Your Questions

Q: Dr. Eppley, I am actually a former patient of yours. I had your 3 prong approach to reducing cheek fat (buccal lipectomy, perioral mound lipo, and buccinator myectomy) back in 2021. The results have been more amazing than I could have hoped and I never thanked you! It is life changing. Anyways, I was recently looking removing a deep glabellar frow line and I saw that you recommend an implant for very deep frow lines. I wanted to know what the cost would be for that? I have included some pictures (which also show the cheek results) of the deep frow line. Thank you

A:Thank you for the long term follow up and good to hear that the results were favorable. In regards to the glabella furrow I don’t see any attached pictures. However I do have pictures of you from 2021 and I can see what you are referring to. I assume that its depth is about the same. I don’t think yours is deep enough to yet justified an implant. I would look more at placing and Alloderm graft right under the furrow to  treat its depth closer to the skin surface. Implants are indicated when it is a deep V shaped indentation that cannot be pushed out by any other soft tissue method.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I have had Porex implants (mandibular area of the jaw) by another doctor. I talked to the other doctor two years ago if it were possible to have one of the implants reduced (it is a bit too prominent on one side). He said it would be possible with access through existing scars, but I waited too long with the decision and now the doctor is retired. Would it be possible, in principle, to have the implant revised by Dr Eppley? 

A:The question is not whether a Medpor jaw angle implant can be revised but whether it can be done so in vivo (in place) as your inquiry suggests. To more accurately answer that question I would need to understand dimensionally what type of implant reduction is needed and where the existing scars are located.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m reaching out to you again regarding the reduction of the temporal muscle and I have a question about it.The superior and inferior temporal muscles are both responsible for mastication. If I were to undergo a total removal of the superior temporal muscle, would the inferior temporal muscle, located around the cheek area, along with other muscles like the masseter, compensate for the activity of the superior temporal muscle? Would this result in these muscles gaining volume and becoming stronger over time, leading to a swelling of the cheeks and face? If so, is there another way to reduce the temporal area without removing the temporal muscle, such as altering the bone structure in this region, or by reducing the superior temporal muscle by 1 cm or less without fully removing it?

A: Your temporal muscle reduction questions are very common. While removing normal muscle seems like it would cause functional or compensatory muscle issues it does not. The proper terms are posterior and anterior components of the temporal muscle in which the entire posterior portion of the the muscles removed and a little of the anterior part. But this reduces 30% or less of the total temporal muscle volume which explains why no dysfunctional jaw motion results as well as no enlargement of the remaining muscle.

The temporal bone is fairly thin so its reduction does not make a significant difference in head width reduction plus it requires a visible scar along the side of the head above the ears. It is muscle removal which provides the greatest benefit in width reduction as well as can be done with no visible scar.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello! I’m from Arkansas and I’m contacting due to my chin length. Ideally I would like to shorten my chin. From frontal view it isn’t too bad but when smiling i feel it throws off my facial proportions. I was just wondering if this possible? Thanks so much!!

A: When a chin changes length by animation (smiling) this suggests a chin pad ptosis rather than a primary bone length issue. It may be what is needed is a combination of both bone and soft tissue reductions and the procedure to treat it varies based on how much of each needs to be removed.

I would need to see a front and side view pictures of your chin, smiling and non-smiling.  

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, you hav suggested vertical lengthening genioplasty and a custom implant for my desired jaw augmentation effects. If the 3D custom implant is made based on my current anatomy (i.e. before the genioplasty), how will that work to enhance the chin? Especially for symmetry and shape. 

A: The vertical lengthening bony genioplasty movement is simulated on the 3D scan and then the jawline implant is built around it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I am looking to remove bone cement that was done about two months ago on top head region. Too much was added on top. Only wanted top side head to fill in and also a bit of back.

A:  In regards to your skull augmentation bone cement removal:

1) What type of bone cement was used…PMMA or HA?

2) Where is the scalp incision used to place it and how long is it?

3) Regardless of the cement used, unless it was put in through a bicoronal scalp incision you have to remove all of it not just part of it,

I am going to assume but the volume of material that appears to be added that is was PMMA bone cement in which complete removal is needed as there is no way to partially remove it due to how it is fractured to remove it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it also possible to get It less sticking out with out changing the shape of my forehead?

A: That question is an oxymoron…if you reduce the protrusion by definition the shape of the forehead will change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What method will be used to make them permanently protrude?

How close will it be to the picture?

Is there anyway we can replicate what’s in the picture?

If I use filler afterwards to increase the protrusion to match the picture, will it eventually be remodeled to match that protrusion?

A: When you are trying to change the natural shape of a facial structure by surgery there is no exact predictability as to how the tissues will respond. What the imaged pictures do is set the goal which will influence how the surgery is done.

In creating increased protrusion of the ear the antihelical fold must be released from behind and a cartilage graft placed to act as a buttress to hold it out. (cadaveric cartilage graft) But the exact outcome can not be exactly predicted beforehand. You push the ears out as far as they will allow to be released and out the largest graft possible and hope that the final result will be close to the goal picture.

Injectable fillers create temporary effects, they do not turn into tissue or create a permanent effect. The material will eventually be absorbed and the effect will be lost.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a consultation regarding forehead augmentation to address asymmetry caused by a recessed frontal bone on one side. The imbalance is structural rather than soft tissue-related, and I am exploring options such as custom implants or bone cement to achieve a more symmetrical appearance. I would appreciate the opportunity to discuss the best approach for my case, potential outcomes, and the overall process.

A: When you have an asymmetry on a highly visible area like the forehead it is always best to use a 3D CT scan and make a custom implant. Bone cements are a very imprecise method of skull augmentation that will only end up creating a new version of the asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, just had genioplasty Do you think that if the surgeon’s plan was to advance the chin forward 6mm and I asked for 5mm will make a significant difference? I’m so scared of having ruined my results and that now the chin will look too small.

A:  1mm is not going to make the difference between a result that is just right or too small.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I would like to change my 600cc hp silicone for 800cc uhp silicone I’m 5’4 with a bwd of 14 the first pics are of me the other 2 are wish pics. Thank you

A: Given that 800cc ultras high profile silicone breast implants exist and the volume change (200cc or 33%) is under 50% this should be very achievable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am distressed by the outcome of my surgery, I just had this midface and temporal lift in Turkey on January 23rd 2025, it’s been 3 weeks last saturday. I find the temporal lift (canthis and eyebrows) too high, too pulled up, I would like to lower it and have a natural look that’s closer to how I was before but without the negative canthal tilt I had. I thought I explained my doctor that i just wanted a subtle lift but his hand is strong because the fox eyes is the fashion over there and that’s what he does more I guess. He says I over worry and that it will come down with time but I feel disfigured, I cant heal 2 months hidding I have a lot to do. I had a negative canthal tilt before, I wanted to elevate my outter corner of my eyes a little bit but, it’s over done to my taste, I feel too much tension and my eyes are blurry I can’t read comfortably cellphone or computer, even with my reading glasses I see blurry, so it strains my eyes because it’s more effort I have provided. I attached picture of me before and after surgery. He used the endoscopic method. his incisions are 1 cm behind the hairlines on each side, And for the mid face lift he went intra oral to lift the tissues and fat pad from the bone and pushed them up. Please help!

A: While 3 weeks may seem like an eternity it is not when it comes to any procedure on which some form of lifting of the face is performed. The effects of gravity and tissue relaxation will make the result less lifted as it heals so what you see now is not the final result.

The only reason to intervene now to take it down is if the goal is to try and return to what you were before as much as possible. Otherwise I wold wait it out and see how it settles out by 2 to 3 months after the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to tell you about a problem with my head shape. It is a condition that I have noticed since my childhood. I have a problem with my head looking too wide from the sides. My father has the same problem. He also has a wide head when viewed from the front, but the back of his head is flat and curved, but mine is normal. Is this because the skull bone is too wide or the temporal muscles are too big? Could it be because both are too wide? Because when I clench my jaw, my head expands quite a bit, and when I open it, it becomes quite thin. Is there a solution to this problem? If so, what is the solution?

A: In the wide head both the bone and muscle are at fault. But on a practical basis it is the muscle removal that offers the greatest benefit in reduction and can be done in a scarless manner from an incision in the crease of the back of the ear.

You also have demonstrated the value of the posterior temporal muscle removed  and anterior temporal muscle release by your mouth opening manuever.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  How long do you estimate recovery time to be: am I going to need another person to assist me with daily necessities (preparing meals, showering)?

2.1. Given that’s correct (I am going to need a caregiver), then  for how long?

3. How much narrower can the shoulders be made?

A: These are very important shoulder narrowing recovery questions which are better answered in depth in a virtual discussion. But in summary:

1) While a full recovery takes 6 weeks the most important recovery period is right after surgery until you can return home. It can be done alone or with someone and, of course, recovery is easier when here with someone and one can return home sooner that way  Most patients return home 4 to 6 days after the surgery.

2)  To really understand the effects of shoulder reduction surgery and the effects of removing 2.5vcms odf bone per side I need to see pictures of your shoulders (front and back vews) to do some imaging of the potential effects.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a lipo for the banana rolls 5 years ago and the suction was probably too strong. Since then I have had a deep crease, especially on the right side.

This causes me pain and discomfort. Do you think I would be a good candidate for a lower buttock lift?

Would this pulling, sagging discomfort improve and how severe would a scar be?

A: A lower buttock lift after liposuction is usually done because it has either caused a lower of the infragluteal fold or has created a banana roll deformity….neither of which you have. An overly deep infragluteal fold with discomfort is a scar contracture issue for which release and interpositional fat grafting is needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I didn’t notice my MARPE changing the width of my mouth at all, which I’d hoped it would. I’m just curious, is there another way to slightly widen the mouth? Also, I’ve heard that you need time for your palate sutures to fuse again until you have jaw surgery. Is that true?

A: I would not expect MARPE to widen the nostrils. Mouth widening is done by a direct softy tissue Y-V corner movement. There is no correlation between any  facial suture developments at the bone level and this external soft tissue site.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in forehead advancement as well as shaping. I have a high hairline and vertical central bossing of the forehead. I believe my hairline would need at least 3 cm of advancement so likely would need tissue expansion. Can you provide me with a general idea of timing for an appt and treatment initation and generally how long does it take and number of visits needed for scalp tissue expansion. Thank you

A: In answer to your questions about a two stage hairline advancement procedure:

1) All scalp expander injections  are done by the patient at home.

2) The time interval between the placement of a the tissue expander and the hairline advancement is 6 to 8 weeks.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley.  I feel like my entire skull is too wide, I know the area above the ear can be narrowed but I was wondering if skull reshaping can be done in such a way that the distance between the 2 ears are reduced.

A: While head narrowing surgery typically refers to decreasing the width of the head above the ears I believe you are referring to the ear themselves which is defined by the location of the eternal auditory canals. Such a reduction is not possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in lower facial artery ligation. I have been experiencing pulsating stinging, soar and painfully arteries just above my both sides of my lips, center area between nostril and lip. Feels like damaged area on artery of about (1cm) this area stings non stop as like it is damaged from some sort of trauma, because of this it pulls on the artery which feels very soar and like a tight string that runs up the side of my nose, up into the inside of each eye. I had a bad infection/disease in my nasal maxillaries that I seen a ENT for and was cleared out by penicillin antibiotics and cortisol steroids 1 year ago. But the stinging and damage in my artery has never stopped in this small area above my lips. I have seen two vascular surgeons and have received dye injected CT scans, but they have said the CT scans wont show the damage or inflammation on those arteries, and they said they do not remove or do procedures on those arteries. This is where I came across your article on the exact area of my problem. Is there a procedure of a four point ligation of this area or can I get a full removal of about a 1cm of artery in this area, as this is causing me massive problems with not being able to do any physical work not being able move around, as if I do it causes pulsating pain and stinging in that area of artery. You are the only Doctor that I have seen that has talked about this area. Could you please help.Thank you

A: In my limited experience with ligation of the facial artery for aesthetic purposes (visible pulsations) it has been a single area of treatment for either double ligations or resection on one side only. In other words for a very focused problem area that clearly could be identified with a treatment that is known to work. (bulging arterial resection = remove the dilated arterial section)

Your situation is very different in many regards. While it appears to clearly involve the facial artery branch there is bilateral involvement and has symptoms which are uncommon from any arteria problem that I have seen. It is uncertain with these symptoms as to whether arterial manipulations would be effective. In addiiton it is also bilateral and what should not be done is bilateral arterial treatment at the same time since this may have vascular compromise issues (necrosis) to the upper lip.

In short the question is not whether facial artery resection can be done but whether it would be effective for the unique problem that you have.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a 22 year old female with  a narrow face that not proportional with face length typically 12.5 cm face width i want a wider face about 14.5 cm width is it possible to widen each side of my face by 10mm through combination of zygomatic arch and jaw implant temple implant if needed i want to now about the possibility before coming to US.

A: The question is not whether such amounts of facial widening can be done at the temporal, arch and jawline area but whether that amount (10mms) is what is actually needed. Patients typically  over estimate their dimensional needs numerically. I would need to see a front view picture for imaging to look at what type of changes are actually needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Wanted to get some info about testicle implants. I currently have silicone in my sack and would like to get it removed but replaced with silicone testicles. Is that possible?

A: If one has had silicone injections in their scrotum the silicone masses/granulomas first need to be removed before testicle implants can be placed. When done concurrently the risk of complications is significant and thus I don’t recommend it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had Custom Jawline & Custom Bilateral Cheek Implants four years ago. I am considering a lower blepharoplasty (for dark circles and slight bags under my left eye) in Seoul (I’m living in Asia now) and just wondering if there are any limitations or considerations I should be aware of when undergoing the lower blepharoplasty.

A: Your cheek implants involve implant material on the infraorbital rims. This does not preclude doing a lower blepharoplasty but your surgeon should know it is there. The implant material should be treated just like it is bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, This is something I’ve wanted to do for a while, and I would love to know all the information behind the surgery! Here are photos of my goals and what i want to achieve with this surgery. i would love to know his thoughtsall the non-photoshopped photos are on the left side!

I also attached some photos of what I mean. These girls have deep eyes and a tall brow bone!

A: Your imaged pictures, description and examples show a modest brow bone augmentation consistent for a female. Such brow bone augmentations are usually in the 3mm range and cross the brow bones like a ribbon as seen in the attached implant models. (which happen to be for a female Asian brow bone and midface augmentation implants)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Im 37 and I have lop ears that are small and curled. I’m not in your area. I was wondering if you can help me find someone in my area? I found otoplasty doctors but they always say they can’t do my ears. I had one consultation and they said they couldn’t guarantee it doesn’t go back to the way it was? Idk I’m kinda lost. Thanks.

A: I would not be able to identify any surgeon in your area who may be suitable to perform your type of otoplasty surgery. But I could tell if your ears are really correctable without significant relapse. I would need some ear pictures to do so.

Dr. Barry Eppley robbers their daughters

World-Renowned Plastic Surgeon pleasure

Q: Dr. Eppley, I am interested in a custom back of the head skull implant. How many days take to recover or how many days should i stay in USA. How many weeks time does it take to make the implant? It is Is my dream to realize that  this type of surgery can be done.

A: The recovery from a skull implant is a lot quicker than most people think particularly on the back of thhe head.  The postoperative swelling which is on the back and sides of the head will largely be gone in 7 to 10 days after the surgery.  You should be able to return home in 2 to 3 days after the surgery. Getting the implant ready for surgery once we have received your 3D CT scan takes between 2 to 3 months.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am 58 and have been on TRT replacement for about a decade. I workout 5=6 days a week, very muscular in shape health nut of a guy. I was inquiring about testicular implants. (I asked my urologist about fat injection and he said the results are very mixed.) I’ve read your article about side by side and wrap around. I live in Montana. Is it patient choice regarding wrap around or side by side?…what governs that decision. What is the overall down time?…and overall cost. thank you.

A: While both testicular enhancement options are available, there are not equal in terms of their risks. Any time you wrap an implant around an oblong/spherical form there is always the risk of secondary disengagement… a risk that persists lifelong. As a result I would encourage the side by side technique where no such risks exist. The success of the side by side technique, as defined by reliably hiding the appearance of the natural testicles, depends on the size discrepancy of the natural testicles vs that of the implants.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I hope this email finds you well, I am hoping to book in for a online consultation with Dr Eppley as I am not in the states so would not be able to visit the office, the procedure I am interested in is the vertical backlift & rib removal, I have a lot of questions and would love to know some more information about the procedure/recovery as a whole as well as knowing if I am a good candidate, I do have loose skin on my back certainly enough to pinch, but I am not a large person by any means so it is not heaps.

Please find images attached to this email in regard to the possible vertical back lift and rib removal, As you can see I am of petite build and healthy weight so no excess fat but just some excess skin as shown clearly in two of the photos. 

A: Thank you for sending all of your pictures. What qualifies someone for a vertical backlift is some degree of skin laxity in which its vertical removal down the center of the back provides visiblle waistline improvement. Usually there is a history of weight loss or pregnancy which would account for the skin laxity. Your picture shows some vertical skin laxity which indicates there is enough for removal. Through the vertical skin excision ribs #11 and #12 and some LD muscle could be removed to further the waistline reduction.

In performing the vertical backlift in your case it is important to not carry the iexision lower than the purple line marked in the attached picture as well as not much further superiorly than the braline

Dr. Barry Eppley

World-Renowned Plastic Surgeon.

Q: Dr. Eppley, Hi there, I wanted to enquire about whether I would be a good candidate for forehead reduction surgery and brow lift. I have a protruding forehead which is quite angular (almost like two horns on either side). I would ideally like this shaved down and then for my hair line to be brought down to allow for better facial symmetry. I’m starting to notice some drooping in my eyelids so a slight lift to my eyebrows may get rid of some of the eyelid folds that’s starting to form with age. Please could you give me some more Information as to what the procedure may entail.Many thanks for your time.

A: Let’s start out with some forehead pictures (front and side views) for my assessment andnimaging to see what changes are possible. But the combination of bony forehead reduction, frontal hairline advancement and a browlift is commonly done.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, . I have an overcorrected right ear from previous surgery. I would like to know if it would be possible to correct using a rib cartilage graft. It’s the mid portion of the ear. And also if possible to create a fold at the top similar to my left ear. I am more than happy to travel to America for the surgery as I am based in Paris France. Thanks

A: In the over corrected ear it is uaually the middle portion which is pulled back too far which can also have an upper third of the ear that lacks a good fold…exactly as you have described. And both ear shape concerns can be corrected simultaneously using a cadaveric cartilage graft for the over corrected middle ear snd suture plication for the under corrected upper ear..

That being said let me see some pictures of your ear to see how these concepts apply.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, How much is forehead augmentation with PMMA bone cement?

A: As a general rule the use of PMMA bone cement is an almost historic method of forehead augmentation due to issues with getting a smooth shape to the forehead,and the need for a bicoronal scalp incision needed top adequately place. As a result the use of PMMA in the forehead has largely been replaced with custom implant designs. There may still be a role for PMMA in forehead augmentation in very select cases where the augmentation is limited.

I would have to see pictures of your forehead and what your goals are to see what is the appropriate type of forehead augmentation material.

Dr. Barry Eppley

World Renowned Plastic Surgeon