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Archive for the ‘custom facial implants’ Category

Recovery from Custom Facial Implants

Monday, October 24th, 2016

 

fig-11a-panfacial-implants-design-front-viewThe decision to undergo surgery with a custom facial implant for aesthetic facial augmentation is an exciting change. Like all elective surgeries, there is a recovery process before the patient will finally see the results of the implant design and surgical placement efforts. This is a predictable process that always involves more swelling than expected and a recovery period that is longer than one wants. In understanding the recovery process, here are five key points to know before surgery.

Most custom facial implants cause a great deal of swelling.What is unique about most custom facial implants is that they are usually larger in size and, as a result, involve more tissue dissection to be placed. While the entry incision(s) may be small, the internal area dissected is much larger.  This usually creates a significant amount of tissue swelling and facial distortion. It is almost always much more than any patient can anticipate. No matter how much you think it can swell and cause the image you see in the mirror to become almost unrecognizable, it will likely be even more so.

The swelling phase is both predictable and prolonged. Facial swelling after implant placement follows a predictable postoperative course. It will take at least two days for the peak of the swelling to occur. While you may feel as though you might not look too badly the day after surgery… more swelling is yet to come. Once the swelling has peaked, it will go down on a decreasing percent resolution over the next six to eight weeks. At ten days, 50% of the swelling will be gone, two-thirds to 75% by three weeks and about 90% by six weeks after surgery. This postoperative course indicates that it will take several months following surgery to truly see the final results of your custom facial implant procedure. Any judgment beforehand would be premature.

The recovery process can be very stressful. While the swelling and the course of its resolution is explained in detail before surgery, managing it can be very different from understanding it. Many patients go through a difficult and psychologically distressing period after surgery. Viewing your own face while it is distorted during recovery is very challenging versus what is revealed during the implant design process in the 3-D planning pictures prior to surgery. This can make some patients concerned that something has gone wrong or they have chosen an incorrect the implant design(s). It is very important to expect this period of adjustment and stress to happen after surgery, and to understand that recovery is a process.  What you see in the mirror just days or weeks after surgery is not the final result.

Evaluating the final results from custom facial implant surgery takes time. Because facial recovery can be very psychologically disturbing, some patients think about changing the implant design or even removing implants in the first month after surgery. Such decisions are completely premature and are emotionally based rather than logical. It is important that one persist through the full extent of the recovery process until the final results of surgery are visible three to six months following the procedure.

custom-midface-implant-design-dr-barry-eppley-indianapolisCustom facial implant results are as much an art form as a science. While the use of 3D CT scans and computer software to design these implants appears very scientific and exacting, it is only partially so. No one can predict with great accuracy how any implant design will look on you. How the soft tissues will drape over the implant and appear on the outside remains an unknown variable in every patient’s surgical outcome. While serious medical issues from this type of facial surgery are rare (e.g., infection), aesthetic adjustments to the implants are not. But before any such secondary surgery should be considered necessary one should wait until the full recovery process is complete.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Female Custom Jawline Implant

Sunday, October 16th, 2016

 

Background: While jawline augmentation is most commonly associated with men, it is gaining aesthetic significance in women as well. A strong jawline is historically associated with increased masculinity. Women are more associated with softer and more recessed chin positions and jawline shapes. But the contemporary female jawline is now desired to have a more definitive jawline with increased angularity particularly at the posterior jaw angle area.

The one jawline dimension that is the hardest to change in both men and women is that of its vertical dimension. Short of orthognathic surgery to correct a deep bite, vertical augmentation with implants is needed to lengthen the lower face. But no standard chin or jaw angle implant provides any substantial vertical elongation. And lengthening the entire jawline as a single unified structure by bony movement requires the chin wing osteotomy with its own set of aesthetic issues.

female-custom-jawline-implant-design-dr-barry-eppley-indianapolisCase Study: This 26 year-old female presented with a history of injectable fillers to her chin to correct a significant chin deficiency. Despite multiple ccs of filler she still had a horizontal chin deficiency. Equally pertinently is that her lower jaw was vertically short compared to the upper two-thirds of her face. A custom jawline implant was designed to both vertically lengthen her entire jawline from angle to chin as well as provide horizontal chin augmentation.

female-custom-jawline-implant-intraoperative-insertion-dr-barry-eppley-indianapolisUnder general anesthesia the custom jawline implant was inserted through an intraoral approach. Three intraoral mucosal incisions were used including an anterior one below the front teeth and two posterior ones behind the second molars. It was inserted as a single piece passing it under the mental nerves from the chin area back to the jaw angles.

female-custom-jawline-implant-fronjt-view-ddr-barry-eppley-indianapolisfemale-custom-jawline-implant-oblique-view-dr-barry-eppley-indianapolisHer immediate after surgery results showed a substantial improvement in the fullness of her lower face. Her chin has better projection and her jawline back to the angles was more visible and defined.

female-custom-jawline-implant-result-side-view-dr-barry-eppley-indianapolisCustom jawline implants in females can be done just as it is in men. The difference is that they are often smaller in overall size with less dimensional augmentation. Creating a sharper and more defined jawline, not necessarily a substantially bigger size, is their usual focus. The exception is in the vertically short jawline where the lower face is disproportionately smaller than the upper two-thirds. In these cases vertical jawline lengthening needs to be done and pull down and out the lower third of the face.

Highlights:

1) Custom jawline augmentation for women can be done as successfully as that in men.

2) For vertical lengthening of the jawline in women only a custom jawline implant will suffice.

3) Most women get smaller custom jawline implants which may allow for a complete intraoral placement approach.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Monday, October 10th, 2016

 

Background: Jawline augmentation has become a popular surgery today as patients seek a stronger and more well defined lower facial shape. Augmenting just the front of the jaw (chin augmentation), while still commonly done, often overlooks a more complete jawline change. The addition of jaw angle implants to that of the chin creates a total jawline change.

While an effective jawline augmentation approach for many patients, the use of three preformed chin and jaw angle implants has a relatively high potential for implant malposition. While any single facial implant always has its own risk of malpositioning, that risk increases three-fold when three implants are used. Most jawline augmentation malpositions occur back in the jaw angle area where implants are hard to place well and can suffer from visible asymmetry.

In cases where the three implant jawline approach has aesthetically ‘failed’ due to implant malpositions, a custom jawline approach should be considered. This changes three implants into a single wrap around implant that is predesigned using computer software. This lessens the likelihood of implant malposition considerably since it is a single implant that is made to fit the jawline precisely.

malpositioned-chin-and-jaw-angle-implantsCase Study: This 30 year-old male had a prior history of unsatisfactory jawline implant augmentation using three implants. The surgical outcome was unsatisfactory as the patient desired a strong angular jawline which he did not achieve. A 3D CT scan showed anteriorly displaced widening jaw angle implants and a cleft chin style implant that was positioned low on the chin bone.

custm-jawline-implant-dimensions-dr-barry-eppley-indianapoliscustom-jawline-implant-replacement-design-dr-barry-eppley-indianapolisA new one-piece jawline implant was created making the chin and jaw angle changes that would more effectively create a more defined and angular jawline. This required a significant vertical elongation at the jaw angles (15mms) and a more pronounced horizontal and vertical change change. The changes in the one-piece implant design were compared to his indwelling inplants in an overlay fashion.

custom-jawline-implant-replacement-surgeryDuring the surgical procedure where the original three implants were removed and replaced by the new custom jawline implant, they could be compared in a side by side fashion. The replacement operation required making a subperiosteal connection between the chin and jaw angles to properly seat the new implant.

While a custom jawline implant does cost more than three preformed implants, there is less control over their shape and position. Should a revision be necessary because of implant malposition the cost will then exceed that of a custom implant. In total jawline augmentation the potential benefits of a custom approach need to be strongly considered. initially.

Highlights:

1) Jawline augmentation using three preformed chin and jaw angle implants can be effective but also has an increased potential for implant malposition.

2) A 3D CT scan will reveal the location of chin and jaw angle implants which can help in the new custom jawline implant design.

3) A custom jawline implant has a lower risk of implant malposition since it is a one piece implant that is made precisely for the patient’s bone shape.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Orbitozygomatic Implant in Facial Asymmetry

Tuesday, September 27th, 2016

 

Facial asymmetry is common and it is often said that everyone has some degree of it. While this is true, more significant facial asymmetries are not common and are a source of frequent patient self-esteem issues. In significant facial asymmetries the entire face is affected from the brow down to the jawline. The affected side is almost always lower as if it is pulled downward. It is extremely rare to ever see a facial asymmetry where the affected side is higher rather than lower than the normal side

The most significant component of facial asymmetry is often around the eye area. This is usually manifest by a difference in the horizontal level of the pupils. The eyeball sits lower as the orbital floor is located more inferior than the opposite normal side. But the orbital floor is not the culprit but a symptom of the overall facial asymmetry. The entire orbitozygomatic bony complex is situated lower. This is seen by the presence of a smaller and less projected cheek and greater soft tissue fullness below the cheek.

In correcting the orbital or midfacial component of facial asymmetry, orbital floor and cheek augmentation are the two skeletal components of the problem that needs to be addressed. There are a variety of materials and methods to this type of skeletal augmentation and all can be successful when done well.

orbitozygomatic-implant-for-facial-asymmetry-dr-barry-eppley-indianapolisorbitozygomatic-implant-design-for-facial-asymmetry-dr-barry-eppley-indianapolisThe more recent availability and use of 3D CT scan imaging and computer designing, however, brings greater precision to the level of the surgical result obtainable for orbito-zygomatic reconstruction in facial asymmetry. Comparing the lower side to the higher normal side allows for an implant that can create a bony augmentation that matches to the other side with millimeter precision. In addition a total one-piece implant can be made that augments all outer areas of the bone including the infraorbital and lateral orbital rim. This would be the most accurate method of implant reconstruction available.

orbitozygomatic-implant-placement-for-facial-asymmetry-dr-barry-eppley-indianapoliscustom-orbitozygomatic-implant-placement-incision-closure-dr-barry-eppley-indianapolisA custom orbitozygomatic implant is placed through a lower blepharoplasty incision. This is a subciliary incision with a small lateral canthal extension. A skin-muscle flap is raised down to the bone where subperiosteal undermining is done to placed the implant. It is important on closure that the orbicularis muscle suspension is done as well as closing the deeper tissue layer over the lateral orbital rim.

It is important to recognize that a custom orbitozygomatic implant provides bone correction but the overlying soft tissues of the eye must often be addressed as well. These could include lateral canthoplasty for outer corner of the eye correction as well as potential upper eyelid ptosis repair. As the eyeball is lifted a ptosis may be created as the upper eyelid position will not have changed. This eyelid correction should be corrected secondarily three months later when all the swelling has resolved and the tissues have stabilized.

Dr. Barry Eppley

Indianapolis, Indiana

Endoscopic Brow Bone Implant Incisions/Scars

Saturday, September 17th, 2016

 

Brow bone augmentation can be done using a variety of techniques and materials. The most common approach has been an open scalp or hairline incision using bone cements to do the buildup of the brow bones. While effective it does necessitate a long incision that is fairly distant from the implantation site and the final shape of the result depends on the surgeon’s artistic shaping skill during surgery.

custom-brow-bone-implant-design-dr-barry-eppley-indianapolisendoscopic-custom-brow-bone-implant-surgical-technique-dr-barry-eppley-indianapolisAnother approach is to place a brow bone implant that is premade from a 3D CT scan. This has a lot of advantages in that the implant design is predetermined before surgery and its placement can be done through a much more limited incisional method. An endoscopic technique can be done using two small paired hairline (or just behind the hairline) incisions. The subperiosteal pocket is developed under endoscopic visualization  and the brow bone implant is inserted through one of the incisions.

endoscopic-screw-fixation-technique-of-custom-brow-bone-implant-dr-barry-eppley-indianapolisendoscopic-screw-fixation-of-custom-brow-bone-implant-dr-barry-eppley-indianapolisThe implant is then positioned and secured, if needed, with small screws using a percutaneous technique. Even though the implant has a custom fit, keeping it from sliding upward is important since most brow bone implants need to sit as long as possible particularly in the male patient. This is a brow procedure that takes only about an hour to complete.

incision-and-scar-healing-of-endoscopic-brow-bone-implant-placement-dr-barry-eppley-indianapolisendoscopic-bropw-bone-implant-hairline-scars-dr-barry-eppley-indianapolisThe hairline incisions offer a very direct approach to the brow bones. Some patients understandably may find these incisions and their resultant scars as potentially problematic. But it has been my experience that these hairline scars in the male patient do well and blend in inconspicuously. It is their irregular zigzag pattern that allows them to heal well as a straight line incision would be more noticeable.

Dr. Barry Eppley

Indianapolis, Indiana

3D CT Scanning of Custom Jawline Implants

Monday, September 12th, 2016

 

Augmentation of the entire jawline has become a popular method for improvement of the lower third of the face. While historically lower facial augmentation was focused on the front half of the jaw (chin), a more contemporary approach considers the jaw angles behind the chin for a complete jawline effect. While most people who seek jawline enhancement will do well with a ‘three-piece’ approach (standard chin and jaw angle implants), some patients need a one-piece jawline implant to achieve their aesthetic goals.

custom-jawline-implant-dr-barry-eppley-indianapolisA total or one-piece jawline implant requires a custom fabrication method. There are no standard or off-the-shelf jawline implants. Using a 3D CT scan a custom jawline implant is designed and manufactured based on input from both the surgeon and the patient. Despite being custom made by computer design, the dimensions of the implant and how well it can achieve the desired patient results remains an art form and not an exact science.

Beyond the design phase, the primary role of the surgeon is to insert the implant and place it as it was designed on the bone in the 3D CT scan. This may sound simple but the reality is that it is a technically challenging procedure to achieve both a good fit and to do so with minimal incisional scarring and surrounding tissue trauma.

Like all facial implants a custom jawline implant can end up malpositioned or have some external aesthetic asymmetry concerns. It is prudent to wait a minimum of six weeks or longer after implant surgery to ensure that most of the swelling has subsided and tissue adaptation has occurred should either of these implant concerns be investigated.

While in days past surgical exploration and facial implant evaluation was done to determine the problem and attempt to resolve it, that should not be the approach with custom jawline implants in particular. There is too much implant volume and surface contact with the mandible to have an accurate evaluation of the problem. In addition much of the implant can not be seen through the limited incisions that were used to insert and position it.

custom-jawline-implant-3d-ct-scan-result-front-view-dr-barry-eppley-indianapoliscustom-jawline-implant-3d-ct-scans-side-view-dr-barry-eppley-indianapoliscustom-jawline-implant-3d-ct-scan-result-top-view-dr-barry-eppley-indianapolisA postoperative 3D CT scan should be for all custom jawline implant positioning concerns. This provides the definitive answer to where all aspects of the implant are positioned on the bone. It is important to be aware that the implant in the postoperative 3D CT scan will not appear like it does in the design images. In the design images a custom jawline implant will appear very smooth. In a postoperative 3D CT scan the same implant will appear fuzzy and not smooth. This is completely normal and reflects the difference between painting on an implant with a design program vs. an image acquired by radiographic acquisition of a low density material.

3D CT scanning is both a necessary preoperative requirement for a custom jawline implant as well as an ideal postoperative method for evaluating implant positioning concerns. Despite the often non-smooth appearance of the implant in a postoperative 3D CT scan, that does not affect its ability to provide clear insight into how the implant sits on the lower jaw bone.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant in a Thin Face

Saturday, August 27th, 2016

 

Background: A well defined and angular jawline has become a desired facial feature for many young men. (and some young women as well) While the strength of the male jawline has never gone out of style, the influence of the internet, social media and smart phones has made it more desirous than ever.

Improving a weak jawline has traditionally focused on chin augmentation. But in today’s contemporary plastic surgery jawline enhancement has evolved to be much more. The evolving styles of jaw angle implants ha enabled the back of the jaw to be augmented to go alone with chin augmentation. Total jawline augmentation is now possible with the use of combined chin and jaw angles implants. Their numerous styles and sizes allow a wide range of jaw enhancement effect.

But the use of preformed implants in a three-piece approach has its limitations. Because the implants are not connected a smooth transition from one implant to the other may not occur. This also limits any significant vertical lengthening effect of the complete jawline. Any jaw asymmetries will be also unlikely to be improved.

The fabrication of a custom jawline implant from a 3D CT scan has a valuable role to play in achieving a lower facial effect that even the best preformed chin and jaw angle implants can not. Because it is custom designed and made it is the best implant approach to have a smooth jawline effect with distinct angularity to it.

Custom Jawloine Implant design Indianapolis Dr Barry EppleyCase Study: This 25 year-old male wanted to improve the shape and definition of his jawline. He wanted  some overall augmentation but more pertinently wanted a well defined and smooth jawline shape. A 3D CT scan was used to make a one-piece jawline implant that provided vertical length along the lower jawline as well as greater squareness to the chin and the jaw angles.

Under general anesthesia the jawline implant was placed through a combined external submental incision and bilateral intraoral incisions. It was able to be inserted as a single piece implant. (although not all custom jawline implants can be) It was secured with three point screw fixation.

Custom Jawline Implant result oblique view Indianapolis Dr Barry EppleyCustom Jawline Implant result Indianapolis Dr Barry EppleyCustom Jawline Implant result side view Indianapolis Dr Barry EppleyHis one year long-term result shows a much more distinct jawline shape with smooth connections from angle to angle. It is important to recognize that not all men, even younger men, can end with such a new jawline shape. One has to have thin facial tissues to show the full effects of the implant. This is evident in almost any face that has a distinct jawline….limited fat and loose skin to allow the shape and size of the lower jawbone to be seen.

Highlights:

1) Creating a well defined and crisp looking jawline requires a thinner face with little subcutaneous fat to see the outlines of the implant.

2) Only a custom jawline implant that wraps around the edge of the bone can create a smooth lower facial contour.

3) The dimensions of the implant are influenced by how much chin projection and the vertical and width increase of the jaw angles.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Jawline Implant Replacement

Sunday, July 3rd, 2016

 

Background: The role of the custom jawline implant in facial augmentation is mainly to create dimensional changes to the jawline that standard preformed chin and jaw angle implants can not accomplish. It also creates a unique effect by uniting the chin and jaw angles to create a wrap around effect.

But one of its other uses is to serve as a revisional implant for ‘failed’ chin and jaw angle implant surgeries. While many patients can achieve satisfactory total jawline results using standard chin and jaw angle implants, some patients do not. The most common reason is malposition of the implants particularly those of the jaw angles. Inadequate implant styles and sizes will also magnify the jawline problem.

Malpositioned Jaw ImplantsCase Study: This 32 year-old male had chin and jaw angle implants placed two years previously. He was unsure of his implant types. He felt that the chin had inadequate projection and was pointing downward. The jaw angle implants simply made his face fuller and did not give any jaw angle definition or enlargement. A 3D CT scan showed that the jaw angle implants were positioned far forward of the actual jaw angles and were of the widening style. The chin implant was of a cleft variety that was positioned low off of the chin bone.

Custom Jawline Implant desigjn over existing jaw implants Dr Barry Eppley IndianapolisA custom jawline implant was designed to create a more effective jawline augmentation effect. The location of the existing chin and jaw angle implants compared to total jawline implant design can be seen in the see-through images.

Custom Jawline Implant Replacement comparison Dr Barry Eppley IndianapolisUnder general anesthesia his existing implants were removed. The jaw angles were made of Medpor while the chin implant was of a hand-carved silicone material. The new custom jawline implant can be compared to the implants that were removed. The custom jawline implant was placed through the previous incisions under the chin and inside the mouth.

Custom jawline implants offer a total wraparound jawline effect that can be used as a primary jawline augmentation procedure or to revise prior unsatisfactory standard chin and jaw angle implant results. Replacing existing implants is more challenging than a primary procedure due to the existing capsule (scar) around the inswelling implants. It must be either removed (on the bone) or released. (on the overlying soft tissue)

Highlights:

1) A custom jawline implant can be a good salvage procedure for unsatisfactory results from the implantation of three standard chin and jaw angle implants.

2) The 3D design process uses the location of the current indwelling implants to guide the designing of the dimensions of the new custom implant.

3) As a single piece implant, a custom jawline implant better assures accurate placement on the bone.

Dr. Barry Eppley

Indianapolis, Indiana

Revisional Custom Jawline Implant Surgery

Friday, June 10th, 2016

 

Custom Jawline Implant Replacement Dr Barry Eppley IndianapolisThe most dramatic and successful augmentation of the entire lower third of the face is best done in most patients by a custom jawline implant. Such an implant is made from a 3D CT scan of the patient. Inserted as a single piece implant that augments the lower face from jaw angle to jaw angle, it can create a a wide range of jaw shape changes.

While the custom design process has many advantages, it is not a perfect aesthetic jawline procedure. This is because the computer nor the surgeon can know exactly how the design will really look on the patient. This is no accurate method to know how the jawline implant design and dimensions will translate to an external facial change in appearance.

Three is also the variable that even the patient does not really know how they will react to the jawline shape change. What one thinks they may have wanted can change when one actually sees it on their face. There is also the issue that some patients may be happy with their custom jawline implant result but may decide later that they would like some change in its design for additional enhancement.

Thus, a custom jawline implant does have the risk of revisional surgery which is almost always for an aesthetic reason. Such revisional custom jawline implant surgery does have several issues that are somewhat different than the initial implant placement. These can impact the recovery period and the attainment of the final aesthetic result.

custom jawline implant replacement designs intraopRevisional; Custom Jawline Implant Surgery Dr Barry Eppley IndianapolisWhile the computer can make any change in the implant’s design, placing the new custom jawline implant can be challenging in some cases. This is mort relevant when the implant is bigger than the initial design. Because the tissues have created an enveloping layer of scar tissue (capsule), it is not just as simple as ‘removing the old implants and slipping in a new one’. The capsule must be either released (capsulotomy) or removed (capsulectomy) to create the necessary space (pocket). This maneuver can be quite challenging in the tight space of the jawline implant pocket which uses small incisions to create and/or modify it.

Because of the difficulty in adequately opening up the capsule, a new custom jawline implant may create more swelling and bruising than the first one. It may also take more operative time than the first operation. It requires patience and diligence on the part of the surgeon to get the new implant properly positioned.

Dr. Barry Eppley

Indianapolis, Indiana

The Custom Midface Implant

Sunday, May 22nd, 2016

 

Facial balance is composed of aesthetic relationships between the three thirds of the face. Most commonly perceived from the profile view, there are various known projections of each facial third that makes it aesthetically appealing. When one of the facial thirds is out of balance it makes the other two–thirds of the face look larger and disproportionate.

Lack of adequate midface projection, or midface hypoplasia, occurs for a variety of reasons. Most commonly this occurs due to natural development and is more prone to occur in certain ethnicities. (e.g., Asians) But other causes include traumatic injuries as well as congenital facial birth defects. (e.g., cleft lip and palate) Lack of adequate midface projection can create a variety of clinical conditions such as negative orbital vectors, class III malocclusions and an overall flatter facial profile even in the face of a satisfactory bite relationship.

There are numerous surgical procedures that are designed to increase midface projection in selective areas. A LeFort I osteotomy moves the lower maxillary level forward. Cheek or infraorbital-malar implants increase fullness in the upper midface area of the inferior orbital rims and cheeks. Fat injections can be used to create a more complete midface augmentation effect but their take and persistence is highly variable.

Custom Midface Implant design Dr Barry Eppley IndianapolisCustom Midface Mask Implant Dr Barry Eppley IndianapolisUsing an onlay bone augmentation approach, the custom midface implant can create complete middle third of the face projection. Made from the patient’s 3D CT scan, the custom midface implant provides projection from the infraorbtial rim down to the anterior nasal spine. Its design looks very much like a mask with larges holes made in it for the relief of the infraorbital nerves. The implant provides augmentation of every midface bony surface in a forward projecting manner. Its thickest part is usually around 7mm and that is around the nasal base. It becomes thinner as it progresses upward over the orbital rims.

Custom MIdface Implant intraop Dr Barry Eppley IndianapolisCustom MIdface Implant intraop placement Dr Barry Eppley IndianapolisThe custom midface implant is placed through an intraoral maxillary vestibular incision.  good cuff of musculomucosal tissue is left inferiorly. The implant is placed by cutting the infraorbital holes superiorly so that can fit around the nerve. Multiple 4mm perfusion holes are placed throughout the implant to allow through and through tissue ingrowth. The implant is secured into position using four 1.5mm screws.

Custom MIdface Implant thicknesses Dr Barry Eppley IndianapolisThe custom midface implant offers complete midface projection without affecting the bite since it is an onlay bone method. While it looks big and overwhelming on the 3D model, it is much smaller when placed onto and into the patient. It provides central augmentation of the midface without increasing the width of the cheeks. It effectively ‘pulls’ out the middle part of the face.

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.

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