Your Questions

Q: Dr. Eppley, I had buccal fat surgery 4 months ago for prolapsed buccal fat pads. However I still seem to have the prolapsed fat pad. Would you agree this is what it looks like? It seems to be quite clearly visible on one cheek. And I have what looks like balls either side of my chin.

A: Any comment that I would make by just looking at the pictures would be pure speculation. If you really want to know what constitutes those full areas that have been diagnosed as prolapsed buccal fat get a 2-D CT scan, which will absolutely confirm what is the cause of those masses.

But if you want me to speculate, I would doubt that those ever were prolapsed buccal fat pads. If they were and the surgery was done correctly, then they would be gone. Thus I would get a CT scan for further insight and you might have argued from the beginning a CT scan would’ve been the best thing to do initially. But as I stated previously, this is just speculation.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I would like to schedule an appointment with the surgeon to discuss the possible options for a forearm implant procedure.

Both of my arms are symmetrical and relatively slim, and my goal is to increase their volume using implants.

What is the average waiting time to undergo surgery at your clinic? Also, how long does the entire process usually take from the initial consultation and evaluation, through the design and manufacturing of the custom 3D-printed silicone implant, until it is ready to be used during the surgery?

A: Thank you for your inquiry and sending your pictures. In looking at your pictures, my impression is that the thinnest part of your forearms is that of the lower forearm or the wrist area as highlighted in the attached picture, Forearm implants historically are placed in the brachioradialis muscle which is located in the upper forearm and does not usually extend down into the wrist area. The reason being is that that is the largest longitudinal muscle in the forearm and ideally you would like the implants to be replaced under muscle fascia to provide maximal soft tissue coverage and to prevent any visible implant edging.

Wrist implants are a bit different because they cannot be placed under any muscle fascia and must be in the subcutaneous tissue. This does not mean they cannot be done, but implant edging is potentially more of an issue.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello, I am interested in scar revision on my right eyebrow. Will it make it look better?

A: When I evaluate a scar for potential revision, there are two issues to consider. First, what are the exact improvements that are needed such as is it depressed, is the scar wide, etc. in other words evaluating the specific changes that may likely make the scar less apparent. Secondly, based on the dimensional needs of the scar, how much better can it really be. An important concept to understand about scar revision is it is best thought of as scar replacement. Meaning there will always be a scar as there is no way to make it invisible. The real question is whether the scar replacement procedure is going to produce a better appearing scar than the one that currently exist. In other words, is it a good gamble to do?

That being said the two issues that appeared to make your scar more visible, based on the pictures, is an inward depression of the eyebrow and a scar line that goes above the eyebrow into the lower forehead skin. Thus your scar revision in my opinion consist sof several small components, including release of the eyebrow tissues with a small fat graft and replacement of the straight scar line above the eyebrow with a broken line closure technique.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, hello! Thank you for the opportunity to ask you a question. If the filler completely satisfied my aesthetic needs for smoothing the chin cleft, will fat grafting give a similar result as the filler, but for a longer term? In the foreseeable future, I am planning an orthognastic surgery with genioplasty and I am also considering the option of eliminating my cleft chin (namely cleft) using alloderm, so as not to carry out two procedures (genioplasty and then fat vaccination), however, I am concerned about the possible risks, both aesthetic and physiological (risks of infection; encapsulation; contouring through the skin; excessive volume or, conversely, lack of it.), is it also possible to simultaneously perform genioplasty using alloderm (as I understand it, supraperiostatically)? Or should I not take the risk and just have two procedures (genioplasty and fat grafting) to get a guaranteed result? I thought about having two possible solutions to the problem, since I have a bone cleft in my chin (but I have read your articles and am aware that this may not always be the root cause, and even with the presence of a bone fossa, some people do not have it on their face or it is very poorly expressed, so I cannot be I am sure that it is my deepening of the bone that is responsible for the cleft of the chin on my face) and I do not know the root cause of its presence on my chin. I attached photos from the Internet with the results of the insertion of a filler for dimple correction (because my filler has already been removed, and I don’t have any suitable photos for comparison, but I have almost identical initial external cleft chin data and had almost exactly the same result.

I would also like to know about the correction of the labiomental sulcus, as I have already said, in the foreseeable future I plan orthognastic surgery with genioplasty, most likely the tactics of chin augmentation will be in the mini chin wing using allogeneic bone blocks in diastases and increasing the vertical height of the chin by onlay bone graft, also using alogenous or autogenous bone plates and most likely, my labimental crease is likely to increase due to this correction, and what is the best way to correct it? I’m leaning towards alloderm, because it can be used to cover up the irregularities of the onlay bone graft (perhaps I’m wrong) and at the same time eliminate the labiomental fold, but I can also consider a dermal fat graft and fat injection. I would like to hear your opinion as a surgeon, who is probably the best at this and has the most extensive experience in eliminating this aesthetic problem. Could you tell me from your experience what is the best way in this situation to eliminate and prevent the occurrence of labiomental fold, given my case. Where is it better to place the alloderm to avoid contouring: above the periosteum (as injections with fat and skin-fat transparency (in your article from February 2026)) or above the muscle, or under the periosteum? Is it also possible to do this in a place with genioplasty, or is it better to do it after? I would like to learn more about the risks of contouring alloderms (and other risks, too, both aesthetic and physiological) to eliminate the labiomental fold. I know that you said that the best option to eliminate this aesthetic defect is a skin-fat graft, because it gives a larger volume, etc., however, I will probably consider it last, because I am not satisfied with the risk of scarring, etc. Therefore, I want to find out which is better than alloderms or fat injections or their possible combination? But if you do them together, what is the best way to place them in soft tissues and again during/after surgery?

Another question about Alloderms, but already in the field of the infra-orbital edge, you say that this is a worthy alternative to implants and it can be supplemented by injecting fat or moving fat from the eyes, I would like to know a few important points: again, about the risks of contouring and the layer of superposition of alloderms and whether the previously performed Ultherapy in this area is a contraindication to if not, how long should I wait between these two procedures to avoid complications and so on? Thank you again for the opportunity to ask you a question!!!

A: I believe you are asking much more than one question. In that regard, I can make the following comments.:

1)if filler has been successful for a chin cleft improvement, then one could anticipate fat grafting will also. The question with fat grafting is whether it will persist longer than that of the injectable fillers.

2) The only procedure you can combine with the genioplasty for a chin cleft or a deep labiomental fold is fat injections.

3) No form of bone manipulation is going to improve a chin cleft or a deep labiomental full. Those problems have to be addressed with soft tissue management.

4) Alloderm is one form of soft tissue augmentation for a chin cleft or deep labi omental fold. However, it does require small, external skin incisions for its placement.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am interested in a genioplasty, jaw angle implants, undereye fat grafting, midface lift.

A: Thank you for your inquiry and sending your pictures. Let us start with the premise of what is the ideal surgical procedure for your undereye/cheek and jawline augmentation needs. There is a little question that the best procedures for your needs are a custom jawline and custom infraorbital –malar implants.

From that perspective, I can make the following comments:

1) Isolated chin and jaw angle implants will provide improvement, but it will not make for a connected look, and you will not have precise preoperative control of the dimensional changes. There is nothing wrong with a combined sliding genioplasty and jaw angle implants as long as you recognize why one is  selecting over a custom jawline implant….cost. Lower cost is fine as long as one recognizes that the result is not the same as the higher cost surgery.

2) when it comes to your under eyes, this is a very different story. You have a significant negative orbit vector for which fat grafting is a poor treatment for it and never works. It will just end up being a wasted procedure. The only effective treatment for a negative orbital vector is a custom infraorbital-malar implant for your under eye problem as it is one of volume and you need significant added support to create a sustained and effective result.

3) You are young and do not have a sagging midface due to tissue laxity. You lack volume/bony support which is needed to create a lifting effect. You do not need a midface lift, you need the addition of structural augmentation.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, My flat head is caused by sleeping position when I was infant. I would like to know which filling material will you prefer to use and why? Please email me for your answer and potentially I will fly to your clinic for such procedure.

A: The most effective and successful method of skull augmentation for any flat head area is a custom skull implant made from the patient’s 3D CT scan.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I want to reduce the width of my the temple region that is lateral to my eyebrow, right above the cheekbone prominence as I feel it is too wide relative to the rest of my face, ruining facial harmony and giving my face in front view a overly wide appearance. Is this area bone or muscle and can it be reduced via reduction or removal. I am not sure I have seen you do this region as opposed to the posterior temporal region that is the back of the head. If not, would botox or the electrical method work?

A: Botox would be the only effective method of muscle reduction in that far anterior temporal region.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello. I’m looking into the possibility of having an even flow contour from my forehead into the top of my scalp i want a more rounded countour look at the peak where they both intersect. And if possible more rounded counter also at the crown of my head.

A: Such a forehead-skull reduction, as shown in the attached imaging, can be done from a bony standpoint. It is more of an issue of access to do the procedure. Where would the incision be placed that would be acceptable in a male with a shaved head. That is the issue that merits very careful consideration.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, A surgeon placed a medium anatomical implant, and while I appreciate the projection, I hate everything else about it. Not only did it make my face wider and longer, it made it masculine and worsened my jowls. I am eager to have it removed and possibly replaced with something different but I’m not sure what I want to do just yet. I have been to several surgeons for consult and have yet to find one I feel comfortable investing in again. The pictures I included are three profiles: one from when I had the first implant, one from after the first implant had been removed, and one with filler in the middle. I also included a couple of pictures from the front just prior to the new implant. There are also two pictures with the new implant. Out of my own curiosity, I outlined my jawline using lipstick and pressed it on a piece of paper. I then measured and cut out a piece of paper in the approximate size and shape of the implant. That picture is also included. Thank you so much for your time, and I look forward to hearing your expert opinion.

A: Thank you for your inquiry and sending your pictures as well as detailing your surgical chin, augmentation history. In my experience, your situation is very common as the use of anatomic style chin implants is rarely successful for females for the exact reasons that you have. The long wings makes the chin wider, fuller, and almost gives the appearance of jowls.

In your drawing, I believe you are trying to show the current shape and projection of your existing implant? That is not the shape of an anatomical round standard chin implant unless the surgeon modified it, which is certainly possible. I don’t think you should consider chin implant replacement unless you know exactly what the style,  size and placement of the chin implant is on the bone so the relationship between the implant and the external shape is appreciated. This is done through a 3-D CT scan in which your silicone chin implant will be very clearly seen. Understanding the relationship between the geometry of the implant and its effects allows for creating a better implant shape with a different and more desired aesthetic effect.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Does insurance cover cosmetic surgery in any situation?

A: That is the question that can only be answered on an individual case basis based on the procedure and the anatomic problem you are trying to improve through an insurance pre-determination process. But as a general statement insurance does not usually cover aesthetic surgery.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am interested in a solid silicone infraorbital / tear trough / lower orbital rim implant. I previously had fat grafting in the infraorbital area and a canthopexy. Would previous fat grafting and canthopexy generally make this unsafe or impossible, or can silicone implants still be considered after examination/photos/CT?

A: Many patients that present for custom infraorbital implants have had prior fat grafting procedures. Such fat grafts are simply autologous soft tissues which do not preclude the placement of implants secondarily.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I had an otoplasty six weeks since my operation. My results aren’t terrible so far, however I do believe I have a telephone ear deformity on both ears. My helix is not visible from the front at all on the left ear especially. I suspect that I will need a reverse otoplasty to make it look more natural in the future. My question is, how soon after the original operation should one look into getting the reverse otoplasty done? Please let me know. Thank you

A: That does appear to the case (telephone ear deformity) At six weeks out it is still possible that just release of the sutures with a small Alloderm graft may be all that is needed. In essence sooner is better than later.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am interested in a consultation regarding a custom wrap-around jawline implant (mandibular angles, body, and chin as a single piece). My goal is to strengthen my side profile which has always been pretty soft, add width to the anterior chin for a more square front-view shape, and define the over all angles to sharpen contour. Some notes on timing and other maybe relevant factors: I did recently have some chin filler a few months ago to attempt to reach my desired result (not present in the photos, these are before), and while the change was positive, it wasn’t major – but did directionally serve as proof of concept. I am also going to attach two edited photos from Qoves to kind of show what I am going for with these implants (I realize this is not a great medium to convey information, but maybe useful to assess whether my expectations for the surgery are reasonable). I would greatly appreciate learning more about what an initial consult would look like. Thank you

A: Thank you for your inquiry and sending your pictures. The use of AI or any type of imaging is done with the purpose of determining what the patient’s goals are. Thus it is very useful even though one should never interpret the outcome as always being exactly that. By you doing your own imaging, you are telling me exactly what your goals are and that is what I need to know in any type of facial reshaping surgery, but particularly when one has to design a custom implant to try and achieve it.

Thus you have already done the first and most important step in the process which is what are your goals. Now that is established we just have to discuss what implant material do you want the jawline implant to be made of and what that entire process looks like from implant design to surgery to the complete recovery process.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Thank you for taking the time to look at my case. I am aware these pictures are not the best. Please let me know if the pictures need to be improved upon.

There are a few things I would like to change about my face. Firstly, both of my jaws are recessed which is pretty obvious from the side shots. I am very inesecure about this. I suspect jaw implants would be best to remedy this, but of course you know best. Removing the appearance of recession would be great if possible. Something to consider: I got a CT scan and it revealed that my TMJ/Jaw Joints are pretty rounded & weak so adding weights through the addition of implants might not be possible.

I would also like to address the deep eye lines under my eyes. Even with a lot of sleep the lines stay. I am not sure if there is a possible solution for removing these eye lines.

Thirdly, my cheek bones are also pretty weak, particularly the side with the scar on my face. Cheek bone implants to help this would be very nice.

Please let me know if you need any more information to recommend procedures. I am very interested in improving my appearance and would like to be as helpful as possible to ameliorate this process. Thank you so much!!

A: Thank you for your inquiry and sending your pictures. I can certainly see your very weak lower jaw and lack of lower orbital and cheek skeletal projection.

The first important decision to make is whether you would benefit by lower jaw advancement surgery, or even by bimaxillary advancements. You have significant lower jaw and chin recession and you must first determine whether correction of that by moving the entire lower jaw would be indicated. So if you have not had a complete assessment for the consideration of this surgery by a maxillofacial surgeon, this is what you should do first. This is the linchpin decision as if you need that surgery this is the very first thing that you do. Once that is done then come back for secondary facial reshaping procedures. If jaw advancement surgery not indicated (which I doubt) or you do not want to do it then we can look at what your options are.

But for the sake of discussion in this email, let’s assume that you are not going to have bimaxillary advancement surgery. Then there was no question that you need a sliding genioplasty for your chin given its severe recession and implants may be needed behind that to build out the entire width of the lower jaw. Implants have virtually no weight so that is irrelevant to your TMJ condition. From a midface standpoint you definitely need custom infraorbital-malar implants to address your lack of upper midface skeletal support.

Dr Barry Eppley

Plastic Surgeon

Q:  Dr. Eppley. I am seeking your opinion on the use of a zygomatic sandwich osteotomy (ZSO) versus (infra) zygo implants for aesthetic zygo augmentation in Caucasian patients.

In your experience, which technique generally provides the better aesthetic result, and why? Do you consider ZSO to be a good option for enhancing cheek/zygo projection, or do you usually prefer implants? What are the main advantages and disadvantages of each approach in terms of appearance and long-term results?

Thank you very much for your time. I would greatly appreciate your opinion.

A: While a zygomatic sandwich osteotomy has its autologous appeal, it has major aesthetic disadvantages. It is essentially a unilateral dimensional procedure that only adds lateral cheek width. It cannot provide any anterior projection to the cheek and most certainly does not do anything for the infraorbital area. Therefore by comparison to a custom infraorbital-malar implant, it is woefully inadequate for the vast majority of patients who need enhanced skeletal support in the upper mid facial area.

It is never a question as to which procedure I prefer, as I can perform both of them, but what are the exact dimensional needs that a patient requires to achieve their aesthetic outcome. When you use the term enhance cheek/zygos you would have to put some dimensional qualifications as to what that means. Once I know what the end target is, then I can tell you which of these two procedures could best achieve it.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Am I a good candidate for cheek implants?

A: Whether one is a good candidate for any aesthetic surgery depends on what are their exact aesthetic goals. The term cheek augmentation is a general one and doesn’t tell me anything about the patient’s specific dimensional needs. So until I know what they are exactly I cannot provide any specific recommendations.

However, what I can do is provide some general guidelines for young male cheek augmentations based on my experience. The vast majority of them seek the high cheekbone look, including augmentation of the under eye area, which is why the custom infraorbital – malar implant is by far the most popular choice amongst young men. The use of standard cheek implants in most men is not gonna produce a satisfactory result unless they are seeking a small lateral cheek augmentation that is does not include the undereye area

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I wanted to ask about whether reducing the vertical height of my chin could be an option for me.

I understand that my chin may not be abnormally long, but aesthetically I tend to prefer a more compact lower-face/chin appearance, so I’ve been wondering whether a conservative vertical reduction could be worth considering. Do you think this is something that could potentially be addressed with burring, or would that not be appropriate in my case?

If it is something you offer, could you also give me a general price estimate or range for this type of procedure?

A: For vertical chin reduction as a female, you would really want to do this through an intraoral approach with a wedge reduction osteotomy. While the alternative is to do a submental chin reduction by burning or shaving from below, most females would not prefer to have a scar under their chin as a result.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, m writing because I’d like to inquire about the side-by-side implantation technique for testicle enlargement. I’ve always had fairly small testicles and now, with TRT, they are even smaller. As a gay man, I’ve, likewise, always wanted a much larger set of testicles. I’d like to discuss possibilities further. I’m also interested to know if you conduct any penis augmentation procedures, as I’m likewise interested in improving length, girth, and overall look of my penis

A: I do not do penile implant surgery. But when one is interested in both penile and testicle implants the penile implant is typically done first as it is more technically demanding and the testicle implants may interfere with penile implant placement (depending upon the type of penile prosthesis used).

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, So I had neuro surgery in the past to fix my epilepsy problem, and it worked. But I was left with both sides of my head unevenly matched and looking to get it fixed and was told from a friend that you guys do great. I’ll take pictures and share them and you’ll notice that one side curves outward as it comes down and the other is flatter and straighter.

A: Happy to hear that your epilepsy surgery worked out great. Undoubtably you had a temporal craniotomy in which the temporalis muscle was stripped down to perform it. While the muscle may have been put back it can atrophy/retract creating asymmetry. That is the likely source of the difference between the shape of the two sides of your head. It is always possible that the craniotomy flap may have sunked in, but usually plate fixation is used and that is not a typical problem today. Please go ahead and send me some pictures of your temporal asymmetry for my evaluation.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I had an undescended testicle brought down when I was a child. As a result of this both testicles are undersized and the right testicle is very small. I am seeking to get prosthetics as the two native testicles are tiny. I have just had an ultrasound and hormone panel taken. So, a double prosthesis that allows both native testicles to stay, for cosmetic reasons as its unliveable with the diminished size. Can you advise

A:  Based on the information provided, it is likely that the smallest testicle would be displaced by a side-by-side implant. In your normal size testicle the interesting debate will be between a wraparound versus a displacement technique. To help with that decision, I would need to know based on your ultrasound, the exact measurements of both testicles.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I recently had genioplasty, cheek and jawline implant (non-custom) surgery earlier this year.. I am happy with the chin result, but I do not love the result of the jawline implants particularly. I think they flare out too much and have too steep an angle, finishing well short of where my chin actually is. This is the product that was used:

Overall, my face currently looks wide, fat, and swollen, although I am now 5 months post op. I’m leaning towards the removal of the jawline implants altogether or replacing them with a different product to achieve what I am looking for. I was planning on a buccal fat reduction and neck lipo procedure as a final phase, but I need to make a decision as I’d prefer to only have one more surgery.

A: Thank you for your inquiry and sending your pictures. It is fair to say at five months after surgery you were looking at the final results of the impact of your jaw angle implants.

One of the issues to be aware is that in the patient with loose neck/jowl skin and naturally thick tissues it takes a powerful implant augmentation procedure to overcome these soft tissue issues. Isolated augmentations at the three corners of the jaw in a standard fashion are never going to overcome these issues. The chin implant is always effective because it is a solitary projecting structure and the chin is not associated with loose tissues. But back at the jaw angles, it is a completely different story.  Isolated jaw angle implants, regardless of their size, are not going to create definition and we usually just end up with a bloated effect.

In essence, you were never a great candidate for isolated jaw angle implants. You have to either go all the way and replace them with a custom wraparound jawline implant which will expand the soft tissues, have a lower facelift to pull back and reposition the jowl/neck tissues so what lies underneath it can be more fully seen or remove your jaw angle implants completely.

The following statements were said with the assumption that your jaw and implants are in the proper anatomic position. That is an assumption, quite frankly, which one should never make. It is very possible that your jaw amngle implants are positioned high and an interior to their desired anatomic position and this could be causing some of the adverse effects that you see.

As a result before I would do anything, I would get a 3-D CT face scan to see exactly where all three of your implants are positioned. Then you can make an informed decision about how to proceed.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I’m inquiring about if you’re able to even out the top of my head, it is very uneven.

A: Thank you for sending your pictures. You do have a tremendously high and overgrown crown of the skull of your head. Therefore, I think the question is how much of that crown height can be reduced for an overall better head shape. To answer that question accurately this requires a 3-D CT skull scan with color bone thickness mapping so we can see what is making the high crown area and can it be reduced and, if so, by what amount. The question is always whether the high crown area is due to an increased bone thickness or is the skull bone normal or even thin and that is a protrusion of the brain creating the height. This would obviously be a critical question to know in terms of making a treatment decision.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I would like to balance my chin with my nose but still look feminine and enhance my jawline.

A: hank you for your inquiry and sending your pictures. As you know, you have a tremendously short chin due to a significantunder development of the lower jaw. Short of major jaw,\ advancement surgery, of which I assume may not be of interest to you, then addressing what we can for the chin area would be the appropriate choice. You clearly need a sliding genioplasty to move the chin bone out as much as possible. While your chin deficiency is probably in the 25 to 30 mm range you likely would only achieve about half that amount with the sliding genioplasty. But given where you started, that amount of change may be more appealing to you than even if it was possible to move the bone out to a so-called normal position. You would likely see normalizing the chin bone position as excessive, particularly as a female. The sliding genioplasty would benefit by submental liposuction to optimize the lower facial improvement. To help you visually understand what that potential change may be I have attached some prediction imaging of that approximate result of the two procedures.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Am I the right candidate for a lip lift? As you can see, my philtrum is visibly on the longer side. I measured it at around 20–21 mm, but I’m not completely sure anymore.

My goal is to achieve a philtrum length of about 14–15 mm with surgery to better harmonize my overall facial proportions. My only concern is that my upper lip might end up looking too feminine or overly rotated, almost like “duck lips.”

I don’t know if this is a benefit or not, but my upper lip is noticeably smaller than my lower lip. I don’t mind a slight amount of rotation, but I’m worried about ending up with an overdone lip lift that feminizes my appearance too much.

Based on what you see, do you think I’m a good candidate for a lip lift?

A: You are a good candidate for the subnasal lip lift as going from 20 to 15 mm of vertical lip length is certainly reasonable. The concerns with the subnasal lip lift are not having duck lips but rather having an A-frame deformity where the amount of vermilion show in the center is far greater than that on the sides.  Those at risk have limited lateral vermilion show initially. This is why such subnasal lip lift patients need a combined lateral vermilion advancements so that they can have a more symmetric lip shape from one mouth corner to the other. You certainly fall into this category.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I’m 9 weeks post reduction T genioplasty and I have noticed a significantly deepened anterior mandibular vestibule, restricted smile and lower lip depression, and sagging chin appearance despite minimal to no swelling. The vestibule was initially much shallower after surgery and opened up/deepened around week 2 or 3. I am concerned about mentalis/chin pad malposition or ptosis. I have spoken to my surgeon, who has advised me to wait, but would like a second opinion. Would you be able to see me for this issue?

A: Many of the symptoms you have are not uncommon after the chin reduction procedure that you underwent. In any type of facial bone reduction, one assumes that the surrounding soft tissues will naturally shrink down and adapt to the decreased bone structure. However, in the chin, this is often a very different story. The soft tissue chin pad does not have the ability to substantially shrink down and, when it does, it contracts around the decreased bone support over a less projected point. This accounts for every symptom that you have. In essence, this is now a mismatch between the bone support and the overlying soft tissue. So it really isn’t chin ptosis in the classic sense it is soft tissue chin pan pad redundancy. I have seen this many times from such procedures performed into orally and the key question is what can you do for it now and will it be effective?

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, . I’m 33yo female. Prior rhino. My nostrils were fairly normal but now peaked…n nose is small and cut out looking overall.. likely due to Morpheus 8. It wiped out my facial fat and gave my nose a weird shape n my forehead has bone ridges. When my forehead was swollen after upper bleph- I really enjoyed what it looked like.

A: Fat grafting to the forehead and nose is very unpredictable in terms of survival and prone to irregularities so its use is restricted to very specific criteria.

For example a prior rhinoplasty would rule out fat grafting due to the scar tissue and the difficulty injecting into such tissues.

By description your forehead is more eligible since it has never had surgery and the problem appears to be skeletonization (lack of soft tissue volume)

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, am seeking advice regarding a longstanding concern about the appearance of my shoulders and clavicles. I have attached photographs that clearly show the issue.

My left clavicle appears noticeably shorter than my right, and my left shoulder seems to sit further underneath the clavicle rather than extending outward in the same way as my right side. As a result, there is much less separation between my left shoulder and clavicle, making it appear as though I have little or no shoulder on that side. In contrast, my right shoulder has a much more typical appearance with greater width and definition.

To the best of my knowledge, this is not the result of any injury or trauma. I have no known medical conditions and have noticed this asymmetry for as long as I can remember, dating back to my early teenage years. My father’s shoulders, while naturally slim, are symmetrical and proportionate, so I have been unable to identify any obvious familial explanation.

This issue has had a significant impact on my confidence and mental wellbeing. I find myself avoiding T-shirts and beach holidays, and I often go to considerable lengths to make my shoulders appear more balanced under clothing. At 32 years old, this remains a source of distress, and although my fiancée is supportive, she does not fully understand the extent of my concern.

I would be very grateful for your assessment of whether there could be an underlying anatomical cause and whether there are any investigations or treatment options that might improve the asymmetry or its appearance.

Thank you for your time and advice.

A: Thank you for your inquiry and sending your shoulder pictures in which the shoulder asymmetry is apparent. The definitive assessment requires a 3D CT chest scan to fully see the bony anatomy and any comments I make are preliminary to that visual analysis.

This appears to be a congenital shoulder asymmetry where the entire shoulder unit is situated lower (not shorter). It does not appear to be an issue with clavicle bone length on the affected side.

But again until I see a 3D CT scan and make measurement of the clavicle length and see its angulation compared to the other side I can not be sure.

There are some potential corrective procedures such as clavicle bone lengthenng and deltoid and trapezius muscle implants. But it is yet unclear what, if any these would be beneficial.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, One more question I know you said 2.5 cm is the max but I seen on the website that the doctor will do 3 cm on each side. Would that still be safe?

A: The safe amount of bone removed in clavicle reduction surgery is ultimately determined during the procedure. However, based on a vast amount of experience with the surgery unless you were about 6’5″ tall you are not going to get 3 cm of bone removal per side.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am writing to you regarding an issue that has troubled me for a very long time; I have a very pronounced skeletal facial asymmetry, visible mainly around the eyes, eyebrows, and cheekbones (zygomatic bones), but also affecting the ears and jaw. In fact, almost all the bony structures show a vertical and volumetric discrepancy between the two sides (confirmed by a 3D CT scan).

I have read almost all the articles on your blog regarding the procedure you perform for vertical orbital dystopia (correcting up to 5mm of vertical difference using an implant).

I have a few questions regarding this:

– In your opinion, what is the extent of the discrepancy between my two orbits?

– Is there a risk of double or blurred vision, or of damaging the optic nerve?

– Since the asymmetry isn’t limited to the eyes, what else do you think should be done to “improve” my appearance and reduce the asymmetry?

– My previous surgeon proposed a zygomatic osteotomy and an orbital implant of a few millimeters, but nothing to raise the eyelids or eyebrows; what is your take on that?

A: In answer to your vertical orbital, dystopia questions;

1) I would estimate that your vertical orbital dystopia is at least 5 mm difference if not more.

2) Anytime you dissect and elevate the soft tissues off of the orbital floor there is always the risk of some potential visual disturbances. In my experience, it most likely could be some temporary double vision. But the greater the orbital floor implant, the more likely that is to occur.

3) Vertical orbital dystopia is not isolated to just the eyeball itself. All of the surrounding bones are lower particularly that of the infraorbital rim and cheek whose correction is part of the custom orbital – malar implant.  This is why just sticking an implant on the orbital floor is an in adequate/incomplete approach to its treatment.

4) One of the key concepts to grasp in the surgical treatment of vertical orbital dystopia is that it is not just a bone problem, everything is lower that surrounds the eyeball, including the eyelids, and very often the eyebrow. If you simply raise up the eye even a few millimeters and don’t adjust the eyelids around them you were going to increase lower lid scleral show and create ptosis of the upper eyelid… problems which you currently do not have. The comprehensive surgical treatment of vertical orbital dystopia requires a combination bony and soft tissue approach.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I want an expert’s opinion on what procedures would be the highest ROI for me to improve my overall harmony/facial attractiveness.”

A: In a male, and you are no exception, the chin and jawline is always one of the most significant changers of the face, in terms of both attractiveness and proportion. In your case, specifically it is the chin rather than the jawline behind it. With your broader forehead and wider spaced eyes and bizygomatic cheek width increased greater vertical and horizontal chin projection is the single greatest change you could make for improvement. If it came down to one procedure only that would have your greatest ROI.

Dr Barry Eppley

Plastic Surgeon