Your Questions

Q: Dr. Eppley, I am 25 years old and I train a lot at different martial arts (kickboxing, wrestling, BJJ, MMA,…) and I even compete in BJJ. I am considering the procedure of a skull reshaping surgery and I would like to know if training and competing in martial arts after the surgery is a problem or not. Furthermore could you give me any recommendations for doctors in europe? Because I only found you here in the states. 

Would appreciate an answer very much. Thanks in advance. 

A: For my patients I recommend they wait three months after any skull reshaping procedure before returning to contact type sports or physical activities.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was in contact with you a while back regarding issues after my sliding genioplasty. It has been 2 years now since the surgery and it’s still tight. The area under the lower lip is very tight, the scar feels very tight and when I move my mouth everything feels even tighter. My lower gums and lower teeth also feel tight and sticky. It’s a weird sensation. 

You did advise that the bone position was high and the chin tissues may be compressed and this could cause the tightness. I also saw on your website that you can use a fat graft in the labiomental fold. I did see this and then try HA filler in the area which does seem to have improved things a little a bit, not significantly but it does help and it seems to help with my speech,

I don’t get as much of the pulling and tugging feelings when speaking like I did before. The filler is voluma so does feel quite hard. It might have been better with a softer filler. I’m not sure the nurse who injected understood my complaint fully too. 

You are the only person in the world it seems who suggests this. I’m astonished that no other surgeons seem to know about this problem!! 

With this in mind, how do you see my revision? If I came to you what would you do with my chin? 

Would you move it down and back and place a fat graft? Is that the way you think it should go or leave the bone and just do the fat graft? 

Here is my X Rays again to remind you and also a 3D scan. 

I’ve been to a facial pain clinic at my local hospital today  and they are telling me this is neuropathic pain as a result of the surgery. They said that this can sometimes, very rarely happen where the brain starts sending the wrong signals causing strange and uncomfortable feelings in the area. They said this is permanent and surgery can make worse and won’t make any better. My surgeon doesn’t agree. 

Your help is so much appreciated.

A: If you are satisfied with the aesthetic result I would do an intraoral release and place a dermal fat graft. That seems to work really well in cases like yours. The observation that injection of HA produced some mild improvement in your symptoms supports this therapeutic approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, After a septorhinoplasty and jaw surgery (upper jaw expansion, impaction and advancement, and lower jaw advancement), I have found that my nose and smile looks much like Bryce Dallas Howard’s after picture on the right. I don’t like how the sides of the nose seem to cave in and the cheeks seem to bulge out and appear artificially bunched up. I much prefer the natural look of the before, and I am not sure what the reason is for looking like that after. Is it due to overexpansion of the upper jaw or is it due to the septorhinoplasty (or other)? Can it be reversed? 

A: These are many of the unspoken soft tissues changes of the midface that can occur after LeFort osteotomies due to soft tissue stripping from the bone and the change of the bone’s shape. Most of these changes are irreversible. The only one that isn’t is nostril widening, the most common adverse aesthetic effect seen after a LeFort osteotomy. This can be treated by secondary nostril narrowing techniques through an external approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, This girl isn’t me (I found her pics on reddit) but the area I circled is almost the same exact area where I have protrusion 

I. Is that subcostal rib margin? 

2. If so are they low enough where they could be removed or shaved? 

3. I don’t mind scars but would the surgery make much of a difference? 

4. Even if they aren’t the subcostal rib margin, are they still ribs that can be removed? 

Thank you. 

A: I don’t see any circle area on the picture so I circled what I think you are likely referring to which would be the lateral subcostal margins. (see attached) Those rib margin areas can be reduced by shaving. It is the most common anterior rib area treated for reduction. It does require a small incision over the area to perform the procedure and the acceptance of the resultant scar is the only limiting consideration.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hello, I am inquiring about clavicle surgery for masculization. My question is whether the clavicle can simply be surgically elongated similar to the limb lengthening surgeries done on femurs. 

I am a body builder with a sub-par shoulder to waist ratio and my waist cannot get any smaller. No amount of muscle development in my shoulders will ever create the taper effect needed. I know that a longer clavicle is what my bone structure needs. Is this possible? And if so, does this surgery have any negative effects on the ability to continue building muscle in the chest and shoulders? 

Thank you.

A: At this time there is no method yet available for distraction lengthening of the clavicles for shoulder width increase. The concept is a valid one but the devices to do so have yet been developed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had a blepharoplasty and rhinoplasty performed on me in the past.  I would like to kindly know:

• Can you make me look like the actor, Pierce Brosnan – with an emphasis on the eyebrows – as though I’m in my early 30’s with dimples and surgically remove my frown lines? (please see our pictures below)  If you can do it, please kindly let me know. If you can’t do it, please kindly recommend a surgeon who can make me look like the actor, Pierce Brosnan.  

• If you can do it, may I kindly ask: what is the ballpark cost?

Thank you kindly, Dr. Eppley.  I look forward to your answers!

A: No surgeon or surgery can make you look like another person. These are not realistic expectations for plastic surgery of the face.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can you do a complete capsulectomy after cheek implant removal either by micro surgery, dissolving the scar tissue with enzymes, or cauterizing? Do you believe that the residual capsule may be absorbed by the body? Are you Is familiar with Implant Illness?

Thank you so much! 

A: In answer to your questions about cheek implant removal:

1) The cheek implants and the capsule on the bone can be removed. The outer capsule attached to the soft tissues can not.

2) The remaining capsule will be absorbed over time.

3) Implant illness is associated with silicone gel implants, almost exclusively of the breasts. There are no known illness cases associated with solid silicone facial implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking at your website about the ‘head widening surgery’. I am bothered by the fact that I have a ‘narrow head’, and that my face looks a bit like a ‘tree leave’. I attached a pic from your website which is a young man having a ‘head narrowing surgery’. Am I right to assume that a ‘head widening surgery’ will have a result of the man’s head before the ‘head narrowing surgery’? Since I cannot find any before-and-after picture for the ‘head widening surgery’. Also am i right in saying that the ‘head widening surgery’ has nothing to do with the temple part of one’s face? If it doesn’t, will a ‘head widening surgery’ create an illusion that one has ‘wider temple’ (more volume), despite the surgery is enhancing a different area (head skull) of one’s face? Moreover, since two implants will be put on one’s sides of the head skull, and since the implants are big in size, will they impose pressure on surrounding nerves? Lastly, I am trying to do research but i’m not seeing doctors that do this surgery. May I ask if you discover such surgery yourself? Is there any surgical case or any before-and-after photos you’d be able to share? Thank you very much!

A: Head widening surgery is done by temporal augmentation with custom designed implants. Whether that is done partially (anterior or posterior areas) or completely (anterior and posterior depends on the type of head widening effect one wants to achieve. Such implants are placed from an incision in the crease of the back of the ear either in the submuscular, subfascial or suprafascial location depending on the temporal coverage needed.

Out of patient’s request for confidentiality, before and after pictures are not available.

Dr. Barry Eppley

Indianaplis, Indiana

Q: Dr. Eppley, I consulted with you in the past about possible chin augmentation, and after that having visited many plastic surgeons for various reasons you are the only one I trust when it comes to facial sculpting/implants. I have moved on from the chin for now because I realized a much more pressing issue is my cheeks. Another plastic surgeon told me I was a good candidate for buccal fat removal, but after reading some of your Q+A on realself I am unsure if that is the exact area where my cheek fullness even comes from so am worried it would not even make a noticeable difference! It seems like no other doctor understands (or at least is transparent) that there are other reasons for chubby cheeks that are NOT the buccal fat and therefore removing it would not fix the problem in those cases! 

I also know I have extremely weak cheekbones in the mid-face beneath my eyes and am just trying to decide if I need an infraorbital rim implant with malar extension or just the malar cheek implant (or if I am better off just with filler.)  I am thinking any cheek implant or filler would be a bad idea without getting rid of the soft tissue fullness beneath the cheek bone FIRST, as it would just add to the fullness. I am just unsure what the best procedure would be for me to address that. While losing 25-30 lbs would effectively get rid of all that fullness in my face, I am already a bit underweight so I know that’s not the answer.

A: Based on your pictures I would say the following:

1) I would view buccal lipectomies and perioral liposuction as a complementary or adjunctive procedure to cheek implants for your midfacial enhancement. Facial defatting alone is not going to create more defined cheeks. One can certainly do the defatting first and see what it looks like.

2) I don’t think you are a good candidate for a cheek implant that has a substantial infraorbital extension as that would require a lower eyelid approach to place. (true custom infraorbital-malar implant) Your infraorbital rim deficiency is mild.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can the plates and screws be removed in the future after cheek reduction surgery? Or, is there a way to do this without using plates/screws (For example – I saw a mention of a non-fixation method)

A:In answer to your questions:

1) The plates and screws can be removed after 6 months if the patient so desires.

2) The Quick Cheekbone reduction surgery does not need the plates and screws because it is done differently. Rather than an anterior cheek bone osteotomy, the cheek bone is merely shaved down. The posterior zygomatic arch osteotomy is angled and the bone is just pushed inward. While the Quick reduction method is faster and avoids plate and screw fixation it also produces less cheek width reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have lost around 100 pounds, since 2013. Last year had a Full Torso Lift and that area looks great. However, the Surgeon I used will not do the following for me. 

– Outside thigh lipo / tuck 

– Inside around knees – lipo / tuck 

– Arm lift – only because my right arm had 9 lymph nodes taken out when I had breast cancer – which were all negative and I have had zero issues with it. 

Can you do these 3 items. I realize this cannot be done all at same time.

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

1) When referring to the thighs I think you mean an extended inner thigh lift (see diagram) which is the appropriate approach to your thigh tissue redundancy.

2) As for the armlift I can certainly understand the concern as the risk of chronic lymphedema could result on the side with the prior lymph node excision. But I think it is reasonable to do if the following criteria are met:

    a) No history of radiation to the armpit

    b) No current chronic arm swelling

    c) A not overly aggressive armlift that does not extended into or past the axillary region.

3) You are correct in that both the arms and thighs should not be done during the same surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, for years I have been following your work and I have esteem for you and envy for your patients, who thanks to you revolutionize their lives. I am a 31-year-old boy suffering from plagiocephaly, my skull has a greater volume in the frontal, parietal and right temporal part and vice versa on the nape. I also dream of undergoing remodeling surgery using prostheses and I hope to find a competent doctor in Italy too. I have some questions to ask you. Having to use two prostheses, would it be possible to avoid cutting from ear to ear and opt for two accesses? Working (given my height) I often bang my head is the risk of the prosthesis moving so high? you work as a farmer in a greenhouse, often with temperatures close to 50 ° C and the sun beating down, can the prosthesis interfere in any way with the tissues or inhibit their ability to dissipate heat? Thank you

A: In answer to your skull implant questions:

1) Even for two skull implants I would never use a coronal incision.

2) Heat nor trauma will not harm skull implants in any way.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Thank you for reviewing my inquiry. I’m wondering if you would recommend a chin implant for me and if yes, what size/type? I am looking for a very conservative, natural, feminine and pretty result, especially since I am petite. 

I have an asymmetric chin, with the left side being shorter than the right and the thickness might even vary, even though it’s subtle. I also have hollowing on the sides that is concerning as I age (I just turned 40). And my chin is a bit square-shaped, so I don’t want anything that is going to make me look masculine. I am thin and have a long-ish face, so I wouldn’t want length either, though I understand with most chin implants some length is a given? 

I had a consultation with a doctor who recommended a size small Implantech extended anatomical implant. However, I see that you are the authority on facial implants and surgery and your opinion would be greatly appreciated, as I would like to plan a procedure and feel that your care and expertise would be of comfort. 

Also, what is the cost of this service under your care? 

Thank you kindly for your time and consideration.

A:Thank you for your inquiry and sending your picture. You have fairly short chin that is angulated backwards and is vertically long. With such anatomy you are not really a good candidate for a chin implant as implants are technically designed to sit on the front of the bone which will make your chin longer. The implant can be moved up higher but this is not how they are ideally designed to work. You are a far better candidate for a sliding genioplasty which can bring your chin forward AND make it shorter. This may not be the operation you want but it is the better chin augmentation option from a dimensional standpoint than an implant with your chin anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Lateral Chin Ostectomies – Narrowing the Broad or Wide Chin…. Saw article about this from you and it felt like something I am interested in. I feel my chin is too wide (the actual fatty part of the chin should not be as long horizontally). I always felt like making it more V shaped would look good. How does this differ from V shape surgery? I want my chin more pointed and narrow. Curious how imaging would look to. I have had a chin implant/buccal fat removal before but this is something that really interests me.

A: Thank you for your inquiry and sending your picture. How to narrow your chin is based on an understanding of why it looks wide…and that is because it is vertically short. So while the chin can be narrowed at its current vertical height (see attached prediction), it is more effective to vertically lengthen it as well. (see attached second prediction) This is known as ‘mini V line’ surgery, technically known as a combined vertical lengthening and narrowing chin osteotomy. (also known as the T-shaped bony genioplasty)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am undergoing double jaw surgery for my recessed maxilla and mandible. I have a lack of undereye support that has caused sclera show and ptosis in both of my eyelids, resulting in a very tired look at rest. I wanted to go for lower eyelid retraction surgery (possibly with a canthoplasty), but I was under the impression that without adequate support, these surgeries have a high chance of failure. 

I mentioned infra-orbital implants to my surgeon (he does indeed do them), but he said that he wouldn’t indicate them in my case because he didn’t feel I needed them, and that he hopes the sclera show will be less after the surgery anyway. I’m hesitant about this, as the sclera improvements I see from only a normal LeFort 1 aren’t really what I was looking for (neutral/positive canthal tilt, no droopiness of the lower eyelid) . He did mention that he was going to use a High LeFort 1 cut instead to help fill out my cheek and midface more. My question is whether a High Lefort 1 would be enough to help provide support to my lower eyelid such that canthoplasty/lower eyelid retraction would be acceptable. I’ve struggled to find answers to this question online, and while my surgeon is very experienced, he prefers to go for the results that the average person won’t mind (lower eyelid surgery is probably not a thing the average person thinks about). 

Thanks for reading!

A:A Lefort I osteotomy, regardless of the level, can not provide any improved infraorbital rim skeletal augmentation/support. To even think this is remotely possible fails to have an understanding of the basic anatomy of the periorbital region.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been meaning to get clavicle lengthening, in order to increase my biacromial width, at some point in the next few years. I just had a question regarding this. Is there a one-to-one correspondence between the gain in biacromial width and the gain in armspan/wingspan? So, for example, if someone gets their clavicles lengthened by 1 inch per side for a total 2 inch increase in biacromial width, does their armspan/wingspan also increase by exactly 2 inches?

Thank you. 

A: That is a very good question, I would assume it would since the clavicle is a horizontal bone and the wingspan is a horizontal measurement affected by shoulder width. But, quite frankly, I have never measured arm span width in clavicle surgery patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in skull width reduction. I have attached a CT scan of my skull. I have a few questions: 

1. Based off my CT scan alone, is my skull clearly wider at the top than average? A google search tell me yes, but I’m sure with your extensive experience viewing CT skull images you can easily say whether mine jumps out as wider than average. 

2. How many millimeters of bone can be burred? 

3. I do not want to remove the temporalis muscles considering my head is widest at the top bony area and removing muscle beneath is will only make it appear even wider–especially considering muscle removal has a far more dramatic effect than bone burring, so even if both were done I imagine I would still get that effect. If only the bone above the temporals muscle were burred, would I be able to avoid a lateral scar? Additionally, would the swelling be less significant considering the muscle won’t be manipulated? 

4. Are there any side effects from such a procedure it would be helpful for me to know about? It’s not a common procedure, so I would can’t find such an answer online. 

5. How long would it take for swelling to reside? 

6. Considering volume is removed from the skull, will the soft tissue shrink back down over the bone? 

Thanks in advance.

A:In answer to your skull reshaping questions:

1) Yes it is.

2) In the 5mm range

3) An incision is needed to do the bone burring. The postoperative swelling would be less than with temporal muscle removal.

4) The scar is the only ‘side effect’. (aesthetic tradeoff)

5)  7 to 10 days for most of it to subside.

6) There will be no problems with loose scalp skin.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I’m a young female looking into mandibular angle implants I came across your social media. Most I’ve seen done is on males do you do this for females add some width and length to the ramus without it looking too masculine ? Also with facial implants which are meant to be lifelong is this true or do they have to be changed down the line because I’ve ready somewhere that Brest implants have had to be removed because of degradation. What is the success rate for mandibular angle implants I’ve seen many say negative things some positive but id really like some more information before I have any consultations with anyone right now I’m just researching. I have pictures of my profile too if that helps thanks.

A: In answer to your jaw angle implant questions:

1) The vertical lengthening style of jaw angle implants is the only really suited for most female jaw augmentations.

2) Solid silicone facial implants should not be confused with gel breast implants. Such facial implants never degrade or need to be replaced due to implant material fauilure.

3) Like all facial implants jaw angle implants have all of the same risks of infection, asymmetry as well as sizing/shape issues.

4) I would need to see some pictures for imaging of potential results of which the most valuable are the front and three-quarter views, the profile view is the least useful in imaging jaw angle implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, First of all, thank you for the more than complete information you provide in your websites. It is very useful for those of us who need information about surgical procedures that are not usually offered by most plastic surgeons. My problem is that I suffer from plagiocephaly, with the right back side of my skull flattened (comprising the occipital, parietal and temporal bones) and the right side of my face being more prominent (forehead, orbital rim and cheekbone) than the left one. Although I have found extremely useful all the information collected in your websites, I have some questions: 

1. In occipital augmentation, and when a single custom implant (due to the extent of the malformation) must simultaneously cover the occipital, parietal and temporal regions, taking into account that the temporal bone is covered by muscle and that the occipital and parietal zones do not, between which layers is the implant inserted, I mean, over which layers does the implant sit? 

2. I have read in your posts that the “bony suboccipital” area (the lower area of the occipital bone that is below the neck muscles and below the superior nuchal line) can’t be augmented due to possible neck muscles problems, but is there any reliable and permanent “muscular suboccipital/subnuchal” augmentation method? Could a custom silicone implant (or semi-custom hand-carved) be placed over the upper neck muscles? Would this implant sit directly over the muscle or in another plane? Over what muscle/s? What durometer silicone implant would be required? Would fat grafting be another permanent option? Would this fat be injected in a submuscular or in a subdermal plane? Would a first previous stage of scalp expansion be necessary or recommended? 

3. In the case of the face, is it possible, by burring technique, to reduce the horizontal projection of the anterolateral region of the forehead and the horizontal projection of the orbital rim (superior, lateral and inferior areas, from the supraorbital notch to the zygomaticomaxillary suture) (black painted areas in the attached picture)? And how many mm approximately? 

Thank you very much for your time and patience.

A: In answer to your questions:

1) Any skull implant that covers a combined non-muscle and muscle areas must go on top of the temporalis fascia.

2) As a general rule there is little aesthetic value to having a skull implant go much beyond the nuchal ridge line of the occiput onto the neck muscles and there are potential complications from doing so. Any soft tissue neck deficiency below the nuchal ridge must be treated by conventional soft tissue augmentation methods (fat injections) although they work poorly in the tight posterior neck area.

3) You are going to get roughly 5 to 6mms of bony reduction on the highlighted forehead and orbital regions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been a clandestine fan of your practice; you’ve been quite innovative. Congrats. 

I have a question about rib resection, something I have no experience with or have thought about much. I just don’t get it, one can make the case that the floating ribs don’t have much effect on the waist (except maybe some for girdlers), and even might confine it by keeping soft tissues from expanding . In any event why do they need resecting, why not just remove a chunk of proximal rib and let the distal end truly float. I read on your Instagram feed that you remove some muscle, how much effect do you think that has? 

A: Thank you for your thoughtful questions about rib resection and in answer to them:

1) Ribs do make a contribution in waist girth, just not in the way that it is commonly perceived. It comes down to their soft tissue support that they provide. It is really about weakening the framework that supports the enveloping soft tissues.

2) When it comes to the floating ribs (11 and 12), 11 is by far more important…and I would argue that 12 is completely irrelevant as it is slmply too short and ‘hidden’ except in exceptionally thin females.

3) The false rib #10 makes an equal contribution as #11 which is why 10 and11 subtotal resection are the keys to the procedure. (12 is usually just taken as a ‘convenience’ and in the spirit of making a maximum surgical effort)

4) How the arc of the rib is weakened doesn’t really matter. Whether that is a distal resection, a segmental mid-resection or a proximal resection. (the latter two being collapse techniques) What does matter, of course, is the surgical risk in doing so. The proximal resection would have the higher risk being closer to the spine and is the hardest to get to being covered by the erecti spinae muscle. Distal resection is the easiest to perform through one very small incision and has a negligble morbidity in doing so.

5) The LD muscle is the largest soft tissue contributor as is incredibly thick even in small females. (1 to 3 cms) Because it has to be transgressed to perform the rib resection I have learned and observed that removing a longitudinal portion of the muscle is helpful in the overall objective with no loss of function.

6) In my experience it is the combination of structural support reduction (rib removal) and soft tissue resection (muscle excision) that creates the result. Thus the term ‘rib removal’ doesn’t really accurately describe what is actually done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I hope this email finds you well and healthy

I am a dermatologist in Brazil and am writing about a male patient with cutis verticis gyrata (CVG) who came to my office at an early stage and I would like to know if you have positive therapeutic experience with fat grafting or PRP for this clinical condition.

Thank you for your time and I wish you an excellent week.

A: In mild cases of CVG injection fat injection grafting can be successful with a combination of  release and injection. PRP alone will not work.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My rhinoplasty questions are:

1. Is it possible to do a nose reshaping with results similar to the pictures I’ve attached? My main concern is how far my nostrils project into my nose tip. I would like to have more of a tip to my nose. I also would like my nose to be just slightly shorter. It is important to me that my nose would look very natural and not extremely narrow or perfect. 

2. I am also concerned about the look of my neck and jaw. I’d like to remove fat from around my lower cheeks, jaw, and neck. Could this procedure be done at the same time as my nose? Are there extra risks to doing both at the same time? 

3. What would be the cost to have both of these done? And the cost for them separately? 

4. Does your team provide financing options? What are the terms of the financing options? 

5. How far out would I have to schedule? 

6. I also have POTS and fibromyalgia, though not to a severe level. Would this affect my candidacy for these procedures? I have been under anesthesia before. 

7. How long would I have to stay locally for these procedures? 

8. How much pain could I expect for both of these procedures? Could I manage the pain with ibuprofen or advil alone?

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

1) While the general type of profile nose shape can be achieved the reduction in nostril length/exposure is probably overly optimistic.

2) Submental/jawline liposuction can be done at the same time as a rhinoplasty. Doing them together does not increase the risks of either procedure over being done alone.

3, 4 and 5) Will be answered by my assistant.

6) I am not aware that POTs or fibromylagia have any adverse effects in these facial procedures.

7) Most patients return home the following day.

8) These are not particularly painful procedures that require any narcotics.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m writing to ask your professional opinion on whether or not my goals are reasonable and obtainable with chin surgery. Ten years ago I had surgery to address my ptotic chin where there doctor removed an ellipse of tissue approx. 5 cm x 8 mm (there was no bone work done). He recommended a small anatomic implant be placed which I kept for 2 years and finally had removed in 2013 because it always felt a bit too tight. Since the removal, I’ve had both functional and aesthetic issues – there is less mobility in the center, and on my left side where the chin doesn’t move down as much as the right side so my mouth appears crooked when I speak. I’ve had Botox to try and help, but all it did was freeze my chin where neither side moved. Aesthetically, I still have a witches chin and on the left side there’s an area in front that’s flat, compared to the right side – this causes a shadow. I’ve added filler to it over the years, which helps a bit, but it takes multiple syringes and isn’t cost effective. I am now considering Smart-lipo and/or platysmaplasty to tighten the area under my chin as well to give me a better “chin-to-neck” transition. My question is will inserting another implant give my chin enough of a boost in front to help with the drooping and fill out the flat area (could more tissue to be removed with a submental tuck?) The doctor noted that I have little mentalis muscle so I’m not sure if that could be contributing to my overall problem. Do you feel there is anything that could be done to address the functional issue – could the implant help at all in that dept? 

I’ve attached photos for reference. Thanks in advance – I hear you’re the expert so I value your opinion.

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

1) The need for the chin implant placement makes no sense to me.

2) Why was a submentoplasty never done as part of your original procedure as this is what you are imaging now.

3) Your imaging is probably a bit overdone/unrealistic but the concept in that direction is what can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I’ve come across your website a couple of times and saw the before and after of the patient who went through the brow bone reduction and forehead augmentation. The results look amazing and I had a couple questions about that because I am planning to get this procedure done. My forehead is too slanted and I have a brow bone that sticks out. It’s funny because I’ve been called a Neanderthal by a couple of people haha. Anyways these are the questions that I had regarding the procedure. 

1. I’m getting a nose job from another place and I don’t know if it will affect the procedure. That’s why my question is which procedure do you recommend getting first? The brow bone reduction and forehead augmentation or my nose surgery? I don’t know if it makes a difference haha. 

2. How long is the procedure? 

3. How long will it take to heal? And does it affect me playing sports for good or just a while? (Soccer in particular) like will I ever be able to header the ball? How long will I have to wait? 

4. Around how much is the cost? 

5. I’m also planning on getting laser hair removal, because my hairline is really low and so I wax it off, will the laser hair removal affect my skull or my bone after my brow bone reduction and forehead augmentation? 

I’d love to hear back from you, thank you! 

A: In answer to your questions:

1) It does not make a difference as to whether the forehead or nose procedure comes first. It really depends on which one has the higher priority if either one does.

2) A combined forehead augmentation and brow bone reduction procedure is 2.5hrs.

3) Good healing would take 6 weeks. I would not head a ball for at least 3 moths after the surgery.

4) My assistant will pass along the cost of the surgery to you.

5) Laser hair removal is superficial, it will not affect the bone beneath it or anywhere else.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am post facelift ( one month) with my 3rd chin implant.  The implant just doesn’t seem right and I would like you to give me your opinion on what size I need. I feel it’s too wide and not feminine at all .  The prior implant shifted off the bone and was creating problems with smiling.

A: The most common problem in female chin implants is they are too wide (extended wings) and have too much projection. Many surgeons use the extended anatomic style for reasons that escape me. This style chin implant coupled with malposition off the bone (due to lack of screw fixation) magnifies the problem.

You can most likely modify the implant you have and secure it firmly in position to achieve a more desired result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a buttock augmentation with implants elsewhere but the implants on the right side flips….I had a MRI but I really don’t know what can be done….some doctor say I can do nothing due my muscle is too thin…..someone say better to remove the implants and exercise it a lot before thinking to a new implant….someone says the muscle is broken, I need just to remove the implants and to ask for a total refund to my surgeon..who knows……I send you a pic with a panoramic view of the MRI but I can send all the files by mail….thank you. Kind regards. 

A: What your MRI shows is that the buttock implants may have originally been placed in an intramuscular position but now appear to be in a partial intramuscular position as the muscle has atrophied over the top of them. (this is not uncommon) With the right implant flipping this is not a problem likely solved by implant replacement. (the implant is not the problem although a bigger implant that is stiffer may help as you undoubtably have gel buttock implants) One other potential option is to lift up the lower capsule of the implant and place it under that next to the muscle. (implant pocket adjustment)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have bone loss in my forehead. One dent is under my hairline going horizontally. It is approximately an inch and a half long (horizontally) and maybe an inch wide.There is another one going down vertically from that one that has now run into the first one that is approximately an inch long and perhaps 3/4 inch wide. Sort of a T shape, see photo. Slightly more to the left than the center of my forehead. I noticed these approximately 15 months ago and they have become larger. My doctor says it is bone loss that we all get with aging. I have osteoporosis. I’m wondering what can be done about this? I’m very concerned that they will keep getting larger. In your experience, what do you think the likely hood of that they will get larger? Thank you.

A: First it is extremely unlikely those forehead indentations are from bone loss. Regardless of how osteoporotic one is or their age you don’t get localized bone loss at random forehead areas. That is simply not biologically possible. These are discrete areas of soft tissue loss. Second, whether they will get larger I can not say. Third, the proper treatment is far injections to help restore lost soft tissue volume.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I had specific questions about the chin implant. I got 2ml of chin filler done this past month and I absolutely love the results! However chin filler isn’t a permanent solution, and it’s also a costly upkeep and migration is bound to happen. I was wondering if for someone in my case who only needed 2ml of chin filler for the desired look, is chin implant worth it? What type of implant is best? Medpor? Silicone? And can custom chin implant provide a v-shaped chin like the fillers? I do not like the regular look of chin implant because they are too boxy.

A: A chin implant is worth it unless you want to continue with ongoing fillers. The key is a silicone chin implant that has been made into a v-shape that provides the slight needed horizontal augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a young male that’s looking for some changes to my chin/jaw. I would like to have a more masculine and chiseled jawline and chin (I have included some photos of the type of result I’m looking for, as well as my own profile currently). I was considering a chin implant however I am aware that my labiomental fold is already quite deep, and I do not want to make this more apparent. 

A: Thank you for your inquiry and sending your pictures. If your goal is to undergo chin/jawline augmentation and not make your labiomental sulcus any deeper then you are not going to have any augmentation procedure. The labiomental sulcus is a fixed anatomic structure. By definition then any form of chin augmentation will make it somewhat deeper so this is unavoidable. There are concurrent strategies (fat injections) to treat the labiomental sulcus at the time of chin/jawline augmentation to try and prevent that adverse aesthetic change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was hoping to get your input on a nerve injury. I had jaw reduction surgery 2 months ago. The square sides were cut and chin shaved (no genioplasty). Now my mouth is crooked when I smile. I marked the numb area on my chin in the attached photo. From looking online it seems this is a mandibular nerve injury. Was this a surgical error and avoidable? Can it recover? Are there any treatments available? 

A: While there was no attached picture, this sounds like weakness of the marginal mandibular branch of the facial nerve…which causes weakness of the lower lip depressor muscle making the smile asymmetric. This is a nerve injury that only time has a chance to recover of which the final outcome may take up to a year to see what degree of nerve function returns.

Dr. Barry Eppley

Indianapolis, Indiana