Your Questions

Q: Dr. Eppley, I am interested in a custom occipital implant. My head is obviously flat. I have been insecure about it since my teenage years. I am know in my late 20’s. I am interested in a custom occipital implant to make the back of my flat flat head perkier and rounder. I was wondering what the estimation of this procedure would be? I was also wondering, since you cut the hair/skin part of the back head, is the scar obvious (aside from hair covering it)? For example, if I were to show that area would the scar be obvious? Thank you. I look forward to your reply.

A: For augmentation of a flat back of the head, a custom occipital implant is the best method. It does require a scalp incision somewhere and that would depend on its size and location on the occiput. The scalp scar usually turns out very well particularly in women. If you shave your head the scar would be somewhat obvious but that is the situation you probably are not going to find yourself in. Great care is taken in aesthetic skull reshaping surgery to preserve hair follicles along and around the scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a revision rhinoplasty that lengthens my nose. I had a rhinoplasty several years that ended up shortening and lifting my nose too much. This is not a good look for a man. I have read that the best way to do the procedure is with cartilage grafts and the rib may be the best source if substantial lengthening is needed. Does the rib graft make the nose feel any different such as being very rigid?

A: When considering revision rhinoplasty for tip lengthening and derotation, it is important to understand the anatomy of the nasal tip cartilages. The nasal tip cartilages are the only structures in the nose that are ‘free floating’, they are not attached to the underlying septum or upper lateral cartilages by fixed rigid attachments. This is why one can move the tip of the nose around freely and it is compressible, unlike the upper nasal bones or cartilages for example. When any tip lengthening procedure is done, which requires cartilage grafts, by definition more structural support is added and it will become more rigid. It will never be as soft and compressible as when it has less cartilage support. How rigid it may become is a function of the type and amount of cartilage grafts that are needed and how they are placed.

The cartilage grafts needed for significant tip lengthening/derotation must be placed between the fixed structures of the nose and the free floating tip cartilages. This is the way you drive down the tip of the nose. In essence, you are building up the underlying support to push out and down the tip. The grafts can not merely be placed on top of the nasal tip cartilages, that is only effective if you need just a few millimeters of lengthening or derotation effect. To really be effective for tip lengthening, straight pieces of cartilage are needed that are placed in an almost tripod fashion behind the tip cartilages. The use of a rib graft ensures that an adequate amount of cartilage is available.

Dr. Barry Eppley

Indianapolis, Indiana