Your Questions
Your Questions
Q: Dr. Eppley, Are the legs and thigh muscle implants customized?
A:While there are standard calf implants available, thigh implants have to be custom made.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I hope this finds you well. I have come across your impressive work and have a question. I am due to have BSSO here in Europe in a couple of months (I’m having the orthodontic work done now). I wondered is this surgery will preclude me from having jaw angle implants at your clinic in the future? Would the hardware relating to the BSSO get in the way?
A:The hardware from the jaw surgery will not pose a problem. Nearly one-third of all jaw augmentation patients have had prior jaw surgery with indwelling hardware present.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello , would you be able to give me an idea what it would cost for back , top and forehead implants, and if for example you would be able to to 2 of those during the same surgery and the other later ( assuming all 3 at the same time wouldn’t work )
A:When large skull augmentations are being considered the typical goal, if the overall augmentations are to be connected which I assume would be the case for back, top and forehead augmentations, would be to place them all at once as a single connected and smooth augmentation. To do so in most patients requires a first stage scalp expander as almost no scalp can take the volumetric expansion in large skull augmentations at once.
How all of that applies to I can not yet say as I would need to see some head pictures and do some skull augmentation imaging to have a cleat understanding as to your exact head augmentation goals.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m 6 weeks post op and my lower lip is contracted. If I get a reversal now can I get my lower lip back? My mouth looks downturned and aged. When would be the limit of time to get a reversal and get my lower lip back? My face looks so long. Please help.
A:I don’t know what amount of bony movements were done in your sliding genioplasty and, while it can certainly be reversed, that is not a guarantee that the soft tissue changes of the lip and mouth will be restored. (they might but no one can say for sure) The only reversal change that would almost certainly be restored is the decrease in vertical height and projection.
The key decision on timing to do so is not about the bone healing but about the certainty that the patient wants to do so based on knowing the true final results…which is not fully evident until 3 months after the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, one of your previous patients referred me for your cat eye surgery. Is it correct that you do this or is it called a “brow lift” on your website? I am very interested. I am also interested in upper eyelid surgery (removal of skin), can these two surgeries be done together? Or is it not recommended
I’m unsure if I need an upper eyelid surgery or brow lift. Maybe both
A: Cat Eye surgery is an exaggerated form of browlifting with emphasis on a significant upward sweep to the temporal or outer half of the eyebrow. In some cases that may also involve a lateral canthoplasty so that the outer corner of the eye has an uplifted appearance as well. By looking at your rounder lower eyelid with scleral show the need for the lateral canthoplasty likely applies.
With nthe uplifted tail of the browlift most patients will not need upper eyelid skin removal. Not that it can not be done together but the browlift may obviate the need to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can my frontal bossing be fixed?
A:Your frontal bossing reduction poses two challenges: 1) how much frontal bone can be safely reduced and 2) where would the incision be placed to do so that would be aesthetically acceptable. #1 requires a CT scan to measure the thickness of the frontal bone from which then I could show you on your pictures what the reduction would likely create. (full or incomplete reduction) To have adequate access to do the procedure, if an adequate result can be obtained, is a challenge in a shaved or bald male. I am mot sure there is a truly great place for the incision but a forehead wrinkle is probably the safest aesthetic choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is the scalp expansion only something that’s needed in the event that all 3 areas are done during a single surgery? If you were to do 2 doing one and the third at a later date … or one at a time, would you need the scalp expansion? Thanks again!
A: Scalp expansion is usually needed when the volume of the implants exceeds 150ccs. Sequentially putting in skull implants does not help that that problem as each implant ‘steals’ scalp for its augmentation effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am 25 years old, my IPD is about 6.5mm, and my ICD is 37mm. This is the average value corresponding to the Korean average of 34mm~37mm. However, as you know, I am Asian, so I have Mongolian folds, which are characteristic of Northern Asians, and unlike Westerners, my inner canthus is covered by skin, which makes my eyes look stuffy. That is why inner canthal surgery is often performed in Korea. However, I need to excise my outer canthus to reveal more than 2mm of my inner canthus on both sides, which makes my ICD look extremely crowded, which is less than 3.3mm… But I heard that you are very famous on Google. But I am worried because 360-degree orbital box fracture is so invasive. But I am asking you because I think you are familiar with lower orbital box fracture. Are there any restrictions on the surgery? I think you don’t have to worry about scars because you are Asian and your dermis layer is so thick. I think it would be enough if my IPD and ICD increased by more than 5mm. If you are able to have surgery or are willing to do it well, I would really like to get it done right away. I am so stressed.In Korea, Lefort 1 is widely performed. However, some surgeons do not accept Lefort 2 or higher surgeries, and some have already retired. I feel like this surgery will be my last hope… Thank you for reading
A: The key question is not whether inferior orbital box osteotomes can be done but whether they could really increase your IPD by more than 5mms. That may or may not occur but what I do know is that it will definitely not increase the ICD by that amount if at all as the problem does not include the medial orbital wall. (only a 360 orbital box osteotomies does which is more invasive than you should undergo)
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I have a small head from my young age. Now my age is 46 and i have started to experience hair loss as before i had very thick hair to cover my head.i am by profession an engineer and this small size of my head is causing problems at my work place and socially as well.
Plz i need to know the following
1 can i have full head augmentation (max volume in cc we can use in implant)
2 how much total cost of the surgery including everything
A:The concept of CCs of a skull implant will not be helpful to you as that relates to volumetric expansion over a large surface area which would be impossible to understand unless one does the actual surgery. It is more useful to think of the skull as 5 surfaces (forehead, top, back and 2 sides) i which you can augment any 2 without a prior scalp expansion. But when 3 or more surfaces are involved a 1st stage scalp expansion is needed. Thus when one speaks of augmenting the whole skull than a two stage skull augmentation procedure is needed. Another concept is that unless one is willing to undergo a coronal scalp incision for implant placement a total 5 surface skull augmentation is very difficult to surgically execute.
That being said I would suggest you look at the five surface skull augmentation concept and rank in order of priority the desired augmented skull surfaces. But for now I have attached some imaging looking at various surfaces of skull augmentation as well as my assistant will pass along the general cost for 1 vs two stage skull augmentation surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I’m currently looking for a surgeon who specializes in midface lifting to treat malar fat sagging.I have read many of Dr Eppley’s articles on cheek lifting but I am not aware if he still performs this procedure? As I also live in the UK, I would appreciate any European surgeon recommendations if that was possible as I’m struggling to find someone with this skill.
Thank you for any help.
A:Midface or cheek lift surgery is very technically sensitive with numerous techniques available and each patient has to be assessed individually to see what may work best for them. It is not like any other forms of ‘facelifting’ where are much more straightforward. There is a reason so many different forms of it exist…there is no one technique that works for everyone.
I would not know who in Europe may offer midface iift surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, Hello, I have previously had a posterior temporal width reduction at your clinic and enjoyed the results. However, I am curious if further reduction can be expected with an anterior temporal width reduction, and/or large skull reduction technique.
A:Using a traditional postauricular approach anterior temporal width reduction produces much more limited results as the entire muscle can not be removed and that muscle is much thicker. When done by a more open superior approach (hemi-coronal scalp incision) the anterior temporal muscle can be treated more effectively……but that is a very rare patient who is willing to put that degree of effort into it.
When you speak of ‘large skull reduction’ could you define further what you mean by that.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, Is chin tightness after genioplasty really fixable? Or its a nerve damage case?
A:Lower lip Tightness after a sliding genioplasty is a contracture/soft tissue deficiency which is definitely improvable by soft tissue release and dermal-fat grafting. Improveable is the term I would use rather than fixable. Overall chin tightness may be a different matter as that suggests an overall bone advancement issue which may require some degree of reversal for improvement.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Dr. Eppley, If you have a look at the front facing photo I sent over, you can see that the right side of my face seems to be wider than the left side. I believe this is due to me having an uneven forehead shape. Do you think I would be eligible for a custom implant to expand the temple area or around that area to even out my face?
A:Facial asymmetries are common and that is one of the benefits of custom implant designing which can see them and compensate for them in the design.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, Hello, you posted several case study about Genioplasty Tightness and dermal fat graft. No where on the internet i can find a review of someone who did the surgery with you. As i’m really interested in getting this procedure done with you, the only person i could find on internet did the same surgery with another doctor based on your study. It didnt work for him and nothing changed and he claim it was due to nerve damage. My questions is, did the dermal fat graft fixed the tightness problem of your costumer
A:I have done that release and graft procedure many times and each patient has gotten some improvement, some more than others. But the key is adequate release and a dermal-fat graft that is big enough to fill the released space.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I had a sliding genioplasty of 5mm forward 8 weeks ago. My face was already long, which I remarked to the surgeon many times, Now my face looks so much longer and I honestly hate the result and wasn’t what I expected at all. A) Is the length of my face going to decrease significantly from here? B) If I decide to move forward with a reversal, is there always laxity, fullness and damage to the soft tissue (I’m only 28 years old)? C) One of my problems is that my lip became thin, is a reversal going to make the lip worse or spoil any chances of the lip getting back to its normal size? Thank you so much, Doctor.
A:In answer to your postop sliding genioplasty questions:
1) What you see at 8 weeks postop is 98% of what the aesthetic outcome will be.
2) With only a 5mm forward movement I would think that the risk of soft tissue laxity with a reversal would be low.
3) A sliding genioplasty reversal is not likely to make the lower lip any thinner…but it wlll also not restore it to its original thickness.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I have an asymmetrical forehead with two bumps, one in height and one in width and one is larger than the other. I would like to know if it is possible to have a completely smooth forehead.
A:What you have are prominent forehead horns, one of which is bigger than the other which creates the major part of the forehead asymmetry. There are two fundamental approaches to your problem:
1) REDUCTION You can reduce the bigger forehead horn to match better to the smaller one but I would doubt you could make both forehead horns completely flat as the thickness of the frontal bones may not permit such an amount of reduction. A CT scan would be needed to make that determination.
2) REDUCTION + AUGMENTATION You can reduce the larger forehead to match the smaller one and then cover the forehead with a thin layer of hydroxyapatite cement to make its contour all even. This would be the only way to make the forehead completely smooth.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I would like the supralateral orbital rim to be addressed but would like to understand the extent to which he can enhance my whole browbone with this approach – is it just the orbital rim or can he go further, is it possible to have a brow bone that goes on my eyebrow or lower down on the holes? I’m not sure what would look aesthetically pleasing . My primary goal is to achieve a deeper-set appearance for my eyes and to have the upper eyelids a lot less visible. My eyes currently appear bulgey and the globe of the eye is visible – I am hoping this approach will create a somewhat masculine appearance slightly too.
Does Dr Eppley know how many millimeters the implant should be to cover over the eyeball? Would this procedure help in concealing the holes in my brow bone (if not it’s not a big deal)? I am also curious if the implant could potentially lower my eyebrows, particularly flattening the arch and shifting them laterally.
A:You have some misconceptions about what a transpapebral brow bone implant can and can not do:
1) It is not a complete brow bone augmentation procedure, it augments the tail or outer half of the brow bone only.
2) Even if the procedure could augment the whole brow bone you can not have that done as there is bone defects across the central brow in which placing an implant over such an area poses a high risk of infection.
3) Short of a bone graft for the central brow bone where the holes are hydroxyapatite bone cement could be used….but never an implant. That, of course, can not be placed through an upper eyelid incision.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will doing a chin reduction generally cause less sagging than a mandibular angle shave?
A:Chin reduction has a very high incidence of chin pad ptosis dependent upon how it is done. If it is done intraorally (which I would almost never do) then chin pad ptosis is likely to result. If it is done by a submental approach where soft tissue chin pad excision is also done then ptosis does not occur. FYI jaw angel shaves do not cause soft tissue sagging. It is amputation of the jaw angles (traditional V line surgery) where that can be a postop issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a bad facelift that changed my jawline completely. The left side is lacking definition and it looks like there was valuable tissue removed.The right side still has some of my jaw left but it to is lacking tissue. There is a nodule on the right where the gonial angle is. When l clinch the masseter muscle it really stands out. I’m not sure why my chin looks bulbous now but it could be fat?I would like to send you pics of my face prior to the procedure and you will get a better idea of what l am trying to say.i believe with implants they can fix the symmetry problem and fill out the deficiency issues.
A:Based on previous pictures sent there is a clear ‘jawline’ asymmetry/deficiency it is not clear to me whether a bone procedure will adequately address a soft tissue created problem…as there is no a 1:1 ratio of bone augmentation to soft tissue change and it would be difficult to accurately what is the needed augmentation even of there was a 1:1 ratio change as 3D CT scans measure bone and not soft tissue. I am not saying it may not work I am merely pointing the challenges in doing so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: D. Eppley, \ I was wondering in Otoplasty if it is possible to remove some bone from behind the ear in order to put the ear back. The reason being is one ear sticks out and the other is generally pretty flat against the head. I also notice the right side of the skull protrudes out a little bit more. Would this even be otoplasty or would this be along skull reshaping?
A:Skull bone removal is not going to help the ears set back further. That requires cartilage and/or sulcus manipulations. It is the differences in the ear structure as to why one ear sticks out further not the skull bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How much is the treatment to remove the dark eye circles?
A:Don’t think of them as removal but rather as treatment to reduce them. All that can be done is to reduce the undereye hollows which will help reduce their appearance but I doubt will make them go completely away. If the only goal is to reduce the color of the dark circles then this will not be accomplished by surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a somewhat specific question about a nose operation that I have not seen before. It is about putting the nose down so that it no longer looks as if it is connected to the forehead and is no longer so high. Is it possible in any way?Because I have never seen this in any surgery, but this would be really important to me.
A:You are referring to reduction about the high radix (frontal nasal junction ) in rhinoplasty. The high radix nose can be reduced but not the degree that you have imaged due to the location of the frontal sinus and nasal airway cavities.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently saw a post about the inferior orbital box osteotomy. I’ve seen the normal orbital box osteotemy but it is too complex and extreme in my opinion. How does the inferior orbital box osteotemy differ from the normal orbital box osteotemy. Can I still expect the same results? I want my Intercanthal distance widened about 5mm and Ipd widened 5mm. Is that possible with the inferior orbital box osteotomy? If not what is the limit on the amount of intercanthal distance and interpupillary distance one can get with the proceducre.
A:Those ICD and IPD changes are likely beyond what an inferior orbital box osteotomy can achieve. While the inferior orbital box osteotomy is a lesser surgery than a full 360m degree orbital box osteotomy as a result it produces less significant changes. (less than 5mms)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, There is a surgeon in Turkey that said they think they can remove my rib hump bilaterally with just doing a 3cm incision to remove rib cartilage, how much of the rib flare could I realistically expect to lose?Would pec implants or a sternum implant WITH pec implants be enough to overcome the mild pectus excavatum?
A:You are referring to subcostal rib flare treatment by subtotal cartilage excision. While this can be effective for some rib flare patients, as an older male with more calcified cartilage and significant rib flare I would be less optimistic as to its effectiveness. If you had to put a percent on it at best I would say a 25% reduction is possible. While some reduction would be achieved it is not going to make a major difference particularly with a mild pectus chest deformity above it.
Ideally you need a diametric approach…meaning augment the chest and reduce the rib flare. (see attached imaging to illustrate the concept) Together that makes each area look better.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was born with bilateral club foot. Surgery was completed when I was 3 months old. I still have thin calf muscles,skinny ankle and short feet which affects my confidence in my personal life. I am 30 years old with no other medical condition. I would like to know more about calf augmentation. Looking forward to hearing from you soon.
A:Compared to many clubfoot patients I have seen you are more favorable for calf implants than some. Your legs below the knees are small but do not appear to be overly tight and constricted. When it comes to lower leg augmentation here are the concepts to know:
1) Calf implants augment the upper half of the lower leg where the gastrocnemius muscle resides, not the whole lower leg. (see attached imaging)
2) Your calf tissues will be tight so implant augmentation is restricted to the medlal gastroc muscle…which is the one that is most seen anyway.
3) Any augmentation below the gastroc muscle to the ankle must be done with fat injection grafting…which has an predictable survival rate but is the only treatment option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I attached 3 pictures, the cropped one being with my jaw open and the right sided temporalis muscle being significantly smaller. Would this be a possible outcome of the surgery? I’m even open to burring of the lateral aspects of my forehead to help reduce width, if at all possible in my case?
A:You have correctly surmised that the temporal muscle thinning with the jaw wide open is a very good preoperative test of whether temporal reduction would be an effective surgery.
The only comment you made which gives some pasue to this answer is… I’m even open to burring of the lateral aspects of my forehead to help reduce width….as temporal reduction surgery does not affect the bony side of the forehead.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Just wanted to look at the possibility of an online consultation for a masculine forehead augmentation.
A:Wiuth your severely backwards sloped forehead but with good br0w projection you would need a custom forehead implant that looks similar to the attached design. The implant’s objective is to normalize the forehead and top of head skull shape that is more consistent with that of a male.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am interested in getting a custom wrap around implant for my jaw and chin. My overall goal is to have a more defined lower part of my face. I would like to have a more defined jaw line, especially toward the back of my jaw where I have little definition. I would like to extend my chin out to align with the lower lip. Right now I have some filler there but it has never made me happy, I would dissolve it prior to surgery. I am also possibly interested in doing a fat reduction on my cheeks, I have very fully cheeks that make my face look rounder, perhaps with the implant I would not feel the need any more. I was curious as to how the design process works, is it possible to have a photo of you augmented to see what your face would look like with the implant prior to ordering it? Also, could you please provide me with an estimated cost for the implant, and possible fat reduction separately? Thank you so much for your time.
A: There is no technology that currently can take a designed implant and show what it would look like on a patient. That may occur some day but is not yet available. Rather custom implant designing is based on targeted imaging of the patient’s facial pictures from which estimates are made as to what implant dimensions can come close to achieving that effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty 4 years ago and I am still struggling my chin is in pain and has complete spasms I get Botox but it’s not lasting more than 7 weeks I don’t know what else can be done my surgeon just sent me to a neurologist they done scans ect and can’t find anything in them My surgeon just says he hasn’t seen this. Before I am desperate is there anything else I can do.
A: This is certainly a very unusual problem after a sliding genioplasty. Given that the procedure requires cutting through and then putting back together the mentalis muscle right at its origin, and then requiring the reattached muscle to be stretched over a longer bone distance (assuming that the chin was lengthened) one can see that is a theoretical source for muscle dysfunction. (although this is done routinuely and the problem of muscle spasm is rarely seen)
While Botox appears to provide some good temporary relief any longer term benefit will require surgical intervention. Surgical options include: 1) reducing the amount of horizontal chin advancement that was done (giving the muscle less length on which two contract) and 2) releasing the muscle introrally and placing an interpositional fat graft. Given the rarity of the problem I can not say which one may be more effective or whether either one would provide assured muscle spasm relief. But anatomically these are surgical remedies that make sense.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if it would be possible, in addition to reducing the width of the face through cheekbone reduction, to shave down the frontal part of the zygoma (in red) & augment the midface area (in black) so that they are similar to the below image.
A: You are referring to the combination of cheekbone reduction osteotomies combined with paranasal-maxillary augmentation. That is a synergistic approach to narrowing the width of the lateral midface (cheeks) and increasing central midface projection and can certainly be done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
