Q: Dr. Eppley, I would love to show less gum when I smile. I have tried Botox and it has slightly improved the amount of gum shown, however I would like a more permanent solution. I have had repositioning which involved sewing the lip down, and although it looked nice for a while, it appeared to stretch out and go back to normal. I am terribly afraid of the procedure which involves cutting the bone, so I’m hoping that a soft tissue correction will fix my smile.
A: Based on your pictures and the magnitude of your gummy smile, I would not be optimistic about any soft tissue procedure significantly improving your gummy smile. As you know, the best procedure for you is a maxillary impaction osteotomy. (vertical upper jaw shortening) Since I do not know exactly what soft tissue procedure you had done, I can not tell whether my soft tissue approach to the gummy smile will provide benefit to you. I am not sure what was exactly done in the ‘sewing the lip down’ procedure and whether it involved labii superioris muscle release and a mucosal v-y lip advancement. I would need to read the operative note from the procedure you had done to tell if a different soft tissue approach to your gummy smile would be more effective.
Dr. Barry Eppley
Q: I had an accident about a year ago in 2009 and got a stitch on my right chin to fix it. The scar is about 1 inch long. I got my real color and texture for the scar. But the skin above the scar had a slight swelling which is making the scar more evident. Is there any way to reduce this swelling? I would like to know the technique and cost of the treatment, which would help to improve the appearance of the scar.
A: The slight swelling to which you refer in your scar is no longer swelling. That would have resolved a long time ago given that this injury is more than a year old. What you undoubtably have is a residual mismatch in the skin edges with the upper edge being slightly higher than the lower one. This gives the illusion of swelling when it is really differences in tissue thickness between the two sides. This is a result of the original repair.
The best and only solution to improve this scar is excisional scar revision. The edges of the scar are opened up and the skin edges are realigned so they lay more flush and can heal back in a smoother fashion.
Dr. Barry Eppley
Q: I would like to know few things about butt implants Dr. Eppley did my breast implants few years ago and now i would love for him to do my butt. I want to go big. What sizes and shapes can I pick from?
A: Buttock augmentation is similar to breast augmentation in some ways but different in others. Buttocks implants, unlike breast implants, are made from a very soft and flexible solid silicone rubber material. They are not fluid-filled. Like breast implants, they can be placed above (subfascial) or under (actually into) the gluteal muscle. Those two different locations carry greater significance in buttock implants than in breast implants,, particularly in terms of recovery. Intramuscular implant placement is preferred but that also limits the size of the implant that can be used and makes the recovery much more prolonged and uncomfortable. One’s anatomy also can also drive this choice because if there is little subcutaneous fat present over the buttocks, the intramuscular location will produce a smaller but more aesthetic looking result. (concealing the implant edges better)
Buttock implants come in either round or oval shapes and have volumes ranging from about 150cc to 400ccs. Unlike breast implants, in which the size range that can be used is much more variable, the size and shape of buttock implants must be more closely matched to the surface anatomy and measurements of one’s buttocks. In the buttocks you don’t have the luxury of just putting in whatever size implant you want. The risks of postoperative problems and complications is higher when you do so.
Dr. Barry Eppley