Your Questions

Q: Dr. Eppley, I got temple implants and they are causing me so much pain whenever anything touches the side of my head. Could it be pressing a nerve? Will I have saggy skin if I remove them? It was silicone  temple implants and I can feel a bump on one side (the side which hurts). It is like maybe the implant has shifted in to a strange position because it isn’t painful or bumpy on the other side. Is it quite easy to remove?

Also I notice it made my cheek look fuller and less hollow. Is that because they rest inside the zygoma arch? And therefore my previous hollow cheeks are not as hollow anymore? Does that happen as a result? I miss my sculpted cheeks. 

A: I am sorry to hear of your problems after temporal implants. Having done a lot of temple implants, these are symptoms that I have never seen nor can I imagine why they are occurring. In my experience, I place silicone temporal implants under the fascia so they sit on top of the temporalis muscle belly. They have never caused any pain or muscle dysfunction by doing so. I would have to know more about your temple implants (material, location of the implant and the incision used to place them) to see if I can determine if there is some explanation. But rest assured that if you removed them, there would be no loose or saggy temple skin.

The good news is that silicone temple implants are easy to remove. You did not tell me whether they are above or below the fascia but you probably don’t know that detail. (that would be in the doctor’s operative note) The difference between the two sides suggests that they indeed are in different positions. (maybe one is below the fascia and the other above it)

With subfascial temple implant placement (the proper temple implant location), there should be no change in the appearance of your cheeks. Sitting under the fascia and not really inside the zygomatic arches (they sit above it), they would not cause any change in cheek contour. Only if they are sitting above the fascia would a change in cheek appearance occur as they would make the cheek look fuller up top. It would be helpful to see pictures of your face and these implants to better answer this question.

It is unclear based on your problems as to whether our temple implants should be removed or placed into their proper position if they are indeed above the temporalis fascia.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am in need of a special type of lower blepharoplasty. I had artefill injected under my eyes and have been having problems with it. Have you ever removed artefill in combinaion with a lower blepharoplasty before?

A: When it comes to lower eyelid procedures, I have seen may different materials placed in the lower eyelid tissues and along the bony orbital rims and orbital floor.  I have removed in the past lumps of fat, clumps of artefill/artecoll, goretex strands and Medpor implants while doing lower blepharoplasties. Many of the particulated injections are often in the orbicularis muscles but because they are usually in clumps. Most of the material can be dissected out and removed as part of the lower blepharoplasty procedure. Your case illustrates the potential problems with using particulated fillers in the thin tissues of the lower eyelids. The appeal of a permanent filler is great but every particulated filler with non-resorbable particles has a great propensity for clumping and fibrosis.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to ask about the inconsistency that I see and you have talked about in jaw angle implant outcomes. For some reason, results seem to be very inconsistent with this procedure even with the same  plastic surgeon. Could you explain why this happens?

A: Jaw angle implants are a very tough procedure to do and ideal symmetry is often a problem. Even in the best and most experienced hands, asymmetry of identically shaped implants is not rare. While the implants may have an identical shape, the patient’s bone often does not and you are trying to precisely fit a preformed shaped implant that does not have an identical match to the bone on which it sits. In short, it is an imprecise science. The only really good symmetrical results that I see consistently is in the use of custom implants done off of a patient’s 3-D model. And this is for good reason, perfectly adapted implants that have been made to fit the patient’s jaw anatomy.

While jaw angle implants can make a significant aesthetic facial difference, one who undergoes the surgery needs to be willing to accept jaw angle asymmetry is a risk as well as it is impossible to guarantee any particular look that will result from the surgery. For the patient who is seeking a perfect result and will only be satisfied with such, jaw angle implants may not be a satisfying procedure for them. That does not mean that a very good result can not be obtained, but perfect asymmetry in any bilateral surgery (jaw angle implants not withstanding) is difficult to achieve.

Dr. Barry Eppley

Indianapolis,Indiana

Q: I am 28 years old and have had 2 kids. I only gained about 25 to 30 lbs with each pregnancy but I still ended up with stretch marks on my lower stomach and loose skin around my belly button. I know that liposuction alone is not the solution for my stretch marks and loose skin. I am at a fairly good weight for me being 5’ 3” and weighing 130 lbs. Which type of tummy tuck do you think would be best for me?

A: While it is impossible to give an accurate assessment without photos, your description of your abdominal concern do make for a philosphic discussion between the two types of tummy tucks.   The conceptual difference between a mini- and full tummy tuck is that the more limited procedure produces less of a result (around the belly button area) but has a smaller and lower placed horizontal scar. The key question is which trade-off can you live with better…a flatter and more complete abdominal result but with a much longer and higher horizontal scar (full) or a less long lower placed horizontal scar but with some stretch marks and loose skin still left around the belly button area. (mini-) There is also a belly button scar difference as the full tummy tuck will have one and the mini-tummy tuck will not.  It really comes down to which aesthetic trade-off  (scar vs amount of improvement) is more important to you.

Many women will less severe lower abdominal concerns (excess tissue) do opt for a mini-tummy tuck. When combined with liposuction in the upper abdomen and around the sides of the waistline, this more limited tummy tuck approach can provide for good improvement with a very acceptable low-placed scar.

Dr. Barry Eppley

Indianapolis Indiana