Your Questions

Q: Dr. Eppley, I had fat graft to the chin a year ago and totally dislike the result. And was wondering if there is a way to reverse this. So my concern is at i had graft directly to the chin. And now it looks really ugly, like it protrudes my lips and nose and make my chin have a round balloon shape.

A:There is not. Once fat is in the soft tissue chin pad it can not be reversed. And don’t  try liposuction as that will only make the problem worse. You will simply turn a round balloon shape into a round and irregular/non-smooth balloon shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, on first glance do i look like the right candidate for infraorbital rim implants and fat grafting around upper and lower eye area? for an overall fully harmonised face as i think that area slightly breaks harmony. 

A:Thank you for your inquiry and sending your pictures. When you have a significant orbital rim skeletal deficiency fat grafting has no role in its augmentation. This requires a custom infra lateral orbital rim design to provide adequate augmentation to treat what is a 3-D orbital rim recession. Fortunately you have fairly good lower eyelid position although a spacer graft of the lower lid would be helpful to extend the augmentation as highest possible up to the lash line where implant cannot reach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Just a question…what’s the different between solid silicone to PMMA for augmentation of the head?

A: For aesthetic onlay skull augmentation PMMA vs Custom Silicone implants are the  two options which have the  following properties:

PMMA Bone Cement

• moldable putty created in surgery which sets into a rigid plastic material in 10 minutes
• once set it is unchangeable in form
• must be shaped blindly once placed under the scalp thropugh small scalp incisions…as a a result prone to asymmetries and edge irregularities
• controlled shaping of the material can only be done through an open coronal scalp incision
• can only be placed on bone, can not cross the bony temporal line onto the muscle
• limited skull augmentation effects (60ccs or less in volume)
• can not be revised secondarily, must be fractured and removed
• lower material cost

Custom Skull Implant

• preformed shape by 3D custom design process
• can be modified intraoperatively if needed I(rare)
• can be placed on bone as well as muscle permitting large surface areas of coverage
•  more significant skull augmentation effects (100cc to 300cc volumes)
• easily removed, modified and/or replaced
• higher material cost

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a consult with a maxillofacial surgeon early next month. Even with this, I feel my midface will remain flat. Is there anything that can be done for this region post double jaw surgery? 

A: This is a common issue even after DJS. This is the role of custom midface implants, whether that be as a total mask or cheek/paranasal implants, which cabn provide the additional projection which the bone movement ca. not create. For some midface deficient patients  the role of DJS is to ultimately lessen the volume load of implants needed if they can not eliminate their need completely.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had an Intraoral chin reduction in 2023 & am seeking a way to tighten up the excess skin left after my surgeon burred down 6mm of bone. After my surgery I now experience sagging skin on my chin that I didn’t have before. I wasn’t happy with the look of the skin on my chin after the surgery so my surgeon did a submental chin tuck in office, but I still feel like there’s skin sagging. I do have a scar underneath my chin. Would I still be able to get a submental chin “tuck” with a previous scar? I’m not exactly interested in more bone work being done, or getting a secondary chin reduction because the first time I was disappointed. I attached a photo of a Lateral Ceph taken this year. This Xray was done 2 years after the surgery.

A: The intraoral chin reduction you had produced exactly the outcome one would expected when its bone support is reduced….an excessive /droopy soft tissue chin pad. The submental chin tuck was the appropriate solution but it was inadequate because it was under done. Since you already have the a submental scar there woild be no reason to not take advantage of it and have a second submental soft tissue reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like a consultation to address moderate skin laxity (mainly due to aging) on my lower buttocks. I am not interested in implants. I’m interested in subgluteal excision and/or spiral thigh lift. or a combination of both. I have spent more money than I care to think about on Morpheus 8, Emsculpt and Radiesse fillers all of which did little to nothing to help. I am too thin for a BBL.

A: Thank you for your inquiry and sending your picture. The only effective for a lower buttock tissue overhang with a defined infragluteal crease is excision. It can be lifted away with an implant, reduced by liposuction or improved by any form of transcutaneous energy-based device treatments for skin tightening or fat reduction. The tradeoff for the definitive treatment is the infragluteal scar.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Im interested firstly in jaw side reduction as I have squared jaw I wanted to the sides to be shaved a bit to reduce that bulkiness and for more symmetrical face while keeping the masculine look.I know its not common for men to reduce their jaws but i feel mine is too big and doesn’t fit my face I need a slimmer jaw while keeping the masculine look.

A: You are referring to a lateral corticotomy of the ramus of the lower jaw, often referred to as jaw angle shaving. The shape of the ramus remains the same but the thickness of the bone is reduced 40% – 50%. The procedure is performed through an intraoral approach under general anesthesia as an outpatient.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello,I was obese for most of my life. In the last 2 years I have lost over 90lbs and am just a few pounds away from my goal weight. Being obese all those years pushed against my xiphoid process and now that the weight has been lost it protrudes a lot, sticking out further than my chest and stomach. I believe the procedure I need is called a Xiphoidectomy.

A: Thank you for sending your pictures. That is an impressive xiphoid prominence, one of the most impressive I have seen. It can be treated by removal (xiphoidectomy) or xiphoid infracture (xiphoid osteotomy). In most cases the xiphoidectomy is done. In more uncommon cases due to an adherent attachment of the diaphragm and ossification of the cartilage an infracturing may be performed with plate fixation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my skull has been misshaped since birth; the exact reason has never been medically diagnosed. Once delivered, I had a bruise on cheek, swelling, and head shape that was not symmetrical that the doctors said would fix itself as I aged. My inquiry is in regard to a custom implant for the “flat side” and skull reduction for the side that bulges. I had a surgeon look at the possibility of a custom implant, but he was uncomfortable with skull shaving since that was not his expertise.

A: Thank you for your inquiry and sending your picture and 3D CT scan. Yours is certainly not the typical plagiocephaly which is a common cause of flatness on one side of the head and a protrusion on the other side.  Regardless of the cause the approach of custom implant augmentation on the flat side and bony reduction on the protrusive side would be a logical approach to which I would makle the following two comments:

1) When designing a custom skull implant that crosses over the bony temporal line onto the side of the head  you have to factor in the thickness of the temporal muscloe which sits on the bone in that area. If not one can inadvertently make the flatter side more full than the protrusive side.

2) When considering bony reduction of a protrusive skull area considerations are how thick is the bone, how much bone thickness can be safely removed and what is the incisional tradeoff for what ajmount of bone removal. This is why it is important to do a color mapping bone thickness of the protruding area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to inquire about the procedure for custom wrap-around testicular implants. I currently have two testicles, each approximately 7 ml in volume. I previously underwent an unsuccessful procedure in which implants were placed in front of the testicles; however, they were later removed for aesthetic reasons.

A:In a scrotum that has prior surgery you are not a great candidate for the wrap around implant concept which has its own risks of postoperative implant disengagement from the testicles. That risk escalates considerably in prior implanted scrotums and those are risks I will not undertake.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I had a consultation with you about 5 years ago, and I’d like to follow up about a specific cranial contour plan. I’m interested in reducing or shaving down the frontal sides of my forehead (the areas that slightly protrude) and then adding volume to the back of my head to create a smoother, more balanced overall shape. Could you please let me know if this combination can be done in one procedure, and whether the occipital augmentation would be with a custom PEEK implant? 

A:Good to hear from you again from five years ago. To specifically answer your skull reshaping questions:

1) the combination of side of the forehead reduction with occipital augmentation would be done as a combined single operation.

2) all forms of aesthetic head augmentation are done by the 3-D design skull implants. Almost all of these are composed of a solid silicone material as that offers the most precise design with feathered edges that can be placed with the smallest scalp incision. That feels just like bone when it is placed on bone. Custom PEEK is not a material that is FDA approved in the United States for any form of aesthetic craniofacial augmentation per the manufacturers. This is a different story in Europe and other places in the world. But even if it was available in the United States the cost to manufacture it would be four times higher than silicone and it would require a complete coronal scalp incision from ear to ear to place due to its inflexible construct. But even if f all of that was not a problem for the patient I still would not use it as it is not possible to manufacture PEEK with super fine feathered edges which is extremely important in skull augmentation as any rounded edges are eventually going to be felt in the shaved head patient are going to be seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My midface is a bit flat. Would I benefit from a LeFort 2 or 3 osteotomy?

A:There is no indication for you, or anyone seeking aesthetic mid face augmentation, for a LeFort 2 or 3 osteotomy Those are operations that look great on diagram but in real life are not appropriate for the aesthetic patient. They are indicated for the syndromic craniofacial patient who has real facial hypoplasia problems where the magnitude of the surgery and its potential risk and complications are more acceptable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I had a chin implant done last year It was an. Omnipore medium/square implant . Immediately after the surgery I noticed asymmentry. The surgeon then suspected it was swelling and did nothing. I can definitely feel it being higher on one side than the other. Tilted angle from the middle. The surgeon says that the asymmetry is too little to do a revision for and that the outcome of a revision with the additional scarring will be too uncertain and risky. A second opinion confirmed it being placed higher on one side, but said the same thing about the outcome of a revision being uncertain. They only offered to do lipofilling on the smaller side. What do you think? Is replacing the implant the best choice in the long run or is the surgery too risky. Around here there is not much expertise in this, certainly not in polyethylene materials. I thank you in advance for replying

A:Thank you for your inquiry and detailing your chin implant issues. Fundamentally I don’t think one should confuse ‘I don’t want to or can’t do it‘ as opposed to ‘it can’t be done’. Most surgeons are not too keen on revising their own work unless they are forced to do it based on the magnitude of the problem. While it is true that in the placement of chin implants perfect symmetry is certainly not always achieved and that, in and of itself, is not rare. The real issue is not whether chin implant asymmetry exist or whether it can be corrected but how much effort does the patient what to put into that pursuit and what risks does one want to take in doing so. Porous materials like Omnipore are great biologically due to the tissue in growth IF one never has to revise or remove it. It is not a great material when that is needed and that will occur in 40% of all chin implants that are placed. It is not a question of whether your chin implant can be operated on in an effort to try and achieve better symmetry. But it requires dissecting the implant out, removing it in its entirety and then reinserting it. Besides the trauma of so doing the likelihood that the implant can be explanted intact without fracturing  is low and it is always prudent when implants of this material are revised to have a backup on hand to use, and one might make the argue that is better just to put in a new chin implant anyway. As you can now see when revising a facial implant of this material the tissue ingrowth is not an asset but a liability.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, From what I’ve read, the closest description of what I’m experiencing is dynamic chin ptosis – my chin only protrudes when I smile or speak. I’d like to reduce that movement and am considering starting with Botox. Could you please advise where you would recommend the injections be placed and approximately how many units may be needed? Thank you so much 🙂

A:This is not a problem in which I would recommend Botox injections as I don’t think it will have a positive effect. This is caused by a  more global facial movement pulling back on the chin revealing and displacing the extra soft tissue chin pad tissues. In essence you would have to paralyze your whole smile to have an effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I believe I am a good candidate for the lower buttock lift with the incision to re-create the bottom gluteal fold in a higher position. I would like to find out if this procedure would make my buttocks look higher by removing hanging lower skin off of buttocks, would it also decrease saddlebag look on sides of thighs, what typical recovery is like,

A:Thank you for your inquiry and sending your pictures to which I can make the following comments:

1) the lower buttock lift would make the fold slightly higher but, most importantly it would remove the overhanging lower buttock tissue.

2) What you definitely do not want as to extend the scar beyond the lateral extent of the existing infragluteal fold. Thus the lower buttock lift by itself will not improve the saddlebags. This issue is better traded by concomitant liposuction.

3) Recovery from a lower buttock lift is primarily that of limiting activities in the first month after the surgery that placed undue stretch on the infragluteal fold incisional closure. This is primarily strenuous activities relating to working out and other associated activities were bending over is greater then 45°. Sitting initially is a bit of a challenge but that is overcome by having a sitting position that does not create a back and leg angle at 90°.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I got my hairline advanced in Turkey roughly 2.-2.5cm. I currently am very unhappy with my results. I never really intended on having a hairline advancement nor was this on my radar. I just wanted my brow bone shaved and the surgeon recommended I do this as well.

I’m very interested in your clinic because I read about the use of ballon/tissue expanders I want my forehead raised atleast 1.0cm-1.5cm if the full inch isn’t possible to restore my facial balance and my masculine identity.

A:Thank you for your inquiry and sending your pictures. When the frontal hairline is lowered this is done by forehead skin removal. With loss of non-hair bearing forehead skin the only way to partially reverse it is to expand the existing forehead tissues to create more skin to be moved upward. I would doubt that a full inch is possible and a more realistic outcome is in the one centimeter plus range.

The concept of s the forehead tissue expander is that it is initially placed, expanded for six weeks at home by you and then allowed to rest for another six weeks before doing the reverse frontal hairline advancement. Trying to shorten that expansion process risks as100% relapse within the first 7 to 10 days after the procedure is completed. While effective I think the hardest part of it is you have to walk around for three months with an obvious and unusual looking forehead.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My main concern is that my brows sit a little high and give me a softer, more feminine look. Ideally, I’d like to lower or reshape them into a stronger, more masculine angle if that’s technically possible. If it’s not feasible, that’s okay too — I’d just like your expert perspective on whether downward repositioning or an alternative adjustment makes sense in my case.

A:Thank you for your inquiry and sending your pictures. Based on my assessment of them I believe what you have is hey differential brow shaped where the tale of the brow is higher than they medial or inner brow area. If the outer half of the brow was more even with that of the inner brow area then I think you would be more satisfied with their shape. Unfortunately there is no reverse brow lifting procedure which could differentially lower the outer half of the brow area. What I would recommend is to initially with eyeliner fill-in the lower half of the outer brow area and see what that looks like. If you find that change successful then you have the options of either micro pigmentation or, more ideally, eyebrow hair transplantation. Either approach would allow for a more controlled brow reshaping

.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I feel self conscious about my profile, specifically the maxillary area and the more downward grown midface. I want to achieve more skeletal support to have a more modelesque appearance. I don’t know what can be done . I feel specifically on profile, my jaw is more rotated down and back and goes at a bad angle. I don’t know what to do.

A:Thank you for your inquiry and sending your pictures. The pictures are not of the greatest quality to make an ideal assessment or do any imaging. But what they demonstrate as best as I could see is that you have a classic conundrum in terms of facial projection. You lack ideal forward projection of the midface and the mandible. This can either be addressed by double jaw surgery or implant augmentations. Each approach has its merits as well as its indications. The logical first approach’s to get an evaluation by a maxillofacial surgeon to determine whether double jaw surgery advancement would be beneficial and whether you want to go to that effort. You only consider implants when you have made the determination that double jaw surgery is either not indicated or it is simply not a surgical approach which you want to do.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a plastic surgeon from Beijing, China. I read with great interest your article published in ASJ on hip augmentation with implants (Evolving Clinical Experiences in Aesthetic Hip Implant Body Contouring) and truly admire your design of the prosthesis. I am also considering performing hip augmentation surgery with implants for my transgender patients.

I have a question and would like to seek your advice: Beyond the mid to long-term postoperative period (i.e., beyond 3 to 6 months after surgery), can patients perform movements such as deep squats, cycling, or yoga? Will they experience discomfort or even compromised stability of the implants? I suspect that when hip flexion exceeds 90 degrees, the deformation of soft tissues around the implant area may exert significant pressure on the prosthesis. I would appreciate your insights on this matter. 

A:Thank you for your thoughtful inquiry. In terms of long-term outcomes from hip implants I have no concerns that the patient will experience discomfort or compromised stability of the implants in any type of physical maneuver. However what is more pertinent is that in some movements such as signifincat hip flexion it may be possible in thin patients to see some of the outline of the implant as the soft tissues change or stretch over the implant in different leg positions. This is, of course, an aesthetic concern and not a functional one. But it is important to point out preoperatively that this will likely occur and is not a rare or unexpected outcome. It is just the nature of putting an implant in an area where the  soft tissue cover will change with dynamic motion while the implant form will remain the same.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested in a 2cm forehead reduction. 

A:The amount of frontal hairline advancement that can be achieved is controlled by the natural elasticity of the scalp. as it is the entire that actually shifts forward in the procedure. There is no accurate predicting  before surgery how much movement can be achieved. Whether that would be 2 cms is unknown but that amount would not be expected for most patients.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have what I believe to be chin ptosis from a chin implant I received last year. The dr kind of refused to acknowledge the problem and instead replaced the implant with a smaller one and the issue remains. Is this something Dr Eppley could address? I had consulted a different surgeon and he’d recommended an oral maxilofacial surgeon but I hope it’s chin ptosis that can be repaired.

A:You are referring to a submental chin pad excision/tuck which is the most effective to chin pad laxity…which is not uncommon after chin implant removal or chin implant downsizing.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Are you all able to also to do 3D models how the person will look after the face implants? Thank you.

A:While the concept of creating custom facial implant designs on the patient’s 3-D skeletal model and then knowing exactly what the aesthetic outcome is would be extremely helpful. However that technology with any accuracy does not yet exist. There is yet no known precise correlation between the push of implants on the bone and exactly how anyone’s very different overlying soft tissues will respond. Currently custom facial implant designs are done based on the patients desired the preoperative changes on their pictures via prediction imaging which serves as a target for the design. This works very well for most cases provided the surgeon is a tremendous experience in doing custom facial implants And has a good feel for how to make designs have a certain aesthetic effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, So my goal is to achieve a natural look as possible. I feel like the height of the ramus is short. The gonial angle i would like to make better. As well as a bit of width projection. As far as the jaw I like the more concave look rather than it being super square, and as far as chin I feel like i do need a bit more projection there as well. I will attach a picture I just took now trying to tuck my beard as much as I could. I’m gonna also attach a picture of my father when he was younger. Also attaching a picture of what I feel I think is that concave look. And I will also be cutting my beard fully by the end of the month and send pictures than as well. I feel like the last renderings were just very square for me. I wanna improve the height of my lower face and also that concave swoop with the jawline rather than it being super square lines.

A:The ability to have the so-called concave swoop to the face only occurs in patients who have thin overlying tissues. In other words you really have to have it initially and a jawline implant is not really going to create it in most people. Your facial soft tissues are not thin and therefore I would not expect that to be a resultant effect. You are trying to sculpt your face for more definition, which is certainly understandable, but thicker tissues largely prevent that from happening the way patients would ideally want. While it is true you can create that effect in a thicker tissue face but the implant has to become so big to make that happen that it becomes unnatural and disproportionate to the rest of the face. That is a long explanation to simply say your expectations are not achievable in terms of definition. Patients send me model face pictures all the time that look like the one you sent. However you have to recognize that those are extremely Photoshopped and altered images and are not real. I can’t create unreal outcomes. I have to do the best I can with the face and the soft tissues that are presented to me.

Dr. Barry Eppley

World-Renowned Plastic SurgeonCan I Get

Q: Dr. Eppley, I had a sliding genioplasty recently, but unfortunately the result wasn’t what I expected. My chin doesn’t look like it used to, and I’m really hoping to restore it to its original position. I’m planning a revision about two months after the first surgery.

Do you think a full reversal is possible in a case like mine? And is it generally easier to move the bone back if the revision is done this soon?

I’d really appreciate your opinion. Thank you so much for your time!

A:Thank you for your inquiry and sending your images. What would be helpful to know is:

1) what was your objective in having the sliding genioplasty?

2) What were the exact bony movements that were done?

3) Do you have any before or after x-rays?

Such information is critical in determining whether you should consider a sliding genioplasty reversal, whether it should be subtotal or complete as well as when might be appropriate to do it.

But the most important question is whether you really do ned to reverse it…and that is best unwon 3 to 4 months after the surgery when you are looking at the final result AND you have had some time to adjust to the facial change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, do I need to was it 6 months before trying to reverse my hairline advancement?

A:I don’t see the benefits of waiting six months after the original surgery to place a forehead tissue expander from a healing or biologic standpoint.

From a psychologic standpoint I could see the benefits of waiting six months as it is always possible how patients feel shortly after a facial change with more time they could come to accept the result. The psychology of this is that you have lived your whole life looking a certain way and when you make a change you may not recognize yourself and wish to return to how you did look (go back home). And for some people time can allow one to accept the change and avoid additional surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can my overdone sliding genioplasty be reversed?

A:Thank you for sending your x-rays. While there is not a side view after x-ray, which provides important information as to how much forward and downward bone movement was actually done, I can see in the Panorex that there are bone gaps which suggest there was vertical elongation.

That being said the bone movement can certainly be fully or partially reversed. As to which is the best approach to take I think one has to go back as to why you have the original surgery. It was clear in your lateral preoperative x-ray you had a short chin. Therefore there were merits as to some forward movement, not vertical elongation, but not to the extent which your surgery was done. Surgeons often overlook the difference in the magnitude of chin augmentations that are tolerated between men and women. The point being that subtotal reversal is likely the most prudent approach as you would certainly like to have some benefit for having to go through two surgeries. The only question remains as to how much reversal should be done. As a general guideline in these situations it is usually 50 to 75% of the horizontal movement done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I also sent pictures of a model of my jaw. I just want to know if Dr. Eppley is amenable to vertically shaving off 4 mm from my chin to reduce its vertical height. I prefer the submental approach since I already have a scar there and I do not want to get a procedure where there is cutting. Thank you

A:Thank you for sending the pictures of your model which clearly shows a 4mm inferior border ostectomy of the chin which I have done many times. Besides the submental approach the keys to the procedure are the  resuspension of the geniohyoid muscle back to the bone and the removal of some created excessive soft tissue chin pad from the bone removal which creates a loss of soft tissue support. If these adjunctive soft tissue procedures are not done it will create some residual soft tissue chin ptosis.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley,I’ve considered for many years a genioplasty for a modest increase to the vertical length of my chin/face. Not looking for a super sharp chin, I know many Asians love the vline but I want to keep the shape but create a little more length (but also not widening). A lot to ask I know! Would a genio be the best solution or can I achieve this with an implant? Thank you!

A:Thank you for your inquiry and sending your pictures. For the modest amount of vertical lengthening you likely desire it could be done either within an implant oor a vertical bony genioplasty. But since you are not looking for a super sharp chin shape  (meaning you are happy with the current shape of the front of the chin), that it would take it a custom chin implant design to do pure vertical lengthening, and to avoid the lifelong presence of an implant which is optimally placed for a vertical chin implant  through a submental incision, the vertical bony genioplasty would be the preferred choice. With this approach you can select the amount of vertical lengthening  you want right up to the actual surgery time based on preoperative measurements and once healed you would never have to think about your chin again given that it was done with your own natural bone. I find that surgeons, particularly those that only do chin implants, make a big deal that the recovery from a bony genioplasty is so severe. But in my extensive experience with chin surgery there is really not a whole lot of difference between an implant and a bony genioplasty when it comes to recovery.

Dr. Barry Eppley

World-Renowned Plastic SurgeonDo I Need A

Q: Dr. Eppley, I know there is too much facial fat on my face but given the progress of cosmetic surgery with you as a pioneer over the last decades,  I am mailing you with interest for facial aesthetic surgery.My goal is to achieve a balanced, masculine facial structure with stronger midface and jawline proportions, while maintaining natural harmony. My bite and airway are normal, so I am looking for aesthetic contouring rather than orthognathic movement so I don’t want to go for Double jaw surgery, rotation etc .I am interested in customized facial implants (malar / paranasal / chin / jawline) and if these can be combined with rhinoplasty in one session.

Could you please give your opinion on

1. Can aesthetic cosmetic surgery be performed on me to achieve my goals.

2. Can a combination of implants be done on me to augument my upper and lower face.

 Please let me know your thoughts on the above. 

Thank you very much

A:The question is not whether you can have custom facial implants and a rhinoplasty at the same time. This combination of facial reshaping surgeries is done regularly. The more relevant question is how effective would they be in terms of achieving your goals. You have one major limiting factor in achieving any semblance of a more defined face and that is of the extensive soft tissue fullness particularly in the cheeks and lower third of the face and neck. While it is true that implant and bony augmentations can stretch out the facial tissues and help create improve definition and shape but the amount of augmentations you would need to do would be very extreme and would make your face too big and still without any desired definition. Even combined with extensive facial and neck defatting I would question whether the augmentations can overcome the soft tissue thicknesses. My concern would be, particularly of the lower third of the face and the jawline is that all you would do is just make your face full or and heavier.

That being said I don’t think the concept of jumping in and doing all of your indicated procedures would be the prudent thing to do for the reasons I have described. A more relevant plan in my opinion is to do the extensive facial and neck defatting with a rhinoplasty and a bony genioplasty and then see if further augmentations may be beneficial. At least with this approach you’re not going to make anything worse or heavier in appearance and you will likely make some facial improvements even if they might not me your ideal expectations. If there is a very positive response to these initial procedures then you can consider additional augmentations on a more favorable facial shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had an endoscopic brow lift earlier this year and the result is over-done. I never wanted my brows lifted this high. My goal was a subtle, more youthful look at the temples because I am still young. Now the middle of my brows sits far too high, and it has completely changed my expression. My eyes look hollow and indented, and my face no longer looks like me. When I gently press my brows down to where they used to sit, they move easily and the appearance looks natural again.

A:An endoscopic brow lift works by what is known as an epicranial shift… meaning the brows are lifted because the entire scalp is mobilized and pushed backwards. No scalp or forehead tissues are removed as in numerous other traditional brow lifting techniques. It is not a procedure where there is a precise control of only portions of the brow and usually the full arch of the  brows are lifted.

Reversing an endoscopic brow lift requires an epicranial shift in the opposite direction towards the brows bringing the entire scalp foreard to push the brows back down. Just like in the original brow lift procedure there’s not going to be precise control of only a limited portion of the brows, the ful larch of the brows is likely going to come down. The fact that you can manually push your brows down into the desired position is favorable in having a positive reverse epicranial shift result.

Dr. Barry Eppley

World-Renowned Plastic Surgeon