Your Questions
Your Questions
Q: Dr. Eppley, I am interested in the look from V line jaw surgery. I currently receive Botox injections into my jawline to narrow my face and I have a filler for my chin. I am of Asian decent but I find that some surgeons in Korea overdue it and some faces look too overdone and I want a more natural look.
I want the look that I currently have. I am looking for a more permanent solution. I would prefer not to have my jaw shaved since I’m satisfied with the look I have now with just having my masseter muscle reduced from Botox.
Since I have success with the Botox into the massetter muscle would you be able to reduce that muscle permanently without complications later on? My filler will also be gone soon, would you be able to narrow the sides of my chin because I don’t want an implant.
How long until I will be presentable to go back to work? How long do I have to stay in the area? Can’t wait to hear from you soon. Thank you.
A: The reason you don’t like Korean jaw angle reduction results is because they amputate (cut off) the entire jaw angle in most cases. While that can have a radical effect on facial width in the front view, it artificially raises the jaw angle and thus can look overdone. (because part of the jaw is missing) That is just one way to do jaw angle reduction. The other way, and the more common and better method that I use on many non-Asians, is the outer corticotomy method. This preserves the jaw angle shape and just makes it thinner. The width reduction may not be as dramatic as the amputation method but it looks more natural (not overdone) and keeps the shape of the existing haw angle which prevents complete soft tissue collapse inward. This form of bony jaw angle reduction is what would be appropriate for you along with some muscle reduction as well. This might be something to consider as muscle reduction by electrocautery usually doesn’t produce as much reduction as Botox does.
For your chin I am assuming you added filler to the central part of the chin to give it projection and make the chin appear more narrow or v-shaped. Thus the bony reshaping method would be an intraoral t-shaped chin osteotomy technique. This narrows the chin in width and also give it some slightly increased projection.
Having both of these surgeries, you could go home in a day or two. Be aware these type of jaw surgeries cause considerable swelling and would take 10 to 14 days before you look presentable for work. (although what defines presentable will vary from person to person)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve talked to one plastic surgeon about doing a lower facelift, but cost and time make that impossible for now. I’ve been reading about fat transferring and it sounds less invasive and as I understand there is less downtime. Also, I’m not quite ready emotionally for a facelift if it can be put off for now.
I’ve considered having injectables, but too often see unnatural looking results and do not like the idea of having to do it every 6 months or so.
Thanks in advance for your consideration.
A: Thank you for sending your pictures. While trying to circumvent a facelift, or delaying to for awhile, is understandable, no non-facelift procedure is going to produce the imaged results that you have provided. I assume that you recognize that issue since only more aggressive skin removal can create that degree of jawline and neck definition.
That being said, there are more limited procedure with less recovery that can be beneficial. Fat injections to the cheeks/midface as well as sub mental/neck /jowl liposuction would provide some aesthetic benefit and would help defer a more formal facelifting procedureuntil a later time. At the least it would be far better than using injectable fillers.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have questions about Occipital Bun Removal. How much does the surgery costs; what is the recovery time; how prominent is the residual scar; how long before I can return to work? I am bald. Additionally, what are the risk of the surgery itself? Thank you.
A: I will have my assistant pass along the general cost of the procedure to you on Monday for Occipital Bun Removal. I would need to see a picture of it to have her provide a confirmed cost of the surgery. This procedure is done through a 3 to 4 cm long fine line incision either right over the knob or in a skin crease (if it exists) above or below the knob. How the scar looks would be the only risk of the surgery. All such scars in my experience heal really well and I have yet been asked to ever perform a scar revision procedure on it. One could return to work within a few days after the surgery. There has never been a problem with getting the bump of bone completely reduced to be level with the surrounding skull bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in the early stages of investigating my abdominal liposuction options for reducing my stomach fat. I sent pictures to you as well and then discussions could continue as needed.
I have attached 3 photos for review. A little background: I am 58, 5’8″, 160 lbs. I work out 5-6 days a week with both weights and cardio but I can not get rid of the so called “stubborn” fat around my mid-section. I am open to different procedures and I have investigated Cool Sculpting with mixed thoughts to that procedure.
Thanks again and I will wait for reply.
A: You have the classic male distribution of fat in the abdomen and flank/waistline areas. You would not be able to loose that on your own unless you dropped your weight to about 140lbs, which is not a sustainable weight for you. You are an ideal candidate for liposuction as this is the most effective and efficient method of reducing it. Non-invasive methods such as Cool Sculpting, at best, will create only about 1/3 as good of a result over a long protracted time with multiple treatments. Most men are not very tolerant of a slow and incomplete treatment process for fat reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am touching base to let you know your response in dealing with my pectoral implants assisted me being successful in making a date to change my pectoral implants later this year. As you are aware I would like to get this right. However based on what has happened I wanted to run by what is going on. As you know I have had the Powerflex 1 271cc pectoral implants placed in my chest which has a projection of 3cm. What my doctor and I discussed is that we would like to change to the Powerflex 2 style implant in the 293cc volume which is the largest of the 3 sizes in a slightly lower projection of 2.5cm. However these ones as you are aware are more spread out which will give me a more medial augmentation towards the sternum.
What I was wondering if you could help me with is that I noticed some surgeons place pectoral implants vertically and horizontally. i wanted to know what looks these two options give and the benefits they have. Secondly my concern now is that I am torn between the choice of using the 293 cc with a 2.5cm projecion or going lower at 203cc volume with a projection of 2.1cm. I do trust my doctor but I don’t feel he has come across a patient like me. My aesthetic goals are to have a noticeable pectoral muscle but with more of a definition of muscle rather than a “busty” “booby” body builder look. I don’t wish to become a bodybuilder. I actually like being a slim and toned male but with muscles similar to when someone shreds or reduces their body fat .
In saying that I might add that I personally find the Powerflex 2 style pectoral implants to look more natural over the anatomical ones. I don’t know if I’m saying that due to my ones being on the larger size but another key point in my current implant is that my implants don’t softely taper off into my real chest like a natural pec muscle would. That is why I am stuck between these two sizes as I want bulk in the lower area of the pectoral muscle and on the top area I would like the implants to taper off into my normal chest area without looking like two big solid implants glued to my chest.
A: Since you are having the original surgeon do your pectoral implant revision, then these are discussions you need to have with him/her. That is your responsibility as well as that of surgeon. Asking other surgeons to try and guide you as to the proper implant selection is both unfair to whom you ask as well as to yourself. Only your surgeon knows what you look like and has a vested interest in your outcome. You either trust your surgeon or you don’t. If you don’t then find another surgeon that you do. Standard pectoral implants come in certain sizes and the results they create are limited and do not work ideally for everyone. When one is seeking very specific results after a first set of pectoral implants have been placed, one should strongly consider having custom pectoral implants made. This will remove all doubt about size and shape concerns.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in rib removal. I’m a thin girl, and I was considering removing four ribs to get a smaller waist. My plastic surgeon in my hometown said he punctured a lung while performing this surgery before and therefore does not do this procedure anymore. Is there anyway to eliminate this risk? Any other major risks and complications with this surgery? Can it be done under local with IV sedation instead of general anesthesia? Thank you for your time.
A: The best way to avoid such a complication as you have described for rib removal surgery is to have someone do it that knows what they are doing. That should be a complication that is easily avoided in experienced hands, particularly down as low as ribs #11 and #12 where the base of the lung does not extend that low. This is a procedure that can only be done under general anesthesia. It is performed in the prone position (with the patient face down) and Exparel long-acting local anesthetic is used for nerve blocks once the rib portions are removed. This is a very safe procedure when down by a surgeon with experience doing it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do you offer scrotal lift and penis webbing removal? I plan to fly over just to have this done.
If you do offer this,
1. What technique is being used to fix it?
2. How long does the procedure take?
3. Can I expect little to no scarring?
Thank you!
A: Such scrotal and penile procedures as you have described are commonly performed in my practice. While I don’t have any visual assessment of your specific penoscrotal anatomic derangements, I can provide some general answers to your questions:
1) Most scrotal lifts are performed by a midline reaction along the raphe. The treatment of penile webbing depends on its location. (e.g., penoscrotal band, glans-shaft webbing etc)
2) Each The procedure takes around one hour to perform under general anesthesia.
3) Most scrotal lifts have very minimal visible. Penile webbing correction may be different as some of the scar lines will likely end up on the penile shaft, which does not scar as well as that of the scrotum.
4) I will have my assistant pass along the cost of the procedure (scrotal lift) to you tomorrow. I would need more information about the penile webbing before a quote can be provided.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, One is I feel I have significant facial asymmetry. Everyone tells me it is not but for some reason I feel like it is. Another problem that I have is that I do not feel like my face is lean enough. I am very skinny but I still feel like my face is not lean. I think one reason may be that my cheekbones are not very prominent. I feel like surgery should be a very last resort since I am only 19 years old but I was wondering if there was anything I could do to make my cheekbones more prominent such as exercises or something. People tell me that I already have a good jawline but I just don’t know what to do. If you could please answer me, it would be much appreciated. I have seen pictures of your work and I think it is just wonderful. That is another question. If I have the cheekbone surgery or any surgery, I am afraid that I will look fake or like plastic. I know that sounds rude or disrespectful and I’m sorry but looking real or fake scares me. Thank you for taking the time to answer my questions. I look forward to hearing from you.
A:Thank you for sending your pictures. I think what creates your face asymmetry is that your left eye has a lower eyelid position and has more scleral show.
I would agree that to make your face appear more lean that cheek implants would be helpful. You can not exercise your cheeks to make them bigger. The key to achieving a natural look is to have cheek implants that are more modest in size.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a revision rhinoplasty. My first rhinoplasty was two years ago and the I had a revision a year later. I have difficulty breathing through my nose. Attached are many photos of my nose as well as two pictures of men – I find their noses especially attractive. I would ask for a nose with similar features. Other surgeons have told me that I have the following problems:
1.) dorsal hump
2.) tip reconstruction to have better tip shape and projection
3.) internal valve collapse – both nostrils are collapsed (seen in
nostril picture)
4.) nostril shape asymmetry – alar notching deformity on the left
side. To fix with alar cartilage graft
5.) deviated septum/nose not on my face straight
6.) My own opinion – nose is too over-rotated. Would like it titled down so that nostrils and tip are more in alignment – making a straight line expression – NOT tilted toward the ceiling.
Very difficult problems. Essentially, all across the board, I have been told that I will need rib cartilage to rebuild my nose as it is horribly damaged. Overall, I would want a more functional, symmetrical and more proportional nose to my face. Again, some cosmetic and functional issues.
A: In regards to your nose and revision rhinoplasty, suffice it to say that it is a difficult challenge. While there are many technical maneuvers in your revision rhinoplasty, the key is adequate cartilage grafts to be able to achieve just about any of them. Your nose is completely collapsed and needs to be rebuilt using cartilage grafts. How successful that can be done depends on the stretch of the scarred nasal skin as it must expand to the underlying rebuilt nasal framework. Without question a rib graft would be needed to supply the graft material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am still interested in this procedure. I feel like my whole face is wide and really would like a more narrow appearance from looking straight on as well as the sides. I feel like if only the jaw angle is cut and chin is lengthened, I would still have a wide face. Is the jaw bone between the angle and chin able to be cut? Also, my chin seems a bit wide. I personally like the whole V-line jaw surgery that is done in Korea. I will attach more pictures here.
A: Let me demystify for you what V-Line Jaw Surgery really is. It is the combination of chin and jaw angle narrowing/reshaping. The intervening bone between the two, known as the body of the mandible, can be changed in any significant way way due to the location of the nerve that runs through it and the proximity of the tooth roots. In some cases the bottom of the body of the mandible may be removed but the width of the bone in this area can not reduced.
The combination of jaw angle reduction and chin surgery that has been previously discussed in prior emails is, in fact, V-Line Jaw Surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to ask how the soft tissue of the face responds to implantation v. osteotomy. I am currently deciding whether to go ahead with zygomatic sandwich osteotomy for lateral projection of the cheekbones, or whether to achieve this change with implants. My decision mostly hinges on the soft tissue response. I want the augmentation to ‘stretch’ the soft tissue as much a possible. Am I right in saying that an cheek osteotomy will achieve this goal better? I say this because its true that a sliding genioplasty will mobilise the submental soft tissue more than a chin implant will (given equal amounts of augmentation). I have thin skin and low bodyfat, I just lack projection meaning that my soft tissue does not appear to wrap around the bone well.
A: If you want to stretch the cheek tissues as much as possible, an implant achieves that better than a zygomatic sandwich osteotomy. This is because by virtue of the implant placement the soft tissues must be elevated off of the bone first and then the implant placed. That does not occur in an osteotomy where more tissue adherence remains. Such a cheek effect from implants or an an osteotomy is not analogous to the chin where the submental area improves from a sliding genioplasty because of the attached muscle stretch not that of the overlying soft tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I know it is still early my custom jawline implant recovery process and I will wait for more of the swelling to subside in the next couple months but I am concerned that the implant may be too wide for my face. Potentially, I think the size of my masseter muscle and the size of the implant may have been too aggressive, combined. You can see in the picture that it actually the widest part of my head now. I know it is a bit pre-mature and I will wait and see if the result changes, but is there a process where you could potentially modify the current implant and make it smaller if need be? Thank you.
A: Thank you for the very early followup and I certainly appreciate your concerns. I have seen and heard it from just about every patient whether it is from a custom jawline implant or just isolated jaw angle implants. When one looks like Quagmire (American Dad), it is very understandable that one thinks the implant may be too wide. (big) And while that may eventually be proven to be true in your ultimate aesthetic judgment, I can offer you the following insightful commentary.
At less than 10 days from surgery, you have not even had 50% of the swelling to go down. The swelling over the jaw angles is always the largest because the thickest of the masseter muscles allows for a large amount of swelling to develop that is very facially distorting. This is very evident in the classic very round appearance to the back of the lower jaw. There is considerable swelling to go down at this point and most people don’t start to feel better about the result until about 3 weeks from surgery. (when about two-thirds of the swelling has gone down) At this point the face starts to assume a more normal shape, albeit still bigger than the implant has actually created, as the final swelling and tissue wrapping down and around the implant has yet to occur.
I would highly doubt that you will see that the implant is too wide by 2 months or so after surgery. But in the advent that you feel that it is, the current implant can be modified to be smaller. (less wide)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the chin wing procedure and from the looks of it it doesn’t enhance the jaw but so I would like to get implants for my jaw.
I have a question about the procedure, I understand it uses bone grafts but can it be used to bring up a weak chin and change the shape of a chin? Like I want to know if it can change the shape of a chin from a round one to square one all using your own bone.
I plan on getting jaw implants but I really want to use the chin wing to change my chin shape with my own bone, thank you.
A: The chin wing is procedure that moves the chin and a long extended limb of bone back to the jaw angles forward and usually down. (vertically longer) It is NOT a procedure that uses bone grafts to achieve its effects. It is an osteotomy that cuts and moves a vascularized inferior border mandibular bone flap. It will not change the shape of the chin from round to square. It merely takes the chin you have and gives it more projection and vertical length.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to retain your expertise as a Consultant as a facial implant designer and then to have the mid-face lift done with you after having the implants replaced with your design here in my country?
I am informed that my insurance fund in my country would actually pay for the replacement of my current implants and thus it makes it more feasible for me to have them replaced here.
My only concern with the local option was the design of the implants (aesthetically). It is manifest that you have more experience with implants and are thus familiar with the most aesthetically suitable design for my facial structure.
Your reply in this regard would be greatly appreciated.
A:I have been asked that question to be a facial implant designer many times but that is not something that I will do. The surgeon should be the same person who both designs and places them. This gives the patient and the surgeon the best chance to get properly placed what has been actually designed. Asking a surgeon to place an implant design that he/she has never done before is a recipe for an adverse outcome.
Dr. Barry Eppley
Indianapolis, Indiana
Dr. Eppley, I am disappointed that I can not have the breast lift and the breast implants done at the same time. I am looking at a size D cup or C cup at the smallest. I guess I am confused that if I just did the lift I thought I would need to do the implant as well or I would look funny. If I need to do them separately, how long in between would I have to wait? Thank you for your time.
A: What is important to realize is that a lift and implant operations fundamentally fight against each other, one uplifts and tightens the breast mound while the implant expands and pushes out on the breast mound. It is easy too see how these two forces may be competing and cause both aesthetic (inadequate lift, inadequate volume) and medical (wound dehiscence, infection, loss of the nipple due to circulation impairment) complications in certain patients. Whether one is at risk for these potential issues depends on two factors; 1) the extent of the breast lift and 2) the size of breast implants desired. Many women do have a combined breast lift-implant operation but they are able to do that because either the extent of the beast lift they need is more limited and/or the size of the breast implant they aesthetically require is not large. Burt when you combine a full breast lift with larger breast implants, this is a surgical combination that at best will lead to unaesthetic result or at worst a major complication.
The interval between a full breast lift and breast implant placement would be three months.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a couple of questions regarding my convex shape and the temporal reduction surgery.
1) Since my right side of the head bulges out more then the left is it possible to make them both symmetrical?
2) Since I live out of the country, when would we be able to do Skype calls about the surgery?
3)How long does recovery last for because I’m in school?
4)How long would I have to stay in Indianapolis after the surgery before flying home?
5) After the surgery do most patients find their heads to be symmetrical or just smaller bulges than before?
A: In answer to your questions about temporal reduction surgery:
- Perfect correction of your temporal asymmetries may be difficult or impossible to achieve.
- All out of town patients have a preoperative Skype consult.
- Recovery is very quick, usually less than a week. There is minimal discomfort.
- You would be able to return home the day after surgery.
- Every patient experiences a less convex head shape on the sides. Whether good symmetry is achieved depends on the natural bone thickness and convexity of the temporal bone as all the posterior temporal muscle is removed during the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to find out if my goals for a complete facial reshaping set of procedures I’d like to have done are realistic. Is the computer-aided imaging I have done myself using an iOS app any realistic at all? I have done the following changes and have suggested ways of doing so in parentheses -obviously your input is going to be helpful- :
1.Increased zygomatic arch width (Custom Zygomatic Arch Implants + Buccal Fat Removal -not certain if the last one is going to benefit me)
2.Increased jaw angle width (Custom Jawline Implant)
3.Shortened nasal tip and lower part of nasal bridge (Open or Closed Rhinoplasty approach)
4.Reduced lower lip protrusion (Lower Lip Reduction) and have moved the lips slightly “upwards” (No idea what procedure would help achieve this type of change)
5.Lengthened the inner and outer corner of the eyes (Medial & Lateral Canthoplasty)
Changes #3 & #4 would have a profound positive aesthetic impact I believe since they make my face much more balanced (even if the apparent height of the face on the left looks elongated due to distortion of the camera)
I’m open to even more noticeable changes anywhere -especially in the lower third of the face and the cheekbones- but for this instance I wanted to create subtle changes to make the imaging look as realistic as possible since I have not expertise skill in doing so.
I certainly understand that it’s very difficult, if not impossible, to make someone look exactly like their own desired morphs of the face but at the same time I have no idea if I will be disappointed or not by the feasibility of the imaging.
Let me know what you think.Thank you for your time.
A: In regards to your facial reshaping prediction images, the jaw angle (standard widening implants), rhinoplasty (open approach) and the zygomatic width (special design zygomatic arch implants ) are realistic. With the proper implant selection and placement, the facial augmentation should be achievable.
However moving the eyes corners further inward or outward is very hard to do in any significant amount. In addition there is no procedure that will move the lips upward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, thank you so much for taking the time to respond to my temporal artery ligation questions. I am wondering if you haven’t treated women for this condition before because (a) women usually have a higher body fat percentage than men and statistically are less likely to have this issue and (b) the women who do have it are able to cover it with their hair?
A: I haven’t treated women for temporal artery ligations before simply because one has never presented for the procedure. There is nothing inherently different in a woman vs a man on how the procedure would be done. But the most likely reason it is far more common in men is because they have larger arteries with thicker muscle layers which are more sensitive to stimulation, perhaps because of the hormonal differences between men and women. (higher testosterone levels)
In theory one would think that many women would be more susceptible than men because they have a thinner subcutaneous fat layer and the temporal arteries would be more exposed. But this is clearly not the case since I have yet to see a female ask to have the procedure done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much volume addition is possible with a single skull implant surgery without a first stage scalp tissueexpander? In your article I read that the maximum addition is about 1.5 cm. A surgeon in Germany, who implants silicone for augmentation, told me that he can add up to 3 cm without using an expander before. In some cases he needs to scrape some mm of the head rind to avoid tension. What’s your opinion? I am really anxious that 1.5cm aren’t enough for me. Many thanks for taking your time.
A: Only by using a full coronal incision (from ear to ear) could more than 1.2 to 1.5 thickness of a skull implant be placed in a single stage procedure. But even a full coronal incision will not permit a 3cm thick skull implant to be placed. And even if it can be placed that is increasing the risks of complications. As an aside I never seen anyone that needs a 3cm thick skull implant. That would make any head too big. For safety sake you have to avoid being too ‘greedy’. It is far better to have 50% to 70% of the result you want that has no complications than 100% of the result that develops a complication. A complication in a skull implant (infection, wound dehiscence) means that the skull implant is coming out and all will be lost.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m considering a nose augmentation operation for central nasal depression with a closed technique. I’ll be using a silicone ePTFE coated nasal implant from Implantech company. (ePTFE Dorsal Nasal Implant) My plastic surgeon has never used such material, he has been mainly using cartilage or silicone, so I will be his first patient.Since you are an experienced plastic surgeon in the US, you have definitely done cases with similar material, what is your impression and opinion about using this type of implant on the bridge of the nose and what was your patients feedback. I have another question here, what if the implant is long and it’s needed to be cut little bit to fit my nose, can my plastic surgeon be able to cut the ePTFE coated silicone? The length of this kind of implant is similar for all sizes but the amount of height of the bridge only differs. I greatly appreciate your valuable reply.
A: Many of my writings on nasal implants as well as my recent reply to your prior email speaks to my favorable experience and opinion of the ePTFE Nasal Implant, whether it is the preformed style (ePTFE coated silicone) or a hand carved pure ePTFE nasal implant. I would trust that your surgeon would have enough preoperative knowledge of the nasal implant and its composition to know how to intraoperatively shape it for each individual rhinoplasty patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to discuss forehead remodeling for a brow bone reduction revision. Attached is a photo from your website to a more masculine forehead. I would ask for the exact opposite. To do that, my angle between the forehead and nose would need to be altered. In addition, my frontal sinus would need to be reconstructed to alter shape and slope of forehead to make more feminine. You can see how protruded it is in my x-ray. Burring down the bone is not appropriate as my original surgery performed did that and it was not successful.
Unfortunately, from that surgery, my surgeon removed most of my frontalis muscle as outlined as the “diamond shape.” I would like something added to hopefully contribute to a more rounded forehead but also to decrease the hollowness when I lift my eyebrows. I am leaning more toward fat injection because it is the least invasive and you
could also take fat from my neck as I don’t have a well defined jawline and this bothers me a lot. I am basically asking you to do it to alter the forehead slope and decrease the visibility of the “diamond.”
A: With your frontal sinus anatomy, a burring reduction was never going to be successful so that is a peculiar brow bone reduction technique that was chosen. Even more peculiar was the removal of the galea/frontalis muscle of your forehead creating an expected soft tissue indentation along the entire excision pattern.
But moving forward an osteoplastic bone flap method is now needed to create a more significant brow bone setback. Managing the forehead soft tissue defect is more challenging. While I would agree that fat injections as an isolated procedure would be reasonable, that is not possible to do during an open brow bone procedure as where the fat needs to go is completely open. The only thing that could be done during the open procedure is to remove a large galeal graft from the scalp behind the frontal hairline incision. The other option is to lay in a thick layer of allogeneic dermis, like Alloderm, as a composite collagen graft. Otherwise fat injections would have to wait 3 to 6 months after the brow bone reduction procedure. Also with fat injections your neck would not have remotely enough fat to do the procedure. It would have to be harvested from elsewhere, usually the abdomen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,the first thing I wanna say is thank you for the hard work you did to make those kind of cosmetic procedures (skull reshaping) available nowadays. And making people with skull shape self concerns happy and more confident about themselves . i have been following your great work since 2015 . So my problem is the lack of height of my head its like the top of the head curved downward to the back of the skull.
i have read that with a first-stage scalp tissue expansion the skull can be augmented up to 2.5 to 3 cms in many places…which is the perfect amount I’m seeking for the crown and vertex areas. I want the thickness of the implant to be reduced to 2 cm on the top of the head near the forehead area so the shape of the head looks harmonic. So is it possible to achieve these goals ? And if so how much is it gonna cost me ? Thank you for the interest and hope get some answer from you soon.
A: You are correct in that with tissue expansion it is possible to achieve up to 2 cm of added skull height using a custom skull implant. This is really the maximum amount that a skull implant should be.
I will have my assistant Camille pass along the cost of a two-stage skull augmentation procedure to you in the next day or two.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have problem with my masseter muscle.(Masseteric muscle hypertrophy). I heard about electrocauterization procedure in your clinic. Is that a permanent solution? What is the average cost of the treatment? Can i try to become pregnant soon after the procedure? or how long should I wait?
A: Electrocautery reduction of the masseter muscle is a permanent procedure as it shrinks part of the muscle due to the thermal injury. This is done through an intraoral approach with elevation of the muscle off of the mandibular ramus bone. Electrocautery is then applied to the internal surface of the muscle throughout its entire length and width. A portion of the muscle will then eventually shrink down as some percent of the muscle fibers/cells die due to necrosis. This is a process that will take a full three months to see the final result when the muscle atrophy is fully complete. This is a masseter muscle reduction procedure that is less commonly performed than Botox injections or external radio frequency treatments.
Trying to become pregnant immediately after a masseter muscle reductionprocedure is not a concern as the masseter muscle has nothing to do with that process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a rib reshaping surgery question. I was just wondering if its possible to alter the total size of the ribcage, like to make it narrower or wider at the bust point? I’ve heard you perform rib removal surgeries, but as far as i’m aware that only affects the lower part of the ribcage towards the waist.
A: I have been asked that question may times over the years about ribcage modification or rib reshaping surgery and the answer is no. Rib removal surgery is done for either horizontal waistline reduction or vertical waistline elongation. But the middle and upper portions of the ribcage can neither be narrowed or augmented as this portion of the ribcage is important for lung function. Any ribs that lie below the apices of the lungs can be reduced for a body contouring effect. But any ribs that wrap around the lungs are needed for support to allow the lungs to expand and contract through the muscular action of the intercostal muscles and the diaphragm.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting to do a Mommy Makeover. I would like to do the procedure the week of March 12th because my daughter will be home from grad school and will be able to help me. I am very serious about making this happen then because I have a lot of important events happening in my life this year and I want to look my best. I have the money so no financing will be needed. Please let me know as soon as possible what you have available for I am researching others. I would like to do the (gummy bear) implants and because of the size of my breast I am sure a re-positioning of my nipples will need to be done. As far as a tummy tuck I would love to have the least invasive procedure, however if that is not possible, I want the one that is recommended best for me.
A: Thank you for sending your pictures. In looking at them I can give you some specific insights and recommendations about the breast and abdominal procedures that you really need.
From a breast standpoint, you have significant breast ptosis (sagging) where the nipple sits below the lower breast fold. Your entire breast mound, including the nipple, needs to be repositioned back up on your chest wall. This is going to require a full breast lift with the resultant anchor pattern scars. You also have some significant breast tissue so, unless you are only looking for a very small breast implant to just create some greater upper pole fullness, you can not have implants placed at the asme time as the lift. A big breast lift with larger implants is a recipe for complications as a combined procedure. I do not know what you breast size goal is so this is an issue yet be be determined. (staged or immediate breast implant)
From an abdominal standpoint, you are in need of a full tummy tuck combined with flank/waistline liposuction. With your anatomy there are no effective less invasive procedures. You simply has too much fat and skin for anything less to make for a satisfying result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would you mind telling me if I am correct in thinking that a smile line lip reduction would basically work in the opposite way as a lip lift in the sense that during a subnasal lip lift, a cut is made and a portion of skin is removed which essentially pulls the upper lip up, closer to the base of the nose, and alternatively a smile line reduction would be cutting out a portion of the upper lip on the inside of the mouth, pulling the lip inward, and thus appearing smaller?
If this is the case, would it be fair to say that this procedure is not reversible? My only concern is that my lips at present are relatively thin, so how much smaller would you expect my upper lip to get? would it be comparable to the amount that appears to make a lip look larger during a subnasal lip lift?
Would lip fillers be an option after this procedure should a fuller lip be desired?
Also, if one had this procedure done, would a subnasal lip lift still be an option for the future at any point down the road?
Would it also be fair to say that you feel that I am not an ideal candidate for the more popular subnasal lip lift at my present age with my present facial aesthetics? As best as I can measure, I have figured that the length from the base of my nose to the lowermost part of my cupid’s bow (or at the center of my cupid’s bow) looks to be exactly 1.5 cm.
A: Your concept about the subnasal lip lift and the smile line reduction is correct. They both achieve some increased upper tooth show by removing tissue but do it at different ‘ends’ of the upper lip. The increased central upper lip size from a subnasal lip lift woule be equivalent to the upper lip reduction achieved by a smile line reduction. Any form of tissue removal on the upper lip is irreversible. Lip fillers can always be placed later into any such lip lift or reduction procedure.
Numbers aside whether one is a candidate for subnasal lip lift depends exclusively on whether the patient thinks they have too much skin between their nose and the upper lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin implant removal. I would like to have my RZ Extended Medpor chin implant (5mm projection) be removed that was implanted about 6 years ago. I’ve had three revision surgeries since then and the implant is still causing intermittent numbness of varying degrees and motor control problems on the right side of the chin due to excessive scaring (according to my surgeon). Cooling and other activities that cause vasoconstriction alleviate the sensory and motor problems whereas anything that causes vasodilation does the opposite. About four years ago a heavy intravenous cortisone regimen that I received for a facial infection almost entirely reversed all my problems. Unfortunately, the numbness and lack of motor control returned within several weeks. Nevertheless, this success with cortisone indicates that my problems could still be reversible after all these years and that in fact scarring could be the main culprit.
I should also note that I never tolerated intraoral incisions well. Each time they caused me at least 1 year of full numbness until sensation would return and I was unable to move my mentalis muscle for the same period of time. It was like glued to my chin. The last revision surgery was done through a submental incision and that didn’t cause any problems.
Do you advise me to have the chin implant removal done?
A: I think the simple answer is…you are never going to have the potential for significant in your symptoms unless you take the risk of doing it. While there are no guarantees in surgery, and every surgery has risks, your over 6 year history of issues since the implant placement strongly suggests that a more defintive solution should be pursued.
Dr. Barry Eppley
Indianpolis, Indiana
Q: Dr. Eppley, I am interested in occipital skull implant augmentation. The back of my head is flat, and I would like to explore the options of surgery. I currently live in Montana. I would like to know what the procedures are for out-of-state patients.? Thanks for your time. I look forward to hearing back from you.
A: All of my skull implant patients are from everywhere around the world so your discrepant geography is the norm for my unique practice. Skull augmentation is done today using a custom skull implant technique made from the patient’s 3D CT scan. This sac is obtained where the patient lives, is sent in and used to make the custom implant online and them manufactured for the surgery. This is a process that takes about a month to complete. The patient then only comes in one time for surgery, arriving the day before and leaving for home within 24 to 36 hours later.
Please send me some pictures of your head from the side view for my assessment for this procedure. From these I will be able to do computer imaging so I can determine how much occipital augmentation you may desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast implant revision. I currently have saline implants below the muscle. I believe they are around 350 to 400 cc. As you can see in the attached pictures my breasts are asymmetric. They increasingly got worst as the capsulation increased. My goal would be to improve this. I’m not young any more so I don’t expect the 25 year perky breast but if the right one could be freed up from the scar tissue to drop and better match the left, I would not be so embarrassed by them. Or, two new ones that matched and didn’t point down at my toes would work too.
A: Thank you for sending your pictures. You are correct in that you have a right breast implant contracture (Grade III) which is the major source of your breast asymmetry. But you also have a Grade III/IV ptosis. (breast sagging) The ptosis plays a major role in defining your two breast implant revision options.
If you choose to live with the ptosis then you could have a right implant capsulectomy and the implant could be made to drop lower. This would be the simplest and most economical approach but also the least aesthetically pleasing one.
Conversely the complete opposite and more comprehensive approach would be to have full breast lifts done with new implants and the aforementioned capsulectomy. This is the most aesthetic approach but is also the most extensive.
As you can see your breast sagging plays a major role in your breast implant asymmetry correction decision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in lip implant removal surgery. I would like to consider removal of my Gore-Tex lip implant. It is uneven and also tender. It was implanted around age 30 and I am now 49 years old. I would consider some type of plumping afterward as I suspect it will have a deflated look.
A: You undoubtably have in an old style Gore-tex lip implant that is probably multi strand in design. You or I would have no idea as to his many strands were actually implanted. (although it is almost always more than just one) These can be challenging to remove and you are correct in that some immediate volume restoration would be helpful. Concurrent fat injections with the lip implant removal would be the appropriate approach since it may add some volume. But it also be a good treatment to prevent adverse scarring/contracture that can occur from such lip implant removal procedures.
Today’s lip implants are far easier to remove as they are a single tubular implant that slides back out just as easily as it is implanted An enveloping capsule that does not adhere to the implant enables its much easier removal.
Dr. Barry Eppley
Indianapolis, Indiana
