Your Questions
Your Questions
Q: Dr. Eppley,There is something I would like to hear your option about. About 1 month ago I got a surgery for a saggital crest removal, like you did in many of your cases. The plastic surgeon removed about 1 mm of it and told me, there is no way to go deeper, because of the diploic space. In your cases you describe about 5-6 mm wich would have been more than enough for me. I think he was scared to burr deeper, he definitely haven’t got the experience in those cases as you.
Let’s say he is right and he was close to the diploic space, is there no way you can burr a little bit into it as well? (Maybe close it again with bone cement f.e.) Btw. No x ray scans were taken
I am looking forward to visit you, I was wondering, how do you reach the 5-6 mm ? A answer would mean a lot to me
A:I obviously can not speak to what was observed during your sagittal ridge reduction surgery or how thick your sagittal ridge actually is. What I can say is that based on my experience it would be unusual for a 1mm bone reduction to end up in the diploic space and there would be a need to stop there. Certainly if you don’t have a lot of experience in skull surgery and don’t have a preoperative CT scan to absolutely know the thickness of the bone I can see why a surgeon would stop short of a maximal reduction.
That being said don’t presume before having another procedure what the bone thickness is. Approach any further sagittal ridge reduction knowing what is both possible and safe. That is how I would do it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in the largest custom butt implant that I can obtain with or without fat transfer. Is 1,000 ccs the largest available? Do you place tissue expanders in the buttocks as an option? Thank you.
A:Unless you have indwelling buttock implants you have correctly surmised that first stage tissue expanders would be first needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to increase the width of my face/head. My forehead area feels especially narrow and I defiantly want to make it wider, including my jaw and cheekbones. My concerns are that my eye and brow area is aligned with my forehead so by increasing my forehead width would my eye area look small and disproportionate? Secondly I also want to increase the width of my skull and at the back too because I have a flatter head. Another one of my concerns is with the safety and scars associated with these procedures.
A: in answer to your skull augmentation questions:
- While the side of the forehead and side of the head can be augmented with custom head widening temporal implants whether that may make your eyes look small can only be determined by looking at these effect swith computer imaging. I would need a front view picture to do so.
- While the sides of the head can be increased that would either eliminate or restrict any augmentation on the back of your head.
- Skull augmentations like these discussed are perfectly safe and can be done with remarkably minimal scarring.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, wrote a month ago with regret after a chin reduction procedure, and if you don’t mind, would you answer some further questions? I had a CBCT scan done before my reduction. It was done intraorally, and the surgeon removed 4.9mm bone from the bottom of my chin then smoothed and rounded the shape. He did not cut into the bone to remove a wedge. I am still regretful, I miss the old length and squarer shape to the chin, despite this being more masculine looking (I am a female) I do think it suited my face and figure better and I miss how I used to look.
The surgeon has suggested another CT and comparing the difference between this and the pre surgery CT and having a custom made chin implant from PEEK material.
My questions are as follows:
1. In your experience with similar cases, with this method how likely is it that my chin will look like the old one?
2. The tubercles of the chin were removed with the reduction, will the custom implant shape give the appearance of these back?
3. The surgeon spoke of placing the implant via the intraoral route, he did not give a reason and I will need to ask his reasoning at our next appointment, but do you see any reason this can’t be done submentally and with local anaesthesia only?
4. The implant will be fixed in place with titanium screws, is this painful, and a reason for using sedation or general anaesthesia?
5. For patients you have seen with facial contouring regret and subsequent restoration with implants, are they generally happy with the results of the implants and do they report that they feel like/recognise themselves again?
6. In this situation, how long should I wait from the initial surgery to having a custom implant made and placed or does it not matter? Is there a possibility my chin bone changes/bone regrows at all?! I’m concerned then that putting an implant on top will make the chin bigger and different to the original. I am looking to have as close to my original chin as possible.
Thank you for reading Dr Eppley, and best wishes to you.
A: In answer to your chin reduction questions:
- It is fair to stay that with a pre and post reduction 3D CT scan you would come as close as humanly possible to restoring your original chin shape.
- A custom design would replicate the original chin shape with the lateral tubercles since you have a pre reduction scan.
- The custom chin implant could be placed submentally. The choice of anesthesia is between the patient and the surgeon, both have to feel comfortable that the implant can be successfully placed regardless of the anesthetic choice. I could answer that question more decisively in regards to local anesthesia once I saw the size of the implant.
- While screw fixation is essential it is not painful.
- Most facial bone restoration patients move on after they have ‘returned back home’ or as close as they can get to it.
- Given that the custom implant design process is several months in duration you initiate it as soon as you are convinced it is needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a small head and face and I want to increase the width of my jaw and mid face. I also want to increase the width of my forehead and temple area as it is very narrow. My concerns have to do with the time it would take to heal and the overall safety and scar. Would I be able to keep my hair short or would scars be visible. I also want it to look somewhat natural. Lastly my concern is that my eye area would look small in proportion to my face if I increase the width of my temple area, unless I can somehow increase the width of my eye area.
A: in answer to your skull augmentation questions:
- While the side of the forehead and side of the head can be augmented with custom head widening temporal implants whether that may make your eyes look small can only be determined by looking at these effects with computer imaging. I would need a front view picture to do so.
- Skull augmentations like these discussed are perfectly safe and can be done with remarkably minimal scarring with incisions behind the ears.
- The recovery from any form of skull augmentation is about the swelling and/or bruising that will result from the surgery. It usually takes ten days or so afterwards to look presentable/normal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, 1. Will the bone grow back to its original size or close to its original size (will the surgery money being spent be in vain after a period of time due to bone regrowth)?
2. Is a consultation done over Skype for those that don’t live nearby?
3. If the surgery doesn’t do enough the first time can it be repeated?
A: I assume you are referring to skull reductions:
1) Bones does not regenerate or come back after it has been reduced.
2) All consultations, regardless of the patient’s geographic location, are done in a virtual manner. (Zoom)
3) All skull reductions are done to the maximum possible (down to the diploic space) where such reductions have to stop. Whatever result that can be achieved then will have been done. There are almost no skull reduction revisions, as once it is done, that is all that can be done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, looking for a resolution for my left shoulder. I had an AC joint injury in 2019, which required surgery. Since the surgery, my left shoulder is smaller than the right one. So, I’m trying to find a solution that will make my shoulder more symmetrical to the other.
A: Thank you for sending all of your additional pictures. They conform that this is an overall shoulder issue.as I would have expected given the origin of the problem.
They are two approaches to take for aesthetic improvement; 1) injectable fat grafting or 2) deltoid/trapezius muscle implants. There are arguments to be made for either approach and neither is wrong. It comes down to the classic debate of autologous (fat = unpredictable volume retention, use of your own tissue with as close to zero risk of infection as possible vs. implant = assured volume, placing a foreigh material in the body with more risks of infection than fat)
It really comes down to your preference.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently had cheekbone reduction which caused my face to look flat and lose so much volume. It caused it to sag. I look 10 years older.
A: Such sagging is a known aesthetic risk of cheekbone reduction due to loss of bone support and soft tissue ligamentous attachments. Partial or total reversal is typically done with implants, preferably custom designs
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q:Dr. Eppley, Hello. I wanted to tell Dr Eppley that my forehead masculinizes my face. There’s a bossing I would like to reduce. And a ‘line’ diving my lower and upper forehead I would like gone if possible. I had a hair transplant 2 years ago.
A: Thank you for sending your pictures. The frontal bossing can be reduced within the limits of the thickness of the bone. While visible reduction will occur I suspect that it can not be reduced enough to eliminate the valley between the bossing and the brow bone area. To smooth out this transition, which will also make the bossing reduction look even better, will require filling in the valley a bit using some bone cement. Whether this addition will absolutely be needed as part of the bossing reduction can be known beforehand. That will have to be an intraoperative judgement.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, how long does the swelling from a chin shave via submental incision last? After 16 days, my chin still looks large. When will I look normal? 🙁
A: Significant resolution of swelling from an inferior border chin shave takes 4 to 6 weeks to occur and complete resolution 2 to 3 months. You are early on in the process and I would expect you to not yet be in the ‘benefits’ phase of the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have gotten a Vertical chin implant and was satisfied with the horizontal projection but the 45 degree angle vertical projection , I tried to like it but feel like I did not need the extra vertical or 45 degree angle look. My question is, if I switch the implant to a Terino square chin implant, will I lose the vertical height and 45 degree projection length and have almost the same horizontal length projection of the chin implant.
A: With the chin pad stretched out at 45 degrees I would be aware that switching to a pure horizontal projecting chin implant with the same horizontal projection may leave some loose tissue vertically. Whether that is significant can only be known by doing it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m interested in testicle enlargement purely for aesthetic reasons. I just want very large testicles.
I’d like to explore these options, and the pros and cons for each. For example, can I still go on a 6 mile run with either approach? How about ejaculation? How long do the implants last?
I also have a small hydrocele on one testicle. Do I need to get this removed beforehand?
A: In answer to your testicle implant questions:
- While there are two method for testicular enlargement (wrap around and side by side) I am not enthusiastic about the wrap around method due to the high rate of complications. (testicle-implant separation) The side by side method is best of one has naturally small testicles not normal size ones.
- Large testicle implants may interfere with running given the larger masses betwen your legs.
- Testicle implants do not interfere with ejaculation.
- A hydrocoele would need to be removed first.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Earlier this year, a close friend of mine died from a brain tumor. She was adamant in her belief until the end that it was due to extensive dental work, including several titanium screws.
I’ve read the article by Zhou, “The unfavorable role of titanium particles released from dental implants”, along with others and I’m wondering if I should have the cheek, chin and jaw implants Dr. previously placed by another surgeon removed?
I am concerned with the release of nanoparticles as well as the Medpor material in the body. And since I have very noticeable masseter muscle dehiscence, I wonder if I should just remove the jaw implants for aesthetic reasons coupled with these health considerations.
I spoke to a prior patient of yours, who spoke highly of you and your skill, and he convinced me to see you for the removal of the cheek implants. He told me that you weren’t able to remove the jaw implants that another surgeon placed (this was after 4 years of being placed and mentioned there were issues with the screws and bone overgrowth, making it impossible to remove). I’ve had my implants in just a little over a year, and I’m wondering if I were to plan for their removal, would there be a way to see beforehand whether you would be able to remove them or if you would have issues similar to your patient’s.
I’m also wondering about the cheek implant removal and the midface suspension that would be required. When I spoke to another surgeon he said that he would suspend the cheek with screws after implant removal. Is this what you would do? As stated earlier, I’m seriously considering moving all foreign objects out of my body so if there’s a way to suspend the cheek without screws, that would be ideal. Please let me know.
Thank you again for your time and thorough explanations in our video chat. I’m looking forward to your response. Thank you, Dr. Eppley.
A: While one debate about the science of your implant concerns one can not debate about your emotional feelings about them. Thus I would agree that all of your implants should be removed. That is clearly the only way you are going to feel comfortable moving forward.
Any implant(s) can be removed. Win’s situation was different in that he was seeking a replacement for which the trauma of removing the jawline implant was not worth the risks for the modest aesthetic improvement to be gained with a new jawline implant design.
While there are benefits in some cheek tissue resuspension with cheek implant removal and screws are a convenient way to do so that would not make much sense given the premise of the surgery. Drill holes and suspending the tissues to the bone would be the non-implant method to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, We spoke a few years back. I was considering surgery to provide a more enchanted jawline/chin.
Whatever your expertise thinks would suit my face best a chin implant could dk the trick but if you think custom would provide me better results j would consider that too.
Curious to hear your thoughts. Below are a few pictures of a jawline I think could look most realistic for my face. And after that photo I will submit photos of myself.
Look forward to hearing back from you.
A: When you compare your jawline to your ideal examples what you lack is a smooth connected jawline look wtih defined shapes at the chin and jaw angles. Such a look can only be potentially achieved by a custom jawline implant. You only chose ‘spot’ implants such as standard chin or jaw angle implants when you can accept that such a result like your examples is not going to be achieved and that some improvement ids better than no change at all.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would the metal plates from a bilateral ZSO interfere with and/or prevent a future upper jaw advancement? I have no plans for this, but generally like the idea of keeping my options open. Especially if I develop sleep apnea as I get older.
A: A Zygomatic Sandwich Osteotomy (ZSO) procedure would not interfere with a subsequent Lefort I Osteotomy.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I got a moderately advanced sliding genioplasty about 4 months ago and I also do boxing. I am wondering if it is safe to return to boxing or sparring at this time. I don’t have an X-ray available and I understand you would need that to make a decision, but just in general would you say it is safe at this moment in time for the average patient (I was advanced 7 mm and 4 mm down).
A: Based on just a general comment with no details about your surgery I believe it would be safe to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in knowing more about the under eye hollow implant. What material is it constituted out of?My right eye is worse than my left eye. Are the implants tailor made in size and shape to each eye? Many thanks.
A: Custom Infraorbital (undereye) implants are made of a solid silicone material.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well. I would like to extend my gratitude for taking the time to read this message. I recently came across information about your clinic and its innovative craniofacial techniques in the field of aesthetic surgery. Through this email, I would like to inquire about the possibility of undergoing a surgical procedure to enhance the shape of my head. Your clinic’s expertise in extracranial skull surgery, coupled with the positive experiences shared by your patients on instagram, has piqued my interest. The prospect of safe and effective procedures to address concerns about the appearance of the head, from brow bones to sides and the back, is truly intriguing.
For a long time, I have felt self-conscious about the shape of my head and had no knowledge that solutions to such concerns might exist. The revelation that such procedures are available has given me hope that I can regain confidence and achieve the changes I desire.
I have enclosed documentation regarding the shape of my head for your review. Could you kindly assess whether surgery could potentially restore a more conventional shape to it? Additionally, I am eager to learn more about the estimated timeline for the procedure and recovery, as well as the associated risks and costs.
I understand that you have a busy schedule, but I would greatly appreciate your time and consideration in evaluating my inquiry.
I am genuinely hopeful about the possibility of collaborating with your skilled team to achieve a more confident and improved appearance.
A: Thank you for your inquiry and sending your 3D CT scan. You have a classic scaphocephalic head shape due to untreated congenital sagittal craniosynostosis. Thus it is long from front to back and narrow from side to side. This is treated in adults by frontal and occipital bone reductions to shorten the length and a custom skull implant to widen the sides and augment the upper back of the head. Your 2D scan slices show that there is enough bone thickness on the forehead and back of the head for some visible reduction in head length.Thank you for your inquiry and sending your 3D CT scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My daughter has been diagnosed with Treacher Collins syndrome and has a concave face. However, her bite is fine, with orthodontics and she has a slightly thinned cartilage (in her TMJ). One surgeon suggested she go for a Total joint replacement, rather than a double jaw surgery since her jaw joint is not stable and may/could get worse with time. I was wondering if I could just do a genioplasty for her for now, to see if we could wait and watch before we proceed for DJS, if she’ll need it in the future. Her airway measures 8mm but so far no symptoms of sleep apnea or tiredness. Thank you
A: Thank you for sending your inquiry and sending her pictures. It is not unreasonable to consider just a genioplasty for now as, even if she ultimately needs any of the other procedures, she would still benefit from an advancing genioplasty anyway.
Given her very short lower jaw/chin she likely would need a jumping genioplasty to get the maximum benefit from the procedure. It would be helpful to have some imaging done beforehand to check how much chin is actually present to be sure the operation can be successfully done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d like to know how much it’d cost to have facial liposuction, this would consist of perioral mound liposuction and the lower cheek area (near the jawline) for a sharper appearance.
I’m looking forward to hearing from you.
A: While such facial liposuction can be done I would not count on it creating a sharper appearance. If you don’t naturally have good bone structure defatting in between the cheeks and jawline is not going to make it more evident.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 21 year old female had an occipital augmentation surgery in South Korea 1.5 years ago (methyl methacrylate was used), however it didn’t fully correct the flatness of the back of my head. Would it be possible to have a revision surgery to augment the back of my head more?
Additionally, I am wondering if you place your implants above or underneath the periosteum?
A: To no surprise PMMA skull augmentation will always be inadequate for occipital augmentation because of its low volume. (usually 60cc of volume or less) Custom skull implants provide much better augmentation as their volumes are in the 120 to 150cc volume range, at least 2X bigger.
All skull implants are always placed below the periosteum.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I know you are an expert when it comes to chin movements and sliding genioplasties. About 4.5 months ago I had a sliding genioplasty done and recently I got a panoramic X-ray done at the dentists office. I noticed that there is a slight dark gap on one side along with a faint black line between the advanced chin bone and the rest of the jaw. My movements were 6 mm forward, 3 mm down, and 3 mm widening. Is this normal?
A: Such asymmetries in the osteotomy lines and in the subsequent back end of the osteotomy lines, while not desired, are not abnormal when the natural chin asymmetry exists with two different lengths/shape of the jawline on each side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, In addition to infraorbital-malar implants to correct my bone structure, do you believe one day it will eventually be necessary to also undergo a blepharoplasty/midface lift to address the loose muscles and ligaments that will become more pronounced over time under my eyes, or will the implant alone should solve the problem?
I would also like to enhance the definition of my jaw with implants. Can this be done during the same surgery?
A: In answer to your questions:
- Eventually, if you live long enough (and that is the goal) the rejuvenative procedures as you have described will ideally be needed. But in the short and intermediate time frame the implants will provide some rejuvenative midfaceimprovements.
- Jaw implants can be placed during the same surgery. Those two types of facial implants are a very common combination.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have very big thigh and tiny legs from my knees down to my ankle is very tiny. This has caused me a great deal of low self esteem. I have always ashamed of myself because of this. Please is there any surgery available for this to be corrected. I want to feel confident about myself. I want to be able to wear clothes that exposes my legs. All my life I wore only pants because of my legs.
A:The question is whether thigh and calf implants would be helpful or not. I suspect their lower leg augmentation effects would be insufficient but they are the only surgical option. I would need leg pictures to evaluate.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have small testicles and was happy to discover your website and the “wraparound” testicle implant method which you offer.I have 2 questions:
1) is there a waiting time for this surgery?
2) I understood that the length of the wraparound model is 6 cm – what is the width?
Alternatively I was also thinking about replacing my own testicles with artificial ones (I am almost 50 y.o. and do not plan children).
1) is the size bigger than “wraparound” solution?
2) will i need to inject anything more than testosterone – after the surgery?
Thank you for your reply in advance.
A:Despite having developed them I am not a huge fan of the wrap around testicle implant concept. The rate of postoperative separation is not insignificant. Solid testicle implants have none of these issues. Thus the side by side method or replacement (testicle removal) methods offer a more assured approaches as well as larger sizes. Regardless of size and implant style the width is always 0.7 that of the length.
Which method is better depends on your natural testicle size and how you feel about being with or without your natural testicles. The merits of removing your own testicles and what that means for hormone replacement afterwards etc are questions best a answered by a Urologist as this is outside my area of expertise.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m planning on getting a bbl as well and I was wondering if that had to be before or after rib removal. Thank you.
A: It makes the most sense to do it after the BBL surgery. See what you get out of the BBL surgery first before deciding whether rib removal is necessary.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a consult for hip augmentation by fat injection and was told I would need to gain weight for the surgery. Do you think I will have enough fat to do the procedure? Can the back between and around the shoulder blades be used for harvest? Is the use of postoperative compression helpful for making the fat survive better?
A: In answer to your questions:
1) Despite having gained weight the reality is that the amount of fat available for the hips is not going to ‘significant”. (but better than not gaining the weight) The term ‘skinny BBL’ is just a nice way of saying you really don’t have enough fat to do the surgery but we will do it anyway…just don’t expect much of a result. When you factor in the important concept of ‘halving’ when it comes to fat transfer the reality of the potential result becomes more apparent. (50% of what is harvested is removed for concentration, that amount is then split in half for each hip injection, and if one is lucky 50% or half will survive. (in the hips it will be less) Mathematically use 1,000cc of aspirate harvest (you will be very lucky to get that amount) and then cut it half for concentration (500cc), divide in half for each hip injection (250ccs) and then at best 50% will survive. (125cc)
2) The harvest sites are the abdomen and flanks. The back (shoulder blades) are not viable harvest sites.
3) No one knows how to make fat survive the best. Every doctor thinks they do. But the reality is that fat injection grafting is modern day alchemy. The biology of fat grafting by injection remains poorly understood in terms of what makes some fat cells survive and why others don’t. Thus postoperative compression vs non-compression is a perception not an established scientific method.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,If I would decide for testicle removal, do I have to inject only Testosterone till end of my life?
Or is there anything else that needs to be injected?
One more question: is the size 5.5 cm or 6 cm in the human shape?
(I saw some doctors use dog shape silicon testicles – I would like human shape).
A: Hormone management in the face of testicle removals is not my area of expertise. You would be well served to consult a Urologist to get accurate answers as to what the hormonal implications are with testicle removals and whether that is a wise medical decision.
All testicle implants that I have ever designed or used are in the human ratio of 0.7 width to length ratio. I have never heard of using ‘dog-shaped’ testicle implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Dr. Eppley is a very knowledgeable surgeon and I know he has a blog where he answers questions. I have a important question for dr. Eppley regarding revision rhinoplasty. I had a diced rib cartilage glue graft placed (dorsal onlay graft), however it looks way too big on my nose and is also wide. Is there a technique to remove this graft completely so that I can my original underlying bridge bone back?
A:That can be done. Such rib grafts heal by fibrous union so they can be safely dissected out for reduction or removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a LeFort I osteotomy to fix a recessed maxilla but it made the area above it recessed. Because of this, I’m interested in an extended custom midface implant for a LeFort III type augmentation, like the one in the picture attached, that I took from your blog (minus the area that the LeFort I fixed, obviously). If, down the road, I want an implant to augment my cheek-archs (like the one in the attached picture, that I also took from your blog), would it be possible to put them on top of the part that already has some of the extended custom midface implant? I know that it is possible to make a single implant for both areas, but I haven’t decided if I want to augment my cheek-archs. Thanks in advance.
A:In answer to your midface augmentation questions:
1) If you have had a successful LeFort I osteotomy you may only need to augment the rest of the midface that lies above it. (see diagram)
2) An arch onlay implant could be laid over the midface implant secondarily.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
