Your Questions

Q: Dr. Eppley, I want to consider total midface augmentation with custom implant.I know you are one if not the best in the world using implants. I have a question. I suffer for years from chronic allergic rhinitis.I would like to know if a custom midface implant may be effected from allergic or sinusitis. In that case is it any problem if i use implant. Could the implant cause more sinusitis infection or increase allergic symptoms? An opinion from you is very welcome due to your experience.

I thank you in advance

A:Your question concerning any possible adverse connection between a midface implant and the maxillary sinus is a understandable one. While the two are in close proximity there is no direct communication between them. They are separated by the anterior bony wall of the maxillary sinus. The bone thickness of the maxillary sinus wall may be thin but it still serves as a solid separation between the sinus air cavity and where the implant would rest on the bone. So no a midface implant would not cause a maxillary sinus problem nor aggravate an existing sinus condition.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m thinking about having a couple of skull reduction surgeries and I was wondering if you could provide a price estimate for all the surgeries together. Overall, through these surgeries I would like to decrease the overall look and size of my skull. Here are the surgeries that I plan on having. 

Temporal reduction: I would like my temporal muscles removed to decrease the width of my head. 

Occipital reduction: I would like bone at the back of my head reduced so that it looks more flat, and less bulging than it is now. 

Forehead bone reduction with hairline advancement/lowering: I would like to the bone under my forehead reduced so that it doesn’t look as bulging as it is now. I also have a pretty long forehead which makes me look like I have a receding hairline. If possible I would like to have my hairline lowered by 1 inch, or 2.5cm. 

Top skull reduction surgery: I would like the bone on top of my skull reduced so the vertical length of my skull is reduced. Just like in the pictures of the large skull reduction surgery. So that the distance between the top of my hair and my hairline is not too big after having the hairline advancement surgery. 

I also have another question in regards to these surgeries. When I do get them, will they all be done together in one session, or will they have to be done separately? Like will I have to wait a couple of months between each surgery? Just so I can know how long it will take to get them all completed. 

Thank you

A:Thank you for your inquiry, detailing your objectives and sending your pictures. All such procedures could be done at once if desired. (see attached imaging) Besides the temporal reductions the back, top of the head and hairline/forehead procedures are interconnected and the effectiveness of one impacts the other two so the ‘front to back’ skull procedures need to be done at the same time. The temporal procedure is independent of the other three and cold be done separately or as part of the other three, that is just a personal choice.

Whether you could get as much as 25mm frontal hairline advancement can not be predicted beforehand and depends on the natural stretch of your scalp. But certainly the back and top of head undermining/bone reductions is going to maximize whatever hairline advancement is possible.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, For a customized jaw implant, do you use a CT scan and special software to design the customized implant?

A: All custom facial implants are designed for each patient off of their 3D CT scan using Geoform implant designing software.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Can midface implant make nasomaxillary complex more forward and change the angle of “cheek line”. By a cheek line I mean a line from lower eyelid to nasal base; on flat midface is it more vertical while on projected midface it is more sloped(I attach photos to make it clean). Standard double jaw surgery with counterclockwise rotation doesnt reach. Probably the best solution to that would be Lefort 2 with counterclockwise rotation or other nasomaxillary osteotomy but its probably more risky. Rhinoplasty also wouldn’t make a difference to cheek line since it would only make nasal tip more projected why the midface is still flat/vertical.

A: A midface implant can very well change the cheek line as you have indicated by improving the projection of the nasomaxillary complex.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I think I am going to have my Terino II implant removed and will be going the custom route. The date for removal will most likely be in around 3 weeks.

However, I thought I should send some more photos in advance of the video consultation so that he gets a better idea of what is going on (in case he thinks it is best to retain the implant for the moment,  and that he may prefer to  remove the current implant and replace with a custom implant at the same surgery (should I decide to proceed and come across to the USA).

Please can you only show him the photos and ask him whether I would be able to keep what I have until any date of surgery (with him removing the old and replacing with new).

However if there is the SLIGHTEST chance that it would negatively impact the new implants and the final “look” then I will simply have to bite my tongue, remove the current implant and wait till first available date. (and grow a beard)

A: Removing it now is fine. What would be ideal is to have a 3D CT scan done before it is removed so we know exactly its dimensions and position on the bone which can provide invaluable information for a new custom implant. (when you know exactly why an implant doesn’t work it helps how to design a new one that will work better)

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley,Hello. Can i get wider and taller chin with genioplasty?

A:I believe you mean a wider and vertically longer chin and by using the term ‘genioplasty’ (which is a generic term for any type of chin change) you probably are referring to a bony genioplasty by osteotomy. An osteotomy can be used to make the chin longer and a bit wider by a midline split and interpositional graft. But if one wants it to have a definitive square shape this is then best done by a custom designed chin implant.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I made a big mistake ten years ago and did a rhinoplasty. The results are not very good, since I looked better before. Recently I’ve been researching the best plastic surgeons to correct it. My nose is broader, rounder and shorter than before the surgery. They cut off too much bones to the sides of the nose bone. Also the top of the cartilage part is cut. My goal was better symmetry, but it came with these big side effects. Instead of trying to correct the symmetry by realigning the cartilage they just made the nose smaller. I prefer my old nose to what I have today. I want to add bone/cartilage to the left and right sides, but ok if only one side is possible. In the close up you can see there is an edge in the middle of the nose. I want to add to atleast right side. They said they removed at most 3 mm so I dont want to add a lot, but I think it will have major improvements to my looks. It would make the nose look more defined and narrower. Its like a pyramid. Cutting off the top of the pyramid and the top will be broader. I also want to know if it’s possible to fix the slight upturned nose. I am open to use cartilage, bone graft from ribs or artifcial grafts. I am aware this is a complex and costly procedure. I have attached 6 pictures. One is how I looked before the surgery. 

Looking forward for a response. Thank you!

A:Thank you for your inquiry and sending your pictures. As you have detailed you had a reductive rhinoplasty which, amongst numerous issues, over rotated the tip of the nose…which men typically do not like. Now what you need is a secondary augmentative rhinoplasty for correction. The key to any augmentative rhinoplasty is to have enough building materials to do the job…which comes down autologous cartilage. Is there enough septum left to adequately add back what is needed or should a small costal rib graft be taken? (ear cartilage is not enough and is curved and structurally weak) Bone grafts are poor rhinoplasty materials and banked or cadaver cartilage is much harder to work with and may be prone to some resorption.

For the nose outside of the tip residual septal cartilage is probably adequate. But to derotate the tip, which requires a tripod structural reconstruction approach, rib cartilage is the best choice. Thus just use rib cartilage and leave the septum and ears alone.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, When I push up the tissue over my chin it creates a better angle and my face looks less long.  I think that my issue has more to do with the tissue/muscle and a reposition of the tissue or muscle would make a big difference.  But I’m not an expert, this is simply what I think.  

I had a lip lift in 2019 and it wasn’t possible to take off more skin due to my chin otherwise I wouldn’t be able to close my lips properly.  In the future I’d like to get another one. This is one of the main reasons why I would like to fix my chin now.  

Thank you,

A:Thank you for sending your pictures. While pushing up on your soft tissue chin pad creates the desired look, soft tissue resuspension will not work or ultimately have the desired effect. That is not a sustainable procedure unless one has true chin pad ptosis which you do not. You have a vertically long chin which requires shortening of the chin bone. This is done through an intraoral osteotomy technique where an interpositional wedge of chin bone is removed. This largely vertical reduction combined with a slight horizontal movement is what is needed to create the desired effect.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a testicular implant, from torsion and removal at birth. I like the idea of the solid silicone. Are you still implanting those solid silicones? 

Do you also have data of infection/removal from all of your procedures? As well as cost? I have a few other questions about high scrotal vs inguinal.

A: In answer to your testicle implant questions:

1) The most common testicle implant that I place are ultrasoft solid silicone styles.

2) In my extensive experience with testicle implants I have seen 1 infection so that infection occurrence rate would be less than 1%.

3) By far the low midline raphe scrotal incision is the superior method of incisional access for testicle implants.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to enquire about buccal fat reversal with dermal fat graft as I underwent it last year. May I asked what is your experience with this surgery and how many cases have you done? 

Kind regards

A: It is an effective procedure based on the 3 cases I have done to date. It works because an en bloc fat graft is placed back into the buccal fat fad space through an intraoral approach.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some computer imaging done at a clinic to show me some face changes. I am wondering if these results are attainable as I am suspicious of Photoshop use.

A:The first concept to grasp is that imaging is designed to set the patient’s aesthetic target …from which the operations are then designed to try and achieve it…not the reverse. So I would not assume the images are suggesting this is exactly what is going to be achieved. What imaging is designed to do is elicit a reaction from you about the various changes shown and see what type of changes you are seeking. This is how i do it in my practice.

But for the sake of discussion let us assume the imaging shown is what you have chosen to be the goals of the various facial changes shown. Is that result achievable?…largely yes provided the procedures chosen can create those type of changes. Thus the more pertinent question is HOW are they saying they are going to achieve those results. Once I know what procedures they plan to do I can tell you whether they would have a reasonable chance of being in the neighborhood of those changes, particularly those of the cheek and jawline.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a virtual consult with you last year  but I’m worried that an augmentative rhinoplasty won’t be enough to create proportions within my side profile since my lips are so protruding, so could you confirm if I need my premolars extracted to bring inward the lips before I get the rhinoplasty or will the rhinoplasty be enough? 

A: Good to hear from you again. You have to realize that you have a major nose-jaw size disproportion which can probably never be made ideal. All you can do with the nose is augment it as much as possible with a rib graft as the skin is only going to stretch so much. As for whether it would be enough from your perspective you have to go with what you see on the predictive imaging. (see attached)

Anyone can have their premolars removed and the teeth moved back which will help with the lip protrusion. You would need to consult with an orthodontist to see how this would work in you. With such orthodontic work an augmentative rhinoplasty could be done before, during or after orthodontics. It doesn’t matter since it is known now that you need a maximal augmentative rhinoplasty from which there is no risk that it can end up overdone or too big.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Two years ago I had a displaced fractured cheekbone and other fractures.  No surgery was done at the time or since. I have been left with a major cosmetic defect and chronic 24hr/7days pain/painful pressure above my upper center and side teeth -same side as the fractured cheekbone. The pain is very debilitating and the cosmetic defect is destroying my self esteem. I am in search of an experienced and talented surgeon that can re-break the cheek fracture/s and put the cheekbone back in place which I hope will not only mostly correct my facial symmetry but also unimpinge whatever nerve is causing the pain and/or remove the stress that the inward rotation of the cheekbone might be putting on the muscles, tendons, ligaments, etc. 

A: Thank you for your inquiry and sending your pictures and x-rays. As you know and have well described, you have the classic untreated ZMC (cheekbone) fracture with its typical and inward rotation into the maxillary sinus. You are correct in that refracturing the cheekbone and repositioning it out and up (derotation) is the correct procedure in your case. Cosmetic camouflage in untreated ZMC fractures is only the best approach if the rotation is very slight or the only issue is soft tissue atrophy over the bone.

The keys to successfully treating the secondary impacted ZMC fracture is rigid fixation and bone gratting  after it is cut and repositioned. The plates will hold it into a better position but derotating the ZMC complex will reveal bony defects particularly along the posterior zygomatic buttress and maxillary sinus walls and possibly the orbital floor.

But the first step is to get a 3D face CT scan so the exact ZMC anatomy in the traumatized side is fully understood before surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley, I have a clavicle that is shorter than the left by 3cms give or take, can it be fixed and look like the left and be symmetrical.

 A :Clavicle lengthening in a normal non-muscular patient is limited to 15 to 20mm lengthening at best. In a well muscularized patient that lengthening would be more limited. So getting 3cms of clavicle lengthening in you is not possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been reading about jaw recession and chin recession, which I now realise to be much of the same issue: if the chin is recessed, so usually is the jaw. 

I have read that when correcting a recessed chin via genioplasty, chin implant, or both, a problem known as the “crescent moon deformity” can occur, whereby there’s a point in which the advancement of the chin looks unnatural because the jaw is still recessed behind it. 

Apparently, the only way to correct this problem would be BSSO, as with a short distance from chin to throat, as is seen in recessed jaws, nothing can compensate other than physically extending the mandible body itself as well as the chin. 

I was wondering what your thoughts were in regards to how this problem pertains to wrap around jaw implants? I was considering one of these implants with you myself, but am concerned it would look unnatural if the mandible body is not long enough in the first place. I have attached an image (sorry for the quality. It’s the only one I have as I currently have a beard). 

From what I’ve read, it seems plausible to be able to correct a recessed chin, lengthen the ramus (jaw height) and add jaw width with a wrap around, but will it ever look natural if someone’s mandible length from the profile view is too short to begin with? 

Many thanks!

A: Thank you for your inquiry and sending your picture. You are not a good candidate for a wraparound jaw implant. Your chin is too short and is tilted downward with a high mandibular plane angle. Short of a BSSO what you need is a sliding genioplasty to bring the chin substantially forward (+10mms) and up. (vertically shorten) Jawline implants behind can be added for a total jaw augmentation effect if desired.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a forward sliding genoplasty almost 20 years ago. It was advanced an estimated 8-10 mm. I was left with a tightness in lower gum line. 3-4 years later after this procedure tightness still existed so the original Dr. did another procedure sliding back the bone half way, so as of now around 4-5 mm advancement forward. This helped the condition a little bit, but the tightness still remains just not as bad after second procedure.

I recently had the bracket removed from chin in May of 2021 hoping this might relieve more of the tightness but that didn’t help. I have no nerve damage. 

I have read many good things about you and I’m in need of an expert in this area. Your opinion would be very helpful as I’m running out of ideas. It would be great to live without this tightness !!  I have lived with it for so long now. 

If there are no other options I would consider moving chin back to its original position.

A:This is not a bone problem, it is a soft tissue problem. Always has been. When you slide out the bone significantly there becomes a relative soft tissue deficiency due to scarring and soft tissue thinning.  When the soft tissue is allowed to contract back into the bony stepoff created by the bone advancement (grafting is not done) this is what can happen.

While setting back the bone helps a bit and was the logical treatment to do, it can not fully solve the scarring/soft tissue deficiency. Taking out the plate never provides any real relief because it does not address the problem…the soft tissue and it just makes more scar. (it is just an easy but wrong target)

You solve a soft tissue deficiency in the chin just like you would anywhere else in the body….release and the placement of new interpositional soft tissue. (dermal-fat graft) It takes an additive not a reductive approach. Some may consider fat injections as the soft tissue additive procedure but that injection approach does not create a good release and the placement of injected fat into scar often does not end up where it needs to be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I would like a bicep implant. I had a botched tendenesis. Tendon was torn and atrophied. Got tendon reattached. Would like to investigate if an implant under atrophied tissue is possible. The tattoos makes it hard to tell, but it’s retracted toward the elbow. It’s balled up like Popeye. I’m not sure I can be helped, but if you could more normal, that’s what I want. 

A:Thank you for sending your pictures which show a classic partially detached distal insertion of the biceps muscle. The problem with this type of bicep muscle deformity is that the arm has two positions, extension and flexion, and the deformity primarily appears in one position (flexion) but looks reasonable in the other. (extension) This poses a reconstruction problem as any treatment done runs into the same issue…looks good in one position but looks abnormal in the other position. Thus you can see the dilemma.

That being said the logical approach is that you have to treat aesthetically both sides of the problem…reduce some of the muscle mass seen in flexion and add some small implant volume below it.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Zygomatic/Malar Osteotomy may be beneficial to my appearance. I have attached a photo of myself when I was very young (around 20 years old) it shows my facial bone structure better then my more recent photo from a couple years ago (im 33 now). Maybe Zygomatic/Malar Osteotomy would be more beneficial than seeking out Orthognathic surgery from another surgeon. What do you think?

A:The malar expansion osteotomy (aka zygomatic sandwich osteotomy) can be an effective procedure for specific cheek dimensional issues. It is intended to widen the cheek bone (zygomatic body-anterior arch) but it will not give it forward projection. At least based on your two attached pictures you do exhibit zygomatic body narrowing. (see attached picture with arrows)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Last year I underwent surgery to improve the mandibular contour through personalized PEEK implants in the chin and jaw. About 3 months after the operation, I had an infection plus a posterior lump on my left side. The doctor drained it, but soon after the abscess turned into a fistula that oozes pus continuously, and it’s been like that for several months. As a consequence of this, the maxillofacial surgeon now proposes to remove the implants as the infection plus abscess and fistula came out as a result of, according to his criteria, a body rejection of the PEEK implants. 

My questions are: 

What has happened to me is due to a rejection (as the doctor assures) or to a potential contamination of the implants before the intervention? 

Can you provide me with some hypotheses about why the infection plus posterior abscess and fistula have appeared? 

Can I go through the same surgery after the current implants have been removed and mouth healed, or there’s any reason/something preventing me to do it? 

Can this happen to me again or is it unlikely? 

Thanks in advance for your help.

A: Throw out the concept of ‘rejection’ of the implant as that is not a biologically accurate explanation…this is an infection….a known risk of any implant surgery and the risks are higher when the implant is introduced through the mouth which is not sterile and can not really be made to be so at the time of surgery.

Implant Infections fool patients because they occur much later than patients are aware…anywhere from 3 weeks to 3 months after the surgery. (most do occur by 6 weeks) When they occur the implant fate is largely sealed due to the development of biofilm on the implant which can not be eradicated by antibiotics alone. Antiubiotics may suppress it for a period of time but can not usually cure it. Removal of the implant is the definitive cure. Implant replacement can be done 6 to 12 weeks later. The risk of implant infection is the same each time the surgery is done. The key question is always what is going to be done differently the next time to try and prevent it from occurring again.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Im interested in the procedure of Rib removal. Can you please provide me more information. I want to know if the ribs are going to be removal or just break them and leave it inside the body. I’m a little confused about that part.

A: Thank you for your inquiry and sending your pictures. There are two methods of waistline narrowing by lower ribcage manipulation, removal vs fracture. I most commonly perform rib removal for waistline narrowing which also includes flank liposuction and muscle trimming…which provides the most comprehensive approach to the inward movement of the waistline. Rib fracture is as the name implies where the ribs are cut and left in place and relies heavily on postoperative corseting to achieve some inward waistline movement. The rib fracture method does not produce as much of a result as rib removal but offers a less invasive surgery and a quicker recovery.

Barry Eppley, M.D., D.M.D.

World Renowned Plastic Surgeon

Q: Dr. Eppley, Im interested in the procedure of Rib removal. Can you please provide me more information. I want to know if the ribs are going to be removal or just break them and leave it inside the body. I’m a little confused about that part.

A: Thank you for your inquiry and sending your pictures. There are two methods of waistline narrowing by lower ribcage manipulation, removal vs fracture. I most commonly perform rib removal for waistline narrowing which also includes flank liposuction and muscle trimming…which provides the most comprehensive approach to the inward movement of the waistline. Rib fracture is as the same implies where the ribs are cut and left in place and relies heavily on postoperative corseting to achieve some inward waistline movement. The rib fracture method does not produce as much of a result as rib removal but offers a less invasive surgery and a quicker recovery.

Barry Eppley, M.D., D.M.D.

World Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to have a small revision genioplasty as my chin was moved too far forward and down, but would not like titanium plates and screws to be in my body. I read that you did a paper on using reabsorbable polylactic-polyglycolic acid plates and screws, claiming they were an effective alternative. Would this be possible for a 2mm reduction genioplasty? I would be willing to have a consulation and procedure with you if possible. Please advise on the reabsorbable plates and screws in particular. 

A: Thank you for your inquiry. I believe what you are specifically desiring is an intraoral secondary genioplasty where the titanium plate and screws are removed, an osteotomy is done to set the chin back by 2mms and the chin bone fixed into position by 2.5mm resorbable lag screws. (see attached) That can certainly be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question about midface (nasomaxillary) projection. My nose(practically entire mid-face) from profile looks quite flat and my cheek line” from profile is almost vertical. I would prefer to have a nose that projects more and a more sloped cheek line. In the book “Aesthetic Surgery of the Craniofacial Skeleton: An Atlas” I read about some osteotomies that advance fragment of nasomaxillary complex and advance it forward and counterclockwise (but I don’t know if such procedures are performed on a regular basis. 

Traditional bimaxillary surgery won’t bring the nose forward so its not really an option. Below I attach pics of my nose, what I meant by cheek line and desired midfacial side profile.

Thank you very much for answer.

A: Thank you for your inquiry and sending your picture and detailing your concerns and objectives. It is esay to get caught up in facial osteotomy designs on drawings and assuming that is the best way to address their facial concerns. In reality these osteotomies have their place but when it comes to increasing the projection of the nose on an otherwise flatter midface this would not be an effective method to do so. (nasomaxillary augmentation)

First you have to define exactly by what you mean by ‘increased nasal projection’. This could entail one of two meanings…increase the projection/fullness of the nasal base or improving the projection of the dorso-columellar line of the external nose. I am going to assume you mean the former since you have described your own lack of midface projection and have been looking at osteotomy approaches to improving it. In that regard it is far more effective and surgically less complicated to adding to the flatter midface, specifically around the bony pyriform aperture around the base of the nose. This onlay augmentation can be done by bone/cartilage grafts, bone cements and custom implant designs. There are advantages and disadvantages to all of these onlay midface augmentation approaches which requires a more detailed discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I have two questions: one, how much does rib shaving cost (or could you give me a start-up estimate)? Two, is it possible to shave down the width of a ribcage? Mine is terribly wide and it gives the illusion of a male shape. This is NOT what I want. I’m also a bit short, which makes it worse! I’d love more of a rectangular shape. Almost adolescent in nature. Thank you!!

A:Rib removal surgery is for specific areas of reductions around the ribcage like the waistline or the subcostal margin. It can not be done for an overall ribcage width reduction as that involves too many ribs to try and reduce. It would not be effective for that aesthetic ribcage concern.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, Ive asked questions on here before but I had another one that is a big factor on wether i would like to get work done. 

When getting multiple procedures done (plagiocephaly in my case), does it cost the same as all of the procedures separately or is there a bit of a discount since it’s being done all together? I would also love to know how much past full plagiocephaly corrections have costed, as price is a huge factor. 

Thank you!

A: The economic benefits of combining procedures comes from the reduction of OR and anesthesia costs. When doing procedures separately there is time to get the patient ready in surgery and time to apply dressings and wake them up which is part of the surgical cost. When combining procedures these ‘startup and closing down’ time/costs are reduced and become one rather than multiple additive units when procedures are done separately.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi. Does you charge same price for shoulder widening even when you only operates on a single shoulder to fix asymmetry? Also how much of lengthening can be done?

A: Thank you for your inquiry. When only one clavicle is being operated on the cost would obviously be less than bilateral clavicle surgery due to a shorter operative time and less hardware used. How much clavicle lengthening that can be achieved depends primarily on the reason for the shoulder asymmetry. Is it a congenital shoulder asymmetry or a traumatic one induced by a fractured clavicle? The next question is how much clavicle lengthening is needed?  (based on x-ray measurements) The answer to these questions is needed to address how much clavicle lengthening can be done…or more pertinently how effective would such surgery be.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it possible to extend the collarbone 3 or 4 times for a total of 12cm or 16cm? I want to get an extension effect of 12cm or more through at least 3 surgeries. Is it possible if there is enough time and rehabilitation?

A: Such a degree of clavicle lengthening (12 to 16cms) is not possible no matter how many times it is done. The tight shoulder girdle and scapula is the limiting factor which provides a ‘stop’ as to how much push the extended clavicle can be allowed to go.. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to get a bit of information on your custom wrap around jaw implants to reshape my jaw line. I had recently had a Bilateral Sagittal Split Osteotomy and Sliding Genioplasty to correct a Class-II Malocclusion. I am currently unhappy with the shape and position of my lower jaw. As it stands I have a jaw that has downward growth; it has a high gonial angle, lacks bi-gonial width, short ramus length, and my chin is a bit recessed. My Maxillofacial surgeon recommended that I find a surgeon that has extensive experience working on reshaping male patient’s jaws. I had spoken to a few plastic surgeons but what caught my attention about your practice was an article you wrote titled “Plastic Surgery Case Study – Custom Jawline Implant Design for the High Gonial/Mandibular Plane Angle Patient”. In this article you went into detail about your procedure to bring a male patient who had a high gonial angle of 150 degrees down to 130 and the importance of understanding the relationship between lowering the gonial angle and the masseter muscle in surgery. 

I wanted to know if you have any experience working on patient’s who have had orthognathic surgery and if a custom wrap around jaw implant could help me get a more ideal male jaw shape.

A: Thank you for your inquiry. Approximately 20% of all custom jaw angle and custom jawline implant patients have had prior orthognathic surgery for the very reason you are experiencing. Orthognathic surgery serves a very valuable role in facial bone surgery but it is primarily affects the sagittal dimension of the face and is very limited dimensionally in what it can change thereafter. This is why it is not rare to see patients who have had single or double jaw surgery seek to use the jaw surgery as a foundation on which to create enhanced 3D features of their facial bones.

I would refer you to www.eppleycustomfacialimplants.com to look at some of the many jaw implant designs I have done in such patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can my skull be cut down 1 to 1.5 inches from back and my face become normal?

A: How much skull reduction can be done from the back requires an x-ray to evaluate the thickness of the bone. But even at the thickest 1.5 inches of skull reduction can never be done as no one’s skull is ever that thick.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to inquire about options that are available to fix the dent in my son’s head which is the result of a head injury and subsequent cranioplasty surgery. I am also interested in having his scar removed if possible. Please let me know if this is something you can help with?

A: Thank you for your inquiry and sending your son’s pictures. I am going to assume that the prior cranioplasty surgery was a craniotomy bone flap which has subsequently sunken in as it healed. (meaning there is a stable base of bone albeit with less than the desired contour) To achieve both objectives, skull contour restoration and reduction of the scalp scars, requires a combination of scalp expansion (first stage scalp expander placement) and 2^nd stage onlay skull reconstruction/augmentation to build out the skull contour. Two stages are necessary as expanding the skull contour without more scalp tissue to cover it will not result in less of a scar appearance. Conversely excising the scars can only be done at the same time if the skull contour is only improved slightly.

Dr. Barry Eppley

Indianapolis, Indiana