Your Questions
Your Questions
Q: Dr. Eppley, Thank you for the pictures and the consult on custom skull implants. I have 10 follow-up questions, if you don’t mind.
1. As you might be able to see in the pictures, the top of my head does not have a lot of volume either (relatively flat). In your professional opinion, do you think the top of my head will begin to look odd if we add volume to the back of my head and my forehead, or can it be smoothed pretty well?
2. How long do the implants last (will I ever have to repeat the procedure)?
3. Does this procedure affect my ability to get Botox or have other facial treatments done (micro-needling, lasers, etc.) – trying to understand if there’s anything I can’t do after the procedure?
4. Will the implants shift as I age, if so, how does that affect the overall look?
5. What is the risk and pain involved in this procedure?
6. Will I need someone to come with me, or can I do the procedure and recover on my own?
7. How soon would I be able to fly home after the procedure?
8. Will I have any loss of feeling in my face or head long-term?
9. What is the success rate of these types of procedures, and what if I am unhappy with the result?
10. Finally, I think I’d like more volume than shown in the picture. Can you help me understand the cost difference and the process for doing the tissue expander first?
Overall, I am very interested in your expert opinion, to ensure I can achieve the best balance/look.
A: In answer to your questions:
1) Ideally you would have the whole head augmented from front to back. But as long as the back and front of the skull is not overly augmented the top of the head will not look too vertically short.
2) The implants are permanent devices that ail never breakdown or need to be replaced due to implant failure.
3) Skull implants do not affect the ability to get any type of skin treatment. (other than forehead Botox injections should not be injected too deep)
4) The implants will never move from their surgically placed position.
5) There will be some temporary swelling and discomfort from the procedure. The only medical risk is implant infection…which I have never seen.
6) It can be done either way.
7) You should be able to fly home in a few days.
8) There should be no long-term numbness in the scalp or the forehead.
9) The success rate is very high. One can always have the implant taken out but I have yet to see that be requested.
10) To get ore volume than that shown you would need a first stage scalp expansion, making it a two-stage procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 25 year old male and I’ve been following your blog for some time. I am interested in the ‘male model’ cheek implants that you have discussed a few times. As far as I am aware, this involves augmenting the zygomatic process of the temporal bone (the zygomatic arches) along with the zygomatic prominence. One particular question posted to you blog caught my interest and it was with regard to raising the position of the zygomatic prominence. You said that it could be done by placing a customized implant higher on the zygoma and performing an ostectomy on the lower part of the zygoma.
This is suitable for my needs, but I was wondering whether a similar thing could be done with my zygomatic arches. In other words, I would like to actually move the position of the zygomatic arch upwards by creating a custom zygomatic arch implant to literally sit higher on the face (compared to the old zygomatic arch). I am assuming some form of bone reduction would be performed on the older, lower zygomatic arch. What do you think about this? I feel as if it is very important because raising the zygomatic prominence without raising the arch will look disharmonious.
The other question that I have is with regard to the efficacy of silicone v. Medpor. I have consulted with another doctor and he informed me that in terms of soft tissue response, Medpor performs better than silicone (1:1.5 v. 1:.7 in terms of soft tissue movement relative to the implant dimensions). Is this an accurate approach?
Thank you.
A: One can not raise up the bony position of the zygomatic arch for one very distinct reason. Along its inferior edge is the attachment of the masseter muscle. This is not going to let the arch raise up any higher without complete disinsertion of the muscle…which would not be a wise anatomic thing to do.
As for the effects on soft tissue from an underlying bone implant placement, the body does not care what the material is that it doing the pushing. It will respond the same regardless of the material used as long as they are of reasonable stiffness. It makes no sense to suggest otherwise and there is no clinical or biologic proof that would remotely indicate that is true. What does matter is the implant shape and thickness, not its material composition.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to remove my jaw angle implants. I really don’t like the results, but I want to know if my skin its getting back to normal after this. Also what is going to happen with the pockets where the implants are? The doctor told me they are médium size silicone implants. Thanks.
A: Since I did not do your surgery and have no idea what you looked like before or now, I can not tell you what will happen when you remove your jaw angle implants. YOur tissues may or mat not completely return to normal. But on the other hand, what difference does it make if you do not like the look they have created. Just like in placing the implants it is a gamble that the result will be good. Int taking them out there is a similar gamble of whether you will return completely to what you looked like beforehand. But if you really don’t like the look (and 9 weeks may be too early to really judge the final result by accommodating to the new look) then I don’t see that you have much choice but to undergo jaw angle implant removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Three months ago I had a forehead reduction. The forehead reduction made a big difference. However, ideally, I wish my hairline would be just a centimeter lower and start exactly where my scar ends. Would you advise me to get the forehead reduction done again to lower it just that extra bit, or would hair transplants be a better option?
A: I am not sure why the frontal hairline is not at the scar line exactly but your scalp must have been was very tight so there must have been some separation. Given the tightness of your scalp, I don’t think it will ever move any lower than it is. Or at least not much lower like a centimeter. For your forehead reduction revision It would be best to have hair transplants done to fill in the difference between the hairline and the scar and this can also be done up over the scar line. This would produce the most natural looking result and be assured of getting the final frontal hairline position that you desire. I would let the scar heal until the three month mark and then have the hair transplant done. In the end yow will have a great forehead result and a very natural one as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Well I had some work done on my ear as a child (Microtia Reconstruction Revision) but I didn’t like the work done so I want to consult with another doctor to see if I can get better work done.
A: Thank you for sending your ear pictures after your microtia reconstruction done years ago. Microtia reconstruction using ribs grafts is a very challenging and humbling surgery for which it is hard to get good and pleasing results every time. Your ear result looks fairly typical to me and generally can be summed up as…not bad but there is room improvement.
The general outline of the ear and its projection from the side of the head is adequate but it lacks the ear details that the underlying framework probably has carved into it. To make improvements I would do the following microtia reconstruction revision:
1) shorten and smooth out the earlobe
2) Create the concave details of the antihelical fold, crus and concha through excision of skin and scar with the placement of small split-thickness skin grafts
There is definite room for improvement in creating some better ears details which is what your ear lacks currently.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, We had a Skype call a few days ago regarding forearm implants. You asked me to draw the part on my forearm where I would like it to be augmented. Please see the attachment and let me know what your opinion is.
A: Thank you for sending your desired forearm implant location picture. While I was initially skeptical when you discussed forearm augmentation of where that location would be, the area you have outlined is in fact,very safe for the placement of an implant. It runs longitudinal to some of the extensor forearm muscles and stops short of the wrist crease. It is in a location where there are no motor nerves or blood vessels of concern. In addition, although perhaps in just one forearm, you have a scar through which the implant could be placed.
Such a forearm implant is custom made based on measurements of the outlines area that you have shown. I would have the implants made with about 1 to 1.5cm of maximal thickness and with feathered edges at the perimeter. The implants would be placed in a subcutaneous rather than a subfascial location as there is on one single large muscle in that part of the forearm.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about deltoid implants if you don’t mind. Basically I have been doing searches for the right type of deltoid implants to achieve my goals. I currently understand there is a limit to how much shoulder width can actually be achieved, I have looked at many deltoid implants from the few surgeons who actually preform them and I realize that all of them seem different. Some add more width some add less width, some look noticeable some don’t look that noticeable. I am going to attach a photo of the deltoid implant goal that I would like to achieve. I understand there are different locations for where the deltoid implant can actually be placed I believe. But here is something that I would like to achieve. The claim on that augmentation is apparently 44cm to 50cm, which may or may not be accurate. Although it definitely did supply a noticeable amount of shoulder width. My shoulder width looks pretty similar to the guy posted in the photo on the left, I am also not thin. This one caught my eye due to the lack of you can’t really tell that there is an implant in his shoulder really. It’s not noticeable to someone who wouldn’t know that the procedure was done.
How much width do you think this patient achieved if you had to guess? Is a result possible like this for me to achieve? Why I am pleased the most with this result is the fact that it makes the actual clavicles look a little longer in my opinion. Thank you so much for reading my email.
A: Since I did not do the patient’s deltoid implants to which you refer I can not accurately tell what thickness those implants were. Beware that the photos you are showing is likely a small deltoid implant placed very high which may had about 1 cmof width. I would not assume that the outline of the implant is not seen just based on a front view picture. Its ‘obscurity’ can only really be determined from a side picture.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young female with a weak recessed chin which is worsened by a skeletal overbite (by 50%). Jaw surgery is too extreme for me so i was thinking of a genioplasty. My main concerns are further elongating my face. I already have an extremely long face and wish to not further it anymore. Is this possible to do? I also want the indent between my bottom lip and chin to not be as noticable (huge indent because my jaw is pushed back from the overbite) thanks in advance!
A: While it is clear by your description that moving the entire lower jaw forward is the ideal procedure, the only skeletal alternative is that of a sliding genioplasty where only the chin bone is moved. When the sliding genioplasty is moved forward, it can also be shortened by a technique known as a jumping genioplasty. This is where the advanced chin bone is placed where in front of the superior segment. This not only provides maximum horizontal projection but also avoids any vertical lower facial lengthening. (and may even make the face vertically shorter) I would need to see pictures if your face to determine whether this is a good genioplasty option for you.
Be aware that your deep labiomental fold is a result of your bite relationship and will not be improved by any form of chin surgery. Only moving the whole lower jaw forward, where the lower teeth push out the labiomental fold, will make any improvement in that aesthetic issue. The labiomental fold is an anatomic area that lies above the chin and thus is not usually improved by any form of chin augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Facial Feminization surgery. I am 55 years old so I know that adds to the complexity to it. I have attached pictures for your review and recommendations.
A: Thank you for sending your pictures. Your FFS surgery is more challenging to image/predict because you have a major facial aging component to it. (older facial feminization surgery) The need to get rid of loose skin in the upper eyelids and the neck /jawline (upper blepharoplasties and lower facelift) as part of the FFS procedure makes looking at the skeletal changes more difficult. I think they are best illustrated in the side view picture.
FFS is a large number of facial reshaping procedures of which not all apply to every patient. What I look for is those facial procedures which I think would have the greatest impact on feminizing the face. These will be different for each patient. In looking at your pictures, I feel the following would be most beneficial:
1) Brow Bone Reduction/Browlift
2) Rhinoplasty
3) Upper and Lower Lip Advancements
4) Earlobe reductions
I think if you put these four facial reshaping procedures with the previous anti-aging facial procedures mentioned (upper and lower blepharoplasties and lower facelift) as a combined FFS procedure. These would have the biggest impact on making a positive facial change.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, your internet page explains that back of head augmentation is possible by use of different kind of surgery. However, I have read a lot about different possibilities such as implants made from silicone or the use of Osteobond. I am struggling a bit by imaging what is best suitable for me and I have a couple of questions. I would be really grateful if you could give me some feedback.
• What is approximately the maximum thickness backhead augmentation you are able to realize without the use of an expander in advance?
• How can it guaranteed that the implants adhering over years and what will happen if they get loosen? Can the implant crack somehow?
• I have shaved skin on my head, a scar doesn’t cares me but can this being done in an asymmetrical way of cut to make the appearance more looking unintended?
• What is about martial arts fighting sport as an hobby, will it be still possible to do those sports or is it dangerous in case of too much force introduction to the implant?
• Can the implant be formed in a way that rim areas on the outer contour are not visible anymore (print through)?
• I read that Osteobond develops heat while curing caused by exothermic chemical reaction. How this will interact with my organism? What is about chemical reaction products – will this interfere somehow?
• In case of problems how easy the implant can be removed again?
• What does the surgery approximately cost? Is there a possibility to stay in your clinic for a couple of days?
I am looking forward to your feedback!
A: In answer to your questions about back of head augmentation:
1) About 15mms is the maximum thickness that the scalp can accommodate.
2) Skull implants do not get loose, that has never occurred.
3) You can design the scarline anyway you want.
4) Having an implant on the back of your head is more protective than restrictive. It is like putting a layer of protection for the bone.
5) The implant is designed to have very thin feather edges to make the implant-bone transition smooth.
6) Osteobond is an inferior alternative to a custom made skull implant. I would never use it on a shaved head…or any head for that matter if I had a choice.
7) The implant is easily removed.
8) My assistant will pass along the cost of the surgery to you later today. You should be able to return home in a few days after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, We have discussed using an implant for my infraorbital-malar augmentation, but I was wondering if fat grafting could be an option as well. I think I would prefer the fat grafting, it seems less invasive and more natural. I attached some photos of my face. Also, I saw that fat grafting could be used for the chin and jaw. I think having a chin that protrudes more would make my nose seem less prominent. I was also curious about having a wider, more square jaw with fat grafting. However, I am mostly concerned with just my cheek/eye area.
Thank you for your help,
A: Fat grafting is a natural body graft but has major issues of initial survival and long-term retention. In your face probably close to 0% of the fat would survive because you have very thin tissues. It is also prone to irregularities and clumping in the eye area as it does not get distributed in a smooth linear fashion. Fat also is a soft material so it does not give a hard push on the tissues and will just make everything more round and soft looking.
In short, fat grafting and implants are not interchangeable facial techniques. They not only are done differently but have very different aesthetic outcomes and long-term implication.
But there is no harm in trying fat first…then you will know for yourself.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m considering getting implants, but I’m worried about both bone erosion and infection. When it comes to bone erosion, I’m worried about how much bone will actually erode and will I have to eventually replace my implant in a few years time? Also, I plan on having some teeth removed and replaced with dental implants in a few years (after implants), will the implants get infected from this or would they remain infection free?
A: Bone resorption is not an issue I have ever seen with any custom jawline implant. There can be bone overgrowth sometimes back at the jaw angles and some mild implant settling into the bone (seen as an implant imprint on the bone) but not inflammatory bone erosion or any other tissue reaction that would necessitate removal of the implant. Teeth removal and the placement of dental implants does not jeopardize the implant per se…although the inadvertent injection of local anesthetic (dental infiltraion/blocks) into the implant may pose the risk of infection to the implant. For this reason full disclosure to the treating dentist is advised so they can appropriately adjust the depth of their needle penetration into the tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have never had any work done to the chin area although years ago I did have a submental incision at the crease where skin and tissue was removed and lipo done. Here are my concerns:
1) Chin Ptosis/witches chin is potentially causing:
a) A deep submental crease causing an unsightly irregularity between the point of the chin and throat. The excessive tissue that I can feel that has drooped down from the point of the chin seems to be part of the problem (chin ptosis). The skin and tissue around the chin is very thick and dense. The bone on the tip of the chin does not appear to be excessive but a profile x-ray would be needed to confirm this. maybe.
b) A very deep labiomental crease seems to have been caused by excessive mental muscle contraction. The crease has worsened as I have gotten older. I would like to have a smooth transition from the neck area to the tip of the chin.
Hope you have some positive things to say about you being able to help me with my profile.
A: Thank you for sending all of your pictures and detailing your concerns. In regards to the potential witch’s chin, that is not what you actually have. A witch’s chin deformity is when the normal chin tissues have slid off the bone for a variety of reasons. This chin soft tissue malposition creates an overhang off the end of the bone which also leads to a deepened submental crease an undesireable chin-neck profile. What you have is a normal bony chin and the chin soft tissues in proper position on the pogonion point of the chin but with a deepened submental crease. The deepening of the submental crease has been exacerbated by the prior facelift both anatomically and visibly.
The difference between a witch’s chin and what you have is anatomically different and requires a diametrically different approach to effectively treat. A witch’s chin is treated by the excision/removal of tissue and resuspension because there is a relative excess of soft tissues that are malpositioned. A deep submental crease with normal chin tissues after a facelift has to be treated by addition and not subtraction. Your chin and neck tissues are likely too tight to be able to simply remove and tighten them and end up with a smooth transition on the underside of the chin into the neck. Conversely the submental indentation needs to be released and augmented. Whether this is done by a dermal-fat graft or an implant onto the bone can be debated, each with their own advantages and disadvantages.
As for the labiomental crease, that is a very difficult problem to improve without some potential aesthetic liabilities. It is very deep and is an inverted skin fold. Nothing simply placed under it (injections of any kind) will push it out. The dermal attachments of the crease have to be released through an incisional approach and a fat graft placed under it. This places a scar in the crease line. While admittedly your labiomental crease line is like a scar anyway, this is an aesthetic issue of which to be aware.
Dr. Barry Eppley
Indianapolisl Indiana
Q: Dr. Eppley, I have some inquiries regarding skull reshaping. I have a problem with the top of my skull, to be more preicise, there is a big “bump” (I can send you pictures if you provide me with your e-mail adress). It’s approximately 1 inch high, 1.5 inches wide, and about 2.5 inches long. I already have a big head, and this only makes it worse. This has caused me much anxiety throughout my life. I would like to know if you had come across with similar cases and if it can be fixed, shaped down to a normal shaped skull? Also, can you tell me what the cost would be of such an operation?
Kind regards!
A: Thank you for your inquiry. By your description I believe what you have is a sagittal ridge/bump. Please send me some pictures of it in a reply to this email for my assessment. It can usually be effectively reduced and I have done so many times. Whether the bony bump can be completely flattened (due to the thickness of the skull) and whether it is magnified by a parasagittal deficiency (whose augmentation may be needed to get a really normal skull shape) remains to be determined by the pictures your send. (and sometimes by x-ray assessment of the thickness of the bony bump)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am seeking brow bone recontouring from a brow bone fracture that I had two years ago. This was never fixed and had left me with a big indent in my brow. Can this be fixed?
A: Thank you for sending your pictures and the x-rays. What you originally had is a depressed frontal bone fracture that involved the frontal sinus and supraorbital rim. It remains as a displaced forehead fracture but a healed one at this point. It is no surprise that a neurosurgeon would want to do a craniotomy to lift out all the bone and get it back into anatomic position through a full coronal scalp incision. This would certainly be the standard neurosurgical approach. But I can understand why that would not be that appealing to you at this point. The alternative treatment strategy would be a brow bone contouring approach. Leave the bone where it is and apply an hydroxyapatite cement over top of the entire depression to recreate a much improved forehead contour. This is an appropriate strategy as long as there is no air leak from the frontal sinus or a CSF leak into the nose. (which I am sure there is not)(
The only debate about this contouring approach is the location of the incision. It certainly makes access easier and a more thorough recontouring can be done with the wide open exposure of the full coronal scalp incision. But that incision/scar may want to be avoided. The alternative incisional access is through one of your existing horizontal forehead wrinkle lines. This avoids the larger scalp scar. I have done this many times for forehead cement application and brow bone reduction in men. It is usually a scar that heals quite well since it is in a natural skin wrinkle which is only going to get more pronounced with time anyway.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I would be able to get an idea of what is able to be done about my face being completely asymmetrical. (facial asymmetry surgery)
This is something that has bothered me my entire life and is only making me more self concious as I get older. I feel as though one side of my face is drooped. It’s not just the eyes or just the nose… every single feature I have is completely different on the right side of my face in comparison to the left. This is made even worse by the fact I am an identical twin, only we’re not identical because I was born like this and she was born with a normal even face.
After plenty of therapy etc there is still no doubt in mind that I cannot keep this face for the rest of my life. Is it possible to get computer imaging of what my face would look like and what could actually be changed to improve it. It also seems as though my jaw is more prominent on one side of my face in comparison to the other.
Thank you 🙂
A: Thank you for your inquiry and sending your pictures. What I see that you need to improve your facial asymmetry is:
1) Right jaw angle implant
2) Right cheek implant
3) Right corner of mouth lift
4) Fat injections to the right face between the cheeks and jaw angle
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please help! I want to change my long face shape! (facial reshaping surgery)I’ve always dreamt of having a shorter face….heart shaped or diamond shaped with higher cheek bones and a more defined jaw. I have a double chin! Also it looks like I’ve broken my nose?? I hate my nose it’s quite long and have always dreamt of a small button nose but it wouldn’t suit my long face. Please help! Thank you excited to see what I would look like!
A: Thank you for your facial reshaping surgery inquiry. While you do have a long midface that is magnified by the fact that your lower/chin is short with fuller neck. While you can not really shorten your face, you can radically change its shape by the following procedures:
1) Sliding Genioplasty – to bring the chin bone and its attached muscles forward as well as help thinning out the neck
2) Neck Liposuction – defat the neck and help create a better cervicomental angle
3) Full Rhinoplasty – straighten narrow and shorten the nose
4) Buccal Lipectomies – thin the face below the cheeks
5) Small Cheek Implants – add some cheek highlights
All these procedures together will create a much different facial shape as illustrated in the attached imaging. In reality the face is not getting shorter, as that can’t be done, but it changes its shape into better a aesthetic balance and proportions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in jaw surgery. I’ve had braces throughout high school. My orthodontist used spurs on the back of my top 4 teeth in order to stop my tongue thrusting. That was unsuccessful and he removed the braces. A year later I went to a different oral surgeon then the one who worked with my orthodontist to have my wisdom teeth out and he mention jaw surgery for my receding chin but wasn’t a priority then. Now my concern is cosmetic as well as functional. I don’t wish to get braces again but want to do things “the right way” to fix both. I do have an uneven and open bite as well as jaw pain. When I currently take pictures I thrust my lower jaw forward and I like the way that looks but I want something more permanent.
A: Thank you for sending all of your detailed information and pictures. I believe you may be confusing a lower jaw advancement (sagittal split ramus osteotomy, SSRO) with a sliding genioplasty. An SSRO moves your whole jaw forward and is primarily done to get the teeth to fit together. It often has a coincidental chin augmentation effect whose magnitude depends on how much the jaw moves forward. An SSRO procedure can not be done without pre- and post surgical orthodontics in the vast majority of cases. Conversely, a sliding genioplasty moves the chin bone forward but leaves the part of the jaw behind it that contains the teeth. Thus it does not improve one’s bite relationship and is only done for its cosmetic chin augmentation benefits.
To come remotely close to the ideal female jawline that you have provided you would really need an SSRO procedure combined with a sliding genioplasty to get that much chin change. Jaw angle implants would then need to be placed six months later. They key to this approach, as previously mentioned, is the need for orthodontics.
The non-orthodontic option, which leaves the existing bite as it is, is a combined sliding genioplasty with concurrent placement of jaw angle implants. Such a result will probably create an outcome that is about halfway between where you are now and the ideal jawline you have shown.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have some information regarding aesthetic shoulder augmentation with silicone implants. (deltoid implants)
After a motorcycle accident when I was young, I broke my right collarbone and in the hospital the doctor decided not to operate the shoulder.
As a consequence the bone of the clavicle is welded overlapping with the aesthetic result of shortening the length of 3 cm shoulder.
Moreover, my body was already thin, and has increased the curvature of the right shoulder to the inside.
A: By your description it is just the right shoulder which is due to the loss of projection of the shoulder due to loss of clavicular length. Your treatment options include:
1) A camouflage approach with the insertion of a right shoulder deltoid implant or
2) Treatment of the source of the problem by clavicular lengthening by osteotomy and plate fixation
I would need to see pictures of your shoulders to determine if a deltoid implant would offer a reasonable aesthetic improvement.
The use of deltoid implants has its advantages over actually cutting and moving the bone depending upon the degree of location of the shoulder deformity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a condition called costo-iliac impingement syndrome where my right 12th rib tip sticks into he right hip due to a laminectomy and spinal fusion I had in 1973. Over time some scoliosis and gravity have made my condition very painful. How much does a procedure like this cost? Do you accept insurance? Are there any surgeons that you know of closer to my area in Dallas Texas? Thanks for your time.
A: The 11th and 12 ribs point down 45 to 60 degrees from the spine unlike all the other ribs above them. It is easy to see with this natural anatomy that any condition that makes one had a tilt to their spine that the 12th rib could contact the hip bone.
Your 12th rib can be safely and effectively removed through a small back incision. This will provide complete improvement in your costo-iliac impingement syndrome symptoms. I will have my assistant pass along the cost of the surgery to you on Monday. We do not accept insurance. I would not know if there are any surgeons who can or would do this surgery in your geographic region. There may be, I just would not know who they would be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve done some research on Facial Feminization Surgery and noticed your website. I am interested in getting some Facial Feminization surgery going forward. I’ve had plenty of surgeries done in the past. I’ve had 4 rhinoplasties with alarplasty and tiplasty, Jawline reduction with chin contouring, chin implant, cheek implant, brow bone reduction, upper blepharoplasty, upper lip lift, hairline lowering, bone cement into forehead. I am not satisfied with how my jaw looks because it doesn’t look “normal”? I had my jawline reduction with chin contouring in 2012. I am not sure if I should consider a jaw implant? Also My chin implant looks masculine in my eye, I was hoping for a more feminine chin implant. I feel like my jawline is too curved if you know what I mean. I guess, when I told my surgeon I wanted a V-shaped face. He gave me that. I am interested in Kim Kardashian and Kylie Jenner’s jaw shape.
A:Thank you for your inquiry. With v-line surgery the jaw angles are removed and the chin is theoretically narrowed. (usually without an implant) This why your jaw line is ‘too curved’ as the angles are now too high. The chin implant that had placed is most likely a ‘male’ chin implant which makes the chin too wide rather than more narrow.
Ideally it would be nice to see an x-rays of your jawline to appreciate its bony contours. But to change the shape of your jawline your would need vertically lengthening jaw angle implants and replacement of your existing chin implant with a more feminine heart-shaped chin implant.
Dr. Barry Eppley
Indianapolis, Indiana