Your Questions

Q: Dr. Eppley, I just wanted to see if this was possible. My lower facial third is 79.4mm. My middle is 60.3mm. My top is 47.6mm. I was to decrease my bottom lip to chin which is at 52mn by 10mm. With a slight burr shave backwards 2mm. I had a sliding genio double jaw surgery several years ago that corrected my underbite but left my lower chin still big and overly projected. I’m aiming for a heart-shaped lower face, so I’d like to reduce my chin vertically by around 9mm and have the chin tapered in width to create a clean, V-line look. Also, if possible, I’d like the chin to be set back just a little — maybe a few millimeters 2-4 — to help with projection. I feel like it slightly juts forward and would look more balanced if it sat closer in line with my lips.

A: With the large chin bone reduction numbers you have described you are not factoring in what happens to all of the overlying soft tissues with such a significant chin bone removal is done (aka loss of support). No matter how that amount of chin bone is done, whether by intraoral wedge removal or a submental inferior border chin shave the residual soft tissues are going to be a potential problem. I would agree that with the prior procedures a submental chin reduction approach would be the most effective because the residual soft tissue chin pad access could be effectively managed. However the key to that being successful is closer to a 4 to 5 mm of vertical reduction with 2 mms of horizontal projection reduction. This is a good example of when it is wise to except less of an aesthetic outcome than you ideally want to avoid other aesthetic issue trade-offs. In this case it is about controlling the length of the submental scar for the soft tissue chin pad reduction

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hey, I’m about to schedule a MARPE producer; could you check with Dr Eppley to see if my mid-face implants will interfere at all with that? 

A:Common question and they will not. While MARPE through the use of mini- bone anchors helps expand the palatal arch such a change is slow and does not place any midface implant at risk. Conversely the midface implant will also not affect the ability of MARPRE in its palatal expansion process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How many months after the mouth widening surgery can you get the revision surgery. And what can you do to get the best results if I am prone to mild hypertrophic scaring. Would I benefit from this kind of procedure? Is it possible to get an after pictures of a patient with hypertrophic scaring and revision?

A:Thank you for your inquiry and sending your picture. Based on this picture that the average with of the mouth is usually at the horizontal level of the vertical line drop down from the pupil of the eye I can certainly see why you would have an interest in mouth widening surgery. Based on your skin type you are not really at a risk for hypertrophic scarring as a Caucasian. But the mouth widening procedure by being done at the corners of the mouth is prone to scar widening in any patient of any skin pigment. As a general rule you don’t want to undergo scar revision shouldn’t be needed for 4 to 6 months after the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in getting a cheekbone reduction surgery for my wide/high cheekbones. However, I am concerned about the strength of the zygomatic bone after the reduction surgery. I participate in many non-competitive contact sports, such as kickboxing and soccer. If I get cheekbone reduction surgery and, after full recovery, I get struck by a ball in the face during soccer or a punch to the face during a kickboxing sparring session, would that compromise the integral strength of the cheekbone?

A:While cheekbone reduction surgery does cut the bone and move it inward at both ends once the two ends are fully healed there is no clinical evidence to indicate hat it makes it weaker or more susceptible to fracture from facial trauma. Given that cheekbone reduction surgery is done almost exclusively in young patients, both male and female, I have yet to see any reports of a secondary fracture from facial trauma in these treated patients. I think the anatomic reason is that once the cheekbone has been moved inward there isn’t much subzygomatic space in which to move further.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a cosmetic concern with my skull. It lacks a bit of volume at the back of my head (a bit flat), has a small bony ridge at the top of my skull, and a slight depression on the front right side of my skull. I wanted to know if flexible implants could be placed in my skull and skin…to smooth out the irregularities? I’d like to know what the budget would be, and how much downtime would I need?

A: Such described skull shape issues are very common in my experience for which custom skull implant designs are the optimal way to treat them. For now I will assume that the small bony ridge, the back end of this sagittal crest, does not need to be reduced. That is what we will base the initial cost estimates of the surgery on. When it comes to downtime from skull implant surgery the recovery can be a remarkably quick because the skull bones are not functional moving bones. Thus recovery’s Is about the swelling of which the majority has gone down significantly to have a more  normal appearance in public in 7 to 10 days after the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to you today to inquire about a personal condition and the possibility of surgical correction. I have a skull deformity characterized by indentations on both sides of my parietal bones, located on the upper back portion of my head. This condition makes the back of my head appear pointed.

I am very interested to know if a surgical procedure exists that could correct this and restore a more conventional head shape. If so, I would be grateful for any information you could provide regarding the potential risks associated with such a procedure, as well as an estimate of the associated costs.

For your reference, I have attached CT scan images of my head to this email.

Thank you for your time and consideration. I look forward to hearing from you at your earliest convenience.

A: Thank you for your inquiry and sending your 3-D CT skull scans. Such skull indentations are not uncommon in my practice experience and the use of custom skull implant designs is the best way to successfully treat them. While the specific skull implant design in your case is yet to be determined the attached image gives you a general concept of that implant augmentation approach for your type of skull deficiency.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I have a question. Im very unsatisfied with my upper head. My forehead is very thin at the top and extremely rounded. Can I make it wider. If yes how.

As you can see If I Take my Hair Up I have a thin egglike head. The Pictures doesnt do this Justice. In reality its even thinner. It bother me so much.I would Like to have the forehead wider on the upper left right corners

So ist could be more balanced to the face and doesnt Look Like a thin egghead ist Something Like this possible. Any Risks?

A:Thank you for sending pictures of your forehead. Now that I have a clear understanding of your specific narrow for had concerns the attached images show the type of custom forehead widening implants that are needed in your case. Ignore the green coloring of the underline for head bone which is done to show the contrasting difference in that the implant colors.

In my extensive aesthetic skull implant experience the most significant risk of the surgery is aesthetic in nature and with this type of implant in particular that of implant edging. When you expand or widen the bony temporal it is necessary for the implant to cross over that line onto the deep temporal fashion to make that type of change. Usually that risk is low and an important part of the implant design to have feather edging and to not try to make it excessively wide. You would be surprised how much 3 to 5mm of projection at the expansion point does on a bilateral basis. In other words your original estimates of 1 cm, provided you mean that on a bilateral basis and not on each side, is probably an accurate estimate of what is needed to make an effective change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if it was possible to combine 3 cranial implants in 1? Forehead, occipital and parietal instead of 3 different procedures or 3 different implants? If so how much would this type of procedure cost usually? Thanks a lot in advance. If the patients scalp can manage it, would it usually be combined into 1 singular implant instead of 3 pieces?

A:To answer your skull implant questions, whether you would need to separate forehead occipital and parietal  implants or whether they would be combined as a single implant is yet to be determined. That is more of an aesthetic question based on the volume of each implanted area and  do they need to be connected for a smooth skull contour. But whether it is a single larger implant or three separate implants they certainly would be done in a single surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, is it possible to remove the gap I have in the glabellar area?

is it possible to make it look like that guy? what bothers me is that hole in between my eyebrows.Thanks.

A: If the deep frontonasal angle is the primary issue  that is always going to require a bone graft or implant to help push it out. Reduction of the brow bone protrusion at the frontal side of the angle is complementary to that effect. ..meaning it helps open up the angle as well.

But will it ever look like your ideal mage….no. Your anatomy is way different.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Please see pics of my legs. I would like both thigh and calf implants. The calf implants are to be long to give my lower leg thickness as my present calf muscle is very short

For the thighs it overall thickness 

My legs are too skinny . I am 5ft 6in.

Will implants with fat graft be the solution?

A: Thank you for your inquiry and sending your leg pictures. I think when it comes to the concept of increasing overall leg thickness that implants are really spot augmentations, or in the legs, a linear line of augmentation. They do not per se create overall thickness, although they can create the perception of a thicker or bigger leg, because of its linear line of augmentation.

When it comes to your calfs with the muscle, being short, or limited to the upper half of the leg, that implant augmentation needs to be longer than the muscle. The only way that can be done is to have an implant that is placed above the muscle on top of its fascia at the subcutaneous level. Fat grafting is not an option for you, since I doubt if you have enough fat reserves to harvest and fat survives very poorly in the lower half of the leg anyway. 

Although your thighs have not been included in your pictures, thigh implants are restricted to the rectus femoris and vastus lateralis muscle unit on the anterolateral thigh.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Could I get a wider forehead with only fillers?

A: For a significant and smooth forehead widening fillers will not be effective. That is simply not the role that the use of an injectable soft filler is meant to do.

But there is always one way to prove or disprove whether fillers will work…try it and see.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a tiny and thin egghead. Especially the forehead are the upper left and right edges are very thin. Is IT possible to make the forehead a Bit wider. Like 1cm. And what surgery material would be ideal in my Case. In the picture you can see what I want.

A: Based on your drawing and description you are referring to forehead augmentation with an emphasis on forehead widening. In many male custom forehead implants it is not uncommon to widen the forehead known as lateralizing the bony temporal line. The wider or thicker the sides of the desired forehead augmentation is the more the implant design must extend posteriorly for a smooth transition. The attached forehead implant design is an example of this concept and not meant to illustrate what your exact implant design may be.

Such custom skull implants are made of solid silicone which offers the only implant material that can can be made with feathered edges, can sit on top of the temporal fascia (which is an absolute necessity) and will feel just like bone.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I had lip lift surgery last June and the results are minimal. I feel like the look hasn’t changed much, the philtrum is just a tad shorter. The surgeon has refused to take a few more millimeters off as he says my smile will be gummy. From the research I’ve done I believe my best bet would be vermillion border – upper – advancement. 

A: In a subnasal lip lift overcorrection can cause an A frame deformity (not a gummy smile) where the central vermilion is much fuller than the sides of the lip creating a vermilion height discrepancy in the shape of the upper lip. Whether you would benefit now with a secondary subnasasl lip lift, a secondary subnasal lip lift that also needs lateral vermilion advancements or converting to a total vermilion advancement requires seeing some pictures of your lips to make that determination. 

The total vermilion advancement is typically served for very thin upper lips with little vermilion show, an upper lip that lacks any significant cupid’s bow shape or for the patient seeking an extreme lip augmentation effect. The reason being when you make a scar line cross the cupid’s bow, as profound as that aesthetic effect may be, you have to have a compelling reason for doing it.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am aware that PowerFlex Pectoral II ACP12-3 (293cc) is an option that we discussed for my pectoral implants.  Would PowerFlex Plus HTPI-2 (596cc) would also be an option for pec’s?

A: That is the big daddy of pectoral implants for those seeking a major/extreme change. A pectoral implant of 596ccs is a radical increase in volume from 293ccs. And one has to be big in stature for it to even fit. (over 6′ tall etc)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m just enquiring if you offer a procedures for the mental crease between my chin and bottom lip? I’ve seen some case studies on your website and they look like exactly what I’m after. I have attached a picture below for context.

A:Thank you for your inquiry and sending your picture. You have a deep labiomental fold because your chin is vertically short. This causes the soft tissue chin pad to be compressed upward deepening the depth of the labiomental full between it and the lower lip. The correct and only treatment is vertical bony chin lengthening with an intraoral osteotomy with an interpositional graft. This will pull down the soft tissue chin pad as the bone lengthens  which will then decrease the visible depth of the labiomental fold. The attached imaging shows the effect on the fold when the chin is vertically lengthened.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve seen your amazing work and read many articles on your website — they’re truly remarkable and insightful. I’m interested in a procedure to correct the back of my head, which is relatively flat and appears somewhat disproportionate. I have a few questions before moving forward: What material would you recommend for this type of augmentation? Given my current head shape, would PMMA be a suitable option? How long should I avoid high-intensity sports after the surgery? I have craniofacial hyperhidrosis — should I be concerned about any long-term effects related to this condition following the procedure? I enjoy skiing, for example — are there any risks associated with impact if materials like silicone are used? How does the implant feel to the touch once healed? Could you please provide an estimate of the total cost of the procedure and your current availability? Thank you very much for your time and consideration. I look forward to your response.

A: The only truly effective material or method for any form of aesthetic skull augmentation of any size significance is custom implants made of a solid silicone material. The use of bone cements is a poor alternative and is only of near historic significance at this point in my skull reshaping experience.

Once you are fully healed, three months after the surgery there are no physical restrictions. Think of a custom skull implant as placing a bumper guard on the skull. It will feel as hard as bone and coincidentally will act as a method of protection.

As for scalp hyperhidrosis that is a superficial issue at the skin level and has no negative impact running implant placed down on the skull bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The main issue is I feel it’s abnormally large head which disproportionate to the rest of my body, in addition to my face being too round and full which I believe significantly distorts my features. I’m 37 years old… 6’1, 275lbs, but even before I gained this weight, I was an avid weight lifter and I incorporated cardio into my workouts. For years I maintained a weight between 235lb-245lbs; however, the weight in my face never seemed to significantly fluctuate as I would have liked. So now I feel surgery is my only option. Essentially, I want a slimmer, more sculpted face. I don’t know if my goals are realistic, and exactly what procedures I would need, but I’m sending pics of myself and the look I’m hoping to achieve.

A:Thank you for your inquiry and sending your pictures. I think we have to acknowledge that you achieving hey look that is similar to the ideal pictures is not achievable as they have completely different faces, body type and wait. But there is nothing wrong with having goals. The real question is what can be done with the anatomy that you have. When it comes to your head shape the most practical improvement would come from narrating the sides of your head so they are less convex and more of a straight profile. When I say practical I am specifically referring to the lack of any visible scars to achieve that change. In the shaved head male one must be very cautious about scars and their  length and location as scars are an aesthetic trade-off that must be balanced against what is the statically again. At least the temporal reduction procedure for head narrowing is essentially scarless.

From a face standpoint it appears in all of your pictures that you hold your jaw down and forward in what is a common jaw thrust maneuver as patients feel that that makes them look better. Besides creating a more defined jawline it also helps lengthen the face or deround it. This deliberate jaw positioning is really a test of the effects of facial lengthening.. Thus it appears that a custom jawline implant to make that type of permanent change without having to create it as well as some cheek defatting would be the most successful procedures to slim or deround your face.

To evaluate these concepts in more detail I need facial pictures from three different angles, front side and three-quarter view in a non-jaw thrust position, to do predictive imaging the effects of the procedures that I feel would most benefit you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, For many years I could only wear a hat because of these deformity. Do you think there is a way to fix it without making it look feminine?

A: Thank you for your inquiry and sending your pictures. I believe what you are referring to is the large brow bone protrusion that you have. When it comes to brow bone reduction, while itis most commonly associated today with forehead head feminization in the transgender patient, in my experience about 50% of the brow bone reductions I have ever done are in men. There are different brow bone reduction variations in male brow bone reduction versus transgender brow bone reduction. In the transgender patient the goal is to make it completely flat which is more consistent with that of the female forehead. In the male the goal is not to make it completely flat but to reduce it enough so that it no longer looks Neanderthal-like or overly protrusive. In essence in the transgender patient the goal is to create a different gender appearance. Conversely in the mail it is about reducing an abnormal protrusion of the brow bone and to make it look more normal in projection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q; Dr. Eppley, For ,my custom jawline implant design ,my questions are: 

Questions

1. What is my skull’s current bigonial width-to-bizygomatic width ratio, and what do you think will be the ideal ratio for me? What percentage does the current implant design change this ratio to? I’m hoping for the ratio to land somewhere in the 90-95% range, but I’ll defer to you on what will look the best. I think the back corners of my jaw are close to an ideal width in their current state and only need a minor augmentation, but I’d be interested to know your opinion on this. While we don’t want to add so much width that it looks weird or unnatural, we do want to add enough width to make a noticeable positive impact, *especially* in the areas nearest to the chin.
2. What is my skull’s current Frankfort mandibular plane angle, and what do you think will be the ideal ratio for me? What angle does the current implant design change this angle to? I’m hoping for something in the 22-25° range, but again, I’ll defer to you. I think my current jaw angle is far too high, and the current implant design appears to me like it might not lengthen the ramus enough to adequately lower this angle, but again, I’ll defer to you on what is ideal for me.

Goals:

We want the implant to “unround” my face and optimize the masculine balance of the lower face, rather than purely maximizing the size of it—all the changes should look very masculine, but also very natural, balanced and proportionate—while we don’t want to undercorrect and not add enough, we also want to avoid overcorrecting and adding *excessive* bulk. The implant should achieve 4 main things: 

1)Significant vertical lengthening of my jaw: we want to lower the ramus and mandibular body to create a more masculine angle and shape. I’ll leave it up to you exactly how much to add vertically, but the result should look very masculine, yet natural.

2)Obviously by adding significant vertical length, we’ll also be adding substantial width, because of the outward sloping angle. We definitely want the implant to add an impactful amount of width, especially in the areas nearest to the chin—but let’s also be careful not to add *too much* width, because I don’t want it to look excessively bulky or boxy. Again, we want the width to look very masculine but natural.

3)Significantly widen the chin in the front, creating a strong, square chin with defined angles. The widening of the chin needs to be significant enough to stretch the skin and get rid of the puffy “carp-like” look in my lips and cheeks. 

4)Horizontally lengthen the chin 4-6 mm, for the same reason—to eliminate the carp lip. If the implant adds a few mm of vertical chin length as a mere byproduct of the wraparound, I wouldn’t be opposed to that either.

A: For the purposes of custom implant design clarifications;

1) Implant designing is not like orthognathic surgery which extensively uses cephalometric landmarks. Thus we do not use any of these measurements, ratios or numbers to make a custom implant as the end goal is to make an external soft tissue change. This is not a measurable process and until someone establishes what the impact is of augmenting bone to its soft tissue effects this will continue to be more of an art than a mathematical science.

2) Implant designing must factor in a major consideration of which a patient would not be aware…. the ability to accurately and safely place it. This consideration has major influences on the design and is one that I would only be aware.

3) The first implant design is a good approximation of what the final implant design would be since I made it based on the general goals of what can be accomplished. From a chin standpoint there can be no changes to this first design given the soft tissue restrictions imposed by the prior vertical lengthening bony genioplasty.  I am not even sure if those implant dimensions will even fit but I am willing to leave it that way as should some implant reduction be necessary it can always be done in surgery. I would rather keep that amount of chin implant volume in the hope that I don’t have to modify it.

4) There is some room for additional implant volume back in the jaw angles as indicated in the attached diagram. However this is the maximum amount but I am willing to do.

5) I can certainly appreciate all of your well described goals but they defy any specific measured way to achieve them. And even if we knew exactly what those measurements would be they would have to be modified if they exceeded my design specifications to be able to be surgically placed anyway. Thus we are really creating an implant design that is driven more by soft tissue limitations as well as what can be placed as a one-piece implant.

6) That being said the overall implant design is certainly going to get you closer to your stated jaw augmentation goals but how close they will do so remains an unpredictable outcome.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in skull reshaping surgery for my 12 month daughter.

A:In the skull reshaping procedures that I perform these are for adults not infants and children.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does the mouth widening surgery also give a wider smile and Is it possible for me to see some after pictures with the scar healed.

A:By definition if you make the mouth wider at rest it will also get wider when one smiles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’m 22 years old and I’m looking for help with facial asymmetry. I have one eye slightly higher than the other, uneven cheeks and smile lines, and a mouth that shifts when I talk.

I’ve been told this is natural and can’t be fixed, but I believe it affects my confidence and quality of life. I’m interested in understanding whether facial balancing surgery or structural correction could help in my case.

I have had facial asymmetry since childhood. I feel that one side of my face appears straight, while the other side looks slightly curved — similar to how hands look when raised in prayer, with one side more inward or rounded.

This difference becomes more visible when I talk or smile, as my face shifts more to one side. I believe the issue may be due to bone structure or muscle imbalance.

Could you please tell me if this kind of facial asymmetry (possibly involving zygomatic bone or jaw alignment) can be corrected through surgery or other treatments?

A: While you have numerous facial asymmetries, as you have mentioned, most of them do not justify surgical intervention as they can not be completely corrected. I don’t think surgery is worth the effort. The exception is your twisted smile which is the result of congenital paralysis of the left marginal mandibular branch of the facial nerve. Your left depressor anguli oris muscle does not work which is why the left lower lip is higher than the right at rest and pulls up even higher as the right lower lip when smiling pulls it to the right. While you can never make the nerve work to activate the depressor muscle you can do a vermilion advancement of the left lower lip to partially camouflage the severity of the smile asymmetry by evening out the amount of vermilion show at rest. 

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I have a prominent zygomatic arch that extends outward due to acromegaly. From beneath the eyes to the ear. Is it possible to push this bone inward without damaging the muscle attached to it?

A: What you are referring to is classic cheekbone reduction osteotomies…which is essentially zygomatic arch osteotomies to move the entire bow of the arch inward. This does not adversely effect the temporalis muscle which passes underneath the arch or the origin of the masseter muscle which attaches to its side.

Before such  surgery it is prudent to get a 3D CT scan to plan the osteotomy bone cuts.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in XL breast augmentation 2,000 cc’s +. I’m a man, so am I a potential candidate?

A: Whether one be a male or female you can’t go from 0ccs to 2,000ccs implant volume in one procedure. The tissues simply will not immediately expand/stretch to accommodate that implant volume.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m trying to understand how the umbilical float procedure is typically consented to. When performing an umbilical float, is the informed consent modified to reflect this technique, or is the procedure generally performed under the standard mini abdominoplasty consent without any changes? I would appreciate any clarification Dr. Eppley or his team can provide.

A: I don’t know the basis of your question but in my practice the decision of using an umbilical float technique (if indicated) in a subtotal or mini- tummy tuck is preoperatively made. That decision may be based on the patient’s preoperative desire (scar avoidance), the desire to keep umbilicus at its current position (no lowering) and/or  an understanding of the relationship of skin removal and the impacts on it from either the umbilical transposition or float techniques.

Dr Barry Eppley

World Renowned Plastic Surgeon 

Q: Dr. Eppley, I’m 38 and had all my top teeth pulled for a full arch implant but I needed to go away for 4 years and experienced extreme bone resorption atrophy and increased underbite and now am not eligible for traditional teeth implants.. but my face lost volume in a crazy way I have bad bone density and my nose started sinking in my face and I have Huge nasal labial folds and my face doesn’t look right I am miserable.. can you guys help?

I’m thinking premaxilla face implants but I dunno I’m worried my bone density is an issue.

A: With severe maxillary bone loss midface implants have a much higher risk of complications due to reduced mucosal soft tissue coverage.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I recently had custom cheek implants make of PEEK with a custom guided genioplasty. I have no pain on the left side or sensibility issue. However, the right side is still numb from the lower eyelid to the upper right lip, and i can’t really move it or smile properly. I was told that it was normal at 10 days post-op, however, i still feel some strange pulsating sensation that are not very painful but still disturbing, again only on one side, it comes and goes. Moreover, the “custom” genioplasty left my chin asymetrical (please find the attached pictures. After reviewing the CT scan, I saw that one of the two screws was not put in the intended original place, but closer to the center. Could it be that the screw is in a dangerous area like the sinus cavity ? Is it normal to still be numb, and how can I see the implants on the CT scan?

A: I can not ethically comment or provide recommendations on surgical management or outcomes when the patient is under active care by the surgeon who performed the procedures..

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Would I need significant lengthening that needs surgery (>6mm) or an implant can suffice to address my concern of a smoother side profile and mental crease removal/smoothening?

A: I think what you mean is whether you need vertical bone lengthening, which is needed for chin length increases greater than 7mms. When less than 7mm is needed then this can safely can be done by an implant.

That determination requires a more indepth assessment and imaging of your pictures. But my initial impression is that 5 to 7mms of vertical length is needed.

But no matter what you do the labiomentla fold can not be ‘removed or completely smoothed out’. That is not an achievable outcome. It can only be partially reduced in depth.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant, which did provide some chin projection improvement, but did not achieve my ideal goals. Will a custom chin implant do better?

A: When considering different implants for an improved and more desired augmentation effect you have to know exactly what the implants are and where they are on the bone. Thus a 3D CT scan is most beneficial as it will clearly this important information. In your first surgery the surgeon guessed what will work. You don’t guess the second time as you have more information that can clearly be identified.

Dr Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I was born with a webbed neck. But don’t have any syndrome that caused it, i really hate the way it looks and am trying to find options to get it done with surgery. First the only option was to have scars on both sides and i chose not to do that, then i saw your surgeries where the scar is at the back, what didn’t look bad, but i was wondering if a surgery like that would be possible for me. Hope you could answer that, thanks

.A:Thank you for sending your neck pictures. Your neck  appearance is fairly classic particularly for non-syndromic neck webbing. Most neck webbing i see is not associated with a genetic proven syndrome such as Turner’s or Noonan’s syndrome. As you may well have read there are different techniques in the treatment of neck webbing which primarily can be differentiated by those that are performed laterally on the side of the neck and those that are based more posteriorly on the back of the neck. While there can be debates about which produces a more effective and sustained correction of the neck webbing it is probably true that a direct lateral approach is a bit more effective. But the visible scarring for many patients may not be a worthy aesthetic trade-off. Thus I have always used a more posterior approach to keep the resultant scars more on the back of the neck as opposed to the sides. With the posterior approach there is always going to be some amount of relapse which is maximized in the first few months after the surgery. This is usually in the amount 30 to 50% from that scene immediately after the surgery. For most webbed neck patients  this is acceptable and they never move on to have a secondary revisional procedure which can maximize the results using the existing scars from the first surgery. This is the trade-off of the posterior approach. As you can see by this description no form of webbed surgery is perfect and each type has their advantages and disadvantages. I, and almost all patients, would prefer the option that better hides the scars. Once the scars are on the side of your neck with the lateral approach, no matter how they are revised, they are always going to be very visible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon