Your Questions

Q: Dr. Eppley, Hi! I am transgender, and like many trans women I struggle with feminizing the lower half of my body. I am ectomorpbic body type and would like to maintain a supermodel structure, but I am struggling with my bodies proportions. This may seem strange but I am wondering if there can be customized implants for the iliac crest of the pelvic bone so that it gives me the appearance of a wider and more feminine pelvic bone? I see a lot of hip and butt implants, but I am wanting something that will feminize my body in a skeletal, anatomical way. Thank you.

A: Thank you for your inquiry on what is known as iliac crest implants which would create a wider pelvic bone. That is as concept that I have been working on for the very need to which you speak.  This is really a cap applied to the widest part of the rim of the iliac crest. While one could argue it should ideally be made of metal, I have found no orthopedic manufacturer in the U.S. willing do so I am looking at an ultrafirm solid silicone material for the iliac crest implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was just wondering if it would be at all possible to design two testicular implants that would have a total size of 120 cc’s that could be implanted over existing testicles?

A:That is too high a volume if you are speaking of 120ccs per side. If you mean 60ccs per side then that is possible to do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a double chin, recessed chin and no jawline, so I got a chin implant, buccal fat removal (sank one side of my face, I hate it), and now my chin looks too wide and longer. My neck is short and I feel it doesn’t suit my face shape or posture. 

I would like a v-shaped chin, but much like my own (since I always felt pretty except in my late 30’s my neck started melting). 

The other doctor helped my jawline look at bit better, he said I didn’t need a necklift. 

The doctor said a genioplasty won’t stretch my lower face too much. I want to age nicely in my neck, since my family are fat faces, necks, no jaw. 

I don’t know what is the best shape for me. Please help! What do you suggest?

A: Thank you for your inquiry and sending your pictures. I am little unclear as to exactly what you are trying to achieve. You have the classic female chin problem where the implant used is too wide due to having wings and is probably positioned too low on the bone…hence making your chin wider and longer. But in trying to get a chin that is horizontally shorter (which I assume is what your natural chin is) that is also more narrow/v-shaped is going to be a problem. Implant removal is going to cause an excessive/lax soft tissue chin pad because it has been stretched out from the implant and will not magically shrink back down.

This leaves you with three options:

1) Get a new chin implant that is v-shaped and sits higher on the bone and live with the exiting horizontal projection,

2)  Remove the existing chin implant and replace it with a t-shaped sliding genioplasty, or

3) Through a submental approach remove the existing chin implant and shave down the sides of the chin to a v-shape and tighten the soft tissue chin pad by a submental tuck.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a wide zygoma arch, and I’ve considering a cheekbone reduction for some time. But I’ve not read review of a single person anywhere who was happy with it. In fact I ran into many people who warn against the cheekbone reduction surgery as it causes droopy eyes and sagging skin. People end up getting face lifts and implants after it. I am attaching an image that will give you an idea of what I look like, however the result of the girl after the surgery doesn’t look great, I’m not sure for what reason. It looks bit extreme. I want to reduce just the width at the back, dont want to reduce the prominence of the cheekbone. I hope you’ll be able to provide me some insight, I have read so much on forums and all and can’t seem to understand as to why the result of this surgery are almost never satisfactory. Both my temples and jaw look concave because of my wide zygoma arch. Will the skin be saggy and eyes droopy due to lack of support and overall lack of definition even if I seek to reduce only 4mm or less at back of the cheekbone (only the arch)? 

Having done some surgeries already in the past I don’t want to take up a huge risk again, kindly refer to the pic attached and let me know if it will be worth it or not. I appreciate your help, thank you so much.

A: I certainly can not tell you whether you should or should not do cheekbone reduction surgery. All I can do is provide you with my experience with the procedure.

1) It is not my experience that the vast majority of cheekbone reduction surgery patients are unhappy or require secomdary management surgery. There are many satisfied patients from cheekbone reduction surgery but they less frequently are the ones most vocal on the internet. But like all aesthetic surgeries there are risks and tradeoffs. The risks are cheek asymmetries and over/under correction. The tradeoffs are potential soft tissue sagging, often of a relatively minor degree since most patients who undergo the surgery are young with better quality tissues.

2) There are many technical variations of cheekbone reduction surgery but the most important of them is the amount of inward bony movement that is done. It can be from 1mm to 10mms. The amount of inward movement is going to affect the risk of soft tissue sagging…the more inward movement the more likely some soft tissue sag will appear after surgery. Many times this operation is done maximally (in a cookie cutter fashion) and those are the patients most likely to experience postop soft tissue sag. The reality of these statements is that the patient has to make an informed choice before surgety….how aggressive does one want the cheekbone reduction to be vs what risk is one willing to take in altering one’s natural facial bone structure onto which the soft tissues are made to be. For some patients it is often better to compromise…accept some but perhaps not ideal reduction to mitigate the postoperative risks.

3) In aesthetic surgery there is always a completely assured way to avoid the risks…don’t do the surgery. After all this is purely elective and your life will continue onward without doing the surgery. As a general observation patients that have deep seated fears about surgical risks are not good candidates for surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would a brow implant result in a lower and more straight brow ridge? Or does it simply enlarge the brow ridge.

A: Because it is a custom design the brow bone implant can be made to have any shape one wants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a couple specific questions regarding custom silicone midface implants (covering the front part of the zygoma as well as the arch up to the temporal bone and the infra orbital rim) and genioplasty 

1.) Would there be any issue on your end with performing the implants on a patient who has had MSE in the past? (maxillary skeletal expander). I ask because the way in which the bizygomatic width increases after this procedure (multiple studies confirm it does) is still unclear to me. If the frontozygomatic sutures are loosened I can imagine some sort of extra width possible without compromising the height or at least the perceived height of the cheekbone. Otherwise, if its fully from a sort of rotation where the arches are angled outward, wouldnt the cheekbones appear lower set post op since the area of the zygomatic arch that protrudes laterally the most would now be lower than pre mse? If this is the case, could you place implants to make the upper-most part of the arch the widest again and resolve this? Would getting both mse and custom implants on the zygomatic arches be redundant then, strictly from an aesthetic vantage point (as opposed to sarpe in lieu of mse and then implants at a later date)? 

2.) Can a genioplasty be performed such so that the chin travels along the occlusal plane, eliminating unsightly step off points and increasing vertical height as well as anterior projection ?? (I imagine if such a thing is done, the chin is simply mobilized and fully removed from the mandible and re positioned, then new bone fills in or if the movement was large enough to necessitate this, a graft is used as a buttress). 

Thank you very much for the help and Id like to extend my thanks for the entirety of your blog, its very helpful to be able to read succinct snippets of your insight and send inquires to such an authority within the field in a colloquial manner. 

A: In answer to your questions:

1) Regardless of what type of maxillary expansion you may have had your frontozygomatic sutures are not ‘loose’ or have been loosed in so doing. Any discussion about your facial skeletal form at any level can not be done on an informed basis without the knowledge of your bony anatomy from a 3D CT scan.

2) While the chin bone can be moved in any direction some bony irregularities along the inferior border and in the convex shape of the anterior chin surface are inevitable. The magnitude of them depends of type of chin movements done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For years I’ve been bothered by the feeling of having some form of excess tissue inside my cheeks at the sides of my mouth. I’ve tried naturally losing weight, ultrasound skin tightening therapy, visiting an oral surgeon and investigating buccal fat pad removal, but all have either had no effect or have told me there’s nothing they can do. 

Given how much this bothers me (I find myself sucking on the tissue 24/7 trying to get it out of the way of my mouth), I’m desperate to find some resolution. 

I came across your site and read about Perioral mounds, and it seems as though this best fits my problem. I’ve attached some images highlighting the problem area, and was wondering whether I’d be a candidate for Perioral Mound micro-liposuction? 

Thanks in advance 

A: You have redundant mucosa in the inside of your cheeks which can be removed by a horizontal elliptical excision. (intraoral cheek reduction) While this will remove the intraoral issues that will probably not provide much improvement to the external appearance which is more consistent with perioral subcutaneous fat collections.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Procedure (s) recommended for making forehead larger, wider, rounder, more contour and lifting volume in glandular region and above brows- more feminine look and less convex face.

A: Thank you for your inquiry and sending all of your pictures. Your facial upper third enhancement goals, which is a not uncommon request for females, can only be achieved by some version of a custom forehead or forehead-temporal implant. It just depends on how extensive in surface areas coverage the augmentative effect needs to be.

A conservative or limited forehead augmentation effect can be achieved with a design that extends not further than the bony temporal line of the sides of the forehead. (see attached) 

Or a more complete forehead-temporal augmentation can be done by a design that crosses well over the bony temporal line which is appropriate for those women that have a natural flatter and narrow forehead shape. (see attached)

And there are numerous variations between these two ends of the custom forehead implant styles.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I read the article about how a custom jaw and skull implant is highly unlikely to fracture or dislocate due to how much surface they take up. My question is regarding the custom cheekbone implants. Will there be a higher risk of fracture or dislocation. I am a male in mid 20´s that trains in boxing recreationally.

A: When I speak of fracture or dislocation in regards to facial implants, and custom facial implants in particular, I am referring to the bone underneath them. Given the coverage of the bone by the implant, which virtually acts like a bumper on the bone, it would make bone injury underneath it much less likely due to the implant’s shock-absorbing and force redistribution effect.

I am assuming you are not referring to the actual implant being fractured (which is virtually impossible) or being displaced. (also very unlikely)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I had some questions about hip augmentation with implants, as well as thigh implants to give the thighs more of a “chubbier” look since I personally think thicker legs are pretty. 

1st, would it be possible to make hip implants that could be put on the bones/under the muscle in the legs/pelvis to make them feel as natural as possible? 

2nd, is it even possible to make thigh implants that would make the legs look a bit wider at the sides of the thighs? I’ll insert a picture of the kind of legs I mean. Instead of making them look toned or defined just kind of making them look less skinny and more soft. 

A: In answer to your hip and thigh implant questions:

1) Hip implants can not be placed under the muscle or next to the bone.

2) Thigh implant can be placed more laterally under the TFL for a more lateral/wider thigh look.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a couple questions about the posterior zygomatic arch osteotomy I forgot to ask during my virtual consultation I was hoping you could answer for me:

1) Will I have a tough time eating post surgery? I’m not sure if working on the zygoma influences the masseter muscle at all and if this will lead to pain during jaw opening and closing for the first several days?

2) With the posterior arch osteotomy and plate fixation, Can Dr. Eppley plate the arch onto the skull a bit higher than where it was originally? In order to bring the entire arch higher and make my cheekbones higher?

A: In answer to posterior zygomatic arch osteotomy questions:

1) The posterior zygomatic arch osteotomy will not affect the masseter muscle or eating in any manner. The masseter muscle attachments are more anterior along the zygomatic arch.

2) The zygomatic arch can not be moved/relocated higher. And even if the posterior end of the arch could be moved higher it would not create the high cheekbone look.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m fairly sure I have nasomaxillary hypoplasia (not to be confused with Couzon’s Syndrome-tier midfacial hypoplasia). The whole area around my nose (zygomas, maxilla, infraorbitals) is recessed and this not only puts me at a great aesthetic disadvantage but also causes me severe obstructive sleep apnea that’s refractory to traditional treatments (mouthpiece, CPAP machine, weightloss – I’m not currently obese). 

As such, I need a Lefort 2 Osteotomy. 

My question to you is: In an effort to minimize the risk of death during the surgery (if I recall correctly, the LF2 osteotomy is supposed to have a 10% mortality rate but I might be confusing it with the LF3 osteotomy), is it surgically possible to completely leave out the nasal bones and only move forward and/or lift the remaining portion of the midface, ie.: zygomas, infraorbitals and maxilla? 

Below, I’m attaching the relevant picture(s) of my face showcasing my nasomaxillary hypoplasia. (the text says: the maxilla, the zygomas and the infraorbital bones are severely recessed. the philtrum appears to be long and flat) 

Thank you in advance!

A: I am not aware of any risk of death from any form of Lefort osteotomies regardless of the level at which it is done. 

What you are describing is what is commonly known as a modified LeFort III osteotomy.

Dr. Barry Eppley

Indianaplis, Indiana

Q: Dr. Eppley, I have provided a picture of an example of the pectoral gap I am talking about. Would it be possible to make the pecs appear closer together? For instance, perhaps putting an implant on the inside part of each pec to make the gap smaller? Would this be possible? Thanks.

A: Thank you for sending your picture. I believe you are referring to placing an implant under the pec major muscle to add volume…which is all that can be done practically but with these caveats:

1) The sternal border of the pectorals major muscle will get bigger/have more volume but will not necessarily move the medial muscle border further into the sternal valley.

2) Such a pectoral implant can not just be a limited implant that only covers the medial area of the muscle as it will be unstable and will slide away from it. It must be an implant that covers the entire subpectoral pocket to be stable. It can have its greatest volume along the medial muscle border but it must have a footprint that covers the whole subpectoral space.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 26 year old petite female with narrow shoulders. I would like to add 3-5 cm on each shoulder. Is shoulder augmentation via silicone implants an option for me? Or will it make me look masculine/bulky? 

A: Shoulder augmentation by deltoid implants is going to add 1 to 1,5cms per side in a petite female. An increase of 3 to 5 cms, even if it were possible, would look out of place and bulky on all females and even in most males.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in doing shoulder widening and I have some questions regarding that:

 1) Regarding deltoid implant: if it is placed over muscles, and if a person works out, wouldn’t implant somehow be in a way of muscle growth? what I mean is if the muscle can grow a lot via weight training, wouldn’t the implant hinder that? 

2) If it is placed over muscle, how is the implant fixated?

A: In answer to your shoulder widening by deltoid implant questions:

1) Subfascial deltoid implants sit on top of the muscle so they would be pushed out with the muscle should it develop hypertrophy. It would not induce a hindrance on muscle growth. 

2) Like all subfascial muscle implants it is the scar encapsulation which provides all the fixation that it needs.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in doing shoulder widening and I have some questions regarding that: 

Can you do multiple clavicle lenthening procedures? – let’s say that 4 cm per side increase would be perfect for me but as you answered in another question, increase of 2 cm per side is maximum, because of fear of bone not healing properly. Could I possibly do one clavicle lengthening surgery now and another on after year or two. 

A: In answer to your shoulder widening by clavicular lengthening questions:

I have never done a two stage clavicle lengthening procedure so I can not speak as to its viability. I would say that if the initial clavicle lengthening procedure healed satisfactorily I would not tempt fate and do it again a second time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have asked about having a submental approach to fixing a hyperdynamic chin ptosis. You have advised against having this surgery due to the fact my chin will slightly decrease, and of course, I want to preserve my chin appearance at rest. 

However I have a oral and maxillofacial surgeon that only works on facial surgery and says he will only works on the mentalis muscle and preserves my chin at rest. I need to know if this is possible, as I don’t want to spend so much money on fixing something that may worsen. 

A very slight decrease is fine by me, but not in a way that will make my chin look recessed in any way. 

He said it is not my chin that needs fixing, it is the mentalis muscle. I’m wondering how does one suspend the mentalis muscle Without the chin being affected. Is this possible? have you done this before yourself? 

My chin at rest is not protruding in any way or big. 

Please can you help me with this?

A: I do not comment on other surgeon’s technique or whether what they say they can do is possible or not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Growing up I’ve always had dark circles and deep hollows under my eyes due to hereditary reasons. So around two years ago I tried filler for the first time and unfortunately it created a darker tint. Looking forward, I was hoping to find a more accurate and permanent solution to the issue. I then learned about the orbital rim implants from your page and was fascinated by your work! Reading about the orbital rim implants from your page I appreciate how the implant covers the tear trough deformity and rings simultaneously, which were my main concerns. Also reading, I saw that the results could also be adjustable if any inconvenience which really got me on board. I was initially concerned regarding scleral show, but then read that typically it must be done with a well done canthopexy to maintain and avoid the problem worsening. I attached some photos below and would love to hear back from you soon! I greatly appreciate your time Dr. Eppley. Thank you. 

A: Thank you for your inquiry and sending all of your pictures. You are correct in that custom infraorbital-malar implants are the preferred correction for your undereye concerns. You are also correct in that lower eyelid management is important during the closure. While you did not show a side view picture, it is likely you have a negative orbital vector.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My forehead has a weird shape to it. I’ve had two bumps (horns) on it for as long as I can remember. I would like them removed if possible. My concern is that my hairline is receding badly, so I’m unsure if I’m even a candidate to have the procedure done. I know that affects the placement of the incision(s). How much does the procedure cost. Please inform me of what you think. Thanks for your time.

A: Thank you for your inquiry and sending your forehead picture. While such forehead horns can be successfully removed the challenge is the incisional access to do so. With your hairline being so far behind the front of the forehead it can not be used for access to perform the procedure. While incision further forward can be used for access my concern would be that you would just be trading off one aesthetic problem for another. (forehead horns fora visible scar)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Are there any procedures that would allow trans man’s hips to become more narrow? I read about iliac crest reduction but I was wondering if there other possible procedures that could make a bigger difference. Is there such a thing as cutting through a specific section of the upper ilium and tilting it closer to the belly button (I hope that doesn’t sound ridiculous)? I understand that even if such a thing did exist it would be high risk, but it’s definitely something I would be interested in.

A: The answer is that there are no other hip narrowing procedures. Trying to cut and move/tilt the pelvic bone is an interesting mechanical drawing concept but not a practical one in terms of medical safety and complication risks.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, hopefully this is my last question regarding hyperdynamic chin ptosis. I am really happy with my chin at rest, and believe if my chin was to be slightly reduced, it will make my face unbalanced.

 Regarding this chin tucking/ reduction surgery, will there be any changes to my chin? what part of the soft tissue is stripped away?

A: Yes there would be some very slight change in horizontal chin projection. And for this reason I would advise against in your case because of your stated concern. Every aesthetic procedure has aesthetic tradeoffs…be very careful about trading off one problem for another that you may dislike just as much. The correction of hyperdynamic chin ptosis works best in the female who also has some dimensional excess of the chin that she also wants changed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have read your articles on mentoplasty with great interest. If it is not too much trouble, I would very much appreciate your advice pertaining to chin reduction surgery.

I would like to ask please:

(I) If undertaking a bony reduction of the chin by way of bone shave/bur, what is the maximal amount that is generally achievable, anteriorly (and vertically)? I appreciate that soft tissues resuspension is vital. 

(ii) What are your thoughts on mentalis or soft tissue pad reduction?

(iii) I am a young female that is requesting a downsize in my chin implant. The previous implant was placed by another surgeon overseas (~1yr ago) via a submental incision, and revised shortly after by the same surgeon. It unfortunately resulted in a pigmented and widened submental scar. Mysubmental tissues are somewhat firm. I want an intra-oral approach in light of this adverse scar outcome. My proposed new implant will only drop anterior projection by 1-2mm, so I do not anticipate a significant issue with chin pad ptosis/excess.  If proceeding with an intra-oral approach, do you do anything in addition to re-opposing the mentalis msucle? Ie Does one need to also anchor mentalis back to the mandible? And if so, do you use a screw and suture, or Micromitek?

Your expert advice is greatly appreciated.

A:In answer to your chin reduction questions:

1) When doing any form of shaving/burring for a bony chin reduction I never do that intraorally. That is only going to result in soft tissue chin pad ptosis no matter what suspension technique is used. I only do that through a submental approach where the soft tissue excess can be managed by an excisional tuck.

2) Soft tissue chin pad reduction, as mentioned above, can be effectively done through a submental approach.

3) If an existing submental scar exists, particularly if it is widened and pigmented, you have nothing to loss by cutting out that scar and performing the chin implant reduction inferiorly. There is a good chance you will make the scar better (and certainly no worse) and any concerns about soft tissue redundancy can be definitely managed. The only reason to ever go intraorally would be if a submental scar did not exist.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have Medpor jaw angle implants andI’m not satisfied with the result. I want them to be removed and I know it can be difficult. I´d like to know if we don’t wait long time after surgery can it be easier ? I’m just 2 months post surgery. 

Thank you

A: I have removed many a Medpor implant and really once they are in place a few weeks to a month it is about the same whether it is 2 months or 2 years in terms of the ease of their removal. It is all about how quickly do the tissues attach to the bone and form an adhesed capsule.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to get custom implants and contouring to fix asymmetry in my face, mostly my jaws and orbitals, as well as add depth to the back of my head.

I’m also interested in more, but worry about how much you could do in one procedure. “More” being a facelift that includes my lips and brows and neck. 

Lastly I understand you do orthognathic surgery. Could you perform maxillomandibular distraction osteogenesis? If so I want that procedure more than anything. I choose distraction over advancement because its results are more controllable, will help with my sleep apnea (undiagnosed but suspected), and will help advance my palate to better support my lips and help reduce marionette lines.

A:Thank you for your inquiry and sending your picture. You have described three types of facial procedures (orthognathic surgery (1), onlay bone augmentation with custom facial implants (2)  and soft tissue rejuvenation surgery (3)) which involve different levels of tissues and which can not or should not be performed together as each one impacts the other one. These three ‘layers’ have to be done separately for a variety of reasons. If layer 1 (orthognathic surgery) is important then it absolutely has to be done first. Layers 2 and 3, however, can probably be done together.

Distraction osteogenesis of the maxilla and mandible is not a practical procedure in adults. Unless the movements are 10mms forward it is not going to help much with sleep apnea and it would also cause great aesthetic distortion of your face. But regardless of what method is used you have to have solid preoperative studies that prove that OSA exists and is obstructive in nature before ever doing any surgery for it.

You have to decide whether layer 1 surgery needs to be done before proceeding on to layers 2 and 3.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to add complete wrap around orbital implants to square out my orbitals and to give my orbitals a compact look. I was wondering if the photoshop look on the right image is a achievable with a wrap around orbital implant? 

A:Thank you for your inquiry and sending your pictures. I would think that in order to achieve your photoshopped image that periorbital augmentation as you have shown in the implant design would go a long way in that regard. But I don’t think the upper eyelid change you have shown will occur just by periorbital augmentation alone. That change involves dropping down the upper eyelid which will likely require adding volume to the actual upper eyelid as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, 33 year old male, I’m interested in your custom jawline & cheek implants. Last year I had full dental implant surgery, after having the teeth extracted, I lost some volume in my lower Jaw & chin area. I already had a recessed chin so it just made it worse to the point I wanted to restore some volume back in a more permanent way. Would this procedure be right for me to help restore added volume in my jaw/chin & cheek area? It looks like it would. Any opinion on the matter would help. Thank you.

A: I believe you are correct in that creating volume along the chin, jawline and cheeks would be best permanently done with custom facial implants. The only area where it will not help is is the trampoline area between the cheekbones and the jawline which is soft tissue based.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, my main concerns are the following: 

1) is my forehead too inclined? 

2) my lower jaw is visibly weak. What can be done? 

3) the angle between my upper lip and nose seems too wide. Is it possible to fix it? And also, is it maybe that my maxilla should be more forward as well? 

I’d like to have your opinion as many have already dismissed my concerns. 

Thank you.

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

1) The slope of your forehead is a bit retroinclined. (see attached imaging)

2) Options are either isolated chin augmentation or a total jawline augmentation. (see attached imaging)

3) You are referring to your nasolabial angle. But when you say wide do you mean too acute or obtuse? Should the angle be bigger or smaller? I believe you mean the angle is too open or greater than 90 degrees. Yours is that way because of protrusion of anterior nasal spine which can be reduced.  Moving the maxilla forward will actually make it worse.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Thank you for your reply. I didn’t mention in my previous message that I had a prior genioplasty of some kind by an oral surgeon some twenty years ago. He removed the plate quite a few years ago. I want to be sure you are willing to perform this surgery on me after learning of my previous surgery before I set up a consultation with you. I have attached x rays, the first was taken two years ago and the second taken a few weeks ago.

Thank you for your time.

A :Thanks for the additional information. Having had a prior sliding genioplasty does not affect getting a submental chin reduction. If anything it supports why the submental approach would be more effective as moving the chin back from an intraoral approach is not an effective chin reduction method.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 29 year old male and I have had an asymmetrical/V-shape head shape since puberty around 12-13 years old. Prior to this period, my head  shape was NOT significantly deformed and my nose was not deformed or large (but they are now). 

But when I hit puberty, my facial structure changed profoundly, because my nose became more prominent and my head shape became significantly unequal and somewhat lopsided. I have a theory that essentially a nose of my mothers side came through during puberty (a kind of genetic mistake) and this has altered/affected my whole overall facial appearance and head structure (including head shape, jaw, back of head, nose).   

My head is asymmetrical (right side more deformed and lower than the left), slightly lopsided (right side sticks out more), V-shaped, lumpy and some bones or muscles in the side of my head move when I clench my teeth (to an unusual degree from what I can see in the general population). I try and hide my weird headshape by styling my hair a certain way, but this is futile as ultimately the hair just reflects the contours of my head, so as the day goes on my hair reflects the head’s asymmetric/deformed shape.  

 Along with my nose, my head shape has affected my quality of life, After googling and seeing your work, which I think is simply excellent, I am therefore interested in having skull correction surgery, an implant or a combination of works done to correct my head shape. Ideally, if surgery is possible with you, I would want there to be a significant improvement such that for all intents and purposes the overall deformity of my head shape is corrected to a large degree.

A: Thank you for your inquiry and detailing your head shape concerns to which I can answer the following questions:

1) Any number of additive/reductive changes can be made to the shape of the skull. You have enumerated your areas of head shape concern and nothing about that description implies that it could not be adequately addressed/improved. It would take a 3D CT scan to correlate what lies underneath to your external concerns and then devise the specific plan to treat it.

2) Custom skull implants can be made in any design (as long as its overall added volume is not excessive) that is needed so your specific shape request can be done.

3) No patient has yet reported to me that they had bothersome persistent scalp numbness after the placement of a skull implant.

4) My assistant Camille will pass along the general cost of the surgery to you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I’m interested in the bone cement filling in the back of my head. I also have migraine so is it possible that this could be partly covered by my insurance? Thank you!

A: Thank you for your inquiry. No form of back of the head skull augmentation, whether done by bone cement or a custom skull implant, is intended to or will relieve migraine symptoms. This is an aesthetic procedure not a medical one.

Dr. Barry Eppley

Indianapolis, Indiana