Q: Dr. Eppley, Thank you for the info on my bad temple implants. I want to remove the temple implants completely and just get cheekbone implants on the arch. But can you tell me, will this have to be two operations? First remove temple implants and then do ct scan to make a model of my cheekbone skull area? Because I want custom cheek implants. I worry if I do both in one operation it will be complicated because the ct scan will show the silicone temple implants (which will be near where the cheek implants will be placed). Do temple implants show up in CT scan? And therefore will the protruding temple implant area show up in the 3D model of the skull that is made from the CT scan? I want to come see you to one remove temple implants completely, and two get custom cheek implants high up on my cheekbone arch. Is that possible?
A: It will not be necessary to do two operations. A 3D CT scan can be done in which the existing temple implants will be seen but they can be electronically removed. Thus custom cheek implants can be made even if your temple implants are present.
Dr. Barry Eppley
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
Q: Dr. Eppley, I have a question about temple implants. What I want is to build width and length to my face through multiple procedures. (Not all done at the same time of course). These include jaw implants to add width and vertical length to the face, a chin implant which meets the jaw implant, and forehead widening from the temporal region up into the sides of the head, and possibly heightening. I believe the chin and jaw implants are relatively straightforward, but the forehead is a bit more complicated to me. Is the recovery period painful for skull reshaping and is there a significant loss of blood? One question I’d like to ask is how much width can be added to the forehead on each side? Is it possible to broaden the forehead up to 1cm on each side stretching from the cheekbone all the way up to the highest part of the head? As you can tell I really want to completely restructure my face to more large proportions and just add volume all over as it has bothering me greatly for some time now. I do not want to do anything with my features as I like my features, its the size of my structure that I really want to change.
A: When it comes to temple implants, there are two major factors to consider in your specific request. First, the amount of temporal and forehead augmentation is only limited by the ability of the scalp to close over it. Based on a lot of experience in these kind of surgeries I would say that a 1 cm increase on each side is very achieveable. Secondly, it will require custom designed temporal implants that would be made to start at the zygomatic arch and create a maximal 1 cm width increase at the point of maximal convexity as it blends into the forehead area. I have designed such temporal implants in the past so this amount of temporal volume addition I have done before.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to get rid of my facial wasting due to HIV. I am interested in cheek implants and fat fillers for lipodystrophy. I have attached a picture of my face for your evaluation.
A: In looking at the one picture you sent, your greatest area of lipoatrophy is in the temples and secondarily in the submalar regions. Compared to many patients that I see, your degree of facial lipoatrophy is fortunately more moderate in severity. Given that you have existing lipoatrophy, and I assume you are on antiviral medication, this makes the use of injectable fat survival precarious at best. For this reason, I make an effort to use permanent synthetic implants when possible for its treatment. These would be applicable to the temporal, submalar and even the nasolabial fold areas. But facial implants do not cover all facial lipoatrophy areas and are at best thought of as building blocks from which to fill around with fat injections as needed. Even though fat injection survival is unpredictable, it is the best filler to use for broader facial areas. And since it is not the only method of treatment that is being done, any survival that is achieved is a bonus to the underlying implants.
Dr. Barry Eppley
Q: Dr. Eppley, In considering getting temple implants for augmentation, I have read some bad reviews about the use of silicone. I realize that these talk about their use in rhinoplasty. It was stated that silicone had a higher chance to shift and possibly become “rejected” by the body. I had read that Gore-tex enables the tissues to grow “into” it so it was less likely to switch or protrude months or years later. How does this relate to implants in the temple region. Also, I have attached an overview of the temporal augmentation procedure written by a doctor. He talks a lot about risks and complications. He makes it sound like it is a bad procedure. What do you think?
A: What potentially can happen to an implant on the nose has no correlation at all to what occurs in the temples. They are two different anatomic sites. In the nose the implant is only covered by thin skin and has potential to be exposed to the contaminated nasal airway and is, in fact, placed by being directly exposed to nasal air and the nasal linings. In the temples, the skin and fat cover is very thick and the implant is placed deep under the fascia and right up against well vascularized muscle. What can happen to an implant in these two anatomic sites is dramatically different when it comes to risk. They are not remotely comparable.
Neither Silicone nor Gore-Tex material will have tissue ingrowth. They both simply become encapsulated as they are smooth-surfaced materials.
When reading the ‘Risks of Temporal Augmentation’ summary that you sent me that was obviously written from a perspective of having never done a more contemporary method of temporal augmentation and has no craniofacial plastic surgery background/experience. It is written based on an old style way of a big coronal incision and placing some type of material under the temporalis muscle. That might be more relevant to a large temporal defect that occurs from a craniotomy but not a cosmetic temporal augmentation.
Dr. Barry Eppley