Your Questions

Q: Dr. Eppley, I have been considering getting cheek implants for a while now. I understand that one of the risks associated with them is asymmetry and I was wondering, what is your stance on revision surgery should it be required? I understand that the OR and anesthesiologist's fees will still be payable by me, but do you still charge your surgical fee or will it be waived/subsidized for your patients? I ask this because my financial resources are limited, and I would just like to be prepared for any financial contingencies should it be required.

A: Your question is a vey thoughtful and forward thinking one that every patient should get clarified before they have surgery. You are correct in asssuming that in most cases my professional fee for revisional surgery is waived or dramatically reduced but the OR and anesthesia costs are still borne by the patient. It is important to clarify what constitutes a revisional procedure also. If there is a problem induced by the execution of the surgery, such as infection, asymmetry, malposition or other implant placement issues, then that would constitute such professional fee reductions/eliminations. If a patient desires additional improvement/enhancement on an already acceptable result (particularly months to years later), then that may modify this revisional fee consideration.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am considering some facial surgery to improve my overall aesthetics. I have previously been through a rhinoplasty, chin implant and cheek implants. While these have been helpful, I still want to get better results. I am hesitant in doing any more surgeries, however, unless the results will be a significant improvement in facial aesthetics and symmetry.  To help me visualize what  I want I have used a facial aesthetic program which morphed the “ideal male ” with mine.  The pictures seem to make the chin width smaller and less square and with an even jawline to the posterior angle of jaw. The images seem to downsize the cheek implants and to make the tip of nose more symmetrical and smaller with a raised nasion. I have attached a few of these  pictures.  The first two pictures are that of an ideal female face with mine.  The last three are the ideal male face combined with mine.  Thirty points on my face were used for my facial proportions to generate these pictures.   Is it possible to achieve this morphed look since it seems the resulting face is more aesthetic.Your thoughts and concerns are greatly valued regarding what is achievable.  If you have a software program regarding what the  postop look will be regarding the different procedures I would be interested in seeing those results.

A: Thank you for sending your images and your thoughtful morphing overlays. While I think they are helpful to see what direction you ideally want to go, I do not find them realistic or that those type of results are achievable. Images like this set the standard of how the patient will judge their outcomes afterwards and it always leads to results that fail to hit the mark and are disappointing. Their greatest value lies in helping the patient determine whether surgery is worthwhile, particularly the patient who has been through previous surgeries and is in the ‘revision mode’. Quite frankly, I and probably most plastic surgeons shutter when a patient goes through this exercise because the results will always fall short. Since I do not feel your results would meet these imaging goals, at least in my hands, I would recommend that revisional plastic surgery may not be worth the expense and recovery.

Dr. Barry Eppley

Indianapolis, Indiana