Are Deltoid Fat Injections Dangerous?

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

Is Medpor Chin Implant Removal Difficult?

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

Should I Be Talking and Smiling After Sliding Genioplasty Surgery?

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

Do You Perform Testicular Enlargement Surgery?

Q: Dr. Eppley, I noticed a post inquiring about testicular enlargement, but the reply just explained the difference between implant & enhancement. I was wondering if you perform this procedure. I’ve been on testosterone replacement therapy for a while and have experienced severe testicle atrophy. The only surgeon I’ve found so far is in Beverly Hills. Any assistance you can provide would be greatly appreciated. 

A: I do perform testicular enlargement surgery and the options are either place testicular implants in front of the existing testicles or use wrap around implants to enlarge the existing testicles. Both are viable options of which the simpler approach is to place 6cms to 6.5mc implants and displace the smaller natural ones which become ‘lost’ behind the much larger implants in front of them.

Dr. Barry Eppley

Indianapolis, Indiana

How Difficult Is It To Remove A Medpor Chin Implant Replacement?

Q: Dr. Eppley, How much more difficult is a Medpor chin replacement vs a virgin implant? Should I be concerned that 90% of doctors seem to say it is impossible?

Should I consider replacing it with silicone instead of Medpor?

How long do I need to wait? If we replaced the exact implant, could we expect very similar results to what I had? I am done with surprises. 

Thanks in advance for info. Your website is helpful.

A: In answer to your chin implant replacement questions:

1) While Medpor facial implants are more challenging to remove than non-adherent silicone facial implants, they can always be successfully removed. Any surgeon that would say otherwise is either inexperienced, lacks an understanding of implant biology or both.

2) You have to replace your current implant with an implant material of which you feel most comfortable. But what your facial implant experience has shown is that ease of reversibility of what is put in the face is an important implant feature that is often under valued. Since one can never be completely assured of any aesthetic outcome, the ability to easily modify or change it is important. Tissue ingrowth into an implant would be of great value if one knew that the need for secondary surgery on it again for any aesthetic reason would never be needed.

Dr. Barry Eppley

Indianapolis, Indiana

Will Skull Reshaping Surgery Affect My Memory?

Q: Dr. Eppley, Will I be normal after doing a skull reshaping surgery, and will it not affect my memory. Will skull reshapping restrict me from going to extreme weather conditions. How long does it takes for 100% recovery. 

A: If I interpret your picture correctly your skull shape concern is the bump on the back of your head to which I can provide the following answers to your skull reshaping questions:

1) Such skull reduction has no effect on brain function and thus will not affect memory or any other cognitive skill.

2) There are no restrictions after surgery whether it be sports or going out in any type of weather.

3) Recovery is very quick. 100% recovery will take just a few weeks.

Dr. Barry Eppley

Indianapolis, Indiana

Are My Jaw Angle Implants Too Big?

Q: Dr. Eppley, I’ve undergone jaw angle implants one week ago and, as many patients, I am worried about the implants’ size. I’ve used the 10mm Terino’s lateral implants. This picture of myself is the pre-op front view m in order for you to know what I was like before and judge better. 

I know it’s very early to judge but I think the implants are little bigger than I expected. I am worried about the outer line of my face and the gonial angle shape which is slightly outer from the cheekbones right now. 

According to your experience do you think the outline of my angles will be shrinked to come slightly inside (OR at least match the cheekbones) in the final result?  (according to the pro-op image) 

Thank you.

A:If you are just one week after surgery every patient will think they are too big. You have less than 50% of the swelling that has gone done which takes a full 6 weeks for most of it to resolve and a full three months before the tissues fully shrink down and wrap around the implants to see the true final effect. Thus no feeling that you have now is an accurate indicator of the final result. No one can predict the final result now, this is a function of time and patience. Your surgeon should have fully advised you of the length of the recovery process until the final results is evident.

Dr. Barry Eppley

Indianapolis, Indiana

Will Cheek Implants Improve Nasal Breathing?

Q: Dr. Eppley, I am interested in silicone cheek implants (with screws) not only for appearance but also in the hopes that it will help my breathing obstruction on my right side of my nose which is alleviated by the skin stretching that would be enacted by the cheek implant (see last photo). I am interested in the implant being purely in the Zygomatic Arch. Is this something that is possible? My submalar space is already full enough I don’t want it to be more full. 

A: Thank you for your inquiry. What it appears you are seeking is a custom design cheek implants that covers the high malar area and goes back along the zygomatic arch. You did not mention the infraorbital area, which is deficient with your negative orbital vector relationship, so I will assume for now that is not part of the implant design. That can certainly be done and is a common custom implant design in my experience. While it can provide the aesthetic benefits you are seeking, I would not go as far as to say it would provide a functional breathing benefit as the finger maneuver to lift the cheek tissues creates a more powerful effect that what almost an implant on the bone can do.

Dr. Barry Eppley

Indianapolis, Indiana

Can An Infraorbital Rim Implant Reduce Scleral Show?

Q: Dr. Eppley, I’m interested in reducing scleral show and raising my lower eyelid, from what I’ve read from your articles the best solution is usually a combination of an infraorbital rim implant combined with a lateral canthopexy. I’ve included some pictures to show if you think this would address these issues.

A:You have correctly surmised that in the presence of infraorbital rim bony deficiency the placement of an infraorbital rim implant or a combined infraorbital rim-malar implant to build up the bone is needed to reduce scleral show. There is a linear relationship between the lower lid margin and the shape and height of the infraorbital bone…which is no an anatomic surprise.

Integrated into the placement of an infraorbital rim implant or infraorbital rim-malar implants are soft tissue procedures such as a cheek lift and lateral canthoplasty which when all combined help drive up the lower eyelids and reduce scleral show.

Dr. Barry Eppley

Indianapolis, Indiana

Can The Dent In The back Of My Head Be Fixed?

Q: Dr. Eppley, I am 21 years old and I have noticed that I have a dent on my crown and its mostly on one side like it is missing bone. I noticed about two years ago when my mom was massaging my scalp. At that moment I was like I don’t care. But now i really care about it because it is so ugly. I have lucky to have a lot of hair. My question is can it be filled with bone? Or some other things to make it normal? Im really unhappy and I hope u guys can help me. I can send photos too in email if u guys send me a email Ican send them. I saw some great results in your website and I don’t care about distance or what ever as its about my confidence!

A: The good news is that a dented skull area can be completely fixed using a variety of techniques. From bone cements to custom skull implants the area of the skull that lacks contour can be augmented. If the skull area of concern is not that large and is back in the hair-bearing scalp area the use of bone cements may be the preferred augmentation method. But most of the time a custom skull implant approach is best. Please send some picture for my assessment and more qualified recommendation. 

Dr. Barry Eppley

Indianapolis, Indiana