Your Questions
Your Questions
Q: Dr. Eppley, With the addition of a peek implant to only the forehead to increase bone thickness and prominence of the forehead, will it automatically cause the top of the head to also look slightly fuller? This is because I imagine that the skin would have to stretched over an extra area over the newly inserted peek implant so the top of the head/overall head shape may look slightly different when stitching back the incision after inserting the new forehead implant?
Many thanks for your help.
A: The front part of the top of the head will have to increase as the footprint of the implant has to extend back further to blend in and have a smooth and natural contour. The material used is irrelevant, the forehead implant design principle remains the same.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, 1. I am an Asian, but can you make my eyes go deep like Westerners with orbital box osteotomy?
2. Is this surgery as dangerous as the Lefort3 surgery?
3. If it is possible to operate deeper, I wonder if the size of the eyes will decrease or increase .
A: The only effective and safe way to make the eyes deeper is periorbital augmentation. Orbital box osteotomies can move the eye horizontally or vertically but can not make the eye look deeper.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I’m interested in a genioplasty revision. To give you context, I had a genioplasty a couple of years ago where my chin was moved forward 8mm and down 3mm, about 8 months later I went in for a revision to have it reversed. The surgeon used the burring method, it’s been over a year and my chin looks bulky, flat and vertically longer than my original chin. I don’t think he did a good job, it could be excess soft tissue or maybe he didn’t reduce the bone vertically enough. This situation has been distressing to say the least.
I think a 4 to 5mm vertical reduction will make it fit my face shape better more closely resemble my original chin. I know you are one of the few experts in this area and I would really appreciate his input and wish he can help with this.
A: Trying to reverse a sliding genioplasty is not best done by burring as, while that reduces some horizontal bone projection, it will create a definite soft tissue chin pad redundancy. Not to mention that a burring technique done intraorally can not reduce the vertical height of the chin.
To now reduce the bony height of the chin, which will further magnify the soft tissue redundancy, it may be best to take a submental approach so both vertical bone height and the soft tissue chin pad redundancy can be simultaneously addressed.
But to provide a more informed recommendation reviewing the CBCT scan would be necessary.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I don’t have syndrome, but I’m stressed because my mid-eye area is very flat. I know that Lefort3 surgery is very dangerous, but I wonder if Lefort2 is also a very dangerous operation to receive for cosmetic purposes.I know there is a prosthesis in the mid-face, but I really want to have a surgery for Lefort2.
A: No form of a LeFort advancement is ‘dangerous’ but it is a major midface surgery that has its own issues/tradeoffs. Whether one is a candidate for a Lefort II procedure depends on their current occlusal relationship and whether a simultaneous lower jaw advancement needs to be performed with it to keep a good occlusion intact.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to extend the collarbone 3 or 4 times for a total of 12cm or 16cm? I want to get an extension effect of 12cm or more through at least 3 surgeries. Is it possible if there is enough time and rehabilitation?
A: Such a degree of clavicle lengthening (12 to 16cms) is not possible no matter how many times it is done. The tight shoulder girdle and scapula is the limiting factor that will prevent the clavicle from being lengthened that far.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking to get a consultation on a BBL – reconstructive surgery. Reaching out to you based on your previous experience in handling similar surgery (Plastic Surgery Case Study – Buttock Reconstruction with Dermal-Fat Grafts).
To give more context, I had a childhood trauma which resulted in a deep scar on one side of my butt. I would like to schedule an appointment with the doctor to discuss the options (regular injected fat vs dermal fat graft vs implant / other options) and the doctor’s availability. I’m planning to get it done as early as possible.
A: Thank you for your inquiry and sending your picture. While I can see your scar I can not tell how contracted or tightly adherent it is. That aspect of the scar is crucial as that determines whether just proceeding with fat injections (minimally adherent) or whether a dermal-fat graft is needed. (moderately to tightly adherent) Because the injury occurred in childhood it is likely the latter in my experience. If so I would do the scar release/dermal fat graft first followed by a BBL after.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am reaching out as I would like to investigate the possibility of getting a forehead implant and a jaw and chin implant.
My main concern is the shape of my forehead, which gives me a bit of an egg-shaped look and ages me somewhat. There are 4 main problems I have identified:
1) the angle at which my forehead slopes is too great, giving me a neanderthal look
2) From the side, the curvature of the front half of my skull exacerbates the egg-shaped look (I think an implant would need to start some way up my skull to compensate, and give my skull a more flat, square look from the side)
3) My forehead has little support at my temples, again contributing to the egg-shaped look, giving a hollow and aged appearance, and this is in contrast to my cheeks and jaw which extend further out
4) the indentations in the middle of my forehead and above my eyebrows really trouble me, especially in photos. I believe some improvement could be achieved with botox to atrophy the brow muscles, and some filler to smooth out the indentations, but because of the 3 above issues identified, I think an implant is the most sensible option! 🙂
Thank you so much for your time. I look forward to hearing from you.
A: Thank you for your inquiry and sending your pictures. You are spot on in identifying in that the correction of your forehead slope/shape extends well beyond the forehead itself. It involves the need to reach up and cover the top of the skull as well as wrap around the sides (temples) to get a smooth uniform effect. (see attached imaging) This is reflective of the anatomy of the overall skull which is a collection of 5 convex surfaces. Most skull augmentations have to cover at least 3 of them to get a uniform and natural looking effect. In you such a forehead augmentation must cover 3.5 surfaces (forehead, temples and part of the top of the skull)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was just curious if a silicone implant place could success push out a moderate labiomental fold. I read in one of your studies that cadaver material such as gortex could be used but would make only a modest difference. For someone who wants the fold more straight and pushed out, could a thicker implant such as a customized silicone implant work better?
A: No form of underlying bone augmentation will push out a deeper labiomental fold as the fold is reflective of the origin of the mentalis muscle to the bone. Improving the depth of the labioimental fold requires soft tissue augmentation. (right under the skin but above the muscle) Whether that should be done by fat injections, the intraoral placement of a dermal-fat graft or some form of a subcutaneous implant can be debated. Bur regardless of how it is done the result you have imaged (a completely eradicated fold depth) is not possible. Halfway between your original fold depth and what you have imaged is a more realistic outcome.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I lack confidence because of my thin and narrow face, I think I look feminine which is not so good. I have a long bottom jaw which is steep. Can mewing work or should I get surgery for implants?
A: The only predictable and sustained method for jaw augmentation is implants. Mewing can not produce the type of jaw augmentation changes that implants can and, once in place, would require no work to maintain the result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need some information about hollowness between eye and brow. Is it possible to use bone graft to fill the hollowness and lowering the supraorbital area. What do you prefer to use on that case. But remember please, only permanent result.
Is it better using implant or bone grafts. Usually plastic surgeons use filler or fat graft but i do not like temporary result.
A: As a general statement while either bone graft or implants can be used to augment/lower the supraorbital rim/brows, custom implants are preferred because they will have a predictable preoperative determined shape, can be inserted through much smaller incisions and will have an assured smoothness. The same can not be said when it comes to bone grafts….not to mention the need for a harvest site.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a small round bony protrusion on the middle of my forehead paired with a browridge. I was wondering if it would be technically possible to shave this bone and add this excess of bone to the browridge ? Thank you very much for your time.
A:While the mid-forehead bony protrusion can be removed and added (recycled) to your brow ridge, such bone grafts will add very little volume and will likely undergo 100% resorption very quickly in the early postoperative period. So the question is not whether such bone transfer can be done but that will be ineffective both in volume addition and in retention.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted your medical opinion on the potential approaches to rib removal surgery. Regarding the rib removal, we discussed the big impact of having the 10, 11, and 12 ribs resected. I would like to hear your thoughts on the following and I have included images (attached) to aid in clarification of what I am trying to ask.
1.- Latissmus muscle resection
During my consultation you mentioned you normally resects the lower part of the latissmus muscle (I show on the image as red). Would it be possible to remove a longer segment for a greater trunk width reduction? I have a broad back and would be interested in this possibility but wanted to hear his thoughts on risks or considerations (reduced strenght, reach, etc).
2.- Rib Resection
Would there be any benefit or risk to instead of doing the traditional rib resection procedure only removing a segment and leaving the remaining “frontal/tip” part of the rib floating? Would this give some protection or would this reduce the waist reduction effect? Would this turn into bigger risks with puncturing organs, rib flail, etc?
A: In answer to your two excellent waistline narrowing questions:
1) It would produce even better results to take a longer strip of latissimus dorsi muscle but the limited flank incisions used for rib removal surgery only permit the wedge of muscle to be taken to be so big/long. A vertical incision on the side of the waistline would permit a much longer width of the muscle to be removed but the aesthetic tradeoff of the scar may be questionable.
2) Your question is whether removing just a central section of the rib and allowing the remaining outer portion to float would produce a similar result as removing the entire outer half of the rib is a good one….and one I have often thought about doing. (rib osteotomy vs rib removal) I suspect if one employed short term corseting to help shape the waistline that it may have similar results as the bony lateral support of the waistline is reduced.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have scheduled for paranasal implant surgery in September. Now I would like to ask you a few more questions about it:
- Do you think it will be advisable to stay in Carmel for 1 or 2 weeks after the surgery in case some complications may occur?
- Can I eat normally the days following the surgery or are the any restrictions?
- Is it possible to have another surgery done (some months) after the paranasal implantation? I am thinking about a facelift in early spring of next year. From your medical point of view, would this be a problem after the paranasal implantation? Will the implants affect the feasibility of a subsequent face lifting in any aspect? Is the planned point of time 4-5 months after the paranasal surgery ok or should I wait longer? Would it be even better to have the face lifting done prior to the paranasal surgery?
A: In answer to your paranasal implant surgery questions:
1) One to two weeks stay after surgery is not necessary. Infectious complications, rare as they may be for the midface, won’t occur until 3 to 6 weeks after the surgery.
2) I would be careful about biting off food for a few weeks with the high vestibular incision. This is easily bypassed by using utensils to replace what the front teeth normally do.
3) You could have any form of facelift surgery within weeks or months after the paranasal augmentation. Such central midface implants have no impact on mid- or lateral facelift surgery, whether done before or after.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want a wider head shape with a temple implant. What shape should the implant be?
A: Thank you for your inquiry and sending your pictures. Because it really involves the side of the entire head a wrap around or extended temporal implant style (head widening implant) is needed to create an harmonious change from the side of the forehead back to the posterior temporal region. It doesn’t have to be very thick (5mm max most likely in the center) but it is the footprint of the implant that is most important in achieving the desired effect. You also don’t want to overdo the width of the implant to keep in balance with your thinner face and what appears to be a leaner body shape as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Am I candidate for eyelid surgery that can help with my droopy outer eyelids, which give me a tired and depressed look.
A: Thank you for your inquiry. You would be a candidate for outer corner eye reshaping (lateral canthoplasty with lower eyelid spacer grafts) but that would not be most effective if just done alone. Your outer eye corners turn down for a reason…they mimic the lack of bone support underneath them. You have lack of underlying midface projection which results in a negative orbital vector. ( projection of cornea is at or in front of the infraorbital rim) Such negative orbital vectors are best treated by adding structural support (custom infraorbital-malar implants) with the lower eyelid reshaping procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Good afternoon, is there a procedure that can be done to protect the facial bones? A protective face mask but permanent? To reduce injury,Thank You.
A: I assume your question is about an internal layer of protection for the facial bones. That can be done and would consist of making a thin firm layer of custom implants that cover the facial bones. Custom facial implants do indeed act like bumpers on the bone, adding a layer of protection even if they are only a few millimeters thick.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have lip incompetence and chin ptosis after chin implant removal and soft tissue reduction surgery, all via a submental approach. Can a mentalis muscle resuspension help in my case?
A: Mentalis muscle resuspensions rarely work when done alone. They have a better chance of success when combined with a small implant placed on the chin which encourages soft tissue adhesion like a Medpor or Goretex material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I believe that I have hyperdynamic chin ptosis. My chin appears normal at rest, it is prominent when talking or smiling. It bothers me, especially while talking. I never had any surgery done. What would be my options to correct the appearance of my chin?
Thanks in advance.
A: Hyperdynamic chin ptosis is treated by a submental approach where excessive chin pad soft tissues are removed and the mentalis muscle insertion is tightened down to the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Had a chin implant last year, unhappy with results. It looks too square and I have jowling. I also had buccal fat removal and FaceTite. Would like your expert opinion on what is best for me. Thanks!
A:While I don’t know what you looked like before the chin implant and what style/size chin implant was placed, but it is clear whatever was used does not fit your face. If the horizontal projection provided by the chin implant is significant (more than 6mms) then I would replace it with a sliding genioplasty which will make it more narrow and help thin the thicker tissues above and behind the chin. Whether that bony genioplasty needs to be a mini V line version for maximum chin narrowing effect I can not yet say. You would also benefit by microliposuction treatment of the perioral, jowl and lateral facial areas. These are areas that are not affected by a buccal lipectomy which only benefits the upper cheek area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After I had my son I had fat leftover on my chin pad. I didn’t feel like myself. I didn’t know if I needed bone reduction or chin pad reduction. I had bone reduction but now looking back i think I just needed minimal chin pad reduction without causing a witches chin and skin tightening underneath. Im genuinely not sure. Now I have a scar left from my surgery and I’m not sure if he did what I needed. I’m two months post opt. I would like a consultation. Thank you.
A: Since I do not know what you looked like before, I can not comment on what I would have done then. What I can comment on is where you are now with an existing submental scar. Since you already have the scar there is no longer the consideration of a scar tradeoff for a soft tissue chin pad reduction. That can be combined with submental skin tightening.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had an endoscopic brow lift 9 weeks ago. I absolutely hate it and it is causing me pain. It actually put so much pressure on my nose that it did damage. I consulted with an ENT today and found out it is true. Can the brow lift be reversed using the same incisions? The left side has sutures and the right has 2 tunnels with sutures.( I was never informed I was getting my scalp drilled) I had this done out of state. I do not want to wait and want the brow lift reversed. Is doing it early better before scar tissue forms? Will everything return as it was before? Will there be any negative complications by reversing the brow lift?
A:I would agree that the sooner the brow lift is taken down (reversed) the more likely the tissues may return closer to normal. I know of no other risks to brow lift reversal other than how successfully will it take you back ‘home’ again.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,Hello I lost my intergluteal cleft because of two times sinus pilondal surgery Is it possible to recreation mine? And how is this surgery ? Is it hard?
A:Intergluteal cleftplasty is most commonly done after pilonidal surgery or the placement of buttock implants that uses a midline incision. In either the sacrocutaneous ligamentous attachments are detached/lost. It is generally successful surgery through excision of midline scar tissue and reattachment of the more normal tissues on the sides back down to the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I contacted you several years ago about a temporal reduction surgery for both sides of my head. I have now time and money to make this operation possible. I have several questions:
– Are there visible scars after the surgery ?
– How much time to go back home after the surgery ?
In advance, thanks for your answers.
A:In answer to your temporal reduction surgery questions:
1) Temporal reduction surgery is done from incisions placed in the postauricular sulcus behind the ear, this there are no visible scars.
2) There are no physical restrictions after surgery. Recovery is really about the swelling and its appearance which takes about 10 days to look more normal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a young man who is three months out from a genioplasty (8mm advancement) and suffering with severe lip and upper chin tightness / tissue tugging when I raise my lower lip or move it sideways. It impacts speech and any slight lip movement.
The genioplasty was a revision after two months because the original operation had left significant asymmetry. So there have already been two operations in quick succession.
As well as significant tightness and discomfort, I have a high-riding and overactive mentalis muscle and rely on this muscle to close my lips at rest due to lip incompetence. When contracted the muscle presents a noticeable bulge and introduces the tight / tugging sensation.
When at rest my lower lip sags and exposes my lower incisors.
I have read your literature on scar contracture of the soft tissues into the void created by the chin step and believe I am suffering with this.
I wondered if you could recommend any specialist in the UK who might be able to help with my issues? As I live in the UK this might make more sense rather than making trips to USA.
I am not sure my current surgeon is familiar with this complication and wish to explore options to try and improve the current feeling.
Is there value in treating this sooner rather than later? Steroid injections, fat injections, for example, as first solution?
Appreciate any advice you can offer in the short term ahead of our consultation.
A:Thank you for your inquiry and detailing your concerns. I would not know who, if anyone, in the UK would perform this procedure to treat this type of postop genioplasty problem. But any non-surgical treatment by injection, regardless of the agent, would not be harmful. It may or may not provide some relief but at the least it will not make anything worse. There is no urgency to jump right in and do anything immediately as the symptoms you have will not get worse.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I want a consultation for waist reduction please. I have flared protruded rib on the left side and short torso. Thank you.
A: Thank you for your inquiry and sending your pictures. Waist reduction is a general term that includes conventional primary procedures of ljposuction and tummy tucks as well as the less commonly performed rib removal surgery. I can see that you have had a prior tummy tuck….although it does not appear that procedure has been maximized. I see a lot of room for improvement in terms of secondary abdominal and flank liposuction all the way around to the spine and into the back. There appears to still be room for more abdominal skin removal.
As a general rule I don’t ‘graduate’ to rib removal in waist reduction patients who have not maximized their results with the primary waistline procedures as this does not create good outcomes. Thus I would advise with your body type and current tummy tuck results to have a the mentioned secondary liposuction and tummy tuck procedures through which the left subcostal rib protrusion could be reduced,,,saving you an additional external scar.
Dr Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I tell you my case, I had surgery first with a lobuloplasty doctor for the use of expansions in my large ears.which amputated part of the lobe, I went to a second doctor who performed an otoplasty and joined part of the lobe to my neck. The truth is that I don’t feel good about the results tbecause I feel that my ears are not proportional to the face or my nose. The first photo is of the right ear and the second is of the left ear (I think it is the worst one)
I appreciate your time and my question would be if there is any possibility of lengthening the ear, could it be a graft?
A: While ears can be shortened they can not be lengthened. There is no graft that can be done to lengthen or expand an earlobe.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. I have heard about you through some of my friends. My concern is about orbital rim, premaxillary and infraorbital areas. My wish is augmentation on the infraorbital area, and orbital rim contouring around the eye to correct the hollowness, so orbital rim and premaxillary zone augmentation. I want all of these done with HA- hydroxyapatite.
My question is can HA be used on the infraorbital area, orbital rimm and premaxillary areas. I need to have an idea if HA can used on such area of faceYou can see an image on attachment , drawn the area with red color which I want augmentation using HA.
Thank you
A:When it comes to the use of hydroxyapatite cement that material is going to work better for bony concavities than bony convexities. Thus the paranasal region is a good place for it. The lower orbital is OK but not great and you simply can’t build the material out into space. (upper orbital rim) HA is intraoperatively mixed to create a paste which is then applied and molded into the desired shape and then allowed to set. So the base upon which it is applied is a major determinant of its predictable augmentative effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello. I need face reshaping and i want to use cranium bone grafts to augment my retruded midface and floor of orbits. Some surgeons told me that i have to do a 3D CT scan for evaluation. This is important because my doctor left me know that the thickness of the skull bone is different on all patients. So when I do the 3D CT will it show in detail the thickness of my skull in milimeters to understand how much bone grafts can be taken from my head to reconstruct my midface and orbits?
A: While a 2D or a 3D scan will allow the various skull bone thicknesses to be measured it is not really necessary. Short of the forehead and temporal region split thickness cranial bone grafts can be harvested anywhere inside the bony temporal lines of the skull. Since the skull has three distinct layers it is the outer cortical table that is taken for cranial bone grafts, not the full thickness of the bone. Scan or no scan you have plenty of good bone to harvest for orbital and midface augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, so Ive read that you use a bone graft from the fibula in order to fill the gap created during clavicle lengthening surgery.
My question is, will this affect one’s eligibility to get leg lengthening surgery if they are lengthening the tibia and fibula?
A: I no longer use a bone graft for clavicle lengthening. It is now a non-bone graft sagittal split clavicle lengthening procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am very interested in decreasing the overall width of my head. I have been reading about both the anterior and posterior temporal muscle reduction procedure and I think both would be a suitable procedure to decrease overall head width. Although I am concerned about thickness of my bone on my forehead which still adds a substantial about of thickness to my head size. Would it be possible to know if I would be a good candidate to have both anterior muscle reduction and forehead recontouring (forehead burrowing) by assessing pictures of my forehead?
A:Your question about head width reduction is a good one since the sides of the forehead and the temporal areas share a similar developmental origin, so often both are involved. The only way to answer that question is with computer imaging to show temporal width reduction without any change to the bony forehead so you can be the judge as to whether forehead reduction is needed as well. (see attached)
Dr. Barry Eppley
Indianapolis, Indiana
