Your Questions

Q: Dr. Eppley, Hello, I’m seeking professional guidance regarding a recessed chin and a weak jawline, particularly in relation to the gonial angle. I also have noticeable facial asymmetry—specifically, the right side of my face shows a more recessed cheekbone and a weaker jaw angle compared to the left. I’d appreciate help understanding the underlying causes of these issues, as well as recommendations for treatment options. I’m especially interested in learning about potential procedures, associated costs, and any risks involved. Additionally, I’d like to know whether small, targeted implants could improve the aesthetic outcome, or if a full wrap-around jaw implant would be more effective. I look forward to your feedback and guidance.

A:Thank you for your inquiry and sending your pictures. You have two facial issues which are somewhat related, an underdeveloped lower jaw and congenital facial asymmetry with the right side being less developed than that of the left. The bony basis for this asymmetry Will become clear if you look at the 3-D CT scan of your face. That being said the first question is that of what are your aesthetic goals for your underdeveloped lower jaw which fundamentally comes down to isolated chin augmentation or a complete jaw augmentation. (see attached imaging) if you didn’t care about the facial asymmetry then that would be a very basic decision of how much effort do you want to put into the lower facial reshaping for what degree of change. The facial asymmetry issue, however, is a game changer in regards to that decision. This is because lower drawl is asymmetric and There’s going to be no successful way to treat that short of a custom implant design approach which then speaks to the aesthetic need for total lower drawl augmentation. Undoubtably your facial asymmetry has a cheap component to it as well and this also would require a custom implant approached to treat.

The concept of the spot implants to treat your jawline augmentation and particularly your facial asymmetry would not be a successful approach as the fundamental problems are not isolated or spot in nature. Surgeons try that approach all the time and all that ends up happening is a different form of facial asymmetry is created and the patient eventually has to graduate to a more comprehensive approach using a 3-D CT scan as the guide for treatment planning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi i would like to do a forehead and back reduction.I would like a flatter back and forehead.

A:Thank you for your inquiry and sending your pictures. You have a combination of an occipital protrusion and frontal or for head bossing. Both can be reduced as per the attached imaging. The bone on the back of the head is very thick and a lot of reduction can be accomplished. The four head bone is thinner so it is unclear just looking at your pictures what degree of reduction you could achieve but it would likely be enough to make a difference.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, my goal is to reduce my neck and trap muscles to achieve a more feminine look. I don’t think I can afford the standard Trap botox treatments of ~6k over 2 years.  I thought electrocautery may be more affordable and effective.

A:I believe what you are fundamentally trying to accomplish is to reduce the thickness of the upper trapezius muscle at the side of the neck per the attached image. Surgery would definitely be more effective but certainly not more affordable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi! I am reaching out regarding your procedure for waist narrowing by rib removal. I understand there is two ways of doing It, one is fully removing the ribs, the other is remodeling them by breaking them in. Which do you do? Also what is the probability of the intercostal nerve damage during surgery with both procedures

A:You are referring to subtotal rib removal of the outer aspects of ribs 10 through 12 with LD muscle reduction (RIB REMOVAL)  versus that osteotomies of the same ribs (RIB FRACTURES) with the need for prolonged corset wear after surgery to allow the ribs to heal in a more inward fashion. I have done both techniques although by far most people come to me for the rib removal method since that is surgically more challenging to do and requires much more experience in rib surgery to successfully perform. One can have a debate about which method is more effective but it’s fair to say removing tissue is going to likely end up with a better result than simply repositioning it. Contrary to the statements of some I do not find out that there are any great differences between them in terms of recovery. When it comes to intercostal nerve damage I have never seen that in either procedure with severasl hundred of ribs treated. But it is a risk and one should not confuse never seen with never could happen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  My right shoulder is much wider than my left shoulder, and my left shoulder is somewhat rounded and sloped.  Looks very asymmetrical and somewhat impinged.  In my teenage years, I’m pretty sure I had broken my collarbone or clavicle, and I never did anything about it.  I’m not 100% sure this is the reason for the narrowness or difference in appearance, but it could be. 

Is this something that can be fixed or remedied to provide a wider and more symmetrical look?

A:If you had a fractured clavicle previously and it was allowed to heal without surgical intervention replaced fixation it always does so with a shortened length. This can certainly create a rounded and more sloped shoulder as that Is exactly what happens clavicle loses length based on its anatomic position and orientation between the sternum in the shoulder joint. This is best confirmed by a 3-D CT scan of your shoulders to clearly display the differences in the clavicles between the two sides.

That being said, and assuming that this diagnosis is correct, the question then is whether one would undergo a clavicle lengthening osteotomy for symmetry improvement. And in a very muscular individual like you with the long standing contracted shoulder girdle could it be successfully  stretched out with the push of a clavicle lengthening procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, had a buccal fat removal which I truly regret. It has thrown off my face proportions and now my face looks very long and narrow. The surgeon assured me that it was a myth that it could age the face and he assured me it would not happen. Are there ways to restore volume in that area to recover plumpness and width? I would give anything to have my old face back. I think I was the wrong candidate for this procedure, since my face was long already and I have poor cheekbone volume. I already tried 2 syringes of Voluma but I still feel like there is something missing in my face.

A:While buccal lipectomies can be a very effective procedure in the properly selected patient, it is not a myth that it can age the face in someone who was never a good candidate for it. Anyone that would say otherwise simply lacks enough experience in doing the procedure or does not have a very good eye for patient selection. In reversing buccal lipectomy’s fat must be replaced. Whether this is done by fat injections into the subcutaneous space of the or the placement of dermal fat grafts back into the now empty buccal space can be debated and each approach has their advantages and disadvantages. One can even consider submalar cheek implants on the masseteric fascia which lies  in the intermediate layer between the subcutaneous space of the cheeks and the deep buccal fat space. Which approach is best has to be determined on an individual patient basis.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a young male with hypogonadism. I am currently on the maximum dose of testosterone gel and I am interested in learning more about the side-by-side procedure for testicular enlargement. I have a few questions: How are the implants secured in place to prevent the appearance of four testes? Are my natural testes sutured back while the implants move freely, or is there another method used? How long do the implants typically last? My goal is to achieve a full, masculine-looking scrotum. Thank you for your time and any information you can provide.

A:In answer to your side-by-side testicular implant questions I can provide the following comments:

1) The success of the side-by-side approach, which is determined by avoiding a four testicle look is the size of the implants. With large enough implants the natural testicles are pushed up and back and out of view because they are attached to the neurovascular cord which naturally pulls them up towards the inguinal canal. The size displacement must be at least 70% or more compared to the natural size of your testicles. When surgeons do not appreciate the importance of volume displacement in this type of testicle implant surgery this is how you end up with four testicle look.

I never secure testicle implants by suture fixation. That tethers them down, and Immobilizes them and creates the potential for discomfort.

2) Solid ultrasoft testicle implants are permanent. Because of their material composition they can never degrade or fail and thus never need to be replaced unless you have secondary aesthetic concerns.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to do  also an hairline advancement. So advance the hairline about 2 cm and make it straight.

A:Certainly one can have a frontal hairline advancement at the same time as frontal bossing reduction as the two procedures are synergistic both in terms of technical execution as well as their aesthetic effects. You never know the exact amount of frontal hairline advancement one can achieve until you’re actually doing the procedure. Does it cannot be predicted before hand whether the line you have made can be reached. Based on my experience I suspect that amount of frontal hairline advancement is a bit over enthusiastic as to what can actually be accomplished. You certainly can reach 50% of that advancement and likely more. I just would not count on reaching 100% or 2 cm of advancement.

Also be aware that a frontal hairline advancement is not likely to make it straight. The advancement will largely follow the existing shape of your hairline.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m considering custom infraorbital-malar implants to reshape my cheek and eye region. As part of that, I want to raise the level of the lower, outermost corner of my orbital rim by around 1mm; my goal is to slightly raise the outer portion of my eyelid. However, I’ve heard that raising the orbital rim could cause persistent discomfort that might only be resolved by removing the implants. Several questions: 1. How likely is this discomfort? Are there any ways to mitigate the risk? 2. Is it reasonable to use infraorbital-malar implants for minor eyelid shape adjustments like this?

A: In answer to your Infraorbital-malar implant questions:

1) The discomfort to which you refer is something I have never seen or been reported by any patient. Having done hundreds of pairs of custom infraorbital and infraorbital-malar implants that is a postoperative problem I have yet encountered. I don’t know the basis of where you heard of such a problem but there would be no anatomic basis for it.

2) Many patients that pursue 3D infraorbital rim augmentation do so with one of the intents is for improved lower lid positioning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How long the recovery will take from webbed neck surgery?

A:It depends on how one chooses to define recovery. What most patients define it by when can they resume most normal activities which should really be within 1 to 2 weeks. From an appearance standpoint one looks good from the beginning and there really isn’t any swelling or bruising to be seen from the front. Perhaps the most important part of the recovery, which for neck surgery should not be a surprise, is that the neck will feel a little sore and turning the head from side to side will be a little tighter for a while.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant placed over ten years ago. nI recall the surgeon used a McGann anatomical chin implant. Immediately once the compression bandage was removed and some initial swelling had resolved I could feel the left wing had been positioned or settled lower than the right. It’s not significant (perhaps 5mm or so) and would really only be perceptible to me or a facial plastic surgeon. However I am considering replacing it with a custom implant. I do recall when I went back to the surgeon post operatively, he commented on the imaging stating that there was some bone ‘erosion’ and he was concerned how superficial the pocket was on the left. 

For revision surgery such as mine, would the current implant be removed and the tissue be allowed to settle for say a month before replacing it (particularly given that superficial left pocket) or can it be done in one surgery? Thank you kindly.

 A:Thank you for your inquiry and detailing your surgical chin history. Most chin implants have some degree of asymmetry or tilt due to the nature have How they are placed. Only very rarely are they perfectly positions due to the limited incisional access by which they are introduced in position. Also, most chair implants will have some degree of bone imprinting often erroneously referred to as erosion. I’m not certain what the term superficial placement means but I suspect it refers to some floating of the implant off of the bone of which I’m not sure, short of having a 3-D CT scan, how that assessment was made.

All of these issues aside they are common and is what I see and almost every Chin implant but I remove and replace. Such removal and replacements are done as a single surgery. There is no benefit or biologic bases for staging such replacement procedures.

When it comes to a custom chin implant replacement a 3-D CT scan is required of which details of your exact chin placement and its effect on the bone Will be evident and will validate your perception of its current placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to ask whether you might consider providing some guidance. I have had two rhinoplasty and one septoplasty over the last 1o years. They have not been successful in correcting the columella position to centre of face. I have read your case study External Repositioning of the Deviated Columella and Nostril when I was researching whether simply repositioning the soft tissue could be helpful as I believe it would. However my surgeon doesn’t seem to agree and will not consider another rhinoplasty, of which I don’t want to go through another anyway. Is there a professional medical opinion you could share with me to pass to her? I wonder whether the hesitation is simply because this isn’t a ‘standard’ approach. Thanks so much in advance 

A:Until I see pictures of the base of your nose I can only make a general statement about an external columella repositioning. Having done it numerous times it is effective and there is no reason it couldn’t be done. Everyone that I’ve ever done it on is in the exact same situation like yours. They been through multiple septorhinoplasties which have failed to align the columella centrally and in some patients it may never be possible by internal repositioning. In some cases the external columella realignment may be combined with the caudal septal graft to ensure it’s new position. I can certainly understand why most surgeons would have an opinion that this is an undoable procedure. But until a surgeon has tried it and failed such negative opinions are irrelevant.

The one issue that does have consideration is that it is likely your prior rhinoplasties were done with an open approach, meaning there is an existing mid-columellar scar. This does raise some concerns about a new incision at the columellar base which leaves a very narrow strip of skin for survival between those two scars (aka vascular compromise). So where are that mid columella incision is exactly could influence whether this is a viable procedure for you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there greater risk for bone recession with a chin implant of the size were using? Around 10mm?

A:You are actually referring to bone imprinting rather than recession or erosion from a chin implant. Since imprinting is a self limiting pressure relief phenomenon in theory larger implants should show more of that  than smaller ones. In my experience however it is not alwaya a linear correlation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was also thinking about canthoplasty, is that service available?

A:I am assuming by your pictures that you are trying to achieve either a neutral for elevated outer eye corner position. If one is trying to achieve a neutral I corner position that I’d lateral canthoplasty alone would be sufficient. However if one is trying to obtain a higher than neutral outer eye corner position than the lateral canthoplasty needs to be combined with a small lower eyelid spacer graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What happens to the space created between old, unchanged facial implants and aging facial bones? Do the human face “fill in” this space to establish continued stability? Atrophy of muscles, bone, etc. is characteristics of aging. A gap is created.

A: The concept of aging facial bones, often spoken about, is actually largely over stated. It is one of those theories that sounds correct since the body does age and atrophy is part of many other body structures but in facial bones it does not really occur in that dramatic fashion. Facial bone atrophy is somewhat of a ‘truism’ meaning it just sounds like it should be true but the reality is it isn’t in the way atrophy is typically perceived. Until a single patient has a 3-D CT scan taken on their face from infancy to old age you can never validate what actually happens to the facial bones with aging.

Thus the concept that a space is created between the bone and an implant, or a gap is created between the two, simply does not occur in an age-related manner. Understanding what actually happens requires a biologic understanding of the encapsulation process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, in clavicle shortening surgery  you can reduce the overall width of shoulder but the drawback is that the hardware (if left on for life) will show and be palpable. If removed, the holes produced by the removed bone screws will render that altered clavicle bone much weaker than pre-surgery. Depending on the pre-surgery morphology of the shoulder, the shortening procedure might also not give much “shortened” new shoulder appearance. Are these accurate statements?

A: In answer to your clavicle length reduction surgery questions:

1) The screw holes that are left right after clavicle hardware is removed will go on and completely fill in with bone in a few months.

2) Based on my experience with the clavicle reduction surgery most if not all patients find that the postoperative shoulder appearance is much improved and more pleasing. Your  supposition that claviclce reduction surgery does not create a shortened new shoulder appearance does not appear to be born out by actual clinical experiences.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I hope this message finds you well.  I’ve been following your work for some time and I’m very impressed by your expertise in craniofacial and skull reshaping procedures.

I’m interested in learning more about a custom skull implant for one side of the head (unilateral augmentation), primarily for aesthetic purposes. Could you please let me know:

• Whether the consultation and design process can be done remotely (for example, by sharing 3D scans or imaging)?
• What kind of recovery time and visible results I could expect?
• And if you currently perform this procedure regularly for aesthetic asymmetry cases?

I’d greatly appreciate any information you could share, including how I might start the consultation process with your office.

Thank you very much for your time and for your outstanding work in this field.

A:In answer to your custom skull implant questions:

1) All parts of the process from consultation to implant design are done remotely. It is only the surgery that you would need to come here to do.

2) The recovery from skull implant surgery it Is usually fairly quick and Within 7 to 10 days most of the significant swelling has resolved. There are no postoperative physical restrictions.

3) Custom skull implant designs are regularly done for a wide variety of aesthetic head shape asymmetries and deficiencies.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a lower blepharoplasty a few months ago and one of my eyes now looks really hollow.It started out looking great. But it was like overnight it lost all the volume. So I was wondering if a tear trough implant would be an appropriate way to treat it.

A:Right after surgery for the first 4 to 6 weeks due to swelling everything can look perfectly smooth. But whenb all the swelling goes away and soft tissue contraction occurs as part of the healing process any contour irregularities or volume discrepancies becomes apparent. This is why it takes 3 to 4 months to truly see any type the facial surgery result in its fine details.

That being said the question is whether a tear trough implant would be the best approach to addressing your right lower lid/cheek junction concerns. I don’t think it is given that the surface area’s coverage of the problem is greater than that of a  tear trough implant. Such an implant risks creating a prominent bump or lump in the volume deficient area. If one was using an implants approach it really takes a custom implant design to provide adequate surface area coverage that has a smooth transition into the surrounding bone. However I think that solution, effective as it may be, is far greater then is what is needed.

From my perspective your options are twofold. One less invasive option is fat injections which,  if well done, can restore volume. Fat injections have the advantage of being able to be placed over a broad surface area and into the area that is actually the cause of the volume deficiency (loss of fat). The other option is an onlay which is draped over the  infraorbital rim onto its anterior surface. Think of it as an ‘implant’ but it is really a sheet of cadaveric dermis which can be custom cut and shaped along the entire rim area over a broad surface. It is juice like an implant but it is really a tissue graft which will integrate into your own tissues with the volume persistence.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there a percentage risk of chin imprinting with the chin implant? Or a general idea of how many patients experience it? 

A:As a general rule 100% of chin implants experience it. It is the normal body response to the pressure of an implant when placed over a solitary pony projection that has a tight enveloping soft tissue envelope.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a young woman who was recently diagnosed with Turner Syndrome. I have a noticeable webbed neck and would like to ask if surgical correction might still be possible at my age. Additionally, I underwent two scoliosis surgeries about 20 years ago, so I wanted to mention this in case it may affect any potential surgical approach. Beyond the physical aspects, Turner Syndrome has affected me emotionally as well. It has caused me to struggle with self-confidence for many years. Unfortunately, in my country, most doctors told me that there was no solution or that surgery would be too risky. I often felt dismissed because they did not want to take the risk. Still, I never lost hope. I kept researching on my own and recently discovered your work on webbed neck correction. Reading about your experience gave me hope that improvement might be possible, even after all these years. I would be very grateful if you could provide some guidance regarding possible treatment options.

A:Thank you for your inquiry and sending your pictures. The question in webbed neck surgery is not whether it is risky, as it is not,  but how effective it will be. My concern in your case is that you have a very short wide neck in which using the posterior or indirect webbed neck technique may either not be effective or,  even if good initial results were obtained, would likely have a 100% relapse. Your type of webbed neck is the most challenging to get any sustained improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley I had head trauma four years ago which required a  temporal craniotomy. As a result I have temple hollowing on my left side due to losing the fat during the craniectomy, so now I am left with a dent on the side of my face that is very hard for me to look at when I have to look at myself in the mirror.. 

I am trying to find someone that can help me fix this problem. I happened to stumble across the skullreshaping.com website and it looked like exactly what I could use for my temple hollowing. I am 100% recovered from my accident and I have been so for multiple years.

A:Thank you for your inquiry and sending your pictures. This appears to be a classic temporal depression after a temporal craniotomy of which a major component of it is likely loss of the temporal muscle volume. It is possible that it also represents the depression of the craniotomy bone flap which would be important information to know. That being said, it can be corrected but understanding whether the deficiency is more bone or soft tissue based is an important treatment consideration. A 3-D CT skull scan will answer that question definitively as well as also provide the platform on which to build an implant which would be the most successful method of temporal depression augmentation given your surgical history.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I Get a second clavicle shortening procedure?

A:Thank you for your inquiry and sending your pictures. As best as I can tell from the pictures the aesthetic difference in the prominence of the two clavicles appears to be in the larger midshaft segment of the bone. After 10 years it would be fair to say, short of major clavicle repositioning surgery without the assurance of a guaranteed outcome, that camouflage of the problem through the use of an implant would be an aesthetically  superior and safer choice. This would be a custom 180 wrap around implant made to cover/enlarge the deformed clavicle, in essence making the clavicle bigger or more prominent.

It would be helpful to see current clavicle x-rays to understand the exact differences in shape between the two clavicles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a sliding genioplasty for recessed chin/jaw and side profile. However, I really like my smile and front profile most of the time. I do not like the double chin I always seem to have, even when my weight is down.

A:Thank you for your inquiry and sending your pictures. From your side view picture with at least a 20 mm chin deficiency you have selected the only appropriate procedure for chin augmentation with this degree of chin recession which is a sliding genioplasty. When one has lived this long with this degree of chin  recession, particularly a female, it is important not to try and normalize the chin position completely is that will likely look unnatural to you and create a face that you might not recognize. For this reason your sliding genioplasty should probably be in the 10 to 12 mm range as estimated in the attached imaging. With this amount of chin of chin advancement it is very likely that your double chin it is very likely that your double chin Will be significantly improved will be significantly improved by the accordion effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Good afternoon,I wanted to inquire about the face shortening surgery. I’m not really sure about the name of the procedure, however, I believe it makes your face look rounder instead of longer, I guess the name is face shortening procedure, correct me if I’m wrong

A:When you are referring to in face shortening surgery is the distance between the eyes and the lips. I don’t believe you are referring to the forehead is it is covered by your head dressing. I also don’t believe you’re referring to the chin which does not look particularly long. There are no effective shortening procedures of the middle part of the face that reduce the external soft tissues. A LeFort 1 impaction surgery can help reduce the long maxilla with excessive tooth show, a.k.a. a gummy smile, but does not reduce the vertical length of the soft tissues of the middle face.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some pictures below. I would like to inquire about lateral canthoplasty, fat transfer to the upper and lower eyelids, mild ptosis repair and spacer grafts all in one if possible. Does the doctor perform drill hole canthoplasty? I would prefer this technique combined with the spacer grafts to eliminate any chance of the lateral canthus from relapsing over time. Whatever he thinks is best for my anatomy is what I prefer, of course. I’m trying to transform my negative canthal tilt into positive by around 5-6 degrees. I understand what matters most is the harmony of the face and making everything look natural. So I’d like to hear if he thinks it’s possible while not making me look uncanny. I also understand that many times surgeons require the patient to have infra orbital implants done as a support so the lower eyelids don’t droop overtime, although I’ve seen that spacer grafts can offer the same assistance in the concept of making sure it doesn’t relapse. That’s my main concern. I’m also trying to lengthen palpebral fissure length horizontally if possible, as I’ve seen many doctors shortening the eye in order to raise the canthal tilt which is what I’m trying to avoid. I’m also aiming at keeping palpebral fissure height to a minimum. Input would be great, thanks!

A:Thank you for your inquiry and sending your pictures. All of the mentioned Orbital procedures that you have described can be performed at one time and are often done so given the effect at the patient desires to create. To answer your specific questions:

1) The need for infraorbital orbital implants in such a surgery depends on whether actual under eye hollows exist and/or the patient wants to correct them. While you do have lower midface/maxillary concavity your infraorbital and cheekbones seem to be strong. Therefore I do not believe that they are an absolute must in your case.

2) When it comes to a lateral canthoplasty the only effective procedure in my hands that has ever worked and is sustained is a drill hole technique. Therefore that is always how I do it.

3) you have to recognize that correcting a negative canthak tilt and creating increased lateral I with/length are contrarian effects. Elevating the outer corner of the eye will not necessarily make it shorter but I wouldmdoubt that it is going to make it longer.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I am a man but I had Facial Feminization Surgery at one point it my life where I believed I was trans, would it be possible to ‘reverse’ most of the forehead work(type 3 browbone reduction and orbital rims shaving)? I know I won’t look exactly like I did before, but I have CT scans from before the surgery. Would a custom browbone be the best solution in this scenario? My main concern is the lack of projection from my orbital rims and lack of a brow bone “break”. Would I have a greater risk of infection or other issues due to previous trauma at that area? Part of my FFS procedure involved hairline lowering, so my skin is probably tighter than before, is that something I should be worried about when it comes to getting a brow bone implant? Thank you

A:You have correctly surmised that the reversal of forehead feminization would be a custom brow bone implant. I have done this numerous times over the years as you are not the only person has reversed course in the transgender process. While you have had a frontal hairline advancement that does not make the lower for head skin any tighter or more difficult to release and augment. Because of your hairline lowering you also have a convenient point of access to place the brow bone implant. The only concern for infection is whether you having complete healing of the setback bone flap of which exposure to the frontal sinus underneath may occur with soft tissue elevation. A current 3-D CT scan will clarify whether that is a potential issue or not. Most of the time in bone flap setbacks there is generally good bony healing around the flap margins.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in a forehead and upper skull contouring procedure to improve the overall proportions of my head. I’ve seen your case where you performed a full-head reduction by a few millimeters, and I’m curious whether it’s possible to apply a similar technique limited to the frontal area.My main goal is to reduce the vertical height of my forehead, specifically the distance between my eyebrows and hairline. I am not looking for hairline lowering surgery, but rather actual bone removal in the frontal region. I will provide an image to illustrate the cut and shape I am imagining. Would this type of procedure be possible, and would it result in a measurable shortening of the forehead — likely only a few millimeters?

A: Thank you for your inquiry and sending your x-ray. The forehead like all other bony areas of the skull can be reduced by burring which entails removal of the outer cortical layer down to the diploic space. The question is not whether that can be done but how effective would it be for the patient’s goals. Based on your x-ray and the red line you have drawn on it that is about 5 mm of bone reduction which the x-ray shows can be safely done. That will result and I someone increase backwards slope to the fore head which appears to be your primary aesthetic goal. Whether that would result in any measurable decrease in the distance between the frontal hairline and the brow bones is more suspect unlike the slope changes from the bony reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Honestly speaking I’d only like to have an opinion It d be very appreciated if the doctor that is a the best could say me his opinion on this implant shape and thickness.

A: Looking at an implant design by itself is meaningless as there is no context to it. What is the basis of this design? How were the dimensions established? What are the patient’s specific VISUAL goals…meaning using the patient’s face pictures and changes made to them that represent the patient’s ideal outcome (aka setting the target for the implant designs)

Without that information this is just facial bones with some implants on them…just a cool 3D art project.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, Do you perform Xiphoidectomy’s at your office? Thank You.

A: Yes. Xiphoidectomies are performed in my surgery center as an outpatient procedure under general anesthesia.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing with an interest in your opinion on how to go about correcting a minor dent in the upper right side of the back of my skull. I would estimate the overall indentation measures about 2″ x 1″ and indents into my skull about 1 cm. This is not a recent development- I have had it for almost all of my life that I can recall and I cannot pinpoint with certainty any specific incident in my childhood that caused it. Thankfully, it does not present a major aesthetic issue at the moment because my hair covers it, but in the event that I’m bald in the future or have a desire to shave my head, I would desperately desire to have the dent fixed. What do you think my options are?

A: The definitive correction method of any skull indent or contour deformity is a custom skull implant made from the patient’d 3D CT scan. This allows for the most accurate contour correction with the smallest scalp incision to place it.

Dr. Barry Eppley

World Renowned Plastic Surgeon