Your Questions
Your Questions
Q: Dr. Eppley, I am interested in chin reshaping surgery. I have attached a picture of asemi-famous internet woman with a great chin (and probably slightly over-filled lips). I did edits to the photos to show what I think would look good on me to the best of my limited abilitie). Something more feminine, generally, and that would reduce the overall narrowness and length of my face. In fact, the most fitting surgery descriptions I’ve found are often “feminization” surgeries for trans women.
Looking forward to discussing it with you.
A: Thank you for sending your picture and providing clarification as to chin reshaping goals. Your imaging results are quite good and helpful. There are two methods of such chin reduction reshaping. One option is the intraoral t-shaped genioplasty. This is the workhorse of the well known V-line jaw reshaping. It can probably achieve about 50% to 75% of the result you are showing. The result you are showing goes fairly far back behind the osteotomy lines of this type of bony genioplasty. The other option is a submental approach which allows for the creation of a straighter line along the bottom of the jawline which can go further back. This would probably come closer to that look but does so with the addition of a scar under the chin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal injectable fillers. My temples are looking rather sunken these days and I’m hoping to get some fillers to the region. Could you kindly advise me on these queries?
– Would Radiesse be a good filler for the temples?
– How much filler is usually needed for the temples?
– I’ve used my fingers to simulate what adding volume to the temples would look like. One of the things I’ve noticed is that it seems to lift my face slightly. Based off your experience, do you notice such an effect from fillers to the temples?
– How much does each syringe of Radiesse cost?
Thank you!
A: When it comes to temporal injectable fillers, Radiesse is a fine choice. Good options would include either Radiesse or the hyaluronic-acid based filler, Voluma. It would take 1 to 2 syringes per side to get a good effect. Using your finger to simulate the effects if filler on your temples gives you an artificial sense on a facial lifting effect. Augmenting the temples by fillers or implants will not lift your face even to the slightest amount.
My nurse will pass along the cost of the syringes to you tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a revision rhinoplasty. I am currently 10 months post op and my nose is soft, I’ve been told that my swelling is gone and this is the final result.
Ive attached the post op report as well as collages of “pre op, post op, and desired revision” noses. Ive also attached photos of my pre op nose and post op nose from different angles. You’ll see that my surgeon blunted my tip and made it bulbous and higher than before. I’d like my nose returned to its length and sharpness. I look forward to your assessment.
A: Thank you for sending your pictures and the operative note. In regards to your revision rhinoplasty, your current nasal tip shape is the result of reductive cartilage techniques. (blunted higher nasal tip as you have described) Thus any effort to re-establish a more defined nasal tip that is longer will require infralobular tip cartilage grafting as an onlay technique. (there are other methods but this would be most effective) This will require cartilage grafts to do so. Since your septum has already been harvested I would not have confidence that re-entry would produce the amount of cartilage needed to get an effective result. This leaves either the ears or the rib. One or both ears would have the required cartilage needed to effectively do the procedure.
In summary the key to your revision rhinoplasty is to restore what has been removed which is cartilage. The grafts are needed to push out the nasal length and give it volume so the overlying nasal tip skin looks longer and somewhat sharper. Whether you can get back completely to where you started can not be predicted beforehand but this approach will come as close as you can be to your preoperative nasal tip shape.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having my under eye hollows treated with injectible fillers. I was wondering if you have ever done this procedure? If so, what product does you use, and what type of needle (blunt) or other? I live 3 hrs away so wanted to ask a couple questions before I booked a treatment. Thanks in advance for your reply!
A:I have placed injectable fillers and fat in the under eye area many times. I consider it the most tricky and precarious place on the face into which any type of filler material can be placed. It is very hard to get a smooth even layer of filler or fat over the lower eyelids and infraorbital rim area. The thin tissue of the lower eyelids are very unforgiving of any material irregularities and every injectable filler procure has some degree of material imperfections. Thus there is a relatively high incidence of contour issues (creating puffiness and irregularities) in my experience of the injected undereye area. Blunt-tipped injection cannulas and hyaluronic-based fillers are always used as these techniques have the best chance of lowering these risks and avoiding bruising. Not everyone is a good candidate for injectable fillers in the undereye area. Thin eyelids and tissue covering over the infraorbital rims have the highest incidence of post injection issues. I would need to see some pictures of your undereyes to determine if you are a good candidate for injection treatments.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was curious how your temporal reduction procedure is done. Do you remove the whole portion of the muscle directly in front of and behind the ear or do you reduce the depth/thickness of the muscle? I have attached a picture that shows what I am talking about specifically. If you do remove the whole portion of the muscle, then what happens if the muscle was too thick and then there is now a visible transitions into the anterior portion of the muscle. I’m worried that it might look odd. What are your thoughts?
A: Thank you for your inquiry about posterior temporal reduction. You are correct in that this is a muscular reduction procedure to decrease head width above the ears. Your attached diagram shows very precisely the location of the muscle removal. I could not have drawn it any better myself. It is not really possible to remove just a portion of the muscle and, even if you could, you would not want to. To make a visible head width narrowing it requires the entire thickness of the muscle to be reduced which is usually 5 to 7mms. (or more in some patients) Your concern about having an uneven edge to the back part of the anterior temporalis muscle (a step-off) is a valid one and a finding I have observed every time I do the procedure. But it is a self-solving problem as the muscle edge shrinks down and becomes more feather edged as it heals. (muscles shrink and contract when injured) This is also helped by using electrocautery at the muscle edge to induce it to shrink as well as the entire temporal reduction procedure is done in the subfascial plane. The tight overlying fascial layer acts to push the muscle down and obscures this temporary step-off as it heals.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thirty four years ago (when I was 12) I had 4 teeth extracted and braces. This pushed back my maxilla and mandible. I saw that you do jaw advancement, sometimes without orthodontics, and I really feel that I need that to open my airways. I’m so tired, yet can’t sleep properly. I was recently diagnosed with sleep apnea. How much is this type of surgery and do you accept Aetna?
A: Thank you for your inquiry. What you are referring to is Bimaxillary Advancements (upper and lower jaw advancement) for sleep apnea. You can’t just move the upper jaw forward alone as that would throw off your bite considerably. One needs to move both the upper and lower jaws forward together so the bite remains the same. This is sometimes covered by insurance but requires a very specific set of qualifications. I would go to Aetna’s policy online and look under what is required in the surgical treatment for sleep apnea. They have very strict criteria for coverage. This is the first place to start. While such surgery can be done like any other aesthetic surgery from a cost basis, it is important to initially see whether you would qualify under your health insurance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Was told by another ps that I’d need a reverse tummy tuck due to existing scar on my stomach. Is this so and what type of results would I get? Have you done this procedure before?
A: Thank you for your inquiry. While your large abdominal scar is certainly an issue for any form of a tummy tuck, I do not see a reverse tummy tuck of being beneficial for you. Reverse tummy tucks are usually down on patients whose lower abdomen is flat and the loose skin they have is above the belly button. Thus by pulling up on the upper abdominal skin the tissue overhang around the belly button is improved. And most of these women are usually thinner with a simple skin pull can be more effective. This is clearly not the situation you have. While you could do a reverse tummy tuck it will have virtually no effect on your lower abdomen and does not really solve the vascular risk issue that you have with your current abdominal scar. In conclusion I have done a fair number of reverse tummy tucks and you would not be a candidate for one in my opinion. The only tummy tuck that would be effective is a more traditional lower tummy tuck. Your large scar does give one pause when considering that procedure but that is a separate issue from your initial question.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently consulted with another surgeon about facial reshaping surgery and his recommendation was to 1) shave down/narrow the chin (as I find it to be too broad) 2) insert implants to create a more angular jawline (in addition my left side is noticeably undeveloped and 3) fat transfer to my cheeks to create more fullness. I am very much at the stage of booking the procedure but i have read a lot of reviews about Dr Eppley (most particularly in regard to these specific procedures) and I would be very keen hear his thoughts..Looking forward to hearing from you.
A: While I would largely agree with those general facial reshaping concepts I would do some of the three procedures differently. Chin narrowing can be done by either shaving or t-shaped intraoral osteotomies. Depending on the type of chin change you are seeking, the latter is usually more effective. Jaw angle augmentation depends on whether width, vertical lengthening or some amount of both are needed. That determination can not be done based on a frontal picture alone, it takes oblique and side view images as well to see who such jaw angle changes would look. I would not use fat for your cheek augmentation. You are too thin to have that work very well. Cheek implants are more predictable and long-lasting. What style and size of cheek implant depends on the type of cheek augmentation change you seek.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am considering breast implant removal. I have bilateral breast implants and now they are encapsulated the left is going under my armpit when I lay down. My insurance is paying for removal of implants and encapsulation removal. My Dr said it would cost $7000 to have new ones put it. I can’t afford that as I’m on Medicaid. I can afford the cost of implants themselves but not for the surgery room, anesthesia and the drs work even though I’ll already be having the other surgery paid for by insurance. My question is how bad will I look after this surgery. I’m so depressed and scared that I’m going to look deformed again.
A: I can not really answer your question without seeing pictures of your current breast situation. But it would be fair to say that the removal of breast implants does not usually return one to their pre surgical breast look. One’s breasts will usually appear worse than they originally were due to the stretched out skin and loss of further breast tissue. This if you felt that your breasts were deformed before the implants were put in then it is very likely that you will feel more so when these implants are removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast fat transfer. I am average in weight and size (5″8 and 137lbs), but seem to develop fat around my obliques (stomach and lower back) and arms much more than the rest of my body; plus I have very small breasts and buttocks. I am very healthy and no matter how much I work out and eat a great diet, those areas of fat won’t budge. I would like to transfer fat from my stomach, lower back, and arms toward my breasts (and possibly my butt depending on the cost). How experienced is your team in breast fat transfers, because I know that it takes multiple people to keep the fat alive while transferring it?
A: While any fat harvested from liposuction can be used for transfer, it is not likely you will have much to actually put into the breasts. And most certainly there would not be enough for both breasts and buttocks. Thus you would need to concentrate any fat harvested for your breast fat transfer.
To give you some perspective on what success breast fat transfer may achieve in breast augmentation, it is important to understand the ‘halfing’ rule. The relevance of this is in getting a visual idea of how much breast size increase may realistically be obtainable. To start let’s make the basic asssumption that it takes about 150cc of fat (or an implant) to make a cup size difference. I will assume based on your description that between the stomach, arms and lower back you may have 1200ccs to harvest. (and that may be a generous estimate but I will use this number) When this amount of liposuction aspirate is then concentrated during surgery (and it is not true that it takes multiple people to keep the fat alive), it usually amounts to in women that around 40% will be end up being concentrated fat and available for injection. This leaves 480cc to be evenly divided between the breasts or 240cc injected per breasts. Then one can estimate that only 50% or half if the injected amount will survive or 120cc per breast. (the percent survival could be higher or lower…but it is almost always lower and rarely higher)
In conclusion you may be able to get a 1/2 cup size breast increase and that is if you can get 1200ccs aspirate and 50% of what is injected survives. The point being is that you might as well take whatever fat is harvested and use it for transfer into the breast but at best the breast augmentation result will be very modest in size. It is important, therefore, to have very realistic expectations. I would consider your procedure as liposuction first and anything that comes of the breast augmentation efforts as a bonus result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have some questions about rib removal surgery:
1. Is the surgery life threatening?
2. Is the surgery considered major surgery?
3. Once the ribs are removed, what negative aspect does that subject your body to, if any?
4. What is the procedure as far as surgery, hospital stay, aftercare, and recovery time?
5. Is the surgery performed in a hospital or the doctor’s clinic?
6. What is the price of the surgery? Does that include aftercare?
7. Are there any additional costs and what would they be and if applicable what would they be
8. How many rib removal surgeries has the doctor performed?
9. Looking at the before and after photos I provided, does the doctor feel he can achieve the result provided in the after photos with the rib removal surgery?
A: In answer to your questions about rib removal surgery:
- The surgery is most definitely not life threatening.
- It depends on how you define major surgery. Compared to surgeries like breast augmentation it would be considered major. But compare to surgeries tummy tuck and BBL surgery, it would be considered less severe.
- I am not aware of any negative aspect of rib removals other than the fine line scars it takes to do perform the procedure.
- This is done in a private surgery center under general anesthesia as an overnite stay.
- It is done in neither a hospital or a clinic but in a surgery center.
- My assistant will pass along the cost of the surgery to you tomorrow. Whether you need any aftercare or not depends on whether you are traveling along or with someone.
- The surgical quote will be all inclusive of the surgical experience.
- I have removed hundreds of ribs for a variety of body contouring and recostructive surgeries.
- I do not think the result you are showing is realistic unless you do a lot of additional waist training after the surgery. By itself it can produce about half of your imaged result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had contacted you about a year ago about my occipital knob reduction surgery. I have since been saving money for this procedure with you. I have also been following procedures you have performed and posted on your website. One that I found very impressive was the occipital implant with knob reduction using a custom implant. I have taken some more profile pictures and played around with possible outcomes. I have attached those to this email. If you could please give me your suggestions and opinions on this that would be great.
A: Good to hear from you again. What you have shown would be a beautiful addition to your occipital knob reduction since you really have a combined occipital problem of a lower protrusion (occipital knob) and an upper deficiency. (occipital flatness) Normally an occipital implant is done by a custom approach using a 3D CT scan. But I have done so many of these occipital implants that in some cases, to save money and still get a good result, I will use another patient’s occipital implant design. (this is known as a semi-custom implant) That saves a fair amount of money and the shape of the flat back of the head is only minimally different amongst most patients as long as there is not a significant occipital asymmetry. The implant is also flexible so there is a lot of give for its fit onto the bone. (once on the bone it feels hard just like bone however)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for reversal jawline reduction surgery to undo my prior V-line jaw reshaping. I have sent you a 3D CT scan. Cal you tell me what procedures I need to get back the jawline that I had?
A: I have reviewed your 3D CT scan and I can now report on what was done on your jawline reduction procedure. You had a straightforward sliding genioplasty of maybe 5mms advancement. (very small) There were three plates used for its fixation. No width reduction as done on the chin, it was simply brought forward. There are no appreciable changes to the rest of the bony jawline. The jaw angles remained structurally intact (no amputation of the angles) There may have been some burring done for a little width reduction but not much.
In conclusion your reversal jawline reduction procedure to return you as close to where you were before would consist of the following:
1) Reversal setback genioplasty
2) Width only jaw angle implants of a small size. (3mm)
Based on the 3D CT scan I do not see the benefit of making custom implants. The chin needs to be set back and performed srandard jaw angle implants can be used too restore the jaw angle width.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been researching Kybella treatment for my moderate jowl laxiity. I consulted with a plastic surgeon and he rejected me suggesting that I lose weight. I am 53 years old, 5’6″ and weigh 150 lbs. I averaged 127lbs through my 40’s to the present. I have great confidence in my dermatologist and she has recommended two treatments of Kybella,and has told me there is a 4% chance of a temporary drooping of the mouth. Most of my research says that Kybella is not recommended for the jowls. I am writing to you because you are the first I’ve come across to suggest that it can be effective for that area. Could you tell me with your experience to this date, if you still think it can be relatively safe and effective in smoothing a mild/moderate jowl sag? Many thanks in advance for your response.
A: The concept of injection lipolysis (Kybella is the one brand name for now) can be done anywhere there is fat. It is not a question of whether it can be done but whether it will be effective and has a low risk of problems in doing so. Thus the jowls can be injected and some mild improvement may be capable of being achieved. It will not be as effective as small cannula liposuction or even a small jowl tucked however. The risk of injecting the jowls is injury to the marginal mandibular branch of the facial nerve. Such injury will not cause month drooping but rather will cause lower lip elevation and smile asymmetry. Such an injury can occur from the intense inflammatory reaction that the injected deoxycholic acid solution causes. Such a reaction occurs in a 1 cm zone around each injection site. As long as one stays well away from the marionette line area of the chin this complication can be avoided. I have never seen it occur in the patients I have injected.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial fat grafting. Can volume loss in face due to no back teeth for a number of years be restored for a fuller face by the use of fat grafting?
What method of fat removal do you use?
What harvesting method do you use?
What is the cost?
Will my face be widen from this procedure?
Can a brow lift be performed at the same time or will fat injections serve the same purpose as a brow lift?
A: Thank you for your inquiry. In answer to your questions:
1) The area to which you are referring ( the soft tissue trampoline area between the cheeks and the jawline) can only be augmented by facial fat grafting. This is a non-bony supported area so only soft tissue augmentation will work.
2) and 3) There is only one method of fat graft harvest and that is by liposuction aspiration.
4) My assistant will pass along the cost of the procedure to you tomorrow.
5) Your face will become fuller/more convex in the soft tissue area between the cheek and the jawline.
6) Facial fat grafting is not a substitute for a browlift. Adding fat to the brows will not lift them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested midface implants. Two years ago, I had a Lefort surgery to advance my upper jaw. I plan on getting a rhinoplasty at a future date. At the present time, I am only interested in getting facial implants to augment the tear trough/cheek areas and the midface. Specifically, I am interested in knowing if I am a candidate for a premaxillary implant and if premaxillary implants are often used on patients who have already had orthognathic surgery. Thank you for your time.
A: In my experience it is not uncommon at all to have patients who have undergone a LeFort osteotomy to subsequently want midface augmentation with implants. This is because, as you have experienced, the Lefort I osteotomy essentially moves the teeth and the lower nasal base forward (or upward) but leaves the rest of the midface ‘behind’.
The key question about midface augmentation is whether standard preformed midface implants will suffice or whether a complete custom midface implant is needed. Standard midface implants include cheek, tear trough and paranasal/premaxillary implants which augment the respective names areas. A more complete total midface implant is designed to create a total augmentation from the infraorbital rim/cheeks down to the lower level of the pyriform aperture/maxilla.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I know that the Hydroxyapatite in the world using only a few professional surgeons. But I know that it is difficult to remove if something goes wrong. PMMA bone cements is more cheap than hydroxyapatite but how much it’s better ? I do not like silicone implants. Their many uses silicone implants since it is easy for surgery but I do not feel that it will give a nice aesthetic effect. And now I am confused choosing between hydroxyapatite or PMMA bone cements.
Could you explain please what is better to use and advantages and disadvantages between . I still do not really understand A: You have several misconceptions about the materials. Hydroxyapatite is fairly easy to remove just like PMMA and silicone implants. In the brow bone area PMMA produces a better aesthetic shape and is easier to place in that area to create the effect. Regardless of the material used, the aesthetic result is based on its shape not the material composition. Quite frankly the best way to brow bone augmentation is a 3D silicone implant made from a CT scan. It is best because the shape and dimensions of the brow bone augmentation is designed and controlled BEFORE surgery. The surgeon’s job then is just to place the implant correctly. All other materials, such as hydroxyapatite and PMMA, require intraoperative shaping and that is far less precise.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal artery ligations. I am talking to a couple of consultants here also and plan to make a decision once I have all the information I need. It appears that you are the most experienced on this procedure – would you mind informing me how many you have done on the past? My main concerns are around potential scarring and hair loss.
I first noted the prominent temporal arteries appeared about six months ago – first on the left side and most recently on my right temple. No idea what is causing them and have not been able to find out but I do get a throbbing/ shooting sensation in them most of the time.
Would the surgery eliminate the throbbing sensation I get as well as the appearance? I have attached pictures for your reference.
A: In answer to your temporal artery ligations questions:
1) I now perform about 1 to 2 temporal artery ligations per month from patients all over the world.
2) The incisions to do the procedure are very small (around 5 to 7mms) and usually heal imperceptibly. Whether you need just one proximal ligation (one point) or a combined proximal-distal ligation (two point) can not be determined until during the procedure. (The vast majority of patients receive a proximal and distal ligation) I have yet to have a patient have an issue with the scars. (at least a patient that has ever told me so)
3) Hair loss is not an issue with this procedure. It has not been seen or reported.
4) With a reduction in the temporal artery flow I would think that the throbbing sensation would decrease or be eliminated. That is what most patients who have these symptoms so state afterwards
5) Your pictures show a classic pattern of an enlarged anterior branch of the superficial temporal artery with its typical snakelike pattern coursing towards the forehead.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a subnasal lip lift. I’ve measured my philtral length from the base of the nose to the upper vermillion border and it is 16mm. I know this isn’t a great distance but it looks large on my small face. I suppose following the 25% rule, 4mm of upper lip shortening would be germane. Am I correct in saying that making the philtrum 4mm shorter will result in 4mm of extra upper vermillion pout to make up for the distance? This does appear to be a lot, but I am not sure how it works. The examples I linked appeared to show very little increase in vermillion show compared to the reduction in upper lip length.
A: In a subnasal lip lift, It is not a direct correlation between the amount of skin under the nose removed and the amount of lip increase that occurs below. Usually it translates to less than 50% and often just 25%. This means that about 1 to 1.5mms of central pout lip increase occurs for a 4mm or 25% vertical lip length reduction in your cases. It is important to remember that tissues do not respond like a block wood. They are elastic and stretch which is why it is not a 1:1 correlation as one would understandably think.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in numerous facial augmentations particularly brow bone augmentation. I saw your work and thought you did an amazing job on your patients. I have struggled with my eyes my whole life and I am trying to obtain a more “masculine” look. I put a word file together to so you what I am trying to achieve. There is this male model who I think has similar features to me and I would like to have some of his features (especially in the eyes). I was even thinking I need an infraorbital rim implant. Hope to hear from you soon!
A: Thank you for your inquiry and sending your pictures. In comparing the two pictures, what you ‘lack’ is a downward brow bone protrusion, fuller supraorbital sulcii, broader cheek/zygomatic arches and a less recessed infraorbital region. There are two fundamental strategies in making these facial changes:
1) Fat injections for all of the above facial areas, or
2) Brow bone/cheek/infraorbital implants for augmentation with fat injections to the supraorbital sulcii.
Facial augmentations can be done by these two methods and each has its own advantages and disadvantages which are well known and come down the degree of invasiveness, amount of recovery and potential permanence of the results. My preference is usually for implants because they offer permanency and can be custom made to fit the patient, which are both major advantages even though they are more invasive.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been made aware of the upper subnasal lip lift, and its ability to make the upper lift shorter. I know that this is a commonly performed procedure. However, as far as I understand, it mainly performed on women who desire increased upper lip pout. In my case, I am looking for a decrease in the distance between the base of the nose and the upper vermillion. My aim here, however, is to minimise the amount of visible pout of the upper lip. To that end, Dr. Eppley, are there any techniques forming part of the lip lift that you aware of that can minimise upper lip pout whilst reducing the philtral length as upper lip pout is not attractive male trait? This aim seems to have been achieved with stunning effect in the attached images. In both of these images (one being your own of course), the philtral distance was reduced, with very little change to the overall shape of the upper lip itself (of course some upper lip fullness is visible but it is not very noticeable and doesn’t detract from the overall result in any way).
A: While there are more women than men that get lip lifts, men do get them as well. It is inevitable that there is some change in the upper lip pout with any subnasal lip lift. The key is what percent of the total vertical lip distance is removed that determines how much the lip pout is changed. As long as the vertical lip distance is not reduced more than 25% the change to the central lip pout is minimal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m so glad that I found your website because I’m searching for a surgeon who can answer me this question.I’m a skinny person and I have a 17 inch neck and it looks very thick on me and I don’t like it. It’s just naturally that thick. I don’t know my body fat right now, but I don’t think that I have a lot because I’m already skinny and there is no fat around my neck, it’s all just muscle. So is there a surgery or anything else that can shrink my 17 inch neck to a 16 size?
For example is it possible to shrink the sternocleidomastoid muscle on both sides by 1 cm? I saw a before and after picture on a website of a woman who shrank her trapezius muscles through Botox injections. If Botox can shrink the trapezius muscle it should also work on other neck muscles like the Sternocleidomastoid muscle. But using Botox on large muscles to shrink them could be dangerous. I really want to lose at least 2 cm from my neck muscles. I know it sounds crazy but it’s really my biggest wish to have a thinner neck. So is it even possible to shrink my genetically large neck muscles?
A: There is no surgical technique to reduce the size of the neck through removal of part of the muscle. While Botox can be injected into any muscle, I have no experience with injecting it into the sternocleidomastoid muscle. Like all other muscles treated with Botox, muscle mass will shrink at least temporarily provided the dose of Botox administered is adequate.. I see no reason why the sternocleidomastoid muscle would be any different in this regard.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in custom cheek implants. I have attached a photo of how I am right now and a photo that shows how I want to make my cheeks look like. I was wondering If I can achieve this look with these implants that you are offering. Also I was wondering if these implants also cover the area of the infraorbital rims because I also want to achieve more squinty eyes. What other surgery do you suggest that I do based on my before picture in order to achieve the best look?? I will definitely be visiting you in the next year because I have heard very good words about you…thanks in advance Dr. Eppley.
A: Custom cheek implants can be designed based on the effects one wants to achieve. Just like make the back part of the cheek implant go back close to the ear, the front part of the implant can be extended to go across the inferior orbital rim as well. I believe that such an implant design can create the facial effects that you have shown by your own imaging. I think this one implant deign would be all that you would need to create your desired midfacial improvements.
Dr. Barry Eppley
Indianapolis, Indiana