Your Questions
Your Questions
Q: Dr. Eppley, I wanted to email you in regards to the cost of a chin augmentation using either an implant or sliding genioplasty. I have a slightly recessed chin I would like to bring forward. I can provide photos. I would like some more information about the custom implant process and how that would work.
A: Thank you for your inquiry and sending your picture. I have done some initial imaging to try and get a feel for what amount of chin augmentation looks sufficient to you. In terms of selecting how to do the chin augmentation:
1) standard chin implants are indicated when the chin deficiency is modest to moderate in size. (like yours)
2) a sliding genioplasty is best done when the amount of chin deficiency is large or the patient very specifically is opposed to an implant.
3) custom chin implants are indicated when the patient’s aesthetic goal can not be achieved by the use of a standard implant. (e.g., very square chin shape)
Based on just this one picture, #1 seems appropriate for you.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, Looking to correct previous gynecomastia surgery. I have bilateral surface irregularities/depressions and scar tethering during flexion. Original surgery completed one year ago with fat grafting completed six months later. Pre and post pictures included.
A: Thank you for your inquiry and sending your pictures. As I understand your history you had an open areolar approach to your gynecomastia reduction complicated by a postoperative crater deformity. This was followed by a second surgery of fat injections in attempt to release the adhesions and improve the contour.
Fat grafting as a treatment for the crater deformity after gynecomastia reduction is an appropriate approach. One can debate whether that should be by injection or the open placement of a dermal-fat graft. Each has their advantages and disadvantages. Fat injections are a more simplified and convenient approach to the problem but how much survives and their contour effectiveness is very unpredictable and far from assured. Dermal-fat grafting is more effective in terms of a successful release and volume retention but it is an open surgery and involves the need for a donor site harvest.
Most surgeons and patients when presented with the two options would understandably opt for the fat injection method. The question moving forward is whether another effort should be made at fat injections or whether one feels better about moving on to a ‘Plan B’ correction method. I can make arguments either way.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I like the first chin augmentation imaging that you did the best, I believe that is the smallest correct? For some reason though I just think I may Iook too masculine. I mean I know I have a boyish face but sometimes I feel like my recessed chin is the only feminine thing about my face lol. I would like to see what it would look like from the front profile because honestly that’s what bothers me the most. I feel like my lower face does not add up to my mid face and I feel like my lower face is sagging— perhaps what I need is a face lift. I honestly don’t know. Maybe you have other suggestions? I’m so lost. You’re the only surgeon I would feel comfortable getting anything done from so I really appreciate your input. Ultimately I guess I just want a more v shaped jawline and chin to look the most feminine that I could possible look. I just gotta figure out what needs to be done. Thank you so so much
A: In answer to your chin augmentation imaging responses:
1) I think it is wise for a female with a significant chin deficiency to be very careful about doing too much, Such patients often have a hard time recognizing themselves afterwards and can never adjust to a so called normal chin position. So the use of computer imaging has helped flush that concept out in you.
2) Since the chin augmentation would be small I would just go with an implant which is probably no more than 5mm horizontal projection and has no extended wings. (anatomic style chin implant) It also would need to be hand modified so it looks just like a V. With implants you have to exaggerate their design on the bone as the overlying soft tissues will blunt their effects. So to have a more narrow chin the implant must literally look like a V.
3) Not doing frontal imaging was not an oversight. You can’t really pull the chin forward with imaging so It won’t show much of anything. Unless one is interested in increased chin width (which you aren’t) frontal imaging is not useful. For chins and jawline the combination of the side and oblique views is the most informative and accurate.
4) A jowl tuckup procedure always makes the jawline sharper as it pulls the soft tissues back over the jawline bone. So the question is not whether that is beneficial but rather how far does one want to go for how much effect. At the least submental/neck/jawline liposuction is needed with the chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Has you ever had patients post-operation suffer from weakness in chewing or keeping the jaw closed after having done the posterior and/or anterior temporalis muscle removal/reduction?
-What sort of feeling should I expect post-operation and during the healing process when Dr Barry performs bone burring on my enlarged temporal line?
-Just to confirm, is it the over-developed anterior section of the temporalis muscle that contributes to forehead width ? I say this cause reducing my forehead width is one of my main goals with this operation.
-Roughly how long would it take for the major swelling to settle down post-operation and for me to comfortably go out in public ??
-Will I lose much sensation on the scalp post-operation from the coronal incision ?
-What medication would I get prescribed with post op and is this medication available back home in Australia ? If not what’s an alternative ?
Looking forward to hearing from you.
A: In answer to your temporal muscle and bony temporal line skull reductions:
1) No patient has ever experienced any lower jaw motion or chewing difficulties after the surgery. When the anterior temporal muscle is manipulated there can be some temporary tenderness with wide mouth opening.
2) Skull bone has no sensroy innervation so no pain/discomfort comes from bone reductions. It is the scalp that has sensory innervation.
3) The width of the forehead is ultimately defined by the prominence of the anterior temporal line.
4) Most patients have a reasonable appearance 10 to 14 days after the surgery.
5) Postoperative pain medication can consist of either narcotics (e.g., Percocet) or potent anti-inflammatory medications. (e.g., Toradol Ketolorac) That is a patient’s choice.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How many centimeters can you extend your shoulder reduction surgery? There are many places where triangular muscles, seolsang muscles, and chest are connected. What are the side effects? Please explain this in detail.
A: The amount of clavicle bone removed in shoulder narrowing surgery is 2.5cms per side. This has consistently shown to be effective and safe and within what is clinically supported by the orthopedic surgery literature for the amount of clavicle shortening that can occur without untoward shoulder function effects. (based on unoperated clavicle fracture repairs)
Other than the small scar in the supraclavicular fossa through which the surgery is performed, there have not been any functional side effects.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What are the chances of getting brain infections or any other risks during the cranioplasty?
A: There is a zero chance of brain infections with cranioplasy. All aesthetic skull reshaping procedures are performed on the outside of the skull not the inside. We do not come close to the dura mater let alone violate it into the subdural space.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m thinking about getting a skull reduction surgery sometime in the future. I’m thinking about specifically getting a temporal reduction surgery, mainly because my head appears overly wide. And I’m hoping to have my head appear more narrow after the surgery is done. I just had one question about the procedure. I read online about the temporal reduction surgery and how it will be carried out. I understand that to reduce the width of the head, you can remove the posterior temporal muscles located on the side of the head. But isn’t it also possible to remove some of the outer layer of the bone located on the side of the head if this bone is thick enough? Just like how it is done with the occipital reduction surgery, where the amount of reduction is limited to the thickness of the outer bone located at the back of the head. I’m asking this because when I plan to get this surgery, I’m hoping to make my head not appear as wide as it does now, and I’m hoping to get the most results from this surgery.
Thank you for answering my questions.
A: In answer to your temporal reduction surgery questions:
1) In every case of temporal reduction I have done removal of the muscle alone has been adequate…even in those that believed that bone reduction was needed as well.
2) Temporal bone reduction can always be done if one is willing to have the incision located on the side of their head. (as opposed to hidden behind the ear when the muscle is removed)
3) The temporal bone is very thin and just a few millimeters can be removed. Thus the minimal benefits gained is usually not worth the scar burden to do it…particularly if one has no hair to hide it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheekbone reduction surgery last week. Upon having my post op CT scan — I noticed my right cheekbone was slightly separated. My doctor said this will heal fine, but I’m still concerned because every time I open my mouth or touch my right cheek—I can feel my cheekbone moving slightly and making tiny cracking sounds. It’s also a little difficult to chew on my right side. I know I’m very early I’m my recovery process, but my main concerns are that this will cause asymmetries in addition to malunion requiring further corrective surgeries and longterm complications such as skin sagging. What are your thoughts based on your experiences, doctor?
Thank you
A: You had the classic oblique cut cheekbone reduction surgery with plate fixation at its most inferior part closest to the intraoral incision. While the left side is ideal the appearance on the right side is not uncommon. There is a slight rotation of the right cheekbone segment which can happen as the superior part of the bone is not accessible for direct plate fixation.
Everything you are feeling on the right side is not abnormal and the bone segment should go on to heal. (it will probably heal with a fibrous union rather than a bony union…which does not matter in a non-mandibular facial bone) The sensation of movement should pass in a few weeks. This slight osteotomy line should not cause any asymmetry.
The risk of soft tissue sagging has nothing to do with the osteotomy line as long as the bone is stabilized from falling inferiorly. Soft tissue cheek sagging often occurs because of the way the procedure has to be done. (stripping of the soft tissues off of the cheekbones) and then reducing the projection of the cheekbone)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve looked over the imaging pictures of my sliding genioplasty chin augmentation and I like the medium and large chin projection changes for my side profile. I wouldn’t want any larger than the large so if youhad to go bigger or smaller from that id prefer smaller. In between medium and large would also be perfect.
I forgot to add, how much do the different changes affect the view from the front and 3/4 view? I know you said it’ll look narrower. How much narrower would the large change be compared to the medium change? And how much longer from the front will my chin be in the end?
Thank you so much!
A: What you are really saying from a dimensional standpoint is keep the projection of the chin behind a vertical line drawn down from the lower lip. And to no surprise in females with naturally smaller chins ‘less is more; so to speak.
The larger forward movement the more narrow the chin will become from the front view.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, Last year I had bilateral testicular wrap around implants. Overall I am pleased, the left one is perfect. The right one however has a strange “pointed” shape at the bottom that is bizarre and sometimes causes pain, I was wondering if this could be rounded?
A: I would assume that this is related to the implant and, thus, it could be depointed (rounded off) in place.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had two sets of hip implants and both were plagued by bulging on the lower end of the implants. How can this be fixed?
A: I have pulled and looked at both your 1st and current hip implant designs. I would suspect that the first lower bulge occurred because the bottom of the implant developed a bend or fold in it. (thin lower edge) The second hip implant design is much thicker (and also heavier) and this probably occurred for the same reason. My thoughts are as follows:
1) This is not an easy problem to solve mainly because there is no assured outcome based on anything that may be done. Good fixes are those where high confidence is in the knowing the exact problem and having a treatment that is known to work for it.
2) I am not sure a change in implant design/shape is the solution. The profile shape of the bottom half of the implant does not match the shape you see in you externally. (see attached side by side comparison) This still suggests a bending problem at the bottom of the implant.
3) If we knew that the implant shape was the issue I would then just hand modify the bottom of the implant to make it have a lower better taper to it. (this is tempting to do and probably has little downside to doing it…probably can’t make it worse but would it work??)
That being said there are only three options:
1) hand modify the current implants as described above
2) Make new implants of higher durometer (stiffer with with better lower half profile shape)
3) Injection fat grafting around the lower half of the implant to make a more gradual transition.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, On Real Self I saw a few answers of yours to questions with regards to vertical augmentation of the chin. You were saying that using chin implants the chin can be vertically augmented up to about 7 mm (but no more) whereas with a vertical bony genioplasty the chin can be vertically augmented up to even 15 mm. The question I had was: from your experiences, what’s about the limit with regards to how much the chin can be vertically augmented with fillers? I’ve heard fillers are usually only good for horizontal augmentation of the chin (but not vertical) but I’d imagine that they could also vertically augment the chin to at least some degree. How much mm would that limit generally be?
Thank you for your time.
A: Injectable fillers can probable increase the vertical length of the chin by 2 to 3mms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have always been curious to know if it is possible to increase the pupillary distance between the eyes? I feel it gives a more feminine look and I just wanted to know if this surgery is possible? If not, is it possible in the near future with new technological advancements? Thank you for your time.
A: The eyes can be made wider if one is willing to undergo orbital box osteotomies as an adult. That is a major commitment that requires a full bicoronal scalp incision and a frontal craniotomy to perform. I do not see this surgical approach changing any time in the near or far future.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can temple implants and tear trough implants make my face more symmetrical? I had BSSO advancement which made the jaw angles more obtuse and desire jaw angle implants too. Would like to know your views via a possible consultation.
A:Thank you for your inquiry and sending your picture. The aesthetic benefits of temporal and infraorbital augmentation are fairly clear when imaging your front view picture. (see attached) The jaw angles are harder to properly visualize from just a front view picture. BSSO surgery is well known to adversely alter the shape of the jaw angle bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Am I a good candidate for reverse abdominoplasty and what’s the approximate cost of this procedure that only addresses the upper abdomen?
A: A reverse or superior-based tummy tuck is indicated in the following:
1) Loose abdominal skin is located above the umbilicus while there is no excess/loose abdominal skin below the belly button. In essence the loose upper abdominal skin ‘hangs around the fixed central umbilical area.
2) The patient does not prefer to undergo a traditional lower tummy tuck with umbilical repositioning or has been through a previous tummy tuck and does not wany to undergo that procedure again.
3) A well defined inframammary breast crease exists that is hidden by some degree of breast ptosis. (sagging)
4) The patient is not opposed to a scar line across their inframammary creases that may cross the midline between their breasts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a trauma to the scrotum and testicles secondary to an assault where an effort to “pop” the testicles through the scrotum occurred. This eventually resulted in the loss of one testicle and caused the posterior skin behind the scrotum to become very stretched out and thinned. Now the remaining testicle hangs low and slides out of the muscular part of the scrotum into the stretched out skin below the scrotum. This feels uncomfortable while sitting and especially while exercising even though I use supportive underwear. The discomfort and appearance reminds me of the assault and restoring things as much as possible would be a great help from this devastating and humiliating injury. In cold conditions when the muscular part of the scrotum contracts, the testicle is pushed into the stretched out area of skin towards my leg and feels uncomfortable. My hope is that if the stretched areas were tightened to keep the testicle in the muscular part of the scrotum, I would be much more comfortable. While I did not have a prosthetic testicle implanted when the more severely injured testicle could not be saved, I am not interested in a prosthetic testicle being added because comfort is a great concern and I feel with one testicle my prospects for comfort is greater since a certain amount of chronic discomfort exists; nevertheless, I would like some of the extra scrotum cleaned up and made to look more tidy. I am not concerned about having large and impressive looking scrotum and testicles, but really want to be comfortable and would prefer to have a smaller, higher positioning of the remaining testicle.
A: Thank you for your inquiry and sending your pictures. What you appear to have is disruption of the enveloping Dartos fascia/cremasteric muscle which allows the remaining testicle to prolapse into the enlarged and thinned skin sac under certain conditions. In essence you have a scrotal hernia. You are correct is that excision of the stretched out skin/tissues with a reinforced closure (aka scrotoplasty) will very likely help with the discomfort as well as its appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to know if you’re able to do a tummy tuck on a kidney transplant patient?
A:Yes I have done it before. (twice) You just have to know that the transplanted kidney is in the abdominal area so it may not involve rectus muscle plication depending upon where the transplanted kidney lies. It also requires clearance from your nephrologist for this elective body contouring surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was born with a congenital mishaped head. Do you do craniotomy’s? Do you work on adults? I had a forehead implant in 2009, it held up for nearly 3 yrs then started sliding. I let it go, saw a surgeon and he was going to take out implant & in 6 months do the craniotomy. As we thought I’d torn my dura mater, it was just a very, very severe infection and now he doesn’t want to do it! I was heart sick. I then saw a colleague of his & she wants to do bone paste. I’m just checking out all my options.
A: As I understand your skull situation, you had some type of forehead implant which became infected and had to be removed. I am assuming there is a remaining frontal bone albeit misshapen and recessed. I assume they have done an updated 3D CT scan of your forehead/skull so that the residual bony anatomy is known. I could not give a qualified opinion as to what your options are now without seeing that scan. Whether any form of synthetic material should be now used is the question. I assume the original implant material was PMMA. Certainly that material should not be used again and HA bone cement would be a better option.
Dr Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a skull implant surgery which was performed using 50CC of PMMA bone cement at the back of my head. There is now also a sizeable dent at the top of my head at the site of the incision ( its very hard to see in these photos due to my hair). This dent is palpable and visible to me after i shower and my hair is wet. I assume it’s because of how the PMMA was molded and where it was placed. How can this be fixed?
A: Thank you for sending your pictures. Nothing went ‘wrong’ with your skull augmentation. It is just that the use of PMMA bone cement is a very limiting technique for skull augmentation because of the low volume of cement that can be used and the frequent irregularities of it due to having to insert it and mold it ‘blind’ as it sets. I abandoned this antiquated skull augmentation technique ten years ago due to such inferior results.
By comparison today’s custom skull implants average about 150cc of volume (3X what you have now) with an assured smooth outer surface and good non-palpable edging into the surrounding bone. You would have to have this bone cement removed and replaced with such a custom skull implant for a much improved result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Could the crease in the back of my head be removed?
A: You have a common horizontal deep scalp crease at the bottom of the occipital bone on the back of your head which is not rare in thicker scalps. Because of its v-shaped indentation it must be treated just as if it was an indented scar. The indentation needs to be excised (cut out) and the scalp edges closed with a more level surface contour
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am emailing you to ask a very particular question. In the times you have performed the Temporal Artery Ligation Surgery, have you ever witnessed hair loss occurring in any of your patients? In fact, have you ever witnessed hair loss occurring in ANY procedure that relates to any procedure or ligation of the head and neck. I am asking because there are wild theories about blood flow being the cause of hair loss. Please get back to me!
A: The answer to your question is no nor would I expect that to ever occur. The scalp is simply too vascular with such an extensive anastomotic network that no single artery ligation effects an overall inflow at all.
I will tell you of a not so wild scalp blood flow fact known as homestasis flow. To maintain a vascular flow input to which it is accustomed if one or multiple inflow vessels are ligated the remaining arterial vessels dilate to increase their inflow, thus maintaining the amount of inflow which originally existed.
This is the vascular basis of pedicled skin flaps which have been used in plastic surgery for over 100 years.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I appreciate if you can provide feedback to my inquiry for ear surgery. Basically I have large size ear which requires upper pole and earlobe surgery and at the same time I am concern that if I do ear reduction surgery (upper pole + ear lobe) my ears might look lower from their position sort of become low set and I am wondering if you can perform AUROPEXY surgery ( lift & rotate) after ear reduction surgery. The purpose is to have smaller size ear but not low set. If this is possible then I would like to book for both surgeries and it is understood that they had to be done with some time distances and can not be done together. I appreciate if you can provide your feedback if this is possible. Thank you and regards
A:While ear reduction surgery can be performed with a very visible alteration in its vertical height, changing the position/orientation of the ear on the side of the ear is more limited. The ear is basically pinned to the side of the ear by the cartilaginous external auditory canal. The position of this canal is fixed as it passes through the skull into the inner ear. The ear canal can be partially released to allow for some ear rotation and the stretch of the ear can allow for some very modest elevation but these changes are less substantial in appearance than that of the ear reduction surgery.
The one question I would ask is how do you know the ear will look too low on the side of the head after ear reduction surgery? The best way to determine if this would even be an issue is to have some computer imaging of the ear reduction done and then see how it looks to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a young trans person who has extremely bad dysphoria, especially around the shoulder and hips area. I have searched online and even asked on forums to no avail, I even called surgeons in my country but no one is doing anything that can help. Then I found you.
I have some questions regarding the shoulder width reduction surgery, does the surgery actually reduce shoulder width? I saw on some forums that apparently it just gives the illusion of being reduced and gives bad posture, is this true?
I’ve also looked into any surgeries that can possibly reduce my frame, when asking about it I was met with hostile responses that I’d end up dying 24 hours later because it would put pressure on the heart.
My last question is regarding the pelvis and hips, are there any surgeries or even experimental surgeries that are being developed to bring the hips closer to that of a female? I’ve been looking up anything relating to this and all I’ve found are resources that may aid in helping to change bone structure like https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.610.BJR-2017-0094.R1 and https://www.ypo.education/orthopaedics/hip/pelvic-osteotomy-t12/video/ . I’m not a surgeon so I don’t know a whole ton about this, all I can do is look at a skeleton and ask questions, like if the clavicle is reduced, wouldn’t the upper rib cage bones also need to be slightly reduced in order to achieve more width reduction? Looking at pictures of a skeleton it looks like the shoulders are connected to a few of the rib cage bones specifically the sockets for the shoulders. I have heard stem cells have been used to help in surgeries, are there any stem cell therapy that’s being developed to help in changing body shape?
Thank you so much for taking the time to read my message, I’m so grateful.
A: In answer to your questions:
1) Shoulder narrowing surgery effectively reduces external shoulder width by removing a segment of the clavicle, the horizontally oriented bone that keeps the shoulder outward. It also does not adversely affect posture. Whomever would say otherwise on these two aspects has no working knowledge of the actual surgery.
2) You can not reduce the ribcage that lies above rib #10 for a variety of medical and surgical execution reasons.
3) Iliac crest implants exist for giving narrow pelvic patients more of a feminine curve.
4) While stem cells have a role in wound healing and the treatment of certain diseases, they have no role in structural body reshaping surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a silicone testicle implant for many many years I had it implanted when I was 25. I’m now 50.. I have been told that they should be replaced after a time. Is this true ? Also the implant is rock hard and I’d prefer something more natural is that available now?
Thanks
A: In answer to your testicle implant questions:
1) There is no recommended time deadline by which testicle implants should be replaced. As long as one has no concerns/problems with them there is no need to replace them.
2) Today’s testicle implants are superior to those of 20 years ago in terms of being much softer and with many larger sizes available.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I would like to undergo the surgery for brow bone implant augmentation, and I am wondering what the sequence of steps will be. I live in Southern Washington, so I assume that I would need to travel to Indiana for the consultation, CT scan, and the surgery itself. I recently learned that there is another type of implant material, porous polypropylene, in addition to the standard silicone material. Do you use this type of alternative material?
A: In answer to your brow bone augmentation questions:
1) the needed 3D CT scan is one you get where you live. We help you find a place to get it and then place the order so you can have it done. Then you mail the disc to us.
2) All consultations, discussions and implant design sessions are done online. You only come here once for the surgery.
3) Porous polyethylene, also known as Medpor, is another facial implant material option, But it offers no advantages, has numerous disadvantages and adds considerable cost to the surgery. i only use it when that is what a patient wants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After my sliding genioplasty my bottom lip is stuck down and can’t move up all the way. What can I do to fix it?
A: While one side view picture provides limited information, a likely cause is that the vestibule on the inside of the lower lip is contracted down into the bony stepoff that has been created by the bony genioplasty. A side view x-ray and a lip pull test would conform that diagnosis. If so the vestibule needs to be released and the bony stepoff grafted, usually with a dermal-fat graft, to provide improved lower lip mobility.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Will I be able to take hard hits to the head and will my hair grow back again after skull reduction?
A: Skull reduction surgery does not affect hair growth. It also still allows adequate brain protection against traumatic injury.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a facelift 3 years ago which left my right tragus blunted. I am self conscious about it’s appearance and never wear my hair up in public.I see that you have experience with this type of deformity.
A: The blunting of the tragus from a retrotragal facelift is due to scar contracture on the tragal cartilage pulling it forward. Technically the problem is a skin shortage and a cartilage deformity. What usually effectively treats it is a release (raising a skin flap over it), rebending and suturing the cartilage back and then advancing the skin flap back over it. (ideally a small full thickness skin graft is most ideal but you don’t want to create a skin color mismatch over it)
Dr Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a question that I wanted to see if you could address. I previously had a alar base reduction and am devastated with the results. The surgeon removed 2.5mm but even that little amount made a big difference as it changed my nostril curvature.
I have been suggested by another doctor that an option is to take a small piece of skin from my nasal floor (where the alar base reduction should have been done originally to avoid losing the curvature) and place that piece of skin into the curve. The skin is the exact same color and contour so irregularities will not be a problem. The second option is taking a small piece from the bottom of my nasal rim (my nostrils have been brought down so I need to have my alar rim raised anyways). My only question is regarding stitching. Since skin is being placed back, I’ll have another marking of scar. Do scars easily fade away and are they noticeable?
A: The best advice I can give you is to be very careful when embarking on a corrective procedure that is also going to leave a scar of some sort. What you don’t want to do is in the goal of correcting one problem you merely create another new problem. In other words every procedure has tradeoffs. If you fix the nostril narrowing but end up with visible scarring, even if it is slight, is that a worthy tradeoff? I can not answer that question for you, only you can. But what I do know is there is no corrective procedure which will not have a tradeoff.
Be very careful about ending up merely going down the ‘rabbit hole’. Plastic surgery is littered with many rabbit hole patients…I see them all the time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I desired a change for awhile but was too young. Have uploaded 3 images of me and 1 with a crude iPhone edit of what the end goal might be. Was mostly wanting to know how plausible it would be or if the desired results in my case are probably too much or too drastic. Essentially my main concerns are about the forehead. One being how it slants back starting right above the eyebrows, whereas I would like it to be more straight up and down. The second concern being that the top of the forehead is too low. The back of my head is at a higher peak than the front, I believe a more level top of the head front to back would look better for me in my case. The photo I crudely drew on just imitates what that might look like if the forehead was different in these two magnitudes. I know you are the best and would be using y’all if I did anything like this. If there are limitations that would prevent that much volume being added it’s just something I’ll have to accept lol! Thanks so much for taking the time!
A: Thank you for your inquiry, detailing your concerns and sending your pictures. Your pictures are taken from fairly far away so I enlarged them and laid them out side by side to see your imaged changes. You are correct in that the near vertical inclination of the forehead is a bit much…for a reason that is not apparent in a side view picture. When you add that much volume in the forehead in profile you have to consider the effects in the front view as well. Since the forehead like the rest of the skull is a large convex surface you can’t just add volume in one dimension without doing so in all other surface dimensions. In other words as the forehead inclination becomes less (more vertical) it must also become wider or the forehead will just look like a porpoise. As a result there are some aesthetic limitations and also some volume limitations based on the stretch of the scalp. Thus the best way to visualize what could be done is to assume that the achievable aesthetic outcome is probably halfway between your ideal and the shape of the forehead you have now.
Dr. Barry Eppley
Indianapolis, Indiana
