Your Questions
Your Questions
Q: Dr. Eppley, I was born with craniosynostosis and had a corrective procedure when I was only a few months old. As I aged, the shape of my head was always a concern for me. I am eventually seeking to get a large skull augmentation procedure performed in the near future. I have a pretty big scar running from ear to ear from the initial surgery and I was curious if this existing scar could be used for another incision or would a new one need to be created?
A:You are correct in that your existing by coronal scalp scar can be used for any secondary skull reshaping needs. What those needs would be requires an assessment of the 3-D CT skull scan, pictures of your head as well as a description of what your head shape concerns.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I have always had a rather large head that has a conical shaped section at the top. I would like to know if I could be a candidate for successful skull reshaping surgery. My desire is for my head to have a more rounded shape. I recently viewed a side profile picture of myself, taken during a vacation. I was not at all pleased with the look of my cranial profile. I’ve attached some screenshots of the picture along with a picture showing red perforated lines of the section of my skull that I would like to remove. Is this even possible to do? Thank you.
A:This is a classic overgrown or elevated crown of the skull enlargement that I have seen many times. The question is not whether it can be reduced but by how much based on the thickness of the bone. This requires a 2-D CT scan to make that assessment. It is safe to say without seeing a CT scan that I can be reduced at least 50% but it would be relevant to know if the bone thickness will permit a reduction like the ideal line of the skull that you desire.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I’ve spent countless hours reading your blog, and reviewing your incredible work.
I had orbital rim, malar and paranasal implants (medpor porex) with accompanying midface lift ten years ago. Although I was pleased at the time, and in the immediate short term, as years passed the extremely subtle intervention has been disappointing. I would like to consider a “refresh” procedure (as opposed to “revision,”) as again, I was pleased at the time, and thankfully the surgery was safe, successful, and recovery was extremely smooth. Fourteen years later, I am still without any ill effects (other than the lack of result).
As such, I started consulting with a number of surgeons, with advice ranging from “never touch porex, especially after that many years,” to those recommending I stack new implants on top of the old ones, to those suggesting removal of old implants and placement of new ones with new material such as PEEK. As I have read your blog, I observed that you do remove porex implants regularly, and suggest never to stack (although the one blog post I read about this subject was regarding silicone, so perhaps I shouldn’t assume that is the case for porex as well?).
So, my question is essentially after so many years, is it possible to remove medpor porex orbital rim, malar and paransals without considerable risk? Or at this point, should I explore other alternatives?
Thank you for any guidance.
A: Thank you for your inquiry. When it comes to indwelling Medpor facial implants and any subsequent surgery all options are on the table that you have mentioned including stacking new implants on top of the existing ones or removing and replacing them for new implants. These are simply surgical techniques and, in and of themselves, should not guide what one does. Nor should what surgeons prefer to do or are capable of doing should be what one does. What matters is what exactly are you trying to accomplish and how much change is needed to the implants you already have. It is easy to see that if you needed some minor or modest amount of additional augmentation then removing and replacing may be more surgery than is warranted. Conversely if you need a significant change in the footprint of the implants and/or projection or a change in the implant concept, then you can see that remove and replace would be the more appropriate strategy. In otherr words first determine your goals (the problem) before deciding what the solution should be.
There are some caveats to the prior statements which include the following. One problem with revising or replacing Medpor implants is that they rarely can be seen in a 3-D CT scan. This can make an understanding of what their current effects are difficult and making new implants that offer more improvement over what they are is less predictable since you cannot see them. But the first step is to always get a 3-D face CT scan and see what can be seen.
Lastly, it does not matter whether Medpor implants are in for 14 years or 14 weeks once the tissue in growth has occurred it remains static. Thus longer indwelling Medpor implants are no more difficult to remove than those of a shorter implantation time.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m interested in s head implant to be taller but I’m not sure how it would look. It’s this a common procedure and does it turn out looking normal? I would like to be about an inch taller
A:At a full inch of height it may or may not look unnatural. At less than an inch it will not. But the best way to determine whether it looks natural or unnatural is to get some head pictures of you and do some imaging with the potential head height changes to see how it looks to you.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi!!! I’m super interested in a few procedures (Clavicle Reduction, Hip Augmentation, and Rib Contouring/Narrowing) and have a few questions! Would love to schedule a consultation to discuss! I’m curious for the Rib Contouring/Narrowing if you all use the RibXCar method or a different procedure for it. I’m also curious about cost and whether any of these procedures can be combined into the same surgery day!
A:While technically the procedures of clavicle reduction, hip implant augmentation and rib waistline reduction surgery can all become combined in a single operation, that would make for a very tough recovery for most patients. As a result I would recommend any two of the three procedures to be combined inthe single surgery.
When it comes to rib modifications for waistline narrowing there are two fundamental approaches, rib removal and rib fracture. Each has their advantages and disadvantages and the differences depend on which you value more…. maximal waistline reduction or a slightly shorter recovery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a fan of your blog articles – thanks for all the helpful information. I’m looking into getting a midface lift as I have sagging In that region from cheek implant removal. I would love to see someone who specializes here such as yourself, but am considering local options for consults to widen my net. One thing that has confused me, is one surgeon had recommended both temporal and oral incision while the other only temporal. When I enquired why (to both surgeons) they either did or didn’t incorporate the oral incision, the first said the oral incision has more nerve damage risk and can look more unnatural. The second said the oral incision is more effective in the area of the nasolabial folds and next to the nose and more of a purely vertical lift there. I’m a bit confused by the conflicting answers and would hugely appreciate any thoughts you had on this.
A: There are different techniques used in mid face lifting. One of the most common is the obliquely oriented temporal approach. The purpose of the intaoral incision in temporal-based mid face lifts is to maximize the mobility of the cheek soft tissues. This may be needed in some patients based on their history while in others it may not be. Because of your history of cheek implants removals you may either have good mobility of the cheeks soft tissues due to the presence of residual capsular tissues (and don’t need the intraoral incisions or, conversely, it may be more scarred down from capsular resorption and you may need to do so. This usually requires an intraoperative judgment to determine that need.
Certainly the intraoral incision is not avoided due to increased nerve damage or because the result may look unnatural.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can i have 5 sessions of Iliac crest reduction?
A: Whatever amount bone reduction that can be done to the iliac crest is accomplished in a single surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Please allow me to provide the context and reasoning for my case. I have a slightly recessed midface but a prognathic upper and lower jaw (SNA angle of 102 degrees), and because of this my upper midface looks significantly recessed compared to my lower third. I would like a cosmetic correction to this issue, but there’s a problem – I don’t believe I can get custom midface implants on their own because my nasion is also recessed and my nasal projection is therefore not sufficient to accommodate midface implants – I would have a sunken/flattened appearance of the nose. In my opinion, trading one disharmony for another is bad practice. Given this state of affairs, am I correct in believing that a Lefort 2 coupled with custom midface implants would be (at least theoretically) the only way to resolve my aesthetic issues without creating new ones? While I understand that this surgery is invasive and not typically offered for cosmetic reasons only, I believe my anatomical situation is somewhat unique and warrants the consideration of this type of operation. What’s your take?
A: A LeFort II osteotomy would seem like a very invasive approach to correcting a recessed nasion, which is the primary reason you are considering it. A nasal implant or rib cartilage graft would achieve the same effect when combined with lower pyriform aperture implant augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would love a consultation around reducing the overall size of my head please.
A: Thank you for sending your video of your head. When you speak of head size reduction that could mean overall head reduction or spot areas of reduction. I am going to assume it is the former. When considering such change the key consideration is surgical access…how do you get there to do it? The only way to do so is a bicoronal scalp incision. Trading of a scalp scar for a head size change must be considered very carefully.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I just want my skull to be symmetric and normal because unfortunatelyI have hereditary baldness stage 6 so my head will be shaved all the time. I need reducing from the top and augmenting at the back left.
A: The augmentation of the left back of the head is done with a custom skull implant most commonly placed through a low small scalp incision over the nuchal ridge.
Conversely reduction of the higher top of the head (crown area) requires a different surgical approach done from an incision on the top of the head.
When these skull reshaping procedures are done together then both are done from the incision on the top of the head at the crown area.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had chin implant surgery that I am not happy with as it makes men look too masculine.
A: Female with ‘male’ chin implant that wanted a more feminine the line shaped chin. This case represents a classic example of surgeons not understanding the aesthetic impact chin implants in the front view or what women are actually seeking. very few women ever want a wider or broader chin. Well there are patients that do want that change they make that very clear from the beginning. Chin implants as they exist today off the shelf are really for men and of all of the seven styles of implants that exist only one is appropriate for most females. But a good aesthetic guideline for female chin augmentation in the front or top view is to make sure the sides of the implant does not violate the aesthetic lines as the jawline come forward. As you can see in this patient’s existing chin implant who seeking a more V-shaped chin effect. it violates this basic principle for the female who is seeking a V shape change in the front view. A new custom chin implant was designed that created a more V-shaped by simply not having wings on the side of the implant. It was also positioned lower on the bone to add vertical height it also contributes to a more narrow and V-shaped look. (Katherine Sanford) this case also illustrates that evening 2025 surgeons continue to only look at chin augmentation in the side view and never look at it from a 3-D perspective which includes the front and three-quarter views as well.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 21 year old healthy male looking to enhance the visual appearance of my lower third. I improve width, definition and masculinity of my jawline by lowering my gonial angle and lengthening my ramus. I have roughly a $10,000 budget. I am am looking to get the procedure done very soon. Pease let me know if there is a time I would be able to come in sometime so that we can go over goals and expectations together. I’m very excited and look forward to hearing back from you!
A:Thank you for your inquiry and providing details about your facial augmentation goals as well as your budget. By definition of your budget you are referring to the use of standard vertical lengthening jaw angle implants as any custom implant design would be beyond your stated budget. While I am not knowledgeable about the cost details of surgery, although I have assistants who are and will provide you with this information, I can give you some important conceptual concepts to understand about elective aesthetic surgery particularly when it involves implants. You need to be aware in considering the cost of elective aesthetic surgery what happens should you need a revision of it. This consideration is not rare as all face and body implants have a revision rate of close to 40% for a variety of aesthetic reasons including symmetry, size and shape of the placed implants. While such revisional surgery is not done at the cost of the initial surgery it is also not free. This is a well known risk of the surgery. Therefore when you consider the cost of such surgery all patients would be wise to ensure that should revisional surgery be needed/desired they are not placed in an adverse financial position.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m looking to shorten the upper jaw (le fort 1 procedure) along with custom jaw/chin implant to give a chiseled jawline look. Ive had a few botched jaw/chin implant surgeries before and been through hell. I admire Dr Eppley’s work and looking to get the result i always desired. Looking forward to discussing further
A:I am going to assume when you speak to shortening the upper jaw that the main objective is to close down your anterior open bite. This would be important not only from an occlusal standpoint but it also would allow the lower jaw to rotate a bit forward which would change any subsequent ijaw mplant considerations. While I have significant experience in such jaw osteotomies these are procedures that I no longer perform. Thus you would need to seek out a maxillofacial surgeon who performs these procedures regularly. Certainly in California there are a lot of surgical options. What I can say is that no form of facial implants should be considered until you have a corrected skeletal base. The only reason to consider implants now is if you are willing to accept your facial bone structure and the open bite that you currently have.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, he is interested in a Temporal Artery Ligation, however he would like to know if the artery near his eye could be ligated as well.
A:The inner orbital vasculature is not a facial area in which I would perform ligation. I have never had a request for it and thus have never done it. I am certain that it can be performed and probably done so safely without any adverse effects. However that is a theoretical statement not backed by any clinical experience.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have questions about cheekbone reduction surgery. What sides of the cheekbone are able to be shaved and minimized. I want it to not protrude out from my face.
A :Cheekbone reduction surgery is performed by osteotomies, usually of the anterior main body of the cheekbone as well as the thin posterior zygomatic arch, to allow for inward movement of the entire cheekbone complex. Cheek bone reduction is not performed by shaving due to limited access, the thinness of the bone, and the occurrence of soft tissue cheek sagging from the stripping off of all soft tissue attachments.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in nuchal ridge reduction. My only concern would be any visible scarring from the burring down or reduction at the back of the head. I could theoretically get it tattooed over but it depends how large these scars would be?
A: The scalp incision needed for nuchal ridge reduction is kept as small as possible. But the further laterally one has to go to access all of the enlarged nuchal ridge the Incision will become longer.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had double jaw surgery with a bony genioplasty that has left me with some jawline irregularities and a chin that is ma bit too bulbous.
1) Would he advise doing a a bone graft into the boney gaps created by the BSSO to improve the indention in the jaw line?
2) Would he advise a genio set back of 2mm here to make the chin less bulbous and improve the chin fold and concavity above it?
A: Provided there is good bony union/healing bone grafts are not contouring materials as they have a high rate of resorption/irregularities. If the goal is a smoother jawline a custom implant design addresses those issues more successfully. This is a common post double jaw/genioplasty problem that I see. (see attached picture)
For the chin all you can do is a 2 – 3mm setback (50% reduction) of the original advancement to make any major difference in its over projected shape or lessening of the deep labiomental fold.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had custom CT-designed midface implants placed originally 4 years, and then a new set of midface implants was designed and placed in 2 years ago. which were larger than the original implants (the current implants both provide ~7 mm in projection, while the original implants each provided ~5 mm and ~3.5 mm of projection). I like the general design of the current implants but feel they may be a bit too large. I noticed that Dr. Eppley has an article discussing the process of shaving down custom midface implants to reduce projection. Thanks
A:You have left out two important pieces of information. First what is the design of these midface implants as I would need to see their design file. Secondly what is the implant material?
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have attached some facial images. My main goal is to address my lip incompetence which causes a strain on my chin. I hope to correct my mouth breathing and grogginess/ sore throat in the mornings after sleeping. I’ve spoken to a few orthodontists about this concern, and they have told me I should consult with a plastic surgeon to review what options I have since it is outside of their scope. I would just like to know what options, if any, there are to address my lip incompetence!
A:You have lower lip incompetence and nocturnal mouth breathing issues because your lower jaw is underdeveloped. Your chin recession is merely a symptom of your lower jaw under development. The optimal approach is a combination of orthodontics and lower jaw advancement surgery. This will rectify all of your associated symptoms to the best that can be achieved.. Short of this ideal solution your only other option is a sliding genioplasty chin bone advancement which will help some of these concerns but will not completely solve them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What do non-custom skull implants start at? I read one of his posts where this was a less expensive option.
A:You are referring to special design (SD) skull implants which are custom implant designs from other patients with similar skull shape conserns where we already have a design file made and just have to print out the actual implant for surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I feel like the inner corner of my eyes is too long, it makes my eyes look very close set. The after picture is how I want my eyes to look. Is something like that even possible? Is it possible to shorten the corner? What procedures would you recommend for a more pleasant looking eyeshape? Would this require the position of the inner core of the eye to be altered? Is that predictable/safe/possible?
A:You are referring to a V-Y inner eye corner shortening which involves closing down the corner by partial excision of the lacrimal lake area. How this may apply to you requires some eye pictures for my assessment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’ve had 2 bbls over the span of 4 years but don’t have enough volume in hips and butt. Looking to get hip implants and butt implants.
A:Thank you for sending all of your well illustrated body pictures. After having been through two BBL surgeries you have reached the end of what fat transfer can achieve for you. Thus your interest in implants for further buttock and hip augmentation is understandable and your only option at this point. While there is always a question of the patient’s goals any time implants are being considered, as you don’t want to go through implant surgery and be disappointed, but given that this is your last recourse for such body augmentations whatever size implants can be safely placed becomes what is achievable.
The relevant question then becomes should buttock and hip implants be done together in a single surgery. Normally I would say no if the patient has had no prior surgery as this can involve considerable recovery and is always more then they initially think. But in the person who is had two BBL surgeries, which I consider relatively equal to such implant surgeries, this then at least becomes an option to consider. I, however, would still be cautious about combining these two body implant surgeries for a variety of reasons beyond just that of recovery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to get my testicles removed and get implants just for bigger size.
A:My first question would be is it really necessary to remove the existing testicles. One can get much bigger implants than the natural testicles and not necessarily remove the existing testicles. This is known as a side-by-side technique. It’s success depends on the size of the natural testicles versus that of the implants. As long as there is at least a 70% increase in implant size over the natural testicles it can work fairly well.
In rare cases I have removed testicles and replaced them with implants but there are numerous considerations with that approach including the role of the testicles in supporting testosterone production as well as reproduction. Obviously, the issue of reproduction is not a concern or you would not be asking about testicle removal.
My initial question then is what is the size of your natural testicles in centimeters along their longitudinal axis?
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Please allow me to provide the context and reasoning for my case. I have a slightly recessed midface but a prognathic upper and lower jaw (SNA angle of 102 degrees), and because of this my upper midface looks significantly recessed compared to my lower third. I would like a cosmetic correction to this issue, but there’s a problem – I don’t believe I can get custom midface implants on their own because my nasion is also recessed and my nasal projection is therefore not sufficient to accommodate midface implants – I would have a sunken/flattened appearance of the nose. In my opinion, trading one disharmony for another is bad practice. Given this state of affairs, am I correct in believing that a Lefort 2 coupled with custom midface implants would be (at least theoretically) the only way to resolve my aesthetic issues without creating new ones? While I understand that this surgery is invasive and not typically offered for cosmetic reasons only, I believe my anatomical situation is somewhat unique and warrants the consideration of this type of operation. What’s your take?
A: A LeFort II osteotomy would seem like a very invasive approach to correcting a recessed nasion, which is the primary reason you are considering it, when a nasal implant or cartilage graft would achieve the same effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 63 yr.old white female with an extremely flat head. I have done some research and discovered that this condition is referred to as plagiocephaly. I was diagnosed with hydrocephalus back in the summer of 2014 and had a VP shunt inserted into my brain. My flat head never really bothered me ,other than hindering my abilty to wear a hat or helmet. Recently though, I have noticed I am experiencing a good deal of back and neck pain due to the position of my head.When I lie down, I am lying directly on my neck. The result is neck pain and very bad headaches!
A: While the shape of the skull affected by plagiocephaly can be improved by a custom skull implant this is an aesthetic procedure that I would not anticipate would provide any functional or pain relief improvements.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering about the actual material Dr. Eppley uses for skull augmentation, I thought it said on the website that he was injecting a type of bone cement – PMMA – can he do something like this or is he only doing the harder or pre-formed implants now then?
A: The use of bone cement has been abandoned due to subpar results and the high rate of irregularities/irregularities. Custom skull implants offer far superior results with a low risk of contour issues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I’m interested in a procedure involving my orbital bone structure. Do you assist with this? My main goal is to address the asymmetry.One eye sits lower than the other. I believe one side of my face is shorter than the other.
A: You are referring to Vertical Orbital Dystopia (VOD) in which one eye is usually lower than the other one and, more times than not, it is associated with an overall vertical facial shortening. There are a variety of VOD techniques to decrease the eye asymmetry by moving the lower eye upward as well as adjusting the soft tissues around the uplifted eye (brows and eyelids) to accommodate the new eye position. (you can’t just move the eye alone as that will create a new aesthetic problem.)
The question is not whether VOD surgery can be done but how much improvement can be obtained and is it worth it. To make a more complete assessment I need a true assessment of what needs to be done a 3D CT scan to assess the underlying orbital bone shape is needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Does your practice offer ultrasound imaging as part of the evaluation for facial procedures? I’m interested in assessing both the cheek and neck areas to better determine if options like a deep neck lift, submental lipo, cheek lipo or revision buccal fat removal would be most appropriate.
I’m 24 and I had submental liposuction, buccal fat removal, and cheek liposuction 4 years ago but most of the fat has returned to those areas. Different surgeons have been giving conflicting advice for procedures.
Specifically, I’m hoping to evaluate:
• Facial fat distribution and muscle tone (e.g., buccinator muscle, SMAS, fribrotic tissue )
• Neck structures (e.g., submental fat vs. deeper compartments, platysma)
Looking forward to your response.
A: Ultrasound imaging is a diagnostic test that I have rarely used for any facial procedure. If you really want to know the details of what lies in the various facial soft tissue compartments an MRI would be more useful.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in buttocks implants, hip implants and rib removal. I have had BBL procedures in 2015, 2016, 2017. Am I a good candidate?
A: After 3 BBL surgeries implants would be her only option for further buttock enlargement, regardless of the implant size.
Rib removal is always synergestic with buttock/hip augmentation. (makes them look bigger)
Given that no further fat can be harvested for the hip augmentation and fat works poorly in the hips anyway, hip implants would be the only treatment option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I feel that the back part of my head is very flat, and that’s why I wear long hair. I don’t know if it will be noticeable in the photos I’m sending you. I also have some receding hairlines or a slightly large forehead. I wanted to know if I could later undergo a hair transplant or a forehead reduction, or if I could do both surgeries together in one operation. I hope you can help me
A: Because skull augmentation (custom back of the head) ‘steals’ scalp to accommodate for the implant a forehead reduction by frontal hairline advancement can not be done at the same ome or any time thereafter. The skull implant however does not preclude from doing a hair transplant later.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
