Your Questions
Your Questions
Q: Dr. Eppley, I am wondering if you could tell me if I would be a good candidate for a sliding genioplasty procedure judging by the attached photo. On the left is what I currently look like, and on the right is how I would like to look. I have talked to a previous surgeon and he says he won’t perform the surgery because my face is already balanced. I disagree, and think my chin needs to be moved down vertically and slightly forward to balance out my face and to decrease the mentolabial fold. I would greatly appreciate your input before I schedule an in person consultation with you.
A: Your supposition about your lack of facial balance is correct as your own imaging has demonstrated. I am baffled how any surgeon could say your present facial profile is balanced. But even if it was in balance it is really up to the patient to determine what they want. That looks to be a sliding geniopasty movement of about 7mm forward and 2mm vertical.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you perform double jaw surgery (Lefort 1+BSSO) for aesthetics, I dont have any measurable occlusion but my maxilla isnt forward grown and possibly even recessed. I attached some pictures below for reference. It would also be great if a wrap around implant can be placed in the same surgical procedure as the Bimax.
A: Thank you for your inquiry and sending your profile picture. Based on your briefly described aesthetic goals, it is hard to imagine that bimaxillary surgery would be appropriate. In the face of a normal occlusion the usual justification for a bimaxillary advancement is in cases of severe sleep apnea. The risks and potential complications of such surgery do not usually justify this degree of invasiveness. It is not a question of whether it can be done but whether it should be done. I would need to have more clear description of your midface goals to provide a more qualified answer.
In addition no form of an implant can be done at the same time as sagittal split lower jaw advancement surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need a LeFort osteotomy to shorten my midface. It is too long from my eyes down to my upper lip.
A: No form of a LeFort osteotomy can shorten the external midface unless one has vertical maxillary excess…and this is only effective because it lessens the amount of tooth exposure. Shortening the length of the bony midface will not shorten the overlying soft tissue and will only result in loss of upper tooth show under the upper lip. The only known external midface shortening procedure is a subnasal lip lift which shortens the distance between the nose and the upper lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am intending to go through with a shoulder width recution via a “Clavicular Osteotomy” And would like to know the price you would charge for the named procedure if possible. Furthermore I would like to know if you have found success in resecting a little more “Aggressively” beyond the initial 2.5cm conservative limit. As I would personally be hoping for 4cm from each clavicle to achieve my goals and would be more than happy to be a “Trial run” to achieve that and help with your clinical outcome research.
In addition I would like to inquire about rib resections. Specifically if you have performed any clinical trials on successful upper rib resections for reducing a wide chest, and if so what sort of price you would charge and what waiver I as a patient would need to sign before going ahead with a procedure of that kind. As I say, I am an extremely motivated patient in that regard and am well informed of the risks associated with such a procedure.
A: In answer to your shoulder width reduction questions:
1) Reducing more than 3cms per side (clavicle reduction is problematic as the distal end of the clavicle causes too much inward shoulder rotation.
2) You can not reduce a wide ribcage above rib # 9 as it relates to a narrowing or inward movement on the sides. There are just too many ribs that would have to he resected to have the desired aesthetic effect and that would create serious pulmonary problems.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I previously contacted you to inquire about getting a Jaw Implant as seen in your Youtube video. I had a Medpor chin implant in 2004 which was attached by a screw. I wanted to know can the implant be taken out without damage. My understanding is that tissues grows into the Medpor implant and would be hard to remove.
A: Medpor chin implants can be safely removed and is very common for me to do in patients ‘graduating’ to a custom jawline implant. A 3D CT scan is needed both for implant design but also to determine the proximity of the existing chin implant to the mental nerves.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please could I have your thoughts on how to solve my bicep implant issues. proposed solution outlined below.
1) Please see attached photos of my arms, I have had bicep implants (placed OVER the muscle but below the fascia)- As you can see the edge on the right arm is very visible and on the left arm the shape is clearly strange looking.
I believe this is down to the re-shaping/molding of the implant not been done correctly, for example on the right arm the edge should have been feathered or filed down to make the thickness of the edge thin compared to the rest of the implant.
2) Please note the implant placed in the biceps was a large Implantech calf implant. I like the additional bulk added by this implant, I just wish the bottom edge wasn’t so visible.
As you can see I have also uploaded photos of an old set of forearm implants I have removed, I have played around/tweaked one of them (hence the amateur style cuts I have made with scissors)
What I have done is try to create a pattern so the implant DECREASES in thickness until the bottom edge, with the aim been to make the edge WAFER/PAPER THIN thereby making the edge of the implant barely visible when placed underneath the skin?
Please could you let me know your thoughts on this idea/proposal? Of course the cuts would need to be made cleanly and straight with professional surgical equipment as opposed to a pair of kitchen scissors.
Many thanks.
A: When implants are used for body areas in which they are not designed (calf implant for a bicep) there are going to be some shape issues. When it comes to feather edging, which is real important in subfascial implants, it is very difficult to try and hand carve a feather edge. The material simply doesn’t allow for precise feather edging to be hand made. This is why for subfascial bicep implants it is better to either 1) custom make the desired implant shape and size, or b ) use a Contoured Carving Block (Implantech, CCB Style 3) which is actually a bicep implant that is called a different name which already has feather edging.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to reduce the length of the head from the top to the eyebrows? If so, how many centimeters? I would very much like to know about the possibility of having the skull get the shape more equalized, because respectively from the front to the middle of my head, it starts with a smaller width, but the width increases considerably from half of the head forward, until back of the head. The same kind of shape also occurs with my head´s length, start smaller, and going to the back of the head it is bigger, I mean, it looks like a climb. So, is it possible to reduce both, width and length? Make larger parts equal smaller ones?
A: In answer to your skull reduction questions:
1) Some modest superior skull reduction can be done as seen in the attached prediction image. This is an amount of 5 to 7mms, not centimeters.
2) The same modest reduction can be achieved in the head width as seen in the attached image.
3) As in height and width similar modest amounts of length reduction can also be done as in the attached image.
As stated in our virtual consultation the question is not whether overall skull reduction can be done but whether the overall modest changes are worth the effort. The attached imaging helps provide some visual information for you to make that decision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, which procedure(s) would be better suited for improving the aesthetics of my lower facial third, a sliding genioplasty or a custom wraparound chin implant?
I have very thin gums, and have had a gum graft performed to thicken an area where there was significant recession. Would this impact my eligibility to have a sliding genioplasty performed?
What is the most suitable procedure to address my subpar cervicomental angle? Would submental liposuction suffice for giving me a defined angle?
Is it possible to achieve 14mm of projection with a custom wraparound chin implant alone?
I look forward to hearing from you.
A:These are all great questions but without knowing what you look like I can only provide some limited answers:
1) A sliding geniopasty and a custom jawline implant have significant different aesthetic effects as one only affects the chin while the other one changes the entire jawline. So these are not directly comparable procedures.
2) The incision for a sliding genioplasty is done on the lip side of the anterior vestibule not on the gingival side of it. Thus one’s periodontal status does not affect the ability to have a sliding genioplasty. But I would have to see a picture of your front teeth and gums to provide a more qualified answer.
3) There are two basic procedures for improving the cervicomental angle of the neck, liposuction and a submentoplasty. A submentoplasty procedure is always superior to liposuction alone as it addresses the central platysma muscle and subplatysmal fat as well.
4) When you say 14mm projection I assume you are referring to horizontal chin projection. The amount of 14mm is right at the perimeter of how much stretch most people’s soft tissue chin pad can accommodate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My concern is my forehead shape and the right side of my head is pointy and very, very uneven. Attached are my pictures, what do you recommend?
A: Thank you for your inquiry and sending your pictures. Your forehead and skull asymmetry is apparent and one can debate whether the source is a left sided deficiency or a right sided overgrowth. But what really matters is which skull reshaping treatment approach produces the best aesthetic result…left-sided augmentation or right-sided reduction. (or even some combination of both) Ultimately I would need to see a 3D CT scan of your skull to understand the full topography of your skull bone asymmetry. But in the interim I have done some computer imaging to look at augmentation vs reduction to determine your aesthetic preference.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a silicone chin implant placed about ten years ago and it was removed five years ago and replaced by a sliding genioplasty. I have received further projection which is great but now I have irregularities in the chin/balling/dimpling probably due to scar tissue?
I’ve been advised fat transfer to resolve deviations would not be optimal there and filler is temporary.
Could a custom chin implant be placed to smooth over in recontouring this chin region or could this area be reopened intraorally and smoothed over internally somehow?
I’m wanting custom Jaw Implants to resolve deficient jawline but the chin ideally improved at the same time.
Your time in responding is greatly appreciated.
A:The chin irregularities are in the soft tissue and not the bone. Thus I would not be optimistic that any form of chin bone augmentation would produce a significant improvement in the chin irregularities. It may…but that would be an unexpected bonus and not an assured outcome. Fat injection grafting would seem to be a more logical approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Last year I had a sliding genioplasty performed in Korea. While I like the shape and projection of my new chin, I have a constant sensation of tightness and my bottom lip feels like it’s being pulled downward and sits lower than previously which exposes more of my lower teeth. I also find that it’s awkward when speaking and my mouth no longer remains closed during sleep causes me to drool. I was hoping you can offer some professional insight as to whether what I’m experiencing is consistent with the healing process as I have been told by the surgeon in Korea. I have attached my X-Ray photos to hopefully shed some light.
A: While it is typical that tightness and lower lip changes do occur after any chin bone surgery, these issues should be largely resolved by almost one year after surgery. if you look carefully at your before and after cephalomertic x-rays it is evident that your lower lip was already pulled down at this early point after surgery. (yes I know there is swelling but lower lip distraction is not a good sign even right after surgery) I am afraid at this point after surgery that your tight sensations and lower lip position are now beyond part of a normal recovery and will be not be self-solving problems. You have lost vestibular height and soft tissue volume and plasticity.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a mouth widening surgery since I have a quite small mouth, that is not very aesthetically pleasing or pretty. Due to the golden ratio: A ratio of lower lip vertical width to upper lip vertical width of 1.6 is also ideal. Now the optimal horizontal width of your entire relaxed mouth (what it looks like when it’s closed with no voluntary effort to widen it) to nose ratio approaching 1.62:1 has been recognized as a very important contributing factor as well in overall perception of facial beauty – the attractive mouth to nose ratio of 1.5:1 should be revised to 1.618:1.
Therefore I did some research on what could be done and I read that there are: surgical methods developed for treating microstomia (a mouth opening that is abnormally small). This procedure is traditionally used for correcting congenital microstomia, or acquired microstomia through burns or disease. However, certain plastic surgeons are well-trained in adapting these surgical techniques for widening healthy narrow mouths using a procedure called a commissurotomy, followed by a commissuroplasty. The first procedure is the cutting procedure and the second is to establish new lateral commissures and rearrange the muscles on the enlarged mouth so scarring is minimal and the mouth remains fully functional.
The photos i want to attach are both pictures of the actress Freida Pinto whose smile I want – and that includes the way her mouth looks when she laughs -, and one of the reasons that is, is because I think her smile/mouth is a bit similar to mine in the way it looks and “functions” (if you can say that). But I will also attach photos of the mouth widening procedure in drawings an such I have found on the internet.
A: Whether you call it a commissurotomy, commissuroplasty or mouth widening procedure these are all basically the same operation. Skin has to be removed, some muscle resected to prevent relapse and allow a pathway for the vermilion-based mouth corner to move into on its way to the outer margin of the resected skin to establish the widened mouth corner.
I would refer you to one of my websites, www.exploreplasticsurgery.com and put in the term Mouth Widening in teh search box. There you will find multiple articles I have written on his aesthetic perioral topic.
No matter how the procedure is done it all comes down to how well the mouth corner scars heal and appear and the acceptance that there is a relatively high risk of scar revision needed for them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty four weeks ago (8mm forward and 2mms vertical) and initially it looked just perfect. But as the swelling has gone down I now know I really want more augmentation. I told the surgeon I would rather have too little than too much augmentation so I probably made the surgeon be too conservative. What are my options now?
A: The not uncommon patient preoperative phrase, ”I would rather have too little than too much’, is an abstract one that may change when looking at actual physical changes. This is not rare. An 8mm forward movement of the chin would not be considered conservative but it all depends on whom it is on, what their initial chin looked like and their interpretation of what looks good to them. But like all facial bone reshaping surgery one never knows how the patient will feel about a ‘new look’ until they actually have it done.
The approach to take depends on how much more horizontal augmentation is needed. (it is all about the millimeters)
Given his original amount of advancement and maintaining bone contact, there is probably only a few more millimeters to go by moving the bone further forward. (changing the plate to a 10 to 12mm plate) In other words maybe another 2 to 4mms with the chin for sure becoming a bit more narrow in the front viewing the notching in the side a bit more palpable..
The other approach is to add an implant on top of the advanced chin bone from a submental approach. This is a more versatile dimensional approach as the amount of horizontal augmentation is greater with added width to the chin as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 20 years old and I noticed witches chin developed a few years ago. I have attached a photo. What type of procedure would you perform?
A: Thank you for your inquiry and sending your profile picture. While most true ‘witch’s chins’ occur from prior surgery or from aging, ir can occur less commonly naturally or congenitally. By definition a witch’s chin deformity is when there is s mismatch between the soft tissue chin pad and the underlying bone support. This is most manifest by some degree of apparent sagging of the soft tissue pad and an underling prominent submental skin crease.
What differentiates an iatrogenic/aging witch’s chin from a congenital one is the tightness of the soft tissue chin pad and the degree of bone development of the underlying chin bone. If one has a deficient bone then any form of chin augmentation will solve it as the soft tissue chin pad is stretched out. If the chin projection is adequate, which yours is, then a soft tissue submental tuck is needed in a ‘vest over pants’ technique.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, the things I wanna improve is my center part of the face which is like dented from the side, but I look okay from the front. I think it also because of my chin shape but I think the risk of having orthognathic surgery is too high. Therefore, I want to consult to see what is the best way for improving it.
A: Thank you sending your picture and detailing your facial concerns. Like many Asian patients there is a general mid facial profile concavity appearance which is manifest both in the nose and midface as well. Since you have specifically mentioned rhinoplasty I will focus my comments just in this facial area.
An augmentative approach to rhinoplasty is the standard procedure in the Asian face. Such augmentation efforts, unlike many Caucasian rhinoplasties, requires significant augmentation efforts which always comes down to using rib grafts vs implants. (and when I refer to implants I mean thee contemporary use of ePTFE implants not the older use of pure silicone implants) This is a classic discussion in the Asian rhinoplasty patient for which there is no perfect answer as either can be used successfully and I have done many with both augmentative approaches. It really comes down to the patient understanding their different risks and choosing which risk profile is more appealing. Such an implant vs autologous graft discussion is well chronicled and comes down to:
RIB GRAFT
- advantages = low to negligible risk of infection, natural material that will never cause any problems long-term once well healed, adequate graft material for all aspects of the rhinoplasty including tip without teh need for sept or ear graft harvests
- disadvantages = donor scar, longer recovery, graft warping/asymmetry
ePTFE IMPLANT
- advantages = no donor scar, more assured straight result as the implant is straight
- disadvantages = higher risk of infection, will still need ear or septal graft for tip augmentation as an implant is never placed across the nasal tip area
As can be seen neither a rib graft or implant approach to significant rhinoplasty augmentation in the Asian nose is perfect, each has their own advantages and disadvantages.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want temporal implants as I have very narrow sides of my head. I think the implants need to be customized as I also have very small brow bones. I want to widen my brows as well. I have attached a front view picture of my head so you can see what needs to be done.
A: Thank you for sending your picture. Based on this information you are in need of a total temporal augmentation (the entire side of the head) procedure which means both anterior (by the side of the eye) and posterior temporal zones. (hair bearing area all the way back to almost the back of the head) This can be done by two different implant methods, a one piece total temporal implant placed at the deep subcutaneous plane (see attached implant example) or a two piece implant approach with a standard extended anterior implant placed in the subfascial plane with a custom posterior temporal implant placed in the deep submuscular plane. There are arguments for either complete temporal augmentation approaches and that permits further discussion.
But since you have also mentioned the need for lateral brow augmentation as well the best approach would be a one piece custom total temporal implant placed in the deep subcutaneous location so the lateral brow area can be included as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had fat grafting to my cheeks and for the first six weeks I was really impressed how good it was looking and it added to my feminine look. But after 6 weeks most of the fat has gone away so I was thinking how can I make that permanent and i was thinking to do cheek implants. I have drawn the area and also send you another pic how i looked directly after the fat graft. So I don’t really want to widen my cheeks. I want more a layer that not makes my face so flat. Will that be possible? If yes I would also like to see those cheek implants before the operation.
A: Thank you for sending your pictures and illustrating your fat grafted areas. The areas you have outlined are not really ‘cheek implant’ areas but are infraorbital-maxillary midface areas. Even the most lateral part of your drawing is barely on the anterior cheek area. This is consistent with the general area of augmentation when patients want to pull their midface forward but not widen it and this is most commonly down with either hand carved ePTFE block implants or custom midface implants. (standard cheek implants do not have a good shape to use in tis area)
While you are correct in that implants offer a permanent solution to the unpredictable volume survival of fat injections, they also differ in the facial areas that ca be augmented. While fat grafts can be placed anywhere on the face, implants must largely occupy bone-based areas. Thus an implant augmentation can only cover the half or two-thirds of the outlines areas you have made. Anything below the horizontal lines I have drawn on your marked areas will not be able to be augmented by implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Would lip implants need to be removed before undergoing mouth widening surgery? Will they cause limitations in how much the mouth corners can be widened? That seem to have made my mouth corners tighter.
A: No they would not as the soft tissue movements would be done lateral to them. It may be possible that the tail of the implants may need to be trimmed if they extend completely to the mouth corners but this is not problematic for the procedure. However doing mouth widening surgery on a patient who have indwelling lip implants is not a clinical situation I have yet seen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had custom medpor infraorbital / cheekbones implants put in, but did not like the results as they emphasised the asymmetry of my cheekbones. I had them removed very shortly afterwards. Now three months later it seems that the procedure has caused some drooping of my cheeks creating nasolabial lines and an unnatural eye appearance. Would a midface lift be a solution to this issue? If so how soon can I get this done considering it’s only been three months from the time of surgery and I still likely have a bit of swelling / numbness.
A: Between the volume expansion created by the implants and the ligamentous detachments of the soft tissue to the bone needed to place them, it would be expected that some cheek sagging would result with their complete removal. The ideal time to have done any type of midface lift would have been concurrently with implant removal knowing this would have been the expected sequelae. But it can still be done secondarily and at nearly three months after surgery it can really be done at anytime as the inflammatory response of the tissues has subsided and the residual numbness, in and of itself, is not a gauge of time for surgical re-intervention. The question now is not whether a midface lift would be appropriate but how effective it would be at correcting the soft tissue sag without incurring any new problems.(e.g., ectropion)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is only skin trimmed during a standard facelift or both skin and muscle? If so, what do you do if you have excess muscle? Thank you!
A: It is common that patients confuse what occurs under the skin in a facelift. Muscles are manipulated in a facelift but only in the central neck through the submental incision. The platysma muscle may be tightened and is some cases even resected (trimmed) and released out laterally. But on the side of the face no muscle exists that can be manipulated. They deeper masster muscle is what occupies the side of the face and can never moved or manipulated as has no role in facial aging. Rather it is the tissue layer above the muscle, the SMAS layer, is what is lifted and repositioned that along with skin removal creates the rejuvenated lower facial appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, On a moment at the beach I was photographed like this. In this moment I was smiling and the photo was spontaneous. I would like to know why I look so good when I smile and I don’t look good when I don’t smile or laugh ?
Is it possible to make my face as beautiful as in this photo while smiling, but to look as good as in the photo even without smiling ? What implant or implants can bring such a beauty to life?
A: Like in all people that smile, two specific facial changes occur…the cheek area gets fuller (which looks better in a thin face) and the upward movement of the corners of the mouth occurs. (smiling…which is always a more pleasing appearance than a horizontally oriented or downturned mouth corners)
When patients like the appearance of their cheeks when they smile (fuller) one has to be careful what happens when that surgical change is done to what they then look like when their face is in the static or non smiling position. There will be tradeoffs between the desired dynamic vs static resting effect. In other words while cheek implants will make your cheeks fuller at rest, that may make them too full when smiling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been reading your articles about various surgeries on your website for many years, and has been a huge fan. And I recently saw your article on a surgery to correct webbed neck, through the photo of the patient, her neck was greatly elongated after surgery.
I have a pretty short and stubby neck, and it’s been a great concern for many many years, I do not have a webbed neck, however I do have quite large trapezius muscles that makes my neck even shorter.
I have tried Botox, with no luck on correcting the problem. And is wondering if a similar surgery like the attached correction of the Webbed Neck With Posterior Excision and Fascial Plication would help with my situation.
Looking forward to your reply.
A: Thank you for your thoughtful and interesting inquiry. By your description of a normal but short/thiick neck I have never done a webbed neck/neck reshaping procedure on such anatomy. The typical true webbed neck (Turner’s syndrome) has loose skin and more normal trapezius muscular thickness which helps explain the often good results in them. The only corollary to your situation that may apply is in a handful of mosaic Turner’s’ patient who has less webbing but wider necks. In these patients neck reshaping/thinning has often proven to have disappointing results. Perhaps more aggressive trapezius muscle reduction would have better results but I would not say that it could create a dramatically thinner and elongated neck.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 45 year old male and the back of my skull has a 45 degree angle shape. I’m interested in correctly this abnormality but cost, success rate and recovery time are my concerns. Would my medical insurance cover this?
A: Thank you for your inquiry which I can provide the following back of head augmentation answers:
1) Such a correction of a sloped back of the head is typically done with a custom skull implant. Although to be certain I would need to see a side profile view of your head.
2) My assistant Camille will pass along the cost of such surgery to you. We do not participate in medical insurance.
3) The success rate of custom skull implant is very high with vert low rates of any complications. It is just a question of how much augmentation is needed and how much the scalp will stretch ti accommodate that need.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I read on one of your forums that 3.5 cms on each clavicle is possible through lengthening… I would be very interested in that! I’m narrow to the point where I have poor range of motion and my shoulders rest rolled over, which keeps me slumped (back training never fully helped) I’d be willing to put in the extra effort with after care/ therapy if this is possible!
I read an article entitled ‘Congenital Forward Shoulder With Clavicle Hypoplasia: Surgical Lengthening By Intercalary Graft Positioning And Plate Fixation.’ I haven’t been diagnosed but this article seems relates to my issue.
A: Lengthening the clavicle for shoulder widening can be done. It is the converse of shoulder width reduction by clavicular bone resection. The differences are that a bone graft needs to be placed as well as longer plate fixation. The critical question is how long the bone graft can be to still support eventual full bony healing. I don’t think enough cases have ever been done to answer that question accurately. Thus I prefer at this time to limit the bone graft length to 2.5cms which results in an inch of shoulder width increase per side. Because of the unique shape of the clavicle lengthening it causes the shoulder to roll outward a bit.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to remove the bulging bone on the back of my head. (occipital knob)I have a few questions about the occipital knob reduction procedure.
- How long does the procedure take?
- What is the recovery time?
- Is the anesthesia local, general or sedation?
- What is the scar size? I am bald.
Thanks in advance
A: Thank you for your inquiry and sending your pictures. In answer to your occipital knob reduction questions:
1) The procedure takes 90 minutes under general anesthesia.
2) Recovery time is really minimal as there are no restrictions after surgery.
3) The attached image shows the location of the incision in the upper horizontal neck crease.
4) My assistant Camille will pass along the cost of the surgery to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, To what degree can infraorbital implants affect the shape of the lower eyelid? My lower lid is just a touch of roundness to it with the inferior sclera visible to a small degree.
Can a custom infraorbital implants create a narrower eye with a more angular lower eyelid?
A: There is no question that custom infraorbital-malar implants can help drive up the lower eyelid level. Whether that is enough on its own to create a ‘more angular lower eyelid’ depends on the current shape of your eyelids. Most likely it would require some eye inner adjustment as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a low set brow ridge that conceals most of my upper eyelid. Even so, it leaves a small semicircular sliver of the upper eyelid exposed. Is it possible to use fillers to conceal this portion of upper eyelid and create a more straight and angular looking upper eye in the process?
A: The best way to know if upper eyelid filler can be effective at reducing the upper eyelid show is to have it done. With an HA filler if it is not as successful as one would like it can always be reversed or let resorb over time on its own. I believe it will help conceal the upper eyelid bit whether it creates a straight or angular looking upper eye is not as clear.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in learning about forehead reduction via forehead bossing and a procedure that can flatten spots on the top of my head from Dr. Eppley:
Could these two procedures and temporal reduction be safely done together?
What would be the individual and total cost of these three procedures?
Are there any video recordings of these procedures? If so, is there anyway that I can view and show these videos to family members?
Could Dr. Eppley please explain or link a recent article about the full operation of these two procedures?
Are there any risks associated with any of these procedures? If so, what is the probability of these risks?
What is the typical duration of recovery from these procedures?
Have prior patients experienced any problems occurring weeks, months and years after surgery?
A: In answer to your skull reshaping questions:
1) Forehead bossing and skull reduction can be done together with temporal reduction surgery.
2) My assistant Camille will pass along that information to you.
3) I am not aware that I have ever shot any videos of these surgeries.
4) Any information on any of these procedures can be found by going to the following: www.exploreplasticsurgery.com and placed in the search box on the hope page the specific procedure name. It will pull up any articles and case reports I have written on the searched topics.
5) Any skull reshaping procedure has the set of risks which vary based on the type of skull reshaping procedure being performed….incision/scar, contour irregularities/asymmetry and over/unercorrection.
6) Recovery from any skull reshaping procedure is largely that of swelling of which the worst of it has usually past by 10 to 14 days after surgery.
7) Other than some minor aesthetic issues I am to aware of any medical sequelae from these procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hey so I’ve contacted before about clavicle lengthening.. something I’m very interested in!! Now, I’m hoping to make the best out of one procedure… is it possible to lengthen each clavicle by 35-40mm? My shoulders are so narrow that they rest rolled over.. and from a cosmetic point of view, I’m hoping to look significantly broader!! Also, was wondering if it’s possible to inject renuva or radiesse into the hands to add volume and thickness to both the back and side of the palms, along with adding thickness to fingers!!
A: In answer to your clavicle lengthening questions:
1) Since clavicle lengthening is done by an interpositional bone graft, and not distraction osteogenesis, a distance of 30 or 40mms is too excessive. The distance of 20 to 25mms per side is more realistic is terms of an improved chance for more rapid and complete healing.
To get to 40mms it would take a combination of clavicle lengthening and deltoid implants.
2) Radiesse or fat are common injection materials for added volume to the back of the hands. Fingers are not injected because of the risk of vascular occlusion due to their tight tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am extremely happy with the outcome of all the surgical procedure Dr. Eppley performed. I had no infections, no complications, and I am more than pleased with the results. I am running 5 miles per day with no pain or complications. I am happy with the professionalism and attention to detail provided by Dr. Eppley’s nurses and staff.
Everything went so well I now wish I had gotten even bigger implants:
-Now the skin has stretched out, would it be possible to upsize the implants?
-if so, how long would I have to wait until the next surgery?
-if so how big could I go?
A: Given the natural stretch of the tissues that occur with time, you could graduate from your 6.5cm testicle implants to 7.5cm testicle implants. As long as you are six months out from the last surgery, your scrotum should be able to handle the additional 20% volume increase.
Dr. Barry Eppley
Indianapolis, Indiana
