Your Questions

Q: Dr. Eppley, I have an uneven brow ridge with uneven eyebrows (one is flat while one is pexed, makes me look constantly expressive). I want to know if it’s possible to correct the asymmetry of my brows and adjust their position so that they are both closer to my eyes, giving more hooding if possible. I have produced a (poorly edited) morph of the look I would like to achieve. How realistic are my goals? Can it be done with implants/ a solution other than fillers and Botox? Thanks.

A: I find that your eyebrow shape goals are only partially realistic. The first question is about the asymmetry…why does it exist? If it is bone based, as the eyebrows often follow the shape of the bone, then a custom brow bone implant for brow bone reshaping can be done which may also help lower them a bit. If the eyebrow asymmetry is soft tissue based this is more problematic as then only temporary Botox injections can be done. Bit either way it is to possible to move the eyebrows inward or any closer as there is not treatment, non-surgical to surgical that can do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to ask a question regarding jaw and cheek implant. Are facial implants such as these visible in dental x-rays? I am strongly considering this procedure but feel somewhat insecure about someone seeing them in x-rays. Is there anywhere I can see how the look on an x=ray? 

A: Non-metallic implants are not seen in a dental x-ray which would be that of a panorex. However any screws used for the implant’s fixation would be.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I have had a prior sliding genioplasty but want more of a result with further horizontal augmentation. But  I’d like to avoid a revision genioplasty. I was wondering if you think it would be possible/advisable to get advancement of the chin and labiomental fold area with a combination of chin implant (I think wraparound would make sense if I’m already having the jaw implants) and some soft tissue procedure to reduce the fold (filler possibly?). I attached a morph of my goal and a superimposition.

A: The amount of horizontal chin advancement you have shown is achievable with an implant. However filling in the labiomental fold can not be done with any form of an implant as that area reflects the attachment of the mentalis muscle which sits above where any implant can be extended. That is an area which can only be augmented by fat grafting. But that part of your imaging is not achievable in the magnitude you have shown.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, A week ago I had mandibular implants placed. My jaw muscles are not extremely large and bloated. Is getting Botox so soon after surgery an option? Would that compromise the result or healing, or would it have any negative effect on the implant? 

Thanks 

A: While your questions are more appropriate for the surgeon who did the procedure and that is really his/her responsibility to answer them, I will do you the courtesy of providing an answer.

Aesthetic recovery from jaw angle implants takes a full three months to see the final result. It would be completely expected to have swollen jaw angle tissues at this early point after surgery. The use of Botox injections would be both biologically and medically the wrong thing to do and could well end up infecting the implants. Time is the answer to your facial swelling issues and there is no easy and simple method to expedite that process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an aesthetic eye spacing concern. I believe my eyes are positioned too close together in proportion to the rest of my face. It is something that has bothered me for a very long time and I am willing to do whatever it takes to find a solution.

Through my own research I have realized that increasing intercanthal or interorbital distance can seemingly only be achieved through highly invasive and expensive craniofacial procedure that would undoubtedly have many aesthetic trade offs of its own. Widening of the nose bridge, full coronal scar and bony step offs seem to be the most significant. Even in consideration of these trade offs, I still feel as though I could benefit from this procedure.

I would first like to know whether it is even possible to achieve such a movement of the orbits (3-6mm) with a high enough degree of accuracy and predictability? If so, is it plausible that a cosmetic patient could undergo the procedure if they were both well informed and highly motivated? I can send pictures for evaluation if it would be helpful.

I just find it very hard to accept that my biggest and most detrimental perceived flaw seems to be one of the only things that does not have an easy cosmetic fix.

Thanks

A: The issue is not whether orbital box osteotomies can be performed to increase intercanthal  distance by 3 to 6mms, because you can, but whether the aesthetic tradeoffs you have mentioned and the magnitude of the procedure (a frontal craniotomy is needed) and its cost could be justified for that type of aesthetic eye change. It would be hard for me to imagine that it would.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a fairly recessed midface and orbital area. This is noticeable from profile and indicated by my negative orbital vector. It also results in the appearance of dark tear troughs under my eyes. I would like to fix this through any means possible. My problem is that I have a great aversion to implants. It is not that I doubt their effectiveness, I am just irrationally uncomfortable with the idea of having them in my face. Though I realize I may have no other choice than to ultimately go with implants… But in any case, my question to you is this: Could you perform any sort of osteotomy that would advance the infraorbital rims as well as possibly the malar-zygomatic complex? If so, I’m guessing it would be a lot more complicated and perhaps risky than simply getting implants, but I’d be very interested to hear about it and understand all my options. Thanks in advance.

A: As you have correctly surmised trying to achieve infraorbital-malar augmentation by osteotomies and/or bone grafting is fraught with many issues such as bony step-offs and  irregularities to name the most prominent of them. But their main aesthetic drawback is that moving the bone fails to raise the infraorbital rim which is a key augmentation dimensiona change needed in addition to moving to forward. in short trying to move the bone is both an inadequate solution as well as one that creates its own aesthetic issues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can the costal margin directly under the breast be shaved/reshaped/removed? Or is that not possible due to it be so close to the chest? Most people I’ve seen with costal margin protrusion are usually lower and not directly under the breast like mine(i have an extremely short torso).

A: The costal margin under the inframammary crease of the breast can be reduced or removed and is a common rib graft harvest site in nose and jaw surgery. The question is not whether it can be done but whether it can achieve the contouring effect that you desire. It is not clear to me yet how rib reduction in that area will improve a short torso.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, In addition to my previous email, I’ve become intrigued by a recent post you put up on IG regarding clavicle reduction. I’m interested in doing somewhat of an “upper body feminization” if you will. I’m transgender (MTF) and am interested in learning more about whether there would be any significant benefits to such a process. I was thinking of a combination of clavicle reduction, scapula reduction and rib removal. 

I understand the rib removal process since it’s relatively straight forward. However, I’m interested to know about the other two procedures and so I have the following questions;

1- in terms of diameter, how much reduction can generally be achieved with clavicle reduction?

2- If scapula reduction can be performed, how big of a scar would result and where would the incisions be placed? 

3- Can all three surgeries be accomplished at the same time?

Aside to the aforementioned questions, I’d also like to get a quote from your office regarding the above procedures. 

I have attached the photos originally requested and an attempt of clavicle photos, please let me know if further photos are needed. 

A: I think it is important to review the anatomy of the scapula which is the best way to determine the implications of its reduction besides the scar. By your pictures the most prominent part of the scapula is its inferior angle. This bony portion of the scapula is the origin of the terms major muscle which has a role in arm movement. Between the scar and the loss of teres major muscle attachment I would be very cautious about considering this type of back contouring procedure. Its is not a question of whether it can be done but whether its tradeoffs are worthwhile. I would be more enthusiastic about it if the inferior angle was shaved rather than completely removed, thus keeping some of the muscle attachments.

In answer to your other questions:

1) For the clavicular reduction procedure, I would refer to one of my websites, www.exploreplasticsurgery.com, where you can search under Shoulder Width Reduction. There you will find detailed answers to your questions as to how the procedure is done with clear pictures of it.

2) I think that putting together all three body contouring procedures together, even if scapular reduction is advised, is too much  from a recovery standpoint,. Even any two of them would be difficult.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’d like to ask 2 questions to Dr. Eppley regarding my future procedures I’m going to get from him 

1) If I get a custom jawline implant and infra-orbital-malar implant, will they always look “sharp / chiselled” or does that depend on bodyfat percentage, and if someone stores a lot of fat on his face then the implant will look “bulky” instead of “sharp/defined/chiselled” (especially the jaw and zygos)? 

2) Why do fillers (Juvederm Voluma in the jaw and chin) lose their sharpness in the first month and instead become “bulky”? Is there a scientific explanation for this? 

Thank you.

A: In answer two your custom facial implants questions:

1) The creation and persistent of any facial angularity done by custom implants depends highly on facial fat content…both initially and long-term.

2) Injectable fillers are soft gels int which the tissues pull back quickly and distort their shape to relieve the pressure they exert. The firmness of implants prevents that effect from happening.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, how would orbital decompression effect palpebral fissure length? I have rather wide set eyes, albeit shallow set ones, and anything that would make my eyes seem horizontally shorter would be sub optimal.

A: The orbital decompression procedure is not known to necessarily affect horizontal palpebral length. Theoretically it may as the eye settles back in but that is not an assured aesthetic effect and most likely would not do so. This aesthetic issue is not a reason to do the procedure or avoid it either.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I just wanted to ask a couple more questions about hip implants if that’s okay. 

I understand the pricing, the pain level, the scar, and that I need about 3cm per side custom hip implants… but I was wondering if it would feel somewhat real and soft at 3cm and won’t be noticeably fake to touch? Also if you would be able to see the implants edges, outline or sticking out in certain movements such as at the gym? The feel and look .. whether it will be noticeable that they’re implants is the only thing stopping me from getting it done. 

Thanks so much 🙂 

A: No implant anywhere on the body will ever feel perfectly natural…as it is not a natural substance in the body. Hip implants are no exception in that regard.

Edging is usually not an issue due to the feathered edges of the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a deep mental crease. Some time ago I underwent a bilateral sagittal split, which I am told was successful and to date, have had no issues. I have regular checkups at the dentist and have been told that my bite is fine, after years of feeling that it wasn’t. For the deep crease the dentist did suggest fillers to me however, I understand this is only a temporary measure and I would prefer a more permanent solution if at all possible.

I did not have my chin altered during the surgery, although I was led to believe this was going to happen and was offered to have it done at a later date, but I declined their offer.

To me my chin has had such an impact on my self confidence over the years and I am wondering if you would be able to help me please 

I am based in the UK and have been unable to find anyone who does this kind of surgery.

Picture of my face taken this week and my chin this week.

Kind Regards

A: If I interpret your inquiry correctly your goal is to have the labiomental crease made less deep. Otherwise the structural shape of your chin is acceptable. While injectable fillers are one treatment option you have correctly assumed that they would be temporary Fat grafting is a more assured option for softening the deep labiomental crease and this could be done by either a percutaneous injection technique or the placement of an intraoral dermal-fat graft….each has their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,“I am looking to enhance jaw and chin area. Attached are six photos-

1. Front- full bite/molar teeth touching

2. Front- relaxed face

3. Front- advancing chin vertically and slightly anteriorly

4. Side- full bite/molar touching

5. Side- relaxed face

6. Side- advancing chin vertically and slightly anteriorly.

#6 shows the type of chinb/jawline change I am seeking.

Thank you. 

A: Thank you for sending your pictures and demonstrating your goals. You have an overall vertically deficient chin/jawline which is most evident in the chin area with a short lower third of the face and a deep labiomental fold. Undoubtably you probably have a deep bite as well. What you are demonstrating by jutting your lower jaw forward and down is an overall vertical lengthening effect which is greatest in the chin area. This exact effect is only obtainable in a pure bone technique by doing a CHIN WING OSTEOTOMY which is an extended version of a sliding genioplasty. The alternative approach is a VERTICAL OPENING BONY GENIOPLASTY with CUSTOM JAWLINE IMPLANTS. There are advantage and disadvantage ago either approach. It really comes down to what type of change, if any, you want at the back in the jaw angle area.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had an orbital floor injury and subsequently had an orbital floor implant added but I may need another metal implant or simply silicone on top of it. Can that be done?

A:You can place either a custom metal or silicone implant on an existing titanium orbital floor implant. This is not a problem to do and is not uncommon as getting the exact orbital volume restored from a primary fracture repair is difficult to do. It is best done in a custom fusion using a 3D CT scan to design the add on implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is a revision genioplasty more risky than the original genioplasty? How soon can a genioplasty be revised? My surgery was two months ago and the lower part of my chin (below the fold) is still out further horizontally than my lips. I value your opinion. Thank you.

.A: In answer to your revisional genioplasty questions:

1) A secondary bony genioplasty has no ore risk than the original procedure…and in some ways may actually be less.

2) You revise a sliding genipalsty as soon as you have assurance that what is being seen is the actual result and not just swelling and lack of complete tissue adaptation yet.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had a previous Custom Chin Implant that provided me with horizontal projection of my chin. However, I would like to have my chin augmented vertically with a sliding genioplasty. I am just curious if the chin implant would be needed to be removed in order for a sliding genioplasty to be performed in order to vertically lengthen my chin around 3mm.

A:Usually there is not problem with doing a bony genioplasty cut just above the chin implant and moving the chin either further forward or for vertical lengthening. But I would have to see images of the custom chin implant design to confirm that a vertical lengthening bony genioplasty can be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had upper jaw advancement surgery, and surgeon did not do alar cinch. My nose has remained the same apart from horribly flared nostrils. They flare outwards and upwards so that frontways on – my nostrils are higher either side than the tip, and they look open from the sides. I have since had alar base reduction which has helped a little but the still flare upwards at the sides. If I pull down under each nostril my nostrils look normal again. Therefore I feel I need the cinch to be done as a stand alone procedure. Please can you advise if and how this can be done..and should I approach a jaw surgeon or a nose surgeon? My previous jaw surgeon is not very helpful and states he has only eve done cinch as part of jaw operation. Many thanks

A: An alar cinch procedure is not the correct procedure for dealing with either horizontal or vertical malposition of the nostrils after a LeFort I osteotomy. That is only a preventative procedure done at the closure of a LeFort I osteotomy, Nostril repositioning by sill or nasal base skin excision is the definitive procedure to change nostril position either flaring or vertical malposition.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an overbite that I’ve been told (by a couple of orthodontists) can only be fixed with jaw surgery.  And due to the overbite I have a pretty recessed chin and my nose appears bigger.

However, jaw surgery is a major surgery and I don’t have the type of support system needed to help me with the length of recovery required.  Also, it would take a long time before I could even have the surgery because of braces, etc.

So I’ve decided to instead check into improving the cosmetic aspects of my recessed chin for now instead of the underlying problem.  I’m thinking a sliding genioplasty would help a lot.  Maybe I would need an implant too.  But that is what I am contacting you for, to find out what you recommend.  My nose might still be proportionately too big also, even after improving my chin.

When I was younger I found a plastic surgeon and had a chin implant and rhinoplasty.  This was before the internet and I really didn’t know what I was doing. I had never heard of sliding genioplasty. The surgery did result in an improvement, but really not a big change. 

I’ve seen before and after photos from you and other surgeons for sliding genioplasties, and they are amazing!  It wouldn’t address my underlying problem, but it would make my profile look so much better! 

I also don’t like the size of my nose but I don’t know how it would look if my chin looked better.  And I’m noticing my face getting a little saggy around my mouth/chin due to age, but maybe the chin surgery would make that less noticeable?

Anyway, I would love to know what you recommend.  Attached are some pictures I took as well as a x-ray from my more recent orthodontist.

A: Thank you for your inquiry and sending your pictures and x-rays. As you know you have an entire short lower jaw and Class II occlusions for which jaw advancement surgery is ideal…but we know the effort to do that at this point in your life is not acceptable. Thus a sliding genioplasty is the procedure you need for cosmetic camouflage because you have both a horizontally and vertically short chin for which an implant does not do well for those combined movements. (the chin implant you have is very small and is positioned too high to have much of an effect) I have done some imaging looking at bony chin movements of 7mm forward and about 5mm vertical as a starting point. While this will help with some of the loose tissue under the chin , the submental area should be ideally treated with liposuction at the same time for best contouring. By the imaging you can see that the nose looks smaller as the lower face comes into better balance. But I also did some imaging looking at nasal tip reduction as well for you to see the combined effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I do have a few questions.  The first are related to the temples:

a.) If Dr. Eppley were to use filler this time around, would that show me pretty much exactly what an implant would look like?

b.)  What is the price differential?

c.) If I went with the implants, would open me up to the possibility of visible scarring or bruising?  How about the filler?  (I’m thinking about the fact that I have to be back at work four days after surgery.

A: In answer to your temporal augmentation questions:

1) Fillers will have some under approximation of what an implant will do as they are not comparative volumes. A standard temporal implant, for example, is the equivalent of 2.7cc of filler per side. Most patients are not going to invest 5 syringes of filler to ‘see what it looks like’.

2) Temporal implants are gong to cause some swelling which will not be gone by four days after the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it normal for gluteal implants placed intramuscularly to flip? And is that something that will become less common with larger implants? If not can anything be done to ensure it doesn’t happen?

A: Buttock implants placed in the intramuscular pocket have a much tighter compression against the implant and often have a wider implant base as well. s a result, It would be very rare for a buttock implant to flip in the intramuscular pocket as there is less pocket relaxation that exists than in the subfascial pocket. I have never seen it or heard of it occurring. That is the same regardless of implant size which is often less also because of the tighter pocket. Such flipping is a potential subfascial pocket concern where often lager implant sizes are used that have higher profile to base width ratios. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering how close you could get me to looking like this guy. (link attached)

I’ll attach some photos of myself and explain what I’d want to change to try and match the male model look. 

I want to know about forehead implants and how to go about getting my forehead to look as similar to his as possible. My forehead slopes back so I want it looking flat and a defined eyebrow ridge. 

I also want to know about jaw implants and how to make my jaw as angular as absolutely possible and much wider.

I really want that sucked in cheek look as well so I want high cheekbones but I’ve read that cheekbone implants aren’t very effective, is this true? 

(like this guy in the leather jacket) 

Look forward to hearing your assessment on how I could best go about looking as much like this guy or just a male model that might suit my face better. 

Kind regards

A:Thank you for your inquiry and sending your pictures. While it is good to have goals, all you can do is take the face you have and see how its proportions and shape can be changed. In that regard that means a forehead-brow bone implant, high infraorbital-malar implants with buccal lipectomies and a jawline implant is how you would reshape your face.

Traditional or standard cheek implants will not create the high cheekbone look, that is true. It requires custom infraorbital-malar implants to create it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to have four to six ribs removed. I am also planning on extra large breast tissue expanders to reach a goal of 5000cc to 6000cc in each breast. Given that would it be safe to remove four ti six 4-6 floating ribs if I have 6000cc saline in my breasts? I am 1.75 cm tall and weigh 54kg. Thanks.

A: I have done rib removal in numerous women who have had breast implants well in excess of 1000ccs. I have no experience in rib removal in women with breast volumes as you have or are going to get. However, I presume your question is based on that such large breast implants would not be supported by a ribcage that has been modified? I don’t see any correlation between implant/body support and a modified lower ribcage. The strength to support that breast weight/size comes from muscle support not a fully intact ribcage.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, several years ago I had a buccal lipectomy. I never liked the result and am searching for a “reversal”. In your blog I have read about the possibility to place a dermal fat graft in the buccal space. This is my preferred option since a dermal fat graft creates more assured volume than fat injections and is a solid graft. I don’t mind having a scar somewhere on the body to harvest the graft. Am I correct in assuming this solid graft would not absorb but replace the lost volume I had pre-buccal fat removal? How many of these procedures have you done in the past to correct buccal fat removal? 

Could you please tell me how much would that approximately cost? Is general anesthesia needed?

I look forward to hearing from you.

A: In answer to your Buccal Lipectomy Reversal questions:

1) It would seem logical that the type of fat graft tor replacement of a previously removed buccal fat pad would be a solid fat graft. As the buccal fat pad is an encapsulated fat pocket of around 3ccs, its replacement could similarly be a solid fat graft of similar volume.

2) While the volume retention of the implantation of a solid fat graft or fat injections can be debated, and never really proven either way on a truly comparative basis, it is more about what the patient wants to go through. Do they prefer having a body harvest site for a likely one time fat grafting procedure (solid fat graft) or do they prefer having less surgery but likely to have to repeat it more than once. (fat injections)

3) My experience in buccal space fat grating has been primarily that of the HIV facial lipoatrophy patient (type 4 and 5) and not a cosmetic buccal lipectomy patient. Although the results should be similar if not better given a more normal ‘fat state’ in a non-HIV patient..

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in hairline lowering. Would I need scalp expansion to do so? I can’t tell how loose my scalp is and whether it can move a lot or not. It seems sort of flexible but I am not sure how much looseness is needed.

A: Whether your frontal hairline can be lowered without scalp expansion depends on how much forward movement the hairline needs to come and how much scalp laxity you have. The latter is more difficult to accurately answer by email but the former can be answered by sending me a picture which shows the hairline marked where you would like it to be.

But it is fair to say that scalp expansion makes every hairline lowering better and more effective but removing all doubt about the needed scalp laxity.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to ask you about how to decide the correct size for jaw angle implants. For reference my bigonial width is 9.8cm without soft tissues and 11cm counting them, my bizygomatic width is 13.6cm. Thanks for the help and greetings.

A: The reality is there is no exact science as to how to select jaw angle implant style and size. X-rays and measurements on them are not really helpful anymore than a chest x-ray is helpful in selecting breast implant size for women. What is the most useful thing to do is computer imaging, looking at various changes in jaw angle shape and size and then seeing how you interpret those changes. From that assessment jaw angle implant styles and size is determined.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been suffering with rib pain for over 2 years now. I can’t walk or do activities without burning pain in my left side. I believe the worst are ribs 11 and 12, possibly 10. I saw that you’ve done surgery for the bottom ribs hitting the iliac crest. I am not sure if thats what happening to mine or not, but I am in a lot of pain. Are all CT scans 3d? I had a CT scan (with contrast) in 2017 when this first started but they did not find anything. I’ve also had a thoracic MRI but nothing found. I am running out of options and not sure wha to do.

A: I obviously can not say for certain whether #11 and #12 rib removals would be the cure for your symptoms.  In costo-iliac syndrome the long lower ribs (or shortened waist on the affected side) can impinge upon the iliac crest. This can be a source of pain that occurs or exacerbated when one bends over onto that side and the ribs actually touch the iliac crest. Otherwise all x-ray studies would usually be negative as they are done in the upright position. This is typical pain that occurs when one bends over but is relieved when one stands straight.

Whether any of this applies to you I can not say. You would certainly not want to got though such rib removals and end up with no relief of your symptoms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have two large dents (step-offs) and a large bony bulge (on left jawline) that resulted from a bad sliding genioplasty done in 2009. I just want my straight jawline back but concerns over someone not experienced in bone work, particularly in what I’ve been told is a complicated repair, have resulted in my waiting years. However, it’s time to do something and from what I’ve seen and read of your work you have performed these types of repairs before. I have pictures that will show the deformities and happy to send. Would you be willing to discuss my situation? Thank you very much for your time.

A: A 3D CT scan is needed to have an accurate assessment of both the bony stepoffs and the bony bulge. I suspect the bony bulge is due to a shift of the sliding genioplasty resulting in one wing that sticks out. This also contributes to a larger bony step off on the opposite side than would otherwise exist. This would ned to be burred down. The bony setoffs from a sliding genioplasty can be treated with an overlay implant. For the sake of absolute accuracy I would prefer to make custom implants to fill in the defects which can be designed off of your 3D CT scan.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if it was possible to widen or enlarge my head, it is small. That along with a jawline augmentation. Is it possible to do simultaneously. How much would that cost? 

Also are there any long term side effects of placing implant on the skull? Such as headaches, or increased chances of other complications? 

A: In answer to your head widening and jaw widening questions:

1) It is possible to concurrently widen your head (temporal augmentation) at the same time as widening of your lower face.(jawline augmentation)

2) Both head and jaw widening will require custom implants to do so.

3) I have never had a patient who has developed any problems with headaches after any form of skull augmentation. This is an extracranial procedure that has no effect on the brain.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in ear reduction surgery. As you can see from the photo, I already had this surgery done but I would like to achieve better results. 

1. Could you please tell me what would be the total price of the surgery (incl. medication, preparation etc.) 

2. Will you be using dissolvable stitches? 

3. Could you use small bandages (patches) instead of big ones that go around the head? 

I took a measures and it turned out that the reduction should be around 5 mm.

A: In answer to your ear reduction questions:

1) Whomever did your original ear reduction used an inappropriate technique resulting in significant notching of your helical rim in a too high superior position.

2) But you are stuck now with using that location for the back cut across the helical rim. Although I believe I can make the helical rom smoother with a secondary ear reduction.

3) I will have my assistant Camille pass along the cost of the procedure to you on Monday. It can be done under local anesthesia.

4) Dissolveable sutures will be used.

5) Only antibiotic ointment is used as a topical dressing.

Dr. Barry Eppley 

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering what I could do to get a defined, sharper chin that projects downward more. I would like a more heart/diamond shaped face. 

I am content with my jaw definition/angles, but I want to project the chin and make it sharper like the model’s. 

I don’t think i would need an immensely dramatic chin implant, but I’d like to know what you think could achieve the result I desire. 

I’ve reviewed my options of a pre-made chin implant and a custom one, and I’m still not too sure what would suit me the most. 

Could the results I desire be achieve with an off-the-self chin implant? I also wanted to know what a semi-custom chin implant is, and what is the cost of custom and semi-custom chin implants. How many millimeters of projection are ample for this result? 

I’m really eager to hear what would work best for me. I appreciate you taking the time out of your day to respond! 

Thank you

A: In answer to your chin implant questions:

1) The dimensional needs of bringing your chin forward and down with a square shape can only be achieved with a custom implant design. Most likley this is a 45 degree projection of 5mms forward and 5mms down. No standard chin implant style can achieve these type of dimensional chin changes.

2) A semi-custom implant design is using another patient’s custom implant design that may (or may not work) well for someone else.

3) My assistant Camille will pass along the cost of such surgery to you later today.

Dr. Barry Eppley

Indianapolis, Indiana