Your Questions

Q: Dr. Eppley, I am writing to you with great respect for your extensive experience and contributions in the field of craniofacial and aesthetic surgery. I have been researching potential avenues to address a specific aesthetic concern I have, and your name consistently comes up as a leading expert regarding more niche but possible surgeries. My concern relates to the spacing of my eyes. While my interpupillary distance is within a normal range, I feel that the inner corners of my eyes (the medial canthi) are positioned relatively close together. This gives my eyes a narrower appearance in relation to the rest of my facial features than I would prefer, and I believe it detracts somewhat from overall facial harmony. I understand that altering the structural relationship between the eyes can be complex. I am not seeking a drastic change (the change seems to be a few millimeters), nor am I approaching this lightly. However, I am keen to understand if there are any established surgical techniques or approaches that could potentially help increase the intercanthal distance, even modestly, to achieve a more balanced look. I would be very grateful for your perspective on whether this type of concern is something that can realistically be addressed surgically. If procedures do exist, could you perhaps offer some general insight into what they might entail, their potential effectiveness for achieving a subtle widening of ICD, and importantly, the typical risks involved? I am trying to carefully weigh whether the potential aesthetic improvement could justify the complexities and risks associated with any relevant procedures. Like I said, moving the eyeballs is not what I’m looking for but rather narrowing the horizontal eye width by changing the medial canthi position (through whatever means you would consider to be safe and direct). I am serious about exploring viable options and am prepared for the associated costs. However, my primary aim at this stage is to first understand the general possibility and validity of such a procedure before proceeding further, for example, with a formal consultation, should a potentially suitable and reasonably safe approach exist. I am happy to provide photographs if that would help clarify my concern at any stage. Thank you very much for considering my inquiry. I appreciate your time and expertise.

A: Essentially what you are describing is the reduction/elimination of the lacrimal lake area of the inner eyes. This could be done by a v-shaped incision along the medial edges of the upper and lower eyelids, excision of the lacrimal lake mucosa and a straight line closure. This moves the inner eye corner more laterally. It is not clear to me yet what the role of any medial canthal tendon manipulations would be or if even needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to flatten to narrow my skull and have it more inward like normal skull. I had a children’s hospital provide me a surgery in my teens because my skull grew outward randomly on one side of my jaw and on the side of my head

I had another surgery over a year ago on the back occipital to reduce that bone, which helped me, but they weren’t able to do the mastoid around the ears because they didn’t have the proper scan and didn’t wanna risk damage to air cells I believe.

A: The mastoid bone is thin as it is largely composed of air cells. Whether a reduction effort is worth it depends on the thickness of the layer of bone over the air cells. This requires a 2D CT scan to make that determination.

Having done mastoid reductions numerous times that experience indicates that some reduction of the mastopid prominence can be achieved but usually not a complete flattening of it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am unhappy with a medpor chin implant that was placed 5 months ago. It is too long, wide, square, and adds to the the asymmetry of my chin. I am interested in replacing it with a smaller implant but I am worried that it will still add to the asymmetry. Is there a way that I can put a smaller implant in without wings while also countering or just not increasing the assymetry? Would a standard implant be able to achieve this or would it have to be custom?

A: This is a self-answering question….persistent asymmetry after a standard chin implant means the next proper step is a custom implant approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a kidney transplant recipient currently taking Tacrolimus (Prograf) as part of my immunosuppressive therapy. I am exploring the possibility of undergoing breast reduction surgery due to ongoing physical discomfort and quality-of-life concerns. Given my medical background, I am seeking guidance and potentially a consultation with a specialist experienced in performing cosmetic procedures on patients with organ transplants. My priority is to ensure that such a procedure would be safe and appropriate in my current condition, with coordination between the surgical and transplant teams if necessary.

A: In the past I have safely performed breast reductions and tummy tucks on several kidney transplant patients. Barring any unknown medical reasons immunosuppression therapy alone is not an exclusion criteria. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, what size is a safer hip implant?

A: The best way to think about it is the size of the hip implant would fall short of your expectations/goals. Big hip implants have a very high rate of problems. The concept is it is better to have 50% of what you want with less risk of complications than 100% of what you want with a complication. As the only way to solve most implant problems is to remove them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I live a very healthy lifestyle, I work out daily I go to the gym, I lift. All with the want to have visible abdominal muscles. After all everyone has abs they just aren’t always defined. I worked out for going on 3 years now and combined with a healthy diet. I was wondering if based on the photos if you think I would be a “good” candidate for Abdominal sculpting. I have researched it in my free time, but it’s very hard to find pre-op “good candidate” photos to tell if I match.

A: The best candidates for abdominal etching are the thinnest where the subcutaneous fat distance between the skin and the abdominal wall is limited.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have too much fat grafting in my cheeks, i see in his webpage Dr, Eppley could help me. I would like to be more natural as I was before the fat grafting.

A: Reversing facial fat grafting is very difficult and there is no ‘returning home’ again. Minor reductions are usually achievable but looking like one did before is not going to happen. Fat grafting has many merits but complete reversability is not one of them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to make the ribcage laterally wider with implants on each rib. Also do you still offer clavicle lengthening. Have you seen dr Leif rogers do clavicle lengthening using distraction osteogenesis? What are your thoughts on distraction osteogenesis of the clavicle bone. The limb lengthening doctor disagrees with the clavicle lengthening.

A: Can the ribcage be widened by rib bone implants….I see no reason why that would not work since the rib provides a stable base on which to place an implant. 

While theoretically any long bone can be lengthened the clavicle poses issues for device application. Until improved devices are developed for the clavicle specifically I remain guarded about its success at the present time. But there is definitely a need for it as clavicle lengthening by osteotomy remains limited in its effects.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have always had the problem of the mental crease, and feeling like it causes a witch chin when I smile and a double chin. I don’t like the crease the most. But I also do not like the protrusion of the chin when I smile and the double chin. I’m not sure if fixing the mental crease would also fix these issues.

A: It is exactly the opposite of what you have stated…making the labiomental crease less deep will not fix a double chin or a witch’s chin. Conversely fixing a double chin or witch’s chin will make the labiomental fold look less deep.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Id like to talk about getting a revision surgery. I received a wraparound custom jawline implant than im unhappy with a year and a half ago. Its too wide laterally, it added 7 or 8 mm width. I think it would be far more aesthetic to add only 3mm laterally. It goes back too far towards the ramus bone which looks unnatural. It doesn’t blend with the natural gonial where it starts curving up. It goes past it which I dislike. It is too round in appearance. I would prefer sharper masculine lines. It also lacks the chin jaw separation that I want. I want to have a more forward projecting chin like 9mm instead of 5mm. I want it to be slightly squared with taper that creates separation between the chin and jaw. I also want to get cheekbone implants to balance the slightly long flat midface. Im not looking to add width laterally just upward and out 5-6mm. Id like them to be sharp and masculine. I want no added submalar fullness. Im seeking that model esque shadow under the cheek that photographs well. Id like them to be well blended so theres no obvious bumps.

A: One of the ‘advantages’ of having a custom implant design implanted and observing the long term outcome is that now you have a better understanding of the cause and effect relationship of an implant’s dimensions. I think you are well on your way to an improved jawline implant design.

For the cheek implants this is a new design concept but one which is fairly common in my experience with male cheek implant augmentation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon 

Q: Dr. Eppley, Is it possible to add canine fossa implants? Similar to how you want cheekbone implants for more cheek prominence and angularity. The shallowness of the canine fossa can have a significant effect on the appearance of the ogee curve and midface fullness. I have attached images below of fossa variances and theirs effects. The faces of the models seem to be on each of the ends of the bony fossa image attached. There seems to be a sliding scale for how much shallowness you want. I have seen this fighter who seemed to have a more medium shawllowness and it looked the best. Had the angularity to see the hollow cheek and most lighting but also too shallow of a cheek can make the midface appear fatter as you can seen in the first model where the second looks leaner simply because less bone.

A: The canine fossa, like any area of the midface, can be augmented with an implant. It is a relatively small concave indentation lateral to the paranasal/pyriform aperture. It can be augmented with an implant and whether that would be of a modified standard implant or requires a custom implant design depends on how much surface area coverage is needed beyond of the canine fossa itself.

Dr. Barry Eppley

World-Renowned Plastic Surgeon 

Q: Dr. Eppley, I had a previous sliding genioplasty. I’m now exploring the possibility of adding a chin implant on top of the previous procedure and wanted to ask if this is something Dr. Eppley offers. If so, could you kindly walk me through the consultation and photo submission process again? It’s been a while, and I’ve forgotten the exact steps from last time. Thank you very much for your time, and I look forward to hearing from you.

A: Good to hear from you again. The success of adding an implant on top of the sliding genioplasty depends on what further aesthetic augmentative changes you are trying to achieve. Unlike a chin implant alone, where larger amounts of implant volume can be added, once a sliding Junior plasty is done of some significance in your case being 10 mm the overlying soft tissue chin had gets much tighter. Thus, while an implant can be added to it the amount of implant volume is going to be a lot less than an a primary chin implant augmentation patient. That being said what changes are you looking to achieve from a dimensional standpoint?

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking to get a set of permanent and customized implants for my cheekbones. As you can see in the photos, I dont have a defined ogee curve whatsoever and it’s only partially visible in certain lighting. My side profile also lacks cheekbone projection. I am looking for a very sharp, masculine ogee curve and Dr Eppley seems like an expert in the topic. 

A:Thank you for sending your pictures. I certainly can see your aesthetic cheekbone concerns and you have correctly surmised that the only effective solution would be custom designed cheek implants. However, you also have to be aware that the fundamental reason you lack cheekbone projection is that you have overall midface deficiency or flatness. This also means you have lack of infraorbital projection anteriorly as well as the cheekbones laterally. Therefore what you really need this custom infraorbital– cheek implants. In addition due to the overall lack of midface projection one has to be cautious in any form of cheekbone augmentation to not overdo the design so it does not look out of proportion to the rest of your face.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Will inner eye widening cause any problem to the eyes’ tear system? And is there anyway to basically reduce the medial area while keeping the lacrimal lake? Like while keeping the medial canthi reducing the sclera?

A: It is done medial to the lacrimal punctums/ducts. The procedure works because of the lacrimal lake reduction not the medial canthal tendon…meaning you can’t shorten the medlal canthal tendon laterally due to its bony anchorage.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I mostly feel like the bottom half of my face is quite heavy and creates a pear shaped look to my face. A lack of cheekbone definition and the appearance of jowls are all part of this. There also seems to be a concentration of fat right by my nose and lips from the side view. Additionally, I feel like there is not enough forward projection of my chin in my profile, leading to a weak profile and my nose still looking quite large in comparison. Ideally, I would like to remove the heaviness and jowls and gain a lifted appearance overall, as well as a stronger profile.

A:As you have astutely pointed out your skeletal deficiencies certainly make a major contribution treat your current facial appearance. The combination of cheek and shin augmentation possibly with some facial defatting would be helpful. While the cheek augmentation needs to be done by implants your chin augmentation is best done by a sliding genioplasty which will have a more profound effect on improving the jowling and the heaviness in the perioral area than an implant.. The attached imaging provides a visual application of these facial augmentation concepts although the magnitude of the desired changes is open to discussion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my question is do you perform hip bone shaving to remove hip dips. If yes how much bone can you remove from hip bone in grams and/or kilograms .Another question what’s the maximum amount of bone you can remove from hip bone to remove hip dips in grams and/or kilograms. 

A:I believe I have answered this exact inquiry previously. But to repeat my prior answer we do not measure iliac crest bone removal by weight (grams or kilograms. Rather it is measured in the amount of linear bone projection  that can be removed which usually is in the 1 to 1.5 cm range. Whether that would be enough to significantly decrease the appearance of the hip dips would require assessment of her pictures with some imaging predictions as to what the effects of iliac crest reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in hip implants. I want to achieve the hour glass body shape. I am lookin to haver bigger hips/tight because my body is more like an inverted triangle.

A:I am always concerned that patients requesting larger hip implant augmentations are much more prone two complications such as chronic fluid collections and implant edging. Smaller hip implants do much better. When I see the phrases such as hourglass body shape, bigger hips and correction of an inverted body triangle all of this indicates the need/desire for larger hip implants. Such hip augmentation patients quite frankly make me nervous I’m About such potential hip implant surgery. Hip implants are uniquely different from all other body implants particularly in their complication rates due to their relatively superficial soft tissue location.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to contact you about my frontal bossing. I want to reshape my forehead. My forehead sticks out in the middle I don’t actually have a big forehead i want to be more flattened.

A:The reality is the forehead bone is not thick enough to make it completely flat. It can become less protrusive but never as flat as you would like. It requires a combination of building the sides a bit and reducing the central protrusion to get the best forehead contour.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Last August, I sent you a question about hip implants and their possible complication of inferior edge show, if it would be possible to inject fat or synthetic fillers around the visible implant edge to try to camouflage it and your answer was yes. Would this camouflage only work while not bending or leaning, like when standing normally? Will it show if I ‘pop’ my hip out or If I lean? When in dynamic motion or dynamically “posing”? Thanks in advance.

A: A treatment like fat injections around hip implants is done in the static position. What may subsequently happen in dynamic motion is different and cannot be predicted. However, it would be safe to assume that the dynamic show would still persist but perhaps be a bit reduced.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a corner lip lift with Dr Eppley about ten years ago and due to aging, I am interested in having another one and want to see if that’s possible.

A:In looking at your preop pictures from ten years ago I suspect you had lateral vermilion advancements due to upper lip vermilion disproportion. Lateral vermilion advancements are often confused with corner of mouth lifts because of some similar effects at the corners. Regardless such lateral upper lip procedures can certainly be repeated.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have long wanted a chin augmentation procedure. What procedure is best for me?

A:Thank you for sending your pictures. You have a major chin deficiency which is really representative of a more global lower jaw deficiency. Barring getting lower jaw advancement surgery your chin augmentation can only be done by a sliding genioplasty. A chin implant is not appropriate in your case given the magnitude of the of the deficiency, which is in the 20 to 25 millimeter range, and that the chin is sloped backward which makes an implant ineffective. Only a bony sliding genioplasty will be effective and, even when done the maximum amount of 12 To 14 mm (see attached imaging) has no risk of being overdone. Fortunately, being a female, the amount of chin augmentation needed is less than that of a male. You also have to be careful given where you’re now that any major change may be psychologically hard to adjust to as you may not recognize yourself after surgery for some time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been looking around and I am interested in undergoing shoulder reduction surgery. I would like to know more about this procedure including complications, price and duration.

A:Thank you for sending your pictures. Shoulder reduction surgery is most effective in the leaner patient with a body type like yours. I have tried to do some predictive imaging to show you the potential results from such surgery but your pictures have issues when it relates to imaging. From the front view the picture is taken too close so there is no room between the edge of the shoulders and the side of the picture to do preditive alterations. The back view picture is a bit better but taken against the side of the door there is going to be image distortions in it.

In my extensive experience with shoulder reduction surgery there have been very few complications. While potential complications always exist the biggest consideration in shoulder narrowing surgery in my opinion is the recovery. One has to be properly educated on the recovery since it involves both shoulders and arms and that poses some postoperative limitations that is very different from clavicle fracture repair surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i am 26 years old. I have concerns about my weak chin/jawline and the neck webbing (which i assume i have). I was wondering if you were able to tell me roughly how much it would cost to fix the neck webbing and the weak chin/jawline. I did see you have performed the surgery on the neck webbing before and was also curious if patients prior have had insurance cover any part of the surgery. I look forward to hearing back from you. Thank you for your time.

A:Thank you for sending your pictures. You do indeed have neck webbing as evidenced by the low and laterally displaced hair line. As commonly seen in neck  webbing, and maybe as a direct result of it, the chin is often short and the neck and jowl area tends to be fuller even in young patients. From a neck webbing standpoint the posterior approach to its improvement is very effective. As part of the neck webbing correction submental in that jawline like the suction can be performed and I small chin implant placed if , as a female, chin augmentation would be viewed as beneficial.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in shoulder widening surgery. It would be great if you could tell me what’s the maximum shoulder widening we can do. 

A: In very muscular patients like you the limits of shoulder widening are increased due to the tightness of the shoulder girdle soft tissues which cause restructions as one tries ti lengthen the clavicles. This is what I think 10 to 15mm of bone length can create.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I must correct myself in my language regarding frontal bossing reduction through deburring.  I’ve provided a number of pictures including two x-rays.  We have similar bone structure.  Hopefully, between these images you might have a better idea of how much frontal bossing you can remove by deburring.  As you said it may be enough to give me a more feminine profile by debossing using a small incision.  Can this procedure result in nerve damage or long term numbing of the area?  Would you be able to also debur the tail of the brow bone over the eyes to open them up more?  

Thank you for your information regarding the rhinoplasty & lip lift as one procedure.  To confirm if you did both together you would perform a closed rhinoplasty to eliminate/reduce scarring?

A:The determination of How much brow bone projection can be reduced, otherwise known as thinning of the outer table of the frontal sinus, is ultimately determined by a 2-D CT scan to make an accurate assessment. Any picture imaging done is an estimate based on experience of  how much likely could be achieved. The tail or outer aspect of the brow bone is not subject to the limitations of the medial brww bones as there is no frontal sinus in this part of the brow bone. While the medial brow bones may be able to be treated due a small scalp incision the outer tale of the brow bones cannot. Using such a limited approach it is better to do the tail of the brow bone reduction using an upper eyelid approach. You are in need of an upper blepharoplasty anyway due to the large amount hooding that you have. Reducing the tail of the brow bone alone is not going to open up your eyes given the large amount of U\upper eyelid skin that exists.

Any method of elevating the forehead tissues is going to result in some temporary numbness which is almost never permanent.

With the type of nasal changes that you need a closed rhinoplasty would be a poor surgical approach. You need an open rhinoplasty to optimize the amount of reduction and reshaping. The scarring from an open rhinoplasty is virtually nonexistent and I’ve never yet seen a scar revision requested from an open rhinoplasty. The concern about an open rhinoplasty in your case is the potential concomitant subnasal lip . There is a small strip of columellar skin that would exist between an open rhinoplasty and the subnasal lip lift incisions which has the rare risk of vascular compromise. As a result I am very cautious when considering combining these two procedures. In looking at your thin upper lip, which has limited vermilion height from corner to corner, the subnasal lip lift is not a good choice for lyour ip augmentation as you will essentially get a A frame deformity. (the center of the upper lip is elevated but the sides  of the lip is not) You would be better served with a vermilion advancement from corner to corner which can also very safely be done with an open rhinoplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a forehead widening or augmentation. My head is very small for my height, but I believe just a forehead temporal implant and possibly reducing the slope would work since I do not want an extreme increase (a 1cm gain in overall circumference could be enough).

I’ve attached what my forehead looks like. It is diamond shaped and particularly narrow. Let me know what can be done.

A:I would need to see a side view picture of your forehead as well for a proper assessment and imaging. But you are certainly referring to a custom forehead-temporal implant design as per the attached imaging. It may not need to extend as far posteriorly as this design is but it conveys the general implant design footprint needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been researching ways to enhance the balance and definition of my facial structure. After reviewing your website and seeing your extensive work with custom facial implants, I am very interested in exploring potential procedures with you.

I naturally have a pear-shaped face, with a relatively narrow upper face, flat cheekbones, almond-shaped eyes, and a narrow forehead and temples. My jawline is stronger in proportion, and I would like to improve the harmony of my facial thirds — specifically enhancing the midface and upper face for a more balanced and structured appearance.

I’m particularly interested in your custom midface implants, infraorbital-malar implants, temporal implants, and possibly forehead augmentation. I am also open to mandibular angle or jawline implants if you believe they would further enhance my facial aesthetics.

I’ve attached a photo for reference and would greatly appreciate your expert opinion on what procedures or implants you would recommend in my case.

Looking forward to your thoughts.

A:Thank you for your inquiry and sending your pictures. Your primary focus in your inquiry has been about mid and upper facial widening which your pictures clearly show a longer more narrow face. This would require custom temporal and infrarbital – malar implants to help widen the upper two thirds of your face as well as provide some augmentation the under eye hollowing. The attached imaging reflects a general concept about the effects of these implants although do not over interpret the details of it. Since you ask about the lower chol augmentation I’ve also done a second set of imaging which includes that of a custom jawline implant.

The purpose of the imaging is to help you think about what changes you feel are best for your facial structure and proportions. I never tell patients what they need. Rather my mission is to help patients think about their problem and potential solutions and the use of imaging guides the patient’s understanding of potential facial changes. In the end it is the patient must decide what they think looks best of them.

Computer Facial Imaging ConceptsAlso, I would read the following attached statement so you can best understand what the role of facial prediction imaging is for facial reshaping surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to you in the hope of receiving your guidance regarding a previous chin surgery that has unfortunately resulted in deeply distressing and long-lasting complications. Years ago I underwent a chin reduction procedure which n hindsight, I have come to understand the following: My very prominent chin was partially a result of orthodontic treatment that, in retrospect, should have been handled differently. I had an underbite which was corrected solely through braces, when surgery in combination with orthodontics would likely have been the appropriate course of action. I had (and still have) an excess of soft tissue in the chin area, which was largely responsible for the visible protrusion—especially noticeable when I laughed, spoke, or smiled. Unfortunately, the outcome of the surgery was very poor, both aesthetically and functionally. Over the years, I’ve consulted multiple plastic surgeons, including facial specialists, but none have been able to offer any real help. Many have assessed the case as too complex and beyond their expertise. Some even consulted colleagues and returned with the same conclusion—that nothing could be done. This has left me feeling hopeless at times. Regrettably, I have never been in contact with a maxillofacial specialist before—something I now realize would have been essential from the beginning. Through extensive personal research, I now understand that my case would partially fall under the field of maxillofacial surgery. I would like to briefly describe my current issues and have attached some photographs for your reference.

Summary of current concerns: There is a clear asymmetry in my chin. The bone appears to have been improperly treated or fractured, resulting in an uneven shape and a protrusion on the left side. This becomes especially noticeable when I speak or contract the area, as the soft tissues seem to sit unevenly over the bone. I also suspect possible nerve damage in the region. The soft tissue has redistributed unnaturally since the procedure, leading to abnormal facial expressions during speech and movement. This includes unusual contractions and tensions, and I strongly suspect that a nerve may have been affected or injured. Liposuction was also performed under the chin, with an incision about 1 cm below the chin. This scar and intervention have altered the appearance of the area—especially in profile—and contribute further to the unnatural look. Altogether, I experience abnormal movement of the chin, accompanied by tension and deformations that affect both my appearance and my self-esteem. The deformities become even more visible when I speak. As a result, I struggle intensely with being filmed (to an abnormal degree) and avoid having my photo taken unless I’m fully prepared. I know that you are an expert in this are and I am wondering if you might be willing to review my case and assess whether there are any possibilities for correction or improvement.  I hope I didn’t bore you and I hope that i could receive some sort of answer from you. Thank you so much for taking the time to read this. I look forward to hearing from you.

A: Thank you for your inquiry detailing your surgical chin history and your present concerns. From my standpoint there is nothing mysterious for elusive about understanding the anatomy of your current chin problem. This is simply the long term effect of having too much soft tissue chin pad tissue for the bone support that it now has which is a direct result of reducing the chin bone and not factoring in at the initial surgery the ultimate soft tissue contracture that is going to occur. This is a common surgical oversight in my experience with chin reductions and I see such complications of differing magnitudes all the time. Surgical improvement can definitely be achieved which requires a soft tissue chin pad release, reduction, perhaps secondary bone smoothing as well as the introduction of some new healthy tissue via fat grafting. Well this approach may not make your chin have a perfectly smooth appearance like it did before the initial chin reduction it certainly is going to make a major improvement.

The reasons surgeons have told you that your chin problem is not improvable is for two reasons. First and foremost they probably have never seen this chin problem before and therefore have no idea how to properly treat it. Equally they may also understandably feel no need to take on a difficult problem that they themselves did not create. Thus their proper answer to your problem should have been that they either do not know how to treat it or do not desire to take on the assignment.

I would have no idea who in Europe has experience in treating secondary chin problems like yours. This does not mean that surgeons do not exist who are capable of helping you. It merely means I would not know who they would be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I was wondering if you guys had a forehead size surgery that will make my forehead not as flat and taller in the front.

A: Forehead reshaping by augmentation, as suggested by your goal of making your forehead less flat and taller, is done by custom forehead implant designs. As a male such a forehead implant design may or may not involved brow bone augmentation as well. Since in your inquiry you did not mention the brow bones your implant design may be relegated to above the level of the brow bones. To give you an idea of such potential for head augmentation changes I would need to see side view pictures of your forehead to do some predictive imaging.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’d like to have a consult on both testicle (Wrapped around my own testicles) implants up to 7.5 cm and fat transfer into the scrotum procedures … purely for cosmetic visual / self improvement. I’m 5’9″ 185 lbs age Caucasian male with an average penis size.

A:Despite having developed the wrap around testicle implant concept I am not its biggest proponent. While the concept has merit and it is most appropriately considered in the younger patient with average sized testicles it does have postoperative problems. The issue is that there is not an insignificant long-term risk of Implant separation from the natural testicle. Having tried numerous technical variations that issue has not been completely eliminated or reduced to the level that I feel the implant concept should be widely used. As a result I reserve its use in patients who are the most motivated by being willing to except that risk. The one factor that seems to have the greatest benefit in reducing that risk is to match the inner chamber of the custom wraparound implants with measurements of the patient’s natural testicles on ultrasound.

Both Fat injections into the scrotum and testicle implants can not be done at the same time, If you get large enough testicle implants there would be no need for fat injections anyway.

Dr. Barry Eppley

World-Renowned Plastic Surgeon