Would Getting 5cm Thick Hip Implants Be A Good Idea?

Q: Dr. Eppley, Hello, I was just wondering, If I got 5cm custom hip implants in really soft implants would they have a risk of folding in the healing process? Because I was told that the normal 5cm implants may cause erosion of the underlying tissues, meaning I would have to have “really soft” 5cm ones, but they may fold whilst healing. Is this same risk with your implants? I just want a second opinion because I’m either going to get my hips done with you or the other place I’ve contacted 🙂 thank you so much. 

A: At 5 cm hip implant thickness, even the ultrasoft silicone is going to feel very firm/hard. The thicker an ultra soft solid hip implant is, the more firm it will feel. This is just a function of material thickness. While at 1 cm it will feel very squishy, at 5 cms it will be almost as firm as a brick. Because of this issue and others, I would never place a hip implant that was more than 2.5 or 3 cms thick at most. This is just asking for a complication of some type.  Hip implants are unique because they are not in or under muscle but on top of its fascia. This makes for higher rates of potential complications. By a lot of painful experiences i can only pass along this piece of wisdom….’it is far better to have an uncomplicated result that may be only 50% of your aesthetic goal than it is to have achieved 100% of your aesthetic goal with complications’.

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Difference Between Submental Liposuction and Submental Lipectomy?

Q: Dr. Eppley,Is there a difference between submental liposuction and submental lipectomy? Do you perform both procedures if this is the case?

A:Technically there is a difference between submental liposuction and submental lipectomy. Submental liposuction, as the name implies, removes fat between the skin and the platysmal muscle by vacuum extraction using a cannula. (like any traditional lipouction only using a smaller cannula) Submental lipectomy is the direct excision of central fat beneath the platysmal muscle. in the midline The combination of submental lipectomy and submental liposuction is always part of the procedure known as a submentoplasty. A submentoplasty is a more aggressive form of neck contouring that also include platysma muscle tightening.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Larger Facial Implant Be Placed After A First Smaller Facial Implant Is Done?

Q: Dr. Eppley, Regarding limitations in the size of facial implants, such as chin implants, would the skin not eventually stretch, gradually, to accomodate the implant? That is to say, have you ever had someone get an implant, wait a year, get a larger implant, or is this irrational? Would the tissues simply become too tight regardless of how long was waited? I know, for example, that as people get fat, their skin extends generally regardless of how fat they get. Is there not the same potential for cosmetic implants? Is there any experimental work being done in this area?

A:It is very common that patients unintentionally undergo a first stage tissue expansion procedure (placement of an initial implant) for a second larger facial implant later. They get one implant size today and then may decide later they want it bigger…which is not a problem to do.

Dr. Barry Eppley

Indianapolis, Indiana

Can I Get A LeFort I Osteotomy After Getting A Custom Jawline Implant?

Q: Dr. Eppley, I am writing this email in regards to the query regarding the custom jaw implants. I had a V-line surgery done around 3 years ago in Korea and since then I have almost lost my jawline definition. I am looking to reverse this surgery dr. Probably around in coming 1-2 months or as soon as I get a leave from work.Actually my question is not regarding the custom jawline implant but regarding the possible implications of it on my future surgery. Actually I am scheduled to get a Lefort 1/ Upper jaw surgery. Its ONLY an upper jaw surgery but not a double jaw surgery. Currently I am undergoing orthodontics and it is scheduled for Summer, 2020. My maxillofacial surgeon is very confident that it is only going to be upper jaw surgery with some setback and Clockwise rotation with some posterior impaction. He said that he won’t touch my lower jaw at all. So my questions are:

1.Is it possible that I can get a custom jaw implant to reverse my V-line surgery  and for jawline augmentation in upcoming August/September 2019 and then still in 2020 can go upper jaw surgery only for my maxilla without any compromising effects on my jaw implant. 

2.Will the custom jaw implant create any hindrance if my maxilla is impacted/rotated or setback or if it has to be removed during my maxilla surgery.

3.Can I get a custom jaw implant now on my mandible but still in future can undergo ONLY upper jaw surgery without any problem.

Thank you so very much for your time Dr. I am really looking forward to get my custom jaw implant with you. My basis of this query is just that as I can get leave now from work and I would like to get my custom jaw implant with you now as I really dislike my un-defined jawline. Looking forward to hear from you soon.

A:Thank you for your inquiry and detailing your issues and upcoming maxillary surgery in 2020. I think all of your three questions revolve around the same issue…can a jawline implant interfere with any aspect of a subsequent LeFort 1 osteotomy? And the answer to that would be no. As long as you know that you are not going to need bimaxillary orthognathic surgery, then placing a custom jawline implant will be just fine.

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Difference Between A Direct Temple Lift and an Endoscopic Browlift?

Q: Dr. Eppley, Is a direct temple lift the same or different than an endoscopic browlift? Or I assume the direct temple lift pulls the tail vertically while the endoscopic browlift pulls the whole brow up to the hairline.

A: There are differences between a direct temple lift and an endoscopic browlift. An endoscopic browlift uses 4 scalp incisions  (2 parasagittal and 2 temporal) to create a total brow lifting effect. Conversely a direct temple lift uses an incision either at the tail of the eyebrow hairline, at the edge of the temporal hairline or back in the temporal hairline to create a tail of the brow lift. Most commonly the incision is placed at the edge of the superior temporal hairline which lifts the tail of the brow in a 45 to 60 degree angulation upward. 

The combination of a lateral cantoplasty and a direct temple lift is the most powerful technique for creating an upward sweep or angulation to the outer eye area.

Dr. Barry Eppley

Indianapolis, Indiana

Does Mouth Widening Surgery Need To Remove Muscle?

Q: Dr. Eppley, this is about mouth widening surgery, I saw online about a question about how mouth widening surgery can improve the length of the mouth and Dr. Eppley answered about 5mm on both sides of mouth, Is that right? I don’t see how wider the mouth can get without cutting too far into the muscle which can be dangerous.

A: All mouth widening surgery involves removing a wedge of orbicularis oris muscle as that this is a necessity to help prevent relapse. There is nothing dangerous about such muscle manipulation/removal. This is a small wedge of the lateral aspect of the muscle which has no functional significance.

Dr. Barry Eppley

Indianapolis, Indiana

Can Medial Canthoplasty Lower The Inner Corner Of The Eye?

Q: Dr. Eppley, I am interested in eyelid surgery to correct negative canthal tilt. I know lateral canthopexy can be done to raise the lateral canthus but i also need the medial canthus to be lowered in both eyes. I talked to one doctor who told me it is impossible to do. I started researching this and found many articles on the topic that have been published throughout the years. All of them describe methods and techniques for reattaching the medial canthal tendon. When i sent one of those articles to the surgeon he told me those techniques do work but they’re only for “medical problems”. I even saw a video of of the procedure being done. I e-mailed another surgeon asking him if it is possible to do and i suggested cutting the bone to which the tendon is attached and moving it down then fixing it in that position. I asked him if that would work and he said that it would and that he’s done things like that before. I just don’t see any reason why this can be done for people who have severe skull fractures/shattered orbitals but not people who are perfectly normal? Is it possible to do or is it impossible? I’m confused and just looking for a real explanation.

A: Medial canthoplasty is a far more challenging procedure than lateral canthoplasty due to the more limited access of the inner eye and the very thin bones to which the tendon is attached. It is also a procedure that is far less successful as a result. While attempting to do it for reconstructive purposes has merit, manipulation of the medial canthal tendon for aesthetic purposes must be considered far more carefully. I would doubt that moving the inner corner of the eye down will be successful if attempted by trying to move the medial canthal tendon downward. The bones of the medial orbital wall are very thin due to the sinus cavity that lies on the other side. This makes secure fixation very difficult. If the goal is to move the inner corner of the eye downward boy a few millimeters it would far more sense to do so by skin manipulation such as a small z-plasty. It would be more effective and incur none of the risks of destabilizing the medial canthal tendon attachments.

Dr. Barry Eppley

Indianapolis, Indiana

What Is The Best Material For A Custom Jawline Implant?

Q: Dr. Eppley, I’m interested in jawline custom implants but what material does the you use? 

A: A custom jawline implant can be made by a variety or materials from solid silicone, Medpor, PEEK or titanium. I am not married to any of them, ultimately that is the patient’s choice. However they are not all equal, meaning there are major differences in cost, how they would be placed (one piece or sectioned into multiple pieces) as well as the size of the incisions to place them. The reason solid silicone is chosen by most patients is its lower cost, ability be placed as a single unified implant and the smaller incisions used to place it. But I have had lots of patients who have chosen other more expensive materials and had equally satisfactory results.

Dr. Barry Eppley

Indianapolis, Indiana

Will A Submentoplasty Procedure Be Noticeable After Surgery?

Q: Dr. Eppley, Thank you for the detailed reply and the options therein. When considering the submentoplasty procedure for neck sagging problem, my questions/concerns are as follows:

Putting aside (for the mpment) the expense of the work needed, there is, for me, the more difficult or challenging elements of having the work done without it being readily identifiable as someone who’s ‘had some work done’.

Can the procedure described be done in stages so as to minimize its obviousness? In the closing paragraph of your last email it appears that you are alluding to a sequence of steps, could those steps be the thresholds for a series of successive procedures or are they too intrinsically woven to be approached separately ?

It’s important to me that my friends and family think I’ve just had a vacation, fallen in love, or gotten laid properly (or all three) when they first see me after the operation.

Additionally, I’d like to know what the pain management path is; would I be put out for the operation,  is the time envelope for the work an hour or two, or significantly more? In terms of pain management history,  I have had some oral surgery and dental implants over the course of a few decades and have always insisted on anesthesia – not the local variety, but rather being put out by an attendant Anesthesiologist.

Logistical speaking, do I need to be swaddled in bandages fo a day, or three, or a week or more ? Travel considerations ?Time of year ?

A: In answer to your submentoplasty questions:

1) The concept of someone wanting to have facial work down and not looking like work has been done is not an issue you should be concerned with given the type of procedure you are considering. By definition a submentoplasty procedure simply can not look overdone. Its real issue is whether it can fully address your neck concerns. So the potential issue is really the opposite of what you think….not looking overdone but can it do enough to satisfactorily improve the problem. If you remember my discussion of your options, the ideal treatment for your neck concerns is a lower facelift. You just may not be ready to undergo that effort at this time.

2) The submentoplasty includes all three components that I discussed which have to be done at the same time. There is no benefit to staging them from a result or recovery standpoint. 

3) Changes in the neck are not really noticeable to other people as a specific identifiable change as people are not that perceptive. They may only ‘notice’ as some type of overlay beneficial change.

4) This is not an operation that is associated with much pain as most facial/neck procedures have low levels of discomfort.

5) Such procedures are done under general anesthesia.

6) There is a chin/neck strap applied for one day after surgery. Thereafter its use is optional.

7) You could return home 1 to 2 days after surgery.

8) The best time to is such surgery is when it suits your schedule the best. Time of year and weather make no difference.

Dr. Barry Eppley

Indianapolis, Indiana

Will Fat Grafting Work Well For Paranasal-Premaxillary Facial Augmentation?

Q: Dr. Eppley, My paranasal-premaxillary area is very recessed. I was wondering If is it possible to do paranasal-premaxillary augmentation with fat grafting. I know that peri-pyriform implants exist, but I want to know If fat grafting can achieve 4mm or more augmentation. Thank you Dr.

 A:Thank you for your inquiry. Can fat grafting be done to the midface and can an initial 4mm paranasal-premaxillary augmentation be achieved….the answer would be yes. The question is not whether fat grafting can be done to the midface but whether it would be successful. (i.e., survive) My experience and the observation from patients who had it done by other doctors is that the survival rates are low. There is also the issue that, even if it survives with some reasonable volume, the look is often more of a bloated/full one and not that of a skeletal augmentation effect which is the source of the problem. Once fat grafts are in there should the look be undesired there is no good way to remove the fat.

Dr. Barry Eppley

Indianapolis, Indiana