplasty to raise my lateral canthus, surgery to raise my lower eyelid, and eyelid fat grafting to resolve soft tissue hollowness. I’d like your opinion on which order I should do these surgeries in? Would it be sensible to do decompression first, or the midface implant first? I also had the idea that doing the eyelid fat grafting may mitigate my concern in question 2, by obscuring the boundary of the implant edge – does you agree that it makes sense to do the fat grafting first?
I’m looking forward to your answers, and thanks so much for your time.
A: In answer to your custom midface implant question:
1) You are correct in that you must be vigilant about how much lateral orbital rim augmentation is done to not create the appearance of unaesthetic temporal hollowing.
2)) You can extend the lateral orbital rim augmentation onto the deep temporal fascia of the temporal region…but there are limits in doing so.
3) I have not seen the vertical elevation of the infraorbital rim cause the problems to which you refer. Even up to 8mms of elevation this has not occurred with the caveat in the presence of someone with abnormally low infrraorbital rim levels.
4) It would most appropriate to do orbital decompression and any procedure that may change the position of the eyeball and eyelids first.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in shoulder reduction surgery with you. I have suffered from my wide shoulders since I can think of, can’t feel fully feminine cause of them.
I am pleased to find out his surgery exists, however not much info and before after pictures are present hence I have no idea what it will look like on me. Also I’m curiosa why no deltoid reduction surgery was being offered so far, as it seems sensible for this issue perhaps even more?
A: Thank you for your inquiry and sending your pictures. I have done some imaging of them to show what I think can be accomplished with shoulder reduction by clavicle shortening. You can not reduce the thickness of the deltoid muscle for functional reasons and, even if you could, you can not approximate the 2.5 to 3cms reduction per side that is achieved with clavicle bone shortening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am aware that your office performs rib removal for body contouring purposes. After doing some research into rib removal and other methods of waistline reduction I have come across the Kudzaev method of waist narrowing[1]. This procedure is currently only popular and performed in eastern Europe and involves performing a partial osteotomy on the floating ribs and then using a corset tightened with a belt on top for 3 months during the healing process where the modified ribs heal and get affixed into their new position. Reading the patent of this method it seems like the incisions that are performed are also smaller (2-3cm) than what is normally done for removal. Additionally, it is claimed that this procedure has little pain compared to removal and can be done under local anesthesia.
A recent academic paper Aesthetic Contouring of the Chest wall with Rib Resection claims that the Kudzaev method doesn’t have clinical trials: “On the other hand, Kudzaev patented a method of narrowing the waist, in 2017, in which the author performs osteotomies on the 11th and 12th ribs by small skin incisions. Thus, he promotes costal fracture, and complements the narrowing of the waist by the use of a corset. In this way, costal resection and its complications are avoided and waist narrowing occurs. However, there is no publication of clinical trials with this approach.”
However, this method seems to have been used frequently in the past with little side effects pertaining to rib contouring when performing extrapleural thoracoplasty for tuberculosis so this technique doesn’t seem particularly new or experimental. It’s only novelty is being used for aesthetic purposes.
Despite the patent saying that only the floating 11-12 ribs can be reshaped, I have talked with a couple Russian plastic surgeons and they claim that the 10th ribs are also able to be narrowed with this method after analyzing a CT scan. Looking at results on Instagram for the surgeons that are performing this, it seems like they are reshaping the 10th rib many other examples I can provide.
Some additional information can be found at as well.
I am wondering if you are aware of this method and what your thoughts of it are. Many of the plastic surgeons that perform this operation claim it’s a much safer operation than removal long term as you retain your ribs. I am also interested if you would be able to perform this operation since I have considered flying to Russia but I would very much prefer to stay in the US for something like this.
A: Thank you for your inquiry and detailing the osteotomy method for waistline narrowing of which I am well aware. Having removed hundreds of ribs for waistline narrowing, and never yet see a single complication or any negative byproduct of removing the outer half of ribs #10,11 and 12, I can not speak for whether rib osteotomies vs rib removal is safer, has a quicker recovery or produces comparative results. What I can say is the following:
1) The skin incisions needed to perform either technique would be similar. I use a 4.5cm single incision per side which can not be made smaller no matter method is used.
2) No form of multiple rib manipulations should be attempted to be performed under local anesthesia. There is no benefit for the patient or the outcome in doing so and may well make the whole experience far less pleasant and even less successful.
3) The key to the technique is obviously the patient’s compliance with the corseting.
4) One of the key components of waistline narrowing is the reduction of the thickness of the lateral border of the latissimus dorsi muscle. This soft tissue reduction provides as much waistline narrowing as that of the rib bone changes.
5) Rb removal has surprisingly less pain afterwards than one would think because there is no bone to heal, it is just a muscle recovery. Whether leaving the ‘fractured’ ribs in place will lead to more postoperative or even long-term rib pain I can not say.
That being said I believe rib osteotomies are a valid method for waistline narrowing….which is probably better called ‘rib osteotomy-assisted corseting’. In the properly motivated patient it is a useful technique But whether it produces similar results to rib removal surgery no one can yet say. They are both similarly safe but one is not safer than the other.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to undergo skull augmentation surgery.
My problem is that my forehead is convex and seen from the front it looks very narrow. The areas to increase are shown in the Figure 1
To hope for a “global” increase it will be necessary to increase the projection of the eyebrow arches.
As the modification would be in the visible part of the skull, the forehead, I was wondering what strategy, materials would you consider minimizing the visibility of the edges of the implants.
Is it possible to use custom implants ( PMMA or HA or silicone) coupled with PMMA or HA in liquid powder form on site to fill the holes?
In the link below it is explained that it is possible to use PMMA as a filler for the holes, can you use this technique?
A: In answer to your implant edge transitional question, there is no need with silicone forehead implants to use bone cements as they have a feather edge to them by design.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a Lefort 1 and genioplasty in the past and it greatly improved my breathing and lip competence. However a small amount of lower lip incompetence persists. Fixing that lip incompetence is my main objective, though aesthetics are very important to me as well. Based on my pictures, what option do you reckon is ideal?
1. Sliding genioplasty with horizontal advancement and no vertical changes
2. Sliding genioplasty with horizontal advancement and 2-3mm vertical reduction via bending of the plate
3. Jumping genioplasty
A: Option #2 is the most viable one. A jumping genioplasty is rarely used because of the major bony stepoffs that it creates.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I totally understand in any form of a facelift nothing is permanent and you return to baseline. My questions are:
1. Does a procedure like the jowl tuck up change how fast or slow you will continue to age?
2. In other words, its purpose is to set back the clock some years: not as much as a deep plane facelift but more than facetite. Is this correct?
3. In my case do you think I need any facial lipo with the jowl tuck up to meet my aesthetic goal or would the jowl tuck up nail it?
4. In my case what would be the second runner up procedure to the jowl tuck up that would impact the appearance and have a slimming effect on my lower face? Examples: Facetite, Agnes RF, Threads, Kybella. (off label in lower face)
Thank you so much for your time!
A: Certainly a jowl tuck procedure has a longer duration of effect than any injectable or energy based therapies by a magnitide of years.
In answer to your specific questions:
1) No. Surgery changes the outward effects of genetic and environmental influences of aging but not its speed.
2) Correct.
3) Small cannula liposction of the submental/jawline and perioral areas is a good adjunctive approach.
4) I would find any of those listed to be very distant runnerups but Threads would be at at the head of the class of these minimally invasive options.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested on total midface augmentation due to very assymmetric and retruded face. I am very interested to use PEEK custom implant. However many surgeons recommend me to avoid implant because according to them such implants will erode or resorb my facial bone over time.
Is there any risk of bone resorption due to implant on the face or does such implant changes my facial bone structure over time?
BY THE WAY, ON YOUR OPINION IS IT POSSIBLE TO AUGMENT TOTAL MIDFACE BY OSTEOTOMY STARTING FROM FRONT ZYGOMA , MALAR, INFRAORBITAL SO TOTAL FACE AND POSSIBLY BONE GRAFTS USING AND IS IT POSSIBLE TO HAVE A GOOD SYMMETRY THIS WAY.
Thank you on your efforts for an answer.
A: In answer to your questions:
1) The potential issue of facial implants and bone resorption has been around for a long time and carries with it numerous misconceptions. While all facial implants, regardless of the material composition, induce some expected imprinting on the bone this should not be construed as active resorption or an issue of any clinical relevance.
2) No form of an osteotomy/bone grafting can replicate the assured smooth preplanned shape of a custom midface implant. The only role for osteotomies in aesthetic midface augmentation is in the patient who does not want an implant AND can accept the irregularities/stepoffs and other aesthetic contour issues that will arise from the much more imprecise nature of osteotomies in this facial area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had custom midface implant surgery performed by another surgeon about 2 years ago, and I am interested in undergoing revision of the implants for a more defined look. However, I do have one concern. The first surgeon performed a subperiosteal midface lift during the surgery to place the implants. I was told that if I have the implants revised by a surgeon who does not perform another subperiosteal midface lift, it could cause the soft tissues to become unsuspended and sag. Having said that, does Dr. Eppley perform a subperiosteal midface lift when he places implants? If not, does he implement any other measures to prevent sagging/collapse of the midface soft tissues?
Thanks
A: By definition every midface implant incorporates a subperiosteal midface lift. You have to resuspend the cheek soft tissues during closure since they have been disinfested and raised to place the midface implant.
Dr. Barry Eppley
Indianapolis, Indiana
