Your Questions
Your Questions
Q: Dr. Eppley, I have a dent on the left side of my head, as a result of a head operation a year ago and the skull has been installed, but I have a small dent on the left side because my head muscles have shrunk, can the dent be repaired?
A:This is a classic indentation from temporal muscle atrophy after a craniotomy. The muscle volume has been lost as the muscle has shrunken down after being elevated to do the bone flap. And even though the muscle was resuspended the muscle shrinks because its point of bony origin has been disrupted. Because the muscle has shrunk its size/volume can not be augmented. It now requires an implant to be paced on top of the muscle under the scalp to fix the temporal concavity. There are numerous implant material to do so. The implant footprint would probably look similar to the attached diagram with 5 to 6mms thickness.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My current chin implant is a size medium, and does have wings. My main concern when I got it was to not look jowly, and for a more even look.. it is rounded- unisex, which I’m not sure why he picked medium or unisex?? I included pictures in the inquiry, but here are more.
A:He picked it because he was not thinking of any of those issues. Some surgeons tend to use one implant style for all patients. You are assuming most surgeons are artists….that is a generous assumption. Most are technicians robotically doing the same style implant for everyone. Hopefully what the patient needs is what the surgeon likes or knows how to do.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I was wondering if you do surgery to enlarge your tongue?
A:I do not. I am not even sure how it would be done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I get a rhinoplasty at the same time as my cheek and jaw implant surgery? Or is it too much surgery at one time?
A: It is not rare for a patient to have rhinoplasty with their cheek and jaw implant augmentations. The question is not whether it can be done but whether the patient wants to do it.It is done for the obvouis reason…convenience and efficiency.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanted to know Dr Eppley’s thoughts on whether or not I can get fillers first to see what projection increase is more desirable for me. Since this is going to be a revision chin surgery I want it to be done once and I don’t have to second guess what I want. Can you let me know if this is something that doesn’t interfere in his way of the revision. Having considered that I will get the fillers that last the least amount of time. So we don’t have to postpone the surgery too far in the future from now
A: There is certainly no harm to ‘test’ chin augmentation using injectable fillers. While it is not necessarily a 1:1 correlation between the effect of fillers in the chin soft tissues and the effect of an implant on the chin bone there is no adverse effect by doing so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello doctor I wanted to ask you how much does the procedure for correcting a flat head cost and what is required for this how long does the operation and recovery take?
A: You are referring to a back of the head custom skull implant. This implant is made from a 3D skull CT scan that the patient obtains where they live.
The operation for skull implant placement is 90 minutes done under general anesthesia. Recovery is largely about swelling which takes 10 to 14 days to significantly resolve.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello! hen I was born my mother said that my head was not fully formed and that she used to put pillows around my head. I didn’t put much attention to it then since I was a boy and didn’t pay attention to my looks. When I see my head today from different angels it looks different (according to me) on the each side. I wonder what the cause to that could be since my head a couple years ago looked normal from all sides. I will drop some pictures below. A pic for left and a pic for right side, and finally a pic of me when I was younger. Is it all in my head or is there actually a change in my head and if so what is the cause/what can be done to fix it?
A: It is difficult in pictures to say what differences exist in head shape between the two sides and I certainly can not say what exists today is different from years ago. The definitive answer about any head shape concerns can be definitely answered by a 3D CT skull scan which will remove all speculation about what its shape is.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, Dr. Eppley. I had a sliding genioplasty of 5mm forward 8 weeks ago. My face was already long, which I remarked to the surgeon many times, Now my face looks so much longer and I honestly hate the result and wasn’t what I expected at all. A) Is the length of my face going to decrease significantly from here? B) If I decide to move forward with a reversal, is there always laxity, fullness and damage to the soft tissue (I’m only 24 years old)? C) One of my problems is that my lip became thin, is a reversal going to make the lip worse or spoil any chances of the lip getting back to its normal size? Thank you so much, Doctor.
A: In answer to your postop sliding geniopalsty questions:
- At 8 weeks after surgery what you are now seeing is 90% plus what the final result will be.
- There is a risk of soft tissue laxity if the sliding genioplasty is fully reversed. Subtotal reversal will lessen that risk.
- Sliding genioplasty reversal is unlikely to make the lip any thinner….but it will also not make it any thicker.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q:Dr. Eppley My testicles have shrunk as I was put on testosterone in my 20’s but into has caused major shrinkage. Im now 65. They are like raisins.. Can you leave them intact and install 2 prosthetic implants below the original instead? Average cost? Id prefer not to use free floating medical grade silicone injections. Thank you
A: With very small testicles the side by side testicle implant displacement technique works vey well with a low complication rate (infection) The key question is what size the testickle implants should be. For an adequate displacement effect I wood recommend at least 5.5 to 6.0cm implant sizes.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I had a sliding genioplasty and a revision done with a bigger plate at your office along with a chin implant. I am currently admitted to a hospital waiting to get clearance for an MRI but they will not proceed unless I provide them with a response from your office about the material of the plates and screws and brochure of the brand of plates and screws since MRI can seriously displace some metals.
A: All metal fixation hardware used in the face and skull today is made of titanium, a. non-ferromagnetic metal. It has been that way since MRIs became clinically used to avoid the risk of any risk of magnetic attraction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, is it possible to get a little bit of the brow bone shaven off with an endoscopic procedure with a small incision in the hairline? I see pictures of then entire scalp being lifted, or they go in via the eyelid, those look too extreme.
A: Brow bone shaving can be done through a limited scalp or hairline but not endoscopically as power instruments can not pass through an endoscopic approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 30 year old male with a 23.5″ head that looks huge for my 5’8″ body. I’m interested in reducing the frontal bossing, lowering the hairline, and having a hair transplant if it’s feasible.
A: Head circumference aside I think the primary problem is the frontal bossing which is magnified by the high hairline. This is a challenging problem in that both issues must be dealt with for an effective improvement. Unfortinately a ‘scarless’; hair transplant alone to move the frontal hairline forward will likely be be inadequate as the density of hair that can be placed and how far forward it can advanced will simply not be enough….and that leaves frontal bossing unchanged.
Normally I would be very cautious about a frontal hairline advancement in a male with a high hairline because of the obvious scar line and you never know just how much forward movement the scalp will permit. Also the greatest movement needed of the hairline is where it is most recessed (temporal hairline) so a frontal hairline advancement does not solve the hairline shape…it moves it all forward along the similar pattern that it has. But if one needs frontal bossing reduction there is no other good incisional choice to do it so that may tip the balance in favor of it for its dual benefit.
That being said my advice is:
1) I would certainly also consult with a hair transplant specialist to get their thoughts about the frontal hairline since this is not my area of expertise.
2) It is prudent to assess the frontal bossing with a 2D CT scan to measure the bone thickness to determine if adequate bony reduction can be safely done.
3) I have attached an image of what I think can be realistically achieved by a combined frontal hairline and frontal bossing reduction. (if the bone permits) The purpose of the image is not to show you exactly what the result would be. Rather it is done for the purposes of howing what I would expect the least result to be….as that should be the trigger for surgery. (not what one may ideally want as who knows if that is ever achievable)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if a hemi-coronal approach for anterior temporalis reduction leaves noticeable scarring and can be combined for a brow lift without altering hairline. (I was considering this anyway).
A:There is no question that a hemi-coronal incision provides adequate access for an anterior temporal muscle reduction. I have attached a patient who had this approach a year ago who did use that same incision for a browlift secondarily. Now he did not care about the hairline or the scar since he wears a hair piece. And you would need that incision at the frontal hairline for the browlift so the frontal hairline does not move. But the purpose of the picture is to show a similar scar on a shaved head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was asked to send details of my chin implant from 2/2023 to see if Dr. Eppley can successfully replace it. I’ve uploaded the notes.
A:What the operative report shows is that your existing chin implant is a combination small (EAC) silicone (4.5mm projection ) with a central wafer placed under it (added 2mms more projection) for a total of 6.5mm total chin projection. The question now is not whether it can be removed and replaced but what issues do you have with it and what changes to your chin augmentation result are you seeking?
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have no facial functioning problems regarding bite or any malocclusion.So it is totally aesthetic except a little sleep apnea. I want that macho handsome look.
I am interested in having a strong masculine augmentation.I do not know whether it can be done with implants or surgeries.I have a short face right from my teenage years compared to men of my age and I am 34 years. I have attached photos of models for reference purposes along with my own .I want to make it clear that I want to have an augmented version of aesthetically pleasant myself only. I did a conservative buccal fat removal surgery in 2019 and circumcision to treat my phimosis in 2020.
I feel that my masseter is very wide so a little bit of shaving along with jowl lipo, chin lipo and necklift can be tried to make my face elongated from the round shape which I have now..In addition I need to have
1. rhinoplasty to elongate my nose
2. Angular jaw
3. Malar augmentation
4. Sliding genioplasty with vertical lengthening of my chin
5. Face tightening if absolutely necessary.
Now I leave the rest to the opinion of the Doctor for suggestion and reference.I will be obliged if he provides me the right surgeries required to achieve a good harmonious masculine handsome man like what I have enclosed along with the approximate cost of the surgeries with implants if necessary.
I am eagerly looking forward to your guidance and reply please. Below attached are pictures of me from different angle and my desired photos just for reference.
A:Unfortunately I am not optimistic you can come anywhere close to your ideal pictures. Your facial tissues are very thick and bottom heavy and even with maximal soft tissue reductions the changes would be very slight…as you probably saw with your buccal lipectomies. As a general rule you can never reduce your way into a more defined facial shape unless you are very close to that initially. And adding implants to the round heavy face often just makes it bigger and more bloated in appearance.
Even with the combination of reduction and augmentation I don’t see changes that are worth the effort.
I wish I had more favorable news but it is equally important to prevent patients from putting in a lot of effort (time, money and recovery) only to find themselves disappointed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Interested in a knee lift. Do you have before and after pictures for me to review? How many of these procedures has the Dr performed?
A: I have performed enough of them to know you have to pick your patients very carefully as the scar tradeoff is another form of an aesthetic deformity. You have to be certain that the patient feels the scar is a better problem to have than the suprapatellar skin folds at the knees….which many women won’t.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to schedule a virtual consultation with Dr Eppley to ask about custom implants to fix my deep undereye hollows and lack of midface volume. I would like to hear his solution for my case.
A:Thank you for sending your pictures. You have general periorbital rim weakness/flattening which is most manifest in the infraorbital rims which is why they look so hollow. Infraorbital rim augmentation would be the best approach. (see attached imaging) The only question is whether that is best done with a custom infraorbital implant or a sheet Alloderm graft….both which can be effective. Given your young age I lean towards the latter but that is a topic up for further discussion.
But if the goal is also to have some midface volume as well then the custom midface implant is the way to go.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello ,a question regarding muscle implants can they be implanted in any visible muscle ? l await Your response Regards
A:In theory that would be correct. The only question would be implant pocket location…whether that would be on top of the fascia, subfascial, intramuscular or submuscular. That would depend on the specific muscle location
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am an adult with what I believe to be scaphocephaly that was untreated as a baby and wish to have it looked upon by a specialist that can help me I would really want this fixed for me and my future.
A:In adults I typically treat the long narrow scaphocephalic skull shape with custom head widening implants. (see attached example of the implant concept) This may also involve some bony reductions as well if aesthetically beneficial and incisional access will permit of the sagittal crest as well as the front and back of the head.
I would need to see a front and side view pictures of your head for an assessment and imaging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I underwent a frontal craniotomy due to a brain tumor, and it left a bone dent and a bulging bone part in my forehead.. What options would you recommend for surgery? And would it be possible to give an estimation of the cost? Thank you
A:Give that this was from a prior craniotomy where a large incision exists for access and there remains bone gaps in the depressed bone flap the use of hydroxyapatite bone cement to fill and smooth over the defect would be the most prudent material approach for forehead recontouring.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a few questions about webbed neck surgery:
So if I understand, the posterior approach will slightly straighten the neck?
Can you briefly describe what happens during the posterior and how long does the recovery process last?
Will it be possible to loosen the trapezius muscles with some physical therapy or kinesiotherapy?
Can the side profile be fully fixed with sliding genioplasty and a chin filler?
A:In answer to your questions;
1) The posterior approach does NOT straighten the neck. The posterior approach is used ti put the scars in a more favorable location than the side of the neck.
2) I would recommend that you visit www.exploreplasticsurgery.com and search under Webbed Neck surgery where you read and see that posterior approach to fully understand it.
3) The trapezius muscles can NOT be surgically loosened.
4) The chin position can be fully corrected in side profile and illustrated in the prior imaging. The amount of chin augmentation shown was just one potential type of change, more or less can also be done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m hoping to get a more full shape with some outward volume as well. Fitting for my size and shape but significantly more than the flat bottom I’ve always had.
A:Thank you for sending your pictures. Your buttocks has a two-fold tissue issue…lack of volume and lower buttock sag or ptosis. While the volume of implant will certainly be helpful in filling out the upper and mid-buttock areas, and will help pick up loose skin in those areas, it is not going to lift up the lower third of the buttocks or get rid of the lower buttock tissue sag. (see attached diagram) That can only be corrected with a lower buttock excision/tuck/lift. The question in that regard is whether the lower buttock sag excision correction should be done at the same time as the buttock implants. From an efficiency/convenience standpoint yes. But from a recovery/scarring standpoint maybe no?? An issue that merits further discussion.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Are the legs and thigh muscle implants customized?
A:While there are standard calf implants available, thigh implants have to be custom made.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I hope this finds you well. I have come across your impressive work and have a question. I am due to have BSSO here in Europe in a couple of months (I’m having the orthodontic work done now). I wondered is this surgery will preclude me from having jaw angle implants at your clinic in the future? Would the hardware relating to the BSSO get in the way?
A:The hardware from the jaw surgery will not pose a problem. Nearly one-third of all jaw augmentation patients have had prior jaw surgery with indwelling hardware present.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello , would you be able to give me an idea what it would cost for back , top and forehead implants, and if for example you would be able to to 2 of those during the same surgery and the other later ( assuming all 3 at the same time wouldn’t work )
A:When large skull augmentations are being considered the typical goal, if the overall augmentations are to be connected which I assume would be the case for back, top and forehead augmentations, would be to place them all at once as a single connected and smooth augmentation. To do so in most patients requires a first stage scalp expander as almost no scalp can take the volumetric expansion in large skull augmentations at once.
How all of that applies to I can not yet say as I would need to see some head pictures and do some skull augmentation imaging to have a cleat understanding as to your exact head augmentation goals.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m 6 weeks post op and my lower lip is contracted. If I get a reversal now can I get my lower lip back? My mouth looks downturned and aged. When would be the limit of time to get a reversal and get my lower lip back? My face looks so long. Please help.
A:I don’t know what amount of bony movements were done in your sliding genioplasty and, while it can certainly be reversed, that is not a guarantee that the soft tissue changes of the lip and mouth will be restored. (they might but no one can say for sure) The only reversal change that would almost certainly be restored is the decrease in vertical height and projection.
The key decision on timing to do so is not about the bone healing but about the certainty that the patient wants to do so based on knowing the true final results…which is not fully evident until 3 months after the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, one of your previous patients referred me for your cat eye surgery. Is it correct that you do this or is it called a “brow lift” on your website? I am very interested. I am also interested in upper eyelid surgery (removal of skin), can these two surgeries be done together? Or is it not recommended
I’m unsure if I need an upper eyelid surgery or brow lift. Maybe both
A: Cat Eye surgery is an exaggerated form of browlifting with emphasis on a significant upward sweep to the temporal or outer half of the eyebrow. In some cases that may also involve a lateral canthoplasty so that the outer corner of the eye has an uplifted appearance as well. By looking at your rounder lower eyelid with scleral show the need for the lateral canthoplasty likely applies.
With nthe uplifted tail of the browlift most patients will not need upper eyelid skin removal. Not that it can not be done together but the browlift may obviate the need to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can my frontal bossing be fixed?
A:Your frontal bossing reduction poses two challenges: 1) how much frontal bone can be safely reduced and 2) where would the incision be placed to do so that would be aesthetically acceptable. #1 requires a CT scan to measure the thickness of the frontal bone from which then I could show you on your pictures what the reduction would likely create. (full or incomplete reduction) To have adequate access to do the procedure, if an adequate result can be obtained, is a challenge in a shaved or bald male. I am mot sure there is a truly great place for the incision but a forehead wrinkle is probably the safest aesthetic choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is the scalp expansion only something that’s needed in the event that all 3 areas are done during a single surgery? If you were to do 2 doing one and the third at a later date … or one at a time, would you need the scalp expansion? Thanks again!
A: Scalp expansion is usually needed when the volume of the implants exceeds 150ccs. Sequentially putting in skull implants does not help that that problem as each implant ‘steals’ scalp for its augmentation effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am 25 years old, my IPD is about 6.5mm, and my ICD is 37mm. This is the average value corresponding to the Korean average of 34mm~37mm. However, as you know, I am Asian, so I have Mongolian folds, which are characteristic of Northern Asians, and unlike Westerners, my inner canthus is covered by skin, which makes my eyes look stuffy. That is why inner canthal surgery is often performed in Korea. However, I need to excise my outer canthus to reveal more than 2mm of my inner canthus on both sides, which makes my ICD look extremely crowded, which is less than 3.3mm… But I heard that you are very famous on Google. But I am worried because 360-degree orbital box fracture is so invasive. But I am asking you because I think you are familiar with lower orbital box fracture. Are there any restrictions on the surgery? I think you don’t have to worry about scars because you are Asian and your dermis layer is so thick. I think it would be enough if my IPD and ICD increased by more than 5mm. If you are able to have surgery or are willing to do it well, I would really like to get it done right away. I am so stressed.In Korea, Lefort 1 is widely performed. However, some surgeons do not accept Lefort 2 or higher surgeries, and some have already retired. I feel like this surgery will be my last hope… Thank you for reading
A: The key question is not whether inferior orbital box osteotomes can be done but whether they could really increase your IPD by more than 5mms. That may or may not occur but what I do know is that it will definitely not increase the ICD by that amount if at all as the problem does not include the medial orbital wall. (only a 360 orbital box osteotomies does which is more invasive than you should undergo)
Dr. Barry Eppley
World-Renowned Plastic Surgery
