Your Questions

Q: Dr. Eppley, if I decide to get a open browlift with hairline lowering (if it stretches) can I later on get a skull implant or will that make it harder or undo the lift?  just confused as to which sequence I can do these and what is a big no no etc.

A: Getting a skull implant or doing a hairline advancement are usually mutually exclusive procedures. Both require the need for scalp tissue so you can have one but it will likely prohibit the other from being done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting custom hip and buttock implants and fat transfer from my abdominal area to my legs. Would all this be possible at one time?

What are the recommended post operation procedures, in particular, how long would I need to be away from my home? As for the follow up, how long after surgery will I need to return back?

A: I think it is important to realize that hip and buttock implants combined is a very challenging recovery of which I would be hesitant to do anymore than that at one surgery. Such recoveries become even more challenging in the patient who must travel for surgery. While the efficiency of doing liposuction/fat transfer at the same time seems appropriate on paper it is does not medically.

How soon one returns home after such surgery depends on whether they are coming by themselves or with someone to assist them. Assuming the former I would anticipate at least a week before returning home.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have always had a hereditary lack of volume under my eyes. My eyes have thin, purplish hued skin under them that lacks fat and creates significant dark circles. I am quite frankly tired of looking tired and believe having the appearance of raised cheekbones and a fuller midface will greatly enhance my appearance and, in turn, self confidence. I have considered fillers as they are cheaper but their impermanence makes me consider more drastic, longer lasting measures.

A: Thank you for your inquiry and sending your pictures. I do agree that skeletal augmentation with custom infraorbital-malar implants would be of great benefit to your midface/periorbital appearance. Done through lower blepharoplasty incisions this would also allow for a little extra lower eyelid skin to be removed. Your lower eyelid skin is severely hyperpigmented and skeletal augmentation alone will not solve that completely. There will still be a need for some postoperative skin treatments to lessen that degree of pigmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I was looking online to see if anyone else had my condition. After shaving my hair I noticed how the back of my head is really indented got concerned. I realized my father also has this but it never bothered us. Aesthetically though, after shaving my hair, I don’t feel comfortable with the shape and would like some information on what and why I have this. If you could email back, it would be great! Thank you. 

A: That is a classic occipital knob/bun type skull deformity with a little extra roll of scalp skin. While usually mainly seen in men that may only be because it is not common for women to have shaved heads, at least compared to men. There is no pathologic reason as to why it exists, it is just a normal skull development in some people. It is treated by reduction of the prominent edge of the bone through a small overlying incision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My son (5) developed a flat head when he was a baby. My daughter (6) also had a flat head due to sleeping on her back, but it corrected itself pretty quickly. Because of this, I assumed my son’s head would correct itself, but it never did… and now I find myself haunted each day by his flat side head. I’ve mentioned it to his Pediatricians many times, but they essentially “write it off”. I have spent many hours researching what can be done at his age, and surgery seems like the only solution. I would love to hear back from you with any kind of information/ help/ support/ referrals. Thank you.

A: Such head shape corrections for flat spots or a flat head I do not do until the teenage years when skull growth is essentially complete.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m sending this email to query about some things I’m concerned about, iIjust saw a case of a patient that had a skull augmentation with 28mm amount of increase of skull height but somehow I still believe that wouldn’t be sufficient enough in my case to achieve the desired results, my skull is just too small, severely flat and noticeably slopped down that I need at least augmentation of 35mm up to 40mm in order to get the skull shape of my dreams, I think I will benefit from a 2 tissue expanders instead of just one during the first stage procedure and an ear to ear incision in order to achieve those amounts of a augmentation. So my questions are, are my esthetic goals attainable ? And what are the procedures taking in order to achieve an amount of augmentation of 34mm up to 4cm?

A: While you may be correct about the approach needed for your optimal skull augmentation results, there are safe limits as to how much the scalp can be stretched and tolerate a big implant load underneath it. What you are asking exceeds those limits and is at very increased risk of complications. Here is a good rule to remember that is particularly relevant in implant augmentations…’it is far better to have half to two-thirds of your aesthetic goals achieved without complications than it is to have 100% of your goals obtained with complications’. That is because most significant implant complications are usually only resolved by removing the implant, thus losing everything.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How did the new implant feel relative to the testicle? Was it indistinguishable or slightly harder? And was it mobile in different positions would it move with the real one?

A: It will feel and move very similar to your natural testicle once the swelling and full healing has occurred. They are made of an ultra soft solid silicone material.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in custom implants for my chin/jawline. and also for cheek augmentation. I am hoping to achieve a more chiseled, high cheekbone look, so I would also want all of the fat removed from my cheeks, and under my chin. 

My other area of concern, that I would like to consult with you about, is my nose. I had my 1st rhinoplasty when I was a late teenager and my 2nd one just 7 weeks ago. Adding length & changing the angle, of a short pug nose isn’t easy.

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

1) The jawline and cheek augmentation concept is straightforward and will help your face the most.

2) You can’t take out all of the fat from the cheeks or under the chin. You can take out some (buccal lipectomies, peorioral and submental liposuction) but not all. This effect is synergestic with the cheek and jawline augmentation.

3) The nose imaging shown is not realistic. You can’t drive down the tip of the nose that much as well as make as thin as shown. It takes a rib graft to supply the cartilage needed to drive the tip of the nose as much as possible.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, When I was a baby I had a very flat head, and never got the helmet or any other treatment. I am now 26 years old and not only is the back of my head still flat, but it has also caused an abnormality to the structure of my face, jaw, eyes, nose, and forehead, which are all out of line, and unsymmetrical. The shape of my head, is something that has really effected me my whole life and something that I am very insecure about. I have to be very particular and cautious with how I style my hair in order to try and make it look less flat. I never let people see me with my hair wet, I never wear my hair down unless it’s teased, and the list goes on… 

I have come across your website, and can see that you do surgeries for improving the shape of a skull/head. I would be very interested in getting this procedure once I know a bit more about it.. Firstly I am just after a rough cost estimate for the surgery (I understand that the cost would be different on everyone) but just as a rough estimate so I can have some sort of an idea. Secondly I am a girl, and I take pride in my hair.. Would I have to shave all my hair off prior to surgery? Would the scar be noticeable? Will the scar stop my hair growth around that area? Will the scar go away overtime? Will the scar be easily hidden? Is there any safety concerns about having this implant? Eg, getting a knock to the head, would it cause extra pain because of the implant? Would it affect the shape? Or move the implant? Would the surgery affect my brain or any internal organs? What is the recovery time for this surgery? 

*the photos also don’t do it justice of how flat my head looks. 

Please let me know if there is anything else I should know about this surgery. 

Thank you, I look forward to your reply soon.

A:While it is unclear yet as whether you need a one vs two stage occipital skull augmentation procedure, I can answer your questions as follows:

1) Hair is not shaved for the surgery.

2) The fine line scalp scar usually heals without excessive widening and would be undetectable in someone with hair. Such scars are permanent.

3) The surgery generally does not adverse effect on hair growth.

4) There are no safety concerns with extracranial onlay skull implants.

5) The implant is more like putting a bumper on the head, it is actually protective rather than detrimental.

6) Trauma will not displace the implant.

7) The implant is on the opposite side of the skull from the brain, thus it is not affected.

8) Depending upon how one defines recovery, the significant part of recovery is over after 10 to 14 days after the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in submalar implant, and one of your patient’s result matches the kind of difference I want. (in -Photo Gallery- -face- -cheek- -patient 4- ) 

May I ask what kind of submalar implant was used to achieve it? especially the material… Because I have been looking through things, and could not quite find any submalar implants… However, I did see a certain implant that I really prefer (if it is the correct choice). It’s Medpor from Stryker, -Design RZ Malar Implants-. (I have attached the picture the Design RZ JOCHBEIN IMPLANTATE one ) 

Will it help me to achieve the result? 

Thank you and best regards

A: None of the polyethylene cheek implants styles you have shown are true submalar implants. These are all different types of malar implants that have some submalar components to them. While I don’t know exactly what type of midface change you are seeking, it is not clear to me as to what the specific shape of the implant should be. Submalar implants are most commonly used for cheek sagging. With an Asian face your aesthetic needs may be quite different.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a little background, I have had buccal fat removal in the past and found that it did not help with the chubbiness and volume in my lower cheek (area next to my lips). 

I’m now looking at perioral mound liposuction/reduction, and I could only find one surgeon in my area that does this procedure and maybe 3 surgeons country-wide. While looking at Real Self, I saw a couple doctors recommending against this procedure, so I was hoping I could get a second opinion from you regarding the safety/risks. I understand that there is a nerve branch running above the mouth and one along the jawline, so theoretically the perioral area should be free of major nerves. My concern is that if I have nerves that run lower or higher than normal (what is the standard deviation for nerve anatomy?), would I be at risk for severe nerve damage? Are there any other potential complications with this surgery? 

A: In answer to your perioral liposuction questions:

1) The effect of buccal lipectomies never reaches as low as the perioral region, no matte what surgeons say. You are a prime example of that basic anatomic concept of facial fat compartments.

2) There are no motor nerves that run through the perioral region. (south of a a line drawn between the corner of the mouth and the tragus of the ear) This is another basic anatomic principle that appears to have escaped those who portend there is potential nerve damage from liposuction in this area.

3) The question is never whether perioral liposuction is safe but whether it would be effective for your facial fullness.

4) Failure to use very small cannulas can result in irregularities/contour issues or over resection.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in subnasal implants to help my midface deficiency, I would be traveling from out of the counrtry and so want to know the price range before I book flights, would you be able to tell me this?

A: The key question is whether these subnasal implants would be standard ePTFE subnasal (premaxillary-paranasal) implants or custom subnasal implants. That difference would depend on your specific dimensional and shape needs. As a general rule most augmentations that exceed 5mms are usually best done with a custom implant approach. I would need to see some pictures to do some imaging to help make that determination.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a sliding genioplasty done two years ago and my chin is still very tight. My chin feels stiff and tight and it can make talking a challenge. Is there anything I can do to try and get the suppleness and lightness back in my chin? It feels very heavy and frozen and just stiff and tight. Even my lower teeth feel tight. If I pull away the muscle in the lip away from the bone the tightness in the teeth goes. I don’t know what’s going on! Any advice?

I’ve tried steroid injections into scar ( scar looks fine ) they didn’t help and I’ve tried PRP in the scar… didn’t work.

A: What would help you immensely is an intraoral release and placement of an interpositional dermal-fat graft. Every symptom you have described is indicative of a contracture/soft tissue deficiency. Steroids and PRP are useless as this is a tissue deficiency problem primarily which subsequently results in the secondary symptoms of scar contracture. Injections will not create new tissue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Thank you for your time. I hope this message will not be too long. 

Almost one year ago I underwent a sliding genioplasty with the aim of improving facial aesthetics and gaining a better lip seal. While there was some aesthetic improvement, the advancement has been quite small and I am left feeling dissatisfied. More importantly, my lip competence has actually increased slightly as I now feel tightness/pulling around the chin, which from what I have gathered is likely related to scar tissue of the mentalis complex. Probably there is more lower incisor show than before, but I do not have good images to compare. I am coming to you as your extensive resources provided online are one of the few touching upon this issue, and if further treatment is advised, which to be honest I hope it is as I am quite bothered with the situation, I would like nothing more than to come to you for this. Unfortunately I do not have access to an after x-ray picture, but have included normal photographs (they are not perfect before/afters but I have done my best). 

My goals are to improve the lip seal, increase chin projection (and potentially reduce height), and if possible reduce the tightness, or at least aim to not make it worse. Given the limited information I have been able to provide, do you think there is anything that can be done? If you prefer to discuss this in a video consultation, rather than via written messages, I would be happy to. 

A: Thank you for your inquiry and sending your pictures. As best as I tell from the pictures your chin advancement was very slight yet your symptoms are fairly significant for the amount of bone movement. It would be very helpful to see an after surgery x-ray to see the actual dimensions of bone movement.

But that issue aside the options are either to leave the chin position alone and do a scar release/interpositional graft (dermal fat graft) to improve your symptoms or to do a secondary genioplasty for further chin advancement and the use of allogeneic corticocancellous bone chips to fill in the step off and eliminate the bony dead space. I would estimate it needs to go at least to the new position as shown in the attachment image.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to change the back of my head. As you can see on the photos down below the back of my head is flat and makes the top of my head really high and the back of my head have a point. The back of my head has a box shape or a square shape.

I saw on your Facebook page that you have several types of shapes of skulls I  want my head to look round and normal. 

Thanks 

A: Thank you for your inquiry and sending your pictures and video. You have a combination of an upper flatter back of head with a lower occipital knob protrusion. (point) To properly reshape the back of your head you need a combination of an occipital knob reduction and a back of head augmentation above it. (see attached diagram)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking in to see if i would be a good fit for head width reduction. A lot of width seem to be more anterior than posterior. On my left side its definitely my temporal bone that protrudes above the ear and the anterior region its solid bone i can feel from where my jaw connects to temporal bone its a bulges quite a bit and solid as a rock. On right side above ear (scar side) it appears it more upper anterior that protrudes. 

My skull is lopsided I look weird in glasses and most hats being the strawberry-ish shaped head. I would like the sides of my head to be more flat, especially where the forehead transition to the sides. Flat v.s bowed. Please advise if you can help. 

A: Thank you for your inquiry. Everything that you are feeling on the sides of your head is muscle and not bone. Everyone thinks it is bone but it is not. The temporal muscle is incredibly thick in the anterior region (2 to 3 cms) while it is thinner in the posterior region above the ears. (1 cm) The question is not whether such muscle can be reduced but how to do so. The posterior muscle removal is straightforward with an incision in the crease at the back of the ear. But the anterior muscle poses different considerations in that it can not all be removed and access to it is much more limited if one wants to have acceptable scars. It is usually treated with electrocautery reduction through very small incisions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had Juvederm about four months ago and ever since I have these lumps on the side of my mouth. Can they be fixed and how? With more filler or do I just need a mini facelift. I’m 48 yrs old and I feel like I look ridiculous with these long lumps. I’ve tried massaging them with heat but nothing makes them better. I have also heard PDO threads might be helpful? Any help would be greatly appreciated. 

A: I think the answer goes back to why you got the injectable filler in the first place. If the goal was to get rid of the nasolabial folds then you have now proven that fillers is not the way to go. You would be better off with a mini-facelift. The injectable filler can be quickly dissolved with hyaluronidase injections.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am actually a previous patient of yours, I received a full custom jaw implant almost two years ago. Honestly, I could not be happier with my results. The fullness that the custom implant provides has given my profile a much more masculine and esthetic look. My jaw angles are also much more ideal and overall I am very happy with how my facial tissues adapted to the implant. The only concern that I still have — and we did briefly discuss this issue before my surgery, is how deep the labiomental fold may become post-surgery. I have always had a relatively deep labiomental fold, even though my chin was exceptionally underdeveloped for my profile. With the addition of the custom chin implant, my labiomental fold has only become more pronounced. I know this issue is not a large concern for most individuals; however, it is less than ideal for me, especially when viewing my side profile. Now that I am considering surgical options, I would love to hear your professional opinion on what can be done to fix this issue surgically, pricing, as well as what sort of expectations I should have post-surgery. I am uploading 4 pictures of my current profile, 1 picture of my profile before the full custom implant (in case you would like to add a before and after to your website), and 1 picture of my ideal labiomental fold (to note if a result like that is even possible). Thank you so much for your time and I look forward to hearing back from you.

A: Thank you for sending your picture and the longer term followup. In my experience there is no more effective treatment for a deep labiomental sulcus than a release and placement of a dermal-fat graft. The deep labiomental sulcus really represents a soft tissue deficient particularly when the chin has been augmented from its congenital shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, -hope you’re doing excellent! Huge fan of your work, as there is a reason you have the credentials/track record you do. (college student-live in Carmel area) Despite never having any cosmetic surgeries, my eyebrows have always been higher-throwing off my facial/width/height harmony. As seen in the first picture, my eyebrows are at there current position. Then, the right and left eyebrow are brought down just by me gently pressing my finger above each eyebrow. I know this seems like an odd request, but my brow bone projection from the side profile seems as if my eyes would be ‘deep set’. Perhaps they already are deep-set, but my eyebrows are just located slightly higher on my brow ridge? I know botox could be mentioned to lower the eyebrows, but would there be any surgical option that is safe/effective long-term? I have analyzed results from different ‘almond eye surgery’ variations, but I believe my overall shape and under-eye support is adequate enough, in your opinion? The lack of lowered brows allows my upper eyelid exposure to be much more visible, throwing off my entire mid-facial measurement. Would there be any way to retract underneath the eyebrows and pull them down towards my eyelid, making them more so “hooded”? 

Appreciate your time, you’re the man!! 

A: Thank you for your inquiry and sending our pictures. I believe you have answered your own questions accurately down to the last one. There is no operation that can pull the eyebrows down. While they can be pulled up (browlift) they can not be pulled down. To do so they have to be pushed down by an underlying brow bone implant which would not cause a good aesthetic tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have some specific questions regarding the projection of my upper and lower jaws because I’m unsure if I would be a candidate for maxillomandibular advancement or not.

Is my maxilla projected forward enough in your opinion? Are my tear troughs caused by a deficient maxilla or something else? I saw an orthodontist two years ago and she said I have class I bite. I have moderate crowding in my lower dental arch and light crowding in my upper arch; I am mentioning this because I’ve read that the teeth can indicate whether the jaws are recessed or projected forward.

I’m also aware that my chin is recessed; do you think I could potentially benefit from a double jaw surgery? I have attached some photos for your reference. 

Thank you,

A: In answer to your questions:

1) I see no indication whatsoever for maxillomandibular advancement surgery. You have adequate forward midface projection and a Class I occlusion.

2) Your moderate infraorbital deficiency and very modest chin recession are independent skeletal underdevelopments of the normal projecting maxilla and mandible.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hey, I am somewhat contemplating getting a chin implant and was wondering what are realistic options.

A: Thank you for your inquiry. I am not absolutely sure what you mean by ‘realistic options’. But in any form of facial augmentation, including that of the chin, the first step is to determine your aesthetic goals and the dimensional requirements to achieve them. (projection, length and width) Knowing the dimensional requirements then allows one to determine if a standard or custom chin implant is best suited to achieve them.

To determine your aesthetic chin augmentation goals I would need pictures as well as a description of your goals to do computer imaging from which we can then determine what would be the appropriate chin augmentation approach for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to reshape my forehead for a more feminine appearance. Here are a couple of images. As you can see, my forehead is rather sloped, instead of rounded. Likewise, from the front, there is a horizontal crevice that can be seen in certain lighting. Also, I am looking at how to make my side profile more feminine and attractive. Thanks!

A: Thank you for sending your pictures. The reason your forehead appears masculine to you is that you have brow bone hypertrophy and a result suprabrow bone break (horizontal crevice that you see) which then becomes a more recessed flatter forehead. Admittedly this is a classic male forehead shape, not that of a female. The combination of brow bone reduction by burring and a small amount of bone cement to the forehead above it will help feminize your forehead.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, i want to question if only trans woman can do shoulder reduction, a cis man can do too? I would like to know if only trans women can do shoulder reduction surgery or cis men can do it too? I feel very dysphoric about my shoulders.

A: Shoulder reduction surgery is not limited to any specific gender. While it is often called shoulder feminization surgery, there is no reason a cis male can not do the surgery if they have excessive shoulder width concerns. An uncommon request should never be confused with a surgical contraindication.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if I could possibly get a quote in regards to the removal of my keloid on the front and back of my ear. This is the result of a piercing and i’ve had it for about 5+ years. Around 3 years ago, I did a couple rounds of steroid injections that did not change the size at all. Please let me know if you’re able to provide me a quote based on the photos attached. Thank you!

A: Once you have an established hypertrophic scar, steroid injections are not going to be effective. Steroids only work in the active phase of scar formation for the most part. These require excision as you have surmised with concomitant injections of Kenalog (steroid) to hedge the chance against recurrence.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I understand there aren’t ‘after’ photos for hip implant augmentation procedure- totally relate to wanting to be discreet on that front. But would you say the patients who get this procedure are usually satisfied / happy with their results? Are there any common complaints / problems after surgery for most patients who have this done?

Thank you!!

A:In answer to your hip implant questions:

1) Patient satisfaction with hip implants, barring any complications (infection,seroma) is generally good. It is important to mention, like most implants in the body, perfection is rarely obtained and there are always some aesthetic deficiencies. (enough projection?? is there any visible edging??) But if one can live with less than ‘perfect’ results then it can be a good body contouring operation. However for the perfectionist this is not a good operation as secondary attempts to make such changes are never a good idea. This is best way I know to stir up trouble, of which infection and seromas can appear, in a secondary operation when manipulating an unnatural substance in the body. Getting the body to accept an implant the first time is a blessing. But I don’t advise patients to ‘spin the roulette wheel’ the second time. As my motto goes with implants anywhere in the body…’an uncomplicated 70 to 80% result is much better than a 100% result with a complication’.

2) I would also add that implants at different anatomic locations in the body have higher risks than others. (thus lower satisfaction rates)  Breast implants, for example, while far from being complication free, have the lowest risk of implant-related complications of any body implant. (extracting implant related deflation/ruptures which are mechanical device complications and not systemic reactions to the implant) The point being is one should not judge the fate of hip implants by the more familiar breast implant. They are much more compatible to buttock implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a chin implant which, while offering some improvement, leaves me wanting for more. How much more different would a custom jawline implant make?

A: Thank you for your inquiry and sending your pictures. You do have a small lower jaw both in projection and width that is disproportionate to the rest of your face. I have done some imaging looking at just one potential type of jaw augmentative change. In answer to your questions:

1) The chin implant would only be removed during the jawline implant placement. For the implant design the chin implant is digitally removed. The size and shape of your current chin implant will be seen in the 3D CT scan.

2) The only relevance of having a chin implant in place and still having the chin deficiency you have is that it is possible you may be better served by removing the chin implant and getting a combined sliding genioplasty and custom jawline implant. This would depend on how dimensionally deficient your actual real chin is and what projection/length you want from this new total jawline augmentation effort.

3) Once I receive a 3D CT scan of your face I will be in a better position comment on whether #2 is the needed approach or not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can I have an idea of the material you use in custom facial implants and how effective it can last when you move and sleep for example. Do you still feel normally with your face like before that. Thank you so much.

A: A variety of different materials can be used for custom facial implants but solid silicone is the most common and versatile. Such materials are permanent and can never degrade or breakdown. Like your normal bone they are unaffected by facial movement or sleeping positions. One’s face will feel normal once one has recovered from the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My pubic bone protrudes by about an inch instead of lying flat against my body (I am certain this issue is due to the bone rather than an overly fatty mons pubis as I am slim and cannot feel much fat there). I find this very unflattering and feel reluctant to wear swimsuits and leggings. Is there any way to safely reduce the size of this bone? Perhaps through bone shaving? Or through reducing the length of the bones that lead to the pubic symphysis? Could this have any adverse effects on sex or pregnancy? I know of many other women through online forums who share this issue and know that a monsplasty would not make a difference. I have attached a picture of someone else’s. Mine is larger. 

A: The height of the pubic bone is the pubic symphysis, an actual joint between the two pelvis bones. The height of its protrusion is consistent in women with being at the level of the clitoris. While this union of the two pelvic bones may indeed be a primary source of your protruding mons it can not be surgically reduced. Besides having numerous suspensory ligaments attached to it, maintenance of the joint surface are essential for weight transfer while walking for example. Thus the only mons reduction procedure you can do is small cannula liposuction which, while not creating a perfectly flat mons profile, does always make a difference of at least 50% of its projection in my experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a bulging temporal artery and my vascular surgeon has performed a ligation on it. (two incisions) However the artery began to bulge a few days after the operation. Do you have any advice for a second ligation that would be more effective? I have provided a picture as well. Please, any info is greatly appreciated. This thing is killing my self-esteem. 

Thank you for your time.

A: What you learn in temporal artery ligations is that two ligation points is insufficient.  While that seems like it would be effective (cut off the front and back flow) it never is. You have to go out further along its course and get several other ligation points as there are more vessels that feed into it that it appears with its superficial location. It would also be interesting to know the exact two locations where it has been ligated which is not obvious in your picture.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read your description of iliac crest reduction surgery with great interest. I am a 40 year old male with distinct protrusion of this part of the pelvic bone. If I understand the description correctly, it can be possible to reduce this part of the bone by surgery. I would like to know more about this possibility, and if this is a procedure you have done.

A: I have harvested many iliac crest bone grafts so the anatomy I know quite well. Thus it is possible to reduce the widest flare (width) of the iliac crest for aesthetic purposes although I have yet to do so.

Dr. Barry Eppley

Indianapolis, Indiana