Your Questions

Q: Dr. Eppley, I had a Lefort 1 osteotomy to correct an underbite a few years ago but I’m unhappy with the outcome. I have quite hollow under eyes and flat cheeks with a heavier puffy lower face and no definition. I would like to achieve a more slim and defined feminine look with more prominant cheekbones. I have been researching infraorbital malar implants and also types of fat removal and masseter botox. Would these procedures help me achieve my aim or should I consider something else. Thank you.

 A: As can anatomically happen in some LeFort advancements the under eye and cheek areas get ‘left behind’ as the maxilla moves forward as this is a low midface procedure that does not affect the high midface area. Given that maxillomandibular position is now the foundation of your face it would make sense to augment the infraorbital-cheek areas. This will certainly improve the undereye hollows and augment the cheeks. The only question is whether this will have a slenderizing effect on the face…of which I am suspicious that it would. Some of your facial volume concerns comes from the now increased midface soft tissue fullness that is a sequelae of the midface degloving that is necessary for the Lefort I procedure. This is where buccal lipectomies/perioral liposuction/masseteric muscle thinning may have a positive role to play in your facial reshaping efforts.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I was hoping you could please help me understand what I can do to resolve the lower heaviness in my face. Despite being 5’11 in height and less than 135lbs, I still (and always have) carried a lot of weight in my face, which becomes particularly pronounced when I smile. I have had masseter reduction with Botox in the past, which has helped but it’s still not getting at the chubbiness at the front and lower sides of my cheeks. Is this buccal fat, masseter or something else? Photos attached. 

A: While I have not seen a truly static picture of your face (all have various forms of smiling which naturally adds to the fullness of your face) your ‘problem’ is undoubtably multifactorial. (meaning the natural thickness of all of your overlying soft tissue…skin, fat muscle, fascia…all make a contribution to the fullness. Thus there is no single one procedure that addresses just one of the tissue components that is going to successfully provide a satisfactory facial thinning effect.

The reality is that the most successful facial thinning procedure I know is the one you would be least motivated to do and one that seems counterintuitive…. a cheek-jowl tuck-up. (a limited form of a lower facelift) This is the most effective approach for facial fullness reduction because it has a known facial sweeping effect, which for an older thinner person may not be a desirable facial change, but in the younger fuller face patient is a positive effect. By tightening the skin, underlying SMAS and removing some buccal fat the face becomes less full.

That being said every other procedure, stand alone buccal lipectomy/perioral liposuction and masseteric muscle/jaw angle reduction provides some modest improvement but never a really significant change.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, My breast implants were put in 1997, I am 64 now, never an issue, they are still soft and no pain at all..but want them out, but cant afford that. I believe they were 350cc. I need a mammogram but refuse the one where they smash you down! i am too afriad of that. Yes, they are old but intact for sure..if they were not intact would’nt my implants be totally deflated? they re still full and round! But if I do this mammo, and they smash em down—I may just invite issues for myself as they might burst…eeek! I cant do that. I read where you wrote a lady back as she had implants that were 31yrs old and you said the shell is not intact any longer anyway…..but….mine is intact or my implants would be deflated correct? 

A: Are they silicone or saline breast implants? I assume since they were placed in 1997 they are saline implants. If so then of there was any loss of integrity of the implant shell they would deflate or be flat.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in tear trough infraorbital/paranasal implants post orthognathic surgery.  My goals are : a positive orbital vector, elimination of dark circles, mitigate areas “left behind” after subspinal lefort I.

A: Most likely you are referring to infraorbital-paranasal midface implant design to fill in what the LeFort I osteotomy did not accomplish. The area of implant coverage is really determined by what you want to see augmented on the outside. The 3D CT scan is merely the platform on which the implants are designed but they don’t necessarily show the desired external aesthetic effects.

While the infraorbital region can be augmented it would be unlikely that the dark circles will be significantly improved….unless a major component of the dark circles is shadowing.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I have really close set eyes and I’d like to get them further apart. I want to get around 6-8mm of extra pupillary distance. Could this be achieved with some sort of implants in the eye orbits? Or in any way that doesnt involve a craniofacial surgery? Thanks.

A: Only orbital box osteotomies done through a frontal craniotomy can achieve that increase in interpupillary distance.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have been on testosterone replacement for ~25 years and have atrophied testicles. I was interested in the wrap around technique; however, after reviewing blog entries, due to the small size of my testes side by side implants would be appropriate. I would be surprised if my right, and larger of the 2, testicle is even 2.5 cm in largest diameter. 

I am concerned that with the degree of atrophy that my scrotum has shrunk considerably as well which may limit the size of implants that can be used. I would want the largest implants up to 6 cm that could safely be used. 

A: With your small testicle size you have correctly assumed that the side by side technique is the best testicular enlargement method. I see no problems with placing 6cm size implants as the scrotal tissues are very elastic. This procedure is done under general anesthesia.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am considering to do the mouth widening procedure that you offer but was wondering how much of the mouth can be widened? Can 8mm be taken by both sides? And can a corner of the mouth lift be done at the same time?

A: 8mms is too much per side and will lead to poor scarring. When doing a corner lift at the same time as widening the movement is at 45 degrees to the horizontal plane. But with the 45 degree movement the amount of horizontal widening will be a bit less.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, hello doctor, I would like to know if after a cheekbone reduction surgery it is possible to place implants, because my face is very wide, but the cheekbone does not project forward, only laterally, and I want to do both but I don’t know if that would be possible, I wait for your answer, thank you very much.

A: The concepts of cheekbone reduction and cheek augmentation, done concurrently or separately, is not incompatible. Cheekbone reduction involves narrowing the width of the cheeks only by osteotomies to bring in the width of the zygomatic arches. Conversely, cheek augmentation can be done on any aspect of the cheek which in your case needs to be done on the anterior aspect just below the orbital rim. As a result you can get anterior cheek projection while decreasing lateral cheek width. 

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m just wondering if you can rebuild jaw bone ? I don’t mean by adding jaw implants. My jaw bones are very thin and just wondering if he’s able to rebuild jaw bone back up?

A: The key question is why is the jaw bone thin? If it is naturally thin then trying to build it out even with bone grafts will fail/be absorbed. if it is thin by some process (was once thicker) than onlay bone grafts may be more successful.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I’m from Vegas, I came upon this website after searching for jaw implants. After seeing some of the custom jawline implants, I noticed one of the ‘skulls’ had a similar jaw and issue that I have. I got an opinion from a jaw surgeon here in Vegas after seeing my x-ray he recommended jawline implants due to an abnormal growth of my left side of my jaw. I hope you can help, take care and have a wonderful day. 

A: Any time there is asymmetry of the lower jaw, a custom implant approach for augmentation would be the best approach….although a custom jawline implant is always the best approach regardless of whether asymmetry exists or not.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I hope this email finds you well. I stumbled upon your Instagram while browsing for possible custom facial implant surgeons, but unfortunately, you are in a different country than mine and I am unable to fly out, by any chance can you consult with me online and help design my implant and I will get the surgery performed locally? If that would be possible I would highly appreciate it. Thank you.

A: I only design custom facial implants for patients in which I also do the implantation. The success of any custom facial implant is a combination of a good design and proper implant placement. A good design becomes compromised if improper placement is performed…which is often what happens when a surgeon with no involvement in the design or experience in placing such implant designs performs the surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am about ready to proceed with a consultation for Pec Implants. I was curious about the PowerFlex Plus Pectoral implants. I note that they are 15cmx19cmx3.9cm in a vertically placed position. Looking for the maximum augmentation, I believe this model/size in terms of projection would be ideal. However, I do not think my chest height could accommodate the 19cm height. Could the implant be place horizontally or could it be shaved to fit my dimensions? Thank you so much!!

A: The proper orientation is as shown in the attachment with the vertical height of 15cm and the horizontal orientation of 19cms with the tail towards the axilla. While the implant can be cut to reduce its dimensions I generally try to avoid doing that unless absolutely necessary as have a cut edge of an implant increases the risk of a chronic seroma. (fluid collection) When very specific dimensions of a pectoral implant is needed, this is the role of a custom pectoral implant design.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question on minoxidil topical solution and the implant placed in 2019. If you may share his thought on this, it would be really helpful.

With likely having male pattern hair loss condition, I apply minoxidil topical solution 5% (e.g. Rogaine) or sometimes 7% on scalp for stimulating hair growth. I applied the solution daily since 2015 and I am likely to continue in the many years to come. 

I am not sure if this would be true but I would imagine long-term application like this, while some minoxidil topical solution (incl. active and other ingredients) is absorbed into blood stream or other via channels, certain amount would be left as residual and stay among the layers of scalp skin. If this makes sense, then when it happens, such residual may penetrate through the layers of scalp skin, and reach the bottom level of scalp skin. As this level of skin is in direct contact with the surface of implant, so do some topical solution residuals. 

As I guess the implant would not absorb minoxidil, it continues to build up on the surface of implant.

I wonder if my understanding above is reasonable.

Then my question is whether such build-up of minoxidil topical solution under scalp skin (above surface of implant) would cause any health issue in that area. If yes. What should I do to avoid such issue or mitigate risks involved.

Any additional comments on this topic would be helpful.

Thank you for your kind attention : )

A: I am not aware that minoxidil builds up under or in the scalp. It is a vasodilator that is absorbed and eliminated after it has its effects.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Five months ago, I underwent double jaw surgery together with V line and cheekbone reduction surgery in South Korea. The result of the surgery was not what I expected, and I have regretted it since. My facial aesthetic appears to be much more feminine and much less attractive compared to pre-operation. I have been finding ways to see if it’s possible to reverse my surgery so I can look like my old self again. I’m planning to reverse my v-line and cheekbone reduction by using a customised silicone wrap-around jaw implant, and have the zygomatic body elevated back out /customised cheek implant after doing a revising double jaw surgery to push both my jaw back out. I have a few questions that I hope you can help me to address. 

1) Do I need to visit you to check if I’m eligible for a customised silicone wrap-around jaw implant and customised cheek implant before I decide to do a revision double jaw surgery to push both my jaw back out? 

2)Is there any chance I’m not eligible for a customised silicone wrap-around jaw implant and customised cheek implant after revision double jaw surgery?

A: I have done many patients such as yourself who are looking to reverse their V-line surgery. I have yet to see such a patient who could not have a custom jawline implant to reconstruct their jawline.The same would apply to the reversal of cheekbone reduction osteotomies. Such surgeries would, of course, await your revised double jaw surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Hey, I read about your practice in a 2019 New York Magazine article… I’d like to get more information on the testicular augmentation “clam shell” implant — e.g., cost of procedure, recovery time, possible complications, detectability by others, effects on testosterone production, etc. Haven’t been able to find that info on your website. Thanks!

A:When it comes to aesthetic testicular enlargement there are two methods: side by side and the wraparound or clamshell implant approach. While the latter has a lot of understandable appeal it does have a significant rate of postop separation which, as a result, always makes it my second choice. I have yet to figure out as assured design that makes postop ‘disengagement’ a negligible or almost non-existant risk.

Otherwise either form of testicular enlargement has no adverse effects on testosterone production and is certainly not easily detectable in most cases.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I have just a major question for Dr. Eppley (maybe he can answer it on his blog)? 

I am considering getting either orthognathic surgery (I have been given the option of DJS or LJS), which would be covered by insurance due to my mild sleep apnea and TMJ, or doing a genioplasty and rhinoplasty with you. I have a class 2 overbite + I don’t like my small chin, and the jaw surgeon recommended a LeFort 1 with CCW rotation and possible 5 mm advancement, and up to a 10 mm BSSO advancement of my lower jaw once my teeth have been put in braces. 

One concern that I have seen folks getting upper jaw advancement/impaction present with is sagging cheeks and more pronounced undereye circles. This seems to happen due to pre-existing flat cheekbones and lack of orbital rim support (which I think I may have). I have attached photos below of me pre-filler. With my existing facial structure, would the risk of my malar fat looking “droopier” be there?

A:Your fundamental question is really about the concept of surgical tradeoffs. The exact midface/cheek concerns you have expressed are very likely to happen as the cheekbones get ‘left behind’. It is a very common aesthetic sequelae in Bimax advancements and while the chin may look better the midface will pay the price for that exchange. Bimax surgery is worth it if significant functional improvement is needed (sleep apnea) or the lower 2/3s of the facial skeleton is recessed and needs to be moved forward. (fat face) In our case it really comes down to the value of sleep apnea elimination and correction of your Class 2 bite. But inevitably it will not be your last surgery as the undereye hollows and the cheek deficiency and low soft tissue cheek fullness that results may likely be undesired aesthetic effects.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I recently read an article that was published by Realself on shoulder surgery, they stated some possible short and long term complications that I don’t remember hearing about during our consultation. It has sparked some questions for me.

In the consultation I was told that the main risks associated with shoulder reduction surgeries is failure of the fixation hardware and non-union of the bones and that if there were to be a complication it would most likely happen in the first couple months. I don’t believe I was made aware of any potential long term complications.

Here are the concerns listed in the article:\

“ Immediate risks of clavicle surgery can include sensory nerve damage or a collapsed lung, while “long-term risks include hardware irritation and, most important, the permanent shift of the shoulder girdle,” The muscles where the scapula and clavicle connect to the arm could become weakened and easily fatigued over time, ultimately impeding the shoulder’s ability to move effectively. “

I’ve also heard some say that the new shorter length of the bone straining to work with the scapula will cause early arthritis down the line. I’ve heard others say that the scapula will move to accommodate the new length of the clavicle. I’m not sure where this information is from though. I of course understand that there is limited research and knowledge on the subject but can you speak at all to arthritis or chronic muscle fatigue being valid concerns? And how would this procedure collapse a lung? 

In the Realself article it also mentions that one should follow this procedure with physical therapy. Is that part of your recovery process? If so, does the PT have to be done with a licensed professional or can it be done from home? If it’s not part of your prescribed recovery do you still recommend it? 

Apologies for the long list of questions but I appreciate your time and attention. Thanks,

A: In answer to your questions the first comment I would make is be very cautious of doctors or others making comments on a procedure that they have never performed. The only opinions that should matter in any surgical endeavor should be from those who have done (surgeons) or have undergone (patients) the exact procedure you are considering having done. Outside of that perspective all such comments are theoretical and lack any proven medical relevance and thus their value should be taken as such.

To date there is no evidence of any adverse long term effects from shoulder reduction surgery which includes the stated muscle fatigue or arthritis. However until the procedure has been performed on hundreds of patients with very long term followup (10 to 20 years) no one can say for certain if any such adverse effects exist….but it seems unlikely based on patients who have been through the surgery in the past five years.

The only relevant long term risk ghat I have seen is whether the patient will want the fixation hardware removed due to either show through the skin or irritation.

Other than at home arm range of motion after 6 weeks postop I do not prescribe any specific physical therapy.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I suffered a severe chemical burn to my scalp while at a hair salon, measuring 8 cm by 4cm. It has now healed and the dermatologist says there will likely be no hair regrowth. I’m looking for direction or recommendation on my next step. I have read about hair transplant, scar reduction and others but am lost as to the approach we should take. Your time is much appreciated. Thank you

A: Despite the utter travesty of your scalp burn injury it is fortunate that its size and location make it the most optimal location for a successful scalp reconstruction. The key is to excise the burn scar and move adjoining hair-bearing scalp into its location. (hair transplants are only reserved for touchups of the final scar if needed) The size and shape of the scarred area makes it ideal for total excision and primary closure in a favorable direction. It would be optimal for the total excision of the scalp scar to have a 1^st stage scalp expander placed to ensure there is enough scalp to cover it without undue tension.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Good day,  doctor, I would like to ask for your help my face is crooked, the left side of my face protrudes, half of my face on the right side is flat and sinks in, I live in Hungary, they can’t help me here I want a character with a straight, beautiful face like Justin Bieber’s, would that be possible?

A: What I was initially going to say, before viewing your pictures, is that you can abandon the concept of creating a good facial shape like some famous person or celebrity. But as it turns out you already have a better more defined facial shape than Justin Bieber’s albeit with the asymmetry. That is mainly because your face is thin and the skeletal structure is very visible and not weak or undeveloped.

That being said in the treatment of facial asymmetry most of the time the flatter less developed side is augmented…sometimes just to match the better side or often the patient chooses to augment both sides with the goal of not only correcting the asymmetry but creating improved facial definition.

The first step in facial asymmetry correction is getting a 3D CT scan from which the treatment plan is based.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, As you know, your facial width, angularity, and overall face in general are different at 10% body fat compared to 18%. As someone who will often fluctuate between 10 and 20 percent body fat throughout the year purposefully to gain muscle mass–how can I guarantee that my genioplasty won’t look great at 18% body fat, but uncanny at 10% body fat? I know a genioplasty involves reshaping the bone, but I am worried about the genioplasty looking uncanny or not harmonious at different body fat percentages. Is this something you accounts for when determining horizontal and vertical mm adjustments?

A: No one can determine what is the ‘right’ amount of dimensional movement of a static facial structure based on how the body may fluctuate around it. All you can do is choose the dimensional changes based on what the patient looks like at the time of surgery. Fortunately the chin is a solitary projecting structure that expands the lower third of the face outward its appearance is probably least affected by weight changes.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I had an otoplasty May 2022 this year and I think my prominent ears were overcorrected. Also, the top of one ear sticks out a bit and the rest of the ear looks like it’s glued to my head. I wanted to know if it would be better for me to get a reversal now or wait it out. I was reading I may be able to avoid using a graft if I do it sooner. 

A: Once you get past the 6 to 8 week from an otoplasty the memory of the cartilage has changes and merely releasing it will not work. While a subtotal reversal otoplasty can certainly be done, the time has passed when avoiding a graft to do so is possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question about your skull reduction procedure for bigger heads? Is it still done? And is can it really shave of 1-2 inches of head circumference? Thanks!

A: Circumferential measurements are not a good method to determine the reductive changes that can be done for larger heads. It is more about reducing certain protruding areas that make it look big.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in wraparound testicular implant, cost, recovery? I am taking testosterone and my testicles have almost disappeared. I would like to know how much it would cost for your largest implants. thank you.

A: Wrap around implants are not a good idea in really small testicles. When the volume of the implant is bigger than that of the existing testicles there is a very high rate of postoperative extrusion or movement of the testicle out of the wrap around implant. instead It is far superior to do the side by side technique in which the very large implants overwhelm the smaller existing testicles and push them to the rear, so to speak. This testicle implant technique has none of the wrap around implant problems and the largest implants can then be placed with the lowest risk of any problems.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am currently about to get double jaw surgery and already have a weak midface and undereye area (bad case of dark circles). Ideally I would like to get midface implant surgery soon after the jaw surgery. I want a lot of mass added to my cheekbones area especially the undereye area. I know the implants will extend to my zygomatic archs will this help change the shape of my face? I feel like I have a very rectangular face and would like some width added to the midface area. Some questions I have: 

– How soon after the jaw surgery would I be able to get the implants placed? 

– How will this process work, do you suggest a virtual meeting and then travel to the clinic? Basically what is the process like from beginning to end? 

– Lastly how big can the implants me, not coverage but how forward or thick can the implants be? What constraints are there to how thick the implants can be?

A: In answer to your midface implant augmentation questions:

1) One would wait six months after a Lefort I osteotomy to have a midface implant procedure. But you would get the process starter within a few months after the orthognathic surgery since it takes a minimum of 3 months to go through the implant design and manufacturing process to get the implant ready for surgery.

2) A 3D CT scan is needed and that can be obtained locally. We place the order for you to have it done. You only come here for the actual surgery.

3) Within what your aesthetic requirements would likely be there are any implant thickness or tissue constraint limiting factors.

4) While I do not know at this time know some of the important features of the midface implant design that would work best for you (implant footprint, single or split design, intraoral vs lower eyelid placement approach) my staff will provide a general quote for the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i always wanted a more heart shaped, small chin and jaw, soft, youthful face instead of square or long. id love your opinion on how i could achieve that look and what seems like the biggest problems. id like to get filler/botox soon but im interested in surgery if it still feels needed. i was thinking jaw botox might be a good start. maybe temple and cheek filler? im 20, slim build

A: The single most important change you need to make your face more heart shaped is to vertically lengthen and narrow your chin. The lower third of your face is disproportionate to the upper two-thirds because your jaw is flat (near zero mandibular plane angle) with a vertically short chin and a wide jaw angle region. You can do filler and Botox in other areas but they will make little difference in changing the shape of your face as they don’t address the real problem. They may provide some minor benefit but the foundational change is that of the lower jaw….vertically lengthen the chin (vertical lengthening bony genioplasty…aka mini V line surgery) and jaw angle width reduction. (masseter muscle reduction by Botox or bony jaw angle and masseter muscle reduction by surgery)

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hi.. how are you? I’m interested in fixing my shoulders with implants, to make them wider. Also in that surgery I would also like to change my breast implants.

Im attaching some pictures so you can see my problem

If possible we can schedule an online meeting so we can discuss everything.

Thank you in advance and hope you can help me 🙂 

A: Thank you for sending your pictures. Admittedly I have never done shoulder lengthening in a female and presumed that I never would….until I saw your pictures and then the desire for it became very clear. Even if you could get even 15mms per side the shoulders would look wider and less rounded. Usually 15mm widening per side in men has proven to be the limit due to the strong shoulder girdle muscles but perhaps in women this is less of a limiting issue??

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, five months ago, I underwent double jaw surgery together with V line and cheekbone reduction surgery in South Korea. The result of the line and cheekbone reduction surgery was not what I expected, and I have regretted it since. How long should I wait for before having a reconstructive custom jaw line implant surgery and cheekbone reduction reversal.

A: At five months postop you can proceed with any further facial bone surgery. The bones and soft tissues are well healed to do so.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I came across your practice from Google and wanted to reach out and ask some questions or possibly set up a consultation. I have a very thin, narrow face and as I’ve aged (42 yrs old) it’s only gotten more emphasized. I had previously had an chin implant put in but I feel as though it almost made my face look longer. Recently I’ve been getting fillers in my jaw, in front of my ear region and in my lower face to build up some volume but it doesn’t seem to be helping and, for the cost, it feels like going the permanent route might make more sense. I don’t know if there is much than can be done for a narrow face but I’d love to get the doctor’s feedback on it. 

A: In the thin narrow face the effective reshaping approach is to shorten it and widen it. A chin implant in a thin narrow face will often make it look longer which is why a sliding genioplasty that brings the chin forward and vertically shortens it is a better chin augmentation procedure in that facial shape type..

Where you have been placing injectable fillers is in the jaw angle region and placing widening jaw angle implants would be a more assured and effective approach. Another effective approach is cheek augmentation, particularly in the malar-submalar region for some midface widening/volume addition.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question in regards to the placement of mandibular angle implants (PEEK/silicone).

In your experience over the last years/decades of placing mandibular implants – normal sized to small implants so not radically large ones – how many of your patients have showed signs of (partial) masseter (PS) disruption/dehiscence? And how many in relation to how many you’ve performed in total?

If a patient had no signs of masseter muscle dehiscence is there a chance that the PS/masseter will be ripped or comprised after surgery after a big hit, yawn or other trauma?

Thank you very much if you find the time to answer.

A: Masseter muscle dehiscence is an immediate sequelae of jaw angle implant surgery that becomes evident when the swelling subsides. It is not something that occurs later even if trauma occurs.

The risk of masseteric muscle dehiscence is directly related to whether the jaw angle implants add vertical  length which requires release of the muscle attachments along the inferior border and angle region where the ligament attaches. That risk is about 5 to 8%. In widening jaw angle implants that risks lower to less than 5%.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking for infraorbital rim implant and i have beem told you are the best surgeon, i got many questions if you could answer them please, is it permanent?, will it fix my scleral show?, will it make my eye more deep set and almond eyes looking?, thank you for the time given dr. Have a good day!

A: With your negative orbital vector (cornea of the eye sticks out further in profile than the infraorbital rim) you have a true skeletal deficiency which is why your lower eyelids are rounded with scleral show. You are correct in that infraorbital rim implants (ideally custom so they saddle the rim and help push up the lower eyelids) are one important part of the solution but not the only one. Spacer grafts are needed for the lower eyelid to ensure vertical lengthening lid support and lateral canthoplasties to get more of the almond eye look.

Dr. Barry Eppley

World Renowned Plastic Surgeon