Your Questions
Your Questions
Q: Dr. Eppley, I hope you’re all well. I’ve just had a revision of my initial Facial Feminisation at another clinic but I have a problem with the appearance of my eyes. One appears hollow and the other more smooth. I’d like to book an online consultation with Dr Eppley, or at least humbly request his feedback for my particular case. Please see the attached images.
I present the following images and I am grateful for any insight he is able to provide. Depending on this, I’d be willing to travel to an in-person consultation if needs be.
A:While I don’t know what you looked like beforehand the 3D CT scan clearly shows the less forward projection of the right tail of the brow, lateral orbital wall, infraorbital rim and cheek. Since not all of these changes could have occurred from the surgery, as only the teil of the brow bone was reduced ,this indicates that much of this bony asymmetry existed beforehand. Thus the brow bone reduction has now made this asymmetry more visually evident as the brow bone support has been removed both horizontally and vertically. Logic would then dictate that restoring some tail of the brow bone would be helpful in decreasing the orbital asymmetry. Such tail of the brow bone augmentation could be done by a transpalpebal (upper eyelid) approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I am thinking to get skull reshaping surgery because back and top of my head is flat. I have two questions.
1- are you using IV sedation for the surgery or general Anesthesia in your clinic?
2- are you using the MMA implants or silicone implants for the surgery?
A: In answer to your questions:
- General anesthesia is used for all skull reshaping surgery. These are not procedures that can be done under any other form of anesthesia.
- Custom skull implants is the far superior method skull augmentation. The use of PMMA bone cement is an historic and poor method of onlay skull augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this message finds you well. I’ve been considering the possibility of a skull implant to increase my height by 2 inches and make my face wider. I’ve noticed that my head is slightly smaller in proportion to my body, and I believe this procedure could help me achieve the desired results that can help me with my professional career and finding balance in my body proportion.
Before proceeding, I would like to inquire about the safety of such a procedure. Additionally, as it’s important for my job, I’d like to know if this procedure is compatible with my lifestyle and if there are any potential risks or side effects I should be aware of. I’m a professional dancer and my lifestyle is very active.
Your professional guidance on this matter is of utmost importance to me, and I would be grateful for your advice.
A:The main comment I would to your inquiry is that it is not possible to be able to increase the height of the skull by 2 inches (50mms) without an undue risk of complications. With scalp tissue expansion one inch (25mms) is reasonable and with a low risk of complications but not 50mms of added height.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi reaching out because I am considering forehead reshaping/ contouring within the next year, but I have a very prominent protruding forehead and don’t know how possible it is. Was wondering I could send a picture to get an idea if this is even possible?
A:Thank you for your inquiry and sending your pictures. Like many patients with frontal bossing you also have a high long forehead (brow-frontal hairline distance) which exacerbates the appearance of the forehead protrusion. While frontal bossing reduction can be done it is important to realize that the forehead bone is not that thick so there are limits as to how much of the convexity can be reduced. (see attached imaging) There is also the issue on how to get there to do the reduction (incision placement but that is for a later discussion.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, So this is my x ray and I’m wondering if the implant can be placed at this angle? Instead of following the angle of the mandible downwards, my doctor said he had to place it at the same angle as the mandible (which also elongates my face).
What are your thoughts? I like the result, but I’d like a little more projection (enough to where my chin lines up with my bottom lip)
A: In your case of chin augmentation you absolutely do not want to elongate your chin. You either have a sliding genioplasty that moves the chin upward as it comes forward or you place an implant higher up on the bone. Be aware that all standard implants have their greatest projection on the lower half of the implant so moving the implant up further on the bone is not a guarantee that some elongation will not occur due to soft tissue chin pad rollout. (which is how chin implants create their effect) If you put the chin implant too high then some horizontal projection is lost and it may create a bump effect up to high in the chin. You have to be wary of trying to use a standard implant in a way that it was not designed to be used.
Biut as a general statement having to place the implant in line with the mandibular plane angle shows la ack of understanding that aesthetic consequence or full knowledge of chin implant placement techniques.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am looking to reverse a genioplasty that I had done last year. I am a 34 yr old male, basically I had an 8mm advancement a couple of years ago which in hindsight I did not really need. I got it reversed to 3 or 4mm but I still did not like the outcome. I realize that at this point it will never be back to the way it used to look but I would be content with close enough. I know Dr. Eppley is one of the few experts in this area and I wanted to see if he could reverse the 3mm, I also still have the titanium plates and screws attached.
The main issue that I had after this procedure is how I look from the front. It seems narrower, and my lower lip appears a little bit rolled in and less full like before. I know 3mm seem insignificant but in my case I have a small mouth and do not feel like a bigger chin fits my face
A: A full sliding genioplasty reversal can be completed. Whether the existing plate and screws can be used to stabilize the fully flush bone edges remains to be determined intraoperatively.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I would like to change my face shape. My primary concern is my chin. It’s short but too wide/prominent at the same time. I also would like to contour my face so that I have more prominent cheekbones and less fatty cheeks. I love my jaw but I wish it was more defined, without adding more mass. I’ve attached pictures of myself and the face shape I’d like to have. What would you recommend? Thanks so much in advance.
A: Most of your facial reshaping goals are contradictory and can not be achieved. For example to make a wide chin more narrow it must come forward along with being narrowed. Also you can’t make the jaw more defined with adding mass/volume. In essence you not factoring in the effects of the overlying soft tissues which can not be changed/reduced. Thus having a more defined facial shape comes from stretching out the soft tissues to better see the bone shape through the overlying soft tissues. You simply can not reduce facial structure into a more defined shape with your facial soft tissue thickness. In short you can’t take your facial shape and make it look like your ideal images… that is simply not going to happen no matter what type of surgery is done. To get a more defined facial shape you have to accept that more structural support (implant) that needs to be added to do so. With that comes more chin projection and some jaw width.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope your well. I am writing to you in regards to having a few questions about custom forehead, temporal widening implant as I am interested in getting this procedure done .
Lastly, I would love to see some before and after pictures to get a better understanding of what I could expect.
A: You are going to find it very hard to find any before and after pictures due to patient confidentiality. Most young people, who make up the majority of custom facial implant patients, are exquisitely sensitized of having their face shown in any capacity…..most likely how you might feel as well.
But in designing custom forehead-temporal implants what results other patients have is not all thaf relevant since every custom design is unique in its shape and thicknesses based on the patient’s aesthetic desires. Such implant designs are based on initially doing imaging of the patient’s pictures to determine their specific aesthetic goals. (known as setting the target) That is how you find out what the aesthetic outcome may be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a couple of questions regarding clavicle lengthening surgery.
Firstly, it appears on your social media that clavicle shortening* is far more prevalent? Is there a reason for this? Are there additional cases of lengthening that can be shared or perhaps a follow up photo of the bodybuilder from your article https://exploreplasticsurgery.com/plastic-surgery-case-study-shoulder-widening-by-clavicle-lengthening-in-a-muscular-male/
Secondly my question is regarding the procedure itself. I’m happy to see that you offer a sagittal split cut for increased stability and thickness. As surgeons often use ground cow bone powder for grafting purposes in surgery, I would like to know if it is possible to use human bone as a solid graft for the same purpose? For example in the saggital split, the two gaps created need to be filled with bone putty. It is possible to completely clean out a donated piece of clavicle from another human for the purposes of placing this in the gap instead of bone putty? This would act to physically prevent relapse/the clavicles sliding backwards and presumable be far more stable than putty.
If this is the case, then can the same graft be applied to a single osteotomy in the middle of the clavicle as opposed to a saggital cut?
Thank you and kind regards,
A: In answer to your clavicle lengthening questions:
1) Clavicle reductions are performed in far greater numbers because there is a greater medical need as well as being a surgery that is more effective and with a much lower risk of complications.
2) As for grafting the bone defects in the lengthened clavicle bone demineralized human bone particles is the most common graft material used in my experience. Other options include human cadaveric corticocancellous blocks as well as the patient’s own bone.
3) The reality is that clavicle lengthening has two distinct features that make it far more problematiic than clavicle shortenng in my experience. First to lengthen the clavicle you have to push out all of the shoulder soft tissue aftachments so the bone can lengthen. This not only is not easy but limiting in the lengthening amount possible. While clavicle reductions can easily shorten the bone 2.5cms or greater per side the maximum lengthening is around 1.5cms per side. Secondly, and a major issue, is that in the lengthened clavicle the shoulder soft tissues act like a fulcrum pushing down across the osteotomy site…often bending even a 3.5mm rigid plate. In short the biomechanical forces applied to the clavicle bone are very different between lengthening vs shortening.
3) Compared to the issues in #3, the choice of bone graft is the least important element in the whole clavicle lengthening process. If the expanded bone can not be maintained structurally stable in the short term the long term effects of the different types of bone grafts are irrelevant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Thank you very much for your reply, and for taking the time to do the imaging! After investigating the matter in greater depth, and taking into account your feedback and the imaging, here are some thoughts that may help to advance the discussion:
– It would appear that the lack of “strength” I perceive is a result of jaws that are a bit recessed, although not to a degree where they have caused any problems that I am aware of. However, since the issue is merely aesthetic, I question the wisdom of undergoing an aggressive treatment like DJS.
– I believe that chin projection is okay as it is and that moving it further forward would not provide an aesthetic benefit.
– Similarly, I don’t have a problem with the width of my jaw and feel that increasing it would change my face more than I would like.
– The main goal is, I believe, to moderately increase the height of the chin and the entire jawline. I originally considered a genioplasty to augment ching height but discarded it for two reasons. The first one is that I’ve been told that it leaves a step in the jawline which can be visible and certainly felt. The second is that it would give the appearance of a longer/narrower face, which is something I would not like.
– My conclusion so far is that I seem to be seeking a result along the lines of what could be achieved with a chin wing procedure that only adds height, without any forward movement. Would you agree with this, based on the previous comments? Is this something that Dr Eppley performs, or is it something that can be replicated through customized implants?
Again, thank you very much for your help, and hope to hear your thoughts.
A: I think we both agree that vertical jawline lengthening is the correct aesthetic goal to which there are 3 ways to try and achieve it with varying effects along the length of the jawline:
Vertical Bony Chin Lengthening – affects chin area only (a 1/3 jawline augmentation procedure)
Chin Wing Osteotomy – affects chin and body of mandible (a 2/3s jawline augmentation procedure)
Custom Jawline Implant – affects the total jawline from chin to jaw angles.
With that understanding the chin wing is a good procedure as long as you understand it will have no lengthening effect on the jaw angles. Once you understand where the osteotomy line is (see attached) it becomes clear it provides no improvement at the jaw angles and its effect fades as one moves back from the chin. In essence it is a 1/2 or 2/3s jaw lengthening procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was curious about shoulder reduction surgery. I live in Australia, and I am not a US citizen. I was wondering about the logistics with having it done via traveling to America.
A: I have had many patients from Australia over the years including patients for shoulder reduction so this is not novel to my practice. But whether from the U.S. or around the world the key element in shoulder reduction surgery is immediate postoperative management and how soon one could go home….with the goal of getting you home as soon as possible so you can complete your recovery is a more familiar setting and support. This will vary a bit per patient based on where one lives and whether one is coming alone or with someone. We help you think this through and plan accordingly way before the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello..I’m looking for a permanent fix for my nasolabial folds. I was considering an implant to this area. What are suggestions or recommendations?
Thank you
A: Nasolabial folds like yours are very difficult to fix because they are largely a soft tissue overhang issue which is somewhat magnified by your flatter midface projection. (although only minimally so) Nasal base implants can help the very upper part of the fold by the nostril but will do nothing else for the majority of it below that level. Thus I don’t see implants of being much value in your case as the deepest areas with the most overhang tissue overhang is at the bottom ½ of the fold. With an inverted V shape to it the only effective approach is going to be a lower facelift/jowl tuckup to move the soft tissues back away from the fold to lessen its depth.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if 9 years old is too young to do surgery? My son definitely has flattening of the back of his head with one side being worse than the other. I brought it up many times to his Pediatrician when he was a baby and they said it would correct itself overtime, which it never did.
My son hasn’t complained too much since he is still young, but I definitely think he will be more self conscious as he gets older. I am just wondering what the best time is to get surgery to try and correct the problem. Thank you so much for any information you can provide.
A: Such custom skull implant surgery is not done until the skull growth is more fully developed, usually after piuberty around age 16 at the earliest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty over 10 years ago and suffer from nerve damage in my whole lower face. Numbness tingling etc. Is there any treatment options for this?
A: That would depend on where the osteotomy cuts are relative to the mental nerve foramen. A panorex x-ray wouild be helpful in that regard. But at 10 years after the event improvement is not likely.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi i’m looking for a solution. Please see attached video. I had double jaw surgery to close open bite 8mm one side 5mm the other lower jaw. Top jaw inpacted down and now I can’t close my mouth at rest without real force and it pulling my bottom lip down.
A: While there are some moderately effective surgeries for lower lip incompetence, the operative words are ‘moderately effective.’ When trying to get 1 cm of lower lip elevation that would classify as an extremely effective procedure which does not exist in lip incompetence surgery. In your case the maxillary downfracture (lengthening) is the real culprit and I don’t see anything done to the lower lip as really overcoming that facial lengthening effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I have thin wrists. Is there a way to increase my wrist size? Increasing the size of my wrist bones? Or injecting fat?
A: Injecting fat into the wrists (distal forearms) does not work, it wlll quickly be absorbed. Implants are the only option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m interested in the forehead horn reduction surgery but I have a few questions.
What is the cost of procedure? Is the incision made within hair line? Does incision cause hair loss? Does the scar heal to the point where it’s not noticeable on darker skin tones? Living out of state, how long would I have to be in Indiana for the whole process?
A:In answer to your forehead horn reduction surgery questions:
1) The incision(s) can be made at or just behind the frontal hairline.
2) The incision does not cause hair loss.
3) Patients have never reported to me that they thought their scars were noticeable, regardless of their skin pigment.
4) Less than 48 hours. Come in surgery, go home the next day.
5_ To provide accurate cost of surgery quotes I would need to see some pictures of your forehead.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I currently have Medpor jaw & chin implants, I’m getting them removed next month. I had them installed 2 years ago. The reason I’m getting them removed is because I am starting to develop sleep apnea & need double jaw surgery however the surgeon I am going to told me that the implants must be removed first. Will I suffer any bone loss or complications from implant removal?
A: I can not provide a qualified answer based on a description alone without any knowledge of your implants or their history…nor should I. These are questions that are best answered by the surgeon who is going to do the actual procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been reading many of your articles on exploreplasticsurgery.com on jaw angle implants and jawline implants. The information on bony overgrowth and tissue ingrowth has been helpful.
I recently got custom jaw angle implants in the Medpor material in late September. While I am still healing, I can tell that the implant on one side is displaced, and I wish to get it revised. Do you think a revision surgery 6-12 months after the original surgery will present problems with tissue ingrowth or bony overgrowth? Or will those features take longer to manifest? I will consult with the original surgeon soon about a revision surgery. If I feel that the surgeon’s plan for revision is insufficient, I may consult your clinic in the future about a removal.
Thank you very much for your time.
A:Given the nature of Medpor material with tissue ingrowth and a high probability of bony overgrowth, if an implant revision is needed it is better to do it sooner rather than later as it is going to be more difficult and less predictable. Later is 6 to 12 months after their initial placement.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I am 40 yrs old and since birth I have aproblem with having a bigger head. My problem is that the skull is too wide and I had a lot of problems from other kids and even now it is problem to have some relationship with girl. I am looking for procedure like this for years, but previously these operations were not possible.
Would it be please possible to reduce the size of my skull, mainly in the area above ears, where the head is too wide and I have long time depression due to it. I am also quite small (only 170cm and 50kg), so the size of my head is much more noticable. Is it possible to help me somewhat please??
A:I believe you are referring to the Temporal Reduction procedure in which muscle is removed from the side of the head not bone. The temporal bone is too thin for its reduction to have any visible effect. (less than 5mms) While the posterior temporal muscle is quire thick above the ears (up to 10mms) and can be removed in its entirety without adverse functional effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Hello there. I read that you removed 6 ribs on Pixee Fox. I just want to ask, if you can operate on an ongoing rib after injury, when I was a child? Or remove it entirely? For some reason the rib is getting wors, pushing my organs. It’s the rib right next to the heart/left nipple. Also, if possible, can you send me some informations about the procedure? Prices, consequence, things that are no longer possible/allowed to do etc.? It’s not because I want to, but I have no choice, if not removed, the consequences are far worser. Also, I am having big troubles with it, when I exercise, just sit in front of the PC, constant pushing etc. It’s life devastating at this point. I can send you pictures of my case?
A:It would strike me that you are referring to a subtotal removal of the problematic rib. It would be important to determine the exact rib location and its deformed shape before removing it. This is best done with a 3D chest CT scan which shows the ribcage in beautiful detail. With the description of your concerns the location of the deformed rib should be readily apparent in such a scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have 1050cc breast implants currently and am wanting to go larger, preferably 2000cc + if possible.
A: I assume that your existing 1050cc volume implants are 800cc saline implants overfilled to 1050ccs. The key questions in increasing their size are:
- Can you just fill the implants you have with more volume or do you need new implants?
- How much more much volume can your breast tissues immediately stretch to accommodate? As a general rule 50% over the original volume is what can be done. Whether more than that is possible can not be known until doing it in surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My surgeon wants to do midface / malar implants as well as jaw angle implants during jaw surgery.
Do you think the smartest choice is to get the jaw surgery first then assess from there how much augmentation I need and where? I hear some people say you should do them separately since you can’t predict soft tissue changes. Especially with the angle implants, I risk the uncanny look.
Thank you so much for your help!
A:Between the increased risk of implant infection and the unknowing of what your exact implant needs are I would never put the two together. Reassess the augmentation needs 3 to 6 months after the double jaw surgery…that is the prudent choice. Never confuse can you do it with whether you should do it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Recently I have been going through older photos and realized my midface is completely sinked in compared to when I was younger. This is shocking because I’m only 21. My cheeks were more pronounced and my scleral show was less prominent. I look very haggard for my age as a result. Could there be any reason for this? I’ve attached a collage below, the top left being me now and the others being when I was younger. I am very insecure about my appearance as a result.
A:The explanation is simple…growth and development. As the lower jaw and the dentoalveolar processes only fully develop in the late teenage and early adult years the once fuller midface now becomes recessive by comparison. That and losing some midface fat from testosterone effects. Your face has now become what it is genetically programmed to be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
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
