Your Questions
Your Questions
Q: Dr. Eppley, I am looking for an otoplasty reversal surgeon who can offer the best possible result for an undesirable otoplasty result in my left ear so. I have attached a picture showing my ear before the otoplasty and a second picture where i had undergone a revision where the sutures and scar tissue was removed in the hope the ear would look how it was before. It shows the antihelix being thick and overfolded in the lower part and the upper part has lost roundness. I appreciate my ear will never look the same as before I had the original procedure but what are your experiences in an antihelix deformity such as this and do you feel you could make a significant difference using any type of revision (cartilage/skin graft, scar release etc).
Thank you for taking the time to read this and I look forward to your response.
A: Thank you for sending your pictures which are very helpful in showing the otoplasty problem. This appears to be an overfolding of the helix, causing a deformity of the antihelix which lies in front of it. The correction would obviously lie in reversing how the otoplasty was done…getting the helical rim to unfold back out. This will not be achieved by releasing any tissues alone as the cartilage is now ‘deformed‘ and has a new shape. The release must be supported by an interpositional graft of which I have used cadaveric rib/bone and the patient’s own small rib graft to achieve a stable otoplasty reversal result. In my experience, this graft technique is essential for the procedure’s success as you have learned that releasing the scar/sutures alone is unsuccessful. (unless it is done within a few weeks/months after the procedure)
Dr. Barry Eppley
Indianapolis, Indiana
Q:Dr. Eppley, I believe that many of the surgeries you perform are far more effective and life changing than traditional plastic surgery procedures.
I’m looking into having forehead, temporal/skull, and chin augmentation, and have found there are very few plastic surgeons are experienced in craniofacial surgery for cosmetic purposes.
I know that plastic surgery in Korea focuses very much on altering the bony structures of the face to achieve a prettier and more youthful appearance and for this reason I have been enquiring with some plastic surgeons in South Korea. Ideally I would prefer to travel to the US and have the above procedures performed by you.
I am interested in having forehead augmentation- preferably using bone cement as I understand that implant placement can be difficult, particularly when placed lower on the skull; I feel that my brows/superior orbital rim are quite flat and contribute to some minor eyelid sagging so would like the forehead augmentation to extend to this area, as well as smoothing out the temporal bone area, and reducing the backward slope towards my hairline.
I’d like head widening implants possibly extending to the temporal region to balance my lower face.
Lastly I’d like to get an “anatomical” or “extended” type chin implant which extends into the pre-jowl area which is quite hollow and shadow-y, and makes my lower cheeks look a little droopy.
A: My understanding of your email is that you seek the following procedures which are primarily Forehead Augmentation and Chin Augmentation. Let me provide some initial clarification on forehead augmentation because your assertion that implants are harder to get lower on the brow bone than bone cement is not accurate. Actually it is the exact opposite. Because foreheads/brow bone implants have a preformed shape they can more effectively positioned on the brow bone area through a smaller incision. Bone cements can achieve the same result but they take a full coronal scalp incision to really place as low as possible.
The biggest dilemma in forehead augmentation is management, if need be, of adding the temporal area in the overall augmentation. Bone cements can not be placed past the anterior temporal line onto the adding temporalis fascia as that often creates the potential for edge visibility and/or pain. Some slight blending of the upper temporal region can be done but it can not extend down too far.
The only really effective method for anterior temporal and posterior temporal head widening is with the use of subfascial implant placements which have to be semi-custom made and are designs of which I only have.
A chin implant that extends back more posteriorly would be the anatomical design which has long tapering wings back to the pre jowl area. That is a fairly standard facial implant request.
In conclusion, the most economic approach would be PMMA bone cement forehead and chin implant augmentation. The cost of the temporal implants would, by your own description, be prohibitive.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal artery ligation. My right temporal artery is considerably larger than the one on my left. Although both are unsightly and bothersome. I have become very self conscious of them. And the are affecting my daily life. At normal rest they are slightly visible. They become increasingly larger and more noticeable when I exercise, when its warm, and when I consume alcohol. And not much alcohol either ! Just a few sips of beer or wine. They even enlarge when I’m talking a lot.
A: Your description of prominent temporal arteries is classic. Prominent temporal arteries can be successfully reduced, and some times completely eliminated, by temporal artery ligation. The secret is to locate the pattern of flow into the visible artery and do ligations both anterograde and retrograde. This is a bit of an art form and, while every temporal artery ligation procedure shows immediate improvement, the real test of the effectiveness of the procedure is what it is like 3 to 6 months afterward.
Temporal artery ligation is a procedure done under local anesthesia in an office setting. Each small access incision for ligation is about 5 to 7mms in length. There is no bruising afterwards with minimal swelling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, i have an occipital fold that I would like removed. I am a 62 year old (hx Type II, obesity) I have a large protruding skin fold at the occipital part of my scalp. I find it extremely bothersome. I’m not sure there is a bone protrusion or just a fold of skin cause I can grab the darn thing between two fingers. I want to get rid of it. I have photos that I can email separately (took them myself and aren’t great quality, but you’ll get the idea).
A: Thank you for sending your excellent quality pictures of the scalp roll on the back of your head. This is a common location for such a scalp skin roll. It can certainly be excised with the aesthetic tradeoff of a fine line scar as its replacement. (occipital skin fold excision) This can be performed as an outpatient procedure with minimal recovery. In the properly’ motivated’ patient it could even be performed under local anesthesia. (although it does not have to be)
Occipital skin fold excision is done by cutting out the redundant skin fold and putting the scalp back together in a more flattened contour. When performed well it can be done with a fairly minimal scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a flatness in the occipital area of my head which is very pronounced, especially with short or wet hair. I have x-rays with a little outline of the augmentation I wish to accomplish. If I were to proceed with an augmentation procedure I would prefer a custom occipital implant. With today’s technology, how big of an incision should I look forward to, and where would this incision be made? Can a custom occipita implant be fabricated using the x-rays I have or is there another form of imaging technology that needs to be used? There is also a slight bump on the top left side of my head. If I wanted to try an shave that down a bit, how much would the incision size change, and can that same incision be used to insert a custom implant for the occipital portion?
A: A custom occipital implant is made from a 3D CT scan, no other form of x-ray will suffice due to inadequate imaging data. A custom occipital implant is usually placed through a low horizontal scalp incision on the back of the head. Unless the skull bump is very near the location of this incision, it would not be able to be reduced through it and another scalp incision closer to it would be needed. There is also the alternative of making a higher scalp incision where the custom occipital implant could be placed and the skull bump could be reduced through the same incisional access.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a tear trough implant. I had a four lid blepharoplasty performed ten years ago followed by an inappropriate injection of Radiesse to both lower lids. Granulomas subsequently developed and were excised a year later but this left me with a depression and mild ptosis of the right lower eyelid. I have had this lower eyelid depression treated with hyaluronic acid fillers for years by a dermatologist, but the depression needs more stable support, especially as I age. I am Interested in consulting with you due to your extensive experience with facial implants. I have attached pictures of my lower eyelids for your review.
A: Thank you for your inquiry and sending your pictures. I can clearly see the depression along the medial half of the right infraorbital rim. As you probably know there are a variety of materials to build up the infraorbital rim. Since the deficiency is really caused by a soft tissue problem (due to the excision of tissues) one could argue that either fat injections or the actual placement of a dermal-fat graft would be the most appropriate technique give the source of the problem. With your history, injections would understandably not be appealing. This leaves the choice then between he dermal-fat graft and a tear trough implant. Each one has their own advantages and disadvantages. But certainly the main advantage of a tear trough implant is its volume stability moving forward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think I need a chin implant. I have a recessed/weak chin and jaw I am looking to get corrected. I had braces as a kid and my teeth fit together fine. I was hoping a chin implant would help alone but my nose might be too large as well.
A: You have at least a 10mm chin deficiency. The choice between a chin implant or a sliding genioplasty is how you would view it from the front view. A sliding genioplasty will keep the chin at its existing narrow width. (unless an overlat implants put in front of it. Conversely a chin implant can make your chin wider/more squatter from the front view. That is what should principally make the aesthetic decision between the two chin augmentation approaches. Regardless of the method used, your labiomental fold will get deeper, unlike what you are showing by pushing your jaw forward to simulate the chin augmentation effect. (this is because the teeth come forward and help augment the labiomental fold)
A chin implant can also help reduce the appearance of a large nose by making the lower face more prominent. It may not eliminate the need for a rhinoplasty is a very large nose but it can delay or even change how the rhinoplasty surgery is done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was in your office a few weeks ago originally for a consultation about liposuction. However after speaking with you, you informed my that the best procedure for my goals would be the extended male tummy tuck. I’m still considering this procedure however, I’m getting a bit nervous as while I have had surgical procedures before, this would be the very first one that is considered “elective”. While I have a few more questions about this procedure and your practice.
I’m not sure if I should email you these questions or if I should schedule an appointment to meet with you. Therefore, I figured I would try email first and if you recommend me coming in, I’m willing to do that as well. Please see the below:
1. I was looking through your website and while I see some of the procedures you have done with respects to this procedure with women, I didn’t see any regarding men. Are there significant differences between performing this procedure on men then women? Also, if I can ask, how many of these procedures have you performed on men?
2. What would be my realistic outcome should I have this procedure done? I realize that you would have to remember speaking with me regarding this question. However, in the event you do I figured I would ask in this email. I have looked online and have seen many success stories regarding this procedure. However, I have also seen many not so successful stories where the outcome had’t met the patients expectations.
A: In answer to your questions:
1) About one-third of extended tummy tucks that are done (usually due to weight loss) are in men. I have done many. What prospective patients fail to appreciate about any plastic surgery website is that any photos shown are just a small fraction of what has been done and are only there to provide a general idea of the procedure. Also plastic surgeons can only post pictures that patients will allow to be posted and that is often a very low percentage of patients…men are the most restrictive in this regard.
2) There is nothing in men that make any form of a tummy tuck harder than in women.
3) Every tummy tuck patient, men or women, achieves great improvement. I don’t ever recall any patient that has ever said it was not worth it or did not have significant improvement. This is particularly true in weight loss patients who have no other mechanism to get rid of their resultant loose skin or tissues. That being said, that does not mean that in some cases a secondary revision may be done to help some solve residual issues (e.g., dog ears, scars, contour asymmetry) No plastic surgery procedure, particularly one that covers such a large surface area, ever produces a perfect result. Whether any remaining or more minor aesthetic issues are bothersome enough for the patient to undergo a touch up or revision procedure will vary for each patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an active depressor septi muscle in a way my upper lip is very shortened during smiling. this muscle has been partially cut during a nose job and it was perfect, but after a few months it has reattached.
Therefore, i would like a permanent outcome… a complete cutting of the muscle. Can you do the incision from inside the mouth? Can you explain to me please the process of the surgery?
A: Since the depressor septi muscle can not grow back or reattach itself after surgery, the temporary improvement you saw was due to swelling and temporary muscle inactivity from the rhinoplasty surgery. Once the muscle recovered from the surrounding surgery, it recovered to full motion like that prior to the nasal procedure.
The depressor septi muscle can be cut from inside the nose or from inside the mouth. I find the intraoral approach to be the most assured at getting a complete release of the muscle. This also allows the best view of the muscle from its origin at the incisive fossa of the maxilla to its insertion on the nasal septum. By electrocautery the muscle can be visualized and released in a controlled fashion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom skull implant.I have a flat back of the head, that I hide every day as much as I can with my hair (no hair loss). I am interested in the skull reshaping procedures using custom implants described in the page: http://eppleyplasticsurgery.com//skull-reshaping/. I am particularly interested by the computer designed flexible implants, and the example photographies of a skull with/without implant in the middle of the section ‘custom skull implant’ matches quite closely my situation. I believe that an additional 50cm3 volume would be largely sufficient to get the desire ’rounding’ effect, after testing with plasticine, however I do not know if this volume would fit under my scalp.
I have listed below my questions (I have a lot, but I am considering very seriously this surgery), I hope you can answer them either by mail or a scheduled interview, as you see fit (however I’m more comfortable writing english than speaking it):
1) what is the volume range of the implants that can be inserted?
2) what is the material used to 3d-print the implant? How long is it supposed to last?
3) what would be the size and position of the scar necessary to insert the implant?
4) can you give me the necessary details of the 3D imagery you need, so that I can already schedule the skull scanner in a nearby laboratory?
5) what would be the cost of such an intervention?
6) If the implant has to be removed, even a few years later. Iis the removal a simple process? Can the screws be removed?
Thank you for your time.
A: In answer to your questions about a custom occipital implant:
- I do think of skull implants in terms of volume. Rather I think about their maximal thickness and how the scalp can stretch to accomodate it. In general, a custom occipital implant of 10 to 12 mms thickness can be tolerated by most patients regardless of the surface area that it covers.
- The implants are made of solid silicone and will last forever.
- The implant is inserted through a low horizontal scalp incision on the back of the head.
- A high resolution (.1mm thocknes slices) skull 3D CT scan is needed.
- My assistant will pass along the cost of the surgery to you tomorrow.
- The implant can be easily removed later. I no longer use screws for implant fixation as they are not needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a sliding genioplasty to correct my weak chin and create a longer jawline. I have fullness at my lower half of the jaw which is actually bone even though it looks like jowls. I have a bone notch half way down my jaw where the bone comes out so the jaw looks fuller and looks too masculine for my liking from the front. I’m not sure where the cut from a sliding genioplasty is but if it is quite far forward so this part of the jaw can be shaved down a bit in addition to moving my chin?
A: Your question is a good one as it relates to the width of the jaw behind the chin where the location of the sliding genioplasty is performed. The bone notch to which you refer is actually normal and is known as the antegonial notch. As the jaw bone descends from that area it can sometimes get a little wider. Whether it can be safely reduced depends on the exact location of the width and its relationship to the mental nerve from the bone which exits somewhere close to that area. While to may be aesthetically desired to reduce it you also don’t what to potentially cause permanent numbness to your lower lip and chin either. The bone cut from a sliding genioplasty is a horizontal one and usually goes back behind the location of the nerve. This bone segment moving usually creates a more narrowing effect to the jawline as it becomes longer. In some cases it may be possible to reduce some of the bone behind it but if I think that the mental nerve is at risk for injury I won’t do it. It all depends on where your mental nerve comes out of the bone in relationship to this area of bone width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant revision or removal. I had my initial chin implant placed about one year ago. Immediately I know it was too big. The doctor talked me into a revision and now it’s pointy and not the shape of areal chin. I Only wanted subtle chin projection. Now I wish I never had it done at all. I am worried about chin ptosis if it is removed especially after reading your info online and I don’t know what to do.
A: I think you have two chin implant revision or removal options:
1) Downsize the chin implant to a much smaller one with intraoral suspension. This still leaves some soft tissue support and has the lowest risk of chin ptosis, or
2) Remove the chin implant entirely and do an intraoral suspension and hope for the best. There is still a chance you may be able to avoid the chin ptosis problem. It is not always a 100% guarantee that it will always happen when a chin implant is removed. The risk is high but it is not 100%. There are successful ways to manage chin ptosis even it occurs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My knowledge about Smartlipo is limited. I have watched many tutorial videos and read information that has been posted on doctors websites. I understand that it is a procedure that uses a laser to help extract the fat. It seems to have less bruising, less downtime and less time one has to wear the compression garment than traditional liposuction.
Maybe Smart lipo is not the best procedure for the unwanted fat on my abdomen, flanks, back bra area, thighs and let’s throw in the chin area for good measure. But that is the reason for the consultation….for you to advise me on options that will best fit my needs.
A: The reason I ask about your perspective on Smartlipo is that it is highly misunderstood…which is not the patient’s fault. Many doctor’s marketing of it is false…or at the least a but understated. Smartlipo is not different in terms of invasiveness, amount of bruising, recovery or downtime than any other form of liposuction. It is just a different way to loosen up the fat to remove it but it is still a very invasive procedure just like every other form of liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a skull implant. I have attached photos of my mutant head. As you can see I got this stupid bald ugly head, it is not very visible from behind but looks very bad from left or right side. It is not very much dented but it is enough and bothers me very much. So many people ask me what happened to my head or they just staring at my head like I came from another planet. Is there any way to fix it? This skin on my crazy head is kinda flexible and I thought it would be enough to pull that skin in a direction to make it less visible or apply some kind of implant under the skin to make my head more round on that flat area and cover that bump/dent. Any suggestions? How long does it take for such a surgery or some other kind of fixing it?
A: Thank you for your inquiry and sending all of your pictures. There is no question that the best and only way to get the back of head built out and smooth is with a custom made skull implant. This can be designed on the computer using a 3D CT scan of you and then inserted through a small low scalp incision to fit over the bone. I have done such skull augmentations many times. I have attached a recent back of the head case that shows how this technology works and how effective it can be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a large congenital nevus on my left cheek. It has been bothering me all my life and at this point I just want it gone. Please see below for pictures. Would skin graft treatment be an option for me and would it have a lesser chance of scarring?
A: Thank you for sending your cheek nevus pictures. The best way to treat your congenital cheek nevus is through a process known as serial excisions. You can’t just cut the whole nevus out or skin graft it as that would end up making it look worse. To end up with the best final scar, one does subtotal removal of the nevus inside its existing margins for two stages spaced three months apart. This does not overstretch the surrounding skin (thus keeping the scar narrow) and keeps making the nevus smaller. After two stages only a thin one of nevus if any will be left for the third and final excision/scar revision. All of these procedures can be done in the office under local anesthesia. There will be a scar but the goal is to have it end up as small as possible without distorting the surrounding cheek tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in eye asymmetry surgery. A few months ago I fainted and fell against a sink. The result was a left eye broken orbit (only the rim below, not a blow out fracture, no displacement). After a few weeks when the swelling was gone, I saw that the position of my left eye was different from the right side. Doctors measured a different of the position of the globe of 1.5 mm. Although it might not be much, in my case it is obvious. Doctors told me that it could be from fat atrophy. Do you think that an implant or so can help me to get my eyes more symmetric again? Many thanks for your response!
A: If an eye asymmetry has indeed developed after some type of orbital fracture, particularly if occurring within the first month after the injury, I would have it assume that this is due to a skeletal issue not fat atrophy. (as that would take many months or even years to be seen) But regardless of its cause a horizontal globe asymmetry can be treated by one of two methods, an implant or fat grafting. A small implant can be used to build up the orbital floor or a dermal-fat graft can also be so placed. (if you happen to have a c-section from your children) This is a simple surgery in which either material can be placed through a limited subciliary or transconjuncitival incision. The hard part is just deciding if such surgery is absolutely necessary and what material to use in doing it should it be so. Please send me a picture of your eyes showing their current state.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an Inquiry regarding breast augmentation, I am wondering if my wife would be a candidate or should even consider a consultation. She had ovarian cancer in 2005 and then in 2014 was diagnosed with Stage 4 head and throat cancer. She is currently in remission. She has always wanted breast augmentation surgery but I wonder now if it would be too late.
A: Just because one has cancer, or even a lifespan that looks limited, does not preclude one from undergoing breast augmentation surgery. I did a lady some time ago who a stage 4 liver cancer. She had always waned to have breast implants and finally fulfilled her wish. She lived for two years after the procedure. It is all about making patients happy. Some people in having a cancer diagnosis may take that trip around the world or climb up Machu Picchu…others may want to have breast implants. There is no medical reason to not do so if her cancer doctors approve and she is not on any active chemotherapy or immunosuppression drugs. Breast augmentation surgery would be comparatively ‘easy’ to go through compared to any of her other cancer surgeries.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in paranasal implants…again. I had jaw surgery five years ago which successfully corrected my under bite, but I still have mid-face concavity. I originally sent you pictures a couple of years ago and you said I was a good candidate for this procedure. A little over year ago I had the paranasal implant surgery done locally, but there were about 3 small tears that opened opened up along the incision line, which lead to infection less than 2 weeks after the surgery. The surgeon offered to redo the procedure after 6 months of healing at a discount, but I didn’t have much faith in him after that.
For the implants, we had selected the larger 7mm porous implants, and it completely eliminated the concavity, and it looked good despite the little bit of swelling that remained.
A:Thanks for providing your paranasal implants history. You obviously had Medpor paranasal implants which I don’t like since they have a higher rate of infection due to their porosity. Paranasal implants are unique amongst facial implants because they have the thinnest soft tissue cover over them being right under the lip. Unless one gets a two layer closure over the implants, which includes a good muscle layer, wound breakdown will occur. It sounds like you probably had a combination of both that lead to an early exit of the implants. Whether the 7mm thickness of the paranasal implants is really adequate is unknown because it really takes up to 6 weeks for all the swelling to be gone. But with your history of prior surgery and now scarred tissues, I would not push it beyond that thickness anyway.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in abdominal panniculectomy surgery although I am not exactly sure what it is but it sounds like what I need. I’m 45 and am about 510 lbs at 5’10.
I need help asap. I have a real bad overhanging belly and a scar from my belly button to waist that’s feel likes it’s ripping. I also have bad hernia that’s randomly pokes out and creates extreme pain.
A: While there is no question that some form of an abdominal panniculectomy could be incredibly helpful, at your level of weight it is also a surgical procedure that has a very high risk and will undoubtably have a 100% complication rate. This most certainly will be from a wound healing standpoint and potentially from medical risks as well. This is also a procedure that would have to be performed in a hospital that would likely need 5 to 7 days of hospitalization…and that is providing that no significant medical complications occur. You are going to have to get a medical reference from your physician who has been following you and has you in the best health as possible for this weight. He/she must also feel that the procedure is medically indicated and that your are cleared to have the procedure.
In short, while an abdominal panniculectomy would provide numerous medical benefits, it is not a procedure that should be approached lightly and with great preoperative consideration. I would assume you know that losing weight by bariatric surgery would be far preferred before undergoing such a procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I absolutely hate my face and how it looks different on both sides. What would I need done to make myself look more symmetrical. I only like the left side. I hate people even looking at my right side and I wont ever take face forward shots. I attached a picture to show you. I just really hate it and very insecure. I feel like everyone can notice that one side of my entire face is higher than the other and that one eye is bigger than the other.
A: Thank you for sending your picture and expressing concerns. I can clearly see the differences between the two sides of your face and most, if not all, of the asymmetry is in the periorbital region. (around the eye) Because the picture you sent may be inverted (mirror image) I am not sure which is the right or the left. But there is one side where the eye is bigger and the brow bone and cheek bone on that side are more developed. While the opposite side has a smaller eye and a slightly lower brow bone edge and smaller cheek.
When it comes to facial asymmetry and facial reshaping surgery that involves the eye, the bigger eye or higher side can not be lowered. Only the smaller side can be made more open or raised. Thus on the smaller side the brow bone can be shaved to raise it, the cheek augmented to make it fuller, the eyeball raised to make the pupil more even with the other side and the upper and lower eyelids raised to expose more of the white of the eye.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a skull implant question. In your experience how do these two materials perform in terms of edge transitions (edge of implant to the skull)? Is there a noticeable step off from the implants onto the skull on a shaved head?
A: In the shaved or bald male head, there is always a concern about a visible transition of a skull implant to the bone. Eventually any less than smooth transition will be seen no matter how thick the scalp is. PEEK implants can not be made with a feather edge to them because of the way they are manufactured. (machined) Furthermore they were never designed to be used an an onlay and the company will probably not make them knowing that it is to be used as an onlay since they are only FDA-approved as inlay skull implants for defects. Conversely silicone skull imlpants can be made with a fine feather edge by virtue of the way they are manufactured. (poured and oulled off of a mold)
In short, a silicone skull implant offers the best material capability for the smoothest implant to bone transition. In the exposed scalp patient a skull implant needs to have a virtual feather edge at its perimeter.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in cheekbone reduction. I am a 24years old female. I would like to have Zygoma reduction. (by intraoral route if its possible) I want to do this surgery to have more slim face. Do you do on the CT face scan analysis and do you use melting screw? Do you do Anterior segmental osteotomy surgery? Looking forward to hear from you. Thank you.
A: Cheekbone reduction osteotomies for facial narrowing is usually done with an intraoral anterior osteotomy of the posterior zygomatic body combined with a posterior osteotomy of the zygomatic arch where it connects to the temporal bone with a very small incision in the hairline. Small 1.5mm titanium plates and screws are used for bone fixation. While resorbable plate and screws can be used they are much more expensive than titanium and do not work as well. While an anterior osteotomy of the posterior zygomatic body can be done alone, it does not create as much facial slimming as when a posterior zygomatic arch osteotomy is done as well. I usually like to see a 3D CT scan before surgery to determine how much inward movement can be obtained with cheekbone reduction osteotomies.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having blepharoplasty surgery to remove the extra skin of the upper eyelids and the skin and fat from my lower eyelids. The poor condition of my eyelids appears to have gotten worse in the past year when I was diagnosed with an IgA automimmune skin condition and have been on dapsone and tetracycline antibiotics which have helped tremendously get it under control. My question is whether this medical condition and my medications will adversely affect blepharoplasty surgery?
A: Dapsone, also known as diaminodiphenyl sulfone (DDS), is an antibiotic that is best known for its treatment for leprosy. It has had this use in leprosy since the early 1940s. Ss an antibiotic dapsone inhibits bacterial synthesis of dihydrofolic acid which is very similar to how sulfa antibiotics work. The most common side effect of dapsone is blood-related with the development of some degree of hemolysis in about 20% of patients on the drug. From a skin standpoint dapsone can cause mild skin irritation, redness and dryness and burning and itching. There is no evidence that it impairs the ability of skin to heal.
Linear IgA bullous disease (LABD) is an autoimmune skin disorder in which blisters form in the skin and mucous membranes. Blistering occurs because of the development of a split between the epidermis and the dermis, where IgA autoantibodies react to components of the hemidesmosome and basement membrane. Linear IgA bullous dermatosis improves or clears with the use of dapsone. Dapsone is often combined with a tetracycline antibiotic for maximal effect. I find no evidence that wound healing is impaired in linear IgA bullous disease. While there are rare cases of eye involvement in LABD, wound healing impairment of the eyelid skin has not been described.
In conclusion, having LABD and being on dapsone medication does not appear in any way to be a contraindication to having eyelid or blepharoplasty surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I suffer from an upper labial artery aneurysm. I also have the visible pulsating happening in the center right of my lower lip too but its in the inside of my lip so it isn’t visible to people that see me. I’ve been suffering with this humiliation for the past ten years.
You can literally see the artery in my upper lip pulsating in the center right part of my upper lip(extremely noticeable to other people). The entire artery through out the right side of my upper lip is so swollen that I can bite it and feel it against my teeth.
But on the same day this happened ten years ago, even though the pulsating on my bottom lip is harder to see, the right side of my bottom lip became severely discolored. The discoloration on the bottom lip is on the right side as well and stops right were the pulsating blood vessel is on my bottom lip. and where there pulsating is on my bottom lip there is a small lump. Do you think that is the source of the pulsating/swollen upper and lower labial artery? At the time all the doctors after all the scans and blood test weren’t able to help me. Just recently did I find out myself that this is a medial condition that other people suffer from. I thought I was alone suffered with this problem.
Will laser therapy work in hiding the pulsating artery?
A: The surgical treatment for an upper labial artery aneurysm or prominent labial artery is ligation. This almost always has to be done through at least two ligation points. In your case it may actually require three given the upper and lower labial artery involvement. In a true aneurysm the protruding sac may also need to be removed as well.
Laser treatments are not going to be remotely effective for this type of vascular problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 43 year old female and suffering from a flat back of my head. I was born with normal head BUT at a very young age (talking 10-15) I have been applying metal rollers to my head and in order to make the curls tight I would tighten up the rollers on maximum and then slept on them – EVERY NIGHT and I remember my head used to hurt in the morning. This was going on for a long period of time because I used to hate my straight hair and wanted them curly….. Then, at later stage as a teenager it became clear that I have destroyed my head shape. The back of my head is very flat.
I understand this would have to be a surgery. I have heard of an implants that could be placed under the scalp to help to improve the shape of the head and I would appreciate if you could let me know whether you have experience in this procedure.
Many thanks in advance.
A: There is no question that the definitive treatment for a flat back of the head is a custom occipital skull implant. I am an international authority on this procedure and have performed it many times. It is done ideally using a 3D CT scan from which the implant is designed and fabricated. Most custom occipital skull implants are placed through a low horizontal incision on the bottom of the hairline on the back of the head. The only question is whether there is enough scalp to stretch over the size of the occipital skull implant that one desires. I would need to see pictures of the back of your head to determine your degree of flatness and how much skull augmentation you need.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I found a picture below on your site, and i wanted to ask you what exactly has been done here.It looks like lip lift but it has been lifted not only in the middle, but on the sides too!I wanted to do a lip lift, but i always was aware that it lifts only the middle part, which makes lips look unnatural, but doctors who I’ve asked said that it is not true. You are the first one who confirmed my suspicions, so I kind of trust your opinion now.
A: You are correct about a lip lift, it can never do more than lift the central part of the lip. (cupid’s bow) It can look natural if it is not overdone. Some surgeons do overdo them because they believe that the more one pulls up in the center that it will somehow lift up the sides. But this, as you have surmised, is incorrect. The lady in the pictures had a lip or vermilion advancement which moves (‘lifts’) the entire vermilion or lip edge upward from mouth corner to mouth corner. This is done by removing a strip of skin at the lip edge.
The lip advancement is a close cousin to the lip lift but is much ore effective and is the only good lip enhancement option in very thin lips. The trade-off for its effectiveness is that it creates a very fine scar at the lip-skin junction. But in properly selected patients this does not turn out to be a concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would the custom forehead implant also augment the temporal regions that require augmentation or would I need separate temporal implants?
I have seen surgeries performed where the implant is rolled up and inserted via a small (4 cm) incision that runs from front to back of the scalp versus side to side. Is this possible regarding the implants you use? Thank you.
A: A custom forehead implant can be made to any dimensions and size including incorporating the temporal region. Whether it should extend past the anterior temporal line at the sides of the forehead into the temporal region depends on where you are looking to achieve temporal augmentation.
The concept of using only a 4 cm long scalp incision to place a forehead implant only applies to small round central forehead implants usually used in women. Men that get a larger custom forehead implant that includes the brow and temporal regions need a longer scalp incision despite the fact that they may be rolled for insertion. A custom forehead implant covers a large surface area and, as as result, need a longer scalp incision for insertion that does a smaller more central forehead implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been googling all night and saw a picture of my butt! When I followed the link it led me to your site. I have suffered with them embarrassment of my saggy butt for most of my life. Even in my late teens when I got down to 95lbs due to working out three times day I still had a saggy butt! I’ve researched butt implants and fat transfer to my butt (I don’t have enough fat) but I really don’t need a bigger butt. I just don’t want the sag. How many of these procedures have you done? How long would I have to stay in Indianapolis after surgery before I could fly home?
A: You are referring to a lower buttock lift or tuck. I have done many lower buttock lifts and it does work well to correct a lower buttock skin sag. Please send me some pictures of your buttocks for my assessment for this procedure. I will have my assistant Camille pass along the cost of the procedure to you later today. You could return home the following day as this is a procedure which is not associated with much pain and all sutures are placed under the skin so there is no need for suture removal later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in revision rhinoplasty. With rhinoplasty surgery my surgeon shortened my nostrils, cut my hump on my bridge, and my nose tip didn’t cut at all, just is rotated upward. I need to know how to reduce with revision rhinoplasty that distance between upper lip and nose and the fat philtrum and how to narrow nose like it was before. Can nose be longer like it was before and narrow with all size. I’ve heard that by lengthening nose with cartilage graft, nose can get wider. I must say again, that I don’t won’t to go with a lip lift, just thinking about revision rhinoplasty.
A: No revision rhinoplasty can reduce the distance between the base of your nose and your lip. Only a lip lift can make that change. There is no procedure of the lip that can reduce or thin out a ‘fat’ philtrum. The only way to narrow the nostrils is by lengthening the nasal tip and this will require a cartilage graft to do so. But this will make the tip longer which may be an undesired aesthetic change. You may instead consider shortening the tip and use alar rim grafts to help wide the nostrils.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am writing concerning liposuction and fat grafting into my breasts. (fat injection breast augmentation) I am curious as to if this surgery could be performed by mid April if I were to schedule immediately. I am 18 and my high school prom is April 30, so I was wanting this as soon as possible. Also, can liposuction incisions be made through previously existing laparoscopic scars? Thank you.
A: The first question about your potential procedure is whether you are a good candidate for breast augmentation by fat injections. The key question is whether you have enough fat to harvest to create enough of a breast size increase to justify the procedure. While the operation is understandably appealing, few women are actually good candidates for it…they either don’t have enough fat to harvest (it takes a lot more than most people think) or their breast size increase goals are not realistic with what fat grafting can achieve. (usually about a half cup size is the typical outcome) Thus it it important to understand that breast implants and fat grafting are not really interchangeable procedures in terms of their outcome.
There are a variety of secondary issues that are also relevant. If you have the procedure by mid-April you would be barely recovered to go to a prom by April 30th. Also more small incisions would be needed to harvest fat than just that from laparoscopic scars. That is because abdominal liposuction alone is unlikely to have enough fat in most people to do a worthwhile fat injection breast augmentation procedure.
Dr. Barry Eppley
Indianapolis, Indiana