Your Questions

Q: Dr. Eppley, Four years ago I had a soft tissue reduction performed on my soft tissue chin pad. It was an intraoral thinning reduction. I was unaware at the time and the doctor did not communicate to me the level of potential for soft tissue contour deformities. The soft tissue took a long time to heal with edema in the excision site for months. Unfortunately, the soft tissue pad is now quite uncontoured and has an irregular shape from the surgery, and it seems as though the chin pad is not attached very well to the bone as it is hyper mobile and bags at the middle section of the chin. It is possible that some mentalis muscle was removed in the excision, I am unsure. I now have soft tissue chin balling to some extent. I have shown in the photos how the soft tissue lifts off the bone if I tilt my head or push the tissue up. 

I have been to multiple surgeons since in pursuit of soft tissue contouring or tightening and or chin reduction. From the x-rays, it is obvious that the bone is not the primary contributor to the horizontal projection, but I have a significant soft tissue excess. In the photos, I have tried to show how the bottom point of the chin is very steep and meets the mid point of the chin (most prominent area) at a very steep angle. It is more pronounced on the right side than the left as the right side seems to have a slight deficit of tissue or is just irregularly shaped now. When i grow out my beard the tissue on the top / middle projects significantly and is a constant nightmare. 

I fear that it may be hard to perform a submental tuck up with the bone as the bone still sticks out and due to the steep angle at the bottom. Maybe somehow with bone repositioning or something the tissue could be draped over it and tightened to create a more contoured appearance. I imagine there would have to be some kind of muscle resuspension too to get the chin to stick down. I have tried to show you all the angles in the photos and have demonstrated pulling down from underneath. The tissue will not come down over the bone perfectly as it is. I also have a little bit of submental fullness or skin excess which may make a submental tuck hard to perform. I have been turned away by other surgeons obviously because any procedure to the bone will result in a horrible soft tissue outcome. I am quite unsure about it and whether anything can be done. It is obviously a highly risky and difficult surgery. The photos do not completely demonstrate how the tissue is mis-shaped.

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

1) Intraoral soft tissue excision is never a good approach for the exact reasons you have observed. But that is past history.

2) The only new piece of information I can provide you is that you have a very flat mandibular plane angle. (chin and jaw angles on same horizontal plane) People that have such flat plane angles often have a soft tissue chin pad protrusion because the chin is actually vertically short. From my perspective the better approach initially and even now is vertical bony chin lengthening. That will do more for the soft tissue chin pad by stretching it out (unfurling it) than any further attempts at soft tissue reduction/manipulation on its own.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I attached photos some of myself from different angles, a morph of myself in the profile view with a possible rhinoplasty and a few “desired aesthetic” photos.  Thank you!

Background:

•I believe I have a weak chin from the profile view and I am unsure if my chin is too short from the front view

•I did breathe through my mouth as a child. As an adult I do not typically breathe through my mouth, only occasionally when I sleep I believe I do

•I had braces when I was around 11years old and it was done by my dentist.

•The middle split in my front tooth seems to be off center with respect to the center of my lip

•One side of teeth seem to be higher than the other side

•I plan on doing rhinoplasty prior to a genioplasty or jaw surgery

•I am looking to get a more defined jawline and a stronger chin that is still feminine

Questions:

1.Out of curiosity, why was genioplasty recommended over a chin implant?

2. Based on my history and photos, is jaw surgery recommended, or would a genioplasty and shaving down one front tooth suffice?

3.Is the morph I created possible/recommended?

4.Would genioplasty be able to give me a more defined jawline?

5.Is it recommended to get rhinoplasty or genioplasty first?

6.How much improvement should I expect for my lip incompetence and mentalis muscle strain with the genioplasty? Is there a way to completely or mostly remove these issues?

A: Thank.you for sending your pictures. In answer to your questions:

1) Give the shortness of your chin and to prevent it from becoming too wide, if you were only doing chin augmentation a sliding genioplasty would be the preferred method. Your chin deficiency is at least or close to 10mms which is beyond what most chin implants can do. It is also important in a female to keep your chin narrow. A sliding genioplasty will improve symptoms such as lip incompetence and mentalis strain far better than an implant.

2) You can not make the determination about whether orthognathic surgery (lower jaw advancement) would be indicated based on facial pictures alone. This requires x-rays and an occlusal assessment.

3) To do computer imaging I need all three facial views particularly the side view of you…which is not in the pictures sent.

4) Genioplasty improves the chin…not the jawline behind it. No form of chin surgery makes a better ‘jawline’. Most people when they refer to jawline mean the back part of the jaw or jaw angles. That requires a different procedure than any form of chin augmentation.

5) The order between rhinoplasty and genioplasty is a personal one. There is no right or wrong order. It is all about what you value first.

6) While a sliding genioplasty will help with lower lip incompetence and mentalis strain there is no predicting beforehand how much it will improve.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had lower jaw surgery at 17 to correct my overbite. My orthodontist said since I grew up with an overbite it cause the deep labiomental crease. It makes me very insecure and I am interested in solutions to fix it, without making my chin bigger since I am scared of it appearing more masculine. I’ve heard fillers and fat grafting sometimes don’t last or have much of a difference. I am interested in what you have to say in what would be appropriate for me. Thank you 

A: While your labiomental fold is deep I do not see any need for chin augmentation. Your chin has adequate projection for a female and any more, as you have rightly stated, runs the risk of making it look too masculine. Your focus should be on treating the deep labiomental fold. The first place to start is to have injectable fillers done and see if you like the change. If so then you can graduate to a more permanent method such as release with interpositional composite fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve always found my forehead to be very irregular, and last month I visited a maxillofacial surgeon in Brazil. He diagnosed me with non-treated Trigonocephaly (although a very soft one).

My forehead is indeed a bit triangular, and I have a ridge on the very top of the forehead, in the hairline, although  I never experienced any neurological disorder. I’ve attached some pictures.

He suggested two different treatments:

1) Customized facial implant, made with a 3D CT Scan

2) Non customized implant (made of bone cement by the surgeon)

He advised the Customized facial implant (made of soft material), as the incision is smaller and results are more predictable. I found you on the internet as a reference for customized implants.

What type of material do you use? I saw many possibilities, such as PTFE, POREX, PEEK, Titanium, Silicone. I worry about the size of the incision, as my father and grandfathers are bald, but the doctor said he would need to cut across the entire head to open and cut (reduce) the ridge on the top anyway.

A: Thank you for your inquiry and sending your pictures. I don’t think there is any question that the superior method for your forehead augmentation is with a custom implant for two compelling reasons: 1) the incision needed to place it would be very small (unlike bone cements which would require a full coronal scalp incision) and 2) the shape precision need for any forehead augmentation shape is very high and unforgiving. Trying to get the proper shape by hand (even if one could accept the coronal incision) is very difficult to do. It is far superior to spend the needed preoperative time in a computer design where the effects of the changes can be better appreciated. This results in a far lower risk of revisional surgery due to shape/contour issues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I also have a really slanted forehead so the top of my head looks very Neanderthal-like. Throughout my high school I’d get called a Neanderthal or homosapien and I’m looking at pictures of me from when I barely started high school and I didn’t have that huge brow bone and my forehead was slanted at a right angle, but I understand that genes play a big role too. I saw a post of a patient you had and my head shape is very similar to that and the after results were fantastic! I want my forehead to look slanted but not too slanted. I would like to know how risky this procedure is and well, you’re the doctor so I’d like more information on this.

I’ve even edited before and after photos of my side profile to show how I want my brow bone to be and I really want you guys to be honest with me and let me know if my look is possible 🙂 another question I have is after my brow bone gets shaved will it make my eyebrows be shaped differently? Cause I like how my eyebrows are shaped and all and does this procedure require the big incision that goes all around my scalp or do you guys also do the small incision at the top of the scalp?

A: Thank you for sending morphed images. What you are showing is a combined brow bone reduction with upper forehead augmentation. Such a result is very possible and this is a common procedure in my practice. This is not a risky procedure and is done through a scalp incision but not one that goes from ear to ear. (coronal scalp incision) Reduction of the prominent brow bones does not change the shape of the eyebrows.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I gather from the website that you do testicular enhancement surgery.

What is the implant made of? I read the details of the configuration (like a clam shell,  fixed in place around the existing testicle). Does it have a natural feel? Is it detectable by airport security.

How many days would I need to be in Indianapolis? I assume it’s an outpatient procedure.

Typically, how quickly can one expect to book an appointment?

Thanks in advance for your response.

A: Thank you for your inquiry for testicular enhancement surgery. I would first direct you to my website, www.exploreplasticsurgery.com and search under Testicle Implants where much has been written on this topic in great detail. To answer your specific questions:

1) All testicle implants are made of an ultrasoft solid silicone material.

2) Such materials have a natural feel which is why they are used.

3) Silicone is not a detectable material by x-ray metal scanners.

4) You would go home the day after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I’m pretty sure I have Vertical Orbital Dystopia as you can see in the picture. Saying this bothers me would be a huge understatement, I’m 20 years old (no health issues), haven’t been in a picture for at least 8 years and can’t look at someone in the eyes because I’m ashamed. I’m desperate to fix this. Obviously I’m not looking for perfect symmetry, but I want to have “normal” asymmetric eye. Seeing all the pictures on your website, I’m really interested and would like to know how much this could cost me and if this is a dangerous procedure. Thank you!

A:Thank you for your inquiry and sending your picture. Your diagnosis is correct (vertical orbital dystopia, VOD) and its magnitude is aesthetically significant. (probably 5mms) The entire right orbital box is lower. This means the brow bone and cheek around the eye are part of the skeletal asymmetry and must be included in the treatment approach. While a preoperative 3D CT scan is needed for proper treatment planning, the concept besides raising up the floor of the eye is that the brow bone above needs to be vertically reduced and the infraorbital rim and cheek below need to be raised as well. In addition you can’t just raise the eye and adjust the bone around it without factoring in adjusting the upper and lower eyelids as well. (if you move the position of the window the overlying shade must similarly be adjusted or the window will look unusual/distorted)

While this sounds like a major undertaking, and it is, but this is the normal collection of procedures that are needed in significant VOD surgery. This is not a dangerous procedure, it is more a question of the magnitude of the asymmetry that can be achieved. It would take looking at the scan to provide a more qualified opinion in that regard.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m thinking of mandibular implant and maybe buccal fat removal. When you see my pics what do you say? In the pictures from 2015 I was working out very heavily and biting my teeth so that the “mandibular” grew bigger. You can see it gave results and my jaw appeared wider. If you look at the picture from 2016, on that picture im’ biting my teeth together and doing a “zoolander pull” with my cheeks and lips. (cant find the correct word in english). That look in the 2016 picture is a look I think look very good on me, do you think that look is possible to achieve? 

I think unfortunately that I have aged a little bit since 2015 and I feel that my cheeks has fallen down a little bit, do you see that too? Maybe I need some kind of face lift? Especially my right cheek I feel has gone down. Little to early maybe with facelift, I’m only 33 years old. 

My fat percentage is right now at 12%, it was the same in 2015.

A:Thank you for your inquiry and sending your pictures. In the spirit of trying to achieve the 2015 ‘sucked in cheek, biting down jaw angle look’, which is commonly requested I would not disagree that midfacial defatting and jaw angle/jawline implant would be the only way to try and achieve it in a non-induced/artificial manner. In regards to your cheeks you are too young and do not have enough loose tissue to justify a cheek/midface lift and the scars to do so. It would be more effective and scar free to do high cheekbone implants which provide their own cheeklifting effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, If you are an active person and are into contact sports like mma or football, are the implants still safe to have? For example, I am really into CrossFit and we do a lot of handstand push-ups where my head hits the floor each rep. Can this cause complications long term in a skull implant?  Provided that I take the proper post op rest and recovery precautions getting back to training.

A: This is a common and understandable question. Once healed I do not see any contraindications to contact sports with either skull or jawline implants. They are very much like placing ‘bumpers’ on the bone which provides some added protection. It would take an incredible amount of force to ever displace them. That being said, repetitive and avoidable trauma to an implanted skull or facial area should be avoided as no one can predict every adverse effect that could occur.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking at sliding genioplasty or chin wing osteotomy. I originally was most interesting in jaw surgery bc I have a slight lisp when I speak along with a recessed maxilla. …..but it depends on how long braces would be on. I just finished smile direct and my teeth are straight and my bite seems to be normal. Would love to get in contact! … I currently have jawline and chin filler in my pics which I’m dissolving soon.

A: Thank you for your inquiry and sending your pictures to which I can say:

1) You are not a candidate for orthognathic surgery as your bite is fine and you have normal facial bone balance. You have an aesthetic jawline deficiency.

2) You are not a candidate for chin wing osteotomy as that procedure does nothing for the jaw angle area and you do not have a vertical jawline deficiency.

3) Your options for total jawline enhancement are either a sliding genioplasty combined with vertical jaw angle implants or a custom jawline implant, each of which has their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have excess neck skin and fat and no jaw line. I am planning on losing about 70 pounds in the next 7 months so I will have even more loose skin on my neck. Should I wait? What procedure would be best to tighten my neck , remove fat and get a jaw line? Thanks 

A:Thank you for your inquiry and sending your pictures. Given that you are planning on losing a significant amount of weight (up to 70lbs) there is no doubt that you should wait and reassess at that time. Weight will remedy most if not all of the fat issue and at your young age help tighten the neck. Then at that point you can reassess the structural appearance of your jawline and see what procedures may be of benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to ask you what are the options I have for a new upper orbital bone shape. I mean the bone of the eyebrows. Is there any procedure to make the bones wider horrzontally?

A: The brow bone reshaping can be made done to make them wider (lateral and superolateral orbital rim) using a custom implant approach. Attached is one version of that concept. This is an acceptable approach provided one is happy with the m,medial or inner brow bone projection/shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, my question is I have had an rhinoplasty it has been 9 months , my nose was quit crooked and I had breathing issues , I went Turkey to get it done , and basically my nose has changed quite abit. The concern I have is the tip of my nose is a bit high still and is very stiff is very uncomfortable feeling , I would like to know if it is normal after 10 months?

A: Without knowing the details of what was done in your rhinoplasty I can not say what is or is not normal. (what cartilage grafting was done and from where) But with a visible scar down the center of your nose I suspect cartiage grafting was done which accounts for both the high and very stiff tip which would be normal when more structural support is added.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 21 year old male, and I have had an overly high forehead from birth (mature hairline without recession, although it will potentially recede in the future). It seems forehead reduction procedures are contraindicated in my case because of the risk of the hairline receding and revealing the scar. Hair transplants are the other option, but I’m not old enough for that yet and would prefer to save donor hair for any real balding that occurs later on. Can anything be done in the implant space, or with other methods, to reduce the vertical height of the forehead in a male? Thanks for your help!

A: As you have noted the concern with hairline advancement in a young male for vertical forehead reduction is what becomes of the frontal hairline scar. That potential concern remains a valid one for which there is no way to subvert that issue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I’m interested in getting buccal lipectomy and perioral liposuction down to the jawline for a less chubby, more angular and masculine look. I had buccal fat extraction done 20 years ago and submental fat lipo. I don’t need submental lipo again but feel I need buccal lipectomy again because it’s still chubby. I really need perioral mound lipo down to my jawline the most. I live in Tampa and would have to travel. How much would this typically cost me? Thank you.

A: Once you have had buccal lipectomy once (provided they really removed the true fat pad), it does not regrow back. So there is no benefit to trying to repeat it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, thank you for responding to my last message, you said with custom chin implant, it is possible to achieve this result. 

Is there a way for me to know whether my soft tissue can theoretically hand this kind of immediate change? 

I also went to a mirror and used a mirror to side of my face, and put a ruler to my chin, my ideal forward expansion of chin would be at most 10mm (ideally if I get an implant, it should line up right below lip when my profile is perfectly horizontal axis as shown in both photos). 

From my observation, my skin is pretty elastic and youthful when I squeeze my chin area to imagine an implant result. 

A: Since you have provided a reasonable estimate of how much dimensional change is needed (10mm horizontal movement), I can say with added confidence that such a change is within the possibility of an immediate implant placement. My general rule is that the amount of stretch provided by the ‘average’ soft tissue chin pad can tolerate a total number 12 to 14mm, which applies to any combination of dimensional change. (horizontal + vertical) Since your chin augmentation need is right below that number I know by experience that adequate incisional closure can be obtained with a 10mm horizontal chin implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m planning to visit you after my jaw surgery in a few months for this specific concern. I would just like to ask a few questions, if that would be okay? 

I have horizontally short eyes (30mm palpebral fissure, but I measured this myself so it’s not accurate) and a negative canthal tilt, would a lateral canthoplasty be able to elongate the width of my eyes and at the same time raise the corners up so that the NCT would be eliminated? I have heard from other surgeons that raising the corners up can make the eyes shorter so I’m just worried? Any other eye surgeries that I would benefit from? 

TLDR: would a lateral canthoplasty elongate my droopy eyes and make it upturned? any other eye surgeries that I would benefit from? 

Sorry for the bombarding of questions! I attached my pictures if that helps a bit.

A: As a general rule a lateral canthoplasty changes the tilt of the outer corner of the eye but will not create a longer palpebral distance. And it is a good thing that it doesn’t as separating the corner of the lids from the eyeball (increasing palpebral length) would generate a lot of eye irritation symptoms. There is an intimate relationship (contact) between the eye corner and the eyeball which should not be anatomically disrupted.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, About one hear ago I had infraorbital rim/cheek implants placed. I had them removed 2.5 months after placement, and I am currently about 9 months post removal. 

I see you write extensively on how the soft tissue can lose its support and sag. However, while I can’t fully rule out sagging, I feel the biggest issue I have is residual puffiness that makes my mid face look bloated. 

My implants were not very thick (about 2mm), but they were large and covered a lot of area. Also my doctor told me he had to detach basically the entire mid face in order to get them in. I think as a result of this I have bloating even in areas below where the implant was. I’d say the worst area is nasolabial fat pad. 

In short though, I don’t feel that sagging is my issue because when I lift up my cheek tissues it doesn’t look natural and that does not seem to be the solution. I think the issue is simply that midface—particularly the fat pads—are more augmented than they were before. 

I imagine it’s a combination of scar tissue, capsule, and tissue stretch. 

I imagine with time a may still see slight improvements, but I was wondering if there is any non surgical solution to make my face look more chiseled and less bloated. 

Would C02 laser, thermage, or ultherapy help in tightening the soft tissue and making it more firm/less augmented and tighten the skin? And if so, which of these procedures would be best? 

Also, at 9 months post op is there even any chance more improvement will come with time? 

Thanks! 

A: While you may not think it is tissue sag (it is definitely not tissue ‘bloat’) that is because pushing on the skin on the outside does not replicate moving up the scarred and lowered internal tissues (periosteum and SOOF tissues) from the initial dissection and release. They have slide down and are what creates the fullness. The proper time to prevent this issue was when the implants were removed (SOOF lift/resuspension) to avoid what could be predictably known to happen when the implants were removed. (the thickness of the implants does not matter, it is their surface area coverage and the tissues that needed to be released is what counts) What you have by now it what it is going to be. There is no non-surgical treatment that is going to solve this problem…although there is no harm in trying.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a surgery recently that was supposed to correct some unevenness of my native chin bone (underneath my chin), but found out afterward that the surgeon cut off one corner of my medpor chin implant rather than file the bone. I was happy with the placement and size of the implant and given that I have already had revision surgery and the risks associated with removing medpor, I wonder if it’s possible to simply replace/ restore the material that was removed rather than replace the whole implant. The surgeon who did this seems unwilling to help (and I honestly don’t trust him anymore anyway), but its hard to find anyone else who is knowledgable about Medpor, so I’m unsure about restoration. Also, if I had to replace it, would removal and replacement with a silicone implant be advisable in the same surgery? Some surgeons have wanted to take it out and let it heal for six months before replacing it. I want to avoid two surgeries, and obviously going six months with a deflated chin would seriously impact my social and work life. Thank you.

A: It would seem most logical to simply replace the missing segment of the Medpor material….if you knew exactly where and what amount of material was removed.

The second approach would be to remove and replace with the identical chin implant that was revised.

Removing and then awaiting any period of time for replacement is to put it succinctly….insane.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had 3 genioplasty operations and the most recent (the third) is because I had orthognathic surgery 5 weeks ago where surgeon had to do double jaw surgery and insisted I needed genioplasty again because of the new position of my jaws, and my face is still swollen from it.

But the issue is, I feel I have too much lower teeth show and want my lower lip to lift up like 3 or 4 mm, along with the chin pad. Could mentalis muscle resuspension work for me? I heard the success rate is not good?

The surgery was in Korea and he used titanium screws in my chin and jaws. Here is a photo and video to demonstrate the lift of chin pad and lip I want, is it even possible?

A: You are correct on both counts….mentalis muscle/chin pad resuspension is the proper corrective approach for your resultant lower lip sag  and it has a high rate of failure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, To visually have a shorter, more convex and feminine face. More round, soft wider foreheads, hoping to use forehead implant to open up forehead and elevate eyebrows as well. Mid face projection with cheekbone implants for projection and width, considered maxillary implants and dental corrections or orthognathic surgery- Main concern if we had to pick one- forehead implant. Need to see a few examples of results.

A: Thank you for your inquiry and sending your pictures. Since you have focused on the forehead the type of augmentation you need is a custom implant that provides  some width into the temporal area and some correction of the backward slope. You may find the attached implant design and patient results helpful in understanding how that type of forehead shape change is achieved. This could be combined with a brow lift done concurrently.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a sliding genioplasty two years ago and 5 days post op, the Doctor asked if I feel numb esp on the left side of my lower lip/chin and I said yes. He said it’ll be gone in 6 weeks or it’ll take years. I waited but 2.5 years after, I still have numbness on the left side of my lower lip. I am experiencing tightness and weird sensation on the area. I now have a crooked smile and I can feel it get tighter when I talk. Is this nerve damage, impingement or muscle weakness? Should I do a revision or remove screws?

A: At this prolonged time after sliding genioplasty surgery the left mental nerve numbness can be assumed to be permanent. Removing the plate and screws will not make any difference in the numbness as they are located far from the mental foramen. Persistent tightness may be improved by release and placement of a fat graft.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a long midface. The length from the eye to the end of my nose is too long. I didn’t found a surgeon who can reduce the Part of my midface. I wanted to know is it possible to reduce the bone of my midface from the eye to the nose? And if it is possible who much is the average price. Thank you for your time and help.

A: You are asking for a midface procedure that does not exist. While the midface bone can be shortened that will change nothing on the outside. The only two midface soft tissue  ‘shortening’ procedures are rhinoplasty and lip lifts. There are no midface narrowing procedures between the eye and the nose.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, I suffer from a condition known as occipital deformational plagiocephaly. I’ve seen that you have significant experience in the correction of this issue through a variety of different methodologies. 

Unfortunately, I reside in Canada. Do you conduct procedures on individuals who travel across the border? If not, would it be possible for you to point me to a Canadian surgeon who has experience in correcting this issue?

A: A significant part of my practice are patients who do not live here. Most occipital plagiocephaly skull deformities are treated by building up the deficient side with a custom skull implant made from the patient’s 3D CT scan. I would assume based on your description that the same would apply to you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a weak chin and a jawline that while pronounced, is also quite steep. I had spoken with you through video consult previously in regards to a custom wrap around jaw/chin implant to fix my jawline along with a buccal lipectomy and perioral lipo to rid myself of genetic chubby cheeks. 

My question is would the wrap around jaw implant alone make my face look chubbier than it already is or would it stretch out may face enough to where I do not have to worry as much about fat removal?

A: The tissue recruitment effect that a custom wrap around jawline implant has comes from the neck and not the face. Thus I would not expect a cheek reduction effect to occur as a result of it. But there is always one way to be certain of that effect…do the jawline augmentation first and see how you feel about the cheeks afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can I fax your office operative notes to get your opinion on how complex my otoplasty reversal would be. Please

A:While I am happy to read the prior surgeon’s operative notes, and more information is never a negative, any form of otoplasty reversal comes down to the same two principles…..adequate cartilage/soft tissue release and an interpositional cartilage graft to hold it. These same two intraoperative techniques must be done regardless of how the ears were pinned back.

Dr. Barry Eppley

Indianapolis, Indiana

Q:Dr. Eppley, I would like to know what procedures/implants are required to achieved hollow cheek like those male models. I know body fat plays a big role but besides that if any implant is needed about how much mm is needed?

A: You are correct in that one needs to have very little facial fat to achieve that hollow cheek look. But when it comes to midface implants achieving that look it is far more about the implant’s shape and surface area coverage than it is about millimeter’s of implant thickness.

Dr. Barry Eppley

Indianapolis, Indiana

Q:Dr. Eppley, I have a question about skull reshaping. In the attached pictures you can see I have two bulges on my forehead, while the one on the right is more prominent than the left one. I think it is bone, as I had this head shape since I was a young boy, but the bulges seemed to grow more throughout puberty. I’m now 22 years old and guess, that they won’t grow much further. Anyways they really disturb me and I don’t feel comfortable with them being so large. 

Do you think this is something you can correct? 

A: Thank you for your inquiry and sending your pictures. You have the classic forehead horns of which your history of them is also classic….grew bigger after puberty. Such forehead horns can be completely reduced by burring. Their method of elimination is straightforward and 100% effective. The vexing question, however, is how to get there and not create scarring that might be considered just as aesthetically disturbing as the horns themselves. This is a common issue in males with higher hairlines of indeterminate long term stability. (indirect hairline incisional approach) The direct forehead wrinkle line approach subverts this issue but then one has to ponder how well the wrinkle line scar will do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if I would be a good candidate for a buccal lipectomy, perioral liposuction and/or buccinator myectomy. I’m 26, 5″6, and weigh 115 pounds yet my face has always seems bloated because of fat cheeks genetics and probably thick skin. I was hoping that maybe with these 3 procedures would a be a good start to get rid any facial fat and have the more concave look in the mid-face. Thank you for your time. 

A: Thank you for your inquiry and sending all of your pictures. Certainly you already have some slight concavity to your midface so I think the three procedures you have mentioned would go a long way in helping you maximize that potential type of facial change. The other procedure that you didn’t mention which will really help is a chin augmentation, particularly a sliding genioplasty. As the chin bone moves forward that helps provide an upper facial slimming effect as well. This would also helps your facial proportions as lower third is smaller compared to your larger cheekbone structure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking to have facial surgery. I know I definitely want rhinoplasty, but I also want to look similar to a particular celebrity. I have attached pictures and would love to know what you think changes can be done. The first pictures are me, and the other pictures are Saweetie. The picture of her in the black blazer is the nose that I want. I hope to hear from you soon!

A: Thank you for your inquiry and sending all of your pictures. While I think it is good to have a very specific goal it is always fair to say one can never be made to look exactly like someone else’s facial feature. I do not consider your goal wildly unrealistic but in rhinoplasty it is all about how the skin will shrink down around the reshaped bone and cartilage framework. Thicker nasal skin is more unpredictable in that regard.

Dr. Barry Eppley

Indianapolis, Indiana