Your Questions

Q: Dr. Eppley, Does Dr. Eppley perform brow bone reduction/type 3 surgery using the coronal incision and or hairline incision approach(s)?  I’m asking in that if he offers the coronal approach would it be possible to get a price range for this surgery?  The reasons being that I have a very tight scalp & I do not believe I need my hairline to be lowered.  I’m within the female range at the center of my hairline.  Filling in the receded portions would be adequate to give me a more feminine side view as it relates to my hairline.  If he were to offer the coronal approach it would also give him access to my entire forehead where he could make further adjustments to the forehead as needed.  This would be an added bonus to having my brow bones alone reduced. 

A: I have performed brow bone reduction by bone flap setback by various approaches including a bicoronal and frontal hairline incisions. Such incisions don’t mean that the frontal hairline needs to be advanced, some patients do and some don’t. That is a patient’s choice or need.

You have correctly surmised that the wide open access afforded by the bicoronal incision allows for complete forehead reshaping which usually means narrowing the forehead along the entire bony temporal line as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q:Dr. Eppley, , I have a brow bone deformity similar in nature to this case you did https://exploreplasticsurgery.com/case-study-one-sided-brow-bone-reduction/, and extends somewhat into the orbit. In my case, I have also a moderate case of anterior plagiocephaly with less prominence on the left side, same as where my brow bone protrudes. I have read about that case and generally am aware of the coronal approach to reduce the prominence through osteotomies. The scale of the incision has always scared me. I am wondering if instead of minimizing, the opposite may be possible. Is it possible to place a forehead implant to correct the plagiocephaly (and would it extend over the temporal area) and also place a secondary custom implant over the smaller side of the brow bone to match? Can it be achieved with small hidden incisions? And if so, do you think it is a good idea?

A: What you are referring to is a compensatory approach rather than treating the direct problem which makes sense depending on the magnitude of the brow bone-forehead asymmetry. The best way to answer that question is to take some face pictures and do some imaging to what this contemporary approach may look like.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, If a jaw implant waS designed to correct the asymmetry (vertical high discrepancy as seen in my scan) would that be where the issue would be with masseters and other soft tissue not wrapping around it (which can cause the irregularity in draping)?  Essentially, would that just be adding fake skeletal structure, but masseters would stay where they were before the implant?

A: In any form of jaw implant that involves the ramus (angle) the masseter muscle is elevated off the bone to accommodate the implant. Thus the premise of your concern has no anatomically accurate. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in:https://exploreplasticsurgery.com/plastic-surgery-case-study-male-mid-abdominal-tuck-for-horizontal-flexed-skin-wrinkles.  I got botched from lipo and I don’t have much other choice , a normal tummy tuck wouldn’t fix it, this one would resolve almost all the issues.

A:Thank you for your inquiry and sending your pictures. You are correct in that the only way to improve or eliminate most of those horizontal skin wrinkles of your abdomen is a mid tummy tuck procedure. Besides the obvious concerns one might have about this unusual location for a horizontal scar across the mid abdominal level at the umbilicus there is also some recovery issues. In my experience the abdomen will remain quite tight for some time which will be seen mostly when standing straight. It may take months until one can comfortably stand perfectly straight which will also have some impact on working out.

Thus, while a mid tummy tuck can be effective for this flexed abdominal skin issue between the scar and the recovery one has to ponder the consideration of this procedure very carefully.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, May i enquire about nasolabial implants. Are they toxic? I was reading they are same as Teflon.

A: No facial implant material used is toxic. One of the material options for such midface implants is ePTFE which is very different structurally from Teflon which is PTFE.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I am interested in potentially having a consultation with Dr. Eppley about Iliac crest reduction surgery and/or shoulder winding surgery. I am a FTM trans man and my main concern is the width of my pelvis which I would like to reduce if viable. However to balance I wouldn’t be against widening my shoulders at the same time but it is not necessary. My priority remains the reduction of my iliac crest to help create a more masculine physique.

A: Thank you for sending your pictures. By your own description your priority is iliac crest reduction which could largely be done through your existing ends of the tummy tuck scars…. Which I assume his what that scar is from. While they would have to be extended a little bit it would not add a lot of extra scar burden. Given that your priority is the iliac crest reduction that should be the procedure you do. While shoulder widening is an option it’s recovery is substantially greater than that of iliac crest reduction. Thus it takes a patient whose major priority is shoulder widening to undergo it.

While not a recognized female to male body contouring surgery iliac crest reduction for the wider and more low angled female pelvis is a logical structural body procedure given your objectives. But I would need to see some hip pictures to determine your candidacy for the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to mention that I had a hip implants before on 2022, but one of them was rejected and the doctor decided to took them off. I would like to try one more time. It is one of que questions I have for Doctor Eppley. Is it possible that my body accept the implant this time?

A:You are referring to infection and not rejection of your prior hip implants. The body does not really reject silicon materials but they can get infected which is one of the well-known implant risks. Because the two look the same they’re often confused.

That being said you do have the liability of existing scars and just because you had an infection in the past does not necessarily mean you will have one with new hip implants.

That’s I think it is reasonable, as you have stated, to give hip implants one more effort to see if you can avoid any postoperative complications this time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, A sliding genioplasty, I hope my chin will continue to project downwards in harmony with my jawline angle instead of stopping short and rounding horizontally.

A:What did you are referring to is a sliding genioplasty that adds vertical length as well as horizontal projection. In essence this is really a 45° bone movement where the amount of vertical lengthening is almost equal to that of the increase in horizontal chin projection. This is one of the advantages of a sliding genioplasty over that of a chin implant unless that chin implant was custom designed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am presently writing and searching for practical information about Ultrasoft solid silicone testicle implants. Are they currently commercialized in Europe ? Can they be delivered from the US ? Would Dr Barry Eppley be open to share which brand or which laboratory manufactures them ?I currently have  implantation of 2 Euro silicone, saline-filled testicular implants (18cc) – 4 interventions betwwen 2011 and 2016. Currently looking forward to replacement of both testicle implants (which after 14 years are becoming very uncomfortable) . Very interested by those mentioned by Dr Eppley’s articles but impossible to find on the internet after extensive research online. The medical team here in France doesn’t seem to know about those new and more recent implants and i would very much like to be able to present them relevant information about it.

A:Most surgeons would not be aware of the newest  forms of solid silicone testicle implants which provide a soft feel, unlimited size ranges, and in the larger implants the innovation of a hollow inner chamber. Such testicle implants are not available in any manufacturer’s catalog. Such custom implants are ones I have developed and used extensively which are made by a top US manufacturer and, any size over 5.0 cms, are made exclusively for my practice.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I am initially thinking of replacement chin implant but now preferring sliding genioplasty instead. Attached are my pictures. I already have a small sized standard extended anatomical chin implant from i planttech. I like the jaw contouring on profile given by the wings of the implant but dont find the horizontal and especially vertical projection enough. 

I havs also attached the initial assessment given by the surgeon on the vertical and horizontal deficiencies. I also have my before chin augmentation pics if required.

A:While a sliding genioplasty can be very effective at adding both horizontal and vertical lengthening it will by the forward bony movement make the chin more narrow.  That is the one dimensional limitation of the sliding genioplasty.  I mention it because you commented in favorably on the wings of the existing implant that you have. That chin feature is what it essentially separates the sliding genioplasty from a custom chin implant design when there is any amount of vertical chin lengthening needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi there, I previously messaged asking about the filling treatment for flattened back of head issue. The reply was that fillers don’t work but I was referring to the method you are using with the PMMA/bone cement. Can you let me know the approximate cost of this? There are only a couple of places that do this and I live much closer to you so that would be best for me. 

A:Due to the inadequate results from the use of PMMA bone cements in skull augmentation they were abandoned almost 10 years ago and replaced with custom implant designs that offer far superior results.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a very flattened back of head about half way down the back. Is it possible to use just the filler type of material rather than implant?

A:No form of synthetic fillers or fat injections in the tight scalp work for skull augmentation. Unlike other face and body areas where the tissues are more supple the tight attachment of the scalp to The underlying skull precludes any effective displacement by the soft nature of any injectable material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, am an aspiring footballer and I would love to continue my football journey. But my insecurities is playing on me. Can I get frontal bossing surgery done and still play football?

A:I would wait to do the surgery until after football life is over.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Had orthognathic jaw surgery done for sleep apnea and recessed jaw. Unfortunately, my right side (weaker side) did not turn out as well as I would have liked. The jawline has an indentation in it, and the genioplasty I feel created an odd chin shape and chin fold from being advanced too far. Surgery involved a Lefort 1, BSSO with 9.7 degrees counterclockwise rotation and 18mm pogonion advancment (6mm) was from the genioplasty. Custom plates were used which probably adds 1.5-2mm to the pogonion as well. Should the genioplasty be set back 2-3mm to fix this and will that cause loose skin under the chin? And can fat grafting be done to improve the jawline and indentation?

A: In  answer to your jawline questions:

1) Setting back the genioplasty 2mms in a young patient will seem unlikely to cause  tissue sagging.

2) Correcting bony asymmetries/irregularities with fat injections is rarely an effective strategy.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 25 year old trans male, who is interested in a iliac crest reduction—even more reduced than pictured. I unfortunately had estrogen dominance for nearly 19 years, and then I was forced on Invega, which seemed to of made my hip bones widen a lot more significantly. I would love to have my masculine physique back, especially since my parents think I never will have a masculine body because of them. A permanent reduction would be amazing!

A: Thank you for sending your pictures. At your body weight and tissue thicknesses any effect of iliac crest reduction will not effective/seen. Iliac crest reduction works best in thin patients where the prominence of the bony crest can clearly be seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a hairline lowering procedure and brow lift and hair transplant to attempt to cover my forehead, and it actually emphasizes my protruding and broad forehead, making it appear more obvious. No one told me my issue was actually my skull bone. Can you narrow my forehead and slope it back? I find that it still looks masculine and I thought the problem was skin and hair, I did not realize skull shape is what makes someone appear feminine.

A:While frontal hairline lowering is a soft tissue procedure it does have a forehead reshaping effect. By definition and making the four head vertically shorter it will make it look wider. This is why preoperative imaging of the effects of hairline lowering are important to undergo understand this effect. The question now is not whether your bony forehead can be reduced, as you have convenient access to do it from the frontal hairline scar, but whether the bony changes would be significant enough to make the surgical effort worthwhile. Thus I would need a front and side view picture of your fore head to make that assessment with some imaging too sure what I think could be realistic and achievable changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i would want to know a bit more about mouth widening surgery, i have a pretty narrow mouth (4cm) and want to change it to about 5-5.2 cm , can you please tell me about the scarring, how bad it is and does it really never go away, and are the results permanent, i’m 18 , i wonder if my age will help healing. Please help me , cause im really scared to end up with permanent big scars , my lips are also a bit down turned.

A:To have an acceptable scarring in mouth widening surgery it is best to keep the amount of widening per side in the 5 to 7 mm range. That would be consistent with your stated goal of changing your mouth with distance from four to 5 cm. In general adverse scarring from mouth widening surgery is not common but always possible in the very sensitive junction of the vermilion and skin at the mobile mouth corners. Mouth widening scars seem to do better in n ales due to their beard skin than females in my experience. Thus it is best to go into surgery with the understanding that scar revisions may be likely and hope that they are not needed. This is consistent with a general overall approach in aesthetic surgery as to ‘prepare for the worst and hope for the best’ .

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Do you have female patients trim hair before placing skull implants?

A: No, I never trim/shave any hair in aesthetic skull reshaping surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m dissatisfied with how asymmetrical and long my face appears. For asymmetry, I’m unsure if I’m supposed to reduce one side, enlarge one side, or a combination of both. For length, I was thinking that increasing volume of midface may help but I’m truly just guessing.

A:Thank you for your inquiry and sending your pictures. You have multiple facial issues which primarily are that of disproportions and asymmetry. You are correct in that your face is vertically long which is magnified by lack of midface projection. The lack of midface projection contributes more to your facial disproportion then the vertical length. But in improving the disproportion midface augmentation provides the best benefits. (see attached imaging) for some vertical chin reduction but this is primarily for the purposes of asymmetry correction. Suffice it to say dimensionally you can augment the midface much more then you can vertically shorten your face.

Your facial asymmetry is localized to that of the lower jaw and the reality is that the longer chin/jaw on the right side is the more ideal location by reduction for asymmetry in improvement. However during a limited reduction along the inferior border from in front of the jaw angles to the chin is very difficult to do with a great degree of precision. While V line surgery is commonly done this is a much more aggressive type of bone removal with the wrong shape to it to be successful in your case. It would also magnify your already vertically long face with elevation of the jaw angle. So while reduction of the longer right jaw seemsx appropriate it comes with its own set of aesthetic problems. Thus it is more predictable to look at augmenting the left jawline, leveling out the longer right chin and anterior jawline and trying to match the two jaw angles. (see attached imaging) Trying to determine exactly what needs to be done based on your pictures is an incomplete assessment and ultimately the 3-D CT facial scan is going to provide better information as to how improve jaw asymmetry as well as its overall shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in structural facial surgery to improve projection, balance, and aesthetic harmony.

I’ve read about your expertise in jaw, midface, and orbital augmentation.

I would appreciate your professional opinion on whether my facial structure qualifies for such procedures.

I’m ready to send photos and any details you might need.

Thank you very much for your time.

A: Thank you for your inquiry and sending your pictures. Based on your inquiry you were trying to determine what structural facial chnagers  may be beneficial. In making an initial determination you have to look at the three facial thirds, the jawline (lower 1/3) , midface (middle 1/3)  and the forehead (upper 1/3), and play around with imaging tools to make some changes to look at their potential impact on improving your facial structure. In that regard I have done so in the attached imaging. These are not meant to be exact surgical resulfs rather they are more conceptual.

The question is never whether one can alter all three of the facial thirds. It is more a question of what facial third changes has the best value and how much effort does one want to put into the extent of the structural changes. In other words in each patient not all facial third changes are equal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a healthy male in my mid-to-late 20s who is seriously interested in undergoing aesthetic skull augmentation, specifically a 360-degree custom cranial implant to increase my overall head circumference and improve cranial aesthetics.

I’ve done extensive research and understand that you’re one of the few surgeons globally with deep experience in custom cranial implants for cosmetic purposes. I’m reaching out to request a consultation regarding the possibility of increasing my skull size by approximately 2–3 inches in circumference using a comprehensive implant approach — covering the occipital, temporal, parietal, and crown regions.

My current skull circumference is approximately 21 inches, and I feel my head is proportionally small for my frame, especially from a front and profile perspective. My goals are:

To increase cranial volume in a natural-looking, symmetrical way.

To enhance facial balance and improve the aesthetics of my head shape.

To explore what’s realistically achievable with a full custom implant.

I am fully prepared to provide imaging (CT scan, head photos) and am open to traveling for surgery if I’m deemed a suitable candidate.

Would it be possible to schedule a consultation with you or your team to discuss this in more depth?

Thank you for your time, and I look forward to hearing from you.

A:Thank you for your inquiry and sending your pictures. As you have expressed an interest overall skull augmentation of a large surface area with specific linear increases let me provide you with some insights about what can and cannot be done.

First and foremost in the shaved head male, regardless of what size skull augmentation one is considering, the location and extent of the surgical incisions and resultant scars to do so is an important aesthetic consideration. Always remember that aesthetic surgery at some levels is really about trading off one problem for another. I think in the shaved head male one has to be very cautious about the trade off of scalp scars for a better head shape.

Secondly when one is considering and a more complete skull augmentation effect the question is always whether the stretch of the scalp will permit it. As a general rule large skull augmentations almost always requirea a first stage scalp expansion procedure.

Third, the amount of skull augmentation that you have indicated by the numbers are not realistic changes. You’re not going to increase your circumferential skull size by 2 to 3 inches. That is not an achievable outcome regardless of what type of two-stage skull augmentation procedure is done. Patients commonly over estimate by numbers how much my skull augmentation they think they need. This is because in skull augmentation the linear numbers are not as important is the overall volume in ccs of the implant. The head is similar to a sphere where volume displacement is more representative of its effect rather than a linear number.

These three concepts are what you need to consider for larger types of skull augmentation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, During my consultation with Dr. Eppley, we discussed skull reduction and he asked if I would still want to reduce my cheekbones afterward. At the time, I was unsure, but I’ve now decided that I definitely do plan to undergo cheekbone reduction.

My question is about facial harmony and sequencing:

Would Dr. Eppley adjust the extent of the skull reduction based on my current cheekbone width — or would he reduce more aggressively if the cheekbones were already smaller to begin with? I’m curious to know if the skull reduction is being tailored to match my current cheekbone structure, or if he’s factoring in my plan to reduce them afterward.

Additionally, I’d like to know — in Dr. Eppley’s opinion, would it be better to undergo cheekbone reduction first to allow for a more aggressive or refined skull reduction result? Or would he recommend doing both procedures at the same time (if that were possible), for maximum overall balance and reduction?

Of course I trust Dr. Eppley’s expertise completely and just want to make sure I’m approaching this in the best order to achieve the most harmonious and noticeable result possible.

A:Ideally, if both procedures are going to be done,  you do the preoperative planning for both the skull and cheek reductions on the patient’s 3D CT scan and then perform them together.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  i was wondeirng if it was possible for a a forehead, supra orbital, and brow ridge implant in just 1 implant alone instead of 3 sperepate implants If possible, how much would it be speculated to cost? And would it be better than having them seperate? Thanks alot.

A: Supraorbital and brow ridge refer to the same area…they are interchangeable anatomic terms. Thus you are referring to a custom forehead-brow bone implant which is always done as a single implant placed on a single surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My eyes are uneven and I’m looking for something to help with it. Would you be able to help? Here is a picture for reference. Thank you!

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 the right eye that is the lower one. There are a variety of VOD techniques to decrease the eye asymmetry by moving the right 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 front non-smiling face picture to do a numerical assessment and a 3D CT scan to assess the underlying bone structure. (only needed of we determine you want to move forward)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a prominent forehead and I would love to reduce it

A: Thank you for your inquiry and sending your pictures. You do have significant frontal bossing which can be reduced if the bone is thick enough to do so. (in most cases it is) To check the bone thickness to make that determination a 2D skull CT scan is needed to measure the actual bone thickness and see how much of the frontal bossing can be reduced.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What are the possibilities of performing surgery on the occipital bone, the back of the head?

A: I do occipital skull bone surgery all the time whether it be for reduction of a protrusion or augmentation of a flat bone. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in XL male pectoral implants. I have Polands syndrome and missing the lower pectoral major muscle on one side. I would like to increase the size of both and correct for the Polands syndrome.

A: Thank you for sending your pictures. When you have Poland’s syndrome or significant lack of tissue development you do not have the option of also augmenting the opposite side of the chest if the goal is improved chest symmetry. It is hard enough to make the left side match the right side as it is now. Augmenting the right side as well as reconstructing the left side will only make the same chest asymmetry you have now only more magnified.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had the Medpor chin implant in April 2024Dr. Eppley describes the burring down and replacement of Medpor implants in his blog. I would like to either have the original Medpor implant burred down to make it smaller or replaced with the smallest chin implant available

A: If the goal is substantial chin augmentation size reduction, which is what your description of the smallest chin implant available means to me, then removal of your existing Medpor chin implant and replacement with a small silicone chin implant would be the appropriate treatment choice.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Will cheekbone reduction osteotomies help to make the ears more visible and the get a more concave especially the lower part of the cheekbones. Also I have infraorbital implants. Is it possible to do the cheekbone osteotomies without damaging the eyes and infraorbital implants?

A:Your request for cheekbone reduction osteotomies is unique giving your prior cheekbone widening osteotomies. In essence you are really trying to return the more narrow cheekbones that you once had. While that bone shape change is achievable I do not think it will make your ears more visible. It would probably have some impact I’m creating a slight bit of increase concavity in the cheek area but this would be fairly limited given the thickness of your overlying soft tissues.

In regards to your existing infraorbital implants I do not know exactly where they are as they are not evident in the 3-D CT scan that you have. (see attached) I suspect they would be safe from the cheek bone reduction osteotomy as they are unlikely to set into the bony step off that you have in your cheekbones.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a lip lift procedure that removed the nasal sills, presumably to hide the scars up inside the nostrils. I would like to restore the appearance of the nasal sills by implants. Is this an effective way to do so?

A: Lost nasal sills are hard to restore and whether augmentation by graft or implants may or may not be effective at doing so. This requires a very discrete line of projection between the columella and the inside of the nostrils.

Dr. Barry Eppley

World-Renowned Plastic Surgeon