Your Questions

Q: Dr. Eppley, I would like to know if it is possible to reduce the volume of the greater trochanter bone ? Because for me, it sticks out a lot and makes my silhouette look very weird. My greater trochanter isn’t in the continuity of my hips and it causes me a great pain (impossible to dress) and I cannot accept it. It looks very ugly. 

Furthermore since the greater is that big, it causes me a lateral pain (on both sides). I would be very grateful if you helped me.

Thank you for your answer.

A:While the greater trochanteric bone can create an unaesthetic bulge in some people, it is important to recognize that it is there for a purpose. It is a bony prominence onto which multiple muscles attach (gluteus minimus, piriformis, TFL) with an associated bursa. Besides the potential functional effects from muscle stripping to get to the trochanteric head there is also the risk of creating bursitis and chronic pain. It is for these reasons that trochanteric bone reduction is not done for aesthetic purposes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I have a natural narrow mouth in neutral position. I am considering a lateral commissuroplasty to make my mouth in neutral position a little bit wider and model look. (2mms each side). However, when I smile my mouth is wide, so by getting this lateral commissuroplasty, while my smile get wider? I don’t want my smile wider, just my mouth when it’s in a neutral/expressionless position.

A: By definition if you make your mouth width greater at rest it will become greater when you smile. That is the aesthetic tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I am considering lateral commissuroplasty of increased outer mouth width (1-2mms) equally. Will the scarring be bad? I know the area around mouth is sensible and easily scar-able. But how bad is it? Can the scars be seen from face to face distance or do you have to really look at your face in closeup to see the scars. I will attach my photos of my desired outcome. Do you think my mouth result is achievable with scars that can’t be seen when talking face to face to someone ? (1-3 feet away)

A: The scars from mouth widening surgery is highly influenced by the amount of lateral movement. The usual amount of mouth widening is in the 5 to 7mms range. When it comes to a 1 to 2mm increase, in which I have never done that small amount, it would certainly create the most favorable scar lines.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a gynecomastia surgery in two years ago. The result looked very good in the first month, but after removing the compression strap a scarred tissue lump appeared on both nipples and the skin was also flabby. Six months later my doctor injected steroids and I didn’t like the result, the nipple became very flaccid and came out, especially when they get cold and the nipple become more prominent and areola appears to have deformities, worse than before the steroid. (dexamethasone)

 The ultrasounds say I have the remains of a gland. The doctor who operated on me says it is better not to move anymore, but I can’t live like this. I feel that I have a lot more breasts than before the surgery. I would like to have your opinion of my situation and how I can improve my case to get on with my life. I can’t wear a t-shirt because the nipples are very marked. Thank you.

A:Thank you for your inquiry and sending all of your pictures. The situation you have now is a tough problem and I would be very cautious about deciding what to do since it is very possible to make it worse. The safest thing to do is to break up the scar tissue and remove a little more tissue on the chest wall with liposuction combined with a nipple reduction. Open excision is very likely to make it worse as you already have some contour irregularities.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, interested in removing excess sagging around belly button and what the cost and procedure would be. 

A:Thank you for your inquiry and sending your picture. With loose skin around the umbilicus there is no good direct way to remove it. (i.e., vertical excision or periumbilical excision) Such scarring is just as bad as the loose skin if not worse. The effective method is a horizontally-based tummy tuck where a new belly button can be made through a fresh skin site. Whether the lower tummy tuck is viable depends of what the rest of your abdomen looks like as well as your tolerance for a lower tummy tuck scar.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a chin Implant 3 years ago when I had a rhinoplasty done. I never wanted a chin implant however the surgeon recommended so I got it. Nine months after I decided to get it removed because I felt it made me look masculine, too much projection. However my skin began to sag after removing it and I don’t like it. I feel like my chin looks so long. What do you recommend should be done to fix this. My skin sags more when I smile. Please advise. Thank you I appreciate your time! 

A:Thank you for your inquiry and sending all of your picture. What you have is very common after chin implant removal, the stretched soft tissue chin pad does not shrink down and go back to its preoperative state/position. Rather it sags/drop due to the two sides of the capsule not adhering. The most effective strategy for its surgical managment is a submental tuck to remove the overhang. An intraoral resuspension seems logical but works inconsistently my experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! While I’m in no place to afford a cosmetic cranial implant right now, I was wondering if I could see results in the future. I’m a 5’9″ male with a cranial circumference of 53 cm. So extremely small, and I absolutely hate my head. Can a cranial implant make my head look normal? My forehead is slanted backwards and the back of my head is flat.

A: A custom skull implant can be designed to improve the slope of the forehead and the flatness of the back of your head. If improving those areas is what constitutes a more normal head shape then it will be a successful procedure for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, for my hyperdynamic chin ptosis, if it is treated by a submental technique where the excessive soft tissue chin pad is reduced/tucked. Will this cause my chin to have dimples, or orange like texture to my chin? Or make my mentalis muscle weak and worsen?

A:Good questions and the answer would be no on both of them. Since the surgery tucks from underneath there are contour alterations in the soft tissue chin pad. Most of the excised submental tissue is skin and fat and not muscle so no mentalis muscle dysfunction will occur.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I have a flat head and I’m struggling alot with my skull’s shape. Can i know how much the scull reshaping costs?

A:The term ‘skull reshaping’ is a very broad term and does not specify the problem being treated or the specific procedure need to treat it. Without a detailed description of your head shape concerns accompanied by pictures to support that description I can not provide an informed answer to your question(s).

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am seeking a rhinoplasty and chin implant. I am transgender and looking to enhance how masculine my face appears as well as improve it aesthetically. I’ve considered buccal fat removal or cheek implants, even liposuction to my chin/jaw area, so I was wondering if you agreed with that assessment. (that it would improve my appearance aesthetically)

A: Thank you for your inquiry and sending your pictures. I have done imaging looking at chin and nasal dorsal augmentation for their potential facial masculinization effects. In terms of achieving those changes the debate is between implant vs rib graft for the nose and implant vs sliding genioplasty for the chin. I would certainly agree that the defatting procedures of buccal lipectiomy,, perioral/facial and submental liposuction would be of benefit in facial slimming/contouring and would be complementary to the nose and chin augmentation efforts.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for a skull as well as heel implants to make myself few inches taller as I am only 5-3 and because my Career is at stake. I tried to reach to few plastic surgeons but could not figure out where I can get the surgery . With a lot of hope I am texting you just to find out if such a surgery is available with you ….Please kindly help.

A: While I can perform a custom skull implant that cam make your head up to one inch taller, I do not perform heel implants or am not aware that it is even a viable surgical procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had cosmetic hip implants done in Los Angeles — twice, actually. The second was to upsize. 

Unfortunately I’m not terribly pleased with the result — while the “width” is roughly what I was going for, the widest point is definitely higher than I would have liked, and the placement of the implants appears uneven when comparing both sides. 

I am just curious if you would consider doing such a remove/replace following a different surgeon’s work, especially knowing that your approach would likely be a bit different (including carving out a larger pocket). If this is something you’d consider, please let me know and I’ll send pictures. 

A: Thank you for your inquiry and detailing your hip implant history. I have no restrictions about performing secondary/revisional surgery on other surgeon’s work as I do it all the time. My only criteria for such surgeries is whether I have a high confidence that what I can do with actually improve the patient’s concerns.

In that regard the critical issues are the shape of the hip implants and their current asymmetrical positioning. The former is the most assured to improve as that is a function of their shape/design of which your exact concerns I have seen numerous times. While I would need to see the design file for your current hip implants, most likely it is that the maximum projection is in the upper third of the implant. Many patients desire the maximum projection area to be lower.

Hip implant asymmetry, however, is a different matter and is not so easily improved. The incisional access to hip implants is remote from the actual encapsulated pocket and visual access is very limited to pocket manipulation/change. While the implant can be lowered through a small incision at its inferior end, raising up a low hip implant is almost impossible to do in my experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I really would like a ball park estimate of forehead masculization before taking the next step. I want to make sure I have enough saved. Thank you. 

A: Thank you for your inquiry and sending your picture. When you speak of forehead masculization you are most likely referring to a combined forehead-brow bone augmentation using a custom implant design concept as shown in the attached images. While brow bone augmentation can be done alone many men that lack brow bine projection have foreheads that slack backward. I can tell whether this exactly applies to you without seeing a side view picture.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a custom jaw implant by another surgeon in 2019, at first it looked good even though it was very swollen. But as swelling subsided, the implant lost all its angularity and Ive been left with a round looking facial shape, which is convex downwards at the mandible. In addition, the masseters detached causing asymmetry and since the doctor didn’t fill the first hole on the mandible with a screw, some soft tissue had filled it and now a small circle of my skin is attached there. If I undergo revision, are you able to fix these problems, especially the convexity /angular-less shape. How will you change the implant design from my current one which I have attached? including the prediction of the final result vs the actual. can I achieve the prediction?

A: Thank you for your inquiry and sending your picture. One of the advantages of having a jawline implant design and knowing the exact aesthetic outcome allows one to know with greater confidence on how a design change would be better. For me I could see in the original design that the jaw angles were too rounded and there is way too much material in the body of the mandible and could have predicted the lower facial shape outcome you have now. A linear jawline implant design may look good on an skeletal model but that design shape is not good for everyone.

But implant design improvements at the jaw angle, however, are going to be compromised now because you have masseteric muscle dehiscence. This implant-soft tissue contour mismatch is not going to be improved by a new implant design and would likely appear worse when the angles have greater angularity.

I have not seen great results with trying to bring back down the retracted muscle once it is scarred/shortened. In my experience it requires a soft tissue contouring method and would eventually consider soft tissue angle implants placed through a very small back of the angle skin incision. This would provide the most assured correction of the angle contour issue and great increased angularity at the same time.

But since you have to replace the implant anyway because of its rounded bowed shape, you might as well change the jaw angle area as well. But don’t expected a new design to solve the soft tissue jaw angle issue. That would have to he addressed secondarily as previously mentioned.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know if it is possible to reduce the width of hips by shaving the great trochanter. Is it possible to narrow the great trochanter? I am thin ( I don’t really have extra fat) but the bone of the great trochanter sticks out a lot. It makes my hips look very weird. I cannot dress because my silhouette looks strange. It bother me lot! I would just like the great trochanter to be in continuity with the rest of my body. Is there any surgery to make that possible? It really the great trochanter that cause all my issues. 

I would really like to have an answer. Thanks a lot

A: The greater trochanter of the femur has numerous important muscular attachments to it that are essential for walking and hip stability. Thus it is not possible to reduce its width for aesthetic purposes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve had extended infraorbital implants with SOOF lift but unfortunately there have been nerve complications with a permanent change in sensation most likely relating to the infraorbital nerve, My upper lip is worst off with a sharp painful feeling when stretched or pressured. The lip is a bit numb but also very sensitive to sharp stimuli like when I bite it. The left side is much worse than the right and a part of it gives off a strange feeling including increased sensitivity to cold and heat. The rest of the areas controlled by the infraorbital nerves, the frontal midface, side of the nose, lower eyelids etc. are numb with occasional weird sensations that come and go. Again the left side is much worse and reacts weirdly with temperature often spreading throughout the area. 

What could cause this, might it be pressure from the implants, scar tissue or perhaps I was unlucky and the nerves have been permanently damaged somehow? Can I hope that this might be treated or are these symptoms telling you that the damage is permanent? 

Thank you.

A: As you have correctly surmised these are infraorbital nerve symptoms. Whether they are due to compression from the implants or from the dissection in placing them is impossible to know by description. You did not say how long ago the surgery was or what the trajectory of change has been since surgery, if any, has occurred. If there has been no improvement since surgery your options would include removal/adjusting the implants to be certain they are not compressing the nerve (a 3D CT scan looking at implant placement would be extremely helpful) and wrapping the nerves with fat grafts to help them heal/recover would be the action steps indicated.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have what you call a (lightbulb) appearance from head shape to narrow jaw. I believe what I need is head width narrowing by temporal reduction. 

I want to know what you charge for this, as well as are there complications with this surgery, or has it been a success every time? 

Thanks 

A: Thank you for your inquiry and sending your picture. Posterior temporal reduction in my experience has been uniformly successful and has experienced no complications.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, There is this recent study published by you: https://exploreplasticsurgery.com/plastic-surgery-case-study-custom-infraorbital-maxillary-malar-implant-as-secondary-midface-augmentation-after-a-lefort-i-osteotomy/?doing_wp_cron=1612719980.9635739326477050781250 

“….a custom implant design allows for a smooth augmentation effect that can blend in with a previous underlying LeFort I osteotomy.” Is it better and more controlled to place such implants after healing from a LeFort 1 or high LeFort 1 or is it better to place them while performing a LeFort 1? 

Thank you.

A: That is a good question whose answer would be influenced by the exact LeFort movement. If a horizontal advancement was involved (and I suspect that is to what you may be referring) then I would wait and do it secondarily because you would then have an implant exposed to the wide open maxillary sinus cavity below it….increasing the risk of infection. And if it as a ‘high’ Lefort osteotomy that osteotomy line is a bit more uncontrolled. Thus the match between what superior augmentation is needed and how the augmentation would blend in to the repositioned bone below it is not precisely known.

In short wait 6 months after the LeFort osteotomy and use a new 3D CT scan to make a precise implant fit that has less risk of infection.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,   I was wondering because I have heard and noticed all surgeons do the bicep/tricep implant insertion differently. Some state that under the muscle can look better and hold better in place but there is the risk of nerve damage going underneath the muscle. I have heard that placing it on top of the muscle/underneath the fascia is much more safe but the implant is more noticeable and can even be felt and one could tell it is an implant?

Is that true? What are your thoughts on that? My goal is to have implants stay tight and not be noticeable or felt. If someone could feel my arm and tell an implant was there, then I think it would make more sense to place it under the muscle as it would hide better.

A: I think everything that you are stating about the two different pocket locations for upper arm is largely accurate with these 3 caveats. 

1) Under the muscle (on the bone) implants will not be as big or noticeable due to the need to use smaller implants.

2) There will be a more visible scar with under the muscle arm implants due to the need for a medial arm incision location.

3) Most of the subfascial implant visibility issues are circumvented with a custom implant design approach where the edges are feathered and not round like in standard implants.

4) Potential injury to the musculocutaneous nerve does exist with under the muscle implants. This is a motor nerve to the forearm and hand. While rare it is an issue to consider.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hello one of my cheek is more receded making it look flat is is possible to bring one of my cheek forward.

A: If you are referring to building out the flatter cheek using an implant then yes. if you are referring to cutting the cheekbone and bringing it forward (rather than width expansion) then no. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I horse back ride 5 days a week. Would there be more risk for when I fall off my horse if I had those ribs removed?

A: Since the inner half of ribs 10, 11 and 12 remain I do not see ant increased should you fall from a horse. But when in doubt there is the rib osteotomy procedure where the ribs are fractured, but left intact, and are molded inward after surgery by corseting.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, “Good morning doctor, I have some questions about Permalip, is smoking a problem? the lips remain hard? thank you”

A: I am not aware that smoking increases any risks from lip implant surgery. The lips will soften as they heal after implant placement. One may be able to feel the implant but it is not because it remains hard.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello. My testicles have become smaller due to testosterone replacement ( I don’t abuse it. My level was 34 !). Are the testicle implants still really firm ? Know a guy who has them and they felt unnatural to the touch. Thanks !

A: You are likely referring to the common use of saline testicle implants which are both small and very hard. Ultrasoft silicone testicle implants, which I use, feel much softer and natural to the touch.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a problem with the length of my nose. The length of my nose takes a large part on my midface. Is it possilble to reduce the wings of the nose and the tip? My wish is to get a reduction of the length of my nose from the eyes to the tip of the nose. I send you a picture where you can See the Red mark that should be reduce. Thank you for your time and help.

A: The only way to shorten a nose by rotating the tip upward…not excising any of the actual tip skin. While I think this would help a little bit, it would probably not be to the degree of change that you seek.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, in the future I want to get skull reduction surgery. My neurocranium is rather large and I understand the reduction is limited. My three main questions are will this lower the hairline sightly because of excess skin, will it raise my eyebrows, and what kind of scarring is left behind and can the scar heal permanently ? As male, I like the positioning of my eyebrows, close to my eye, and I do not want the eyebrow position to change. And I have always had a high hairline, and getting forehead reduction surgery is not option because I might go bald when I’m older. So I was wonder if this surgery does the trick. I saw a picture of a women undergoing this treatment on your website and her hairline lowered. So I was wondering if she got a forehead reduction from the skull reduction surgery?

A: In answer to your skull reduction questions:

1) I have not seen the frontal hairline lowered in skull reductions. I am not sure to which patient you refer.

2) I have not seen the eyebrows raise from skull reductions, that is potentially an issue in large skull augmentations.

3) The incision used and the resultant scarring left behind depends on what type of skull reduction procedure it is.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking for a surgeon who can make my hips as wide, or close to my shoulders. I noticed you said America only uses soft implants, I was wondering if you could order and use hard implants. Titanium or mesh implants to place on the crest. I do not believe I will ever have enough fat to make my hips wide enough, or that my body won’t burn it.

A: Thank you for your inquiry and sending your pictures. I assume when you say making your hips wider you are referring to the wing of the iliac crest and not the hip region below it. There are no standard iliac crest implants so they have to be custom made. Whether they are made of ultrahard solid silicone or titanium is patient preference and cost related.

The company to which you refer (Ostymeditech), although apparently US-based, does not return phone calls or emails, for reasons unknown to me.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 32 year old man. I want a customized implant to provide forward projection to my infraorbital rims. Uniquely, I want this implant to move the frontal process of the maxilla forward. Here, I am referring to the point at which the infraorbital rim meets the frontal process. This would typically be a portion of the face moved by the Le Fort 2 osteotomy. I want to raise my infraorbital margin too. I want this implant to extend onto the zygomatic arch to provide a small amount of lateral projection there. I want no lateral movement of the zygomatic body, because I dislike cheekbone mass. 

The key objective for me however, is to widen the perceived appearance of my orbital complex. I’ve noticed that this is an under appreciated and core aspect of beauty that most male models possess. I believe that this is possible by widening the brow bone, the lateral orbital rim and the zygomatic arch. 

I have so many questions on the theory of this, but I will limit them to 4 questions for your blog, and for now I will ignore the brow bone aspect. And then maybe send another email for a further round of questions. I hope this is ok with you. 

1) Is it possible to widen the bones that surround the side of the eye, to achieve this ‘broad eye area’ look? I believe that the answer is yes, but I’m unclear how to preserve harmony with the anterior temporal area. My concern is that making the lateral orbital rim project laterally, will create an unnatural ratio between the width of the lateral orbital rim and the width of the anterior temporal zone. 

In your experience, is this easily resolvable by extending a lateral orbital rim implant into the anterior temporal area to widen it to the same degree? And most importantly, does this look completely natural and not too ‘egg’ shaped? 

2) Regarding raising the infraorbital margin – my concern is that if I’m simultaneously raising and pushing forward the infraorbital rim – would this not create an unnatural appearance by making the infraorbital margin sit well above the lower border of the obicularus oculi? Obviously in its natural form, the infraorbital margin and the obicularis oculi have a high degree of correlation in their vertical positions. I am concerned about pushing the rim forward, too high above the natural position of these muscles. Might we do a SOOF lift with lower eyelid retraction surgery to resolve this problem? 

3) I’m also aiming to get a few other eye procedures: cosmetic orbital decompression for bulging eyeballs, a canthoplasty to raise my lateral canthus, surgery to raise my lower eyelid, and eyelid fat grafting to resolve soft tissue hollowness. I’d like your opinion on which order I should do these surgeries in? Would it be sensible to do decompression first, or the midface implant first? I also had the idea that doing the eyelid fat grafting may mitigate my concern in question 2, by obscuring the boundary of the implant edge – does you agree that it makes sense to do the fat grafting first? 

I’m looking forward to your answers, and thanks so much for your time.

A: In answer to your custom midface implant question:

1) You are correct in that you must be vigilant about how much lateral orbital rim augmentation is done to not create the appearance of unaesthetic temporal hollowing.

2)) You can extend the lateral orbital rim augmentation onto the deep temporal fascia of the temporal region…but there are limits in doing so.

3) I have not seen the vertical elevation of the infraorbital rim cause the problems to which you refer. Even up to 8mms of elevation this has not occurred with the caveat in the presence of someone with abnormally low infrraorbital rim levels.

4) It would most appropriate to do orbital decompression and any procedure that may change the position of the eyeball and eyelids first.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in shoulder reduction surgery with you. I have suffered from my wide shoulders since I can think of, can’t feel fully feminine cause of them. 

I am pleased to find out his surgery exists, however not much info and before after pictures are present hence I have no idea what it will look like on me. Also I’m curiosa why no deltoid reduction surgery was being offered so far, as it seems sensible for this issue perhaps even more?

A: Thank you for your inquiry and sending your pictures. I have done some imaging of them to show what I think can be accomplished with shoulder reduction by clavicle shortening. You can not reduce the thickness of the deltoid muscle for functional reasons and, even if you could, you can not approximate the 2.5 to 3cms reduction per side that is achieved with clavicle bone shortening.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am aware that your office performs rib removal for body contouring purposes. After doing some research into rib removal and other methods of waistline reduction I have come across the Kudzaev method of waist narrowing[1]. This procedure is currently only popular and performed in eastern Europe and involves performing a partial osteotomy on the floating ribs and then using a corset tightened with a belt on top for 3 months during the healing process where the modified ribs heal and get affixed into their new position. Reading the patent of this method it seems like the incisions that are performed are also smaller (2-3cm) than what is normally done for removal. Additionally, it is claimed that this procedure has little pain compared to removal and can be done under local anesthesia.

A recent academic paper Aesthetic Contouring of the Chest wall with Rib Resection claims that the Kudzaev method doesn’t have clinical trials: “On the other hand, Kudzaev patented a method of narrowing the waist, in 2017, in which the author performs osteotomies on the 11th and 12th ribs by small skin incisions. Thus, he promotes costal fracture, and complements the narrowing of the waist by the use of a corset. In this way, costal resection and its complications are avoided and waist narrowing occurs. However, there is no publication of clinical trials with this approach.”

However, this method seems to have been used frequently in the past with little side effects pertaining to rib contouring when performing extrapleural thoracoplasty for tuberculosis so this technique doesn’t seem particularly new or experimental. It’s only novelty is being used for aesthetic purposes.

Despite the patent saying that only the floating 11-12 ribs can be reshaped, I have talked with a couple Russian plastic surgeons and they claim that the 10th ribs are also able to be narrowed with this method after analyzing a CT scan. Looking at results on Instagram for the surgeons that are performing this, it seems like they are reshaping the 10th rib many other examples I can provide.

Some additional information can be found at as well.

I am wondering if you are aware of this method and what your thoughts of it are. Many of the plastic surgeons that perform this operation claim it’s a much safer operation than removal long term as you retain your ribs. I am also interested if you would be able to perform this operation since I have considered flying to Russia but I would very much prefer to stay in the US for something like this.

A: Thank you for your inquiry and detailing the osteotomy method for waistline narrowing of which I am well aware. Having removed hundreds of ribs for waistline narrowing, and never yet see a single complication or any negative byproduct of removing the outer half of ribs #10,11 and 12, I can not speak for whether rib osteotomies vs rib removal is safer, has a quicker recovery or produces comparative results. What I can say is the following:

1) The skin incisions needed to perform either technique would be similar. I use a 4.5cm single incision per side which can not be made smaller no matter method is used.

2) No form of multiple rib manipulations should be attempted to be performed under local anesthesia. There is no benefit for the patient or the outcome in doing so and may well make the whole experience far less pleasant and even less successful.

3) The key to the technique is obviously the patient’s compliance with the corseting.

4) One of the key components of waistline narrowing is the reduction of the thickness of the lateral border of the latissimus dorsi muscle. This soft tissue reduction provides as much waistline narrowing as that of the rib bone changes.

5) Rb removal has surprisingly less pain afterwards than one would think because there is no bone to heal, it is just a muscle recovery. Whether leaving the ‘fractured’ ribs in place will lead to more postoperative or even long-term rib pain I can not say.

That being said I believe rib osteotomies are a valid method for waistline narrowing….which is probably better called ‘rib osteotomy-assisted corseting’. In the properly motivated patient it is a useful technique  But whether it produces similar results to rib removal surgery no one can yet say. They are both similarly safe but one is not safer than the other.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to undergo skull augmentation surgery. 

My problem is that my forehead is convex and seen from the front it looks very narrow. The areas to increase are shown in the Figure 1 

To hope for a “global” increase it will be necessary to increase the projection of the eyebrow arches.

As the modification would be in the visible part of the skull, the forehead, I was wondering what strategy, materials would you consider minimizing the visibility of the edges of the implants. 

Is it possible to use custom implants ( PMMA or HA or silicone) coupled with PMMA or HA in liquid powder form on site to fill the holes? 

In the link below it is explained that it is possible to use PMMA as a filler for the holes, can you use this technique? 

A: In answer to your implant edge transitional question, there is no need with silicone forehead implants to use bone cements as they have a feather edge to them by design.

Dr. Barry Eppley

Indianapolis, Indiana