Your Questions

Q: Dr. Eppley, What kind of suture technique  does Dr. Eppley use in the forehead reduction ( hairline lowering surgery) to reduce suture tension?

A: Bone anchored flap scalp advancement…that is the most effective method of reducing tension on the scalp-forehead suture line closure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I always thought my head is really wide and weirdly shaped. I think I didnt look like that when I was a child and now It looks like its huge and rounded. Is it possible that my bones grew up and thats the reason I look like this or it could be my temporal muscles? I feel like its very wide and uneven. Its a huge problem for me beacuse it makes me insecure and I compare myself to other head shapes but never saw something like mine. I’m searching for all the things that could make my head smaller but i fail. I would be glad if you gave me any answer if something could help reduce my problem.

A: The side of the head is composed of the convex temporal bone and the thickness of the temporal muscle. While considerable muscle reduction can be done on the side of the head only a limited amount of bone can be removed. Thus to determine whether surgery may be beneficial a 2D CT scan is needed to evaluate the bone to muscle ratio at various locations on the side of the head.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested in knee lift and lower buttock lift ( ptosis case II) I had failed thigh lift and my buttock dropped.

A: Thank you for sending your well illusrated buttock and knee pictures. Your buttock pictures show a low infragluteal crease with a resultant elongated buttock appearance. The type of buttock lifted is what I call a Style 2 version where an excision is done and the crease ie elevated shortening the vertical length of the buttocks.

Unlike the buttocks the knees are not as favorable for an excisional approach. I see no excessive suprapatellar skin folds or redundancy and, as a result, no favorable placement area for a scar line. Small cannula liposuction for selective reshaping of the knee would be a less risky treatment consideration.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been interested in getting a rhinoplasty as well as a chin implant/genioplasty. My question is, in your professional opinion, does a genioplasty have an advantage over a chin implant when it comes to breathing/opening the airway? My understanding it that it stretches the muscles out more which improves sleep apnea. Wouldn’t chin implants do the same? I’m getting a rhinoplasty and my surgeon uses medpor chin implants. Thank you in advance.

A:In looking at your side view picture you definitely need a sliding genioplasty over a chin implant. Your chin recession is significant and a sliding genioplasty will also keep the chin narrow. A chin implant is definitely not what I would do and, even if a teaching implant was indicated, I certainly wouldn’t use one composed of Medpor which is going to leave your chin wide and bulky an, when you were unhappy with the result, going to be very difficult to remove later.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q:Dr. Eppley, Hello, Im looking into skull augmentation focused on temporal and forehead areas. i believe i have an underdeveloped skull and facial structure. please see attached pics and video. my overall skull seems underdeveloped and grown downward. i was planning on getting cheeks and a chin implant for forward projection and width to help correct the “long narrow face” appearance but i wonder if the temple and forehead bone structure needs correction too; and which is more important for my facial structure.

the back of my skull seems quite flat too but st the moment what i really want corrected is the long narrow 2-D facial appearance. would appreciate the doctors opinion on my case. thank you

the space between the end corner of my eyes and my hairline is very very small, maybe that contributes to the 2D effect.

A: Thank you for your inquiry and sending your pictures. You have the classic narrow skull shape which also influences the longer and more narrow facial shape. In looking at weather for head and temper widening being effective I have attached some initial imaging to evaluate that concept. Such a head widening implant design may or may not need to meet in the middle of the forehead, probably in your case it would not need to being a female, but attached is an implant concept in how to make the type of imaged change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My eyes are uneven and I’m looking for something to help with it. Would you be able to help? Here is a picture for reference. Thank you! is a pic. Please let me know if he thinks he can bring one eye up higher and if he thinks I would look drastically different. Also, if you know the cost that would be great. Thank you so much!

A:Thank you for sending your picture. This is a classic case of aesthetic vertical dystopia (VOD) where the ride I is 3 to 4 mm lower than that of the left. It is important to understand that in VOD it is the entire orbital box and all of the overlying soft tissues that are lower. As a result it is not just lifting up the right eye only that will be successful. The lower eyebrow and upper and lower eyelids must be repositioned as well if the eye is moved up or otherwise the blog gets buried under the upper eyelid and a lot of scleral show above the lower eyelid.

As a result there is usually a five procedure approach to treating VOD. But the first and most important question is how much improvement can be obtained. Or will the surgical effort be worth it for the patient based on the outcome that can be achieved. That, of course, depends on each individual patient and how one defines the term ‘drastically different’. As a general statement it would be fair to say that achieving ideal symmetry of the right eye to the left cannot be obtained. Improvement or reduction in the amount of asymmetry is what is achievable and that is probably best defined as halfway between perfect symmetry and where the eye is now. Will you see a change… yes. Will it be ideal…. no.

The other way to think about the problem is what is the patient’s level of concern. If it is not overly bothersome and the inquiry about surgery is more explorative then I would not do the surgery. If it is a major issue of concern and the patient is willing to do about anything to get some level of improvement then the surgery would likely be worth it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like a very dramatic midface transformation; I have been insecure of my strong nasolabial folds and premature genetic jowls since I was a child. I would like the implant to be at least 2-3 cm thick in some areas, for example the under-nose area, where my recession is evident. 

A: Thank you for your inquiry and sending your pictures. By description what you are seeking is a midface augmentation effect. But you are way overestimating the amount of augmentation you would need. Besides that the midface soft tissues could never accommodate a 2cm to 3cm implant expansion no one has ever had or needed more than a 6 to 7mm (less than 1 cm implant thickness) augmentation to achieve a significant effect.

The same applies to the chin where a sliding genioplasty is the preferred procedure for best soft tissue expansion.

It is common that patients over estimate their augmentation needs by the numbers as they can not appreciate that implant volume is more important a linear number.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, , I have been on corticosteroids for around 20 years due to kidney disease, and I had a kidney transplant 12 years ago. Over time, long-term steroid use has significantly changed the shape and size of my face and head, as shown in the attached photos (age 16 before steroids vs. age 35 now). The facial changes are quite noticeable, but I’m not sure if the change in head size is clearly visible due to the head covering. In reality, my head has noticeably shrunk in a way that feels disproportionate to my body. I’m unsure whether this is due to bone structure changes or loss of muscle and soft tissue. I had considered a custom implant, but my doctor advised against it due to the high risk of infection related to immunosuppression. Would fat grafting to the face or skull be a safer alternative to improve appearance? Or is there any other low-risk option suitable for a kidney transplant patient? Thank you for your time.

A: Under the consideration of immuno suppression, in terms of cranial facial augmentation, whule fat grafting would be considered the least risky treatment approach I would expect that there would be 100% loss of the injected fat, even if you had enough to harvest to do it. Thus, any chance of success requires implant placement. While there is always an increased risk of infection with any surgical procedure on a patient on high-dose chronic steroid use I do not share the opinion that the risk of infection and implant placement makes it an impossible procedure to consider. Of course, there was always going to be some increased risk of infection in an immuno suppressed patient over someone who is not on these medication. But fortunately, the craniofacial area is well vascularized and tips the balance in a tissue bed that is otherwise less than ideal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello! I was wondering if you perform surgeries that can increase the space between the eyes? My eyes are too close together, and I am interested in getting a surgery to make them more wide-set

A: The type of procedures that can make a significant difference in increasing interpupillary distance, orbital box, osteotomies, or not generally considered aesthetic procedures due to the scope of the surgery. Meaning the aesthetic trade-offs of a bicoronal scalp scalp scar to perform an effective orbital box translocation must be considered very carefully.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I am interested in your large skull reduction procedure. My head circumference is about 23.5 inches, and it looks disproportionately large compared to my frame. I was wondering if the burring method could be used around the entire skull to reduce the size, and if it would be possible to get the circumference under 23 inches, which I know depends on my anatomy, just hypothetically speaking. Also, if you could tell me an estimate of the cost, that would be great. Thank you!

A: In a more complete skull reduction procedure based on the need for a circumferential reduction, the bone burring technique only applies to the bony forehead and back of the head.  For the sides of the head, it is the temporal muscle that is reduced as that is the dominant tissue over the thin, temporal bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to make my face more angular. I thought that a three level facial augmentation could be my best option. Is it a good idea or does It risk too look “too much” for me? I’m not sure about brow bone augmentation btw. I’ve had double jaw surgery and rhinoplasty in the past and some facial fillers and I’m quite satisfied about the results. My face Is more harmonious than before. This is like an extra to bring some angularity and I’d like that to be natural. Thank you!

A: Thank you for sending your pictures. You are correct in that to make your face more angular ideally it involves all three levels. Technically the upper and mid face are the most needed in that regard as they lack projection unlike your lower drawl. Because of your prior jaw surgery major strides in lower jaw shape improvements have already been achieved. You’re also correct in that a ‘little bit’ in each area goes a long way and it is the composite overall augmentation that makes the more angular face change. Anytime you do two or three levels of facial augmentation almost always one has to be most cautious about excess  projection as opposed to when one has a singular major facial level deficiency.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have VOD (right eye lower). I will send (attach) photo. can it be fixed? I am planning on getting the right eyebrow lifted with botox next week (I have done this before), which kind of helps to even things up, but as you can see, the pupils do not line up horizontally at all.

A:Thank you for your inquiry and sending your picture. When the eyebrow is raised the perception of VOD becomes more apparent. Unlike raising the eyebrow with Botox injections, however, lifting up the eye requires more effort. Elevating the eye also requires adjustments of the upper and lower eyelids that drape over and around  it. As a result it takes a combination of four procedures to satisfactorily do so including an orbital floor-rim implant for globe elevation, lateral canthoplasty for raising  the outer corner of the eye with spacer grafts of the lower eyelid and upper lid level elevation. (ptosis repair)

I never few VOD surgery as a ‘fix’ as ideal symmetry between the eyes can never be achieved. Rather it offers an improvement than lessens the perception of the VOD.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to know more information about scalp rolls removals and wrinkled skin at back of head.

A:Thank you for your inquiry and sending your pictures. In looking at your pictures my suspicion is that this scalp roll may be associated with a bony overgrowth of the occipital knob or nuchal ridge line. It would be very unusual in a young person with your neck shape to have true excessive scalp  rolls alone. The determination if the scalp roll is caused a bony projection is how it feels. If the scalp roll feels fixed and minimally mobile then it is due to a bony projection which needs to be reduced with a little bit of excessive scalp removal. If it is soft and mobile, moves up-and-down, then it is a soft tissue issue alone where excision of the scalp roll is needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in undergoing a reverse otoplasty targeting the lower and middle portions of my ear. I previously had otoplasty and part of the ears are too close to my head. From my research, I believe this may require the use of a grafting material to achieve the desired projection. Given your extensive experience with these procedures, I’d greatly appreciate your insight into a few questions I have: 1. Is it possible to achieve the desired ear projection without using an implant? In other words, could existing ear cartilage be harvested and repositioned to act as a structural strut? If so, would this compromise the aesthetics, structure, or shape of another part of the ear? 2. If cartilage harvesting is not viable, what materials are commonly used as struts, and what are their pros and cons? I’ve researched several materials and would like to know your thoughts on each: • Cadaver Rib Cartilage: This seems quite stiff—comparable to a popsicle stick. But this is just my uneducated opinion in looking at online pictures and reading that ear cartilage is elastic while rib cartilage is hyaline (and much stiffer). Could this rigidity become problematic or painful/irritating when side sleeping? I’ve also read that cadaver cartilage may reabsorb over time. If that happens, would the ear lose its projection? And what does reabsorption mean in these cases? Additionally, why is cadaver ear cartilage not commonly used? Could it provide subtle support in projecting while preserving the natural softness of the ear? • Implantech ePTFE Ear Implant: This material appears to mimic the flexibility and texture of natural ear cartilage. However, it doesn’t seem to be widely used. Is there an elevated risk of infection associated with this implant? If so is it a lifelong risk or just for a period of time after surgery? • AlloDerm: While not commonly used for this purpose, could AlloDerm serve as a strut to project part of the ear outward? Is it strong enough to act as a buttress in the cartilage? Does it carry a significant infection risk? Is its texture similar to ear cartilage? Meaning it is softer/ flexible. Can it reabsorb like rib cartilage? It says this can promote tissue regeneration. What does this mean? Can something natural regrow to take its place and maintain this buttress in the ears? • Medpor Ear Implants: What exactly is Medpor? Is it a rigid plastic or something more flexible like the ePTFE material from Implantech? My primary concerns are: • Will the graft material remain stiff permanently if using cadaver cartilage or another material? • What is the long-term risk of infection? Is infection only a concern during initial healing post-surgery for some time, or can an infection on some materials develop years later even without injury to the area such as a cut? Thank you in advance for your time and guidance. I look forward to your thoughts.

A:You have correctly surmised that in a reverse otoplasty it takes a strong strut of material to push the ear out and maintain that position. I have used a wide variety of materials from titanium plates to cadaveric rib cartilage. They all have had various degrees of success but the rib cartlige has been the most successful as it provides the strongest strut. As you have also surmised the trade-off for its use is that it will be stiff on the back part of the ear. It is also a graft does not resorb as it acts more like an implant even though it is a biologic material.

The other most successful option would be an ePTFE wedge material from the ear implants that I developed for implantech. That could be placed in the released anti-helical fold and would avoid the stiff feeling strur on the back of the ear. Its trade-off is that it is an implant with associated higher risk of infection/extrusion. But in my experience to date that risk is very low. No implant material, however, can never better the negligible risk of infection with a biological material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I have currently have silicone implants, size medium. Please see link to the model below:

https://www.implantech.com/product/conform-terino-malar-shell/

Previously to this, I had the combine malar shell implants in size small:

https://www.implantech.com/product/combined-submalar-shell-2/

I absolutely loved these implants and feel they really suited my face. Unfortunately I developed a small infection, so the surgeon opted to remove them and do a wash out. When he reinserted the implants, they had ordered a different model by mistake which is what I have now!

I feel the projection is not quite right and would like something that projects a little lower in my mid face.

I have had the current implants for over a year now. My goal would be to either remove these implants and do a custom implant, or remove these implants and replace with the original model.

A:The effects of any facial implant is a function of the implant’s shape and size as well as its placement. You are assuming in looking at these two different cheek implant effects that they have identical placement both times and the only difference is in the two implant shapes and sizes. Assuming  that to be true, which is a big assumption in facial implant surgery, if you were happy with the first set of implants logically that would mean you should just replace what you currently have with the original malar shell implants.

Oner of the benefits of custom implants is the ability to create implant designs which do not currently exist as an off-the-shelf available implant.One of the other benefits of custom implants is the ability to see exactly where’s your current implants are placed and then designs can be made around to specifically create the optimally desired implant shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, https://exploreplasticsurgery.com/case-study-correction-of-eyeorbital-asymmetry-with-hydroxyapatite-cement/ Hello, I found you through this article. The man in your post is experiencing the same problem with my eyes. I live in Türkiye, and I don’t know if there are any doctors specializing in this. If I were to come to you for an examination and surgery, could I inquire about the average cost for the same or similar procedure?

It’s visible in the photo I sent you. I think it’s called Orbital Dystopia. I’m curious about what can be done and how much it costs.

A:VOD improvement rarely comes from a single procedure such as orbital floor augmentation regardless of the material used to do it. It usually requires a combination of bone augmentation and management of the upper and lower eyelids as well as the eyebrow that drapes around the lwoer eyeball and orbital socket. All structures have to be addressed for a satisfactory improvement. It usually takes a combination of five individual procedures done doing a single surgery which include orbital floor– rim implant augmentation, endoscopic brow lift, lower eyelid elevation with spacer grafts, lateral canthoplasty and upper eyelid elevation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, can woman get this done the side of your head temporal implant and can it increase cognitive function?

A: Women as well as men can have temporal implants if so indicated. This is a cosmetic procedure which has no effect on cognitive function.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 66 yr old male who has always been very thin and very limited in the pectoral muscle area. I have read that pec implants can be done on males. I would be interested in seeing if you feel I would be a viable candidate and if I would really be able to notice a difference. Thank you

A: Pectorals implant for chest enhancement has been done in males for almost 40 years so this is not a new aesthetic concept. What has changed over the years is the improved softness of the implant material and the different shapes and sizes that are available.

I am sure you would be a candidate as the only eliminating factor would be a patient who is opposed to implants.

There are many different sizes so the goal is to find what your upper limit of tolerance is for the chest size change which can be determined by in office sizing via sample placements.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve always struggled with insecurity about my facial structure — especially the roundness of my face. Despite being healthy and at a low body fat percentage, I’ve always had a “baby face” appearance that doesn’t reflect how I feel internally. About 7–8 months ago, I underwent chin implant surgery and neck liposuction. The neck contour has improved significantly and I’m happy with that outcome, but the chin implant didn’t give me the downward/vertical length I was hoping for. While it added decent projection, it didn’t structurally elongate my face the way I envisioned. I’ve done a lot of research and I truly believe that a downward and narrowed sliding genioplasty (9–11mm) combined with aggressive buccal fat removal would finally give me the definition and structure I’ve always wanted. I’m aiming for a more angular, masculine V-line — with sucked-in cheeks and better lower-third harmony. I also value facial balance and would prefer 3D imaging or planning if possible. I’d really appreciate the opportunity to discuss this with you directly and hear your thoughts on what’s realistically achievable in my case. If you’d like, I can provide photos and my previous op report for context. Thank you so much for your time.

A: Thank you for sending your pictures and detailing your previous facial surgery. Besides the lack of any vertical lengthening the extended wings of the current implant also make it wider than your original chin. These two chin implant issues work against derounding your face. I would agree that a bony genioplasty that provides vertical lengthening and horizontal projection and makes the chin more narrow wil do better in derounding your face.

The combination of chin lengthening and cheek soft tissue reduction is always synergestic at derounding the face.

A few caveats:

1) I would doubt that 10mms or moreof vertical lengthening is what is needed. More likely it would be in the 6 to 8mm range.

2) You can keep the chin implant attached to the bone to maintain horizontal projection although the wings of the implant need to be removed. When vertically lengthening a chin with an implant in place the downward movement of the bone allows the implant to add some vertical lengthening as well.

3)A maximal cheek defatting requires a combination buccal lipectomy and perioral liposuction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The left picture of the (first collage) is when I had the Omnipore small chin implant in, the right side is before I had the implant in.In the second collage, the same thing left is when I had the implant in, and right is before the implant. (As you can see my chin is smaller in the before pics, I also had a cleft chin.In the 2nd pic I sent are the details of the implant I had, it was only inserted in me for 7 weeks orally. (Through the mouth). And the last pic is me currently as you can see is the implant shape and width are still there.

I also want to note to Dr Eppley that it was inserted wrong in my chin area when I did a CT scan to take it out as the Dr told me it was inserted below my lip area instead of by my bone. And they removed it on June 13th, and I had it put in on April 26th. Can you please ask Dr Eppley if my chin will return to pre-op appearance and what are options as well (if any) thanks!

A: I think your fundamental question is, after these multiple chin implant surgeries, will your chin return to its original shape…and that answer is unequivocally it will not. Once ther soft tissues have been widely released to place an implant and then removed, and it doesn’t matter if the implant is in one week or one year, the soft tissues will not shrink down to exactly what they were before. The only question is how far or close from preop will they be. That answer awaits time and full healing which could take up to a year to see the final result. There are no surgical options should they not return to the exact preop shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking to add height but trying to avoid limb lengthing would skull implant be the only option.

A: A skull implant will create some modest height (1.5cms) but far far less than limb lengthening can do…so they are not remotely comparable in terms of height enhancement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How Do I get of my “turkey neck”. I am a male 78 years old.

A:Thank you for your inquiry and sending your picture. What you are describing is a direct necklift through excision of the turkey neck which can be done in various geometric patterns. Older males choose this option, as opposed to a traditional lower face – neck lift, for a variety of reasons including the desire to avoid hey more invasive and lengthy surgery as well as putting scars in and around the ears. While I direct necklace does put the scar in a more visible location in men due to beard skin that midline neck scar generally heals favorably.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I’d like to ask a question to Dr Eppley and ask what’s the maximum of forward movement that supraorbital and glabella implants can mimick? Same thing for the midface /maxilla

A:I don’t know what the maximum forward movement at Implants could do for the upper and lower face is that number remains is very patient specific. But I can tell you the largest movements that I have done which are 8 mm in the forehead and brow bones and 7 mm in the mid face.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m looking to infraorbital implants or infraobital-malar implants. My infraobital bone is deficient and it creates a negative orbital vector, dark under eyes, unsupported, round eyes. I want to create a more sharp appearance to the eye and more under eye support. I’d be very to keen to do a virtual consultation with you as soon as possible if you believe you can help me.

A:Thank you for sending all of your pictures and detailing your facial concerns and objectives. In reviewing your pictures you are correct in that you have a significant negative orbital vector and all of the associated periorbital orbital findings that come with it. Certainly the fundamental treatment is infraorbital – malar custom implants (see attached example IOM design for this problem) to correct the skeletal deficiency and Improve the under eye support. But this alone will not be fully adequate in the correction of the sagging lower lids with excessive scleral show. In severe cases like yours you cannot count on the implant alone to drive up the lower eyelids to any significant degree. This also requires lower lid spacer grass and a lateral double hole canthoplasty which is performed at the same time as the implants. It takes an all-out effort to maximize whatever result as possible from these techniques.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have Bellafill in my cheeks under the test through I want removed. I have severe swelling g and use steroids to get the swelling g down. It’s awful. I want it removed without a scar will a facelift remove it? What can be done?

A: Bellafill is a permanent filler because of its PMMA bead composition. It creates its effect I having scar tissue in circle and in case the implanted beads. While it is easy to place by injection it is very difficult to remove due to the encasement of Scar tissue. It cannot be removed by liposuction suction or any scarless procedure. The only way to remove it is to cut it out. I do not know exactly how much filler you had placed or where in the cheeks it is located. So as a general statement your supposition that a facelift approach may be necessary to remove it is probably accurate.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to inquire about the feasibility, estimated cost, and scheduling for a specific comprehensive facial reshaping plan with Dr Eppley.

The procedures I am interested in pursuing are as follows:

 * Custom Brow Bone Implant

 * Custom Cheek Implants

 * Custom Jaw Angle Implants

 * Sliding Genioplasty (for chin shortening and advancement)

 * Mandibular Contouring (bone shaving for jawline definition)

Before scheduling a formal consultation, I would be grateful if you could provide some preliminary information on the following questions:

 * What is the estimated cost range for performing this entire list of procedures?

 * What is the current approximate waiting time for an initial consultation and for a subsequent surgical date?

 * From a surgical perspective, would Dr. Eppley typically recommend performing all of these procedures in a single, comprehensive operation, or would he advise staging them into multiple surgeries?

Thank you for your time and assistance. I look forward to your response.

A:Thank you for your inquiry and detailing your specific procedural requests. In answer to your specific questions about them:

1) The rate limiting step in any surgical procedure that includes custom designed implants is the time it takes to go through the design and manufacturing process of them. This is usually around three months from wearing the 3-D CT scan is received on which the implants are designed.

2) The question is not whether all of your requested procedures can be done in the same surgery as they can. It would not be rare to do so. The issue is not a technical or medical one about a comprehensive or stage surgical plan. Which approach is best is multi factorial and must be determined on an individual basis looking at the factors of aesthetic priorities, economics, travel and recovery considerations. But when you really break down the list of procedures that you are considering it would strike me that a comprehensive operation would not be unduly difficult for recovery and, since all of the procedures are augmentative, they all would seem to be important given what the likely the overall aesthetic goal is.

3) in looking at your list of procedures I would question the need for mandibular contouring assuming jaw angle and chin augmentation are being done which may obviate the need for that procedure. As a general rule you cannot reduce bone to create definition, it takes augmentation to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to try to reduce the appearance of my nasolabial fold, and fill in some hollows under my cheekbones and (ideally) around my nose—ultimately to add fullness to (and maybe appear to shorten) my midface.My left side in the picture is a bit more what I was going for, but I’m just drawing on my phone screen, so it’s all a little rough.

A:When you look at the six separate or three paired areas of facial hollows that you have illustrated that could certainly be addressed by implant augmentation of the bone. Giving their relatively discrete locations I would just modify some existing implants to create the augmentation effect for the sub mailer cheek, paranasal and upper maxillary regions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I saw that Dr. Eppley posted online about using fat grafting to treat coccydynia. I was hoping he can answer some questions:

Is fat grafting for coccydynia more effective than injections?

Does this treatment usually involve multiple treatments or is it usually a one time surgery?

What is the approximate success rate for fat grafting to treat coccydynia?

A:There are two types of fat grafting, liquid injections and solid dermal–fat grafts. What you are specifically referring to in the treatment of coccygodynia is the surgical placement of a solid dermal–fat graft. This has a much higher take rate and is more appropriate for coccydynia than fat injections would ever be. The success rate is fairly high as defined by significant take and retention of the dermal fat graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dr. Eppley, I have extra skin on my nose due to an implant placement that was removed several years ago. I’d like the attached procedure from your website. My goal is to be able to see my nostrils more from the front. I attached a before picture of myself  and current picture. Please do not hesitate to ask any questions. 

A: Thank you for your inquiry and sending your pictures. While one technique that you have attached for improving nostril show via alar rim retraction can be effective but there are associated scar concerns along the alar – facial groove where the excision is done. Another technique is to directly excise tissue along the alar rim which I think would be preferred given that the scar would be more on the inside of the nose or at least along the edge of the Alar rim (red lines in diagram) It would likely also be more effective because it is done exactly where you were looking for the effect rather than an excision of the alar – facial groove where one is counting on a lifting effect to make the improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m curious if it’s possible to modify the medial canthus to be more downturned or positioned slightly lower, like shown in the photo below. I understand this area is very difficult to alter due to the intricate anatomy, such as the nasolacrimal duct and puncta, which is why most surgeons avoid operating on it for purely cosmetic purposes. Also not to mention the overall nicheness and subtlety of the area make it a very rare procedure. That said, I’m wondering if it’s feasible to lower the medial canthus by just 3mm or so, and if so, how this could be done. I’ve heard that external soft tissue procedures, like a Z-plasty, could be used to stretch it downward, emulating it, but I question if such a method could achieve the extent shown in the photo, and I’m also unsure about its long-term stability. Thank you for your time!

A:You do realize that the image you have shown is not real and those are photoshopped changes. That being said the inner eye corner can be lowered, perhaps not as much is shown in the altered image, by changing the position of the lacrimal lake not the medial canthus, by a Y-V advancement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon