Your Questions

Q: Dr. Eppley, I have crater chest deformity. I had not long ago had gynecomastia reduction surgery and it’s gone horribly wrong. My nipples are caved in and they are partially black. I am devastated. What do I do now?

A: Thank you for the clarifications and sending your pictures. What you have is an over resection of tissue through an open gynecomastia reduction approach that has left both a crater deformity as well as partial nipple-areolar necrosis. While I don’t know exactly how long ago the surgery was I would suspect on the appearance of the nipple-areolar complexes that it as just a few weeks at longest. 

Your options at this point are the following:

1) Let the extent of the crater deformity and nipple-areolar necrosis declare itself (the extent iof the contour deformity and how much the nipple-areolar complex will survive) over the next few months and then treat secondarily with fat grafting and nipple-areolar scar revision, or

2) Undergo immediate injectable fat grafting to help restore the contour and possibly limit the extent of the nipple-areolar tissue loss. (what is black is likely full-thickness tissue loss) This still may require some revision later but by adding healthy tissue back in with some stem cells it will expedite the healing process as well as provide some early contour improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m contacting youfAfter reading your answer on Real Self. I am very much worried as I had a terrible otoplasty that left my ears over pinned (3 months ago), it is a true nightmare as I asked the doctor not to do it!!! I am just curious about any possibility to make my ears stick out again. You wrote that the ears can stick out again trough an incisión of the scar tissue that is holding the ears folded. Is this enough or do we have to mold the cartílage again?What could you recommend me to do? Doctor used Stenstrom technique with one absorbable stitch per ear. Thank you.

A: It is unlikely that just release of the sutures will make the ear come back out as the memory of the cartilage is now lost at three months after surgery. That only works in the first few weeks after surgery. It now requires a tissue bank cartilage graft to hold the ear back out once it is released. That is the fundamental principle of a reverse otoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had eyelid surgery before. I had festoons so to get rid of them the Dr. pulled my lower eyelids and now they bow. I look Asian now. I would like to put in an orbital rim implant and small lower cheek implant. I also have one eye that looks closed and i am not sure if because pulling on lower is forcing upper down. My questions are:

1) Can we add a orbital implant under eyes plus lower cheek bone implant to add fullness because I look caved in?

2) Can you make me look less Chinese and have an eye shape like I had before?

3) Can you work on upper lid so it doesn’t look like my eye is closing and maybe work on one or both upper lids? I have big scars and hopefully can reduce scars??? After surgeries and healing occurs can have scar reduction surgery???

A: Thank you for your inquiry and describing your eyelid concerns. By your description you had an aggressive lower eyelid procedure in an effort to ‘lift out’ the festoons. (which is very prone to lower eyelid ectropion problems) The bowing down is the rounding of the lower eyelids due to loss of vertical height. The upper eyelid issue is a bit unclear to me. But I will need to see pictures of your eye area to provide a more qualified opinion. Until then I can answer your questions as follows:

1) An infraorbital rim-malar combined implant can treat the caved in look which is the result of inadequate volume.

2) To get your eyes back to normal and less deformed, it will require a combination of #1 and lower eyelid reconstruction with spacer grafts for the lower lids and lateral canthopexy.

3) I am as yet unclear about your upper eyelids so I shall wait to comment until I have seen pictures of them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 55 year-old make and I am interested in reducing the sagging underneath my chin (upper neck area – below the jaw)

A: Thank you for sending your pictures. You have the classic beginning of a  neck sag with a central band of tissue running down the center of the neck between the chin and close to the sternal notch. Of all the tissues in the neck that can sag, this type of neck band is largely skin. This is a what I call a ‘tweener’ neck contouring problem. Meaning if was more severe you would absolutely need a lower facelift/necklift and if it was less severe perhaps liposuction alone may be adequate.

While it is important to point out that a lower facelift/necklift is the definitive treatment for your neck problem, I will make the assumption that you may not be committed to going quite that ‘far’ just yet. A direct necklift would also be tremendously effective but you are too young to do well with a central vertical neck scar in place of the central neck band.

Thus this leaves the submentoplasty procedure as the most viable option. One trough a small incision under the chin it is a three level central neck contouring procedure consisting of a combined liposuction above the platysma muscle, direct removal of subplatysmal fat and plastyma muscle plication or corseting…all done with the neck reshaping intent of improving the cervicomental angle.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a very tiny 28 year old who is constantly mistaken for being 15. I have a 32AA cup size, and my torso goes straight up and down with no curves. My hips do not curve out more than my waist. In addition, I am also 5ft tall so my ribs are only about 3/4 of an inch above my iliac crest. Because of this, I believe I have no inward curve of my waist. Rather than implanting silicone to fill my bust, I feel I would be more confident with a rib removal to enhance a curve and make my waist skinnier than my hips. I do not believe I need a tummy tuck. I have a tiny bit of fat on my rectus abdominus, external obliques, and lower back combined. But my waist circumference is 29 and my hips are 33. I only weigh 103 lbs while I am 5ft0in tall so I do not have a lot of fat. My stomach does protrude past my flat chest into a bit of what looks like bloating, but I always have this shape. I have visible abdominal muscles below my tiny bit of fat, which is why I don’t think I would need a tummy tuck.

Two questions: 

1) Do you think rib removal without a tummy tuck would give me more of a womanly shape (smaller waist to hip ratio)? Where would the scars be and how big without a tummy tuck?

2) Do you think I am chronically bloated or store more fat internally (greater omentum) rather than on top of my abs? Like I said I am only 103 lbs, 5ft. 29 inch waist and 33inch hips. but my stomach protrudes almost looking like I am 3 months pregnant perhaps. I have also been told by my parents that this “protruded stomach body shape” runs in the family and is thought to be Lordosis. Could this really be the case?

A: Thank you for your inquiry and providing the details of your body shape and objectives to which I can make the following comments:

1) Rib removal for horizontal waistline reduction is done through small (4.5 cms) oblique back incisions and removes ribs #11 and 12 and usually #10 as well. This is never performed through a tummy tuck as these ribs are not reachable from that anterior approach.

2) The type of rib removals done through a tummy tuck approach are the anterior subcostal rib cage margins of ribs #7, 8 and 9 and is done for subcostal rib protrusions not horizontal waistline reduction.

3) Very thin and petite women are one of the major patient groups that seek out rib removal surgery for the exact reasons you have described….to provide some inward curve to an otherwise straight torso.

4) Being thin and virtually having no breast tissue, even low weight females can have a pseudo abdominal pooch. It would be exacerbated by a lordotic condition for sure. Whether that applies to you I can say since I do not know what your body exactly looks like.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My face has a lot of asymmetry to it. One eyebrow is significantly higher than the other. My chin points more in one direction. It almost appears as though one part of my face stopped growing with the other half. I had braces a while back, and I remember having a pretty dramatic shift in my teeth (bracket came out of holder). My TMJ worsened, and I believe it all goes hand in hand. I was told this couldn’t be fixed because it was a vertical bony orbit asymmetry. 

A: Thank you for your inquiry and sending your pictures. You have a right-sided facial hypoplasia which is most manifest at the north (eye) and south (chin) ends. The most significant component of your facial asymmetry is your vertical orbital dystopia (VOD) and the surrounding changes that come with it from a lower orbital box. (lower brow bone and eyebrows, lower upper eyelid, lower globe position, lower orbital rim and smaller cheek) 

It is not an accurate statement that it ‘can’t be fixed’. While perfect eye symmetry may not be achievable, significant improvements can usually be obtained. The first step in the diagnosis and treatment planning process is a 3D CT scan which will clearly show the bony differences and what can be done to improve them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, During our initial video chat I had mentioned that the second lip lift had also caused further descent of my nasal sill resulting in increased nostril show from the front. I consulted some other surgeons in LA about it around the same time, and like you, they all said that nothing could be done to raise the sill back up but I was told by two of them about another way to potentially address the problem. From looking at my side profile (attached for you to see), they both said my nasal tip seems to be rotated upward quite a lot and that I could afford to rotate the tip down with a septal extension graft, and that could correct or at least significantly improve the problem.

I’ve seen some before and afters and it definitely seems worthwhile. I was interested to know what you thought as well.

A: While it is true that you can’t raise the nasal sill back up, it may be able to be partially camouflaged by tip rotation. Doing some computer imaging from the side profile it should be able to be demonstrated whether that is a valid aesthetic effect/concept. On paper it would seem to be but ‘seeing’ is believing from the patfient’s perspective.

When it comes to downward nasal tip rotation there are the two ways to do so. An internal septal extension graft is one option which provides a push of he tip cartilages downward from behind. The other approach is infralobular onlay grafting (using septum) to build out he tip cartilages and push the skin down. Having used both I have found either approach can work. The choice would depend on how much tip rotation is needed to create the desired effect. I will have to do some computer imaging and would need a side view picture of your nose to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in doing a brow lift. However I noticed a lot of surgeons in specific countries are proposing that an endoscopic brow lift with an endotine ribbon provides a more fixated and long-lasting result compared to traditional endoscopic brow-lifts.

I also had never knew Endotines supplements other lifts such as: Face lifts, Neck-Lifts, Forehead, and etc. 

What is your opinion on this? I am interested to get a few surgeries by you. I was curious on your forehead lifts.

A: While some form of fixation is useful in all endoscopic brow lifts, there is no clinical evidence to support the contention that the result is better short or long-term with use of either an endotine platform or ribbon. There are many different forms of endoscopic browlift fixation (e.g., screws, bone tunnels) and the only thing that is clear is that one of them is needed. I have used resorbable/metal endoscopic screws and bone tunnels for years and they work very well. The key with whatever form of fixation that is used is how easily it is inserted through a small endoscopic incision and what aesthetic risks come from their use.

But being a male seeking a browlift, the form of fixation used is the least important consideration in your surgery. The most important is whether your hairline location and density can support a superior scalp approach or whether an inferior transpalpebral (through the upper eyelid) approach is needed. If done from below then the only form of fixation that can be used is the placement of an endotine platform.

I would need to see pictures of your forehead to make that determination.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Are hollow cheeks an asset or liability? I’ve been considering filling them, but am hesitant. Wish I could attach some photos. 

Models have them. So do gaunt faces. 

Why is it some can look so young with hollow cheeks while others so old? 

Is it simply the degree of hollowing? Or is there something more, like the distribution of fat— so that someone could be “hollow in a good way” or “hollow in a gaunt way”. 

Is it a male vs. female thing, with males looking chiseled and females gaunt? 

Yet another possibility I could think of is that hollow cheeks complement some bone structures but detract from others. 

The photos attached are of my cheeks. I’ve been considering filling them to restore youthfulness. Advised I’ve received has ranged from “recommended, will turn the clock back years” to “are you crazy, you know how many people want hollowness like that but can’t get it”. Please advise!

A: Since I have no idea what you look like or your idea of facial aesthetics I can only make the following comments:

1) There is a difference between youthful and isolated hollow cheeks and an age-related overall facial lipoatrophy in which hollow cheeks occur. The youthful one can be aesthetically appealing (hollow on a good way), the aging one never is. (hollow in a gaunt way)

2) What level of cheek and jaw bony prominence that exists around hollow cheeks has a major influence on the perception of hollow cheek aesthetics.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I feel that addressing the visible septum in left nostril and the rightward curve in the lower third of my nose will go a long way in improving my facial symmetry.  Based on what happens when I push the septum into a central alignment, I think that the septoplasty will help to lower the right nostril which is being pushed up and to the right by the deviated septum.

While my understanding of the basics of a septoplasty are pretty clear, I have a few questions. First, do you typically perform these as an open or closed procedure? Second, do you anticipate that the straightening of the septum could result in a shortening of the nose? I am currently bothered by the tip of my nose sometimes rotating up and showing more nostril. I have read that an upward tip rotation is sometimes a complication of septoplasty and was wondering if there are ways to help prevent this.  

Lastly, is there a way to very slightly lower the effective alar rim height or alar arch to reduce nostril show through the septoplasty (in other words, besides a separate complicated grafting procedure)? Is there a way to increase the length of the septum to slightly rotate the tip forward/down?  Below is an example of how much improvement even a mm or two of alar arch reduction provides.

A: In news to your septoplasty questions:

1) While a septoplasty will reduce the appearance of it into the left nostril, it would be a procedure that I would expect to lower the right nostril rim. As I have never seen an isolated septoplasty make that happen nor can I envision the anatomic reasons why it would.

2) All isolated septoplasty procedures are performed closed.

3) Straightening the septum would not make a nose appear shorter per se. Expecting that outcome is the same as that of it being capable of lowering a high alar rim.

4) I am not aware of ever seeing an isolated septoplasty create nasal tip rotation nor would there be a anatomic explanation for that effect. When septal shortenng is performed at the same time as other tip procedures with the specific intent of tip rotation it has a useful role at that time.

5) Lowering an alar rim requires placement of a graft to do so since this really represents a tissue ‘defect’. If done using a closed approach a chondrocutaneous ear graft is needed. If part of an open rhinoplasty a cartilage alar rim graft Is used.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a male interested in having several procedures, preferably done in one session if possible.

I am wondering if it would be possible to have the hairline lowering and custom brow ridge implants be done through the same incision along the hairline to minimize scarring?

With the infraorbital implants I am looking to correct my negative orbital vector, but am also hoping that the saddle will provide support decreasing the vertical measurment of my eyes slightly. Would this be possible?

One concern is the fact that I previously had lower eyelid retraction surgery (midface lift) through the inside of the lower eyelids. Could the placing midface implants through the same incision site wreck my previous eye work?

Thank you.

A: Thank you for your inquiry and asking all very good questions to which I can provide the following answers:

1) A hairline or pretrichial provide excellent access for the placement of a brow bone implant.

2) An infraorbital implant that increases its vertical height (which by definition means it saddles the rim) can create some lower lid leveling/elevation as there is a relationship between lid-infraorbital rim levels. The key is that it just be a vertical infraorbital rim implant style.

3) While I don’t know what type of midface lift you had and where the vectors of support are, the elevation along the infraorbital rim does not extend into the cheek area. So I don’t envision, based on what I know now, that it would disrupt a prior midface lift.

Dr. Barry Eppley 

Indianapolis,Indiana

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