Your Questions
Your Questions
Q: Dr. Eppley, I’m interested in jaw implant. The main concern is that the jaw dips in before reaching the chin. My beard conceals it. I think my chin could be wider but it protrudes enough. My perception is that the gonial angle is wide enough though could reach a bit lower. I don’t want sharp angles because of my heritage. Its more about a well proportioned harmoneous fresh face not trying to make it more masculine . Well I mean a bit wider chin, not a square shape.
A: By your description this indicates that there is probably an extended antegonial notch shape of the mandible. A 3D CT scan would conform that descriptive supposition which is needed for a custom implant design. The value of custom implant designs is that they can be made for the exact anatomic defect regardless of what it is.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My concern is my right jaw as it looks shorter and smaller than my left jaw . My orthodontist said the only way to fix it is surgery or implants but he doesn’t recommend it. What about a mandible condylectomy?
A: You don’t violate/injury a functioning joint for an aesthetic jaw asymmetry concern. That would not be prudent medical choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I was wondering if I can get more vertical length with my chin (about 2.5-3cm lower than my current chin) and to get the columella and tip of my nose marginally more parallel to the ground. I am not very good at photoshopping but I have just sent you 2 views. I like your oblique just that the chin has to be lower and the nose tip and columella marginally more parallel to the ground. Can you modify what you had sent me?
A:The key concept to understand about computer imaging is that it is not to show the patient the exact result that will happen as no one can predict that with 100% accuracy. The role of imaginng servesas a visual method to determine the patient’s goals and create an understanding of what can and can not be accomplished. Thus I can make the following comments to your response to my initial imaging.
In regards to vertical chin lengthening due to the restrictions of stretch of the soft tissue chin pad, one can get up to 7mms (0.7cm) of length with an implant and up to 15 -18mms (1.5 – 1.8cms) length with an intraoral vertical lengthening bony genioplasty. Thus getting 2 to 3cms of vertocal chin is never an achievable outcome. That is surgically not possible.
Again due to soft tissue restrictions (nasal trip skin) you can drive down the tip of the nose to a 90 degree nasolabial angle. There simply is not enough skin stretch to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a septorhinoplasty along with custom facial implants. The primary motivation is correcting my deviated septum, but I’m also interested in the rhinoplasty aspect to reduce the hump and make the nose a little less projecting. Initially, I was planning to look into this procedure after the jaw/cheek procedure as it seemed like a lot to take on for one surgery. But I wanted to get your thoughts/advice if I could.
A:Combining a septorhinoplasty with custom facial implants can be done and it is not uncommon to do so. Whether one should so or not depends on multiple factors which ultimately comes down to the convenience of one surgery and whether the custom facial implants by their effect may preclude the need for any nose reshaping surgery. The question is not a medical one but a personal choice one.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a brow bone reduction surgery in 2014 which has had a few problems since then. Not sure if it was a type I or III. The goal was NOT to feminize my face. I have provided a pic of my brow bone before the surgery at age 35. I had a Liam Neeson brow. I have a depression at the top center incision line and also what appears to be grooves or cracks. I would need to have an open incision from ear to ear again, but the only way to resolve this.
My goals are to improve a more smoother more symmetrical MASCULINE even surface forehead from left to right
1.) take bone fragments pieces from top incision line indentation; reinsert them (bone grafting of my own bone material) to smooth out even to achieve a uniform contour.
2.) bone grafting of extended curved fractures from lower middle of forehead to arched upper outer forehead
3.) smooth out small bump on middle of far left forehead
4.) discuss right orbital add bone grafting technique to upper inner corner only (bone paste or bone cement, human tissue glue or donor bone from rib or hip) My left orbital rim is masculine, please do not change at all. My right orbital rim is feminine. This is due to a childhood trauma injury.
5.) may discuss adding a little bone grafting material to middle (between eyebrows) for a more masculine appearance
These ideas I would like an opportunity to discuss with you to consider your best practice approach and of your recommendations.
A: A needed 3D Ct scan scan will certainly show the bony contours/irregularities/defects that have resulted from a prior brow bone setback surgery. And while knowing those details are important, and all will be seen in surgery once exposed, the fundamental reconstruction decision is how to recontoiur the bone to a smooth and somewhat augmented appearance. While bone grafting is an option, and we are talking about harvesting cranial hone grafts, and its appeal is understandable it is not a great material to use for contouring. Cranial bone grafts are hard pieces of bone, have non-smooth edges, there is no great way to secure them and they will undergo some amount of resorption. (not structurally stable as an onlay graft) Cranial bone grafts are great for large inlay defects but not as a refined forehead contouring material. The far better choice is hydroxyapatite cement (HAC) which works like drywall putty when mixed, can smoothly fill in and augment any bony contour, is structurally stable when hardened (after 10 minutes of application) and the bone will bond to it due to its calcium phosphate mineral composition.
I will always do what the patient wants once when they have been fully informed of their options but in secondary brow bone/forehead contouring HAC is always the better material due to its smooth contouring capabilities.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi I had a surgery to undue a lipoma on my head and the surgeon made an error in communication and shaved down my masculine profile slanting my head back and feminizing it day of surgery with electrical burr he called “bony prominences and shaving contouring” which I would of never wanted done again unfortunate miscommunication. I saw a picture of man that Dr Eppley did that gave me hope again a picture that looks like my old profile he did – I was wondering if what was done to me can be fixed I really want my old masculine profile back I would be interested in what the Dr thinks and was wondering if insurance covers this or how much for the bone cement implant to get it how it used to be above eyebrow and mid forehead. Before surgery is grey photo and with hat -and after is ones with black beanie shown Thank you please contact me asap I just want hope this can be fixed I am in California but would travel I really miss my old profile.
A:I am not sure how you go from a lipoma (osteoma??) excision to a complete forehead/brow bone reduction….but that is irrelevant now. In terms of restoration and the technique to do it it depends on the scope (surface area) of involvement and the contour change needed. HA cement works fine IF the needs is small and doesn’t require any contour other than a flat surface augmentation of limited thickness. Otherwise a custom forehead-brow bone implant is needed
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, i had double jaw surgery and custom mid face implants. Unfortunately im dealing with an issue that despite a sizeable infra-orbital implant – 5mm , i have significant depression and hollowness under the implant. My theory is that the ligaments were cut and the soft tissue/periosteum and fat pad sags below the implant, causing two issues 1) the shadows and sagging appearance and 2) lack of projection from the implant. When i pull my skin and fat up and back, the ogee curve is restored and the implant looks quite nice What do you think? Is this implant sagging from the surgeries? Or is my implant not big enough. I feel the lateral size of the implant is plenty large. Also one side is significantly worse than the other.
A: When you have an adverse aesthetic effect from an implant-related surgery it is always due to the same three potential issues….implant design, implant size and implant placement. Sometimes it is just one, two or all three. It is never due to anything else. The release of the osteocutaneous ligaments occurs in every facial implant surgery and a necessary component of bone or implant surgery so that is never the culprit.
I would know immediately the cause looking at your implant design and pictures of your face. The orbital area is an unforgiving area for implants due to the thin overlying soft tissues so it is easy to have design flaws, over/under sizing and/or incorrect or asymmetric placement that will be very visible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I am interested in a forehead/brow/temple implant and nose hump implant. 4 years ago I had facial feminization surgery and nose hump reduction surgery and would like the reversal by adding more volume to my brow that is on top of my nose and adding a orbital rims and temple augmentation as well thru a scalp incision. I also wish to have my nose hump added without having to have an incision in my nostrils so if possible by adding it from the top of my head as well. Is this possible? And can you provide me with a quote?
A: My interpretation of your needs is the following:
1) Secondary Forehead-Brow Augmentation
2) Primary Temporal Augmentation
3) Secondary Nasal Augmentation. (is it frontonasal or lower at the dorsal hump area….I believe you mean the latter)
I assume from the prior surgery that a long scalp incision already exists.
Based on this general description I can’t yet say how this would be done…meaning is #3 part of #1 implant design or would it be separate? (I suspect it is separate…and probably could not be done from above in a satisfactory manner)
How does the temporal augmentation fit in with the forehead? Is it separate or is it connected to the forehead-brow bone augmentation?
As you can see there a lot of different moving parts here so it would impossible yet to provide any costs associated with these surgeries until I understand better what needs to be done. This requires a picture analysis with imaging done to determine your desired changes.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I am a 44 year old male who eight years ago I had Medpor Chin, Jaw and Cheek implants and Rhinoplasty. I was extremely pleased with the result. But I had an infection two years ago and the jaw and chin implants had to be removed. I now wish to re-implant the jaw and chin. My research tells me PEEK may be superior to Medpor as I don’t want to have a repeat of an infection and removal.
A: PEEK is a fine facial implant material with its own advantages and disadvantages. Whether PEEK is superior to Medpor in terms of a lower risk of infection has never been scientifically validated.But in theory being non-porous it may be. But an implant is an implant is an implant no matter what the material is so the risk of infection can never be completely eliminated.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have facial asymmetry. Could custom implants improve my facial asymmetry? My right mandible is longer, and my cheekbone is farther back. The left side mandible is shorter, and the left cheekbone is more forward.
A: These are classic findings in facial asymmetry for which custom implant designs have great utility. But there are numerous augmentative and reductive approaches in facial asymmetry correction as well as unilateral and bilateral techniques But the first place to start is to get some face pictures for imaging followed by a 3D CT scan for further analysis and treatment planning.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I just had a sliding genio done last week. I had no idea it would make such a drastic difference on the appearance of my face from the front. I can’t recognize myself in the mirror anymore – my jaw is too rounded and my lips are smaller. I don’t love the side profile either, I feel like the surgeon advanced a bit too much. I think it was only 5mm unless he changed mid-procedure, and I’m hoping that’s a small enough movement to make reversal somewhat uncomplicated. My question is, how likely is it that I can get my old face back? I want to fully reverse. I’m 22 so I’m hoping my skin is elastic enough to look mostly the same after reversal. Also, I’m aware it’s still swollen, but I’m realizing far too late that I won’t like it regardless, because my face will be different from the front. Thank you so much.
A: The first concept to grasp is that at just one week after the surgery you are far removed from what the final result will be. There is a large amount of swelling at this point which will enlarge and distortt the entire chin area. Many sliding genioplasty patients at just one week after surgery do not feel that different than you do. Proper pre-surgical education would have informed you that you will feel that you have made a wrong decision up until 2 to 3 weeks after surgery win the swelling has gone down enough that you may be convinced a good result is possible. This is a classic postoperative phenomenon in many forms of facial structure or surgery. As a result I don’t recommend that patients try to reverse a procedure like a sliding genioplasty until at least six weeks after surgery when they have a better feel for what the result actually is. If still unsatisfied then a better decision can be made about whether a complete or subtotal reversal is best. It is important to remember that you did the procedure for a reason and this is why many patients that do not like their sliding genioplasty result usually opt for a subtotal reversal as opposed to a complete one.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I unfortunately inherited my mom’s sharper wider hips. It is in the actual bone structure and I have always hated it. Is there a way you can help me identify exactly what part of my hips are wide and also let me know if anything can be done? Thank you
A: These pictures show that that the ‘hip width’ concern is at the level of the greater trochanter of the femur (way below the iliac crest) which can not be surgically reduced without serious functional issues.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Wrap Around Implants – is it an option? The actual size impacts my self esteem and something I am searching about. How is it done?
A: Wraparound testicle implants are designed based on: 1) The patient’s desired size (external diameter) and 2) the patient’s natural size. (internal diameter of the hollow chamber) That is determined by a preoperative ultrasound for testicular size measurements.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Could you place implants behind the head to augment head volume please?
A: Custom back of the head skull implants is a procedure that I do all the time. The only question is how much volume is needed/desired and whether this can be done with an immediate implant placement or requires a 1st stage scalp expansion.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have two forehead bumps protruding I was wondering if my ct scan can be looked at and see if we can do anything about it thank you.
A: These are likely forehead horns since they are paired. (two of them) The qiestion is not whether they can undergo reduction but whether the bone is thick enough to allow complete reduction. Your 2D scan would provide that information with the slices that go through the forehead bump areas.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Is it possible to remove potentially in the future around 2.5 mm of tissue around the nose to create a way slimmer nose that would create a more feminine/nose look how is the limit for tissue removed.
A: The only area of the nose will tissues can be externally excised is the nostrils or nasal base for nostril narrowing. But for the rest of the nose no such excisions can be performed without severe scarring.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley ,I have searched all over for assistance with a lower rib on the right side of my body. It cracked in year 2020 with a fall, when it healed I was told it over produced the bone substance used for healing the cracked rib. This has caused me to have severe discomfort as it feel like I am being stabbed from the inside out. At one point they did an exploratory surgery to determine it was in fact my rib. I have been to: 2-3 PCP, an orthopedic surgeon, a neurologist ( thinking numbing nerves would help ). I am out of options, everyone tells me I am stuck with this. I can’t workout anymore, run and jump as it pokes me, sex is hard. It is really killing my quality of life and depressing me. I would like to see about fixing it, as it’s causing pain. Yes, some days are worse than others. I can’t even sit at times. I have been googling things and your practice came up, is this something you would be interested in looking into for me? I have read it may have to be out of pocket, but I have also read since it’s related to a past injury and causing pain we can work in insurance as well. Please help
A: I assume the exact rib is known and there is an x-ray (plain film) that shows its location. (need that info) Rib resection would be the logical treatment approach. The only question is where it is located and can it be safely reached.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley ,I am inquiring about a sliding genioplasty. I have attached some photos to show what would roughly be my goal in this surgery. My chin is recessed and seems that it would require some downward and forward repositioning to achieve a desired result. I was wondering if this seems within reach with this type of surgery.
A:I don’t think that type of chin augmentation change is completely achievable. What you are showing is a significant horizonal advancement and significant vertical shortening….a change only remotely possiboe with a sliding bony genioplasty., The problem is that with a conventional sliding genioplasty it would be very challenging and almost impossible to get that amount of vertical chin shortening no matter how much you tilted up tehg repositioned chin bone. Such a change requires a jumping genioplasty where the cut chin bone is moved directly in front of or ‘jumped onto the bone above it. The problem with the jumping genioplasty technique is that you never know whether the attached muscles to the down fractured chin segment will allow that amount of stretch to make that jump….sometimes it will and others it may not in my experience.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, My circumcision as a child left me with very little skin on the shaft of my penis, a large amount of scrotal webbing, and a scrotum where it feels like my testicles do not fit. Is surgery and option to reduce the webbing and possibly increase the size of my scrotum so that my testicles sit more comfortably?
A:Penoscrotal webbing can usually be improved by either a z-plasty or a skin graft.
A tight scrotum requires tissue expansion either with a true tissue expander or by the placement of side by side testicle implants to stretch the scrotal tissues.
These are general statements. How they may apply to you requires further information. (pictures that show your concerns)
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am a previous patient of Dr Eppley’s, and have an implant across my brow ridge, forehead, and eye sockets. I am interested in getting an eyebrow piercing that would sit over the surface of my implant. Does a piercing in this are pose any risk to the implant, particularly as it relates to a potential infection?
A:It should not as they would have no reason to be down at the bone/implant level with a piercing…..but they should be informed that an implant exists in the area.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a jaw implant to balance my appearance. I am a dentist and before organizing a consultation I could order here a CBCT scan of myself before I go to the US for a consultation with you. Thanks and kind regards.
A:While a 3D CT scan is eventually needed as it serves as the basis on which the implant design is created, it is not essential for a consultation or evaluation…as the scan does not tell us how to make the implant…it is just a platform on which to build it. What is essential initially are facial pictures on which computer imaging is done to determine your aesthetic jaw augmentation goals. That does not need to be done in person which is why most patients anywhere in the world come here only for the surgery. Everything else can be done in a virtual manner.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hey how you doing Doc, how you been doing?it’s been a while, I don’t know if you remember Me I was your patient back in 2018 for custom midface and jawline implants. Everything on my side is Great the outcome came out excellent. I have one small thing to ask of you if you could design, it’s something Dental it is called Gingival Mask / gingival Veneers…you see the little problem I still have it’s that the upper gums of mines are still deficient they are flat and by creating this it will add volume by lifting and pushing forward the upper lip area like a Lefort 1 and will also show my upper front teeth. I have created homemade gingival mask but I’m no dentist. the Area of the upper gum I’m talking about are “Alveolar Mucosa and mucogingival junction”… I’ll send you pictures and videos of the gingival mask that I’m talking about, it’s like a denture but for upper gums, it’s actually easy to create but the dentist down here in Florida are just talentless. These are some labs that I’ve read online that dentists send it to create it, Glidewell lab or the Chromeworks Lab Let me know if you could create this for Me thank you.
A:Good to hear from you again, I remember you like it was yesterday. Originally being a dentist I am familiar with the Gingival Mask device and as the final piece to your midface horizontal deficiency I can see why that would be appealing to you. This is an acrylic device that is made from an upper dental model that is sent out to a lab like Glidewell as you have mentioned. Since it relies on a maxillary impression/model this is why you should work with a local dentist since this is the foundation on which the appliance is made. Unfortunately you can not use the 3D CT scan from which your midface and jaw implants were made.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Plastic Surgery Case Study – Combining A Custom Jawline Implant with a Sliding Genioplasty This was an interesting article you wrote. Thankyou. Here are my thoughts: I like the idea of a sliding genioplsty (only for the chin) but if resorption of the bone stemming from silicone implants is a primary reason folks go the SG route then doesn’t this approach sort of defeat the purpose? (overlaying to 2 mmm of silicone over a 10 mm SG advancement) or are the forces acting upon the chin different enough in that situation to not be overly concerned? Can you use Peek Custom Jaw Implants that taper down to the chin area for a smooth transition (that covers any step-offs) but doesn’t actually cover the chin in order to avoid resorption concerns on the chin? My other question is do you use custom printed cutting guides and custom built plates to secure the SG? I estimate I need about 5mm horizontal and 5mm vertical but of course, a digital mock up or 3D printed template might lead to a better visualization in order to confirm.
A: I think you missed the main reason a sliding genioplasty is combined with a custom jawline…it is done when the amount of chin augmentation exceeds what the soft chin pad can tolerate. (stretch over an implant) Thus only a sliding genioplasty can be used for the amount of chin augmentation needed.
Can the jawline implant be made of PEEK and can cutting guides be used for the chin….yes on both counts as long as the patient can tolerate the additional costs to do so. And that the use of a very rigid material like PEEK will not permit the jawline implant to fiully merge into the sliding genioplasty. (its rigidity prohibits such placement)
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley I need a revision of my brow bone contouring surgery back in 2014. I would like more information re: brow bone revision contouring while maintaining a male appearance. I have an indentation in the center at the hairline, narrow arched groves from center curving upward & outward toward each side and a small bump on the left side. I see on your website that you have used hydroxyapatite and bone cement for surgical use of brow bone recontouring. I would like to use the most natural product that works with the human body/immune system as apposed to silicone, which the body over time rejects. I would also like to discuss other products, perhaps titanium or other recommendations.
A:The material of choice for any form of brow bone contouring depends on what type of structural change is needed and what type of incisional access is used to do it. Because the brow bone is a small area of the forehead HA can be a good choice as the material demand (volume needed) is low. That being said what is first needed is a 3D CT scan of your forehead to understand the exact condition of the brow bones. I assume you had a bone flap setback in 2014 in which bone defects along the osteotomy line may exist as well as other contour issues as you have described. I would also assume that this was like done from a more wide open access from a scalp incision.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, What kind of scarring can I expect from the surgery?Will this surgery affect a future pregnancy? As in would my rib cage be more vulnerable later on to any kind of breakage or damage while pregnant? I am not pregnant nor plan to be, but wanted to ask.
A:Because this is cartilage scoring and not cartilage excision the two small incisions are each side would be very limited.
No form of rib remodeling has any impact on potential future pregnancies.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I have an asymmetry in my mandible. My left side is narrower then the other side. I came across your website and was wondering how this works for people who live in Europe. Can I send over a CT scan made here for the design of the implant? And can it be send over and do I have to find a plastic surgeon here in Belgium, or is it only possible if I fly over to the US for the surgery?
A: In answer to your custom jawline implant for jaw asymmetry logistical questions:
1) You send me the 3D CT scan (which you get where you liver) from which I design the implant with you in a virtual fashion.
2) You only come here for the actual surgical implantation.
3) You return home in 1 to 2 days and all followups are done virtually
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, My concern is my right jaw as it looks shorter and smaller than my left jaw . My orthodontist said the only way to fix it is surgery or implants but he doesn’t recommend it.Can filler fix this ?
A:Filler may provide some temporary improvement but not a permanent fix. Only a custom implant can provide a permanent fix.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I feel like my face is very asymmetrical and imbalanced and lacks dimension. I feel like I need some sort of implants – cheek or paranasal. And a forehead augmentation – but I don’t know if fat grafting or an implant is more suitable. My right temple goes inward and my right jaw is narrower than the right, so I feel like I need an implant on my right jaw. But at the same time I feel like I need to shave my left jaw and my chin for more contour.
A:While you do have differences between the two sides of your face (see attached grid analysis) when it comes to surgical correction you have to have a very clear idea as to what exact procedures are needed so that the surgical efforts can help minimize the asymmetry. You have described deficiencies which are largely based on your right face which seems correct given that your pictures show a classic right facial vertical asymmetry. (shorter from top to bottom)….provided these pictures have not been reversed. But the first step in facial asymmetry is to get a 3D CT face scan so the bony differences, as most of the facial asymmetry is bony based, can be clearly identified and the properly treatment planned. In most facial asymmetry deficiencies this means custom implant designs.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am reaching out to request a virtual consultation regarding my concerns about the appearance of my forehead and hairline. I have noticed that the prominent bones on my forehead have an unusually large appearance, which has been a source of insecurity for me. I am considering plastic surgery to address this issue and improve my overall facial aesthetics. Additionally, I would like to discuss options for altering my hairline, as it is not as full as I would prefer. After conducting extensive research, I have decided that your expertise aligns with my goals, and I believe that you would be the ideal surgeon to help me. Although I am currently located in the New York City region and unable to travel to your office in Carmel, Indiana, I am eager to move forward with a virtual consultation. I hope that during this meeting, we can discuss my concerns in detail and explore possible solutions. I am looking forward to the possibility of working with you and hopefully proceeding with surgery within this year. Thank you for your time and consideration. I look forward to your response.
A:Thank you for sending all of your pictures. Your forehead concerns represent a considerable challenge for which there is no easy fix. It is a combination of a sloped skull with protruding upper forehead and a significant posterior location of the hairline including the temporal hairline. Each one magnifies the other problem and they are developmentally connected. But it is the hairline that is the worst offender than the bone shape as a more anteriorly located hairline will make the skull-forehead shape look better…but the reverse would not be true.
When considering a frontal hairline advancement the key question is how much forward movement is needed. The reality is that of you don’t get at least 2.5 to 3cms forward movement it would not be worth it. (see attached diagram) This will require a first stage scalp expander to do so.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in your methodology to correct hyperdynamic chin ptosis.
A: You have hyperdynamic chin ptosis because your chin is a bit vertically short which creates a mismatch between the bone and the overlying soft tissue chin pad. This is why the chin pad pulls down with smiling…there is nothing to block it from doing so. Therefore the most effective treatment would be a small chin implant added to the bone to prevent that from happening. This of course will create some modest chin augmentation effect so you have to be certain that is an acceptable tradeoff. (see attached image) The other approach would be a small vertical lengthening bony genioplasty (5mms) done intraorally.
Dr. Barry Eppley
World Renowned Plastic Surgeon
