Your Questions
Your Questions
Q: Dr. Eppley, Hi. I was wondering how much mm can I get as a chin implant? Is it possible to get 13,5 mm? Will this be an issue with the tissue inside my chin (to close)?
A:At 13.5mm, which requires a custom chin implant to do, that is probably beyond what can be placed and the tissues brought to close over it. When the chin requires that amount of augmentation it is small and the overlying chin pad tissues are very tight. This is why most chin augmentations that are over 10mms have a sliding genioplasty as opposed to an implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I feel like my head is too small, I was wondering if I can make it taller with an implant or fat graft?
A: Only an implant can make the head taller. (skull heightening) mFat grafting for skull augmentations does not work. The height increase with the immediate placement of a skull implant is 10 to 12mms. With a first stage scalp expansion that can be increased to 20 to 25mms. of height.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dr. Eppley, Hello, I am 8 months postop now with really thin skin after a closed rhinoplasty and my tip skin was pretty much gone I thought for a while. Now my tip is shrink wrapping even more all of the sudden and causing a bifid tip? The right half of my tip cartilage has been longer than the left all thus time and it’s also really obvious from the front. Can this still be uneven swelling? What can be done to fix it?
A:At 8 months after a rhinoplasty this is not swelling this is the reveal of the shape of the nose that eventually occurs. While there is a lot of appeal to a closed rhinoplasty it does not offer complete exposure of the cartilage structures of the tip so some asymmetries/irregularities would not be uncommon. The key question is where these residual tip cartilage anomalies could be adequately addressed by a secondary closed rhinoplasty. I would think the bifid tip could be treated by a cartilage graft placed between the domes. The differences in the lengths of the lower alar cartilages are more challenging in that regard but could also be done so. Obviously opening the tip is the more visualized and assured method of revision but you have gotten this far into your nasal surgery without doing so so another closed effort at it seems worthwhile.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like more information on testicular implants. I have very very small testicles but I’m scared to get implants and move forward with surgery. Is there any type of information or statistics to reassure me that the testicular implants help instill the confidence I’ve been lacking to move forward and live my life and be proud of who I am?
A:You are asking a question to which there is no assured way to know what effects testicle implants will do for your self-confidence. That being said I would think the most useful question in that regard is….how many men in which I have placed testicle implants for enhancement (not replacement) take them out because they do not like them or because they have ‘learned’ they are better off without them than with them? The answer is so few that I can not recall of a single case. (it is possible they may have went elsewhere to have them removed but if so I would not know)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well. I am writing to inquire about jaw and chin implants for my aesthetic concerns.
Based on my facial structure, I am wondering if a custom or non-custom implant would provide me with a better aesthetic result. Additionally, I am curious about the cost comparison between a custom wrap-around implant versus separate chin and jaw implants.
Lastly, I am interested in your opinion on using PEEK implants for this procedure and their respective pricing. Would you recommend PEEK implants for me based on my facial anatomy?
Thank you for your time and expertise. I appreciate any information you can provide on these matters.
A: A custom jawline implant is always the better jaw augmentation method over the use of three standard chin and jaw angle implants for both aesthetic reasons as well as a lower potential risk of complications. (asymmetry, implant malposition) The only reason to ever use standard implants is cost as long as one can accept their higher risk of aesthetic complications.
When it comes to implant materials, the body doesn’t care. An implant is an implant is an implant in how it reacts to it. It treats them all the same by a normal encapsulation reaction. And they all will feel like bone. There are, however, differences in how they are designed and surgically placed between the completely rigid (e.g., PEEK) and the semirigid silicone materials. There are also major cost differences between them, at least in the U.S.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to ask how can i make my orbital rims more vertically compact to create hunter eyes????
A: To shorten the vertical interorbital rim height (brow bone to infraorbital rim), this requires a combination of brow bone and infraorbital rim implants that drop down (brow bone) and raise up (infraorbital rim) the bony edges.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Have severe plagiocephaly in the back of the head and would like advice on options.
A:Most plagiocephaly patients benefit from building out the flat side of the back of their head with a custom skull implant. How that applies to you is yet unknown to me since I have not seen pictures of your head or a 3D CT scan of your skull.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have had deep dark circles under my eyes since I was a baby. I am looking into tear trough implant surgery.
A :You are headed in the right direction to improve your lower eyelid fat herniation due to lac of infraorbital bony rim support. These would have to be custom infraorbital implants as they need to create a 3D augmentation of the underlying bone not just sit in front of the bone edge which is all that standard infraorbital rim implants. This would be combined with herniated fat removal through a lower blepharoplasty approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, After a custom skull implant, I am still able to get an MRI done, correct? I assume there is nothing metallic used for the procedure? You performed a cranioplasty on me in 2016 and I have been very satisfied with the result! Thank you for all you do!
A: There are no concerns with getting an MRI after a custom forehead implant. There are two small titanium microscrews initially placed to secure it which are MRI-compatible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously got lower jaw surgery and genioplasty for a total of 14mm of movement. I am now considering more chin augmentation either in the form of an implant or genioplasty. Please recommend best next steps, thanks.
A: Having had two bone surgeries for your current chin projection it would make the most sense to build on top of what already exists with an implant for the final chin projection effect. The two prior surgeries and the amount of movement needed have made an implant possible at this point for your secondary chin augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting a custom skull implant and I have long hair. Would the surgery cause hair loss in anyway since a silicone will be inserted in between the skull and scalp?
A: Skull implants are placed on the bone beneath the overlying five layers of the scalp. As a result it does not cause hair loss as the hair follicles reside between the 1st and 2nd scalp layers…the implant resides beneath the fifth layer of the scalp.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had radiation to my neck at 10 years old I’m 37 years old now my neck or trapezius muscle won’t grow. Is there any implants for neck and trapezius?
A: Trapezius implants do exist and are placed through a small posterior neck incision. (see attached)
Neck implants can be placed along the sternocleidomastoid muscle. They are a bit trickier because of the crossing of the greater auricular nerve in the midportion of the muscle so I might consider injection fat grafting instead…which may be preferable anyway because of your history of neck radiation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I believe my upper lips are too thin. Is there surgery to make te thicker?
A: In the thin upper lip male the best procedure for making the lip have more visible vermilion show (look bigger/fuller) is the vermilion advancement procedure. This is a particularly effective procedure when the sides or the whole upper lip are particularly thin. (have scant vermilion exposure)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i! I got some stock jaw and chin implants and am not 100% pleased with the results. I was wondering if you do contouring/shaping post install and how the recovery would be.
A: I am not sure of your question. When jaw augmentation is done with standard implants and are not happy with the results, how to proceed depends on the nature of the problem. Is the problem implant size, implant positioning or the type of implants used? In my extensive experience it is rarely that a few implant adjustments gets the patient to a satisfactory outcome. More times than not the problem is that what the patient wants to achieve could never have been achieved with standard implants and they then have to convert to a custom implant approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to inquire about rib removal surgery (shortening of ribs: #12, #11, #10) with latissimus dorsi muscle reduction. I am wondering if it’s possible to undergo this surgery if I plan to have children in the future.
A: Good question. Such surgery has no adverse effects on getting pregnant or carrying the baby to term.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m really interested in waistline narrowing, I’ve tried Lipo and had a BBL but I still do not have the feminine waistline I want . I saw there is such a thing as rib repositioning as opposed to traditional removal and wondered if this would be a good option for me since I really want minimal scar and to recover as quickly as possible so I can get back to my normal activities.
A: There is no real scar difference between rib fracture and rib removal for waistline narrowing as both require access to the ribs. The former relies on 3 months of postop compression to produce a result that averages less than 50% of rib removal outcomes. There is no real recovery difference as rib fractures take just as long to feel goods again as rib removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would the muscle I have on my frame restrict the amount of length that could be attained from the surgery? If so would I be able to stretch my muscles out for a extended period of time prior to surgery to negate this?
A: What I have found is that in all shoulder lengthening patients the shoulder girdle is tight, whether one has muscle hypertrophy or not. (although it certainly feels tighter in the more muscle developed patient) Whether a stretched out shoulder helps or not for this surgery can be debated. But it certainly can only help particularly when significant muscle development is present.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wish to pursue cheekbone augmentation. Is it possible to achieve that through a malar osteotomy rather than implants, or will I require implants?
A: The first step in any form of facial augmentation, cheek augmentation included, is to determine the dimensions of change desired. While you did not specify what your cheek augmentation goals/dimension were your pictures show a flat infraorbital and anterior cheek area but what appears to be adequate.
A malar osteotomy is a one dimensional operation as it only can create cheek width. A cheek implant has a three dimensional effect which appears to be more suited to your aesthetic needs.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 26 year old female and I have been researching how to fix my perioral mounds for a couple years now and cannot seem to find a solution that I find suitable for myself.
I’m not sure why this is such a hard issue to fix but it is becoming VERY bothersome to me and I’d like to find a solution. It does not matter if I am slightly overweight or in perfectly good shape my perioral mounds never go away.
I can tell they are definitely a combination of fat and very thickened mucosa, I feel like I could just bite off the very inside corners of my mouth and it would completely take care of the problem.
A: Based on your pictures you are referring to a combination of perioral mound liposuction for the external lower cheek bulge and an inner buccal mucosal elliptical excision to treat both sides of the cheek contour issue. Those insights are diagnostically correct and you are also correct in that this is a straightforward surgery to do. (at least for me)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Am I a good candidate for hip implants?
A: 1) If you have adequate fat to harvest (and you do) you always try fat injections first. While fat retention in the hips is not known to be great you always try it first and see how much is retained. Even if the fat augmentation result is inadequate it prepares the hips better for implants…which needs all the subcutaneous fat thickness around them you can get.
2) The risk of complications in hip implants improves when one doesn’t get too ‘greedy’ in size and thickness…which I have illustrated in the attachments.The question thus is not whether one can have hip implants but whether the size that lowers the risk of complications is aesthetically acceptable.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 21-year-old young man. I get a lot of stress when I look in the mirror because my head circumference is 62cm, and I found out about your existence while looking for surgery.
I have a few questions.
First, is it possible to have a bone-cutting operation in every part of the skull?
I’m wondering is it possible to reduce the bone under my ear (so that the length between my two ears is reduced), and is it possible to reduce the skull bone under my cheekbones.
Secondly, I would like to ask you is it possible to reduce the Temporal bone and parts of the parietal bone attached to the temporal muscles above the ear (so that the length of the parietal bone decreases from the front),
and if you can, how much mm did you shave on average for the average patient?
Also, I would like to ask how long the cut bones were in the case of the patient who cut the most.
I would really appreciate it if you could answer a long and complicated question. Also, I hope everything I asked is possible.
A: In answer to your skull reduction questions:
1) Bone reduction can not be done ob every part of the skull. The sides of the skull have a large muscle component which is what is reduced. (temporal resuction) That is infinitely more effective than temporal bone reduction.
2) There is no skull bone underneath the cheekbones.
3) Parietal skull reduction can be done.
4) The average skull bone reduction is 5 to 7mms. The average temporal muscle reduction is 7 to 9mms.
5) I do not understand the question of ‘how long the cut bones were’. I assume you are referring to surface area of the bone to which I have seen/done entire surface areas of the skull reduced. The only limitation as to how much of the skull can be reduced is surgical access….where and how long does the scalp scar need to be done to do the amount of skull reduction wanted/needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I have done blepharoplasties only on my left upper eyelid so I can’t close it fully and my left eye is more open. Could we put a tissue expansion for ”growing” extra skin?
A: Short of a skin graft (you can’t tissue expand an eyelid) time and stretching the eyelid is the answer to allow secondary tissue relaxation to help get back to a more competent eyelid closure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, According to what I have seen in several web pages the orbital box osteotomy is the only way to separate the eyes. As I have seen this operation is very complex, so I was wondering if you do it in patients with close eyes but within normal parameters, simply for cosmetic reasons. I mean adding 6-8 millimeters between both pupils, making the inner canthal distance about 6 millimeters wider.
A: It is not a question or whether orbital box osteotomies can be done in someone with ‘normal parameters’, but it how it should be approached. Doing traditional orbital box osteotomies using a coronal scalp incision and a frontal craniotomy seems to be a mismatch between the magnitude of the problem and the solution. A more acceptable approach, where the surgery seems better matched for the problem is a modified orbital box osteotomies which avoids a coronal scalp incision and a frontal craniotomy. Going through the combined approach of lower eyelid and intraoral incisions only the interpupillary distance can be increased by 3 to 4mms per side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am currently suffering from sagging buttock glutes as a result from brazilian but lift surgeries, which I would like to get removed.
A: Thank you for sending your pictures to which I can make the following comments:
1) I would not consider fat injections to the buttocks (aka BBL surgery) reversible…or at least I would be very cautious about doing it. While liposuction can be used to remove fat from the buttocks that will undoubtably leave the buttocks with some contour irregularities and increased sagging. Like letting the air out of a balloon the decompressed tissues will collapse to some degree.
2) The only effective way to treat sagging buttocks is at the infragluteal fold level through excision. It doesn’t really lift the buttocks per se but does remove any overhang as the level of the fold…which is sort of a ‘lift’.
3) in looking at your pictures I believe what you may be trying to achieve is some reduction in buttock size (which is why the liposuction) with a lower buttock lift. (see diagrams)
That being said, some liposuction of the buttocks (don’t try and remove a lot of fat due to the risk of irregularities) with infragluteal excisional tucks/lifts.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am scheduled for my surgery and ready to go so far. A question I have is with my forehead reduction is will my hairline. Also be lowered with it, since the bony layer is being reduced?
A: The frontal hairline can not be lowered when a skull implant is being placed, either during or afterwards. A frontal hairline advancement relies on the scalp being able to be loosened and moved forward. In other words a frontal hairline advancement requires a total epicranial tissue shift. The skull implant ‘steals’ whatever scalp mobility exists to cover its volumetric increase.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, This surgery is known as corrugator muscle lysis or frown lines removal. It is a permanent solution because the procedure will surgically “disrupt” (cut and resect) the corrugator muscle. The surgical approach can either be done endoscopically (no scar) or as part of a conventional forehead lift or brow lift procedure. However I want the glabellar muscle between the eyebrow removed completely so that part of my forehead is flat again! because botox doesn’t work for me. Is this something you could do?
A: Of this concept I am familiar. However regardless of the technique used (an open approach is far better than an endoscopic approach for more effective muscle removal) you have to be careful about total muscle removal in the glabellar region as that will result in a visible glabellar indent. The muscle adds soft tissue thickness which is not insignificant so you want to avoid total removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My lower glutes sag & have about1-2 inches if not more of saggy loose skin that just hangs. I think I need lower glute skin removal.
A: I can certainly see the infragluteal fold overhang and agree that the only improvement will come by excision. My concern would be the heavy volume of buttock tissue above it and its potential adverse impact on incisional healing and the risk of postoperative wound dehiscence. (in an area which is already stressed in that regard because of sitting) The vast majority of patients that undergo lower buttock tucks/lifts have much smaller buttock sizes/weights above it. I am not saying it can’t be done but that potential complication in you is higher.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a reversal jaw reduction and reversal cheekbone reduction procedure and would like to know how long I should plan to stay in Indiana before returning to my home country. Thank you for your time.
A: Most jaw and cheekbone reduction reversals require custom implants made to augment back part or all of what has been removed from the surgery. This requires the implants to be made from the patient’s postoperative 3D CT scan. That is a scan that is obtained where the patient lives which is then sent to me for design and manufacture, a process that takes several months to do and does not require a patient visit.
I assume when you refer to how long you would be here for the surgery and then able to return home….3 to 4 days after the surgery at most.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I`m interested in facial asymmetry correction using hydroxyapatite(I suppose my bone structure at right and left side of eyes and under eyes area are different a bit). And also I`d love to have my brow bones augmented using the same material.
A: Hydroxyapatite cement, while having biologic appeal, would be a very poor material for any facial bone asymmetry correction as its application is very imprecise. Plus as a general rule you don’t make intraoperative eyeball assessments of how to correct facial bone asymmetries. This usually just leads to ongoing asymmetry issues. The most accurate way to do facial asymmetry corrections is with a preoperative 3D CT scan to accurately determine what is the actual millimeter difference between the two sides. From which accurate custom implants can be designed to provide the best asymmetry correction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My right clavicle is 1 to 2 inches shorter than my left clavicle. It causes my body to slant to my left side and makes weight lifting difficult and mentally takes a huge toll on me.
A: The current ‘problem’ with clavicle lengthening is that its limit is 15mm, maybe 20mms of lengthening that can be achieved. In the congenitally short clavicle who knows if even that amount is possible to be lengthened. That amount of change seems inadequate given the significant length differences between the two sides that you have described.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
