Your Questions
Your Questions
Q: Dr. Eppley, I have a few questions regarding facial implants. I did not see this addressed on your blog so thought I would ask. My question is regarding the known/ suspected long term effects of having facial implants if any. While I understand that for instance solid silicone implants such as the jaw/ chin implants I’m interested in will last a lifetime; however, what does the aging process hold for those that have such implants? Does placing an implant under the largest muscle (of the jaw) have drawbacks as I age. ( only in my 30’s now) Will jowls/ sagging skin etc show up faster since the muscle is now stretched over this new ( larger jaw)? How will chewing be effected if at all due to this as I age. Or will aging and its various processes just march on as if I never had anything done and just as if I was born with this new wider jaw and more pronounced chin? Thanks again for your time.
A: Facial implants, of any location, have no negative impact of facial aging and may actually have the reverse effect. As implants add volume by addition to the bone, they may prevent some tissue sag, or delay it, that will inevitably occur with aging. Jaw angle implants have no negative effect on chewing other than the initial discomfort and stiffness in mouth opening right after surgery that persists for a few weeks.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have had two c-sections over ten years ago and a tummy tuck with hernia repair five years ago. Then to my surprise I found out I am pregnant again. I am obviously going to need a c-section but am concerned as to whether the scar tissue from my tummy tuck will cause problems for this procedure.
A: It is actually not rare that pregnancies happen after a woman has had a tummy tuck, even though they may have gotten the tummy tuck under the premise that they were done having children. I see at least one or two cases a year of the identical circumstances. A tummy tuck scar presents the incisional guideline for the c-section and provides the obstretician with unparalleled access for the c-section if they desire. The scar tissue from the tummy tuck poses no problem for the c-section and does not cause any more scar tissue than that which would normally exist from a prior c-section.
One of the interesting issues that a c-section poses after a tummy tuck is the potential for simultaneous excision of redundant skin during the closure of the c-section. Some women are curious about or desire a simultaneous tummy tuck at their c-section. A traditional tummy tuck that incorporates a muscle repair can not be done very well due to the enlarged uterus from the pregnancy, but the loose abdominal skin can be removed. The existing tummy tuck scar provides an opportunity, without adding additional scar, to remove any obvious skin overhang at that time. This combined c-section abdominoplasty adds nothing to the mother’s recovery and can also be done under the same epidural anesthetic.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I write to you to inquire if Lefort 1 osteotomy can be done for cosmetic purposes ( for instance: if a person considers herself to have a long mid face). I know my question is vain and somewhat selfish, but it is something that really bothers me about my appearance. Thank you for your time.
A: While a low level maxillary osteotomy (LeFort I) is usually done for some functional benefits (improved occlusion), it can also be performed for a pure cosmetic benefit. The usual reason that is done is in the patient with a long midface and a gummy smile. This is known as LeFort I impaction or vertical maxillary shortening. This is almost the only incidence where a LeFort osteotomy can be performed without having to cut (move) the lower jaw as well. Depending upon how much vertical movement is being done, the lower jaw (mandible) may autorotate enough so that orthodontic tooth movement/alignment before and/or after surgery may not be needed. Because of this potential issue, it is imperative to have an orthodontic consultation prior to considering this surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have poland syndrome, dextrocardia and pectus excavatum. My left side chest is sunken because of pectus excavatum and heart is located on right side because of dextrocardia. I do not have any disabilities in my day to day activities but I’m not happy with the physical appearance of my chest. Also, since I got Poland syndrome the left side of my chest seems to be slightly smaller while compared to the right side. I had undergone a plastic surgery procedure a few years ago in which my back muscle was transposed to fill the absence of pectoralis muscle but still the shape is not good. After going through your website I felt you could help me to get my left chest same to look more like my right. I have been analyzing various options and I came across the application of kryptonite in filling up the dent due to pectus excavatum so I thought the same procedure can also be used for my case. But still the muscle is absent which may need fat grafting from other parts of the body or adjustment of LD muscle further. Please find attached photos for your kind review. I request you to kindly advise me on your recommendations.
A: I have taken a look at your pictures and what I see is a lack of pectoral/chest volume on the left side and a typical high positioned nipple. I do think you would benefit by volume addition but I would not use bone cement. Besides the fact that Kryptonite is no longer commerically available, it would be very difficult to get it in the right place and have a smooth contour. The chest volume you are missing is much more than a cement can do anyway. I would use a modified pectoral silicone implant as you already have the LD muscle flap coverage for it. It could be inserted through the upper end of your midline abdominal scar. This would add volume without increasing scar burden. In addition, I would do an inferior crescent nipple lift to move it downward. This would not create complete horizontal nipple symmetry with the other side but would be helpful. Usually you can get about a cm. nipple movement. These would be two helpful manuevers to lessen your current degree of chest asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a chin implant done on 2/1/2011. It was a 7mm projection Mettleman style. The right side looks wonderful and I cannot feel the implant really at all. On the left side, however, the implant traces nicely along the edge of the jawbone until aproximately the last 8mm of the wing. At that point it swings upward at about a 40 degree angle. The wing can be felt intraorally with my finger near the bottom of my mouth on that side. Aesthetically, on that same side, there is a jowling effect. I do not know if this is due to the free floating wing or if the wing has pushed other tissue upward and created a lump or ball. My surgeon has suggested that we wait 6 weeks and then go in intraorally and either “tuck” the wing back under the periosteum or simply snip it off IF it is beyond the point of the pre-jowl sulcus, thus accomplishing the pre-op goal of filling in that area. He described it by saying that that what is now the “floor” of the pocket where the wing is malpositioned will be the “ceiling” if we tuck it back under the periostium. I believe he would suture the ceiling so as to ensure the wing doesn’t communicate with the previous pocket and again migrate north. Does this sound like a reasonable plan to you?
A: With today’s extended chin implants, exclusively those made out of silicone, the most common complication is wing malposition. The ends of the silicone implant wings are very thin and easily bent or folded onto themselves if the pocket made during surgery is not fully developed and extended enough to accommodate the full length of the implant. Because you can feel the end of the implant in the vestibule at the side of your mouth,it is bent up in that direction which also causes an implant to create a bulge in the jowl area. There are several approaches to fixing the malpositioned implant wing. The intraoral approach is one and is the easiest. The implant can also be removed, the pocket extended and replaced but involves ‘more surgery’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am the mother of 3 children and am soon to be age 35. After going through 3 pregnancies my breasts are definitely not what they used to be. They not only have gotten smaller but they seem to sag more now than before. With each pregnancy they have gotten progressively worse. I know that I need an augmentation but am uncertain if I need a lift also. How do you know if you need a breast lift when getting an implant?
A: An implant will do a great job of adding volume to a deflated breast but it will not lift up a sagging breast. This is contrary to what most women think an implant can do. When the position of the nipple is close to, at, or below the lower breast crease/fold, some type of breast lift will be needed. This is regardless of whether one is getting an implant at the same time. Without a breast lift, the implanted bigger breasts will merely drive down the position if the nipple and may even make it look worse. This can be predicted before surgery by carefully looking at the nipple position and the amount of loose breast skin. When lifts are done at the time of breast implants, the procedure is known as augmentation mastopexy.
Dr. Barry Eppley
Indianapolis, Indiana