Q: Dr. Eppley, I have an indented lower end of my sternum, I think it is called pectus excavatum. I have read about implants to fix but I don’t want a scar on my chest to put it in nor do I ever want any problems with an implant down the road. I was wondering if I was a good candidate for an injectable method of pectus excavatum repair. That seems perfect to me for my chest problem. I have attached some pictures.
A: Thank you for sending your pictures. You have a very discrete lower tail of the sternal depression or a limited pectus excavatum deformity. It’s size and location is deal for an injectable form of pectus excavatum repair or sternal augmentation, the question is one of which material to use. The options include your own fat, hydroxyapatite granules or an hydroxyapatite cement. Having used all three for an injectable sternoplasty approach, I would opt for hydroxyapatite granules or fat. While I love injectable fat (and yes even you as a thin guy have enough to harvest) as it is both natural and will never created an abnormal contour problem, it is very prone to partial or complete resorption due to the tight attachment of the sternal tissues. The pressure of the tight overlying skin is the cause of fat atrophy/resorption. How much of the fat will take can not be precisely predicted before surgery. Hydroxyapatite granules can be injected, are very moldable (as they are granules), will not resorb, and have low risk of any contour/shape issue. Any of the bone cements (composed of hydroxyapatite) are great space fillers and are permanent but are very prone to being overfilled or having an irregular shape (as they set as a hard mass), thus requiring a revisional procedure for adjustment should that occur.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a variety if procedures including brown bone reduction, rhinoplasty, chin augmentation and correction of my chest which I think is a pectus excavatum deformity. I have attached a variety of pictures so you can see all of the problems. I would like to know what you think.
A: I have taken a careful look at your pictures and can make the following comments.
1) Your chest deformity is very slight and not a true form of pectus excavatum. Regardless of what it may be called, I see no surgical procedure that would be worthwhile. Given the mild nature of the sternal groove/depression, the only option would be to build up the sternum with an injection technique to avoid any significant visible scarring. The problem is that it would be virtually impossible to get a smooth result. Without such a result, you would end up with an equally distracting aesthetic problem.
2) Forehead/brow bone reduction is not an option for you due to the mild nature of the bossing and the need to have a scalp scar to do it. That is always a challenging problem in a male. The trade-off of a scalp scar is not a worthy exchange.
3) Your chin shows both a significant horizontal and vertical deficiency. Its amount of deficiency makes your nose look bigger than it really is. It is the one feature on your face that would make the most dramatic change. Because of these three-dimensional chin deficiences, a chin implant is not a good option as it only brings it forward. Only a sliding genioplasty can bring the chin forward and down which are the changes that you ideally need.
4) The only beneficial changes that I see in your nose is the tip. It could be made thinner. But I would not change the height nor the smoothness of the dorsal line. I would also not change the tip position by making it any shorter or have anymore upward rotation. In essence, a tip rhinoplasty is all that you need.
I have attached some computer imaging based on the chin and nose changes.
Dr. Barry Eppley