Your Questions
Your Questions
Q: Dr. Eppley, I am thinking of getting orbital rim implants to improve my lower eye hollows socket area and mainly to raise my lower eyelids so less scleral show is showing…
Can cheek implants placed very high have the same effect of pushing up lower eyelids? Give a less round eye look?
Also will there be lower eyelid retraction after orbital rim implants?
A: It is important to understand that neither orbital rim or cheek implants is going to drive up the lower eyelids to improve scleral show and give the eye less of a rounded eye look. In fact, one of the potential side effects of these implant procedures when done through a lower eyelid approach is lower eyelid retraction. If technically done well and orbicularis muscle resuspension and lateral canthopexies are performed with closure, lower eyelid retraction can be prevented and may even help with less scleral show. But bone-based implants can not push up on the lower eyelid and improve the level of the lash line across the eyeball. The bone levels lie well below the lash line of the eyelid. This is a common misconception which can be verified by pushing up on he cheek tissues and you will see that it does not change the position of the lower eyelid. (unless you really push up far which is not a realistic surgical effect)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to discuss lip aesthetics. I have noticed that in certain people, their lips in the relaxed, open mouth position, there is a nice exposure of the upper teeth. I would say that this is an attractive trait.
I would like to posses this feature, but unfortunately, I don’t. When I relax my lips and hang them open slightly, I only feel the my bottom lip hangs and only the bottom row of my teeth show. My upper row teeth do not make an appearance because my upper lip doesn’t move when relaxed. Photos attached,
I have fairly thick lips for a male, so I am looking at getting lip reduction. My question is how to achieve that ‘upper teeth open mouth’ look? Would a lip lift help?
Is there a specific name for this look that I can Google?
A: The procedure yo are seeking does not have a specific name because it is a combination of two well known procedures to try and create the effect you are after. What you need is a combination of a sub nasal lip lift with an upper lip smile line reduction. The lip lift will raise up the central part of the upper lip. (ratio of about 4 :1, meaning for 4mm of skin removed under the nose it will move the smile line level of the upper lip 1mm) Then a horizontal reduction of the vermilion-cutaneous junction of the upper lip of about 4 to 5mms will help raise up the bottom of the upper lip. Together you should be able to develop some natural upper tooth show. The lower lip will, of course, need to be reduced by about 7 to 8mms to match better with the upper lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a septorhinoplasty procedure. I have snoring issues and a previous broken nose. I am curious about price and how much insurance would cover to fix a deviated septum to help with breathing. along with reconstruction surgery to slightly change nose appearance. As far as reconstruction, I would like to make it more defined from the front with a more feminine profile.
A: When it comes to nasal surgery, insurance only provides potential coverage for functional airway issues with the nose. (i.e., breathing difficulties) These include procedures like septoplasty, turbinate reductions and middle vault reconstruction with spreader grafts. Whether they would provide such coverage requires a written pre-determination letter by the evaluating surgeon. For a written pre-determination letter to be considered by the insurance company, a CT scan must first be done to verify that there is internal nasal anatomic derangement. A pre-determination letter that is not accompanied by a CT scan report will be automatically denied.
Insurance will not pay for any cosmetic changes to the outer appearance of the nose. That would be additional costs for the operating room, anesthesia and surgeon’s fee for this type of aesthetic rhinoplasty changes. These are not considered reconstructive regardless of how they developed.
Functional and cosmetic rhinoplasty procedures are commonly done together (septorhinoplasty) with the patient having financial commitments based on the limits of the insurance policy and the extra costs associated with the cosmetic portion. Those exact cost numbers can only be provided now based on what the fees associated with the cosmetic portion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a lip lift question. I’m attaching pictures of myself with and without a smile. I don’t have a problem showing too little teeth when I smile, but when I am just speaking very little of my top teeth show at all. Do you think a lip lift will be of benefit for me?
A: With a very thin lip from one mouth corner to the other, a subnasal lip fit may likely create a pulled central upper lip but still leaving thin sides. This often looks unnatural particularly if one ask the lip lift to do too much. (over lifted) I think your lip is too thin for that procedure to produce an appreciable result and runs the risk of looking unusual. I would have to do some computer imaging to see what it looks like. More likely a lip advancement (vermilion advancement) would produce a more effective and natural looking result. It would also create a more even amount of increased upper tooth show.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about cheek implant removal.I had cheek implants done a little more than two years ago. They were placed in a way too medial cheek close to my nose next to the paranasal area. They were very big…XXL. I’m 25 years old and I had them yanked out seven months ago. Even though the implants are out I now have this extra volume, edema, or scar tissue like augmentation that looks horrible. iImassage it everyday hoping that it will help to make it go down.
Is there anyway I can ever go back to my original look where I was flat cheeked in that area? Is massaging helping or can i use steroid injections? It looks quite awful because most good looking people rarely ever have volume in this area and its more of a characteristic of old people where cheek soft tissue has moved middle and downwards.
I understand the risk of steroid injections but at this point i feel like its my only option. I’m quite desperate and don’t want this extra augmentation here to be with me for my whole life since its unsightly.
A: While you can certainly do steroid injections, I would not be optimistic that it will work the way you want it to. Steroids work by breaking down scar tissue. While there is some scar tissue present no doubt, much of the ‘extra’ tissue mass is stretched out normal tissue. Like removing large breast implants, the original breast tissues are stretched out and will never return to normal. The same issue applies with large cheek implants. Whether strategies such as cheek tissue repositioning (moving it laterally and reattaching to the bone would be helpful, I could say without seeing pictures of the problem.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve seen you on real self and seems like you are great with chin implants/surgery. I’ve had a consult with a couple other surgeons…one of them imaged my chin too big. The pic looked ridiculous! I’m wanting to know what you recommend for a female chin augmentation like myself. The other surgeon suggested a 2 or 3 mm implant. I have a chin dimple also. Would the chin implant cover the dimple? If so that would be great because I don’t like the cleft. Thank you!
A: The key to your female chin augmentation, which is not rare for females, is to not use a male chin implant approach. Your chin needs about 3mm (maybe 4mm) horizontal AND some vertical increase as well. That will work best with your vertically shorter total facial height adding more total facial length in a subtle fashion. In addition chin implant should not be round but have a more tapered shape to it to keep the new chin ‘slim’. The chin implant may push out the chin dimple/cleft but I wouldn’t count on it. It is best supplemented with a small amount of injected fat right into the dimple at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, after breast augmentation why do women usually have high placement of their implants even when insertion of the implant is inframammary? Also, why do the implants drop? Why doesn’t the surgeon just place them where they belong? Is it due to the type of implant used? (e.g. size, textured vs smooth?) Maybe you can offer some clarity?
A: Your breast augmentation question is an excellent one and the phenomenon of ‘high riding’ breast implants early after surgery is common. In fact, the plastic surgeon does place the implant in the desired position during surgery. But it is important to remember that the implant places some degree of stretch on the overlying skin which is greatest in the new lower pole of the breast mound. (nipple down to lower breast fold) In getting larger breasts much of that effect (at least 50%) comes from increasing the size of the lower pole of the breast. Tissues in this area are much tighter than that above the nipple and often new skin is recruited form the abdomen to accomodate the effects of the immediate and often dramatic volume expansion. (lowering of the breast fold)
This lower pole expansion will create a rebound effect as it needs time to relax after surgery. Since the upper pole of the breast has much softer tissues, the breast implants will often naturally ride up for a while from this rebound effect. Thus the early high riding implant. Once the lower pole skin relaxes the implants can drop down into the original pocket for which it was created. (implant settling)
How significant this rebound effect is and how high and how long breast implants may be high riding is influenced by many factors. The quality and amount of breast skin, size of the implants, and whether they are smooth or textured all influence this postoperative healing process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year old female who underwent several facial procedures last year. I had a vertical chin shortening and a midface lift. I know feel that my chin is too short for my face. Also the midface lift has caused my eyes to look worse than before with too much scleral show. What can be done for these problems now? Wouldn’t you agree that I really do not look better than before?
A: Whether an aesthetic operation produces a pleasing outcome is for the patient to judge not me. What I can say is that you obviously have concerns/questions about the chin and eye areas so I will make some comments about them. If you just showed me the after result of your chin, I would not say it is too short. But given where you started I could understand why you may feel that it is. The good news is that chin lengthening is more reliable than chin shortening whether it be done by an opening bony genioplasty or a vertical lengthening chin implant.
Your eyes clearly have lower lid retraction, a sequelae of the midface lift, which is unclear to me why that was ever done. Given how your eyes looked and your young age, undergoing a midface lift runs a very high risk of lid retraction because you have no extra skin. Such lower lid retraction most likely will require posterior lamellar reconstruction with palatal grafts to get the lid margins up a few millimeters. Lower lid retraction is a far more challenging problem than vertical chin lengthening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have a consultation for the rib removal, I really want a more hourglass shape, i have read that to be a candidate for this procedure you have to be short waisted which I think I am. I contacted one other surgeon and he said he only does this surgery through a tummy tuck incision. I was wondering if there are any other options as I am not a candidate for tummy tuck and I really dislike that scar. How much is this procedure? And how long would it be before I can fly back home?
A: Please send me some pictures of your body/waistline so I can assess whether this would be a good procedure for you. Also if you can, please draw on yourself with a marker as to the rib protrusions that you think would benefit by removal. I have never done rib removal through a tummy tuck incision and have always done it through small direct incisions. There is certainly no reason to do it through a tummy tuck incision unless one is also wanting and needing a tummy tuck as well. Its only advantage is that the lack of a chest wall scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello! I came across you on RealSelf. I have been wanting to get this small bump in the bridge of my nose evened out. After reading the positive reviews of Dr. Eppley, I am interested in speaking more. Thank you for your time!
I have always had a small bump on my nose and I am looking to fix that in order to have a better profile view. I have always been extremely self conscious about my nose and it also doesn’t help that I do not have a strong jawline either.
I have looked into rhinoplasty surgery, but I thought maybe injectable fillers would be better if my issue is minor.
A: Thank you for sending your picture. Based on this picture, I would say that putting filler above the bump is not a good idea. You have a bump on your nose because the nasal tip is too low, not because the bridge and the edge of the nasal bones is too high. You are a rare example where what you have is a ‘pseudohump’. A hump that is artificially created by other nasal structures that are too low. Your bridge or hip height is actually normal.
In my opinion, rhinoplasty surgery would be much better. But you can always try fillers and if it does not create a better result it will always go away and then you will know for sure about rhinoplasty surgery for sure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in brow bone reduction. I have a prominent brow ridge and orbital region. The orbital region is particularly prominent. I am not a candidate for coronal incision as I have a receding hairline. I have been told by a couple of surgeons that it is possible to do an eyelid incision to shave down the orbital bone region. Would this be something that is possible at your clinic? Thanks for any help.
A: The transpalpebral (through the eyelid) approach be used if the outer half of the brow bone needs reduced. (tail of the brow bone) But it can not be used for the inner half of the brow and glabellar region due to the location of the supraorbital and supratrochlear nerves, They directly exit the lower end of the brow bone in this area and block access to any type of brow bone reduction. If one was willing to sever these nerves and live with permanent numbness of the forehead and frontal scalp then this approach could be used. But I know few patients who would consider this a good tradeoff. The other option would be to do the procedure through a horizontal forehead wrinkle if you have a prominent one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, when I retire I will do a general over-all facial rejuvenation/enhancement and possibly a slight rhinoplasty tune-up/reduction. Probably fairly aggressive because due to my life situation, there is no need to “look like the same person, just well rested”. Now, is there any logical/preferable order in which to do these things? I had a successful facelift several years ago. I can say that I I don’t care if I spend the first three months looking swollen and feeling pain – the end results are well worth it, plus I am just not a whiner. But I thought I might do the rhinoplasty first/separately, so that the follow-on surgeon can correctly judge the amount of change needed with the “new nose”. Thus the question: how much of the facial implant work can be done all at once?
A: Without knowing what you look like or exactly need, I can not give a very precise answer. In general, I routinely perform all facial procures at one time including any implant work and rhinoplasty. How one facial procedure affects another can really be determined before anything is done by computer imaging. But certainly there is no reason you could not do the rhinoplasty first and then three to six months later do the remainder of any facial reshaping procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, we have talked before and i was trying to get surgery done for flat back of the head in 2011. I had some financial problems that is why I didn’t do it. Back in thoe days we talked about Kryptonite bone cement method which it had minimum scarring but expensive. I’m looking in to doing the procedure sometime this coming October 2015 and I was browsing your websites and I found this new approach that you have called Custom Skull Implants by using 3D CT scan.
My questions are
1- What is the price difference between Krypton bone cement and custom skull implant
2- I know the scar is less in Krypton bone, but how big is the scar for implant
3- Recovery time for the implant?
4- How long it will take to make the implant after CT scan?
5- Infection risks?
Thank you very much
A: In regards to a custom occipital implant, your financial concerns have served you well as this is a far superior method for improving the flat back of the head.
- My assistant will pass along the exact cost of a custom occipital implant to you tomorrow.
- The incision is usually placed very low in the occipital hairline and is usually a horizontal incision of 7 to 9cms. When the incision this low, almost in the upper neck, any scar concerns are significantly diminished.
- Recovery is usually less than a week to return to most normal activities.
- It takes about 3 weeks to design and manufacture the implant after the 3D Ct scan is received.
- While infection is always a concern for any implant in the body, I have yet to see one with a custom silicone occipital implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know how long take scars go away from a fat transfer operation. They got some fat from my tummy and put under my eyes. I had a sleepy look eyes. It looks one side it’s kind of went down but my other eye (I mean under the eye) still all puffed out and doctor says its “scar”. It’s hard and it seems like slowly slowly is going away but I’m 10 months now after the surgery and still hard under the skin,
I would like to know if it will EVER go away that scar or will EVER become soft as the fat suppose to be? And if so WHEN? I’m really desperate. It’s my face and I don’t like that people looking at me like what happened to me. The idea was to look better not worse. :o((
A: Unfortunately you are asking a question about a clinical result that I have not yet seen with facial fat transfer. The biggest after surgery issues with injectable fat grafting is how well it survives and irregularities. (lumps/bumps) I have never seen persistent hard lumps many months after its placement. I would assume that it is fat and may or may not be some scare tissue. Certainly ten months is a long time but as long as there is some improvement in it, patience would still be warranted. I would also consider very dilute Kenalog (steroid) injections into to to encourage additional softening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in scar therapy to reduce the raised scar on the bridge of my nose caused by a racket strike during a game of racketball two months ago. Interested in the recommended procedure and number of treatments/visits, etc.
A: Thank your for your inquiry and sharing a picture of your nasal scar. It is important to realize that it is early after the injury and the scar healing process is active and ongoing. If you want to do everything you can do to ensure optimal scare outcome, I would recommend a single fractional laser treatment followed by the daily application of a scar gel and the night time application of occlusive taping. This sequence of scar therapy You can be pleasantly surprised how much better it can look in 3 to 6 months. It is also important to realize that these recommendations are based on a single picture assessment taken from a side view picture only.
When it comes to topical gels a wide variety of options exists and none has been clearly proven to be better than another. The same applies to the number of occlusive tapes and sheets which exist.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I think my eyes are slightly uneven but I doubt anything can be done about that and that’s okay. I would like to change the prominent eyebrow structure from the center of my face extending to the outside supraorbital ridges. (brow bone reeduction) They are also slightly uneven. People often ask me if mosquitoes bit my eyebrows. The other thing that bothers me is my weak jaw line. I push my lower jaw out so its less obvious. (chin augmentation)
I know I will never look like a super model, its not even something that I want. I would just like a more symmetrical, angled, softer looking face. Thank you so much for your time and effort, Dr. Eppley. I hope it’s what you need in order to assess for possible procedures.
A: Thank you for sending your pictures. What they should is considerable brow bone protrusion from the glabella to the outer orbital rim. Even without x-rays I can tell that is due to significant frontal sinus hypertrophy and will require an osteoplastic bone flap setback technique for your brow bone reduction and not just burring alone to get a significant reduction. The brow bone protrusion you have is very similar to what I see in men with two distinct medial brow bone mounds. The slope of your forehead is also fairly retroclined and it would be ideal to augment the upper forehead at the same time to really change the entire shape of your forehead.
From a chin standpoint, it is both horizontal and vertically deficient in regards to being in balance to the rest of your face. While a sliding genioplasty would be the historic solution (due to the need for increased vertical chin height), my newer vertical lengthening chin implant (small size in your case) would work well as it brings the chin both forward and down. (at 45 degrees) This would a very good solution for you that is more cost effective than a sliding genioplasty with a much quick recovery as well.
Now that I know exactly what need to be done, I will have my assistant pass along the combined costs of the procedures to you on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been wanting breast implants for a long time and have been researching a lot of doctors and implants. I would like to speak about the augmentation with you. I have has one consult last year and I really liked the doctor but he only did saline implants and I think I am leaning more towards silicone implants but would like to discuss both with a doctor that does both.
A: Saline and silicone filled implants are both FDA-approved options for breast augmentation. They do share certain similarities, they both create equally effective enlargements of the breasts and are equally safe. Looking at augmented breasts from the outside, it would be impossible to tell what type of breast implants was used. But beyond their external appearance, they do have several very distinct differences. Saline implants are associated eventually with palpable and visible ripples on the bottom and sides of the breasts which does not occur with silicone implants. Most women will say that silicone implants feel more natural as a gel-filled implant feels better than a bag of water. A dramatic difference between the two is in how hey will eventually fail. (they will not last a lifetime and will eventually need to be replaced) Saline implants fail by a dramatic loss of fullness like like that of a flat tire. Silicone implants never lose volume because the gel does not act like a liquid (like a gummy bear candy) and just stays in place and with same volume even if the bag sustains a tear or a hole. For this reason alone, silicone breast implants last longer than saline implants.
The concise version of this story is that there is one and only one reason to ever get saline breast implants….cost. They are the most economic form of breast augmentation because a pair of saline implants costs less to buy than a pair of silicone implants from the manufacturer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 27 year-old male hoping to improve my facial appearance with the use of facial implants. I have a rough idea of the kind of result I’d like to achieve and have attached pictures below of me now and a photoshopped version emulating the improvements I’d like to achieve. I have no idea whether I can use preformed implants or need to have custom facial implants made.
I’m interested in chin, jaw, forehead and orbital rim implants. I actually have no cheekbones whatsoever either forward or laterally which creates a very unusual appearance, but so far I’ve been using filler for correction.
Please let me know about how I can get these changes, estimated costs involved etc. I would really like to come to you for surgery as I know you are one of the best.
Thanks for your time and I really look forward to your response.
A: Based on your own morphing, the jawline change is absolutely that of a single piece custom wrap around jawline implant. That is the only type of jaw implant that can make a smooth jawline from the angle to the chin as you have shown. The lack of cheek and orbital rims (zygomatico-orbital deficiency) can be managed by two separate implants but a single custom made infraorbital-malar implant is the best implant to make a smooth transition all the way across the orbital rim and into the cheeks in the very thin tissue of the lower eyelids and cheek. What I notice in the forehead is increased brow bone prominence. Again a custom designed implant to achieve that change is always best since there are no preformed brow bone implants from which to choose.
I will have my assistant pass along the cost of custom implant surgery that would cover all these facial areas. It is possible to use a variety of preformed implants in most of these areas and some designs that I have used for other patients. But that is more of a piece meal approach that can be used if necessary but less than ideal for these more complex facial implant changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like my silicone butt injections removed. Does the scar tissue contain silicone oil, fat oil or is it just scar tissue? Will this procedure help reduce my butt from being sensitive? Is breaking up the lumps dangerous? Can it travel to other places when it’s broken up?
A: Silicone buttock injections can not be removed per se. They can be treated by liposuction and/or fat injections. These techniques allow for some of the silicone to be removed but what it mainly does is break up any hard tissue lumps (e.g., oil cysts and their surrounding scar tissue) caused by the silicone material as well as place new fat in and around where the silicone material/tissue reactions have occurred. Whether these efforts are worth it depend on what symptoms you are now experiencing. These efforts will not change any outside pigmentation changes in the skin but can help with some visible contour issues such as indents.
Oil cysts means silicone oil cysts. Breaking up the lumps is not dangerous. It is the injection of the material that poses the risk of getting in a blood vessel and traveling to other places.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 32 year old female with flat cheekbones that make my eyes look prominent. I have noticed that whenever I laugh the lower eyelid retraction vanishes and the eyes look quite normal. So I am thinking a fat transfer can considerably correct the problem. But I would like toknow if the maxillary hypoplasia is so severe as to make necessary the use of orbital/cheek implants. Or do you believe in using large volumes of fat transfer to treat such cases. And can fat grafts be used in the cheek eyelid junction too?
A: You have astutely discerned the two approaches to anterior midfacial/lower orbital hypoplasia. The bone can be built up with implants or fat can be added to the soft tissues that drape over the bones. Each has their own distinct advantages and disadvantages and the actual anatomy and severity of the tissue deficiency will play a major role in that treatment decision. It would be very helpful to see pictures of your face to provide a more specific answer to your exact facial concerns.
Having done a lot of both infraorbital and tear trough implants and fat grafting in this area, I am facile with both techniques and my treatment decision rests with what is best to anatomically correct the problem. Anatomic needs should dictate the treatment, not what ay surgeon is most familiar with doing. What I can tell about treating this area in general is that I often use a combination of both implants and fat grafting to get the best result. Implants can only go where the bone is, fat injection grafting can volumize soft tissues where implants can not. (e.g., lower eyelid above the infraorbital rim)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial feminization surgery but for different reasons that the typical facial feminization surgery patient. I am a 27 year-old female but my features have been destroyed by acromegaly making me unable to recognize myself. I want the frontal bossing removed and the overall size of my nose reduced. Have you ever worked on an acromegaly patient before? Do you think these two (generally speaking) procedures will improve my features or will I need a reduction in chin, etc? I had my pituitary tumor removed four years ago and my IGF-1 levels are controlled by medication. I have attached pictures of me both and before the acromegaly developed.
A: You are correct in that you desire/need for facial feminization surgery is rare. I have worked on a few acromegaly patients in my career and making significant changes can be challenging based on how much their face has become ‘overgrown’. You appear to have a favorable starting point where some changes (e.g., frontal bossing, chin and jawline reduction) can be visibly improved given that they result from excessive bony deposition and the bone is likely thicker than normal. There are limits in rhinoplasty because there is often as much skin thickening over the nose as there is bone and cartilage excess. As in any rhinoplasty patient the limits of what can be seen on the outside is partially controlled by how much the skin will shrink over a reduced osseocartilaginous framework. Based on just a frontal view alone, it is hard to assess his much nasal changes can occur. (as well as other areas of the face)
Since your pituitary tumor has been removed and your IGF-1 levels are being monitored/controlled, facial surgery would be reasonable to do as the risk of causing an excessive healing response to tissue manipulations (i.e., overgrowth) has been eliminated. It would be important to get an assessment of your facial skeletal features with a 3D CT scan so bone size/thicknesses can be assessed preoperatively. That can be ordered by me to any imaging facility that you choose where you live. Also please send some cur6rent picture from different angles (non-smiling) for my further assessment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in chin reshaping. I think my mid face and chin are long (I assume it’s easiest to fix just the chin). I’d like to reduce vertical height by at least a third and increase chin projection. I may also consider some work on my nose. (narrow bridge, hump removal, refine tip).
A: Thank you for sending your pictures. It is far easier to vertically shorten facial height by working on the chin. Midface vertical length can only be reduced by a maxillary impaction surgery which can only be done if one has true vertical maxillary excess. (too much tooth and gum show at rest)
Your chin appears long because of it is horizontally short and rotated backward. A sliding genioplasty can be done to bring it forward and to vertically shorten it at the same. To see how this would look, computer imaging needs to be done. To do this type of computer imaging analysis, I need non-smiling pictures from the front and profile views to get a non-distorted imaging. As beautiful as your smile is, it distorts the soft tissues of the chin and nose. This is the one time where smiling is not helpful!
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a tummy tuck. My questions are:
1. Cost- do you know if insurance pays for the surgery or is it out of pocket?
2. Hospital stay – how long or outpatient procedure?
3. How long off of work?
4. Cost for an office consultation
A: Thank you for your tummy tuck inquiry. In answer to your questions:
1) Tummy tuck surgery is a cosmetic procedure and is not covered by insurance unless one has a large overlying abdominal pannus that has documented medical symptoms that have undergone unsuccessful non-surgical treatments. To be considered for insurance coverage a predetermination process is necessary.
2) Unless it is a very large abdominal pannus and the patient has other medical issues, tummy tuck surgery is typically an outpatient procedure.
3) How much time one would need off work after a tummy tuck depends on what type of work one does. But as a general statement, two weeks for an office for sit down job and three weeks or more for a very physical occupation.
4) As a cosmetic tummy tuck there is no charge for am office consultation.
Dr. Barry Eppley
Indianapolis, India
Q: Dr. Eppley, What is the material used to widen my face at all areas. (especially the area at side from zygoma to lower jaw) Will silicone material be the best ? I have tried fat transfer but it was little volume and only had a temporary effect. I wish to widen my face with permanent and semisolid material. I have attached my photo. Thanks a lot.
A: The best way to permanently widen your face is by using a combined custom facial implants approach with jawline and zygomatic arch designs made from a solid silicone implant material. They will provide an immediate and lifetime change. With a custom design they can be made to match in their upper and lower facial width increases so one is not wider than the other.
Fat injections in you was never going to work. And even if the fat took it would look soft and ill-defined. But most importantly your face is too thin to ever have any fat graft take very well. Fat grafts always work better when there is some natural subcutaneous fat into which they are placed.
The only issue here is that there will be a concavity between the mid- and lower facial widths increases where there is no bone support. I assume this is one of the areas where the fat injections were placed that did not work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in frontal bone reduction. (forehead reduction) What’s the average bone thickness of the frontal bones? How much can you usually take off that will a visible different?
A: Burring is the only effective method for forehead reduction or reduction of frontal bone bossing. Frontal bone thicknesses can range from 12 to 17mms in my experience. The bone can be reduced down into the diploid space. How thick the bone is down into that space (how much can the frontal bone be reduced) is best determined by a lateral skull film or CT scan by which the amount of bone reduction can be measured. In my experience that is anywhere from 5 to 8mms. That may not sound like a lot of frontal bone reduction but when done over the entire surface of the forehead it can create a much greater effect than the numbers alone would suggest.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation by fat injections. I have no interest in implants whatsoever. I’ve attached a couple pictures for assessment. Do you think I would get a reasonable breast augmentation result (one to two cup sizes bigger) if the fat was taken by liposuction from just my abdomen and flanks. I just weighed myself this morning and my weight is around 170, but I’m typically 165. I’m approximately 5’7” tall.
A: Thank you for sending your pictures and your inquiry in fat injection breast augmentation. I think you have a low amount of fat to harvest to do the procedure given what your breasts are initially like and what your goals are. They have several unfavorable characteristics including a very narrow breast base with large areolae, breast mounds that are very widely separated and a very wide chest width. It would take more fat than you have to inject your breasts to increase the size of your breast mounds to the level that you are seeking. With the amount of fat needed and the assured loss of 50% of what is injected, your breast augmentation result is not going to meet your goals. If you can accept more modest goals such as a 1/2 cup to maybe one cup size bigger, then you become a better candidate for fat injection breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am struggling with my confidence as a result of having a big head. I have read lots of articles on your webpage, and I would really like to do have something done with my head size. It is basically just big in every dimension. So I would like to do these surgeries:
1. Narrowing of head. (Partly removal of the temporal muscle and burring of bone)
2. Shorten the length of my head from my forehead to the back of my head.
3. I would like to reduce the height of my head. (For instance by burring down the sagittal ridge)
I have always had a quite big head, but I was involved in an accident recently, which provoked a bump on the back of my head. So my questions are, how much would it be possible to reduce the skull in the questioned areas?
A: You have highlighted the five site specific skull reduction locations (front, top, back and sides) where reduction procedures are possible that can have an effect on overall head size. It is hard to put an exact number or percent as to how much head size reduction would result from these collective efforts Since every patient is different with varying amounts of head size protrusions and bone thicknesses, each case has to be evaluated on an individual basis. The question is not whether one can perform all these skull procedures but whether the end result justifies the effort. I would need to see pictures of your head from different angles to provide an answer in your case. Ultimately a CT scan is needed to assess the thicknesses of the bone and muscle which also helps in making that determination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a nasal implant question. I would like to have the very tip of my nose lengthened but have been told that my existing implant must be removed due to the fact that it causes the skin of the tip to harden and in future years the implant will cause problems anyway? During my first rhinoplasty a little cartilage was added to the tip. I didn’t feel that it was nearly enough. I have a blue silicone implant in the bridge, “Flowers” is the brand.
A: If you want to lengthen your nasal tip, placing cartilages on top of the nasal implant in the tip area can be done. (if the implant even goes down over the tip) There is no reason to remove the nasal implant to do so.
By the way, if you have a blue colored implant on your nasal bridge, that is not an actual implant. That is the nasal implant sizer used to try in before placing the real implant. Some surgeons unethically place sizers instead of the real implants because they cost only 10% as much as the real implant. That is why the company colors them blue, to try and prevent surgeons from using the sizers as the actual nasal implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am inquiring about the possibilities regarding slimming down my face. It is just long and wide and does not look proportional to my body at all. What could be done to reduce the size of my face? I obviously see that there are limits of what can be done. Whereas I for instance could have jaw reduction and/or cheek cutting. But what sort of experience do you have here?
A: In facial reshaping surgery, slimming the face can be done by three different approaches depending on the dimensions involved. Normally the face could be vertically lengthened to make it look less wide. The face could also be made less wide (width reduction) without changing the vertical length. Lastly, a combination of vertical lengthening and width reduction can be done which often is the most effective.
Your facial dimensions and concerns (‘long and wide’) leave you with only facial width reduction options as you have noted. Cheekbone narrowing and jaw reduction would be the logical procedures of cboice. Whether this would include vertical chin reduction to help with the long face can be debated since vertical facial shortening works against facial width efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin augmentation and rhinoplasty after our consultation? What are the logistics of the actual procedure…i.e, time needed to recover, possible adverse short and long term effects, are the results permanent or will it need to be altered down the road to maintain its new shape, and are allergic reactions to the implant material common?
Another concern of mine is that I train in jiu jitsu (it’s like wrestling pretty much) so would the implant possibly be jostled loose if I were to get knocked in the chin? If so, would the sliding genioplasty yield similar results or no? I do like the chin implant.. just worried that it could be a potential problem.
A: The combination of rhinoplasty and chin augmentation is a very common facial reshaping surgery because of its dual benefits in changing two important areas of facial prominences. These are outpatient procedures done under general anesthesia. The most significant recovery is the first week when the nose will have a tape and splint dressing and the chin will be the most swollen. After the first week the nasal splint comes off so it is easier to be seen out in public without having had obvious surgery. Most of the swelling is gone by about three weeks after the procedure although it really takes a full three months before one should critique the results.
Both the rhinoplasty and chin augmentation create permanent effects through bone and cartilage modifications (nose) and the placement of a non-degradable implant. (chin) There is no such thing as an allergic reaction to a silicone implant although there is the rare occurrence of the risk of infection (1% or less) The chin implant will be secured in placed by small screws so between screw fixation and the enveloping scar that occurs around any implant, it will never move regardless of almost any degree of physical contact. You would have to break the bone to move the implant.
The biggest risks or need for revisional procedures for either a rhinoplasty or chin implant are aesthetic in nature…how does it eventually look and is the patient satisfied. The overwhelming reason for revision of any facial aesthetic procedure is the patient desire for additional changes/improvement in the shape of the nose or chin.
Dr. Barry Eppley
Indianapolis, Indiana
