Your Questions

Q: Dr. Eppley, I had custom CT-designed midface implants placed originally 4 years, and then a new set of midface implants was designed and placed in 2 years ago. which were larger than the original implants (the current implants both provide ~7 mm in projection, while the original implants each provided ~5 mm and ~3.5 mm of projection). I like the general design of the current implants but feel they may be a bit too large. I noticed that Dr. Eppley has an article discussing the process of shaving down custom midface implants to reduce projection.  Thanks

A:You have left out two important pieces of information. First what is the design of these midface implants as I would need to see their design file. Secondly what is the implant material?

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some facial images. My main goal is to address my lip incompetence which causes a strain on my chin. I hope to correct my mouth breathing and grogginess/ sore throat in the mornings after sleeping. I’ve spoken to a few orthodontists about this concern, and they have told me I should consult with a plastic surgeon to review what options I have since it is outside of their scope. I would just like to know what options, if any, there are to address my lip incompetence!

A:You have lower lip incompetence and nocturnal mouth breathing issues because your lower jaw is underdeveloped. Your chin recession is merely a symptom of your lower jaw under development. The optimal approach is a combination of orthodontics and lower jaw advancement surgery. This will rectify all of your associated symptoms to the best that can be achieved.. Short of this ideal solution your only other option is a sliding genioplasty chin bone advancement which will help some of these concerns but will not completely solve them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What do non-custom skull implants start at? I read one of his posts where this was a less expensive option.

A:You are referring to special design (SD) skull implants which are custom implant designs from other patients with similar skull shape conserns where we already have a design file made and just have to print out the actual implant for surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I feel like the inner corner of my eyes is too long, it makes my eyes look very close set. The after picture is how I want my eyes to look. Is something like that even possible? Is it possible to shorten the corner? What procedures would you recommend for a more pleasant looking eyeshape? Would this require the position of the inner core of the eye to be altered? Is that predictable/safe/possible?

A:You are referring to a V-Y inner eye corner shortening which involves closing down the corner by partial excision of the lacrimal lake area. How this may apply to you requires some eye pictures for my assessment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve had 2 bbls over the span of 4 years but don’t have enough volume in hips and butt. Looking to get hip implants and butt implants.

A:Thank you for sending all of your well illustrated body pictures. After having been through two BBL surgeries you have reached the end of what fat transfer can achieve for you. Thus your interest in implants for further buttock and hip augmentation is understandable and your only option at this point. While there is always a question of the patient’s goals any time implants are being considered, as you don’t want to go through implant surgery and be disappointed, but given that this is your last recourse for such body augmentations whatever size implants can be safely placed becomes what is achievable.

The relevant question then becomes should buttock and hip implants be done together in a single surgery. Normally I would say no if the patient has had no prior surgery as this can involve considerable recovery  and is always more then they initially think. But in the person who is had two BBL surgeries, which I consider relatively equal to such implant surgeries, this then at least becomes an option to consider. I, however, would still be cautious about combining these two body implant surgeries for a variety of reasons beyond just that of recovery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to get my testicles removed and get implants just for bigger size.

A:My first question would be is it really necessary to remove the existing testicles. One can get much bigger implants than the natural testicles and not necessarily remove the existing testicles. This is known as a side-by-side technique. It’s success depends on the size of the natural testicles versus that of the implants. As long as there is at least a 70% increase in implant size over the natural testicles it can work fairly well.

In rare cases I have removed testicles and replaced them with implants but there are numerous considerations with that approach including the role of the testicles in supporting testosterone production as well as reproduction. Obviously, the issue of reproduction is not a concern or you would not be asking about testicle removal.

My initial question then is what is the size of your natural testicles in centimeters along their longitudinal axis?

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Please allow me to provide the context and reasoning for my case. I have a slightly recessed midface but a prognathic upper and lower jaw (SNA angle of 102 degrees), and because of this my upper midface looks significantly recessed compared to my lower third. I would like a cosmetic correction to this issue, but there’s a problem – I don’t believe I can get custom midface implants on their own because my nasion is also recessed and my nasal projection is therefore not sufficient to accommodate midface implants – I would have a sunken/flattened appearance of the nose. In my opinion, trading one disharmony for another is bad practice. Given this state of affairs, am I correct in believing that a Lefort 2 coupled with custom midface implants would be (at least theoretically) the only way to resolve my aesthetic issues without creating new ones? While I understand that this surgery is invasive and not typically offered for cosmetic reasons only, I believe my anatomical situation is somewhat unique and warrants the consideration of this type of operation. What’s your take?

A: A LeFort II osteotomy would seem like a very invasive approach to correcting a recessed nasion, which is the primary reason you are considering it, when a nasal implant or cartilage graft would achieve the same effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 63 yr.old white female with an extremely flat head. I have done some research and discovered that this condition is referred to as plagiocephaly. I was diagnosed with hydrocephalus back in the summer of 2014 and had a VP shunt inserted into my brain. My flat head never really bothered me ,other than hindering my abilty to wear a hat or helmet. Recently though, I have noticed I am experiencing a good deal of back and neck pain due to the position of my head.When I lie down, I am lying directly on my neck. The result is neck pain and very bad headaches!

A: While the shape of the skull affected by plagiocephaly can be improved by a custom skull implant this is an aesthetic procedure that I would not anticipate would provide any functional or pain relief improvements.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering about the actual material Dr. Eppley uses for skull augmentation, I thought it said on the website that he was injecting a type of bone cement  – PMMA – can he do something like this or is he only doing the harder or pre-formed implants now then? 

A: The use of bone cement has been abandoned due to subpar results and the high rate of irregularities/irregularities. Custom skull implants offer far superior results with a low risk of contour issues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’m interested in a procedure involving my orbital bone structure. Do you assist with this? My main goal is to address the asymmetry.One eye sits lower than the other. I believe one side of my face is shorter than the other.

A: You are referring to Vertical Orbital Dystopia (VOD) in which one eye is usually lower than the other one and, more times than not, it is associated with an overall vertical facial shortening. There are a variety of VOD techniques to decrease the eye asymmetry by moving the lower eye upward as well as adjusting the soft tissues around the uplifted eye (brows and eyelids) to accommodate the new eye position. (you can’t just move the eye alone as that will create a new aesthetic problem.)

The question is not whether VOD surgery can be done but how much improvement can be obtained and is it worth it. To make a more complete assessment I need a true assessment of what needs to be done a 3D CT scan to assess the underlying orbital bone shape is needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does your practice offer ultrasound imaging as part of the evaluation for facial procedures? I’m interested in assessing both the cheek and neck areas to better determine if options like a deep neck lift, submental lipo, cheek lipo or revision buccal fat removal would be most appropriate. 

I’m 24 and I had submental liposuction, buccal fat removal, and cheek liposuction 4 years ago but most of the fat has returned to those areas. Different surgeons have been giving conflicting advice for procedures. 

Specifically, I’m hoping to evaluate:

• Facial fat distribution and muscle tone (e.g., buccinator muscle, SMAS, fribrotic tissue ) 

• Neck structures (e.g., submental fat vs. deeper compartments, platysma)

Looking forward to your response.

A: Ultrasound imaging is a diagnostic test that I have rarely used for any facial procedure. If you really want to know the details of what lies in the various facial soft tissue compartments an MRI would be more useful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in buttocks implants, hip implants and rib removal. I have had BBL procedures in 2015, 2016, 2017. Am I a good candidate?

A: After 3 BBL surgeries implants would be her only option for further buttock enlargement, regardless of the implant size.

Rib removal is always synergestic with buttock/hip augmentation. (makes them look bigger)

Given that no further fat can be harvested for the hip augmentation and fat works poorly in the hips anyway, hip implants would be the only treatment option.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I feel that the back part of my head is very flat, and that’s why I wear long hair. I don’t know if it will be noticeable in the photos I’m sending you. I also have some receding hairlines or a slightly large forehead. I wanted to know if I could later undergo a hair transplant or a forehead reduction, or if I could do both surgeries together in one operation. I hope you can help me

A: Because skull augmentation (custom back of the head) ‘steals’ scalp to accommodate for the implant a forehead reduction by frontal hairline advancement can not be done at the same ome or any time thereafter. The skull implant however does not preclude from doing a hair transplant later.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does Dr. Eppley perform brow bone reduction/type 3 surgery using the coronal incision and or hairline incision approach(s)?  I’m asking in that if he offers the coronal approach would it be possible to get a price range for this surgery?  The reasons being that I have a very tight scalp & I do not believe I need my hairline to be lowered.  I’m within the female range at the center of my hairline.  Filling in the receded portions would be adequate to give me a more feminine side view as it relates to my hairline.  If he were to offer the coronal approach it would also give him access to my entire forehead where he could make further adjustments to the forehead as needed.  This would be an added bonus to having my brow bones alone reduced. 

A: I have performed brow bone reduction by bone flap setback by various approaches including a bicoronal and frontal hairline incisions. Such incisions don’t mean that the frontal hairline needs to be advanced, some patients do and some don’t. That is a patient’s choice or need.

You have correctly surmised that the wide open access afforded by the bicoronal incision allows for complete forehead reshaping which usually means narrowing the forehead along the entire bony temporal line as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q:Dr. Eppley, , I have a brow bone deformity similar in nature to this case you did https://exploreplasticsurgery.com/case-study-one-sided-brow-bone-reduction/, and extends somewhat into the orbit. In my case, I have also a moderate case of anterior plagiocephaly with less prominence on the left side, same as where my brow bone protrudes. I have read about that case and generally am aware of the coronal approach to reduce the prominence through osteotomies. The scale of the incision has always scared me. I am wondering if instead of minimizing, the opposite may be possible. Is it possible to place a forehead implant to correct the plagiocephaly (and would it extend over the temporal area) and also place a secondary custom implant over the smaller side of the brow bone to match? Can it be achieved with small hidden incisions? And if so, do you think it is a good idea?

A: What you are referring to is a compensatory approach rather than treating the direct problem which makes sense depending on the magnitude of the brow bone-forehead asymmetry. The best way to answer that question is to take some face pictures and do some imaging to what this contemporary approach may look like.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, If a jaw implant waS designed to correct the asymmetry (vertical high discrepancy as seen in my scan) would that be where the issue would be with masseters and other soft tissue not wrapping around it (which can cause the irregularity in draping)?  Essentially, would that just be adding fake skeletal structure, but masseters would stay where they were before the implant?

A: In any form of jaw implant that involves the ramus (angle) the masseter muscle is elevated off the bone to accommodate the implant. Thus the premise of your concern has no anatomically accurate. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in:https://exploreplasticsurgery.com/plastic-surgery-case-study-male-mid-abdominal-tuck-for-horizontal-flexed-skin-wrinkles.  I got botched from lipo and I don’t have much other choice , a normal tummy tuck wouldn’t fix it, this one would resolve almost all the issues.

A:Thank you for your inquiry and sending your pictures. You are correct in that the only way to improve or eliminate most of those horizontal skin wrinkles of your abdomen is a mid tummy tuck procedure. Besides the obvious concerns one might have about this unusual location for a horizontal scar across the mid abdominal level at the umbilicus there is also some recovery issues. In my experience the abdomen will remain quite tight for some time which will be seen mostly when standing straight. It may take months until one can comfortably stand perfectly straight which will also have some impact on working out.

Thus, while a mid tummy tuck can be effective for this flexed abdominal skin issue between the scar and the recovery one has to ponder the consideration of this procedure very carefully.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, May i enquire about nasolabial implants. Are they toxic? I was reading they are same as Teflon.

A: No facial implant material used is toxic. One of the material options for such midface implants is ePTFE which is very different structurally from Teflon which is PTFE.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I am interested in potentially having a consultation with Dr. Eppley about Iliac crest reduction surgery and/or shoulder winding surgery. I am a FTM trans man and my main concern is the width of my pelvis which I would like to reduce if viable. However to balance I wouldn’t be against widening my shoulders at the same time but it is not necessary. My priority remains the reduction of my iliac crest to help create a more masculine physique.

A: Thank you for sending your pictures. By your own description your priority is iliac crest reduction which could largely be done through your existing ends of the tummy tuck scars…. Which I assume his what that scar is from. While they would have to be extended a little bit it would not add a lot of extra scar burden. Given that your priority is the iliac crest reduction that should be the procedure you do. While shoulder widening is an option it’s recovery is substantially greater than that of iliac crest reduction. Thus it takes a patient whose major priority is shoulder widening to undergo it.

While not a recognized female to male body contouring surgery iliac crest reduction for the wider and more low angled female pelvis is a logical structural body procedure given your objectives. But I would need to see some hip pictures to determine your candidacy for the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to mention that I had a hip implants before on 2022, but one of them was rejected and the doctor decided to took them off. I would like to try one more time. It is one of que questions I have for Doctor Eppley. Is it possible that my body accept the implant this time?

A:You are referring to infection and not rejection of your prior hip implants. The body does not really reject silicon materials but they can get infected which is one of the well-known implant risks. Because the two look the same they’re often confused.

That being said you do have the liability of existing scars and just because you had an infection in the past does not necessarily mean you will have one with new hip implants.

That’s I think it is reasonable, as you have stated, to give hip implants one more effort to see if you can avoid any postoperative complications this time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, A sliding genioplasty, I hope my chin will continue to project downwards in harmony with my jawline angle instead of stopping short and rounding horizontally.

A:What did you are referring to is a sliding genioplasty that adds vertical length as well as horizontal projection. In essence this is really a 45° bone movement where the amount of vertical lengthening is almost equal to that of the increase in horizontal chin projection. This is one of the advantages of a sliding genioplasty over that of a chin implant unless that chin implant was custom designed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am presently writing and searching for practical information about Ultrasoft solid silicone testicle implants. Are they currently commercialized in Europe ? Can they be delivered from the US ? Would Dr Barry Eppley be open to share which brand or which laboratory manufactures them ?I currently have  implantation of 2 Euro silicone, saline-filled testicular implants (18cc) – 4 interventions betwwen 2011 and 2016. Currently looking forward to replacement of both testicle implants (which after 14 years are becoming very uncomfortable) . Very interested by those mentioned by Dr Eppley’s articles but impossible to find on the internet after extensive research online. The medical team here in France doesn’t seem to know about those new and more recent implants and i would very much like to be able to present them relevant information about it.

A:Most surgeons would not be aware of the newest  forms of solid silicone testicle implants which provide a soft feel, unlimited size ranges, and in the larger implants the innovation of a hollow inner chamber. Such testicle implants are not available in any manufacturer’s catalog. Such custom implants are ones I have developed and used extensively which are made by a top US manufacturer and, any size over 5.0 cms, are made exclusively for my practice.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I am initially thinking of replacement chin implant but now preferring sliding genioplasty instead. Attached are my pictures. I already have a small sized standard extended anatomical chin implant from i planttech. I like the jaw contouring on profile given by the wings of the implant but dont find the horizontal and especially vertical projection enough. 

I havs also attached the initial assessment given by the surgeon on the vertical and horizontal deficiencies. I also have my before chin augmentation pics if required.

A:While a sliding genioplasty can be very effective at adding both horizontal and vertical lengthening it will by the forward bony movement make the chin more narrow.  That is the one dimensional limitation of the sliding genioplasty.  I mention it because you commented in favorably on the wings of the existing implant that you have. That chin feature is what it essentially separates the sliding genioplasty from a custom chin implant design when there is any amount of vertical chin lengthening needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi there, I previously messaged asking about the filling treatment for flattened back of head issue. The reply was that fillers don’t work but I was referring to the method you are using with the PMMA/bone cement. Can you let me know the approximate cost of this? There are only a couple of places that do this and I live much closer to you so that would be best for me. 

A:Due to the inadequate results from the use of PMMA bone cements in skull augmentation they were abandoned almost 10 years ago and replaced with custom implant designs that offer far superior results.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a very flattened back of head about half way down the back. Is it possible to use just the filler type of material rather than implant?

A:No form of synthetic fillers or fat injections in the tight scalp work for skull augmentation. Unlike other face and body areas where the tissues are more supple the tight attachment of the scalp to The underlying skull precludes any effective displacement by the soft nature of any injectable material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, am an aspiring footballer and I would love to continue my football journey. But my insecurities is playing on me. Can I get frontal bossing surgery done and still play football?

A:I would wait to do the surgery until after football life is over.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Had orthognathic jaw surgery done for sleep apnea and recessed jaw. Unfortunately, my right side (weaker side) did not turn out as well as I would have liked. The jawline has an indentation in it, and the genioplasty I feel created an odd chin shape and chin fold from being advanced too far. Surgery involved a Lefort 1, BSSO with 9.7 degrees counterclockwise rotation and 18mm pogonion advancment (6mm) was from the genioplasty. Custom plates were used which probably adds 1.5-2mm to the pogonion as well. Should the genioplasty be set back 2-3mm to fix this and will that cause loose skin under the chin? And can fat grafting be done to improve the jawline and indentation?

A: In  answer to your jawline questions:

1) Setting back the genioplasty 2mms in a young patient will seem unlikely to cause  tissue sagging.

2) Correcting bony asymmetries/irregularities with fat injections is rarely an effective strategy.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 25 year old trans male, who is interested in a iliac crest reduction—even more reduced than pictured. I unfortunately had estrogen dominance for nearly 19 years, and then I was forced on Invega, which seemed to of made my hip bones widen a lot more significantly. I would love to have my masculine physique back, especially since my parents think I never will have a masculine body because of them. A permanent reduction would be amazing!

A: Thank you for sending your pictures. At your body weight and tissue thicknesses any effect of iliac crest reduction will not effective/seen. Iliac crest reduction works best in thin patients where the prominence of the bony crest can clearly be seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a hairline lowering procedure and brow lift and hair transplant to attempt to cover my forehead, and it actually emphasizes my protruding and broad forehead, making it appear more obvious. No one told me my issue was actually my skull bone. Can you narrow my forehead and slope it back? I find that it still looks masculine and I thought the problem was skin and hair, I did not realize skull shape is what makes someone appear feminine.

A:While frontal hairline lowering is a soft tissue procedure it does have a forehead reshaping effect. By definition and making the four head vertically shorter it will make it look wider. This is why preoperative imaging of the effects of hairline lowering are important to undergo understand this effect. The question now is not whether your bony forehead can be reduced, as you have convenient access to do it from the frontal hairline scar, but whether the bony changes would be significant enough to make the surgical effort worthwhile. Thus I would need a front and side view picture of your fore head to make that assessment with some imaging too sure what I think could be realistic and achievable changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i would want to know a bit more about mouth widening surgery, i have a pretty narrow mouth (4cm) and want to change it to about 5-5.2 cm , can you please tell me about the scarring, how bad it is and does it really never go away, and are the results permanent, i’m 18 , i wonder if my age will help healing. Please help me , cause im really scared to end up with permanent big scars , my lips are also a bit down turned.

A:To have an acceptable scarring in mouth widening surgery it is best to keep the amount of widening per side in the 5 to 7 mm range. That would be consistent with your stated goal of changing your mouth with distance from four to 5 cm. In general adverse scarring from mouth widening surgery is not common but always possible in the very sensitive junction of the vermilion and skin at the mobile mouth corners. Mouth widening scars seem to do better in n ales due to their beard skin than females in my experience. Thus it is best to go into surgery with the understanding that scar revisions may be likely and hope that they are not needed. This is consistent with a general overall approach in aesthetic surgery as to ‘prepare for the worst and hope for the best’ .

Dr. Barry Eppley

World-Renowned Plastic Surgeon