Your Questions

Q: Dr. Eppley, Do you guys perform temporal “reduction” surgery

A:As the inventor of temporal reduction surgery I perform it regularly. How this may apply to you requires Picture assessment as well as a description of what your estimated goals.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d love to better understand the scope of midface augmentation. Would any of the following effects be realistic?

• Smoothing or softening of nasolabial folds (see attached photos for current nasolabial folds when smiling)
• More defined hollow cheeks / less puffiness in the midface
• A slightly wider-looking mouth through midface skin traction?
• A more angular look from subtle skin elevation near the jawline?

A:In answer to your specific questions about midface augmentation:

1) Improvement of the nasolabial folds is not going to occur with any form of midface augmentation particularly when one is smiling.

2) Depending upon the implant design it may be helpful in creating some increased submalar hollowing/indentation. However the more a short approach to that outcome is really a reductive one based on cheek fat removal.

3) The mouth is not going to get wider with any form of midface augmentation. It does not create a midface skin retraction effect.

4) mid face augmentation is not going to create I more angular jawline look. That can only occur from a direct jawline augmentation approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I am wanting hip implants. Am I a good candidate?  I would be coming from Australia. How long will I have to stay in America for?

A:My extensive hip implant augmentation experience I have learned tonight place too big of a hip implant to lower the risk of potential complications. Thus the attached imaging shows the amount of augmentation that I am willing to do. Your length of time here does not need to be more than five days although, one of the important elements of postoperative recovery is the need for drains. Those drains need to stay in 2 to 3 weeks. Thus you will be going home with drainss in which we will guide you through the process of eventually removing them at home at the appropriate time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How much would I expect the cost to be for something like Custom Orbital Floor-Rim Implant in the Treatment of Aesthetic Vertical Orbital Dystopia, for my situation? My right eye would ideally look like the left once raised.

A:First of all I do not know your ‘situation’ when it comes to your eye and asymmetry as I have never seen any pictures of your problem. Secondly in the treatment of vertical orbital dystopia a custom implant made to raise up the eye and infraorbital rim pi is rarely the sole solution to the problem. It is a foundational part of the VOD surgery but it is almost always requires other soft tissue adjustments to be done around the eye, the eyelids and brow, as raising the eyeball alone will change the lids-eye relationship in an unfavorable way. And the eyelids and brow do not move upward because the eyeball is raised. Thus it is very rare that a custom orbital implant alone will satisfactorily address the problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in a lip lift with lip reduction. Do you perform it with muscle cut under the nose too? My upper lip is already to forward and I want to avoid making it even go more forward after a lip lift.

I naturally have an upper lip that is somewhat projected forward(also had silicone injection years ago), and I’m concerned that a lip lift might increase that projection or cause the lip to appear overly everted.

I’m specifically looking for a subtle and natural result — with a shorter philtrum and better tooth show, but without making the upper lip stick out more.

Could you please let me know if your technique is muscle-sparing or including cutting,and if it avoids adding forward projection?

A:In a subnasal lift lift I never remove underlying orbicualris muscle. This not only deepens the nasolabial angle in an unfavorable manner but often causes prolong difficulty with smiling and other lip motions. Thus it is a skin only procedure in my experience.

The logic of why some surgeons remove muscle in the procedure is that  it limits any postoperative relapse. While there is merit to that relapse prevention the trade-offs are not worth it in my opinion. Long term follow up has demonstrated that most primary subnasal lip lifts, depending upon how much skin is removed, will within the first six months undergoing 10 to 20% relapse of length. But this to me as a better problem then issues that can occur with muscle removal in the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a few weird bumps on my upper head and I want them removed but how much would that cost.

A:I would need a much more description of the weird bumps (where, how many, what do they look and feel like) to determine what may need to be done to remove them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m in the UK and have been unable to find a surgeon to improve my orbital dystopia here to get an improvement in my eye asymmetry. Would I be able to send you a picture of my eyes & an image from my CBCT scan to see if you would be able to assist me? I am very nervous about considering surgery outside of the UK but would like to know if it’s at all feasible for me. I would like to get an idea of the cost of an infra-orbital rim implant (possibly combined with cheek implants). As if an implant is an option in my case I would be very keen to do so. 

A:Thank you for your inquiry and sending your picture and 3-D CT scan. Almost every custom vertical orbital dystopia implant is a combination of the orbital floor, infraorbital rim, and cheek as the entire composite bone unit is situated lower. While  this would be effective in your case based upon the amount of millimeters that the left eyeball is lower than the right, 5mm or less, it is important to understand that you cannot just move the eyeball alone as the eyelids are not going to follow it upward. Thus  almost every vertical orbital dystopia patient requires concomitant upper and lower eyelid repositioning with their custom implant. Fortunately, your left eyebrow is minimally lower than that of your right and does not require management.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I feel like my hairline sits on top of my head because of these protruding bones in the frontal lobe. I even have a bony eyebrow ridge in the middle. Ideally I would like my forehead to be more symmetrical. Where my forehead could be lowered and I can wear lower haircuts

I have to grow my hair to hide my forehead and I want to feel confident having a lower hair cut

I would ideally like for it to sit lower with a more smoothed out forehead.

A: You have the classic forehead horns combined with a high hairline. The treatment of both are linked, meaning to get a significant forehead shape change the bony horns must be flattened and the frontal hairline advancement. The question is not whether the forehead bony horns can be completely reduced as they almost always can. The more significant question is how much can the frontal hairline be advanced, and straightened, which can never be truly known until one is in surgery performing it. The frontal hairline can be advanced, but its just a question of how much and can it really be made straight.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley,  Hi, Im almost satisfied with the way I look. There is one Thing that bothers me for my whole life. My forehead but only within the area above the hairline Looks a bit like Gollum. That bothers me so much. Is there any way to change it without the risk of losing hair?

A: I am not precisely certain how the Lord of the Rings character Gollum applies to the top of your forehead and some pictures of it will make that clear. But as a clarification no form of skull reshaping surgery causes hair loss.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’d like some additional information on your very soft low durometer silicone testicle implant. I currently have silicone filled implant and have almost given up hope that I’ll ever be comfortable again as it is as hard as a rock. I’m very interested in yours with it being extremely soft and squishy and have no risk of eventual failure or need for replacement. is there any way I can get a sample shipped to me (I’ll return). I just want to see it for myself before scheduling a procedure.

A: The key to the a very soft testicle implant gives beyond just having an ultra soft silicone durometer. It just also be designed with a small hollow inner chamber to maximize softness when compressed. Thus it is both a material and implant design improvement.

We don’t ship implant samples to patients as these are proprietary medical devices.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I hope you’re doing well. I recently underwent a subnasal lip lift and, unfortunately, was left with an A-frame deformity—the center of my lip was lifted significantly, while the sides remained relatively unchanged. As my daughter puts it, I now look “botched.” For context, my philtrum measured 18mm before surgery, and the surgeon removed 6mm evenly across the subnasal line. The vertical distance from the base of my nose to the top of the central lift looks appropriate, so I don’t believe too much was removed from the center. I’ve read about the extended subnasal lip lift technique you pioneered to specifically avoid this type of outcome. I’m wondering if it’s possible to perform a revision that lifts only the sides to correct the A-frame deformity—without taking any more from the central philtrum. I also want to mention that I’m not a good candidate for a corner lip lift due to my darker skin tone and risk of scarring. Could you kindly advise: Whether this kind of targeted revision is feasible in my case? How long I should wait before considering a revision? And whether Botox could help temporarily improve the appearance in the meantime? Thank you so much for your time and expertise. I would be happy to send photos if needed.

A: The only option to improve the shape of the upper lip after an ‘overdone’ subnasal lip lift are lateral vermilion advancements. There is no ‘extended’ subnasal lip lift technique that will change the outer downturned portions of the upper lip. Botox injections will not help.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Has Dr. Eppley performed this intraoral mentalis release + dermal-fat graft procedure on additional patients since the published case? I was wondering if it lasts long since usually fat is mostly reabsorbed?

A: I have performed it many times. But this is not the best procedure for you as your deep labiomental fold exists becaiuse your chin is vertically short and the soft tissue chin pad is compressed up against the lower lip creating the deep indentation. The appropriate procedure and I far more effective one is a vertical bony chin lengthening. Also, and I compression tissue site a dermal fat graft will not work well for adequate and sustained depth of fold reduction.

There is usually a 50% greater survival from dermal-fat graft placement in the face.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, As for the jaw and cheekbones, I definitely understand that I won’t achieve those inspiration pictures with the implants alone, as the photos are augmented and the girls are very thin. They were more to show off how sharp I like a jaw rather than what I expect from the implants, if that makes sense. As we had discussed, I would be happy if the implants could replace my cheek and jaw filler and give at least a slightly sharper look than filler can provide. Do you think that’s achievable? It’s perhaps worth noting that I was very far from my normal weight in the “before filler” pics I sent, and I’m already closer to my usual level of fitness again, so the implants won’t have to work quite as hard as when I’m holding more weight in my face.

A:When it comes to comparing the effects of filler and bone based implants, understandably, they are not really similar. Fillers tend to produce a more rounded type of augmentation well implants have the potential to create more sharpened features. This is possible because in implant designs the key is to make a very exaggerated form of the implant design on the bone knowing that the overlying soft tissues will have a quilt like effect dampening some of the implant’s shape. This means that the implant’s design on their 3-D facial bone structure can you look unusual to some patients who have the mistaken impression that an implant design looks on the bone is what it’s exact effect will be on the outside.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Regarding lip advancements, after giving it much thought, I agree that a sub nasal lip lift would not achieve the results I’m hoping for and would love to move forward with the upper/lower lip advancements paired with upper/lower V-Y for projection. That said, while I know you’re a master of scars and so the risk is relatively low, I would love your thoughts on how I can correct less-than-ideal scarring should it happen. I’ve heard methods like CO2 lasering or even lip tattooing can help, but I would love your thoughts on the best options in case, just in case.

A:When it comes to treating lip scarring, I’m Almost always surgical revision is the best route. This of course depends on what the magnitude of that scarring is. But most of the time this is a fine white line let maybe 1 to 2 mm wider than we ideally want. People spend a lot of time and resources on laser resurfacing but this is really not usually a good route to go. Depending upon the fine line scarring it is always possible that lip tattooing is a good backup plan but the first and primary goal is to have a scar that looks good enough that does not mean anything done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, So this is what my profile looks like right now, primarily trying to get height in the lower third, and just wanted to know what my options are. I do think a bimax with maxillary downgraft would probably be my best option but I’m trying to avoid a very invasive procedure like that. Was more thinking of genio with chin implant for some verticality but not sure how good that would look.

Is there any implant+genio approach that would be able to get me sufficient height in the lower third or would orthognathic be my only option for that?

A:If the goal is vertical facial lengthening you’re not going to find a Bmax procedure with downgrafting  very favorable as this Is going to on lengthen your midface with potentially excess tooth show. So beyond that being a very invasive procedure it probably is not going to be that aesthetically beneficial and may have adverse tradeoffs

Jaw osteotomies aside you then have to decide whether it is vertical chin lengthening alone or total jawline lengthening that you desire. Vertical chin lengthening can be done by a bony genioplasty or an implant depending upon how much vertical length you actually need. If the goal is total jawline lengthening then a custom implant would be required to do so which may or or may not be combined with a bony genioplasty depending upon how much vertical chin length is needed.

To help illustrate these basic vertical lengthening concept I have attach some initial imaging showing the differences between chin only in total jawline vertical lengthening.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,, I’m seeking your expert opinion on revising a complex aesthetic and soft tissue issue following multiple surgeries of the chin/jaw. Background: I have condylar hyperplasia — my right jaw joint grew longer than the left, causing my entire jaw and chin to be skewed to the left. The right side of my face is noticeably bigger than the left. To try to improve this asymmetry, I had my first genioplasty in my early 20s, However, by my early 30s my chin still sat too far to the left, so I had a revision genioplasty. Even after the revision, my jaw remained crooked, so I had orthodontic treatment (braces) in preparation for full double jaw surgery to properly realign everything. I underwent double jaw surgery at the end of 2022, and the surgeons reversed the previous genioplasty at that time. Unfortunately, I developed two infections after surgery, which required them to remove the lower plates — so my lower jaw has been cut into and operated on multiple times. Current concern: Since all these surgeries, I now have persistent lower lip incompetence: My bottom lip does not touch my top lip at rest. My bottom teeth are always visible, and the lower lip sits too low and slightly everted. This looks unnatural and really affects my confidence. I believe this is due to mentalis muscle detachment, soft tissue stretching, and scarring from multiple surgeries and infections. What I’m hoping for: Your expert assessment on what is causing this — mentalis detachment, scar contracture, tissue deficiency, or all three. Your advice on whether mentalis resuspension (possibly with vestibuloplasty and dermal-fat grafting) would be suitable and realistic for me, given my extensive surgical history. Examples of similar cases you have corrected (before/after photos, if possible).. I can provide detailed photos (frontal, profile, lips at rest and forced closed), plus all my surgical and orthodontic records if helpful. I’m open to a virtual consult and prepared to travel from Australia if you think I am a candidate. Thank you so much for your time and for considering my situation, I truly appreciate your expertise.

A: Thank you very your inquiry and detailing your a complex surgical history… although when it comes to lower lip incompetence this is not an unusual background. The problem is your prior genioplasty has been reversed, losing support to your soft tissue chin pad and lower lip. Well I do not know the dimensions of your prior genioplasty any loss of horizontal projection and having head multiple surgeries to do so is going to result inching pad contraction and lower lip incompetence.

That being said there are limited surgical options to try to improve it which, from my experience, means basically do everything that you know how to do and hope it provides adequate improvement. Thus, as you have mentioned, mentalis resuspension, dermal fat grafting and a shortening vestibuloplasty are all of the soft tissue procedures. How this applies to you I cannot say based upon a verbal description alone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, is it risky or dangerous to do forehead reduction and hairline advancement at once? And you can’t do the forehead flatter than you showed me in the imaging?

A: It is common to do both forehead bone reduction and hairline advancement at the same time.

In imaging I try to show what I think is a certain amount of foreherad bone reduction …as that should be the trigger for surgery. Whether more may occur can not be known beforehand.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q:Dr. Eppley, I am considering having cosmetic surgery to improve my chin/jaw. I feel like my small chin gives my face a boyish/weak look. I would like my chin to be considerably stronger and more prominent to balance my face. Could I be a candidate for a sliding genioplasty? I would prefer to avoid implants.

A: With the focus on the small chin and with an emphasis on avoiding implants then by these parameters a sliding genioplasty would be the treatment option. This is a good treatment option provided one does want want the chin any wider or have a specific shape (square chin).

Now it is a question of determining what are the desired dimensions of the chin bone movement that look best to you. To make that determination a would need a side view picture of your face to do some predictive imaging.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, my son is almost 3 years old and has plagiocephaly that is noticeable. I am wanting information regarding the surgery to correct his skull. Thank you.

A: In aesthetic skull reshaping surgery I don’t treat patients under the age of 18 years old.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I found your practice by researching the arterial pulse in my cheek just left of my mouth. It showed up a few years ago and is now very noticeable, extremely so in certain lighting. I’m hoping to consult about surgical options. Scar potential and price. I’m attaching a photo of the location.

A: Your picture shows a classic facial artery pulsation in its location and appearance. This occurs at the bifurcation of the facial artery at the level of the corner of the mouth where it splits into a Y with one branch heading to the upper lip and the other along the side of the nose. Its cause is either an aneursym of the bifurcation or an aberrant loop of one of the takeoffs of thr branches. Treatment is by ligation of the pulsatile branch by an overlying small direct incision.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a custom jawline implant and photos were requested for imaging.

  I would like to send new photos to use for the editing process but I do have some filler in my chin, probably 1/2 syringe or slightly more. Is it best for me to dissolve the filler before sending photos so it’s represents the most accurate depiction of my chin?

A: FYI Imaging is not about showing patients their results. Rather it is about determining the patient’s goals. 

That being said whether the filler should be dissolved depends on the magnitude of its augmentation effect. If it is modest in effect then I would leave it. If its effects are more significant than I would dissolve it.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, How can my wide forehead and skull be reduced?

A:Thank you for sending your pictures. In assessing them it is important to recognize that the enlarged temporal muscles contribute as much if not more and that of the wider skull forehead bone. Thus treating both bone and muscle is extremely important for a satisfactory reduction. In fact that concept is so important that if you reduce the skull bone without reducing the muscle it would look even worse.

While it remains to be seen how much bone reduction your skull thickness will permit the enlarged temporal muscle has no such limits and will provide a greater reduction then that of the bone. Attached is some imaging of what I think in the best case scenario can be achieved.

Dr. Barry Eppley

World-Renowned Plastic Surgery

Q: Dr. Eppley, I had FFS four years ago and I am on the path of detransition and want to see what could possibly be done to give me back more masculine face especially my forehead, brows chin and nose.

A:While I don’t know what exact procedures you had in your FFS surgery three years ago I would assume that most of them were structural in nature. You have mentioned three structural areas in your inquiry being that of the fore head, nose and chin. Thus it would be logical to assume that forehead-brow bone, nose and chin augmentations would be helpful. To make a more accurate assessment these potential changes it would be helpful to see a side view picture of your face as well as well as pictures of what you look like before your FFS surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Inquiry Regarding Facial Harmony and Jaw Surgery Options. I’m reaching out to consult you regarding a long-standing concern I have with my facial structure. I feel that my face appears too oblong, with limited forward projection and a pronounced gonial angle. These aspects have impacted my confidence, and I’m exploring possible surgical options to improve my facial harmony and jaw definition. Specifically, I would like your expert opinion on whether a double jaw surgery (maxillary and mandibular advancement) would be appropriate in my case to enhance midface projection and balance. Alternatively, could jaw implants — particularly to improve gonial angle definition — offer an effective solution on their own? Additionally, I’ve noticed some jaw asymmetry, which I’m hoping to address. I am currently undergoing orthodontic treatment to correct a slight overbite and align my teeth. Could you please let me know what diagnostic steps (e.g., imaging, consultation) you would recommend to evaluate my candidacy for either approach? I would greatly appreciate your guidance on the best path forward. Thank you in advance for your time and expertise.

A: Thank you for sending all of your pictures. Based on these pictures it is hard to imagine the double jaw surgery has any benefit for you. Your midface lack of projection concerns lie above the LeFort I osteotomy level in which only in for orbital – malar implants can be of benefit. Asymmetry aside your lower jaw simply lacks some more defined structural enhancements at the chin and jaw angle areas. Again this is best treated by an implant approach rather than jaw bone surgery. (aka SSRO advancement) Jaw asymmetry is almost always best treated by a 3D implant approach as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I have a protuberance on my occipital bone that bothers me aesthetically. I would like to reduce it to improve my appearance. Is it possible to reduce it? This is my CT scan.

A:Thank you for your inquiry and sending your picture and x-rays. You have an acceptable bone enlargement which I have seen many times before. Your 2-D and 3-D CT scan show that the bone has more than adequate thickness to get a significant surgical reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a flat back side of my head. I was just wondering how long the process is? how long i would have to be in recovery? Will I be under? Or awake for this procedure?

A:Thank you for your inquiry and sending your pictures. You have a classic flat upper back of the head which is treated by a custom skull implant. Such a skull implant is made from the patient’s 3-D CT scan which they initially get where they live through our orders. The implant design and fabrication process takes 2 to 3 months to have it ready for surgery. Surgical placement of a custom skull implant is done under general anesthesia and, depending upon how are you choose to define recovery, gets some postoperative swelling which will take 10 to 14 days to largely go away.  There is no otherwise recovery limitations other than that of the swelling.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in mentalis muscle/chin pad resuspension. I’m highly motivated, but the operation must improve my aesthetic and medical condition, not make it worse of course.Since the primary genioplasty, I’ve had enormous discomfort in speaking, with this feeling that the muscle is preventing me from going back up, which borders on the internal scar of the vestibule. The mentalis muscle is very active and doesn’t seem to communicate with the lower lip despite all its efforts 🙂 the vestibule in my case is very deep with a large internal scar that seems to create a border and separate the muscle from the lower lip area, which is far too low. On the frontal X-ray, you’ll see that there’s some kind of wire (and maybe plates and screws or not ?) preventing my muscle from rising?

IN PROFILE YOU can see the chin (added or not) and the material that can support the higher attachment of the muscle?

I understand that there is a combination of techniques: muscle suspension, chin support (yes?) and a shortening vestibuloplasty? (shortening the depth of the vestibule by sewing the two edges of the vestibule mucosa higher together to support a higher lower lip and prevent relapse).

If the doctor sees a lasting solution I am available.

A:Thank you for sending your x-ray which shows a single wire ligature, which an old-fashioned method for chin osteotomy fixation, can be effective based on the amount of chin bone movement. That being said the wire ligature it is not impeding muscle movement although it would be removed in mentalis/chin pad resuspension surgery. As you have correctly noted mentalis resuspension is more then just a single technique and involves multiple combined tissue approaches as you have mentioned.

While there are no other methods to improve your problem, as I have previously pointed out, mentalis and chin pad resuspension is a challenging procedure with variable long term outcomes. There are no guarantees in any surgery and mentalis resuspension is no different. The question is not whether it will make anything worse, which it will not, but how much improvement in the long-term can it achieve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question about skull reshaping material PMMA.On your website it reads the material has flexibility and it qualifies as silicon on the periodic table.My question is: once the PMMA piece has been inserted under the scalp, if you press upon the scalp, does it feel soft or does the scalp feels hard like skull?

A:The use of PMMA (bone cement) has long been abandoned in aesthetic skull augmentation due to inferior results compared to custom silicone skull implants which also feel just like bone. PMMA is a synthetic plastic polymer while silicone is more pure element.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I noticed that Dr. Eppley specializes in clavicle lengthening osteotomy. This is something I would also be interested in. I had a right clavicle fracture which was missed and resulted in a malunion. My right shoulder and arm are sagging, and my neck seems to be narrower at the base. My goal is to have the malunion fixed and symmetry restored.

A:You are referring to a right clavicle lengthening procedure to try to improve shoulder symmetry. The key element in considering that procedure is what does the shape of the right clavicle bone look like. X-rays are needed to measure the differences in the links of the two sides as well as that of the angulation of the classical bone. Ideally the 3-D CT scan it’s best to appreciate three dimensional differences and the length in shape of the clavicle. However even regular clavicle x-rays would be useful.

You use the term of ‘fixing the malunion’ but I suspect it is no longer a non healed bone. Rather you likely have a healed right clavicle that is both shorter and now with the different angulation then that of the left side. That distinction is important as a true nonunion requires an autologous bone graft. Conversely a healed fracture site may not need a bone graft for straightening. But this is where radiographic analysis of The two clavicle bones is paramount.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am curious about what you offer when it comes to rib remodeling. I am a transgender person looking to not just narrow my ribs at the waist but further up to my 7th rib if possible .i am also wondering if the precedure that he preforms to do this will also reduce the projection of my ribs at the front. Aka rib flair. Many thanks.

A:I have done rib removal/remodeling up to rib number eight but not rib number 7. Ribs 10 through 12 are treated I sub total removal. Conversely due to their different anatomy ribs nine and eight are treated by and ostectomy with plate fixation to reduce their arc. I don’t see any benefit to treating ribr number 7 is that is almost at the breast level.

The anterior subcostal ribs when treated for excessive flare are usually treated by two point cartilage weakening with postoperative garment compression/remodeling.

Dr. Barry Eppley

World-Renowned Plastic Surgeon