Your Questions
Your Questions
Q: Dr. Eppley, I have gotten a Vertical chin implant and was satisfied with the horizontal projection but the 45 degree angle vertical projection , I tried to like it but feel like I did not need the extra vertical or 45 degree angle look. My question is, if I switch the implant to a Terino square chin implant, will I lose the vertical height and 45 degree projection length and have almost the same horizontal length projection of the chin implant.
A: With the chin pad stretched out at 45 degrees I would be aware that switching to a pure horizontal projecting chin implant with the same horizontal projection may leave some loose tissue vertically. Whether that is significant can only be known by doing it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m interested in testicle enlargement purely for aesthetic reasons. I just want very large testicles.
I’d like to explore these options, and the pros and cons for each. For example, can I still go on a 6 mile run with either approach? How about ejaculation? How long do the implants last?
I also have a small hydrocele on one testicle. Do I need to get this removed beforehand?
A: In answer to your testicle implant questions:
- While there are two method for testicular enlargement (wrap around and side by side) I am not enthusiastic about the wrap around method due to the high rate of complications. (testicle-implant separation) The side by side method is best of one has naturally small testicles not normal size ones.
- Large testicle implants may interfere with running given the larger masses betwen your legs.
- Testicle implants do not interfere with ejaculation.
- A hydrocoele would need to be removed first.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Earlier this year, a close friend of mine died from a brain tumor. She was adamant in her belief until the end that it was due to extensive dental work, including several titanium screws.
I’ve read the article by Zhou, “The unfavorable role of titanium particles released from dental implants”, along with others and I’m wondering if I should have the cheek, chin and jaw implants Dr. previously placed by another surgeon removed?
I am concerned with the release of nanoparticles as well as the Medpor material in the body. And since I have very noticeable masseter muscle dehiscence, I wonder if I should just remove the jaw implants for aesthetic reasons coupled with these health considerations.
I spoke to a prior patient of yours, who spoke highly of you and your skill, and he convinced me to see you for the removal of the cheek implants. He told me that you weren’t able to remove the jaw implants that another surgeon placed (this was after 4 years of being placed and mentioned there were issues with the screws and bone overgrowth, making it impossible to remove). I’ve had my implants in just a little over a year, and I’m wondering if I were to plan for their removal, would there be a way to see beforehand whether you would be able to remove them or if you would have issues similar to your patient’s.
I’m also wondering about the cheek implant removal and the midface suspension that would be required. When I spoke to another surgeon he said that he would suspend the cheek with screws after implant removal. Is this what you would do? As stated earlier, I’m seriously considering moving all foreign objects out of my body so if there’s a way to suspend the cheek without screws, that would be ideal. Please let me know.
Thank you again for your time and thorough explanations in our video chat. I’m looking forward to your response. Thank you, Dr. Eppley.
A: While one debate about the science of your implant concerns one can not debate about your emotional feelings about them. Thus I would agree that all of your implants should be removed. That is clearly the only way you are going to feel comfortable moving forward.
Any implant(s) can be removed. Win’s situation was different in that he was seeking a replacement for which the trauma of removing the jawline implant was not worth the risks for the modest aesthetic improvement to be gained with a new jawline implant design.
While there are benefits in some cheek tissue resuspension with cheek implant removal and screws are a convenient way to do so that would not make much sense given the premise of the surgery. Drill holes and suspending the tissues to the bone would be the non-implant method to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, We spoke a few years back. I was considering surgery to provide a more enchanted jawline/chin.
Whatever your expertise thinks would suit my face best a chin implant could dk the trick but if you think custom would provide me better results j would consider that too.
Curious to hear your thoughts. Below are a few pictures of a jawline I think could look most realistic for my face. And after that photo I will submit photos of myself.
Look forward to hearing back from you.
A: When you compare your jawline to your ideal examples what you lack is a smooth connected jawline look wtih defined shapes at the chin and jaw angles. Such a look can only be potentially achieved by a custom jawline implant. You only chose ‘spot’ implants such as standard chin or jaw angle implants when you can accept that such a result like your examples is not going to be achieved and that some improvement ids better than no change at all.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would the metal plates from a bilateral ZSO interfere with and/or prevent a future upper jaw advancement? I have no plans for this, but generally like the idea of keeping my options open. Especially if I develop sleep apnea as I get older.
A: A Zygomatic Sandwich Osteotomy (ZSO) procedure would not interfere with a subsequent Lefort I Osteotomy.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I got a moderately advanced sliding genioplasty about 4 months ago and I also do boxing. I am wondering if it is safe to return to boxing or sparring at this time. I don’t have an X-ray available and I understand you would need that to make a decision, but just in general would you say it is safe at this moment in time for the average patient (I was advanced 7 mm and 4 mm down).
A: Based on just a general comment with no details about your surgery I believe it would be safe to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in knowing more about the under eye hollow implant. What material is it constituted out of?My right eye is worse than my left eye. Are the implants tailor made in size and shape to each eye? Many thanks.
A: Custom Infraorbital (undereye) implants are made of a solid silicone material.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well. I would like to extend my gratitude for taking the time to read this message. I recently came across information about your clinic and its innovative craniofacial techniques in the field of aesthetic surgery. Through this email, I would like to inquire about the possibility of undergoing a surgical procedure to enhance the shape of my head. Your clinic’s expertise in extracranial skull surgery, coupled with the positive experiences shared by your patients on instagram, has piqued my interest. The prospect of safe and effective procedures to address concerns about the appearance of the head, from brow bones to sides and the back, is truly intriguing.
For a long time, I have felt self-conscious about the shape of my head and had no knowledge that solutions to such concerns might exist. The revelation that such procedures are available has given me hope that I can regain confidence and achieve the changes I desire.
I have enclosed documentation regarding the shape of my head for your review. Could you kindly assess whether surgery could potentially restore a more conventional shape to it? Additionally, I am eager to learn more about the estimated timeline for the procedure and recovery, as well as the associated risks and costs.
I understand that you have a busy schedule, but I would greatly appreciate your time and consideration in evaluating my inquiry.
I am genuinely hopeful about the possibility of collaborating with your skilled team to achieve a more confident and improved appearance.
A: Thank you for your inquiry and sending your 3D CT scan. You have a classic scaphocephalic head shape due to untreated congenital sagittal craniosynostosis. Thus it is long from front to back and narrow from side to side. This is treated in adults by frontal and occipital bone reductions to shorten the length and a custom skull implant to widen the sides and augment the upper back of the head. Your 2D scan slices show that there is enough bone thickness on the forehead and back of the head for some visible reduction in head length.Thank you for your inquiry and sending your 3D CT scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My daughter has been diagnosed with Treacher Collins syndrome and has a concave face. However, her bite is fine, with orthodontics and she has a slightly thinned cartilage (in her TMJ). One surgeon suggested she go for a Total joint replacement, rather than a double jaw surgery since her jaw joint is not stable and may/could get worse with time. I was wondering if I could just do a genioplasty for her for now, to see if we could wait and watch before we proceed for DJS, if she’ll need it in the future. Her airway measures 8mm but so far no symptoms of sleep apnea or tiredness. Thank you
A: Thank you for sending your inquiry and sending her pictures. It is not unreasonable to consider just a genioplasty for now as, even if she ultimately needs any of the other procedures, she would still benefit from an advancing genioplasty anyway.
Given her very short lower jaw/chin she likely would need a jumping genioplasty to get the maximum benefit from the procedure. It would be helpful to have some imaging done beforehand to check how much chin is actually present to be sure the operation can be successfully done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d like to know how much it’d cost to have facial liposuction, this would consist of perioral mound liposuction and the lower cheek area (near the jawline) for a sharper appearance.
I’m looking forward to hearing from you.
A: While such facial liposuction can be done I would not count on it creating a sharper appearance. If you don’t naturally have good bone structure defatting in between the cheeks and jawline is not going to make it more evident.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 21 year old female had an occipital augmentation surgery in South Korea 1.5 years ago (methyl methacrylate was used), however it didn’t fully correct the flatness of the back of my head. Would it be possible to have a revision surgery to augment the back of my head more?
Additionally, I am wondering if you place your implants above or underneath the periosteum?
A: To no surprise PMMA skull augmentation will always be inadequate for occipital augmentation because of its low volume. (usually 60cc of volume or less) Custom skull implants provide much better augmentation as their volumes are in the 120 to 150cc volume range, at least 2X bigger.
All skull implants are always placed below the periosteum.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I know you are an expert when it comes to chin movements and sliding genioplasties. About 4.5 months ago I had a sliding genioplasty done and recently I got a panoramic X-ray done at the dentists office. I noticed that there is a slight dark gap on one side along with a faint black line between the advanced chin bone and the rest of the jaw. My movements were 6 mm forward, 3 mm down, and 3 mm widening. Is this normal?
A: Such asymmetries in the osteotomy lines and in the subsequent back end of the osteotomy lines, while not desired, are not abnormal when the natural chin asymmetry exists with two different lengths/shape of the jawline on each side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, In addition to infraorbital-malar implants to correct my bone structure, do you believe one day it will eventually be necessary to also undergo a blepharoplasty/midface lift to address the loose muscles and ligaments that will become more pronounced over time under my eyes, or will the implant alone should solve the problem?
I would also like to enhance the definition of my jaw with implants. Can this be done during the same surgery?
A: In answer to your questions:
- Eventually, if you live long enough (and that is the goal) the rejuvenative procedures as you have described will ideally be needed. But in the short and intermediate time frame the implants will provide some rejuvenative midfaceimprovements.
- Jaw implants can be placed during the same surgery. Those two types of facial implants are a very common combination.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have very big thigh and tiny legs from my knees down to my ankle is very tiny. This has caused me a great deal of low self esteem. I have always ashamed of myself because of this. Please is there any surgery available for this to be corrected. I want to feel confident about myself. I want to be able to wear clothes that exposes my legs. All my life I wore only pants because of my legs.
A:The question is whether thigh and calf implants would be helpful or not. I suspect their lower leg augmentation effects would be insufficient but they are the only surgical option. I would need leg pictures to evaluate.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have small testicles and was happy to discover your website and the “wraparound” testicle implant method which you offer.I have 2 questions:
1) is there a waiting time for this surgery?
2) I understood that the length of the wraparound model is 6 cm – what is the width?
Alternatively I was also thinking about replacing my own testicles with artificial ones (I am almost 50 y.o. and do not plan children).
1) is the size bigger than “wraparound” solution?
2) will i need to inject anything more than testosterone – after the surgery?
Thank you for your reply in advance.
A:Despite having developed them I am not a huge fan of the wrap around testicle implant concept. The rate of postoperative separation is not insignificant. Solid testicle implants have none of these issues. Thus the side by side method or replacement (testicle removal) methods offer a more assured approaches as well as larger sizes. Regardless of size and implant style the width is always 0.7 that of the length.
Which method is better depends on your natural testicle size and how you feel about being with or without your natural testicles. The merits of removing your own testicles and what that means for hormone replacement afterwards etc are questions best a answered by a Urologist as this is outside my area of expertise.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m planning on getting a bbl as well and I was wondering if that had to be before or after rib removal. Thank you.
A: It makes the most sense to do it after the BBL surgery. See what you get out of the BBL surgery first before deciding whether rib removal is necessary.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a consult for hip augmentation by fat injection and was told I would need to gain weight for the surgery. Do you think I will have enough fat to do the procedure? Can the back between and around the shoulder blades be used for harvest? Is the use of postoperative compression helpful for making the fat survive better?
A: In answer to your questions:
1) Despite having gained weight the reality is that the amount of fat available for the hips is not going to ‘significant”. (but better than not gaining the weight) The term ‘skinny BBL’ is just a nice way of saying you really don’t have enough fat to do the surgery but we will do it anyway…just don’t expect much of a result. When you factor in the important concept of ‘halving’ when it comes to fat transfer the reality of the potential result becomes more apparent. (50% of what is harvested is removed for concentration, that amount is then split in half for each hip injection, and if one is lucky 50% or half will survive. (in the hips it will be less) Mathematically use 1,000cc of aspirate harvest (you will be very lucky to get that amount) and then cut it half for concentration (500cc), divide in half for each hip injection (250ccs) and then at best 50% will survive. (125cc)
2) The harvest sites are the abdomen and flanks. The back (shoulder blades) are not viable harvest sites.
3) No one knows how to make fat survive the best. Every doctor thinks they do. But the reality is that fat injection grafting is modern day alchemy. The biology of fat grafting by injection remains poorly understood in terms of what makes some fat cells survive and why others don’t. Thus postoperative compression vs non-compression is a perception not an established scientific method.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,If I would decide for testicle removal, do I have to inject only Testosterone till end of my life?
Or is there anything else that needs to be injected?
One more question: is the size 5.5 cm or 6 cm in the human shape?
(I saw some doctors use dog shape silicon testicles – I would like human shape).
A: Hormone management in the face of testicle removals is not my area of expertise. You would be well served to consult a Urologist to get accurate answers as to what the hormonal implications are with testicle removals and whether that is a wise medical decision.
All testicle implants that I have ever designed or used are in the human ratio of 0.7 width to length ratio. I have never heard of using ‘dog-shaped’ testicle implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Dr. Eppley is a very knowledgeable surgeon and I know he has a blog where he answers questions. I have a important question for dr. Eppley regarding revision rhinoplasty. I had a diced rib cartilage glue graft placed (dorsal onlay graft), however it looks way too big on my nose and is also wide. Is there a technique to remove this graft completely so that I can my original underlying bridge bone back?
A:That can be done. Such rib grafts heal by fibrous union so they can be safely dissected out for reduction or removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a LeFort I osteotomy to fix a recessed maxilla but it made the area above it recessed. Because of this, I’m interested in an extended custom midface implant for a LeFort III type augmentation, like the one in the picture attached, that I took from your blog (minus the area that the LeFort I fixed, obviously). If, down the road, I want an implant to augment my cheek-archs (like the one in the attached picture, that I also took from your blog), would it be possible to put them on top of the part that already has some of the extended custom midface implant? I know that it is possible to make a single implant for both areas, but I haven’t decided if I want to augment my cheek-archs. Thanks in advance.
A:In answer to your midface augmentation questions:
1) If you have had a successful LeFort I osteotomy you may only need to augment the rest of the midface that lies above it. (see diagram)
2) An arch onlay implant could be laid over the midface implant secondarily.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am interested in an upper vy lip advancement for both volume and elevation, but do not know if I am a good candidate. Also, would like to talk about the technique in general since so few docs do it — even though it seems like a great surgery. Curious as to risks and outcomes.
A:You are not a good candidate for V-Y upper lip enhancement as you have a long upper lip. The V-Y procedure adds volume but can not elevate the lip or decrease the distance between the nose and the upper lip. With a good Cupid’s bow shape the more appropriate procedure for your upper lip enhancement is a subnasal lip lift combined with lateral vermilion advancements.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,There are numerous places where I have seen you state that safe skull reduction cannot enter the diploic space, but in the case of this patient it appears you reduced his skull all the way down to the inner table – why is the diploic space the standard stopping point, and why was that rule able to be ignored in this instance?
A: What I always say is that skull reductions are taken down to the diploic space. You only find the diploic space by entering it. The diploic space is very thin so entering it usually means you are virtually through it. That is a good stopping point as the inner cranial table is now what is left…leaving some layer of bone over the underlying dura mater covering of the brain.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope you wouldn’t mind giving me some advice/thoughts. In 2022 I had bilateral gonial angle reduction and a bit of excess bone from middle of chin shaved off. Very happy with gonial angle reduction but the improvement in my front view wasn’t what I was hoping for.
Consulted a surgeon this year and underwent chin reduction – he cut 5mm off the chin point and narrowed it. Unfortunately, I’m very regretful of this, feeling like I needed that extra length to balance my face and feel chin looks too short and round. It is early after surgery and I still have some submental swelling. Aware I need to let things settle physically and mentally, however I have a few queries.
1. When would be a good time to have a repeat CBCT post surgery? ‘m keen to see what exact changes where made and where on the mandible and what can be done to restore my chin as closely to what it previously was.
2. Would a vertical lengthening genioplasty be an option? My original surgeon offered dermal filler.
3. What are your thoughts on custom made chin implants to restore the original shape and length of the chin? Would these be made using exact measurement differences of the bone from the pre and post surgery CT scans? I am 30 years old and healthy, would I likely need a repeat procedure in future if i was to get an implant?
Psychologically, I feel I prefer the permanent aspect of the genioplasty and the fact it is ‘replacing’ what I’ve taken off – bone. Appreciate I can’t turn back time and struggling with regret.
4. I am concerned, although have recovered well, about future intraoral incisions and effect on the mentalis muscle. Can a vertical lengthening genioplasty be done submentally?
I have included some photos. Many thanks for reading, and thank you for the information you share on your website, it has been by far my most helpful and informative source recently.
A: In answer to your questions:
1) Anytime is OK to get a 3D CT scan of your chin/lower jaw. The bone shape is not going to change with more healing time.
2) The only autologous approach to improvement would be a vertical lengthening genioplasty. I do not know how the previous reduction was done but the 3D scan will make that clear.
3) A custom chin implant is the non-autologous option as long as one can accept an implant to do it. Such implants are permanent., Unless you had a pre-reduction 3D CT scan that can be matched to the postop 3D CT scan there would be no way to know exactly how to do the ‘perfect’ restoration froma dimensionally standpoint. This applies to a vertical lengthening genioplasty as well.
4) The vertical lengthening bony genioplasty can not be done from a submental approach, only a custom chin implant can.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well. I am writing to inquire about the possibility of midface shortening surgery using the lefort principle, followed by a subnasal lip lift. I am aware that midface shortening surgery is a complex and unconventional procedure, and I understand the risks it carries.
I have been contemplating midface shortening surgery for roughly 5 years. While I understand that this procedure is not as common as some others, I am genuinely interested in exploring the possibilities it may offer in achieving a more balanced facial appearance, although I don’t bring the needed characteristics like a gummy smile etc. I am simply displeased with the aesthetic of my midface.
I am committed to making an informed decision about the surgery and would greatly appreciate the opportunity to schedule an online consultation with you. I want to emphasize that I am approaching this decision with realistic expectations and a strong commitment to my well-being. My primary objective is to be satisfied with the appearance of my face. If you would be open to discussing the possibility of midface shortening surgery with me, I would be grateful for the opportunity to meet online with you at your earliest convenience.
Thank you for taking the time to consider my inquiry.
A: Doing a LeFort I impaction is NOT going to shorten the external midface. That is a procedure that works only to decrease excessive tooth and gum show. And in the patient who has a normal tooth to lip relationship it will bury the upper front teeth under the upper lip creating an aged appearance.The only procedure that has any effect on vertical midface shortening is the subansal lip lift whose effect is limited to altering the distance between base of the nose and the upper lip.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a prominent supraorbital bone and I want to do supraorbital bone ( eyebrow bone shaving) Is it possible to shave or peel the excessive supraorbital bone by minimal invasive technique (endoscopic technique) because the problem that I have a baldness on the both sides of the head and I don’t want to have a long visible scar on my forehead. And is it possible to remove the excessive eyebrow bone by making an incision on the upper eyelid ( transpalpebral technique) in order to avoid the long visible scar the resulted from the conventional open method for the forehead rasping. Thanks
A: Your question about the access for any form of brow bone reduction is a good one and that is always the challenge in male brow bone reductions. Whether it is burring or bone flap setback the endoscopic and transpalpebral approaches will not work. There is no good instrumentation through the endoscope to make any significant brow bone reduction possible and the upper eyelid incision provides limited access to the brow bones because of the supraorbital nerves which are impossible to work around without permanent injury to them. Thus in many men the choices become a mid-forehead incision, which can work well if a horizontal wrinkle line is present, and a frontal hairline incision if the frontal hairline is not too far back.
I would agree that the typical coronal scalp incision is not an acceptable scar tradeoff for most men.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, my son had a poorly performed otoplasty which resulted in excessive pinning of the middle third of both ears. We have been researching the cadaver cartilage bracing reverse otoplasty procedure and are curious what the recovery for that procedure would look like. How many months would the ears need to be protected during sleep? How have your other patients protected their postoperative ears during sleep? Any information is appreciated.
A:I have never done any special ‘protective’ maneuvers after a subtotal reversal otoplasty including any postoperative dressing…although to date these have all been in adults.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have lost a lot of weight but i need more hips and but, and BBL is not possible. What can de doctor suggest for me with visible results.
A: In thin patients like yourself, particularly after weight loss, buttock implants are possible but not hip implants as you don’t have enough tissue to support them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had scoliosis surgery 2.5 years ago and it was successful but still have a bit of a curve. My question is, do I qualify for the rib removal surgery? I have uneven waistline due to the curvature of the spine that I’d like to correct.
A: Having prior scoliosis surgery does not preclude one from having rib removal surgery later. From your inquiry it appears the goal would be to improve the waistline asymmetry which shows more fullness on the right side. This would indicate that only the right side needs to be done which could be approached from your midline spine surgery scar.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What would you say is the biggest change that went from when I was 16 to me right now at 23 ? Is it soft tissue (skin, fat pads) or bone changes ? I feel like my midface looks especially sunken now compare to before. I’d like to look like I did before (and ideally better) but I don’t know how. I’ll try to state my issues as clearly as possible:
-I believe that my midface looks sunken in from the front especially (and I’m talking about the lateral orbitals, infra/zygomatic region and paranasal area). I’m not sure if this is just in my head but if it’s not would I benefit from some type of lefort 3 surgery ?
-I feel like I have a long-ish midface (nose) or oversized nose and mouth relative to my midface. I’m not sure if this is an optical illusion.
-My jaw and chin seem recessed as well
Would you agree with my statements ? I would very much appreciate your insights, thank you kindly
A: Since I don’t have any reference pictures from age 16 I can’t speak to a change. All I can speak to is that now your midface is flat. (lacks horizontal projecion from the orbital rims down)
While you may be seeking a Lefort III effect that is not going to come from an osteotomy unless you have a significant Class III malocculsion…which you don’t. Thus any midface augmentation is going to need to be done by a custom midface mask implant. (see attached implant design example)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m very interested in infraorbital-malar implants, as well as potentially paranasal implants to improve my deficient midface after I have a LeFort I osteotomy and BSSO that’is scheduled later this year. So I’m writing this as I have two questions for you! First one is how long after should I wait to have a consultation about these implants due to residual swelling and the bones healing etc. In terms of getting the actual implant i’ve seen online that waiting 6 months after is enough although I will ask my surgeon specifically on that. But what I mean is to have the initial consult and get the process started in deciding on the implants and design? My second question is how the process in determining the appropriate sizing of the implants to get my desired result works? As having mild midface hypoplasia I believe I’d need larger implants but don’t really understand how the planning goes for it. Like I know what I would want my end result to look like and would be able to create that look in a picture with a sort of filter, but seeing pics of scans of the implant on my skull and measurements etc. is quite confusing to me on what it would actually look like on my face. I would hate for it to be too big, or too small and have to revise, which is why I’m curious how you go about that.
Thank you very much and hope to hear back soon!
A:In answer to your custom midface implant questions:
- You need to begin the process at any time since the implant design process takes 3 to 4 months and getting a surgery date may taken even longer.
- The implant design process requires a lot of learned experience to understand what shape and measurements on an implant design mean to an external facial change. This is a translation that no patient can really make with any accuracy…although some try. (and often fail with their chosen measurements) This is why patients should largely leave those design decisions up to me. Implant designing is not an exact science and is more of an art form.
Dr. Barry Eppley
World-Renowned Plastic Surgeon