Your Questions
Your Questions
Q: Dr. Eppley, I had cheek implant surgery with Dr Eppley many years ago, and I have a question if the Dr used any metal or screws in my face during the surgery to hold the implants in place. Im writing because im going to have a MRI Scan soon and i need to know if there was any metal, screws, or other matieral atached other then the implants? It would be very helpfull too know this.. Thanks alot for your help!
A: I can not recall the specifics of any surgery from 11 years ago. But since I always use screws for facial implant fixation I will assume that was done in your case. Such medical-grade facial screws since 1991 have been composed of titanium, a non-ferromagnetic metal, they are perfectly safe for undergoing MRIs.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if it’s possible, and safe (low risk for botching/complications), to widen the alar base of the nose. It really adds a strong touch of masculinity that my face is missing. In particular by trying out morphs in a photo editing program, the alar base alone being made wider makes the biggest difference.
A: As long as the nostril widening was not more than a few millimeters that could be done without undue scarring.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have a mild case of Cutis Verticis Gyrata and, while researching possible treatments, I found your article “Plastic Surgery Case Study – The Treatment of Scalp Cutis Verticis Gyrata with Subgaleal Release and Fat Grafting” on the website exploreplasticsurgery. I believe my situation is similar to the patient presented in your article, and after consulting with a plastic surgeon, she was enthusiastic about the procedure. However, since it is not widely reported, she had some doubts, especially regarding the step of releasing the scalp before performing fat grafting. She expressed concern about the arteries in that region. I would like to clarify this point with you and, if you allow, I would like my doctor to contact you directly so she can ask further questions and benefit from your expertise with this procedure, as I intend to undergo the surgery. CVG bothers me a lot. Attached are photos of my scalp. I would also like to know if the procedure proved effective in terms of fat resorption, and whether you have performed other similar cases.
A: As long as the CVG is not too advanced with deep linear V shaped scalp lines releases with fat grafting will provide improvement in its appearance in my experience.
If your surgeon is questioning the arteries in the scalp’ with a release this tells me they have little scalp surgery experience.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, big fan of your work. Im looking to get custom jaw and cheek implants, and was looking to replicate this jaw/cheek structure from this male model. Have you designed one that closely resembles his features before? Same cheekbones and that same type of sharp jaw angle.
I’ve seen many custom cheek and jaw implant designs before but curious to see which one directly resembles this model’s approximate structure.
Here is my most recent CT scan, i have standard jaw implants and a chin implant
Im going to get a sliding genioplasty, but in terms of jaw and cheek implant design, i was wondering if doctor Eppley designed ones closest to the model before?
A: You have a completely inaccurate concept of how custom facial implants are designed. No one knows the skeletal shape of these model faces or what implant designs can come close to creating them. The only way to know with any accuracy is to take a 3D CT scan of their face and overlay it on a 3D CT scan of your face to show the bone shape differences. Short of that method custom implant designing is a best guess estimate….and even this assumes you have the right soft tissue thicknesses where such implants can show through enough for their full effect to be seen.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, How long does it take to get custom facial implants made?
A: The rate limiting step in any surgical procedure that includes custom designed implants is the time it takes to go through the design and manufacturing process of them. This is usually around two to three months from when the 3-D CT scan is received on which the implants are designed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been struggling with what i think is Parry Romberg on both sides of my face for the past year. It has been mentally and emotionally draining and is affecting my everyday life. nPlease help!!
A: Thank you for sending your pictures. While you do have a grade III or IV facial lipoatrophy condition this is definitely not Parry Romberg syndrome. Parry Romberg syndrome follows the distribution of the trigeminal nerve and has a very linear pattern of atrophy. It also tends to only occur on one side. of the face. What you have is an overall lipoatrophy which has affected all of the fat compartments from the temporal down to the buccal spaces resulting in this classic gaunt facial appearance. Once the fat is lost it is lost and the body is not going to restore it. This is a reflection of a more systemic cause such as significant weight-loss, certain medications and various medical conditions.
Regardless of the cause there’re various methods to treat this type of facial lipoatrophy. The most obvious treatment is that of fat injections into the temporal and submalar/lateral areas of the face provided one has enough donor sites to harvest the needed fat. One could argue how well will fat survive in areas where fat originally was and disappeared. That is a logical debate but the benefit of fat injections is that they are autologous and have no known medical side effects…. not because it is the most assured treatment. But it remains as a first-line treatment for those patients who are so motivated. The alternative are temporal and submalar cheek implants which provide a more assured and sustained result. These will do well in those two major areas but will not provide any augmentation in the lower facial areas from the mouth along back to the ear. This area can be concomitantly treated with either fat injections or there are various tissue banks tissue grafts and even thin implants that can be placed into this soft tissue area.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I got custom infraorbital implants to correct my undereye hollowing which it did not do. I have attached the implant design file.
A:Just because implants were made custom does not mean they are going to create the desired effect. Besides accurate placement the other major component of an aesthetic outcome with custom implants is their design in terms of surface area coverage and various thicknesses throughout the implant. My first question when I see someone who has had custom implants that did not create the desired shape or created and the fact that they did not anticipate is…. what was the basis of this implant design? Why was this implant designed this way and what were the original objectives?
As I am not privy to all of that prior information I can only look at the current problem… which is persistent under eye hollowing. While this implant design does cross the infraorbital area it only provides horizontal infraorbital rim augmentation which will either maintain or worsen the presence of any pre-existing under eye hollowing. To properly treat under eye hollowing the infraorbital rim area must be augmented both vertically and horizontally known as saddling the rim. This implant design does not do so and even though it provides infraorbital rim augmentation it never had a chance to improve under eye hollowing. This is a flawed implant design to achieve that effect. This undoubtably was done by a surgeon who has never used implants to improve under eye hollowing and tried to do so with an implant design placed intraorally. The only way to successfully treat under eye hollering is an implant design that saddles the rim and is placed through a lower eyelid incision.
Given the benefits that your current implants provided in the cheek area my tendency would be to design new implants that sit on top and round these existing implants place they will lower eyelid incision.. Stacking implants on top of each other has its potential disadvantages but in your case may be the most appropriate approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I underwent a chin implant five weeks ago and am unhappy with the result. It is too wide and blocky in appearance. I think I should switch to a sliding genioplasty. I am also concerned about long term bone erosion with a chin implant. What do you think?
A:Thank you for your very detailed inquiry. To which I can make the following general statements:
First you are only five weeks after your surgery which is way too early to make definitive judgments about the final results and what you may or may not do. I do not recommend nor do I operate on patients before their fourth month after surgery as is that is when the true effects of the final bits of swelling and shrink wrap effective the soft tissues have occurred.
Second I would be very cautious about making a radical change in your chin augmentation approach when the changes you are seeking may well be able to be achieved by an implant. Every operation, chin implant or sliding genioplasty, has its issues. There is no perfect operation whether it be chin argumentation or any other surgery…. particularly if one is going to evaluate the results under the microscope so to speak. The only valid reason in my opinion that you would switch to a sliding genioplasty, after the requisite four month postoperative period. Is that you have decided that you simply do not want any foreign material in your body. If that is the issue then whatever the aesthetic trade-offs are for a sliding genioplasty become irrelevant. The concerns that you have pointed out about a chin implant, soft tissue compression and so-called bone erosion, our biologic fallacies. They are commonly believed even among surgeons but they are simply incorrect about their understanding of what they are seeing. Implants do not cause bone erosion, they can cause implant settling which is a passive self-limiting reaction to the tissues to the interposition of an implant that violates the natural biologic boundaries of the soft tissues. This occurs in all implants throughout the body that’s not unique to the chin. But because of the frequency of dental x-rays it is the most observed phenomenon of all implants in the body. Be aware that even the sliding genioplasty has a response to the pressure displacement of the overlying soft tissue caused by the new bone position…. which means the moved chin bone will change its anterior shape often losing about a millimeter of projection over time. Yet nobody calls this well-known phenomenon bony erosion. It is just another example, in this case an autologous surgery, of biologic adaptation of a bone shape that has changed anatomic position from what it was developed to be.
Third I would also caution any patient how about trying to take an overall good result and trying to make it ideal. As I often tell patients as well as other surgeons secondary or revision on surgery always presents the opportunity to make something worse or develop a complication the patient did not previously have. Just because your first surgery was uncomplicated and healed well is no guarantee that whatever you do the next time will do as well. This does not mean that one should never have secondary surgery within initially satisfactory result just let one needs to be mindful of the potential risk and fully understand what the trade-offs are.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Based on the photos I sent, I am concerned about the overall width of my head, particularly the prominent temporal areas and the flat back (occiput). I would like to know if my case could be addressed through temporal reduction (muscle or bone) and/or an occipital implant to balance the proportions. Could you please let me know if these procedures would be appropriate for me? Thank you very much for your time and evaluation.
A:Thank you for your inquiry and sending your pictures. To make sure I have correctly identified your concerns based on the description I have attached your pictures with the areas highlighted but I believe to which you refer. The most straightforward to her correct is that of the occipital deficiency as a custom skull implant will provide an immediate and effective resolution to that problem. From my head widening standpoint you have a high temporal widening which is probably reflective of a boned problem more than that of the muscle. Is the temporal muscle originates from the bony temporal line in that area it usually is thinner than that which lies below it. This means that traditional temporal reduction surgery, which is muscle removal alone, will provide some improvement but probably not optimal. While it would be more ideal to reduce the bone in that area as well, which can be done, I would be concerned about the incisional access to do so given the short hair that you have in that area. Meaning I am leery about the scar trade-off to obtain that additional level of improvement.
As a result, if it were me, I would get the cccipital augmentation and the traditional temple muscle remvoal and then see the level of motivation based on the improvement obtained about whether bony temporal reduction would secondarily be considered.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I’ve heard a lot of great things about your work, and I wanted to reach out to you since I believe you are the best professional to assist me in this matter.
On the top left side of my head, I have a medium-sized indentation. It’s not a large area, but it makes a noticeable difference in how my head looks. What I’d really like is to add some volume there so the contour appears more even.
Unfortunately, about three years ago I found a physician and tried the silicone 1000 microdroplet technique, which I now feel may not have been my best decision. I don’t believe I have much of it there, but after the second treatment, the doctor told me it wouldn’t be possible to safely achieve the fullness I wanted that way. I also understand this could present complications in the future. Since then, I’ve been exploring other options.
From my research, I’ve considered two possibilities:
- A custom implant, placed through a hairline incision, possibly with removal of some silicone if that’s feasible.
- Fat grafting after removing some silicone, though I feel an implant might be more reliable.
I realize there are risks and limitations, especially with the presence of silicone, which is why I wanted to ask your opinion. I even sketched a quick graphic and included some photos.
I would really value your thoughts on whether something like this could work, or if there’s another solution you’d recommend and could assist me with.
A:Thank you for your detailed inquiry and sending your pictures to which I can say the following:
1) Your left upper temporal deficiency is clear in your pictures. Whether that represents a bone contour deficiency or a difference in the muscle between the two sides cannot be determined by a picture alone. But regardless of the actual anatomic nature of the deficiency the best procedure would be an under the muscle bone based implant to augment it. That would have the least risk of any short term or long-term implant related issues. What the dimensions of that implant would be would be able to be determined by a 3-D CT scan IF it is a bone base deficiency… Which I suspect that it is.
2) in a bone based implant under the temporal muscle the prior silicon injections would have no bearing or adverse effect. As you have mentioned the injected volume is likely very small and would probably not be an issue even if some form of implant augmentation was done on top of the muscle as opposed to under it.
What I would initially recommend is to get a 3-D skull CT scan and really evaluate the anatomic nature of the problem. That will help guide what treatment approach would be most effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q; Dr. Eppley, I am very interested in learning more about the Iliac Crest Reduction procedure that your clinic offers. I would greatly appreciate it if you could provide me with information regarding the following:
- The approximate cost of the surgery.
- What is typically included in the quoted price (surgeon’s fee, anesthesia, hospital stay, post-operative care, etc.).
- The expected recovery time and any lifestyle restrictions following the procedure.
- Whether this surgery can be combined with other contouring procedures (such as liposuction or body sculpting).
- Potential risks or limitations that patients should be aware of before undergoing this operation.
As I am located outside of the United States, I would also like to know if you offer virtual consultations for international patients.
Thank you very much for your time and assistance. I look forward to your reply.
A: In answer to your questions about iliac crest reduction;
1) Most patients will experience some initial walking discomfort due to the trauma to the TFL fascia along the iliac crest. But this is self-limiting and usually resolves within 7 to 10 days after the surgery.
2) Iliac crest reduction can be combined any other body contouring procedure.
3) Ither than the fine line incision/scar to do the surgery I think the biggest potential limitation is how much bone can be reduced and whether this will match what the patient’s aesthetic objectives are. This is an issue which should be determined preoperatively and not decided postoperatively. To do so I would just need to see some pictures of your hips as well as an understanding of what your surgical objectives are.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Thank you very much for your detailed explanation and for clarifying the situation with my current Medpor cheek implants. Based on this information, I would like to kindly ask:
Given the specific models, what options would you recommend in my case?
Do you think it is possible to design and place new, better-fitting implants that could solve the current problems?
My main concern is to understand what is realistically achievable and whether you feel confident that you could help me in this situation.
Thank you again for your time and guidance. I look forward to your opinion.
A:Thank you for sending your additional information. These are classic Medpor inferior orbital rim implants, which only come in 3 mms of horizontal projection, that have been placed intraorally with double screw fixation on the side as seen in your 3-D CT scan. As I have seen many times for these implants they create both a ledge and do not improve or increase under eye hollowing. As I probably previously stated you can’t simply add horizontal augmentation to the infraorbital area, a 2-D solution, for undereye hollowing, which is a 3-D bony problem.
To provide improvement of the result that you currently have these implants need to be replaced with custom infraorbital rim-malar implants that provide a 3-D augmentative effect. These are placed through the lower eyelid which is a direct approach to implant placement and being able to place an implant that actually saddles the rin. Your existing Medpor implants will need to be removed exactly the same way in which they were placed, intraorally, as the screws have been angled in from that direction and cannot be removed from a superior eyelid approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I understand Dr. Eppley has performed dermal fat injections to treat coccydynia. I recently had this procedure done and for about 4 weeks it completely eliminated my tailbone pain. But the pain returned not long afterwards and now my pain is the same as it was before surgery. My plastic surgeon is attempting the surgery again in a few weeks. My question is, does Dr. Eppley have a list of post op recommendations to increase the success of dermal fat injections? I was told I can exercise fully after 4 weeks, including using weights and I wonder if that was detrimental to the surgery.
A:I don’t do fat injections for coccydynia and have never have for the very reason you have experienced….100% of the injected fat will resorb and the benefits will be very temporary (4 to 6 weeks). I do dermal-fat grafts not injections. This is the placement of a solid fat graft through an open incision with or without some tailbone bony reduction. This type of solid fat graft has a much higher incidence of survival and is far superior is pressure area lie the coccyx.
FYI Fat injections (liquid) is not the same as a solid fat graft.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Is subcostal rib margin shaving/reduction completely put of question for a kidney pancreas transplant patient who is 5 years in and has never had an episode of rejection? I imagine rib remodeling is because the patient needs to wear a corset for months which i would think probably puts pressure on the transplanted organs.
A:Your supposition about not doing rib reduction in the kidney-pancreas transplant patients is correct. This would not be a good benefit to risk ratio.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am contacting you now because I have come across your case report about correction of sagging buttocks: https://exploreplasticsurgery.com/plastic-surgery-case-study-long-term-persistence-of-the-infragluteal-fold-in-lower-buttock-lifts/
I have one patient with a double fold after liposuction in the dorsal thigh area about 18 months ago. She has tried thread lift, fillers and some skin tightening at other clinics with no result. We have been discussion a surgical procedure similar to what you have described in your case report.
In my experience it is always difficult to elevate tissues against gravity long-term, and I have told her that there is a risk that the native gluteal fold with time will appear lowered even though if we can correct the double fold. However, you seem to have overcome this; your results are not only nice but also are long-lasting.
Therefore, I wonder if you could elaborate a bit on which sutures that you use (permanent?), and if there are any other pearls/caveats that could be useful to know.
A:One of the most common reasons for lower buttock lift surgery is when liposuction is done for the banana roll deformity. Having done many lower buttock lift surgeries I have never found descent of the re-created fold to be a problem.. Technically the excision creates the elevation of the fold and efforts to deliberately lift the fold are not really needed. By definition it is the overhang that is being removed and the excision merely re-establishes the original fold which was not visible because of the overhang. This is what you see when liposuction suction has created the problem which is really a form of pseudo ptosis. Why all of the other trial procedures do not work is because they simply cannot get rid of what is a tissue excess. That concept of a lift through threadlifts and skin tightening is an erroneous concept for the problem. You can’t lift or skin tighten away tissue excess
With the excision I secure the dermal edges of the excision down to the gluteal fascia. I don’t use permanent sutures, rather In use long lasting resorbable sutures.
The biggest postoperative problem i lower body lifts, as defined by the need for revision on surgery, is not the descent of the fold but some hypertrophic scarring which may require a secondary scar revision.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I am wondering what can be done regarding a protrusion at the top of my head where I believe the coronal sutures come together(?!).the protrusion is like a line that goes from left to right, not front to back. It is a pronounced raised line that I worry about for aesthetic reasons.
A:You are likely referring to a raised coronal suture line which can cause a transverse protrusion. If the bone is thick enough it can be reduced by burring. A preoperative CT scan is done to make that determination.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is it possible to make jawline/chin/bone implants for the face permanent? By permanent I am talking about the implant fusing over time and becoming bone. It bothers me that if I have a silicone implant if I hit my jaw hard on something by accident or get punched it may slightly change position.
A:No type of implant material currently used for jaw implants can ever turn into bone over time. In fact no current implant material even has the ability for bone to bond to its undersurface where it contacts the bone. Fortunately those issues are actually irrelevant when it comes to any postoperative concerns about any type of implant material moving with trauma later. Between the early benefits of screw fixation and the more important encapsulation process that happens with scar tissue forming around the implant within the first six weeks of surgery it is impossible for the implant to ever move later. This is well known to surgeons who perform this type of surgery when they have to secondarily reposition or replace an existing implant. The encapsulating scar makes that procedure challenging. It is also important to recognize that most custom jaw implants have large surface area involvement which results and a lot of encapsulating scar over and around the entire implant. Of all the potential issues that one could have about jaw implants long term movement due to trauma is simply not one of them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a BBL with buttock implant five years ago. My buttock Implant are malpositioned, flipped and sagging and they split out of the muscle. What can be done now?
A:Thank you for sending your pictures. Based upon your description of concerns your buttock implants would have to be outside of the muscle as this would be the only reason they would flip and/or sag. Intramuscular placement about it implants is not associated with implant flipping or sagging.
I obviously have no information as to what the specifics of your buttock implant surgery as to how they were initially placed. It would be most helpful, if possible, to see the operative note from your surgeon from that surgery.
That being said, knowing that they were 455cc implants, in my experience those would be very difficult to get complete muscular coverage even if they tried to place them on an intra-muscular basis. Even if they got complete muscular coverage over them the size of implants would ultimately split the muscular closure due to pressure and they would have ended up either completely or partially outside of the muscle. Once outside the muscle then they can flip and sag. It would be easy to confirm this diagnosis with a CT scan if there is any doubt about the current implant location. However, a physical exam would likely provide verification of my explanation.
To solve this problem implants would need to be repositioned into the intramuscular space. It would be prudent to downsize the implants to the 350 to 400 mL range to successfully do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I underwent aggressive liposuction on my legs, which resulted in skin laxity and uneven skin surface, with dimples, protrusions, and irregularities. I am looking for an experienced surgeon in calf augmentation who can properly assess my case and give me the best recommendation.
A:Thank you for your inquiry and sending your pictures. I believe your fundamental question is whether calf implants will improve your skin laxity and uneven surface contour. The answer is that it will not. Calf implants are placed on top of the muscle under the fascia which also only goes about halfway down between the knee and the ankle. While it will make the appearance of the calfs bigger I would not count on it improving the problems that you have which are at the subcutaneous tissue level… a tissue level that is above that of the muscle. Calf implants will probably make a little bit of improvement in these issues but my point is that if you’re expecting a major or a complete eradication of all of the contour problems that have been created by the liposuction then you will be disappointed. One undergoes implants for the primary goal of bigger calfs. If any improvement in the skin contour is obtained that would be considered a bonus but not an expected outcome.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Why is barred chest surgery in such a gray zone? It seems like surgeons are completely belittling it and not even trying to do anything about it.
A:Barrel chest surgery is not in the gray zone. It literally is in a no zone as it has never been performed before and understandably it has increased risk and unknowing benefits of performing the procedure. Only now is lower rib surgery becoming more mainstream but anything above rib 10 is completely unknown to any surgeons except the very few who have ever done it…. which to my knowledge is only me. The question is not whether it can be done whether would it be worth the surgical effort and potential risk to do so for primarily an aesthetic concern. Another words how much benefit can actually be obtained given the effort involved. Until one day the procedure is actually done on a patient those answers will remain unknown. But you can’t fault surgeons for not willing to take on those risks when the benefit is not known.
I think the fundamental problem with barrel chest surgery is to obtain a good improvement you have to treat all of the ribs probably from #4 down to #9 on both sides. That would be quite a surgical undertaking as well as the risks of pneumothorax x 10. That might be I’m to consider if we knew the good benefits could be obtained. But given that we don’t you can see the great hesitancy to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello i had a forehead augmentation done with dr eppley and planning to get a temporal lift i just want to ask if this is risky as i have an implant on my forehead.
A:One can safely have a temporal lift with an underlying forehead implant. The implant in these situations can actually be beneficial as it allows for convenient suture anchorage that is easier to place that doing it through the bone or temporal fascia.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, A few questions: 1. In your experience, is it very possible, by means of the various procedures you offer, to go from a non-model to a model-look, as defined by the actual beauty-standards of today? If so, what procedures are often required for this? 2. To achieve the Hunter eye look, one of the essentials is upper eyelid hooding. In your experience, is an infraBROW-implant better than fat grafting in the area? Can both be combined? Is one usually enough? 3. Can the fat harvested through say perioral liposuction be used as an injection in the upper eyelid or nasolabial folds in the same surgery? Thank you.
A:In answer to your questions:
1) What you are referring to when asking about going for a non-model to a model look is whether you can take an average looking male and make them look like a male model. In general, except for the rarest of circumstances, this is not an achievable outcome.
2) to achieve upper eyelid putting the most effective approach for most patients is going to be fat grafting. Whether it is best to do a combined brow bone in implant with the fat grafting must be determined on an individual patient basis.
3) the amount of fat that is obtained from perioral light perception is never going to be enough to do an adequate amount of upper eyelid fat grafting. To do upper eyelid fat grafting, particularly worth combined with nasolabial fold grafting requires a separate harvest site as at least 15 to 20 mL of fat need to be harvested.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had double jaw surgery on June 3 and am unhappy with the results. I feel like my maxilla was not moved forward nearly enough, and my bottom jaw keeps trying to move further forward but the maxilla is in the way. The surgeon brought the maxilla down when I think it should have been brought up and forward. I am interested in fixing the issue but really don’t want to do another full hospital stay- are you able to do an in-office le fort I with local anesthesia? I know this is possible in other countries. Otherwise, what options do you think I have? I am concerned with both function and aesthetics, and I feel that both are lacking.
A:I would never do or even attempt jaw osteotomies under local anesthesia. Now that the bone cuts have been made and plates applied you could do the procedure under general anesthesia as an overnite patient in a surgery center.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I came across your contact information online. After reading your reviews, I decided to reach out to you regarding the possible removal of an occipital fold procedure.
A:Thank you for sending all of your well illustrated pictures. As occipital scalp rolls go yours is a fairly minor one in terms of the magnitude of its size. It does not have an associated overhang which is what occurs in larger occipital scalp rolls.. This raises the question of whether the scar trade-off would be favorable, meaning is a fine line scar across the lower back of your head better than the appearance that the fold has now. Of this I am uncertain even though this is an individual patient judgment. But it is important to remember that once the scar is createdm there is no magical eraser to remove it later if one does not feel it was a worthy trade-off.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanted to know if the doctor preforms a surgery to fix a deformity of the ribcage like barrel shaped ribcage thanks I’m willing to go for a very aggressive risky approach as long as it provides a real change im tired of living with this deformity its impacting my quality of life in every single way my hurts from hunching it all the time trying to hide my protruding barrel chest it’s just unacceptable and very unappealing.
A:In the barrel chest deformity it would be necessary to do rib reduction osteotomies at multiple levels probably from rib # 5 down through #9. The question is not whether this can be done but how effective would be in doing so. To my knowledge no one has ever performed such a procedure before so knowing how effective it would be remains speculative. The unknown variable in removing lateral rib segment at this level of the rib cage is how much flexibility of the ribs exist, in other words can you close down the resected rib ends and put them back together and , if so, how large of a rib segment can be safely removed. I know from doing rib reduction osteotomies at rib #9 that at least one cm of rib bone can be removed and the two ends plated it back together. But does the same rib flexibility exist as you go higher up on the ribcage? For now we can only speculate that it does but until the surgery is attempted no one can answer that question with certainty.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I am considering facial contouring procedures and wanted to ask specifically about reducing the width of my face. Would it be possible for you to let me know if decreasing my face width is feasible in my case, and if so, by approximately how many millimeters it can realistically be reduced? I am planning to do around 5mm on each side, and I would like both bitemporal and bizygomatic length be reduced. Also, I would like to ask if buccal fat removal, alarplasty, epicanthoplasty+lateral canthoplasty, and lip lift/philtrum reduction can be done altogether in one surgery
A: Thank you for your inquiry and sending your pictures to which I can make the following comments:
1) in terms of bony facial width reduction, otherwise known as cheekbone reduction osteotomies, you certainly can get 5 mm per side of bizygomatic width reduction. When it comes to bitemporal width reduction that answer depends on whether you are referring to anterior or posterior temporal reductions. Most likely based on your desire for a facial with reduction you are referring to the anterior muscle compartment. Of that you cannot really reduce that area particularly above the zygomatic arch. There is no good method of anterior temporal muscle reduction particularly closer down to the level of the bony zygomatic arch we’re the greatest thickness of the muscle exists.
2) it is common for buccal lipectomies, nostril narrowing, lateral canthoplasties/epicanthoplasties and subnasal lip lifts to be performed in a single surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to reduce he “vertical height” of the anterior nasal spine, which is what I was asking if could be reduced/shaved from the bottom. This would help reduce the total nose height of the face.However, this might reduce the bone support for the Nasal Columella. To which I proposed if, a bone graft or cartilage could be used on the top of the anterior nasal spine, hence increasing its vertical length again but this time on the top. And then a rhinoplasty is performed. In this way, theoretically, the nasal height was changed but the bone support and the nose shape etc are still ideal. This surgery also in turn could help us in improving other craniofacial measurements like the length of midface (this theoretical reduction of nose height will increase philtrum height which we can again decrease with a lip lift thus reducing the midface length).
I just wanted you to ask you if this is possibly even THEORETICALLY, I’m aware that no surgeons have ever done it officially.
A:Thank you for your clarification on your surgical objectives. I don’t think the question is whether such an operation can be technically done as it is fairly straightforward as you have illustrated despite the fact that it probably has never been done in exactly the way you have described. My concern would not be whether it can technically be performed but whether in so doing the aesthetic outcome is exactly what you think it may be. The problem is you’re making a lot of assumptions about the aesthetic outcome based on drawing on a skeletal model. That is often a flawed concept as what happens at the bone level does not always translate to the outward aesthetic effect. One major consideration is that if the objective is to reduce mid facial length that is simply never going to happen no matter what you do at the bone level. Everyone fails to factor in to what happens to all the overlying soft tissue no matter what you do to the bone… It does not go away and thus external mid facial length is never really changed. The only effective mid facial length reducing procedures are sub nasal lip lift and reductive rhinoplasties that are associated with increased tip rotation. Nothing you can do at the bone level is ever going to decrease external midfacial length.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a genioplasty last year and then a revision earlier this year. I developed a deep mentolabial surcus that I never had before in my life. I’m so unhappy with the look of this sulcus or crease and I think it looks so masculine. I just hate how my chin looks in general. I think my chin looks unrefined and like a block. I think I was expecting it to look like an implant with a more elegant curvature and definition. Is there anything that can be done about A) the sulcus. Would it be possible to soften it? I also have developed chin ptosis and it looks just awful when I smile or talk. How is that treated permanently? Can a lower facelift get rid of all of that sagginess? Is it possible to surgically remove the extra soft tissue that has formed. I really appreciate your advice
A:Based on your postoperative pictures, and I have no idea what you look like before the surgery, this looks like a perfectly normal postoperative result from a sliding genioplasty. I don’t find the labiomental sulcus to be particularly deep and I don’t see any way to take that sulcus and make it less deep. As a general rule and a sliding genioplasty the shape of the chin from the front view usually gets a little bit more narrow but not wider. I suspect what you do not like about this result is that you probably were seeking a more V-shaped chin which could only really have ever been achieved by a V shaped chin implant that does not have any wings. While I obviously have no knowledge about your preoperative discussion with your surgeon but based upon this outcome and your issues with it this was simply not the best chin procedure for you given what your chin shape goals were. A sliding genioplasty is usually not a good choice when one wants a very controlled shape to the chin.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanted to inform myself about what you can do aesthetically to a skull. I am a 28-year-old man. I was born with a broad skull, or in medical terms, brachycephaly. My question is: what can I do about this later in life? I would like to have surgery. The reason is that this condition weighs heavily on my mental well-being. I don’t go out much anymore because I’m so insecure about it. I used to be able to partially hide this with long hair, but I started losing my hair a year ago, and it’s no longer hideble. My head is spread out to the sides and my head is flattened at the back Attached is a photo of what my skull looks like. I hope to hear from you. Thank you in advance!
A:Thank you for your inquiry and sending your pictures. You have a classic case of aesthetic brachycephaly with a flattened back of the head with a widened parietal – temporal sides of the head. The most practical procedures for improvement would be a custom scholar implant for the back of the head and reduction of the sides through a temporal reduction procedure. Ideally you would like to reduce the temporal– parietal bony eminences as well but I don’t think that aesthetically justifies a vertical incision over that area. The temporal reduction procedure is essentially scarless within an incision on the back of the ear in the crease.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, So my actual face is like the attached pictures.But I desire a look similar to this picture
My bite is perfect I just need the change for aesthetic purposes.. Do you think Bimax is the best solution or implants?
A:Based on your face now and your desired goals double tall surgery with absolutely not be the correct procedure. Your most major skeletal deficiency is in a very short chin with indistinct Jaw angles. That is best addressed by a sliding genioplasty combined with a wraparound custom jawline implant. Your chin deficiency is significant and is probably in the 12 to 14 mm range she’s beyond what an implant alone should do. The jawline behind it however can only be augmented with implants. Therefore you combine the two concepts into a sliding geniopolasty with the custom jawline implant that blends into it and creates a total overall jaw augmentation effect.
Your mid face only lacks some cheekbone prominence well the rest of it has adequate horizontal projection. Therefore this can only be addressed by an implant approach.
As you have already stated your bike is perfect and your concerns and not functional.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
