Your Questions

Q: Dr. Eppley ,I’m considering getting jaw angle implants. Looking at images of jaw angle implants on the internet, I noted from some images that the jaw angles seem to flare out.  Then I came across your website. When a woman has jaw angle augmentation, are the bottom of the jaw angles suppose to flare out ?                

Perhaps this is natural ? When you have jaw angle augmentation, the bottom of angles flare out?

Questions:

1. Are jaw angle implants suppose to flare out? Is this natural? (see attached image) 

2. On the other hand, would it be strange or look strange ( unnatural) to only increase the height of the jaw angle implants?

Kind regards,

A: Thank you for your inquiry and sending the jaw angle implant design images to which I can say the following;

1) The desired end result in any jaw angle patient is determined by preoperative imaging of the patient’s pictures. An implant design is created from what is believed to be the desired aesthetic result as seen in the picture imaging.

2) While most women need more vertical lengthening than width, that must be determined on an individual basis.

3) One can not determine from just an implant design whether that is aesthetically appropriate for particular patient.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to ask you about my options. I had done midface augmentations with injectable PMMA. 

The infraorbital area looks a bit empty and I am not happy with results. I choose PMMA because I lost of facial fat by bad diet. 

I am planning to take procedure to downsize tissue created by PMMA. Only the soft tissue has been filled with PMMA. No medical complications with PMMA, only poor results. 

Is it  possible to augment my midface area with infraorbital rim by custom infraorbital-cheek silicone / medpor implants? 

If it is possible how many months I will have to wait from liposuctions of PMMA.

A: Thank you for your inquiry and sending your information. There is no problem with using bone-based implants (custom infraorbital-malar implants) with any form of injectable filler in the overlying soft tissues. I would wait three months after the last injectable filler treatment so you have a good idea of your actual residual facial contour appearance is.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, I have a question about your clavicle lengthening procedure. I would like to know how long it takes for both clavicles to heal after the procedure and if it is possible to operate both clavicles at the same time or do you need to treat one clavicle at a time? Thank you.

A: Unlike clavicle reduction osteotomies where direct end to end viable bone is put back together, clavicle lengthening requiring an interpositional bone graft. This requires 2X the healing time for bone to grow through the graft which is 3 months instead of 6 weeks.

Your question is an interesting one in that should one or both clavicles be operated on at the same time. While recovery is certainly lengthened by bilateral surgery, having to harvest a fibular bone graft provides an argument to do both shoulders at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I had very hollow under eyes and underwent a lower bleph with fat repositioning but still not happy with my under eyes. I’ve looked into orbital rim implants and read on a forum from one of your past patients that he had orbital rim implants with you and it filled the hollow and lifted the lower lid slightly. This is exactly what I’m hoping for, it’s mostly the outer part of my under eye that is hollow and lacks projection and I’d like my lower lid lifted somewhat. I’ve attached some pictures that show what I’m hoping to improve. Thanks!

A:Thank you for your inquiry and sending your pictures. I would not have expected any efforts at lower eyelid fat transposition to solve under eye hollows. In an already fat deficient area simply moving what already exists is not going to provide any real volumetric improvement. You are correct in that infraorbital implants are the only method that can reliably improve the hollow undereye areas. But standard infraorbital implants (tear troughs) are not going to work as they only provide limited horizontal augmentation and not any vertical height increase which is the key in improving undereye hollows. This requires a custom infraorbital implant approach to address both the correct augmentation dimensions needed as well as have it fit your specific bony anatomy.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Ten years ago I had a lost 130 pounds. I subsequently regained 40. I now weigh 185 lbs. My chest circumference is 40 inches yet my hips are roughly 32 inches. I had tummy tuck with liposuction about 4+ years ago and I have significant gouging in my left flank. What would be the best procedure to reduce my upper abdomen/ chest area and improve my overall appearance.

A:Thank you for your inquiry and sending all of your pictures. In looking at your goals of chest and upper abdominal reduction your options are:

1) I would take advantage of your prior midline abdominal scar line and do liposuction and further vertical excision of abdominal tissues to reduce the entire abdominal width. (aka vertical tummy tuck) In the original fleur-de-lis 360 degree tummy tuck you had the area of least reduction is in the abdominal areas above the belly button.There is always more tissue to be secondarily removed vertically.

2) The chest area is more challenging but getting the breasts more lifted and medially located with lateral chest wall excision of excess tissue would be of benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I have a question I’m 4’11 and 98 lbs and I’m a 32B but I want to get high profile, round shape and smoothed surfaced 34DD silicone gummy bear breast implants. Is this size too big for me? I’m trying to achieve a full figure with cleavage enough for myself to notice it. Also will implants sag if I breastfeed with them? Thank you and God bless. 

A:Thank you for your inquiry and sending your picture. The perception of breast size is a relative concept. It is not a question of what anyone else thinks about a patient’s chosen size, it is what the patient thinks looks good to them. So whatever volume it takes to achieve the size you think looks good is what is the correct size. That is the value of volumetric sizers, it allows the patient to pick a size based on volume (not bra size) they like. Breast implants will not interfere with breast feeding.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, after having read so much and so good about you as a surgeon, I decided to write to you, first of all to see if you can give me your opinion. I had two facial lipofillings, the first one had a great result and I had a success that I had never experienced before, but it was low enough and the surgeon told me to repeat it. in the second lipofilling I now have excess retained fat especially in the area under the cheekbone, in what is the transition under the cheekbone, which makes a cheekbone too big. 

Can the injections of Kybella work? I have photos of myself with a good result, I am very clear where there is excess fat and where it is necessary to lower that excess fat but I do not know if it is possible to do so with Kybella after lipofilling, I do not know. If you could have 3-4 treatments and it took 6 months in total, you would give me one of the best news in the world. I would show you the photos where I have been successful and show you how I am now, I am 34 years old, I don’t know if that works against me. Once again, thank you very much.

A: Thank you for your inquiry and detailing your facial fat transfer concerns. I would certainly agree that the safest thing to do is Kybella injections. No one can say for sure how well they would work in submalar fat transfer reduction but their downside (limited result) is a far better one than the risk of overcorrection. The fact that they are done in a series helps better gauge and control their effects.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in facial feminization surgery of which I would like to start with cheek augmentation surgery first. Based on what I have seen of off the shelf cheek implants I know I would need custom cheek implants to achieve the midface look I am seeking. I have attached pictures and videos to show what I would like to achieve for my cheek augmentation.

A: Thank you for your inquiry, sending your picture and videos and very thoughtful commentary to your approach to facial feminization surgery. Choosing one or two procedures at a time is a very appropriate way to approach it because it makes you feel comfortable. Some prefer to dive into the pool so to speak while others wade in from the shallow end…it is all about what makes the patient feel comfortable.

You have made your cheek augmentation goals very clear and the only question is what is the best way to achieve them, meaning what I call a custom or semi-custom cheek implant approach. You have correctly surmised that no form of a standard cheek implant is going to achieve your goals. A custom cheek implant approach is when a 3D CT scan of the patients is used to create a very specific design. A semi-custom approach is when I go to my library of cheek implant designs (other patient’s custom designs) and print off one of them that I feel has a good chance to achieve your goals. The cheekbone and arch is not structurally that complex so if the patient so chooses that can be a good option. I would also agree that a buccal lipectomy with the cheek implant is a good complementary procedure as the two work synergistically to create the most significant change which is what you appear to be seeking. Whether one combines that with a rhinoplasty is merely a matter of opportunistic choice.

I have attached a model example of what you are seeking probably a bit more than that) and an example of the cheek implant style that it takes to achieve it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was searching for a method how to be taller, and i found your website. It says in your hospital you do silicone head implant to grow taller. I would really like to be 5cm taller. I was thinking about Ilizarov limb lengthening but it would be too risky. I would like to do the surgery to boost my self confidence and for my job.

Please help me

A: Thank you for your inquiry. Limb lengthening by distraction is the definitive way to gain 5cms in height. A custom skull implant, due to the limitations of scalp stretch, can only make you taller by about 2cms at most.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, have a 3 year old daughter who was diagnosed as an infant with torticollis. She developed severe brachycephaly as a result. We helmeted her for over 6 months but achieved minimal results. Her head remains quite wide, flat across the back and her forehead protrudes. As a mother who has lost countless hours of sleep stricken with guilt about what I could’ve done differently, I’m at the point where I’m trying to figure out what her options might be later in life. I see some really promising before and after photos on your site of adults you have treated. What age would you say the youngest patients arrive at your office? Teenagers? Clearly we would be a ways away, but I would love some perspective on what I might be able to tell her when she grows up and realizes her head is a really strange shape. Thank you for your time!

A: The aesthetic correction of head shape abnormalities through onlay augmentations and/or bone reductions (skull reshaping surgery) is not done until at least the teenage years when the skull is more grown and the bone is thicker.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been dissatisfied with my lower third for years. Specific concerns include an undefined jawline, deep nasiolabal folds, lip incompetence, mentalis muscle strain when I try to close my mouth, and a slight overbite. I also have non-cosmetic issues like chronic snoring. Recently, I’ve realized many of my issues may be due to a weak/short chin. I like the idea of a genioplasty for my chin because while I would like to improve its projection and slightly reduce its vertical height, I do not want to change my appearance drastically or look like someone else; my goal is simply to improve my overall facial harmony and address structural issues. Based on this and my photos, would I be a good candidate for sliding genioplasty?

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

1) You are a good candidate for a sliding genioplasty to which you have addressed the correct dimensions…forward and shorter.

2) How much forward and shorter is open to discussion. But, as a general rule, the real aesthetic risk is in too much forward projection in women. It is usually important to keep a more retroclined profile chin position from the nasal tip and lips. (see attached)

3) Given the amount of chin bone movement I would not expect any improvement in your snoring. It usually takes 10 to 12mms of bony chin advancement for that to occur.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have facial implants that goes around my entire jawline, cheek and paranasal implants, Goretex material. I thought this would fix my problem but turns out orthognathic surgery (Bimax) is what I should have done.

I have now consulted with a maxillofacial surgeon and he said that it was best was to remove all the implants and around 6 months later do the bimaxillary surgery.

The reason is because he can’t give an accurate image of what I would look like with the implants in my face. He has not removed Gore Tex material before but has worked with Medpor.

My question is, what are the risks and complications of removing goretex implants and especially by some who has not done it before with that material?

A: Removing ePTFE implants is very similar to that of Medpor. There will just be a lot more of them in your face.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a black male considering a chin implant. I am Fitzpatrick skin type V/5. I am told the submental incision route for placing the implant is best but I am quite worried about scarring on my more melanated skin. I can’t seem to find any images of a submental scar on darker skin that has healed. Do you know where I might find this? I see lots of examples of caucasian incisions that have healed beautifully but I am skeptical about how camouflaged the scarring will be on darker skin. 

Thanks a lot.

A: I have never seen adverse scarring in darker skin pigments such as Fitzpatrick 5 from a submental skin incision for a chin implant. In reality the greatest concern for reactive scarring is in the intermediate skin pigments not on either ends of the Fitzpatrick scale. But even in these risker intermediate skin pigments even they do fairly well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve attached your original morph (which I like very much) as well as 5 clear photos of myself from all angles. Forgive me for being so thorough, but I want to give you as much to go off of as possible since it is not feasible for me to meet him until the day before surgery, and my original photos were not as clear.

I have slight natural chin asymmetry. I believe he stated that he may be able to position the implant so as to not accentuate asymmetry, but I want to be sure I am clear on this aspect. What is the difference in approach,  if any, when using a standard implant on someone with mild asymmetry like myself? Or is it likely that the implant will also be asymmetrical?

A: As I stated earlier the dimensional changes you seek for your chin can be equally achieved by either a standard chin implant or a sliding genioplasty. In these circumstances the decision between two then comes down to cost, any predilection towards either an autologous vs alloplastic approach and the procedure’s reversibility/ease of secondary modification.

Of these three deciding factors the only one I can provide insight about is the latter…the ability to secondarily reverse or modify the result. This is certainly more easily done with an implant. While patient’s understandably never think before surgery about this very important concept, the reality is that in the broader world of facial reshaping surgery this is not uncommon at all. You can look at all the computer imaging you want but, in the end, you have to ‘wear it’ to really know how you feel about it. There is no way to predict beforehand with unerring accuracy any patient’s emotional acceptance of any type of facial shape change.

While one can try and shift the implant to camouflage a bony chin asymmetry, it is important to remember this is not a custom chin implant made specifically for your bony anatomy. Thus efforts at trying to correct the asymmetry by a standard chin should be viewed as hopeful but not assured. Its improvement is best viewed as a bonus but not absolutely expected.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am planning to get Sculpra filler (I think at cheek area and temples). Do my cheek, jaw, and chin implants make Sculptra riskier? Do you think that I would be substantially more likely to have some sort of abnormal growth or other unusual response? Thank you for any thoughts you have.

A: Good to hear from you. You can certainly have Sculptra injections for the cheeks and temples. For the injections near the cheeks I would just let the injector know there are cheek implants deep down at the bone level. For Sculptra injections they are usually placed more superficial than other types of injection materials. Just because you have implants will not make the Sculptra material (PLLA crystals) act in any way abnormally.

Let me know if you have any further questions,

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a transgender male to female and I would like to get more curves. I am interested in rib removal for waistline as well as buttock and hip augmentations.

A: Good talking to you this morning and sending all of your pictures. In looking at them your obvious fundamental goal is to take a straight body shape and give it some curves. In that regard, the first question a patient such as yourself needs to ask themselves is which is more important for you…..buttocks or hips? I recognize that both are but I ask this question because the following surgical principles apply:

1) You can not satisfactorily augment the buttocks and the hips at the same time….as a significant part of those results are going to come from implant augmentations.

2) Rib removal waist reduction is important for either hip or buttock augmentation but you can’t recovery wise have all three at the same time.

3) You have enough fat to harvest to use for buttock or hip overlay grafting. (meaning composite buttock augmentation = intramuscular implant placement and overlay fat injections OR hip implants with buttock fat grafting)

4) Putting that together means the options if buttock augmentation is more important than the hips:

     Rib Removals with Buttock Implants and Fat Injections (with full abdominal, flank and back liposuction for harvest)

5) If the hips are more important:

    Rib Removals with Hip Implants and Fat Injections to the Buttocks  (with full abdominal, flank and back liposuction for harvest)

6) Of course any of these procedures can be done separately or even:

      Rib Removals and Fat Injections to the Buttocks  (with full abdominal, flank and back liposuction for harvest)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I previously had surgery to install Implantech’s Flower Mandibular Glove in size L https://www.implantech.com/product/flowers-mandibular-glove/ 

Unfortunately, I had to remove the chin implant due to an infection from a fishing-related accident; a fishing hooking was lodged into my chin – and an infection ensued. 

Instead of going with same implant I am thinking to add a square chin implant style.

I feel like I have a round face feel like It could be improved with more of square chin and square jawline … I also plan to have buccal fat removal done as well. 

I would really appreciate your opinion on this. 

I have attached photos with and without the implant

A:Thank you for your inquiry and sending your pictures. Sorry to hear about the fishing accident….that is a new one for getting a chin implant infected based on my experience. When selecting a new chin implant style, the one advantage you have is that you had a prior chin implant style and you know what look that created. Certainly a square chin implant style would produce a less round look and the style 2 is appropriate for your face as the style 1 has too narrow a chin width. With your rounder face the buccal lipectomy can only help. The combination of a new square chin implant with the buccal lipectomy, together, will help your facial reshaping efforts better than either one alone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a deficient chin and would need an advancement of 8-10mm to bring my chin in line with my lips. I’ve done a fair amount of research and understand that I have a choice between chin implant or sliding genioplasty. I have no preference other than I would like to look my absolute best, but I have heard some testimonials that a sliding genioplasty tends to be a more visually pleasing procedure in this range of advancement. 

My issue is my side profile. My question is whether or not he believes one of these procedures has an edge over the other in efficacy or aesthetic outcome if I do not need much (or any) vertical lengthening. Is this too large a range of advancement for a non-custom implant? Do you tend to lean towards the genioplasty in advancements of this size?

A: Thank you for your inquiry in regards to chin augmentation. The classic ‘debate’ between a chin implant and a sliding genioplasty is not really a debate at all most of the time. The key question is what are the patient’s dimensional requirements for their chin augmentation. In side profile both proceeds can achieve  an 8 to 10mm advancement. But where they differ is in their ability to achieve any vertical and width changes. A chin implant can make the chin wider or more square, a sliding genioplasty can not. A sliding genioplasty can make the chin more narrow, a chin implant can not. A sliding geniopalsty can make the chin vertically longer or shorter while a chin implant is much more limited in that regard. So as you can see these dimensional changes must be factored into the choice between the autologous and alloplastic chin augmentation options.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I am an Asian male and I have a large complex with my head shape. I have a very prominent side head, so the head width is very wide. When I was photographing a head ct, I was told that there was not enough temporal muscle and the skull was only 5mm thick. In this case, can the head width be reduced by more than 1 cm? And is it true that men have at least 5 mm of posterior temporal muscles? Since I out of the USA, if I went to the United States to have surgery, I am worried that I will have to come back because the operation is impossible. Should I send CTpictures to you to make sure? And what is the estimated cost when you’re contracting the temporal muscles and the skull?

A: Thank you for your inquiry and sending your picture. In my experience the average Asian male has a posterior temporal muscle thickness than ranges from 8 to 10mm per side. This is thickest just above the ear and then gradually thins as it heads up to the bony temporal line of the skull. I do acknowledge that the typical Asian skull is naturally wider at the posterior temporal area but the bone is thin and the focus is on the muscle removal. I have yet to see any male patient who had posterior temporal muscle reduction that did not have a visible improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can you please let me know if you think I’d be a good candidate for a chin implant? If so, what type of implant would you recommend? Do you typically use general or local anesthesia for chin implant surgeries? Please see attached photos of my chin. Despite my recessed chin, my bite is normal. I used to have an extreme overbite but I corrected it with braces as a child. 

Thank you!

A: Thank you for your inquiry and sending your pictures. Ideally you would be far better served by a sliding genioplasty because your chin needs vertical lengthening as well as increased horizontal projection. With a vertically short chin and a deep labiomental sulcus it is more ideal to vertically unravel the compresses chin tissues. It is also better for your submental neck tissues as well. But since you asked about a chin implant that also would be beneficial but not as good as the sliding genioplasty. I would use either an anatomic or small vertical lengthening chin implant style. The key about using an implant in the patient who is better served by moving the chin bone is to not ask the chin implant to do too much. With your soft tissue anatomy this is how you get into undesired aesthetic effects.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a hair transplant procedure recently and they tried to build up my temple area with more hair follicles. After it was done not long after my left temporal artery began to bulge and now it’s staying that way and it’s look very much bothers me, especially when I workout. I’m desperate for a solution to remove the bulging artery but would not like a noticeable scar in its place. If you could help me I’d be very grateful.

A:Thank you for your inquiry and sending your pictures. That is the classic pattern of the superficial branch of the anterior temporal artery. That is treated by a multi level ligation technique through very small (5mm) incisions. Those incisions heal well and have never posed any adverse scarring issues. This is a procedure performed under local anesthesia with minimal recovery and no post ligation physical restrictions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,The problem that plagues me is the shape of my head. I have a small head, behind it is flat and above and narrow and has indentations, irregularities. A surgeon promised me the transfer of fat. He told me that the insertion of prostheses is a risky, very, very expensive operation that leaves scars on the scalp. I am unsure about the method because I know that the fat is reabsorbed and therefore I should intervene again. Are there other materials that can be used that do not leave scars and are long lasting ? I do not know what to do. This malformation has conditioned my whole life. What do you recommend? Is there is a solution for my case. Pending your reply, I offer you my best regards.

A: Thank you for your inquiry and detailing your head shape concerns. In essence you are asking for skull augmentation of unknown amounts. (at least to me at this point) While injectable fat grafting can be a very useful technique in the face, it has a very poor outcome in the scalp/skull for a variety of reasons. But most importantly it can never provide an adequate push on the tight overlying scalp tissue to create a substantial head shape change. While there would be no harm in doing a fat injection operation it is simply not going to work for a visible head shape improvement. But I can fully understand why almost any plastic surgeon would offer a fat injection solution because that is all they know how to do. But I have yet (short of the forehead) ever seen a successful skull augmentation result with fat grafting. It is also common that plastic surgeons, who have never seen or done aesthetic skull augmentation surgery, would make comments about the operation that are inaccurate. (if they have no first hand experience they would serve the patient better by simply stating they have no knowledge about that type of surgery)

Effective skull augmentation requires the placement of a custom designed skull implant made from the patient’s 3D CT scan. These are typically inserted through relatively small scalp incisions. Whether this wold be effective for your aesthetic head shape change would require doing some computer imaging of pictures of your head to determine what type and magnitude of change you are seeking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello Doctor! I’ve read many of your answers and have seen your results and would love to go to you for my lip aug. I was wondering how you do the smile/lip widening and bull horn lip lift. I just had one syringe of lip filler last month for vertical height.

A:Thank you for your inquiry and sending your pictures. They dilemma that you have with your upper lip is that the central part is very long from a skin standpoint with a good cupid’s bow shape but the sides of the upper lip vermilion are very thin. Thus a subnasal lip lift done alone, which only affects the central portion of the upper lip, is going to create a significant upper lip vermilion disparity when the cupid’s bow area vermilion gets bigger and the sides of the upper lip remain the same. As a result a subnasal lip lift has to be combined with direct lateral vermilion lifts to keep the upper lip vermilion show more in balance. The other alternative is a total upper lip vermilion advancement, which is what you really need, but the fine line scar across the whole upper lip is more than I would do when you have such a good cupid’s bow shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, You did my breast implant surgery two years ago. I had wanted the silicone implants removed and a silicone implant put in at a total of 1600 ml. Due to my physical limitations you were only able to bring my liquid up to 1050. Since it has been almost 2 years is it possible for you to add saline to bring me up to 1600, or some larger amount than I presently have, without removing the present implants? Can you do this in your office? I don’t know much about the required procedure. Thanks.

A: Good to hear from you. One can always add more saline volume after the tissues have been relaxed a bit from prior expansion. To add more volume to a saline implant (breast implant overfill) a small areolar incision is used to access the filler port of the implant from directly above it. Then volume is added until the tissues feel tight again. There is no question that more volume can be added, the only question is how much. I suspect it would be at at least 300cc and may be possible up to 500ccs. That would just depend on what the tissues fill like when doing it. While this would be a virtually painless after surgery with no real recovery, it is challenge to access the filler port on the implant without rupturing it. Thus it is not an office procedure but could be done under IV sedation in the operating room.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,, is it possible to vertically advance the bottom jaw via the ramus? I understand that most surgeries involving the ramus are used to correct jaw asymmetries but I would simply like to lower the position of my bottom jaw as it is poorly positioned and makes my face appear crowded to the centre. Is that possible? And if it is I would like to pair that surgery with a Lefort 1 or 2 and genioplasty or other chin advancement surgery. 

A: If I understand your question I believe you are referring to doing a horizontal osteotomy and vertically lengthening the ramus.  (jaw angle lengthening) While this is surgically possible there are several technical issues that make its use very limited…it would require an external skin incision, plate fixation and a bone graft to do so. Such an effort seems aesthetically adverse when there are simpler alloplastic methods to accomplish the same effect.

However the broader question of how ramus lengthening fits in with a LeFort and sliding genioplasty procedures is not a question that can be answered without pictures, x-ray and dental analysis.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For my face what would be the best procedure to chisel out jawline and cheekbones? Kybella? Buccal fat removal?

A:Thank you for your inquiry and sending your picture. I can certainly see why you seek more defined cheekbones, and possible the jawline , because of your long and narrow face. Your cheeks seem structurally deficient compared to your jawline so providing some increased width and prominence would create improved facial balance. As a general rule trying to defat the fat to create more defined or chiseled cheeks never works…unless one has great cheekbone structure (which you don’t) and there is a lot of fat in their face. (which you also don’t) Do not waste resources on facial fat removal…focus on cheekbone augmentation as that will have a far greater effect. Whether that would be with the use of standard or custom cheek implants is an issue open for further discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting a chin implant as well as jaw angle implants. I had a couple of questions I was hoping to get answered: 

– Are you currently open for virtual consultations and procedures during coronavirus? 

– For your implants, is the material used made of silicone? 

– I see that there are many different shape options for the implants, how is the best shape for my face determined prior to the procedure? 

– I would need to come from out of town, what is the recommended length of stay to handle both the procedure and all follow up appointments after the procedure, and how does acquiring the pain medication post-procedure work? 

I’ve attached a profile image to confirm that the 2 procedures I’ve mentioned are doable and whether or not you would recommend them.

A:Thank you for your inquiry and sending your chin augmentation imaging. In answer to your questions:

1) My surgery center has been open since May 30th.

2) As you may know there are multiple materials available for both standard chin and jaw angle implants as well as a custom jawline implant. (solid silicone, porous polyethylene and PEEK) Each has their advantages and disadvantages and it is up to the patient with my education guidance to make a selection that suits them the best.

3) Computer imaging is used to determine the patient’s aesthetic goals. A side view picture alone is inadequate to do so. It requires at least a front, side and three quarter view pictures to use imaging to determine what you like and don’t like. From that information the implant style and size are selected for standard implants or designed for custom implants.

4) All preoperative evaluations are done virtually, patients usually come in to meet me the day before surgery, most patients return home 1 to 2 days after the surgery and all followups are done virtually.

5) Pain and antibiotic medication prescriptions are provided before surgery of which the pain prescription has to be filled in state.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I’m interested in calf implants and possibly implants put in my ankle. I have very skinny legs below my knees that don’t match the rest of my body?

A:Thank you for your inquiry and sending all of your pictures. It is also very helpful that you were clever enough to send a back view picture with you on toes which shows the full extent of the inner and outer gastrocnemius (calf) muscles. I can certainly see why you have interest in lower leg augmentation as the size of the your leg between your knees and ankles is disproportionate to that of the upper legs and hips. Calf implants can only be placed where the muscle is located. Your calf muscles are small in width but they are also vertically short. Thus calf implants, while providing some improvement, are restricted as to how low they can go down the keg. (see attached imaging prediction) There are no implants for the lower half of the lower and ankles as there is no space to put them with very tight tissues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an asymmetric orbital rim problem where my left eye is lower than my right eye. I have taken a picture and drew a red line where the horizontal plane should be. Since I have a long face is it possible to move my right eye down to the same level as my left eye?

A:Thank you for your inquiry and sending your picture. In vertical orbital dystopia the debate is whether to raise the lower eye (orbital floor augmentation) or drop down the higher eye. (orbital floor downfracture) The augmentative operation is moron predictable because you are directly choosing the amount of orbital floor augmentation. Trying to drop down the higher eye is a bit more unpredictable as how much the the orbital floor should be lowered is not always 1:1 with the vertical position of the eye. Preoperative assessment with a  3D CT scan of your bony orbits would provide further insight into that consideration.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a sliding genioplasty about two years ago. It has left me with a deep and tight labiomental fold. The maxillofacial surgeon who performed the procedure suggested division of the muscle and overlapping them to release the fold. I see on your website that you strongly suggest a fat graft to correct the deep fold. Is that what you would suggest for me?

A:Thank you for your inquiry and sending your pictures, With your tight and indented labiomental sulcus a release and interpositional graft is clearly the best treatment in my experience. Tissue tightness and a depressed contour indicates a soft tissue deficiency. Any form of manipulation of the muscle alone will either not work or make it worse. Like any form of a scar contracture you can’t make it better but just moving around the already scarred tissue, that is a conceptually flawed approach.

Dr. Barry Eppley

Indianapolis, Indiana