Your Questions

Q: Dr. Eppley, That’s an example of the procedure I’m talking about. Upon searching, I believe it’s called smile line implants. 

A: Those are paranasal/labiomental fold implants…which has nothing to do with face shortening or surgery to try and accomplish that effect.

Paranasal implants augment the nasal base area and may indirectly reduce the depth of the upper nasolabial fold area by the side of the nose and increase nasal base projection.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I want to remove a big chin implant but I don’t want extra skin. I’m looking for a surgeon. When I smile its not really fitting to my face. People have suggested just taking it out but I rather fix the extra skin too.

A: I believe you are referring to the concomitant procedure of chin implant removal with submental chin pad resection.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in a forehead contouring procedure that goes beyond the standard “brow bossing reduction.” My main concern is the lateral width and curvature of my forehead. I would like to achieve a narrower and more compact forehead, with a softer transition from the upper lateral forehead (above the tail of the eyebrow) toward the temporal region. I’m not referring to the central bossing or frontal sinus area — my goal is a bony reduction and reshaping of the outer table in the lateral and superior forehead zones, possibly extending to the fronto-parietal junction. From what I understand, this might be considered an “extended forehead contouring” or “fronto-temporal reduction” procedure. Could you please let me know: • Whether you perform this type of contouring (not just Type I shaving). Thank you for your time and expertise.

A: That type of  forehead reshaping/reductive contouring is very common in my practice. Sucfh reductions can be done within the limits of the bone thickness. Fortunately the forehead is the thickest at the sides along the bony temporal line for the tail of the brow bone up to behind the hairline. You have correctly identified its proper name, Fronto-Temporal Reductions.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a lot of neck sagging and lack of jaw prominence and s short chin. I would like a total jaw augmentation as well as a necklift. What do you think? 

A: Thank you for your inquiry and sending your pictures. Your case poses a bit of a conundrum as the jaw augmentation and the neck lift are linked, not only by anatomic proximity but by their aesthetic effects. Normally in older men with more modest signs of jowling and neck sagging can be adequately improved by the placemcent of a custom jawline implant alone. But your degree of neck sagging is too advanced for the effects of a jawline implant alone to adequately address it. In fect the posterior 2/3s of a jawline implant would not be seen at all. Only the effects of the chin portion would be able to be seen. Thus a necklift (full lower facelift) is absolutely needed.

Point #1.  You can have a necklift without jaw augmentation but you should not have a jaw augmentation without a necklift.

A custom jawline implant and a necklift can be combined but that makes for a challenging recovery particularly in terms of swelling. The normal swelling from a jawline implant could have a negative effect on the necklift results.

By its open exposure at the back of the jaw angle and ear a necklift provides the opportunity to use that exposure for aid in placing the jaw angle portion of a custom jawline implant. But due to thicker tissues in men that is more challenging to do so than in women

Point #2 A necklift and custom jawline implant can be combined but should they??

Ideally one would have a necklift first and then a custom jawline implant secondariy. And one could argue that to maximze the benefits of both this is how it should be done. An altternative strategy, and an historic one, is to combine a necklift with chin augmentation. Get the most forward part of the jaw more projected as chin augmentation has no negative effects on the results of a necklift and actially makes its results even better. The needed submental incision for the central part of the necklift provides a convenient opportunity to place an extended chin implant. If a total jaw augmentation effect is desired later the expansion of the chin soft tissues  makes the placement of a custom jawline implant a bit easier.

Point #3 An amalgamated approach of  a necklift and chin augmentation blends the two surgeries without making the recovery more difficult and provides some structural enhancement to the necklift as well.

In conclusion the two approachs and their advanatges and disadvantages are:

#1 Necklift + Ciustom Jawlne Implant =  One stage approach, maximum recovery but with maximium result. The swelling from the jawlijne implant may have a slightly negative effect on the necklift result.

#2 Necklift + Chin Implant = Two stage approach, more traditional necklift recovery, gets some of the jaw augmentation benefits, one may or may not go for more complete jaw augmentation later.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Will my labiomental fold eventually soften? I had a 5 mm sliding genioplasty 5 weeks ago, and around weeks 3.5 to 4 I noticed a really deep crease in that area. It’s worrying me that it might stay like this. My surgeon says I’m still swollen based on my photos, but my bottom lip feels tight with certain movements and my smile still isn’t back to normal. Will that crease improve after the full 3 months of recovery, or is this likely how it will look? Thank you!

A: The full effects of a sliding genioplasty, like any facial bony reshaping procedure, wil be fully seen when all swelling has resolved and the soft tissue shrink wrap effect will have occurred. This is around the 3 month postoperative time period. It is fair to say that with any chin augmentation procedure, implant or bony advancement, the labiomental fold is going to get deeper. This is an expected and unavoidable sequelae of the surgery. The question is never whether the labiomental fold will get deeper but by how much. As for lower lip tightness longer postoperative time periods are needed to determine that outcome.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, My concern is that my lower face appears vertically short, which makes my neck seem longer and my head proportionally smaller. When I relax my jaw slightly (keeping my lips closed), my face looks noticeably more balanced, which makes me think I might have lower facial vertical deficiency.I’m interested in understanding whether a vertical lengthening genioplasty could improve overall balance and create a more proportional facial appearance. I want my head to appear bigger because my neck seems way too long compared to my small face. I look forward to your feedback.

A: By your own description and more open jaw positioning you have demonstrated that vertical lengthening of the jawline, or even the chin, creates better craniofacial proportions. You can call this a lower facial deficiency or a normal jaw development that looks better if it had more vertical length. Either way the more relevant question is how much  vertical lengthening of the chin is needed.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m interested in a temporal skull implant, but i wanted to ask, how many centimeters can i add to my skull circumference with this implant? I want to make the temporal area more full

A:Thank you for your inquiry and sending your pictures to which I can make the following comments:

1) Head circumference is a useless aesthetic measure and is not how you determine the effects of temporal augmentation. Temporal augmentation is a function of how much linear increase in width can be created and what effects does that look like in the front and back views.

2) As a general guideline 5 to 7 mm temporal width increases work well for most patients and the maximum amount of lateral width  is 9 mm.

3) Using the average amount of temporal with increase on your own pictures this is probably what would likely be close to the result.(see attached imaging)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Could a Custom Jawline be done in PEEK/Titanium?

A:Yes, it is done all the time. It costs more but it can be done. Also be aware that the dimensions of the implant will be smaller when composed of these rigid materials as they pose placement limitations.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I underwent a custom implant treatment on the occipital area (right side) at your clinic earlier this year. I’m very satisfied with the results, but I’m missing a little volume just above my ear (lower right occipital area), so I’d like to have additional surgery.(I don’t think it needs to protrude much.) I have a few questions: 1) Is it possible to undergo surgery again? 2) Is it okay to insert new implants on top of previous implants? (I’ve seen a question from a patient who underwent surgery with stacked implants. Is there any problem with that?) 

A:Good to hear from you and I am pleased to hear that you had a successful surgery with the satisfied result. It is not rare that a custom skull implant patient may want a little additional volume later. In those cases what is used is an overlay implant which fits on top of the existing implant. That can be a very successful strategy as long as the amount of additional implant volume is not excessive…. which in your case does not appear to be so.

What I would do is go back to original implant design file and mark on it where you want the additional volume is needed. I have attached some pictures of your implant design for you to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested to see what procedures are worth it for me, insecure about my side profile, especially lower jaw and chin. DJS, LJS, or sliding genioplasty?

A:Thank you for your inquiry and sending your x-rays. However, X-rays are not the means by which you determine the appropriate strategy for any facial reshaping surgery. Such strategies are determined by looking at the patient’s pictures and doing predictive imaging of various facial changes And seeing what the patient prefers. Then and only then are the x-rays potentially useful as the platform in making such as in planning DJS or making custom implants. But x-rays by themselves do not provide meaningful direction for determining optimal aesthetic changes

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a woman interested in a minimal forehead augmentation, and I would like your advice. I have attached reference photos to show my desired result, and I would like to know if this outcome is realistic and achievable. I would also like to schedule a virtual consultation with you. In preparation, I have a few questions: Is it possible to receive a digital rendering or simulation of the expected results during consultation? What are the requirements before undergoing this procedure? What is the typical recovery process like, and how long does it take? Will there be any changes to the hairline, baby hairs, or overall hair growth? What type of scarring should I expect, and how does healing progress in the long term? Between implants (standard or custom) and fat grafting, which would you recommend in my case, and what does each option involve? Is the procedure permanent, and if so, is it reversible if needed? Are there specific instructions for aftercare, including what to avoid during recovery? I am also considering rhinoplasty. I was wondering which of the two procedures would be best to do first? Or is there no importance regarding order? Since I am an international patient, I would also like to know what arrangements are available for hospital stay, local accommodations, and overall patient support?

A: Thank you for your inquiry and sending your imaged forehead augmentation results. Indeed this would be considered a minimal forehead augmentation of but a few millimeters. In answer to your questions about this potential procedure:

1) there is no question that the only way to do it is with the custom implant design. This type of change is so specific that it had better be absolutely controlled before surgery in every dimension. Contrary to the popular perception of many the more limited the patients desired result is the more precise the whole surgical process must be. A custom forehead implant would also be completely reversible. Such a forehead  implant design is done based on a 3-D CT scan that you get really live. The whole implant design process is done virtually and there is no reason for you to come here for. You’re only come once for the actual surgery.

2) this is a procedure that would take one hour to do under general anesthesia as an outpatient.

3) Because the forehead is a nonmoving bone like the rest of the skull the recovery from a physical standpoint would be very minimal. It is just about swelling and how long that takes to go  down to look more normal which would be 7 to 10 days after the surgery.

4) whether one does rhinoplasty before, during, after such for head augmentation as a matter personal preference. From a technical standpoint one procedure is not influenced by the other. Aesthetically, however that may be different. Therefore you have to decide which one of the procedures is most important, if there is one, and then let that be your guide as to the order of the procedures.

5) Every patient in my practice is just like you. We have no one from here locally. Therefore every day we manage people who fly in for surgery and then leave. This is a procedure where you only come in the day before the surgery where we formally meet, have surgery the next day and there’ll be no reason for you not to return home within a day or two after the procedure. There will be no benefit to sitting here waiting for the swelling to go down before you return home. You can but ultimately what we really care about is does this look like 2 to 3 months after the surgery when you know what 100% of the result really is.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I have a pronounced sagittal crest which then transitions into a flat angled shape at the back of my skull. I was hoping to understand whether a mix of surgery and implants could correct the shape without making the skull overly-large looking? Happy to schedule a consultation if you believe this is something you could help with. Many thanks,

A: The combination of a sagittal crest reduction and augmentation to the upper back of the head is certainly a very straightforward procedure to do if that would be the appropriate resolution to a better head shape for you. In that regard I would need to see some pictures of your head to confirm that that would be the appropriate approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’m seeking professional guidance regarding a recessed chin and a weak jawline, particularly in relation to the gonial angle. I also have noticeable facial asymmetry—specifically, the right side of my face shows a more recessed cheekbone and a weaker jaw angle compared to the left. I’d appreciate help understanding the underlying causes of these issues, as well as recommendations for treatment options. I’m especially interested in learning about potential procedures, associated costs, and any risks involved. Additionally, I’d like to know whether small, targeted implants could improve the aesthetic outcome, or if a full wrap-around jaw implant would be more effective. I look forward to your feedback and guidance.

A:Thank you for your inquiry and sending your pictures. You have two facial issues which are somewhat related, an underdeveloped lower jaw and congenital facial asymmetry with the right side being less developed than that of the left. The bony basis for this asymmetry Will become clear if you look at the 3-D CT scan of your face. That being said the first question is that of what are your aesthetic goals for your underdeveloped lower jaw which fundamentally comes down to isolated chin augmentation or a complete jaw augmentation. (see attached imaging) if you didn’t care about the facial asymmetry then that would be a very basic decision of how much effort do you want to put into the lower facial reshaping for what degree of change. The facial asymmetry issue, however, is a game changer in regards to that decision. This is because lower drawl is asymmetric and There’s going to be no successful way to treat that short of a custom implant design approach which then speaks to the aesthetic need for total lower drawl augmentation. Undoubtably your facial asymmetry has a cheap component to it as well and this also would require a custom implant approached to treat.

The concept of the spot implants to treat your jawline augmentation and particularly your facial asymmetry would not be a successful approach as the fundamental problems are not isolated or spot in nature. Surgeons try that approach all the time and all that ends up happening is a different form of facial asymmetry is created and the patient eventually has to graduate to a more comprehensive approach using a 3-D CT scan as the guide for treatment planning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi i would like to do a forehead and back reduction.I would like a flatter back and forehead.

A:Thank you for your inquiry and sending your pictures. You have a combination of an occipital protrusion and frontal or for head bossing. Both can be reduced as per the attached imaging. The bone on the back of the head is very thick and a lot of reduction can be accomplished. The four head bone is thinner so it is unclear just looking at your pictures what degree of reduction you could achieve but it would likely be enough to make a difference.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, my goal is to reduce my neck and trap muscles to achieve a more feminine look. I don’t think I can afford the standard Trap botox treatments of ~6k over 2 years.  I thought electrocautery may be more affordable and effective.

A:I believe what you are fundamentally trying to accomplish is to reduce the thickness of the upper trapezius muscle at the side of the neck per the attached image. Surgery would definitely be more effective but certainly not more affordable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi! I am reaching out regarding your procedure for waist narrowing by rib removal. I understand there is two ways of doing It, one is fully removing the ribs, the other is remodeling them by breaking them in. Which do you do? Also what is the probability of the intercostal nerve damage during surgery with both procedures

A:You are referring to subtotal rib removal of the outer aspects of ribs 10 through 12 with LD muscle reduction (RIB REMOVAL)  versus that osteotomies of the same ribs (RIB FRACTURES) with the need for prolonged corset wear after surgery to allow the ribs to heal in a more inward fashion. I have done both techniques although by far most people come to me for the rib removal method since that is surgically more challenging to do and requires much more experience in rib surgery to successfully perform. One can have a debate about which method is more effective but it’s fair to say removing tissue is going to likely end up with a better result than simply repositioning it. Contrary to the statements of some I do not find out that there are any great differences between them in terms of recovery. When it comes to intercostal nerve damage I have never seen that in either procedure with severasl hundred of ribs treated. But it is a risk and one should not confuse never seen with never could happen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  My right shoulder is much wider than my left shoulder, and my left shoulder is somewhat rounded and sloped.  Looks very asymmetrical and somewhat impinged.  In my teenage years, I’m pretty sure I had broken my collarbone or clavicle, and I never did anything about it.  I’m not 100% sure this is the reason for the narrowness or difference in appearance, but it could be. 

Is this something that can be fixed or remedied to provide a wider and more symmetrical look?

A:If you had a fractured clavicle previously and it was allowed to heal without surgical intervention replaced fixation it always does so with a shortened length. This can certainly create a rounded and more sloped shoulder as that Is exactly what happens clavicle loses length based on its anatomic position and orientation between the sternum in the shoulder joint. This is best confirmed by a 3-D CT scan of your shoulders to clearly display the differences in the clavicles between the two sides.

That being said, and assuming that this diagnosis is correct, the question then is whether one would undergo a clavicle lengthening osteotomy for symmetry improvement. And in a very muscular individual like you with the long standing contracted shoulder girdle could it be successfully  stretched out with the push of a clavicle lengthening procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, had a buccal fat removal which I truly regret. It has thrown off my face proportions and now my face looks very long and narrow. The surgeon assured me that it was a myth that it could age the face and he assured me it would not happen. Are there ways to restore volume in that area to recover plumpness and width? I would give anything to have my old face back. I think I was the wrong candidate for this procedure, since my face was long already and I have poor cheekbone volume. I already tried 2 syringes of Voluma but I still feel like there is something missing in my face.

A:While buccal lipectomies can be a very effective procedure in the properly selected patient, it is not a myth that it can age the face in someone who was never a good candidate for it. Anyone that would say otherwise simply lacks enough experience in doing the procedure or does not have a very good eye for patient selection. In reversing buccal lipectomy’s fat must be replaced. Whether this is done by fat injections into the subcutaneous space of the or the placement of dermal fat grafts back into the now empty buccal space can be debated and each approach has their advantages and disadvantages. One can even consider submalar cheek implants on the masseteric fascia which lies  in the intermediate layer between the subcutaneous space of the cheeks and the deep buccal fat space. Which approach is best has to be determined on an individual patient basis.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a young male with hypogonadism. I am currently on the maximum dose of testosterone gel and I am interested in learning more about the side-by-side procedure for testicular enlargement. I have a few questions: How are the implants secured in place to prevent the appearance of four testes? Are my natural testes sutured back while the implants move freely, or is there another method used? How long do the implants typically last? My goal is to achieve a full, masculine-looking scrotum. Thank you for your time and any information you can provide.

A:In answer to your side-by-side testicular implant questions I can provide the following comments:

1) The success of the side-by-side approach, which is determined by avoiding a four testicle look is the size of the implants. With large enough implants the natural testicles are pushed up and back and out of view because they are attached to the neurovascular cord which naturally pulls them up towards the inguinal canal. The size displacement must be at least 70% or more compared to the natural size of your testicles. When surgeons do not appreciate the importance of volume displacement in this type of testicle implant surgery this is how you end up with four testicle look.

I never secure testicle implants by suture fixation. That tethers them down, and Immobilizes them and creates the potential for discomfort.

2) Solid ultrasoft testicle implants are permanent. Because of their material composition they can never degrade or fail and thus never need to be replaced unless you have secondary aesthetic concerns.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to do  also an hairline advancement. So advance the hairline about 2 cm and make it straight.

A:Certainly one can have a frontal hairline advancement at the same time as frontal bossing reduction as the two procedures are synergistic both in terms of technical execution as well as their aesthetic effects. You never know the exact amount of frontal hairline advancement one can achieve until you’re actually doing the procedure. Does it cannot be predicted before hand whether the line you have made can be reached. Based on my experience I suspect that amount of frontal hairline advancement is a bit over enthusiastic as to what can actually be accomplished. You certainly can reach 50% of that advancement and likely more. I just would not count on reaching 100% or 2 cm of advancement.

Also be aware that a frontal hairline advancement is not likely to make it straight. The advancement will largely follow the existing shape of your hairline.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m considering custom infraorbital-malar implants to reshape my cheek and eye region. As part of that, I want to raise the level of the lower, outermost corner of my orbital rim by around 1mm; my goal is to slightly raise the outer portion of my eyelid. However, I’ve heard that raising the orbital rim could cause persistent discomfort that might only be resolved by removing the implants. Several questions: 1. How likely is this discomfort? Are there any ways to mitigate the risk? 2. Is it reasonable to use infraorbital-malar implants for minor eyelid shape adjustments like this?

A: In answer to your Infraorbital-malar implant questions:

1) The discomfort to which you refer is something I have never seen or been reported by any patient. Having done hundreds of pairs of custom infraorbital and infraorbital-malar implants that is a postoperative problem I have yet encountered. I don’t know the basis of where you heard of such a problem but there would be no anatomic basis for it.

2) Many patients that pursue 3D infraorbital rim augmentation do so with one of the intents is for improved lower lid positioning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How long the recovery will take from webbed neck surgery?

A:It depends on how one chooses to define recovery. What most patients define it by when can they resume most normal activities which should really be within 1 to 2 weeks. From an appearance standpoint one looks good from the beginning and there really isn’t any swelling or bruising to be seen from the front. Perhaps the most important part of the recovery, which for neck surgery should not be a surprise, is that the neck will feel a little sore and turning the head from side to side will be a little tighter for a while.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant placed over ten years ago. nI recall the surgeon used a McGann anatomical chin implant. Immediately once the compression bandage was removed and some initial swelling had resolved I could feel the left wing had been positioned or settled lower than the right. It’s not significant (perhaps 5mm or so) and would really only be perceptible to me or a facial plastic surgeon. However I am considering replacing it with a custom implant. I do recall when I went back to the surgeon post operatively, he commented on the imaging stating that there was some bone ‘erosion’ and he was concerned how superficial the pocket was on the left. 

For revision surgery such as mine, would the current implant be removed and the tissue be allowed to settle for say a month before replacing it (particularly given that superficial left pocket) or can it be done in one surgery? Thank you kindly.

 A:Thank you for your inquiry and detailing your surgical chin history. Most chin implants have some degree of asymmetry or tilt due to the nature have How they are placed. Only very rarely are they perfectly positions due to the limited incisional access by which they are introduced in position. Also, most chair implants will have some degree of bone imprinting often erroneously referred to as erosion. I’m not certain what the term superficial placement means but I suspect it refers to some floating of the implant off of the bone of which I’m not sure, short of having a 3-D CT scan, how that assessment was made.

All of these issues aside they are common and is what I see and almost every Chin implant but I remove and replace. Such removal and replacements are done as a single surgery. There is no benefit or biologic bases for staging such replacement procedures.

When it comes to a custom chin implant replacement a 3-D CT scan is required of which details of your exact chin placement and its effect on the bone Will be evident and will validate your perception of its current placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to ask whether you might consider providing some guidance. I have had two rhinoplasty and one septoplasty over the last 1o years. They have not been successful in correcting the columella position to centre of face. I have read your case study External Repositioning of the Deviated Columella and Nostril when I was researching whether simply repositioning the soft tissue could be helpful as I believe it would. However my surgeon doesn’t seem to agree and will not consider another rhinoplasty, of which I don’t want to go through another anyway. Is there a professional medical opinion you could share with me to pass to her? I wonder whether the hesitation is simply because this isn’t a ‘standard’ approach. Thanks so much in advance 

A:Until I see pictures of the base of your nose I can only make a general statement about an external columella repositioning. Having done it numerous times it is effective and there is no reason it couldn’t be done. Everyone that I’ve ever done it on is in the exact same situation like yours. They been through multiple septorhinoplasties which have failed to align the columella centrally and in some patients it may never be possible by internal repositioning. In some cases the external columella realignment may be combined with the caudal septal graft to ensure it’s new position. I can certainly understand why most surgeons would have an opinion that this is an undoable procedure. But until a surgeon has tried it and failed such negative opinions are irrelevant.

The one issue that does have consideration is that it is likely your prior rhinoplasties were done with an open approach, meaning there is an existing mid-columellar scar. This does raise some concerns about a new incision at the columellar base which leaves a very narrow strip of skin for survival between those two scars (aka vascular compromise). So where are that mid columella incision is exactly could influence whether this is a viable procedure for you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there greater risk for bone recession with a chin implant of the size were using? Around 10mm?

A:You are actually referring to bone imprinting rather than recession or erosion from a chin implant. Since imprinting is a self limiting pressure relief phenomenon in theory larger implants should show more of that  than smaller ones. In my experience however it is not alwaya a linear correlation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was also thinking about canthoplasty, is that service available?

A:I am assuming by your pictures that you are trying to achieve either a neutral for elevated outer eye corner position. If one is trying to achieve a neutral I corner position that I’d lateral canthoplasty alone would be sufficient. However if one is trying to obtain a higher than neutral outer eye corner position than the lateral canthoplasty needs to be combined with a small lower eyelid spacer graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What happens to the space created between old, unchanged facial implants and aging facial bones? Do the human face “fill in” this space to establish continued stability? Atrophy of muscles, bone, etc. is characteristics of aging. A gap is created.

A: The concept of aging facial bones, often spoken about, is actually largely over stated. It is one of those theories that sounds correct since the body does age and atrophy is part of many other body structures but in facial bones it does not really occur in that dramatic fashion. Facial bone atrophy is somewhat of a ‘truism’ meaning it just sounds like it should be true but the reality is it isn’t in the way atrophy is typically perceived. Until a single patient has a 3-D CT scan taken on their face from infancy to old age you can never validate what actually happens to the facial bones with aging.

Thus the concept that a space is created between the bone and an implant, or a gap is created between the two, simply does not occur in an age-related manner. Understanding what actually happens requires a biologic understanding of the encapsulation process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, in clavicle shortening surgery  you can reduce the overall width of shoulder but the drawback is that the hardware (if left on for life) will show and be palpable. If removed, the holes produced by the removed bone screws will render that altered clavicle bone much weaker than pre-surgery. Depending on the pre-surgery morphology of the shoulder, the shortening procedure might also not give much “shortened” new shoulder appearance. Are these accurate statements?

A: In answer to your clavicle length reduction surgery questions:

1) The screw holes that are left right after clavicle hardware is removed will go on and completely fill in with bone in a few months.

2) Based on my experience with the clavicle reduction surgery most if not all patients find that the postoperative shoulder appearance is much improved and more pleasing. Your  supposition that claviclce reduction surgery does not create a shortened new shoulder appearance does not appear to be born out by actual clinical experiences.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I hope this message finds you well.  I’ve been following your work for some time and I’m very impressed by your expertise in craniofacial and skull reshaping procedures.

I’m interested in learning more about a custom skull implant for one side of the head (unilateral augmentation), primarily for aesthetic purposes. Could you please let me know:

• Whether the consultation and design process can be done remotely (for example, by sharing 3D scans or imaging)?
• What kind of recovery time and visible results I could expect?
• And if you currently perform this procedure regularly for aesthetic asymmetry cases?

I’d greatly appreciate any information you could share, including how I might start the consultation process with your office.

Thank you very much for your time and for your outstanding work in this field.

A:In answer to your custom skull implant questions:

1) All parts of the process from consultation to implant design are done remotely. It is only the surgery that you would need to come here to do.

2) The recovery from skull implant surgery it Is usually fairly quick and Within 7 to 10 days most of the significant swelling has resolved. There are no postoperative physical restrictions.

3) Custom skull implant designs are regularly done for a wide variety of aesthetic head shape asymmetries and deficiencies.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a lower blepharoplasty a few months ago and one of my eyes now looks really hollow.It started out looking great. But it was like overnight it lost all the volume. So I was wondering if a tear trough implant would be an appropriate way to treat it.

A:Right after surgery for the first 4 to 6 weeks due to swelling everything can look perfectly smooth. But whenb all the swelling goes away and soft tissue contraction occurs as part of the healing process any contour irregularities or volume discrepancies becomes apparent. This is why it takes 3 to 4 months to truly see any type the facial surgery result in its fine details.

That being said the question is whether a tear trough implant would be the best approach to addressing your right lower lid/cheek junction concerns. I don’t think it is given that the surface area’s coverage of the problem is greater than that of a  tear trough implant. Such an implant risks creating a prominent bump or lump in the volume deficient area. If one was using an implants approach it really takes a custom implant design to provide adequate surface area coverage that has a smooth transition into the surrounding bone. However I think that solution, effective as it may be, is far greater then is what is needed.

From my perspective your options are twofold. One less invasive option is fat injections which,  if well done, can restore volume. Fat injections have the advantage of being able to be placed over a broad surface area and into the area that is actually the cause of the volume deficiency (loss of fat). The other option is an onlay which is draped over the  infraorbital rim onto its anterior surface. Think of it as an ‘implant’ but it is really a sheet of cadaveric dermis which can be custom cut and shaped along the entire rim area over a broad surface. It is juice like an implant but it is really a tissue graft which will integrate into your own tissues with the volume persistence.

Dr. Barry Eppley

World-Renowned Plastic Surgeon