Your Questions
Your Questions
Q: Dr. Eppley, Hello. I had a PEEK implant operation on the right side of my jaw on November 2024. This was for the correction of a slight asymmetrical jawline. I feel like everything is healed, but it seems like the masseter muscle is too high up, not where it is supposed to be. My doctor said that the muscle will get stronger over time and move down to its natural position. Is this true, or is there a possibility that the masseter muscle was displaced during the PEEK implant operation?
A: By description you likely have masseter muscle dehiscence, where the insertion of the masseter muscle ligaments have become detached from the bone as a result of the pocket dissection for the implant placement. As a result the muscle retracts upwards from loss of its ligamentous attachments. The muscle is ‘not going to get stronger and move back down’….that makes little biologic sense and is not an anatomic reality.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Now taking another look at the morph of nostril narrowing and mouth widening, im thinking the change is quite conservative. Would it be possible to exceed those in both of the procedures?
A: The purpose of predictive imaging is to show patients realistic results and only show what I believe can be expected from the surgery. While more significant changes can be surgically done the risk of adverse/hypertrophic scarring escalates considerably.
There is a good guideline to remember about certain aesthetic procedures….it is better to have 2/3s of what you want with no complications than 100% of what you want with them. In this surgery scarring is the problem around the nostrils and the mouth corners in particular they can be very difficult to improve.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q; Dr. Eppley, I was looking around online for what the forehead bumps on my temples were and I found your websites which seem to exactly describe the shape as “Forehead Horns” and that you offer a Forehead Horn Reduction procedure. My forehead horns look extremely similar to the first picture you give on your website: https://skullreshaping.com/wp-content/uploads/2023/01/ba-Male-Forehead-Horn-reduction-dr-eppley.webp Reaching out to get an idea of how much this procedure would cost, potential scarring, and the recovery timeline. Hopeful for a response, Thanks and regard
A: Forehead horn reductions are typically done by bone burring if they are not too prominent and the bone is thick enough h to do so. Because of the need for linear access the small incisions needed to do each side can not be too far behind the frontal hairline.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, If an implant is done in the head are there any side effects?
A: When you say side effects that could mean risks associated with the surgery (e.g., infection)n or any adverse immunologic reactions from the implant long term. In the case of the latter that answer is no.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will webbed neck surgery fix my turkey neck?
A: In the webbed neck it is common to have a concomitant turkey neck on the front side…often associated with a short/weak chin. This can be improved with a chin augmentation and submental/neck liposuction. The webbed neck surgery will not by itself improve the chin/neck issues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I was wondering if you could remove 8 cm off my shoulders? Thank you.
A: 8cm of bone removal can not be done for the clavicles. The most that could be done is 5 to 5.5cms.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. Is it possible to get nose tip rhinoplasty in boy at the age of 16 for purely cosmetic enhancement (nose tip is slightly bulbulous, not severe or anything close case). If so, is parents agreement needed? If this cosmetic procedure is not possible at this age, then can I plan the surgery for future and get it done as soon as I turn 18?
A: Having a rhinoplasty under age 18 requires parental consent.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, im currently questioning about the possibility to remove some “extra” bone in the sides of my skull, easy example of a person who has the same thing as me would be Tyler Steinkamp. Is this even possible? Looking to hear back from you!
A:When it comes to reducing the width at the side of the head it is about muscle removal and not bone. This is a procedure known as temporal reduction. The temporal bone is very thin well the temporal muscle is usually thicker than the bone. Thus successful reduction of the side of the head comes from removal of the posterior portion of the temporal muscle. How that applies to you I cannot say until I see a front view picture of your head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I’m interested in chin implant. his is the picture of a longer chin that I like.
A: For vertical chin lengthening the options include a custom implant or a vertical lengthening bony genioplasty. However the aesthetic outcomes of these two choices are quite different. If one needs 5 mm or less of vertical chin lengthening then an implant will be adequate. However when more than 5 mm is needed, and that is clearly what your ideal picture shows, one needs a vertical lengthening bony genioplasty. The change from your chin to that of your ideal picture is in the 8 to 10 mm range.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I met with another doctor in FL and he talked about side by side testicle implant procedure, but my testicles are 2x3cm currently and he recommended 4x5cm and I am concerned I don’t have enough skin to accommodate both without forcing my current testicles into my abdomen or possible ending up with a very uncomfortable situation.
You lay out the risks, but go into wrap arounds so I thought it might be a viable option for me as a 61 year old (not as active as a young man may be; more aesthetic for me)
Let me know your thoughts, just trying to be practical and not end up with an uncomfortable situation
A:Thank you for sending your pictures to which I can say the following:
1) For a side to side testicle implants approach to be effective they would need to be larger and the 4 x 5 cm implants recommended to you.
2) While I can appreciate your small and tight scrotal skin envelope the complications of pushing the testicles into the abdomen or causing chronic discomfort due to compression our testicle implant problems that I have never seen,
3) that being said I would agree that if you were to do anything the wraparound implant approach would be preferred over the side-by-side technique.
4) The wraparound testicle implant approach is a very clever concept for testicular enhancement and, although I am the one that has developed it, I remain very cautious about its use. It is associated with a not insignificant rate of postoperative separation of one or both of implants from the natural testicle. That problem seems to have been improved by making implants based on an ultrasound assessment of the exact natural testicle implant size so the inner chamber of the implant matches closely to that of the natural testicles size. Well this appears to have lowered the risk of that problem it does not make it zero. Thus any patient considering this approach must be accepting of this risk. In addition even though implant can be placed back over the testicles in a secondary surgery the rate of re-separation remains high and I do not view that as a viable solution. Therefore the operation either works or it doesn’t.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, when doing my research I’ve seen studies indicating facial bones stop developing as early as 16 but some doctors say in the mid 20s. My question is what age do regions like the mandible, brow ridge and zygomatic bone stop developing because unless there is major growth why do you have to wait before putting on an implant. My final question is ever since I started boxing at around 15 i noticed my brow ridge has become more prominent is this due to bone remodelling due to external forces. Many Thanks.
A: In answer to your facial bone development questions:
1) Waiting to put in implants until age 18 or older is more about psychological concerns and not about bone development. I think once you get past age 16 unless the bone deficiency is minor (1 or 2mms) I don’t have any concerns about implant on subsequent bone development.
2) It could that the frontal sinus is becoming more fully pneumatized (developed) rather than a reaction to the trauma of boxing.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m writing with regard to the sliding genioplasty revision that I was discussing with Dr. Eppley a few months ago. I would like to do this, but I have a question about removing the surgical steel wires that were used. I am experiencing nerve pain and numbness on my lower lip and chin, and I wonder if removing the wires could help with that. I wonder what the best timeline would be. Should I have the original surgeon remove the wires as soon as possible, and allow time to heal from that before doing the revision with Dr. Eppley? Or, would it be best to wait and continue healing and have the wires removed at the same time as the revision with Dr. Eppley? The surgery was done last June, and the step off is visible on my right side. My original surgeon wants to do a revision genioplasty, but I’m not sure he will be able to correct it, and I don’t think I can risk worsening the nerve pain. He is alternatively offering to do a fat transfer to the step off, and to only remove the wires. I have a pretty pronounced inferior border that sticks out, and I also wonder about burring that down a bit before the step off is filled in with the gortex strips. I wonder about additional cost for removing wires, as my original surgeon will charge only the surgical center fee. I apologize for the long email, and appreciate any feedback.
A:When it comes to the wires used for a sliding genioplasty they usually are placed nowhere close to the mental nerve. Persistent numbness and discomfort after sliding genioplasty like you have described is more likely a reflection the original bone cut and the surgery required to do it. Thus I would doubt that the wire removal is going to help much in that regard. However I have not seen a postoperative Panorex x-ray to confirm if that statement is accurate. Fat transfer in general is often not a great treatment for a bony deformity. However if your economic commitment is low to have the wires removed and the fat grafting done I do not think there’s any harm in doing so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can you please tell he what size implants I can go up to? I am currently 1050ccs and would like to go to 1500cc to 1800cc if possible.
A:Using overfilled saline implants the actual volume increase you can reach can be precisely known until you are actually doing it. You reach the maximum stretch/tightness of the breast tissues with the placement of the volume and then you have to stop. It is possibe to go from 1050 to 1500…most likely. Will you reach 1800ccs…I doubt it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi there I am interested in getting more information on your back lift surgery and, potentially, your waist line narrowing procedure and a rhinoplasty revision. I have horizontal stretch marks on my back that I would be looking to cover up with the vertical scar as I understand skin must be excised with the procedure. Is the vertical line typical in your back lift surgeries? Further, with the waist line narrowing procedure, I would like to discuss the risks associated with this procedure. Finally, my plan is to have a rhinoplasty revision which I understand sometimes involves using ribs depending on the procedure. I’d like to have the information to form a plan appropriately while weighing the risks associated with all procedures. I have already had a few cosmetic procedures. I look forward to speaking with you soon.
A:The vertical backlift is an excisional concept for lower torso/waist narrowing when excess back skin in particular exists. The indications for the procedure is if such excessive skin is from weight loss or liposuction….although some may just have it naturally. It differs from the more common horizontal or bra line lift which removes skin horizontally across the back which has a very different torso tightening effect. Through either type of backlift rib removal can be performed.
The key question in your case is what is your primary objective? While horizontal skin stretch marks may get removed in the process that would be an incidental effect and that alone would not serve as the reason to do the surgery given the scar tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am interested in the one port endoscopic removal of a forehead lipoma. May I know how long the cut will be to remove it?
A: It is 2.5cms long for endoscopic forehead lipoma removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I happened to be at the dentist today and captured a panorex image of my chin. The center and to the left of center is where I feel a firm lump. I wonder if the more hyper dense area could represent that. I know it’s not a diagnostic image, but the general margin seems interesting. It’s interesting that the bottom of my chin looks bumpy because it feels bumpy. I wonder if this is where the residual chin implant material is.
A:A panorex x ray is a bit of a distorted image (like a globe that has been spread out to be a map) but the gross irregularities that appear are real given the prior surgery as all implants cause benign bony changes. A 3D CT scan would be the most informative but since we are going open it up anyway that will be the definitive assessment of what is there. (removal any residual implant material and smooth out the bone)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a custom skull implant. I have a few quick questions about it:
1. Do you provide any kind of guarantee or certificate after the surgery, regarding the quality and long-term durability of the implant?
2. Is it possible to stay and recover at your clinic for about 4 to 6 days post-surgery before returning to home?
3. Would it be fine if I decide to come alone? I don’t really have anyone I can trust with me in such a delicate situation, so I’d be traveling and recovering by myself.
A: In answer to your skull implant questions:
1) This is a solid silicone material, not like a gel-filled breast implant, so there is no question about its long term structural sbtability.
2) Patients usually stay overnite in the surgery center the first night after the surgery. They then stay at a local hotel for however many days they need before they go home.
3) Patients most commonly come alone so that would be our normal experience.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, my goal is to drop down the brows to reduce upper eyelid exposure and make the brow shape more like a straight line rather than an arch at the corner, is that possible ? Also the incision could be made from the top of the skull at the hairline with small incision not the whole front line skull incision?
A: Brow bone implants can help lower the brows somewhat but not usually a major amount. The same applies to changing the natural shape of the eyebrows. You do brow bone implants for the primary reason of brow bone augmentation. Any other potential benefits (brow lowering and straightening) are a bonus if they occur.
Brow bones implants are placed using an endoscopic technique and the implant is introduced through a small incision behind the hairline. It is always necessary to secure the brow bone implant into place and this is most common done through small upper eyelld incisions to check the tails of the implant position as well as place a 1.5mm small screw on each side for fixation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, Doctor Eppley. How long after reversing my sliding genioplasty can I get a chin implant?
A: I would wait at least three or four months to let the chin bone heal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I just want my head shape to appear normal.
A: In looking at your head asymmetry it is a bilateral diametric problem, meaing the right side of your head is smaller while the left side is bigger. Thus to treat it successfully the conceptual approach is that the right side needs to be augmented while the left side needs to be reduced. (see attached picture with the purple be the augmentation while the red is the reduction) The specifics of those changes await to be determined by a 3D CT scan assessment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to ask a few questions about skull implants:
• What material would be used for the implant?
• How durable is it long-term?
• What is the price of the surgery?
• And how long would the recovery take? I need to plan my return home accordingly.
A: In answer to your skull augmentation questions:
1) Custom skull implants are made of solid silicone.
2) This is a material that is non-biodegradable and will last long past a patient’s lifetime.
3) Skull implant recovery is largely about swelling of the head and sometimes the face which takes 10 to 14 days to largely resolve. One does not wait until the swelling has resolved to go home. Most patients head home in 2 to 3 days after the surgery a female with hair can camouflage much of the swelling. There are also no sutures ro remove as they are all dissolvable.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello.I have read your case study about Tragus Cartilage Reshaping after Facelift (https://exploreplasticsurgery.com/case-study-tragus-cartilage-reshaping-after-facelift/) I had the same experience after my mini Facelift and now after 1 year my tragus is still deformed and it seems permanently changed. I was wondering if there is someone you can reccomend here in Europa that can form my tragus back to my original form surgicaly? I have uploaded before and after picture of my tragus.
A: While I am certain you could have it done in Europe I would not be able to tell you whom could do it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am investigating the possibility of having an occipital skull reduction. I’m aware that an MRI is required to investigate this possibility further, and private scan clinics in Canada still require a Dr.’s referral to complete this scan. I will also have to travel to a different province to have a scan completed. I am wondering if your clinic will be able to provide a referral in advance of me requesting a consultation, or if a consultation is required first.
A: We can only provide referral letters to established patients…and it is a CT scan not an MRI.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, the problem with my head shape is that it is small from all sides and is inclined inwards from all sides(front ,back and sides)
so the pics you have attached are an augmentation from all sides i guess .
but i would at least want an augmentation from forehead and two sides to have a wider head and flatter forehead.
I am attaching your first proposal you suggested me and needed to know the following
1. my question is if we have to go for three sides augmentation do we still require two stage surgery.. I mean do we need tissue expander surgery in that case..
2. are these augmentation for life time .
3′ please also guide the procedure on how we can move step by step to move further.
A: 1( As long as the implant volume does not exceed 150ccs, regardless of its surface area coverage, a first stage expansion will not be needed.
2) Such skull implants are solid silicone so they are structural stable for a lifetiime.
3) The key to the whole process is a getting a 3D CT scan which serves as the platform on which the implant is design.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously had chin reduction surgery, which left my chin too short and pointy, especially when I smile. To improve it temporarily, I had fat grafting and filler placed in my chin area about 2 years ago. While that helped a bit, my chin still looks short and feels unnatural, and I would like to restore its original shape through reverse genioplasty or a custom chin implant, depending on what you think is best.
A: To restore the shape of the chin after a reduction performed by a t-shaped bony genioplasty there are two options:
1) Recut the chin bone to shorten it and widen (it was narrowed by a central wedge if bone removal and extend down a bit longer) it which will need at least some cadaveric bone graft to do so.
or
2) custom chin implant
If you look at the dimensional changes needed (wider and shorter) it would seem that doing #1 is more appropriate since an implant can not make the chin shorter only wider.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, hello there. Please can you tell me how much experience the surgeon has in the following surgeries and approximate prices? Pelvic Plasty Clavicle Shortening Lower rib removal Thank you
A: I performed the 1st rib removal surgery in the US ten years ago and have done hundreds of cases since.
I am only one of three surgeons in the world that perform clavicle shortening osteotomies and have over 150 shoulder reduction surgeries.
I am the only surgeon in the US that is authorized to perform the Pelvic Plasty procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My 23 month son has untreated moderate plagiocephaly. I saw you had done an implant for a child in the photos. I am wondering the process, age and if the procedure needs to be redone as a young adult?
A: Skull implants for plagiocephaly are only done on patients 16 years and older.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi there! I was wondering how many vertical backlift surgeries you have done since this one posted on your website in 2022? Also wondering where you are based? I am interested. Thanks
A:Over the past 3 years I have done eleven of them, four with rib removals and seven without. The key qualifier is how much loose back or torso skin one has as demonstrated by the pinch test.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I got chin lipo done with you guys a few years ago. I would like to sharpen my jawline even more and am interested in submentoplasty surgery. How much is the submentoplasty surgery?
A:The intent of a submentoplasty is really to help the neck (cerviciomental) angle. I don’t see it as a method to make the jawline more pronounced. It is very difficult, if nit impossible, for most patients to reduce their way into a better jawline.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I wanted to enquire regarding some facial cosmetic surgeries. I was interested in buccal fat removal, cheek and chin liposuction, and possibly jaw + chin implants.
A:I can certainly see what you are trying to accomplish….take a rounder facial shape and change it into a more defined one. A good guideline to remember in facial reshaping is that one can not reduce their way into a better facial shape, augmentation is the primary method. Meaning the fat removal procedures you have mentioned, which are all needed, are ancillary to improving your facial shape. Facial augmentation, such as that of your jawline, is the primary driver of change.(see attached imaging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon