Your Questions
Your Questions
Q: Dr. Eppley, I am a 28 year old ciswoman and have had temple augmentation with bone cement (hydroxyapatite) around 8 years ago. At the same time, I also had some of my brow bone burred down through a coronal incision (to get rid of that neanderthal look) and a brow lift to reattach the muscles and skin in a natural position.
I was initially very happy with the results, but over time the hydroxyapatite has somehow disintegrated and I am now back to having hollow temples (and a narrow head shape in general).
I am now looking for a more temporary solution and am thinking of temporal implants. Specifically, I am looking into custom-made temple implants starting at my temples and extending to the side of my head (I attach pictures of similar augmentations I found on your website).
Further, I am thinking about further burring down my brow bone bossing and – while the coronary incision is already open – potentially also reducing the radix of my nose (not sure if this is possible through a coronary incision though, but I thought this may be possible and would be really interesting to know). More precisely, I asked the surgeon back then to undercorrect the bossing and not lift my brows more than necessary as I wanted the most subtle of results. After eight years during which my brows have had time to drop again, I am now looking to redo this (but this time properly without undercorrection).
Before scheduling a consultation with you, I wanted to reach out and make a quick inquiry about feasibility and cost (I understand that this is very individual but a ballpark price would be really helpful to know whether I can afford surgery with you) to make sure that I don’t waste your time with an unnecessary consult. If possible, I would be really grateful if you could give me some initial answers on following questions:
1) Very roughly, how much would an augmentation with custom-made implants (similar to the ones attached to this email) cost including the implants?
2) Can the radix of the nose be shortened through a coronary incision?
3) Very roughly, how much would burring down the brow bone and (if possible) radix – using a coronary incision and closing with a brow lift – cost?
A: Using your existing coronal scalp incision the placement of custom temporal implants, radix nasal reduction and a bro9w lift can be performed. The radix reduction will need to be supplemented by an intranasal approach as well as the verst high radix reduction needs bidirectional osteotome bone cuts to be successful. The browlift is the tricky one as using a coronal incision to do it sacrifices scalp which I don’t like to do if it can be avoided.
These are all good cost questions and I will have my assistant pass along some cost estimates to you.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 19 year old female who will go trough double jaw surgery with Lefort 1 and Genioplasty for aesthetics in around 3 months. From what I understand, jaw surgery cannot change negative canthal tilt and sunken in cheekbones. This is an aspect I really wish to fix after my double jaw surgery. I have been told I should do a fat graft to the face, but I am looking for something more permanent. Do you think infra orbital implants with cheek implants could fix my canthal tilt and sunken in cheekbones to give more of a model look? And how much time do you think I should wait after double jaw surgery to get the other procedure ? Thank you
A: In answer to your facial augmentation questions:
- The definitive treatment of infraorbital-malar augmentation is custom implant designs. While these are great for skeletal augmentation it needs to be supplemented with lateral canthoplasties to help lift up the outer corner of the eyes.
2) I would wait 6 months after double jaw surgery before doing these finishing aesthetic surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently got some feminization filler recently but I would love my brow bone to be less pronounced and a nose job and possibly my Adams apple.
A: Brow bone reduction, rhinoplasty and tracheal shaves are all common FFS procedures that can done in a single surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, One important point for me is also the overall head size.
I’m very self-conscious about my head circumference, which is only about 56.8 to 57 cm. I’d like to ask realistically:
- With the type of augmentation shown in the simulation (including the possibility of some light lateral fill if needed), what would my new head circumference be approximately?
- What is the maximum size I could realistically reach while still keeping an aesthetic and natural result?
A: In answer to your skull augmentation questions:
- Custom skull implants provide augmentative changes for head shape contour improvements. They are not done for a measured circumferential head size change. Some benefit in those measurements may occur but is not an effect I would predict or comment on.
- The implant volume/size any patient’s head can accommodate is based on the stretch of the scalp. That is the limitation of head size change and is determined on an individual basis.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How soon after a mini facelift and lateral brow lift can I get temple implants? I’ve always had hollowed temples but after getting the mini facelift they look even more depressed. I have gotten fillers before and they worked very well for me. I’m now interested in getting temple implants. My plastic surgeon doesn’t offer this.
A: Three months after brow and facelift surgery when you are fully healed temporal implants can be placed.
Dr. Barry Eppley
World-Renowned Plastic SurgeonHow Soi
Q: Dr. Eppley, I’m trans MTF I saw your article about reduce the shoulders I have width prominences deltoid also is the possible to reduce ? How much? Thanks
A: If you are asking if the deltoid muscles can be reduced along with clavicle reduction osteotomies…that is a procedure that has never been done as there has never been a need/request. But the scarring from doing so would not seem, to be a good tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 26 year old woman who is a candidate for jaw surgery, but I’m unsure if I want to go through with it. I would be doing the surgery only for aesthetic reasons and am worried that the front of my face will look worse after the operation. I’m interested in paranasal augmentation because I have pronounced nasolabial folds due more to my bone structure and less to soft tissue sagging. However, I’d like for any method of paranasal augmentation I choose to not interfere with a future lefort if I change my mind. I was reading about hydroxyapatite cement, which, assuming a surgeon can cut through bone bonded with HA, seems like the perfect method except for maybe allergic reactions/soft tissue redness? I am not sure. Could you explain my options for the material used in paranasal augmentation (if any) and the pros and cons for each? Thank you for your time!
A: What you are really asking is what the easiest reversal method for paranasal augmentation should a LeFort I osteotomy be desired in the future. Silicone or ePTFE paranasal implants are the easiest to remove since there is no or limited tissue ingrowth into the material. While hydroxyapatite cement can be cut through with a saw it is not an easy material to remove due to the bone bonding that occurs to it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi I want to reduce the width of my skull at the top most part. Please find the pictures attached and suggest whatever is suitable.
A:With a high temporal bulge you would like to know if muscle reduction would be successful as this would be the only scarless treatment with an incision in the crease of the back of the ear. I suspect it would be but it would be important to get a 2D skull CT scan so it can determined what is the composition of that bulge (bone vs muscle) in theory at that level of the temporal area it should be more bone than muscle. However having done the temporal reduction procedure many times in similar cases muscle removal alone has been very successful. You can’t tell by feel whether it is going to be muscle because all muscle feels just like bone on the side of the head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a special surgery inquiry about reshaping/minimizing the trapezius muscles and I’m wondering if that’s at all possible as mine are quite large and I’m a transgender woman.
A:The question is not whether the trapezius muscles can be surgically reduced but by how much can they be reduced and what would be the scar trade-off in doing so. I would have to see some pictures of your shoulders from the front and back views to make a better assessment in that regard.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to schedule a virtual consultation. I recently had a BSSO when I should’ve had double jaw surgery. I really do not like the deep hollows next to my nose and my recessed looking cheeks. I am wondering if a revision jaw surgery that includes the upper jaw would make sense, or if paranasal implants or fat grafting would produce the same effect.
A: What I can say in general is that the aesthetic effects of onlay augmentation to the central midface versus LeFort one advancement is not similar as it relates to the effect on the base of the nose in the upper lip. When it comes to deep in for orbital hollows and deficient cheeks a Lefort I osteotomy will make no improvement to those recessed area and will likely make them look worse. This is where implants can provide improvement that moving the bone can’t. Fat grafting is rarely a satisfactory treatment for a skeletal deficiency.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dr. Eppley, Do you have any experience in reversing hairline lowering or somehow improving a forehead that has been overly shortened.This patient is now 2 weeks out.
A:When it comes to a frontal hairline advancement that has been accompanied by a brow lift this is largely an irreversible procedure as the procedure works by sacrificing tissue to do so. A frontal hairline advancement alone can have some degree of reversal by a posterior epicranial shift. But when a brow lift has been done as part of the procedure there is no room to shift the entire scalp backwards without overly elevating the eyebrows. Unlike some procedures wear time and tissue relaxation can be beneficial this will not be of any assistance in helping the short forehead look better.
This does not mean it is impossible to lengthen a short forehead but it would take tissue expansion which very few patients would be willing to undergo and certainly wouldn’t be considered before 3 to 6 months after the original procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanna know if is possible add volume in my occipital and top of my head cause both areas are flat, and how much would cost.
A:The question is not whether you can have skull implant augmentation to add volume to the back and top of your head but rather how much of a change do you seek and how much effort are you willing to put into it. Skull and taste and Zara ultimately limited by this stretch of the scalp tissue. Modest changes can occur with the immediate placement of a custom scholar implant. However significant changes require a first stage scalp expansion or a two stage skull augmentation procedure. As a female what you are requesting it is very common in my experience and in most patients the story will play out as follows… An immediate placement of an implant will provide improvement but generally about 50% of what the patient ideally wants where as a two-stage augmentation approach provides the most that the patient can hope to accomplish. Whereas the easiest route will be helpful but will leave one wanting. The harder route requires more effort and expense but achieves the most hat is humanly possible in any patient.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I found your contact information online ( https://www.eppleyplasticsurgery.com/chin-surgery-gallery/) and saw that you perform “mentoplasty,” specifically ” Chin Augmentation ( Chin Implant)” in one-day procedure.I would like to have implants (not Botox injections, and I’m not looking for the surgical procedure that involves cutting off the jawbone) placed in two areas of my jaw:
– One implant on each side at the end/corner of the jawbone,
– One implant at the chin tip.
Could you please confirm whether you perform this type of procedure? If so, how many weeks in advance should I schedule an appointment?
Since I am a foreigner, I am interested in having the procedure done on the same day I visit your clinic. Also, I do not speak English, so I kindly ask that all communication be conducted via email. Would that be possible?
If so, could you please provide me with the total price of the procedure, in euros, for the implants in the areas I have specified.
Thank you in advance for your response and offer.
A:Thank you for sending your pictures. What they show is a classic vertical chin deficiency with a deep labiomental fold. The chin otherwise has reasonably good horizontal projection. The correct treatment for this problem is a vertical lengthening bony genioplasty as you ideally need at least 10 mms of increased chin height. This is illustrated in the attached prediction images. While you can use an implant for vertical chin lengthening it cannot achieve the same amount of increased chin length due to the restriction of the soft tissue chin pad. It will achieve roughly half or 5 mm of what lengthening the chin bone can do. W there is nothing wrong with using a chin implant it is just important to know that the aesthetic outcome will be more limited.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m getting in touch to enquire about a possible consultation regarding noticeable eye asymmetry that I’ve had for as long as I can remember. I’m currently trying to understand whether this is primarily skeletal (orbital bone positioning) or if it may be largely soft tissue-related — or a combination of both. I have attached an assortment of photos both relaxed, squinting and with my eyes shut. What’s interesting is that at least in my eyes, the asymmetry diminishes significantly when I am squinting & when I shut my eyes. Is it possible that it could be a combination of both skeletal & soft tissue and as a result, squinting or shutting my eyes improves the symmetry some what? I have quite prominent eyelids (genetic, my dad has the same) and one of them seems lower than the other.
If soft tissue is indeed a factor, would anything improve the symmetry or appearance in general of my eye area, such as a blephoraplasty? I plan on getting a CT scan soon. Appreciate your insights.
A:Thank you for sending your pictures. You have classic vertical orbital dystopia (VOD) of the left eye. (see attached imager) it only looks better when you squint or shut your eyes as you simply see less of the eyeball and thus it looks better for less asymmetric. While there is a soft tissue component to it (the upper and lower eyelids are positioned lower just like the eyeball) a blepharoplasty we’ll not provide any form of a correction. This is a foundational issue in which the entire left orbital box is positioned to lower. This requires a combined orbital floor/rim augmentation with overlying eyelid adjustments.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can i get wider lips?Does it look naturally?Does my face muscles work correctly after that?Is there a scar?
A:You are referring to the mouth widening surgery. This can be done and generally lengthens each mouth corner by 5 to 7 mm. It does not interfere with any of the workings of the facial muscles. It does leave a fine line scar around each mouth corner.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am curious about surgical excision of the tattoo on my foot. I have done 6 laser treatments with little progress. It is rather painful and disappointing to see it barely change. They initially said I would need 17 treatments on my foot, but I fear I’ll need more since it still looks like this after 6. Is excision possible for this area? If so, what does the process and healing involve? These are pictures after treatment that’s why there’s blisters etc. please let me know!
A:That is far too large of an area on the foot (50% of its dorsal surface) to consider elective skin grafting. That would probably cause more problems than it would solve given the proximity of the extensor tendons.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d like to know if it’s possible to operate the eyebrows due to acromegaly? I have bilateral bulked eyebrows, the corrugator muscle looks as if I were angry 😡. And i got fillers because I was tired of looking with that bilateral bulky eyebrows like an edema. I’d like to know if it’s possible to make my forehead flat normal again? I also want an upper blepharoplasty, both sides look swollen, bulky, like boxer eyelids. And I got fillers the last two years and it migrated, and made it very heavy the eyebrows and heavy. I send photos of how I was before, my eyebrows were normal, flat, and with the changed of eyebrows and eyelids very different and it has affected tremendously my self esteem. Thank you!
A:Thank you for sending your pictures. I believe your concerns are based on the heaviness of your eyebrows/brown bones. Some of your pictures are showing a temporal brow lift through the use of your fingers. If the question is whether the tail of the brow bone scan be reduced combined with a temporal brow lift possibly with a lateral canthoplasty to create an upward sweep of the outer aspect of the eyebrow and eye corner which will help reduce the narrow and heavy appearance s of he upper eyelids/orbital area….then that answer would be yes. That would certainly be the correct approach to your aesthetic concerns
.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am following up the concept of the iliac crest implant as a bony anchor for hip implants. Would an implant like something in the photos be feasible? My thought is to use the interlocking mechanism as a way to prevent migration as well as an anchoring point for slightly larger implants.
A: The biggest advantage of using iliac crest anchorage for any form of a hip implant is this would be the best method for the symmetry of placement. There usually is not any significant concerns about hip implant migrations given their size and location. Technically, the larger the hip implant is the less likely it can really migrate or change position after surgery. (actually I have never seen a hip implant ‘migrate’). But the concerns of hip implant size is not really about their migration but about the increased risk of complications particularly seromas, inferior implant bending and implant edging. This is where there is another benefit of the titanium plate on the iliac crest as it would support the implant better and would likely eliminate the inferior implant bending concerns. It may or may not help with implant edging. it would have no impact on the risk of chronic seromas.
As I look at your hip implant design I could see that it is of a very significant size in terms of surface area coverage. This is exactly the type of hip implant that does have the highest rate of complications. While the iliac crest plate may help with some of them it does not eliminate all of them and still makes it a higher risk implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I’m a man interested in “male enhancement”, so to speak. I’m researching testicular implants as a safer alternative to self-administered silicone injection. I’ve been experimenting with saline and dextrose infusions and achieved great temporary results, but what I’m really looking for is a semi-permanent or permanent size increase. I found your implant page through a google search, and was wondering if you could answer a few questions for me. Is 8.5cm the maximum size you would be willing to implant, or is that just the largest you’ve done so far? Are there adjustable implants that could be inflated and deflated as desired? What are the risks and possible complications of implants, particularly when getting into larger sizes? What sort of recovery timeframe should I expect? What kind of costs would we be looking at? Don’t need specific quotes, just a general idea. Thanks for your time!
A:When it comes to the size of an implant in testicular enhancement my only concerns are for the patient’s safety with a low and acceptable risk level of complications. Such complications are primarily infection, chronic seroma or fluid collection and wound dehiscence. There isn’t any question that the size of an implant effects these potential risk levels. There is no absolute size number or scientific method to determine when the size threshold is exceeded. This is a matter of preoperative and intraoperative judgment.
That being said there is a reason the largest size testicle implants that I’ve ever seen is 8.5 cm. That reason is that patients focus on the linear number and have no appreciation for the amount of volume that such an implant size creates. Somewhat like breast implants the effects of testicle implants are more about volume there are about any specific linear measurement. But no matter what larger size testicle implant is chosen before surgery you never know absolutely until you’re trying to place them what will and will not fit. Thus when one chooses an extreme size they have to be prepared that that might not actually fit and would have to be reduced down in surgery.
Unlike breast implants there are no adjustable testicle implants. These are ultra soft solid implants in a specific size has to be chosen before surgery. This does not mean that one could not do an inadvertent two stage procedure, meaning the largest size that will fit is initially placed and then an even larger size can be placed later. This is a form of tissue expansion without using a tissue expander which does not exist for the scrotum anyway.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I just want to get piece of mind that after the reduction of bone on skull it has zero chance of regrowing.
A: In answer to your skull reduction concerns:
- I have never seen bony regrowth in an adult.
- After the bone is reduced it is covered with a layer of bone wax to prevent even a minimal amount of regrowth
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I am a 32 year-old male interested in undergoing your clavicle lengthening surgery. I am 6ft. tall, slender frame, with a bi-deltoid width of approximately 18 inches. Although I am fully aware of the individual factors determining the outcome, I was hoping to gain 2 cm per side without loss of mobility.
A: Unfortunately with the techniques that are available today clavicle lengthening of 1 to 1.5cm per side is what can be reasonably expected given the restrictions of the soft tissues of the shoulder girdle. I would be more enthusiastic about the procedure if 2 to 2.5vms per side could be consistently obtained in every patient.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I’m a 25-year-old male living in Germany, and I’m reaching out to inquire about custom cranial implant surgery — specifically for occipital augmentation. I have a noticeably flat back of the head and would like to improve the posterior contour with a rounded, visibly projected occiput. My goal is to achieve a clearly defined, aesthetically curved occipital area — one that appears masculine and full, but still remains proportionate and natural to the rest of my skull and face. I am not seeking anything extreme — just a correction that brings balance and proper cranial shape from profile and 3/4 views. I also wonder if you believe a small augmentation to the upper back of the skull (top/vertex) might be beneficial to create a smoother, more continuous curve — or if occipital augmentation alone would be sufficient in my case. If possible, I would greatly appreciate your professional opinion on what you believe would work best for me based on a visual assessment — just from photos at this stage. I’d be happy to send profile photos, measurements, and undergo a CT scan if needed for evaluation.
A:Thank you for your inquiry and sending your head picture. Based on the attached imaging I believe this is the type of change you are seeking. As you have mentioned this would be a small augmentation to the upper back of the head. Imaging of your pictures is what sets the aesthetic goals. A 3-D CT scan is only the platform on which the skull implant is designed. The scan does not tell us what is achievable nor what your exact aesthetic goals are.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I like to know more information in looking to getting a reduction of my brow bone because I’m not happy with the appearance of my forehead. Thank you.
A:Thank you for sending your good quality pictures which makes it clear as to your desire for a brow bone reduction. You have very strong brow bones that involve not only the frontal sinus medially but the tail of the brow bone laterally. But like many men who may seek the brow bone reduction the issue is where to place the incision to do so. I see no good place to place any form have a scalp incisional approach due to the concerns of visible scarring. There are other non-traditional brow bone reduction approaches which include a central mid forehead incision as well as eyebrow incisions. While the fine line scarring from these approaches it’s better than any scalp approach there’re still some scar concerns. Like many aesthetic surgeries a basic principle to follow is that many such surgeries are merely trading off one problem for another. You have to be certain that the trade off, in this case the scar, you would view better the\an the problem you now have (brow bone protrusion). Only the patient can make that judgment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My goal is a slimmer, more defined face. I am primarily considering perioral liposuction.Not looking for a wider face by itself (so not sure about adding implants), but if adding width is a way to achieve thinness + definition, then jaw/cheek implants might be a consideration.
In general, I’m not 100% committed to any one procedure and try to keep an open mind to any procedure that might help me get closer to that goal.
A:With an already very lean face the benefits of perioral liposuction on its own would be very limited if much at all. A good facial reshaping concept to remember is that one can never defat their face into improved definition. That rarely if ever works because the cheek defatting procedures have limited or modest effects. Their best benefits are seen in the rounder fuller ace. In the lean face where very little cheek fat exists these procedures do not have great value, certainly on their own
To achieve improve definition in the lead face it would really require small implant augmentations of the corners (cheeks and jaw angles in your case) to do so. (see attached imaging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 29 year old female and have had temple augmentation with bone cement (hydroxyapatite) around 8 years ago. At the same time, I also had some of my brow bone burred down through a coronal incision (to get rid of that neanderthal look) and a brow lift to reattach the muscles and skin in a natural position.
I was initially very happy with the results, but over time the hydroxyapatite has somehow disintegrated and I am now back to having hollow temples (and a narrow head shape in general).
I am now looking for a more temporary solution and am thinking of temporal implants. Specifically, I am looking into custom-made temple implants starting at my temples and extending to the side of my head (I attach pictures of similar augmentations I found on your website).
Further, I am thinking about further burring down my brow bone bossing and – while the coronary incision is already open – potentially also reducing the radix of my nose (not sure if this is possible through a coronary incision though, but I thought this may be possible and would be really interesting to know). More precisely, I asked the surgeon back then to undercorrect the bossing and not lift my brows more than necessary as I wanted the most subtle of results. After eight years during which my brows have had time to drop again, I am now looking to redo this (but this time properly without undercorrection).
Before scheduling a consultation with you, I wanted to reach out and make a quick inquiry about feasibility and cost (I understand that this is very individual but a ballpark price would be really helpful to know whether I can afford surgery with you) to make sure that I don’t waste your time with an unnecessary consult. If possible, I would be really grateful if you could give me some initial answers on following questions:
!) Can the radix of the nose be shortened through a coronary incision?
A:Thank you for your inquiry in detailing your prior surgical history and present concerns. In answer to your specific questions:
1) You are referring to custom temporal implants that provide augmentation to the anterior and posterior temporal areas. Well such an implant would normally be placed doing an incision in the crease of the back of the ears of your existing coronal scalp incision provides unparalleled access for their placement.
2) since your first brow bone reduction procedure was done by burring the critical question is whether are the anterior table of the frontal sinus Will now permit more bone burning reduction or whether it is now so send that any further reduction requires a bone flap technique. Only a 3D CT scan, which would be needed to design custom temporal implants anyway, couldn’t make that accurate assessment.
3) Significant reduction of the high radix typically requires a bidirectional osteotome technique. One cut needs to be made from the internasal approach along the dorsal line and then a 90° superior cut either needs to be made in a percutaneous fashion or, as you have mentioned, from an existing coronal scalp incision. The coronal approach of course would never be used for a high radix reduction but in your case if brow bone reduction is going to be done this would be a convenient way to do the superior bone cut.
4) while a coronal incision does provide the opportunity for a brow lift I would be cautious about the mechanism by which that occurs. Hey Coronel brow lifts by removing a strip of scalp at the incision location. In other words one is going to sacrifice some hair to do it. It is hard for me to be enthusiastic about that concept. I would rely more on the effects of the implant augmentation and some internal suture plication to the bone rather than to sacrifice any hair for a modest brow lift.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello there doctor, is it possible to solve a case where the nose length is too long, creating a long appearance to the midface despite an ideal philtrum length? I have seen a couple of results that appear to have caused this apparent reduction using a technique called the quadrangular lefort 1, but I’m curious as to what your thoughts are.
A:In using the term nasal length you may be referring to the reduction of nasal projection. An increase in tip projection can certainly occur from a LeFort I Advancement as the underlying septum has been pushed forward driving out the lower alar cartilages. There are a variety of standard techniques in rhinoplasty for achieving tip deprojection.
But if you are referring to actual midface shortening in the answer is going to be no. There are no available techniques that are effective for creating an external reduction and midface vertical length.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, had traditional liposuction done to remove saddlebags. There was a massive amount of swelling and bruising afterwards, but as it went down it became evident that the surgeon removed way too much fat. He left with me two very large dents on the hips and a ton of excess skin on my butt that folds over the back of my thighs and bulges out on the sides. The surgeon denied there was a problem and said this was a good result. I knew that was not true so I consulted 2 other surgeons and both said additional liposuction, fat transfer, and a butt lift would be the only solution, but that would leave me with a large scar across my back. One surgeon said I didn’t have enough fat to fill in the dents, but I do have fat in my flanks and my lower butt and thighs. After much research, I found you and I’m hoping I’d be a good candidate for a lower buttock lift. My main goal for surgery would be to remove the lumps bulging out from the sides, fix the indents, and remove the excess skin. I’d also like the appearance of the gluteal fold to be fixed so that I don’t have a square lower butt with the fold extending all the way out to my thighs. I want the fold line to be much shorter and arch upwards, out towards my outer thigh (kind of like a boat anchor).
A:Thank you for your inquiry, detailing your surgical history as well as your present concerns to which I can say the following:
1) While a lower buttock lift is the only solution to your buttock sagging/ptosis I do have concerns about the location or appearance of the outer half of that buttock lift scar. If you look at where the greatest extent of your buttock ptosis is it is in the outer half more than the medial half. To adequately improve the lateral buttock fullness the scar line is going to have to come out of where your existing infragluteal crease is and make it very visible. (as you have aptly described as a boat anchor change) Also to get rid of that fullness it would have to go far more laterally than I think most patients would prefer. This does not mean that it cannot be done but you have to be mindful of a basic aesthetic principle and a lower buttock lift in you would be a classic example of it. Meaning many aesthetic surgeries are merely trading off one problem for another. Thus you have to be certain that you like the other problem much better than the problem that you currently have. Whether a visible scar or how your buttock appears now is better can only be a judgment made by you.
2) When it comes to filling in the dents/over resected areas I do not see where you have fat to harvest to have adequate volume for injection. But given the lack of any other treatment options, and being mindful of not creating additional over resected areas from the fat harvest, fat injections would be your only treatment option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Does skull reshaping make the head smaller?
A:Skull reductions are best thought of as contour reductions not as an overall head size reduction procedure. Skull reduction patients that focus on circumferential head measurements as the barometer for the success of the procedure will be disappointed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I like to know more information in looking to getting a reduction of my brow bone because I’m not happy with the appearance of my forehead. Thank you
A:Male brow bone reductions are different from feminizing brow bone reduction in three ways. First, males that are bothered by other prominent brown bones have significant protrusions and almost always require a bone flap production procedure. Secondly, the goal is not to completely flatten the male brow bone reduction patient but to leave some residual brow bone projection. Thirdly, and perhaps the most significantly, is the issue of surgical access. Where to place the incision for problem reduction in the mail is often the most aesthetic challenging aspect of the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in cheekbone and jawbone reduction surgery. Am I a good candidate for this surgery?
A: Thank you for your inquiry and sending your pictures. The question is not whether these facial bone reduction procedures can be performed on you, as they can, but whether in so doing they can achieve your aesthetic objectives. While most patients would say they want a smaller face it is important to recognize that the thickness and laxity of the overlying soft tissues will impact how such reductive changes are seen.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
