Your Questions
Your Questions
Q: Dr. Eppley, I have significant facial asymmetry whereby my mandible is less developed on the right than on the left. This causes the left side of my face to look “empty” and flat, with my chin pointing off to the left. I am hopeful that this can be improved with a jaw implant. The problem bothers me a lot, and makes me camera shy. Improving my facial balance would mean a lot to me, and I would be very grateful for a chat with you about this.
A: Thank you for your inquiry and sending your pictures. In mild cases of jaw asymmetry (5mms or less from chin midline) a total jaw implant can be a very effective procedure to correct the asymmetry as both sides of the jawline and chin are built out differently to make the chin/jaw symmetric from the front view. But when the jaw asymmetry is more significant with the chin shifted more than 5mms from the midline as in your case the build out between the two sides can make the chin and jawline too wide for your face to achieve symmetry. Thus in your case you use a sliding genioplasty to shift the chin back to the midline and concurrently place custom jawline implants to build up the two sides which merge into the repositioned chin bone by preoperative computer design.
These recommendations are based on a picture analysis. But ultimately review of a 3D CT scan and looking at various chin bone changes and implant designs will determine the best treatment plan for your face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After you put a temporal implant on the muscle, will I feel discomfort when chewing?
A: Placing a temporal implant under the fascia and on top of the muscle will not cause any long-term discomfort with mastication. Most patients will experience some tightness on mouth opening right after the surgery due to the muscle trauma but this is temporary. The best way to get over the tightness is to stretch and eat and chew normally.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had some minor openings of my armpit incisions after getting pectoral implants. Is this normal?
A: This is perfectly normal with axillary fold incisions and is not rare after pectoral implant surgery. They are located in a tough spot to heal and often will develop some varying amounts of incisional edge separation which begin to appear 2 to 3 weeks after surgery. The proper strategy is to let them go on to heal secondarily. (from the inside out) No oral antibiotics are needed and trying to reclose these will fail 100% of the time. The body will naturally heal these up in 2 to 3 weeks. I would continue to shower and don’t worry about getting them wet. They may develop a little bleeding from time to time which is very normal as granulation tissue fills up the wound openings. Once the granulation tissue develops up to the wound edges the incision will close over it very rapidly. Your current wound care strategy is perfectly fine. This is just a very minor bump along the recovery process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom occipital skull implant. My questions are:
Who will perform the procedure?
What could go wrong?
What is the chance of having to repeat the procedure?
Are the sutures self absorbing? How long does it take to heal?
Can one place ones head on a pillow where the sutures are?
Can one bathe and comb hair?
What are the chances of infection?
Do I need to come back for a follow up?
Would there be any facial swelling?
How soon can I return to my work/daily activities?
Is it safe for radiography?
Is it visible in an x-ray?
A:In answer to your custom occipital skull implant questions:
1) I perform the procedure exclusively.
2) When you say going wrong what you mean is what are the known risks and complications of the procedure which in skull implants is always infection, asymmetry, visible edging and size. (too big or too small)
3) All skin sutures used are resorbable which takes 2 to 3 weeks to go completely away.
4) There are no restrictions are head positioning after the surgery.
5) One can shower the next after surgery and shoer and wash their hair 48 hours after surgery.
6) I have never yet seen a custom skull implant infection.
7) All followups are done in a virtual manner.
8) Some patients may experience facial swelling in the temples and eye area which resolves in 7 to 10 days after the surgery.
9) There are no physical activity restrictions after the surgery. You do what feels comfortable.
10) All skull implants are safe for any form of postoperative imaging.
11) Custom skull implants are invisible in a plain x-ray, seen as a radiopaque layer in 2D and MRI scans and will be seen as an actual implant in 3D CT scans.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello I have provided some pictures of myself. I would like to achieve a lower third similar to the men attached in the attached pictures.
My questions would be:
1)Is it possible for me, after surgery, to have that angular lower third?
2)What surgery would i need? I suspect i would need a custom jaw angle implant(after reading your website).
3)I also have some “smaller” problems like jowls and some perioral mounds. Would those also be fixed by the skin stretching i would achieve after the jaw angle implants(if my assumption is correct)?
4)Would fillers be a good idea for a “preview” of the result i would get after the implant?
5) Do I have other skeletal or soft tissue defects which i am missing? I am afraid of the idea of doing surgery and then finding out there are other things to improve. For example do you think i lack forward growth?
6) I also think i have an asymmetry but i can not figure out if it is due to bone or soft tissue asymmetry.
A: In answer to your jawline augmentation questions:
1) While model pictures provide ideal goals, what can realistically be achieved must be determined on each person’s face by predictive imaging which provides a general concept of the potential change. (see attached)
2) You are correct in that only a custom jawline implant can create that potential lower third of the face change.
3) Any jowls are usually completely eliminated by the implant augmentation. Perioral mound fullness requires microliposuction which is often done in combination with jawline augmentation.
4) Fillers do not provide the same type of jawline change that implants on the bone create, largely due to the volume differences. (e.g., 4 or 5 ccs of fillers does not create the same effect as a 12 to 15cc implant…which is what it would be for what you are trying to achieve)
5) One of the primary objectives of computer imaging is to see how changing one part of the face affects the others. That is the way to determining if other parts of the face are being ‘left behind’.
6) Almost all facial asymmetries have a significant skeletal basis for them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an otoplasty but it resulted in my ears too pinned back and i don’t like it and my surgeon said the reversal is not possible so i’m looking for a solution even if my ears can’t be reversed to the original place completely
Also almost 10 years ago i had a genioplasty to get my chin augmented and balanced and i liked the result. However the surgery also created a more feminine and pointy look which i don’t like and wish to get my chin more masculine.
Here in turkey most doctors use intraoral cut to place an implant and they don’t have custom implant options but i prefer a cut under my chin and prefer custom implant also.
These are my two man concerns, thanks in advance
i m looking forward to hearing from you
A: Thank you for your inquiry and sending your picture to which I can make the following comments with attached imaging:
1) A subtotal otoplasty reversal is very possible. The key is when the ear is released from behind it requires an interpositional graft to hold it out….otherwise it will just heal back into where it was very quickly. For this graft I use cadaveric (tissue bank) rib cartilage)
2) Many chins become more narrow when they are advanced by a sliding genioplasty. Making a custom square chin implant cap to fit over the bone can make it as square as you like. You are correct in that placing it using a submental incision would be the best way to do it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What would you say is the maximum amount of vertical increase an implant to the posterior mandible could achieve?
What amount would seem ideal for my mandible in your opinion?
Thank you
A: The amount of jaw angle augmentation that looks best to you is the ideal amount of change. To help you think about that those type of changes I have attached some imaging looking at differing amounts of change. I would also caution you that using the side view along in assessing jaw angle changes can be deceiving. The more distinct the jaw angle becomes in the side view the longer or boxier the face will become in the front view. So all jaw augmentation imaging should be done from a multiview assessment to understand how one view affects the other views.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My friend who is 21 years old now had an accident and needed a craniotomy. She recovered completely over a year and underwent 2 cranioplasties… as the small part of wound on front skull was not healing she underwent rotation flap 6months back… but even that failed… the small part of wound is open again… what do we do now?
A: I assume the bone underneath the open scalp wound is that of the original craniotomy flap or some form of cranioplasty material from her secondary cranioplasty procedures?? Either way both are a non-vascularized base which is why it opens up as the tissue ingrowth from the scalp edges can not survive over an essentially dead surface.
But I don’t have enough information to provide a truly qualified opinion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I believe that you can solve my issue. I am looking for a team of plastic and neurosurgeon who could do skull remodeling surgery in adult for me for my skull abnormal shape, not only reshaping by burring down the bone, but a radical open surgery to remodeling the skull.
I have a tall shaped skull and little narrow from sides,
In consulting some physicians they suggest doing barrel stave or other techniques same that been used in craniosynostosis .
Knowing its risky surgery and its pure cosmetic, but I believe in your experience to take my case .
Thank you
A: While this is a standard technique in infants and possibly up to 2 or 3 years of age, it is not an appropriate procedure in an adult. This is because the basic premise of such surgery is that the dura is osteogenic and has a great capability to heal once the bone is staved open. That healing ability does not exist in adults. This healing limitation coupled with the lack of the ability to bend the skull bone in adults due to its thickness makes this an ill-advised procedure in an adult…or at the very least one prone to a significant risks of complications for what is a cosmetic procedure.
While there are skull reshaping techniques for adults they are based on extracranial techniques not intracranial ones.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a deep mental crease on my chin that i want surgically fixed. i want a permanent solution for removing the line instead of fillers and Botox. i read on the internet that there is a surgery to release the muscle from the skin so the line is no longer there.
A: There are surgical procedures that can help reduce a deep labiomental fold but no procedure can completely remove it. You have an inverted V-shaped crease which is the most refractory to change. While placing fat grafts behind to push it out, these V-shaped folds are very resistant to such maneuvers. The external open approach with dermal graft placement is the most effective but that results in a fine line scar very much like the one you have from the indentation…only less deep.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in procedures that could address the look of my chest after my Nuss procedure; the bar was implanted about a decade ago and removed years after. The surgery was successful in that my breathing, sternum and Haller index are now close to normal. However, because of my flared ribs, after several years of weightlifting, my chest still looks underdeveloped. One of the inner corners of my pectoral muscle close to the sternum also appears to have a small defect, as if a 1 inch bite were taken out (only visible when I have very low body fat)
I’ve attached a couple of photos of me from the front and side in my natural posture (i.e. some anterior pelvic tilt); you can see the Nuss scars. I also took a photo where I tried to make it easier to see where my rib cage is.
My goals would be to minimize the look of my flared ribs with minimal scars by making my pectoral muscles larger/more normal (i.e. in front of my ribs rather than behind). I imagine there might be a variety of different options to address this, so I would be curious if you could share what a couple of options and costs might be, from least to most expensive.
Thank you for your advice!
A: Thank you for your inquiry and sending your pictures. From your description your chest reshaping goal is to narrow the wide sternal gap between the medial borders of the pectoralis major muscles. You are correct in that augmentation of the medial border of the muscles would help in that regard and that such augmentation needs to be on the outside of the muscle and not beneath it.
While this is the correct concept, achieving that effect is a challenging one. The use of an implant to achieve that type of extramuscular change requires a low sternal incision to place it and getting an implant with the right shape, thickness and with perfectly feathered edges is a design challenge. Since this is soft tissue augmentation and not bone there is no great way to use 3D CT scanning for implant design. This would have to be based on external measurements/designing. (which is not all that uncommon)
The far simpler and scarless approach is with the use of fat injections and you have the abdominal/flank donor sites in which to harvest. The ever present problem with fat injections is that their survival is far from assured and direct placement into the muscle may not necessarily provide the desired medial muscle edge enlargement closer to the sternum.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, a problem of mine is when my hair covers the top half of my ear, i look horrible. When i move my ear up with my finger it looks better, or i cut the hair around my ear to always show the top half, otherwise it looks strange. Can you move the ear cartilige up by pinning it? I think it looks better that way, Thanks.
A: Unfortunately the ear has a fixed position on the side of the head by virtue of the external auditory canal which enters the skull bone. As a result the ear can not be moved vertically up or down. I have tried numerous techniques to achieve a vertical ear repositoning effect but none have been successful to date.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, While one of my goals is to reduce the sternum gap, my main goal is actually to make it so that my profile from the side appears more normal, potentially by increasing the size / projection of my pectoral muscles so that they are in front of my (flared) ribs like normal, rather than behind. Another surgeon suggested that standard pectoral implants could be used to accomplish this but was curious if you had an alternative take.
A: Thank you for the clarification to which I can make the following comments:
1) To achieve a chest projection that is enough to meet the projection of the flared ribs that is probably at least 4cms….a projection that almost no standard pectoral implant can achieve with the exception of the PowerFlex Plus implant at 3.9cms with 600cc volume. Whether its dimensions of 15cm tall x 20 cm wide would be adequate for your chest remains to be determined. Your chest augmentation goals are right on the cusp of needing custom pectoral implants
2) The placement of any pectoral implant, by definition, is not going to make the sternal gap appreciably less as submuscular implants do not change the existing muscular insertion along the sternum.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am reaching out to find a good doctor who can remove permanent filler done 5 years ago in the Middle East. I don’t know the name of the permenant filler and I can’t reach out to the doctor who did the filler since he is located in Syria at this time. I got treatment locally where they took some tissue from my belly and implanted it into my cheeks but the filler is still in my cheeks and around he eyebrows causing allergic reactions if I put anything on my face such as a mask and has caused a dent that needs to be taken care as well. During my prior treatment they didn’t take out the filler and they said this needs to be done but they did confirm it is not silicon and they couldn’t find out the name of the filler.
Please help us and let us know what is the steps need to be taken? Many thanks for your help and response!
A: Unfortunately there are limited techniques for trying to remove any form of permanent filler in the face. In the cheek area a facelift approach is the only approach to doing so where some of the filler in the subcutaneous space may be able to be removed. Around the eyebrow area access is more limited and it would depend on where exactly the problematic area is. I would need to see pictures taken where the areas of the problematic fillers are marked out on the face.
What you had done perviously was undoubtably fat injections placed into the filler injected facial areas in an effort to dilute their effects by introducing new tissue cells. This appears to have provided minimal improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! I’m a year postpartum (29 years old) and looking for a mommy makeover (breast lift & replacement of current implants, waist/abdominal/love handle liposuction for a more defined waist). I’m reaching out to you in particular, even though I live in Manhattan, because you also do rib removal and I’ve always had a boxy waist but wanted a small waist my entire life.
Could I do that as part of a mommy makeover? Do you have any before-and-after photos fo rib removal?
A: Rib removal can be done in conjunction with a tummy tuck. To learn more about rib removal surgery I would refer you to one of my websites, www.exploreplasticsurgery.com and search under Rib Removal where the kay details of the surgery and before and after pictures can be seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to increase wrist size diameter with fillers? I am insecure about my 6 inch puny looking wrists and I’d love to wear a wider watch. How difficult would this be?
A: I have no experience in putting fillers into any extremity including the wrist. And even if it was done the result would be short term as all fillers eventually get reabsorbed. It would make more sense to me to augment the bone at the sides of the wrist (radius or ulna) even though I have never done it for wrist enlargement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Left alar asymmetrical, I’ve had 2 rhinoplasties and don’t know what to do. I just want my nostrils to be sisters not twins.
A: Your left nostril has alar rim retraction, presumably from the prior open rhinoplasties. Such alar rim retraction repair (alar rim lowering) requires a septal cartilage rim graft.
It is possible that one may see the right nostril rim as too low (although i doubt it) in which case it can be raised.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I asked you a couple weeks ago about the graft to fill out the labiomental fold and you said the bone graft used to vertically lengthen the chin would naturally help flatten the fold. I realized today, though, that what I was wondering about is actually a fat graft.
I found a photo in the chin surgery gallery on your website that refers to what I was talking about, on “Patient 49”. It says “intraoral placement of dermal-fat graft for labiomental fold reduction”. I’m wondering if this is part of our current plan, and if not, whether he thinks it would be helpful or necessary.
And last I’m wondering, if I did opt for an implant in the future for the purpose of adding chin width, what minimum/maximum dimensions could or would an implant add vertically and horizontally as a byproduct? My thinking is that if genioplasty can only add a max of 12 mm vertically but an implant could add an extra few mms on top of that, then that would be an added advantage of the implant overlay. And if we only needed 5-8 mm of horizontal projection with this surgery but an implant would add a few mms minimum laterally, then we’d want to account for that with the genioplasty. Or maybe the implant can be customized so that it adds 1-2 mms vertically and 0 mms laterally.
A: It would not be prudent to place two nonvascularied grafts right next to each as that increases the risk of infection. So no a dermal-fat graft is not placed at the same time as a tissue bank bone block used with a vertical lengthening bony genioplasty.
As a general rule a few millimeters horizontally and/or vertically is what can be accomplished by a secondary overlay implant after a bony genioplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The long and short story is that I had a very prominent pointy chin and had surgery to reduce it. After that surgery, I returned to same surgeon with concerns years later of a widow’s chin (not sure terminology-but the chin muscle was very pointy and the chin was asymmetric. I am not sure that I would like to have surgery again-slightly frightened. I am looking for alternative possibilities and was wondering about the use of filler in appropriate areas to give more balance and symmetry. I am sooooo impressed with you and how you are able to really correct and bring better balance and overall better appearance and results.
A: With the reduction of the pointy chin, obviously done from below through a submental incision, there was no consideration for the rest of the shape of the chin as it blends into the jawline or what would happen to the overlying soft tissues with the removed bone support. Thus this is your chin situation.
There are only two directions to go….additive (trying to reverse the loss of bone support)….or reductive in a effort to redrape the soft tissues and further reshape the bone. There are advantages and disadvantages to either approach. Since the additive approach can be done non-surgically by filler there is no reason not to first give that a try. Its effects are immediate and it is completely reversible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you help rectify bad rounded eye-mid face please. This all occurred after a prior lower blepharoplasties.
A: Thank you for your inquiry and sending your picture. With this severe lower lid retraction the needed management is a combination of a midface resuspension (either cranial suspension or direct rim drill hole suspension) with lateral canthoplasties and spacer grafts to the lower eyelids. Small cheek implants may also have a role to play here.
How long ago was your original surgery?
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have sent in photos to see if I am a good candidate for liposuction. My areas of concern are my stomach, thighs, and buttocks. Please help!!!
A: Thank you for your inquiry and sending your pictures. While you do have fat that can be removed by liposuction in the abdomen, flanks and thighs (liposuction of the buttocks is almost never done), the quality of the skin in these areas is an issue. The aesthetic success of liposuction depends on the overlying skin’s ability to shrink down and be smooth once the fat underneath it is reduced. When the skin has an irregular contour and is loose/lax this is a setup for significant postoperative contour irregularities that would be greater than what existed before surgery.
As a general rule aesthetic plastic surgery is often about ‘trading out one problem for another’. You just have to be sure the problem you are acquiring is one you like better than the one you currently have. In some cases these tradeoffs are not that significant. In your case that tradeoff is much more suspect….is a reduced fullness with increased skin irregularities better?
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in a custom facial implant to help correct my facial asymmetry due to hemi facial microsomnia. If I decide to proceed with that surgery, I’m also Interested in facial rejuvenation procedures if it’s possible to be performed in the same surgery. In regards to my microtia of the ear. I’ve had reconstructive surgery as a child. I’m curious with advancements in medicine, if anything was possible to better define my ear. I currently am not comfortable wearing my hair up without covering my ear.
A: Thank you for your inquiry and sending your pictures. I see as the major component of your facial asymmetry is that of the right chin/jawline. (see attached) Using a 3D CT scan a custom right jawline implant can be made to match the jawline length of the other side. The tilt in the smile line (mouth corners) will still persist however which can be improved by a left mouth corner lift. (easier to lift the lower normal side than lower the higher abnormal side)
For the ear there are two secondary problems with the ear reconstruction result. First, and a major one, is that the vertical length of the reconstructed ear is simply too long. I don’t know what the length of the other ear is but using the length of the nose as a guide, it can seen how long it is. (see attached) I think the cartilage framework was simply jnitiallly placed too high or made too big. How to change that is an interesting conundrum as it would involve a wedge resection of the middle part of the framework to vertically shorten it. The second more easily improved problem is that much of the ear lacks details without recognizable concavities between the helical rim and the antihelical fold/crus convexities. This could be improved by removing the skin on the outer surface of the ear and replacing it with a new skin graft after creating more detail in the cartilage framework.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young male who recently had v line surgery to correct severe facial asymmetry. I am satisfied with the results but the surgery reduced my once very prominent/masculine jaw angle into essentially a curved line from the earlobe to the chin. I was hoping to look into jaw angle implants to restore the prior strong angle once my recovery is complete around june/july. I’ve attached CT scans as well.
Thanks!
A: Thank you for your inquiry and sending your 3D CT scan. Secondary jaw angle implants can be done and in all post-V line surgery jaw reconstructions I have done a custom implant approach is used to meet the unique and remodeled jaw angle shapes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hooding of eyes began years ago, paternal family has very hooded eyes. Botox worsens the issue and eyesight is slightly decreasing due to eyelid falling. Constantly feel tired from heavy eyes.
A: Thank you for your inquiry and sending your pictures. In the young person with ‘hooded’ eyes, the question is whether this is due to true excess of upper eyelid skin, a low brow position or a combination of both. Your pictures support a low medial brow position with some mild upper eyelid skin excess. I think the low eyebrows are a major contributor in your case to the hooded eye appearance and their heavy feel. Thus removal of eyelid skin alone may only provide a mild improvement in your concerns and probably only very short term. While a browlift is the correct anatomic approach, if their low location is not a concern or your high hairline a concern for taha procedure then an upper eyelid procedure alone would need to be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After a revision rhinoplasty with a chief complaint of increased nostril show, I was told a prior lip lift probably altered the nasal sill and that my original rhinoplasty surgeon made a poor decision in not pursuing alarplasty with wedge excision, and I have poor scarring on a deformed nasal sill where an attempt to correct was performed. I am unhappy with my nasal base and my surgeon, who I trust a lot, recommended I find a surgeon who performs lip lifts to bring the sill up, as he was only comfortable with wedge excision. I am wondering if this is possible and what the scarring risks are. My surgeon did not want to lengthen my nose any more and I do not want to pursue a third revision. I really do not want much of my nostrils to show. Thank you for your time.
A: I believe what are asking is whether a combined subnasal lip lift (for scarring removal) and nostril narrowing (for more narrows = less nostril show) can be performed. The answer is yes with scarring that is probably less than what you have now if done well. But as it relates to the subnasal lip lift the real tradeoff is not the scarring but whether the increased central lip fullness that will result is acceptable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 25 years old and 6’1″ tall. I have a big head towards the back and a bit pointy. Since I was little kid, I was dreaming to reduce the size of my skull. Since the main bone that needs to be reduced here is the occipital bone, I wonder how much this bone can be reduced. The size of my head is 56 cm when I measure it from the forehead level. I would like to learn how much reduction can be done with thinning of the tissue on the bone and some parts of the occipital bone itself.
Thank you in advance
A: Thank you for your inquiry and sending your pictures. You are referring to a commonly reduced skull area. Rather than focusing on circumferential head measurements or even how much thickness of skull bone can be removed, neither of which really convey what type of change occurs on a large convex surface area of bone. It is better to look at potential profile changes in the head shape from different angles. (see attached)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi i had a few facial implants removed about a year and half ago after having them in for 8 months that included jaw angle, chin, and cheek implants, everything has gone back to preop accept for my masseter muscle on my left side hide has pulled offt the bone a bit and needs to be reattached in the correct position and i have a circular lump of scar capsule from cheek implant capsule on my right cheek bone im looking to possibly have both corrected.
A: Masseter muscle dehiscence is a very difficult problem to anatomically correct by trying to move the muscle back over the bone…that almost never works in my experience. Camouflaging it my soft tissue camouflage is more effective.
Most likely the cheek scar capsule you reference is up in the soft tissues and may not be on the bone per se. Thus its successful removal may or may not be possible.
Dr.Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been spending a couple months in Florida this year. I read in the newspaper about a minimally invasive laser facelift. I wanted to see if this was some thing Dr. Epley does? Also, what he thinks of this procedure?
A: I think like all minimally invasive facelfit approaches they are effective if your facial aging problem is very early on or minimal. Like most things in life, what you put into it usually determines what you will get out of it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been searching for answers for awhile regarding my jawline. My whole life I’ve been told I am disfigured due to the angle of my jaw. I never spoke to anyone about my concerns before and would like to know the honest truth. Because you are specialist I was wondering if you could give me some information on why my jaw line looks like this but if this anything I can do to change it. Sorry for the grammatical errors in advanced
Thank you
A: You have classic steep mandibular plane angle jaw shape with a short chin and high jaw angles. Both can be corrected by commonly performed chin and jaw angle augmentation procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, would like to ask about the large depression in the coronal suture between the frontal and parietal bones of the head.
When I looked up this in English, I found a surprising number of images that matched my worries, and I was very interested in this medical institution that provides implant treatment to deal with those worries.
My skull has a larger dent than the one I have in this hospital.
If you shorten your hair, the dents will be noticeable.
Also, something that I wear on my head, like a helmet, doesn’t fit my head well, and when I wear it, it quickly shifts. Since I was a kid, the shape of my head has been a big problem for me both physically and functionally.
I was also looking for a medical procedure that could repair the dent. However, there are so few medical institutions in Japan that perform such surgery, so I couldn’t find the answer I was looking for in Japan.
The dents are so big that I asked my parents if they had brain dysfunction as a kid and if the doctor had pointed out anything about it. .. But my parents said they had never been told by a doctor that they needed medical treatment.
A: What you are describing is what I call the coronal dip skull deformity where a depression exists that runs across the top of the head along the coronal suture line….which is due to an actual depression with the bone around it being normal in size. This is what your first two pictures are showing and this is treated by a custom made skull implant that fits right over the coronal dip depression from side to side.
Your last two pictures, however, show a different type skull problem in which a pseudo coronal dip appears because the back of the head (parietal bones) has overgrown. This is a different skull shape problem.
Dr. Barry Eppley
Indianapolis, Indiana
