Your Questions
Your Questions
Q: Dr. Eppley, My son has Occipital Plagiocephaly and his head is flat on one side of the back of his head. He is only 8 years old but when he’s old enough to understand I want to talk to him about possibly correcting the shape of his head by having cosmetic surgery. How much does the procedure cost and would h still be able to play football for years after the procedure or should we wait and consider the procedure after high school/football?
A: As a general rule I wait until after puberty to place custom skull implants. One can have the procedure and then go on to play football.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I suffer from my neck, and after researching I concluded that it is called webbed neck, so I contacted one of your assistants on Facebook and gave me this website. I want to know how successful this surgery is and how dangerous it is, will the suture effect remain with me, and how long my recovery will be . And to be honest with you, I am very afraid of this surgery. I also want to reshape my ears.
A: Thank you for your inquiry and sending your pictures. You indeed have a webbed neck deformity presumably of the mosaic variety. There is the classic low hairline that follows the upper webs and as well as the ears which are pulled down a bit and have some conchal hypertrophy.
This is one of the hardest webbed necks to improve due to the tightness of the neck tissues. This is first time I have ever seen a male with a webbed neck so the midline location of the posterior neck scar is more problematic than it would be in a female with longer hair in the back. This poses a unique challenge. The success of webbed neck corrections depends on how loose the skin is on the back of the neck and how easily the webs can be pulled inward.
Dr. Barry Eppley
Indianapolis, Indianapolis
Q: Dr. Eppley, Hello! I have read quite a bit about the external occipital protuberance, I am very interested in the procedure; Although the size of my head is somewhat wide, however, I present said protuberance and when sliding my fingers over the area the nuchal lines feel very pronounced, all four stand out together with the inion. Can you help me resolve the question about whether I am suitable for the procedure?
A: Thank you for your inquiry. One is a candidate for occipital bump / nuchal ridge reduction if one feels it is too prominent. This is a procedure that is most often performed on men due to their short hairstyles, where the prominences of the occipital bones are more clearly seen. But this does not exclude women from undergoing the procedure if they find it bothersome.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a few questions about clavicle lengthening.
1. If the clavicles are lengthened without lengthening the scapula, will the scapula follow and become wider naturally or pull the clavicles back inwards eventually and will it look natural aesthetically?
2. How much can each clavicle be lengthened by?
A: In answer to your questions:
1) There is no known impact of lengthening or shortening the clavicle, at the bone lengths that are typically done, on adverse scapular position or function.
2) Clavicles are generally lengthened 1 inch or 2.5cms per side.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to pose the questions my son has regarding the logistics of the plastic surgery and what is achievable and what it not as his guardian.
In his email he asked the following questions :
1. Is it possible to shorten the vertical length of the nose by 5 mm, while reducing it in size (in how much it protrudes outwards, the width of the nostrils, straighten the bridge and sharpen and lift up the drooping tip)
2. Is it then possible to perform a lip lift to reduce the space between the eyes and mouth
3. While operating on the mouth is it possible to
3a. Perform a corner of mouth tuck to reduce the width of the mouth by 5 mm on each side)
b. Do a lip reduction so as to reduce the thickness of the lips
A: In answer to your questions:
1) It is not a question as to whether in rhinoplasty surgery all of those dimensional movements can be done but whether the degree of change (e.g., sharpen, reduce in size) that the patient desires can realistically be achieved. Not knowing what the patient’s nose looks like now or what their exact nose shape goals are I can not say.
2) A subnasal lip lift reduces the distance between the base of the nose and the upper lip. That may create the appearance that the midface is a bit vertically shorter.
3a) While the mouth corners can be brought in 5mms per side, the tradeoff for doing so is a fine line scar from where the old mouth corner was to where it is now. That can be a dubious tradeoff for many patients.
3b) A lip reduction can be done to decrease the thickness of the lips. As a general rule lip size can be reduced in the 25% to 33% range.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello I don’t have pictures to upload I’m just looking for your opinion on this: In your opinion is it ever really necessary to place malar or submalar cheek implants in through an eyelid incision? Or could this be accomplished intraorally.
A: While a lower eyelid approach is one method for placing any form of a cheek implant, that is more commonly done by Eye surgeons as that is what they are most comfortable performing. However, the intraoral approach is far more commonly performed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Ive been looking into cranial implants for some time to add some width to the shape of my skull and finally decided to do something about it. I’ve been doing some research and most surgeons seem to use medical grade PEEK or titanium implants. The quotes I’ve received have come up particularly expensive for one implant alone. I saw that you use silicone for larger cranial implants, how to they compare to PEEK or titanium? And are they more affordable? The implants from your pictures look great, my only issue is I don’t seem to be able to find any other medical providers, establishments or distributors anywhere that use silicone for their cranial implants. Is there a reason for this? And do you print your own, using your own materials? And is it standard rubber silicone? Sorry for all the questions! Would really appreciate your insights.
A: A silicone implant for aesthetic onlay cranial augmentation is far superior and more affordable than either PEEK or titanium. It is completely erroneous to think that a very rigid material is needed for aesthetic skull augmentation. You are confusing replacement of lost skull bone with aesthetic onlay skull augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi, I recently had sliding genioplasty surgery and I’m very unhappy with the result. My surgeon has told me revision is impossible and he refuses to do it, despite me crying in his clinic saying I want one. He told me that revision is dangerous and if anyone tried my entire jaw would shatter. Is this true? I’m really worried and upset that I’m going to hate my face forever.
A: All sliding genioplasties can be revised whether it is shortly after surgery or years later. Doing a sliding genioplasty revision does not put the jaw at risk for fracture. (shattering)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am writing to get your opinion on whether I should pursue a genioplasty with you vs. jaw surgery. I have sleep disordered breathing and after having a CT scan and seeing how small my airway is — it’s only 3mm wide at the narrowest — I feel like I’m a textbook case for MMA with counterclockwise rotation. However, I’ve seen six or seven different doctors with this problem and have been essentially dismissed by all of them. I have a consultation with a surgeon coming up in October but after that I’m about ready to throw in the towel and seriously consider other options.
I am curious whether you think a genioplasty would be able to provide enough augmentation considering how small my chin is, and whether it would make an appreciable difference in my breathing. My other concern is about the upper lip. I’m self conscious about how long and flat my philtrum is, and I’m guessing jaw surgery would help support it whereas a genioplasty wouldn’t make any difference. A lip lift would help, but I don’t want to make my gummy smile or lip incompetence any worse than it is. Would you suggest any other options?
Thank you for any advice.
A: Thank you for your inquiry and sending your pictures and x-rays. Why you would not be a candidate for bimaxillary advancement for your OSA I can not say. But your chin can probably support a 12 to 14mms horizontal advancement. Usually if one gets above 10mms there is some modest OSA benefit as that is very similar, if not more, than a genioglossus advancement OSA procedure.
A sliding genioplasty or orthognathic surgery has no impact, positive or negative on the upper lip shape or length. That requires a direct upper lip lift approach, which if kept in the rule of thirds, will not create a gummy smile or lip incompetence.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, last year we had contact because I was really interested in skull reshaping. I would like to ask for your advice again.
Today I still struggle with the same problem and I still always wear bun to hide the shape of my head. To wear hair down is my biggest wish and this is why I am reaching out to you again.
I have a vague memory of what you recommend but the one thing I do remember is that int as just so expensive for me that I will never have the ability to ever do the surgery.
I found a clinic here where I live and had a consult with a surgeon and they recommended to get volume in the crown space of my skull with a fat transfer treatment. This is more affordable for me.
My question is whether you think this is a good solution for my skull augmentation problem.
A: Injection fat grafting is usually a very inferior approach to skull implant augmentation unless the area is very small. But it is harmless to try and given your described economic limitations this is your only treatment option.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can a customized wrap-around jaw implant be designed to give a chin an additional vertical projection (downwards) or do one need to perform it with a sliding genioplasty for a vertical projection effect to be included?
A: It depends on the amount of vertical chin length needed as well as how much horizontal chin projection is being done. It is a balance between these two types of dimensional change to ensure that the soft tissue chin pad can wrap around and safely close over the newly projected chin. As you can see the answer to your question is more complex than a simple yes or no.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Please see pictures of my face attached for you to look at. I also like to ask you if I would need orthognathic surgery because it was brought up by my dentist if that is the case can I do that at the same time as my jaw line implant and cheek implants. Thank you
A: The question is not whether you need orthognathic surgery (to bring your lower jaw forward) but whether you want to pursue that route which requires before and after orthodontics as well as a total lower jaw advancement surgery. This is a discussion that is best had with an orthodontist who can assess your bite and what type of change could be done. You can’t make an orthognathic surgery judgment based on external pictures alone.
While you can do cheek implants with lower jaw orthognathic surgery you can not do a jawline implant at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in a jaw reshaping / reduction procedure. I’ve considered a trip to South Korea but don’t love their V-line approach.
My biggest concern would be sagging skin as a result but looking at your results, I believe there are techniques to address that. Possibly fat grafting under eyes and temples and a brow lift.
I’d like to discuss details and learn what else you would recommend based on my facial proportions analysis. I’m attaching a few pictures in different angles /lighting.
A: Thank you for your inquiry and sending your pictures. I would agree that traditional v-line surgery in your case would not only leave you with loose skin but would have disfigured your lower face. That is too radical a jaw reduction procedure for what you really need. Desquaring the chin through lateral tubercle reductions and perhaps some jaw angle width reduction is what is appropriate for your anatomy, all of which can be performed through an intraoral approach. These procedures maintain the vertical length of the reduced bones and thus the support to the attached soft tissues.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if I decide to get a open browlift with hairline lowering (if it stretches) can I later on get a skull implant or will that make it harder or undo the lift? just confused as to which sequence I can do these and what is a big no no etc.
A: Getting a skull implant or doing a hairline advancement are usually mutually exclusive procedures. Both require the need for scalp tissue so you can have one but it will likely prohibit the other from being done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting custom hip and buttock implants and fat transfer from my abdominal area to my legs. Would all this be possible at one time?
What are the recommended post operation procedures, in particular, how long would I need to be away from my home? As for the follow up, how long after surgery will I need to return back?
A: I think it is important to realize that hip and buttock implants combined is a very challenging recovery of which I would be hesitant to do anymore than that at one surgery. Such recoveries become even more challenging in the patient who must travel for surgery. While the efficiency of doing liposuction/fat transfer at the same time seems appropriate on paper it is does not medically.
How soon one returns home after such surgery depends on whether they are coming by themselves or with someone to assist them. Assuming the former I would anticipate at least a week before returning home.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have always had a hereditary lack of volume under my eyes. My eyes have thin, purplish hued skin under them that lacks fat and creates significant dark circles. I am quite frankly tired of looking tired and believe having the appearance of raised cheekbones and a fuller midface will greatly enhance my appearance and, in turn, self confidence. I have considered fillers as they are cheaper but their impermanence makes me consider more drastic, longer lasting measures.
A: Thank you for your inquiry and sending your pictures. I do agree that skeletal augmentation with custom infraorbital-malar implants would be of great benefit to your midface/periorbital appearance. Done through lower blepharoplasty incisions this would also allow for a little extra lower eyelid skin to be removed. Your lower eyelid skin is severely hyperpigmented and skeletal augmentation alone will not solve that completely. There will still be a need for some postoperative skin treatments to lessen that degree of pigmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I was looking online to see if anyone else had my condition. After shaving my hair I noticed how the back of my head is really indented got concerned. I realized my father also has this but it never bothered us. Aesthetically though, after shaving my hair, I don’t feel comfortable with the shape and would like some information on what and why I have this. If you could email back, it would be great! Thank you.
A: That is a classic occipital knob/bun type skull deformity with a little extra roll of scalp skin. While usually mainly seen in men that may only be because it is not common for women to have shaved heads, at least compared to men. There is no pathologic reason as to why it exists, it is just a normal skull development in some people. It is treated by reduction of the prominent edge of the bone through a small overlying incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My son (5) developed a flat head when he was a baby. My daughter (6) also had a flat head due to sleeping on her back, but it corrected itself pretty quickly. Because of this, I assumed my son’s head would correct itself, but it never did… and now I find myself haunted each day by his flat side head. I’ve mentioned it to his Pediatricians many times, but they essentially “write it off”. I have spent many hours researching what can be done at his age, and surgery seems like the only solution. I would love to hear back from you with any kind of information/ help/ support/ referrals. Thank you.
A: Such head shape corrections for flat spots or a flat head I do not do until the teenage years when skull growth is essentially complete.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m sending this email to query about some things I’m concerned about, iIjust saw a case of a patient that had a skull augmentation with 28mm amount of increase of skull height but somehow I still believe that wouldn’t be sufficient enough in my case to achieve the desired results, my skull is just too small, severely flat and noticeably slopped down that I need at least augmentation of 35mm up to 40mm in order to get the skull shape of my dreams, I think I will benefit from a 2 tissue expanders instead of just one during the first stage procedure and an ear to ear incision in order to achieve those amounts of a augmentation. So my questions are, are my esthetic goals attainable ? And what are the procedures taking in order to achieve an amount of augmentation of 34mm up to 4cm?
A: While you may be correct about the approach needed for your optimal skull augmentation results, there are safe limits as to how much the scalp can be stretched and tolerate a big implant load underneath it. What you are asking exceeds those limits and is at very increased risk of complications. Here is a good rule to remember that is particularly relevant in implant augmentations…’it is far better to have half to two-thirds of your aesthetic goals achieved without complications than it is to have 100% of your goals obtained with complications’. That is because most significant implant complications are usually only resolved by removing the implant, thus losing everything.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How did the new implant feel relative to the testicle? Was it indistinguishable or slightly harder? And was it mobile in different positions would it move with the real one?
A: It will feel and move very similar to your natural testicle once the swelling and full healing has occurred. They are made of an ultra soft solid silicone material.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in custom implants for my chin/jawline. and also for cheek augmentation. I am hoping to achieve a more chiseled, high cheekbone look, so I would also want all of the fat removed from my cheeks, and under my chin.
My other area of concern, that I would like to consult with you about, is my nose. I had my 1st rhinoplasty when I was a late teenager and my 2nd one just 7 weeks ago. Adding length & changing the angle, of a short pug nose isn’t easy.
A:Thank you for your inquiry and sending your pictures to which I can say the following:
1) The jawline and cheek augmentation concept is straightforward and will help your face the most.
2) You can’t take out all of the fat from the cheeks or under the chin. You can take out some (buccal lipectomies, peorioral and submental liposuction) but not all. This effect is synergestic with the cheek and jawline augmentation.
3) The nose imaging shown is not realistic. You can’t drive down the tip of the nose that much as well as make as thin as shown. It takes a rib graft to supply the cartilage needed to drive the tip of the nose as much as possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, When I was a baby I had a very flat head, and never got the helmet or any other treatment. I am now 26 years old and not only is the back of my head still flat, but it has also caused an abnormality to the structure of my face, jaw, eyes, nose, and forehead, which are all out of line, and unsymmetrical. The shape of my head, is something that has really effected me my whole life and something that I am very insecure about. I have to be very particular and cautious with how I style my hair in order to try and make it look less flat. I never let people see me with my hair wet, I never wear my hair down unless it’s teased, and the list goes on…
I have come across your website, and can see that you do surgeries for improving the shape of a skull/head. I would be very interested in getting this procedure once I know a bit more about it.. Firstly I am just after a rough cost estimate for the surgery (I understand that the cost would be different on everyone) but just as a rough estimate so I can have some sort of an idea. Secondly I am a girl, and I take pride in my hair.. Would I have to shave all my hair off prior to surgery? Would the scar be noticeable? Will the scar stop my hair growth around that area? Will the scar go away overtime? Will the scar be easily hidden? Is there any safety concerns about having this implant? Eg, getting a knock to the head, would it cause extra pain because of the implant? Would it affect the shape? Or move the implant? Would the surgery affect my brain or any internal organs? What is the recovery time for this surgery?
*the photos also don’t do it justice of how flat my head looks.
Please let me know if there is anything else I should know about this surgery.
Thank you, I look forward to your reply soon.
A:While it is unclear yet as whether you need a one vs two stage occipital skull augmentation procedure, I can answer your questions as follows:
1) Hair is not shaved for the surgery.
2) The fine line scalp scar usually heals without excessive widening and would be undetectable in someone with hair. Such scars are permanent.
3) The surgery generally does not adverse effect on hair growth.
4) There are no safety concerns with extracranial onlay skull implants.
5) The implant is more like putting a bumper on the head, it is actually protective rather than detrimental.
6) Trauma will not displace the implant.
7) The implant is on the opposite side of the skull from the brain, thus it is not affected.
8) Depending upon how one defines recovery, the significant part of recovery is over after 10 to 14 days after the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in submalar implant, and one of your patient’s result matches the kind of difference I want. (in -Photo Gallery- -face- -cheek- -patient 4- )
May I ask what kind of submalar implant was used to achieve it? especially the material… Because I have been looking through things, and could not quite find any submalar implants… However, I did see a certain implant that I really prefer (if it is the correct choice). It’s Medpor from Stryker, -Design RZ Malar Implants-. (I have attached the picture the Design RZ JOCHBEIN IMPLANTATE one )
Will it help me to achieve the result?
Thank you and best regards
A: None of the polyethylene cheek implants styles you have shown are true submalar implants. These are all different types of malar implants that have some submalar components to them. While I don’t know exactly what type of midface change you are seeking, it is not clear to me as to what the specific shape of the implant should be. Submalar implants are most commonly used for cheek sagging. With an Asian face your aesthetic needs may be quite different.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, For a little background, I have had buccal fat removal in the past and found that it did not help with the chubbiness and volume in my lower cheek (area next to my lips).
I’m now looking at perioral mound liposuction/reduction, and I could only find one surgeon in my area that does this procedure and maybe 3 surgeons country-wide. While looking at Real Self, I saw a couple doctors recommending against this procedure, so I was hoping I could get a second opinion from you regarding the safety/risks. I understand that there is a nerve branch running above the mouth and one along the jawline, so theoretically the perioral area should be free of major nerves. My concern is that if I have nerves that run lower or higher than normal (what is the standard deviation for nerve anatomy?), would I be at risk for severe nerve damage? Are there any other potential complications with this surgery?
A: In answer to your perioral liposuction questions:
1) The effect of buccal lipectomies never reaches as low as the perioral region, no matte what surgeons say. You are a prime example of that basic anatomic concept of facial fat compartments.
2) There are no motor nerves that run through the perioral region. (south of a a line drawn between the corner of the mouth and the tragus of the ear) This is another basic anatomic principle that appears to have escaped those who portend there is potential nerve damage from liposuction in this area.
3) The question is never whether perioral liposuction is safe but whether it would be effective for your facial fullness.
4) Failure to use very small cannulas can result in irregularities/contour issues or over resection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in subnasal implants to help my midface deficiency, I would be traveling from out of the counrtry and so want to know the price range before I book flights, would you be able to tell me this?
A: The key question is whether these subnasal implants would be standard ePTFE subnasal (premaxillary-paranasal) implants or custom subnasal implants. That difference would depend on your specific dimensional and shape needs. As a general rule most augmentations that exceed 5mms are usually best done with a custom implant approach. I would need to see some pictures to do some imaging to help make that determination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a sliding genioplasty done two years ago and my chin is still very tight. My chin feels stiff and tight and it can make talking a challenge. Is there anything I can do to try and get the suppleness and lightness back in my chin? It feels very heavy and frozen and just stiff and tight. Even my lower teeth feel tight. If I pull away the muscle in the lip away from the bone the tightness in the teeth goes. I don’t know what’s going on! Any advice?
I’ve tried steroid injections into scar ( scar looks fine ) they didn’t help and I’ve tried PRP in the scar… didn’t work.
A: What would help you immensely is an intraoral release and placement of an interpositional dermal-fat graft. Every symptom you have described is indicative of a contracture/soft tissue deficiency. Steroids and PRP are useless as this is a tissue deficiency problem primarily which subsequently results in the secondary symptoms of scar contracture. Injections will not create new tissue.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you for your time. I hope this message will not be too long.
Almost one year ago I underwent a sliding genioplasty with the aim of improving facial aesthetics and gaining a better lip seal. While there was some aesthetic improvement, the advancement has been quite small and I am left feeling dissatisfied. More importantly, my lip competence has actually increased slightly as I now feel tightness/pulling around the chin, which from what I have gathered is likely related to scar tissue of the mentalis complex. Probably there is more lower incisor show than before, but I do not have good images to compare. I am coming to you as your extensive resources provided online are one of the few touching upon this issue, and if further treatment is advised, which to be honest I hope it is as I am quite bothered with the situation, I would like nothing more than to come to you for this. Unfortunately I do not have access to an after x-ray picture, but have included normal photographs (they are not perfect before/afters but I have done my best).
My goals are to improve the lip seal, increase chin projection (and potentially reduce height), and if possible reduce the tightness, or at least aim to not make it worse. Given the limited information I have been able to provide, do you think there is anything that can be done? If you prefer to discuss this in a video consultation, rather than via written messages, I would be happy to.
A: Thank you for your inquiry and sending your pictures. As best as I tell from the pictures your chin advancement was very slight yet your symptoms are fairly significant for the amount of bone movement. It would be very helpful to see an after surgery x-ray to see the actual dimensions of bone movement.
But that issue aside the options are either to leave the chin position alone and do a scar release/interpositional graft (dermal fat graft) to improve your symptoms or to do a secondary genioplasty for further chin advancement and the use of allogeneic corticocancellous bone chips to fill in the step off and eliminate the bony dead space. I would estimate it needs to go at least to the new position as shown in the attachment image.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to change the back of my head. As you can see on the photos down below the back of my head is flat and makes the top of my head really high and the back of my head have a point. The back of my head has a box shape or a square shape.
I saw on your Facebook page that you have several types of shapes of skulls I want my head to look round and normal.
Thanks
A: Thank you for your inquiry and sending your pictures and video. You have a combination of an upper flatter back of head with a lower occipital knob protrusion. (point) To properly reshape the back of your head you need a combination of an occipital knob reduction and a back of head augmentation above it. (see attached diagram)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking in to see if i would be a good fit for head width reduction. A lot of width seem to be more anterior than posterior. On my left side its definitely my temporal bone that protrudes above the ear and the anterior region its solid bone i can feel from where my jaw connects to temporal bone its a bulges quite a bit and solid as a rock. On right side above ear (scar side) it appears it more upper anterior that protrudes.
My skull is lopsided I look weird in glasses and most hats being the strawberry-ish shaped head. I would like the sides of my head to be more flat, especially where the forehead transition to the sides. Flat v.s bowed. Please advise if you can help.
A: Thank you for your inquiry. Everything that you are feeling on the sides of your head is muscle and not bone. Everyone thinks it is bone but it is not. The temporal muscle is incredibly thick in the anterior region (2 to 3 cms) while it is thinner in the posterior region above the ears. (1 cm) The question is not whether such muscle can be reduced but how to do so. The posterior muscle removal is straightforward with an incision in the crease at the back of the ear. But the anterior muscle poses different considerations in that it can not all be removed and access to it is much more limited if one wants to have acceptable scars. It is usually treated with electrocautery reduction through very small incisions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had Juvederm about four months ago and ever since I have these lumps on the side of my mouth. Can they be fixed and how? With more filler or do I just need a mini facelift. I’m 48 yrs old and I feel like I look ridiculous with these long lumps. I’ve tried massaging them with heat but nothing makes them better. I have also heard PDO threads might be helpful? Any help would be greatly appreciated.
A: I think the answer goes back to why you got the injectable filler in the first place. If the goal was to get rid of the nasolabial folds then you have now proven that fillers is not the way to go. You would be better off with a mini-facelift. The injectable filler can be quickly dissolved with hyaluronidase injections.
Dr. Barry Eppley
Indianapolis, Indiana
