Your Questions
Your Questions
Q: Dr. Eppley, Do you have female patients trim hair before placing skull implants?
A: No, I never trim/shave any hair in aesthetic skull reshaping surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m dissatisfied with how asymmetrical and long my face appears. For asymmetry, I’m unsure if I’m supposed to reduce one side, enlarge one side, or a combination of both. For length, I was thinking that increasing volume of midface may help but I’m truly just guessing.
A:Thank you for your inquiry and sending your pictures. You have multiple facial issues which primarily are that of disproportions and asymmetry. You are correct in that your face is vertically long which is magnified by lack of midface projection. The lack of midface projection contributes more to your facial disproportion then the vertical length. But in improving the disproportion midface augmentation provides the best benefits. (see attached imaging) for some vertical chin reduction but this is primarily for the purposes of asymmetry correction. Suffice it to say dimensionally you can augment the midface much more then you can vertically shorten your face.
Your facial asymmetry is localized to that of the lower jaw and the reality is that the longer chin/jaw on the right side is the more ideal location by reduction for asymmetry in improvement. However during a limited reduction along the inferior border from in front of the jaw angles to the chin is very difficult to do with a great degree of precision. While V line surgery is commonly done this is a much more aggressive type of bone removal with the wrong shape to it to be successful in your case. It would also magnify your already vertically long face with elevation of the jaw angle. So while reduction of the longer right jaw seemsx appropriate it comes with its own set of aesthetic problems. Thus it is more predictable to look at augmenting the left jawline, leveling out the longer right chin and anterior jawline and trying to match the two jaw angles. (see attached imaging) Trying to determine exactly what needs to be done based on your pictures is an incomplete assessment and ultimately the 3-D CT facial scan is going to provide better information as to how improve jaw asymmetry as well as its overall shape.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I’m interested in structural facial surgery to improve projection, balance, and aesthetic harmony.
I’ve read about your expertise in jaw, midface, and orbital augmentation.
I would appreciate your professional opinion on whether my facial structure qualifies for such procedures.
I’m ready to send photos and any details you might need.
Thank you very much for your time.
A: Thank you for your inquiry and sending your pictures. Based on your inquiry you were trying to determine what structural facial chnagers may be beneficial. In making an initial determination you have to look at the three facial thirds, the jawline (lower 1/3) , midface (middle 1/3) and the forehead (upper 1/3), and play around with imaging tools to make some changes to look at their potential impact on improving your facial structure. In that regard I have done so in the attached imaging. These are not meant to be exact surgical resulfs rather they are more conceptual.
The question is never whether one can alter all three of the facial thirds. It is more a question of what facial third changes has the best value and how much effort does one want to put into the extent of the structural changes. In other words in each patient not all facial third changes are equal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a healthy male in my mid-to-late 20s who is seriously interested in undergoing aesthetic skull augmentation, specifically a 360-degree custom cranial implant to increase my overall head circumference and improve cranial aesthetics.
I’ve done extensive research and understand that you’re one of the few surgeons globally with deep experience in custom cranial implants for cosmetic purposes. I’m reaching out to request a consultation regarding the possibility of increasing my skull size by approximately 2–3 inches in circumference using a comprehensive implant approach — covering the occipital, temporal, parietal, and crown regions.
My current skull circumference is approximately 21 inches, and I feel my head is proportionally small for my frame, especially from a front and profile perspective. My goals are:
To increase cranial volume in a natural-looking, symmetrical way.
To enhance facial balance and improve the aesthetics of my head shape.
To explore what’s realistically achievable with a full custom implant.
I am fully prepared to provide imaging (CT scan, head photos) and am open to traveling for surgery if I’m deemed a suitable candidate.
Would it be possible to schedule a consultation with you or your team to discuss this in more depth?
Thank you for your time, and I look forward to hearing from you.
A:Thank you for your inquiry and sending your pictures. As you have expressed an interest overall skull augmentation of a large surface area with specific linear increases let me provide you with some insights about what can and cannot be done.
First and foremost in the shaved head male, regardless of what size skull augmentation one is considering, the location and extent of the surgical incisions and resultant scars to do so is an important aesthetic consideration. Always remember that aesthetic surgery at some levels is really about trading off one problem for another. I think in the shaved head male one has to be very cautious about the trade off of scalp scars for a better head shape.
Secondly when one is considering and a more complete skull augmentation effect the question is always whether the stretch of the scalp will permit it. As a general rule large skull augmentations almost always requirea a first stage scalp expansion procedure.
Third, the amount of skull augmentation that you have indicated by the numbers are not realistic changes. You’re not going to increase your circumferential skull size by 2 to 3 inches. That is not an achievable outcome regardless of what type of two-stage skull augmentation procedure is done. Patients commonly over estimate by numbers how much my skull augmentation they think they need. This is because in skull augmentation the linear numbers are not as important is the overall volume in ccs of the implant. The head is similar to a sphere where volume displacement is more representative of its effect rather than a linear number.
These three concepts are what you need to consider for larger types of skull augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, During my consultation with Dr. Eppley, we discussed skull reduction and he asked if I would still want to reduce my cheekbones afterward. At the time, I was unsure, but I’ve now decided that I definitely do plan to undergo cheekbone reduction.
My question is about facial harmony and sequencing:
Would Dr. Eppley adjust the extent of the skull reduction based on my current cheekbone width — or would he reduce more aggressively if the cheekbones were already smaller to begin with? I’m curious to know if the skull reduction is being tailored to match my current cheekbone structure, or if he’s factoring in my plan to reduce them afterward.
Additionally, I’d like to know — in Dr. Eppley’s opinion, would it be better to undergo cheekbone reduction first to allow for a more aggressive or refined skull reduction result? Or would he recommend doing both procedures at the same time (if that were possible), for maximum overall balance and reduction?
Of course I trust Dr. Eppley’s expertise completely and just want to make sure I’m approaching this in the best order to achieve the most harmonious and noticeable result possible.
A:Ideally, if both procedures are going to be done, you do the preoperative planning for both the skull and cheek reductions on the patient’s 3D CT scan and then perform them together.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i was wondeirng if it was possible for a a forehead, supra orbital, and brow ridge implant in just 1 implant alone instead of 3 sperepate implants If possible, how much would it be speculated to cost? And would it be better than having them seperate? Thanks alot.
A: Supraorbital and brow ridge refer to the same area…they are interchangeable anatomic terms. Thus you are referring to a custom forehead-brow bone implant which is always done as a single implant placed on a single surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My eyes are uneven and I’m looking for something to help with it. Would you be able to help? Here is a picture for reference. Thank you!
A: You are referring to Vertical Orbital Dystopia (VOD) in which one eye is usually lower than the other one and more times than not it is the right eye that is the lower one. There are a variety of VOD techniques to decrease the eye asymmetry by moving the right eye upward as well as adjusting the soft tissues around the uplifted eye (brows and eyelids) to accommodate the new eye position. (you can’t just move the eye alone as that will create a new aesthetic problem.)
The question is not whether VOD surgery can be done but how much improvement can be obtained and is it worth it. To make a more complete assessment I need a true front non-smiling face picture to do a numerical assessment and a 3D CT scan to assess the underlying bone structure. (only needed of we determine you want to move forward)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a prominent forehead and I would love to reduce it
A: Thank you for your inquiry and sending your pictures. You do have significant frontal bossing which can be reduced if the bone is thick enough to do so. (in most cases it is) To check the bone thickness to make that determination a 2D skull CT scan is needed to measure the actual bone thickness and see how much of the frontal bossing can be reduced.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What are the possibilities of performing surgery on the occipital bone, the back of the head?
A: I do occipital skull bone surgery all the time whether it be for reduction of a protrusion or augmentation of a flat bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in XL male pectoral implants. I have Polands syndrome and missing the lower pectoral major muscle on one side. I would like to increase the size of both and correct for the Polands syndrome.
A: Thank you for sending your pictures. When you have Poland’s syndrome or significant lack of tissue development you do not have the option of also augmenting the opposite side of the chest if the goal is improved chest symmetry. It is hard enough to make the left side match the right side as it is now. Augmenting the right side as well as reconstructing the left side will only make the same chest asymmetry you have now only more magnified.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had the Medpor chin implant in April 2024Dr. Eppley describes the burring down and replacement of Medpor implants in his blog. I would like to either have the original Medpor implant burred down to make it smaller or replaced with the smallest chin implant available
A: If the goal is substantial chin augmentation size reduction, which is what your description of the smallest chin implant available means to me, then removal of your existing Medpor chin implant and replacement with a small silicone chin implant would be the appropriate treatment choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will cheekbone reduction osteotomies help to make the ears more visible and the get a more concave especially the lower part of the cheekbones. Also I have infraorbital implants. Is it possible to do the cheekbone osteotomies without damaging the eyes and infraorbital implants?
A:Your request for cheekbone reduction osteotomies is unique giving your prior cheekbone widening osteotomies. In essence you are really trying to return the more narrow cheekbones that you once had. While that bone shape change is achievable I do not think it will make your ears more visible. It would probably have some impact I’m creating a slight bit of increase concavity in the cheek area but this would be fairly limited given the thickness of your overlying soft tissues.
In regards to your existing infraorbital implants I do not know exactly where they are as they are not evident in the 3-D CT scan that you have. (see attached) I suspect they would be safe from the cheek bone reduction osteotomy as they are unlikely to set into the bony step off that you have in your cheekbones.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a lip lift procedure that removed the nasal sills, presumably to hide the scars up inside the nostrils. I would like to restore the appearance of the nasal sills by implants. Is this an effective way to do so?
A: Lost nasal sills are hard to restore and whether augmentation by graft or implants may or may not be effective at doing so. This requires a very discrete line of projection between the columella and the inside of the nostrils.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, about 3 weeks ago I had a lip lit where they removed 0.5 mm and my total upper lip was 0.10 mm, I see that there is very little space between the nose and vermilion and my teeth are also very visible, I close my mouth with the help of my lower lip, but I don’t like how it looks, I also cut my frenulum to get my upper lip lower and I am using pressure tapes to lower it in addition to massages… What can I do to get my upper lip to lower at least 2 mm?
A: Time is your friend here. This is an excisional operation in which the skin removed can not be replaced. Time is what will help it relax (lengthen) a bit. Remember it has only been three weeks not three months or three years from when the procedure was performed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Born with undescended testicle left side, right one is a little larger than normal. Have always desired to look normal with appearance of both testicles but never felt comfortable with what I’ve read online from various surgeons on the procedure until I stumbled upon Dr. Eppley’s. Can you tell me if I’m a fair prospect for getting this done and how long I would have to wait after surgery implantation before returning home?
A: Essentially you need a testicle implant for a testicle that has never appeared in the scrotum. The size of the testicle implant would be comparable to the size of the opposite descended testicle which would mean a standard testicle implant could be used. This is an outpatient procedure and you could return home the following day.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a cleft patient who have undergone successful cleft and rhinoplasty surgeries in the past. I am currently in the middle of teeth straightening and is looking for the right doctor for a paranasal implant procedure. Thank you for taking the time to read this message.
A: As a cleft patient I assume you are referring to the classic paranasal deficiency on the cleft side due to an underlying alveolar-maxillary deficiency. Because of its cleft origin I would be cautious about considering an implant for its augmentation. It would be best to first get a 3D CT face scan to see what the underlying bone around the cleft site looks like. If there is is a good bone foundation, usually from a prior alveolar bone graft, then an implant may be appropriate. (And the scan may show that a custom implant design may be needed) If not then either a cadaveric or autologous bone graft would be the more appropriate choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, By doing shoulder reduction surgery does it decrease the distance of the shoulder or only the collarbone resulting in a slim appearance? Is there’s any surgery that decrease the distance of the shoulder let say 18 cm to 14cm? Thank
A: Clavicle reduction osteotomies reduces the visible width of the external shoulders.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do under eye implants last into old age? I noticed on some aging vs youthful faces diagrams that the under eyes can hollow with age. In the diagram I also noticed that the canthal tilt gets lower as support gets worse. I can only imagine aging with a silicone implant whose base starts hollowing and then your eyes slowly become more uncanny/odd looking. The top of the implant won’t hollow but the base will which shouldn’t happen in normal circumstances with bone, where the top of the implant (which should be bone) hollows and reshapes. The brain from what I have been researching into is highly attentive to small millimeter changes. Below I linked the diagram. Dr eppley if this seems to make sense is this a problem down the road that will need revision of your eyes do start looking odd due to the implant sinking?
A: Any undereye or undereye-cheek implant is structurally solid and will never change form so the implant pe se does not change with aging. But the soft tissues around it obviously will. But like implants along the jawline the implant in the undereye area is going to help with protection/retardation of the aging effects as better bone support/structure is always better than less.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hav read the article entitled ‘Clavicle Lengthening by Distraction Osteogenesis for Congenital Clavicular Hypoplasia: Case Series and Description of Technique in the Journal of Pediatric Surgery from 2013. How do you think this applies to aesthetic shoulder widening surgery for men?
A: I am very familiar with that article which has four problems from my perspective:
a) Uses an external distraction technique so the scarring would not be good for an aesthetic shoulder widening patient.
b) Those patients treated had congenital shoulder narrowing so their tolerance for scarring is much different than yours would be. They are also pediatric patients in a national health system so they have no room to complain about their care.
c) Plate fixation was still needed in half the patients particularly those with longer distraction lengths.
d) Distraction periods were as along as 6 to 9 months….long time to have an ex fix device in place.
In other words old style external distraction devices are just not suited for the aesthetic patient. I would do the currect sagittal split lengthening approach despite its issues before I would ever do that distraction technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously reached out regarding surgical options for addressing plagiocephaly, a condition that has long been a personal concern for me. I am now interested in proceeding with the surgery and understand that a consultation is the necessary first step.
At this stage, I would like to inquire about the current wait times for scheduling such a procedure. Could you please provide information on the typical timeline from consultation to surgery?
A: Plagiocephaly is treated by the placement of a custom skull implant. This implant is made from the patient’s 3D CT skull scan and is takes around three months to go through the design and fabrication process. That becomes the typical waiting period for surgery. Patients typically schedule the date of their surgery when they initiate the implant design process
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have previously had hydroxyapatite added to the jawline and chin, which I am not happy with and would like to remove some if possible.
I would then like look at how to achieve a more angular look to my jawline. I also had it to my cheeks and various other areas which I am happy with.
I have had some to my outer brow which I am also happy with, however I would like to add some more to lift the eyebrow to form a straight line rather than curve downward – I am not sure if you can change the shape of the bone in this location also to soften the curve of the socket
Below is a crude visualization, existing on left and proposed on right
- Removal of hydroxyapatite to top of chin
- Buzz down of chin bone to straighten
- Removal of hydroxyapatite to jawline and potential buzz down to straighten and give a sharper line – may also benefit from J Plasma lipo to remove fat and shrink skin
- Build up of the mandibular at the ear junction to create a sharper more define angle
- Build up of eyebrow area at outer end to straighten end of brow and reduce curve down – not sure if can buzz down bone here to soften the round eye socket look
A: Thank you for your inquiry and detailing your surgical history and objectives to which I can say the following:
- Hydroxyapatite cement is very difficult to remove over a large surface area like the jawline through limited incisions. It may have been placed through such limited incisions but it can not be reversed/removed/modified that way.
- Regardless of these difficulties you need a current 3D face CT scan which will show the extent of the challenge.
3) As a general rule one can not reduce their way into improved jawline definition. Thus I do not consider your imaged jawline results achievable. (jaw reduction with improved definition) Removal of the hydroxyapatite (if possible) and J Plasma lipo simply will not work.
4) Improving the jaw angle and brow bone shape by augmentation has a better chance to be successful.
But providing clarity to all four stated points requires the 3D CT scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Specifically, I would like to know whether your practice performs circumferential outer‑table bone burring or other techniques that reduce the overall circumference and height of the head (rather than simply smoothing bumps or adding implants).
Could you please let me know if you offer true skull‑size reduction? Just want things to be super clear before I make this very important decision, appreciate your understanding.
A: Outer table bone removal is the only way to do almost any skull reduction procedure. It is simply a matter of how much surface area of the skull that needs to be treated and what is the incisional access needed to do so. For larger surface area skull reductions a bicoronal scalp incision is needed. The other important issue is how thick is your outer table and is it thick enough that its reduction would make it worthwhile. This is why a 3D skull CT scan is needed to make that assessment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope you are all well. In my research I ran across your site. Do you have experience working with male to female trans patients regarding forehead reconstruction to create a more female appearing forehead? Your response indicating if you do or not would be appreciated.
Thank you and have a great day!
A: You are referring to forehead feminization of which the base procedure is a brow bone reduction which may also include forehead narrowing as well. This is a type of forehead reshaping in which I have a lot of experience.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty reversal 10 days ago of 5mms. I’m really worried that the chin area looks like a fat, round, fleshy block, and that it has no shape or contour . It is affecting my whole face shape, since now my lower face looks so rounded and has lost it’s V shape. Is there hope that the muscles and soft tissue will adhere to the bone? What are the possible treatments for this? Can I place a small implant to give the soft tissue the contour and support it needs.
A: The first concept to grasp is that at 10 days after surgery you certainly are far removed from the final result. It will take 3 to 4 months to see the true final outcome to let all the swelling resolve and the soft tissue wrap effect has occurred.
Secondly when you reduce the projection of the chin it is going to lose some of its tapered shape.
Third, should an increased tapered shape be desired after 4 months of healiong a V-shaped chin implant can be placed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to schedule lipo with 3D etching with another surgeon. Would you recommend that I do this surgery first before a back lift or would it be better to do the back-lift first? I’m worried about loose skin afterwards.
A: Absolutely do the liposuction first and the backlift later for the very loose skin reason you have mentioned. It will also make the backlift more effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in thigh and leg implant/augmentation. I had a BBL three years ago.
There was fat grafted to my thighs but it didn’t all stay and I don’t want to risk that happening again which is why I think I would be better suited for implants
Ultimately I just want to be more proportionate on my lower half
I don’t wear shorts or dresses that expose my legs because they are so thin compared to the rest of my body.
A: While I would agree that thigh implants are your only potentially effective treatment option there are some reservations I have in your case. It appears that the greatest deficiency is in the lateral thigh where such implants have their greatest complications due to their more superficial location. (implant show/edging) Thigh implants work best in the anterolateral thigh where they are placed under the fascia…but this appears to be of less aesthetic value in your case.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will the sagittal ridge reduction surgery leave a big scar or any scar visible tissue?
A: Every incision leaves a scar, it is just a matter of how noticeable it is. But scalp incisions do exceptionally well and sagittal skull reduction incisions are very small (usually less than 4cms)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know how many centimeters it is possible to reduce in a reduction of the temporal region of the skull. I do not have a large head, I am a man who is 164 cm tall and has a 53 cm head. My face is narrow (14 cm from one end of the zygomatic bone to the other), but the temporal region is approximately 16 cm, which creates a mismatch between the face and the upper part of the head, as if my head were inflated. Would it be possible to equalize these measurements? Would it also be possible to reduce the top of the head in the same surgery? I appreciate your answer.
A: While temporal reduction is a very effective operation for narrowing the side of the head it is not a procedure which has measured outcomes …meaning I don’t evaluate the results by circumferential head measurements or temporal thickness. Outcome are determined by visual changes. (Does the head look less wide or have less convexity.
From a measurement standpoint all I can say is that the average temporal muscle thickness at the level of the top of the ear is 7 to 9mms in most male patients. Thus removal of the posterior temporal muscle will reduce the bitemporal posterior distance in the range of 1.2 to 1.5cms for most patients.
But the best way to estimate preoperatively of the potential head width change is predictive imaging based on the patient’s pictures.
Top of the head reduction can be combined with temporal reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some questions about large skull augmentations using a first stage scalp expansion.
- I know you said the procedure would raise the hair line’s position, by how much do you estimate it would? I would just like to know if you think it would be a noticeable amount.
- Aside from the two phase expansion, are there any downsides to a large augmentation?
- Since you said this was similar to a lefort I, would this lower the philtrum? And or increase the width of the alar base?
- I understand it is a substantial augmentation, do you think it would be advisable to further reduce the amount being augmented?
- If I were to do just a temporal and top augmentation without the frontal augmentation would there be noticeable margins from the front view?
- Would the skull augmentation affect the position of my eyelid/eyebrows
A: In answer to your large skull augmentation questions:
1) Since how much hairline change, if any, can not be accurately predicted beforehand make the assumption in considering the procedure that a hairline change will occur and it will be noticeable.
2) In general a large skull implant does not necessarily have more risks than a smaller skull implant.
3) A midface mask implant has some similar effects to that of a LeFort I advancement with the exception that it does not change the upper lip because it does not affect the incisor tooth position.
4) Imaged changes may be a goal but in the end the amount of skull augmentation will be controlled by what the scalp tissues can tolerate.
5) The risk of implant edging is always eliminated when the edge of the implant stays at or behind the hairline.
6) Large skull augmentations may have a limited eyebrow lifting effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Good morning/afternoon, my question is do you perform hip bone shaving and if yes how much can you remove in one procedure in grams or kilograms?
A: In my experience with iliac crest reduction it is done in a linear amount not by weight. In most cases 1.0 to 1.5cms of bone removal is performed in the more prominent anterior half of the iliac crest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
