Your Questions
Your Questions
Q: Dr. Eppley, I would like to ask, in general, what is the maximum upper jaw advancement movement in mm (Lefort 1) that will not cause discrepancy between the lower and upper midface and that will not disrupt the facial harmony?
A: This is a question that would be affected by many factors most notably the shape of the face. Thus a specific answer can be provided to a general type question without pictures to understand the basis of your question.
Dr. Barry Eppley
World-RenownedPlastic Surgeon
Q: Dr. Eppley, I am interested in getting a combination of surgeries done. The surgeries I am interested in consist of shoulder narrowing plus rib removal and iliac crest implants.
Could these surgeries be done at the same time? And would I require assistance from another person (ie family member) or friend to be present for my recovery?
A: All three such body contouring surgeries, shoulder narrowing, rib removal and iliac crest implants, impose a lot of stress on the body and make for a very difficult recovery, particularly when you have early limited use of your arms. Thus these trio of body contouring surgeries should not be done together. Any two of them at the same time is commonly done and that is enough of a recovery on its own.
In regards to coming alone or with someone it can be done either way and we see both commonly. Suffice it to say, particularly with shoulder narrowing surgery, that having someone with you makes the recovery a bit easier and you would likely return home a few days sooner due to the added assistance. When you come alone we just have to put more forethought into your immediate postop recovery management as we have to provide some support for it.
Dr. Barry Eppley
World-RenownedPlastic Surgeon
Q: Dr. Eppley, I am curious about ribcage narrowing. Removing my floating ribs wouldn’t make much difference I don’t think. It’s my side ribs that bulge out making my back too wide for my narrow frame. I have no fat really.
It’s rib 10,9,8. My floating ribs do not show much because my side ribs stick out. The sides of my ribs feel hollow.
My hips and legs are extremely small My ribcage is narrow from the side. Looked like the ribs squash sideways slightly.
A: Rib removal of the non-floating ribs is more limited than the floating ribs. Rib #10 can be partially removed as it wraps around the side of the torso and rib #9 can be shaved down in the same side torso area. This is the maximal ribcage reduction/.narrowing that can be done. I would also agree that removal of ribs# 11 and #12 is of no benefit to you in what you are trying to achieve.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wan to reduce the size of my face as it is larger than a normal human being as its size is extra large.
A: I don’t see any effective method for reducing the size of your face. What makes your face ‘large’ is the amount of thick soft tissue over it. There are numerous defatting procedures and even that of skin reductions (aka facelift) but the question is how effective they would be in making an overall facial size reduction. I suspect they would help make it a bit less full/thinner but not necessarily smaller in size.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Here are some pictures of my face. Based on these would it be possible to say that the lefort 1 surgery affected my facial harmony?
A: Every Lefort I osteotomy alters the natural shape of the face essentially leaving what lies above it behind. (infraorbital-malar region) Your current facial pictures certainly reflects that postop issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My breast implant size, I think there is 250 in one and 235 in the other. They are saline, probably close to 15 years old. Yes, I would like to go up in size.
A: Thanks for the info. To see an appreciable/visible increase in breast size you should at least go into the breast implant sizes of 300, probably 350 to 375cc. Always more than a 30% volume increase its needed to see a difference.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, As you can see I have the side of the skull on the right in the photo and on the left in life larger than the other. What I would like would be to refine and reduce this side so that it is homogeneous with the other side.
A really flattened skull on the left with a bump while the other side is normal. I would like to know if it was possible to do something or if it is impossible.
Know if we could raise the skull at the back of the left side so that it is less flat and much more aesthetic.
A: As part of your plagiocephaly there are differences between the shape of the two sides of your head. The options are to either reduce the larger side or augment the smaller side. That is a personal choice based on one’s aesthetic preference.
The flatness on the back of the head is a classic concern in plagiocephaly which is commonly treated by a custom designed skull implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m interested in both the cheekbone reduction and double eyelid surgery. Therefore, I was wondering which one should I do first? Lastly, how soon could I have the plates and screws removed and is shaving of the Zygoma cheaper than L-Osteotomy method?
A: The order of cheekbone reduction and double eyelid surgery is a personal one and the two, while anatomically close, are not related or affected by the other. The one you do first is the one that is most important to you.
Shaving of the zygoma is usually a poor choice for many cheekbone reduction patients as its effects are more limited and is a procedure that is not aesthetically interchangable with cheekbone reduction osteotomies. They each have different indications for the cheekbone reduction patient.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 42 year old male. I follow you on Instagram. I would like a consultation about my right clavicle. When I was 8 years old, my father had me fire a rifle that caused a greenstick fracture on my right clavicle. The callus makes a prominent bump as you can see in the pictures attached. I work out a lot, but there is asymmetry. I would like to know if it’s possible to fix the clavicle and add chest implants that would improve the appearance of the upper chest.
‘A: Clavicle Reshaping and pectoral implants can be done together. I suspect the bump is either a hyperostosis at the fracture line or it developed a slight bend at the fracture site. Either way the bump can be likely be shaved. down/smoothed over without compromising the integrity of the clavicle. I would check a clavicle x-ray to have a full understanding of what the bump is.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, For my plagiocephaly compared to the side of the skull I think reducing the bigger side is a better solution. The back of my head will have to be cohesive with the side reduction by increasing the flatness. I also have a few questions to ask you about the risk of this delicate operation since it touches the head. Are there any infectious risks or any other risks? The intervention keeps the desired outcome alive. I mean, aren’t implants changing over time? and Does this procedure present a risk on the nature of the hair or causes it in loss. Recovery after the operation is it essentially pain or difficult? And keep your big scar for life ?
A: The amount of the bigger side that can be reduced will be determined by the CT scan but almost assuredly it can not be done enough to match the other side. As a result reasonable symmetry is not going to be obtained by bone reduction alone.
I have never yet seen an infection from any form of skull reduction or skull implants.
Skull Implants are structurally stable and do not change over time.
Skull reshaping surgery does not adversely affect hair growth.
Recovery after skull reshaping surgery is neither painful or difficult.
Scalp scars from incisional access are permanent.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have two inquiries, the first wanting to know which option testicle implants of side by side and wrap around allows for the largest sizes? I was also wondering if surgical steel or something could be included to make them weight more?
A: Both testicle enhancement techniques allow for the same increases in size but the wrap around technique has a much higher complication rate with not infrequent implant separation.
Metal can be incorporated into a central hollow chamber in the implant but it is important to recognize that this is an off-label implant technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My question is relate to a 5mm genioplasty reduction i had done 25 years ago. As a result I’ve lost some contour as far as the muscle below the lip fold. I’ve read that tissue can be tied up to create the natural curve. In a second procedure A small chin implant was placed to restore the fold but I’m still a bit flat. The area looks great when I add filler to that muscle but I’d love to not have to continue to do that. Is it possible to ‘tie up the tissue’ so that I’m not quite so flat from front and side and as a result the chin would be a bit shorter? Thank you!
A: I would not confuse the aesthetic effects of filler with soft tissue resuspension. That is not the effect tissue suspension would create and, even of it could, it would not be a sustained effect. Such tissue resuspensions frequently fail after a few months.(fall back down) The potentially more effective approach is submental chin tuck to make the chin shorter and fat injections to the labiomental fold.
The other option, since fillers works so well, is fat injections with the hope that some of the injected fat survives.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hey just wondering at what age would you perform skull reshaping surgery? Would it be 18 or fully grown or what age would you consider performing this surgery? Thank you
A: Adults age 18 and older is the minimum age for skull reshaping surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a question about the general behavior of implants when removed. Perhaps you can answer this: Does removing implants after 6 months cause any permanent tissue damage and face changes? Does it create saggy skin or slightly change your appearance, etc? Or will the face and muscles go back to normal with some very minor tissue damage (only where the cuts were done during surgery, etc)?
A: The best way to think about any implant removal in the face is that the face will never return to 100% normal after implants are removed. It is just a question of how close it returns to normal which will be dependent on what type material composition) of facial implants have been removed, their size and shape and their facial location.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have recently had a canthoplasty to fix my eye asymmetry and tilt 6 months ago. I’m at the point now where I believe I need more volume with infraorbital implants. Is this possible after me having a canthoplasty?
A: Having a prior lateral canthoplasty does not preclude getting infraorbital implants secondarily.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can i still get infraorbital malar implants if i got a cheekbone reduction before?
A: That is not an implant limitation. Custom infraorbital malar implants can be placed over any bony anatomy regardless of its prior surgical changes.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to inquire about potential surgical options to address my lifelong condition which I believe to be Brachycephaly. Please find attached photos and a video for reference. The key concerns I have are as follows:
1) Bulb-like appearance due to protrusion above my ears on both sides of my head.
2) Asymmetry caused by one side protruding more than the other.
3) Different protrusion of my ears, causing an imbalance.
4) Brachycephaly causing a noticeably large head with a circumference of 59cm/23.22 inches, often inviting unwanted attention and comments.
5) Flat shape at the back of my head, deviating from what is considered typical.
6) Abnormally high, top part of my head.
A change in my head shape would significantly impact my life in various ways. After discovering your work while researching similar cases, I am optimistic about finding a solution. Your expertise in this field is truly life-changing for individuals like me who have faced social challenges.
As a resilient and positive person with a strong support network, I am eager to explore options to address this condition. I appreciate your time and dedication to your profession.
A: You are referring to these procedures:
1) Bilateral Temporal Reductions
2) Left Setback Otoplasty
3) Custom Back of Head Skull Implant
4) Sagittal Ridge Skull Reduction
Any combination or all of them can be performed during the same surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, . I was born with a left-side form of facial asymmetry due to underdevelopment of various facial structures. My left eye sets lower than the right and my left cheek bone is flatter than the right. I also have some chin asymmetry. I am not looking for my face to be perfect just hoping for more facial asymmetry. I look forward to hearing from you.
A: Based on your comments your primary areas of facial asymmetry concern are: 1) left eye, 2) left cheek and 3) chin. The correctuve procedures would be: 1) Left cheek implant, 2) chin asymmetry osteotomy and 3) left orbital floor implant with eye corner adjustments. You have correctly surmised that improvement is the realistic goal not perfect symmetry.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a webbed neck. I have dealing with it for 50 years. I always wanted to improve the appearance of my neck. I’m unsure if I can gain more natural movement but I’m interested in finally achieving a goal of having a smaller neckline.
A: You have what appears to be a mosaic type of webbed neck which typically has less wide neck webs. But the skin and deeper soft tissues are tight and, as a result, does not respond well to webbed neck surgery.
FYI. Webbed neck surgery does not improve the range of motion of the neck.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I read your post regarding filling the step-off that occurs with sliding genioplasty.
Does this bone fill eventually become solid bone that is fused to the chin structure? Or does it remain bone chips? I’m fascinated by this technique as I worry that the step off of a sliding genioplasty will be visible and noticeable, especially in the jawline. How does this technique address these concerns?
A: I assume you are referring to the central stepoff of a sliding genioplasty as opposed to the lateral stepoffs that occur along the inferior border. The blog post to which you cite refers to the central stepoff as opposed to your description which refers to the potential lateral jawline stepoff.
As a general answer to your question about the fate of the use of cadaveric bone chips, if placed during the primary procedure, some of it turns into bone and some of it becomes fibrous scar tissue. But in either case it serves as a volumetric fill which its primary objective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in potentially getting skull reshaping as I feel my head (temple area) is very narrow at the top instead of round. I have a heavy bottom/jaw that’s wider than my forehead. Would like it to be more balanced. Can I get information and range of potencial cost?
Thank you
A:Thank you for your inquiry and sending your pictures. What you are referring to are extended temporal or head widening implants that wrap around the side of the head to create increased width. Attached is an example of the concept as well as potential changes in you. (which can also be more or less)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a question about chin reduction through the submental approach. From a lateral view, the protruded chin should be brought to the level of the lower lip. However, from the frontal view, what changes can we expect? Will the shape change considerably? If the patient wants it, could the shape of the chin be preserved? For example, keep a square chin square after the bone reduction.
Please advise
A:In a horizontal chin reduction the bone is reduced back and its shape can either be maintained or changed based on the patient’s aesthetic desires. Keeping a square bony chin shape is a predictable outcome.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’ve done a bit of research on clavicle shortening surgery. I’m a 23 year old female, however my shoulders are really borad compared to the rest of my body. I do have some questions before booking a vitual meeting for the surgery.
As I’m coming from Denmark, and travelling alone. What is the minimum required of days to stay? I can’t stay for too long. And do you offer a place to stay after surgery, when travelling alone (of course paid)
Will the surgery cause my shoulders to roll inwards, making it look like I have a bad posture?
And is there any long term risks of the surgery, which you’ve seen with your patients? Such as nerve pain/damage, pain in shoulders/arms, or lower mobility? , or any impact on the back muscles during time?
Can I expect any complications during pregnancy or birth?
Will the metal inside the shoulders cause any trouble when visiting airports?
A:You have correctly surmised that the biggest issue in clavicle shortening surgery, particularly for overseas patients who are traveling alone, is the immediate postop recovery logistics. We advise all of such patients to stay at the Hyatt Place right next to my office and very close to my surgery center which makes everything easier. I would anticipate you returning home 5 to 7 days after the surgery.
The surgery does not cause the shoulders to roll in to any significant degree nor does it affect your posture once fully recovered.
I have seen no adverse musculoskeletal effects from the surgery.
The surgery will cause no issues with subsequent pregnancies.
The metal hardware used is titanium which is both MRI compatible and not a problem with airport scanners.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Hello, can you provide a price range for what forehead augmentation with pmma might cost for a man at your clinic? I understand you can’t give specifics but I’m just exploring the idea at this point and am wondering what I should be planning for. Thanks
A:PMMA is a very limited forehead augmentation technique that has many liabilities which as a result I no longer use it. I only use custom made forehead implants now due to their far superior controlled aesthetic results and lower risk of complications…not to mention a smaller scalp incision to place it as well.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, One part of my discussion with the doctor is the possible lowering of eyebrows, which may be done by upper eyelid incision. This is not included in the agreement. I am assuming that this would be a part of my forehead implant augmentation procedure.
A: As stated earlier an upper eyelid incision is typically used for custom forehead-brow bone implants to make sure the implant is seated low enough over the brow bones. In so doing optimal release of the brow bone tissues is done. Whether this will make the eyebrows become lower is not predictable, as these tissues are very tight and have little stretch, but between that maneuver and the implant whatever lowering of the eyebrows that is possible will be achieved.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Idk If I had brachycephaly but my head is wide from the sides and kind of flat in the back could I remove temporal muscle and combine with a prosthesis in the back, as my face is round with my head wide looks 0 aesthetic, dr, do you think that tia could work? I leave a pic of my head
A: You have correctly surmised that the combination of temporal reduction (see attached imaging) to narrow the sides and a custom skull implant for the back of the head would be the combination of skull reshaping procedures that would provide the head shape changes you desire) That is a good bidimensional change for the wider but short (front to back) skull shape.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know if i would be a good candidate for any facial implant that could make my undereye/ midface volume loss disappear. I’m going to send some pictures as attachments.
Thank you for your time and help!
A:You have small facial bones with underdeveloped/weak bone structure around the eyes and cheeks. This not only appears as midfacial volume loss but makes the normal infraorbital fat look herniated, the lower eyelids sag with scleral show and the eyes appear overly prominent. The only effective treatment is a custom infraorbital-cheek-maxillary implant. (see attached images)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Good afternoon! I was your patient last year for infraorbital malar implants and the results are amazing! This time in interested in lateral comissuroplasty for making bigger and wider lips. I would like to know if it can be performed under local anesthesia? What is the possible widening? Thank you very much and have a wonderful day!
A:Good to hear from you again and I am very glad your IOM implants worked out well. When it comes to mouth widening surgery, which can be done under local anesthesia, the key concepts to grasp about it are:
1) The mouth corners will be lengthened (widened) but that does make the corners wider. (increased vermilion show – see attached imaging)
2) The need for scar revision on mouth widening is not low.
3) The alternative approach to your concerns are lateral vermilions advancements which will make the outer portions of the upper lip wider/fuller, may increase the mouth width a few millimeters and has a low scar revision rate. (see attached imaging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would you ever consider doing cosmetic work on the femoral heads/acetabulum?
I’m a male with unfortunately wide hips. I think this is due to either a genetic condition or a lack of high testosterone during puberty. Anyway, being 23 now, options to amend this cosmetic issue are very limited. I know from some of the other questions you answered, you may or may not offer “iliac crest reduction” which you say could help. My issue is that the size of my hips aren’t really a matter of the iliac crest. They’re instead because of the femurs. In general, I think most surgeons steer clear of touching the femurs since they’re obviously super critical to locomotion and daily activity. However, in researching this subject, I’ve noticed several medical procedures I think may reduce the distance between the femoral heads (and thus the hip width). I’m talking about things like total hip replacement, femoral angle of inclination surgery, and possibly even acetabulum deepening.
Yes, those procedures are all medical. But as cosmetic surgeon with willing patients who accept the possibility of risk, why not appropriate them to cosmetics? I think myself and thousands of other unfortunate men would flock to it.
A:My two comments would be:
1) Those type of greater trochanter/femur manipulations are within the province of an orthopedic surgeon not a plastic surgeon.
2) In the diagram attached I would doubt that the narrowing effect on the ‘hips’ would be externally noticeable…and it would have to be to justify that effort and risk.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had brain surgery 30 plus years ago that has left me with 2 small divots which I am trying to have filled.
A:With a prior history of a craniotomy, or at least burr holes for decompression, those divots would represent the through and through skull defects from that procedure. Such burr holes defects can be covered over with a variety of materials from bone cements to implants. I suspect a bone cement material would be fine but it would be worthwhile to check an x-ray before doing any surgery so there is a full understanding of what lies underneath these indentations.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
