Your Questions
Your Questions
Q: Dr. Eppley, I’m interested in rhinoplasty to correct nasal asymmetry.
A:Thank you for sending all of your nasal pictures. I am going to assume that you have never had any prior nasal surgery and this is either the natural result of your facial development. While fundamentally what you see is nasal asymmetry there is also some development differences between the two sides. This is particularly seen in the nostrils where the right nostril is smaller and more highly position than that of the left. As a result in straightening the nose through basic cartilage and bony repositioning techniques the left nostril will also have to be reduced to better match that of the right side. This will be particularly needed given that there will be a right shift of most of the nose This will automatically make the right nostril smaller and the left nostril bigger, hence the needed left nostril narrowing needed with the overall procedure. The best nasal asymmetry results come from an open Septo rhinoplasty procedure. Whether you may also want narrowing of the nose particularly in the tip is a personal choice which you have not mentioned up to this point.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in custom temporal implants for head widening. My questions are:
1) Do you factor in the implant’s design the amount of postoperative swelling that will occur?
2) What is the usual thickness of head widening temporal implants?
3) Can you make an implant design and then show me what it will look like on myself?
4) Can I see before paying for the surgery what my implant design would look like?
5) Can you predict how much temporal fullness will be lost when the swelling subsides?
6) Can I connect the previously placed custom skull implant on the top of my head with these new custom head widening temporal implants?
7) how can I be assured that after the swelling subsides I will have the head widening amount that I want?
A:I can answer all of his questions in advance of our virtual consultation.
1) Since these are custom implants they can be designed with any thickness dimensions as long as they can fit or be surgically placed. For the purposes of factoring in the effects of postoperative swelling one simply has to guess how many more millimeters that would be an implant thickness. There is no exact science as to how to factor in for postoperative swelling. To me what that means is maybe an additional 2 mm of thickness.
2) Since these implants would be submuscular a safe temporal with is 5 to 7 mm maximum.
3) There are no tools to accurately show people what their postoperative results may be. All we can do is use preoperative Photoshop to determine the patient’s goals. Ai is not going to be helpful as is there is no database of information about the effects of implants on an external appearance.
4) The only method to show a 3D implant design/rendering is to actually engage the implant design process with 3D Systems. They are the company that does all of that implant designing but they don’t do so until they are paid.
5) There is no known method to tell you how much fullness will be lost after the swelling subsides.
6) You can always in the future add volume to the front or back of your head with additional implants, that is not an issue and can easily be done with additional implant designs. The problem is if you try to connect the front or back to the sides where the implant must sit above the muscle on top of the fascia where implant edging and chronic fluid collections are real postoperative possibilities.
7) There are no strategies for maintaining postoperative width fullness. You pick a number that you want the implant to be and you hope when it is all done and said that it largely achieved what your with desires are.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My hope with reaching out to you, would be that you can help me find my way back to my old self. I had a deep plane facelift that took all of my volume and left me looking much older even at a full year if healing. I am interested in a custom cheek implants. I do not want an apple cheek. I have also included attached images (which are most likely phoroshopped) of the desired aesthetic look I would like to achieve. If at all possible, I would like my old self back.I do not want filler, nor fat grafting. I had micro and nano fat with the deep plane, which now gives the appearance of jowling, as my cheeks have lost volume, so it looks like areas are sagging and hollowed out, this is in my orbital area as well. I will forward those pictures revealing the poor result. Please help!
A:Thank you for your inquiry and sending all of your pictures. This is an unfortunate outcome and I can certainly understand your concerns and objectives. The soft tissues of the cheeks have lost projection (technically not lost volume, just that the volume has now been displaced laterally, strerched ad compressed by the tighter overlying skin) You are correct in that any type of soft tissue augmentation is destined to fail because the pressure of the tighter tissues will be hard to give any adequate push outward with a soft material. Only an implant off of the bone Canal provide they needed secondary projection.
The concept of the cheek augmentation that you are now seeking is largely bone based. The traditional apple cheek augmentation effect is more soft tissue based where much of the augmentation is below the actual cheekbone. You are also correct in that only a custom cheek implant design can reliably affect this type cheek projection change.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What are your thoughts on the incision for the mouth widening surgery being done inside of the mouth. I know there is an option for lip corner lift and was wondering if the same could be done for this procedure.
A: To be effective mouth widening requires skin removal as it is a relocation of the vermilion – cutaneous border further out on the side of the face. Thus any attempt to do intraoral mouth widening is not going to work.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How soon post Radiesse filler can I get the jaw augmentation done? Is there a waiting period (I got it in April).
A:I am not concerned about existing filler as it does not interfere with the custom jawLINE implant design or surgical placement. Whatever filler is present will quickly be resorbed due to the swelling and inflammation from the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I don’t like the protruding forehead/frontal bossing and the prominent occipital protuberence… if they could be rounded a bit i hope it wud do a good job in both shape and reducing size. Thank you
A:Thank you for sending your pictures. The question is not whether the occipital prominence and the frontal bossing can be reduced… as they can. The most important issue is surgical access to do so. Typically the occipital prominence is approached placing asmall horizontal incision on the lower end of the occipital bone at the bottom of the prominence and this heals extremely well. The frontal bossing of the forehead is usually approached with a frontal hairline incision which also can heal very well. The other option is halfway between the two with a long scalp incision from the top of one ear to the other to approach both areas. Besides the undesirable length and location of this incision it also does not provide the best access to the occipital prominence.
Both procedures can be performed during this same surgery under general anesthesia. The exceptional prominence reduction is first done in the prone position and then you would be turned over while asleep to do the frontal Boston reduction in the supine position.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’ve been struggling with the shape of my pelvis, and I came across your page regarding iliac crest reduction. I’m currently considering pelvic contouring surgery, and I would like to ask you a few questions. As a woman, I’m concerned that my pelvis appears high and narrow, giving it a more masculine look. Would it be possible to shave or lower the upper part slightly to create a more feminine silhouette?
A: In the high and narrow pelvis you cannot make it wider or have a more feminine silhouette by shaving down the iliac crest. This will simply make it a bit less high but will provide no width to it. The definitive procedure is the application of a titanium iliac crest implant which is designed to do exactly what you want to achieve. This implant sits on the side of the iliac crest and its entire intent is to feminize the pelvis. (see attached diagram) Such implants come in a variety of widths from 15 mms up to 50 mm. The most common widths used is 35 mm but by your own description you may not even need that amount. More accurate sizing depends on knowing your height and weight as well as seeing pictures of the thickness of the soft tissues over your iliac crest. As the widths become greater this can in some patients cause a sub iliac hollow which is which is why in the complete Pelvic Plasy procedure the titanium plate is combined with an attached silicone hip implant. But as long as the width of the implant is not too great and one does not have a pre-existing sub iliac hollow the attached hip implant may not be needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Apart from mouth widening surgery, I am also wanting to replace my breast implants, I currently have 950cc silicone implants and am wanting to have much larger silicone implants (1300 or 1400cc, Mentor have just released these size silicone implants.) Would that be possible to combine the two surgeries together?
A:Yes it would. Mentor now has silicone 1140, 1240, 1330 and 1430cc implants available.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do you guys perform temporal “reduction” surgery
A:As the inventor of temporal reduction surgery I perform it regularly. How this may apply to you requires Picture assessment as well as a description of what your estimated goals.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d love to better understand the scope of midface augmentation. Would any of the following effects be realistic?
- Smoothing or softening of nasolabial folds (see attached photos for current nasolabial folds when smiling)
- More defined hollow cheeks / less puffiness in the midface
- A slightly wider-looking mouth through midface skin traction?
- A more angular look from subtle skin elevation near the jawline?
A:In answer to your specific questions about midface augmentation:
1) Improvement of the nasolabial folds is not going to occur with any form of midface augmentation particularly when one is smiling.
2) Depending upon the implant design it may be helpful in creating some increased submalar hollowing/indentation. However the more a short approach to that outcome is really a reductive one based on cheek fat removal.
3) The mouth is not going to get wider with any form of midface augmentation. It does not create a midface skin retraction effect.
4) mid face augmentation is not going to create I more angular jawline look. That can only occur from a direct jawline augmentation approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I am wanting hip implants. Am I a good candidate? I would be coming from Australia. How long will I have to stay in America for?
A:My extensive hip implant augmentation experience I have learned tonight place too big of a hip implant to lower the risk of potential complications. Thus the attached imaging shows the amount of augmentation that I am willing to do. Your length of time here does not need to be more than five days although, one of the important elements of postoperative recovery is the need for drains. Those drains need to stay in 2 to 3 weeks. Thus you will be going home with drainss in which we will guide you through the process of eventually removing them at home at the appropriate time.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How much would I expect the cost to be for something like Custom Orbital Floor-Rim Implant in the Treatment of Aesthetic Vertical Orbital Dystopia, for my situation? My right eye would ideally look like the left once raised.
A:First of all I do not know your ‘situation’ when it comes to your eye and asymmetry as I have never seen any pictures of your problem. Secondly in the treatment of vertical orbital dystopia a custom implant made to raise up the eye and infraorbital rim pi is rarely the sole solution to the problem. It is a foundational part of the VOD surgery but it is almost always requires other soft tissue adjustments to be done around the eye, the eyelids and brow, as raising the eyeball alone will change the lids-eye relationship in an unfavorable way. And the eyelids and brow do not move upward because the eyeball is raised. Thus it is very rare that a custom orbital implant alone will satisfactorily address the problem.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m interested in a lip lift with lip reduction. Do you perform it with muscle cut under the nose too? My upper lip is already to forward and I want to avoid making it even go more forward after a lip lift.
I naturally have an upper lip that is somewhat projected forward(also had silicone injection years ago), and I’m concerned that a lip lift might increase that projection or cause the lip to appear overly everted.
I’m specifically looking for a subtle and natural result — with a shorter philtrum and better tooth show, but without making the upper lip stick out more.
Could you please let me know if your technique is muscle-sparing or including cutting,and if it avoids adding forward projection?
A:In a subnasal lift lift I never remove underlying orbicualris muscle. This not only deepens the nasolabial angle in an unfavorable manner but often causes prolong difficulty with smiling and other lip motions. Thus it is a skin only procedure in my experience.
The logic of why some surgeons remove muscle in the procedure is that it limits any postoperative relapse. While there is merit to that relapse prevention the trade-offs are not worth it in my opinion. Long term follow up has demonstrated that most primary subnasal lip lifts, depending upon how much skin is removed, will within the first six months undergoing 10 to 20% relapse of length. But this to me as a better problem then issues that can occur with muscle removal in the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a few weird bumps on my upper head and I want them removed but how much would that cost.
A:I would need a much more description of the weird bumps (where, how many, what do they look and feel like) to determine what may need to be done to remove them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m in the UK and have been unable to find a surgeon to improve my orbital dystopia here to get an improvement in my eye asymmetry. Would I be able to send you a picture of my eyes & an image from my CBCT scan to see if you would be able to assist me? I am very nervous about considering surgery outside of the UK but would like to know if it’s at all feasible for me. I would like to get an idea of the cost of an infra-orbital rim implant (possibly combined with cheek implants). As if an implant is an option in my case I would be very keen to do so.
A:Thank you for your inquiry and sending your picture and 3-D CT scan. Almost every custom vertical orbital dystopia implant is a combination of the orbital floor, infraorbital rim, and cheek as the entire composite bone unit is situated lower. While this would be effective in your case based upon the amount of millimeters that the left eyeball is lower than the right, 5mm or less, it is important to understand that you cannot just move the eyeball alone as the eyelids are not going to follow it upward. Thus almost every vertical orbital dystopia patient requires concomitant upper and lower eyelid repositioning with their custom implant. Fortunately, your left eyebrow is minimally lower than that of your right and does not require management.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I feel like my hairline sits on top of my head because of these protruding bones in the frontal lobe. I even have a bony eyebrow ridge in the middle. Ideally I would like my forehead to be more symmetrical. Where my forehead could be lowered and I can wear lower haircuts
I have to grow my hair to hide my forehead and I want to feel confident having a lower hair cut
I would ideally like for it to sit lower with a more smoothed out forehead.
A: You have the classic forehead horns combined with a high hairline. The treatment of both are linked, meaning to get a significant forehead shape change the bony horns must be flattened and the frontal hairline advancement. The question is not whether the forehead bony horns can be completely reduced as they almost always can. The more significant question is how much can the frontal hairline be advanced, and straightened, which can never be truly known until one is in surgery performing it. The frontal hairline can be advanced, but its just a question of how much and can it really be made straight.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, Im almost satisfied with the way I look. There is one Thing that bothers me for my whole life. My forehead but only within the area above the hairline Looks a bit like Gollum. That bothers me so much. Is there any way to change it without the risk of losing hair?
A: I am not precisely certain how the Lord of the Rings character Gollum applies to the top of your forehead and some pictures of it will make that clear. But as a clarification no form of skull reshaping surgery causes hair loss.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I’d like some additional information on your very soft low durometer silicone testicle implant. I currently have silicone filled implant and have almost given up hope that I’ll ever be comfortable again as it is as hard as a rock. I’m very interested in yours with it being extremely soft and squishy and have no risk of eventual failure or need for replacement. is there any way I can get a sample shipped to me (I’ll return). I just want to see it for myself before scheduling a procedure.
A: The key to the a very soft testicle implant gives beyond just having an ultra soft silicone durometer. It just also be designed with a small hollow inner chamber to maximize softness when compressed. Thus it is both a material and implant design improvement.
We don’t ship implant samples to patients as these are proprietary medical devices.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I hope you’re doing well. I recently underwent a subnasal lip lift and, unfortunately, was left with an A-frame deformity—the center of my lip was lifted significantly, while the sides remained relatively unchanged. As my daughter puts it, I now look “botched.” For context, my philtrum measured 18mm before surgery, and the surgeon removed 6mm evenly across the subnasal line. The vertical distance from the base of my nose to the top of the central lift looks appropriate, so I don’t believe too much was removed from the center. I’ve read about the extended subnasal lip lift technique you pioneered to specifically avoid this type of outcome. I’m wondering if it’s possible to perform a revision that lifts only the sides to correct the A-frame deformity—without taking any more from the central philtrum. I also want to mention that I’m not a good candidate for a corner lip lift due to my darker skin tone and risk of scarring. Could you kindly advise: Whether this kind of targeted revision is feasible in my case? How long I should wait before considering a revision? And whether Botox could help temporarily improve the appearance in the meantime? Thank you so much for your time and expertise. I would be happy to send photos if needed.
A: The only option to improve the shape of the upper lip after an ‘overdone’ subnasal lip lift are lateral vermilion advancements. There is no ‘extended’ subnasal lip lift technique that will change the outer downturned portions of the upper lip. Botox injections will not help.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Has Dr. Eppley performed this intraoral mentalis release + dermal-fat graft procedure on additional patients since the published case? I was wondering if it lasts long since usually fat is mostly reabsorbed?
A: I have performed it many times. But this is not the best procedure for you as your deep labiomental fold exists becaiuse your chin is vertically short and the soft tissue chin pad is compressed up against the lower lip creating the deep indentation. The appropriate procedure and I far more effective one is a vertical bony chin lengthening. Also, and I compression tissue site a dermal fat graft will not work well for adequate and sustained depth of fold reduction.
There is usually a 50% greater survival from dermal-fat graft placement in the face.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, As for the jaw and cheekbones, I definitely understand that I won’t achieve those inspiration pictures with the implants alone, as the photos are augmented and the girls are very thin. They were more to show off how sharp I like a jaw rather than what I expect from the implants, if that makes sense. As we had discussed, I would be happy if the implants could replace my cheek and jaw filler and give at least a slightly sharper look than filler can provide. Do you think that’s achievable? It’s perhaps worth noting that I was very far from my normal weight in the “before filler” pics I sent, and I’m already closer to my usual level of fitness again, so the implants won’t have to work quite as hard as when I’m holding more weight in my face.
A:When it comes to comparing the effects of filler and bone based implants, understandably, they are not really similar. Fillers tend to produce a more rounded type of augmentation well implants have the potential to create more sharpened features. This is possible because in implant designs the key is to make a very exaggerated form of the implant design on the bone knowing that the overlying soft tissues will have a quilt like effect dampening some of the implant’s shape. This means that the implant’s design on their 3-D facial bone structure can you look unusual to some patients who have the mistaken impression that an implant design looks on the bone is what it’s exact effect will be on the outside.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Regarding lip advancements, after giving it much thought, I agree that a sub nasal lip lift would not achieve the results I’m hoping for and would love to move forward with the upper/lower lip advancements paired with upper/lower V-Y for projection. That said, while I know you’re a master of scars and so the risk is relatively low, I would love your thoughts on how I can correct less-than-ideal scarring should it happen. I’ve heard methods like CO2 lasering or even lip tattooing can help, but I would love your thoughts on the best options in case, just in case.
A:When it comes to treating lip scarring, I’m Almost always surgical revision is the best route. This of course depends on what the magnitude of that scarring is. But most of the time this is a fine white line let maybe 1 to 2 mm wider than we ideally want. People spend a lot of time and resources on laser resurfacing but this is really not usually a good route to go. Depending upon the fine line scarring it is always possible that lip tattooing is a good backup plan but the first and primary goal is to have a scar that looks good enough that does not mean anything done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, So this is what my profile looks like right now, primarily trying to get height in the lower third, and just wanted to know what my options are. I do think a bimax with maxillary downgraft would probably be my best option but I’m trying to avoid a very invasive procedure like that. Was more thinking of genio with chin implant for some verticality but not sure how good that would look.
Is there any implant+genio approach that would be able to get me sufficient height in the lower third or would orthognathic be my only option for that?
A:If the goal is vertical facial lengthening you’re not going to find a Bmax procedure with downgrafting very favorable as this Is going to on lengthen your midface with potentially excess tooth show. So beyond that being a very invasive procedure it probably is not going to be that aesthetically beneficial and may have adverse tradeoffs
Jaw osteotomies aside you then have to decide whether it is vertical chin lengthening alone or total jawline lengthening that you desire. Vertical chin lengthening can be done by a bony genioplasty or an implant depending upon how much vertical length you actually need. If the goal is total jawline lengthening then a custom implant would be required to do so which may or or may not be combined with a bony genioplasty depending upon how much vertical chin length is needed.
To help illustrate these basic vertical lengthening concept I have attach some initial imaging showing the differences between chin only in total jawline vertical lengthening.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,, I’m seeking your expert opinion on revising a complex aesthetic and soft tissue issue following multiple surgeries of the chin/jaw. Background: I have condylar hyperplasia — my right jaw joint grew longer than the left, causing my entire jaw and chin to be skewed to the left. The right side of my face is noticeably bigger than the left. To try to improve this asymmetry, I had my first genioplasty in my early 20s, However, by my early 30s my chin still sat too far to the left, so I had a revision genioplasty. Even after the revision, my jaw remained crooked, so I had orthodontic treatment (braces) in preparation for full double jaw surgery to properly realign everything. I underwent double jaw surgery at the end of 2022, and the surgeons reversed the previous genioplasty at that time. Unfortunately, I developed two infections after surgery, which required them to remove the lower plates — so my lower jaw has been cut into and operated on multiple times. Current concern: Since all these surgeries, I now have persistent lower lip incompetence: My bottom lip does not touch my top lip at rest. My bottom teeth are always visible, and the lower lip sits too low and slightly everted. This looks unnatural and really affects my confidence. I believe this is due to mentalis muscle detachment, soft tissue stretching, and scarring from multiple surgeries and infections. What I’m hoping for: Your expert assessment on what is causing this — mentalis detachment, scar contracture, tissue deficiency, or all three. Your advice on whether mentalis resuspension (possibly with vestibuloplasty and dermal-fat grafting) would be suitable and realistic for me, given my extensive surgical history. Examples of similar cases you have corrected (before/after photos, if possible).. I can provide detailed photos (frontal, profile, lips at rest and forced closed), plus all my surgical and orthodontic records if helpful. I’m open to a virtual consult and prepared to travel from Australia if you think I am a candidate. Thank you so much for your time and for considering my situation, I truly appreciate your expertise.
A: Thank you very your inquiry and detailing your a complex surgical history… although when it comes to lower lip incompetence this is not an unusual background. The problem is your prior genioplasty has been reversed, losing support to your soft tissue chin pad and lower lip. Well I do not know the dimensions of your prior genioplasty any loss of horizontal projection and having head multiple surgeries to do so is going to result inching pad contraction and lower lip incompetence.
That being said there are limited surgical options to try to improve it which, from my experience, means basically do everything that you know how to do and hope it provides adequate improvement. Thus, as you have mentioned, mentalis resuspension, dermal fat grafting and a shortening vestibuloplasty are all of the soft tissue procedures. How this applies to you I cannot say based upon a verbal description alone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, is it risky or dangerous to do forehead reduction and hairline advancement at once? And you can’t do the forehead flatter than you showed me in the imaging?
A: It is common to do both forehead bone reduction and hairline advancement at the same time.
In imaging I try to show what I think is a certain amount of foreherad bone reduction …as that should be the trigger for surgery. Whether more may occur can not be known beforehand.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q:Dr. Eppley, I am considering having cosmetic surgery to improve my chin/jaw. I feel like my small chin gives my face a boyish/weak look. I would like my chin to be considerably stronger and more prominent to balance my face. Could I be a candidate for a sliding genioplasty? I would prefer to avoid implants.
A: With the focus on the small chin and with an emphasis on avoiding implants then by these parameters a sliding genioplasty would be the treatment option. This is a good treatment option provided one does want want the chin any wider or have a specific shape (square chin).
Now it is a question of determining what are the desired dimensions of the chin bone movement that look best to you. To make that determination a would need a side view picture of your face to do some predictive imaging.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, my son is almost 3 years old and has plagiocephaly that is noticeable. I am wanting information regarding the surgery to correct his skull. Thank you.
A: In aesthetic skull reshaping surgery I don’t treat patients under the age of 18 years old.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I found your practice by researching the arterial pulse in my cheek just left of my mouth. It showed up a few years ago and is now very noticeable, extremely so in certain lighting. I’m hoping to consult about surgical options. Scar potential and price. I’m attaching a photo of the location.
A: Your picture shows a classic facial artery pulsation in its location and appearance. This occurs at the bifurcation of the facial artery at the level of the corner of the mouth where it splits into a Y with one branch heading to the upper lip and the other along the side of the nose. Its cause is either an aneursym of the bifurcation or an aberrant loop of one of the takeoffs of thr branches. Treatment is by ligation of the pulsatile branch by an overlying small direct incision.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a custom jawline implant and photos were requested for imaging.
I would like to send new photos to use for the editing process but I do have some filler in my chin, probably 1/2 syringe or slightly more. Is it best for me to dissolve the filler before sending photos so it’s represents the most accurate depiction of my chin?
A: FYI Imaging is not about showing patients their results. Rather it is about determining the patient’s goals.
That being said whether the filler should be dissolved depends on the magnitude of its augmentation effect. If it is modest in effect then I would leave it. If its effects are more significant than I would dissolve it.
Dr Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, How can my wide forehead and skull be reduced?
A:Thank you for sending your pictures. In assessing them it is important to recognize that the enlarged temporal muscles contribute as much if not more and that of the wider skull forehead bone. Thus treating both bone and muscle is extremely important for a satisfactory reduction. In fact that concept is so important that if you reduce the skull bone without reducing the muscle it would look even worse.
While it remains to be seen how much bone reduction your skull thickness will permit the enlarged temporal muscle has no such limits and will provide a greater reduction then that of the bone. Attached is some imaging of what I think in the best case scenario can be achieved.
Dr. Barry Eppley
World-Renowned Plastic Surgery
