Your Questions

Q: Dr. Eppley, is it possible to remove the gap I have in the glabellar area?

is it possible to make it look like that guy? what bothers me is that hole in between my eyebrows.Thanks.

A: If the deep frontonasal angle is the primary issue  that is always going to require a bone graft or implant to help push it out. Reduction of the brow bone protrusion at the frontal side of the angle is complementary to that effect. ..meaning it helps open up the angle as well.

But will it ever look like your ideal mage….no. Your anatomy is way different.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Please see pics of my legs. I would like both thigh and calf implants. The calf implants are to be long to give my lower leg thickness as my present calf muscle is very short

For the thighs it overall thickness 

My legs are too skinny . I am 5ft 6in.

Will implants with fat graft be the solution?

A: Thank you for your inquiry and sending your leg pictures. I think when it comes to the concept of increasing overall leg thickness that implants are really spot augmentations, or in the legs, a linear line of augmentation. They do not per se create overall thickness, although they can create the perception of a thicker or bigger leg, because of its linear line of augmentation.

When it comes to your calfs with the muscle, being short, or limited to the upper half of the leg, that implant augmentation needs to be longer than the muscle. The only way that can be done is to have an implant that is placed above the muscle on top of its fascia at the subcutaneous level. Fat grafting is not an option for you, since I doubt if you have enough fat reserves to harvest and fat survives very poorly in the lower half of the leg anyway. 

Although your thighs have not been included in your pictures, thigh implants are restricted to the rectus femoris and vastus lateralis muscle unit on the anterolateral thigh.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Could I get a wider forehead with only fillers?

A: For a significant and smooth forehead widening fillers will not be effective. That is simply not the role that the use of an injectable soft filler is meant to do.

But there is always one way to prove or disprove whether fillers will work…try it and see.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a tiny and thin egghead. Especially the forehead are the upper left and right edges are very thin. Is IT possible to make the forehead a Bit wider. Like 1cm. And what surgery material would be ideal in my Case. In the picture you can see what I want.

A: Based on your drawing and description you are referring to forehead augmentation with an emphasis on forehead widening. In many male custom forehead implants it is not uncommon to widen the forehead known as lateralizing the bony temporal line. The wider or thicker the sides of the desired forehead augmentation is the more the implant design must extend posteriorly for a smooth transition. The attached forehead implant design is an example of this concept and not meant to illustrate what your exact implant design may be.

Such custom skull implants are made of solid silicone which offers the only implant material that can can be made with feathered edges, can sit on top of the temporal fascia (which is an absolute necessity) and will feel just like bone.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I had lip lift surgery last June and the results are minimal. I feel like the look hasn’t changed much, the philtrum is just a tad shorter. The surgeon has refused to take a few more millimeters off as he says my smile will be gummy. From the research I’ve done I believe my best bet would be vermillion border – upper – advancement. 

A: In a subnasal lip lift overcorrection can cause an A frame deformity (not a gummy smile) where the central vermilion is much fuller than the sides of the lip creating a vermilion height discrepancy in the shape of the upper lip. Whether you would benefit now with a secondary subnasasl lip lift, a secondary subnasal lip lift that also needs lateral vermilion advancements or converting to a total vermilion advancement requires seeing some pictures of your lips to make that determination. 

The total vermilion advancement is typically served for very thin upper lips with little vermilion show, an upper lip that lacks any significant cupid’s bow shape or for the patient seeking an extreme lip augmentation effect. The reason being when you make a scar line cross the cupid’s bow, as profound as that aesthetic effect may be, you have to have a compelling reason for doing it.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am aware that PowerFlex Pectoral II ACP12-3 (293cc) is an option that we discussed for my pectoral implants.  Would PowerFlex Plus HTPI-2 (596cc) would also be an option for pec’s?

A: That is the big daddy of pectoral implants for those seeking a major/extreme change. A pectoral implant of 596ccs is a radical increase in volume from 293ccs. And one has to be big in stature for it to even fit. (over 6′ tall etc)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m just enquiring if you offer a procedures for the mental crease between my chin and bottom lip? I’ve seen some case studies on your website and they look like exactly what I’m after. I have attached a picture below for context.

A:Thank you for your inquiry and sending your picture. You have a deep labiomental fold because your chin is vertically short. This causes the soft tissue chin pad to be compressed upward deepening the depth of the labiomental full between it and the lower lip. The correct and only treatment is vertical bony chin lengthening with an intraoral osteotomy with an interpositional graft. This will pull down the soft tissue chin pad as the bone lengthens  which will then decrease the visible depth of the labiomental fold. The attached imaging shows the effect on the fold when the chin is vertically lengthened.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve seen your amazing work and read many articles on your website — they’re truly remarkable and insightful. I’m interested in a procedure to correct the back of my head, which is relatively flat and appears somewhat disproportionate. I have a few questions before moving forward: What material would you recommend for this type of augmentation? Given my current head shape, would PMMA be a suitable option? How long should I avoid high-intensity sports after the surgery? I have craniofacial hyperhidrosis — should I be concerned about any long-term effects related to this condition following the procedure? I enjoy skiing, for example — are there any risks associated with impact if materials like silicone are used? How does the implant feel to the touch once healed? Could you please provide an estimate of the total cost of the procedure and your current availability? Thank you very much for your time and consideration. I look forward to your response.

A: The only truly effective material or method for any form of aesthetic skull augmentation of any size significance is custom implants made of a solid silicone material. The use of bone cements is a poor alternative and is only of near historic significance at this point in my skull reshaping experience.

Once you are fully healed, three months after the surgery there are no physical restrictions. Think of a custom skull implant as placing a bumper guard on the skull. It will feel as hard as bone and coincidentally will act as a method of protection.

As for scalp hyperhidrosis that is a superficial issue at the skin level and has no negative impact running implant placed down on the skull bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The main issue is I feel it’s abnormally large head which disproportionate to the rest of my body, in addition to my face being too round and full which I believe significantly distorts my features. I’m 37 years old… 6’1, 275lbs, but even before I gained this weight, I was an avid weight lifter and I incorporated cardio into my workouts. For years I maintained a weight between 235lb-245lbs; however, the weight in my face never seemed to significantly fluctuate as I would have liked. So now I feel surgery is my only option. Essentially, I want a slimmer, more sculpted face. I don’t know if my goals are realistic, and exactly what procedures I would need, but I’m sending pics of myself and the look I’m hoping to achieve.

A:Thank you for your inquiry and sending your pictures. I think we have to acknowledge that you achieving hey look that is similar to the ideal pictures is not achievable as they have completely different faces, body type and wait. But there is nothing wrong with having goals. The real question is what can be done with the anatomy that you have. When it comes to your head shape the most practical improvement would come from narrating the sides of your head so they are less convex and more of a straight profile. When I say practical I am specifically referring to the lack of any visible scars to achieve that change. In the shaved head male one must be very cautious about scars and their  length and location as scars are an aesthetic trade-off that must be balanced against what is the statically again. At least the temporal reduction procedure for head narrowing is essentially scarless.

From a face standpoint it appears in all of your pictures that you hold your jaw down and forward in what is a common jaw thrust maneuver as patients feel that that makes them look better. Besides creating a more defined jawline it also helps lengthen the face or deround it. This deliberate jaw positioning is really a test of the effects of facial lengthening.. Thus it appears that a custom jawline implant to make that type of permanent change without having to create it as well as some cheek defatting would be the most successful procedures to slim or deround your face.

To evaluate these concepts in more detail I need facial pictures from three different angles, front side and three-quarter view in a non-jaw thrust position, to do predictive imaging the effects of the procedures that I feel would most benefit you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, For many years I could only wear a hat because of these deformity. Do you think there is a way to fix it without making it look feminine?

A: Thank you for your inquiry and sending your pictures. I believe what you are referring to is the large brow bone protrusion that you have. When it comes to brow bone reduction, while itis most commonly associated today with forehead head feminization in the transgender patient, in my experience about 50% of the brow bone reductions I have ever done are in men. There are different brow bone reduction variations in male brow bone reduction versus transgender brow bone reduction. In the transgender patient the goal is to make it completely flat which is more consistent with that of the female forehead. In the male the goal is not to make it completely flat but to reduce it enough so that it no longer looks Neanderthal-like or overly protrusive. In essence in the transgender patient the goal is to create a different gender appearance. Conversely in the mail it is about reducing an abnormal protrusion of the brow bone and to make it look more normal in projection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q; Dr. Eppley, For ,my custom jawline implant design ,my questions are: 

Questions

1. What is my skull’s current bigonial width-to-bizygomatic width ratio, and what do you think will be the ideal ratio for me? What percentage does the current implant design change this ratio to? I’m hoping for the ratio to land somewhere in the 90-95% range, but I’ll defer to you on what will look the best. I think the back corners of my jaw are close to an ideal width in their current state and only need a minor augmentation, but I’d be interested to know your opinion on this. While we don’t want to add so much width that it looks weird or unnatural, we do want to add enough width to make a noticeable positive impact, *especially* in the areas nearest to the chin.
2. What is my skull’s current Frankfort mandibular plane angle, and what do you think will be the ideal ratio for me? What angle does the current implant design change this angle to? I’m hoping for something in the 22-25° range, but again, I’ll defer to you. I think my current jaw angle is far too high, and the current implant design appears to me like it might not lengthen the ramus enough to adequately lower this angle, but again, I’ll defer to you on what is ideal for me.

Goals:

We want the implant to “unround” my face and optimize the masculine balance of the lower face, rather than purely maximizing the size of it—all the changes should look very masculine, but also very natural, balanced and proportionate—while we don’t want to undercorrect and not add enough, we also want to avoid overcorrecting and adding *excessive* bulk. The implant should achieve 4 main things: 

1)Significant vertical lengthening of my jaw: we want to lower the ramus and mandibular body to create a more masculine angle and shape. I’ll leave it up to you exactly how much to add vertically, but the result should look very masculine, yet natural.

2)Obviously by adding significant vertical length, we’ll also be adding substantial width, because of the outward sloping angle. We definitely want the implant to add an impactful amount of width, especially in the areas nearest to the chin—but let’s also be careful not to add *too much* width, because I don’t want it to look excessively bulky or boxy. Again, we want the width to look very masculine but natural.

3)Significantly widen the chin in the front, creating a strong, square chin with defined angles. The widening of the chin needs to be significant enough to stretch the skin and get rid of the puffy “carp-like” look in my lips and cheeks. 

4)Horizontally lengthen the chin 4-6 mm, for the same reason—to eliminate the carp lip. If the implant adds a few mm of vertical chin length as a mere byproduct of the wraparound, I wouldn’t be opposed to that either.

A: For the purposes of custom implant design clarifications;

1) Implant designing is not like orthognathic surgery which extensively uses cephalometric landmarks. Thus we do not use any of these measurements, ratios or numbers to make a custom implant as the end goal is to make an external soft tissue change. This is not a measurable process and until someone establishes what the impact is of augmenting bone to its soft tissue effects this will continue to be more of an art than a mathematical science.

2) Implant designing must factor in a major consideration of which a patient would not be aware…. the ability to accurately and safely place it. This consideration has major influences on the design and is one that I would only be aware.

3) The first implant design is a good approximation of what the final implant design would be since I made it based on the general goals of what can be accomplished. From a chin standpoint there can be no changes to this first design given the soft tissue restrictions imposed by the prior vertical lengthening bony genioplasty.  I am not even sure if those implant dimensions will even fit but I am willing to leave it that way as should some implant reduction be necessary it can always be done in surgery. I would rather keep that amount of chin implant volume in the hope that I don’t have to modify it.

4) There is some room for additional implant volume back in the jaw angles as indicated in the attached diagram. However this is the maximum amount but I am willing to do.

5) I can certainly appreciate all of your well described goals but they defy any specific measured way to achieve them. And even if we knew exactly what those measurements would be they would have to be modified if they exceeded my design specifications to be able to be surgically placed anyway. Thus we are really creating an implant design that is driven more by soft tissue limitations as well as what can be placed as a one-piece implant.

6) That being said the overall implant design is certainly going to get you closer to your stated jaw augmentation goals but how close they will do so remains an unpredictable outcome.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in skull reshaping surgery for my 12 month daughter.

A:In the skull reshaping procedures that I perform these are for adults not infants and children.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does the mouth widening surgery also give a wider smile and Is it possible for me to see some after pictures with the scar healed.

A:By definition if you make the mouth wider at rest it will also get wider when one smiles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’m 22 years old and I’m looking for help with facial asymmetry. I have one eye slightly higher than the other, uneven cheeks and smile lines, and a mouth that shifts when I talk.

I’ve been told this is natural and can’t be fixed, but I believe it affects my confidence and quality of life. I’m interested in understanding whether facial balancing surgery or structural correction could help in my case.

I have had facial asymmetry since childhood. I feel that one side of my face appears straight, while the other side looks slightly curved — similar to how hands look when raised in prayer, with one side more inward or rounded.

This difference becomes more visible when I talk or smile, as my face shifts more to one side. I believe the issue may be due to bone structure or muscle imbalance.

Could you please tell me if this kind of facial asymmetry (possibly involving zygomatic bone or jaw alignment) can be corrected through surgery or other treatments?

A: While you have numerous facial asymmetries, as you have mentioned, most of them do not justify surgical intervention as they can not be completely corrected. I don’t think surgery is worth the effort. The exception is your twisted smile which is the result of congenital paralysis of the left marginal mandibular branch of the facial nerve. Your left depressor anguli oris muscle does not work which is why the left lower lip is higher than the right at rest and pulls up even higher as the right lower lip when smiling pulls it to the right. While you can never make the nerve work to activate the depressor muscle you can do a vermilion advancement of the left lower lip to partially camouflage the severity of the smile asymmetry by evening out the amount of vermilion show at rest. 

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I have a prominent zygomatic arch that extends outward due to acromegaly. From beneath the eyes to the ear. Is it possible to push this bone inward without damaging the muscle attached to it?

A: What you are referring to is classic cheekbone reduction osteotomies…which is essentially zygomatic arch osteotomies to move the entire bow of the arch inward. This does not adversely effect the temporalis muscle which passes underneath the arch or the origin of the masseter muscle which attaches to its side.

Before such  surgery it is prudent to get a 3D CT scan to plan the osteotomy bone cuts.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in XL breast augmentation 2,000 cc’s +. I’m a man, so am I a potential candidate?

A: Whether one be a male or female you can’t go from 0ccs to 2,000ccs implant volume in one procedure. The tissues simply will not immediately expand/stretch to accommodate that implant volume.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m trying to understand how the umbilical float procedure is typically consented to. When performing an umbilical float, is the informed consent modified to reflect this technique, or is the procedure generally performed under the standard mini abdominoplasty consent without any changes? I would appreciate any clarification Dr. Eppley or his team can provide.

A: I don’t know the basis of your question but in my practice the decision of using an umbilical float technique (if indicated) in a subtotal or mini- tummy tuck is preoperatively made. That decision may be based on the patient’s preoperative desire (scar avoidance), the desire to keep umbilicus at its current position (no lowering) and/or  an understanding of the relationship of skin removal and the impacts on it from either the umbilical transposition or float techniques.

Dr Barry Eppley

World Renowned Plastic Surgeon 

Q: Dr. Eppley, I’m 38 and had all my top teeth pulled for a full arch implant but I needed to go away for 4 years and experienced extreme bone resorption atrophy and increased underbite and now am not eligible for traditional teeth implants.. but my face lost volume in a crazy way I have bad bone density and my nose started sinking in my face and I have Huge nasal labial folds and my face doesn’t look right I am miserable.. can you guys help?

I’m thinking premaxilla face implants but I dunno I’m worried my bone density is an issue.

A: With severe maxillary bone loss midface implants have a much higher risk of complications due to reduced mucosal soft tissue coverage.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I recently had custom cheek implants make of PEEK with a custom guided genioplasty. I have no pain on the left side or sensibility issue. However, the right side is still numb from the lower eyelid to the upper right lip, and i can’t really move it or smile properly. I was told that it was normal at 10 days post-op, however, i still feel some strange pulsating sensation that are not very painful but still disturbing, again only on one side, it comes and goes. Moreover, the “custom” genioplasty left my chin asymetrical (please find the attached pictures. After reviewing the CT scan, I saw that one of the two screws was not put in the intended original place, but closer to the center. Could it be that the screw is in a dangerous area like the sinus cavity ? Is it normal to still be numb, and how can I see the implants on the CT scan?

A: I can not ethically comment or provide recommendations on surgical management or outcomes when the patient is under active care by the surgeon who performed the procedures..

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Would I need significant lengthening that needs surgery (>6mm) or an implant can suffice to address my concern of a smoother side profile and mental crease removal/smoothening?

A: I think what you mean is whether you need vertical bone lengthening, which is needed for chin length increases greater than 7mms. When less than 7mm is needed then this can safely can be done by an implant.

That determination requires a more indepth assessment and imaging of your pictures. But my initial impression is that 5 to 7mms of vertical length is needed.

But no matter what you do the labiomentla fold can not be ‘removed or completely smoothed out’. That is not an achievable outcome. It can only be partially reduced in depth.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant, which did provide some chin projection improvement, but did not achieve my ideal goals. Will a custom chin implant do better?

A: When considering different implants for an improved and more desired augmentation effect you have to know exactly what the implants are and where they are on the bone. Thus a 3D CT scan is most beneficial as it will clearly this important information. In your first surgery the surgeon guessed what will work. You don’t guess the second time as you have more information that can clearly be identified.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I was born with a webbed neck. But don’t have any syndrome that caused it, i really hate the way it looks and am trying to find options to get it done with surgery. First the only option was to have scars on both sides and i chose not to do that, then i saw your surgeries where the scar is at the back, what didn’t look bad, but i was wondering if a surgery like that would be possible for me. Hope you could answer that, thanks

.A:Thank you for sending your neck pictures. Your neck  appearance is fairly classic particularly for non-syndromic neck webbing. Most neck webbing i see is not associated with a genetic proven syndrome such as Turner’s or Noonan’s syndrome. As you may well have read there are different techniques in the treatment of neck webbing which primarily can be differentiated by those that are performed laterally on the side of the neck and those that are based more posteriorly on the back of the neck. While there can be debates about which produces a more effective and sustained correction of the neck webbing it is probably true that a direct lateral approach is a bit more effective. But the visible scarring for many patients may not be a worthy aesthetic trade-off. Thus I have always used a more posterior approach to keep the resultant scars more on the back of the neck as opposed to the sides. With the posterior approach there is always going to be some amount of relapse which is maximized in the first few months after the surgery. This is usually in the amount 30 to 50% from that scene immediately after the surgery. For most webbed neck patients  this is acceptable and they never move on to have a secondary revisional procedure which can maximize the results using the existing scars from the first surgery. This is the trade-off of the posterior approach. As you can see by this description no form of webbed surgery is perfect and each type has their advantages and disadvantages. I, and almost all patients, would prefer the option that better hides the scars. Once the scars are on the side of your neck with the lateral approach, no matter how they are revised, they are always going to be very visible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in rhinoplasty to correct nasal asymmetry.

A:Thank you for sending all of your nasal pictures. I am going to assume that you have never had any prior nasal surgery and this is either the natural result of your facial development. While fundamentally what you see is nasal asymmetry there is also some development differences between the two sides. This is particularly seen in the nostrils where the right nostril is smaller and more highly position than that of the left. As a result in straightening the nose through basic cartilage and bony repositioning techniques the left nostril will also have to be reduced to better match that of the right side. This will be particularly needed given that there will be a right shift of most of the nose This will automatically make the right nostril smaller and the left nostril bigger, hence the needed left nostril narrowing needed with the overall procedure. The best nasal asymmetry results come from an open Septo rhinoplasty procedure. Whether you may also want narrowing of the nose particularly in the tip is a personal choice which you have not mentioned up to this point.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in custom temporal implants for head widening. My questions are:

1) Do you factor in the implant’s design the amount of postoperative swelling that will occur?

2) What is the usual thickness of head widening temporal implants?

3) Can you make an implant design and then show me what it will look like on myself?

4) Can I see before paying for the surgery what my implant design would look like?

5) Can you predict how much temporal fullness will be lost when the swelling subsides?

6) Can I connect the previously placed custom skull implant on the top of my head with these new custom head widening temporal implants?

7) how can I be assured that after the swelling subsides I will have the head widening amount that I want?

A:I can answer all of his questions in advance of our virtual consultation.

1) Since these are custom implants they can be designed with any thickness dimensions as long as they can fit or be surgically placed. For the purposes of factoring in the effects of postoperative swelling one simply has to guess how many more millimeters that would be an implant thickness. There is no exact science as to how to factor in for postoperative swelling. To me what that means is maybe an additional 2 mm of thickness.

2) Since these implants would be submuscular a safe temporal with is 5 to 7 mm maximum.

3) There are no tools to accurately show people what their postoperative results may be. All we can do is use preoperative Photoshop to determine the patient’s goals. Ai is not going to be helpful as is there is no database of information about the effects of implants on an external appearance.

4) The only method to show a 3D implant design/rendering is to actually engage the implant design process with 3D Systems. They are the company that does all of that implant designing but they don’t do so until they are paid.

5) There is no known method to tell you how much fullness will be lost after the swelling subsides.

6) You can always in the future add volume to the front or back of your head with additional implants, that is not an issue and can easily be done with additional implant designs. The problem is if you try to connect the front or back to the sides where the implant must sit above the muscle on top of the fascia where implant edging and chronic fluid collections are real postoperative possibilities.

7) There are no strategies for maintaining postoperative width fullness. You pick a number that you want the implant to be and you hope when it is all done and said that it largely achieved what your with desires are.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My hope with reaching out to you, would be that you can help me find my way back to my old self. I had a deep plane facelift that took all of my volume and left me looking much older even at a full year if healing.  I am interested in a custom cheek implants. I do not want an apple cheek. I have also included attached images (which are most likely phoroshopped) of the desired aesthetic look I would like to achieve. If at all possible, I would like my old self back.I do not want filler, nor fat grafting. I had micro and nano fat with the deep plane, which now gives the appearance of jowling, as my cheeks have lost volume, so it looks like areas are sagging and hollowed out, this is in my orbital area as well. I will forward those pictures revealing the poor result. Please help!

A:Thank you for your inquiry and sending all of your pictures. This is an unfortunate outcome and I can certainly understand your concerns and objectives. The soft tissues  of the cheeks have lost projection (technically not lost volume, just that the volume has now been displaced laterally, strerched ad compressed by the tighter overlying skin) You are correct in that any type of soft tissue augmentation is destined to fail because the pressure of the tighter tissues will be hard to give any adequate push outward with a soft material. Only an implant off of the bone Canal provide they needed secondary projection.

The concept of the cheek augmentation that you are now seeking is largely bone based. The traditional apple cheek augmentation effect is more soft tissue based where much of the augmentation is below the actual cheekbone. You are also correct in that only a custom cheek implant design can reliably affect this type cheek projection change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What are your thoughts on the incision for the mouth widening surgery being done inside of the mouth. I know there is an option for lip corner lift and was wondering if the same could be done for this procedure.

A: To be effective mouth widening requires skin removal as it is a relocation of the vermilion – cutaneous border further out on the side of the face. Thus any attempt to do intraoral mouth widening is not going to work.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How soon post Radiesse filler can I get the jaw augmentation done?  Is there a waiting period (I got it in April).

A:I am not concerned about existing filler as it does not interfere with the custom jawLINE implant design or surgical placement. Whatever filler is present will quickly be resorbed  due to the swelling and inflammation from the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I don’t like the protruding forehead/frontal bossing and the prominent occipital protuberence… if they could be rounded a bit i hope it wud do a good job in both shape and reducing size. Thank you

A:Thank you for sending your pictures. The question is not whether the occipital  prominence and the frontal bossing can be reduced… as they can. The most important issue is surgical access to do so. Typically the occipital prominence is approached placing asmall  horizontal incision on the lower end of the occipital bone at the bottom of the prominence and this heals extremely well. The frontal bossing of the forehead is usually approached with a frontal hairline incision which also can heal very well. The other option is halfway between the two with a long scalp incision from the top of one ear to the other to approach both areas. Besides the undesirable length and location of this incision it also does not provide the best access to the occipital prominence.

Both procedures can be performed during this same surgery under general anesthesia. The exceptional prominence reduction is first done in the prone position and then you would be turned over while asleep to do the frontal Boston reduction in the supine position.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’ve been struggling with the shape of my pelvis, and I came across your page regarding iliac crest reduction. I’m currently considering pelvic contouring surgery, and I would like to ask you a few questions. As a woman, I’m concerned that my pelvis appears high and narrow, giving it a more masculine look. Would it be possible to shave or lower the upper part slightly to create a more feminine silhouette?

A: In the high and narrow pelvis you cannot make it wider or have a more feminine silhouette by shaving down the iliac crest. This will simply make it a bit less high but will provide no width to it. The definitive procedure is the application of a titanium iliac crest implant which is designed to do exactly what you want to achieve. This implant sits on the side of the iliac crest and its entire intent is to feminize the pelvis. (see attached diagram) Such implants come in a variety of widths from 15 mms up to 50 mm. The most common widths used is 35 mm but by your own description you may not even need that amount. More accurate sizing depends on knowing your height and weight as well as seeing pictures of the thickness of the soft tissues over your iliac crest. As the widths become greater this can in some patients cause a sub iliac hollow which is which is why in the complete Pelvic Plasy procedure the titanium plate is combined with an attached silicone hip implant. But as long as the width of the implant is not too great and one does not have a pre-existing sub iliac hollow the attached hip implant may not be needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Apart from mouth widening surgery, I am also wanting to replace my breast implants, I currently have 950cc silicone implants and am wanting to have much larger silicone implants (1300 or 1400cc, Mentor have just released these size silicone implants.) Would that be possible to combine the two surgeries together?

A:Yes it would. Mentor now has silicone 1140, 1240, 1330 and 1430cc implants available.

Dr. Barry Eppley

World-Renowned Plastic Surgeon