Your Questions

Q: Dr. Eppley, I am interested if you can do a procedure with my head it’s squarish and I’ve done chin filler but my face still looks like a angry looking face and squareish,I’ve also been made fun of a lot for the size of my head ,and one side of my face is fatter than the other.

A:You are referring to two separate but related craniofacial shape concerns, your head and your face. With a wide full and vertically short face the best approach is a vertically lengthening bony genioplasty. Fillers are a waste of resources since you need at least 10mm lengthening to have a noticeable change. This is not an effect fillers could ever achieve. With a wide full and asymmetric face (you have total facial asymmetry as the left side is smaller than the right from top to bottom), provided the goal is to try and make the right side closer to that of the right, right cheek bone reduction and cheek defatting (buccal lipectomies) would be needed. (see attached imaging)

From a head standpoint desquaring the wider head requires temporal line reductions from front to back on both sides for a more narrow head shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Asymmetrical eye area and jaw/mouth seems to go toward one side than centered.

A:Like most facial asymmetries they are usually complete, meaning the entire side of the face is affected if you look close enough from top to bottom. In a superior facial asymmetry, like yours, the eye is the most affected and visible asymmetry but other subtle changes exist involving the cheek, nose, mouth and jawline.

In facial asymmetry corrections it is just a question of how far or complete a correction one seeks. This also affected by yield…how much change can be done at what effort.

In facial asymmetries like yours most patients focus on the eye area has having the greatest benefit. In vertical orbital dystopia corrections it is important to remember that the eyeball is framed by the eyelids and overlying eyebrow so you can just up the eyeball alone without making framework adjustments as well.

The first step in the process is to get a 3D CT scan of your face to fully understand the extent of the bony asymmetries as well as this is the platform on which the orbital floor-rim-malar implant is designed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I had a coronal brow lift years ago when that procedure was much more common. I was wondering if a coronal brow lift can be reversed. I know endoscopic brow lifts can be reversed, but I wasn’t sure about coronal brow lifts. I basically want the lower brow look that is poplar these days, I’ve seen people on the internet refer to the look as hunter eyes. I want to lower them to conceal the upper eyelid. Can this be done using standard reverse brow lift surgical techniques or using a drop down supra implant in the forehead area?

A: I don’t know how achievable getting the Hunter Eye look is in someone who has had a coronal browlift. It is so rare to ever run across a male who has had such a browlift procedure, not to mention one that is now seeking the very antithesis of that operation. However what I do know is four things:  1) it would certainly require a brow bone implant, 2) the coronal browlift incision/scar provides unlimited access to place such a brow bone implant and be able to get it low enough in position, 3) re-elevating the forehead flap will allows galeal releases to be done which would help reverse the browlifting effect and 4) the results of your browlift is not severe or overdone plus it has aged a bit. (aka lost some of its effect)

That being said, I don’t know of the exact result you have shown can be achieved but I do know the best way to try and do it and it is very intriguing to see how much of such an outcome can be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some pictures however the camera quality is poor. I have also added privacy features for privacy reasons as you can imagine this is a sensitive issue for me and I want to maintain as much privacy as possible. Despite the poor camera quality and how the pictures look overall, I am serious about doing the procedure. 

The ideal outcome would be to improve overall head shape by doing a sagittal dip correction in addition to doing a forehead reduction and recontouring for the forehead area to appear more flat in appearance. I am also seeking to correct temporal bulges on the sides of my head and to correct occipital flattening/asymmetry.

Please let me know what the best option to achieve the outcome I am looking for, the possible cost, timeline for the procedure to be done and any other relevant information.

A: Thank you for sending all of your pictures. Based on the pictures and your description you are referring to a comprehensive 5 surface skull reshaping procedure which includes from front to back:

1) Forehead Reduction

2) Sagittal Dip Correction

3) Bilateral Temporal Reductions

4) Occipital-Parietal Augmentation

All of these skull reshaping procedures can be done at the same time. There are two options we need to consider which will affect the cost of the surgery…1) incisional access and 2) what type of implant material. The best way to all four procedures is through a coronal scalp incision and the only way such a forehead reduction can be done. This scar tradeoff may preclude the forehead reduction part of the procedure. All other procedures can be done through very small separate incisions where the scar tradeoff is not a major consideration. The implant materials could be either bone cement or custom skull implants. The former requires a coronal scalp incision to use while custom implants can be placed the previously mentionde small incision.

Thus I need to know what you want to do from an incisional standpoint as that will dictate what can be done and the cost to do it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to know your opinion about my deep nasolabial folds, I’m 50 years old woman. Are paranasal implants better options for me?

A:You have type IV deep inverted nasolabial folds. They will be refractory to any method of augmentation whether that is done by direct injections or an underlying push from implants on the bone. Think of it as scarred V indentations in the soft tissue. The only improvement option, and a significant one, is excision. That will definitely level out the folds and is the only method by which deep inverted folds can be improved. That may sound radical but you already have a deep groove in the skin anyway so a fine line scar will not look any worse.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello there! I am reaching out because I have a special case of a forehead reduction I did about a month ago and the results are not what I expected unfortunately. The hairline was lowered too low (3.7 almost 4cm in height) and the scar is straight not curved to make it seem more natural. I was just wondering if it’s possible to fix this by raising the hairline about 1-1.6cm? I don’t have much laxity on my forehead anymore  my previous doctor removed a lot of skin.

A:Forehead reduction by frontal hairline advancement (aka forehead skin removal) is essentially an irreversible procedure. Once the skin is removed you can’t put it back. The only way to try and revere some of it is through the placement of a tissue expander where you may be able to gain 1 cm or so  of forehead length back.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m looking into getting personalized Temporal Implants because of an issue with temporal hollowing that needs fixing. I’ve got a buzzcut, so it’s crucial to me that the incisions are kept really small. Could you let me know where the incisions are typically made and also give me an idea of the total cost for the procedure?

A:Before determining potential incision location and cost of the procedure I would need to know exactly what ‘personalized Temporal Implants’ means in terms of the surface area of coverage. What temporal area needs to be augmented?

But as a general statement such implants are usually placed from an incision in the sulcus of the back of the ear.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am very interested in improving my butt size a lot and sliming my abdomen area/ love handles I am a relatively skinny 35 year old female and I’m ready to start living my best life what would be the procedure for something like this to get started? My concerns are with implants the results are there immediately but with fat grafting you only keep about 80% of what was injected and won’t see full final results for almost a year advice? My information may not be correct please correct me if I was misinformed.

A: One correction….fat grafting results are unpredictable and the maximum result is seen by 6 weeks after surgery. It may or may not become less later.

But the key question is whether fat grafting is even an option in someone who is ‘relatively skinny’. Do you even have enough fat to even get a short term result. That would depend on what your buttocks looks like now and what your buttock augmentation goals are. I would need to see pictures of both to make that determination.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Would a lower buttock lift help remove some loose skin from the back of my upper thighs?

A: It will help a little of the loose thigh skin but only at the top near the infragluteal fold. But in general it is not a thigh lift procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a mini lower facelift and wrap around jaw implant put in around 2021. Since then, I have struggled with jawline contour irregularities and a face that appears to be sagging more than it was pre-facelift. Interested in a consultation to identify what can be done.

A: While I don’t know what you looked like before this surgery what I do know is:

1) You have classic masseteric muscle dehiscence (see attached picture) in which there is no muscle coverage over the implant. This is primarily the result of the implant design in which it is usually prudent to not extend the implant beyond the posterior border of the jaw angles.

2) Mini facelifts in young patients without any real age-related tissue laxity often up with hypertrophic scarring around the ears…which you have. But putting the jawline implant in at the same time as the mini lift does not allow the more anterior tissues to be properly undermined and redraped posteriorly. (the implant blocks it)  Thus the jaw ssgging that did not exist before the surgery. Jawline implants alone have a powerful effect on jowling and neck sagging and by themselves have a mini lift effect.

The solution is to trim the angle portion of the implant back to the muscle border, close the muscle over it and do a better mini-lift…all of which can be done through your existing facelift scars.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, ), i was a totally surprised with the common risks associated with skull implant surgery from an article I read,  for example but not limited to 

 * bleeding in the brain! As far as I know cement bone material will be implanted between the scalp layer and the skull itself, so hoe this will may occur a bleeding in the brain.

* infection in the brain! 

* swelling in the brain area!

* memory and speaking problems.

 Actually these risks curb my decision to move forward with this surgery. So, may you please,doctor, explain these risks?

A: The article to which you refer was not written by me and I don’t know who the author was or their experience in aesthetic skull reshaping surgery. What I can say based on my extensive experience with this surgery is that none of the risks to which they refer are possible. This is EXTRACRANIAL surgery  not intracranial surgery thus there are no risks of brain injury, infection or damage.

The risks associated with aesthetic skull augmentation are aesthetic in nature such as implant infection (not yet seen), implant asymmetry, edging and size and shape consideration iof the final outcome. There is also the risk of visible scarring from the incision used to place the implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What is the difference between the terms Cranioplasty and Skull Reshaping?

A: Those terms are somewhat interchangeable as both refer to changing the skull shape. However the term ‘cranioplasty’ is an older surgical name and refers to the historic reconstruction of lost skull bones. The term ‘skull reshaping’ is a contemporary term which refers to aesthetic changes of the skull shape whether that is augmentation and reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I would like to know if Botox could also be an option for temporal reduction, since it’s a muscle and I have already received injections to reduce the muscles in my jaw and it works very well. If that’s the case, I would start with Botox, which is less invasive, by getting injections from my surgeon near my home. thank you for your time.

A: Botox is a good place to start. Its effects are not the same as surgery, which produces a more dramatic head narrowing, but usually you will see some modest head width reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, In 2018 I had a neck lift & chin implant. I have included a profile picture pre-surgery as well as a profile & frontal post surgery. Although I am pleased with the implant from the front… the profile angle, I do not like. I feel it is not positioned correctly as well as projecting too much. During the procedure in 2018 the doctor over liposuctioned the areas along my neck line and left dimples. In 2019 the same doctor transferred fat into those area to get rid of the dimpling. After having the neck lift my submandibular glands were more noticiable and cause my neck to look fuller since they were not addressed during the neck lift.

A: I would agree that the chin implant has provided too much projection. Without knowing exactly the implant material and its style and size I can not say exactly how to downsize it. I am not so sure that is positioned improperly but implant positioning is something i never guess at. A 3D CT scan will erase the ‘mystery’ of implant position on the bone as well as its shape and size. (provided it is silicone, Medpor can not be seen in a scan.

Correcting exposed submandibular glands after a facelift is usually best done by subtotal or total gland removal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had hairline lowering surgery three year ago. The doctor removed almost 1.5 inches and left me with an uneven scar as well as a significantly lowered forehead that is unnatural and disproportionate to my features. I have read and saw a comment from Dr. Eppley online that with the help of tissue expanders over the course of weeks/months, it could help stretch the skin and restore the length of the forehead. I would really like to discuss this with him as I want to restore the size of my forehead to it’s original state.

A: While I don’t know whaf your original forehead length was, even if it was an inch (25mms), no amount of tissue expansion is going to reverse that amount of forehead tissue removal.  At best it may be half that amount.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 23 year old woman, who had a chin implant removed over a year ago. I had it removed because I didn´t like how big/wide it was. Both the implantation and removal went fine (both were done from under the chin) and I am now fully healed. However, my chin is not the same as before.

The main issue is that the chin itself feels (and looks) loose and like the tissues are no longer attached to the bone, but just rests on top of it. I also believe there is excess tissue now as I can sort of “fold” the fat in my chin by pinching it. At rest my chin looks slightly uneven with a bumpy texture and when I smile/talk, one side of the chin is pulled forward and the other down, which gives an uneven appearance.

I would like my chin to be firm again, but not much bigger as I like the size my chin is now.

I was wondering if it might be possible to put in a small medpor implant that is visibly insignificant to give the muscles and fat something to adhere to and at the same time removing the excess soft tissue.

Do you think that could be an option? And if not, what else (if anything) can be done? I can live with scarring under the chin as I already have a 4 cm scar there from the other surgeries.

Additionally, the two surgeries has left me with what appears to be loose skin under the chin. I was hoping that could be addressed at the same time as the chin itself.

Looking forward to hearing your thoughts!

A: When a chin implant is removed the chin almost never goes back to what it was before the implant was placed. Besides the created excess of the soft tissue chin pad the tissues have lost their ligamentous attachments so some degree of ptosis can occur.

A submental chin pad excision and tuck is the correct treatment. Whether a thin layer of Medpor or ePTFE for tissue adhesion can be debated  but there is some theoretical merit to it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in having a custom forehead implant designed and surgically placed. The surgery/design that fits my case is highly similar to your cases:

– https://exploreplasticsurgery.com/plastic-surgery-case-study-custom-forehead-implant-in-male-forehead-reshaping-with-pseudo-brow-bone-protrusion/

– https://exploreplasticsurgery.com/plastic-surgery-case-study-combined-sagittal-crest-skull-reduction-and-custom-forehead-implant-augmentation/

– https://exploreplasticsurgery.com/plastic-surgery-case-study-correction-of-an-upper-forehead-slope-with-a-custom-skull-implant-and-bone-bump-burring/

Since there are not many surgeons out there who have experience in designing/placing these specific implants there is very little information online about the recovery/healing process for the 3 specific abovementioned cases: so similar implant design and volume Could you elaborate on the healing proces of these cases: the invasiveness of the procedure is my main concern in deciding to go ahead – since I have not much days to take off from work.

– Can I drive one/two days after surgery?

– What will swelling/bruising be like 3 days after surgery?

– What will swelling/bruising be like 1 week after surgery?

– What will swelling/bruising be like 2 weeks after surgery?

– From what day will people not be able to tell that I had any surgery done?

I am in good physical condition, 29 yrs old and normal swelling/bruising reactions.

Thank you very much for your consideration.

A: The physical recovery from a custom forehead implant (that does not incliude the brow bone) is mainly related to swelling and how long it persists. In answer to your specific quesi0ons about the recovery:

1) You can drive 1 to 2 days after surgery

2)  Forehead swelling peaks at 2 days after the surgery, 50% is gone by one week, 75% is gone by 2 weeks and most if not all of the swelling is gone by 30 days after the surgery.

3) Generally 7 to 10 days after the surgery one appears socially acceptable/passable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was thinking of having a genioplasty I would like to bring it forward as well as widen/broaden it I was thinking maybe 4mm forward and 2-4mm broadening but I’m scared if I broaden it 4mm and bring it forward 4mm It will look the same but broader (still recessed if that makes sense)

Question 2 (this question is referring to the photo attached).

is there any way to prevent this from happening in my genioplasty?

A:I am not sure I understand the premise of your question. If you bring the chin forward and widen it it is not going to look more ‘recessed’. But what I think you are really referring to, as indicated by the red dots in your picture, is that is where you see the chin as narrow and that is exactly where widening the chin will NOT affect. It widens it centrally not laterally. Only a custom chin implant can reliably create horizontal chin projection as well as increased lateral chin width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a consultation with you regarding undergoing a possible revision sliding genioplasty.  I am 1 week s/p SG elsewhere — my surgeon reports we did a 10mm horizontal advancement. Recovery afterwards has been easy and unremarkable, but after doing comparison photos now I can see that we didn’t achieve near as much projection as we anticipated. I’m 100% aware that full results won’t be apparent for some time still, but my understanding is the horizontal projection is not going to meaningfully improve. I’ve attached a photo comparing pre, my surgeon’s prediction via morph, and now 1 week post. Any thoughts on why this may have happened? Is the predicted morph something you think you would be able to realistically achieve, and if so is it more optimal to do a revision within 6 weeks?

I am going to call your office today regarding scheduling a full consultation, but I understand it can be easier to revise an SG within 6 weeks of surgery and hence was hoping to get your input sooner if possible. I can also proceed with getting any recommended imaging sooner this way.

Greatly appreciate your time and input —

A:My first question is whether that was really a 10mm forward movement. While one can debate about how much forward movement the morph actually is (looks somewhere in the 10 -14mm range) your one week after surgery picture (which would have some swelling) doesn’t look anything like a 10mm movement to me. That doesn’t mean it wasn’t (I wasn’t there) but that is not what I would think a 10mm advancement would do at one week postop. The absolute way to know is a lateral cephalometric x-ray. To some degree how much movement was done is somewhat irrelevant as no matter what it was it was not enough. It clearly needs to be double what was done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in having my chin/jaw asymmetry fixed. I was wondering how much would it cost to shave down one side of the chin or jaw. I have an x ray of my jaw and I could send a picture of my face currently. But let me know please!

A:Thank for sending your pictures and x-rays. When it comes to jaw asymmetry corrections in which the chin is in the midline it is always a debate between reducing the longer side or augmenting the shorter side. While this is always primarily driven by the patient’s aesthetic desires such a decision is also influenced by the type of surgery needed to make the those changes. Augmenting the longer side is always ‘easier’ because a preoperative implant design controls matching the symmetry to the opposite longer side. It is also done by a combined submental skin incision in front with an intraoral incision to position the implant in the back. Conversely reducing the longer side is technically more challenging because the chin-jaw bone cut initially made from the front submental incision can not extend all the way to the back of the jaw angle due instrumentation and access limitations. The completion of the bone cut through the jaw angle can also not be done intraorally as the power equipment used can not make such a small amount of inferior border bone removal. It requires the second incision to be a small one at the back end of the jaw angle externally to be completed. In other words you need a dual incisional linear access for the bone removal. (see attached image)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in getting an orbital rim implant with you. Would this be possible to get if I have had a prior canthoplasty? My main concern is if my new lower eyelid would be too thigh to have the implant placed through the lower eye lid.

A: I don’t have any concerns that the higher position of the lower eyelid would pose a problem for placing orbital rim implants. I have seen many patients with a long distance between the lower eyelid and the orbital rim with significant IOM hypoplasia. You would always like to avoid making a lower eyelid approach is someone who has had prior lower eyelid reshaping surgery…but that is not rare to run across the need to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am hoping to travel for revision ZMC fracture repair surgery. I am concerned about the asymmetry of my face since my injury.

A: Asymmetry after ZMC fracture repair is not uncommon, either due to bone alignment issues or soft tissue volume loss.  The latter is often overlooked. But to determine the exact cause of why the asymmetry exists a 3D CT scan should be done to accurately assess the difference. A submental or Towne’s view plain film is not precise enough to determine discrete bony differences.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, So, ‘wrapping’ my head around leaving my natural testicles and acquiring larger sized implants to ‘hide’ them.My main concerns are: not having four testicles visible, how the silicon objects feel inside me (movement, weight, etc), and the effects on sexual function (pleasure, discomfort from pressure when the scrotum tightens during erection/intercourse, etc.)

Would you offer any guidance to these questions?

A: In answer to your testicular enhancement questions:

1)  The way to avoid a ‘4-pack’ scrotum can be avoided with the side. by side testicle implant technique is to have the implants be at least 60% to 70% bigger than the natural testicles…which requires c custom testicle implant approach. As a general rule that makes most side by side technique using a 6.0 to 6.5cm size.

2)  I am not aware of any postoperative issues with feel on negative effects on sexual function. The average weight of a 6.0/6.5 size testicle implant is 75 to 90 grams. ( one lb = 454 grams)

3) Unlike natural testicles which are tethered by a cord (neurovascular pedicle) testicle implants have no such attachments this they are free to move around and generally settle lower in the scrotum than the natural testicles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, here were a few questions I completely forgot to ask you about my custom infraorbital-malar implants surgery and was wondering if you could pass them along:

1. I had Photorefractive Keratectomy (PRK) surgery done several years ago to correct my myopia. Is this a problem with respect to my upcoming surgery with Dr. Eppley?

2. Regarding the implants: does adding the “saddle” to the implants create or increase a risk of blindness or double vision resulting from the surgery?

3. Would it be possible to get a quote for revision surgery that would be done in the event that I do not like the final result?

4. Just to make sure: will the “lateral” projection in the zygomatic arch region be 4mm, or 3mm as previously planned? It is a bit hard to tell from the 2nd IOM implant design document. I would like to keep the lateral projection in the cheekbone area subtle.

A: In answer to your custom IOM implant questions:

1)  The risks of any form of eyelid surgery after corneal reshaping is an increased risk of corneal drying should lid competence be compromised. (in the first 6 months after the surgery) This is more pertinent in traditional lower blepharoplasty where eyelid tissues are removed. That risk is significantly reduced when the lower eyelid procedure is one of access rather than tissue removal.

2) The saddle on the infraorbital rim has no risk of blindness or double vision. The saddle sits on the infraorbital rim and does not extend back onto the orbital floor.

3) Such a quote would rely on knowing what the revision would be for and how it would be done. That could be anything from the gamut of a lower lid adjustment, implant adjustment to implant replacement. That woulo be hard to predict before surgery if it  was ever needed.

4)  Currently that is 3mm but can be adjusted to less in surgery if needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Curious what the recovery time is for the tear trough implant procedure?

A: The recovery from any infraorbital rim implant is completely about the swelling and the bruising which usually takes about 2 to 3 weeks to fully resolve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I would like to get a jaw implant sometime in the next month or two, or whenever your next availability is. I got dermal fillers in NYC 3 months ago but would like something more permanent. Essentially I would like a more 90 degree jawline, i’m already pretty happy with my chin although I would still like to consult about all the options.

A: In answer to your jaw augmentation questions:

1) I mainly do 3D jaw implants made specifically from the patient’s 3D CT scan…a design and manufacturing process that 3 months to complete.

2) Standard jaw angle implants do exist and they may be appropriate for some patient’s aesthetic needs but that requires computer imaging of pictures to determine exactly what the patient wants to achieve. Standard jaw angle implants have their aesthetic limitations as well as higher risks of asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What type of vertical chin lengthening procedure do I need?

A: The correct vertical chin lengthening procedure depends on three factors; 1) how much vertical lengthening does one need, 2) shape of the lengthened chin, and 3) whether one prefers an implant or prefers to move their own bone.

Assuming #2 and #3 are not relevant issues it comes to #1 in which 5mms or less of lengthening can be done by an implant but anything greater than that requires a vertical bony chin lengthening procedure. To help you think about those potential changes the attached imaging shows a more modest effect with an implant vs a stronger effect with the bone lengthening procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, do this under IV sedation or local? I’ve done a 6 hour revision open rhijo with rib under local and a breast Aug. I had a feminizing laryngoplasty and don’t want to damage it with a tube for GA. Would like to do rib removal or lux, but without the tube. Is it possible?

A:While I understand the premise of the question you can not do rib removal surgery under any form of anesthesia other than a general. One should not confuse face/neck surgery with invasive body surgery…they are completely different with one being superficial (face ) vs the other being deep. (body) I have have done many transgender patients who have had vocal cord surgery under general with a 6.0 tube and it has never been a problem. But again I certainly understand why you would ask the question.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Currently I have questions about whether or not  revision work can be performed on me – specifically if a reverse sliding genioplasty along with a vertical chin length reduction and jaw implants is possible. I had Vline surgery and a sliding genioplasty done 2 months ago and despite not being fully recovered (knowing that ideally I need to wait 10 months before I have another correctional surgery), I am not happy with the results as my surgeon did not listen to what I had wanted during my consultations. The surgeons technique and results are not botched on a technical standpoint but aesthetically it is not what I wanted and it is causing me a lot of mental destress. My surgeon did not reduce the length of my chin vertically at all but rather reduced the width of my face and gave me a sliding genioplasty. I did not need the sliding genioplasty and I believe it’s making my face/chin appear longer in tandem with my overall jaw width reduction. I miss having more width to my face. I am very distressed about my current facial contouring results and I am hoping to get my self confidence and life subsequently back! 

A:Thank you for sending your pictures and x-rays. Like many patients who feel they have an overcorrection from their V line surgery, what you would have felt better about is if you have half the V line reduction that was performed. (but that is not how V line surgery can be done…it is a radical procedure where the intraoral access only allows a lot of jaw angle bone removal)  Custom jawline implants can help restore some of that missing bone…a subtotal V line reversal) From the chin standpoint you had a classic t-shaped genioplasty where the width of the chin was reduced. This is not a sliding genioplasty per se, it is the typical chin procedure that is commonly done in V line surgery. Not height reduction or increased forward projection was done. The height of the chin can be reduced secondarily as a vertical reduction genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello,I had a procedure done at your office a few years back on maker my head smaller that required removing the temporal muscle.would it be worth my while to do the bone burning on the sides of the skull to make it even smaller?as it is still larger than normal.

A:The greatest yield in head narrowing surgery is from removal of the temporal muscle. The convex part of the temporal bone is very thin (less than 5mms) so bone burring usually has a very minimal effect…which is why it is rarely done. The other issue with temporal bone reduction is access. Unlike temporal muscle removal which is done from a hidden incision behind the ear, temporal bone reduction requires an incision that runs up along the sides of the head in a more visible location. Thus between the limited improvement and the scar temporal bone reduction is only done in exceptional circumstances. (the patient who is willing to do everything possible regardless of the scar tradeoff)

Dr. Barry Eppley

World-Renowned Plastic Surgeon