Your Questions

Q: Dr. Eppley, Hello. I have read that the most amount of lengthening that could be done was about 1-2 inches. Based on this image below, how much width do you think could be added? Would it be possible to achieve a v taper?

A:I would doubt that clavicle lengthening alone due to the soft tissue limitations will create a V taper. (see attached imaging)  It would likely have to be combined with a deltoid implant as well to have any chance of doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m looking into supraorbital rim implant. Because I want to get asian blephraplasty which is asian double eyelid surgery which will give me a double eyelid and remove the monolid eye look I beielve, then I think canthoplasty is something I may need for the right eye size and width and cantal tilt. Because I want an eye area that will improve my attractiveness and looks and most importantly look natural and boost the attractiveness. I’m wondering if a more masculine attractive eye like the model Jordan Barret would suit my face because it’s striking and doesnt look very round almond eye. I feel like right now my eye is narrow and a lot wider narrow compared to a round eye look so I feel like Jordan Barrets western eye would suit me because It will suit my ethnicity face because of his eye being more narrow than round and sharp because of the down turned medial canthas and positive cantal tilt. But his eyebrows are low set and his brow ridge is also what makes his eyebrows lowest and more masculine and give him that eye look, I’m just wondering if getting supraorbital rim implant to make my eyebrows lower set so closer to my eyes visually on the outside and by having a slightly small increase projection of the brow ridge? to give that look that most attractive male model eyes have. But I’m not sure if this is something that will actually make me look better or won’t be right for me because of maybe my ethnicity etc. And I feel if I try and get the similar eye to Jordan Barrett that it won’t look ideal because my brow ridge isn’t slightly more projected and my eyebrows aren’t low set enough to give that deep set and compact, hunter eye look. The reason why I feel his eye type might suit me is because he has a town turned medial canthas which I have already because my race, and his eye is narrow and positive tilt which I have narrow eye and I think postive cantal tilt or might need canthoplasty to adjust. Most importantly I dont want to ruin my looks and look uncanny I’m not doing this for a trend I generally want to improve my face attractiveness for the better. Thank you!,

A:Thank you for your detailed inquiry and sending your pictures. Your pictures demonstrated very flat brow area but that is also consistent with the projection of your midface. I think your overall fundamental question is whether a brow bone or supraorbital rim implant help lower your eyebrows. That is a common question amongst young man and the answer is….maybe and if so slight. Because of the tightness of the brow bone tissues no matter how significant a brow bone implant is it is difficult to lower the eyebrows by any significant amount. Do I think it will give you a compact Hunter eye  look… Aand that answer is no. Your brow bones are too flat and your eyebrows are too high to expect any type of brow bone augmentation to make that type of significant change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, do you do saddled infraorbital implants with PEEK? If so, what kind of incision do you use to insert them?

A:In the United States PEEK is not a material that is allowed to be used for custom facial implants for aesthetic purposes. It is not approved by the FDA for any craniofacial bone application below the level of the skull.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How long after Bimax jaw surgery can I get infraorbital-malar implants? 

A:Since the infraorbital – malar area is at a superior level to that of the LeFort I osteotomy you only need to wait long enough so all of the tissues settle down and you have a clear understanding of weather augmentation in the upper mid face area is really needed. In short this would be 3 to 4 months after your double jaw surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I get custom cheekbone implants combined with a canine fossa extension to fill in my deep canine fossa and create my dream hollow cheek look.

A:With custom implant designing you can make implant any way one wants to try and achieve a desired aesthetic effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like you to remove the elongated crown so that my head becomes rounder.

A:Thank you for your inquiry and sending your pictures. I can definitely see your skull concern quite clearly. Crown of the skull reduction is not an uncommon skull reshaping procedure. The key question is how much of it can be safely reduced. This would be determined by 3-D CT skull scan with color mapping of the bone fitness to ensure that an adequate reduction could be done safely.

The question in any skull protrusion is whether it is a result of thicker bone or whether it is the brain pushing the bone out and the bone is actually thinner. While in the vast majority of cases it is due to figure bone it is critically important to make that distinction before undergoing surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been a client of yours who is considering adding implants on my Sagittal skull look of cone shape and to ask to of muscles that move on side of head when chewing for mid year next year if possible, when you get a chance to respond, Thank You!….

A:Good to hear from you again. I believe your question is whether any type of skull implant will interfere with the temporal muscles on the side of the head that are responsible for jaw motion. And the answer is no on the basis of these two points; 1)t the temporal muscles stop at the temporal line of the skull and do not cross onto the top of the head. Thus any type of skull implant that sits between the bony temporal lines does not encroach upon the temporal muscles and 2) even if a skull implant crosses the bony temporal line it sits on top of the deep temporal fascia that covers the muscle. Thus it does not have any interference with the muscle movement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I started noticing changes in my skull two years ago. First thing I noticed was the skate ramp that developed at the back, then a couple symmetrical lumps on the lower back, and eventually my head started looking wider, giving me a baby or alien-like appearance, which I really dislike. As bad as the back is, I’m more concerned with the sides at the moment. Does it look like a muscle thing or did my skull actually grow? Is there a way to remedy this, considering the fact that I’m bald? Thank you

A:Thank you for your inquiry in sending your pictures and x-rays. Skull bone is not really known to grow in an adult unless there is a metabolic or hormonal reason to do so which is very rare. I think what is happened over time, and this is normal, is that the scalp thins a bit an the underlying shape of the bone and muscles become more apparent. Your long term before and after pi0ctures substantiate that the size of the bone and muscles has not really changed but it has become more noticeable or ‘defined’.

Regardless of its origin I think the three head shape concerns that could be effectively addressed with minimal scarring are the flat upper back of the head, the bony lumps beneath it and the wide side of the head due to the thickness of the temporal muscles…. which appear to be all of your head shape concerns.

FYI the vast majority of aesthetic skull reshaping patients are men who are either bald, have shaved heads, or very thin overlying hair cover. So you fit right into the typical Scott reshaping patient.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had one previous surgery along the sagittal suture about one and a half years ago by a german surgeon, but the result was not satisfactory. I am interested in additional bone burring along the sagittal line but more laterally this time. Also The scar in that area has become significantly indented and is about 10 cm long.

Additionally I am considering a slight reduction of the upper forehead by a few millimeters in a small area.

A:Thank you for your inquiry and sending your pictures. That is certainly an impressively large scar by my standards for doing sagittal crest reduction surgery and illustrates  exactly why a midline scalp  incision like that is not a favorable one. However that is the scar that you now have and it can certainly be used for further surgery and revised for a better scar outcome.

The important issue in any form of skull reduction is safety or how thick is the only area in which one what’s reduced. In many sagittal crest skull deformities the thickest part of the bone is the crest and it can become remarkably thin as it goes into the parasagittal area. Does it is important to know before surgery exactly what the thicknesses of bone are in your circled areas to see how much further reduction could be done. This is done by taking your 3-D CT scan and doing color mapping of the bone thicknesses. While this is important in any skull reduction patient it becomes especially relevant in someone who has had prior skull reduction surgery.

One could make the argument that since a scalp scar revision is necessary anyway one may as well remove a few millimeters of bone wherever possible by using the eyeball test in reduction to see how much could be removed. However with modern technology there is no reason not to do her preoperative bone thickness assessment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering how much of an impact that a supraorbital implant can have on the “hooding” of the upper eyelid, and if it can be done sparingly. I was also curious if this can be done in conjunction with a fat graft?

A:I believe your fundamental question is whether a brow bone implant can create enough fullness in the upper eyelid that upper lid fat grafting would not be necessary.  And if it can’t can upper lid fat grafting  be done at the same time as a brow bone implant?

The answer to the first question depends on your existing upper eyelid shape or depth of your supratarsal sulcus. That would be impossible to answer without seeing some actual pictures of your eye-brow  bone area. The second question is more straightforward to answer in that injection fat grafting to the upper eyelids can certainly be done at the same time as a brow bone implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, As you can see, I have fat deposits along the sides of my mouth.  I have been reading online that these are called perioral mounds. I have also read that they can be removed with micro liposuction. If this can be done to fix the problem that would be great. If not, I would like to know what needs to be done to fix this.

A:You can’t just have perioral liposuction as that will not be effective. Perioral liposuction works well in young people with taut skin. But in the older patient with age-related changes with loose skin and jowling a lower facelift is needed to properly address the problem. In short in the young patient you can spot treat the problem but the older patient the issue is more global and thus requires a far different approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a right recessed cheekbone and slightly recessed jawline. i would like to do an augmentation for both.

A:In facial skeletal asymmetries custom implants made from the patient’s 3D CT scan is the ideal method for correction. That is a scan you get where you live (we provide you with the order to get it) and then send it to me for analysis and implant planning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a scalp roll excision procedure on the back of my head. Can I see what the scar would look like in someone.

A:The scar question is a good one and is the most appropriate metric as to whether the surgery is worth it or not to a patient in my opinion. Like many aesthetic surgeries the question is whether the trade-off for the procedure would be viewed better than the initial problem being treated. In that regard I like to show this scalp scar picture  of an occipitao scalp roll excisionk done by another surgeon which shows, in my experience,  the worst scalp scar that I have ever seen from this procedure. The patient came to me for scalp scar revision. The relevancy of this scar picture is that one should decide on the procedure as to whether it is worth it based on the assumption that this is what their scalp roll excision scar would look like. As I consider this to be the worst case scenario. It is important to recognize that in considering any aesthetic surgery you don’t make the decision for it based on what you hope is the best result possible as that may not happen an is not completely predictable. Rather you make the assumption of the worst-case scenario and let that be the trigger point for doing this surgery or not. Therein lies the value of showing patients the worst-case scenario not the best scar result that has ever been seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I’m getting asian eye surgery so I can maximize the look but I will try to keep a lot of the eye shape features the same from mine and the male models like a down turned medial canthas, and a narrow eye shape not too round like most asian patients get without thinking. Do you think it’s best to get the brow ridge implant first before the asian eye surgery?

And my mid face from the side does look flat not only because my forehead and brow ridge and eye area but because I dont have a good nose bridge because of my race, but thats the last thing I will get, because with most of those male models their brow ridge and nose look so well together like they are almost connected with perfect harmony etc so I will in the future get a nose job so it can match the brow ridge implant I get 2 to 4 mm if thats the right length needed without it being too much, visually my eyebrows might look a couple mm closer to my eyes because of the projection of the brow ridge?

But overall do you recommend no more than 2 to 4 mm projection of the brow ridge I’m aiming for the lowest my eyebrows can look visually and closer to my eyes which if thats a slight difference from going to high to medium thats a win, and with the asian eye surgery that will open my eyes slightly but not too much because a compact narrow eye shape is my goal still not like those anime or k pop looks that are the opposite to Sean oprey, Jordan barret, Chico lachowski, brad Pitts eyes, so that will add the illusion of my eyebrows being closer as well.

A: There is no question that the brow bone implant should be placed first as the swelling from that surgery could disrupt any concomitant or previous eyelid surgery.

You probably need more than 2 tio 4mms for the brow bone augmentation, 5mms forward and 3mm down would be the better implant measurements.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Dr. Eppley,I am reaching out to inquire about doing a hairline raising procedure. I had facial feminization surgery about a year ago that included a hairline lowering procedure. This improved my temple recession. However, the surgeon also lowered the center of my hairline to avoid creating an extreme arch to my eyebrows. Overall, I am dissatisfied with how lowering my center hairline has impacted the proportion of harmony of my face. I am looking for options to extend my hairline up 1-2cm. Based on my research, I am under the impression this could be done by performing a two stage procedure. 1) leveraging a tissue expander to stretch the skin of the forehead 2) remove the tissue expander and remove a portion of the skin behind the hairline (behind the hairline to avoid making a weird hairline) to extend the position of the hairline up. Ive included pictures below of my current pic and a morphed ideal pic. Can you please let me know if Dr Eppley thinks he is able to achieve this?

A:Thank you for your inquiry and sending your pictures. As you have well explained what you are trying to achieve is an increase in the non-hair bearing upper forehead area of at least 1 cm or maybe even as much as 1.5 cm. The options to do so include the following:

1) Laser hair Removal. I would be remiss if I did not mention that this is always an option and it certainly the only nonsurgical one short of shaving/plucking. Its advantages are it is not surgery and it offers precise control of the location of the raised frontal hairline. You do have one advantage for laser hair removal in that you have dark hair in which it always works the best because of the darker pigment attraction. The obvious disadvantage is the need for multiple treatments to achieve the effect and whether you can get rid of 100% of the hairs..

2) Forehead Tissue Expansion. As you have previously described the surgical alternative is a four head tissue expansion followed by upper forehead flap advancement with excision of the undesired frontal hairline. Well this can be effective, as tissue expansion on a bonus surface has been around for 50 years now, there are some specific disadvantages. First and foremost the location of the tissue expander is going to be very prominent and will create its own temporary aesthetic deformity. The tissue expander really needs to stay in place for several months to allow the tissues to expand and properly relax. The relaxation phase is actually more important than how much it is expanded. The error in this approach that I see people do is they don’t believe the tissue expander and long enough for the understandable reason of its obvious presence. The second issue with forehead flap expansion is the potential for relapse. This can be largely overcome, however, by securing the advanced forehead flap to the bone. Thirdly, I don’t think you would be able to achieve a 2 cm expansion into the frontal hairline. Hey more realistic outcome it Is a 1cm advancement due to the naturally very tight tissues of the forehad

So as you can see the two stage forehead expansion and flap advancement is a straightforward concept. But wearing the expander on your forehead for the duration needed is the challenge of the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q:Dr. Eppley, Hello, I’m interested in clavicle lengthening. I haver a 45cm bideltoid measurement. I’m tall even I’m proportional for my height, it’s a small bideltoid size. I would like to lengthen 2 cm per clavicle.

A:The most important question in clavicle lengthening is whether the procedure is worth it based on what can be achieved. Due to the limitations of the shoulder girdle soft tissue attachments the average amount of clavicle lengthening in my experience is in the 15 to 18 mm range per side, not quite 20 mms. That creates an effect that is roughly equivalent to what it looks like if you roll your shoulders backward with so-called perfect posture. That is the change that occurs as the oblique orientation of the clavicles drives the shoulders out and back. It is probably best to think of it as shoulder squaring rather than shoulder widening per se. What that means to you can be seen in the attached imaging on what I think can be accomplished with the amount of clavicle that is possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Hi doc  I wanted to ask how much narrowing can be done typically for shoulders ? I know it varies but just curious about the possibility  – and also do you suggest getting breast implants before this procedure or after ?

A:The typical amount of clavicle shortening per side is 2.5 cm. The best way to appreciate what that means is to see some pictures of your shoulders and to do some imaging as to what that effect may be.

In regards to breast implants I don’t think it matters whether they are done before, during, or afterwards. The only thing that matters for make timing standpoint is that if it is done after shoulder narrowing surgery it should be at least 3 to 4 months before doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Could you please in addition let me know the following:

– how long in advance do I need to be in the clinic (time needed for preparation of the skull implant);

– how long after the surgery do I need to stay in the USA for the post-treatment?

– what is the material that is used for skull implants?

– what is the percentage of the alopecia cases?

– does the alopecia needs treatment?

A:1) All custom implant designs are done through a virtual process, not on site.

2) 3 to 5 days

3) Soldi Silicone

4) 0.01%

5) Shock hair loss is not an issue if the implant design does not exceed the capacity of the scalp stretch. in other words let me make then design by what I know is best to avoid that potential issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am strongly considering a subtle chin and paranasal augmentation procedure. I’ve been genetically gifted with a small jaw and huge cheeks, now that I’m in my mid-30s and the fat pads have decreased, all my sagging soft tissue is hanging out below my jawline. I’ve consulted several doctors, and they advised a full facelift to excise the excess SMAS. I’m looking to achieve a more balanced heart shaped face based on my natural foundation, and prefer permanent methods that will factor in facial bone loss from aging. 1. Should I do the facelift or the structural augmentation first? 2. How long should I wait in between procedures? 3. Would a chin implant or sliding genioplasty be better for my anatomy / situation? approximately how much advancement? I’m ok with my chin’s vertical length and just want to increase its projection. 4. What kind of implant material would be best for my paranasal area? I mainly want to correct how sunken in my nostrils look and soften the appearance of nasolabial grooves. 5. The left side of my face is more structurally sloped than the right, exacerbating the appearance of asymmetrical nostrils. Is it advisable to try to correct for this with paranasal augmentation? Thank you for your expertise.

A:Thank you for your inquiry and sending your pictures. As a general statement you always want to make whatever structural changes are needed first before you manipulate the overlying soft tissues. In some cases the bony procedures hey obviate the need for significant soft tissue changes such as a facelift. Whether that would happen or not cannot be predicted beforehand but I think you always want to address the foundation first onto which the soft tissue envelops.

For the chin I have done some imaging to determine the magnitude of horizontal projection you may find acceptable. As a general rule in females one has to be very cautious about too much horizontal projection and I would estimate what I have image to be about 5 to 6 mm. Whether this is done by an implant or a sliding genioplasty can be debated, and this amount of forward chin  projection can be accomplished by both, but usually moving the bone is better for the submental areas and the contour of the neck to reduce its fullness. One should always do some submental liposuction on the underside of the chin anyway to optimize the result.

For the paranasal augmentation I currently prefer ePTFE paranasal implants which works quite well and the tissues integrate into the implant’s surface. The asymmetry of your nostrils is only partially contributed to by the underlying bone. You also have alar rim retraction which is not going to be solved by paranasal implants.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The right side of the back of my head is flat with no projection. I believe it was because i slept on my right side too much as a baby. So I want an implant there. My left and middle back head is fine. Also the right side of my head on the side sticks out too much which makes my face shape look round and wider. So I would like to make that side more narrow and less round so its more so i can have a square, symmetrical head shape like my left side. I attached photos and marked the areas i want improved with a red marker.

A:Thank you for sending your pictures and providing the clear explanation of your head reshaping goals. That is treated by a combination of a right custom back of head skull implant and a right posterior temporal muscle removal. The process begins by getting a 3D CT skull scan which serves as the basis for the skull implant design. That is a scan you can get done locally and we provide you the order to get it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Fat transfer to the face is highly unpredictable and have a high cell mortality rate. To avoid hematomas, calcifications, lumpiness and infection that is often attributed to fat transfer to the face and because the face is so visible to the public world, most plastic surgeon do NOT recommend fat transfer to the face. Some plastic surgeons comment that fat transfer to the face is more trouble in the long run than what it is worth. By the 1 year mark, most patients are extremely unhappy with the results. What is your opinion about fat transfer to the face during a facelift procedure?

A: Your perception about fat grafting to the face seem to be contrary to what its use is in aesthetic facial surgery amongst most surgeons. It is widely used as an adjunct in facelift surgery as the current perception is that volume loss is a significant component of the facial aging process. And facelift surgery is not a volume addition procedure but a tissue redistribution[rearrangement directed surgery. Fat grafting therefore seems logical to add volume back to what a facelift of any form can not do. That being said the issues with fat grafting are more about who benefits from it and what is its longevity…the answers to which are not scientifically known. But because it is an autologous procedure with intraoperative harvest and immediate put back into the patient and whose main ‘complications’ are resorption and lack of volume retention its clinical use precedes scientific investigations like a drug or device to full evaluate safety and effectiveness.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have read that many plastic surgeon believe the deep plane facelifts are extremely dangerous due to the plane being manipulated is the location of so many delicate facial nerves. Those who perform deep plane facelifts speak highly of it and criticize limitations of the traditional SMAS-adjacent facelifts. This can be a conflict of interest since a doctor will naturally only speak highly of what he/she performs.

A: The real questions about the deep place facelift is not whether it is dangerous or has a higher rate of complications, although it does have some increased risks, are patient selection, risks vs benefit analysis and where does it fit into the facial rejuvenation surgery armamentarium. It is always important to remember that facelift surgery is elective aesthetic surgery and in a highly competitive market driven now by online patient research marketing and promotional information frequently gets way ahead of the proven science of a procedure. Also, there is no standard as to what a deep plane facelift really is. In short is a deep place facelift better and is it worth the increased risk and costs? That answer will vary per patient based on the anatomy and degree of facial aging as well as how much ‘effort’ that are willing to invest in the improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, If you remove some chin or jaw reduction surgery, could that removed bone be milled and  “processed” to replace a small silicon implant for temporal or suporalateral orbital implant? This is for a patient who wants to use all his/her own body tissues. All foreign material, including silicon implants, will trigger and interact with the patient’s immune system.

A: Bone can be recycled from another regional surgery and used as an onlay graft material…that is not new and has a long historical precedence for so doing in craniofacial surgery. The question is not about whether it can be done in aesthetic facial surgery enhancements but rather one of effectiveness for what one is trying to achieve. For its use as a facial augmentation material it can be milled into small chips, mixed with fibrin glue and used as a paste to be placed on bone. For small augmentation areas like the cheeks, chin or tail of the brow this bone graft onlay approach may be effective. But for the soft tissue temporal area such bone grafts would be useless and fat injection grafting is the more appropriate autologous technique.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve always been self-conscious about my weak chin, but am unsure what the right solution is. I’ve received multiple consultations about options, but surgeons can’t agree on what type of implant is best. I’m curious whether you think an implant or a sliding genioplasty would be better. If an implant is the right choice — what type? Extended anatomical, flowers mandibular glove, something else? And what size?

A: The major decisions in chin augmentation are the method (implant vs sliding genioplasty) and the amount of changes desired (dimensions of augmentation….projection, height and width considerations). The method chosen is more emotionally driven in whether one is a more of an autologous person (anti-implant) or whether a ‘less invasive’ technique (implant) is preferred. As long as the dimensions needed fall within what each can do hen either technique is acceptable. Based on your pictures I would say that 10mms or less of chin projection is needed with no vertical change so either technique can achieve this type of dimensional change.

There are certain caveats in female chin augmentation that are important. First, less is always more when in comes to a horizontal projection. The most common error is overprojection. Females tolerate less change than men. The second most common error is a chin that becomes too wide. This is an implant related problem as winged chin implants are usually not a good choice for females.

That being said the actual dimensions of chin augmentation are determined preoperatively by imaging of the patient’s pictures of various types of dimensional changes to see what looks best to the patient.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in rib contouring to fix this protruding rib and to create a more narrow upper body.

A: You appear to have a unilateral subcostal rib flare. That can be treated by either cartilage cuts and bending of the flared segment (requiring 6 weeks of banding to ensure that it heals in an inward position or a more open shaving/excision of the flared subcostal rib margin. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if orbital box osteotomy to increase my IPD, this is for cosmetic purposes, as my eyes are too close together, and I don’t like how I look.

A: The magnitude of orbital box osteotomy surgery is excessive and not appropriate for your IPD problem. It is a reconstructive procedure more than it is a cosmetic procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to enquire if there’s any surgery/ treatment that would be able to soften my labiomental crease in my chin? I’ve been advised about lengthening my chin vertically but I’d be worried it would look too long from the front view. Could a fat transfer or bone graft to the fold area work? Or a intraoral release as most of my chin is soft tissue/ muscle. I have attached a picture below of my chin along with an edited version without the fold, which I’m wanting to achieve. Thank you

A: Thank you for your inquiry and sending your pictures to which I can say then following:

1) There is no question that your deep labiomental fold is due to the vertically short chin and a soft tissue chin pad that is bunched up on the short chin bone. In other words too much soft tissue for the amount of bone that exists tio support. This is also evidenced by the curved mandibular plane angle and a chin projection for a female that brings out toi the lower lip level. As a result any treatment that avoids dealing with the real problem is going to be limited in its effectiveness.

2) That being said  the only non-bony lengthening treatment option is an intraoral release with an interpositional dermal-fat graft to help push out the depth of the fold. That will not create the degree of depth reduction you have shown, as that is not achievable, but it will help

Dr. Barry Eppley

World-Renowned Plastic Surgeon.

Q: Dr. Eppley, I am wondering if it’s possible to “heighten” the mentalis fat pad and mentolabial fold, and shorten the sublabial subunit using fat grafts to create the look of a more robust, masculine chin. I’ve made this mock up in photoshop and am curious to hear your opinion on whether it is plausible to emulate with surgery or not. I am also curious to hear from you from an anatomical standpoint on what exactly causes the variations in it’s height & position. Is it the mentalis muscle insertion? Or is it just the fat distribution? Thank you!

A: I think your chin appears that way due to the soft tissue distribution of the chin pad.

To potentially achieve that type of change it would require a combination of an intraoral dermal-fat graft underneath the labiomental fold and external subcutaneous fat injections.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Based on your experience and where craniofacial surgery is realistically headed, do you expect limited orbital widening for normal anatomy (beyond very small changes) to become meaningfully safer or more justifiable for cosmetic use in the next decade or do you see the risk–benefit balance staying essentially the same?

A: For eye widening using limited orbital box osteotomies already exists (inferior orbital box osteotomies) or can be done with 3/4 orbital box osteotomies using a coronal scalp incision if the patient can tolerate the fine line scalp scar. Both approaches avoid a frontal craniotomy which is what separates a more limited approach vs a major craniofacial surgery which is more justified in more severe craniofacial deformities. 

It is eye narrowing on which the intracranial orbital box osteotomies can not be avoided for any degree of effectiveness.

I don’t see these approaches changing much in the foreseable future. The  partint demand is low so the need for innovation for a limited market is likewise very low. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon.

Q: Dr. Eppley, I am interested in discussing testicular implants. I have read that Dr. Eppley does this procedure, and does it differently than some other surgeons, however, I see no evidence of this procedure on his website. Please confirm that Dr Eppley performs this procedure before I book a consultation.

A; I am not sure where you are looking. Between the Testicle Implant page on Eppley Plastic Surgery and all the content on the topic on Explore Plastic Surgery there is voluminous content available on how I perform the procedure and the implants used.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can Mms chin be augmented successfully with less than 10mms projection?Also, I’ve found that almost no one mentions using Glasgold wafers or Flower mandibular glove implants. Are they just not as common?  Or do they not work for my anatomy?

A: The relevance of the 10mm number is that is what creates the absolute separation between a chin implant and a sliding genioplasty. Any chin augmentation 10mms or greater can not be done with an implant as those sizes do not exist in standard implantys and would look odd in most patients with a large mass of implant sticking on top of the chin bone. This then enters sliding genioplasty territory.

Once under 10mms projection and no need for vertical chin shortening a chin implant is then possible. The reality is that all stahdard chin implants are not good for females becaiuse they widen the chin…which few females want. Only the anatomic chin implant style works for most females and even that style has to be modified to make sure the chin does not look too round.

Be aware that most plastic surgeons and patients focus exclusively on the side profile change in chin augmentation which is a 2D approach to a 3D facial structure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon