Your Questions

Q: Dr. Eppley, I would like to ask you a few questions about your skull reshaping technique. Unfortunately I am suffering from a plagiocephaly, my skull has a flattening on the frontal, temporal and left parietal bone and on the right occipital area. I literally studied his two websites and he gave me hope. the asymmetry is not obvious but is a cause of great discomfort. I really appreciated his work and I believe in my case it would be ideal to use silicone implants. I would like to ask you how much the costs vary on average, what complications can arise and the average duration of an implant. In case of infection, is it possible to perform a new operation? Unfortunately I work as a farmer and I am exposed to extreme temperatures (over 40 ° Celsius) and with the sun beating right on the scalp, extreme heat and sunshine could affect the prosthesis by heating it and creating discomfort or even complications? there are more suitable materials in this case, perhaps focusing only on the bony part and not on the muscular part. I apologize for the many questions but his work has given me hope, thank you for your kind attention.

A: Thank you for your inquiry and detailing your concerns to which I cam make the following comments:

1) I would agree that your description of your head shape concerns is best treated by a custom skull implant.

2) I will have my assistant Camille pass along the general costs of the surgery to you on Monday.

3) Skull implants have a very low rate of any complications as I have never yet seen an infection or any other medical problems with their use. They will last a lifetime and never need to be replaced 

4) Silicone only changes physical shape (melts) at 190 degrees Celsius so being exposed to the sun is no problem.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if it would be possible to have my face scientifically looked at and see if there is a way to maximize my overall sex appeal to women. Like just start measuring things and see what things can be done to make my face super attractive with out just making one feature really big i.e jaw/ cheek bone. Obviously I am looking for permanent results. And i will be testing the overall result of the surgery using Tinder and seeing if there was a marked difference. I have done experiments on Tinder of very attractive men getting 200 matches while i only get 5 a month. Is there any way to enhance the features of my face to make me look like a model without just making one feature larger i.e jawline, cheekbones? Like is there some kind of mathematical formula for figuring out what on a face needs to be changed in order maximize female attraction to it? If all the science says for male faces is make the cheek bones and jawline more pronounced and that is what makes all male faces attractive then I would advise you to look at men who have some what slender jawlines but are still extremely attractive to females such as the model Francisco Lachowski. His jawline and cheek bone is not very pronounced but his midface is very smooth is there any way to obtain this effect?

A: What is possible with your face for aesthetic improvement will require my assessment and computer imaging based on your pictures. While facial improvements are usually possible I would not go so far as to say anyone can be surgically made to create a ‘male model look’ unless their facial features are close to that look initially.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had one question about a procedure. I am wanting to augment my chin in profile view. I noticed my bottom lip protrudes out a bit past the upper lip, which ruins the harmony of the side profile. I wondered what is the procedure to fix this? My bite is slightly not aligned so would aligning the teeth make the bottom lip sit back more? Or is the chin not lacking enough projection giving the illusion? I have attached an image. My goal is to have the upper lip and lower lip equal in protrusion or upper lip slightly more protrudes and have the chin more projected. What recommendations do you have?

A: There is no surgical procedure to move your lower lip back. (lower lip setback) Lip positions are controlled by the teeth behind them. Dental realignment may offer some improvement in that regard or even a lower jaw setback procedure…neither of which you ned based on your current dental alignment/bite relationship.

While a lower lip can be surgically reduced in size, this will not necessarily move it back. (posterior respositioning) 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a advancement sliding genioplasty done 1 month ago and would really appreciate a second opinion. Since the surgery I have been unable to move my lower middle lip despite having normal sensation. My lower lip appears to have half the volume it used to and it looks sucked in giving me the appearance of someone who has no teeth. When I smile my lower middle lip does not move and therefore covers all my lower middle teeth and even covers a bit of my two front teeth. When I speak it looks like my face is frozen. The original surgeon said this is normal however I have not seen this mentioned in any journal papers or on any forums. I am very worried about the functional impairment I am having and am not sure if this can be corrected? I am happy to send the preop and postop xrays. I believe the amount of advancement was 5mm horizontal and no vertical lengthening. Thank you so much for your time.

A: Thank you for your inquiry. Since I do not know the degree of the symptoms of which you speak, I can not say if that is normal or not. Admittedly this is not a postoperative issue that I have been told by any of my patients previously….which suggests it may not be completely ‘normal’. The more relevant question is whether what you are experiencing will resolve on its own or may merit surgical attention. To make that determination I would need to see pictures with your mouth at rest and then smiling.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to reach out and let you know how my rib removal recovery is healing three weeks after surgery.

1) I’m still experiencing some swelling after my rib removal, which I know is common. My left side seems to swell more than my right. Is this normal? 

2) Also, I’ve been experiencing a lot of skin sensitivity on my anterior torso. I imagine this is just nerve regrowth, but wanted to ask if it’s normal and why it’s occurring. 

3) My liposuction  sites are healing very well! They do get itchy at times, which I assume is part of the healing process. How many ccs of fat was removed from my torso? Was it 360 or just to my love handles? 

Thank you again for your wonderful work and attention. I look forward to hearing back

A: Thank you fo the followup to which I can provide the following answers to your rib removal surgery recovery questions:

1) Complete swelling resolution from the surgery sites will take up to 3 to 4 months to fully resolve. Some residual swelling and even periodic flareups of it is very common at this point.

2) Skin nerve sensitivity is very common over liposuction treated areas that develops after surgery as the tiny skin nerves regrow and create various temporary dysesthesias of which sensitivity is one of them. This will be a self-resolving issue as more healing occurs.

3) You had ‘270’  liposuction of the waistline since the very front of the abdomen was not treated. There was about 100 to 150cc of aspirate per side.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 25-year-old male and I have two quick questions for you. The first is the approximate cost of a custom jawline implant. If it varies depending on certain factors, then just a general idea or an average cost would be great to know. Secondly, is it a problem if my chin already possesses the horizontal projection that I desire? In other words, if I only want to add to my jawline–but not to my chin projection–is this a possibility? (I have already had corrective orthognathic surgery and a genioplasty, but my jawline is still very weak).

A: In answer to your custom jawline implant questions:

1) The cost of a custom jawline implant is fairly standard and I will have my assistant Camille pass along the cost of the surgery to you tomorrow.

2) Having an indwelling chin implant with adequate projection does not make it any easier or harder to design and place a custom jawline implant. The existing chin implant serves as an established anterior set of dimensions which is incorporated into the new implant design.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, About my philtrum – it measures around 16mm and including the upper lip (to stomion) it is about 24-25mm.

I would like reduction to reduce this by 3-4mm. But I don’t want a bigger upper lip, nor do I want more tooth or gum show. It seems like I am not an ideal candidate for this procedure.

However after doing photoshop morphs of my mouth, I look far better when I move the entire mouth upwards by 3-4mm. 

I’m wondering how we could accomplish something close to my morph. I would require chin reduction too, and I would also consider a commissuroplasty to widen the mouth by 6-8mm in total.

A: In answer to your questions:

1) A subnasal lip lift by definition will change the upper lip…that is unavoidable. The Cupid’s bow area of the upper lip directly under the nose is going to get fuller to some degree and there may be slight tooth show. At 3 to 4mms of skin excision these changes will be slight but present nonetheless. (probably not the tooth show with that small excision) In essence your morph is not completely realistic.

2) Mouth widening is usually done with maximal 5mms per side.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been considering few more options for my facial reshaping. Instead of the wraparound custom jawline implant, I would like to see if a genioplasty and injectable filler is something you can do. I already have a Lefort 1 and BSSO, hence the genioplasty/filler appears to be an ok option and I would not have the risk of infection from the implant.

A: While a bony genioplasty for the chin and injectable filler for the jaw angles can be used instead of a jawline implant, the aesthetic result would not be the same. While the bony genioplasty can create horizontal and vertical lengthening it does not provide any width increase. Injectable fillers would have to be used for the rest of the jawline and, while adding some volume, would not create any definition, just roundish volume.

In short, the bony genioplasty may be able to create similar changes to the chin as an implant the effects of the rest of the jawline by fillers would be far inferior to an implant.

It is not a question of whether this alternative approach to an implant can be done but whether the outcome would be aesthetically acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, the top of my head is flat. Is there any procedure to treat it? I would prefer a filler rather an implant. But let me please know if there is a treatment. Let me also know about risks and fees. 

A: Short of an implant, there are no reliable synthetic fillers or fat injections treatments that are either practical or reliable for skull augmentation. Given that even a small skull implant is a minimum of 50ccs volume one is to going to have to use 50 syringes of a synthetic filler for a comparative effect and a temporary one at that. While fat offers much more volume than injectable fillers at a better cost, its take is notoriously poor in the tight tissues of the scalp The unpredictability of scalp injections also makes them prone to contour irregularities as well..

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a custom glabellar implant. My questions are:

1)Is it placed through coronal incision?

2)How many mms of projection can be added?

3)Is bone erosion a huge issue?

4)Range of cost?

A: In answer to your custom glabellar implant questions:

1) Such an implant is placed through en endoscopic technique with a 3 cm scalp incision. There is never a need to use a large corona scalp incision to place such a small forehead implant. The endoscopic technique works very nicely for the placement of small forehead implants through small scalp incisions. 

2) Such an implant’s dimension is designed from a 3D CT scan to meet your aesthetic needs. I do not see any reasonable limit to the mms of projection obtainable. Glalbellar augmentation, by definition, is a naturally smaller forehead implant which fills in the depression between the brow bones centrally and the upper forehead.

3) Bone erosion is a non-existent concern.

4) My assistant Camille will pass along the cost of the surgery to you tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had Medpor jaw angle implants placed (medium design onlays) However I am not completely satisfied as it was the RZ mandibular angle implants I thought I was getting but I thought I’ll give it time to see the results. But they have added absolutely zero vertical length at my angle and are too small. 

I am looking for a revision jaw angle implant surgery and I want it done with best chance of success and it’s your name I’m constantly hearing of . I am wanting these removed and replaced with the large RZ implants.  I’m hoping for a good bit of flare along with a drop down at the angle also. What would be the start in getting a rough cost and the getting the process started with yourself. 

A: Thank you for your inquiry and detailing your jaw angle implant surgery history. Whether your goal of achieving ‘a good bit of flare with a drop down at the angle’ with standard jaw angle implants remains unknown to me at present. Until I know exactly where your current implants are positioned, how they compare to that of the dimensions of RZ implants, and what you look like before, now as well as what your computer imaged goals are, I do not yet have confidence that such a standard implant exchange can be aesthetically successful for you. 

It becomes critical to determine before another surgery that it can truly be successful. Given the challenge that removing Medpor jaw angle implants poses, you would want to have a high level of confidence that it will work.

The first step is to get a 3D CT scan of the lower jaw (CBCT or cone beam scan) to see the current location of your implants.

Dr. Barry Eppley

Inianapolis, Indiana

Q: Dr. Eppley, I am 72 years old and am only interested in getting rid of my turkey waddle with a direct necklift. Surgeons here in New York  do not want to do this surgery because it is an older technique. I have had a consult with a surgeon here in New York but his cost was well  over 10k for this simple surgery. 

A: Thank you for your inquiry. The reason surgeons are hesitant to do this surgery (direct necklift) is because of the scar that runs down the middle of the neck….which in women is much more of a concern that it is in men who have beard skin which heals better than non-hair bearing skin.

While a direct necklift is less invasive surgery with a quicker recovery than a traditional lower facelift, I would not call it ‘simple’ surgery. It still requires time and good technique to adequately get rid of the turkey waddle while creating a fine line scar in a visible area of the neck. 

I will have my assistant Camille pass along the cost of the surgery to you tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have numerous lower third facial reshaping questions:

1. Based on the “wish-pics” I shared with you, do you think it would be possible to get favorable results with just a well defined custom chin implant, micro-liposuction to the jawline, and buccal fat removal? or are the jaw-implants needed as well? I’m afraid I may look too masculine or the angle may look unnatural.
2. Will I still have a continuous look to my jawline if I get the 3 custom pieces instead of the wraparound or will there be noticeable gaps in between?
3. Do I need a custom chin implant for the look I want to achieve (less recessed more prominent harmonious chin) or will an out-the-box chin implant do? 
4. Do you have any pictures you can share with me of similar cases of female jawline augmentation? I found only a few on  your website.
5. What % of your jaw implants are female?
6. What % of your patients get revisions after a jawline procedure? 
7. What % get infections from the implants?
8. What other surgeries would you recommend to improve my facial profile to look more balanced?

A:Thanks for resending the email and providing all of your pictures. The answers to your questions are as follows and are abde done your pictures and the effect of a ‘jaw thrusting’ maneuver:

1) Such a jaw thrusting maneuver always bring chin forward and at a 45 degree angle. This also tends to thin out the face from under the cheeks back to almost the jaw angle area. No where in this maneuver does it necessarily make the jaw angles wider or more square.  Thus it seems appropriate that the right design of a chin implant and buccal lipectomies and perioral and jawline liposuction would be appropriate.

2) As in #1 I question the values of any jaw angle augmentation at this point. I would rather do first what is described in #1.

3) A standard chin implant will not work as it can not create the important 45 degree lengthening needed. It is either a custom chin implant or a sliding genioplasty. I personally prefer the latter as it is better for the neck as it pulls the neck muscles forward as the chin bone comes forward. 

4) Whatever pictures have been approved by patients to post (and most don’t) is available on www.exploreplasticsurgery.com and you can  look under different procedures in the search box.

5) For any form of chin/jawline augmentations about 20% are females. Males dominate this type of facial procedure.

6) The very specific type of jawline augmentation needs to be identified as they can be very different. A  jawline augmentation procedure that relies on a sliding genioplasty would have revision rates less than 5%. Those that involves  a custom chin implant around 10% or less.

7) Chin implant infections, of any size or shape,  are in the range of 1% to 2%.

8) I think your primary focus in the lower third of your face seems appropriate. That is the most ‘out of balance’ facial feature you have.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Lately the shape of my skull has been bugging me and I wanted to get a professional opinion on it. I have a dip/ridge at the center top of my skull. At times when I’m taking to people are work I can see their eyes dart over to the abnormalities in my skull. Naturally this stings the confidence a little bit. 

With your years of expertise, would you deem the shape of my skull as misshapen enough it needs corrective surgery? 

Would my skull require alot of corrective material? What kind of cost am I looking at? The recovery process? 

I have so many questions and don’t know if I’m asking the right ones.

A: Thank you for your inquiry and sending your pictures. A shaved head makes for a complete reveal of anyone’s head shape and I can clearly the dip to which you refer which is a transverse indentation along the original coronal suture lines. That is ideally treated by filling in the skull dip which is best done through a less than one inch incision placed in the middle of it which will heal imperceptibly. The augmentative material would be a custom implant design from your 3D CT scan.. It would really be like a thin strip of material which you can almost envision from the outside.

Whether this should be treated I can not say since this is a cosmetic issue of which only you can make that determination. I can only tell you how it would be done should you choose to do so..

I will have my assistant Camille pass along the cost of the procedure to you later today.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I previously had a BSSO/Lefort I to open up my severely restricted airway and address sleep apnea. While I did receive some relief from the apnea (about 50% improvement in nighttime breathing), the aesthetic result has been a huge problem for me. I had delicate features going into the surgery and the effect of advancing both the upper and lower jaws threw my overall facial balance and harmony out of whack. I have never become accustomed to my new look. This has upset me greatly since the surgery – especially the look of the upper jaw. I look odd and unnatural. A year after the surgery I had cheekbone implants to create greater balance by addressing my midface deficiency. I also had a genioplasty to address my concerns with the chin and jaw that I felt were too strong for my delicate features. But obviously neither one of those procedures are going to address the impact on my appearance caused by the maxillary advancement – and my chin and mandibular still remain too strong in appearance, overwhelming my other features. I fear this imbalance is only going to get worse with age. Can a BSSO/Lefort I ever be set back a bit, or essentially reversed? Does it involve major surgery and a long recovery like the original BSSO/Lefort I? Can you help me? Thank you for your time.

A: Thank you for your inquiry and detailing your history. A maxillomandibular advancement can be reversed in most cases of which the surgery and the recovery would be identical to the first time as it is the same operation just a different direction of movement. As a result this gives one some serious consideration between balancing the aesthetic tradeoffs and the functional improvements gained from the first procedure. Whether are other alternatives to that approach I can say without comparing your before and after surgery pictures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question about the zygomatic process of the temporal bone (I believe that’s what it’s called—I’m referring to the bone on the side of the head that connects the ear to the cheekbone). For me, my face is asymmetrical in that it’s wider on the right side of my face than my left. I was wondering if there’s any procedure to thin the bone a few mm and improve symmetry. I have read several posts by you and I believe it is called a posterior zygomatic arch osteotomy.

Thank you.

A:Thank you for your inquiry. You can reduce the prominence of the temporal process of the zygomatic arch. (or the zygomatic process of the temporal bone….depending upon how one chooses to call it) I have done so many times. This is technically called a posterior zygomatic arch osteotomy. This is done by an angled osteotomy with plate and screw fixation to hold the cut bone inward. This is done through a small vertical skin incision at the back end of the sideburn hair in front of the ear.

A very relevant question is whether this is the actual bony reason you perceive an external facial asymmetry. Ideally a 3D CT scan would be needed to confirm the diagnosis before one should do the surgery. The differences in the two sides of the face at the posterior zygomatic arch area will be clearly revealed by such a scan.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have quite a few questions about sagittal ridge skull reduction surgery. 

What does the procedure actually entail? I have a pretty decent idea from researching a few surgeries that you have already performed like this. 

What is the downtime after this kind of procedure? I can’t take a ton of time off work. 

What is the post surgery scarring like? 

Finally, do you think I would be a good candidate for this procedure? I have a less prominent saggital problem than some other I’ve seen on your site, but more than one I’ve seen. 

I have questions about cost and financing as well, but I’m sure those can wait until we discuss more. Pics below, but I can take better ones if needed.

A:Thank you for sending your pictures which chooses a classic posterior sagittal ridge skull shape. In answer to your sagittal ridge skull reduction surgery questions:

1) The procedure involves a burring (shaving) reduction of the raised ridge through a small scalp incision (3.5 ms) behind it.

2) .The recovery is very quick, no more than a few days other than some mild scalp swelling.

3) Such scalp incisions heal very well. No patient has ever requested a scar revision or had any issues with the scar.

4) Your candidacy for the procedure is based on how much it bothers you and what you want to put yourself through for its reduction.

5) My assistant Camille will pass along the cost of the surgery to you on Monday.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an issue where my right eye is lower than my left eye. I also have an issue that my eyes are droopy looking from one side which is my left. So I decided that I wanted a cat eye surgery to help me to be confident. I am going to Iran in a couple weeks time & I am going to get the corner of my eyes drilled for the cat eye. However I know that my eye is still going to be vertically not aligned. I messaged another doctor and they said there could possibly be a risk if they perform the procedure on me to get it to be vertically aligned. In real life you can’t tell unless you stare at my eyes. most people do not even know that they are like this. but in pictures it always comes out 10x worse and it just makes me feel insecure. is there any way to fix this problem ? Sorry for the long message and thank you doctor.

A: In vertical orbital dystopia (VOD) the eye is lower because the bone underneath it (orbital floor and orbital rim) are lower than the other side. This may also affect the cheek as well. A 3D CT scan would be needed to determine the exact shape of the bone underneath it to best determine how ti build up the bone to raise the eye. The upper and lower eyelids are also lower so that has to be addressed as part of the surgery as well. The two eyes are never going to be perfectly symmetric but significant improvements can be obtained.

Whether you elect to treat your VOD has an impact on Cat Eye surgery. If you are going to treat the VOD, Cat Eye surgery should be done after.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Firstly, I would like to say it’s great to get in touch with you. I wanted to ask a question about fillers. I like the the idea of custom wraparound jaw implant and custom Malar-zygo implant, but I wanted to ask if you could do a filler that would emulate the look of those two implants? I feel that it would be a good try on for the look, and if i like it, I could get implants down the road later. My goal is just to add get a decent result without too much deviation. Would fillers be able to let’s say add mass in the jaw and make zygos look more projected? Do you have fillers for this option? 

A: The simple answer is injectable fillers are not going to replicate what implants do, particularly of the jawline and along the infraorbital area. They are materials that have rvery different chemical structures and degrees of hardness/softness and are placed at different tissue levels. Fillers produce indistinct amorphous voluminization while implants produce a more distinct and defined look.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, On my question on Real Self, you answered me that chin, jaw and Infraorbital-malar augmentation would be of my benefit. 

I know Infraorbital-malar augmentation can be achieved by a custom made implant only. 

But what about the chin and jaw augmentation? Do you think it could also be achieved by standard implants in my case? Or do you recommend to get a custom wrap around implant to augment my jaw and chin, and make it more symmetrical? 

Also, I know it’s not easy to answer questions on the price, because it’s very specific for each individual, but could you maybe tell me something more about the price-range for both a custom jawline implant and a custom Infraorbital-malar implant? 

My goal is to get a more masculine look, and make my face more symmetrical and balanced, and get the high cheekbone look. 

I will provide the same pictures I posted on Real Self.

A: The short answer is if one is getting one set of custom implants (Infraorbital-malar) it would sense to do a second custom at the same time (jawline) sine the manufacturer offers a significant discount for designing and making of two custom implants using the same design sessions.

My assistant Camille will pass along the cost of such procedures to you by tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had consultation with three other plastic surgeons and they all just say that chin/neck lipo, or submental lipo or whatever it’s called, is what I need, and 1 said chin lipo + buccal fat removal. I weight 183 lbs and I am 5’10 which put me in sort of the overweight part regarding BMI, but even when I was younger and I wasn’t particularly overweight, there still hasn’t been what I wanted.

Basically what I want is a stronger jawline and sort of make my face less round if you get what I mean.

A: Thank you for sending your pictures. While submental/neck/jawline liposuction has some merit you should expect those changes to produce a minimal to very modest improvement and I would guess that your description of a stronger jawline and a less round face is not going to be achieved. Fat removal alone can simply not produce any significant amount of facial defining change. That is offered to you because that is what almost all plastic surgeons know to do. But the change you ideally seeking will not be achieved by a reductive approach only even though you do not have a classic weak jawline per se. 

You are only gong to change your jawline in any significant way by total jawline skeletal expansion. (augmentation) It does not have to be a lot but some total jawline augmentation is needed with the fat removal to really take you to where you ideally want to go. I will send some computer imaging tomorrow morning to illustrate what I mean which is likely much more in line with your goals.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve always had a round face despite my normal weight. One and a half year ago, I underwent a laser liposuction (submental and lower third face) plus a buccal fat pad removal. And masseter botox, too.

My face shrinked but I’m not happy with the results because I remained with a little over correction in the right side that improved with a hyaluronic acid filler. But the worst for me it’s the hypocorrection of the lower third of my face.

What I looking for is to define just a little bit the lower third creating a less puffy jawline in the front view. I don’t want to creat ea depresssion in that area.

I know there’s a risk in liposuction the jowl area. But Is it possible without creating irregularities, just the necessary amount for creating a more straight line in the lower third jawline.

Thanks

A: Thank you for your inquiry and sending your pictures. While the jowl area can be treated with microliposuction with a low risk of causing irregularities, it is probably unlikely to create a perfectly smooth jawline either. Now that your face has been deflated by fat removal the residual jowl fullness is a lax skin issue. To really create a smooth jawline the skin needs to be pulled back along the jawline with a limited lower facelift or jowl tuck procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am inquiring about clavicle reduction surgery. (shoulder narrowing)  How much reduction can be achieved by your team?  How much bone is removed per clavicle?  Where are the scars positioned? What is your timeframe for recovery? How much does this surgery cost, excluding travel expenses? I am asking both out of personal motivation and interest, as well as to compile information about surgeons willing to preform this procedure for others reference. 

Thank you for your time. 

A: In answer to your shoulder narrowing (clavicular reduction) surgery questions:

1) A 2 cm length of the clavicle bone is removed per side which roughly translates into a one inch shoulder width reduction per side.

2) The 4 cm incisions is placed directly over the osteotomy site at the mid-clavicular level.

3) Recovery and what activities are done are based on clavicle bone repair healing. Such bone osteotomies takes about 6 to 8 weeks to fully heal when one can return to all normal physical activities.

4) My assistant Camille will pass along the cost of such shoulder narrowing surgery to you tomorrow.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My goal is a more masculine face with better-defined jaw, chin, and cheek bones. Basically the “male model” look. I’m wondering if Dr. Eppley thinks an infraorbital rim implant would be desirable to provide definition beneath my eyes. I suspect that recessed infraorbital rims cause my under-eye area to look hollow.  Please let me the know the extent to which you think I would benefit from these facial implants. 

Thank you!

A: Thank you for your inquiry and sending your pictures. You do have the type of face that would respond well to infraorbital-malar and jawline implants. That type of favorable face has two main characteristics; 1) fairly lean with not a thick soft tissue layer and 2) reasonable facial skeletal development. This allows implants of modest-moderate size to show through and create better facial definition. This may not make you a ‘male model’ but it will take what you are born with and take it to a more defined angular facial look.

Custom infraorbital implants, if they have enough height, can drive up the lower eyelid and decrease scleral show. How much they improve undereye hollows depends on how much horizontal projection they have as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 24 year old male with height of 165cm (5ft 5inches)),

While I would like to increase my height I consider methods such as  Limb lengthening by osteogenesis distraction (where bones are actually broken and lengthened) to be too extreme especially given my starting height, 1-2 inches will be sufficient for me, (3-4 inches is not necessary).

I saw the article on your website (https://exploreplasticsurgery.com/plastic-surgery-case-study-male-custom-heightening-skull-implant/):

1) With use of a scalp expander first would an increase of 2 inches of height be possible with a custom implant??

2)  What is a rough ball park estimate cost of such a procedure? 

A: Thank you for your inquiry in regards to custom skull heightening implants. Depending on one’s natural scalp elasticity, an immediate insertion of a custom skull implant will create close to an inch of additional height. But it will take a first stage scalp expansion to permit the placement of a larger custom skull implant to get closer to 1 1/2 inches.

I will have my assistant Camille pass along the cost of a two stage custom skull implant process on Tuesday.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in learning more about jawline augmentation by the wrap around implants, I don’t think I need customs ones however so are there any that have been premade? I currently have a triangular face but aiming for a more U shaped, masculine shape, will this be possible? also what is the cost, i have attached picture of what I currently look like, and another of what results I am aiming for.

A: Thank you for your inquiry and sending your imaged pictures which shows a smooth confluent jawline augmentation effect back to the jaw angle areas. It would require other facial views of imaging to see the full 3D jawline effect that you seek. One view alone does not provide all the information needed. 

While your jawline augmentation needs are modest by my standards, that does not mean it is easy to achieve. Getting such a smooth and even effect is always most assured by a custom jawline implant made from the patient’s 3D CT scan. Only by creating an implant that naturally expands the shape of the jaw can such a smooth effect be seen in my experience. Standard chin and jaw angles implants are what is known as spot augmentations which are fine if just the chin and/or jaw angle area needs a specific augmentation. But smooth and confluent jawline augmentation effects do not come from the use of standard implants not specifically made for the patient.

I will have my assistant Camille pass along the cost of the surgery to you on this coming Tuesday.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in having an otoplasty on my left ear. While I did not find many of these types of surgeries during my research, I would like to ask you a few questions.Have you performed similar surgeries in the past, and if so, could you please send me some before and after photos?

What type of method do you plan to apply for this type of surgery and where will the scars be located? Will I have a small scar on the helix of my ear?

I was thinking about a reconstruction from the upper middle up to the top of the ear with the use of a cartilage graft for support, as I saw in one of your surgeries. Do you think that is the best technique to apply on my ear?

A: Thank you for your inquiry and seeding your pictures. You have a form of a constricted ear as seen by the folded over helix from the middle of the ear (3:00 position) up to the center of the top of the ear. (12:00 position) While some may refer to it as a Stahl’s ear, because of its pointed appearance, it does not have a third crus so it is not a classic case of it. The helix is also setback behind the antihelical fold as part of the overall hypoplasia. Interestingly some helical cartilage can be seen protruding from behind the helical skin almost as if the cartilage is adequate by the skin is deficient.

But I do think that the skin needs more helical cartilage support to both pull the helical rim skin back over it as well as provide some more projection. As you have noted a cartilage graft is needed to do so an the right amount and curve to it comes from a small portion of the subcostal rib #9 or #10.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a young male and will be getting angular custom jaw implants, a chin implant and cheek implants next month. When I asked my Dr. about the wrap-around implant you offer, he mentioned he is not a fan of this type of implant because it requires complete degloving of the muscles. I have attached the MRI images showing the custom jaw implant that has been ordered from the implant company. Prior to proceeding with the surgery, I was wondering if I can get the opinion on the type of implants my doctor is proposing. After looking at pictures of the wrap-around implant, I’m concerned that with separate angle and chin implants I’m getting, it will be very difficult to achieve both a smooth jawline and a wider and more projected chin, because the vertical lengthening only exists at the back of the jaw bone, and does not extend to the chin. I would really appreciate if you can provide me your medical opinion on this and whether or not you believe what a better result would be obtained in my case with a wrap-around implant. Many thanks, 

A: Thank you for your inquiry to which I can make the following comments:

1) I do not comment on facial implant designs of other doctor’s patients. That is not appropriate for either the patient or the treating surgeon.

2) I would disagree, however, with the concept that a total jawline implant requires complete muscular degloving as that is not based on an anatomic understanding of jawline soft tissue anatomy. The muscles that do need to be elevated are the mentalis (chin) and the masseter (jaw angles), there are no muscular attachments between the two. Interestingly these are the same muscles that must be elevated for separate chin and jaw angle implants. What is elevated in a total jawline implant is the need for complete subperiosteal elevation.

3) I think your aesthetic concerns are well founded which is why the use of separate chin and jaw angle implants has largely been replaced in my practice with the wrap around implant concept. It simply offers a superior aesthetic result that has fewer postoperative complications such as asymmetry. When the jawline is weak or underdeveloped it makes more sense to augment the whole problem as a single unit that it does to add ‘spot’ augmentations to the three corners of the lower jaw for most patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am reaching out to you in regards to my son who is an early teen. He had a nevus sebaceous birthmark removed from the crown of his headless year. The plastic surgeon was able to do a primary closure. At first the scar looked great, but at almost a month , the scar widened dramatically. Now we have him scheduled for a scar revision with a different plastic surgeon who wants to do extensive undermining and galeal scoring with vertical mattress suturing. Can you give me some insight?

A: It is perfectly normal and to be expected that all scalp scars will widen with any form of excision. The size of the excision will determine how much subsequent widening will occur. This is an unavoidable phenomena because the scalp is tight and is really skin stretched over a beach ball so to speak. While the scar may look great for a few weeks, the widening will subsequently occur. The extent of the widening will be fully manifest by three months after surgery and no revision should ever be done before them…as the tissues need time to relax. This is all part of the typical preoperative education. 

I tell all scalp excisional patients, particularly children and teens, that there will be a likely 100% chance of the need for subsequent scar revision. Most likely the wide scar is less than the original excision so the tension will be less and the scar will be better. The techniques that have been described are appropriate and represent the maximum approach for ‘Plan B’.

There is also the phenomenon of lost hair next to scar which can be confused with a ‘wide scar.’ The scar is actually narrow but loss of hair (hair shedding) makes it look wider than it is. In some scars it may be a combination of a true wide scar and loss of hair shafts. This is another reason to wait to see what impact any hair regrowth will create on the scar’s appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Thank you for responding so quickly! I would like your opinion on what could make my face look more symmetric and give it more definition, if possible. Basically, I would like to look like I have good bone structure. I’m not trying to look like any particular celebrity, but I’ll use their pictures to show what I like. I have several facial reshaping procedures in mind, but perhaps you will suggest something different.

I’m 27 years old, female, had braces to correct an overbite over 10 years ago, a primary closed rhinoplasty and a subnasal lip lift last ye5ar. I’ve tried lip fillers both before the lip lift and after.

Overall, I think my nose is better, but I’m not completely happy with it. As far as my lips go, I like the view from the side much better now, but the front still bothers me. Fillers never did much for me in my opinion.

I think I look drastically different bare-faced. Makeup helps me create some definition and angularity in my face, larger upper lip and a more symmetric nose. Of course, makeup can only do so much. I’d rather get more significant and lasting changes.

Here are my specific questions. I’ll start with what had already been operated on and then get to facial implants.

NOSE

I still have a remaining bump that is visible from certain angles. I wanted a more concave bridge and a tip that’s rotated a bit up to create an effect of a slightly shorter nose. I also think it lacks symmetry from the front and even with makeup I have difficulty making it look straight. My original nose had a bump and a bulbous tip, but didn’t seem crooked to me. My breathing was great before surgery, now it’s a bit worse, but not to the point where it bothers me.

Do you think it would be worth it to operate on it again?

LIPS

I just want my top lip to be close in shape and size to the bottom lip. Unfortunately, the lip lift didn’t give me a top lip. And I don’t like what fillers do to me (too puffy, not enough vertical red lip). So I feel stuck. The surgeon who performed my lip lift told me multiple times that both vermilion advancement and V-to-Y would look horrible because there would be no white roll and my lip would look pasted on, but I just don’t see what other options I have. The only thing he suggested was Botox lip flip to prevent the top lip from curling inwards when I smile and more filler. I am not happy at all with the current state of my lips – still very thin top lip when I look straight on, nonexistent on the sides unless I overline significantly, plus now if I close my mouth completely there’s a visible strain in my chin, that’s why I mostly keep the mouth slightly open – if I close it, my chin flattens.I don’t like how (in my opinion) it makes me look sad or angry.

What can I do?

CHEEKS

I’m interested in a custom model implant that extends all the way back. I’d like the effect of very prominent cheekbones, but I know there are limitations.

Do you think that’s achievable for me?

CHIN/JAW

My goals are: shorter, more protruding chin, and a defined jaw. I’ve always felt my chin is a little too long vertically, but in addition to that after a lip lift when I close my mouth my chin looks recessed. I also carry some fat around my jaw even when my weight fluctuates lower. It’s just never been really defined. I’ve had one surgeon recommend a neck lift, but I don’t know if that will be enough – I’m not sure how good my underlying structure is. I think my face always looked soft.

What would be a good solution here? Sliding genioplasty and a custom jaw implant? Something else?

A: Thank you for sending all of your pictures and detailing your concerns. You are correct in that makeup can make a person look completely different. But it is also helpful because it shows what the patient is trying to achieve.

As I understand it your prior surgeries have included a closed rhinoplasty and subnasal lip lift. Your goals now are to basically have a more defined facial structure and fuller lips. In essence this comes down to the following facial reshaping options:

NOSE  While your initial rhinoplasty provided improvement (reduced the hump) it reflects the more modest changes that typically occur from a closed rhinoplasty and largely left the tip relatively unchanged. You are probably seeking a more complete rhinoplasty to lower the bridge further, reduce tip projection and provide some tip rotation This is the way you are going to get a somewhat smaller and more shapely feminine nose.

CHEEKS You need some defatting underneath them from buccal lipectomies and perioral liposuction to create less fullness between the cheekbones and the jawline. This will also create a bit of a cheek augmentation effect. A custom heel-arch style always provide the best definition .

LIPS. When women draw their lips on and they look better they are basically adjusting the position of the vermilion. While a subnasal lip lift creates more central upper lip fullness it does not address the sides of your lip which is why you like it from the side view but not so much from the front view. This can only be addressed by a vermilion advancement.

CHIN-JAW. Your chin needs to come forward and be narrowed (sliding genioplasty) and some small jaw implants that help create a more visible angle to the back would create a more total jawline effect with the chin.

These are my initial thoughts,

Dr. Barry Eppley

Indianapolis, Indiana