Your Questions
Your Questions
Q: Dr. Eppley, At the age of 42 I have decided to get testicular implants. As it is purely for aesthetic purposes my approach is: go big or go home. So I have decided on an implant size of 7cmx5cm. We have decided on orchiectomies for both testes which will be followed by hormonal replacement. I am writing to you due to curiosity concerning two matters: 1- the orchiectomy ( should we re-explore just adding the implants (however there will be 4 testicles then) 2- what have been the largest testicular implants you have done ( if I’m going to go big, I am going to go impressive ). Regards
A: My suggestion would be if you really want to end up at 7cm or or even 7.5cm testicle implant size, you should at least place 5.5/6.0 cms implants at the same time as the orchiectomy. This will allow for a tissue expansion effect to occur or at least prevent significant scrotal skin retraction. This would then be followed by the larger implants 3 to 4 months later. It is important to remember that the the best time to place implants, particularly at the larger ‘extreme’ sizes, is in a non-scarred issue bed.
The largest testicle implants I have done is 7.5cms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m hoping you can get back to me. Essentially my main issue is the lack of mandible width and asymmetry in my lower jaw. There is absolutely no definition and I have a long, narrow face. The other problem is that one side is a lot “worse” than the other, it’s as if my jawline goes into my neck. When I look around I don’t see anyone else with this issue.
I’d like to explore the use of filler or implants to add a considerable amount of width to make the jawline more “square”. (I’m not saying I want or need to achieve a supermodel look, I’d just like more width on both sides), and to also add “definition” and to “sharpen” the mandibular angle on the side/profile view (In other words… Make it actually visible).
Can you tell me why exactly I look this way? Is it due to the shape of the mandible/the way it grew? A lack of fat/tissue? Both?
The chin is also somewhat weak, and slightly more “recessed” on that same side mentioned, so I would consider the use of filler here as well (if I went that route)
My concerns are that:
1) I’m not sure if what I want to achieve is realistically possible with dermal filler (I know other options exist… Like implants)
2) If it is possible, then roughly how much would be needed?
3) Would it need to be injected along the entire “edge” of the mandible? Or can it be concentrated in one area to achieve the desired result?
I think that is all I have for now. If there’s any other information or things to note that the doc can tell me, I would love to hear it.
If you need any other pictures please let me know.
Thank you for listening to, and reviewing my case.
A: Thank you for your inquiry and sending your pictures. What you have is a high mandibular plane angle deformity due to significant and asymmetric ramus development. This is not a jaw deformity you can treat very effectively by injectable fillers as the volume to do so is so high that it is cost prohibitive for most people and certainly not a long term solution. The best treatment is probably a sliding genioplasty combined with custom jaw angle implants. This provides good chin augmentation and also the needed jaw angle vertical length and width that is missing.
But first a 3D CT scan is needed to fully see the shape of your lower jaw. That visual information is invaluable in treatment planning.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I have a few questions about the waist narrowing procedure. How much inches do you lose off your waist? And is it possible that it will make your shoulders look too big? I have a big waist and not much fat, so liposuction wont work and was looking for a way to make my ribcage smaller. Can you also exercise after the procedure?
Thank you
A: Thank you for your inquiry. In answer to your waistline narrowing questions
1) Most patients lose in the range of 1 to 3 inches based on their body type.
2) I think it would be impossible to ever make someone’s shoulders look too big after any waistline narrowing procedure. That is giving more credit to the surgery that it is possible to achieve.
3) There are no physical restrictions after the surgery.
4) Whether this is a procedure that may be effective for you requires an assessment of a front or back view picture with computer imagng to show you what is possible with this surgery on you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if a chin wing osteotomy is possible, after a sliding genioplasty was done? Was looking for someone in my area to ask about this but I’m not sure if there is anyone – maybe you would know. But either way I figured I would reach out to you with this inquiry as I see you have extensive experience with these types of matters.
Thank you for the info!
A: Suffice it to say that once the oblique bone cut is made from a traditional sliding genioplasty the ability to do a chin wing procedure is then lost.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently scheduled to have a consultation regarding shoulder narrowing and rib removal surgery. I wanted to ask if it was realistic to talk about having facial feminization surgeries/procedures done during the same operation, unless the shoulder narrowing and rib removal surgeries are too demanding. I understand that computer facial imaging is required for FFS. So if it is possible to have FFS done during the other procedures, would I need to reschedule or schedule another appointment for more time? Currently my appointment is set to be a 30 minute consultation. I look forward to hearing back from you!
A: We can talk about everything (face and body) during our consultation. In the properly selected patient facial feminization surgery and body contouring procedures can be done at the same time. I will define what properly selected means during the consultation.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, How long does recovery take from masseter reattachment surgery, how many months for swelling, how many months till i will look normal etc.
A :In my experience actual masseter muscle reattachment surgery is often not advised as its success is so low. Camouflage with soft tissue implants is far more effective, can be done under local anesthesia and has a very minimal recovery. How that may or may not apply to you would require a picture assessment of the soft tissue contour deformity of your jaw angles. (clenching and non-clenching pictures) But in actual masseter muscle reattachment surgery the success of the procedure can be fairly well judged by 6 weeks after surgery when most of the swelling has subsided.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, had a chin implant inserted a couple months ago and the result is not what I’m looking for – it widens my lower face too much and does not give me the vertical length that I was hoping to achieve. I’ve attached a few pictures of my current face with the chin implant. I would like to remove the chin implant and do a sliding genioplasty instead. However, I do like the profile projection that the implant gives me and would like the genioplasty to give me the same projection.
Additionally, I would like to do a T-Shaped Osteotomy for a V Line chin.
A: Thank you for your inquiry and sending your pictures. I believe you are correct in that removing the chin implant (will reduce the width) and replacing it with a lengthening/narrowing form of bony genioplasty will add length and be able to restore the lost projection of the chin implant. (although I don’ know what that is currently) The combination of bony lengthening with advancement will create more of a tapered appearance which would be enhanced by adding a 4mm midline resection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the skull reshaping surgery. I really don’t know how to explain it. The photos are a better demonstration. It’s like around my temples and upward it’s “caved in” or like slants not really sure how to describe. I have already submitted the consultation form but there was no photo upload option so I’m sending this one also thanks.
A:Thank you for your inquiry and sending all of your pictures. They illustrate well your concerns, an anterior temporal-lateral forehead deficiency. One treatment option is fat injections as they offer the least invasive approach. The issue with fat injections is how well they will survive but it is a valid treatment option. The second approach with assured volume although more invasive is the placement of custom anterior temporal/lateral forehead implants with the goal as seen in the attached imaging prediction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have already undergone an ablation of the frontotemporal muscles of the skull to obtain a cranium of less wide appearance combined with a fracture of the zygomatics but I would like to know if it is possible to carry out a bone cranioplasty which will consist of cutting the bones of the skull and to file them to then reattach them with small vices because I find that my skull has not sufficiently lost in width with the procedure of removing the temporal muscles and I would like to be able to file the bone directlyIn advance, thank you for your answer.
A: I am not sure what you mean by ‘ablation of the frontotemporal muscles’ as this would imply electrocautery treatment to induce some muscle atrophy. This is very different and far less effective than temporal muscle removal techniques which create very visually effective head width reductions. So my first question is what was actually done and was the muscle reduction effect maximized as this will always be the most effective approach to skull width reduction. I would have to read the operative note to understand what was actually done.
That being said what you are asking is whether bone flaps can be created and pushed inward as a method to reduce skull width…and the answer is no in adults. The brain occupies the intracranial space and it requires the space that it now has. Any skull bone efforts that impinge on the territory of the brain (aka compress the brain in any way) has adverse medical consequences.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had bilateral silicone gel breast augmentation in 2013. I was listening to a blogger and the blogger said you’re not supposed to do certain chest exercises if you’ve had breast implants (i.e. push up and chest press). I wants to know if there are certain chest exercises I am not supposed to do.
A: I am afraid the blogger is passing along incorrect/uninformed information. There are no chest exercise restrictions after breast augmentation surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,What would happen if I get fat transferred to my scalp and end up getting fat necrosis?
A: Fat necrosis means the fat dies and is absorbed which means the procedure basically did not work….which is the risk of any fat transfer no matter where it is performed on the body.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need a Chin ptosis correction Hello I had a chin medpor implant ten years ago. i decided to remove the implant with maxillofacial surgeon and this was the report. (Clinical and radiographic exam revealed : Poorly placed medpor chin implant. Based on that the patient underwent the following surgery under general anesthesia : -Removal of old medpor implant – Genioplasty advancement of 6mm. Intraoperatively it was found that the old medpor implant caused severe bone resorption in the area because it was not fixed in place. Following the surgery the patient was not happy with the final result) After that i went to another maxillofacial surgeon and he decided to make another surgery and this was his report: (Under GA nasoendotracheal tube previous chin plate exposed and found to be only 2mm advancement done in the previous surgery plate removed reduction Genioplasty 2mm anterior and 0 posterior of chin fixation with two L shape plate size 1.5mm in the thickness with 4 screws 6 mm in length). After 6 months i go back to him i was not satisfied with the result as you can see in the pictures drooping chin and drooping of the soft tissues in the chin pad when i smile. The doctor said i have two things First fibrosis and increased chin soft tissues. After the chin muscle droop it caused sagging of the tissues that the reason of the shape you have from the side view. I do not want just a surgical correction i also want an aesthetic shape if it’s possible .
A: Thank you for your inquiry, detailing your history and sending your pictures. You have chin pad ptosis but without lower lip incompetence. Presuming you are happy with your current chin projection the correct procedure would be a submental resection of the low hanging soft tissue chin pad. This would be the most effective procedure for eliminating the soft tissue chin pad overhang albeit with a fine line scar under the chin. If you are not happy with your current chin projection then I would need to see some x-rays to look at what has been done to your chin from the prior bony genioplasty procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like your advice. I had a rhinoplasty 5 years ago and along with that procedure the doctor recommended a sliding genioplasty which I agreed on. I believe he did a 5 mm advancement. He was an oral maxillofacial surgeon that fixed my sisters cleft lip. Well I recently got braces and the orthodontist became a little concerned and said my chin goes to the side a little bit. I see what he is saying and do feel it is a little longer on one side. Would this issue be able to be fixed or is it too complicated and not worth it? I actually really loved my chin before it was symmetrical and fit my face better I think. Do you think I should get it reversed? Or would fixing the asymmetry be safer? Not sure what to do or if I should just leave it alone all together. I have become self conscious about it and realized I only take pictures on an angle because of the asymmetry. I’ve attached my before and after pictures the before picture is the one with the mask haha I don’t have many pictures from that long ago. Your advice on this would be greatly appreciated! Thank you.
A:Thank you for your inquiry, detailing your history and sending your pictures. Whether it is worth the effort to straighten your chin is a personal decision, not one I can make for you. What I can tell you is the options for improvement. First I would not completely reverse it because that may create another aesthetic issue….chin ptosis or soft tissue sag. Rather I would focus on straightening it which can be done one of two ways. Intraoral realignment of the bone or a submental shave technique of the asymmetric larger side. Further insight into which approach is better would require a look at an x-ray. (even a simple panorex would be helpful but a cone beam scan of your chin is most ideal)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the facial feminization procedures of Forehead Brow Bone Reduction, Zygoma Reduction, and Jaw Reduction I was about to have these procedures done by a well-known FFS plastic surgeon on the east coast. But my trans friends’ results were either very bad or unnoticeable after 6 months of recovery. My friends felt like the surgeon had his students do the procedures.
I’m hoping to have very good and noticeable results with you.
A: Thank you for your inquiry and sending your pictures. When it comes to your brow bone-forehead reduction I believe that will create a very noticeable change as seen in the attachment predictions. But when it comes to the lower 2/3s of your face there are some significant limitations in potential reductive effects due to your thick soft tissue layer over the bone. Cheekbone reduction osteotomies combined with buccal lipectomies and perioral/facial liposuction is needed to make for any visible change for the middle face. However, your wider and vertically shorter face poses a real challenge for changes in the lower third. The good news in that regard is that the chin needs to be lengthened and brought forward (mini V line surgery) which will help the most for making the lower face a bit thinner. While the jawbone behind it is wide the thick masseter muscle and overlying soft tissue poses real limitations of any visible results done to the bone. The width of the jaw angles and the masseter muscles need to be thinned as a combined effort, which will help, but it will never be as narrow or ideal as you would ever like it to be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 19 year old girl who are planning facial contouring surgery. After reading a lot of reviews facial sagging was a big problem for cheekbone reduction surgery. In one of your article you said that sagging can be prevented. I saw a lot of type of method for cheekbone surgery. I am not a doctor hence it is hard for me to say which is better and which is not. Can you recommend me a method which can prevent any soft tissue, skin sagging. Someone advised me, if i get to choose best method and take good aftercare then there would be no sagging. Is it true. Can there be no sagging at all. After the surgery what should i do to prevent from sagging.
Thank you,
A: The risk of soft tissue sagging after cheekbone reduction is always possible no matter what technique is used to do it. That has to be an acceptable risk if one is to consider having the surgery. No surgeon can ever tell you that it can never happen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Over ten years ago I was diagnosed with bilateral viral-induced brachial plexopathy. This resulted in loss of function and the eventual atrophy of my deltoid muscle groups. I have perhaps 50% recovery on my left side and 0% on the right. I have no functional limitations. I did have a fat grafting (24 cc) procedure done last year to the right deltoid area. The improvement was minimal.
A: Thank you for your inquiry and sending your pictures. That is certainly a most unusual medical event and the first I have seen such in the shoulder area. While fat grafting is always the first treatment approach it would be difficult to get much of a result with only 24cc of fat injected. Your probably needed at least 50 to 60cc at a minimum. But moving beyond fat grafting the definitive deltoid augmentation procedure is implants. Normally in typical aesthetic shoulder augmentation deltoid implants are placed under the muscle. But whether that would be possible with such deltoid muscle atrophy, particularly on the left side, I can not say just by looking at pictures. But deltoid implants can also be placed on top of the muscle under the fascia as well.
Such deltoid implants would have to be custom designed due to the differences between the two deltoid muscle sizes. This is actually done by making drawings over the shoulder areas and then taking measurements of them. I usually have the patients draw on themselves and take their measurements of length and width of the resultant footprint of the implant shape. We would obviously havhe to account for the differences in the two muscle thicknesses.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you for reading my message. I am curious what solution, if any could achieve a specific type of width reduction in the lateral temporal cheek area with a concave curvature below the cheekbones and above the jaw angle to create a more heart shaped face. Basically I want use a cheekbone implant combined with some sort of soft tissue manipulation to pull back/up the skin to highlight the skeletal structure and reduce the fullness in this area.
I have attached three reference images to illustrate my goals.
One image shows me squinting to accentuate the cheekbones while applying a small amount of pressure with my finger in the temple/masseter region to very gently “push in” or pull back the skin and simulate a roughly .25 inch/6mm reduction in width with a concave curvature to highlight the skeletal structure to create the heart shaped look.
The second image shows me squinting but without applying pressure with my finger, which shows the normal state without the width reduction or concave curvature.
The third image shows a patient who has undergone masseter reduction with Botox which achieves this exact width reduction/concave curvature below the cheekbones that I’m looking for.
The problem is that I don’t have particularly large masseter muscles. I am assuming mine are “average” and are roughly ~12 mm thick, so if they are average in size they would need to be reduced in thickness by roughly 50% in order to achieve the 6mm reduction I’m seeking. I’m not sure how anatomically viable this is.
I also understand that the ramus portion of the jawbone sitting underneath the masseter muscle is extremely thin and I’m assuming it would not be feasible to shave this area of bone very much or at all without compromising the nerve running through it.
In summary I’m trying to figure out how to create this .25 inch/6 mm width reduction with a concave curvature below the cheekbones given my skeletal/soft tissue profile? Would cheekbone implants be be sufficient to pull the skin to simulate what I’m doing in the over by pressing my finger? Masseter muscle reduction? Liposuction of the lateral cheekbone area? Could a mini-facelift pull the skin back slightly to highlight the skeletal profile?
Is this achievable at all?
Thank you again for reading.
A: The facial reshaping effect you seek is not going to come from a masseter muscle reduction as that is not the area in which you are indicating. That is the parotid gland/SMAS area above the level of the bulk of the masseter muscle…and you are obviously not going to do a superfical parotidectomy to achieve that effect. An aggressive buccal lipectomy that gets the pterygoid extension and a SMAS excision in front of the parotid gland…..with cheek-arch implants will likely achieve that effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Your blogs were really helpful and made understand more about surgery. I am interested in cheekbone reduction. But i do not want flat face , i still do like cheekbone curve. But my cheekbone is way too big so i just want to reduce it little bit and make it look aesthetically pleasing. First is my face, second and third are my goal. One thing i am afraid is skin sagging. Since i am 20 many surgeons said i will not sag but reading your blogs i nderstood anyone is in risk. I read usually ligaments do not re attach to the bone and it droops down. I heard ligaments, soft tissue heal in 12 weaks if we take good post care then ligaments can attach back. Is it true?If i do not talk, make facial expressions in 12 weeks would my soft tissue attach back? If not how can i prevent from sag? Would ligaments attach back? Sorry for long questions. Thank you.
A: Thank you for your inquiry. What you are describing is a modest cheek bone reduction of perhaps 3 to 4mms per side. As you have stated in your inquiry the risk of cheekbone reduction osteotomies for soft tissue cheek sagging can never be completely zero…no matter what technique is used. I think what you are saying is correct in that if you get out 3 to 4 months after the surgery and no soft tissue sagging has occurred then it probably will not occur later. Facial expressions after surgery will not effect whether soft tissue sagging occurs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,for the submental chin reduction why do you prefer to do the incision under the chin vs inside the mouth?
I’ve read other surgeons have used rib bone for the maxillary augmentation curious on why do you prefer to use eptfe implant material?
Thank you for your help and time.
A: In answer to your questions:
1) Chin reductions done intraorally have a very high risk of soft tissue sagging and can not manage the soft tissue excess that results from reducing the bony support of it. From a submental approach both bone and soft tissue excesses can be removed producing a better result. The tradeoff, of course, is the fine line scar under the chin.
2) Rib grafts can be used for midface augmentation and I have done so numerous times. Usually, however, patients don’t want the scar and recovery from doing the rib graft so the vast majority of patients choose an implant. But the decision between rib graft vs implant midface augmentation is a personal one and that is up to the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, So I’m currently doing some research on different places where I can get a Forehead Reduction/Recontouring done. And I just wanted to ask what is the average cost. I understand that it depends on how I start off but if I could just get a rough estimate that would help a lot. I am an out of town patient. So what can I do if I were to come to your practice.
A:You are correct in that not knowing what needs to be done it is hard to provide an accurate cost of the surgery. Usually when a female uses the term ‘Forehead Reduction’ they are referring to a frontal hairline advancement. Then when the term ‘Forehead Recontouring’ is used, whether it is male or female, this typically refers to bony reduction. Thus when you use these two terms together this implies a combination frontal hairline advancement with bony reshaping. I will assume that is the procedures you need to achieve your aesthetic goals until told otherwise.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello again, I first reached out to back in 2013 (inquiring about correcting my ocular Dystopia in my left eye.
I feel I’m ready to finally have the procedure done.Attached Image on the Left was in 2013 , image on the right was a few months ago.
As I mentioned before this has always effected my confidence and has been a large contributing factor to the depression I struggle with.
You said I you felt you could improve my situation and that from the photos it appears that I have 3mm to 4mm of dystopia. Since last we spoke I’ve reviewed your website and noticed that plastic inserts are sometimes used to raise the orbital floor. I’ve also read in some cases you also lower the higher eye in addition to lifting the lower one.
Two concerns that I have is that in addition to the lower position of my left eye, my tear ducts are also not aligned, would this cause a separate issue as that is fixed tissue?
Also the shape of my right eye level slants up toward the inside where my left slants down. I’m concerned that if we are able to raise the eye, this might actually make things worse due to the eye lids also being different.
Does that make sense?
In addition to the eye surgery, I’d like to consider having my chin corrected to be more symmetrical as well. It slants (left) to the side of my lower eye.
A: Thank you for your repeat inquiry as I still have your initiual inquiry and picture on file from 2013. In answer to your question:
- It does appear that the left eye is a few millimeters lower than the right. It would take a 3D CT scan to confirm what the actual differences are. Most patients get their CT scans in their local area but one can also be obtained here.
- You are correct in that the tear duct position is fixed.
- In almost all cases of VOD surgery the eyelids/eye corner must be addressed at the same time. Moving up the eye will make the overlying soft tissue asymmetries more apparent.
- Most VODs do not exist in isolation. They are often part of an overall facial asymmetry in which other facial features have differences as well. Your chin would be an example of that more global facial asymmetry effect. How best to correct that would come from information obtained in the 3D CT scan.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant performed about 6 months ago and the tightness/ stiffness persists. If I talk more during work, sing or make more movement with my mouth, my chin starts swelling up again and the stiffness increases. The middle area of my lips is still numb. At this point, I’m really doubting whether the stiffness/ swelling will ever resolve. Appearance-wise I think it looks fine but truly the discomfort is causing me to want to have my chin implant removed. My questions are:
1. What are the side effects of implant removal?
2. Will there be sagging/ ptosis of chin after removal?
3. The numbness was probably the most bothersome for me after the chin implant was performed and the recovery was very slow. Will removal of the
implant cause a new loss of sensation all over again?
4. Would scarring/ capsule have developed within these few months and can cause cosmetic irregularities in the chin?
5. When I make an upward movement with my lips, I can see a ridge/ bumpiness along the labiomental fold where the incision is. Will that remain or get
worse after implant removal?
I would greatly appreciate any answers to my questions!
Many thanks!
A:In answer to your chin implant removal questions:
1) The only side effect from chin implant removal, besides the loss of chin projection, is whether soft tissue chin pad sagging will occur.
2) Always assume there will be post removal saggjng and then hope that it does not occur.
3) Removal of the chin implant will not cause an exacerbation or recurrence of the menal nerve numbness.
4) A capsule forms around every implant in the body very quickly after surgery so you do have one for sure. But that is the least of your concerns and is not the source of any subsequent irregularities of the chin
5) I don’t think any bumpiness along the labiomental fold will get worse with inplant removal.
While not one of your questions, it sounds like you had an intraoral chin implant placement and it is likely the implant is sitting high on the bone…which would account for every symptom you have described.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was curious about buccal fat removal and other suggestions to remove “baby face”.
A:Thank you for your inquiry and sending your pictures. Most ‘baby faces’ are really a combination of excessive soft tissue and weaker facial skeletal support. While fat removal (buccal lipectomy and perioral liposuction) will make an improvement it is important to realize that these changes will be modest and will not make a dramatic transformation. But for many this can be a good and fairly straightforward starting point with little downside to see how much improvement can be obtained from soft tissue reduction alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what are the procedures needed to correct vertical orbital dystopia? Will just putting an implant under the eye alone work?
A: I use a 6 step approach to VOD correction. Step 1 = placement of custom orbital floor-rim implant to raise the eyeball up. Step 2 = transpalpebral brow bone reduction to raise up the lower than normal tail of the brow bone. Step 3 = drill hole lateral canthoplasty to raise up the lower eye corner position. Step 4 = transpalpebral brow lift to raise up the lower eyebrow through the upper eyelid in the bald/shaved head male where traditional browlifting techniques are not good options, otherwise an endoscopic browlift technique is used, Step 5 = spacer graft to the lower eyelid to support the middle part of the lower eyelid in a more upward position. Step 6 Upper eyelid ptosis repair, needed as the eyeball moves but the position of the upper eyelid will remain the same if not treated.
This comprehensive approach to VOD is necessary as just raising the eyeball alone will create other undesired changes around it if the posiions of the eyelids/eyebrows are not addressed. It would be like raising the window frame but keeping the shades in the same place. It is easy to get focused on the custom implant because it takes more than that to imporove the overall eye asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’d like to inform myself whether it’s possible to dissolve the fat pads by the mentalis muscle in the middle of the chin (it makes my chin look square) – or, if it’s necessary to shave the chin bone, and why those fat pads would be needed.
A: The mentalis muscle fat pads can not be dissolved or removed. They are not traditional fat and access to them surgically would result in muscle and nerve dysfunction. They exist not as a metabolic type off fat but to permit muscles to move unaffected by the adjacent muscles…much like that of the buccal fat pad. Chin bone modification is the only approach to desquaring the chin. (narrowing genioplasty)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a full skull reduction and hairline lowering procedure. I have always had an issue with my large head and I do want to make it smaller. In addition, is it possible to make my face less wide as I feel like the sides of my face are chubby? With both surgeries, do you think I will be able to receive a significant change in my head shape? I have put a black line on where I would like my reduction results to be. If not, what would you recommend? With my larger forehead, Im not really sure what head shape I have. Overall, I just want to have a nice head shape for my facial features as I feel like my head shape doesn’t compliment it.
A:Thank you for your inquiry and sending your pictures. When it comes to skull reduction and frontal hairline advancement surgery, because of the different incisions needed for both they are contradictory to ever being performed together. As a result you should focus on the frontal hairline advancement. Once any incision is ever made behind the frontal hairline the hairline advancement can never be subsequently performed.
For the frontal hairline advancement the degree of advancement you are showing would require a first stage scalp expansion. Your scalp is too tight to ever move that much on its own. The first stage scalp expansion is also best for the frontal hairline scar. I suspect that when your hairline is advanced and the amount of forehead show reduced your head shape size will no longer be an issue.
As for ‘chubby’ cheeks typical defatting procedures of buccal lipectomy and perioral liposuction are performed for that type of facial fullness reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I figured that I would check with you to be on the safe side about root canal treatment. I had a scan done when I was looking into getting a missing tooth replaced. They informed me that I have an infection above another tooth and suggested that I go to another dentist and get a root canal. I wanted to check with you to be on the safe side since my premaxillary implant is in that region.Is there anything that the doctor should be aware of.
A: Having to get a root canal and having an implant in the immediate overlying area is extremely pertinent. Because they have to give local anesthetic injections there are two considerations:
- There is a very good chance that local anesthetic injections may not work as they rely on diffusion and the implant will likely block it from having an effect. If you look at a picture of the general area where the implant is and the location of the tooth in question (right upper canine) you can see that they are ‘neighbors’.
- There is an equally good chance that the local anesthetic injection will be injected right into the implant, which besides not having it work, could get the implant infected.
Thus it would be prudent that I speak to the treating dentist so they are aware of this issue and devise an anesthetic approach that will work as well as avoid causing an implant infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 29 years old. Used to weigh 320lbs but now about 230-235. I have been doing bodybuilding and competitions for at least the last 5-6 years. I stay around 12-18% body fat yearly. But no matter how clean I eat, or strict my workouts are I can only see my abs when I’m down to 3-5% body fat. Would ab etching benefit me?
Here are the pictures per request. Interested in ab etching.
A: Thank you for sending your pictures. Abdominal etching is unique in liposuction because it does something that is not done in any other form of liposuction…the removal of fat to deliberately create a contour depression. (in this case the etch lines) One of the basic principles of success in liposuction surgery, abdominal etching included, is the ability of the skin to shrink and contract down around the areas where the fat is removed. Your abdominal skin is challenged in that regard because of the weight loss where much of the elastic fibers in the skin have been irreversibly stretched out and the ability of the skin to shrink and contract has been compromised. (as evidenced by the stretch marks)
Theoretically abdominal etching in you should not be that successful because of the condition of your abdominal skin. I suspect what that really means is you will get some improvements but one should not expect typical well demarcated etch lines to appear from the procedure…. probably more of a hint of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been meaning to get a vertical lengthening chin implant and I’m looking for a 8 mm vertical increase. However, I think the biggest on-shelf VLC implant only provides 6 or 7 mm vertical increase. I was wondering if it is possible that a VLC implant can be customized to provide 8 mm vertical increase or is 7 mm the maximum?
A: There is a reason no standard chin implant exceeds 7mms in vertical length…as that is about the limit of how much the chin bone can be expanded by an implant and still get the soft tissue chin pad over the end of the implant during closure. Whether the additional 1mm of increase would be excessive is hard to predict before actually placing the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I can do fat transfer into breasts and buttocks at the same time?
A: You can if one has enough fat to do so but that would be very unlikely after concentration of the fat aspirate. For the vast majority of patients they have just enough fat that devoting it all to one site (buttocks or breasts) is usually what is done. It would be exceptionally rare that any patient would have enough fat to harvest to treat four ‘mound’ areas in a single surgery.
Dr. Barry Eppley
Indianapolis, Indiana
