Your Questions

Q: Dr. Eppley, Hello! I was wondering if you perform surgeries that can increase the space between the eyes? My eyes are too close together, and I am interested in getting a surgery to make them more wide-set

A: The type of procedures that can make a significant difference in increasing interpupillary distance, orbital box, osteotomies, or not generally considered aesthetic procedures due to the scope of the surgery. Meaning the aesthetic trade-offs of a bicoronal scalp scalp scar to perform an effective orbital box translocation must be considered very carefully.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I am interested in your large skull reduction procedure. My head circumference is about 23.5 inches, and it looks disproportionately large compared to my frame. I was wondering if the burring method could be used around the entire skull to reduce the size, and if it would be possible to get the circumference under 23 inches, which I know depends on my anatomy, just hypothetically speaking. Also, if you could tell me an estimate of the cost, that would be great. Thank you!

A: In a more complete skull reduction procedure based on the need for a circumferential reduction, the bone burring technique only applies to the bony forehead and back of the head.  For the sides of the head, it is the temporal muscle that is reduced as that is the dominant tissue over the thin, temporal bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to make my face more angular. I thought that a three level facial augmentation could be my best option. Is it a good idea or does It risk too look “too much” for me? I’m not sure about brow bone augmentation btw. I’ve had double jaw surgery and rhinoplasty in the past and some facial fillers and I’m quite satisfied about the results. My face Is more harmonious than before. This is like an extra to bring some angularity and I’d like that to be natural. Thank you!

A: Thank you for sending your pictures. You are correct in that to make your face more angular ideally it involves all three levels. Technically the upper and mid face are the most needed in that regard as they lack projection unlike your lower drawl. Because of your prior jaw surgery major strides in lower jaw shape improvements have already been achieved. You’re also correct in that a ‘little bit’ in each area goes a long way and it is the composite overall augmentation that makes the more angular face change. Anytime you do two or three levels of facial augmentation almost always one has to be most cautious about excess  projection as opposed to when one has a singular major facial level deficiency.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have VOD (right eye lower). I will send (attach) photo. can it be fixed? I am planning on getting the right eyebrow lifted with botox next week (I have done this before), which kind of helps to even things up, but as you can see, the pupils do not line up horizontally at all.

A:Thank you for your inquiry and sending your picture. When the eyebrow is raised the perception of VOD becomes more apparent. Unlike raising the eyebrow with Botox injections, however, lifting up the eye requires more effort. Elevating the eye also requires adjustments of the upper and lower eyelids that drape over and around  it. As a result it takes a combination of four procedures to satisfactorily do so including an orbital floor-rim implant for globe elevation, lateral canthoplasty for raising  the outer corner of the eye with spacer grafts of the lower eyelid and upper lid level elevation. (ptosis repair)

I never few VOD surgery as a ‘fix’ as ideal symmetry between the eyes can never be achieved. Rather it offers an improvement than lessens the perception of the VOD.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to know more information about scalp rolls removals and wrinkled skin at back of head.

A:Thank you for your inquiry and sending your pictures. In looking at your pictures my suspicion is that this scalp roll may be associated with a bony overgrowth of the occipital knob or nuchal ridge line. It would be very unusual in a young person with your neck shape to have true excessive scalp  rolls alone. The determination if the scalp roll is caused a bony projection is how it feels. If the scalp roll feels fixed and minimally mobile then it is due to a bony projection which needs to be reduced with a little bit of excessive scalp removal. If it is soft and mobile, moves up-and-down, then it is a soft tissue issue alone where excision of the scalp roll is needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in undergoing a reverse otoplasty targeting the lower and middle portions of my ear. I previously had otoplasty and part of the ears are too close to my head. From my research, I believe this may require the use of a grafting material to achieve the desired projection. Given your extensive experience with these procedures, I’d greatly appreciate your insight into a few questions I have: 1. Is it possible to achieve the desired ear projection without using an implant? In other words, could existing ear cartilage be harvested and repositioned to act as a structural strut? If so, would this compromise the aesthetics, structure, or shape of another part of the ear? 2. If cartilage harvesting is not viable, what materials are commonly used as struts, and what are their pros and cons? I’ve researched several materials and would like to know your thoughts on each: • Cadaver Rib Cartilage: This seems quite stiff—comparable to a popsicle stick. But this is just my uneducated opinion in looking at online pictures and reading that ear cartilage is elastic while rib cartilage is hyaline (and much stiffer). Could this rigidity become problematic or painful/irritating when side sleeping? I’ve also read that cadaver cartilage may reabsorb over time. If that happens, would the ear lose its projection? And what does reabsorption mean in these cases? Additionally, why is cadaver ear cartilage not commonly used? Could it provide subtle support in projecting while preserving the natural softness of the ear? • Implantech ePTFE Ear Implant: This material appears to mimic the flexibility and texture of natural ear cartilage. However, it doesn’t seem to be widely used. Is there an elevated risk of infection associated with this implant? If so is it a lifelong risk or just for a period of time after surgery? • AlloDerm: While not commonly used for this purpose, could AlloDerm serve as a strut to project part of the ear outward? Is it strong enough to act as a buttress in the cartilage? Does it carry a significant infection risk? Is its texture similar to ear cartilage? Meaning it is softer/ flexible. Can it reabsorb like rib cartilage? It says this can promote tissue regeneration. What does this mean? Can something natural regrow to take its place and maintain this buttress in the ears? • Medpor Ear Implants: What exactly is Medpor? Is it a rigid plastic or something more flexible like the ePTFE material from Implantech? My primary concerns are: • Will the graft material remain stiff permanently if using cadaver cartilage or another material? • What is the long-term risk of infection? Is infection only a concern during initial healing post-surgery for some time, or can an infection on some materials develop years later even without injury to the area such as a cut? Thank you in advance for your time and guidance. I look forward to your thoughts.

A:You have correctly surmised that in a reverse otoplasty it takes a strong strut of material to push the ear out and maintain that position. I have used a wide variety of materials from titanium plates to cadaveric rib cartilage. They all have had various degrees of success but the rib cartlige has been the most successful as it provides the strongest strut. As you have also surmised the trade-off for its use is that it will be stiff on the back part of the ear. It is also a graft does not resorb as it acts more like an implant even though it is a biologic material.

The other most successful option would be an ePTFE wedge material from the ear implants that I developed for implantech. That could be placed in the released anti-helical fold and would avoid the stiff feeling strur on the back of the ear. Its trade-off is that it is an implant with associated higher risk of infection/extrusion. But in my experience to date that risk is very low. No implant material, however, can never better the negligible risk of infection with a biological material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I have currently have silicone implants, size medium. Please see link to the model below:

https://www.implantech.com/product/conform-terino-malar-shell/

Previously to this, I had the combine malar shell implants in size small:

https://www.implantech.com/product/combined-submalar-shell-2/

I absolutely loved these implants and feel they really suited my face. Unfortunately I developed a small infection, so the surgeon opted to remove them and do a wash out. When he reinserted the implants, they had ordered a different model by mistake which is what I have now!

I feel the projection is not quite right and would like something that projects a little lower in my mid face.

I have had the current implants for over a year now. My goal would be to either remove these implants and do a custom implant, or remove these implants and replace with the original model.

A:The effects of any facial implant is a function of the implant’s shape and size as well as its placement. You are assuming in looking at these two different cheek implant effects that they have identical placement both times and the only difference is in the two implant shapes and sizes. Assuming  that to be true, which is a big assumption in facial implant surgery, if you were happy with the first set of implants logically that would mean you should just replace what you currently have with the original malar shell implants.

Oner of the benefits of custom implants is the ability to create implant designs which do not currently exist as an off-the-shelf available implant.One of the other benefits of custom implants is the ability to see exactly where’s your current implants are placed and then designs can be made around to specifically create the optimally desired implant shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, https://exploreplasticsurgery.com/case-study-correction-of-eyeorbital-asymmetry-with-hydroxyapatite-cement/ Hello, I found you through this article. The man in your post is experiencing the same problem with my eyes. I live in Türkiye, and I don’t know if there are any doctors specializing in this. If I were to come to you for an examination and surgery, could I inquire about the average cost for the same or similar procedure?

It’s visible in the photo I sent you. I think it’s called Orbital Dystopia. I’m curious about what can be done and how much it costs.

A:VOD improvement rarely comes from a single procedure such as orbital floor augmentation regardless of the material used to do it. It usually requires a combination of bone augmentation and management of the upper and lower eyelids as well as the eyebrow that drapes around the lwoer eyeball and orbital socket. All structures have to be addressed for a satisfactory improvement. It usually takes a combination of five individual procedures done doing a single surgery which include orbital floor– rim implant augmentation, endoscopic brow lift, lower eyelid elevation with spacer grafts, lateral canthoplasty and upper eyelid elevation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, can woman get this done the side of your head temporal implant and can it increase cognitive function?

A: Women as well as men can have temporal implants if so indicated. This is a cosmetic procedure which has no effect on cognitive function.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 66 yr old male who has always been very thin and very limited in the pectoral muscle area. I have read that pec implants can be done on males. I would be interested in seeing if you feel I would be a viable candidate and if I would really be able to notice a difference. Thank you

A: Pectorals implant for chest enhancement has been done in males for almost 40 years so this is not a new aesthetic concept. What has changed over the years is the improved softness of the implant material and the different shapes and sizes that are available.

I am sure you would be a candidate as the only eliminating factor would be a patient who is opposed to implants.

There are many different sizes so the goal is to find what your upper limit of tolerance is for the chest size change which can be determined by in office sizing via sample placements.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to widen the mouth ever so slightly with a corner lip lift? Or is a commisuroplasty the one and only way? Would there be a difference in achievable width in different cases? For example would there be more width for someone with a downturned mouth than someone with a “normal” mouth?

A: All of your suppositions about the effects of corner lip lifts and widening are correct.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve always struggled with insecurity about my facial structure — especially the roundness of my face. Despite being healthy and at a low body fat percentage, I’ve always had a “baby face” appearance that doesn’t reflect how I feel internally. About 7–8 months ago, I underwent chin implant surgery and neck liposuction. The neck contour has improved significantly and I’m happy with that outcome, but the chin implant didn’t give me the downward/vertical length I was hoping for. While it added decent projection, it didn’t structurally elongate my face the way I envisioned. I’ve done a lot of research and I truly believe that a downward and narrowed sliding genioplasty (9–11mm) combined with aggressive buccal fat removal would finally give me the definition and structure I’ve always wanted. I’m aiming for a more angular, masculine V-line — with sucked-in cheeks and better lower-third harmony. I also value facial balance and would prefer 3D imaging or planning if possible. I’d really appreciate the opportunity to discuss this with you directly and hear your thoughts on what’s realistically achievable in my case. If you’d like, I can provide photos and my previous op report for context. Thank you so much for your time.

A: Thank you for sending your pictures and detailing your previous facial surgery. Besides the lack of any vertical lengthening the extended wings of the current implant also make it wider than your original chin. These two chin implant issues work against derounding your face. I would agree that a bony genioplasty that provides vertical lengthening and horizontal projection and makes the chin more narrow wil do better in derounding your face.

The combination of chin lengthening and cheek soft tissue reduction is always synergestic at derounding the face.

A few caveats:

1) I would doubt that 10mms or moreof vertical lengthening is what is needed. More likely it would be in the 6 to 8mm range.

2) You can keep the chin implant attached to the bone to maintain horizontal projection although the wings of the implant need to be removed. When vertically lengthening a chin with an implant in place the downward movement of the bone allows the implant to add some vertical lengthening as well.

3)A maximal cheek defatting requires a combination buccal lipectomy and perioral liposuction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The left picture of the (first collage) is when I had the Omnipore small chin implant in, the right side is before I had the implant in.In the second collage, the same thing left is when I had the implant in, and right is before the implant. (As you can see my chin is smaller in the before pics, I also had a cleft chin.In the 2nd pic I sent are the details of the implant I had, it was only inserted in me for 7 weeks orally. (Through the mouth). And the last pic is me currently as you can see is the implant shape and width are still there.

I also want to note to Dr Eppley that it was inserted wrong in my chin area when I did a CT scan to take it out as the Dr told me it was inserted below my lip area instead of by my bone. And they removed it on June 13th, and I had it put in on April 26th. Can you please ask Dr Eppley if my chin will return to pre-op appearance and what are options as well (if any) thanks!

A: I think your fundamental question is, after these multiple chin implant surgeries, will your chin return to its original shape…and that answer is unequivocally it will not. Once ther soft tissues have been widely released to place an implant and then removed, and it doesn’t matter if the implant is in one week or one year, the soft tissues will not shrink down to exactly what they were before. The only question is how far or close from preop will they be. That answer awaits time and full healing which could take up to a year to see the final result. There are no surgical options should they not return to the exact preop shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking to add height but trying to avoid limb lengthing would skull implant be the only option.

A: A skull implant will create some modest height (1.5cms) but far far less than limb lengthening can do…so they are not remotely comparable in terms of height enhancement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, in the pictures I just woke up so the veins or whatever it is it is still sort of flat it gets worse as the day goes on. This is the result of a short scar lower lift. when I went back to the plastic surgeon she said there was nothing she could do

it has been about 31/2 months since I had it done, will it get any better is there any way to shrink those veins or whatever they are???? because by night time it does get a lot worse.

A: Those are not veins but a branch of the facial artery. This is evident by three factors:

1) its serpiginous course

2) It gets worse as the day gones on

3) The temporal correlation with its occurrence after a short scar facelift. (compression)

This is treated by multi level ligations under local anesthesia

Dr. Barry Eppley

World-Renowned Plastic Surgeon.

Q: Dr. Eppley, How Do I get of my “turkey neck”. I am a male 78 years old.

A:Thank you for your inquiry and sending your picture. What you are describing is a direct necklift through excision of the turkey neck which can be done in various geometric patterns. Older males choose this option, as opposed to a traditional lower face – neck lift, for a variety of reasons including the desire to avoid hey more invasive and lengthy surgery as well as putting scars in and around the ears. While I direct necklace does put the scar in a more visible location in men due to beard skin that midline neck scar generally heals favorably.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I’d like to ask a question to Dr Eppley and ask what’s the maximum of forward movement that supraorbital and glabella implants can mimick? Same thing for the midface /maxilla

A:I don’t know what the maximum forward movement at Implants could do for the upper and lower face is that number remains is very patient specific. But I can tell you the largest movements that I have done which are 8 mm in the forehead and brow bones and 7 mm in the mid face.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m looking to infraorbital implants or infraobital-malar implants. My infraobital bone is deficient and it creates a negative orbital vector, dark under eyes, unsupported, round eyes. I want to create a more sharp appearance to the eye and more under eye support. I’d be very to keen to do a virtual consultation with you as soon as possible if you believe you can help me.

A:Thank you for sending all of your pictures and detailing your facial concerns and objectives. In reviewing your pictures you are correct in that you have a significant negative orbital vector and all of the associated periorbital orbital findings that come with it. Certainly the fundamental treatment is infraorbital – malar custom implants (see attached example IOM design for this problem) to correct the skeletal deficiency and Improve the under eye support. But this alone will not be fully adequate in the correction of the sagging lower lids with excessive scleral show. In severe cases like yours you cannot count on the implant alone to drive up the lower eyelids to any significant degree. This also requires lower lid spacer grass and a lateral double hole canthoplasty which is performed at the same time as the implants. It takes an all-out effort to maximize whatever result as possible from these techniques.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have Bellafill in my cheeks under the test through I want removed. I have severe swelling g and use steroids to get the swelling g down. It’s awful. I want it removed without a scar will a facelift remove it? What can be done?

A: Bellafill is a permanent filler because of its PMMA bead composition. It creates its effect I having scar tissue in circle and in case the implanted beads. While it is easy to place by injection it is very difficult to remove due to the encasement of Scar tissue. It cannot be removed by liposuction suction or any scarless procedure. The only way to remove it is to cut it out. I do not know exactly how much filler you had placed or where in the cheeks it is located. So as a general statement your supposition that a facelift approach may be necessary to remove it is probably accurate.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to inquire about the feasibility, estimated cost, and scheduling for a specific comprehensive facial reshaping plan with Dr Eppley.

The procedures I am interested in pursuing are as follows:

 * Custom Brow Bone Implant

 * Custom Cheek Implants

 * Custom Jaw Angle Implants

 * Sliding Genioplasty (for chin shortening and advancement)

 * Mandibular Contouring (bone shaving for jawline definition)

Before scheduling a formal consultation, I would be grateful if you could provide some preliminary information on the following questions:

 * What is the estimated cost range for performing this entire list of procedures?

 * What is the current approximate waiting time for an initial consultation and for a subsequent surgical date?

 * From a surgical perspective, would Dr. Eppley typically recommend performing all of these procedures in a single, comprehensive operation, or would he advise staging them into multiple surgeries?

Thank you for your time and assistance. I look forward to your response.

A:Thank you for your inquiry and detailing your specific procedural requests. In answer to your specific questions about them:

1) The rate limiting step in any surgical procedure that includes custom designed implants is the time it takes to go through the design and manufacturing process of them. This is usually around three months from wearing the 3-D CT scan is received on which the implants are designed.

2) The question is not whether all of your requested procedures can be done in the same surgery as they can. It would not be rare to do so. The issue is not a technical or medical one about a comprehensive or stage surgical plan. Which approach is best is multi factorial and must be determined on an individual basis looking at the factors of aesthetic priorities, economics, travel and recovery considerations. But when you really break down the list of procedures that you are considering it would strike me that a comprehensive operation would not be unduly difficult for recovery and, since all of the procedures are augmentative, they all would seem to be important given what the likely the overall aesthetic goal is.

3) in looking at your list of procedures I would question the need for mandibular contouring assuming jaw angle and chin augmentation are being done which may obviate the need for that procedure. As a general rule you cannot reduce bone to create definition, it takes augmentation to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to try to reduce the appearance of my nasolabial fold, and fill in some hollows under my cheekbones and (ideally) around my nose—ultimately to add fullness to (and maybe appear to shorten) my midface.My left side in the picture is a bit more what I was going for, but I’m just drawing on my phone screen, so it’s all a little rough.

A:When you look at the six separate or three paired areas of facial hollows that you have illustrated that could certainly be addressed by implant augmentation of the bone. Giving their relatively discrete locations I would just modify some existing implants to create the augmentation effect for the sub mailer cheek, paranasal and upper maxillary regions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I saw that Dr. Eppley posted online about using fat grafting to treat coccydynia. I was hoping he can answer some questions:

Is fat grafting for coccydynia more effective than injections?

Does this treatment usually involve multiple treatments or is it usually a one time surgery?

What is the approximate success rate for fat grafting to treat coccydynia?

A:There are two types of fat grafting, liquid injections and solid dermal–fat grafts. What you are specifically referring to in the treatment of coccygodynia is the surgical placement of a solid dermal–fat graft. This has a much higher take rate and is more appropriate for coccydynia than fat injections would ever be. The success rate is fairly high as defined by significant take and retention of the dermal fat graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley, I have extra skin on my nose due to an implant placement that was removed several years ago. I’d like the attached procedure from your website. My goal is to be able to see my nostrils more from the front. I attached a before picture of myself  and current picture. Please do not hesitate to ask any questions. 

A: Thank you for your inquiry and sending your pictures. While one technique that you have attached for improving nostril show via alar rim retraction can be effective but there are associated scar concerns along the alar – facial groove where the excision is done. Another technique is to directly excise tissue along the alar rim which I think would be preferred given that the scar would be more on the inside of the nose or at least along the edge of the Alar rim (red lines in diagram) It would likely also be more effective because it is done exactly where you were looking for the effect rather than an excision of the alar – facial groove where one is counting on a lifting effect to make the improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m curious if it’s possible to modify the medial canthus to be more downturned or positioned slightly lower, like shown in the photo below. I understand this area is very difficult to alter due to the intricate anatomy, such as the nasolacrimal duct and puncta, which is why most surgeons avoid operating on it for purely cosmetic purposes. Also not to mention the overall nicheness and subtlety of the area make it a very rare procedure. That said, I’m wondering if it’s feasible to lower the medial canthus by just 3mm or so, and if so, how this could be done. I’ve heard that external soft tissue procedures, like a Z-plasty, could be used to stretch it downward, emulating it, but I question if such a method could achieve the extent shown in the photo, and I’m also unsure about its long-term stability. Thank you for your time!

A:You do realize that the image you have shown is not real and those are photoshopped changes. That being said the inner eye corner can be lowered, perhaps not as much is shown in the altered image, by changing the position of the lacrimal lake not the medial canthus, by a Y-V advancement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Who is the manufacturer of the very soft low durometer silicone testicle implant? I would like to conduct my own research of the prosthesis before continuing.

A: All such custom low durometer silicone testicle implants are manufactured exclusively for me by the Implantech company. You will not find any information from the manufacturer or their website in regards to these implants due to their exclusive custom design and manufacturing for my practice.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I desire to enhance and harmonize multiple facial and cranial features through a combination of custom-based implant augmentation and soft tissue procedures. My primary concerns include upper projection and asymmetry of the midface and lower face, disproportionate upper and lower lips, narrow oral commissures, dissatisfaction with the previous rhinoplasty, and a notably narrow forehead and cranial width. The overall goal is to achieve a more proportional, sculpted, and balanced craniofacial structure, with refinement and strength in both hard and soft tissue aesthetics. Requested Procedures: 1. Custom Forehead Implant with Cranial Extension (?): The correction of the narrow upper third of the face with forehead widening. The goal is to create a wider upper face that harmonizes with the augmented midface and jawline, while providing a mid skull- widening effect without excessive frontal projection. 2. Custom Wrap-Around Jawline Implant: I seek augmentation and definition of the mandibular angle, body, and chin with a single-piece custom implant designed to create a seamless jawline contour. 3. Custom Infraorbital-Malar Implant: To address the midface volume deficiency and midface under projection, I desire augmentation of the infraorbital rim and malar region. 4. Subnasal lip lift: To address the elongated philtrum and insufficient upper lip vermilion show. 4. Bilateral Mouth Widening and Lifting: To address concerns about the width and downward slant of the oral commissures. 5. Revision Rhinoplasty: A comprehensive revision including: Nasal Width Reduction: To address flared alar bases and improve nasal base proportions. Tip Reshaping and Narrowing: To refine the nasal tip, reduce bulbosity, and enhance tip definition. Nasal Bone Osteotomy: To narrow the upper bony vault and restore dorsal continuity and symmetry.

A:Thank you for your very detailed inquiry into a variety of custom facial implants and soft tissue procedures that I commonly perform in men. The first place to start is to send me some face pictures so I may do some initial imaging in a process which I call targeted imaging to determine what is possible and also what are your exact goals.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I had a genioplasty back in 2019 in which the chin was advanced 8-12mm. In 2022 I began gender transition. In 2024 I underwent facial feminization surgery in which the surgeon went through the mouth again to do jaw contouring to resolve the step deformity that was created by the genioplasty. The surgeon who did the FFS was resistant to reversing the genioplasty or shaving the chin back because he aesthetically felt it looked best where it is positioned post-geniopalsty. However, I continue to experience dysphoria and dissatisfaction because of the boniness the projection adds to my face. I am interested in either reversing or shaving back the chin about 4-6mm.

A:I see no reason why your chin projection could not be reduced. To reduce it by shaving as, whether one is that a prior genioplasty or not that always results in chin pad ptosis. In the genioplasty patient that risk would be even higher than normal. Therefore the correct procedure would be a setback bony genioplasty where the risk of chain pad ptosis is more limited. The other question given your FFS history is whether during your setback the width of the chin should be reduced as well in a T-shaped bony genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. I have received micro fat transfers ender my eyes and enhancing my cheek area twice. Each time, I LOVED the initial results (probably partially driven by swelling) but then the results faded over the next couple of months. I’m looking for a more permanent solution that is a bit more precise as well. Because the fat transfers are able to deliver the initial result that I love, it seems likely that the aesthetic balance I’m looking for is achievable.

A:When you say you had fat grafting under your eyes I am not exactly sure where that exactly is which makes a difference inwhether a more permanent solution, infraorbital implants, could provide a similar aesthetic improvement. Fat grafting of the  undereyes could  have been done exclusively along the infraorbital bony rim, in which implants may produce a similar effect Or fat grafting could have been done along the rim and up into the eyelids where no form of bone augmentation could be helpful. I would need to see some pictures of your eyes to provide a more informed answer as to whether implants maybe beneficial in your case.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I desire to enhance and harmonize multiple facial and cranial features through a combination of custom-based implant augmentation and soft tissue procedures. My primary concerns include upper projection and asymmetry of the midface and lower face, disproportionate upper and lower lips, narrow oral commissures, dissatisfaction with the previous rhinoplasty, and a notably narrow forehead and cranial width. The overall goal is to achieve a more proportional, sculpted, and balanced craniofacial structure, with refinement and strength in both hard and soft tissue aesthetics. Requested Procedures: 1. Custom Forehead Implant with Cranial Extension (?): The correction of the narrow upper third of the face with forehead widening. The goal is to create a wider upper face that harmonizes with the augmented midface and jawline, while providing a mid skull- widening effect without excessive frontal projection. 2. Custom Wrap-Around Jawline Implant: I seek augmentation and definition of the mandibular angle, body, and chin with a single-piece custom implant designed to create a seamless jawline contour. 3. Custom Infraorbital-Malar Implant: To address the midface volume deficiency and midface under projection, I desire augmentation of the infraorbital rim and malar region. 4. Subnasal lip lift: To address the elongated philtrum and insufficient upper lip vermilion show. 4. Bilateral Mouth Widening and Lifting: To address concerns about the width and downward slant of the oral commissures. 5. Revision Rhinoplasty: A comprehensive revision including: Nasal Width Reduction: To address flared alar bases and improve nasal base proportions. Tip Reshaping and Narrowing: To refine the nasal tip, reduce bulbosity, and enhance tip definition. Nasal Bone Osteotomy: To narrow the upper bony vault and restore dorsal continuity and symmetry.

A:Thank you for your very detailed inquiry into a variety of custom facial implants and soft tissue procedures that I commonly perform in men. The first place to start is to send me some face pictures so I may do some initial imaging in a process which I call targeted imaging to determine what is possible and also what are your exact goals.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi is there any procedure that can make my nose taller? I have a short midface and short nose and want it to end lower on my face. I can imagine Le fort 1 or Le fort 2 alongside a rhinoplasty increasing length and projection might be possible? I made a mock up of what I’m looking to achieve would this be possible and what procedures would it require?

A:On your own imaging you are demonstrating augmentation of the the midface and the dorsum of the nose. Options for mid face augmentation include a LerFort I osteotomy, which would be appropriate for moving the lower mid face at the teeth level but it will not augment any midface area above that level… and your imaging clearly shows a total mid face augmentation.  A Lefort II osteotomy looks more effective on paper but is not a particularly good operation for a total midface augmentation. Also any type of LerFort osteotomy advancement Is also going to require the lower jzwe to be advanced as well to maintain a good occlusal relationship… Which seems to partially negate any of the above mid face augmentation effects.

This leaves a custom midface implant, in your case, is probably the most effective mid face augmentation procedure because the dimensions of augmentation are better controlled. This would commonly be combined with a nasal augmentation using either an implant or a rib graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon