Your Questions

Q: Dr. Eppley, I hope this message finds you well. I was wondering if I would be a good candidate for buccal fat lipectomy and/or perioral liposuction as I want a slimmer face between my cheeks and jawline with the goal of a more angular-looking masculine facial shape. And if so, I would like to know what the price would be for these procedures.

For reference, I’m a 21-year-old male who’s 6’2 and has fluctuated between 180-190 over the last 1 1/2 years. Despite the rest of my body being pretty skinny, my face appears very bloated to me and very round. I do think my cheekbones are big and rounder than most people due my dad’s side having big and round cheekbones. However, I still think my face carries too much fat and it just doesn’t fit the rest of my body being pretty skinny. I drink plenty of water as well every day and do about 30 minutes of cardio exercise everyday.

The last time I felt that my face didn’t feel very bloated was when I was hovering around 170 lbs around 2 1/2 years ago but I don’t want to be at that weight because it just seems too skinny for the rest of my body. I would ideally like to be around my current weight or even around 200 if I decide to get into weightlifting in the future.

I also noticed that the right side of my face is wider than the left side of my face and so I wasn’t sure if correcting that asymmetry would also help my face in looking more slimmer. My dental arch on the right side of my face also isn’t as wide as my left side as you can see in the photo where I’m smiling, so I wasn’t sure if invisalign would help with this asymmetry by narrowing the right side of my face as I’ve read about people’s faces narrowing after invisalign expansion of the dental arch. I’m not sure if this claim is true or would be applicable in my case.

I was also wondering if you know if there are any risks invisalign could have on my face if I decide to get that in the future to correct my smile if I do end up getting a potential buccal fat lipectomy and perioral liposuction in terms of the risk of my face look too gaunt or narrow.

Thank you for the help!

A: In answer to your questions:

1) You would be a good candidate for facial defatting via buccal lipectomies and perioral liposuction. However be aware that one can never defat their face into a more angular shape…that degree of change is not completely realistic from a soft tissue reduction alone.

2) Facial asymmetry correction will not make the face any slimmer, just more symmetrical.

3) I see no adverse risks of undergoing Invisalign on your external facial shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I am interested in deltoid implants to have a bigger looking shoulder. Is this something you do?

A:Thank you for your inquiry and sending your video. While the clever sleeves you put over your deltoids (which is what you may wear under your clothes to create an enhanced deltoid appearance) are not the exact shape of deltoid implants or how they are placed under the muscle, they do convey a sense of deltoid augmentation size. How thick are these sleeves at their widest part which would help choose the size of deltoid implant for you?

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hey, I just had a random question for Dr. Eppley.  I was just watching this debate and noticed the face of this one journalist.  To me it looks like she had plastic surgery and it’s too obvious.  I was wondering, am I right about that, and if so how can we avoid the same look on my face.

A: I can not say whether this person has had facial plastic surgery or not.  It is just as likely that is her natural face and makeup highlights her prominent bone structure. But she has a lean long face and your facial structure and skin is different. It would be fair to say you couldn’t make your face look like that even if you wanted it to.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Good morning, sir. I’m inquiring about the upper orbital period, and I want my forehead and eyebrow bones to pop out. The forehead near the forehead hairline is lying back, so I want this part to be raised at a right angle and make an eyebrow bone, but I wonder if it’s possible as a surgery. And I wonder how much it costs. I’d like to know the operation time, recovery period, and operation method.

A:You are specifically referring to a custom forehead-brow bone implant (see attached), the most effective way to achieve this upper facial shape change. Placed through a limited scalp incision behind the hairline it takes about 90 minutes to surgically placed. Recovery is all about swelling of which  it will take about 10 to 14 days to look non-surgical.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been thinking about getting a chin implant for awhile now and have started the process of making it a reality. I still want to look like myself, but I’m very self conscious about my profile due to how my chin slants.

A:With a horizontally short but long and retroclined chin position, a chin implant would not be the correct chin augmentation procedure. (it will lengthen an already long chin) A sliding genioplasty is the better aesthetic choice as it can bring the chin foreward as well as vertically shorten it in the advancement process. (see attached imaging)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Rib removal is my primary focus. I am concerned about risks short and long term and advantages disadvantage of fracturing va removal. Also looking at a skinny bbl or full lipo and skin tightening possibly.

A: My comments to your inquiry and pictures are:

1) any form of defatting, particularly BBL surgery, should be performed before structural waist reduction. (aka rib removals)

2) This link to a blog that I have written on the topic of rib fracture vs osteotomy will provide you with my insights about these two rib modification procedures for waist reduction.

https://exploreplasticsurgery.com/rib-removal-vs-r…arrowing-surgery/

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been wondering if it would be possible to lower the brow ridge and eyebrows to obtain a more masculine, aggressive eye area through a two-step process:

1. Insert a supraorbital, or brow ridge, implant that hooks around the bottom of the forehead and over the top of the eye socket, or even into it, sort of like an infraorbital/cheek implant that wraps around the bottom of the eye socket. This would theoretically bring the brow bone down and not just outward, covering up at least part of the upper eye lid, similar to how a cheek implant makes the cheekbones look higher.

2. Assuming the eyebrows don’t move along with the brow implant due to soft tissue, laser-remove the top of the eyebrows and transplant new follicles below the existing eyebrows, or over the brow bone implant, essentially shifting the eyebrows down over the implant.

Do you think this would be feasible? If not, what limiting factors would there be?

A:In answer to your brow bone augmentation questions:

1) While a brow bone implant can wrap around the supra-lateral orbital rim there is no assurance that it will drive down the eyebrows as much as you may desire. How effective it would be in that regard depends on one’s starting eyebrow position on the bone.  The eyebrow tissues are quite rigidly fixed to the bone and the tightest part of the forehead is the lower third so stretching that area out is difficult if the goal is a much lower eyebrow position into the upper eyelid area.

2) Technically what makes the most sense is tissue expansion of the lower third of the forehead with an initial implant. Then if that doesn’t achieve  the deaired lowering a second larger more angulated brow bone implant would as the tissues have been released and stretched out.

3) Hair removal and hair transplantation can be done for the eyebrows as you have described and would be an option after the initial brow bone implant in lieu of a second brow bone implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have had a lot of surgery on my body/lower abdomen, and am very happy with it all. I only have 1 long term issue, which is fairly severe implant show on my hip implants naked, especially from a backwards facing angle. I am fairly thin at about 130lbs 5’8.

I am considering replacing the implants in 2024/2025. I was wondering 1) if it’s realistic in the first place to be able to get hip implants without significant implant show/an unnatural look and 2) If implants could be replaced with the new metal lilac crest option? 

A :Partial hip implant show in a thin person is common, I would almost say the norm. (at least to be expected) Whether that can be improved depends on the original design of the hip implants. The implant pocket themselves rarely can be successfully adjusted. I would have to see the original implant design file and then match that up with where your implant show is to provide a more qualified answer.

Hip implants vs iliac crest implants strive to achieve very different hip augmentation effects so I would not consider them aesthetically interchangeable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Would an iliac crest reduction be possible any time soon? And what would the process of approving such an experimental surgery take?

A:There is nothing experimental about iliac crest reduction surgery. The tern experimental implies that it has never been done before and its effects are unknown. Neither applies to iliac crest reduction surgery. Just because it has been very rarely done to date should not be confused as experimental. That being said the more pertinent question with iliac crest reduction is how effective it would be for the problem that one is trying to improve. I would need to see some pictures to make that assessment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have webbed neck. Now I frequently getting pain of my back bone and right side chest pain and shoulder pain. Can you please explain about this problem how i get rid of this. 

A:Traditional webbed neck surgery is done to improve the appearance of the webs (aesthetic benefit) not to alleviate any musculoskeletal symptoms. (functional benefit) The posterior approach I use for webbed neck surgery may actually worsen those symptoms but at the least will not make them better. That being said of one assumes that the webs are a source of the pain then I could envision a partial trapezius muscle release done through a direct incision overlying the arc of the web as being potentially helpful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Would you be able to share how much weight one might get incorporating a metal insert into a testicle implant?  What’s the largest size available for testicle implants? 

A:Testicle implants can be made of any size, design is not the question. What size will safely fit is the real question.

The metal insert will increase its weight by about 20%.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have very small and actually still shrinking testicles. I have had testicle implants put in, but it was my first time and I did not communicate everything like I wanted I guess. These work great, but are way smaller than I wished. One of my real testicles is pretty much gone and the other is barely noticeable. The implants I have are pretty big and still have a lot of room, but I wanted bigger.

I think about 3 years ago and they are a more hardened silicone (which I really don’t like). They don’t feel natural, but yet are a vast improvement over what I did have. I don’t remember the exact size, but I would say based on my research that they are of medium size. Yes, they were side-by-side implants….my normal testicles have reduced to the point of not being too workable with the wrap around types.

A:Testicle implants don’t come in small, medium or large sizes as they are listed in cms. (lengths)  You likely had CCB4 implants from Implantech, an older style that has more firm silicone, which range in size from 2.0 to 5.0cms. Thus the ‘medium’ size would be 3.9 or 4.0cms. Newer softer testicle implants now exist I(CCB8) but the largest standard size is 5.0cms. With only a 20% size increase you would not really notice much difference to justify the effort if that was the implant size used. You need a custom implant design, which perhaps was your initial goal anyway, and now the only question is where along the custom implant design sizing (5.5 to 8.5cms) would best achieve your augmentation goal. Probably 6.5cms would do but that is open for further discussion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, i am reaching out to know if id be a good candidate for forehead reduction along with a hairline advancement? I had severe frontal bossing along with some forehead horns before and I went through two surgeries to get them removed. The first one, the surgeon didn’t remove them quite well, and they were very prominent. The second one, he did a better job, however these bony projections still showcase in the light. He promised to use a burring technique, but he just used a hammer and a nail sort of technique and used some type of fine roller to smooth my forehead out. It’s been over 5 years, and i still get chronic pain flare ups in these areas from time to time, but it’s not too bad. I really just want to have these bony projections and front bossing gone! I plan on graduating school soon, and really want to just live more normally. Thank you

A:I have never heard of using an osteotome technique for any type of forehead reduction…as that would not be effective. I see some scars on the forehead located near the horns which raises the question if the prior reductions were done by direct incisions over them. (another unusual approach to them.

A frontal hairline advancement provides the ideal exposure to do a proper burring reduction of the upper forehead.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I get a good result from a hairline advancement?

A:Thank you for sending your pictures and I can see the basis for your request. Hairline advancements are about two basic concepts; 1) what is your hairline advancement target, and 2) what is the natural stretch of the scalp and its ability to achieve it.  As a Caucasian female you have the thinnest and least stretch capability of all ethnicities. Thus I have attached a diagram showing what can be achieved by the natural stretch of our scalp (a 1 cm advancement, black line) vs what can be achieved by a two stage advancement with a first stage scalp expansion. (green line) It is all about what type of result can you accept vs how much effort do you want to put into it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr Eppley, Can infraorbital rim implant give a 9 mm forward projection for bug eyes.

A:9mms is probably more forward projection than your tissues can tolerate. But I think the concept of needing a significant infraorbital rim augmentation based on your side view picture, as much as the tissues can tolerate, is what you need. (5 to 7mms)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have an indented line (most likely linear morphea) that started at my hairline and migrated vertically/diagonally down my forehead over the course of a couple years. I’ve had 2 fat transfers, and the dent always reappears 2 weeks after transfer. The first one the doc did was targeted but final results looked bumpy in parts while the dent came back just as prominent, so the second time, he did the whole forehead. The indent still retuned (see attached before and after pics) along with more bumps and depressions in different places. Is a forehead implant an option to help smooth out my forehead? It looks great the week after each fat transfer surgery, but when the swelling goes down, it seems the fat also doesn’t hold, or doesn’t hold in the depression where I need it and just hold in random bumpy spots elsewhere. I need something permanent, hence my inquiry about implant.

A: Linear scleroderma affects the soft tissue in its early or more mild forms and thus the fat grafting you have done, although unsuccessful, was the appropriate treatment for the anatomic location of the problem. An implant on the bone, while permanent, is likely not going to solve these multiple soft tissue contour issues that are up in the soft tissue and may well magnify them by pushing them out more. I would be very suspicious that a forehead implant would either not make a significant improvement or may make it worse.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,Good morning,I’ve searched treatment for webbed neck and came across your website. I’m 49 years old and have lived with webbed neck all of my life and it’s getting unbearable in every day life. It’s starting to pull my face down and range of motion is getting worse.

I’ve tried myofascial release, massage, chiropractor and physical therapy with little to no relief. I would like more information on the procedure if you think surgical intervention would be the best option for me.

A:”Traditional’ webbed neck surgery is done for its aesthetic effect on pulling in the webs…which by the way it is done I would think may worsen your musculofascial symptoms. (which most webbed neck patients in my experience do not have) I think what you may be seeking/asking is whether the webs can be released at the fascial/trapezius muscle level which would probably be the only technique that could potentially provide symptomatic relief. This could be done but would require a more direct approach at the tightest point of the web. (see attached, white arrow) To do so would require a direct incision along  the line of the web, whether it is a straight line or Z-plasty can be debated. (see attached, purple lines) By this approach the muscle/fascia can be back cut which should theoretically break some of the line of contracture.

While this direct approach is never done in traditional webbed neck surgery, because of the scars,  your case may be one of the rare indications for it given your symptoms.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am 22 and have previously had hairline lowering/forehead reduction surgery. The measurements of this surgery was 20/20/24mm (R/C/L) of cranial forehead removed. I would like to enquire if there is surgery to reverse this or for my hairline to be raised/ reshaped/curved/augmented. I feel like I now look more masculine and my hairline appears unnatural now.

Looking forward to hearing your response.

A: Frontal hairline advancement is an essentially irreversible procedure surgically. Once the non-hair bearing forehead skin is removed there is no way to replace it. The only treatment option would be laser hair removal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, After doing extensive research, I came across your name and some of your kids studies. Five years ago I had a BBL performed. The surgeon performed Lipo on the banana roll area, very aggressively, and the glute on the right side has collapsed. I am curious about the option of an infra Glo thigh lift to correct the ptosis. If you could also speak to scarring long-term and what that looks like that would be helpful.

A:I can certainly see the merits of a right lower buttock lift/tuck given its much lower and asymmetric position on the right since this is the only way to change it. Scarring is of course the tradeoff for doing it, which as along as it stays away from the labia medially and does not go beyond the lateral crease into the hip area, generally does well with a low rate of the need for scar revision.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 35 year old female.I already had a double jaw surgery several years ago and I do not like my face since…I have the feeling my bone structure is not right.After double jaw surgery my cheeks went away, a very prominent chin appeared and it is obvious now that I do not have jaw angle.

Now, I would like to know which are the solutions / implants to get so as to get a global facial harmony. Could you please help me to find out?

A:You do have a very high jaw angle which makes your chin appear overly prominent. Vertical jaw angle implants is the conceptual approach to that jaw shape problem. (see attached image)

“Missing’ cheeks also be augmented although double jaw surgery is not known to negatively affect the shape of the cheeks. (cheekbone reduction surgery is)

The definitive preoperative step given your surgical history is a 3D facial CT scan which will not only show the shape of your facial bones (and hardware) but also is the platform from which the implants are designed to treat it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I am a 31 year old female and have had one fat transfer to the undereye,cheeks & lips in 2022 & one round of undereye filler in 2020. My main concern is the area under my eye to the top of my cheek. Hereditarily  I have a very long face with little to no protruding bone structure.  My goal is to bring more harmony & balance to the undereye & cheek area so that it is not separated. 

A:Based on your description and location of prior fat injections and fillers (smiling pictures camouflage the true state of your cheek shape) my assumption is that you are seeking a permanent implant-based augmentation of the undereye (nfraorbital) and anterior cheek (malar) facial areas….which can certainly be done. Ideally this is best accomplished by a custom infraorbital-malar implant design placed through lower eyelid incisions. This is done using a 3D CT face scan which can be obtained in your local area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to get the opinion of Dr Epply on whether my ankle liposuction can be improved. I already had some liposuction in the calves/ankle area previously, but there is still some fat remaining  particularly around the Achilles tendon area. (see attachments) I’m hoping this can be made more defined but I am also wary of avoiding irregularities.

A:Not knowing what you looked like initially I can not say for sure how much further improvement you can get but I suspect some. But remember the rewards are diminishing after the first liposuction surgery. Whatever improvements are possible would be modest

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been considering facial implants for quite some time now because facial filler hasn’t worked for me in the past. Could you please give me a rough estimate or the average price range for the following implants, if they were to be custom made, so that I can get an idea of how much I would need to set aside for them?

Paranasal implant

Premaxillary implant

Peri-pyriform implant

Temporal implant

Forehead implant

Infraorbital rim implant

And for the consultation, surgery, CT scan and other miscellaneous fees, would all of these be a one time payment if I were to hypothetically get multiple facial implants in one setting?

A: On your list of areas of facial augmentation the only truly standard implant is that of the temporal implants since it is a soft tissue-based implant. All the others require custom designed implants to effectively treat.

Bilateral Temporal Implants

Custom Forehead Implant

Custom Midface Implant (infraorbital, paranasal-premaxillary)

All such implants could be placed in a single surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to lift my nostrils on both sides so that the base of the left and right sides that joins with my upper lip area is brought up to align horizontally with my central nasal area.so instead of my nose being ‘upturned’, it becomes horizontally straight. I have screenshot the photos from your gallery and can share them.

A:You cannot effectively raise the base of the nostrils by 5 mms, It is one thing to lower them by skin removal but raising them is a different and more challenging matter.

Dr. Barry Eppley

World-Renowned Plastic SurgeonCan My

Q: Dr. Eppley, I have been considering a sliding genioplasty or a chin implant recently. I have a decently prominent labiomental fold which worries me for either procedure. I am already happy with the vertical length of my chin and am really only looking to get a horizontal lengthening to bring my chin forward. Would you recommend either procedure and how could the further deepening of the labiomental fold be prevented?

Thanks in advance for your expertise!

A:When it comes to a limited one-dimensional chin augmentation change (horizontal advancement of 5 to 7mms) either a chin implant or a sliding genioplasty can be equally effective. The decision between the two thus becomes a matter of personal choice.

Regardless of whether a chin implant or a sliding genioplasty is done the labiomental fold is going to deepen, this is anatomically unavoidable. The only surgical treatment to try and mitigate that effect is fat injections.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have seen your time table for swelling progression with jaw implants and you mentioned most of it would be gone within 6 weeks. My question is would this timeline be extended if multiple revisions surgery happen in the first few weeks? For example if the surgeon removes and places other jaw implants within the first 2 weeks would that prolong the swelling timeline or it wouldn’t really affect it?

A: Since it is my practice philosophy to not do implant revisions for aesthetic purposes for a minimum of 3 months the swelling question is irrelevant. It takes a full 3 months to really know the near complete effects of any structural facial augmentation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Could such an implant produce a result looking like this, or would this shaping be impossible to achieve with maxillary implants like the one In the photo. I really want my upper maxilla to come forward but I don’t think I’d ever be able to get surgery so I think I’d need custom maxillary implants?My goal is to get forward growth and also fix my lack of undereye support presuming that custom maxillary implants can also act as infraorbital-malar implants.

A: The concept of a total midface (infraorbital-maxillary) implant is a valid one done through the custom design process for the exact effect you are trying to accomplish. (LeFort III advancement minus the lower dentoalverolar region)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking to get some surgeries eventually for gender affirmation and my PCP recommended your office if I had some more specific questions. The surgery I am mainly interested in at this time is FFS. Does Dr. Eppley recommend a certain time being on HRT before he performs this? Also, would it be possible to get an estimate on how much this usually costs?

A: FFS is a collection of over a dozen procedures, most of which are done to change the structure/shape of the face. Not every patient needs all of the available FFS procedures based on the natural shape of their face. The FFS procedures of greatest value must be determined on an individual basis based on a picture assessment and computer imaging of potential changes. Once this is determined then the cost of such surgeries can be provided to you.

In addition I would wait a minimum of six months after being on HRT before proceeding with FFS surgery….not so much because it makes major face changes but more for assurance that this is the correct change in life you desire to do.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  i am interested in getting custom jaw implants and upper maxilla implants with Dr Eppley. i’m a transgender woman and previously have had a few jaw surgery procedures during my transition including double jaw surgery and also mandible shaving (all done in Korea) i’m from the UK. i got these done years ago and i never was so happy with the results as i feel the surgeon shaved off too much of my mandible and as i am aging all the definition is now gone in that area. i want to get more of a western ideal squarer jaw, and also correct the asymmetries i have in my upper mandible as i have had some bone loss in this area due to the jaw surgeries and want more projection using a custom implant in the midface/nasolabial fold/upper maxilla area

A: Thank you for your inquiry and detailing your surgery history and current objectives. Your V line surgery history is not uncommon as such surgery can only be done one way,,,significant bone removal due to the intraoral access used to perform it. A custom jawline is the only way to achieve partial or complete restoration of the jawline. Foe the midface it is yet unclear whether a custom implant approach is needed as opposed to standard ePTFE premaxillary-paranasal implants. For now I will. assume the former.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Quick question, I’m considering to have a skin rejuvenation procedure done with CO 2 laser or something similar, I’m wondering, will these risk damaging my infraorbital implant if used on the tissue that lies above?

A: Thanks for the long term followup. In terms of the IOM Implants they are down at the bone level while any form of skin rejuvenation affects only the skin/dermis. No significant heat or tissue damaging effects can get that deep. In addition the implants are structurally stable up to 190 degrees Celsius before they will melt so I believe they will be OK!

Dr. Barry Eppley

World-Renowned Plastic Surgeon