Your Questions
Your Questions
Q: Dr. Eppley, I have a question on minoxidil topical solution and the implant placed in 2019. If you may share his thought on this, it would be really helpful.
With likely having male pattern hair loss condition, I apply minoxidil topical solution 5% (e.g. Rogaine) or sometimes 7% on scalp for stimulating hair growth. I applied the solution daily since 2015 and I am likely to continue in the many years to come.
I am not sure if this would be true but I would imagine long-term application like this, while some minoxidil topical solution (incl. active and other ingredients) is absorbed into blood stream or other via channels, certain amount would be left as residual and stay among the layers of scalp skin. If this makes sense, then when it happens, such residual may penetrate through the layers of scalp skin, and reach the bottom level of scalp skin. As this level of skin is in direct contact with the surface of implant, so do some topical solution residuals.
As I guess the implant would not absorb minoxidil, it continues to build up on the surface of implant.
I wonder if my understanding above is reasonable.
Then my question is whether such build-up of minoxidil topical solution under scalp skin (above surface of implant) would cause any health issue in that area. If yes. What should I do to avoid such issue or mitigate risks involved.
Any additional comments on this topic would be helpful.
Thank you for your kind attention : )
A: I am not aware that minoxidil builds up under or in the scalp. It is a vasodilator that is absorbed and eliminated after it has its effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Five months ago, I underwent double jaw surgery together with V line and cheekbone reduction surgery in South Korea. The result of the surgery was not what I expected, and I have regretted it since. My facial aesthetic appears to be much more feminine and much less attractive compared to pre-operation. I have been finding ways to see if it’s possible to reverse my surgery so I can look like my old self again. I’m planning to reverse my v-line and cheekbone reduction by using a customised silicone wrap-around jaw implant, and have the zygomatic body elevated back out /customised cheek implant after doing a revising double jaw surgery to push both my jaw back out. I have a few questions that I hope you can help me to address.
1) Do I need to visit you to check if I’m eligible for a customised silicone wrap-around jaw implant and customised cheek implant before I decide to do a revision double jaw surgery to push both my jaw back out?
2)Is there any chance I’m not eligible for a customised silicone wrap-around jaw implant and customised cheek implant after revision double jaw surgery?
A: I have done many patients such as yourself who are looking to reverse their V-line surgery. I have yet to see such a patient who could not have a custom jawline implant to reconstruct their jawline.The same would apply to the reversal of cheekbone reduction osteotomies. Such surgeries would, of course, await your revised double jaw surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Hey, I read about your practice in a 2019 New York Magazine article… I’d like to get more information on the testicular augmentation “clam shell” implant — e.g., cost of procedure, recovery time, possible complications, detectability by others, effects on testosterone production, etc. Haven’t been able to find that info on your website. Thanks!
A:When it comes to aesthetic testicular enlargement there are two methods: side by side and the wraparound or clamshell implant approach. While the latter has a lot of understandable appeal it does have a significant rate of postop separation which, as a result, always makes it my second choice. I have yet to figure out as assured design that makes postop ‘disengagement’ a negligible or almost non-existant risk.
Otherwise either form of testicular enlargement has no adverse effects on testosterone production and is certainly not easily detectable in most cases.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I have just a major question for Dr. Eppley (maybe he can answer it on his blog)?
I am considering getting either orthognathic surgery (I have been given the option of DJS or LJS), which would be covered by insurance due to my mild sleep apnea and TMJ, or doing a genioplasty and rhinoplasty with you. I have a class 2 overbite + I don’t like my small chin, and the jaw surgeon recommended a LeFort 1 with CCW rotation and possible 5 mm advancement, and up to a 10 mm BSSO advancement of my lower jaw once my teeth have been put in braces.
One concern that I have seen folks getting upper jaw advancement/impaction present with is sagging cheeks and more pronounced undereye circles. This seems to happen due to pre-existing flat cheekbones and lack of orbital rim support (which I think I may have). I have attached photos below of me pre-filler. With my existing facial structure, would the risk of my malar fat looking “droopier” be there?
A:Your fundamental question is really about the concept of surgical tradeoffs. The exact midface/cheek concerns you have expressed are very likely to happen as the cheekbones get ‘left behind’. It is a very common aesthetic sequelae in Bimax advancements and while the chin may look better the midface will pay the price for that exchange. Bimax surgery is worth it if significant functional improvement is needed (sleep apnea) or the lower 2/3s of the facial skeleton is recessed and needs to be moved forward. (fat face) In our case it really comes down to the value of sleep apnea elimination and correction of your Class 2 bite. But inevitably it will not be your last surgery as the undereye hollows and the cheek deficiency and low soft tissue cheek fullness that results may likely be undesired aesthetic effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently read an article that was published by Realself on shoulder surgery, they stated some possible short and long term complications that I don’t remember hearing about during our consultation. It has sparked some questions for me.
In the consultation I was told that the main risks associated with shoulder reduction surgeries is failure of the fixation hardware and non-union of the bones and that if there were to be a complication it would most likely happen in the first couple months. I don’t believe I was made aware of any potential long term complications.
Here are the concerns listed in the article:\
“ Immediate risks of clavicle surgery can include sensory nerve damage or a collapsed lung, while “long-term risks include hardware irritation and, most important, the permanent shift of the shoulder girdle,” The muscles where the scapula and clavicle connect to the arm could become weakened and easily fatigued over time, ultimately impeding the shoulder’s ability to move effectively. “
I’ve also heard some say that the new shorter length of the bone straining to work with the scapula will cause early arthritis down the line. I’ve heard others say that the scapula will move to accommodate the new length of the clavicle. I’m not sure where this information is from though. I of course understand that there is limited research and knowledge on the subject but can you speak at all to arthritis or chronic muscle fatigue being valid concerns? And how would this procedure collapse a lung?
In the Realself article it also mentions that one should follow this procedure with physical therapy. Is that part of your recovery process? If so, does the PT have to be done with a licensed professional or can it be done from home? If it’s not part of your prescribed recovery do you still recommend it?
Apologies for the long list of questions but I appreciate your time and attention. Thanks,
A: In answer to your questions the first comment I would make is be very cautious of doctors or others making comments on a procedure that they have never performed. The only opinions that should matter in any surgical endeavor should be from those who have done (surgeons) or have undergone (patients) the exact procedure you are considering having done. Outside of that perspective all such comments are theoretical and lack any proven medical relevance and thus their value should be taken as such.
To date there is no evidence of any adverse long term effects from shoulder reduction surgery which includes the stated muscle fatigue or arthritis. However until the procedure has been performed on hundreds of patients with very long term followup (10 to 20 years) no one can say for certain if any such adverse effects exist….but it seems unlikely based on patients who have been through the surgery in the past five years.
The only relevant long term risk ghat I have seen is whether the patient will want the fixation hardware removed due to either show through the skin or irritation.
Other than at home arm range of motion after 6 weeks postop I do not prescribe any specific physical therapy.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I suffered a severe chemical burn to my scalp while at a hair salon, measuring 8 cm by 4cm. It has now healed and the dermatologist says there will likely be no hair regrowth. I’m looking for direction or recommendation on my next step. I have read about hair transplant, scar reduction and others but am lost as to the approach we should take. Your time is much appreciated. Thank you
A: Despite the utter travesty of your scalp burn injury it is fortunate that its size and location make it the most optimal location for a successful scalp reconstruction. The key is to excise the burn scar and move adjoining hair-bearing scalp into its location. (hair transplants are only reserved for touchups of the final scar if needed) The size and shape of the scarred area makes it ideal for total excision and primary closure in a favorable direction. It would be optimal for the total excision of the scalp scar to have a 1st stage scalp expander placed to ensure there is enough scalp to cover it without undue tension.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Good day, doctor, I would like to ask for your help my face is crooked, the left side of my face protrudes, half of my face on the right side is flat and sinks in, I live in Hungary, they can’t help me here I want a character with a straight, beautiful face like Justin Bieber’s, would that be possible?
A: What I was initially going to say, before viewing your pictures, is that you can abandon the concept of creating a good facial shape like some famous person or celebrity. But as it turns out you already have a better more defined facial shape than Justin Bieber’s albeit with the asymmetry. That is mainly because your face is thin and the skeletal structure is very visible and not weak or undeveloped.
That being said in the treatment of facial asymmetry most of the time the flatter less developed side is augmented…sometimes just to match the better side or often the patient chooses to augment both sides with the goal of not only correcting the asymmetry but creating improved facial definition.
The first step in facial asymmetry correction is getting a 3D CT scan from which the treatment plan is based.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, As you know, your facial width, angularity, and overall face in general are different at 10% body fat compared to 18%. As someone who will often fluctuate between 10 and 20 percent body fat throughout the year purposefully to gain muscle mass–how can I guarantee that my genioplasty won’t look great at 18% body fat, but uncanny at 10% body fat? I know a genioplasty involves reshaping the bone, but I am worried about the genioplasty looking uncanny or not harmonious at different body fat percentages. Is this something you accounts for when determining horizontal and vertical mm adjustments?
A: No one can determine what is the ‘right’ amount of dimensional movement of a static facial structure based on how the body may fluctuate around it. All you can do is choose the dimensional changes based on what the patient looks like at the time of surgery. Fortunately the chin is a solitary projecting structure that expands the lower third of the face outward its appearance is probably least affected by weight changes.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I had an otoplasty May 2022 this year and I think my prominent ears were overcorrected. Also, the top of one ear sticks out a bit and the rest of the ear looks like it’s glued to my head. I wanted to know if it would be better for me to get a reversal now or wait it out. I was reading I may be able to avoid using a graft if I do it sooner.
A: Once you get past the 6 to 8 week from an otoplasty the memory of the cartilage has changes and merely releasing it will not work. While a subtotal reversal otoplasty can certainly be done, the time has passed when avoiding a graft to do so is possible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a question about your skull reduction procedure for bigger heads? Is it still done? And is can it really shave of 1-2 inches of head circumference? Thanks!
A: Circumferential measurements are not a good method to determine the reductive changes that can be done for larger heads. It is more about reducing certain protruding areas that make it look big.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in wraparound testicular implant, cost, recovery? I am taking testosterone and my testicles have almost disappeared. I would like to know how much it would cost for your largest implants. thank you.
A: Wrap around implants are not a good idea in really small testicles. When the volume of the implant is bigger than that of the existing testicles there is a very high rate of postoperative extrusion or movement of the testicle out of the wrap around implant. instead It is far superior to do the side by side technique in which the very large implants overwhelm the smaller existing testicles and push them to the rear, so to speak. This testicle implant technique has none of the wrap around implant problems and the largest implants can then be placed with the lowest risk of any problems.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am currently about to get double jaw surgery and already have a weak midface and undereye area (bad case of dark circles). Ideally I would like to get midface implant surgery soon after the jaw surgery. I want a lot of mass added to my cheekbones area especially the undereye area. I know the implants will extend to my zygomatic archs will this help change the shape of my face? I feel like I have a very rectangular face and would like some width added to the midface area. Some questions I have:
– How soon after the jaw surgery would I be able to get the implants placed?
– How will this process work, do you suggest a virtual meeting and then travel to the clinic? Basically what is the process like from beginning to end?
– Lastly how big can the implants me, not coverage but how forward or thick can the implants be? What constraints are there to how thick the implants can be?
A: In answer to your midface implant augmentation questions:
1) One would wait six months after a Lefort I osteotomy to have a midface implant procedure. But you would get the process starter within a few months after the orthognathic surgery since it takes a minimum of 3 months to go through the implant design and manufacturing process to get the implant ready for surgery.
2) A 3D CT scan is needed and that can be obtained locally. We place the order for you to have it done. You only come here for the actual surgery.
3) Within what your aesthetic requirements would likely be there are any implant thickness or tissue constraint limiting factors.
4) While I do not know at this time know some of the important features of the midface implant design that would work best for you (implant footprint, single or split design, intraoral vs lower eyelid placement approach) my staff will provide a general quote for the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i always wanted a more heart shaped, small chin and jaw, soft, youthful face instead of square or long. id love your opinion on how i could achieve that look and what seems like the biggest problems. id like to get filler/botox soon but im interested in surgery if it still feels needed. i was thinking jaw botox might be a good start. maybe temple and cheek filler? im 20, slim build
A: The single most important change you need to make your face more heart shaped is to vertically lengthen and narrow your chin. The lower third of your face is disproportionate to the upper two-thirds because your jaw is flat (near zero mandibular plane angle) with a vertically short chin and a wide jaw angle region. You can do filler and Botox in other areas but they will make little difference in changing the shape of your face as they don’t address the real problem. They may provide some minor benefit but the foundational change is that of the lower jaw….vertically lengthen the chin (vertical lengthening bony genioplasty…aka mini V line surgery) and jaw angle width reduction. (masseter muscle reduction by Botox or bony jaw angle and masseter muscle reduction by surgery)
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hi.. how are you? I’m interested in fixing my shoulders with implants, to make them wider. Also in that surgery I would also like to change my breast implants.
Im attaching some pictures so you can see my problem
If possible we can schedule an online meeting so we can discuss everything.
Thank you in advance and hope you can help me 🙂
A: Thank you for sending your pictures. Admittedly I have never done shoulder lengthening in a female and presumed that I never would….until I saw your pictures and then the desire for it became very clear. Even if you could get even 15mms per side the shoulders would look wider and less rounded. Usually 15mm widening per side in men has proven to be the limit due to the strong shoulder girdle muscles but perhaps in women this is less of a limiting issue??
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, five months ago, I underwent double jaw surgery together with V line and cheekbone reduction surgery in South Korea. The result of the line and cheekbone reduction surgery was not what I expected, and I have regretted it since. How long should I wait for before having a reconstructive custom jaw line implant surgery and cheekbone reduction reversal.
A: At five months postop you can proceed with any further facial bone surgery. The bones and soft tissues are well healed to do so.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I came across your practice from Google and wanted to reach out and ask some questions or possibly set up a consultation. I have a very thin, narrow face and as I’ve aged (42 yrs old) it’s only gotten more emphasized. I had previously had an chin implant put in but I feel as though it almost made my face look longer. Recently I’ve been getting fillers in my jaw, in front of my ear region and in my lower face to build up some volume but it doesn’t seem to be helping and, for the cost, it feels like going the permanent route might make more sense. I don’t know if there is much than can be done for a narrow face but I’d love to get the doctor’s feedback on it.
A: In the thin narrow face the effective reshaping approach is to shorten it and widen it. A chin implant in a thin narrow face will often make it look longer which is why a sliding genioplasty that brings the chin forward and vertically shortens it is a better chin augmentation procedure in that facial shape type..
Where you have been placing injectable fillers is in the jaw angle region and placing widening jaw angle implants would be a more assured and effective approach. Another effective approach is cheek augmentation, particularly in the malar-submalar region for some midface widening/volume addition.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have a question in regards to the placement of mandibular angle implants (PEEK/silicone).
In your experience over the last years/decades of placing mandibular implants – normal sized to small implants so not radically large ones – how many of your patients have showed signs of (partial) masseter (PS) disruption/dehiscence? And how many in relation to how many you’ve performed in total?
If a patient had no signs of masseter muscle dehiscence is there a chance that the PS/masseter will be ripped or comprised after surgery after a big hit, yawn or other trauma?
Thank you very much if you find the time to answer.
A: Masseter muscle dehiscence is an immediate sequelae of jaw angle implant surgery that becomes evident when the swelling subsides. It is not something that occurs later even if trauma occurs.
The risk of masseteric muscle dehiscence is directly related to whether the jaw angle implants add vertical length which requires release of the muscle attachments along the inferior border and angle region where the ligament attaches. That risk is about 5 to 8%. In widening jaw angle implants that risks lower to less than 5%.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking for infraorbital rim implant and i have beem told you are the best surgeon, i got many questions if you could answer them please, is it permanent?, will it fix my scleral show?, will it make my eye more deep set and almond eyes looking?, thank you for the time given dr. Have a good day!
A: With your negative orbital vector (cornea of the eye sticks out further in profile than the infraorbital rim) you have a true skeletal deficiency which is why your lower eyelids are rounded with scleral show. You are correct in that infraorbital rim implants (ideally custom so they saddle the rim and help push up the lower eyelids) are one important part of the solution but not the only one. Spacer grafts are needed for the lower eyelid to ensure vertical lengthening lid support and lateral canthoplasties to get more of the almond eye look.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I’ve been looking at your custom jawline implants and I have a question. How high along the ramus can a custom jawline reach. All your custom jawline implants only augment the area below the bottom row of teeth along the ramus. Is there an anatomical reason for this? Thanks!
A:Because it is aesthetically counterproductive to place any augmentation higher up on the ramus in most cases. All that does is push out the masseter muscle fullness which works against having a more defined jaw angle region.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to come to see you for perioral mound liposuction (if applicable). However, I would only be able to go by myself. If I come alone, would I still be able to have surgery if I take an Uber?
2) I had a chin implant and buccal fat removal procedure done about 2 years ago, but my cheeks still seem chubby at the bottom and I’m not sure if they are my perioral mounds or my jowls. Can you please take a look at my photos and advise if this can be fixed? Please keep the photos anonymous. Thank you so much in advance!
A:Technically you do have perioral mounds and a bit of jowling. But on a practical basis perioral mound and lateral facial liposuction is what you likely to do. While a jowl tuckup procedure would produce the best result you are unlikely to be motivated to have that procedure at your age.
Such facial liposuction procedures are performed on an outpatient basis. As a general rule we don’t permit a patient to climb into an Uber ride right after having a general anesthetic.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello Dr Eppley! About 1.5 years ago, I had a custom wrap around silicone jaw implant to fix what i felt were subtle assymmetries. I’m a 35 year old woman, and thought for some reason this would give me the same face shape, only sharper.
This has not only masculinized my narrow face into a square one, but makes my jaw look boxy rather than tight. After intense depression and being told by my doctor that my constant pain and discomfort would go away ( it hasn’t), he’s now agreed to remove it. I wish he had when I first wanted it out, which was right away.
My question is this: I have not been able to find many pictures of jaw implant removal– only chin implant removal. I am afraid of developing jowls after this or loose, sagging skin and tissues. My surgeon removing it says not to worry, and that no muscle repair will be necessary, which makes me even more scared to go through with this.
Will I look anything like my old self even if not identical? Do you remove these implants? Have you done so on women? Can you help me?
A:Removing a wrap around jawline implant is certainly less traumatic than putting it in. The question you are asking is will your face go back to the way it was before the implant placement. That is a multifactorial question based on size of the implant etc. But it is safe to assume that it will largely go back but I would not expect it to be 100%. Changes may occur along the posterior jawline, such as jowling and a little bit of loose tissue over the jaw angle areas, as you have mentioned. But given your dissatisfaction with the outcome (undoubtably a result of the design…women jawline implant designs are much different than men and the most common design error is to not appreciate those aesthetic facial gender differences), whatever the soft tissue changes may be by removing it should be a worthwhile tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am not happy with the aesthetics of my eye, even if I can consider that I have a good shape of the eyes in fact I already naturally have almond eyes I think that the eye is too high because I have a low and round lower eyelid, I would like have a more masculine eye therefore less high and straighter I would like to know which would be the most suitable operation among those you perform to make the lower eyelid straight and raised and what the indicative cost would be, I also made a morph to let you understand what I mean.
A: You have mentioned that your eyes are too high because your lower eyelids are too low. In reality your eye position is good/normal but the lower eyelid is too low. Anatomically you have this appearance because you have a negative orbital vector. (the cornea of the eye protrudes in profile further than the infraorbital rim) In essence you have an infraorbital rim deficiency and, given that the shape/position of the lower eyelid parallels that of its supportive underlying bony infraorbital rim, it is no surprise that your lower eyelids are more rounded.
Understanding the anatomic reason for why your lower eyelids look like they do tells how to best raise them and make them straighter. (aka vertical eyelid lengthening) This requires a combination of infraorbital rim implants and spacer grafts to the lower eyelids.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a question about Le Fort I Osteotomy. From what I saw online the procedure is able to raise the nasal spine of the maxilla. Would this then shorten the vertical height of the nose by raising the base of the nose? The issue that I have is that my nose is vertically long but the tip is not the issue so a rotation would not work. As such I was wondering if the osteotomy would raise the base of the nose to shorten it. It not is there other procedures that could do so. My goal would be to have the vertical height be shortened by 3-4 mm. Thank you for your time.
A:You can’t shorten a nose by altering his skeletal base. That will not change the large overlying nasal skin envelope.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a question about eye area; what procedures would be necessary to replicate those eyes? My eyes are not as deep set and instead of this angular shape are more almond shaped. Canthal tilt also sits lower. So I guess orbital implants with horizontal and vertical projection would be necessary. But how much vertical augmentation of supraorbital rim can be achieved and will brows come down?
I attach front and profile of my eyes and the ones I would like to achieve. Thank you very much.
A:I don’t think you can replicate that eye shape exactly. But certainly periorbital augmentation is the key with brow bone augmentation being the most important. The eyebrows will come down with brow bone implants particularly with a design that lowers the bone edge…just not as much as the example you have provided.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to you because I have an asymmetry of the jaw, the right is more developed than the left, I am 28 years old and to have more symmetry I thought of one of your customized implants on the less developed jaw, but first I would like to have an idea of the result aesthetic of my face by temporarily adding volume to the jaw in a reversible way for this reason they advised me to do a test with a lipoffilling or the Radiesse, in his opinion which is better of the 2 products to fill the less grown jaw and understand the aesthetic result that would I have a fuller face waiting to do the custom implant?
A: While the use of non-permanent injectable fillers is a good first step in treating jaw asymmetry I certainly would not use fat as it can be hard if not impossioble to remove later if the long term plan is an implant correction.. Radiesse is a long lasting filler and would be fine if an implant correction is 18 to 24 months into the future. Otherwise hyaluronic-based injectable fillers would be a better choice as they last less long and are easily reversed. As an aside fillers or fat placed in the subcutaneous tissues do not have the same aesthetic effect as bone-based implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have what I think is brachycephaly with a very flat back of the head but also the sides of the back of the head are pointy and flat. My question is how much bigger and rounder can these areas become with a custom skull implant? Also does the silicone feel soft ? Like if someone touches those areas can they feel it ? Or if you lay down does it feel soft or just like bone?
it’s like my head doesn’t have a back, its appears cut in half. I think my case is very very very severe. I can’t go outside without a hat. I think if you can fix this it will be truly life changing for me ! I hope and pray and I’m waiting for your answer. thank you
A:Thank you for sending all of your pictures. You do have classic brachycephaly which accounts for the shape of the back of your head. That can be improved by a custom solid silicone skull implant which will feel just like bone. The amount of augmentation is controlled by the stretch of the scalp and I would estimate that to be in the amount shown. (see attached image)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am wondering if I am a good candidate for rib removal. I am also looking to downsize my breast implants and was wondering how that would relate time wise to get rib removal.
A:Thank you for sending your pictures. Lean patients get the best waistline results from rib removal surgery of which you fall into that category. That would need to be combined with abdominal liposuction in your case. Breast implant size change can be done before, at the same time as rib removal surgery or after. If done before or after I would allow 2 months on either side of the waistline narrowing surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m sending this email as an inquiry into Aesthetic Skull Reshaping Procedures.
I’ll start with a bit of an overview of my situation and what I hope to achieve:I’m a bald male. I have a depression/groove in the top right side of my skull. As a result, the right-side profile of the top of my head is concave while the left profile has a gradual convex shape. I’ve provided photos to clarify my description
It is my hope that a small custom implant (about 5cc volume) can be shaped and inserted to fill in the depression, to give the right side of my head a more convex shape similar to that of the left side (though I’m not expecting perfect symmetry).
I do also have a couple of more specific questions:
- I’m concerned the filling material would be noticeable and unnatural looking with my shaved head (e.g. the edges can be seen). Are you confident this would not be the case and how do you prevent this?
- How do you ensure the implant is placed in the correct location on the skull?
- I live overseas. Would it be practical to undergo this process with online consultations and a single two-week trip?
Thank you for your time. I hope to hear back with your thoughts soon.
A: You have correctly surmised that a small custom skull implant is the correct solution to what is known as a coronal suture line dip. In answer to your questions:
1) Feather edging of the implant design is what prevents what is known as ‘implant reveal’ or visible edging.
2) It takes a lot of experience to know how to properly position skull implants through small scalp incisions. But the location of the incision and knowing how the implant is supposed to fit are the keys. (this is why a custom design is needed)
3) The entire process, except for the actual surgery, is done in a virtual manner.
FYI The vast majority of aesthetic skull reshaping patients are just like you, the male with a shaved head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am a young female 117 lbs and 5’5. I’ve always had a very round fat face despite being very skinny everywhere else. I think one of the main reasons for this is my recessed chin. I’ve been looking into genioplasty and chin implants, but i’ve read that through genioplasty it can also help my jawline. My dream results would be a pronounced jawline and normal chin that matched my weight (I feel like Ariana Grande is a very good example). I don’t know if such drastic changes would be possible with just genioplasty or if I would need filler or liposuction. I currently live in Texas, but so have heard such amazing things about you, so I am willing to make the commute.
A:I don’t think there is any question that a sliding genioplasty (10mm plus forward movement is the preferred chin augmentation procedure and would make a world of difference for you. That combined with some midfacial defatting (buccal lipectomy and perioral liposuction) with make a major facial transformation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I understand that a cheek implant is placed primarily on the bone, but I was wondering how far off the bone can a cheek implant hang? Especially in the submalar region?
Thank you
A: Cheek implants are commonly positioned off the bone onto the masseteric muscle fascia to obtain lower cheek fullness. It can go as far down along the masseteric fascia as the intraoral vestibular tissues will allow.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
