Your Questions

Q: Dr. Eppley, My little boy is soon to be 6 years old. He has a wide head with flattening mainly to one side and his ear is slightly pushed forward on that side.

I would like to try and get this sorted for him before at this age. Is this something you can help him with?

I think you can use a skull cement that can be used at his age? Is this very costly? And is it effective? Does it leave much of a scar? How long does it take? 

We are based in the uk but I don’t think this can be done in the uk? 

I am really keen to sort and how do we progress with this?

A: When it comes to treating occipital plagiocephaly in children the only good option, in my opinion, is hydroxyapatite cement. While such HA cements don’t really turn into bone, the body does view them as more ‘natural’ and develops osseous integration with the surface of the skull. While such HA bone cements are the ideal material they are not perfect and have several notable downsides which include the following:

1) Placement of them requires direct visual access to properly place and shape the cement. This means that a longer scalp incision is needed to do so.

2) Any bone cements have to be placed exclusively on the bone or otherwise they will fracture. Since plagiocephaly skull deformities wraparound the side of the head into the posterior temporal muscle region, such corrections are imcomplete.

3) HA cements in the U.S. are very expensive compared PMMA acrylic bone cements. But PMMA is a material that should not be used in children due to the growing skull.

For the reasons so stated above I advice parents to wait until the teenage years when a more effective method in treating plagiocephaly exists (custom skull implant) and the use of these other more effective materials are placed in a skull that has undergone much of its development.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I would like to ask about the customized skull, how hard is it and is it safe and almost as hard as the original bone?

A: A custom skull implant will feel just like bone and when implanted you can not tell the difference between it and your natural skull….even though outside the skull it has some flexibility and is not as rigid/stiff as bone. It is a common misconception that an onlay (on top of bone) skull implant should be as hard as bone…that is wrong. It is an inlay skull implant replacement for full thickness defects which should have a stout rigidity to it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, in terms of the occipital procedure, what kind of swelling can I expect and will any hair be shaved to make the incision? Or in other words, will I be able to go back to work pretty soon afterward without worry about the scar being seen as it’s healing and any swelling being noticeable?

A: In answer to your occipital skull reduction questions:

1) No hair is shaved for the procedure.

2) Most of the swelling that occurs is on the back of the head and does not affect the face. So it is really not that noticeable to others. So you should be able to go back to work fairly quickly.

As for the forehead one treatment option that we did not discuss was fat injections, a minimally invasive procedure with virtually no recovery. While it is not what I would consider for medium or larger types of skull augmentation but for small contour concerns it is an option.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m curious are there any surgeries to make the eyes look further apart? I know an orbital box osteotomy actually moves the eyes further apart but that’s a obviously a very invasive surgery for a couple of mms.

A: Whether it is 2mm or 10mms the only way to physically move the eyes further apart is with the orbital box osteotomies. Admittedly the lesser the amount of separation needed the more the orbital box osteotomies is a solution that is much bigger than the problem merits.

Dr. Barry Eppley

Indianapolis, Indianapolis

Q: Dr. Eppley, Hey I’m a transgender female patient who is interested in getting hip implants cause I have hip dips and they make me feel like I look boyish.

A: Of all body contouring procedures, hip implants have the highest rate of postoperative problems. I have learned to choose patients carefully for this procedure to lower these complications risks. My preoperative assessment includes pictures of the patient’s hip areas with imaging predictions of what I consider realistic outcomes. The patient’s soft tissue thickness is also a key consideration. Thin tissue patients with little subcutaneous fat have a high risk of implant show/edging.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had an endoscopic brow lift 3 years ago and I am left with 4 vertical lumps on my forehead (pictures). The surgeon who did the brow lift believes it is scar tissue. 

Do you think you could treat those scars by any means ? Would it require surgery or maybe just steroid injection ? 

Thank you 

A: This is a most unusual sequelae from an endoscopic browllift that I have never seen or heard of before. While you can certainly try steroid injections I would not expect that to provide any improvement. I don’t think this is scar tissue nor could I biologically explain why such scar tissue would occur along these very specific vertical ‘lines’ since in an endoscopic brow lift there are no periosteal/galeal tissue releases done along these lines. There are only vertically ‘pull points’ located at the scalp incision locations. My speculation would be that this is more likely related to the vertical pull of the browlift which has created tension lines in the forehead.  I don’t think it is a coincidence that the tissue lumps are vertical in orientation and that the browlift is based on a vertical tissue pull.

If that is a correct theory then the only solution may be a horizontal release of the galea of the forehead as is more commonly done in open forehead procedures. What is clear that at 3 years postop this is not an issue that time and tissue relaxation will solve.

But I make these comments based on only seeing two pictures and having no specific knowledge of the endoscopic browlift technique

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had cheekbone reduction surgery via osteotomy 2 weeks ago. The bones were reached and fractured intraorally and with exterior incisions. On my sideburns where the exterior incisions were made there are really hard lumps which are a concern to me because I don’t know if it’s swelling that will eventually dissipate and flatten out or the zygoma arch is sticking out. What is it? 

A: All I can say is that it is either swelling or the back ends of the zygomatic arch sticking out. It is either one or the other. But that would be impossible for me to say based on just your description alone. A x-ray of course would provide the definitive answer if you must know immediately.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What are your thoughts on Vermillion Advancement and why is this better or worse than the bullhorn/gullwing? I have very thin upper lift and downturned mouth. 

Thank you!!

A: FYI bullhorn = subnasal lip lift, gullwing = vermilion advancement

While you can have a subnasal lip lift you should not have it by itself as this will result in an A frame deformity. With the sides of your upper lip absent/folded in and the mouth corners turned down the subnasal lip lift by itself will make the upper lip look even more disproportionate. The subnasal lip lift only changes the central upper lip and not the sides. Thus a subnasal lip lift in you must be combined with a lateral vermilion advancement/corner of mouth lift to look right.

You could also have a total vermilion advancement but with some cupid’s bow presence and a long upper lip I would go with the former which will produce a greater upper lip shortening effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am wanting to fix dents in my butt cheek that I might have gotten from a steroid shot when I was younger. I’ve had this noticeable set of dents/dimples for as long as I can remember. These dents show more when I’m simply standing or wearing tight clothes. I am always covering it up with shirts and long clothes. I don’t want butt implants. I am okay with my butt size. What are my options to fix this deformation?

A: This is a classic soft tissue indentation from exactly what is known to cause it…previous injection therapy. This is not a problem that would be improved by buttock implants anyway. This requires contouring reconstruction with fat. Given the broad and fairly shallow base of the indentation fat injections would be the appropriate treatment choice.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested into getting a few things done in your Clinic. I would like to get Hip Implants, Rib Removal and my Shoulders narrowed. Is it possible to get it done in one surgery? And how long would you recommend to stay in your clinic?

About me: I’m trans (mtf) and have no medical problems. 

I’m looking forward to hearing from you.

A: Thank you for your inquiry. The question about whether all three body contouring procedures you have mentioned could be done at once is a recovery issue not a technical one. Since you would most likely be coming by yourself it would be very tough on you to do all three at once. I would choose which two of them have the highest aesthetic priority for you. Those two alone would make recovery hard enough. From an aesthetic standpoint it would also be important to look at some imaging changes to determine what can realistically be achieved from these procedures on you. That may also help with establishing procedural priorities.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m wondering if a submalar cheek implants works effectively on African-American skin for someone with facial lipodystrophy?

A: I am not aware that there are any racial differences when it comes to the aesthetic effects of submalar cheek implants. If someone is a good candidate they can be effective regardless of race, age or gender.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a couple quick questions regarding the posterior temple reduction surgery that I have been very interested in. I’ve been reading up on it and it says that after the surgery, the full results won’t be shown until 6 weeks after. Why is this? Is it because there’s a shrink wrap effect that takes place to where the skin flattens and tightens over where the muscle was removed? Or is it because it takes 6 weeks for swelling to go down and for the muscle to atrophy? I understand you have two methods of either removing the whole muscle or tapering it off towards the back. Is there a significant difference between the two? Thanks in advance

A: To see the operation’s full effect it takes complete resolution of all the swelling. Like any other face or skull surgery this is the expected time for the full aesthetic effect to be seen. Most patients are well into the benefits phase by 2 or 3 weeks after surgery but its 100% result takes the full 6 weeks.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to email you in regards to the cost of a chin augmentation using either an implant or sliding genioplasty. I have a slightly recessed chin I would like to bring forward. I can provide photos. I would like some more information about the custom implant process and how that would work.

A: Thank you for your inquiry and sending your picture. I have done some initial imaging to try and get a feel for what amount of chin augmentation looks sufficient to you. In terms of selecting how to do the chin augmentation:

1) standard chin implants are indicated when the chin deficiency is modest to moderate in size. (like yours)

2) a sliding genioplasty is best done when the amount of chin deficiency is large or the patient very specifically is opposed to an implant.

3) custom chin implants are indicated when the patient’s aesthetic goal can not be achieved by the use of a standard implant. (e.g., very square chin shape)

Based on just this one picture, #1 seems appropriate for you.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, Looking to correct previous gynecomastia surgery. I have bilateral surface irregularities/depressions and scar tethering during flexion. Original surgery completed one year ago with fat grafting completed six months later. Pre and post pictures included.

A: Thank you for your inquiry and sending your pictures. As I understand your history you had an open areolar approach to your gynecomastia reduction complicated by a postoperative crater deformity. This was  followed by a second surgery of fat injections in attempt to release the adhesions and improve the contour.

Fat grafting as a treatment for the crater deformity after gynecomastia reduction is an appropriate approach. One can debate whether that should be by injection or the open placement of a dermal-fat graft. Each has their advantages and disadvantages. Fat injections are a more simplified and convenient approach to the problem but how much survives and their contour effectiveness is very unpredictable and far from assured. Dermal-fat grafting is more effective in terms of a successful release and volume retention but it is an open surgery and involves the need for a donor site harvest. 

Most surgeons and patients when presented with the two options would understandably opt for the fat injection method. The question moving forward is whether another effort should be made at fat injections or whether one feels better about moving on to a ‘Plan B’ correction method. I can make arguments either way.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I like the first chin augmentation imaging that you did the best, I believe that is the smallest correct? For some reason though I just think I may Iook too masculine. I mean I know I have a boyish face but sometimes I feel like my recessed chin is the only feminine thing about my face lol. I would like to see what it would look like from the front profile because honestly that’s what bothers me the most. I feel like my lower face does not add up to my mid face and I feel like my lower face is sagging— perhaps what I need is a face lift. I honestly don’t know. Maybe you have other suggestions? I’m so lost. You’re the only surgeon I would feel comfortable getting anything done from so I really appreciate your input. Ultimately I guess I just want a more v shaped jawline and chin to look the most feminine that I could possible look. I just gotta figure out what needs to be done. Thank you so so much

A: In answer to your chin augmentation imaging responses:

1) I think it is wise for a female with a significant chin deficiency to be very careful about doing too much, Such patients often have a hard time recognizing themselves afterwards and can never adjust to a so called normal chin position. So the use of computer imaging has helped flush that concept out in you.

2) Since the chin augmentation would be small I would just go with an implant which is probably no more than 5mm horizontal projection and has no extended wings. (anatomic style chin implant) It also would need to be hand modified so it looks just like a V. With implants you have to exaggerate their design on the bone as the overlying soft tissues will blunt their effects. So to have a more narrow chin the implant must literally look like a V.

3) Not doing frontal imaging was not an oversight. You can’t really pull the chin forward with imaging so It won’t show much of anything. Unless one is interested in increased chin width (which you aren’t) frontal imaging is not useful. For chins and jawline the combination of the side and oblique views is the most informative and accurate.

4) A jowl tuckup procedure always makes the jawline sharper as it pulls the soft tissues back over the jawline bone. So the question is not whether that is beneficial but rather how far does one want to go for how much effect. At the least submental/neck/jawline liposuction is needed with the chin implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Has you ever had patients post-operation suffer from weakness in chewing or keeping the jaw closed after having done the posterior and/or anterior temporalis muscle removal/reduction? 

-What sort of feeling should I expect post-operation and during the healing process when Dr Barry performs bone burring on my enlarged temporal line? 

-Just to confirm, is it the over-developed anterior section of the temporalis muscle that contributes to forehead width ? I say this cause reducing my forehead width is one of my main goals with this operation. 

-Roughly how long would it take for the major swelling to settle down post-operation and for me to comfortably go out in public ??

-Will I lose much sensation on the scalp post-operation from the coronal incision ? 

-What medication would I get prescribed with post op and is this medication available back home in Australia ? If not what’s an alternative ? 

Looking forward to hearing from you. 

A: In answer to your temporal muscle and bony temporal line skull reductions:

1) No patient has ever experienced any lower jaw motion or chewing difficulties after the surgery. When the anterior temporal muscle is manipulated there can be some temporary tenderness with wide mouth opening.

2) Skull bone has no sensroy innervation so no pain/discomfort comes from bone reductions. It is the scalp that has sensory innervation.

3) The width of the forehead is ultimately defined by the prominence of the anterior temporal line.

4) Most patients have a reasonable appearance 10 to 14 days after the surgery.

5) Postoperative pain medication can consist of either narcotics (e.g., Percocet) or potent anti-inflammatory medications. (e.g., Toradol Ketolorac) That is a patient’s choice.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How many centimeters can you extend your shoulder reduction surgery? There are many places where triangular muscles, seolsang muscles, and chest are connected. What are the side effects? Please explain this in detail. 

A: The amount of clavicle bone removed in shoulder narrowing surgery is 2.5cms per side. This has consistently shown to be effective and safe and within what is clinically supported by the orthopedic surgery literature for the amount of clavicle shortening that can occur without untoward shoulder function effects. (based on unoperated clavicle fracture repairs)

Other than the small scar in the supraclavicular fossa through which the surgery is performed, there have not been any functional side effects.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What are the chances of getting brain infections or any other risks during the cranioplasty?

A: There is a zero chance of brain infections with cranioplasy. All aesthetic skull reshaping procedures are performed on the outside of the skull not the inside. We do not come close to the dura mater let alone violate it into the subdural space.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m thinking about getting a skull reduction surgery sometime in the future. I’m thinking about specifically getting a temporal reduction surgery, mainly because my head appears overly wide. And I’m hoping to have my head appear more narrow after the surgery is done. I just had one question about the procedure. I read online about the temporal reduction surgery and how it will be carried out. I understand that to reduce the width of the head, you can remove the posterior temporal muscles located on the side of the head. But isn’t it also possible to remove some of the outer layer of the bone located on the side of the head if this bone is thick enough? Just like how it is done with the occipital reduction surgery, where the amount of reduction is limited to the thickness of the outer bone located at the back of the head. I’m asking this because when I plan to get this surgery, I’m hoping to make my head not appear as wide as it does now, and I’m hoping to get the most results from this surgery. 

Thank you for answering my questions.

A: In answer to your temporal reduction surgery questions:

1) In every case of temporal reduction I have done removal of the muscle alone has been adequate…even in those that believed that bone reduction was needed as well.

2) Temporal bone reduction can always be done if one is willing to have the incision located on the side of their head. (as opposed to hidden behind the ear when the muscle is removed)

3) The temporal bone is very thin and just a few millimeters can be removed. Thus the minimal benefits gained is usually not worth the scar burden to do it…particularly if one has no hair to hide it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had cheekbone reduction surgery last week. Upon having my post op CT scan — I noticed my right cheekbone was slightly separated. My doctor said this will heal fine, but I’m still concerned because every time I open my mouth or touch my right cheek—I can feel my cheekbone moving slightly and making tiny cracking sounds. It’s also a little difficult to chew on my right side. I know I’m very early I’m my recovery process, but my main concerns are that this will cause asymmetries in addition to malunion requiring further corrective surgeries and longterm complications such as skin sagging. What are your thoughts based on your experiences, doctor? 

Thank you 

A: You had the classic oblique cut cheekbone reduction surgery with plate fixation at its most inferior part closest to the intraoral incision. While the left side is ideal the appearance on the right side is not uncommon. There is a slight rotation of the right cheekbone segment which can happen as the superior part of the bone is not accessible for direct plate fixation.

Everything you are feeling on the right side is not abnormal and the bone segment should go on to heal. (it will probably heal with a fibrous union rather than a bony union…which does not matter in a non-mandibular facial bone) The sensation of movement should pass in a few weeks. This slight osteotomy line should not cause any asymmetry.

The risk of soft tissue sagging has nothing to do with the osteotomy line as long as the bone is stabilized from falling inferiorly. Soft tissue cheek sagging often occurs because of the way the procedure has to be done. (stripping of the soft tissues off of the cheekbones) and then reducing the projection of the cheekbone)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve looked over the imaging pictures of my sliding genioplasty chin augmentation and I like the medium and large chin projection changes for my side profile. I wouldn’t want any larger than the large so if youhad to go bigger or smaller from that id prefer smaller. In between medium and large would also be perfect.

I forgot to add, how much do the different changes affect the view from the front and 3/4 view? I know you said it’ll look narrower. How much narrower would the large change be compared to the medium change? And how much longer from the front will my chin be in the end?

Thank you so much!

A: What you are really saying from a dimensional standpoint is keep the projection of the chin behind a vertical line drawn down from the lower lip. And to no surprise in females with naturally smaller chins ‘less is more; so to speak.

The larger forward movement the more narrow the chin will become from the front view.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, Last year I had bilateral testicular wrap around implants. Overall I am pleased, the left one is perfect. The right one however has a strange “pointed” shape at the bottom that is bizarre and sometimes causes pain, I was wondering if this could be rounded?

A: I would assume that this is related to the implant and, thus, it could be depointed (rounded off) in place.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had two sets of hip implants and both were plagued by bulging on the lower end of the implants. How can this be fixed?

A: I have pulled and looked at both your 1st and current hip implant designs. I would suspect that the first lower bulge occurred because the bottom of the implant developed a bend or fold in it. (thin lower edge) The second hip implant design is much thicker (and also heavier) and this probably occurred for the same reason. My thoughts are as follows:

1) This is not an easy problem to solve mainly because there is no assured outcome based on anything that may be done. Good fixes are those where high confidence is in the knowing the exact problem and having a treatment that is known to work for it.

2) I am not sure a change in implant design/shape is the solution. The profile shape of the bottom half of the implant does not match the shape you see in you externally. (see attached side by side comparison) This still suggests a bending problem at the bottom of the implant.

3) If we knew that the implant shape was the issue I would then just hand modify the bottom of the implant to make it have a lower better taper to it. (this is tempting to do and probably has little downside to doing it…probably can’t make it worse but would it work??)

That being said there are only three options:

1)  hand modify the current implants as described above

2) Make new implants of higher durometer (stiffer with with better lower half profile shape)

3) Injection fat grafting around the lower half of the implant to make a more gradual transition.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, On Real Self I saw a few answers of yours to questions with regards to vertical augmentation of the chin. You were saying that using chin implants the chin can be vertically augmented up to about 7 mm (but no more) whereas with a vertical bony genioplasty the chin can be vertically augmented up to even 15 mm. The question I had was: from your experiences, what’s about the limit with regards to how much the chin can be vertically augmented with fillers? I’ve heard fillers are usually only good for horizontal augmentation of the chin (but not vertical) but I’d imagine that they could also vertically augment the chin to at least some degree. How much mm would that limit generally be?

Thank you for your time.

A: Injectable fillers can probable increase the vertical length of the chin by 2 to 3mms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have always been curious to know if it is possible to increase the pupillary distance between the eyes? I feel it gives a more feminine look and I just wanted to know if this surgery is possible? If not, is it possible in the near future with new technological advancements? Thank you for your time.

A: The eyes can be made wider if one is willing to undergo orbital box osteotomies as an adult. That is a major commitment that requires a full bicoronal scalp incision and a frontal craniotomy to perform. I do not see this surgical approach changing any time in the near or far future.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can temple implants and tear trough implants make my face more symmetrical? I had BSSO advancement which made the jaw angles more obtuse and desire jaw angle implants too. Would like to know your views via a possible consultation.

A:Thank you for your inquiry and sending your picture. The aesthetic benefits of temporal and infraorbital augmentation are fairly clear when imaging your front view picture. (see attached) The jaw angles are harder to properly visualize from just a front view picture. BSSO surgery is well known to adversely alter the shape of the jaw angle bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Am I a good candidate for reverse abdominoplasty and what’s the approximate cost of this procedure that only addresses the upper abdomen?

A: A reverse or superior-based tummy tuck is indicated in the following:

1) Loose abdominal skin is located above the umbilicus while there is no excess/loose abdominal skin below the belly button. In essence the loose upper abdominal skin ‘hangs around the fixed central umbilical area.

2) The patient does not prefer to undergo a traditional lower tummy tuck with umbilical repositioning or has been through a previous tummy tuck and does not wany to undergo that procedure again.

3) A well defined inframammary breast crease exists that is hidden by some degree of breast ptosis. (sagging)

4) The patient is not opposed to a scar line across their inframammary creases that may cross the midline between their breasts.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a trauma to the scrotum and testicles secondary to an assault where an effort to “pop” the testicles through the scrotum occurred. This eventually resulted in the loss of one testicle and caused the posterior skin behind the scrotum to become very stretched out and thinned. Now the remaining testicle hangs low and slides out of the muscular part of the scrotum into the stretched out skin below the scrotum. This feels uncomfortable while sitting and especially while exercising even though I use supportive underwear. The discomfort and appearance reminds me of the assault and restoring things as much as possible would be a great help from this devastating and humiliating injury. In cold conditions when the muscular part of the scrotum contracts, the testicle is pushed into the stretched out area of skin towards my leg and feels uncomfortable. My hope is that if the stretched areas were tightened to keep the testicle in the muscular part of the scrotum, I would be much more comfortable. While I did not have a prosthetic testicle implanted when the more severely injured testicle could not be saved, I am not interested in a prosthetic testicle being added because comfort is a great concern and I feel with one testicle my prospects for comfort is greater since a certain amount of chronic discomfort exists; nevertheless, I would like some of the extra scrotum cleaned up and made to look more tidy. I am not concerned about having large and impressive looking scrotum and testicles, but really want to be comfortable and would prefer to have a smaller, higher positioning of the remaining testicle.

A: Thank you for your inquiry and sending your pictures. What you appear to have is disruption of the enveloping Dartos fascia/cremasteric muscle which allows the remaining testicle to prolapse into the enlarged and thinned skin sac under certain conditions. In essence you have a scrotal hernia. You are correct is that excision of the stretched out skin/tissues with a reinforced closure (aka scrotoplasty) will very likely help with the discomfort as well as its appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to know if you’re able to do a tummy tuck on a kidney transplant patient? 

A:Yes I have done it before. (twice) You just have to know that the transplanted kidney is in the abdominal area so it may not involve rectus muscle plication depending upon where the transplanted kidney lies. It also requires clearance from your nephrologist for this elective body contouring surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was born with a congenital mishaped head. Do you do craniotomy’s? Do you work on adults? I had a forehead implant in 2009, it held up for nearly 3 yrs then started sliding. I let it go, saw a surgeon and he was going to take out implant & in 6 months do the craniotomy. As we thought I’d torn my dura mater, it was just a very, very severe infection and now he doesn’t want to do it! I was heart sick. I then saw a colleague of his & she wants to do bone paste. I’m just checking out all my options.

A: As I understand your skull situation, you had some type of forehead implant which became infected and had to be removed. I am assuming there is a remaining frontal bone albeit misshapen and recessed. I assume they have done an updated 3D CT scan of your forehead/skull so that the residual bony anatomy is known. I could not give a qualified opinion as to what your options are now without seeing that scan. Whether any form of synthetic material should be now used is the question. I assume the original implant material was PMMA. Certainly that material should not be used again and HA bone cement would be a better option.

Dr Barry Eppley

Indianapolis, Indiana