Your Questions
Your Questions
Q: Dr. Eppley, During my consultation with Dr. Eppley, we discussed skull reduction and he asked if I would still want to reduce my cheekbones afterward. At the time, I was unsure, but I’ve now decided that I definitely do plan to undergo cheekbone reduction.
My question is about facial harmony and sequencing:
Would Dr. Eppley adjust the extent of the skull reduction based on my current cheekbone width — or would he reduce more aggressively if the cheekbones were already smaller to begin with? I’m curious to know if the skull reduction is being tailored to match my current cheekbone structure, or if he’s factoring in my plan to reduce them afterward.
Additionally, I’d like to know — in Dr. Eppley’s opinion, would it be better to undergo cheekbone reduction first to allow for a more aggressive or refined skull reduction result? Or would he recommend doing both procedures at the same time (if that were possible), for maximum overall balance and reduction?
Of course I trust Dr. Eppley’s expertise completely and just want to make sure I’m approaching this in the best order to achieve the most harmonious and noticeable result possible.
A:Ideally, if both procedures are going to be done, you do the preoperative planning for both the skull and cheek reductions on the patient’s 3D CT scan and then perform them together.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i was wondeirng if it was possible for a a forehead, supra orbital, and brow ridge implant in just 1 implant alone instead of 3 sperepate implants If possible, how much would it be speculated to cost? And would it be better than having them seperate? Thanks alot.
A: Supraorbital and brow ridge refer to the same area…they are interchangeable anatomic terms. Thus you are referring to a custom forehead-brow bone implant which is always done as a single implant placed on a single surgery.
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!
A: You are referring to Vertical Orbital Dystopia (VOD) in which one eye is usually lower than the other one and more times than not it is the right eye that is the lower one. There are a variety of VOD techniques to decrease the eye asymmetry by moving the right eye upward as well as adjusting the soft tissues around the uplifted eye (brows and eyelids) to accommodate the new eye position. (you can’t just move the eye alone as that will create a new aesthetic problem.)
The question is not whether VOD surgery can be done but how much improvement can be obtained and is it worth it. To make a more complete assessment I need a true front non-smiling face picture to do a numerical assessment and a 3D CT scan to assess the underlying bone structure. (only needed of we determine you want to move forward)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a prominent forehead and I would love to reduce it
A: Thank you for your inquiry and sending your pictures. You do have significant frontal bossing which can be reduced if the bone is thick enough to do so. (in most cases it is) To check the bone thickness to make that determination a 2D skull CT scan is needed to measure the actual bone thickness and see how much of the frontal bossing can be reduced.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What are the possibilities of performing surgery on the occipital bone, the back of the head?
A: I do occipital skull bone surgery all the time whether it be for reduction of a protrusion or augmentation of a flat bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in XL male pectoral implants. I have Polands syndrome and missing the lower pectoral major muscle on one side. I would like to increase the size of both and correct for the Polands syndrome.
A: Thank you for sending your pictures. When you have Poland’s syndrome or significant lack of tissue development you do not have the option of also augmenting the opposite side of the chest if the goal is improved chest symmetry. It is hard enough to make the left side match the right side as it is now. Augmenting the right side as well as reconstructing the left side will only make the same chest asymmetry you have now only more magnified.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had the Medpor chin implant in April 2024Dr. Eppley describes the burring down and replacement of Medpor implants in his blog. I would like to either have the original Medpor implant burred down to make it smaller or replaced with the smallest chin implant available
A: If the goal is substantial chin augmentation size reduction, which is what your description of the smallest chin implant available means to me, then removal of your existing Medpor chin implant and replacement with a small silicone chin implant would be the appropriate treatment choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will cheekbone reduction osteotomies help to make the ears more visible and the get a more concave especially the lower part of the cheekbones. Also I have infraorbital implants. Is it possible to do the cheekbone osteotomies without damaging the eyes and infraorbital implants?
A:Your request for cheekbone reduction osteotomies is unique giving your prior cheekbone widening osteotomies. In essence you are really trying to return the more narrow cheekbones that you once had. While that bone shape change is achievable I do not think it will make your ears more visible. It would probably have some impact I’m creating a slight bit of increase concavity in the cheek area but this would be fairly limited given the thickness of your overlying soft tissues.
In regards to your existing infraorbital implants I do not know exactly where they are as they are not evident in the 3-D CT scan that you have. (see attached) I suspect they would be safe from the cheek bone reduction osteotomy as they are unlikely to set into the bony step off that you have in your cheekbones.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a lip lift procedure that removed the nasal sills, presumably to hide the scars up inside the nostrils. I would like to restore the appearance of the nasal sills by implants. Is this an effective way to do so?
A: Lost nasal sills are hard to restore and whether augmentation by graft or implants may or may not be effective at doing so. This requires a very discrete line of projection between the columella and the inside of the nostrils.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, about 3 weeks ago I had a lip lit where they removed 0.5 mm and my total upper lip was 0.10 mm, I see that there is very little space between the nose and vermilion and my teeth are also very visible, I close my mouth with the help of my lower lip, but I don’t like how it looks, I also cut my frenulum to get my upper lip lower and I am using pressure tapes to lower it in addition to massages… What can I do to get my upper lip to lower at least 2 mm?
A: Time is your friend here. This is an excisional operation in which the skin removed can not be replaced. Time is what will help it relax (lengthen) a bit. Remember it has only been three weeks not three months or three years from when the procedure was performed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Born with undescended testicle left side, right one is a little larger than normal. Have always desired to look normal with appearance of both testicles but never felt comfortable with what I’ve read online from various surgeons on the procedure until I stumbled upon Dr. Eppley’s. Can you tell me if I’m a fair prospect for getting this done and how long I would have to wait after surgery implantation before returning home?
A: Essentially you need a testicle implant for a testicle that has never appeared in the scrotum. The size of the testicle implant would be comparable to the size of the opposite descended testicle which would mean a standard testicle implant could be used. This is an outpatient procedure and you could return home the following day.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a cleft patient who have undergone successful cleft and rhinoplasty surgeries in the past. I am currently in the middle of teeth straightening and is looking for the right doctor for a paranasal implant procedure. Thank you for taking the time to read this message.
A: As a cleft patient I assume you are referring to the classic paranasal deficiency on the cleft side due to an underlying alveolar-maxillary deficiency. Because of its cleft origin I would be cautious about considering an implant for its augmentation. It would be best to first get a 3D CT face scan to see what the underlying bone around the cleft site looks like. If there is is a good bone foundation, usually from a prior alveolar bone graft, then an implant may be appropriate. (And the scan may show that a custom implant design may be needed) If not then either a cadaveric or autologous bone graft would be the more appropriate choice.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, By doing shoulder reduction surgery does it decrease the distance of the shoulder or only the collarbone resulting in a slim appearance? Is there’s any surgery that decrease the distance of the shoulder let say 18 cm to 14cm? Thank
A: Clavicle reduction osteotomies reduces the visible width of the external shoulders.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do under eye implants last into old age? I noticed on some aging vs youthful faces diagrams that the under eyes can hollow with age. In the diagram I also noticed that the canthal tilt gets lower as support gets worse. I can only imagine aging with a silicone implant whose base starts hollowing and then your eyes slowly become more uncanny/odd looking. The top of the implant won’t hollow but the base will which shouldn’t happen in normal circumstances with bone, where the top of the implant (which should be bone) hollows and reshapes. The brain from what I have been researching into is highly attentive to small millimeter changes. Below I linked the diagram. Dr eppley if this seems to make sense is this a problem down the road that will need revision of your eyes do start looking odd due to the implant sinking?
A: Any undereye or undereye-cheek implant is structurally solid and will never change form so the implant pe se does not change with aging. But the soft tissues around it obviously will. But like implants along the jawline the implant in the undereye area is going to help with protection/retardation of the aging effects as better bone support/structure is always better than less.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hav read the article entitled ‘Clavicle Lengthening by Distraction Osteogenesis for Congenital Clavicular Hypoplasia: Case Series and Description of Technique in the Journal of Pediatric Surgery from 2013. How do you think this applies to aesthetic shoulder widening surgery for men?
A: I am very familiar with that article which has four problems from my perspective:
a) Uses an external distraction technique so the scarring would not be good for an aesthetic shoulder widening patient.
b) Those patients treated had congenital shoulder narrowing so their tolerance for scarring is much different than yours would be. They are also pediatric patients in a national health system so they have no room to complain about their care.
c) Plate fixation was still needed in half the patients particularly those with longer distraction lengths.
d) Distraction periods were as along as 6 to 9 months….long time to have an ex fix device in place.
In other words old style external distraction devices are just not suited for the aesthetic patient. I would do the currect sagittal split lengthening approach despite its issues before I would ever do that distraction technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously reached out regarding surgical options for addressing plagiocephaly, a condition that has long been a personal concern for me. I am now interested in proceeding with the surgery and understand that a consultation is the necessary first step.
At this stage, I would like to inquire about the current wait times for scheduling such a procedure. Could you please provide information on the typical timeline from consultation to surgery?
A: Plagiocephaly is treated by the placement of a custom skull implant. This implant is made from the patient’s 3D CT skull scan and is takes around three months to go through the design and fabrication process. That becomes the typical waiting period for surgery. Patients typically schedule the date of their surgery when they initiate the implant design process
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have previously had hydroxyapatite added to the jawline and chin, which I am not happy with and would like to remove some if possible.
I would then like look at how to achieve a more angular look to my jawline. I also had it to my cheeks and various other areas which I am happy with.
I have had some to my outer brow which I am also happy with, however I would like to add some more to lift the eyebrow to form a straight line rather than curve downward – I am not sure if you can change the shape of the bone in this location also to soften the curve of the socket
Below is a crude visualization, existing on left and proposed on right
- Removal of hydroxyapatite to top of chin
- Buzz down of chin bone to straighten
- Removal of hydroxyapatite to jawline and potential buzz down to straighten and give a sharper line – may also benefit from J Plasma lipo to remove fat and shrink skin
- Build up of the mandibular at the ear junction to create a sharper more define angle
- Build up of eyebrow area at outer end to straighten end of brow and reduce curve down – not sure if can buzz down bone here to soften the round eye socket look
A: Thank you for your inquiry and detailing your surgical history and objectives to which I can say the following:
- Hydroxyapatite cement is very difficult to remove over a large surface area like the jawline through limited incisions. It may have been placed through such limited incisions but it can not be reversed/removed/modified that way.
- Regardless of these difficulties you need a current 3D face CT scan which will show the extent of the challenge.
3) As a general rule one can not reduce their way into improved jawline definition. Thus I do not consider your imaged jawline results achievable. (jaw reduction with improved definition) Removal of the hydroxyapatite (if possible) and J Plasma lipo simply will not work.
4) Improving the jaw angle and brow bone shape by augmentation has a better chance to be successful.
But providing clarity to all four stated points requires the 3D CT scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Specifically, I would like to know whether your practice performs circumferential outer‑table bone burring or other techniques that reduce the overall circumference and height of the head (rather than simply smoothing bumps or adding implants).
Could you please let me know if you offer true skull‑size reduction? Just want things to be super clear before I make this very important decision, appreciate your understanding.
A: Outer table bone removal is the only way to do almost any skull reduction procedure. It is simply a matter of how much surface area of the skull that needs to be treated and what is the incisional access needed to do so. For larger surface area skull reductions a bicoronal scalp incision is needed. The other important issue is how thick is your outer table and is it thick enough that its reduction would make it worthwhile. This is why a 3D skull CT scan is needed to make that assessment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope you are all well. In my research I ran across your site. Do you have experience working with male to female trans patients regarding forehead reconstruction to create a more female appearing forehead? Your response indicating if you do or not would be appreciated.
Thank you and have a great day!
A: You are referring to forehead feminization of which the base procedure is a brow bone reduction which may also include forehead narrowing as well. This is a type of forehead reshaping in which I have a lot of experience.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty reversal 10 days ago of 5mms. I’m really worried that the chin area looks like a fat, round, fleshy block, and that it has no shape or contour . It is affecting my whole face shape, since now my lower face looks so rounded and has lost it’s V shape. Is there hope that the muscles and soft tissue will adhere to the bone? What are the possible treatments for this? Can I place a small implant to give the soft tissue the contour and support it needs.
A: The first concept to grasp is that at 10 days after surgery you certainly are far removed from the final result. It will take 3 to 4 months to see the true final outcome to let all the swelling resolve and the soft tissue wrap effect has occurred.
Secondly when you reduce the projection of the chin it is going to lose some of its tapered shape.
Third, should an increased tapered shape be desired after 4 months of healiong a V-shaped chin implant can be placed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to schedule lipo with 3D etching with another surgeon. Would you recommend that I do this surgery first before a back lift or would it be better to do the back-lift first? I’m worried about loose skin afterwards.
A: Absolutely do the liposuction first and the backlift later for the very loose skin reason you have mentioned. It will also make the backlift more effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in thigh and leg implant/augmentation. I had a BBL three years ago.
There was fat grafted to my thighs but it didn’t all stay and I don’t want to risk that happening again which is why I think I would be better suited for implants
Ultimately I just want to be more proportionate on my lower half
I don’t wear shorts or dresses that expose my legs because they are so thin compared to the rest of my body.
A: While I would agree that thigh implants are your only potentially effective treatment option there are some reservations I have in your case. It appears that the greatest deficiency is in the lateral thigh where such implants have their greatest complications due to their more superficial location. (implant show/edging) Thigh implants work best in the anterolateral thigh where they are placed under the fascia…but this appears to be of less aesthetic value in your case.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will the sagittal ridge reduction surgery leave a big scar or any scar visible tissue?
A: Every incision leaves a scar, it is just a matter of how noticeable it is. But scalp incisions do exceptionally well and sagittal skull reduction incisions are very small (usually less than 4cms)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know how many centimeters it is possible to reduce in a reduction of the temporal region of the skull. I do not have a large head, I am a man who is 164 cm tall and has a 53 cm head. My face is narrow (14 cm from one end of the zygomatic bone to the other), but the temporal region is approximately 16 cm, which creates a mismatch between the face and the upper part of the head, as if my head were inflated. Would it be possible to equalize these measurements? Would it also be possible to reduce the top of the head in the same surgery? I appreciate your answer.
A: While temporal reduction is a very effective operation for narrowing the side of the head it is not a procedure which has measured outcomes …meaning I don’t evaluate the results by circumferential head measurements or temporal thickness. Outcome are determined by visual changes. (Does the head look less wide or have less convexity.
From a measurement standpoint all I can say is that the average temporal muscle thickness at the level of the top of the ear is 7 to 9mms in most male patients. Thus removal of the posterior temporal muscle will reduce the bitemporal posterior distance in the range of 1.2 to 1.5cms for most patients.
But the best way to estimate preoperatively of the potential head width change is predictive imaging based on the patient’s pictures.
Top of the head reduction can be combined with temporal reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some questions about large skull augmentations using a first stage scalp expansion.
- I know you said the procedure would raise the hair line’s position, by how much do you estimate it would? I would just like to know if you think it would be a noticeable amount.
- Aside from the two phase expansion, are there any downsides to a large augmentation?
- Since you said this was similar to a lefort I, would this lower the philtrum? And or increase the width of the alar base?
- I understand it is a substantial augmentation, do you think it would be advisable to further reduce the amount being augmented?
- If I were to do just a temporal and top augmentation without the frontal augmentation would there be noticeable margins from the front view?
- Would the skull augmentation affect the position of my eyelid/eyebrows
A: In answer to your large skull augmentation questions:
1) Since how much hairline change, if any, can not be accurately predicted beforehand make the assumption in considering the procedure that a hairline change will occur and it will be noticeable.
2) In general a large skull implant does not necessarily have more risks than a smaller skull implant.
3) A midface mask implant has some similar effects to that of a LeFort I advancement with the exception that it does not change the upper lip because it does not affect the incisor tooth position.
4) Imaged changes may be a goal but in the end the amount of skull augmentation will be controlled by what the scalp tissues can tolerate.
5) The risk of implant edging is always eliminated when the edge of the implant stays at or behind the hairline.
6) Large skull augmentations may have a limited eyebrow lifting effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Good morning/afternoon, my question is do you perform hip bone shaving and if yes how much can you remove in one procedure in grams or kilograms?
A: In my experience with iliac crest reduction it is done in a linear amount not by weight. In most cases 1.0 to 1.5cms of bone removal is performed in the more prominent anterior half of the iliac crest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to you with great respect for your extensive experience and contributions in the field of craniofacial and aesthetic surgery. I have been researching potential avenues to address a specific aesthetic concern I have, and your name consistently comes up as a leading expert regarding more niche but possible surgeries. My concern relates to the spacing of my eyes. While my interpupillary distance is within a normal range, I feel that the inner corners of my eyes (the medial canthi) are positioned relatively close together. This gives my eyes a narrower appearance in relation to the rest of my facial features than I would prefer, and I believe it detracts somewhat from overall facial harmony. I understand that altering the structural relationship between the eyes can be complex. I am not seeking a drastic change (the change seems to be a few millimeters), nor am I approaching this lightly. However, I am keen to understand if there are any established surgical techniques or approaches that could potentially help increase the intercanthal distance, even modestly, to achieve a more balanced look. I would be very grateful for your perspective on whether this type of concern is something that can realistically be addressed surgically. If procedures do exist, could you perhaps offer some general insight into what they might entail, their potential effectiveness for achieving a subtle widening of ICD, and importantly, the typical risks involved? I am trying to carefully weigh whether the potential aesthetic improvement could justify the complexities and risks associated with any relevant procedures. Like I said, moving the eyeballs is not what I’m looking for but rather narrowing the horizontal eye width by changing the medial canthi position (through whatever means you would consider to be safe and direct). I am serious about exploring viable options and am prepared for the associated costs. However, my primary aim at this stage is to first understand the general possibility and validity of such a procedure before proceeding further, for example, with a formal consultation, should a potentially suitable and reasonably safe approach exist. I am happy to provide photographs if that would help clarify my concern at any stage. Thank you very much for considering my inquiry. I appreciate your time and expertise.
A: Essentially what you are describing is the reduction/elimination of the lacrimal lake area of the inner eyes. This could be done by a v-shaped incision along the medial edges of the upper and lower eyelids, excision of the lacrimal lake mucosa and a straight line closure. This moves the inner eye corner more laterally. It is not clear to me yet what the role of any medial canthal tendon manipulations would be or if even needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to flatten to narrow my skull and have it more inward like normal skull. I had a children’s hospital provide me a surgery in my teens because my skull grew outward randomly on one side of my jaw and on the side of my head
I had another surgery over a year ago on the back occipital to reduce that bone, which helped me, but they weren’t able to do the mastoid around the ears because they didn’t have the proper scan and didn’t wanna risk damage to air cells I believe.
A: The mastoid bone is thin as it is largely composed of air cells. Whether a reduction effort is worth it depends on the thickness of the layer of bone over the air cells. This requires a 2D CT scan to make that determination.
Having done mastoid reductions numerous times that experience indicates that some reduction of the mastopid prominence can be achieved but usually not a complete flattening of it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am unhappy with a medpor chin implant that was placed 5 months ago. It is too long, wide, square, and adds to the the asymmetry of my chin. I am interested in replacing it with a smaller implant but I am worried that it will still add to the asymmetry. Is there a way that I can put a smaller implant in without wings while also countering or just not increasing the assymetry? Would a standard implant be able to achieve this or would it have to be custom?
A: This is a self-answering question….persistent asymmetry after a standard chin implant means the next proper step is a custom implant approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a kidney transplant recipient currently taking Tacrolimus (Prograf) as part of my immunosuppressive therapy. I am exploring the possibility of undergoing breast reduction surgery due to ongoing physical discomfort and quality-of-life concerns. Given my medical background, I am seeking guidance and potentially a consultation with a specialist experienced in performing cosmetic procedures on patients with organ transplants. My priority is to ensure that such a procedure would be safe and appropriate in my current condition, with coordination between the surgical and transplant teams if necessary.
A: In the past I have safely performed breast reductions and tummy tucks on several kidney transplant patients. Barring any unknown medical reasons immunosuppression therapy alone is not an exclusion criteria.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
