Your Questions
Your Questions
Q: Dr. Eppley, I have a question about deltoid implants if you don’t mind. Basically I have been doing searches for the right type of deltoid implants to achieve my goals. I currently understand there is a limit to how much shoulder width can actually be achieved, I have looked at many deltoid implants from the few surgeons who actually preform them and I realize that all of them seem different. Some add more width some add less width, some look noticeable some don’t look that noticeable. I am going to attach a photo of the deltoid implant goal that I would like to achieve. I understand there are different locations for where the deltoid implant can actually be placed I believe. But here is something that I would like to achieve. The claim on that augmentation is apparently 44cm to 50cm, which may or may not be accurate. Although it definitely did supply a noticeable amount of shoulder width. My shoulder width looks pretty similar to the guy posted in the photo on the left, I am also not thin. This one caught my eye due to the lack of you can’t really tell that there is an implant in his shoulder really. It’s not noticeable to someone who wouldn’t know that the procedure was done.
How much width do you think this patient achieved if you had to guess? Is a result possible like this for me to achieve? Why I am pleased the most with this result is the fact that it makes the actual clavicles look a little longer in my opinion. Thank you so much for reading my email.
A: Since I did not do the patient’s deltoid implants to which you refer I can not accurately tell what thickness those implants were. Beware that the photos you are showing is likely a small deltoid implant placed very high which may had about 1 cmof width. I would not assume that the outline of the implant is not seen just based on a front view picture. Its ‘obscurity’ can only really be determined from a side picture.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young female with a weak recessed chin which is worsened by a skeletal overbite (by 50%). Jaw surgery is too extreme for me so i was thinking of a genioplasty. My main concerns are further elongating my face. I already have an extremely long face and wish to not further it anymore. Is this possible to do? I also want the indent between my bottom lip and chin to not be as noticable (huge indent because my jaw is pushed back from the overbite) thanks in advance!
A: While it is clear by your description that moving the entire lower jaw forward is the ideal procedure, the only skeletal alternative is that of a sliding genioplasty where only the chin bone is moved. When the sliding genioplasty is moved forward, it can also be shortened by a technique known as a jumping genioplasty. This is where the advanced chin bone is placed where in front of the superior segment. This not only provides maximum horizontal projection but also avoids any vertical lower facial lengthening. (and may even make the face vertically shorter) I would need to see pictures if your face to determine whether this is a good genioplasty option for you.
Be aware that your deep labiomental fold is a result of your bite relationship and will not be improved by any form of chin surgery. Only moving the whole lower jaw forward, where the lower teeth push out the labiomental fold, will make any improvement in that aesthetic issue. The labiomental fold is an anatomic area that lies above the chin and thus is not usually improved by any form of chin augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Facial Feminization surgery. I am 55 years old so I know that adds to the complexity to it. I have attached pictures for your review and recommendations.
A: Thank you for sending your pictures. Your FFS surgery is more challenging to image/predict because you have a major facial aging component to it. (older facial feminization surgery) The need to get rid of loose skin in the upper eyelids and the neck /jawline (upper blepharoplasties and lower facelift) as part of the FFS procedure makes looking at the skeletal changes more difficult. I think they are best illustrated in the side view picture.
FFS is a large number of facial reshaping procedures of which not all apply to every patient. What I look for is those facial procedures which I think would have the greatest impact on feminizing the face. These will be different for each patient. In looking at your pictures, I feel the following would be most beneficial:
1) Brow Bone Reduction/Browlift
2) Rhinoplasty
3) Upper and Lower Lip Advancements
4) Earlobe reductions
I think if you put these four facial reshaping procedures with the previous anti-aging facial procedures mentioned (upper and lower blepharoplasties and lower facelift) as a combined FFS procedure. These would have the biggest impact on making a positive facial change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, your internet page explains that back of head augmentation is possible by use of different kind of surgery. However, I have read a lot about different possibilities such as implants made from silicone or the use of Osteobond. I am struggling a bit by imaging what is best suitable for me and I have a couple of questions. I would be really grateful if you could give me some feedback.
• What is approximately the maximum thickness backhead augmentation you are able to realize without the use of an expander in advance?
• How can it guaranteed that the implants adhering over years and what will happen if they get loosen? Can the implant crack somehow?
• I have shaved skin on my head, a scar doesn’t cares me but can this being done in an asymmetrical way of cut to make the appearance more looking unintended?
• What is about martial arts fighting sport as an hobby, will it be still possible to do those sports or is it dangerous in case of too much force introduction to the implant?
• Can the implant be formed in a way that rim areas on the outer contour are not visible anymore (print through)?
• I read that Osteobond develops heat while curing caused by exothermic chemical reaction. How this will interact with my organism? What is about chemical reaction products – will this interfere somehow?
• In case of problems how easy the implant can be removed again?
• What does the surgery approximately cost? Is there a possibility to stay in your clinic for a couple of days?
I am looking forward to your feedback!
A: In answer to your questions about back of head augmentation:
1) About 15mms is the maximum thickness that the scalp can accommodate.
2) Skull implants do not get loose, that has never occurred.
3) You can design the scarline anyway you want.
4) Having an implant on the back of your head is more protective than restrictive. It is like putting a layer of protection for the bone.
5) The implant is designed to have very thin feather edges to make the implant-bone transition smooth.
6) Osteobond is an inferior alternative to a custom made skull implant. I would never use it on a shaved head…or any head for that matter if I had a choice.
7) The implant is easily removed.
8) My assistant will pass along the cost of the surgery to you later today. You should be able to return home in a few days after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, We have discussed using an implant for my infraorbital-malar augmentation, but I was wondering if fat grafting could be an option as well. I think I would prefer the fat grafting, it seems less invasive and more natural. I attached some photos of my face. Also, I saw that fat grafting could be used for the chin and jaw. I think having a chin that protrudes more would make my nose seem less prominent. I was also curious about having a wider, more square jaw with fat grafting. However, I am mostly concerned with just my cheek/eye area.
Thank you for your help,
A: Fat grafting is a natural body graft but has major issues of initial survival and long-term retention. In your face probably close to 0% of the fat would survive because you have very thin tissues. It is also prone to irregularities and clumping in the eye area as it does not get distributed in a smooth linear fashion. Fat also is a soft material so it does not give a hard push on the tissues and will just make everything more round and soft looking.
In short, fat grafting and implants are not interchangeable facial techniques. They not only are done differently but have very different aesthetic outcomes and long-term implication.
But there is no harm in trying fat first…then you will know for yourself.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m considering getting implants, but I’m worried about both bone erosion and infection. When it comes to bone erosion, I’m worried about how much bone will actually erode and will I have to eventually replace my implant in a few years time? Also, I plan on having some teeth removed and replaced with dental implants in a few years (after implants), will the implants get infected from this or would they remain infection free?
A: Bone resorption is not an issue I have ever seen with any custom jawline implant. There can be bone overgrowth sometimes back at the jaw angles and some mild implant settling into the bone (seen as an implant imprint on the bone) but not inflammatory bone erosion or any other tissue reaction that would necessitate removal of the implant. Teeth removal and the placement of dental implants does not jeopardize the implant per se…although the inadvertent injection of local anesthetic (dental infiltraion/blocks) into the implant may pose the risk of infection to the implant. For this reason full disclosure to the treating dentist is advised so they can appropriately adjust the depth of their needle penetration into the tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have never had any work done to the chin area although years ago I did have a submental incision at the crease where skin and tissue was removed and lipo done. Here are my concerns:
1) Chin Ptosis/witches chin is potentially causing:
a) A deep submental crease causing an unsightly irregularity between the point of the chin and throat. The excessive tissue that I can feel that has drooped down from the point of the chin seems to be part of the problem (chin ptosis). The skin and tissue around the chin is very thick and dense. The bone on the tip of the chin does not appear to be excessive but a profile x-ray would be needed to confirm this. maybe.
b) A very deep labiomental crease seems to have been caused by excessive mental muscle contraction. The crease has worsened as I have gotten older. I would like to have a smooth transition from the neck area to the tip of the chin.
Hope you have some positive things to say about you being able to help me with my profile.
A: Thank you for sending all of your pictures and detailing your concerns. In regards to the potential witch’s chin, that is not what you actually have. A witch’s chin deformity is when the normal chin tissues have slid off the bone for a variety of reasons. This chin soft tissue malposition creates an overhang off the end of the bone which also leads to a deepened submental crease an undesireable chin-neck profile. What you have is a normal bony chin and the chin soft tissues in proper position on the pogonion point of the chin but with a deepened submental crease. The deepening of the submental crease has been exacerbated by the prior facelift both anatomically and visibly.
The difference between a witch’s chin and what you have is anatomically different and requires a diametrically different approach to effectively treat. A witch’s chin is treated by the excision/removal of tissue and resuspension because there is a relative excess of soft tissues that are malpositioned. A deep submental crease with normal chin tissues after a facelift has to be treated by addition and not subtraction. Your chin and neck tissues are likely too tight to be able to simply remove and tighten them and end up with a smooth transition on the underside of the chin into the neck. Conversely the submental indentation needs to be released and augmented. Whether this is done by a dermal-fat graft or an implant onto the bone can be debated, each with their own advantages and disadvantages.
As for the labiomental crease, that is a very difficult problem to improve without some potential aesthetic liabilities. It is very deep and is an inverted skin fold. Nothing simply placed under it (injections of any kind) will push it out. The dermal attachments of the crease have to be released through an incisional approach and a fat graft placed under it. This places a scar in the crease line. While admittedly your labiomental crease line is like a scar anyway, this is an aesthetic issue of which to be aware.
Dr. Barry Eppley
Indianapolisl Indiana
Q: Dr. Eppley, I have some inquiries regarding skull reshaping. I have a problem with the top of my skull, to be more preicise, there is a big “bump” (I can send you pictures if you provide me with your e-mail adress). It’s approximately 1 inch high, 1.5 inches wide, and about 2.5 inches long. I already have a big head, and this only makes it worse. This has caused me much anxiety throughout my life. I would like to know if you had come across with similar cases and if it can be fixed, shaped down to a normal shaped skull? Also, can you tell me what the cost would be of such an operation?
Kind regards!
A: Thank you for your inquiry. By your description I believe what you have is a sagittal ridge/bump. Please send me some pictures of it in a reply to this email for my assessment. It can usually be effectively reduced and I have done so many times. Whether the bony bump can be completely flattened (due to the thickness of the skull) and whether it is magnified by a parasagittal deficiency (whose augmentation may be needed to get a really normal skull shape) remains to be determined by the pictures your send. (and sometimes by x-ray assessment of the thickness of the bony bump)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking brow bone recontouring from a brow bone fracture that I had two years ago. This was never fixed and had left me with a big indent in my brow. Can this be fixed?
A: Thank you for sending your pictures and the x-rays. What you originally had is a depressed frontal bone fracture that involved the frontal sinus and supraorbital rim. It remains as a displaced forehead fracture but a healed one at this point. It is no surprise that a neurosurgeon would want to do a craniotomy to lift out all the bone and get it back into anatomic position through a full coronal scalp incision. This would certainly be the standard neurosurgical approach. But I can understand why that would not be that appealing to you at this point. The alternative treatment strategy would be a brow bone contouring approach. Leave the bone where it is and apply an hydroxyapatite cement over top of the entire depression to recreate a much improved forehead contour. This is an appropriate strategy as long as there is no air leak from the frontal sinus or a CSF leak into the nose. (which I am sure there is not)(
The only debate about this contouring approach is the location of the incision. It certainly makes access easier and a more thorough recontouring can be done with the wide open exposure of the full coronal scalp incision. But that incision/scar may want to be avoided. The alternative incisional access is through one of your existing horizontal forehead wrinkle lines. This avoids the larger scalp scar. I have done this many times for forehead cement application and brow bone reduction in men. It is usually a scar that heals quite well since it is in a natural skin wrinkle which is only going to get more pronounced with time anyway.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I would be able to get an idea of what is able to be done about my face being completely asymmetrical. (facial asymmetry surgery)
This is something that has bothered me my entire life and is only making me more self concious as I get older. I feel as though one side of my face is drooped. It’s not just the eyes or just the nose… every single feature I have is completely different on the right side of my face in comparison to the left. This is made even worse by the fact I am an identical twin, only we’re not identical because I was born like this and she was born with a normal even face.
After plenty of therapy etc there is still no doubt in mind that I cannot keep this face for the rest of my life. Is it possible to get computer imaging of what my face would look like and what could actually be changed to improve it. It also seems as though my jaw is more prominent on one side of my face in comparison to the other.
Thank you 🙂
A: Thank you for your inquiry and sending your pictures. What I see that you need to improve your facial asymmetry is:
1) Right jaw angle implant
2) Right cheek implant
3) Right corner of mouth lift
4) Fat injections to the right face between the cheeks and jaw angle
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please help! I want to change my long face shape! (facial reshaping surgery)I’ve always dreamt of having a shorter face….heart shaped or diamond shaped with higher cheek bones and a more defined jaw. I have a double chin! Also it looks like I’ve broken my nose?? I hate my nose it’s quite long and have always dreamt of a small button nose but it wouldn’t suit my long face. Please help! Thank you excited to see what I would look like!
A: Thank you for your facial reshaping surgery inquiry. While you do have a long midface that is magnified by the fact that your lower/chin is short with fuller neck. While you can not really shorten your face, you can radically change its shape by the following procedures:
1) Sliding Genioplasty – to bring the chin bone and its attached muscles forward as well as help thinning out the neck
2) Neck Liposuction – defat the neck and help create a better cervicomental angle
3) Full Rhinoplasty – straighten narrow and shorten the nose
4) Buccal Lipectomies – thin the face below the cheeks
5) Small Cheek Implants – add some cheek highlights
All these procedures together will create a much different facial shape as illustrated in the attached imaging. In reality the face is not getting shorter, as that can’t be done, but it changes its shape into better a aesthetic balance and proportions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw surgery. I’ve had braces throughout high school. My orthodontist used spurs on the back of my top 4 teeth in order to stop my tongue thrusting. That was unsuccessful and he removed the braces. A year later I went to a different oral surgeon then the one who worked with my orthodontist to have my wisdom teeth out and he mention jaw surgery for my receding chin but wasn’t a priority then. Now my concern is cosmetic as well as functional. I don’t wish to get braces again but want to do things “the right way” to fix both. I do have an uneven and open bite as well as jaw pain. When I currently take pictures I thrust my lower jaw forward and I like the way that looks but I want something more permanent.
A: Thank you for sending all of your detailed information and pictures. I believe you may be confusing a lower jaw advancement (sagittal split ramus osteotomy, SSRO) with a sliding genioplasty. An SSRO moves your whole jaw forward and is primarily done to get the teeth to fit together. It often has a coincidental chin augmentation effect whose magnitude depends on how much the jaw moves forward. An SSRO procedure can not be done without pre- and post surgical orthodontics in the vast majority of cases. Conversely, a sliding genioplasty moves the chin bone forward but leaves the part of the jaw behind it that contains the teeth. Thus it does not improve one’s bite relationship and is only done for its cosmetic chin augmentation benefits.
To come remotely close to the ideal female jawline that you have provided you would really need an SSRO procedure combined with a sliding genioplasty to get that much chin change. Jaw angle implants would then need to be placed six months later. They key to this approach, as previously mentioned, is the need for orthodontics.
The non-orthodontic option, which leaves the existing bite as it is, is a combined sliding genioplasty with concurrent placement of jaw angle implants. Such a result will probably create an outcome that is about halfway between where you are now and the ideal jawline you have shown.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have some information regarding aesthetic shoulder augmentation with silicone implants. (deltoid implants)
After a motorcycle accident when I was young, I broke my right collarbone and in the hospital the doctor decided not to operate the shoulder.
As a consequence the bone of the clavicle is welded overlapping with the aesthetic result of shortening the length of 3 cm shoulder.
Moreover, my body was already thin, and has increased the curvature of the right shoulder to the inside.
A: By your description it is just the right shoulder which is due to the loss of projection of the shoulder due to loss of clavicular length. Your treatment options include:
1) A camouflage approach with the insertion of a right shoulder deltoid implant or
2) Treatment of the source of the problem by clavicular lengthening by osteotomy and plate fixation
I would need to see pictures of your shoulders to determine if a deltoid implant would offer a reasonable aesthetic improvement.
The use of deltoid implants has its advantages over actually cutting and moving the bone depending upon the degree of location of the shoulder deformity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a condition called costo-iliac impingement syndrome where my right 12th rib tip sticks into he right hip due to a laminectomy and spinal fusion I had in 1973. Over time some scoliosis and gravity have made my condition very painful. How much does a procedure like this cost? Do you accept insurance? Are there any surgeons that you know of closer to my area in Dallas Texas? Thanks for your time.
A: The 11th and 12 ribs point down 45 to 60 degrees from the spine unlike all the other ribs above them. It is easy to see with this natural anatomy that any condition that makes one had a tilt to their spine that the 12th rib could contact the hip bone.
Your 12th rib can be safely and effectively removed through a small back incision. This will provide complete improvement in your costo-iliac impingement syndrome symptoms. I will have my assistant pass along the cost of the surgery to you on Monday. We do not accept insurance. I would not know if there are any surgeons who can or would do this surgery in your geographic region. There may be, I just would not know who they would be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve done some research on Facial Feminization Surgery and noticed your website. I am interested in getting some Facial Feminization surgery going forward. I’ve had plenty of surgeries done in the past. I’ve had 4 rhinoplasties with alarplasty and tiplasty, Jawline reduction with chin contouring, chin implant, cheek implant, brow bone reduction, upper blepharoplasty, upper lip lift, hairline lowering, bone cement into forehead. I am not satisfied with how my jaw looks because it doesn’t look “normal”? I had my jawline reduction with chin contouring in 2012. I am not sure if I should consider a jaw implant? Also My chin implant looks masculine in my eye, I was hoping for a more feminine chin implant. I feel like my jawline is too curved if you know what I mean. I guess, when I told my surgeon I wanted a V-shaped face. He gave me that. I am interested in Kim Kardashian and Kylie Jenner’s jaw shape.
A:Thank you for your inquiry. With v-line surgery the jaw angles are removed and the chin is theoretically narrowed. (usually without an implant) This why your jaw line is ‘too curved’ as the angles are now too high. The chin implant that had placed is most likely a ‘male’ chin implant which makes the chin too wide rather than more narrow.
Ideally it would be nice to see an x-rays of your jawline to appreciate its bony contours. But to change the shape of your jawline your would need vertically lengthening jaw angle implants and replacement of your existing chin implant with a more feminine heart-shaped chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in pectoral implant revision surgery. I currently have pectoral` implants. These were custom made to my specifications. I had a larger implant made for more projection.I am fairly happy with them except they are too firm and they do not feel natural when massaged. I was wondering if there is such a thing as custom pectoral implants that can be designed to be inflatable with saline or silicone? I want somewhat firm implants although I wish the implants to have some softness to them as to mimic a pectoral muscle. Thanks for your assistance with this question.
A: While I don’t know the manufacturer and durometer (scale of stiffness used in silicone implants), it is very possible that new custom pectoral implants can be made of very low durometer that really mimic muscle tissue. This ultrasoft durometer of silicone is what I use on all custom body implants. This may be what you have in (although I doubt it) but I would need more specifics about the implants you have in to better answer that question. Most certainly you do not want a saline implant which would be worse than what you have now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would gummy smile surgery consist of all four elements below? Or sometimes only some of them?
1. V-Y procedure
2. Muscle release / levator muscle transection
3. Using a premaxillary implant after muscle release
4. Vestibular shortening.
I understand (1), (2) and (3). However, I am not sure I understand (4) Vestibular shortening. What is that?
Do you need to examine my mouth before you can determine whether an operation is possible?
How long will I have swelling after surgery?
Is the swelling visible to others after 4-5 days?
Success rate
What is the success rate? Is there always success in the treatment?
Alternatives
I do not want a botox treatment, because it is temporary.
What is your opinion on Lip Lowering Surgery? Do you use it?
A: In answer to your questions:
1,2 and 4 are always done in Gummy Smile Surgery. A premaxillary implant is rarely used unless one has a premaxillary deficiency.
A Gummy Smile surgery can be done on anyone with a gummy smile. Seeing pictures of your face and seeing it at rest and smile is the examination that is needed.
Most of the swelling will ben gone in 7 to 10 days after the procedure.
There is always going to be some permanent improvement, it is just question of how much. I have never performed a revision on such surgery to date.
Lip Lowering Surgery is the same as a vestibuloplasty. It is part of every Gummy Smile Surgery
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I hope this email finds you well. Next month will mark one year since I had my custom jawline implant augmentation surgery with you. To say I am happy with the results is an understatement. I think you did a fantastic job in selecting and placing the implants. Here are recent pictures.
As I mentioned, I am very very happy with the results. I just have one question. I have been working out quite actively over the past year, and I am almost 20 pounds heavier (mostly lean muscle) than when I saw you last year for my surgery. I’m still working out and continuing to change my physique so I wouldn’t want to do anything just yet, but my question is as follows: Do you think I could get another augmentation to make the jawline more pronounced? I would think the implants would need more width as well as more of a vertical component. Also, would I benefit from perioral and/or buccal fat removal?
Thanks again and I look forward to hearing from you.
A:Thank you for the one year followup and I am very happy to hear of your satisfaction with the result. For your and my interest I have attached your matched before and after results from your surgery.
The question about replacing your existing custom jawline implant with a new one is not whether it can be done (as it can) but whether it should be done. From that perspective I would offer the following comments to ponder:
1) Would you be keeping this new physique lifelong? You wouldn’t want to place a new implant now for your current body shape and weight only to get thinner later and have it look too big.
2) Any implant surgery is a gamble both in the aesthetic outcome and in the potential for risks. You have spun the roulette wheel twice so to speak and have won each time. But that is not an assurance that doing it a third time would result in such good fortune. Complications can and do happen…and such a complication like an infection could risk losing it all. Statistically speaking, each new surgery is an independent event for which the outcome of past events has no relevance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, When an individual gets revision for sliding genioplasty, three to four months after initial procedure, and the same cut that was used in the initial procedure is traced and used again for the revision? is bone freshening a requirement?
Meaning do the end segments of the bone have to be “freshened” or can the cut simply be traced and reused without such practice taking place?
I think I remember hearing that freshening the bone segments or doing ‘something’ with them (can’t recall the exact maneuver) is necessary if nonunion is to be prevented. Is this true?
A: In a sliding genioplasty revision you have to make a fresh bone cut. In essence the exact original procedure is redone if the procedure is done after the bone is healing. (6 to 8 weeks after the first surgery) I assume this is what you mean by ‘bone freshening’. Before the bone is healed, the down fractured bone segment can be simply unscrewed, repositioned and then resecured.
Usually one doesn’t have a good idea as to the final result (3 months afterward) until the bone is healed. So most sliding genioplasty revision procedures require a new bone cut to do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I currently have custom made cheek, chin, and jaw implants and I feel they are too big overall and I would like your opinion on replacing them.
I have had numerous facial procedures over the last 25 years, and I am pretty happy with how they turned out, but the facial implants miss the mark each time and have been re done a few times. As you can imagine, I am very nervous about potentially going through this again. I think my mistake has been bringing in photo’s of celebrities that look nothing like me and trying to achieve a look that is unrealistic. I would like to just look like a hot version of myself:) I have also not been cognizant enough of each doctors aesthetic, and I have not been hands on enough when the design of the implants have been planned. I’ve just left it up to the doctor to produce them after explaining what I would like. I would want to be involved in the process and think things through very carefully.
My specific concerns/questions:
1. I dislike the cheeks the most. While I love the look of high cheek bones, I feel there is too much projection to look natural, and the emphasis is near the sides rather than the apples of the cheeks where I would prefer it. They are submalar which I think make my cheeks look too puffy. I would love a more sculpted, defined look (but not gaunt). My cheeks bunch up when I smile and I have some very slight aching in my face.
2. The jaw implants are a little too big. I would prefer a softer, more feminine angle.
3. The chin is a bit too large and square. I would really like to go back to my natural heart shaped face and more delicate chin.
4. Would I need a facelift after removing such large implants? I’m 49 and that is one thing I have not done.
I have attached photo’s of myself currently as well as my before picture and what my goal face looks like. I understand you are not a magician, but it gives you an idea of what I would prefer.
I really appreciate your time.
A: Thank you for sending all of your pictures and images. I would certainly agree that you should approach any further facial surgery with both caution and skepticism. When custom facial implants do not produce the desired result, it is always only due to two reasons… either the design of the implants is inadequate or the end goal was never realistic regardless of the implant design. In looking at your current face and now and what your goal is….that is a smaller and more refined facial look/angularity. I would think taking your face from where it is now to anything close to that desired look is not realistic. It is easy to make a face bigger with implants but it is never easy to make a face much smaller as the overlying thickness of the soft tissues now has a major impact. But to answer your specific questions:
1) I would agree that your cheek implants are too bit and cover too much of the maxilla. (I am not sure why they ever covered the maxilla at all actually)
2) Your jaw implants are actually relatively small. But they are anteriorly placed and are designed to be a widening style. What you actually need is small vertically lengthening style instead.
3) Your chin implant is very small and thus should not be there at all. If you want a smaller chin you would need to remove the Implant and reshape the bone.
4) I see no benefit to a facelift for you. Loose or sagging skin is not an issue you have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast implant revision with size reduction. I got large breast implants when I was younger but now they are too big and give me back and shoulder pain. I wanted them replaced with smaller implants. I want smaller and more perky breasts now!
A: Thank you for sending your pictures. There is never a problem with downsizing your implants. The question is what happens to the enlarged skin sleeve… as it will just drop and sag. In the spirit of what you really are trying to accomplish (smaller breasts with less pull on your back/neck) you would have to have a breast lift with smaller implants to really get that effect. Smaller implants alone will not be enough. You must get the enlarged breast tissue and skin back up on the chest wall. This is really no different than a true breast reduction patient. Just that in the augmented patient, the breast ‘reduction’ comes from either downsizing or removing the indwelling implants.
It is easy to make a breast larger with implants but it is not so simple to get a well shaped smaller breast by just downsizing or removing the implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, So basically what I would want ideally is to get my waist and love handle- area reduced by liposuction and to fill in my hips where the sort of dent in right at the top of my thighs. I want the arch where my butt begins at my lower back to be more defined and I want the overall appearance of the entire butt to be quite a bit bigger and fuller. Basically the hourglass shape is my ideal body! I also would really like to know if harvesting fat from my arms would be feasible. I have been an athlete my whole life and have tried every diet and workout plan to loose fat in my arms and they just always stay big. They’re by far my biggest insecurity and I would love if we could address them if posssible.
Thank you!!
A: Thank you for sending your pictures. What they show is the following based on your objectives:
1) You would be able to get a good waistline and love handle reduction by liposuction.
2) While arm liposuction can be done, it never creates a substantial size reduction. The improvement would be far more modest.
3) You have enough fat available to fill in the hips dents.
4) You do not have enough fat to create the ‘entire butt to be quite bigger and fuller’. Whatever fat is left over after using it for the hips can be placed in the buttocks but that will not be enough for any significant buttock size increase.
5) Buttocks always look bigger because of the waistline reduction above it in BBL surgery. But it is a not a realistic goal to achieve a much larger buttocks with the limited fat you have to harvest.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 18 years old and have saved up for a few years for a procedure I’ve always wanted done, changing my eyes shape. (eyelid reshaping) I’ve done a lot of research on the type of procedure. The catch is that my eyes already have an upward tilt to them, I want them to curve them downward. Can you explain to me if this can be done.
A: What you don’t like about your eyes is that the lateral canthal position is quite high. Rather than having a horizontal inner and outer eyelid corner position, your outer eyelid corner is angled upward. This is a more typical of some types of Asian eyelids and very uncommon in Caucasian eyelids. The only way to change that tilt and potentially bring down the lower eyelid position is by repositioning the lateral canthal tendon position. This may level out the eyelids but will not necessarily give a rounded eye appearance, increase the amount of scleral show or make the eyelids look less ‘squinty’. It may have some positive effects in these regards but they can not be precisely predicted before surgery. Bringing down the outer corner of the eye is much less commonly done than trying to raise it but it can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in extra large breast implants. I now have 2500cc saline implants and my wish is to come to 3000 or over. I want my breasts higher, more together in the middle of the chest. Now they go outside to the sides.. Before my current saline implants I had silicone breast implants. My wish would be to go back to silicone but at that size is it impossible or in Germany a Dr say to me you could put two implants in one breast ?
So my question to you : you would make a surgery in the size ???
I have no internal bra .
Many regards
And what is your suggestion to reach my aim ?
A: Thank you for your inquiry. I would need to see pictures of your breasts to give a more qualified answer.
But what you want to achieve is both challenging and many not be possible. Ideally what you need is a silicone implant of that size with a broader implant base. Nowhere in the world that I am aware of are silicone breast implants made greater than 1500ccs. While stacking implants has been done it is recipe for complications and breast deformity so I would not recommend that approach.
Regardless of the implant size you would have to get the breast mounds higher which can only be done, partially, by an internal bra approach. Any form of true external breast lifting has unacceptable scars. But with such large breast implants getting the breasts up and closer together is virtually impossible due to the implant volume.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thanks for your email and all the helpful advice. A lot of what you told me was new information to me and I attempted to do further research for myself but, for instance, in regard to a mucosal smile line reduction, all the relevant info posted online that I could find was written or published by you, and pretty much you exclusively. Since you seem to be an authority on this procedure and if you don’t mind, I have a few questions.
Some of the things I had questions about were as follows:
-In regard to the smile line lift, how does this compare to a lip lift? How would a procedure like this affect the way my lips/smile look, ie, would they appear bigger, smaller, etc?
Would it affect at all the aesthetics of the rest of my face? Do you have any photos that you are able to share with me that would demonstrate this?
What do you think the chances of getting results of showing more upper incisors would be, and do you feel that this would be the best way to improve the cosmetics of my smile/face as opposed to some other operation, such as orthognathic surgery, or a totally different issue that needs addressed other than lack of incisor show, etc?
-In regard to a midface deficiency, I also have dark circles under my eyes that seem premature. 2 years ago my sister died and then last year my lifelong best friend died as well, and since those events I’ve noticed the darkness appear to get darker accompanied by fine lines, which I’m presuming had to do with a combination of stress and the natural aging process in my 20’s. Do you think I would benefit from either malar implants or fillers in my cheek area? Do you think I am too young or otherwise not an ideal candidate for a lower blepharoplasty, as from what I’ve seen online it seems to have good results for preorbital discoloration like mine. Furthermore, IF you do recommend cheek implants, do you suppose that it would affect my smile in itself by pulling the skin upward or would the anatomy not be affected in this way?
I’ve attached a few additional photos with this email that specifically show my smile/teeth from a front as well as side view should you find it helpful.
Thank you so so much for all your helpful insight, it is very useful for me to get an idea of what my best options would be, and much appreciated
A: In answer to your questions:
- A smile line lift will, by definition, make your upper lip look smaller and will not change the vertical distance between your nose and upper lip. Conversely, a subnasal lip lift shortens the vertical distance between the nose and lip, makes the central upper lip look bigger as well as increases tooth show.
- Due to patient confidentiality I do not pass patient’s surgery results by email.
Lip lifts and orthognathic surgery are done for completely different reasons, they are not comparable procedures. - At your young age you need to either try injectable fillers or fat first for under the eyes and/or cheeks. Implants are only a consideration based on those injectable and reversible outcomes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few questions concerning forehead implants.
1. what are the implants made out of? and is it possible for them to break?
2. do the implants need to be replaced and do they feel like your natural bone once they’re put in place? and.
3. can you choose the shape you want your forehead to be?
thank you 🙂
A: In answer to your forehead implant questions:
1) Most forehead augmentations today are usually done with a custom implant approach made from a 3D CT scan. The implant material is silicone of which it is not possible for it to break or degrade/breakdown over time.
2) Forehead implants will feel firm just like your natural bone. They will never need to be replaced for implant failure or degradation since that does not occur.
3) As part of the custom design process, forehead implants are designed as best as possible to meet the patient’s aesthetic forehead/brow bone shape desires. They are designed based on what the surgeon interprets as the patient’s forehead shape goals. The computer can not take the patient’s desired image and make an implant that will match that exactly. It is up to the surgeon to make that ‘artistic’ translation from patient desires to implant design.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, With the forehead augmentation, does that include the space between the eyebrows? Do your forehead muscles heal over the bone cement? Could it be placed on top of brow bones or will that be risky because its too close to the eyes? How old do you have to be to get it done? and will it tighten the skin on the forehead and eyelids (if you apply it to the brow bones)? Sorry for too many questions 🙂 I just want to get the surgery done in a year or so but I can’t find specific information.
A: Thank you for your inquiry. In answer to your forehead augmentation questions:
1) In forehead augmentation the design and location of the augmented areas is determined by the patient’s aesthetic goals.
2) Augmenting the brow bones as part of the forehead augmentation is common.
3) Age is not relevant to the procedure, it can be done from the teenage years to old age. The desire to do it is the only limiting factor.
4) Any forehead/brow augmentation will have some degree of upper eyelid skin tightening based on the size of the augmentation. But in general it has limited ‘eye lifting’ effects.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a lip lift done 2.5 months ago and I’m having complications. The tip of my nose is being pulled downwards when I smile and is very tight. 8 mm was removed from my lip and it is also very unnatural looking and high in the middle and thin on the sides. I posted on this site for help and no one has responded. I am depressed and desperate for answers. I thank you kindly in advance.
A: Thank you for sending your pictures. Your lip situation is one that is the result of too much central lip removal. It is now too short and tight. It usually takes 3 to 6 months for complete settling of the result but what you see is probably about 90% of what the result will be. You should be pulling on the upper lip regularly to try and stretch it out a bit.
A lip lift is an irreversible procedure. Once the skin is removed it can’t be put back. This is why upper lip lifts should be done conservatively, most upper lip lifts I have ever done have been between 4 to 5mms at most.
Your upper lip issues and concerns should be addressed by the surgeon who performed the procedure. There is not a surgical solution to these concerns.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a teenage breast lift. My daughter is 15. And she just lost over 150 pounds when she decided to get some weight off of her. She’s real insecure about her breasts though, they say they are just ” flabs where my chest is ” and ” no 15 year olds breast should be like that. So the real question is. How young is too young for you? I just want my daughter to be comfortable in her own body.
A: As long as she has maximized her weight loss, (and I would think that at over 150lbs she has done so) then she could have aesthetic breast surgery at any time. Even at 15 years of age, her breasts are not going to grow nor are they going to change in any favorable way. And give her understandable insecurity I see no problem with her age for whatever breast surgery (lift, implants or both) would make her feel more comfortable with her body. While teenage breast lifts are uncommon, your daughter’s situation sounds very reasonable to have the surgery even at her young age. The only question is whether she would desire implants for more volume at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a jaw angle implant revision.I want to remove both pairs of indwelling jaw angle implants and replace with new true vertical lengthening jaw angle implants.
In your website, I saw the vertical lengthening jaw angle implants. I am not sure if they come in different sizes. I am positive that Vertical Lengthening implants are what I should have had implanted in the first place.The trick would be deciding on the size. From the profile view, you can see that the vertical length isn’t bad. The bottom part of the implant does go vertically far enough, but there is no mass at the bottom. This makes me wonder about the size we would have to use.
The first Medpor implant did not have any effect from the front view. It did make a difference from the side view, though. In my opinion, the picture where I’m sitting in the car, it shows that a could use some vertical lengthening and widening in the lower part of the face. I am not looking to have a very strong jaw, but in my opinion, it makes a big positive aesthetic diferrence when the angle is visible from the front view. It defines the face.
A:Thank you for the additional information. Not knowing exactly what style and size of Medpor jaw angle implants you have in and where they really are sitting on the bone makes it very hard to know whether this is truly an implant style/.size problem or whether it is more of an implant positioning issue. A jaw angle implant can look quite different based on where it sits on the bone. You can’t tell just by looking on the outside either of those important issues which play the determining role in what new implant may be needed in your revisional jaw angle implant surgery. Therefore I would recommend you get a 3D CT scan so you can really know what you have in, where it is on the bone, and then know why it looks like it does on the outside. Just guessing on the implant exchange is a sure way to end up with another aesthetic problem…and the next surgery will likely be just as traumatic as the first as getting those Medpor implant out is never easy.
You also have to consider one potential reality is that maybe no jaw angle implant shape or size can give you that exact look you have imaged. While I would agree that is a good look, actually getting there may or may not be possible.
Dr. Barry Eppley
Indianapolis, Indiana
