Q: Dr. Eppley, I am interested in getting facial implants and am gathering information about getting plastic surgery. My intention is to improve my facial features with facial implants and cosmetic plastic surgery. I would like to get your professional impression and advice to enhance my look.
The areas that I would like to improve are:
– Jawline. I think I have an elongated face. So, I am looking for a more square and strong jaw.
– Cheeks and Eye Hollows. I am starting to notice some eye hollows. I think I do not have a strong features in this area, they are somehow “flat”. At this time, it is not bad, but I believe with time they will get more pronounced.
– Upper Eyelids. I notice that I have extra skin on my eyes lids, especially on my left eye.
– Any suggestions to make the face more aesthetically balanced and harmonious with the rest of the face.
– I am concerned about the scars and the surgery around the eyes. I do not mind internal scars but external incisions concern me.
– What is the material used for the facial implants? I read about Silicone, Medpor and Gore-Tex. I would like to know your impressions about these materials, and their pros and cons, and why you use ones over the others.
– Asymmetry, implant shifting and/or misplacement (due to position, scarring, etc.)
– Final look. I would like to look natural and not “done”.
– Revisions. What is your policy in case of revisions?
– Complications during and/or after surgery. What is your policy in case of complications during the surgery and/or after the surgery? nerve damage?, secondary effects?, responsibility, cost, etc.
– Bone erosion with implants over time. What is going to happen with the implants when I get older. I am 30 years old at this time. What is going to happen with the implants and the bones when I am 85-90 years old? the implant, the screw, the bone. Is there any research done about this?
– I can imagine you have heard this before, but I would like to get the “model” look. Strong, symmetrical, pleasing features. I attached some photos of some ideal looks, by all means I don’t want to look exactly like a specific “celebrity” or “model”, it is just an idea of the look I am looking for.
– Could you provide me with your professional impressions about the surgery/ies that I will be benefiting from, their related costs and results?
– Do you provide any imaging about the possible results. I attached photos of my face in different angles.
– What are the difference between conventional and custom designed implants? what are their costs?
– How long will I have to stay in Indianapolis after the surgery?
– When would I be able to return to my normal life work, exercise, being in public, etc?
– How much discomfort should I be expecting in the surgery?
A: I have done some computer imaging on your face for the various facial implants for the following procedures:
1) Square chin augmentation
2) Vertical lengthening as a well as width expansion jaw angle implants
3) Cheek implants
4) Fat injections to the lower eye hollows/tear troughs
In answer to your questions:
– there would be no external incision with fat injections
– implants would be silicone, best because of better shapes and easily reversible or modifieable
– all implants would be screwed into place
– natural comes from not using too big of implants, particularly when multiple implants are being used.
– we have a complete page of the revision policy which you would get to read before surgery.
– bone erosion is a non-issue. The implants will look the same decades from now as they will one year after surgery.
– you are correct in assuming that every male who wants this kind of surgery wants the ‘male model’ look. Those who have a chance to come close to that look have to have thinner faces and some decent underlying facial bone structure…you are the uncommon one that actually fulfills these criteria.
– I have attached some imaging predictions for your review. I will have my assistant pass along the costs to you in a day or two.
– you should be fine with standard implants. Custom implants are always ideal but at the additional costs of $7500 they had better provide a real difference…which in your case they do not.
– 2 to 3 days, all based on how you feel.
– that is based on how you feel and look, somewhere between 10 and 21 days after surgery.
– jaw angle implants provide the most discomfort, the other procedures are much less.
Dr. Barry Eppley
Q: I desire a larger more prominent but one that is more sculpted. Can you do the a cleft chin implant with the y fissure? Or a chin dimple? I am looking for a square chin implant with the y fissure. I have a implant now but it is not squared and not exactly what wanted.
A: Chin implants today come in a vareity of styles and sizes. Some of those styles from different manufacturers include square chin implants and chin implants that have a central vertical groove or cleft in them. I find the square chin implants very effective for those men that need more transverse chin width. The cleft chin implants, however, look good on drawings and would theoretically appear to create an often desired chin cleft. In reality, however, the external appearance of the cleft may not always appear due to the effect of the overlying thickness of the soft tissues of the chin. That is why I also create a vertical groove in the muscle and sew the tissues into the clefted chin implant to be sure that an external effect is seen. Chin clefts in implants can be done with either a dimple or a vertical fissure or groove. When trying to place one in conjunction with a chin implant, it is more reliable to have a vertical groove or notch whether the implant has that shape or not. You can always take a squate style chin implant and cut a cleft or vertical groove in it at the time of surgery. That is a simple intraoperative manuever to do during chin implant augmentation.
Dr. Barry Eppley
Q: I`m considering having some plastic surgery and that`s the reason I`m writing to you. I am 28 years old and I`ve got a very rounded face with lot of babyfat and I want to make it more sharp/angled and more masculine looking. I have had a rhinoplasty done on my nose when I was 18 and it looks great from the profile, the only thing is that from up front one of the sides is indented and I was thinking that either an injectable filler to build up that side up or a silicone implant to make that side more fuller and match the other side. I don`t need a major or new nose job, just to fill up one side of my nose. I`ve got a double chin and even when I was thinner I still didn`t have a 90 degree angel between my neck and chin. So I want a liposuction and tightening of the neck muscles. I think this will also help to make my jawline stand up a bit more. I have a very round and big chin. It`s not too big but it`s very round so I was thinking that the liposuction of the double chin and platysmaplasty will also help to give my chin more angles but I`d also like to have a small dimple there. This will give me that masculine clefted chin look. I`d also like to have liposuction of my lower face (removal of buccal fat) to give it more angles and make it less rounded and more masculine. I think some cheek implants will give my face more bone structure. I want to remove the bags under my eyes. I`d like the procedure where the incision is from the inside of my eyelid. My upper lip is a bit uneven. One side is more rounded than the other, so I`d like to correct and get more symmetry to my lips. It`ll be nice to get them a bit bigger too. I have attached some photographs for you to review and await your comments/recommendations.
A: In reviewing your photographs and your concerns, I can make the following suggestions/recommendations:
1) Nose. Your nose is asymmetric because you have left upper cartilage/middle vault collapse. That is why it appears deviated due to the inward turning of the dorsal line. This is the result of your prior rhinoplasty. That is best corrected not by an implant or an injectable filler, but by cartilage grafting. The use of a left spreader graft and a crushed cartilage onlay graft over the indented area is the treatment of choice.
2) Lips. Fat injection grafting would be best. Although a vermilion advancement would perfectly correct the left upper lip asymmetry (lack of vertical height), that fine line scar in a male would be unacceptable.
3) Lower Eyelids. The lower eyelid bags could be removed by a transconjunctival lower blepharoplasty with fat removal only.
4) Cheeks. Cheek implants would be a good choice for your malar-infraorbital hypoplasia. I would also add fat injections above the cheek implants along the infraorbital rims.
5) Cheeks. Buccal lipectomies are needed to get rid of the fullness below the cheek bones which are going to be highlighted with the implants.
6) Chin. A square-shaped chin implant is needed with the placement of a central dimple or cleft, whichever is your preference. The chin implant would have minimal forward projection but is more to create fullness on each side.
7) Neck. it could be improved by some liposuction and a corset muscle plication (platysmaplasty ) to maximize the cervicofacial angle.
Lastly the Jaw Angle. A would do some liposuction around the jaw angle area to try and make it a little more distinct although the result would be fairly subtle.
Most of these procedures you had already surmised but here is what can be realistically done in an effort to achieve more of a sculpted masculine facial appearance.
Dr. Barry Eppley