Your Questions
Your Questions
Q: Dr. Eppley, Hi there, I previously messaged asking about the filling treatment for flattened back of head issue. The reply was that fillers don’t work but I was referring to the method you are using with the PMMA/bone cement. Can you let me know the approximate cost of this? There are only a couple of places that do this and I live much closer to you so that would be best for me.
A:Due to the inadequate results from the use of PMMA bone cements in skull augmentation they were abandoned almost 10 years ago and replaced with custom implant designs that offer far superior results.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a very flattened back of head about half way down the back. Is it possible to use just the filler type of material rather than implant?
A:No form of synthetic fillers or fat injections in the tight scalp work for skull augmentation. Unlike other face and body areas where the tissues are more supple the tight attachment of the scalp to The underlying skull precludes any effective displacement by the soft nature of any injectable material.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, am an aspiring footballer and I would love to continue my football journey. But my insecurities is playing on me. Can I get frontal bossing surgery done and still play football?
A:I would wait to do the surgery until after football life is over.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Had orthognathic jaw surgery done for sleep apnea and recessed jaw. Unfortunately, my right side (weaker side) did not turn out as well as I would have liked. The jawline has an indentation in it, and the genioplasty I feel created an odd chin shape and chin fold from being advanced too far. Surgery involved a Lefort 1, BSSO with 9.7 degrees counterclockwise rotation and 18mm pogonion advancment (6mm) was from the genioplasty. Custom plates were used which probably adds 1.5-2mm to the pogonion as well. Should the genioplasty be set back 2-3mm to fix this and will that cause loose skin under the chin? And can fat grafting be done to improve the jawline and indentation?
A: In answer to your jawline questions:
1) Setting back the genioplasty 2mms in a young patient will seem unlikely to cause tissue sagging.
2) Correcting bony asymmetries/irregularities with fat injections is rarely an effective strategy.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 25 year old trans male, who is interested in a iliac crest reduction—even more reduced than pictured. I unfortunately had estrogen dominance for nearly 19 years, and then I was forced on Invega, which seemed to of made my hip bones widen a lot more significantly. I would love to have my masculine physique back, especially since my parents think I never will have a masculine body because of them. A permanent reduction would be amazing!
A: Thank you for sending your pictures. At your body weight and tissue thicknesses any effect of iliac crest reduction will not effective/seen. Iliac crest reduction works best in thin patients where the prominence of the bony crest can clearly be seen.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a hairline lowering procedure and brow lift and hair transplant to attempt to cover my forehead, and it actually emphasizes my protruding and broad forehead, making it appear more obvious. No one told me my issue was actually my skull bone. Can you narrow my forehead and slope it back? I find that it still looks masculine and I thought the problem was skin and hair, I did not realize skull shape is what makes someone appear feminine.
A:While frontal hairline lowering is a soft tissue procedure it does have a forehead reshaping effect. By definition and making the four head vertically shorter it will make it look wider. This is why preoperative imaging of the effects of hairline lowering are important to undergo understand this effect. The question now is not whether your bony forehead can be reduced, as you have convenient access to do it from the frontal hairline scar, but whether the bony changes would be significant enough to make the surgical effort worthwhile. Thus I would need a front and side view picture of your fore head to make that assessment with some imaging too sure what I think could be realistic and achievable changes.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i would want to know a bit more about mouth widening surgery, i have a pretty narrow mouth (4cm) and want to change it to about 5-5.2 cm , can you please tell me about the scarring, how bad it is and does it really never go away, and are the results permanent, i’m 18 , i wonder if my age will help healing. Please help me , cause im really scared to end up with permanent big scars , my lips are also a bit down turned.
A:To have an acceptable scarring in mouth widening surgery it is best to keep the amount of widening per side in the 5 to 7 mm range. That would be consistent with your stated goal of changing your mouth with distance from four to 5 cm. In general adverse scarring from mouth widening surgery is not common but always possible in the very sensitive junction of the vermilion and skin at the mobile mouth corners. Mouth widening scars seem to do better in n ales due to their beard skin than females in my experience. Thus it is best to go into surgery with the understanding that scar revisions may be likely and hope that they are not needed. This is consistent with a general overall approach in aesthetic surgery as to ‘prepare for the worst and hope for the best’ .
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do you have female patients trim hair before placing skull implants?
A: No, I never trim/shave any hair in aesthetic skull reshaping surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m dissatisfied with how asymmetrical and long my face appears. For asymmetry, I’m unsure if I’m supposed to reduce one side, enlarge one side, or a combination of both. For length, I was thinking that increasing volume of midface may help but I’m truly just guessing.
A:Thank you for your inquiry and sending your pictures. You have multiple facial issues which primarily are that of disproportions and asymmetry. You are correct in that your face is vertically long which is magnified by lack of midface projection. The lack of midface projection contributes more to your facial disproportion then the vertical length. But in improving the disproportion midface augmentation provides the best benefits. (see attached imaging) for some vertical chin reduction but this is primarily for the purposes of asymmetry correction. Suffice it to say dimensionally you can augment the midface much more then you can vertically shorten your face.
Your facial asymmetry is localized to that of the lower jaw and the reality is that the longer chin/jaw on the right side is the more ideal location by reduction for asymmetry in improvement. However during a limited reduction along the inferior border from in front of the jaw angles to the chin is very difficult to do with a great degree of precision. While V line surgery is commonly done this is a much more aggressive type of bone removal with the wrong shape to it to be successful in your case. It would also magnify your already vertically long face with elevation of the jaw angle. So while reduction of the longer right jaw seemsx appropriate it comes with its own set of aesthetic problems. Thus it is more predictable to look at augmenting the left jawline, leveling out the longer right chin and anterior jawline and trying to match the two jaw angles. (see attached imaging) Trying to determine exactly what needs to be done based on your pictures is an incomplete assessment and ultimately the 3-D CT facial scan is going to provide better information as to how improve jaw asymmetry as well as its overall shape.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I’m interested in structural facial surgery to improve projection, balance, and aesthetic harmony.
I’ve read about your expertise in jaw, midface, and orbital augmentation.
I would appreciate your professional opinion on whether my facial structure qualifies for such procedures.
I’m ready to send photos and any details you might need.
Thank you very much for your time.
A: Thank you for your inquiry and sending your pictures. Based on your inquiry you were trying to determine what structural facial chnagers may be beneficial. In making an initial determination you have to look at the three facial thirds, the jawline (lower 1/3) , midface (middle 1/3) and the forehead (upper 1/3), and play around with imaging tools to make some changes to look at their potential impact on improving your facial structure. In that regard I have done so in the attached imaging. These are not meant to be exact surgical resulfs rather they are more conceptual.
The question is never whether one can alter all three of the facial thirds. It is more a question of what facial third changes has the best value and how much effort does one want to put into the extent of the structural changes. In other words in each patient not all facial third changes are equal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a healthy male in my mid-to-late 20s who is seriously interested in undergoing aesthetic skull augmentation, specifically a 360-degree custom cranial implant to increase my overall head circumference and improve cranial aesthetics.
I’ve done extensive research and understand that you’re one of the few surgeons globally with deep experience in custom cranial implants for cosmetic purposes. I’m reaching out to request a consultation regarding the possibility of increasing my skull size by approximately 2–3 inches in circumference using a comprehensive implant approach — covering the occipital, temporal, parietal, and crown regions.
My current skull circumference is approximately 21 inches, and I feel my head is proportionally small for my frame, especially from a front and profile perspective. My goals are:
To increase cranial volume in a natural-looking, symmetrical way.
To enhance facial balance and improve the aesthetics of my head shape.
To explore what’s realistically achievable with a full custom implant.
I am fully prepared to provide imaging (CT scan, head photos) and am open to traveling for surgery if I’m deemed a suitable candidate.
Would it be possible to schedule a consultation with you or your team to discuss this in more depth?
Thank you for your time, and I look forward to hearing from you.
A:Thank you for your inquiry and sending your pictures. As you have expressed an interest overall skull augmentation of a large surface area with specific linear increases let me provide you with some insights about what can and cannot be done.
First and foremost in the shaved head male, regardless of what size skull augmentation one is considering, the location and extent of the surgical incisions and resultant scars to do so is an important aesthetic consideration. Always remember that aesthetic surgery at some levels is really about trading off one problem for another. I think in the shaved head male one has to be very cautious about the trade off of scalp scars for a better head shape.
Secondly when one is considering and a more complete skull augmentation effect the question is always whether the stretch of the scalp will permit it. As a general rule large skull augmentations almost always requirea a first stage scalp expansion procedure.
Third, the amount of skull augmentation that you have indicated by the numbers are not realistic changes. You’re not going to increase your circumferential skull size by 2 to 3 inches. That is not an achievable outcome regardless of what type of two-stage skull augmentation procedure is done. Patients commonly over estimate by numbers how much my skull augmentation they think they need. This is because in skull augmentation the linear numbers are not as important is the overall volume in ccs of the implant. The head is similar to a sphere where volume displacement is more representative of its effect rather than a linear number.
These three concepts are what you need to consider for larger types of skull augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
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
