Your Questions
Your Questions
Q: Dr. Eppley, I have questions regarding skull width reduction.
1) Can the bone on the side of the head be thinned, or just the muscles? I’m asking because I think the top part of my head above the muscles might need to be thinned also.
2) Is skull width reduction predictable? Meaning if the muscles on the sides of the head are extracted, is it possible to remove say 4mm and keep some of it (maybe by thinning the muscles instead of completely removing them) or does the entire muscle have to be removed?
3) Is the result usually smooth, or are the noticeable bumps after the procedure?
A: In answer to your head width/temporal reduction questions:
1) The temporal muscles on the side of the head make up the majority of its width. Bone reduction has little width reduction effect. However, if the temporal line at the top of the muscle needs to be reduced that is done by bone burring.
2) Temporal muscle removal is largely an all or none approach as predictable thinning of the muscle can be not done, particularly from the hidden incision behind the ear.
3) Because what lies under the muscle is smooth bone the contour of areas where the muscle is removed will be smooth. The only potential contour issue is the transition of the cut edge of the muscle along the line of cut from the top of the ear up to the bony temporal line. Usually this muscle cut line is not seen, as it typically flattens out over time, but there is always a risk that some area of transition may be seen with movement. (jaw opening) This is really only a potential relevant issue in men who completely shave their head.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hope you are are well. It was good to visit you last summer to have a one on one session about mouth widening surgery – I believe it was well worth the traveling costs.
I have one question before proceeding to confirm the surgery – Is ingrown hairs on the mouth corners a concern?
Looking forward to your feedback.
A: While I have not yet seen that to be a problem in mouth widening in males, since males have beard skin it is always a potential possibility. Around the mouth area in men when the vermilion borders are advanced out further into the face, the vermilion-cutaneous junction is now going to involve the hair follicles. This creating an entrapped hair follicle (iatrogenic ingrown hair) is always possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Two years ago I had an orthognathic surgery with a sliding genioplasty. One month later a second bimaxillary surgery was done to correct the errors of the first. At this surgery the chin was brought back to its original position and the mentalis muscle. Six months later I underwent a third bimaxillary surgery at which a resuspension of the mentalis muscle was attempted but I believe that due to the huge swelling it was not reattached at the right height.
From pictures and video you can see the lip incompetence and the descent of the tissues which creates a strange projection of the chin and a descent of the upper and lower lip. What can be done to resolve the situation?
A: Thank you for your inquiry and detailing your extensive bimaxilary and chin surgery history. Between the three chin surgeries and the expansion and secondary set back of the bony chin, this strikes me as more of a tissue excess issue not a lack of adequate soft tissue suspension. Having had a failed mentalis muscle suspension x 2, this does not speak well for what any further suspension procedure would do. Mentalis muscle suspension works best when there is a true chin ptosis with visible sagging of the chin pad which can be seen to hang off of the chin. Your chin, however, looks more like an overall excess of chin tissue for the bone not a true ptosis. Between the trauma and soft tissue degloving from the three bimaxillary procedures as well as that of the chin surgeries, I think you have an overall chin pad soft tissue excess and laxity for which a suspension procedure is not going to solve.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a receded jaw and because of this my cheekbone is behind the line of my eye. (negative orbital vector) This causes my cheeks to sag and I am developing sagging and dark under eyes. I am wanting cheekbone augmentation to correct this and stop the progressive sagging. I was lined up to see a local surgeon who has developed a surgery using a coral extract called hydroxyapatite that he uses to build up the bone structure by making an incision through the under eye. Once he has done this he also says he will remove some of my sagging under eye skin and seal it up. I was wondering if you have heard of this surgeon or procedure, whether you think it’s safe and what you would recommend to combat my condition?
A: The use of hydroxyapatite blocks and granules for facial bone augmentation have been around since the 1980s. There is nothing new or novel about its use or any surgeon that still uses it. Various HA granule concoctions have been used over the years with agents such as blood or PRP to turn it into a more workable putty or a semi-injectable material. While seemingly a great idea twenty five years ago because of its bone compatibility and bone ingrowth which does occur into it, it has almost completely fall out of favor because of contour problems and secondary revisional difficulties with it. Potential contour problems such as irregularities, lumps/bumps and lack of smoothness are all the result of the difficulty with creating an absolutely smooth contour with a material that is a collection of granules. I am certain any surgeon that still uses it will say that is not a problem with their technique but having treated numerous hydroxyapatite granules patients with inadequate results and secondary irregularities this is clearly not always the case.
While hydroxyapatite offers the most biocompatible material for facial bone augmentation, this biologically appealing feature is overshadowed by its aesthetic limitations. The same can be said today for hydroxyapatite cements which can be applied in a much smoother fashion but adequate and assured contouring of it requires good visualization like an open skull site not in the limited confines of the face where discrete incisions are used often remotely placed from the site of actual augmentation.
In short there are today far superior methods of precise facial bone augmentation that can be properly planned before surgery. Having the surgeon whip up a mixture of a material and place it using an eyeball technique is really outdated and almost of historic significance in my opinion. While no facial bone augmentation is perfect the unforgiving nature of the thin tissues of the eyelid and cheeks requires good preoperative planning (3D design) and a material which allows for a good fit to the bone, a smooth other surface and the desired amount of augmentation and contours.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am enquiring about skull reshaping for my son who is very self conscious about his receding hairline which has highlighted a ridge bump on his scalp. We would like to explore possibility of reshaping.
Many thanks in advance.
A:Thank you for your inquiry and sending pictures of your son’s skull issue. He has the classic posterior sagittal crest deformity which typically ruins from the beginning of the sagittal suture at the coronal suture line junction back to the original location of the posterior fontanelle. It its typically raised 5 to 7mms and is thickest as it approaches the back part off it. In most cases the sagittal crest can be completely taken down provided that the bone is of adequate thickness. Most of the time the ridge exists because the bone is thicker along the crest not thinner but a preoperative CT scan is needed to assure that is so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking for improved upper lip symmetry. I would like to show my upper teeth more when I smile. As of right now my left side is droopier than the right. As well as when I smile, I would like my teeth to be exposed more.
I wasn’t born like this. Never had trauma. Started to notice this 3-4 years ago, when I started to use Juvederm fillers (root cause of the problem?). No fillers for the past 2 years. I even did a reversal around 9 month ago to make sure there is no residue. Never had botox in the area.
Considering direct lip lift (maybe in conjunction with bull horn) but tissue needs to be lifted laterally vs in the middle. NOT looking for Botox or fillers.
Most in surgeons here are not trained to perform modified or direct lip lift and are concerned about scarring along vermilion border. They suggest bullhorn lift, but that alone will only exacerbate the problem. As a young caucasian female, I noticed scars heal well on me, almost unnoticeable.
A: Thank you for your inquiry and sending your illustrated pictures. For cases of lip asymmetry where the vermilion borders are at different vertical levels, only a vermilion advancement (wha you are calling a direct lip lift) will be effective. By directing relocating the vermilion-cutaneous border on the left side can you have sustained improved lip asymmetry. You are correction in that fillers and a bullhorn lip lift will not effective as the pull of a subnasal lip lift is central and not lateral. And while this does result in a fine line scar at the vermilion border it does heal in most cases fairly well and is an acceptable tradeoff for the improved lip symmetry.
You may be correct in that the cause may be well be the use of injectable fillers since your lip asymmetry did not exist before their use and there really is no other case for it without a traumatic injury history.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently considering getting a mouth widening surgery but would like to know more information about it. My main question is about the pain of it. I’m assuming you are not awake when you get the surgery, however what is the pain like afterwards?
A: While one can have a sedation or general anesthesia for an isolated mouth widening procedure, that has never been needed in my experience. This is a procedure that can be done fairly comfortably under local anesthesia in all cases I have ever done for any isolated corner of the mouth surgery. But that being said it is all about making the patient feel most comfortable and if some sedation will help in the regard then that approach would also be appropriate. Pain after the procedure is not something that I have heard patients say much about.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have scrotal reduction. I’m an athlete and I am use to working out. For the last sic months I have been having trouble from the stretched out skin on my scrotum and I’m not able to workout as I used to do.
Please help me as I love working out and I’m not able to workout because of this discomfort. The main reason for choosing scrotal lift is to remove my discomfort while doing exercise and I also don’t like its appearance. I am vyoung and not married and want to know if this will it affect my sex life if I have scrotoplasty? I have heard that it effects sperm quality and testosterone hormone levels which will be not good. Please clarify my questions.
Waiting for your reply, thank you
A: Scrotal reduction is a skin removal procedure that tightens and lifts up the scrotum. Such skin removal is done along the medial raphe which is a natural midline skin crease of the scrotum. There is no negative effect on sperm production or testosterone levels as the testicles are not affected in the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve had mandible augmentation (angle of the mandible)with Medpor and a chin implant with silicone. The chin implant seems a bit off and small. And I was expecting my jaw to be wider, more striking, yet instead, it is just longer vertically, and makes me look much chubbier. Would I need to have everything removed before a CT scan? How much would removal be, and an estimate of your 3D custom implant cost/timeframe? Thanks so much, I really don’t feel myself, and when the masseter is contracted the bulge is higher.
A: Thank you for your custom jawline implant inquiry. There are multiple styles of Medpor jaw angle implants and it is hard to say but your own description what style you have implanted. That would be important to know before any further surgery and the best way to get that information is from your prior surgeon. They would be able to tell you what style, size and catalog number it is. Knowing what shape and size an implant is and what the resultant external shape it creates is very useful information when contemplating how a new implant design may produce a better more desired result.
It is not necessary to remove any of the implants before getting a 3D CT scan. The existing implants will be seen in the scan and then digitally removed when designing a new custom implant.
It generally takes 4 to 6 weeks to design a custom jawline implant and have it ready for surgery.
Lastly what you have is masseteric muscle dehiscence and subsequent retraction, an aesthetic problem in jaw angle implant surgery that is difficult to fix. Several treatment options are available to try and mitigate the lack of soft tissue thickness over the implanted jaw angle area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was Googling under “forehead skull reduction” hoping to find someone that could help my problem. I was almost sure that such kind of procedure did not existed, until I saw your website.
I wish I had known this ten years ago. Back then I was traumatized by all the bullying done to me. It was because of the size of my forehead. Not only in length (high hairline) but also from the side, it was not in proportion. (my forehead skull sticking out more than the rest of my face).\ Because of this problem, I wore a headscarf every day to cover up the abnormal shape of my head.
I was so depressed back then. Luckily I wrote my problems down on a forum, where people advised me to seek help from a hair transplant surgeon. I subsequently got a hair transplant which helped a lot. However, a hair transplant did not solve all my problems. It did lower my hairline, but it did not change my bone structure.
I still would like to have this fixed, even if it is only 1 cm smaller, it will make a huge difference for me. I hope you could help me. I will send some pictures along.
I can not wait to hear from you, i have been waiting for this almost my whole life.
A: Thank you for your forehead reduction inquiry and sending your pictures. What you have illustrated is about a 5 to 7mm reduction in forehead projection which is what its possible given the thickness of the frontal bone. It would be helpful to obtain a preoperative x-ray of your forehead to determine the bone thickness and provide a guide as to how successful the procedure may be. The other key question about the procedure is where to place the incision to do it which can either be aright at the hairline (and moving your frontal hairline even lower) or further back in the scalp. (where the hairline must remain at the same frontal position)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been following some of your posts on Real Self and I just had a few questions. I was wondering if my chin/jaw goals are achievable or not. So, I’ve attached 6 frontal pictures of myself, followed by 6 profile pictures, to give you a good idea of what I look like at the moment. My own assessment is as follows:
1. My jaw vertical development is quite bad; the chin is not tall enough.
2. When viewed from the front, my jaw seems quite round/feminine.
I was wanting to address (1) and (2). In particular, for (1) I’m wanting to get a taller chin by around 1 cm, and for (2) I’m wanting to get a more angular jaw from the front (however I don’t want the jaw to be any wider than it is; just more angular). I was wondering if all this is possible given my starting point? (BTW, in addition to the six frontal pictures and six profile pictures of what I look like currently, I’ve also attached at the end a morph of what I want my chin/jaw to look like; would you say this morph is achievable?)
A: Thank you for your inquiry and sending all of your facial pictures to which I can say the following about your chin and jawline reshaping objectives:
1) What you have is a lack of adequate vertical development of the lower jaw with a nearly flat mandibular plane angle.What you are tying to achieve is vertical jawline lengthening which is primarily in the chin and tapers backward towards the angle.
2) There are three ways to try and make this lower jaw shape change:
a) Chin wing osteotomy
b) Vertical opening sliding genioplasty combined with custom lateral jawline implants (done either as one or two stages)
c) Custom Inferior border implant
Each of these three approaches has their advantages and disadvantages whose detailed description exceeds this method of communication. But regardless of the method the greatest amount of vertical lengthening is at the chin and is probably in the 10 to 12mms range.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had a stock chin implant procedure which resulted in lack of desired projection but most importantly chin ptosis during animation. Just wanting to know the approximate price range to perform a stock chin implant revision + chin ptosis correction.
A: I would need to know more information about the past chin implant procedure (incisional approach, type of implant, any x-rays of it) and what your chin ptosis looks like. It is incredibly rare to develop chin ptosis from placing a chin implant as it almost always occurs from removing a chin implant. The only scenario I can currently envision that could account for chin ptosis is if the implant was placed intraorally and it was positioned too high, thus driving down the soft tissue chin pad.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a genioplasty to slide my chin forward 6mm about half a year ago to improve my recessed chin. Although it looks great from the side i am really not liking the effect it had on my face from the front. It seems my face looks longer and brought out its flaws and imperfections. Because of this I am considering a few options. First I was considering moving the chin back like 2mm to decrease the length it added and soften how much the shape stands out. But then I found your work and now I’m wondering if reversing the genioplasty altogether and replacing with a custom chin implant would better achieve what my goals were. One concern I have is that the custom chin implant will have the same effect of just making my face longer and having the weird shape of my face stand out. I wanted to get the your input on this idea of reversing the genioplasty and replacing it with a custom chin implant.
A: Just based on your description alone it would seem that a subtotal sliding genioplasty would be the most predictable approach to vertically shorten the chin. It seems that there would be too many variables in considering a total reversal and replacement with a custom chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wondering if you could tell me if I would be a good candidate for a sliding genioplasty procedure judging by the attached photo. On the left is what I currently look like, and on the right is how I would like to look. I have talked to a previous surgeon and he says he won’t perform the surgery because my face is already balanced. I disagree, and think my chin needs to be moved down vertically and slightly forward to balance out my face and to decrease the mentolabial fold. I would greatly appreciate your input before I schedule an in person consultation with you.
A: Your supposition about your lack of facial balance is correct as your own imaging has demonstrated. I am baffled how any surgeon could say your present facial profile is balanced. But even if it was in balance it is really up to the patient to determine what they want. That looks to be a sliding geniopasty movement of about 7mm forward and 2mm vertical.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you perform double jaw surgery (Lefort 1+BSSO) for aesthetics, I dont have any measurable occlusion but my maxilla isnt forward grown and possibly even recessed. I attached some pictures below for reference. It would also be great if a wrap around implant can be placed in the same surgical procedure as the Bimax.
A: Thank you for your inquiry and sending your profile picture. Based on your briefly described aesthetic goals, it is hard to imagine that bimaxillary surgery would be appropriate. In the face of a normal occlusion the usual justification for a bimaxillary advancement is in cases of severe sleep apnea. The risks and potential complications of such surgery do not usually justify this degree of invasiveness. It is not a question of whether it can be done but whether it should be done. I would need to have more clear description of your midface goals to provide a more qualified answer.
In addition no form of an implant can be done at the same time as sagittal split lower jaw advancement surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need a LeFort osteotomy to shorten my midface. It is too long from my eyes down to my upper lip.
A: No form of a LeFort osteotomy can shorten the external midface unless one has vertical maxillary excess…and this is only effective because it lessens the amount of tooth exposure. Shortening the length of the bony midface will not shorten the overlying soft tissue and will only result in loss of upper tooth show under the upper lip. The only known external midface shortening procedure is a subnasal lip lift which shortens the distance between the nose and the upper lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am intending to go through with a shoulder width recution via a “Clavicular Osteotomy” And would like to know the price you would charge for the named procedure if possible. Furthermore I would like to know if you have found success in resecting a little more “Aggressively” beyond the initial 2.5cm conservative limit. As I would personally be hoping for 4cm from each clavicle to achieve my goals and would be more than happy to be a “Trial run” to achieve that and help with your clinical outcome research.
In addition I would like to inquire about rib resections. Specifically if you have performed any clinical trials on successful upper rib resections for reducing a wide chest, and if so what sort of price you would charge and what waiver I as a patient would need to sign before going ahead with a procedure of that kind. As I say, I am an extremely motivated patient in that regard and am well informed of the risks associated with such a procedure.
A: In answer to your shoulder width reduction questions:
1) Reducing more than 3cms per side (clavicle reduction is problematic as the distal end of the clavicle causes too much inward shoulder rotation.
2) You can not reduce a wide ribcage above rib # 9 as it relates to a narrowing or inward movement on the sides. There are just too many ribs that would have to he resected to have the desired aesthetic effect and that would create serious pulmonary problems.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I previously contacted you to inquire about getting a Jaw Implant as seen in your Youtube video. I had a Medpor chin implant in 2004 which was attached by a screw. I wanted to know can the implant be taken out without damage. My understanding is that tissues grows into the Medpor implant and would be hard to remove.
A: Medpor chin implants can be safely removed and is very common for me to do in patients ‘graduating’ to a custom jawline implant. A 3D CT scan is needed both for implant design but also to determine the proximity of the existing chin implant to the mental nerves.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please could I have your thoughts on how to solve my bicep implant issues. proposed solution outlined below.
1) Please see attached photos of my arms, I have had bicep implants (placed OVER the muscle but below the fascia)- As you can see the edge on the right arm is very visible and on the left arm the shape is clearly strange looking.
I believe this is down to the re-shaping/molding of the implant not been done correctly, for example on the right arm the edge should have been feathered or filed down to make the thickness of the edge thin compared to the rest of the implant.
2) Please note the implant placed in the biceps was a large Implantech calf implant. I like the additional bulk added by this implant, I just wish the bottom edge wasn’t so visible.
As you can see I have also uploaded photos of an old set of forearm implants I have removed, I have played around/tweaked one of them (hence the amateur style cuts I have made with scissors)
What I have done is try to create a pattern so the implant DECREASES in thickness until the bottom edge, with the aim been to make the edge WAFER/PAPER THIN thereby making the edge of the implant barely visible when placed underneath the skin?
Please could you let me know your thoughts on this idea/proposal? Of course the cuts would need to be made cleanly and straight with professional surgical equipment as opposed to a pair of kitchen scissors.
Many thanks.
A: When implants are used for body areas in which they are not designed (calf implant for a bicep) there are going to be some shape issues. When it comes to feather edging, which is real important in subfascial implants, it is very difficult to try and hand carve a feather edge. The material simply doesn’t allow for precise feather edging to be hand made. This is why for subfascial bicep implants it is better to either 1) custom make the desired implant shape and size, or b ) use a Contoured Carving Block (Implantech, CCB Style 3) which is actually a bicep implant that is called a different name which already has feather edging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to reduce the length of the head from the top to the eyebrows? If so, how many centimeters? I would very much like to know about the possibility of having the skull get the shape more equalized, because respectively from the front to the middle of my head, it starts with a smaller width, but the width increases considerably from half of the head forward, until back of the head. The same kind of shape also occurs with my head´s length, start smaller, and going to the back of the head it is bigger, I mean, it looks like a climb. So, is it possible to reduce both, width and length? Make larger parts equal smaller ones?
A: In answer to your skull reduction questions:
1) Some modest superior skull reduction can be done as seen in the attached prediction image. This is an amount of 5 to 7mms, not centimeters.
2) The same modest reduction can be achieved in the head width as seen in the attached image.
3) As in height and width similar modest amounts of length reduction can also be done as in the attached image.
As stated in our virtual consultation the question is not whether overall skull reduction can be done but whether the overall modest changes are worth the effort. The attached imaging helps provide some visual information for you to make that decision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, which procedure(s) would be better suited for improving the aesthetics of my lower facial third, a sliding genioplasty or a custom wraparound chin implant?
I have very thin gums, and have had a gum graft performed to thicken an area where there was significant recession. Would this impact my eligibility to have a sliding genioplasty performed?
What is the most suitable procedure to address my subpar cervicomental angle? Would submental liposuction suffice for giving me a defined angle?
Is it possible to achieve 14mm of projection with a custom wraparound chin implant alone?
I look forward to hearing from you.
A:These are all great questions but without knowing what you look like I can only provide some limited answers:
1) A sliding geniopasty and a custom jawline implant have significant different aesthetic effects as one only affects the chin while the other one changes the entire jawline. So these are not directly comparable procedures.
2) The incision for a sliding genioplasty is done on the lip side of the anterior vestibule not on the gingival side of it. Thus one’s periodontal status does not affect the ability to have a sliding genioplasty. But I would have to see a picture of your front teeth and gums to provide a more qualified answer.
3) There are two basic procedures for improving the cervicomental angle of the neck, liposuction and a submentoplasty. A submentoplasty procedure is always superior to liposuction alone as it addresses the central platysma muscle and subplatysmal fat as well.
4) When you say 14mm projection I assume you are referring to horizontal chin projection. The amount of 14mm is right at the perimeter of how much stretch most people’s soft tissue chin pad can accommodate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My concern is my forehead shape and the right side of my head is pointy and very, very uneven. Attached are my pictures, what do you recommend?
A: Thank you for your inquiry and sending your pictures. Your forehead and skull asymmetry is apparent and one can debate whether the source is a left sided deficiency or a right sided overgrowth. But what really matters is which skull reshaping treatment approach produces the best aesthetic result…left-sided augmentation or right-sided reduction. (or even some combination of both) Ultimately I would need to see a 3D CT scan of your skull to understand the full topography of your skull bone asymmetry. But in the interim I have done some computer imaging to look at augmentation vs reduction to determine your aesthetic preference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a silicone chin implant placed about ten years ago and it was removed five years ago and replaced by a sliding genioplasty. I have received further projection which is great but now I have irregularities in the chin/balling/dimpling probably due to scar tissue?
I’ve been advised fat transfer to resolve deviations would not be optimal there and filler is temporary.
Could a custom chin implant be placed to smooth over in recontouring this chin region or could this area be reopened intraorally and smoothed over internally somehow?
I’m wanting custom Jaw Implants to resolve deficient jawline but the chin ideally improved at the same time.
Your time in responding is greatly appreciated.
A:The chin irregularities are in the soft tissue and not the bone. Thus I would not be optimistic that any form of chin bone augmentation would produce a significant improvement in the chin irregularities. It may…but that would be an unexpected bonus and not an assured outcome. Fat injection grafting would seem to be a more logical approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Last year I had a sliding genioplasty performed in Korea. While I like the shape and projection of my new chin, I have a constant sensation of tightness and my bottom lip feels like it’s being pulled downward and sits lower than previously which exposes more of my lower teeth. I also find that it’s awkward when speaking and my mouth no longer remains closed during sleep causes me to drool. I was hoping you can offer some professional insight as to whether what I’m experiencing is consistent with the healing process as I have been told by the surgeon in Korea. I have attached my X-Ray photos to hopefully shed some light.
A: While it is typical that tightness and lower lip changes do occur after any chin bone surgery, these issues should be largely resolved by almost one year after surgery. if you look carefully at your before and after cephalomertic x-rays it is evident that your lower lip was already pulled down at this early point after surgery. (yes I know there is swelling but lower lip distraction is not a good sign even right after surgery) I am afraid at this point after surgery that your tight sensations and lower lip position are now beyond part of a normal recovery and will be not be self-solving problems. You have lost vestibular height and soft tissue volume and plasticity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a mouth widening surgery since I have a quite small mouth, that is not very aesthetically pleasing or pretty. Due to the golden ratio: A ratio of lower lip vertical width to upper lip vertical width of 1.6 is also ideal. Now the optimal horizontal width of your entire relaxed mouth (what it looks like when it’s closed with no voluntary effort to widen it) to nose ratio approaching 1.62:1 has been recognized as a very important contributing factor as well in overall perception of facial beauty – the attractive mouth to nose ratio of 1.5:1 should be revised to 1.618:1.
Therefore I did some research on what could be done and I read that there are: surgical methods developed for treating microstomia (a mouth opening that is abnormally small). This procedure is traditionally used for correcting congenital microstomia, or acquired microstomia through burns or disease. However, certain plastic surgeons are well-trained in adapting these surgical techniques for widening healthy narrow mouths using a procedure called a commissurotomy, followed by a commissuroplasty. The first procedure is the cutting procedure and the second is to establish new lateral commissures and rearrange the muscles on the enlarged mouth so scarring is minimal and the mouth remains fully functional.
The photos i want to attach are both pictures of the actress Freida Pinto whose smile I want – and that includes the way her mouth looks when she laughs -, and one of the reasons that is, is because I think her smile/mouth is a bit similar to mine in the way it looks and “functions” (if you can say that). But I will also attach photos of the mouth widening procedure in drawings an such I have found on the internet.
A: Whether you call it a commissurotomy, commissuroplasty or mouth widening procedure these are all basically the same operation. Skin has to be removed, some muscle resected to prevent relapse and allow a pathway for the vermilion-based mouth corner to move into on its way to the outer margin of the resected skin to establish the widened mouth corner.
I would refer you to one of my websites, www.exploreplasticsurgery.com and put in the term Mouth Widening in teh search box. There you will find multiple articles I have written on his aesthetic perioral topic.
No matter how the procedure is done it all comes down to how well the mouth corner scars heal and appear and the acceptance that there is a relatively high risk of scar revision needed for them.
Dr. Barry Eppley
Indianapolis, Indiana