Your Questions

Q: Dr. Eppley, So I have a very small head. So small that I’m convinced I have the smallest head on earth for a healthy adult male. I know for sure it’s smaller than 54cm. I have a few questions about this procedure but rest assured I will be making an appointment in the future. 

How much does the surgery cost? That way I know how much to save 

What can I do in the meantime to maximize the enlargement potential? Collagen supplements? 

Will there be scars? If so where? Will the cuts be anywhere hair is located? 

I’m worried the head enlargement will throw off the rest of my features. If so will there be an option to enhance those as well?

A: In answer to your head enlargement questions:

1) The cost of head enlargement surgery depends on how it is done. (one vs two stage)

2) Head enlargement surgeries are maximized by doing a two stage approach which employs a first stage scalp expansion which permits a larger implant to be placed.

3) The scalp incision is usually placed near the crown of the scalp.

4) Most head enlargement surgeries are probably not going to be big enough to make the face look too small.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I love your work and I am very interested in your shoulder narrowing surgery! Have you done any cis-gendered women? Also, do they end up looking hunched over? Thank you !!!

A: About 25% of shoulder narrowing patients are cis-females so they do request the procedure just not as much as the transgender patients.

Patients do not develop a hunched shoulder appearance afterwards. That is only a posture you see in the early postoperative period because it is the most comfortable position for the shoulders. It also results from keeping the elbows close to one sides in the first few weeks after surgery to protect the healing clavicle osteotomy sites.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The testicle implant I have was placed nearly twenty years ago. My actual testicle size is about 3.5 – 4 Cm approx….I used a simple ruler to measure them. I would like to get a large implant for both sides to improve size and also a softer and natural to the touch.

You suggested new size implants of 5.5 Cm for both sides. Are these medium or large implants?. I’m a little concerned that a 5.5 Cm wraparound might strangle my actual testicle. Is it possible? Is it better unrestricted or restricted? No dancing around in the wraparound.  I’m looking for the perfect fit physically and visually and since I have a small frame, nothing ridiculous, too big .. 🙂

Thank you so much again!

A: In answer to your testicular implant questions:

1) Most likely your natural testicle size is about 4 cm+. I assume the testicle implant is smaller, probably more in the 3 cms size range.

2) The largest standard off the shelf testicle implant is 5 cms. Most men who get testicle implants would still consider that ‘small’.  Thus either 5.5 seems reasonable for both sides as that is an upgrade but not by an unreasonable amount.

3) Wrap around testicle implants do not strangle or compress the existing testicle or the attached cord. In fact the risk with them is the opposite of your concern…having the testicle slipping out of the wrap around implant. That is why they are sutured into the implant to prevent that potential postoperative issue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a male and I was wondering if u could fix my asymmetrical face and one of my eye brows go up higher than the other side and on one side of my lip is bigger than the other side and the other side of my face is sagging than the other. 

A: Thank you for your inquiry and sending your picture. What you have is a right side of the face asymmetry caused by a developmental shortness on that side compared to the left side. That is most manifest mainly by the right vertical orbital dystopia (right eye lower than the left eye) which is the cause of the lower right eyebrow. Like all facial asymmetry corrections it comes down to determining what is most important to improve vs the tradeoffs (scars) in doing so. What I tell all my facial asymmetry patients is to make a liost of thge priorities so I can go through it with them and discuss what can be done and the potential tradeoffs in doing so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a male and I was wondering if you could fix my asymmetrical face and one of my eyebrows go up higher than the other side and on one side of my lip is bigger than the other side and the other side of my face is sagging than the other. 

A: Thank you for your inquiry and sending your picture. What you have is a right side of the face asymmetry caused by a developmental shortness on that side compared to the left side. That is most manifest by the right vertical orbital dystopia (right eye lower than the left eye) which is the cause of the lower right eyebrow. Like all facial asymmetry corrections it comes down to determining what is most important to improve vs the tradeoffs (scars) in doing so. What I tell all my facial asymmetry patients is to make a list of the feature priorities so I can go through it with them and discuss what can be done and the potential tradeoffs in doing so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to ask Dr Eppley 3 quick questions regarding brow bone reduction.

– what is the average bone thickness over the frontal sinus? 

– how much bone can we shave over the frontal sinus? (in mm)

– and what is the minimal bone thickness we can let over the frontal sinus?

 (without risks of tissue dying)

A:In answer to your brow bone reduction questions:

1) The average of the frontal sinus table in men is 3mms.

2) Since 1mm needs to be left, 2mms can be reduced by burring.

3) As stated in #2, 1mm.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, If the effect of temporal muscle injection is relatively small, can the anterior temporal bone and the posterior temporal bone be erased about 1cm by bone grinding? At the same time, I have another question, that is, the zygomatic arch, temple and forehead in my CT are relatively wide, can I remove about 1cm of bone on both sides by bone grinding? Thank you very much!!

A :How do yo know that the effect of temporal muscle reduction is small/inadequate? The temporal bone is fairly thin so a 1 cm bone reduction is not possible.

As for the forehead/temporal/zygomatic arch, a 1 cm per side reduction can not be done as the bone is not that thick. More realistically it is 5 to 6mms per side for a 1.0cm collective cheek width reductions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, In regards to the Pelvic Plasty procedure (iliac crest implants) where is the incision made to place them and what type of scar does it leave?

A: The incision for iliac crest implants is made at the posterior iliac crest region and is about 3 cms in length. This requires the surgery to be done in the prone position. (face down) The incision is made in the panty line so it is in a good location for being hidden in underwear. It is closed for fine sutures using a subcuticular suture technique in which all sutures are buried under the skin. As a result they don’t need to be removed and also leaves no suture track marks. It usually heals as a fine line scar and rarely requires the need for scar revision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,I was wondering if it would be beneficial to do the Scrotox injections to keep things relaxed while healing from getting large testicle implants? Worried about the incisions being pulled due to the natural swelling that will occur after the surgery. Maybe not a issue but curious…

A:Incisional dehsicence has never been a problem in large testicle implants in my experience so I think the expense of Botox injections may not be a good expediture. It certainly does not hurt but am not sure if the benefits are worthwhile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I shave one eye lower than the other one and it has been so since birth. After researching on the internet I believe I have Vertical Orbital Dystopia. What can be done to make my eyes more symmetrical in appearance?

A: Thank you for your inquiry and sending your picture. To learn in detail what can be done for moderate VOD I would refer you to one of my websites, www.exploreplasticsurgery.com where you can place in the search box the term Vertical Orbital Dystopia and read the various articles about its surgical treatment. The first step in the process begins with obtaining a 3D CT scan of your face so the measured differences between the two orbital boxes can be determined.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I really appreciate your medical service. Thank you for posting superior medical job at this site. I`m living at Asia and preparing for MTF surgery. I have two questions about body contouring surgery. 

First, how long should I stay for healing process? (Essential hospitalization term) Second, Which surgeries can be done at once? For example, subcostal rib removal and shoulder reduction go on first and later rib removal. Or all at once. Also if none of them can`t be done together, please tell me. 

Once again, I feel truly thankful that your hospital provides such a beautiful surgery. 

Thank you for all.

A: Thank you for your inquiry. In answer to your questions:

1) Shoulder reduction and rib removal can be performed together in the exceptionally well qualified patient but we will assume for now that they would be done separately.

2) The subcostal rib removal procedure can be combined with either shoulder reduction or rib removal. Whether that is a good procedure for your remains to be determined.

3) When to return home from either procedure partially depends on whether you are traveling along or with someone. For now I will assume the former. Thus for shoulder reduction one could return home 10 days after surgery. For rib removal it would be quicker in the 4 to 5 day time period.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How many custom implants can be placed in one session? Is it possible for chin, jawline, zygomatic arch and temporal implants in one session?

A: Placing multiple custom facial implants during the same surgery is common in my experience. I have seen as many as ten custom skull and facial implants placed in a single surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been looking for plastic surgery for  supraorbital augmentation because my eyes are like Asian eyes and i like caucasians eyes. The  Caucasian supraorbital bone covers eyes and it makes the deep and shadowed which I find attractive. It sounds like that I am trying to change my race. But if i can do the surgery i want to get the surgery So my question is “is it possible” ? Thank you for reading my text. 

A: What you are referring to is brow bone augmentation, sometimes referred to as supraorbital rim augmentation, which I do with a custom brow bone implant. While it is more commonly done in males there is no reason it can not be done in females as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a long time I have had some major insecurities with forehead. I liked my look but not side profile.I went to a FFS doctor to do a forehead reduction since I felt it was so masculine and people have always said I look different from my side profile and this was a huge problem for me. I could not even wear sunglasses because my forehead stuck out too much. I told the doctor to not remove to much bone, nothing from my forehead but only the bone you take out and put in. I said to him to not shave my brow bones to much since I like my look around my eyes and to NOT give me the «surprised look» 

My brow bione is almost completely shaved and not existing. I am so so so sad, and this has ruined my whole facial expression. I have been deeply depressed since the surgery.. I found you and you brow bone implant, and I think now you are my only hope to get back my look and protection around my eyes. Is it possible to fix this?

A: Thank you for your inquiry and sending yiour pictures.You unfortunately represent an overcorrection brow bone reduction result. Fortunately it can be improved/partially reversed by a custom brow bone implant. To avoid going completely back to where you started you probably only need a 3 to 4mm thick implant at most. Attached is an example of such an implant footprint although your implant thicknesses would be different. You already have the access incision to place ot of which scar revision could be done on it at the same time

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I am just inquiring if you are able to correct SCAPHOCEPHALY, which is when the head shape is slightly narrow and abnormally long? 

If so, are you able to help children and adults? 

Thank you

A:I do have an approach to treat adult scaphycephaly as seen in the attachments which consists of some anteroposterior bone reduction and widening skull augmentation by a custom skull implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a tummy tuck 7 weeks ago and I am concerned the results are below my expectations. I found your details through a google search and am wondering if you can give me your opinion please

I had liposuction, muscle tightening/stitches and skin removed from the upper and lower abdomin. 

I would have expected to have a pretty tight and flat abdomen by now but I still have cellutite and soft skin that I can grab handfuls of. My weight and measurements have not reduced and I am quite underwhelmed by the results.

Are my expectations too high? I was told 6 pack definition was not impossible and I am very far away from that result. Will it get better as time goes on or is this as good as it gets? 

I have an appointment with my surgeon in 1 week and will express my concerns. 

This is the second time I have been through the surgery, as the first time was a complete disaster and the surgeon was happy to redo the work. 

I have attached some photos to help explain. 

Thank you for your time. 

A:Thank you for sending your pictures to which I can add the following secondary comments:

1) You had an inverted T type tummy tuck which was appropriate if the goal was to keep the horizontal part of the scar very low. This type of tummy tuck does not remove as much skin as other more extended types of tummy tucks but less skin removal is the price to be paid for the scar location. A supraumbilical type full tummy tuck would have produced a more significant result with much greater skin removal but at the price of a much higher and longer horizontal scar. The aesthetic danger is this approach in you is that you may have been a lot flatter and tighter but may have hated the scar…in which there is not going back. (aka poor tradeoff)

2) I think your expectations (after this secondary surgery) may have been too high. A 6 pack ab result was never a remotely realistic expectation or anything even close to that outcome.

3) I suspect the fundamental issue here is one of miscommunication or lack of adequate preoperatve education/understanding between patient and surgeon. You are what I would call a ‘tweener’ meaning a traditional full tummy tuck may have produced a better ooutcome but with an unfavorable scar location vs a more limited type of tummy tuck which has a better scar but less of an aesthetic improvement. I am not sure you clearly understood your situation before surgery. In patients like you I go to great lengths in making sure they understand their choice and the involved tradeoffs before the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am in love with the results that can be achieved with forehead reshaping/temporal line reductio. I want to do the same for myself. Only problem is I have had hair transplant where they take strip of skin from back of head. So to do the temporal line reduction, I don’t think I’ll be able to do hairline incision like the guy did from the Web page as doing so will drastically reduce blood flow to head. Are you able to do a thin 1-2 cm incision at near ears and then use endoscope to do burring? Or I can do the thin 1-2cm incision right in top of the anterior temporal line. I don’t mind the scar.

A: In answer to your questions about temporal line reduction:

1) The frontal hairline incision has nothing to do with decreasing the blood flow to the head, it is all about the scar.

2) You can not do burring using an endoscopic technique.

3) A more limited incision at the top of the temporal line can be used probably in the 3cm length range.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am planning to get cheekbone reduction surgery. I have done lots of research and understood and accepted the certain risk of skin sagging. My surgeon recommended me lifting the muscle while doing the cheekbone reduction surgery to precent from sagging. Can this help the sagging? Even if i sag would smas facelift help? Because you mentioned that it is hard to fix skin sagging from surgery with facelift. Thank you.

A:I do not know what ‘lifting the muscle’ means or how that would be done at the time of cheekbone reduction surgery. Once the muscles are lifted off the cheekbones to do the surgery there is no method to put them back.

The definitive treatment for significant cheek sagging is a SMAS based facelift or some form of a lower eyelid or temporal cheeklift.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley: I have some questions about vertical orbital dystopia (VOD) surgery which I would appreciate if you could answer for me.

1. For VOD surgeries like mine, what risks/complications should I be aware of?

2. Out of all the VOD surgeries you’ve performed, have you seen any cases of severe or irreparable complications (e.g., loss of eyesight, severe nerve damage, etc.)?

3. I got a second opinion from another surgeon, who recommended against an implant, saying it involves too much risk.  He recommended I proceed in stages – trying blepharoplasty + brow lift + fat transfer first to see if I’m satisfied with that. I am skeptical this would give satisfactory results, but what are your thoughts? If we did something like this, would we still have the option of adding the implant later?

4. I feel unclear on some important details of the surgical plan, like where the incisions will be made, where the brow bone will be reduced, etc. Do you have an article or other description of these procedures that closely matches what you are planning in my case? Or how can I best get educated on these details? (I have been reading articles on the website, but don’t know how closely they apply to my case.)

A: In answer to your VOD questions:

1) The major risks are aesthetic in nature and mainly revolve around how well the eyelids follow the eye superiorly. In VOD perfect symmetry is rarely obtained, it is a question of the degree of improvement.

2) I have never yet experienced any significant complcations from this type of orbital surgery.

3) I can only comment on what I do. I can not speak for other surgeon’s experience or techniques. Certainly doing the procedures that have even mentioned can be done as they do not burn any bridges for doing other procedures later.

4) I would go to www.exploreplasticsurgery.com and search under vertical orbital dystopia where the procedure is fairly well explained, both in description and with pictures.

Dr Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know if the temporal constriction/reeduction is feasible. My forehead and the left and right sides of my skull above my ears are wide, which makes my head bulky in a beatle or tie. Maybe the temporalis muscle resection isn’t going to be as effective as I’d like. The hair transplant was done but made it look bigger. Is it possible to reduce the width of my upper skull by bone grinding or excision?My CT is attached to the file. Thank you very much.

A: Thank you for your inquiry and sending your pictures. The traditional temporal reduction procedure is done further back than you have illustrated, that is why it is called the posterior temporal reduction. You are illustrating an anterior temporal/bony temporal line/side of the forehead reduction…which can be done but requires a coronal scalp incision to do so. The key to the anterior procedure is the large amount of muscle thickness that has to be reduced and not the bine which is quite concave underneath it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it achievable via liposuction or removing of excess skin to get a uniform “smile” gluteal fold across both glutes. This problem has deeply affected my self esteem and i am looking for someone with experience in correcting the issue with beautiful results. Your response and considerations will be greatly appreciated. 

A: Thank you for your inquiry and sending your picture. What you are seeking is to have a uniform infragluteal crease on both sides. Right now you have a partial double fold, a higher medial partial crease and a lower complete crease.

One can not liposuction between the two and create a single infragluteal crease. This is often tried but never works. Rather this requires an excisional approach where the skin is removed along the lines of the existing two creases and put together into a single crease. (lower buttock lift/tuck) Whether the resultant scar to do so would be viewed as a worthy tradeoff is patient dependent.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a lip lift done last year in which 11 mm of skin was removed from my philtrum, which was 24 mm, and I’m wondering if there are any procedures that could be done, for example tissue expansion or skin grafting, that could add some mm back to the philtrum. 

I scar pretty well so I’m willing to risk a potential scar to restore the proportions and function of my face and philtrum.

A: There is no lip lift reversal procedure…short of a skin graft which would produce unacceptable scarring. This is why in a lip lift the amount of tissue removed should be cautiously done as there is going back. You can always do more but never can less be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a very serious facial problem, the left side is different from the right, and the left eye is smaller than the right and the mouth goes more to the left. Please let me know if you can perform surgical corection. Thank you

A: Thank you for your inquiry and sending your pictures. You have classic congenital facial asymmetry which is superiorly based which is why your lower eye/VOD is the most visible part of it. (VOD = vertical orbital dystopia = lower eye) The VOD can be effectively improved usng a 3D CT scan of the patient’s face to create a custom implant that raises the eye which also needs to be accompanied by upper and lower eyelid/eyebrow adjustments to go with it.

Correction of the VOD is the most significant way to untwist the face/lengthen the shorter side. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read about your procedure to shave a Subcostal Rib Protrusion. I had a trauma to my left rib. After it fully healed there is a pointy protrusion that interferes with laying on my stomach or side on hard surfaces (like yoga, Jiu Jitsu, or even just crawling under a car to work on it). 

Can you tell me how often you have done the surgery? Do you have any before and after photos? What is the recovery time? How bad is the scarring? 

Thanks 

A: I have done a handful of subcostal rib protrusion patients…all with the same history of trauma. Usually what occurs is a disarticulation of the costochondral junction with a resulting protrusion of the more mobile cartilage side. You are correct in that the protrusion can be be reduced by shaving of the cartilage to make it more level with the bony side. I would need to see a picture of the chest wall protrusion to confirm this supposition based on your description of it. The scarring from the surgery is very small as the surgery uses the ‘mobile window’ concept. There are no physical restrictions after the surgery as you can not harm the surgical site. There will be some expected soreness and it usually takes about a month until one can comfortably return to any form of strenuous physical activity.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the clavicle lengthening procedure and have several questions about it.

1. What is the overall cost of the procedure? 

2. Will the bone restore the full diameter after a complete recovery or will the bone remain thinner in the expanded area? 

3. How long after the surgery will I be able to do sports again involving overhead movement? (For example lifting weights, basketball or swimming) 

4. How long will I have to stay in the U.S before returning home? 

5. During the recovery process, is it possible to use the arms for a few times a day, for daily uses like using the bathroom or showering? 

6. How exactly will the surgery change the proportions of the body? Is there a visible difference in shoulder width and will it change the shoulder to hip ratio? Are the surrounding muscles going to stretch, widen and change shape? (For example the chest) 

Thank you for your time. 

A: In answer to your clavicle lengthening questions:

1) My assistant will pass along the cost of the surgery to you layer today.

2) The bone should approximate the normal thickness of the clavicle once it it fully healed.

3) It would 3 months after the surgery until I would recommend returning to strenuous sports activities.

4) It would be reasonable to fly out of the country within 7 to 10 days after the surgery.

5.) The protocol is to generally limit significant arm elevation for a few weeks after the surgery. There are some obvious activities of daily living that you have to do.

6) The operation creates a visible increase in shoulder width of about 1″ per side. This causes no muscle dysfunction anymore than if you pull your shoulders way back now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in chin reduction of soft tissue chin pad with no bone removal? I was wondering if I could get a chin reduction of the soft tissue chin pad only with no bone removal…my bone is fine. I just have a lot of chin pad..looks like a ball on the end of my chin…I hate my profile and I will never take pics because of this…Thanks so much!

A: In ‘fleshy’ chins reduction of the soft tissue chin pad is the definitive treatment and is the only method to reduce the chin prominence. In some patients no chin bone needs to be removed if the soft tissue chin pad is loose enough. In other cases a little bone is removed to allow the reduced soft tissue chin pad to close properly without undue tension on the incisional closure. That is an intraoperative judgment but the role of bone removal, if needed, is to allow more chin pad to be excised.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I came across your website while searching for skull reshaping solutions. I was interested to know a little be more about sagittal skull reshaping. The back of my head and a bit on the top are flat. I had 2 questions: 

1 – Are you the only people in the country that perform such a procedure? Is it something invested here? I ask because I am from New York and I am having a tough time finding a clinic here. 

2 – Is this a relatively new procedure? Are there any long term studies on any negative effects? 

Thank you!

A: Thank you for your inquiry. In answer to your skull reshaping questions which appears to be an augmentation issue of the crown area of the skull:

1) I can not speak for whom else may perform such skull reshaping surgery. It is not information I would know.

2) I have performed such skull reshaping surgeries for decades. Technology has changed but the basic concepts of the procedure are not new and I have taken techniques and technology rom reconstructive craniofacial surgery and applied to aesthetic head shape concerns to develop a whole niche area of plastic surgery heretofore not previously developed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, i am interested in rib removal. I am a fitness trainer and I need a narrow tail. What is the effect after the treatment plus wearing a corset? Is it possible to reduce the lateral abdominal muscle ?? 

A: Thank you for your inquiry and sending your picture. Having done someone similar to you before, the combination of rib removal and some inward modification of the LD muscle over it will maximize whatever amount of waistline narrowing that is humanly possible. The wearing of corsets after rib removal surgery is only recommended for the following two circumstances: 1) as a method of short term postoperative maximal compression to get rid of swelling or 2) to be used in conjunction with rib osteotomies/fracture to help shape the now mobile lower ribcage as it heals.

While a section of the external abdominal oblique muscle can be removed, this requires a separate incision to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, At the age of 42 I have decided to get testicular implants. As it is purely for aesthetic purposes my approach is: go big or go home. So I have decided on an implant  size of 7cmx5cm. We have decided on orchiectomies for both testes which will be followed by hormonal replacement. I am writing to you due to curiosity concerning two matters: 1- the orchiectomy ( should we re-explore just adding the implants (however there will be 4 testicles then) 2- what have been the largest testicular implants you have done ( if I’m going to go big, I am going to go impressive ). Regards

A: My suggestion would be if you really want to end up at 7cm or or even 7.5cm testicle implant size, you should at least place 5.5/6.0 cms implants at the same time as the orchiectomy. This will allow for a tissue expansion effect to occur or at least prevent significant scrotal skin retraction. This would then be followed by the larger implants 3 to 4 months later. It is important to remember that the the best time to place implants, particularly at the larger ‘extreme’ sizes, is in a non-scarred issue bed. 

The largest testicle implants I have done is 7.5cms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m hoping you can get back to me. Essentially my main issue is the lack of mandible width and asymmetry in my lower jaw. There is absolutely no definition and I have a long, narrow face. The other problem is that one side is a lot “worse” than the other, it’s as if my jawline goes into my neck. When I look around I don’t see anyone else with this issue.

I’d like to explore the use of filler or implants to add a considerable amount of width to make the jawline more “square”. (I’m not saying I want or need to achieve a supermodel look, I’d just like more width on both sides), and to also add “definition” and to “sharpen” the mandibular angle on the side/profile view (In other words… Make it actually visible). 

Can you tell me why exactly I look this way? Is it due to the shape of the mandible/the way it grew? A lack of fat/tissue? Both? 

The chin is also somewhat weak, and slightly more “recessed” on that same side mentioned, so I would consider the use of filler here as well (if I went that route) 

My concerns are that: 

1) I’m not sure if what I want to achieve is realistically possible with dermal filler (I know other options exist… Like implants) 

2) If it is possible, then roughly how much would be needed? 

3) Would it need to be injected along the entire “edge” of the mandible? Or can it be concentrated in one area to achieve the desired result? 

I think that is all I have for now. If there’s any other information or things to note that the doc can tell me, I would love to hear it. 

If you need any other pictures please let me know. 

Thank you for listening to, and reviewing my case.

A: Thank you for your inquiry and sending your pictures. What you have is a high mandibular plane angle deformity due to significant and asymmetric ramus development. This is not a jaw deformity you can treat very effectively by injectable fillers as the volume to do so is so high that it is cost prohibitive for most people and certainly not a long term solution. The best treatment is probably a sliding genioplasty combined with custom jaw angle implants. This provides good chin augmentation and also the needed jaw angle vertical length and width that is missing.

But first a 3D CT scan is needed to fully see the shape of your lower jaw. That visual information is invaluable in treatment planning.

Dr. Barry Eppley

Indianapolis, Indiana