Your Questions
Your Questions
Q: Dr. Eppley, I am interested in forearm implants. I previously had a fat transfer to my wrist areas that did not work.
A:While fat grafting to the wrist (technically the distal forearm) was reasonable to initially try I have never seen it work there as there is little subcutaneous fat to help it survive. Technically you are referring to wrist (distal forearm)and not proximal forearm implants. That is more than a semantic difference. Proximal forearm implants are in the upper 2/3s of the forearm and are muscle type implants that are under somewhat thicker tissues and are not exposed to wrist join movements. Distal forearm or wrist implants are subcutaneous implants placed right under the skin, the tissue cover is very thin and they are exposed to flexion and extension movements of the wrists and hands. The point being is the proximal forearm is a better implant location in terms of potential postoperative problems than the distal forearm closer to the wrist. That being said distal forearm implants can be done with the understanding that they can come up to but not cross the bony bump closer to the wrist which are the ends of the ulna laterally and the radius bones medially. (see attached image, red arrows) Whether one or both sides need to be done (in green) is up for discussion. Such implants are made using a moulage or measurement technique to create their computer designs.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to get more information on the CVG (cutis verticis gyrata) Can Foperation the doctor performed on the scalp using fat that was harvested from the body, was it successful at adding volume to the lines of the cvg and what side effects did the patient get? I have some lines and was wondering if this operation would be successful, if you can message me back at me email for more information I would greatly appreciate it.
A:Fat injection grafting works best in mild CVG where the linear lines are not deep and inverted depressions…like yours. It does help soften them but doesn’t completely eliminate them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting a custom midface implant to try and project my maxilla more, but will this implant alone not cause my upper jaw to appear more forward then my lower jaw causing and unattractive look. If this would happen what other treatment could I do along with this in other to even out the appearance.Thank you very much
A:I am confused by your question. By definition a custom midface implant is done for its aesthetic effect of increasing midface projection not for its maxillary protective effect. Thus it will make the midface (not the lower dentoalveolar area most anatomically accurately called the upper jaw) to have more fullness. That issue aside how increasing midface projection will affect the balance of your face is best determined by doing so initially computer imaging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had Double Jaw Surgery three years ago and was very happy with the results. But as swelling went down, the HA paste turned out to not add much augmentation at all to my gonial angle/jaw width/cheeks. Two years laterI had a custom wraparound implant and infraorbital implants done and then a revision shortly after to fix a chin asymmetry and protruding infraorbital implant on my right side (you could see it sticking up a bit on my skin).
I’m unsure if I like the level of anterior projection in my cheeks from the infraorbital implant and wish I had more lateral/zygote projection.
However, the main issues are, essentially, asymmetries in the chin and possibly too much augmentation (my chin passes the line of congruence with my bite). As well as fixing the visible/palpable stepoff in the right infraorbital implant.I was told by my surgeon that a revision would be further sculpting the already-placed implants but I’m wondering if remaking them would lead to a more “perfect” result.
One major difficulty of my implant surgery was the HA paste from my double jaw surgery–he had to scrape it off to try and get the implants to fit flat and said it was one of the toughest implant surgeries he’s had to do. And also that my right infraorbital issue is because it’s sitting on top of a plate from my double jaw surgery..
I’m looking to get a different opinion and inquire if you would have any suggestions for me and possibly having a revisional surgery done.
A: In reading your inquiry I can make the following comments:
- I would be very cautious about the pursuit of perfection in facial augmentation results, particularly when it involves implants. You have already learned some valuable lessons from your prior surgeries….each surgery leads to its own unique set of postoperative issues. The closer you get get to good the more relevant these tradeoffs become. (risk vs benefit ratio)
- You have chosen an implant material, which while reversible, is very traumatic to the tissues to remove…much more so than putting it in. That has great relevance in the risk vs benefit ratio consideration.
- Without even reviewing any information on your case my initial response is to fix the most obvious problems (chin projection and right IOM implant) and accept that result as it is once that is completed. That is the most obvious path to concluding your facial surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Recently, a plastic surgeon noted that my frenulum was attached and performed a surgical procedure to release it. While it did improve my gummy smile slightly, unfortunately, it exacerbated my double lip issue. I currently reside in Tampa, Florida, and have been diligently researching experienced plastic surgeons who specialize in this procedure. During my search, I came across your website and was impressed by your expertise.
I’m a healthy individual, and although this deformity has bothered me for some time, I’m understandably concerned about the potential risks of further intervention. However, I’m determined to find a solution and would like to schedule an appointment as soon as possible to discuss the best course of action.
Thank you for your attention to my inquiry.
A:The interesting aspect of your double upper lip is that you have a significant gummy smile with it. And by your own history release of the maxillary frenulum (which is not an effective treatment for a gummy smile) further exposed an already present double lip. This poses a treatment dilemma as should just the double lip be treated (which may make the gummy smile worse), should the gummy smile be treated (which may not fully correct the double lip) or should both be treated concurrently. My suspicion is that the latter applies through a lowering vestibuloplasty technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I currently have braces and will be widening my mouth. I am looking to get the double jaw surgery to move my mandible and maxilla forward and then eventually getting implants to widen my face. Can you ask Dr.Eppley if he would be able to apply the implants after I get the surgery done? Also what implants would Dr.Eppley use to widen my face. I think I can cover my small head with hair but would definitely like to widen my face and make it bigger. My face is not far from square shaped so I would like to get a square shaped in my lower face but not anything that looks too unnatural.
A :Implants can be done after double jaw surgery in which custom cheek-arch and jawline implants are needed to do so. This is a fairly common request after double jaw surgery to maximize the aesthetic facial outcome.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Thanks for getting back to me. I had scalp reduction surgery back in April which improved my condition somewhat. I still have some wrinkled and I’d like to see of I can get a smoother appearance through fat grafting. I wanted to wait about a year to let my scalp really heal before trying other treatments. Here are some pictures where you can see the improvement. I’m currently in South Korea on an international assignment but at some point I’d like to consult with you to determine if fat grafting can improve my condition. My timeline would be April 2024.
Please let me know if you think I’d be a good candidate for fat grafting.
A: Given the prior scalp reduction for your CVG fat grafting would be a reasonable option now. You don’t have any hair follicles of concerns (given that you shave your head) so there is no risk of affecting hair growth from the fat injections.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am wondering if theres a specific procedure to get more of a ”hooded” eye look. I will attach two images, one of my eyes and one pic of what I mean by hooded eyes.
Let’s say I want to have a result in the middle between what my eyes look right now and the hooding on the second pic, so not 100% as hooded as the second picture but more like 60%. Would that be possible and what procedure would you recommend that is not too invasive?
Thank you for your time and I am looking forward for your reply.
A:The difference in shape between your upper eyes and that of your example is that you have a retracted supratarsal sulcus. (v profile shape compared to the hooded eye which has no sulcus and more skin) Since you can’t add skin the approach has to be to make the supratarsal sulcus less deep by volume. This could be done by synthetic fillers, fat injections, dermal-fat grafts and/or infrabrow implants. It is not clear which one of these is the best option since so few procedures like this have been done. Nor is it clear how effective it is on your scale of 0 to 100% of the goal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, about the lengthening limits for clavicle masculinization, the maximum achievable amount is around 25mm, would more lengthening be possible with a second clavicle lengthening surgery later in time ? (for example a year or more)And what would the second lengthening amount be if such a scenario is possible.
Thank you
A:The limits of clavicle lengthening is 15 to 18mms. It is only a clavicle reduction that can be done 25mms or more. Seeing how these lengthening osteotomies heal I do not see doing a second stage osteotomy without a significant risk of non-union.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,From my understanding from other surgeons there are a lot of risks associated with rib removal surgery. After reading the Dr. Eppley’s website, he lays out the case for it being a rather safe procedure. I am a single mother and can’t afford any major complications.
Can you let me know what complications Dr. Eppley’s patients have encountered with rib removal and how or what specifically does he do to mitigate major risks/issues. Has he ever had a deaths doing this procedure? What can or should I be concerned about long-term with removing ribs?
A: I have never encountered one single complication, major or minor yet from rib removal surgery….so it is fair to say it is a safe procedure in the way I do it. I would try to avoid putting much stock into surgeons commenting on the procedure unless they have actually done it. Admitredly it is a procedure, by name, that sounds risky but the reality is that is has far fewer problems than tummy tuck or BBL surgery which are also torso reduction procedures.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I was interested in getting a temporal brow lift. But I also would like to have a custom forehead implant.. so my question is would it be worth getting a brow lift before the implant? Would the implant throw off the dimensions of the browlift.
A:You would not get a browlift before forehead augmentation as that would be a wasted effort. You either do it during the forehead augmentation or wait until after. But before would be the worst timing for it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m a 5’6 Trans woman who is interested in clavicle reduction/ overall shoulder narrowing. However, my main question is if you’d be able to reduce the size of my ribcage alongside this procedure?I know you’re able to re-section the lower ribs, but I was hoping you’d be able to reduce the width and overall size of the mid/top ribs too? I just think if that were a possibility, it’d change my life drastically and would go great with the shoulder reduction surgery.I just feel really bulky and large for my height, and I’d love more than anything to have a smaller ribcage.
A: Thank you for your inquiry and sending your pictures. In answer to your ribcage narrowing question, there is no safe method to reduce the overall width of the fixed ribcage above the level of rib 10. If there was a way that it could be done I would be doing it. Unlike the lower ribs the rest of the ribs play an important role in respiration and their circumferential support can not be lost at more than one rib level.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I had double jaw surgery to correct an underbite a few years ago. It improved my facial harmony but I still have facial asymmetry. It seems extreme but from my left side I literally find myself quite handsome, and from my right side I truly despise the way I look. The difference is subtle, but it must be noticeable. The jaw angle is different (and worse) on my right side, as well as my cheekbone is much less pronounced, and nearly flat under the eye on the right. It results in a much worse look on that side. Hopefully the pictures make that clear. I have very noticeable asymmetry from the front as well. I would love to find out what could possibly be done implant-wise on the right side. Thank you sir.
A:In any facial asymmetry, subtle or major, the first step is to get a 3D CT scan of the face to determine the exact bony differences between the two sides. Given that your left facial side is the goal what are the bony differences between the right cheek and jaw angles from the lefgt that makes them asymmetic shape. Between the scan and using mirroring software for implant design this will provide the most accurate asymmetry correction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello there, I’m wondering if there is a way to shorten my face. I believe that my nose is too long and the space between the bottom of my nose and the top of my lip is too long also. Please advise on how this can (is possible) be fixed. Thank you in advance.
A:In vertical facial shortening there are only four procedures to effectively do so….forehead reduction by hairline advancement, rhinoplasty, subnasal lip lift and vertical chin reduction. The midface always poses the biggest challenge for vertical shortening and, while rhinoplasty and a subnasal lip lift are what can be done, their effects are limited given the large amount of midface tissues that exist. That being said you have correctly identified these two potential midface procedures. Now the question is how effective would they be. To help make that determination I would need side profile and ¾ view facial pictures to do so imaging in that regard.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m heavily considering bone burring for the entire top of my skull due to it being too high/long/narrow, and would like to know before I’d fly in for a preoperative CT scan just how unusual it is for your patients skull to allow for less than the approximately 5mm to 7mm bone reduction off the top? I’m not sure anything less than 3mm or 4mm would be worth it for me personally, unfortunately.
Your reply would be really appreciated. Thank you in advance
A:How much bone can be removed from the skull requires a CT scan which can get where you live. We can order that for you so you can get it done locally. In almost any skull 3 to 4mms can be assuredly reduced. The real question is will the thickness of the skull allow for more than that amount of bone removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I currently have a chin implant in (Vertical Lengthening Chin in Medium). It is an okay result, but there are visible ridges and it doesn’t provide as much vertical lengthening as I would like. from my research, I think either a vertical lengthening genioplasty or custom chin implant would be a better option. I am looking to schedule a consultation with Dr. Eppley. I am interested in his opinion on what would be best for my desired results.
A: The decision between a custom vertical lengthening chin implant and a vertical lengthining osteotomy is determined by two factors: 1) how much more vertical chin lengtheninng do you need, and 2) is there a need for chin width or a specific chin shape. Once these two parameters are known then the decision between the two chin lengthening options will be clear.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have just seen that you also offer forehead lengthening ? I would also be really interested by that procedure and would have a few questions.
The technique you’re using consists of – I quote : “The most successful treatment of the short forehead is a two-stage approach with a tissue expander placed first followed by a pretrichial browlift approach.”.
May I ask if the pretrichial browlift will change something to the brows/eyes ? As I would like to have my forehead lengthened but not my brows/eyes changed.
How much lengthening of the forehead is possible using this technique, and could it be sort of shared with the skull reshaping to achieve a more satisfying/bigger result?
A: Forehead lengthening = increasing the amount of skin between the brow bones and the frontal hairline…which can only be achieved by moving back the frontal hairline. Thus the forehead skin needs to be stretched with a tissue expander followed by a frontal hairline setback which will leave the eyebrow position unchanged. In some ways it could be called a reverse pretricial browlift but that is not the best term to use since the brows are not involved at all. A better tern is am frontal hairline setback.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What are the side effects of shoulder extension surgery?
A: The primary complication is failure of the fixation which results in non-union, or more likely, bending of the clavicle across the osteotomy site.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Last February I underwent chin augmentation surgery using a personalized peek implant. I chose to have an implant rather than a genioplasty because, having also had an asymmetry of the chin, in addition to increasing the forward projection of the chin, I wanted to correct the asymmetry and the custom made system seemed like the best solution but unfortunately I am not satisfied with the results.
I had an implant with an advancement of 14mm, perhaps a little too much, this advancement created a greater projection of the chin which was the result I wanted but compared to before the surgery the chin also gives the impression of being vertically longer In reality, the height of the implant is only 1mm but I believe that the shape of my chin bone combined with the notable forward projection that I have had gives the visual impression of a chin that has also grown vertically, this It was a result that I didn’t want and I don’t like. It creates a face that’s too long. Furthermore, the chin turned out too wide for my face type. I’m attaching a photo of the implant.
In summary, the implant managed to give me greater symmetry and forward projection which I desired but I am not satisfied because it increased the vertical height of my chin and the width too much.
1) Making a new implant with the same shape but reducing it by 25% in projection and width, i.e. making a projection of 10mm instead of 14mm and reducing the width of the chin by making the front part of the chin straight from 3cm to instead of 4cm Could I get the effect of a less long face?
2) Will the 3cm straight front part of the chin make my chin look pointy or is 3cm an acceptable measurement to have a straight and squared chin but not too wide? I would like a chin similar to the one in photo 1
3) After 8 months, can the grafting of a new implant that is 25% smaller than the previous one cause ptosis of the chin or will the soft tissues shrink?
Thank you
A: By looking at your implant design it was very clear that it was going to add vertical height….as that is exactly what it was designed to do. (obviously unrecognized beforehand) Your implant follows the line of the inferior border downward whereas it should have been turned upward particularly when a big advancement is being done. This concept would need to be incorporated into any implant design. Whether it is 8 days or 8 months reducing chin implant size/projection will create some loose soft tissue chin pad which may need to be tucked from the submental approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, linear scleroderma has disfigured my forehead. I have read about fat grafting as a good solution to correct the forehead.
A: Fat grafting is not a proper solution for your linear scleroderma as the forehead skin atrophy is too deep and the skin is thin and hyperpigmented. The correct approach would be to excise (cut out) the abnormal forehead skin and smooth out the underlying indent in the bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am enclosing some photos of myself to share what I consider my issue with what I believe is plagiocephaly.. My questions are as follows what would be your guidance and technique to help me find balance in my forehead and face. With the right side being more pronounced and bulbous would it be to build up to that half or would it be to contour down to my left side shape. My other question is I already have scars from hair transplants on the side and back of my head could these existing scars be used to perform needed surgeries. I will be making a video consultation with you soon and hopefully arranging surgery to help with this issues that have troubled me for most of my life. . I thank you for your time and your kindness.
A: In the treatment of plagiocephaly, in which one side of the forehead is protrusive and the contralateral back side oif t6he head is flat, the appropriate approach is forehead reduction and back of head augmentation. In answer to specific questions about this approach:
- Your strip harvest scars provide convenient access for the back of head augmentation. While the loss of scalp from the harvest makes the volume of augmentation a bit more cautious, your back of the head augmentation does not appear to need a great deal of volume.
- For the forehead, while augmentation is always easier and more predictable because it uses an implant, it would in you create a frontal bossing appearance so it is not the correct aesthetic choice. Forehead reduction poses challenges in terms of incision location and in how much reduction can be obtained, but its general concept is the better one. A 3D CT will allow for better assessment of the difference between the two sides and it is very possible that a combination (reduction one side and augmentation of the other side) approach may also be best.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 28yr old male and I’am interested in having a Reduction Cranioplasty. I have a large bump on the top right side of my head that has been causing me a lot of pain/discomfort and have taken multiple X-ray and ct scans thinking that it might have be a cyst or lipoma. Every doctor that I have seen about this issue has basically said that same thing, stating that there is no significant abnormalities noted in the area of outward bowing in the right side of the calvarium/parietal region. Attached is a picture of one of my ct scans.
A: You have a bony protrusion of the right temporal-parietal skull location that is very evident in the 2D CT scan. It appears that a reduction of that area based on bone thickness can not make it completely symmetric to the other side. But the combination of temporal muscle and skull bone reduction (down to the diploic space) can certainly lessen its prominence.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a kidney transplant Sept 2022. I also had gastric Bypass 2018. I was 405 lbs and now I am 190 lbs at 5’7″. #1. Do you have experience working with kidney transplant patients? #2. Is it possible for me to get a panniculectomy or tummy tuck without harming my new kidney? As you can imagine I have a TON OF SKIN especially around my stomach area and I really need help and guidance.
A: As long as you have medical clearance from your nephrologist you should be able to safely undergo a panniculectomy. The cadaveric kidney is usually on the upper anterior abdominal wall but that is not a problem with a skin excision procedure which is what a panniculectomy is. I have done several tummy tuck procedures in kidney transplant patients without any healing issues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, as in photo I have a high mandibular plane angle. For Dr Eppley’s vertical lengthening jaw angle implants, do these need to be placed underneath the masseter pterygoid sling? Or is that for the jaw angle widening implants only?
A: All bony jaw angle implants are placed on the bone underneath the masseter muscle.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What would be the process be like to design new implants precisely if I already have other implants that cover my own jaw?
Even if i have had the implants for almost 9 years now, could they be safely removed and replaced with new ones in the same operation? I have read that when removing medpor implants the bone and soft tissue itself can be detached, so this aspect worries me quite a bit. Does Dr. Eppley have experience removing this type of implants in the mandibular angles succesfully?
Finally, approximately how long it would take for the swelling to go down significantly?
Thanks in advance.
A: With Medpor implant replacements there is no designing implant replacements precisely because they can not be seen on a 3D CT scan unlike other materials. Unless they were custom implants originally, where their exact designs were known before placement, there is no way to know see the implants now on the bone.
I have removed hundreds of Medpor facial implants and they can always be successfully removed…albeit with more trauma to the tissues than when they were placed.
Medpor Implant replacements will have similar swelling and recovery period as the original implantation surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in shoulder narrowing surgery. I have been very impressed with the results presented on your website and, as far as I’m aware, most people who had undergone this surgery seem to be rather happy with their outcomes. I would like to ask you a few questions about this surgery:
1. As I am currently a bit underweight, I would like to know whether I need to gain more healthy weight before proceeding with the surgery itself, for an easier recovery process. Is that correct? (I will provide all the measurements below)
2. If I understand correctly, reducing the clavicle bone length would slightly roll the shoulders forward. Should I try to compensate for this effect by exercising my core back muscles before and/or after surgery? On a similar note, would using a posture corrector after the clavicles heal enough be of any use in correcting the posture initially?
3. Lastly, I would like to know whether having a smaller ribcage and quite broad shoulders allow for a slightly greater clavicle width reduction.
Height: 5’9″
Weight: 110lbs
Thank you for your time and consideration.
A:In answer to our shoulder narrowing surgery questions:
- One’s weight is irrelevant to the surgery. The thickness of the soft tissues over the clavicle has no bearing on doing the surgery.
- Your weight is less important than your nutritional health. If in doubt you check your protein and albumin levels which are indicators of the ability of tissues to heal.
- The rolling in of the shoulders is a temporary effect of the postoperative positioning of the arms in recovery. It is not a long term effect.
- The amount of clavicle bone that can be removed is related to the length and shape of the clavicles, the width of the ribcage has no bearing on how much clavicle bone can be removed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I need to speak with the surgeon about how he intends to prevent hypertrophic/keloid scarring from rib removal surgery. I’m prone to hypertrophic scars when not managed right. I’ve had surgeries successfully without them and had a couple where I did keloid because of messy/shoddy stitching.
A:Based on my experience in rib removal surgery hypertrophic scarring is not what I have seen. It is true that thicker more pigmented skin does not scar as well as thinner less pigmented skin but an average scar result in such skin from rib removal surgery is shown in the attached result.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i’ve reached out before because the shoulder narrowing is something i’ve definitely wanted to get done. I was thinking about doing one side at a time. i’ve notice that my right shoulder’s clavicle is a bit more curved, and i know that you put straight plates in there, so idk if my case would be a problem?
A: A staged approach to shoulder narrowing is perfectly valid and has certain advantages in terms of recovery. It is common that one clavicle is longer and/or more curved than the other. That does not pose any problems for the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi is there a surgery to make the inner eye corners more down turned I read on your website about z plasty.
A:Yes there is. Turning the lake of the inner corner of the eye down can be done by either a Z-plasty or a Y-V advancement.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a very long upper lip. My teeth was not showing when I smiled. Then I had a bullhorn lip lift 2 times. The middle Part is now perfect but the mouth corners are too low in my opinion. This gives me a sad or uninteresting face mpression ff I do not mmile slightly.
In your opinion would the upper lip ook more harmonic If the lateral corners were lifted?
A:A subnasal lip lift affects the central 2/3s of the upper lip which becomes fully apparent when it is done twice, creating vermilion show disproportion. Lateral vermilion advancements would be the only to make for more proportionate vermilion show from one mouth corner to the other. Although be aware the effect of these lip procedures will make the upper lip fuller (more vermilion show) than the lower lip.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
