Can Both Muscle and Bone Be Removed In Temporal Reduction Surgery?

Q: Dr. Eppley, Can I ask three questions about temporal reduction surgery? I have wide head.

1: Can you scrape the bones under the muscles of the temporal region? I learned temporal muscle reduction surgery by reading your articles as it will work for making head width more narrow. 

https://exploreplasticsurgery.com/anterior-vs-posterior-temporal-reduction-for-head-width-narrowing/ 

To be honest my case is so severe that I wonder if scraping the bone as well as anterior and posterior muscle reduction is needed. 

My back head (especially right side) is flat so here is needed to insert an implant. This is why my face bone is totally weird, not only back but also side,around the top of the head as well. 

2. Can I take consultants with you face to face? I know I can take it with virtually  but I hope I can take face to face consultation with you. 

I never mind extra fees. 

3: Do you use plastic surgery simulator for computer?

A: In answer to your temporal reduction questions:

1) Bore reduction can be done as well as muscles reduction but to do so that will change the location of the incision from behind the ear to the side of the head.

2) I will have my assistant Camille contact you to schedule an office face to face consultation time.

3) I always use computer imaging to try and demonstrate potential results.

Dr. Barry Eppley

Indianapolis, Indiana

When Can I Resume Taking Accutane After V Line Surgery?

Q: Dr. Eppley, Recently, I did a V line jaw reduction – an osteotomy and shaving of the mandible and a genioplasty. I had a fat graft to my temples too! However, I’ve been breaking out quite a bit. I was hoping to take Accutane to alleviate this. It has been almost a month since my surgery. I was wondering when it is safe for me to take it? I’m also really really afraid my bones are going to grow back after the jaw reduction as I’m very young.

Also, I’m interested in an Asian blepharoplasty + ptosis correction and an undereye fat graft with you. How long should I wait after I finish Accutane? 

A: It is perfectly fine to take Accutane one month after such facial hone surgery. I would wait until you are off Accutane for three months until proceeding with the blepharoplasty and fat grafting procedures. While Accutane primary affects the healing of epidermal wounds (and the evidence for this effect is questionable) in theory it does not affect they healing of tissues such as muscle, fat and bone. But it is always better to be conservative particularly in regards to elective facial surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Jaw Implant Make My Face Above It Concave?

Q: Dr. Eppley, I’m interested in reshaping my face with you making it more attractive and add angularity. I’ve been told I have thick soft tissue resulting in weak contours so I was wondering if I can thin the soft tissue. The side of my face is convex but I want more of a concave side, as shown in the picture because I heard the implant stretches the tissue. Would this be achievable with a jaw implant alone if widening the gonials. Thank you

A: Unless your face has that concave look initially, no form of jaw implant is going to have that effect. The tissue stretching effect of a jawline implant is on that of the neck not the face. That is where the pull off the soft tissues is affected. It may help a loose or saggy beck as it pulls the neck tissues up as the lower and outer border of the lower jaw is expanded. 

Similarly any ability to get a more concave face requires direct defatting of it and some form of cheek augmentation above it to have any chance of that type of facial reshaping effect.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Calf Implant Withstand Strenuous Physical Activities?

Q: Dr. Eppley, I saw your website allows free consultations/questions about plastic surgery. And I was curious about a singular calf implant. 

I was born with club foot but after correction the mass in my right leg developed different from the left. It was much smaller but over the years I have made major progress but I know it will never be equal. I am in my mid 20’s and live a very active life. And wanted to know if a calf implant can handle such a lifestyle. From hiking, wakeboarding, marathons and mixed martial arts and things like of that nature; without risk of popping or shifting. I’ve read there are different types of implants such as soft and solid silicone etc and which would be better suited for activity. 

I know the recovery time can be a little long but I would be willing to wait as long as possible to guarantee results. 

A: Thank you for your inquiry. Clubfoot is the most common reason for the use of a unilateral or solitary calf implant. A calf implant is composed of an ultrasoft but solid silicone that will last a lifetime and can withstand any type of physical exertion or trauma.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Hairline Advancement and Skull Augmentation Be Done At The Same Time?

Q: Dr. Eppley, I’m interested in undergoing a full skull reshaping procedure that would include brow reduction and forehead reshaping (with potentially a hairline advancement as well) as well as back of the skull implants for a flat back of the head. I would need to fly in for this procedure so I was wondering if the entire surgery from consultation to procedure could be done in one trip? If so, how many days would I be flying in for and when would appointments be available for the surgery? I was hoping I could get an overall cost estimate as well for the procedures I listed if possible. Thank you.

A: Thank you for your inquiry. I will have my assistant Camille contact you to schedule a virtual consultation time to review some basic concepts about your skull shape needs and how to achieve them.

The concept of a hairline advancement with any form of skull augmentation is contradictory. Hairline advancements base their success upon having the scalp mobility to shift the hairline forward/lower. Conversely occipital augmentation needs scalp to allow it to be expanded from underneath. Thus you can’t do both at the same time. To do all that you have mentioned would require a two stage approach with all frontal procedures done first and any occipital augmentation done later.

Dr. Barry Eppley

Indianapolis, Indiana

What Can Be Done To Help My Chin Appearance After A Lower Jaw Advancement Surgery?

Q: Dr. Eppley, I recently had a lower jaw advancement but it did not change my chin like I thought it would. Can you look at my pictures and records and tell me what you would recommend for further facial/chin improvement.

A: Thank you for sending your records. What that show me is the following:

1) You have a Class II bite relationship with a horizontal and vertical lower jaw deficiency for which the lower jaw advancement (BSSO) was an indicated procedure.

2) While the BSSO brought the lower jaw forward it was unable to correct the vertical deficiency at the chin.

3) While you did not state what your aesthetic concerns were with the outcome my assumption is that that you feel the chin stick out too far and has bunched up the soft tissue chin pad. This is because the vertical shortness of the chin remains unaddressed.

4) I would think the correct approach would be to vertically lengthen your chin which would improve your facial balance, setback the chin back a bit and unravel the bunched up soft tissue chin pad. (vertical lengthening bony genioplasty)

Dr. Barry Eppley

Indianapolis, Indiana

Will A Custom Jawline Implant Make My Cheeks Hollow?

Q: Dr. Eppley, I am considering custom jawline implant with you that wraps around the whole including chin. I am wondering if widening my mandible would stretch the soft tissue and make my cheeks appear slightly hollow. Could you look at my photo and the model to see if my goal is possible with the jawline implant alone. Thank you.

A: That is an easy question to answer…which is no. A custom jawline implant by itself will not make the cheeks more hollow. Even with every cheek procedure that is available (buccal lipectomies and perioral liposuction) such a cheek effect is not going to happen in you. That is not a realistic goal with your natural facial shape. What those models have that you don’t have is cheeks. You have to have the facial defatting procedures and the addition of cheeks to get close to that type of facia shape change.

Dr. Barry Eppley

Indianapolis, Indiana

Are Sperm Counts Affected By Testicular Wraparound Implants?

Q: Dr. Eppley, I’ve seen your article about testicular wraparound implants. 

It seems to be a very interesting alternative to standard half curved implants that always looks to be a bit easy to detect. 

How many patients have you already implanted that kind of implants? 

No blood circulation issues or decrease of sperm due to maybe hotter testicle temperature du to implant? 

How much did it will cost to have that surgery done? 

Thank you in advance and have a nice day.

A: In answer to your custom testicular wraparound implant questions:

1) I have performed six such cases or twelve total implants.

2) Since the testicle is dissected out on its neurovascular pedicle before placing it inside the implant, no circulatory or testicular survival issues would be expected.

3) I can not speak to the issue of sperm counts as that is not a preoperative or postoperative test that is done. In any such patients that have been implanted they have all been older (greater than 50 years of age so viable sperm was not a concern to them)

Dr. Barry Eppley
Indianapolis, Indiana

Are My Rib Removal and Custom Hip Implant Goals Realistic?

Q: Dr. Eppley, My height 5’1 weight 102 Ibs. I’m a short torso  

want to get rid of hip dips and want to know which procedure is the best for me? 

Questions:

1) How long should I stay in Indianapolis?

2.) If I had consultation for first time after that, how long does it take time to customize implant?

3.) Does hip implant and rib removal are the best way to give my body hourglass figure?

Thank you.

A: Thank you for your inquiry and sending your pictures to which I can make the following comments:

1) While it is good to have well defined goals, the ideal images you have provided are not ones that are realistic with your body or can be done in a safe manner. I have attached a realistic imaging prediction based on rib removal and custom hip implants of  what can be achieved in the effort to give you more of an hourglass shape.

2) The lead time for manufacturing of custom hip implants is three weeks. What I do is have a virtual consultation with the patients where measurements are shown how to be done from which I develop the implant dimensions based on that discussion.

3) I would say give yourself 10 days to be here before returning home.

Dr. Barry Eppley

Indianapolis Indiana

Do Custom Skull Implants Require Screws For Fixation?

Q: Dr. Eppley, First off, my desired surgery objective is still this: a more symmetrical, fuller, rounder head shape, with no (or very minimal) impact to hair follicles and craniofacial health.

With this aim, here are some questions I’d like to have your views on. I really appreciate your time to attend this email. Thank you Dr. Eppley!

1. About screws

I learned that in most cases, screws are used in order to stably attach an implant to one’s skull. These photos show how they look: https://exploreplasticsurgery.com/wp-content/uploads/2018/09/Screw-Fixation-of-Custom-Occipital-Plagiocephaly-Skull-Implant-intraop-Dr-Barry-Eppley-Indianapolis.jpg

What is the material of the screws, 100% titanium?

Are they screwed into the skull bone?

If so how deep do they go?

Are there chances that the way the screws are drilled does harm to one’s brain in particular, or to one’s health in general?

Are screws detectable when the person is going through a security check/scan, for example, at airport customs or other similar sort of checks in public places?

Is there other attachment methods that don’t use screws?

If using screw is the best option, why?

2. Implant material

In one of your articles, it says “Total skull enlargement and augmentation can be done using either bone cements or a custom implant”

Which method should I choose and why?

Will an implant with either method cause migraine and headache to a patient?

Does the procedure cause hair follicle damage (consequently causing hair loss) post-operation, in short-term or permanently?

Is there things that I can’t do due to having an implant on my skull, for example, some intense sports, pressure massage on the scalp, or other strength and movement placed on the head?

Will either material cause problems or discomfort feelings when I am in hot temperature, for example in a sauna, or tropical summer climate with 40+ degrees, and in icy cold environment, say winter in North Canada?

What is the worst case of side effect caused by implant material?

One of your articles talks about injectable bone cement. https://exploreplasticsurgery.com/product-review-osteovation-injectable-bone-cement-small-skull-contouring/

For my case, is there benefit of using injectable bone cement, compared to custom implant(s)? Why?

3. Pieces of implant

In one of your articles, it says “A large custom skull implant replacement requires a two piece design approach to keep the scalp incision more limited.”  

For my case, would you recommend to have 1 or 2 pieces (known as geometric split implant insertion technique?)? Why or why not?

Where is recommended for the incision?

 

4. Design and desired shape

I could see this case study has some similarities to what my shape issue is and what the outcome could be. I may prefer a rounder shape outcome instead of square shape in this example though.

https://exploreplasticsurgery.com/case-study-creating-the-model-head-shape-with-a-custom-skull-implant/

May I know what are the parts that I will be invovled during the design stage?

I know there requires doing 3D CT scan, discussing on a design, and maybe other parts?

I currently live outside the U.S., but I can consider to come to the U.S. during the design stage, if this is necessary to help create a better design. Do you think this is necessary? Where is it better to do the required 3D CT Scan, in Australia or the U.S.?

5. About first stage scalp expansion

My understanding is that it is very similar (or just the same) to a regular augmentation procedure. The only difference is that by doing it, it is assumed that there will be a second time procedure with the aim to further enlarge the implant size/volume. Therefore, a “first stage scalp expansion” itself is a separate, complete skull reshaping procedure, and after that, whether or not one pursues a second surgery is optional.

Is my understanding correct?

As the ideal scenario is that my shape problem could be solved fully (or to a high level of satisfaction) through one single surgery, so I’d like to find out more specifications of the design during the design stage. I can’t wait to get to that stage : )

 

6. About potential removal

Are there common reasons that one needs to remove an implant during later stage in their lives?

If needed, can a removal be done, and is there major risk from a removal?

7. Other questions

How long do you suggest me to stay in the U.S., for best catering to the designing stage and recovering from surgery?

What is the earliest procedure date can be booked, if you have information on this?

Is there recommendations on budget accommodations?

Thank you for your attention. I really hope all goes well on your side. Speak soon!

A: In answer to your skull augmentation questions:

1) Screws are made of titanium and are self-drilled into the skull to a depth of about 2mms. They are not detectable by an airport scanner.

2) Custom skull implants made of solid silicone are the superior augmentation method because they are premade based on the patients’s 3D CT scan and can be placed through much smaller scalp incisions than the full coronal scalp incisions that bone cements require. Because they are placed down the bone level they have no adverse effects one the hair follicles or hair growth.

3) A first stage scalp expansion is needed of the patient requires more than a 125 to 150cc volume of implant augmentation.

4) The shape of the custom skull implant can be whatever the patient wants since it is predesigned from a 3D CT scan which the patient gets in their geographic location. All imlpant design planning can be done remotely.

5) Whether a first stage scalp expansion is needed is based on the patient’s aesthetic desires. (how much augmentation do they want and what are they willing to go through to get it)

6) A custom silicone skull implant is easily rempved/reversed if desired.

7) Most patients return home 2  to 3 days after surgery.

Dr. Barry Eppley

Indianapolis, Indiana