Your Questions
Your Questions
Q: Dr. Eppley, I am at wits end. 🙁 I had goretex implants in nasal-labial folds about 12 yrs ago. They capsulated shortly after and I looked hideous. So I've been filling around them for years even had a face lift. Finally, about 6 months ago I had them removed and replaced with Alloderm.. It looks worse!!! One side is hard and they both show thru the skin. The company will not give me info. Can they be successfully removed??? Today, I am having Ultherapy in hopes of tightening to minimize the awful protrusions.:((I used to be a model and now I can't even look in a mirror)
A: I see no problem with easily removing Alloderm. It does not usually incorporate much into the surrounding tissues. It gets encapsulated, almost like your original Gore-tex implants, which is why it contracted and became distorted. In hindsight, that probably was not the best choice for a replacement for the Gore-tex as it did exactly what could have been predicted in that situation. I would not expect Ultherapy to make any difference. That approach is a hopeful but flawed concept. A much better replacement once they are removed would be dermal-fat grafts or fat injections, a natural tissue that will heal into the surrounding tissues adding volume and will not develop contractures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have deep nasolabial folds and a mouth whose corners turn down. I have read about a way to improve them by using your own tissue through grafting. I had a facelift already which got rid of my jowls and helped my neck but didn’t do a thing for the area around my mouth. I don’t want to treat them with injectable fillers because that will only be temporary. Are you familiar with this tissue grafting technique?
A: What you are talking about is an old plastic surgery technique, dermal-fat grafts, that has been applied to a cosmetic problem. A dermal-fat graft is a piece or strip of skin that has a thin layer of fat on its underside. The overlying epithelium or skin layer is removed, leaving just the dermal skin layer with the attached fat. Provided that the graft size is not too big, it survives quite well as the blood vessels of the recipient site attach quickly to the vessel ends in the dermis. This allows a quick return of blood flow to the fat thus enabling it to survive.
For use in the face for nasolabial folds, it must be taken from the lower buttock crease or any other large scar site and must be at least 6 to 7 cms in length for each nasolabial fold. From inside the nose, a tunnel is made under the nasolabial fold curving down to the corner of the mouth. The dermal-fat graft (dermis side up) is then placed through tunnel and fixed to the corner of the mouth through a small incision from inside the corner. It is then lifted and tightened from inside the nose and the excess graft trimmed and closed. The graft simultaneously augments the nasolabial fold and lifts the corner of the mouth. I have done this procedure numerous times and it does have its merits. But the issue is that it requires a harvest site and the buttock crease is almost always the best choice because of the thicker dermis. The discarded skin from a pretrichial browlift can be used as well. There are also other simpler ways to achieve both of these facial objectives. Fat graft injections combined with a corner of the mouth lift is another approach. But for the right patient who does not mind a buttock scar, the dermal-fat graft approach can be used.
Dr. Barry Eppley
Indianapolis, Indiana