EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

February 6th, 2016

Technical Strategies – Triceps Implants

 

Silicone implants are available for male muscle augmentation at a variety of body sites. The most well known male body implants are the pectoral and calf implants. Implants for the arms and shoulders can also be done but they are far less well known and performed. Arm implants can be done for the bicep and tricep muscles and are most commonly done together.

tricep muscleThe triceps muscle, technically known as the triceps brachii muscle (three headed muscle of the arm), is the single large muscle on the back of the arm. Its contraction is what causes the straightening of the arm by extension of the elbow joint. Aesthetically the triceps muscle is not thought of as important as the anterior biceps muscle. But augmentation of the biceps muscle can not really be done without triceps enlargement to keep a well balanced muscular upper arm.

Triceps Implants Incision Dr Barry Eppley IndianapolisThe placement of triceps implants is best done under general anesthesia in the prone position. With the arms extended out on arm boards and the elbows bent at 90 to 120 degrees, good access is obtained to the back of the arm. With this positioning, a 3.5 cm skin incision can be made in the posterior axillary skin crease.

Triceps Implants Insertion Dr Barry Eppley IndianapolisTriceps Implants Insertion 2 Dr Barry Eppley IndianapolisDissection is carried down to the triceps  fascia through a moderate layer of subcutaneous fat. There are no major nerves or blood vessels that are in the path of this dissection. The fascia is incised and a subfascial plane is easily dissected down the whole back of the arm  to within a few centimeters of the elbow. A soft flexible silicone triceps implant (contoured carving block, Implantech) is sized, cut to length, and then thread into the subfascial pocket. It is important that the implant is positioned exactly on the back of the arm and stays passively below the fascial incision.

Triceps Implants Incision Closure Dr Barry Eppley IndianapolisAfter the implant is adequately positioned, the triceps fascia is closed as well as the dermis of the overlying skin. The skin is then closed with a subcuticular suture.

The surgical technique for triceps implant placement is highly aided by properly positioning the patient so that unimpeded access is provided to the back of the arm.

Dr. Barry Eppley

Indianapolis, Indiana

February 5th, 2016

Revision Plastic Surgery

 

Cosmetic procedures and their outcomes can be influenced by how the body responds to the traumatic insult of surgery and the unpredictable forces induced by wound healing. As a result, undesired aesthetic outcomes can occur. This may necessitate the need or desire for revision plastic surgery.

In plastic surgery, the occurrence of complications presents different issues from most other types of surgical disciplines. Unlike more typical postoperative problems such as infection or bleeding, the healing of the surgical site in a cosmetic procedure may be perfect but the desired appearance of the operated area less than desired. The development of a suboptimal appearance exposes the cosmetic surgery patient and the surgeon to the potential need or desire for revisional surgery.

Since appearance was the primary objective of undergoing the surgery, the rate of revisional surgery is going to change based on a patient’s perception of the outcome. While the actual need for revisional surgery varies amongst the type of cosmetic procedure performed,  it has been estimated that it averages in the range of 10% to 15%.  Certain procedures, usually those that involves implants, can be substantially higher. Conversely, many other procedures manipulate one’s own natural tissues to create their effect and, as a result, their revisional rate is in the low single digits.

While revisions of cosmetic surgery results may often be relatively minor, and usually way less than the original surgery, their risk of occurrence is most certainly not rare. Any cosmetic surgery patient needs to understand that the risk of revision plasticl surgery is real and not to make the assumption that such things just happen to others and they are somehow immune to this possibility.

When postoperative complications develop and the need for revisional surgery becomes apparent, it is not a moment of happiness for either the patient or the surgeon. The cosmetic patient is dissatisfied as they never really anticipated that this might happen, no matter how well disclosed this risk was before surgery. Surgical problems are often thought of as ‘something that happens to other patients’ or are the result of some type of ‘surgical negligence’…neither of which is rarely true.

The cosmetic patient is understandably focused on the potential benefits of the operation, not the statistical risks of revisional surgery. This thought process has been unintentionally fostered by plastic surgeons themselves with the many promotional advertisements promising ‘weekend facelifts’, ‘scarless surgery’, and many unrealistic outcomes or recovery times.  As a result, cosmetic surgery is often not seen as the very real surgery that it is with its many potential risks.

Like the patient, the surgeon is equally not enthused about the need for revisional surgery either. There are many reasons surgeons can feel that way, from knowing that the patient is disapppointed,  a perceived failure of their own abilities and as to how this may reflect on their own reputation and image. As a result of these opposing perspectives and even potentially conflicting agendas, a discrepancy may develop between the patient and surgeon as to the need and advisability of revisional surgery.

When needed, however, surgical revisions should be done in the proper setting and under the appropriate circumstances. Certain minor revisions can be reasonably performed under local anesthesia in the office. This approach is simple and avoids the use of the operating room. Many times, however, this office approach to surgery is ‘overused’ in an effort to save the patient further expense. Many revisions are best done in the operating room under an anesthetic that provides a more comfortable experience for the patient and also allows the surgeon to more adequately perform the revision plastic surgery.

Dr. Barry Eppley

Indianapolis, Indiana

February 4th, 2016

Outcome Assessment of Facial Feminization Surgery

 

facial feminization surgeryFacial feminization surgery is a recognized collection of facial reshaping procedures that are primarily used in the treatment of gender dysphoria. Based on recognized anthropometric studies, the key craniofacial characteristic that separate a male from a female face is the shape of the forehead, the frontonasal junction and the shape of the chin. Thus, facial feminization surgery encompasses forehead recontouring/brow bone reduction, rhinoplasty, chin/jawline reduction/reshaping and tracheal shaves.

While facial feminization surgeries are becoming more commonly performed, an important question is how successful is this surgical process. Before and after surgery pictures can show either modest or significant changes, but how are the results perceived by the transgender patients on whom they are performed?

In the February 2016 issue of the journal Plastic and Reconstructive Surgery, the paper entitled ‘Full Facial Feminization Surgery: Patient Satisfaction Assessment Based on 180 Procedures Involving 33 Consecutive Patients’. In this study, an assessment of patient satisfaction after male to female FFS procedures that included outcome measurements after forehead and chin remodeling. Thirty-three (33) patients between the ages 19 and 49 years old over a ten year period were treated with a total of 180 facial procedures. The authors used a FFS flow chart that included two basic combined hard and soft tissue steps that are completed in six months. Step 1 is orthognathic surgery, rhinoplasty and chin/jaw reshaping (hard tissue) and/or facelift, blepharoplasty and structural fat grafting. Step 2 is forehead and orbital reshaping (hard tissue) and/or hairline lowering/browlift, tracheal shave and neck liposuction.

All treated patients showed excellent cosmetic results and were satisfied with their procedures. Photographs showed a successful loss of masculine features. Patient satisfaction after facial feminization surgery in this patient series was high. The facial physical improvements had significant psychological and social benefits that improved their quality of life.

This clinical FFS series is unique in several ways. First their approach to FFS surgery is somewhat different in that it introduces orthognathic surgery as part of the first stage. While there are some transgender patients that would benefit by this type of facial skeletal surgery, it would apply largely to younger patients who are more willing to commit to an investment in that effort. Most transgender patients I have seen and treat would have little interest in facial osteotomies unless they have a major malocclusion. Secondly, they treat the lower half of the face first, followed by a second stage attention to the upper face. For many transgender patients, the forehead is often a high priority and is often done first and there is no guarantee there will be another opportunity for additional procedures later.

Facial Feminization Surgery Indianapolis Dr Barry EppleyWhile it is clear there is no exact ‘formula’ for how to stage or even perform facial feminization surgery, various approaches can be used. When the procedures are done successfully, whether in a comprehensive single stage or in multiple stages, patient satisfaction surgery with FFS can be quite high.

Dr. Barry Eppley

Indianapolis, Indiana

February 3rd, 2016

Case Study – Extended Abdominal Liposuction

 

Background: Liposuction, both by number of procedures performed and body surface area, is the most common aesthetic body contouring procedure. While a large number of different face and body parts can be treated by liposuction, the treatment of abdominal and waistline fat accumulations is the most popular requested area. While initially intended to treat smaller abdominal amounts of fat, abdominal liposuction has evolved to become a larger surface area treatment wrapping around the sides in the back.

Extending abdominal liposuction into the back has been shown to be very safe in properly trained and experienced hands. With fat removed in a near circumferential manner around the lower torso, it is no surprise that major body shape improvements can be seen. How much abdominal flattening and back roll reduction can be achieved is highly influenced by the amount and quality of the overlying skin. Back skin always has a greater amount of contractile ability due to its greater dermal thickness. Abdominal skin  often has less ability to shrink down smoothly due to loss of elasticity from pregnancies and weight loss.

As liposuction has evolved over the past 35 years in the U.S., numerous types of technologies have been applied to how liposuction has been performed. All of these technologies are largely about how the fat is broken up so that it can be suctioned out. While it is easy to get caught up as a potential patient in the different energies and marketing names of these liposuction types, nothing is more important than the skill and experience of the surgeon performing the procedure.

Case Study: This 46  year-old African-American female desired to liposuction to further what she has been able to achieve by diet, exercise and weight loss on her own. She had hit the proverbial wall in any further body shrinkage of her stomach, waistline and back.

african-american abdominal liposuction result front view Dr Barry Eppley IndianapolisUnder general anesthesia and using pre-liposuction tumescent infiltration, power-assisted liposuction of the entire abdomen, pubis, flanks and back rolls was performed. Using a 4mm cannula, a total of 3,800cc of fat aspirate was obtained. Essentially lipsuction as performed until the aspirate became more red than yellow.

african-american abdominal liposuction result oblique view Dr Barry Eppley IndianapolisHer postoperative swelling was considerable, as expected, and it really took her a full three months to have a complete recovery. Until the treated areas are no longer tender, feel soft and the sensation in the overlying skin is back to normal, all swelling has not resolved and the skin maximally contracted back down.

african-american abdominal liposuction result side view Dr Barry Eppley IndianapolisInterestingly at her three month postoperative evaluation, she felt she had no significant change in the fullness of her abdomen or a reduction in her back rolls. Comparing her before and after surgery pictures showed that her perception was not accurate.

african-american Back and Flank Liposuction result back view Dr Barry Eppley IndianapolisAlso of interest was the apparent change in the appearance of her buttocks. While no fat injections were done into her buttocks, the significant reduction in the waistline above her buttock made it seem that she had.

Highlights:

  1. Liposuction of the torso (abdomen, waistline and back) is the most commonly performed body contouring procedure.
  2. When liposuction is done in a near circumferential manner around the waist, a dramatic reduction can be achieved in the shape of the torso.

3. Liposuction does not always eliminate all stomach or back rolls if too much excessive skin exists.

Dr. Barry Eppley

Indianapolis, Indiana

February 3rd, 2016

Case Study – Trapezius Muscle Implants

trapezius muscleBackground: The trapezius muscle is a large superficial muscle in the upper back. It extends from the occipital bone superiorly down to the spine to the lower thoracic vertebrae and then out laterally to the shoulder blade. (scapula) Muscular development of the trapezius muscle by male body buillders and exercise enthusiasts is focused largely on the upper portion of the muscle as it is the most visible from the front as it ascends up the sides of the neck.

The superior or upper portion of the trapezius can be most effectively enlarged through exercises that elevate the shoulders. Maintaing persistence of this type of muscle hypertrophy requires diligence to muscle training. For those men who are unable or do not desire to achieve trapezius muscle enlargement, there are several surgical options to bypass these efforts.

Fat injections can be done into the trapezius muscle provided one has enough fat to do so. While a viable muscle augmentation method, the take and persistence of the injected fat is not assured. Like many other muscle areas of the body (pectoral, biceps, triceps, gluteus and gastrocnemius) implants can be used to achieve an assured and permanent enlargement effect.

TrapeziusMuscle Implants preop Dr Barry Eppley IndianapolisCase Study: This 50 year-old male desired to have larger upper trapezius muscles. He had adequately built up his arms and chest muscles but could not get his upper ‘traps’ to proportionately match.

Trapezius Muscle Implants Markings Dr Barry Eppley IndianapolisTrapezius Muscle Implants surgical technique Dr Barry Eppley IndianapolisTrapezius Muscle Implants surgical technique 2 Dr Barry Eppley IndianapolisUnder general anesthesia and in the prone position, 3.5 cms skin incisions located at the base of the neck/upper shoulders were made. The trapezium fascia was identified and incised. Subfascial pockets were made along the outline of the desired implant locations. Soft solid silicone carving blocks were fashioned in the desired shape and inserted into the pockets. The size of the trapezius muscle implants measured 10 cms long, 4 cms wide and 1.5  cms in height. The fascia was closed separately from that of the skin closure.

Trapezius Muscle Implants immediate result Dr Barry Eppley IndianapolisHis immediate intraoperative results shows the dramatic increase in the upper trapezius muscle projection. Short of some initial postoperative discomfort, he can be back exercising in 7 to 10 days after surgery.

The upper muscle fibers of the trapezius muscle run from the bottom of the occipital bone out to the posterior border of the lateral third of the clavicle. While not traditionally thought of as a muscle that can be augmented, the upper portion of the trapezius can be. Increasing its visible height from the front by placing a small implant at its most superior fiber level is a straightforward technique that can be done in an hour of operative time for both sides. The key is to place the implants in the subfascial plane to prevent their visible outlines.

Highlights:

  1. Trapezius muscle augmentation can be done surgically done by fat injections or the use of trapezius implants.
  2. Trapezius muscle implants are placed in the subfascial plane of the upper trapezius muscle.

3) Small contour solid silicone implants produce an immediate  augmentation of the upper trapezius muscle.

Dr. Barry Eppley

Indianapolis, Indiana

February 1st, 2016

Custom Jawline Implant After Surgery Swelling

 

Facial implants of any type of dimensions will always cause some temporary swelling and bruising. Both types of performed jaw implants, chin and jaw angles, cause a predictable amount of facial swelling that will most certainly be viewed as significant by the patient. Typical facial swelling takes two days to reach its peak and the swelling resolves on a predictable downward projectory. I tell my patients that 50% of the swelling will be gone by 10 days, 75% by 21 days and 95% by six weeks after surgery. Final critique of the facial result should await a full three months.

Female Custom Jawline Implant design Dr Barry Eppley IndianapolisA custom jawline implant, will cause the greatest amount of facial swelling than any other type of known facial implant. It combines the postoperative swelling seen in isolated chin and jaw angle implants into one single jawline enlargement. It probably causes more swelling than these two facial implants combined because the entire jawline is dissected free from angle to angle in a subperiosteal plane.

Sequential Custom Jawline Implant swelling front viewSequential Custom Jawline Implant swelling right oblique viewA custom jawline implant can create some dramatic changes to the lower face. But the patient needs to be aware of the magnitude of the swelling and bruising that will occur as it can be very unsettling. As is typical for any facial implant, the swelling from a custom jawline implant will not be ‘bad at all’ the first night after surgery. But by the next day some significant swelling will have developed. It is the second day after surgery when the true magnitude of the swelling will be appreciated. While normal, it is always more than most patients anticipate. This patient example shows the progression of swelling in a three picture sequence of before surgery, day 1 and then day 2 after surgery.

Sequential Custom Jawline Implant Swelling submental viewWith the face naturally ballooned up several days after surgery, patients naturally wonder if something is wrong. Some patients may even question to themselves if having this surgery was the right decision. With the face so distorted, the patient is halfway across the ocean…having left home with a face that was very familiar but far from arriving at their new look. (final destination.) Sitting between these two sides can understandably make patients feel very uncomfortable. But patience and time will resolve the facial swelling. It usually takes about three weeks before one feels like they are becoming more normal and they start to see the benefits of the planned jawline change.

What causes much of the swelling after placement of a custom jawline implant is the disruption of the masseter muscles off the bone. The masseter muscles are the largest muscles on the face and their disruption is the source of much of the facial swelling and the temporary stiffness of jaw opening.

Dr. Barry Eppley

Indianapolis, Indiana

January 27th, 2016

Custom Jawline Implants for Women

 

Jawline enhancement or jawline augmentation is where various dimensions of the lower facial skeleton are built up. Unlike chin augmentation, jawline augmentation refers to both chin and jaw angle for a more overall effect. Such a jawline effect is typically thought of as being exclusively for men. And while that is true most of the time, there are an increasing number of women who are undergoing the procedure.

Women who benefit by jawline enhancement  fall into several types. The first are those women who have an overall shorter jaw by development or genetics that is seen in the chin area as being both horizontally and vertically short. This also means that the jaw angles are higher and indistinct in shape. Another deficient jawline in females is that created by the well known V line surgery. Some women once having it want to reverse it and return back to their naturally normal jaw shape.

Female Custom Jawline Implant design Dr Barry Eppley IndianapolisFemale Custom Jawline Implant thickness Dr Barry Eppley IndianapolisThe best method for total jawline enhancement in females is a custom jawline implant. Covering the entire jawline from angle to angle creates a vey powerful effect on the lower face. For this reason, many female custom jawline implants in women are made smaller than for most men.

Custom Female Jawline Implant intraoperative insertion 2 Dr Barry Eppley IndianapolisThe smaller size of most female custom jawline implants makes them fully capable of being inserted through incisions inside the mouth. The smaller flare and thickness of the jaw angles makes their passing under the mental nerve in a subperiosteal tunnel uncomplicated. The usually more modest amount of chin augmentation allows for good mentalis muscle closure over the implant intraorally.

Female Custom Jawline Implant early result front viewCusytom Female Jawline Implant early result oblique viewEven though they are smaller that does not mean that the early jaw swelling after placement of a custom jawline implant will not be significant. It takes a full six weeks before the vast majority of the jawline swelling has gone away. It is important for women to be patient as the jaw can look too big as these one week after surgery pictures show.

 

Dr. Barry Eppley

Indianapolis, Indiana

January 26th, 2016

Case Study – Mini Tummy Tuck with Liposuction

 

Background: Pregnancy affects most women adversely from an abdominal standpoint. The expansion and stretching of the abdominal skin is most severely seen in its central aspect around the umbilicus. The peri-umbilical region is well known to develop radiating stretch marks, loose skin and be a reservoir for refractory fat collections.

For most women the amount of peri-umbilical deformity requires a full tummy tuck to adequately resolve. But for some women the amount of skin excess in the lower abdomen does not justify the long lower abdominal scar. Conversely, liposuction alone will make the area less full but will leave an irregular contour due to the skin excess. Skin with stretch marks has a dubious ability to shrink down smoothly after underlying fat removal.

For those women with an intermediate peri-umbilical abdominal problem, a strategy that combines both fat and skin removal makes the most sense. Aggressive liposuction can be supplemented by skin removal and tightening to lessen the risk of skin irregularities. A limited or mini tummy tuck an keep the lower abdominal incision very low with less scar length while creating the needed abdominal skin tightening.

Case Study: This 44 year-old female had a very large but discrete fat collection around her belly button. Given her body size and type, the amount of peri-umbilical tissue excess was disproportionate. She has reached her potential for what she could change by weight loss and exercise.

Mini Tummy Tuck with liposuction result front viewUnder general anesthesia, full abdominal and flank liposuction was initially performed. A total of 3.5 liters of liposuction aspirate was surprisingly obtained. This was not expected given her body size. A low mini tummy tuck was then performed with release of the umbilicus and allowing it to float downward and then reattached from the inside.

Mini Tummy Tuck with liposuction result obloique viewMini Tummy Tuck withu liposuction  result side viewHer six month results showed a completely flat abdomen with a much improved waistline shape. Her mini tummy tuck scar was low enough that it was situated below her underwear line.

For women that do not have enough excess tissues to warrant a full tummy tuck, combining overall liposuction with a smaller tummy tuck can be a good alternative. Some plastic surgeons feel that there is no good role for a mimi tummy tuck procedure as it does not produce enough of a result. While this may be true for many women who seek abdominal improvement, it clearly is not the case for all as this patient’s result demonstrates.

Highlights:

  1. Central abdominal peri-umbilical tissues distortions are common for many women after pregnancies.
  2. With loose stretched periumbilical skin, liposuction alone will produce an inadequate result.

3. Combining liposuction with slower skin removal and repositioning (mini tummy tuck) produces the best result in profound cases of peri-umbilical lipodystrophy.

Dr. Barry Eppley

Indianapolis, Indiana

January 26th, 2016

Calf Implants Surgical Technique

 

Calf augmentation can be done by two surgical methods. The most historic and reliable is the use of synthetic calf implants. A more recent but far more unpredictable technique is that of fat injections. Each calf augmentation method has its advantages and disadvantages but, like breast augmentation, fat injections are a good volume addition technique in only a very few carefully selected patients.

While calf implants are well known, the surgical method to place them is done by very few plastic surgeons. With good surgical technique, calf augmentation can be done with a good aesthetic outcome and very successful long-term results.

Calf Implant Incisions Dr Barry Eppley IndianapolisThe placement of calf implants is done from incisions behind the knees. A separate incision is need for either medial or lateral implants placed over the gastrocnemius muscles. Each incision does not need to be longer than about 3.5 cms. It should be placed directed in the visible skin crease in the popliteal fossa which is seen  even in young patients.

Calf Implant fascial incision Dr Barry Eppley IndianapolisOnce the skin incision is made, dissection is carried down through the subcutaneous fat to the the dense fascia layer over the muscle. One may encounter cutaneous sensory nerve branches at the end of the incisions and they should be preserved and pushed aside. Once the fascia is encountered it is incised at the same horizontal length as the skin incision.

Calf Implant Insertion Technique Dr Barry Eppley IndianapolisCalf Implant insertion Technique 2 Dr Barry Eppley IndianapolisA subfascial pocket is developed with special instruments that can create the dimensions needed without tearing the overlying fascial lining. It is important the the pocket not be developed too long so that the fascia is not violated at the bottom of the pocket where it gets adherent to the soleus region. Also the pocket should not be developed across the midline union of the gastrocnemius muscles to prevent implant drift. The calf implants are inserted by squeezing them through the skin and fascial incisions. The special double layer design of the calf implants (Implantech body contouring implants) allows them to be compressed and pushed through small incisions without tearing of his soft gel shape.

Calf Implant Incision Closure 2 Dr Barry Eppley IndianapolisOnce positioned into the pocket, the implant should like well below the fascial incision line. In closing the incision, the underlying fascia should not be attempted to be closed. (which often is impossible anyway) Closing the gastrocnemius fascia makes the calf area very tight and increases after surgery pain. A flap of fat should be used to cover the fascial opening. The skin is then closed in two layers with dissolvable sutures. The incision is covered by tapes and the calfs ace wrapped.

While calf implants are more invasive and involve a longer recovery than fat injections, well placed subfascial implants provide a permanent method of calf augmentation. The subfascial placement of the implants will require several weeks of recovery until one can resume full physical activities.

Dr. Barry Eppley

Indianapolis, Indiana

January 24th, 2016

The Vertical Lengthening Chin Implant

 

Chin augmentation is the most historic but still the most commonly performed facial augmentation procedure. While many other types of facial implants have been developed, increasing projection of a deficient lower face is still the most potentially dramatic facial augmentation change of them all.

Chin implants have evolved considerably over the past few decades with numerous new styles. The fundamental concept of these style changes has been to create a more natural chin augmentation look or augment different regions of the chin area. But the one constant of all the chin implant styles is that they create a straight horizontal dimensional increase. This is so because all of the implant remains on the front edge of the chin bone.

But some chin deficient patients have more than just a horizontal bone deficiency. Certain short chins are also vertically deficient as well. Historically the only surgical method to substantially increase chin height was an opening wedge sliding genioplasty.  While effective some patients would prefer to avoid a bone cutting surgery.

While it is true that a standard chin implant can be placed very low on the  bone(on its ledge so to speak), this is not how the implant is designed or made to be used. This makes it potentially unstable to sit on the lower end of the bone and, even in doing so, produces a a very limited vertical lengthening effect.

Vertical Lengthening Chin Implant vs Standard Chin Implant Dr Barry Eppley IndianapolisTo address the combined horizontal and vertically lacking chin with an implant, the vertical lengthening chin implant (Implantech) has been developed. What is unique about this chin implant style is that the projection of the implant goes down from the chin at 45 degrees. This creates a combined horizontal and vertical increase. The implant actually sits on the ledge of the chin by design and thus it is more stable. To ensure optimal stability and positioning, a single 2.0mm screw can be placed through the implant to the bone when done from a submental incision. When done intraorally, a 1.5mm screw can be placed through the top edge of the implant to prevent any risk of upward migration. (which actually should be done with all chin implants placed intraorally)

Vertical Lengthening Chin Implant result 1 Dr Barry Eppley IndianapolisVertical Lengthening Chin Implant result 2 Dr Barry Eppley IndianapolisProper patient selection for the vertical lengthening chin implant is critical. It should only be used in patients with a significant vertical deficiency of the chin that also has a horizontal shortness as well. Most of these patients with have an almost 45 degree backward slant between the lower lip and chin. In general, the shorter the horizontal chin deficiency the more likely there will chin height shortness as well. Because it is an implant the width of the chin will also get bigger as the chin gets longer with greater horizontal projection. (a key aesthetic consideration)

Vertical Lengthening Chin Implant result 3 Dr Barry Eppley IndianapolisIn some men with slight or even no real vertical deficiencies, the addition of chin height will create a stronger or more masculine lower facial appearance. While this may be effective for some men, this is not a good strategy for women.

Vertical Lengthening Chin Implant sizes Dr Barry Eppley IndianapolisDifferent sizes (angulations) of the vertical lengthening chin implant are available which can increase the vertical up to 7ms while increasing the horizontal up to 12mms. Such chin augmentation changes may allow some patients to avoid an osteotomy of the chin.

The vertical lengthening chin implant is truly the first 3D chin implant ever made as it increases all three chin dimensions.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

Read More


Free Plastic Surgery Consultation

*required fields



Pricing

The cost of any type of elective plastic surgery plays a major role in the decision to undergo the procedure(s).

Get Your Quote Here


My Plastic Surgery Story

Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits


Categories