Your Questions

Q: Dr. Eppley, Hello, I am interested in facial balancing, particularly the midface area. I would like to address pronounced nasolabial folds and a flat midface.

A:Thank you for your inquiry and sending your pictures. There are numerous factors that go into the appearance of nasolabial folds any young person of which one of them is a flatter central midface projection. Lower pyriform aperture (premaxillary– paranasal) augmentation can be helpful in reducing the appearance of nasolabial folds although they will not completely eliminate them. A debate can be had as to whether such implants should be custom made or to use standard implants but that is a discussion for a later date.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, DomI need chin augmentation? Apparently, I am borderline. I mainly just want better definition not increased size.

A:There is nothing borderline about whether you have a weak projecting chin as it is deficient in both horizontally and vertically. The only thing borderline about it is from an aesthetic standpoint of how much chin augmentation you can accept if any. It is impossible to achieve better chin definition without an increase in size. Increased definition of any body part is always going to involve some change in the dimensions of its size.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Generally curious what procedures you would recommend given my complaint. I don’t like the ratio of my narrower and recessed forehead to my cheekbones and jaw width resulting in a big lower face. Not sure where to add or subtract from. I sometimes feel like my jaw is very wide but not sure if that is because my chin is a bit short and under projected for my face. I really don’t know if I would benefit from jaw shaving + chin implant versus a jaw implant that adds length to my face. Another question is cheekbone narrowing – would this give the results I want? I know it is common amongst asian people but I’m pretty wary of taking away what seems to hold up you whole face. It does seem to look good in photos. I don’t mind the anterior projection of my forehead, but hate how flat it looks at the 3/4 angle. At the same time not happy with the loose skin under my chin. Would a chin or jaw implant fill that loose skin and take care of the jowls? or would I need a neck lift in conjunction with the implant.

A: Thank you for your inquiry and sending your pictures. My initial reaction is that your needs are more reductive in nature rather than augmentation. My speculation is that what bothers you is the natural facial structural shape that is consistent with your ethnicity…. meaning the lower two thirds of your face is wider and more square. Thus while you can augment your forehead, in and of itself,  that just takes your  base concerns and magnifies them making the entire face broader. The focus is on your mid and lower face of which you have a flat mandibular plane angle which makes for a broader lower jaw and naturally wider cheeks.. While n there may be a role for some vertical chin lengthening cheek and  jaw angle reductions are the methods to narrow your lower face.

To summarize my initial reactions are: 1) cheek and jawline goal reductions, 2) vertical chin lengthening and 3) moderate forehead augmentation to correct the shape and the three-quarter view. This will certainly help the submental and jowl areas in regards to loose soft tissue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, it’s great stumbling on your website. I do have a similar horizontal indentation on the top of my head and I wonder if your plastic surgery would not only fix the aesthetic concern but headaches, and migraines like symptoms (sensitivity to light, sound and smell) that appear to be exacerbated by the indentation. I will sincerely appreciate your feedback

A:This is the classic indentation across across the coronal suture line on the top of the head between the bony temporal lines. This is an aesthetic skull deformity that is not known to be associated with any functional issues. Thus fixing the skull contour defect by a custom skull implant  would not be expected to cause any change in your headaches or  other symptoms.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I wanted to ask a question about facial asymmetry and possible procedures to address it. On one side of my face, my eye sits lower, along with the eyebrow, eyelid, and cheekbone. I was wondering which procedure would be best to correct this. I’ve read about combining an orbital rim implant with a cheek implant. However, I’m concerned that if the eye is raised with an orbital rim implant, the eyebrow and eyelid—since they are already lower—might appear more covered. In that case, I understand that an eyebrow lift might also be needed to bring the eyebrow and eyelid to the same level as the other side. This approach could make the eye and cheekbone more symmetrical, but the eyebrows might still be uneven. That led me to wonder whether fat transfer to the opposite eyebrow and eyelid could be an option. By adding volume to that side, it might lower the eyebrow slightly and help both eyebrows and eyelids sit at the same level. Is that something that would be possible?

A:What you are describing is classic vertical orbital dystopia, which means the entire orbital box in all of the soft tissues around it are low. As you have correctly surmised correcting the orbital floor, rim and cheek bone positioning by a custom-made implant is not the total solution to the problem. In fact that alone will likely make it look more apparent because you have to change all the soft tissues around it including  the upper and lower eyelids as well as the eyebrow. to look right with the implant induced changes. Thus  most cases of vertical orbital dystopia surgery must be comprehensive of which the implant is but one part of it.

Fat grafting of the opposite eyelid is not going to make it lower. It will merely make it look fuller. As a general rule for almost all cases of any type of facial asymmetry you do not usually try to improve it by changing the good side. That being said this is a general guideline of which how about exactly replies to you is unknown since I’ve never seen a picture of your eye asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am scheduled (this upcoming week) to have a mid-facelift with a fat transfer and buccal fat removal. During the initialconsultation, the surgeon mentioned that based on the look and projection I’m looking to achieve, facial implants might be needed.  He also advised to have the implant procedure done a few months after the mid-facelift and fat transfer, so we can better determine more accurately the implant specifications once the swelling and fat transfer have subsided. The implant and placement that I’m interested in is a thin, elongated implant to be placed right under the temple and extend on the high point of the cheeks.

Here are my questions:

• Is there a benefit to having 2 separate procedures, one for the facelift and the other for the implants? (I prefer to have one procedure to prevent another anesthesia)
• Is there a possibility to not need a fat transfer at all if implants are used?
• Where will the incision be for the implant? Through the hairline, mouth, or inner lower eyelid? 
• Is there an option to use Porous polyethylene instead of silicone? 

A:Thank you for your inquiry and sending your pictures. The first and most important question is what exactly are you trying to achieve. I could probably guess based on the procedures that are being considered as well as your young age and your pictures. However I really don’t want to guess and I need for you to tell me specifically what that is.

But some of the answers to your questions without knowing your goals I can say the following:

1) it is likely what is meant by that you may need facial implants is that if the first procedures aren’t effective for your goals then implants will need to be done later. That’s the question is not whether these procedures should be combined or separated but based upon your goals what is going to be the most effective approach. Until I know your exact goals it is impossible to say whether such procedures should be done together, separate, or whether only one of them should ever be done.

2) One of the basic reasons for implants as to avoid the use of fat or filler injections later… Provided the area of augmentation needed is in the zone where the implants are placed.

3) Since I don’t know what your goals are for the type of implant that is being considered here I cannot yet say what would be the access to place it.

4) While porous polyethylene is always an option in any type of facial implant augmentation it generally it’s not a good choice in my experience because of its extreme difficulty in secondary modification or removal. And although everybody thinks they would never be the patient who would need their implants revised the reality is there is a 40% risk of that occurring which makes it not rare. In addition if one is having implants in the mid facial area due to the thin tissues porous polyethylene does not have feather edging by virtue of the way it is manufactured which means means there will be a palpable and sometimes visible edge to them. Tissue ingrowth into an implant material always sounds good provided the implant positioning, shape and size is perfect and you never have to touch them again for as long as you live. But when any secondary changes are needed tissue ingrowth becomes a major liability and no longer an asset.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, When you say 50% chance of success, meaning 50% chance of other complications left with more/other problems worse than before? Have you had patients left worse than before? Any successful cases you could share pictures or is it all confidential? How does the recovery process looks like?

A:The 50% success rate in mentalis resuspension refers to that in those with an unfavorable outcome they relapse back the where they started…. never worst just not any better.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My current atrophied testicles are quite small.My testicles have atrophied a lot. They are very small. About 10 years ago I had some type of inhjectabole filler placed into the skin of the scrotum. I was never told exactly what the filler was but it was allegedly a filler that promotes collagen growth. As a result my scrotum skin has remained quite thick.

I would like to increase my testicle size. Considering the current size of my testicles and my desired implant size, is the wraparound method even possible?

I like the idea of this method but my concerns / questions about this method are:

If I come off TRT and get my natural testosterone levels back up with the help of HCG (or whatever else I need to take), I fear my testicles either not being able to grow, or getting crushed as they grow, and it just being uncomfortable. Is this fear justified?

I fear not being able to feel for testicular cancer… am I correct that this would make it impossible? Are there any other ways to check for testicular cancer? Would I have to get an MRI or x-ray if I wanted.

A:Thank you for your testicular size information. Testicles of that small size would not be a candidate for the wraparound implant method as they are at a high risk of slipping out of the implant encasement. In addition if there is any chance that the testicle size could go up or down based on hormone therapy that is another contraindication for the wraparound augmentation method. Only the testicular implant displacement method would be appropriate in your case

I don’t know exactly what injectable material was placed into or around your scrotal skin but when you use the term micro injections you are likely referring to silicone oil. This is substantiated by the fact that the scrotal skin has remained thick due to the persistence of injected material and the surrounding fibrous capsule that is created by it. The relevancy of having silicon in  the scrotal skin is when you intervene with surgery the risk of infection is increased because of the silicone oil. While most of the silicon oil is encased away from the incision there undoubtably is some where the incision would be made.

As for the detection of testicular cancer any implants placed in the scrotum definitely has some negative effect on the ability to detect it. How significant that may be is not known. The implant displacement method is better in that regard as the natural testicles still remain ‘free’  and potentially palpable. The implants do bot interfere with the ability to do any diagnostic imaging such as ultrasound or MRIs/

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if I could get a quick opinion on the tragus and a SMAS facelift? Is it typical for a surgeon to cut off the top of the tragus during a facelift? Mine did and I’m not sure why? Photos attached. (Before pics are with yellow lines.) Wondering what your thoughts are. Thank you!

A:The goal of any facelift technique where a retrotragal incision is used is to preserve the tragal cartilage and shape. That obviously did not happen in your case. The why of it is a question for your surgeon to answer.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, would it be possible to add such a ‘mini’ implant to my under-eye area to address the hollowness? Right now honestly, the under-eyes are the one aspect of my face I find to be considerably deficient aesthetically even after IOM implants/fat transfers (i.e. the chin is not that bad all things considered). Fat transfers always leave a bit of hollowness after months.later so I was wondering if some smaller implants stacked on top of the existing IOMs could help with this in the same fashion as you discussed for the chin?

A:The residual undereye hollowing lies above the bone/implant level in the soft tissue area between the augmentation and the lashline of the lower lid which is what I believe to which you are referring. This is not an area in which hard structural augmentation is effective without causing potential lower eyelid mobility issues.. It requires soft tissue augmentation which is why you see fat injections some commonly used (abeit usually not effective) The alternative and more effective soft tissue augmentation methods include laying in a leager thicker Alloderm sheet or a thin dermal-fat graft across the entire lower eyelid.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a question regarding chin tightness after a revision chin reduction following an initial sliding genioplasty. As I have read your previous answers mentioning a lack of soft tissue causing the tightness, would a potential chin narrowing and height reduction procedure alleviate this symptom due to the reduced surface area that the soft tissue has to be stretched to cover – effectively mimicking having more soft tissue in the area? Or can this only be addressed with a fat graft? Thank you!

A:It’s a soft tissue deficiency/scar problem not a bone excess problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if it would be possible (and if so what the main issues would be) to make a low osteotomy on the iliac crest and then rotate it inwards as a mean to achieve a greater hip reduction than it’s currently offered with the iliac crest resection method. In the attached file there’s the visual representation of what I mean. At the right is the unmodified hip and at the left the modified hip where I show two versions of the same idea, one (left) where the osteotomy goes above the ASIS process and the other (right) where the osteotomy does not go through the ASIS but below it and above the AIIS. The right one is probably the better option as it would allow for a bigger reduction and it would not mess with the process destined to support the TFL, sartorius muscle and the inguinal ligament. I’m also wondering if the gluteus muscles like the gluteus medius and the iliacus muscle on the iliac fossa would be a problem. Also, maybe rehabilitation would be harder because of the stretching of the muscles and ligaments. Thanks for your time.

A:Thank you for your thoughtful inquiry in regards to the iliac crest osteotomy. I would not disagree with you from a conceptual standpoint and clearly the one where the osteotomy line leaves the ASIS intact would be the more effective one in terms of inward movement and it is obviously prudent to leave the inguinal ligament attachment intact. Technically this would be more of a bone cut and tilting the iliac crest inward with the placement of inter-positional grafts (cadaveric bone chips) in the opening wedge that is created. I could see some issues trying to just push the iliac crest inward because of what lies on inner surface of the pelvis. But, quite frankly until you actually do it it’s hard to say which bony movement can actually be done with greater ease. This obviously would require some plate fixation.

I see only two potential issues with this approach really crest reduction. The first is you would have to strip off all of the TFL fascial attachments along the crest to expose the bone for the osteotomy cut. Whether they could be put back by suture suspension to the  crest is unknown, and if not,  what does that mean for postoperative ambulation. Secondly, how much greater benefit comes from moving the bony crest inward as opposed to shaving reduction. Theoretically you would think you would but I would not be so certain.  A fair amount of bone can be shaved off laterally that easily exceeds one cm. On the 3-D model you have to actually simulate both of them and see how much different it really is. In other words is the greater effort involved in the  iliac crest osteotomy  worth the additional improvements that provides over that are shaving. Like all aesthetic procedures the risk to benefit ratio must be very carefully calculated. And in iliac crest shaving reduction there have never been any significant aesthetic or functional issues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have had chin and jaw implants (both silicone, the jaw implants are fixated by screws, the chin implant is not) for roughly 10 years now. They were placed about a year apart, with different surgeons. I regret having anything in my face, and am looking to remove them entirely, and do a sliding genioplasty to make up for resorption from the chin implant, if this is possible and safe to do. I no longer can tolerate the feeling of the implants inside of me, and I do not like the look of them especially in motion and certain lighting, and just want to revert back to my normal self as closely as I can. I am a bit worried about resorption or impressions left from the jaw implants, and the overall process of removal. I think I may benefit from a CBCT scan (I believe that’s what it is called), to see what’s going on underneath.

A: Thank you for your inquiry and detailing your objectives of chin and jaw angle implant removals. It is quite normal on the lower jaw for any type of implant to have some imprinting on the bone as well as bony overgrowths. How significant implant imprinting is on the bone and the amount and locations of the bony overgrowth can be quite variable and is not related to implant size, material, or duration of implantation. These are natural biologic phenomenon from the presence of an implant which violates the congenital anatomic boundaries of the tissues. This is not a pathologic reaction and it has no functional significance.

If it is important to visualize the bony impressions and the amount of bony overgrowths this requires a 3-D CT Scan with digital removal of the implants and colorizations of the imprinted areas as well as the bony overgrowths. This can certainly be done but does not impact the implant removal process.

If the goal, in addition to implant removal, is to try and restore the bone contour as much as possible to its pre-surgical state you could fill in the bony impressions with cadaveric  bone chips. While you could do a sliding genioplasty to compensate for the impression left by the chin implant that maybe overkill for the amount of oppression death that exist and bone chip placement alone may be more appropriate.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m trying to clarify whether this is even a real, standard option (not some crazy experiment). In the same way rhinoplasty is a well-established solution for a nose someone doesn’t like, is surgically increasing facial width (e.g., via cheek/malar and/or jaw angle implants) a recognized and commonly performed solution for patients with a proportionally narrow face?

Specifically, has this been routinely done before with the goal of increasing lateral facial width from a frontal view, and is this considered a normal indication for these procedures?

I’m not asking about extremes, only whether moving from narrow toward normal proportions through skeletal widening is a legitimate, established approach.

A: Skeletal widening of the face, whether it is the jawline or cheeks has been a standard surgical procedure with implants since the 1990s. It has become improved and more patient specific with contemporary custom implant designs. Such facial widening cannot be achieved by any bone-based procedure such as osteotomies or bone grafts.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to ask about the feasibility of achieving a small, conservative increase in intercanthal distance (approximately 2–3 mm total or 1-1.5mm per side) through a combination of limited bony and soft-tissue approaches.

Specifically, I was wondering whether a 180° orbital box osteotomy combined with soft-tissue adjustments such as medial canthoplasty / medial canthal tendon repositioning, could potentially create a modest increase in ICD while preserving the natural length and shape of the medial canthus (i.e., without visible shortening or distortion of the inner eye corner).

A:An inferior orbital box osteotomy works best for modest increases in the intercanthal distances. Technically it is not really 180° as the inner bone cuts cannot cross the bony location of the lacrimal sac.

The required soft tissue procedure in the corner of the eye to increase the distance between the two sides is not a medial canthoplasty.. This is done by V-Y lengthening procedure of the external lacrimal lake area which moves/closes down the inner eye corner out 2 to 4 mm on each side.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I previously had a chin implant that initially created vertical elongation, but over time the contour has become rounded and anterior. I’m concerned about capsular contracture or bone remodeling and want an evaluation comparing implant revision versus sliding genioplasty. I loved how my implant looked at first, but over time I believe the shape has changed.

A:What you are experiencing is a normal phenomenon that most patients are completely unaware. First and foremost almost all standard chin implants have a round and bulbous shape to them and they are usually placed on the front edge of the bone. It takes a long time after surgery to truly see the final chin shape because of the unrecognized shrink wrap effect of the overlying soft tissues. This is why it can take a year or longer to see these details  as eventually the chin assumes the shape just  like of the implant that sits underneath it.. which in some patients can like a bump on the bone. This effect has nothing to do with capsular contracture which does not occur in facial implants because they are not meant to be a movable and flexible structure like an implant is in the breast. Nor is it due to bone remodeling. In short this is due to the actual shape of the implant being seen long-term over time.

The first step to do to determine what your best options are as to understand fully the shape size and location of the implant on the bone.  Never guess what is going on underneath or make judgments out what one should do based on an external appearance The needed information requires a 3-D CT scan which will clearly show this information. Then you can evaluate the options of replacement with a custom chin implant or a sliding genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I saw a surgery you did to shrink a person’s head, is it possible on me?

A: Skull reductions are best thought of as area reductions…not shrinking the whole head down. Thus the key question is what skull areas are the most promienent to you. In looking at your pictures I would assume the back of the head which is where the skull biones are the thickest and teh greatest amount of reduction can be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley, My goal is to get rid of the sagging skin above my knee.

A: Crescentic shaped excisional knee lifts can remove suprapatellar skin rolls with the tradeoff of a crescentic scar line.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I like the chin augmentation imaging but I wish the jawline was sharper. Would this be possible with weight loss? Also, I think the chin looks a bit pointy.

A: 1) A sharper jawline s never going to come from a sliding genioplasty or any form of soft tissue reduction. Better jawlines only come from augmenting the entire jawline.

2) Your reaction to the amount of chin augmentation means it is too strong or too much. Which indicates that a bone movement of 5mms, to 6mms is the most you can aesthetically tolerate.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: DR. Eppley, Overall, my stomach looks good standing, but when I sit down I notice skin folding that feels more like mild skin laxity rather than excess fat. I’m looking for an honest opinion on whether this is better addressed with observation, a conservative approach, or if any surgical option would even be worthwhile in my case. Given my prior experience with Dr. Eppley and how much I trust his judgment, I would really value his opinion on the abdominal concern and whether anything should be done at all.

A: The answer to your abdominal question which is whether there is merit in doing anything comes down to two considerations. First how much of a skin roll is present when sitting down and how laxitu does the lower abdomen  have when standing up. AS good way to make that determination is to take a marker when you are sitting down and outline the upper and lower margins of the skin roll from side to side. Then see what that looks like when standing and then do the pinch test, meaning grab the upper and lower margins of the marked areas centrally and see how easily it comes together. If it is hard to get together then a lower mini tummy tuck scar may not do well. If it comes together fairly easily then there’s enough skin laxity for a more favorable scar outcome.. The second consideration is how you feel about a lower abdominal scar as a trade off for that sitting skin roll.. Where that scar will be located and how long it might be will require me to have knowledge as to what that marked area looks like when standing up.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hey there, I am interested in testicular implant surgery for cosmetic enlargement (not medically required – I have both testicles though they have atrophied a lot from being on TRT). How much is the total cost of procedure? And if custom implants were needed, how much more would that be? 

A:The first question is which method of testicular enhancement do you need,  displacement versus a wraparound approach. That would depend on the degree of atrophy that your testicles has. Many men on hormone supplementation d undergo significant atrophy and usually this is treated by the displacement method. Either way such testicle implants are all made custom and that is a process which could take up to 30 days to manufacture and receive the implants for surgery. The maximum size of standard testicle implants is 5.0 cm which is neither sufficient for the displacement method and obviously cannot be used as a wraparound implant.

The first place to start is to tell me by simple measurements what is the current size of your testicles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I want to go from 700cc to 2000 cc breast implants.

A:Trying to go from 775 CC breast implants to 2000 cc breast implants is neither possible, and even if it was, it is certainly not advised. That is a complication waiting to happen. On a more practical basis going from 775 cc  to approximately 1200 cc using silicone gel breast implants is more achievable in terms of tissue tolerances as well as minimizing the risk of complications. That is still a 62% increase in size. As a general rule in secondary implant enlargements a 50% increase is usually what the  tissues will tolerate (stretch) inside the existing pocket.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Here are some pics of my damage occipital bone. I was involved in a roll over accident I hit my head so I have a bump on the rear right of my head, a hole fractured inwards as you can see in the image a circled. I’m trying to see if I can reshape my fracture occipital bone, to look more like a normal occipital bone more round in the back.

A:Thank you for sending your pictures. Most certainly the damage occipital bone can be adequately reconstructed for a better contour. Which technique that would be best to do that, either the application of hydroxyapatite cement or a custom skull implant, cannot be determined from your pictures alone.  It really takes a 3-D skull CT scan to fully appreciate what the exact contour deficiency is compared to the opposite side. I don’t know whether the area that you have circled on your pictures represents the scope of the contour of depression or whether are you merely circled it to indicate the area. For now, until a 3-D CT skull scan shows us what is the best method.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a sliding genioplasty 7 months ago. Unfortunately, ever since then I have been facing lip imcompetence, open lips at rest and feel like I have to pull a muscle everytime I force my lips to close. Additionally from my observation the surgery has left me with a longer chin, longer philtrum and a different lip shape. I wondered if this would get better if the titanium plate was removed. My surgeon has dismissed my concerns and seemed clueless when I mentioned mentalis muscle resuspension. He only injected a steroid injection on my chin saying that this was scar tissue, unfortunately that didnt help with my problem at all. 

A:Such lower lip incompetencies after a sliding genioplasty can be very hard to correct. But what I can say with good prediction is that removing the plate and screws alone will provide no improvement as this is a soft tissue sag issue. In the execution of an intraoral mentalis muscle resuspension procedure the hardware would be removed as a matter of convenience as well as getting it out of the way for the new suspension point. Having performed many hundreds of mentalis resuspension procedures over the years I view their success rate as about 50%. Judging the real success of such a procedure is not what it is like in the first few weeks but what it is like 3 to 4 months later.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon