Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a chin reshaping/chin reduction procedure. My chin is fairly square and big and I feel very insecure about it. It’s not big to the point where it’s the first thing people notice, but I hate it so much and I think it makes my otherwise feminine face look disproportionate. What can be done to reshape a chin? It seems to be one plastic surgery procedure where very little is written about it and very few plastic surgeons actually do it. How is it done and what is the recovery like?
A: There are numerous option in chin reshaping/reduction surgery. Your chin is wide and square for your face and even maybe a bit vertically long. It does not appear to be to protrusive or horizontally long which is a key feature that affects how chin reshaping is done. .Your chin can be reshaped to be slightly shorter and more narrow through an intraoral genioplasty approach. From inside the mouth, the bone is cut, like a sliding genioplasty, and narrowed and then put back together, thus leaving no external incisional scars. This will create a more tapered chin that is more triangular shaped rather than square as it is now. Any bony chin surgery is associated with a fair amount of swelling that will take about three weeks to enter the benefits phase and a full six weeks to see the final result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a chin implant questions/issue. In my opinion, I have a recessed chin and jaw. Eight years ago, I had a large silicone chin implant inserted, and liposuction below my chin. At my consultation, the plastic surgeon asked if I breathed through my mouth, which I realized I do. Ever since then, I have been on a quest to resolve this issue. I have been to an ENT doctor who said my nasal passages checked out fine. But since I feel that my chin implant did not provide me with enough projection (I am 41 years old but one year ago I had a platysmaplasty for loose skin beneath my chin), and my lips still do not close with out mentalis strain, and as I age I feel that my lack of a supportive jaw is not helping, I would really like to take action. Also, I recently discovered that chin implants have been known to cause bone erosion, which frightens me. I had braces as a teenager, and still have a bit of an overbite, but I do not know where that leaves me as far as options to both improve my appearance and breathing functions. I sincerely appreciate your time and thoughtfulness, as this is quite daunting to me.
A: The chin implant issue that you describe is a common one that I hear about. Between your appearance and breathing issues, your description suggests that your lower face/jawline appearance can be improved. With a naturally short lower jaw, a large chin implant that is still inadequate in projection and a residual mentalis strain, this indicates to me that you need a sliding genioplasty for a chin implant replacement. Besides the limitation of chin implant projection (10mms or less), increasing the chin point by an implant will not improve mentalis muscular function nor any lower lip incompetence should it exist. Your existing chin implant may have also developed some settling into the bone. (often erroneously referred to as ‘bone erosion’ which is not harmful) By removing your chin implant and performing a sliding genioplasty you will improve your chin projection, eliminate the mentalis strain, and also improve your neck profile. I would need to see some pictures of your face to verify these statements but your description is not a rare problem that I see with indwelling large chin implants.
As for your breathing issues, nothing you do to the chin will have any impact on your nasal airway exchange.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping/liposuction for my son. For several years my 16 year old son has expressed concerns with excess fat in the cheek/chin/neck area. He has a genetic double chin that upon weight loss did not help and did not go away. In tears, my son asked if he could do what I did (lower face lift/liposuction) While I do not feel it would be necessary for him to go as extreme, I told him I would research his options. In my own experience, I know it’s not something that diet and exercise alone can help with. As a parent though I am conflicted regarding the risks/ psychology etc. of a surgery for cosmetic purposes at his age. Thank you in advance for your help and information!
A: When it comes to facial reshaping via fat removal, there are several specific areas in the face where fat extraction can be very helpful. This includes the neck (liposuction), buccal fat pad (buccal lipectomy) and the perioral mounds. (liposuction) All three areas would be of benefit to your son based on his pictures. That may not necessarily completely deround is face or give him a thin face but would make a substantative improvement.
When it comes to plastic surgery in teens, the major consideration is their level of expectations. Being less mature and often being guided by information that they find on the internet, their sense of realistic expectations and the necessary recovery process until they truly see the final results is often not accurate. But from a physical standpoint, there is no greater risk of these facial procedures in a teen ager than in an older adult.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in scar revision of my wide midline abdominal scar from a prior surgery. One surgeon I saw recommended a geometric broken line closure (GBLC) type of scar revision. You have recommended a more simpler vertical excision and straight line closure. My question is why would you choose that particular procedure over the GBLC if the broken line procedure yields better results?
A: There is no guarantee that a broken line closure will produce a better result on a midline abdominal scar and there is no medical evidence to support that it will. And if the scar should widen to any degree, you will have more scar length than what you started with. Whomever advised you that a GBLC for your midline abdominal scar (that has never had a revision before) was the right choice for scar revision is simply wrong. That is simply not done on many body scars. It is most commonly done on facial scars which are a completely different in how they heal than any scar below the neck. You should initially do the simplest and least risky scar revision technique first and then proceed to more complex forms should that not produce a substantial improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get a tummy tuck and belly button reconstruction. I’m not sure what type I need. I workout approximately 5 days a week. I have a lot of scar tissue near my c-section scar that is bothersome. Would a procedure also help with the scars? What type do you recommend?
A: You are correct in your assessment that you would benefit by a tummy tuck. When it comes to tummy tucks there are really only two fundamental types; a mini- or limited and a full tummy tuck. The difference between the two is in the the location and amount of abdominal tissues removed. With uncommon exception, most women are better off with a full tummy tuck because it produces a better result, remakes the belly button and provides the best exposure for complete rectus muscle plication. As part of the tummy tuck, all scar tissue from the previous c-section(s) would be removed regardless of whether one gets a mini- or full version.
Be aware that many tummy tucks also incorporate liposuction as part of it to get a better overall result.. That could be liposuction of the flanks beyond the zone of the tissue excision or above the zone of tissue excision in the upper abdominal area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in abdominal scar revision. I’m a 22 year old female who had a major surgery resulting from a self inflicted wound that occurred in a more troubled time as a youth. I still have the ugly scar and started research on my z-plasty scar revision for two years now. I’d love to do a consult with you. I’m turning 23 this year and would love to be in my first two piece. I have attached a photo of “my struggle”. Hope to hear from you soon.
A: When it comes to your abdominal scar revision, I see no reason why you would ever have a z-plasty type revision. Your scar revision would be a straight linear scar revision in which the scar is simple vertically excisioned and then closed in a linear fashion. This is the only type of scar revision you should ever have. While it will not make the scar go completely away, it will make it much more narrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been diagnosed with a mild midface deficiency. I would like to have this corrected to end up with the most aesthetic appearance possible. I have been reading about facial implants and the work you have done with them. I would like to achieve a reduction of the depressions on either side of the nose, reduction of the heavy creases going down to the corners of my mouth and better projections of my face to make it look less wide and flat. In addition I am also interested in lip implants. I already have some lip implants placed. They were the type that look like spaghetti and the size was 4mm top and bottom. I would like to add to these to make my lips bigger. Specifically I would like to show more of the pink lipstick area rather than just make them stick out more. I would also like to bring the implants out to the edges of my mouth to make the lips and mouth appear wider.
A: When it comes to facial implants, there are a lot of facial changes that they can make…and there some changes that they can not. For a mild midface deficiency, consideration can be given to paranasal implants to bring out the base of the nose and anterior submalar implants to provide some upper midface projection. The lower nasolabial folds as they approach the corners of the mouth will not be affected by any bone-based implant. This area is best treated by fat injections.
In regards to the lips, you either have more recent Permalip silicone implants or older style Advanta lip implants. Either way it is not a good idea to double stack lip implants as there will be a great tendencey to have them roll or twist on one another. You may exchange them for the largest 5mm implants but, for the sake of a 1mm increase, that is not likely to make much of a difference. Furthermore, some of the lip changes you desire can not be achieved by lip implants. No implant will increase the vertical height of the vermilion (pink lipstick area) nor will they make the corners of the lip appear fuller or wider, they are too thin in this area. To make these kind of lip changes, you will need to consider a vermilion or lip advancement procedure which directly changes the location of the vermilion…which is what is needed to make the type of lip changes you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in skull reshaping reduction of the size of the back of my head. For a long time, I have had a distressing issue with the prominence of the back of my head in what I believe to be the occipital bone region. The problem is primarily located slightly right of centre of the back of my head. In other words, from side view, my head sticks out more on the right side than it does on the left and the bone can visibly be felt as thicker and more protruding. It also doesn’t help that my crown area feels very flat and almost leads into a boat shape back of the head. After much research, I do not necessarily believe that I have a form of craniosynostosis, though I am not ruling out the possibility of perhaps a mild manifestation of it.
As a young 25 year-old man, are there options out there for me to possibly reduce the ‘sticking out’ of the back of my head, so that I can have a more ‘normal’, flatter back of the head? I have attached two photos, taken from either side of my head, so that you can notice how one side sticks out more than the other (though my occipital bone in general sticks out much more than normal). I also appreciate that it may be hard to tell by the photos because of my hair coverage, which I keep as an attempt to mask the bumps. I understand that things of this nature are usually dealt with more in children but I came across your site when researching possibilities for occipital reduction.
A: Skull reshaping of the prominent back of the head is very common in my practice. It is never a question of whether occipital bone reduction can be done, it is always a question of whether the reduction achieved will be significant enough to justify the effort. As a general rule, 5 to 7mms of occipital bone can be reduced. That may not sound like much but usually produces a noticeable size reduction. Just based on your description of the problem, it sounds like this amount of reduction would be adequate to make a difference in your back of the head shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had fat grafting to my face and I love it. I am three weeks out and I have noticed already that some of the fullness has started to go down. I would prefer it to stay this way and I don’t want it to go down. How much of the fat will stay and how will I know when the result is finally stable? I don’t think my doctor overfilled at all. And the first two weeks I looked amazing, but things have changed over the past week and it is not nearly as full now as it once was. 🙁
A: Fat grafting is a wonderful technique for a variety of facial enhancement issues but it plagued by unpredictability of fat graft survival. A good guideline for the amount of volume retention after fat grafting is to wait at least until 6 weeks after the procedure. Generally the success of most fat grafting results is seen by then by ultimately a final judgment should not be done until 3 months after the procedure. That is also the time when fat grafting can be repeated if necessary. At just three weeks after the procedure you will very likely lose more fat, it is just a question of how much more over what period of time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a subnasal lip lift. I have a long upper lip and I think it would make my face more balanced and attractive. I have not read anywhere on how one determines the amount of skin that can be removed between the lip and the cupid’s bow. I want the maximum to be removed but I still want it to look natural and not be overdone. I want to increase the size of my upper to the maximum as it is basically non-existent now. Also, will the subnasal lip lift increase the size of the whole upper lip and not just the cupid’s bow directly underneath the nose? Thank you.
A: In a subnasal lip lift, you do not want to remove more than 1/4 to 1/3 of vertical distance as measured along the philtral columns. Whether that is 6 or 8mms is a judgment between aggressiveness but also wanting to avoid an unnatural and potentially irreversible overdone result. Applying the principle that it is easier to remove more later but you can’t reverse it, I would take no more than 6 to 6.5mms of skin. Also a subnasal lip lift will not change the amount of exposed vermilion out to the mouth corners, it will only change the upper in teh middle third or within or under the nose area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in learning about suprapubic liposuction. I’ve been searching for answers for my 8 year old son for 8 years. He has a buried penis. He has had two surgeries already when he was 2, which rearranged the skin on his penis to have it appear normal looking, however nothing was done with the suprapubic fat pad. It took me two years to finally get someone to acknowledge that there was actually a problem with my son’s penis. He was a stalky baby weighing nearly 9lbs, and I was told he would lose the mound when he grew and was a toddler. He didn’t, he’s still a stalky child, very active but never loses the mound. His penis is totally hidden, but can be exposed if he pushes the fat pad down around it. He is active in hockey and baseball and is getting to the age where it needs to be addressed before he starts getting ridiculed by his peers. I would really y appreciate any information you could give me regarding this procedure.
A: Suprapubic liposuction can very helpful in children and adults with a buried penis problem. The suprapubic mound is a common companion of the buried penis problem. It is not fat that is responsive to weight loss nor will it go away as one gets older. Suprapubic mound liposuction can be very effective at reducing the mound and helping get some more penile exposure. There is a limit as to how much penile exposure will occur but the fat mound can be significantly reduced. Suprapubic mound liposuction is a simple outpatient procedure that uses small cannulas to extract the fat through two small groin incisions. (4mms) The recovery is very short although it takes several months for all the swelling and firmness to dissipate from the base of the penis.
Dr. Barry Eppley
Indianapolis, Indiana