A:In forehead augmentations today there are two materials to use, hydroxyapatite bone cement and custom forehead implants. The use of PMMA bone cement is, by comparison. is an historic and inferior material to use for this or any form of skull augmentation. As a result I do not use it anymore. That being said the more pertinent question is whether an HA bone cement or custom forehead implant offers superior aesthetic results . To make that determination I would need to see some pictures of your forehead that shows your concerns.

Dr. Barry Eppley

Plastic Surgeon

The post Is PMMA A Good Material For Forehead Augmentation? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

​Is it possible, with current or upcoming technology, to treat a severe infection by cleaning and disinfecting the existing custom implants (like PEEK or Titanium) and re-inserting them, rather than having to completely discard them and pay for a brand-new set? Are there any specific materials or protocols you use that allow for salvaging the original implants even in the case of a significant infection?

​I appreciate your expert guidance on this as I plan my long-term transformation.

I would also like to ask about the future of implant technology. As a medical student planning this for 2040, I am curious if there are any ongoing research or upcoming materials—such as antibiotic-eluting PEEK, silver-nano coated surfaces, or bio-active scaffolds—that are specifically designed to be ‘infection-proof’ or treatable without removal?

​Since a full facial reconstruction is a significant long-term investment, I want to know if the field is moving towards materials that allow for deep disinfection and salvage in the event of a severe infection. Any insights into current clinical trials or future trends in material science for custom implants would be incredibly helpful.

Apologies for the specific year mentioned earlier; that was meant to highlight my long-term commitment. However, I want to clarify that if the current technology already offers implants that are infection-resistant or treatable without removal, I am ready to move forward with the procedure as soon as possible. My priority is the safety and longevity of the reconstruction, and I am eager to learn about the best materials available today that meet these criteria.

A:In assessment of the risk of infection in facial implants that risk changes considerably depending upon where on the face they are placed. In my extensive facial implant experience over 35 years I have yet to see an implant infection of the forehead, orbital or cheek areas in which the implants were placed transcutaneously. Almost all implant related infections come from the intraoral placement in the lower midface and lower jaw. That risk is in the 1% to 2% range.

I do not see into the foreseeable future any developments implant technology, by material or design, that will eliminate the known risks of implant related infections that exist today.

Dr. Barry Eppley

Plastic Surgeon

The post What Does The Future Hold For Infection-Free Facial Implants? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

 A:When it comes to aesthetic skull augmentation I can provide you with the following answers to your questions:

1)  There are no existing injectable fillers that can provide any defective or persistent skull augmentation defects. Only implants can do so.

2) Any type of skull implant is made custom based on the patient’s 3-D CT scan.

3) When it comes to custom skull implant materials the best option remains solid silicone in terms of both tissue tolerance, desired shape and ease of insertion. While they can be made out of PEEK that requires a full bicoronal scalp incision with wide detachment of the scalp from the skull to place it. Most patients are not willing to have that long scalp scar on their head for the sake of having that material. But for those who are so motivated it can certainly be done. PMMA material is not used for custom implants. That is an historic putty like material used in open applications which relies intraoperative shaping for its limited effects.

Dr. Barry Eppley

Plastic Surgeon

The post Can Custom PEEK Implants Be Used For Head Widening? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

My main question is about your consultation process. During a private consultation, do you also evaluate the face and recommend which implants or procedures might improve facial harmony and overall appearance?

I am asking because I am not entirely sure which implants would be appropriate for my face (for example jawline, chin, infraorbital rim, etc.), and I would be interested in a professional assessment of what could potentially improve my facial balance.

Do you also offer planning or visual simulations to show possible outcomes or different implant designs?

Thank you very much for your time.

A:In the world of facial reshaping surgery, a lot of which is done with implants although there are a few a autologous procedures, it would be very important to know what the patients aesthetic goals are. This is determined preoperatively by imaging of the patient’s pictures to determine their aesthetic targets. There is a common misunderstanding of imaging and the belief that it is done to show outcomes… which is not its purpose as no one can predict with any accuracy what any surgical outcome will be. Conversely it is done to determine what the patient’s goals are from a visual standpoint. Then the operation is designed with these visual targets in mind and hopefully come as close as possible to those imaged goals with the surgical plan.

Such imaging does not guarantee that the preoperative Visual goals will be achieved. But what I do know is you could never hit a target you never had.

Dr. Barry Eppley

Plastic Surgeon

The post How Do I Determine Which Facial Implants Would Improve My Facial Balance/Appearance? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

A:Untreated ZMC fractures are not rare and present with contour depression that you describe. There are two approaches to restoring contour after such untreated midface frsctures, recut the bone and reposition it (that fracture is now fully healed) or doing an overlay implant to match the better projection on the opposite side. I have done it many times both ways and it’s fair to say that big custom overlay implants approach is far easier to undergo and gets more accurate results. The only reason to re-cut the bone at this point is if somebody says I simply don’t want an implant. But in so choosing one has to recognize that the magnitude of the surgery, the recovery, and this that it.com is not going to be similar to that of an implant.

That being said one piece of information that is critical In making these decisions is to get a 3-D CT face scan so we can fully appreciate the skeletal differences between the two cheeks sides. That is a scan that can be arranged and ordered in your local geographic area and then sent to me for review.

Dr. Barry Eppley

Plastic Surgeon

The post Can My Old Depressed Cheekbone Fracture Be Fixed? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

A:The bump on the end of the distal clavicle requires a small separate incision over it for reduction. The incision for clavicle shortening osteotomies is ‘miles away’ so to speak from the distal clavicle bump.

Dr. Barry Eppley

Plastic Surgeon

The post Can The Bump On My Clavicles Be Reduced? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

A: A 3D CT scan is needed to understand the exact nature of the bony asymmetry. But as a general statement the options are either recut the bone reposition it orally or come externally through a submental incision and reshape the bone by shaving. Which one is best depends on the dimensions of the asymmetry.

Dr. Barry Eppley

Plastic Surgeon

The post How Can An Asymmetrical Sliding Genioplasty Be Straightened? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Would you be able to provide some general guidance on the recommended time between these two procedures? That would help me plan my consultation accordingly.

I’m planning to undergo the procedures in about 4–5 months. I want to first complete the cheekbone reduction procedure, and then do the jaw implants and rhinoplasty together afterward. So it would be helpful to understand the timeline I should expect. 

A: Three (3)  months after the cheekbone reduction should be sufficient healing time for further facial surgery.

Dr. Barry Eppley

Plastic Surgeon

The post When Can I Have Jaw Implants After Cheekbone Reduction Surgery? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

A: Three months after a hair transplant a custom forehead  implant can be surgically placed.

Dr. Barry Eppley

Plastic Surgeon

The post When Can A Forehead Implant Be Done After A Hair Transplant? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

A: While I respect your concerns about general anesthesia, and this is not a rare request, I do not perform any form of scrotal surgery under local anesthesia.

Dr. Barry Eppley

Plastic Surgeon

The post Can Penoscrotal Webbing Correction Be Done Under Local Anesthesia? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.