Your Questions

Q: Dr. Eppley, Lateral Chin Ostectomies – Narrowing the Broad or Wide Chin…. Saw article about this from you and it felt like something I am interested in. I feel my chin is too wide (the actual fatty part of the chin should not be as long horizontally). I always felt like making it more V shaped would look good. How does this differ from V shape surgery? I want my chin more pointed and narrow. Curious how imaging would look to. I have had a chin implant/buccal fat removal before but this is something that really interests me.

A: Thank you for your inquiry and sending your picture. How to narrow your chin is based on an understanding of why it looks wide…and that is because it is vertically short. So while the chin can be narrowed at its current vertical height (see attached prediction), it is more effective to vertically lengthen it as well. (see attached second prediction) This is known as ‘mini V line’ surgery, technically known as a combined vertical lengthening and narrowing chin osteotomy. (also known as the T-shaped bony genioplasty)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am undergoing double jaw surgery for my recessed maxilla and mandible. I have a lack of undereye support that has caused sclera show and ptosis in both of my eyelids, resulting in a very tired look at rest. I wanted to go for lower eyelid retraction surgery (possibly with a canthoplasty), but I was under the impression that without adequate support, these surgeries have a high chance of failure. 

I mentioned infra-orbital implants to my surgeon (he does indeed do them), but he said that he wouldn’t indicate them in my case because he didn’t feel I needed them, and that he hopes the sclera show will be less after the surgery anyway. I’m hesitant about this, as the sclera improvements I see from only a normal LeFort 1 aren’t really what I was looking for (neutral/positive canthal tilt, no droopiness of the lower eyelid) . He did mention that he was going to use a High LeFort 1 cut instead to help fill out my cheek and midface more. My question is whether a High Lefort 1 would be enough to help provide support to my lower eyelid such that canthoplasty/lower eyelid retraction would be acceptable. I’ve struggled to find answers to this question online, and while my surgeon is very experienced, he prefers to go for the results that the average person won’t mind (lower eyelid surgery is probably not a thing the average person thinks about). 

Thanks for reading!

A:A Lefort I osteotomy, regardless of the level, can not provide any improved infraorbital rim skeletal augmentation/support. To even think this is remotely possible fails to have an understanding of the basic anatomy of the periorbital region.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been meaning to get clavicle lengthening, in order to increase my biacromial width, at some point in the next few years. I just had a question regarding this. Is there a one-to-one correspondence between the gain in biacromial width and the gain in armspan/wingspan? So, for example, if someone gets their clavicles lengthened by 1 inch per side for a total 2 inch increase in biacromial width, does their armspan/wingspan also increase by exactly 2 inches?

Thank you. 

A: That is a very good question, I would assume it would since the clavicle is a horizontal bone and the wingspan is a horizontal measurement affected by shoulder width. But, quite frankly, I have never measured arm span width in clavicle surgery patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in skull width reduction. I have attached a CT scan of my skull. I have a few questions: 

1. Based off my CT scan alone, is my skull clearly wider at the top than average? A google search tell me yes, but I’m sure with your extensive experience viewing CT skull images you can easily say whether mine jumps out as wider than average. 

2. How many millimeters of bone can be burred? 

3. I do not want to remove the temporalis muscles considering my head is widest at the top bony area and removing muscle beneath is will only make it appear even wider–especially considering muscle removal has a far more dramatic effect than bone burring, so even if both were done I imagine I would still get that effect. If only the bone above the temporals muscle were burred, would I be able to avoid a lateral scar? Additionally, would the swelling be less significant considering the muscle won’t be manipulated? 

4. Are there any side effects from such a procedure it would be helpful for me to know about? It’s not a common procedure, so I would can’t find such an answer online. 

5. How long would it take for swelling to reside? 

6. Considering volume is removed from the skull, will the soft tissue shrink back down over the bone? 

Thanks in advance.

A:In answer to your skull reshaping questions:

1) Yes it is.

2) In the 5mm range

3) An incision is needed to do the bone burring. The postoperative swelling would be less than with temporal muscle removal.

4) The scar is the only ‘side effect’. (aesthetic tradeoff)

5)  7 to 10 days for most of it to subside.

6) There will be no problems with loose scalp skin.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I’m a young female looking into mandibular angle implants I came across your social media. Most I’ve seen done is on males do you do this for females add some width and length to the ramus without it looking too masculine ? Also with facial implants which are meant to be lifelong is this true or do they have to be changed down the line because I’ve ready somewhere that Brest implants have had to be removed because of degradation. What is the success rate for mandibular angle implants I’ve seen many say negative things some positive but id really like some more information before I have any consultations with anyone right now I’m just researching. I have pictures of my profile too if that helps thanks.

A: In answer to your jaw angle implant questions:

1) The vertical lengthening style of jaw angle implants is the only really suited for most female jaw augmentations.

2) Solid silicone facial implants should not be confused with gel breast implants. Such facial implants never degrade or need to be replaced due to implant material fauilure.

3) Like all facial implants jaw angle implants have all of the same risks of infection, asymmetry as well as sizing/shape issues.

4) I would need to see some pictures for imaging of potential results of which the most valuable are the front and three-quarter views, the profile view is the least useful in imaging jaw angle implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, First of all, thank you for the more than complete information you provide in your websites. It is very useful for those of us who need information about surgical procedures that are not usually offered by most plastic surgeons. My problem is that I suffer from plagiocephaly, with the right back side of my skull flattened (comprising the occipital, parietal and temporal bones) and the right side of my face being more prominent (forehead, orbital rim and cheekbone) than the left one. Although I have found extremely useful all the information collected in your websites, I have some questions: 

1. In occipital augmentation, and when a single custom implant (due to the extent of the malformation) must simultaneously cover the occipital, parietal and temporal regions, taking into account that the temporal bone is covered by muscle and that the occipital and parietal zones do not, between which layers is the implant inserted, I mean, over which layers does the implant sit? 

2. I have read in your posts that the “bony suboccipital” area (the lower area of the occipital bone that is below the neck muscles and below the superior nuchal line) can’t be augmented due to possible neck muscles problems, but is there any reliable and permanent “muscular suboccipital/subnuchal” augmentation method? Could a custom silicone implant (or semi-custom hand-carved) be placed over the upper neck muscles? Would this implant sit directly over the muscle or in another plane? Over what muscle/s? What durometer silicone implant would be required? Would fat grafting be another permanent option? Would this fat be injected in a submuscular or in a subdermal plane? Would a first previous stage of scalp expansion be necessary or recommended? 

3. In the case of the face, is it possible, by burring technique, to reduce the horizontal projection of the anterolateral region of the forehead and the horizontal projection of the orbital rim (superior, lateral and inferior areas, from the supraorbital notch to the zygomaticomaxillary suture) (black painted areas in the attached picture)? And how many mm approximately? 

Thank you very much for your time and patience.

A: In answer to your questions:

1) Any skull implant that covers a combined non-muscle and muscle areas must go on top of the temporalis fascia.

2) As a general rule there is little aesthetic value to having a skull implant go much beyond the nuchal ridge line of the occiput onto the neck muscles and there are potential complications from doing so. Any soft tissue neck deficiency below the nuchal ridge must be treated by conventional soft tissue augmentation methods (fat injections) although they work poorly in the tight posterior neck area.

3) You are going to get roughly 5 to 6mms of bony reduction on the highlighted forehead and orbital regions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been a clandestine fan of your practice; you’ve been quite innovative. Congrats. 

I have a question about rib resection, something I have no experience with or have thought about much. I just don’t get it, one can make the case that the floating ribs don’t have much effect on the waist (except maybe some for girdlers), and even might confine it by keeping soft tissues from expanding . In any event why do they need resecting, why not just remove a chunk of proximal rib and let the distal end truly float. I read on your Instagram feed that you remove some muscle, how much effect do you think that has? 

A: Thank you for your thoughtful questions about rib resection and in answer to them:

1) Ribs do make a contribution in waist girth, just not in the way that it is commonly perceived. It comes down to their soft tissue support that they provide. It is really about weakening the framework that supports the enveloping soft tissues.

2) When it comes to the floating ribs (11 and 12), 11 is by far more important…and I would argue that 12 is completely irrelevant as it is slmply too short and ‘hidden’ except in exceptionally thin females.

3) The false rib #10 makes an equal contribution as #11 which is why 10 and11 subtotal resection are the keys to the procedure. (12 is usually just taken as a ‘convenience’ and in the spirit of making a maximum surgical effort)

4) How the arc of the rib is weakened doesn’t really matter. Whether that is a distal resection, a segmental mid-resection or a proximal resection. (the latter two being collapse techniques) What does matter, of course, is the surgical risk in doing so. The proximal resection would have the higher risk being closer to the spine and is the hardest to get to being covered by the erecti spinae muscle. Distal resection is the easiest to perform through one very small incision and has a negligble morbidity in doing so.

5) The LD muscle is the largest soft tissue contributor as is incredibly thick even in small females. (1 to 3 cms) Because it has to be transgressed to perform the rib resection I have learned and observed that removing a longitudinal portion of the muscle is helpful in the overall objective with no loss of function.

6) In my experience it is the combination of structural support reduction (rib removal) and soft tissue resection (muscle excision) that creates the result. Thus the term ‘rib removal’ doesn’t really accurately describe what is actually done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I hope this email finds you well and healthy

I am a dermatologist in Brazil and am writing about a male patient with cutis verticis gyrata (CVG) who came to my office at an early stage and I would like to know if you have positive therapeutic experience with fat grafting or PRP for this clinical condition.

Thank you for your time and I wish you an excellent week.

A: In mild cases of CVG injection fat injection grafting can be successful with a combination of  release and injection. PRP alone will not work.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My rhinoplasty questions are:

1. Is it possible to do a nose reshaping with results similar to the pictures I’ve attached? My main concern is how far my nostrils project into my nose tip. I would like to have more of a tip to my nose. I also would like my nose to be just slightly shorter. It is important to me that my nose would look very natural and not extremely narrow or perfect. 

2. I am also concerned about the look of my neck and jaw. I’d like to remove fat from around my lower cheeks, jaw, and neck. Could this procedure be done at the same time as my nose? Are there extra risks to doing both at the same time? 

3. What would be the cost to have both of these done? And the cost for them separately? 

4. Does your team provide financing options? What are the terms of the financing options? 

5. How far out would I have to schedule? 

6. I also have POTS and fibromyalgia, though not to a severe level. Would this affect my candidacy for these procedures? I have been under anesthesia before. 

7. How long would I have to stay locally for these procedures? 

8. How much pain could I expect for both of these procedures? Could I manage the pain with ibuprofen or advil alone?

A: Thank you for sending your pictures to which I can say the following:

1) While the general type of profile nose shape can be achieved the reduction in nostril length/exposure is probably overly optimistic.

2) Submental/jawline liposuction can be done at the same time as a rhinoplasty. Doing them together does not increase the risks of either procedure over being done alone.

3, 4 and 5) Will be answered by my assistant.

6) I am not aware that POTs or fibromylagia have any adverse effects in these facial procedures.

7) Most patients return home the following day.

8) These are not particularly painful procedures that require any narcotics.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m writing to ask your professional opinion on whether or not my goals are reasonable and obtainable with chin surgery. Ten years ago I had surgery to address my ptotic chin where there doctor removed an ellipse of tissue approx. 5 cm x 8 mm (there was no bone work done). He recommended a small anatomic implant be placed which I kept for 2 years and finally had removed in 2013 because it always felt a bit too tight. Since the removal, I’ve had both functional and aesthetic issues – there is less mobility in the center, and on my left side where the chin doesn’t move down as much as the right side so my mouth appears crooked when I speak. I’ve had Botox to try and help, but all it did was freeze my chin where neither side moved. Aesthetically, I still have a witches chin and on the left side there’s an area in front that’s flat, compared to the right side – this causes a shadow. I’ve added filler to it over the years, which helps a bit, but it takes multiple syringes and isn’t cost effective. I am now considering Smart-lipo and/or platysmaplasty to tighten the area under my chin as well to give me a better “chin-to-neck” transition. My question is will inserting another implant give my chin enough of a boost in front to help with the drooping and fill out the flat area (could more tissue to be removed with a submental tuck?) The doctor noted that I have little mentalis muscle so I’m not sure if that could be contributing to my overall problem. Do you feel there is anything that could be done to address the functional issue – could the implant help at all in that dept? 

I’ve attached photos for reference. Thanks in advance – I hear you’re the expert so I value your opinion.

A: Thank you for your inquiry and sending all of your pictures to which I can say the following:

1) The need for the chin implant placement makes no sense to me.

2) Why was a submentoplasty never done as part of your original procedure as this is what you are imaging now.

3) Your imaging is probably a bit overdone/unrealistic but the concept in that direction is what can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I’ve come across your website a couple of times and saw the before and after of the patient who went through the brow bone reduction and forehead augmentation. The results look amazing and I had a couple questions about that because I am planning to get this procedure done. My forehead is too slanted and I have a brow bone that sticks out. It’s funny because I’ve been called a Neanderthal by a couple of people haha. Anyways these are the questions that I had regarding the procedure. 

1. I’m getting a nose job from another place and I don’t know if it will affect the procedure. That’s why my question is which procedure do you recommend getting first? The brow bone reduction and forehead augmentation or my nose surgery? I don’t know if it makes a difference haha. 

2. How long is the procedure? 

3. How long will it take to heal? And does it affect me playing sports for good or just a while? (Soccer in particular) like will I ever be able to header the ball? How long will I have to wait? 

4. Around how much is the cost? 

5. I’m also planning on getting laser hair removal, because my hairline is really low and so I wax it off, will the laser hair removal affect my skull or my bone after my brow bone reduction and forehead augmentation? 

I’d love to hear back from you, thank you! 

A: In answer to your questions:

1) It does not make a difference as to whether the forehead or nose procedure comes first. It really depends on which one has the higher priority if either one does.

2) A combined forehead augmentation and brow bone reduction procedure is 2.5hrs.

3) Good healing would take 6 weeks. I would not head a ball for at least 3 moths after the surgery.

4) My assistant will pass along the cost of the surgery to you.

5) Laser hair removal is superficial, it will not affect the bone beneath it or anywhere else.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am post facelift ( one month) with my 3rd chin implant.  The implant just doesn’t seem right and I would like you to give me your opinion on what size I need. I feel it’s too wide and not feminine at all .  The prior implant shifted off the bone and was creating problems with smiling.

A: The most common problem in female chin implants is they are too wide (extended wings) and have too much projection. Many surgeons use the extended anatomic style for reasons that escape me. This style chin implant coupled with malposition off the bone (due to lack of screw fixation) magnifies the problem.

You can most likely modify the implant you have and secure it firmly in position to achieve a more desired result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a buttock augmentation with implants elsewhere but the implants on the right side flips….I had a MRI but I really don’t know what can be done….some doctor say I can do nothing due my muscle is too thin…..someone say better to remove the implants and exercise it a lot before thinking to a new implant….someone says the muscle is broken, I need just to remove the implants and to ask for a total refund to my surgeon..who knows……I send you a pic with a panoramic view of the MRI but I can send all the files by mail….thank you. Kind regards. 

A: What your MRI shows is that the buttock implants may have originally been placed in an intramuscular position but now appear to be in a partial intramuscular position as the muscle has atrophied over the top of them. (this is not uncommon) With the right implant flipping this is not a problem likely solved by implant replacement. (the implant is not the problem although a bigger implant that is stiffer may help as you undoubtably have gel buttock implants) One other potential option is to lift up the lower capsule of the implant and place it under that next to the muscle. (implant pocket adjustment)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have bone loss in my forehead. One dent is under my hairline going horizontally. It is approximately an inch and a half long (horizontally) and maybe an inch wide.There is another one going down vertically from that one that has now run into the first one that is approximately an inch long and perhaps 3/4 inch wide. Sort of a T shape, see photo. Slightly more to the left than the center of my forehead. I noticed these approximately 15 months ago and they have become larger. My doctor says it is bone loss that we all get with aging. I have osteoporosis. I’m wondering what can be done about this? I’m very concerned that they will keep getting larger. In your experience, what do you think the likely hood of that they will get larger? Thank you.

A: First it is extremely unlikely those forehead indentations are from bone loss. Regardless of how osteoporotic one is or their age you don’t get localized bone loss at random forehead areas. That is simply not biologically possible. These are discrete areas of soft tissue loss. Second, whether they will get larger I can not say. Third, the proper treatment is far injections to help restore lost soft tissue volume.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I had specific questions about the chin implant. I got 2ml of chin filler done this past month and I absolutely love the results! However chin filler isn’t a permanent solution, and it’s also a costly upkeep and migration is bound to happen. I was wondering if for someone in my case who only needed 2ml of chin filler for the desired look, is chin implant worth it? What type of implant is best? Medpor? Silicone? And can custom chin implant provide a v-shaped chin like the fillers? I do not like the regular look of chin implant because they are too boxy.

A: A chin implant is worth it unless you want to continue with ongoing fillers. The key is a silicone chin implant that has been made into a v-shape that provides the slight needed horizontal augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a young male that’s looking for some changes to my chin/jaw. I would like to have a more masculine and chiseled jawline and chin (I have included some photos of the type of result I’m looking for, as well as my own profile currently). I was considering a chin implant however I am aware that my labiomental fold is already quite deep, and I do not want to make this more apparent. 

A: Thank you for your inquiry and sending your pictures. If your goal is to undergo chin/jawline augmentation and not make your labiomental sulcus any deeper then you are not going to have any augmentation procedure. The labiomental sulcus is a fixed anatomic structure. By definition then any form of chin augmentation will make it somewhat deeper so this is unavoidable. There are concurrent strategies (fat injections) to treat the labiomental sulcus at the time of chin/jawline augmentation to try and prevent that adverse aesthetic change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was hoping to get your input on a nerve injury. I had jaw reduction surgery 2 months ago. The square sides were cut and chin shaved (no genioplasty). Now my mouth is crooked when I smile. I marked the numb area on my chin in the attached photo. From looking online it seems this is a mandibular nerve injury. Was this a surgical error and avoidable? Can it recover? Are there any treatments available? 

A: While there was no attached picture, this sounds like weakness of the marginal mandibular branch of the facial nerve…which causes weakness of the lower lip depressor muscle making the smile asymmetric. This is a nerve injury that only time has a chance to recover of which the final outcome may take up to a year to see what degree of nerve function returns.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My son has Occipital Plagiocephaly and his head is flat on one side of the back of his head. He is only 8 years old but when he’s old enough to understand I want to talk to him about possibly correcting the shape of his head by having cosmetic surgery. How much does the procedure cost and would h still be able to play football for years after the procedure or should we wait and consider the procedure after high school/football?

A: As a general rule I wait until after puberty to place custom skull implants. One can have the procedure and then go on to play football.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I suffer from my neck, and after researching I concluded that it is called webbed neck, so I contacted one of your assistants on Facebook and gave me this website. I want to know how successful this surgery is and how dangerous it is, will the suture effect remain with me, and how long my recovery will be . And to be honest with you, I am very afraid of this surgery. I also want to reshape my ears.

A: Thank you for your inquiry and sending your pictures. You indeed have a webbed neck deformity presumably of the mosaic variety. There is the classic low hairline that follows the upper webs and as well as the ears which are pulled down a bit and have some conchal hypertrophy.

This is one of the hardest webbed necks to improve due to the tightness of the neck tissues. This is first time I have ever seen a male with a webbed neck so the midline location of the posterior neck scar is more problematic than it would be in a female with longer hair in the back. This poses a unique challenge. The success of webbed neck corrections depends on how loose the skin is on the back of the neck and how easily the webs can be pulled inward.

Dr. Barry Eppley

Indianapolis, Indianapolis

Q: Dr. Eppley, Hello! I have read quite a bit about the external occipital protuberance, I am very interested in the procedure; Although the size of my head is somewhat wide, however, I present said protuberance and when sliding my fingers over the area the nuchal lines feel very pronounced, all four stand out together with the inion. Can you help me resolve the question about whether I am suitable for the procedure?

A: Thank you for your inquiry. One is a candidate for occipital bump / nuchal ridge reduction if one feels it is too prominent. This is a procedure that is most often performed on men due to their short hairstyles, where the prominences of the occipital bones are more clearly seen. But this does not exclude women from undergoing the procedure if they find it bothersome.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a few questions about clavicle lengthening.

1. If the clavicles are lengthened without lengthening the scapula, will the scapula follow and become wider naturally or pull the clavicles back inwards eventually and will it look natural aesthetically?

2. How much can each clavicle be lengthened by?

A: In answer to your questions:

1) There is no known impact of lengthening or shortening the clavicle, at the bone lengths that are typically done, on adverse scapular position or function.

2) Clavicles are generally lengthened 1 inch or 2.5cms per side.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to pose the questions my son has regarding the logistics of the plastic surgery and what is achievable and what it not as his guardian. 

In his email he asked the following questions : 

1. Is it possible to shorten the vertical length of the nose by 5 mm, while reducing it in size (in how much it protrudes outwards,  the width of the nostrils, straighten the bridge and sharpen and lift up the drooping tip)

2. Is it then possible to perform a lip lift to reduce the space between the eyes and mouth

3. While operating on the mouth is it possible to 

                    3a. Perform a corner of mouth tuck to reduce the width of the mouth by 5 mm on each side) 

                      b. Do a lip reduction so as to reduce the thickness of the lips

A: In answer to your questions:

1) It is not a question as to whether in rhinoplasty surgery all of those dimensional movements can be done but whether the degree of change (e.g., sharpen, reduce in size) that the patient desires can realistically be achieved. Not knowing what the patient’s nose looks like now or what their exact nose shape goals are I can not say.

2) A subnasal lip lift reduces the distance between the base of the nose and the upper lip. That may create the appearance that the midface is a bit vertically shorter.

3a) While the mouth corners can be brought in 5mms per side, the tradeoff for doing so is a fine line scar from where the old mouth corner was to where it is now. That can be a dubious tradeoff for many patients.

3b) A lip reduction can be done to decrease the thickness of the lips. As a general rule lip size can be reduced in the 25% to 33% range.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I don’t have pictures to upload I’m just looking for your opinion on this: In your opinion is it ever really necessary to place malar or submalar cheek implants in through an eyelid incision? Or could this be accomplished intraorally.

A: While a lower eyelid approach is one method for placing any form of a cheek implant, that is more commonly done by Eye surgeons as that is what they are most comfortable performing. However, the intraoral approach is far more commonly performed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Ive been looking into cranial implants for some time to add some width to the shape of my skull and finally decided to do something about it. I’ve been doing some research and most surgeons seem to use medical grade PEEK or titanium implants. The quotes I’ve received have come up particularly expensive for one implant alone. I saw that you use silicone for larger cranial implants, how to they compare to PEEK or titanium? And are they more affordable? The implants from your pictures look great, my only issue is I don’t seem to be able to find any other medical providers, establishments or distributors anywhere that use silicone for their cranial implants. Is there a reason for this? And do you print your own, using your own materials? And is it standard rubber silicone? Sorry for all the questions! Would really appreciate your insights. 

A: A silicone implant for aesthetic onlay cranial augmentation is far superior and more affordable than either PEEK or titanium. It is completely erroneous to think that a very rigid material is needed for aesthetic skull augmentation. You are confusing replacement of lost skull bone with aesthetic onlay skull augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I recently had sliding genioplasty surgery and I’m very unhappy with the result. My surgeon has told me revision is impossible and he refuses to do it, despite me crying in his clinic saying I want one. He told me that revision is dangerous and if anyone tried my entire jaw would shatter. Is this true? I’m really worried and upset that I’m going to hate my face forever. 

A: All sliding genioplasties can be revised whether it is shortly after surgery or years later. Doing a sliding genioplasty revision does not put the jaw at risk for fracture. (shattering)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am writing to get your opinion on whether I should pursue a genioplasty with you vs. jaw surgery. I have sleep disordered breathing and after having a CT scan and seeing how small my airway is — it’s only 3mm wide at the narrowest — I feel like I’m a textbook case for MMA with counterclockwise rotation. However, I’ve seen six or seven different doctors with this problem and have been essentially dismissed by all of them. I have a consultation with a surgeon coming up in October but after that I’m about ready to throw in the towel and seriously consider other options.  

I am curious whether you think a genioplasty would be able to provide enough augmentation considering how small my chin is, and whether it would make an appreciable difference in my breathing. My other concern is about the upper lip. I’m self conscious about how long and flat my philtrum is, and I’m guessing jaw surgery would help support it whereas a genioplasty wouldn’t make any difference. A lip lift would help, but I don’t want to make my gummy smile or lip incompetence any worse than it is. Would you suggest any other options?  

Thank you for any advice.

A: Thank you for your inquiry and sending your pictures and x-rays. Why you would not be a candidate for bimaxillary advancement for your OSA I can not say. But your chin can probably support a 12 to 14mms horizontal advancement. Usually if one gets above 10mms there is some modest OSA benefit as that is very similar, if not more, than a genioglossus advancement OSA procedure.

A sliding genioplasty or orthognathic surgery has no impact, positive or negative on the upper lip shape or length. That requires a direct upper lip lift approach, which if kept in the rule of thirds, will not create a gummy smile or lip incompetence.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, last year we had contact because I was really interested in skull reshaping. I would like to ask for your advice again.

Today I still struggle with the same problem and I still always wear bun to hide the shape of my head. To wear hair down is my biggest wish and this is why I am reaching out to you again.

I have a vague memory of what you recommend but the one thing I do remember is that int as just so expensive for me that I will never have the ability to ever do the surgery.

I found a clinic here where I live and had a consult with a surgeon and they recommended to get volume in the crown space of my skull with a fat transfer treatment. This is more affordable for me.

My question is whether you think this is a good solution for my skull augmentation problem.

A: Injection fat grafting is usually a very inferior approach to skull implant  augmentation unless the area is very small. But it is harmless to try and given your described economic limitations this is your only treatment option.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can a customized wrap-around jaw implant be designed to give a chin an additional vertical projection (downwards) or do one need to perform it with a sliding genioplasty for a vertical projection effect to be included?

A: It depends on the amount of vertical chin length needed as well as how much horizontal chin projection is being done. It is a balance between these two types of dimensional change to ensure that the soft tissue chin pad can wrap around and safely close over the newly projected chin. As you can see the answer to your question is more complex than a simple yes or no.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Please see pictures of my face attached for you to look at. I also like to ask you if I would need orthognathic surgery because it was brought up by my dentist if that is the case can I do that at the same time as my jaw line implant and cheek implants. Thank you

A: The question is not whether you need orthognathic surgery (to bring your lower jaw forward) but whether you want to pursue that route which requires before and after orthodontics as well as a total lower jaw advancement surgery. This is a discussion that is best had with an orthodontist who can assess your bite and what type of change could be done. You can’t make an orthognathic surgery judgment based on external pictures alone.

While you can do cheek implants with lower jaw orthognathic surgery you can not do a jawline implant at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in a jaw reshaping / reduction procedure. I’ve considered a trip to South Korea but don’t love their V-line approach. 

My biggest concern would be sagging skin as a result but looking at your results, I believe there are techniques to address that. Possibly fat grafting under eyes and temples and a brow lift.

I’d like to discuss details and learn what else you would recommend based on my facial proportions analysis. I’m attaching a few pictures in different angles /lighting. 

A: Thank you for your inquiry and sending your pictures. I would agree that traditional v-line surgery in your case would not only leave you with loose skin but would have disfigured your lower face. That is too radical a jaw reduction procedure for what you really need. Desquaring the chin through lateral tubercle reductions and perhaps some jaw angle width reduction is what is appropriate for your anatomy, all of which can be performed through an intraoral approach. These procedures maintain the vertical length of the reduced bones and thus the support to the attached soft tissues.

Dr. Barry Eppley

Indianapolis, Indiana