Q: Dr. Eppley, How much does back of head surgery cost? I also have indentations on the side of my head. Not sure what caused it, but I suspect some kind of bone loss and it really bothers me. the back part more than the sides. Do you use OsteoBone?

A: 1) If you want to use OsteoBone this will require a large scalp incision to place and contour, known as a full coronal scalp incision from ear to ear across the top of they head

2) Using custom skull implants made of solid silicone these can be placed with much smaller incisions, usually a low horizontal one of less than 9 cms on the back of the head.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How much time will the custom wrap implant take to settle (heal)?  How durable are the implants(what if some hits me hard or I fall down)? 

A: In answer to your custom jawline implant questions: 

1) The setting or healing from a custom jawline implant involves multiple phases which to the patient is only judged by what they see on the outside. The worst of the swelling takes about three weeks to subside but full healing and judging the final results takes up to three months after surgery.

2) The material used is permanent, will never break down or degrade and will never needed to be replaced due ti material failure. The material is impossible to fracture or break due to trauma and thus it is like putting a bumper on the jawline…which makes it very difficult to develop a jaw fracture later from just about any amount of trauma.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley: I understand that with this type of osteotomy, the shoulder broadening effect is capped at about two inches.

Would undergoing this procedure now mean that I am unable to undergo any further broadening of the clavicle later in life as the technology progresses?

As an extension to that, can the surgery be undergone twice? Is the broadening effect capped at two inches at a time, or two inches total?

A: Your question is a good one but there is not a known answer because it has never been done or requested. You are correct in that clavicular lengthening is done at 2 cms per side due to the need to have bone grow across this bone grafted site. Once healed it would be fair to assume that further lengthen could be done later but I can not verify that based on personal experience. But you are also correct in that technology will advance and there is no reason not to  believe that larger and secondary clavicle lengthening procedure will be done in the future as the technology advances.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am strongly considering getting a custom jawline implant. 

I have a few questions, the first is: will I be prescribed painkillers afterwards or is it possible to forego this?

Also, how long would I need to be out of work after this procedure? Could I get any sort of doctor’s note and do employers usually recognize this as medical leave? 

Would there be any sort of discount to get cheek implants put in at the same time? I assume the cost of getting anesthesia once rather than two separate times (once for jaw, once for cheek) would save some money. 

Finally, how far in advance does this need to be planned? I get my schedule only one month in advance. It’s not a big issue because I can potentially move things around or call out sick, but just wondering. 

Also, I know costs vary but can you give me some idea of the cost of a custom male chin and jaw implant and also the cost of a custom cheek implant? 

Also, I know this is an even more speculative question but what are the chances someone could go from average appearance to “attractive” or “hot” with these types of surgeries? 

Thank you, 

A: In answer to your custom jawline implant questions:

1) The use of narcotic medications after surgery is optional.

2)  How much time you will be off work is highly dependent on your facial appearance. Most patients probably don’t truly feel comfortable being seen in public for 2 to 3 weeks after surgery.

3) Doing multiple procedures is always more economical than doing them separately.

4) My assistant Camille would know better about the scheduling process as well as the cost of the surgery.

5) The interpretation of appearance change from any type of cosmetic surgery is as a highly personal one in which I could not provide a quantitative answer based on a theoretical question.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am planning on skull reshaping surgery with reduction on my head in the future and am wondering is it possible to have both sagittal and temporal reduction and how much of a difference does it make on the head? Also do you have to shave your head for the procedure? Another question I had is are is procedure out of pocket.

A: In answer to your skull reshaping surgery questions:

1) Both sagittal crest and temporal muscle reduction surgeries can be done at the same time.

2) It is not required to shave your head for the surgery.

3) To preoperatively determine the effects of the surgery I always try to do computer imaging. That can be more challenging with a full head of hair but there to do so still has value.

4) The procedure would be out of pocket as I do no participate in any health insurance plans

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in a custom forehead implant as my brow should look much better with a bit more projection. My forehead has to much backward slope and it is narrow. Perhaps I would also need custom temporal implants or fat grafts, but I’m not sure. My biggest concert is that it looks natural and, for example it is not too curved towards the midline, mantaining a natural shape for the glabella, temporal ridges and orbital rims. I have also the concern for permanent numbness or long-term complications due to the implant material.

A: Thank you for your inquiry and in answer to your custom forehead implant questions/concerns:

1) Permanent forehead numbness is not a problem that I have seen in any patients who has reduced custom forehead or custom forehead-brow bone implants.

2) The key to having any custom facial implant achieve a natural look is to not overdo any of its dimensions. Getting a good shape is achieved through 3D computer design looking at all angles to ensure that it has a natural flow into the surrounding facial features.

3) I would need to see some pictures to do some computer imaging for a better idea as to the type of result you are seeking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello. Is it possible to completely augment the front of the face. Just front of the face like the complete maxilla. See attached example. So I need infraorbital and complete front of face down to and around the nose and nasolabial area. Can you do that? What material would you use?

A: Yes it is possible to augment the entire midface from the infraorbital rims down and around the nose. This is what I call the ‘Midface Mask Implant’. It is best made of solid silicone which allows it to be placed from a completely intraoral approach in most cases. It is important to place perfusion holes into the implant to allow for tissue ingrowth between the midfacial soft tissues and the underlying maxillary bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, One question related to deltoid fat injections: I see many articles online how fat should only be grafted to a deltoid within a certain triangular shape on the side dealt. Is this true? 

-Or can be fat be injected anywhere intramuscularly into the deltoid muscle, including the front deltoid?

-I believe the triangular shape on the side dealt is to keep you clear of arteries. But going by your last email it sounds like there is no concern at all..?

Thanks in advance!

A: In answer to your deltoid fat injections questions:

There are three heads to the deltoid muscle, all of which can be injected with fat. Their arterial blood supply, where the artery is larger, comes in more proximal to where the fat is injected. The concern about fat emboli with fat injections is about inadvertent injection into a large vein which is a low pressure system that flows away from the muscle towards the lungs. There are no such large veins like those that are present in the buttocks in the deltoid muscles.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently had a 10 year-old Medpor chin implant shaved yielding poor results. I need to replace it and am worried about complications. How long will I be visibly swollen? Wondering how long until I am presentable. How difficult/risky is a Medpor remove/replace? Failure is not an option due to my job. While I hate my shaved implant, I cannot afford to risk a worse result. Is this a difficult as I think it is or would you consider this routine?

A: I have removed many Medpor facial implants and they are all removable despite their increased tissue adherence Their removal is usually equivalent to the swelling that occurred during their initial replacement…which I assume one would view as significant.  The question, which I assume is what you are referring to by ‘failure’, is what are you going to replace it with?  Will the replacement create an improved result? Failure certainly does not refer to an inability to get the implant out.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I had a sliding genioplasty last week. Recovery is going well and wanted to ask you a few questions:

1. Is jogging/running exercise okay? (Now 3 days post op)

2. Is it recommended to keep talking/smiling and basically retrain my lips? Some exercise for my lips. Or keep them stagnant while healing? That area feels a bit sore when talking and smiling.

3. Where do you think the swelling is going to go down the most?

A: In answer to your sliding genioplasty recovery questions:

1) Jogging and exercise are okay to do.

2) Any form of lip/mouth movement, while uncomfortable due to stiffness, is not harmful and will help the chin/perioral area get softer sooner. Keeping it immobilized is not helpful for a faster recovery.

3) The progression of swelling resolution will follow the non-linear course of 50% resolution by 10 days, 66% by three and 90% by 6 weeks. The last remaining aspects of the swelling will take a full three months for a 100% resolution.

Dr. Barry Eppley

Indianapolis, Indiana