Your Questions

Q: Dr. Eppley, I think I have a short face syndrome. How can I treat it, I’ve turned 19 recently and I am thinking about getting a surgery in 2-3 years, cause I feel pretty bad having this short chin, also my face doesn’t look harmonious at all because of this, What surgery would you reccomend Dr Eppley? I attach 2 pics, side and front, I would be very happy with your reply, cause I know I want a surgery, but I’m not sure what surgery would that be.

A:With your very short lower third of the face and flat mandibular plane angle you would need either a chin wing osteotomy or custom jawline implant. Either one will differentially vertically lengthen the entire jawline, greatest at the chin and less so as it proceeds back to the jaw angles. Such a treatment approach presumes that orthognathic surgery is not an option. (which I can not say just based on your external facial pictures)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Here are two more chin surgery questions:

1. My chin is deviated 2mm to the left (as indicated on CT scan). I take it that can only be corrected via an SG reversal and not by burring with a submental approach?

2. Could you explain a little more why reversing the SG (in whole or in part) will be more effective here for correcting the ptosis than a submental tuck w/jaw implants? Your writings seem to suggest that the submental approach is more effective – or that sometimes both are needed simultaneously.

Thanks again for answering my numerous questions.

A:In answer to your sliding genioplasty questions:

1) An inferior border burring approach can be used to correct a chin asymmetry.

2) The submental approach is always more effective than any intraoral approach because it better manages the soft tissue redundancy/ptosis. But that also depends on the degree of chin ptosis that exists.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I have a question about scalp advancement/forehead reduction procedures in men. I know most of the time these procedures are down with a trichophytic hairline incision and generally they heal very well. If a man (in this case me, I’m a 30 year old guy) and as I got older my hairline were to recede a bit, would this scar be very noticeable or does it generally blend well?

A: The long-term fate of a frontal hairline incision in a young male is a good question to which the answer is not one of which I know. I have done plenty of hairline incisions in young men and have yet to see a hairline recession later. This does not mean that it can not happen, just that I have not yet seen it. I would speculate that the scar line should this occur will not just ‘blend in’ and be invisible however.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a tall, narrow skull, which as a man is an aesthetic death-sentence. Women want a short, compact so-called “warrior skull” with the facial bones developed and forward-projected while maintaining overall facial harmony, along with a flat occiput and skullcap. 

Question: Is there a way to significantly reduce the size of my neurocranium? 

Because the two factors causing my tall and narrow skull are my long midface (vertical maxillary excess) and large neurocranium.

A: The skull can certainly be reduced in height. Whether one would view how much safe height reduction is allowable by the bone thickness (7mms) is the relevant aesthetic question.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I saw a case on your site the Ligation for Prominent Pulsations. The Dr stated that you wouldn’t see the full results until months later. I was wondering if the surgery helped this patient? 

Thank you

A: In the treatment of prominent pulsations of facial arteries (most commonlhy the temporal artery) by facial artery ligation the elimination of the pulsations must occur immediately at the conclusion of the procedure. The definitive test of a permanent result is months later to be certain some of the pulsations has not recurred from an unseen feeding vessel into the artery. You likely misintepreted judging the long term outcome for the immediate one.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, so about 2-3 years ago I was dating this guy and very long story short he punched me in the face and fractured my left cheekbone. I never got a surgeon to look at it because honestly I’m super broke. I mean I have money for small payments but I definitely don’t have thousands to spend. I guess I’m really wondering how much exactly is costs? It’s just been bothering me a lot recently and if I can save up the money to come to you to get it fixed I would love that. So how much would I be looking at do you think? Also idk if you can tell in the picture but I tried to point out where it was fractured. Sometimes my jaw gets stuck or pops weird and honestly I’m just really self conscious about it and I wanna put that part of my life behind me.

A: Thank you for your inquiry and sending your picture. What you have is the classic zygomatic arch fracture, a unique but well known type of cheekbone fracture. This is where the arch of the bone is broken and the two ends stick inward (like a bridge pushed inward at the middle of its span), creating an external contour depression over the arch as well as the ends of the broken bone sticking into the masseter muscle. (which is why your jaw gets stuck when trying to open) Int the treatment of acute zygomatic arch fractures the displaced bone is pushed back outward through a minimal invasive surgery. (Gilles approach) For a long term displaced zygomatic arch fracture this would probably not be successful in keeping the bone pushed back into place but it may get the bone stuck into the muscle out of the way improving the jaw sticking. For the contour deformity I would then just injection fat graft it at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would like lip implants and corners of mouth to have less frown. Can both procedures be done at the same time?If I’m a good candidate please quote me a price and how long it usually takes to get scheduled. Thank you.

A: Thank you for your inquiry and sending your picture. Lip augmentation and corner of the mouth lifts can be done concurrently under light IV sedation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in breast augmentation and a few other procedures. I’ve done some research and it seems as if the Revolve system provides the longest lasting results. Is that something you do??

A: There are numerous specific systems and many ‘by hand’ fat preparation methods for concentrating fat for injection. Resolve is one of the commercial preparation systems and I have used it many times. There is no real prospective data on any of these preparation methods as determining fat graft survival is a multifactorial issue of which preparation is just one variable. So to say Resolve produces the longest lasting results in fat grafting is not clinical data that would be supported by most plastic surgeons.

Any time there are dozens of different ways to do the same thing, with many vocal proponents that their way is the best, that is a sure sign that there is no one best proven way to do it. Nowhere is this more evident in plastic that with injectable fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I find your articles very informative and interesting to read .I am wondering what is your opinion on the use of PEEK for infraorbital rim augmentation? Best wishes.

A: PEEK material is just fine for infraorbital rim augmentation. It is matter of the patient’s choice as well as the cost of the material and the ability to get it positioned properly based on the size of the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My surgeon has ordered x-rays, and the radiology clinic will call me next week to schedule those. I wasn’t going to bother you again, but I won’t get a second consultation with him (or really a way to communicate directly with him) until after he has the x-rays, and there’s a question that is causing me to worry and lose sleep. This implant is held by a single screw in the very center of the chin, and it is oriented upward about 30 degrees which should make it very accessible for an intra-oral incision.. However, it is much larger than the screws that normally appear to be used with chin implants. From an older x-ray which I have this screw is estimated to be 17 mm long – about 6 mm through the plastic and 11 mm into the jawbone (no kidding). Will this size make it easier or more difficult to remove the screw? Will the bone recover and refill with this size screw? Changes in the bone have caused the implant to become uncomfortable, and I particularly feel pressure around that screw, so I definitely want it out. So I really want to know if that screw will be an impediment to removal.

Thank you again so much.

A: While such a screw length into the bone was completely unnecessary for implant fixation, its removal should be successful as long as the screw head has not been stripped. But even if it has it can usually be removed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read some news about the use of the “fat grafting” technique to increase the height.  Basically, there would be fat injections under the heels. I wonder if you find it a good idea and a valid and lasting method to increase height by inches. I am doubtful about the lifetime stay in that area, that is from what I read ( but you will be able to give me the exact answer ),your own fat worked with stem cells, is not a permanent method for injections. Lipofilling would last less than fillers but above all, there is another doubt. Injecting fat under the heels will it bring problems to the foot and posture or even just to walk normally ? Let’s say that motor functions and heavy exertions are limited by these lipofilling to the heels. 

I don’t know, what do you think Dr. Eppley ? Do you find it valid?

A: The only established method for height increase is distraction lower limb lengthening. Fat is a soft material whose retention would be very poor in high weight-bearing areas. It would be hard to imagine that fat injections into the heels would be a successful heightening procedure. I do not find this concept a valid method for any heightening effect at all.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I suppose this is an artery on my temple extending up into the forehead.. It pulsates the entire length of the bulge. Can it be removed? Thank you

A: Thank you for your inquiry and sending your picture of your prominent anterior branch of the superficial temporal artery. Admittedly, even in my extensive experience with his problem, I have never seen one that big and prominent. This is treated by multiple point ligations to shut off the flow into it. It is not treated by excision as the frontal branch of the facial nerve runs in proximity to it with a high risk of permanent paralysis of eyebrow movement if total excision of the artery was undertaken.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in knowing more about dermal fat graft for coccydynia.

A: Thank you for your inquiry. The use of a dermal fat graft for coccygeal coverage is done to provide additional padding to reduce its prominence and discomfort due ti lack of adequate soft tissue coverage. It may or or may be combined with a modest bit of coccygeal bone reduction. The graft is usually harvested from the lower abdomen although it could be taken from many other body areas as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wonder if I could call upon your unique expertise one more time. I have found a plastic surgeon locally who is willing to remove my chin implant. He believes it may be a Medpor after all but won’t know for sure until he gets in there. I would prefer that another implant not be placed right away, and the chin be left “empty.” I tried to search online for photos of people who had had implants removed and not replaced, but there’s really nothing out there. My questions are: 1) what is this likely to look like – will the chin be droopy or have excess skin?; and 2) will the tissues fill in and the pocket tighten up so that a future implant (smaller, silicone, and a different shape) will fit relatively securely?

I value your opinion as I just don’t know how much experience other doctors have with this type of situation.

A: It would be safe to assume that the soft tissue chin pad will be somewhat droopy after chin implant removal. It is not a question of whether a soft tissue sag will occur, only in its aesthetic magnitude. Thus a submental tuck type technique would be beneficial. There is no future problems with chin implant replacement provided it is secured by screw fixation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a tall neurocranium (the upper third of my face is too big/tall compared to my lower and middle third), this results in a tall and narrow skull which, for males, isn’t sexually dimorphic thus not attractive. I want a more compact, “shorter” skull, so to speak. 

Is it possible to somehow reduce the size of the neurocranium AND/OR make the skullcap completely flat (which is a desired trait in men)? The most important part of this question is the FIRST PART (“Is it possible to somehow reduce the size of the neurocranium?”). 

Even if I fix my lower third and middle third with osteotomies followed by implants, my tall neurocranium will ruin my facial aesthetics.

A:I would say that a flatter top pf the head is more possible than a substantial size reduction as the skull which  will usually only allow a 7 to 8mm  reduction of the outer cortical bone layer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had a bony ridge in my forehead every since my youth. It’s visibility fluctuates with how much weight is on my face. I don’t mind the ridge that much though sometimes in photos you can see it. There are 2 protruding elements and a depression in the middle. However, when I lost alot of weight the bony ridges are painful. Sometimes it feels like the bone is pushing into my skin (especially when dehydrated during physical activity). Is there anyway to shave that ridge down a bit? It also protrudes more when I lose weight. 

A: Such an upper bony ridge of the forehead is not rare and can be effectively reduced by a bone burring technique through a hairline incision. (forehead reduction) I suspect it protrudes a bit more when you lose weight because the overlying soft tissues becomes a bit thinner.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my right occipital bone is a little bigger than left, maybe 4mm I think. It doesn’t bother me that much but when I think about this I feel “sad”. My head otherwise is round and overall good. My right back is but a little bit back. I don’t want to use a 3D Implant, its possible with a drill to make it round? Because I have afraid of using a 3D Implant and not getting a “normal life”, and if happens something in the future with the 3D Implant? Thank you!

A: Leaving the misconception of the long term effects of skull implants aside, whether a reduction on the bigger right occipital side (occipital reduction) may suffice to make it rounder I can not say without seeing pictures. But as a general statement usually reducing the bigger occipital skull side is not enough to make it more round in most cases. If the true difference between the two sides was 4mms it may. But often if the head shape difference between the two sides is noticeable on the outside it is bigger than it looks on the inside. Only a 3D skull CT scan can provide a definitive answer to the actual bony thickness differences between the two sides.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley ,I’m considering getting jaw angle implants. Looking at images of jaw angle implants on the internet, I noted from some images that the jaw angles seem to flare out.  Then I came across your website. When a woman has jaw angle augmentation, are the bottom of the jaw angles suppose to flare out ?                

Perhaps this is natural ? When you have jaw angle augmentation, the bottom of angles flare out?

Questions:

1. Are jaw angle implants suppose to flare out? Is this natural? (see attached image) 

2. On the other hand, would it be strange or look strange ( unnatural) to only increase the height of the jaw angle implants?

Kind regards,

A: Thank you for your inquiry and sending the jaw angle implant design images to which I can say the following;

1) The desired end result in any jaw angle patient is determined by preoperative imaging of the patient’s pictures. An implant design is created from what is believed to be the desired aesthetic result as seen in the picture imaging.

2) While most women need more vertical lengthening than width, that must be determined on an individual basis.

3) One can not determine from just an implant design whether that is aesthetically appropriate for particular patient.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to ask you about my options. I had done midface augmentations with injectable PMMA. 

The infraorbital area looks a bit empty and I am not happy with results. I choose PMMA because I lost of facial fat by bad diet. 

I am planning to take procedure to downsize tissue created by PMMA. Only the soft tissue has been filled with PMMA. No medical complications with PMMA, only poor results. 

Is it  possible to augment my midface area with infraorbital rim by custom infraorbital-cheek silicone / medpor implants? 

If it is possible how many months I will have to wait from liposuctions of PMMA.

A: Thank you for your inquiry and sending your information. There is no problem with using bone-based implants (custom infraorbital-malar implants) with any form of injectable filler in the overlying soft tissues. I would wait three months after the last injectable filler treatment so you have a good idea of your actual residual facial contour appearance is.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, I have a question about your clavicle lengthening procedure. I would like to know how long it takes for both clavicles to heal after the procedure and if it is possible to operate both clavicles at the same time or do you need to treat one clavicle at a time? Thank you.

A: Unlike clavicle reduction osteotomies where direct end to end viable bone is put back together, clavicle lengthening requiring an interpositional bone graft. This requires 2X the healing time for bone to grow through the graft which is 3 months instead of 6 weeks.

Your question is an interesting one in that should one or both clavicles be operated on at the same time. While recovery is certainly lengthened by bilateral surgery, having to harvest a fibular bone graft provides an argument to do both shoulders at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I had very hollow under eyes and underwent a lower bleph with fat repositioning but still not happy with my under eyes. I’ve looked into orbital rim implants and read on a forum from one of your past patients that he had orbital rim implants with you and it filled the hollow and lifted the lower lid slightly. This is exactly what I’m hoping for, it’s mostly the outer part of my under eye that is hollow and lacks projection and I’d like my lower lid lifted somewhat. I’ve attached some pictures that show what I’m hoping to improve. Thanks!

A:Thank you for your inquiry and sending your pictures. I would not have expected any efforts at lower eyelid fat transposition to solve under eye hollows. In an already fat deficient area simply moving what already exists is not going to provide any real volumetric improvement. You are correct in that infraorbital implants are the only method that can reliably improve the hollow undereye areas. But standard infraorbital implants (tear troughs) are not going to work as they only provide limited horizontal augmentation and not any vertical height increase which is the key in improving undereye hollows. This requires a custom infraorbital implant approach to address both the correct augmentation dimensions needed as well as have it fit your specific bony anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Ten years ago I had a lost 130 pounds. I subsequently regained 40. I now weigh 185 lbs. My chest circumference is 40 inches yet my hips are roughly 32 inches. I had tummy tuck with liposuction about 4+ years ago and I have significant gouging in my left flank. What would be the best procedure to reduce my upper abdomen/ chest area and improve my overall appearance.

A:Thank you for your inquiry and sending all of your pictures. In looking at your goals of chest and upper abdominal reduction your options are:

1) I would take advantage of your prior midline abdominal scar line and do liposuction and further vertical excision of abdominal tissues to reduce the entire abdominal width. (aka vertical tummy tuck) In the original fleur-de-lis 360 degree tummy tuck you had the area of least reduction is in the abdominal areas above the belly button.There is always more tissue to be secondarily removed vertically.

2) The chest area is more challenging but getting the breasts more lifted and medially located with lateral chest wall excision of excess tissue would be of benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I have a question I’m 4’11 and 98 lbs and I’m a 32B but I want to get high profile, round shape and smoothed surfaced 34DD silicone gummy bear breast implants. Is this size too big for me? I’m trying to achieve a full figure with cleavage enough for myself to notice it. Also will implants sag if I breastfeed with them? Thank you and God bless. 

A:Thank you for your inquiry and sending your picture. The perception of breast size is a relative concept. It is not a question of what anyone else thinks about a patient’s chosen size, it is what the patient thinks looks good to them. So whatever volume it takes to achieve the size you think looks good is what is the correct size. That is the value of volumetric sizers, it allows the patient to pick a size based on volume (not bra size) they like. Breast implants will not interfere with breast feeding.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, after having read so much and so good about you as a surgeon, I decided to write to you, first of all to see if you can give me your opinion. I had two facial lipofillings, the first one had a great result and I had a success that I had never experienced before, but it was low enough and the surgeon told me to repeat it. in the second lipofilling I now have excess retained fat especially in the area under the cheekbone, in what is the transition under the cheekbone, which makes a cheekbone too big. 

Can the injections of Kybella work? I have photos of myself with a good result, I am very clear where there is excess fat and where it is necessary to lower that excess fat but I do not know if it is possible to do so with Kybella after lipofilling, I do not know. If you could have 3-4 treatments and it took 6 months in total, you would give me one of the best news in the world. I would show you the photos where I have been successful and show you how I am now, I am 34 years old, I don’t know if that works against me. Once again, thank you very much.

A: Thank you for your inquiry and detailing your facial fat transfer concerns. I would certainly agree that the safest thing to do is Kybella injections. No one can say for sure how well they would work in submalar fat transfer reduction but their downside (limited result) is a far better one than the risk of overcorrection. The fact that they are done in a series helps better gauge and control their effects.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in facial feminization surgery of which I would like to start with cheek augmentation surgery first. Based on what I have seen of off the shelf cheek implants I know I would need custom cheek implants to achieve the midface look I am seeking. I have attached pictures and videos to show what I would like to achieve for my cheek augmentation.

A: Thank you for your inquiry, sending your picture and videos and very thoughtful commentary to your approach to facial feminization surgery. Choosing one or two procedures at a time is a very appropriate way to approach it because it makes you feel comfortable. Some prefer to dive into the pool so to speak while others wade in from the shallow end…it is all about what makes the patient feel comfortable.

You have made your cheek augmentation goals very clear and the only question is what is the best way to achieve them, meaning what I call a custom or semi-custom cheek implant approach. You have correctly surmised that no form of a standard cheek implant is going to achieve your goals. A custom cheek implant approach is when a 3D CT scan of the patients is used to create a very specific design. A semi-custom approach is when I go to my library of cheek implant designs (other patient’s custom designs) and print off one of them that I feel has a good chance to achieve your goals. The cheekbone and arch is not structurally that complex so if the patient so chooses that can be a good option. I would also agree that a buccal lipectomy with the cheek implant is a good complementary procedure as the two work synergistically to create the most significant change which is what you appear to be seeking. Whether one combines that with a rhinoplasty is merely a matter of opportunistic choice.

I have attached a model example of what you are seeking probably a bit more than that) and an example of the cheek implant style that it takes to achieve it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was searching for a method how to be taller, and i found your website. It says in your hospital you do silicone head implant to grow taller. I would really like to be 5cm taller. I was thinking about Ilizarov limb lengthening but it would be too risky. I would like to do the surgery to boost my self confidence and for my job.

Please help me

A: Thank you for your inquiry. Limb lengthening by distraction is the definitive way to gain 5cms in height. A custom skull implant, due to the limitations of scalp stretch, can only make you taller by about 2cms at most.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, have a 3 year old daughter who was diagnosed as an infant with torticollis. She developed severe brachycephaly as a result. We helmeted her for over 6 months but achieved minimal results. Her head remains quite wide, flat across the back and her forehead protrudes. As a mother who has lost countless hours of sleep stricken with guilt about what I could’ve done differently, I’m at the point where I’m trying to figure out what her options might be later in life. I see some really promising before and after photos on your site of adults you have treated. What age would you say the youngest patients arrive at your office? Teenagers? Clearly we would be a ways away, but I would love some perspective on what I might be able to tell her when she grows up and realizes her head is a really strange shape. Thank you for your time!

A: The aesthetic correction of head shape abnormalities through onlay augmentations and/or bone reductions (skull reshaping surgery) is not done until at least the teenage years when the skull is more grown and the bone is thicker.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been dissatisfied with my lower third for years. Specific concerns include an undefined jawline, deep nasiolabal folds, lip incompetence, mentalis muscle strain when I try to close my mouth, and a slight overbite. I also have non-cosmetic issues like chronic snoring. Recently, I’ve realized many of my issues may be due to a weak/short chin. I like the idea of a genioplasty for my chin because while I would like to improve its projection and slightly reduce its vertical height, I do not want to change my appearance drastically or look like someone else; my goal is simply to improve my overall facial harmony and address structural issues. Based on this and my photos, would I be a good candidate for sliding genioplasty?

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

1) You are a good candidate for a sliding genioplasty to which you have addressed the correct dimensions…forward and shorter.

2) How much forward and shorter is open to discussion. But, as a general rule, the real aesthetic risk is in too much forward projection in women. It is usually important to keep a more retroclined profile chin position from the nasal tip and lips. (see attached)

3) Given the amount of chin bone movement I would not expect any improvement in your snoring. It usually takes 10 to 12mms of bony chin advancement for that to occur.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have facial implants that goes around my entire jawline, cheek and paranasal implants, Goretex material. I thought this would fix my problem but turns out orthognathic surgery (Bimax) is what I should have done.

I have now consulted with a maxillofacial surgeon and he said that it was best was to remove all the implants and around 6 months later do the bimaxillary surgery.

The reason is because he can’t give an accurate image of what I would look like with the implants in my face. He has not removed Gore Tex material before but has worked with Medpor.

My question is, what are the risks and complications of removing goretex implants and especially by some who has not done it before with that material?

A: Removing ePTFE implants is very similar to that of Medpor. There will just be a lot more of them in your face.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a black male considering a chin implant. I am Fitzpatrick skin type V/5. I am told the submental incision route for placing the implant is best but I am quite worried about scarring on my more melanated skin. I can’t seem to find any images of a submental scar on darker skin that has healed. Do you know where I might find this? I see lots of examples of caucasian incisions that have healed beautifully but I am skeptical about how camouflaged the scarring will be on darker skin. 

Thanks a lot.

A: I have never seen adverse scarring in darker skin pigments such as Fitzpatrick 5 from a submental skin incision for a chin implant. In reality the greatest concern for reactive scarring is in the intermediate skin pigments not on either ends of the Fitzpatrick scale. But even in these risker intermediate skin pigments even they do fairly well.

Dr. Barry Eppley

Indianapolis, Indiana