Your Questions

Q: Dr. Eppley, Is there a procedure to make my neck appear larger? Either implants or a fat transfer? I would like to have this done.

A: You are likely referring to SCM (sternocleidomastoid) neck implants which would be the only way to do it. This is a very rare type of aesthetic augmentation and I have only done it once before.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i want to push out my maxilla to reduce nasal labial lines, perform fat transfer for the indentation after I had a alarplasty, and for the chin jaw also to push out the chin to reduce marionette lines.

A: Expanding the skeletal base will help push out the soft tissues and reduce some of the overlying indentations. For the cental midface this is premaxillary and paranasal implant augmentation. The only question is whether this is to be done by standard ePTFE or custom designed implants. For the chin such expansion is best done from a sliding genioplasty which pushes out the overlying tissues the most effectively.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hii does doctor eppley remove all three sets of ribs or just two?

A: That depends on the patient’s preference in terms of result and incision location.That is the differernce between Type 1 and Type 2 rib removal surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to reduce the soft tissue in my cheeks and face to reduce the width of my face, I have buccal fat removal and liposuction few times, and after a specialized CT scan that also reveals soft tissue mass, I was told I have a lot of soft tissue mass in my cheeks and would like to reduce this as soon as possible.

A: After buccal lipectomies and multiple liposuction procedures I would doubt  further surgery will make much of a differemce…provided the prior procedures have been done well and thoroughly. The soft tissue ‘mass’ you are likely referring to is fibrofatty tissue which is very resistant to removal and there are numerous facial nerve branches in the cheeks so you don’t want to get over aggressive.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My 7-year-old daughter cannot wear a sports helmet due to the shape of her skull (widening in the back of the head). This is interfering with her ability to safely play sports and socialize. We believe this is a functional impairment as it is going to affect her entire childhood. Are there options for parental consent?

A: At just 7 years old the skull has not developed enough bone thickness that skull reductions can be safely performed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My head skull shape larger and forehead shorter how can I fix.

A: Based on just this one picture and a description of your goals I would say that the top of head can reduced by bone removal and the forehead can be lengthened by augmenting it with a custom forehead implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is the temporalis muscle large enough to cause a noticeable difference? Because when I touch my head, it feels as if I’m touching the bone.

A: Every patient says the same thing when they feel the side of their head. But the reality is that soft tissues will feel like the backing on which they are placed….like wallpaper on a wall. Most patients would say, for example, that their scalp is very thin because it feels fairly solid when most patient’s scalps are least ¾ inch and some up to 1 ½ inches thick.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Your practice had both Exilis and Skin Tyte II for a long time. Which is more effective at tightening skin? I’m interested for my thighs after losing 100 pounds. Thank you.

A:With a 100lb weight loss this necessitates a surgical solution not a non-surgical one.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, which surgery corrects this asymmetry I have mild asymmetry in maxillary sinuses and one side of zygomatic bone is more prominent and frontal process of maxilla deviation.

A:Since I have no idea what your face looks like I can only make a comment based on your description alone. What you are describing is facial asymmetry with one side being more prominent than the other. Like all facial asymmetry is the key question is which side does one prefer, the more prominent side for the less prominent side. That we’ll then determine whether this is an augmentation operation or a reductive one.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to do vermilion advancement procedure on a lip that has a lip implant in it? Is it still possible to get lip implants or are lip implants no longer available?

A:It is possible to do a Vermilion advancement with an indwelling lip implant. The lip implant is deeper while the vermilion advancement is more superficial and thus they are in two different tissue planes.

Currently silicone lip implants, the only commercially available lip implant for the past 15 years, is no longer available.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am considering a full face augmentation. I’m frankly tired of “soft” or “initially good-but-then-less-good” changes (fillers and the like) and looking for a drastic, over-the-top change (that a certain model, among others, has, I’ve uploaded pictures of whom I refer to) I know of no other surgeon other than you, who seems to offer the possibility for such radical changes. I realize there are limitations to what can be achieved. Please let me know if the goal of looking similar to the model I’ve attached pictures of (in terms of jaw, cheeks and eye-area (Hunter eyes)) is possible. My (unqualified) prediction is that the buccinator myectomy procedure (already done buccal fat removal, although it is possible not all of it was removed, but that’s a discussion for another day perhaps), liposuction, custom (enormous!) jaw-forehead-cheek-implants, hunter eye procedure (already done canthoplasty but not satisfied, I need a revision and no spacer graft was used, you can see old scars, those could probably be used and at the same time revised) mouth-widening and lip lift (my teeth don’t show when I smile, might as well do this with the widening methinks), possibly midface-lift (with same incision used for the cheek-implants, just to get rid of the nasolabial folds (?)), could make me look very similar to the model, or at the very least take me to the “unusually nice”-look-domain.

A:Thank you for your inquiry, detailing your surgical objectives, and sending your pictures. As you have noted achieving the ideal model face look that You have shown has its limitations is your face it’s not the same as his face. That being said you are correct in that radical changes requires an aggressive and comprehensive approach. The use of custom jawline, cheek and for head brow bone implants can make for some dramatic facial changes. There are some other soft procedures, lateral canthoplasty, perioral suction and buccinator myectomy, that are often performed in conjunction if any of these custom facial implant augmentations. Other procedures such as lip lift and mouth widening should be deferred to a later surgery date.

All of the facial implant procedures can be performed at once but, as you might expect, one has to be prepared for a significant facial recovery. Extreme changes requires extensive surgery which  results in some prolonged recovery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Inquiry About Occipital Silicone Implant for Flat Head Correction I hope this message finds you well. I am interested in undergoing a **silicone implant procedure to correct a flat area at the back of my head** (likely caused by early childhood sleeping posture). I am an adult male with no underlying medical issues, and the condition is purely aesthetic. I would like to ask a few questions: 1. Do you offer **custom-designed occipital silicone implants**? 2. What is the **estimated total cost** of the procedure (including CT scan, implant design, surgery, and aftercare)? 3. How long is the **recovery period**, and how soon can I travel back? 4. How far in advance do I need to book a consultation? 5. Could I send you photos or CT scans to get a preliminary evaluation? Thank you in advance. 

A:In answer to your custom back of head skull implant questions:

1) The implant is made from a 3-D CT scan which most patients acquire in their own geographic location and the scan is then sent to me for implant design. The average time from beginning the design until surgery can be done is three months.

2) Recovery from a back of the head scholar implant is fairly quick and most patients returned home in 2 to 3 days after the procedure. This does not mean that you’re fully recovered when they returned home just that they are fully capable of traveling. Most of the swelling that occurs from such surgery is largely gone in 10 to 14 days after the procedure.

3) please send some side view pictures of your head so I can do some imaging to show your potential outcomes from the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to know if I could have surgery for a bone I have at the back of my head. I’ve had it for years, and I feel self-conscious about it.

A:That is a classic extended occipital knob which can be successfully reduced using a small overlying incision. Recovery is very minimal and one returns home the following day.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been searching for a solution to my problem for a long time, where my head appears large on the sides above the ears… I have suffered from bullying for years, and when I shave my hair, I feel despair and lose confidence in myself.

I want to ask you, please: Are these types of procedures extremely dangerous? And could they cause me problems in the long term?

A:Thank you for your inquiry and sending your pictures. Do You have the classic increase convexity on the side of your head which is from a combination of muscle thickness in the convex shape of the underlying temporal bone.. Given that the temporal bone is thin and cannot be reduced to any significant degree that would warrant a scar on the side of your head the focus would be on muscle removal which can definitely provide some improvement.

Temporal reduction surgery is a very common skull reshaping procedure in my practice which is as safe as any other aesthetic surgery and causes no functional problems. When I speak to functional problems I am  specifically referring to jaw motion and chweing of which no problems have ever been seen in hundreds of such procedures performed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Thank you so much, when you say nasal base area, is that excluding the central premaxillary region? In my case the bone right under the nose is well projected but above the mouth it is more deficient. So I am wondering how much improvement can be made there.

A:I was specifically referring to the paranasal base area and not the central area of the  nasal spine or pre-maxillary region. If the area under the nose is adequately projected (nasolabial angle) then no augmentation needs to be done.l. Premaxillary augmentation it’s about improving the nasolabial angle between the nose and upper lip. It will provide no benefit to and above the mouth area that is more deficient. This is an area in which an implant cannot extend due to the tight gingivomucosal tissues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley, When I was two years old, I fell down a flight of stairs and smashed the front of my head against a wrought iron railing. According to my mom, the hit “cracked my skull open.” As far as I know, I was taken to the ER where they performed some kind of surgery to get my skull back together. The trauma left a scar about three inches long in the front of my skull, but it also left what I consider to be a significant indentation in the front of my skull. I’m 52 and it has bothered me for my entire life, but up until recently has been covered by my hair. Now, I’m starting to lose my hair in the front and the thought of this years old secret being revealed is terrifying to me. I know the pictures are terrible quality, and they don’t indicate the problem very well, but I was hoping to get your take on it as I try to navigate this problem. Even a rough estimate of what something like this might cost would be helpful, and what options I might have as well. In your opinion, might an insurance company pay for part of the surgery? Any advice you could offer would be appreciated!

A:Thank you for sending your pictures. While the nature of your original injury may be uncommon having a skull contour indentation with an overlying surgical scalf scar is not rare. More importantly the improvement of the skull contour as well as a scar revision can be concomitantly done and would certainly provide improvement. How the skull contouring would be improved depends on first looking at a 3-D CT scan to fully understand the extent in depth of the indentation. Most commonly a custom skull implant would be made for that improvement based on the 3-D CT scan.  In more limited skull contour depressions with wide-open exposure during the existing scalp scar it is also possible that hydroxyapatite bone cement could be used for smoothing out the bone indentation. Until I see the 3-D CT scan I could not say which skull contouring option may be preferred.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello! Im considering rib remodeling but you offer rib reshaping. How do I get a consultation thank you! My problem is I have flared rib cage. I may need a reversed tummy tuck as well to adress the mid line skin laxity  Im after extended tummy tuck and muscle repair after losing 105 lbs.

A:Thank you for your inquiry and sending all of your before and after pictures. First I would like to heavily congratulate you and your surgeon on what really is a spectacular result from where you have started. You could not have hope for a better outcome than what you have achieved. That being said as you’re now look to try to improve upon this initial spectacular result further improvements are going to start to more carefully look at the benefit to risk ratio. What I mean by that specifically is there going to be some more visible aesthetic trade-offs as you are try to improve upon this result.

From a tummy tuck standpoint it is important to remember that the commonly performed abdominoplasty/panniculectomy is a horizontal excisional based operation. It is not a 3-D excision. Meaning it cannot adequately address the vertical dimension of the skin excess unless one had an original fleur-de-lis type tummy tuck which you did not. A reverse tummy tuck is not going to help you as that is another horizontally based excision with a higher scar line under the breasts. What do you really need is a vertical excision for the skin redundancy and to help pull the sides of the waistline i . While that is the anatomically correct dimensional change it is hard for me to imagine that most patients would consider a vertical scar line down the center of their abdomen as an acceptable trade-off. I certainly have seen patients do it but most of them do not look as good as you do after this operation.

As for the flared rib cage I would have similar concerns about the placement of subcostal scars given where you’re at now. If you should happen to have access to the subcostal rib area from a secondary vertical secondary tummy tuck that would be a different matter.

As you can see from the above descriptions you now have to be a lot more cautious and thoughtful about the choices you make as more visible scar lines are going to result from doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’m reaching out because I would like to correct a physical feature that has bothered me for a long time. Specifically, I have a prominent or protruding forehead, not due to its height or width, but because of the forward curvature or bulging shape of the frontal bone. My forehead appears too rounded or convex, especially when viewed from the side (profile view). I’m looking for a radical and permanent solution, ideally through bone contouring or forehead reduction surgery (frontal bone reshaping / cranioplasty). I would like to know if I might be a suitable candidate for this procedure, and what the typical results, risks, and recovery process would be. I can send photos (front and side) if needed. Thank you in advance for your time.

A:This is classic frontal bossing which makes the central  part of the forehead stick out further than the sides. This can be reduced by phone burning method provided that the bone is thick enough to do so. This requires your preoperative CT scan to make that determination. More likely than not the bone is probably thick enough given your darker skin pigmentation. However I do not guess what the bone thicknesses is rather I need to know exactly what it is.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley I would like to know how many centimetres each side may be lengthened using the bilateral lengthening technique. I heard it to be one inch on each side. I would like to gain two inches on each side. Would I need to have the procedure done twice to reach my goal? If so, whats my recovery time and how long will it take between surgeries?

A:To provide clarifications on the clavicle lengthening procedure;

1) The maximum clavicle lengthening per side with current technology is 15 to 20 mm (less than one inch)

2) clavicle lengthening can only be done one time and cannot be repeated twice.

Thus what you want to accomplish cannot be safely or effectively achieved with the current method of clavicle lengthening based on my experience.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if you could please provide an assessment, based on the photos attached, as to whether you think I would be a suitable candidate for a chin implant. I am considering a vertical chin implant from Implanttech, to add to both horizontal and vertical projections. The only concern that I have is that it may accentuate the labiomental fold which is already moderately deep in my opinion, as I do not want to end up with a witch chin. If not a chin implant, I will start considering sliding genioplasty instead as an alternative. Grateful for your valuable opinion. Many thanks in advance.

A:Thank you for sending your pictures. When you have a primary vertical length deficiency of the chin, primary meaning that the need for vertical lengthening is greater than the need for horizontal advancement, this always poses challenges that most standard chin implants cannot overcome. While there is one style of standard chin implant, the vertical lengthening chin implant, it has imitations. It was developed years ago and extensive experience with it has demonstrated that in almost every case itx shape is going to have to be modified so that is not overly round. It also has a set amount of horizontal and vertical lengthening, which are equal, and as a result most of the time is also have to be modified to fit the patient. The standard vertical chin implant has its role in chin augmentation but the reason to use it is economic, meaning one chooses it not because it is the best approach to the problem but because it costs less than the better solutions.

In vertical chin lengthening the better approaches are either a bony genioplasty or a custom vertical lengthening chin implant. Each of these has their benefits and it is important to understand their differences. In the bony genioplasty the amount of vertical lengthening is essentially unlimited and there is never any concerns about the soft tissue chin pad following the bone downward. Its primary aesthetic limitation is that it cannot widen the chin or make it more square which for some men may be an issue. In a custom chin implant the amount of vertical lengthening achievable is in the 6 to 7 mm range because of the need for the soft tissue chin pad to be able to be redraped over the implant once it is released for implant insertion. In a custom-designed implant it has the advantages a precise control over the amount of vertical and horizontal changes as well as the shape and the placement a Screw fixation holes.

That being said and how it applies to you, based on my initial imaging which may or may not be an acceptable amount of change, you really have the option of either the bony genioplasty or a custom implant if you prefer to go to the best solution approach. Your chin augmentation dimensional needs fall within the scope of what both approaches can do with the understanding of the aesthetic differences between them

In regards to the labiomental fold it is important to understand that any form chin orientation done either by the bone or an implant is going to deepen it to some degree. This is unavoidable as the fold represents the insertion of the mentalis muscle which sits above the effects of any form of chin augmentation. The advantage of vertical chin lengthening is that it does help to mitigate the labiomental fold deepening effects. The deepening comes from the horizontal advancement and the vertical lengthening helps decrease that effect as it pulls the soft tissue chin pad downward. It would also be fair to say that the  bony genioplasty more favorably decreases the labiomental fold deepening effect as it has a more downward repositioning of the soft tissue chin pad.

As an ancillary comment to the effect of chin augmentation in your case, you ideally would benefit from submental liposuction to optimally improve the cervicomental angle and avoid a double bubble profile result.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My lips (upper and lower) have been drying and cracking for long time now and the vermillion border is damaged . Topical applications dont help  because the whole skin is eroded and turns sore and painful. without topical application it geta scabby and very tight i cant move then.

A:Thank you for your inquiry and sending your pictures. What you are describing is chronically damaged dry vermilion which can clearly be seen in your pictures of which the lower lip appears to be more severely affected than the upper lip. The surgical treatment is to remove the damaged part of the dry vermilion in a lip reduction procedure which is done for symptomatic relief rather than primary esthetic purposes. By so doing you will either improve or completely solved the problem based on how much of the Involved dry Vermilion can be safely removed. This is done at the expense of some reduction in your lip size as well as a fine line scar at the wet – dry lip junction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in making my jaw angles more angular like your attached result. How long is the recovery and how much pain is there?

A:Thank you for your inquiry and sending your pictures. What you’re asking about his vertical lengthening  jaw angle implants. This is the most common jaw angle implant style used in women. While any procedure that involves elevation of the masseter muscles over the jaw angle area causes some postoperative discomfort the bigger issue of which to be where is the significant swelling that will result and that it will take two to three weeks until your face look better with the full final result taking 6 to 8 weeks after surgery to be more fully seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I get mouth widening surgery?

A: Your mouth is a bit narrow but what really magnifies that is that the vermilion of the upper and lip thin out/disappear before it gets to the corners. This always makes the mouth appear more narrow than it really is. If the upper and outer vermilion is advanced this not only changes the shape of the lips but also makes them appear somewhat wider. (see attached imaging) The point being is not usually a good idea to try and widen the mouth there is a lack of vermilion at the corners. All this does is make the corners look like narrow slits. There is a balance between the mouth width and the vermilion fullness in creating a better looking mouth shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I think my forehead is very small and it bothers me a lot and I want to fix it and also the back of my head is flat and I wanted the doctor to look at it.

A: Thank you for your inquiry and sending your pictures. I can clearly see your fore head concerns. The forehead is short in vertical skin length and lacks bony projection. Probably the shortness of the forehead skin contributes more to the appearance of the small forehead Dan does the lack of bony projection but the two are linked particularly in terms of the approach to correct.

As you may know there are soft tissue procedures to shorten the vertical length of the forehead but there are none to vertically lengthen it. To gain any vertical length you must increase the bony projection/shape of the forehead which can only be done buy a custom for head/skull implant. Obviously the more you do so the more the skin stretches and creates a larger appearance of the forehead. But there is a delicate balance between too much implant projection and creating an unusual appearance. However the tightness of the forehead and scalp skin is going to limit how much for head augmentation can be achieved so this is probably not a significant concern. To evaluate what I think is realistically possible attached I have done some imaging looking at one amount of forehead augmentation to see what the effect is on the size of the forehead and the location of the frontal hairline.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had lip widening surgery done in turkey last November. I had my bottom lip made bigger and the corners of my top lip made bigger but not the vermilion so it looks a bit weird when I smile. My main concern is the corners of my mouth when I open my mouth wide. The scar tissue stops me from opening it properly and it looks weird so want to widen my mouth a bit I want to vermilion lip lift so my top lip is higher than the sides.

A:This is not a lip problem that I have great confidence I can provide the improvements you are seeking. Once you get scar issue near the mouth corners you have as good a chance of making it worse as you do in making it better.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant done four years ago. My lower lip has never regained full sense (feels like it was numbed at the dentist) and apparently the implant was just some sort of “stock” implant and not crafted to my jawline so I have to have filler put in on both sides of the implant to keep it from having a severe divot in each side. Wondering if it can be removed and replaced with a properly fitted one. I assume the nerve damage is more than likely permanent, unfortunately, but if not that would be fantastic news as well.

A:Thank you for your inquiry and detailing your chin implant surgical history. I obviously cannot speak to the style size or location of your existing chin implant on the bone. Although t is a fair statement to say that a custom implant design would better address placement and location of an implant on the bone and would blend better into it. It may also be possible that your mental nerve damage is due to the location of one of the wings of the implant right next to the nerve causing compression. By removing the implant this may help some of the numbness improve although that should’ve been done long ago for that to provide a good chance of nerve recovery. But in rare cases I have seen patient’s numbness improve in similar situations at postoperative time periods when you would think it would be very unlikely to occur.

The first place to start is to get a 3-D CT scan of your chin/lower face to evaluate your chin implant’s size style and location on the bone. This will provide significant insights into how to proceed forward.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, As U can see in the picture My lower face is very wide , I have had buccal fat removal and liposuction , after a CT scan, it was revealed that I have big mucosal space and my bone structure and size was normal width but the mucosal space is giving the wide face

I already have buccal fat removal, I just need to reduce the soft tissue of my cheeks.

A:Admittedly I have never heard of a ‘big mucosal space’  nor exactly what that means or how that would even be diagnosed on a CT scan.

That being said I think what you are asking about is a more complete soft tissue cheek reduction procedure. While a buccal lipectomy has benefits it is not a complete cheek reducing procedure and does not address the lower soft tissue components of the cheeks. To complete full soft tissue reduction of the cheeks perioral/lateral facial suction and a buccinator mucosal myectomy is what is needed to maximize whatever thinning of the tissues between the bony cheeks and the jawline can be achieved.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m considering getting a midface implant like this one on your website, and I was wondering what is the maximum amount of forward project you do in these cases, particularly in the paranasal region lateral to the nasal cavity since I feel that’s where my bone is most deficient.

A:I have seen patients put as 9 mm i the paranasal region but this would be an exceptional amount in the rarest of circumstances. Much more commonly patients have 4 to 6 mm  of projection in the nasal base area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am inquiring to see if I would be a candidate for mouth widening surgery as I have a very small mouth.

A:Thank you for your inquiry and sending your picture. Your mouth appears small in width for two reasons; 1) it actually is a bit small in width BUT 2) that is magnified by the complete lack of lateral vermilion height in the upper lip from the cupids bow out to the true mouth corner. As a result the actual mouth with is not truly being shown. The appropriate procedure for improvement is lateral upper vermilion advancements to have they visible lip actually extend out to the mouth corner and smaller lateral Vermilion advancements of the lower level next to the mouth corner so more of its actual with can be seen. This will make the mouth look wider even though actually the math corner has never been moved. This is illustrated in the attached imaging. You cannot do these procedures simultaneously with the true mouth widening as that would create adverse scarring around the mouth corners. But I think this provides a significant improvement that True mouth widening is not really needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to have chin implant removed that was placed submental 25 years ago (XL silicone) I know from reading your blog (most informative that I have seen) that there is no way to know the outcome of removal.The most important aspect of removal to me are function and motor skills opposed to cosmetic due to a family situation. I have more of a general question with the understanding that it would be more guesswork. My question is if I’m correct that mentalis reattachment stemming from the intraoral approach is the primary driver of lower lip incompetence in your opinion? I.e., with the submental approach for emoval,, it is more soft tissue and ligament stretch that may cause chin pad sagging causing a cosmetic deformity but if the mentalis is preserved there is a better chance of not having an effect on speech and motor ability? Thanks for the assistance you provide on the blog it is very informative & helpful – would certainly like to utilize you for this procedure as I think your credentials and experience are unmatched.

A:When considering the removal Chin implant that is associated with lower lip incompetence be aware that new matter how it is removed, intraoral versus submental, the lower lip incompetence is likely to get worse. This would be particularly relevant when one has an extra large chin implant. While you can go intraorally and remove it and do mentalis resuspension, the likely outcome would be no improvement in the lower lip incompetence at best and some increase in it at worst. Mentalis resuspension is not a predictable procedure but it works best when it is supplemented by some form of chin augmentation. But when structural chin support is being removed, AKA Chin implant removal, the operation is very likely to not be successful at all.

Dr. Barry Eppley

World-Renowned Plastic Surgeon