Your Questions

Q: Dr. Eppley, a problem of mine is when my hair covers the top half of my ear, i look horrible. When i move my ear up with my finger it looks better, or i cut the hair around my ear to always show the top half, otherwise it looks strange. Can you move the ear cartilige up by pinning it?  I think it looks better that way, Thanks. 

A: Unfortunately the ear has a fixed position on the side of the head by virtue of the external auditory canal which enters the skull bone. As a result the ear can not be moved vertically up or down. I have tried numerous techniques to achieve a vertical ear repositoning effect but none have been successful to date.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, While one of my goals is to reduce the sternum gap, my main goal is actually to make it so that my profile from the side appears more normal, potentially by increasing the size / projection of my pectoral muscles so that they are in front of my (flared) ribs like normal, rather than behind. Another surgeon suggested that standard pectoral implants could be used to accomplish this but was curious if you had an alternative take.

A: Thank you for the clarification to which I can make the following comments:

1) To achieve a chest projection that is enough to meet the projection of the flared ribs that is probably at least 4cms….a projection that almost no standard pectoral implant can achieve with the exception of the PowerFlex Plus implant at 3.9cms with 600cc volume. Whether its dimensions of 15cm tall x 20 cm wide would be adequate for your chest remains to be determined. Your chest augmentation goals are right on the cusp of needing custom pectoral implants

2) The placement of any pectoral implant, by definition, is not going to make the sternal gap appreciably less as submuscular implants do not change the existing muscular insertion along the sternum.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am reaching out to find a good doctor who can remove permanent filler done 5 years ago in the Middle East. I don’t know the name of the permenant filler and I can’t reach out to the doctor who did the filler since he is located in Syria at this time. I got treatment locally where they took some tissue from my belly and implanted it into my cheeks but the filler is still in my cheeks and around he eyebrows causing allergic reactions if I put anything on my face such as a mask and has caused a dent that needs to be taken care as well. During my prior treatment they didn’t take out the filler and they said this needs to be done but they did confirm it is not silicon and they couldn’t find out the name of the filler.

Please help us and let us know what is the steps need to be taken? Many thanks for your help and response!

A: Unfortunately there are limited techniques for trying to remove any form of permanent filler in the face. In the cheek area a facelift approach is the only approach to doing so where some of the filler in the subcutaneous space may be able to be removed. Around the eyebrow area access is more limited and it would depend on where exactly the problematic area is. I would need to see pictures taken where the areas of the problematic fillers are marked out on the face.

What you had done perviously was undoubtably fat injections placed into the filler injected facial areas in an effort to dilute their effects by introducing  new tissue cells. This appears to have provided minimal improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I’m a year postpartum (29 years old) and looking for a mommy makeover (breast lift & replacement of current implants, waist/abdominal/love handle liposuction for a more defined waist). I’m reaching out to you in particular, even though I live in Manhattan, because you also do rib removal and I’ve always had a boxy waist but wanted a small waist my entire life. 

Could I do that as part of a mommy makeover? Do you have any before-and-after photos fo rib removal? 

A: Rib removal can be done in conjunction with a tummy tuck. To learn more about rib removal surgery I would refer you to one of my websites, www.exploreplasticsurgery.com and search under Rib Removal where the kay details of the surgery and before and after pictures can be seen. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it possible to increase wrist size diameter with fillers? I am insecure about my 6 inch puny looking wrists and I’d love to wear a wider watch. How difficult would this be?

A: I have no experience in putting fillers into any extremity including the wrist. And even if it was done the result would be short term as all fillers eventually get reabsorbed. It would make more sense to me to augment the bone at the sides of the wrist (radius or ulna) even though I have never done it for wrist enlargement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Left alar asymmetrical, I’ve had 2 rhinoplasties and don’t know what to do. I just want my nostrils to be sisters not twins. 

A: Your left nostril has alar rim retraction, presumably from the prior open rhinoplasties. Such alar rim retraction repair (alar rim lowering) requires a septal cartilage rim graft. 

It is possible that one may see the right nostril rim as too low (although i doubt it) in which case it can be raised.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I asked you a couple weeks ago about the graft to fill out the labiomental fold and you said the bone graft used to vertically lengthen the chin would naturally help flatten the fold. I realized today, though, that what I was wondering about is actually a fat graft. 

I found a photo in the chin surgery gallery on your website that refers to what I was talking about, on “Patient 49”. It says “intraoral placement of dermal-fat graft for labiomental fold reduction”. I’m wondering if this is part of our current plan, and if not, whether he thinks it would be helpful or necessary.

And last I’m wondering, if I did opt for an implant in the future for the purpose of adding chin width, what minimum/maximum dimensions could or would an implant add vertically and horizontally as a byproduct? My thinking is that if genioplasty can only add a max of 12 mm vertically but an implant could add an extra few mms on top of that, then that would be an added advantage of the implant overlay. And if we only needed 5-8 mm of horizontal projection with this surgery but an implant would add a few mms minimum laterally, then we’d want to account for that with the genioplasty. Or maybe the implant can be customized so that it adds 1-2 mms vertically and 0 mms laterally.

A: It would not be prudent to place two nonvascularied grafts right next to each as that increases the risk of infection. So no a dermal-fat graft is not placed at the same time as a tissue bank bone block used with a vertical lengthening bony genioplasty.

As a general rule a few millimeters horizontally and/or vertically is what can be accomplished by a secondary overlay implant after a bony genioplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The long and short story is that I had a very prominent pointy chin and had surgery to reduce it.  After that surgery, I returned to same surgeon with concerns years later of a widow’s chin (not sure terminology-but the chin muscle was very pointy and the chin was asymmetric.  I am not sure that I would like to have surgery again-slightly frightened.   I am looking for alternative possibilities and was wondering about the use of filler in appropriate areas to give more balance and symmetry. I am sooooo impressed with you and how you are able to really correct and bring better balance and overall better appearance and results. 

A: With the reduction of the pointy chin, obviously done from below through a submental incision, there was no consideration for the rest of the shape of the chin as it blends into the jawline or what would happen to the overlying soft tissues with the removed bone support. Thus this is your chin situation. 

There are only two directions to go….additive (trying to reverse the loss of bone support)….or reductive in a effort to redrape the soft tissues and further reshape the bone. There are advantages and disadvantages to either approach. Since the additive approach can be done non-surgically by filler there is no reason not to first give that a try. Its effects are immediate and it is completely reversible.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can you help rectify bad rounded eye-mid face please. This all occurred after a prior lower blepharoplasties. 

A: Thank you for your inquiry and sending your picture. With this severe lower lid retraction the needed management is a combination of a midface resuspension (either cranial suspension or direct rim drill hole suspension) with lateral canthoplasties and spacer grafts to the lower eyelids. Small cheek implants may also have a role to play here.

How long ago was your original surgery?

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have sent in photos to see if I am a good candidate for liposuction. My areas of concern are my stomach, thighs, and buttocks. Please help!!!

A: Thank you for your inquiry and sending your pictures. While you do have fat that can be removed by liposuction in the abdomen, flanks and thighs (liposuction of the buttocks is almost never done), the quality of the skin in these areas is an issue. The aesthetic success of liposuction depends on the overlying skin’s ability to shrink down and be smooth once the fat underneath it is reduced. When the skin has an irregular contour and is loose/lax this is a setup for significant postoperative contour irregularities that would be greater than what existed before surgery.

As a general rule aesthetic plastic surgery is often about ‘trading out one problem for another’. You just have to be sure the problem you are acquiring is one you like better than the one you currently have. In some cases these tradeoffs are not that significant. In your case that tradeoff is much more suspect….is a reduced fullness with increased skin irregularities better?

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in a custom facial implant to help correct my facial asymmetry due to hemi facial microsomnia. If I decide to proceed with that surgery, I’m also Interested in facial rejuvenation procedures if it’s possible to be performed in the same surgery. In regards to my microtia of the ear. I’ve had reconstructive surgery as a child. I’m curious with advancements in medicine, if anything was possible to better define my ear. I currently am not comfortable wearing my hair up without covering my ear.

A: Thank you for your inquiry and sending your pictures. I see as the major component of your facial asymmetry is that of the right chin/jawline. (see attached) Using a 3D CT scan a custom right jawline implant can be made to match the jawline length of the other side. The tilt in the smile line (mouth corners) will still persist however which can be improved by a left mouth corner lift. (easier to lift the lower normal side than lower the higher abnormal side)

For the ear there are two secondary problems with the ear reconstruction result. First, and a major one, is that the vertical length of the reconstructed ear is simply too long. I don’t know what the length of the other ear is but using the length of the nose as a guide, it can seen how long it is. (see attached) I think the cartilage framework was simply jnitiallly placed too high or made too big. How to change that is an interesting conundrum as it would involve a wedge resection of the middle part of the framework to vertically shorten it. The second more easily improved problem is that much of the ear lacks details without recognizable concavities between the helical rim and the antihelical fold/crus convexities. This could be improved by removing the skin on the outer surface of the ear and replacing it with a new skin graft after creating more detail in the cartilage framework.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a young male who recently had v line surgery to correct severe facial asymmetry. I am satisfied with the results but the surgery reduced my once very prominent/masculine jaw angle into essentially a curved line from the earlobe to the chin. I was hoping to look into jaw angle implants to restore the prior strong angle once my recovery is complete around june/july. I’ve attached CT scans as well.

Thanks!

A: Thank you for your inquiry and sending your 3D CT scan. Secondary jaw angle implants can be done and in all post-V line surgery jaw reconstructions I have done a custom implant approach is used to meet the unique and remodeled jaw angle shapes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hooding of eyes began years ago, paternal family has very hooded eyes. Botox worsens the issue and eyesight is slightly decreasing due to eyelid falling. Constantly feel tired from heavy eyes. 

A: Thank you for your inquiry and sending your pictures. In the young person with ‘hooded’ eyes, the question is whether this is due to true excess of upper eyelid skin, a low brow position or a combination of both. Your pictures support a low medial brow position with some mild upper eyelid skin excess. I think the low eyebrows are a major contributor in your case to the hooded eye appearance and their heavy feel. Thus removal of eyelid skin alone may only provide a mild improvement in your concerns and probably only very short term. While a browlift is the correct anatomic approach, if their low location is not a concern or your high hairline a concern for taha procedure then an upper eyelid procedure alone would need to be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, After a revision rhinoplasty with a chief complaint of increased nostril show, I was told a prior lip lift probably altered the nasal sill and that my original rhinoplasty surgeon made a poor decision in not pursuing alarplasty with wedge excision, and I have poor scarring on a deformed nasal sill where an attempt to correct was performed. I am unhappy with my nasal base and my surgeon, who I trust a lot, recommended I find a surgeon who performs lip lifts to bring the sill up, as he was only comfortable with wedge excision. I am wondering if this is possible and what the scarring risks are. My surgeon did not want to lengthen my nose any more and I do not want to pursue a third revision. I really do not want much of my nostrils to show. Thank you for your time.

A: I believe what are asking is whether a combined subnasal lip lift (for scarring removal) and nostril narrowing (for more narrows = less nostril show) can be performed. The answer is yes with scarring that is probably less than what you have now if done well. But as it relates to the subnasal lip lift the real tradeoff is not the scarring but whether the increased central lip fullness that will result is acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 25 years old and 6’1″ tall. I have a big head towards the back and a bit pointy. Since I was little kid, I was dreaming to reduce the size of my skull. Since the main bone that needs to be reduced here is the occipital bone, I wonder how much this bone can be reduced. The size of my head is 56 cm when I measure it from the forehead level. I would like to learn how much reduction can be done with thinning of the tissue on the bone and some parts of the occipital bone itself. 

Thank you in advance

A: Thank you for your inquiry and sending your pictures. You are referring to a commonly reduced skull area. Rather than focusing on circumferential head measurements or even how much thickness of skull bone can be removed, neither of which really convey what type of change occurs on a large convex surface area of bone. It is better to look at potential profile changes in the head shape from different angles. (see attached)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi i had a few facial implants removed about a year and half ago after having them in for 8 months that included jaw angle, chin, and cheek implants, everything has gone back to preop accept for my masseter muscle on my left side hide has pulled offt the bone a bit and needs to be reattached in the correct position and i have a circular lump of scar capsule from cheek implant capsule on my right cheek bone im looking to possibly have both corrected.

A: Masseter muscle dehiscence is a very difficult problem to anatomically correct by trying to move the muscle back over the bone…that almost never works in my experience. Camouflaging it my soft tissue camouflage is more effective.

Most likely  the cheek scar capsule you reference is up in the soft tissues and may not be on the bone per se. Thus its successful removal may or may not be possible.

Dr.Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been spending a couple months in Florida this year. I read in the newspaper about a minimally invasive laser facelift. I wanted to see if this was some thing Dr. Epley does? Also, what he thinks of this procedure?

A: I think like all minimally invasive facelfit approaches they are effective if your facial aging problem is very early on or minimal. Like most things in life, what you put into it usually determines what you will get out of it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been searching for answers for awhile regarding my jawline. My whole life I’ve been told I am disfigured due to the angle of my jaw. I never spoke to anyone about my concerns before and would like to know the honest truth. Because you are specialist I was wondering if you could give me some information on why my jaw line looks like this but if this anything I can do to change it. Sorry for the grammatical errors in advanced 

Thank you 

A: You have classic steep mandibular plane angle jaw shape with a short chin and high jaw angles. Both can be corrected by commonly performed chin and jaw angle augmentation procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, would like to ask about the large depression in the coronal suture between the frontal and parietal bones of the head. 

When I looked up this in English, I found a surprising number of images that matched my worries, and I was very interested in this medical institution that provides implant treatment to deal with those worries. 

My skull has a larger dent than the one I have in this hospital. 

If you shorten your hair, the dents will be noticeable. 

Also, something that I wear on my head, like a helmet, doesn’t fit my head well, and when I wear it, it quickly shifts. Since I was a kid, the shape of my head has been a big problem for me both physically and functionally. 

I was also looking for a medical procedure that could repair the dent. However, there are so few medical institutions in Japan that perform such surgery, so I couldn’t find the answer I was looking for in Japan. 

The dents are so big that I asked my parents if they had brain dysfunction as a kid and if the doctor had pointed out anything about it. .. But my parents said they had never been told by a doctor that they needed medical treatment. 

A: What you are describing is what I call the coronal dip skull deformity where a depression exists that runs across the top of the head along the coronal suture line….which is due to an actual depression with the bone around it being normal in size. This is what your first two pictures are showing and this is treated by a custom made skull implant that fits right over the coronal dip depression from side to side.

Your last two pictures, however, show a different type skull problem in which a pseudo coronal dip appears because the back of the head (parietal bones) has overgrown. This is a different skull shape problem.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am writing this email with regards to a Jaw reduction surgery I had 8 months ago. I initially went with regards to minimal asymmetry in my chin. I asked about a genioplasty procedure to address this. 

The maxillofacial surgeon proceeded to say that my chin was very broad and that I had a square face shape and this was a bony deformity. My 3D CT face scan was compared to images on Google of a ‘female skeleton’ image and a ‘male skeleton’ image. The surgeon then went on to say that my face resembled the male skeleton and that my face was masculine. I was very self-conscious and shocked to hear this. I was then told the only treatment option to address this was a ‘facial contouring surgery’. I was told that they were offering the newest and latest surgery technique. I was also told that it would be a modest surgery and the only side effect from surgery would be lip swelling. I was told that I would see a better version of myself and the results would be minimal. 

I was misled and deceived about the nature of the surgery. The finalized ‘bony cuts’ were never shown to me and I was not even made aware of how much bone in mm would be reduced. I did not anticipate a dramatic reduction of this nature and that I did not want a reduction along my entire mandible. 

Unfortunately, the surgery has resulted in an overcorrection. The left side of my jaw angle has been removed (reduced by 17mm) and the right side jaw angle was not removed. I have more asymmetry in my jaw which looks very unpleasant (left side being more deficient).  The jawbone surrounding my chin has been chiselled off leaving me with a much narrower and distorted chin. I have muscle/tissue balling and bulging in my chin and I am also unable to move my lower lip. I have also developed a lot of scar tissue. 

I have been devastated and aggrieved by the jaw surgery for the past 8 months, which significantly added to my depression. I have had no support from the surgeon who has conducted this procedure on me. I have arched my post-surgery CBCT face scan here and I also have reports (measurements in mm of both left and right side of my mandible) and I also have 3D models of my Pre-Surgery and Post Surgery mandible. 

I am looking for a correction surgery to recover my original jawline and reconstruct my mandible skeleton.

Hoping for your guidance and kind perusal on this matter. Many thanks.

A: Like some jaw reduction surgery patients the outcome is unsatisfactory due to either over correction and/or asymmetry. If this was an effort at v line surgery or even jaw angle reduction, the after surgery 3D CT scan speaks for itself. Fortunately the right jaw angle remains unchanged so the issue is really the left side. A custom left jaw angle implant would suffice for returning the bone as close back to preop as possible.

I can not comment on the chin as there are no front views provided of either before or after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a young male with mild hypertelorism and this given me cosmetic pain for a long time.
I heard that patients with mild hypertelorism undergo orbital wall osteotomy, not orbital box osteotomy. Box osteotomy is burdensome. The range I want to correct is about 4mm. And I don’t have the Mongolian folds that are characteristic of Asians. I don’t need soft tissue surgery.

I want to correct it with an extracranial approach, but I don’t have much information.I heard that you wrote a thesis on this.

A: When you refer to an extracranial approach to mild hypertelorism correction you could be talking about a variety of procedures. One approach is medial wall infracture with lateral orbital wall implant to push the eye inward  a few millimeters. For small amounts of hypertelorism improvement this can certainly be a less invasive way to achieve it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like my forehead slope reduced, as much as possible. I figured it would involve a bit of brow bow reduction, forehead implant and hairline advancement surgery.

A: By your description maximizing the forehead slope reduction would be done by inferior brow bone reduction and forehead implant augmentation. Frontal hairline advancement is more about decreasing the visible length of the forehead not necessarily about changing its slope. But when the other two are done bringing the hairline forward does eliminate the part of the forehead that starts to slope backward no matter how much the forehead is augmented.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, A person who has already had a canthoplasty (almond eyes surgery) or an infraorbital implant can have a zygomatic arch implant placed without damaging the prior canthoplasty or orbital implant? 

A: The best method for placement of a zygomatic arch implant is through the lower eyelid where direct linear access to the arch can be done. This is the most assured method of getting them into ideal position and with good symmetry between the two sides. Would that disrupt the prior work…probably not. But if those areas can be avoided that is the 100% assured way that it would not. That leaves the intraoral route to do so…the most difficult way to place any implant design that has a long zygomatic arch component.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a scrotum augmentation with XL implants of approx. 7cm. Do you have testicular implants that are 6 or better 7 cm in size or do they have to be specially made? Is it even possible to insert 7 cm implants into a normal scrotum or does a 6 cm implant have to be inserted beforehand? 

Kind regards

A: Any ultrasoft solid silicone testicle implant larger than 5.0cms has to be custom made. We have all such computer designs from 5.5cm to 7.5cms already on file so they can be quickly manufactured when needed. I think that a scrotum with normal sizes testicles is NOT going ti be able to accommodate two 7cms testicles immediately….that is simply too much volume for even the very stretchable scrotal skin to be able to safely do. Two 6.0cms implants would be more reasonable to do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, my head is extremely extremely small and flat. Basically like microcephaly making me look like a monkey when I expose it. Can anything be done to round it out? Also, will this procedure affect hair growth?

A: Skull augmentation with custom made implants for exactly your concerns (small head) are routinuely done. The key question is whether this would need to be a one vs two stage skull augmentation procedure based on how much skull augmentation you need and the ability of the scalp to stretch to accommodate it. How this applies to you is not yet known. Such skull augmentations do not affect the ability of the hair to grow after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Quick question can a slanted forehead be corrected? There’s a really steam slope on my forehead more noticeable on the profile.

A: An excessively sloped forehead is a very common indication for forehead augmentation surgery. This is best done by a custom made forehead implant where the degree of slope correction can be preoperatively selected along with important design issues of how far back onto the top of the head it needs to go s well as how to blend into the sides of the forehead around or across the bony temporal line.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, how long does temporal reduction surgery usually takes? And is it done with a scalpel or shaver? I´m curious because of the incision size you know, one thing is the head narrowing but on the other hand its scar after.

And is it only a partial resection of temporalis muscle? Isn’t it necessary – to smooth out with bone cement in case that hollowness might occur? 

And if I am right – does the partial temporalis resection look like this?

A: In answer to your temporal reduction questions:

1) The usual surgical time is 90 minutes.

2) Temporal muscle removal is done by a combination of elevators and electrocautery.

3) The incision is limited to the postauricular crease on the back of the ear.

4) Postoperative hollowness has not been a problem due to the eventual atrophy of the cur edges of the remaining muscle left behind.

5) A more accurate reflection of the cut line and the amount of muscle removed can be seen in the attached diagram.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an inquiry about custom vertical jaw lengthening implants. I have downward swung jaws that make my lower third somewhat long, my gonial angle very high, a short ramus, and very steep jaw (40 degrees). As far as the implants on the jaw go I have 2 questions. 

1. Can these implants be created with minimal width expansion? I am not too worried about my jaw width, I don’t need or desire a jaw as wide as my zygos. 

2. This is my largest worry: Will the distance the jaw/gonion is lowered translate to the most outward point on my jaw from the front lowering the same amount? I worry that lowering my gonions 1 – 1.5cm will cause my lower face to look blocky and bloated from the front since my somewhat long chin will still exist but now my jaw angles will be below my mouth. Is there any implant design method that can lengthen my ramus but not severely change jaw angle placement? 

I am really considering this procedure along with sliding genioplasty in the next year but this second point of contention has me extremely worried. 

Thanks.

A: Because they are custom jawline implants they can be made however one deems appropriate. The usual minimal width of material is 3mms. As a general rule few patients with high jaw angles need or are advised to go 10 to 15mms on the vertical jaw angle drop for the very reason you describe as well as the high risk of masseteric muscle dehiscence.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to inquire about the Occipital Bun reduction surgery. What is the cost, recovery time, and potential scarring after the procedure. I have no hair and wear my hair bald so the scarring would be visible and wanted to know how prominent the scar would be. I have attached some photos.

A: I would advise he go to www.exploreplasticsurgery.com and search under Occipital Knob Skull Reduction and look at the many cases done so he can appreciate the small incision used and the resultant minimal scarring from the procedure. There is a very minimal recovery time and I am not so sure I would even call it much of a recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I have been looking at some your posts and although you don’t think temporal bone reduction is necessary and muscle reduction is the way to go for a more effective result I just wanted to ask how much of the temporal bone are you able to reduce.

A: The key question is whether the scar up the side of the head is worth it for the additional 2mms or 3mms of temporal bone removal that can be achieved. You can’t do bone removal from the incision behind the ear. In essence for the minor amount of extra temporal width that can be achieved by bone removal the visible scar to so is usually not an acceptable tradeoff. In addition to date no patient who has had muscle removed has ever said they needed additional width reduction afterwards.

Dr. Barry Eppley

Indianapolis, Indiana