Your Questions

Q: Dr. Eppley, I was curious about your opinion on the possibility of reducing or tightening the malar fat pad (I believe that’s the deep medial cheek fat) in the male face to create a more skeletal contour from the three-quarter view, potentially through some type of facelift or midface suspension procedure. In the attached photo, the patient underwent a facelift with fat grafting that created a fuller, more uniformly convex contour in the cheekbone + cheek area, which I think looks great on women. What I’m wondering is whether the opposite effect can be achieved for a man: preserving the prominence and convex contour of the cheekbone while creating more concavity in the area below it, resulting in a sharper, more concave, skeletal appearance. I’m especially interested in whether this can be accomplished primarily through soft-tissue repositioning/reduction rather than cheekbone augmentation or implants. Thanks in advance!

A:In short you cannot lift your way into improved skeletal contours of the midface. You either have to augment the cheekbone area or do tissue removal beneath it. The concept of trying to lift the fat pad up to create a submalar concavity is fundamentally flawed.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hi I was wanting to see if I’d be a good candidate for brow bone implant. I’m Asian (female/22 years old) so I have a flatter forehead and want to improve my orbital depth compared to my eyes.

A:Brow bone augmentation in females is very uncommon compared to that of males. And all of the female brow bone augmentations I have ever done it is always been in the Asian female with a flatter forehead –brow bone profile. Most of the time this has been a combined forehead brow bone implant to improve overall projection of the upper third of the face. How this applies to you remains to be determined which requires some face pictures for my assessment and imaging.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I would like to hear your advice on the path toward improving the width of my mandible and my zygos. A previous doctor advised that I was not the best candidate for bimaxillary surgery but instead implants suited me best. My goal is of course facial improvement/male model look. Thank you, I look forward to hearing from you

A:It is an accurate statement that A BIMAX procedure only produces sagittal projection and cannot do anything for facial width, only implants can.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hi, I’m desperate to get some advice from Dr Eppley. I underwent an upper lip V-Y mucosal advancement in 2024 in the UK. I have been left with significant functional and aesthetic issues as a result. Unfortunately, the surgery was a disaster from day one. The doctor did not suture the mucosa up properly, and left large flaps of mucosa inside my mouth hanging down over my teeth. When I queried about this, he told me to come back and he would remove the hanging flaps, which I did. Even more unfortunately, more problems arose and persisted as time went on. Functionally, my speech and movement now feels very restricted, with a constantly tight/pulling sensation along the scar-line inside my mouth. As well as that, I appear to have developed a very strange double-lip appearance when making certain mouth and facial movements. The inner mucosa seems to bulge and hang down over my top teeth if I pucker my lips or open my mouth in an “O” shape, making for a very unsightly and strange appearance. I am absolutely desperate for any advice at all. If it’s not too much trouble, I’d be so grateful if Dr Eppley could take a look at my pictures and give me some advice, or alternatively if he wants me to have an official remote consultation, I am more than happy to do so. I’m just so desperate to improve my situation. I’ve been living with it for over 2 years now and it hasn’t gotten any better over time. It really affects my ability to work. I’d be very grateful for any help whatsoever, thank you so much.

A:Based on your pictures this appears to be very similar to a congenital double upper lip which occurs due to redundant mucosa behind the wet-dry line. The origin of yours, of course, is different and is obviously due to the V-Y advancement… although I am having a little trouble trying to imagine how that happened. I suspect it wasn’t a conventional V-Y procedure.

That being said, at least by looking at your pictures, I would think that a horizontal excision of the mucosal role may  provide some improvement.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello, I would like to inquire about the pricing of your custom midface mask/saddled orbital implants. I presume they are a better option than a double jaw surgery, since I get the feeling a djs would not fix my insufficient undereye area or even the weak maxilla. I would also like to know what other procedures I could have done concurrently to fix my disharmonious side profile. Perhaps a forehead implant/brow shave? I am also concerned about the nose and upper eyelid exposure. Anyway, I can pay for a comprehensive multifarious approach and look forward to hearing from you

A:Thank you for your inquiry and sending your pictures. With a normal sagittal projection of your maxilla-mandibular skeletal unit double jaw surgery certainly would not address the, by comparison, significant upper midface horizontal recession. Even though some of the midface deficiency is at the LeFort I level double jaw surgery still is not appropriate. You have correctly surmised that onlay imlant  augmentation above the dentoalveolar level up to the infraorbital rims will be beneficial for which the midface mast concept is truly useful.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I have cheek fat i would like to get rid of. I work out often and am around 15% body fat, but my face fat will not leave. I am tired of having chipmunk cheeks.

A:The first thing to recognize is the anatomy of your facial concerns. You have a long face with minimal cheekbone support. Much of your facial fullness concern lies below the facial equator line (see attached drawing) more in the perioral and lateral facial area. What lies north of the facial equator line is the effects of the buccal fat pad which it Is fairly minimal. Aggressive removal of your buccal fat pad is going to result in a long-term gaunt facial appearance which can be very hard to reverse. The upper mid facial problem is as much a lack of skeletal support as it is due to any fatty prominence. You can even argue that a small cheek augmentation with very modest buccal fat removal would be the more appropriate plan for what lies north of the facial equator line (see attached image). 

What lies south of the facial equalizer line is the subcutaneous fat layer of which microliposuction would be appropriate for treating  it from the corner of the mouth back to the jaw angle area.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, For some initial context, I currently have 800cc silicone sub-muscular implants that I have had for about 10 years. I have been interested in going larger for a while, but I wanted to stick with silicone. From what I understood, the sizes above 800cc for silicone that became available a few years ago were primarily for reconstructive surgery.

I came across one of Dr. Eppley’s articles (https://exploreplasticsurgery.com/mentor-large-breast-implant-sizes-greater-than-800ccs/) and became curious if that was the only allowed use of those extra large sizes or if they were also available to those just looking for a larger option.

So, I wanted to see if those sizes in silicone (930-1445cc) were an option outside of a reconstruction situation. If so, I’d have a few more questions as I plan towards it, but I wanted to start there.

A:Silicone implants over 800 cc size, as offered by Mentor, are FDA approved for breast reconstruction. However it is common practice to use such devices off label for aesthetic indications. This is done for a wide range of medical implants including those of the breast. For example the use of breast tissue expanders for the subsequent placement of extra large breast implants. The tissues expanders are only FDA approved for breast reconstruction.

That being said the subsequent question is how much bigger than 800 ccs can your tissues accommodate. That depends on several factors and can never be fully known until actual surgery but as a general rule you can probably go up to one third to maybe 40% more than that of what you already have.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I have vertical orbital dystopia. Am interested in improving symmetry via implant – please give me an email/ call to discuss procedure possibilities and a quote.

A:Vertical orbital dystopia is usually a lot more complex to treat than an implant alone. The implant has a role to play and is a foundational procedure but it also requires adjustments of the upper and lower eyelid around it to look right. In addition there is aa 50% chance of the need for adjustment of the eyelid positions later.

So  VOD surgery is not quite as simple as it seems.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am very interested in your rib removal surgery. I just had RibXscar done in December. Had 4 ribs on each side fractured. Corseted for 6 months total when I was initially told 3. Began my recovery first with a size 18 and downsized to a size 16 corset. With being fully committed to the corseting i still got significant amount of inches back. So I’m ready to a more serious procedure. What is the recovery for rib removal? Is this surgery as painful as RibXscar? You mentioned corseting as well. Can you explain your corseting process. I am an athlete and extremely lean. 14% body fat as a female and train twice a day. I understand I won’t be working out during recovery but when I resume to my normal workout schedule months later. Will it affect my results? And are these results permanent?

A:The first and most important step in considering rib removal surgery after rib fracture surgery is to obtain a 3-D CT scan to evaluate the osteotomy sites and the shape of the ribs. Only then can it be determined if rib removal surgery can produce a better outcome. It is intuitively obvious that when you remove bone and muscle you’re likely to get a better and more sustained response than if you just reshape the tissues that you have.

Unlike rib fracture surgery in rib removal surgery the purpose of waist garment shaping is to help with swelling as well as to compress the soft tissues down shaped down in the healing process. It is a supplemental part of the procedure unlike in rib fracture surgery where it nis an absolutely component of making whatever result can be achieved by tissue modifications.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I would need your advice and help. I have way too large brow bones… it has been my biggest insecurity throughout my life and something that has affected me enormously in life. Unfortunately, I cannot afford to undergo cosmetic surgery so my question is… how big is the chance that I can get a surgeon to reduce my forehead even if it is a so-called cosmetic procedure. I have been to a doctor and mentioned it, that I feel bad about my forehead and that everyone notices that the brow bone is deformed… but he said that I am a man and I shouldn’t think about it… I cannot stop thinking about it. I don’t know what to do… Just need someone to talk to about this specific thing…

A:There is little question that you have large overgrown frontal sinuses which is the anatomic origin of the prominent brow bone projection that you have. I think in reading your inquiry that you are trying to find a surgeon who will do your brow bone reduction in Sweden as a functional surgery covered under the National Health System. To that issue I can make no constructive comment since I am not part of the Swedish health system.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, These inner areas of the thigh are too straight due to over liposuction and doesn’t have the curvature.  I want to have a curve like this like what I had previously.

A:Because the origin of the problem is fat removal the most anatomic reconstruction is going to be the placement of a fat back into the subcutaneous space. However because of the origin of the issue you’d likely may have had lipo suction i  other areas that may have depleted your options for donor harvest. Which, although I am only surmising, may be why you are investigating implants as an option even though you have not said so specifically in your inquiry.

Implants in the inner thigh, while perhaps effective for creating an improved contour, is potentially problematic for two specific reasons. First leg implants such as thighs are for muscular argumentation and are usually placed under the fascia of the muscle which desires to be augmented. There is no such muscle in the inner thigh and your problem is a subcutaneous fat contour one not a lack of muscle development. This place is the implant in the subcutaneous space which is prone to a variety of issues including srroma formation as well as possible implant edge visibility. Secondly, running down the inner thigh is the saphenous vein which could likely be traumatized during the implant pocket creating leading to bleeding and a hematoma.

It is for these reasons that I would not undertake or recommend inner thighs implant to try to create the contour that you once had.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, On the smile and tooth show point, that’s helpful to know up front. A few follow-up questions on the direct upper lip excision along the smile line:

– How much additional tooth show is typically achieved with this approach?

– What does the scar look like at maturity, and how visible is it during normal expression?

– Can it be performed in the same operative session as the midface and jawline work, or is it staged separately?

– What is the typical recovery timeline, and are there any functional considerations (lip mobility, sensation) I should be aware of?

A:In answer to your specific questions:

1) Usually one to 2 mm of increase tooth show is achieved by smile line reduction.

2) The scar line from small line reduction is at the wet– dry line of the upper lip.

3) Smile line reduction can be performed at the same time as the other facial procedures.

4) There is going to be some short-term tightness with smiling but, given that you may be having a custom midface mask implant placed intraorally as well , that is an issue you’re going to have anyway in the short-term that will take about a month after surgery to fully resolve.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, my upper lip covers my upper teeth when I smile, especially towards the middle two teeth. The lips form kind of a v shape where the corners of my mouths are raised while the middle of it droops. Not to be confused, the sides of my lips also cover my upper teeth, just not as much as the middle. I desire full upper teeth show across the whole lip, sides and the middle. Ive attached how I’d like it in the third and fourth pictures. I do get the same effect as the model picture when I forcibly, unnaturally fold upper lip inward, causing it to fold in half and also be thinner allowing full upper tooth show like the model.

For reference my lips are already full so I don’t think a lip lift wouldn’t help my case. Also, I don’t know if this case is due to my narrow palate or weak maxilla.

To note, in the winter, when I smile, the line in upper lip becomes more apparent because one side of the line is drier than the other (which is the bottom side of my upper lip covering the top of my upper teeth).

A:Much like a patient with the true double lip you have excessive mucosa which hangs down from the inside of the lip. This is treated by an internal mucosal incision or would sometimes can be called a smile line reduction.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley,I read your statement: “One approach is medial wall infracture with lateral orbital wall implant to push the eye inward a few millimeters.” I was wondering whether moving only the eyeballs inward could also reduce the distance between the medial canthi by a small amount. My concern is that my pupils are already positioned somewhat toward the nasal side, and if the eyeballs are moved further inward while the medial canthi do not move at all, I worry that it could create an appearance similar to esotropia (crossed eyes).

In this situation, could the intercanthal distance decrease by even 1–2 mm?

A:Most likely it would not.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I had a chin implant with chin/neck lipo and later had the implant removed. Since then, I’ve been dealing with movement-related changes in my chin and lower lip, excess tissue under my chin, and lower-face contour changes with some volume loss

A:Thank you for sending your pictures. These are the not uncommon sequelae of chin implant removal. The soft tissue chin pad has been stretched and never shrinks down to what it was before the implant was placed. The tissues also do not attach back as adherent as they once were. I don’t know why the chin implant was removed nor what type and size of chin implant it was. You have two basic options:

1) Add back implant volume, albeit smaller and better shaped than what it was before. I assume the chin implant was removed because it was too big/wide…a common error in female chin implant augmentations, 

2) Submental chin pad reduction (removal of overhang)

It is important to recognize that with #2 option the only symptom that will be improved is the pad overhang.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am looking to have my temporalis muscle reduced. I have always been bothered by a much bigger temporalis muscle on the right side of my head than on its left. It makes it really asymmetrical. Being bald for a few years it makes it even more noticeable.

I’ve been doing Botox injections for more than a year and it works well. However I am now looking for a permanent solution. I have read your articles on temporalis muscle reduction and I am interested. I am a French national living in France and I haven’t found yet a surgeon doing it here.

I have few questions if you don’t mind. In order to get the surgery done should I stop Botox injections – for the muscle to go back to its initial size? In understand that cost vary on individuals but you would you ming sharing with me an estimate cost for such an intervention?

A:In answer to your temporal muscle reduction questions:

1) You do not need to stop doing Botox injections

2) Assuming that the majority of your temporal muscle hyperytrophy is in the posterior section of the muscle then the ‘standard’ temporal reduction technique applies.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am interested in flat back-of-head reshaping / occipital augmentation.

I would like to ask a few questions:

1. What is the estimated total cost for this procedure, including surgeon fee, implant/material, facility fee, anesthesia, CT scan/design, follow-up, and any other related fees?

2. If I travel from Canada to the U.S. for the surgery, how many days should I expect to stay in the area before I can safely fly back?

3. For this procedure, what material would you recommend in my case: my flat head is caused by infant sleep position which my parents intentionally made it this way. Is going to be the custom PEEK implant or PMMA bone cement?

4. Comparing PEEK vs PMMA, which one is more permanent and low maintenance?

5. Since this is back-of-head reshaping, would I need to adjust my sleep position after surgery to protect the result? Long term, can sleeping on the back of the head affect the shape, position, or longevity of the augmentation?

6. What are the common risks or complications for this procedure, especially infection, shifting, uneven contour, scalp thinning, hair loss around the incision, or revision surgery?

A:In answer to your back of the head augmentation questions:

2. You would return home 48 hours after the surgery

3.  and 4.When it comes to skull augmentation the use of PMMA bone cement is now historic and a problematic material we should no longer be used due to its many disadvantages. The far superior material is a solid silicon custom-made skull implant which has feathered edging and can be placed to small scalp incisions.. While PEEK as a satisfactory skull augmentation material it does not have fine feathered edging and requires a bicoronal scalp incision to place it. This makes it an inferior material to that of solid silicone and its use reserved only for those patients are motivated to accept these trade-offs.

5. With back of the head skull augmentation there is no reason to ‘protect’ the results. You can lay on it immediately without any problems affecting the implant or its position.

6. In my extensive experience of over 500 custom skull implants there have been very few significant complications. We do not see hair loss or adverse widening of the scalp scars or hair loss around it. We have yet to see an infection. The most common need for revision is in patients who desire to have an even greater augmentation secondarily.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I have mild hypertelorism, which creates the appearance of pseudoesotropia. Is it possible for an adult patient to undergo surgery for aesthetic reasons to address this issue? I would be satisfied if only the medial canthi could be moved closer together, without repositioning the entire orbits. Unfortunately, I do not have epicanthal folds, so medial epicanthoplasty is not an option for me.

If a procedure like the one shown in the attached image is not available for cosmetic purposes, could medial canthal tendon repositioning produce a similar result, and would such a procedure be feasible in my case?

A:Without seeing the picture I can’t say whether medial canthal tendon repositioning would be helpful in your case. However given the incisions needed to do medial canthal tendon repositioning I would be very cautious about whether those scar trade-offs would be worthy of it even if the repositioning procedure would be beneficial.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Saw an article of one of your clavicle widening cases. Are you still realizing this type of surgery? I’m interested in this surgery and would like every detail. My clavicle length currently is 16-17cm each side, I’d like to get up to 2cm each

A:Thank you for your inquiry and sending your pictures. Unlike clavicle reduction surgery for shoulder narrowing, clavicle lengthening surgery poses more challenges in terms of the amount of bone length that can be achieved due to the attachments of the soft tissue shoulder girdle. As a result I have found that 15 to 18 mm per side is the maximum that can be achieved safely and effectively. The soft tissue attachments of the shoulder girdle will simply not allowed the bundling to be pushed any further than that. As a result patient selection for clavicle lengthening is much more restrictive than that it is for clavicle shortening. While I have done hundreds of clavicle reduction osteotomes I’ve only done less than 10 clavicle lengthening osteotomies.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello! I would like to inquire about a structural facial bone surgery.

My goal is true forward structural projection (not width). I am looking for:

1. Forehead/Glabella segment osteotomy and forward advancement

2. Midface bone advancement

A:Thank you for your inquiry and sending your pictures to which I can say the following:

1)  As an adult you are not going to do forehead and midface advancement osteotomies. Those are procedures reserved for babies and children with significant congenital deformities where the extent of the surgery and the thinner nature of the bones permit it. But even if it was advised to be done in an adult the aesthetic result with bone edging and irregularities would not be a good aesthetic outcome.

2) in adults such augmentations, which are commonly done in Asian patients, are achieved by custom forehead and custom midface mask implants which are far more effective aesthetically with less risk and are subsequently easily reversed or revised if desired.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley Hello,Can remodeling or reconstructive surgery of the frontal bone reduce the width of the forehead?

I would like to understand what is realistically possible on a normal frontal bone, without any bump or deformity.

If it is possible, what are the realistic quantitative limits (in millimeters or centimeters), and which specific areas of the frontal bone can actually be modified?

Thanks

A: To know the exact thickness of the frontal bone and what reductions are possible a 3D CT skull scan is needed with color mapping of its bone thicknesses. This is now standard preoperative protocol for most skull reduction procedures.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley I had a well done lip lift very happy with the result. Several months later, another surgeon recommended custom cheek and jaw implants to address facial bone asymmetries. Over the following year, the implants were placed, revised, and ultimately removed. Each surgery involved incisions through my upper gumline.

Since those procedures, my upper lip has changed dramatically. The inner mucosa feels shortened, tight, and scarred, causing the lip to curl inward rather than outward. I have difficulty closing my mouth comfortably and feel there is not enough internal lining left to properly support the lip. The philtrum also appears longer than it did after my lip lift, despite increased tooth show.

My primary concern is restoring the upper lip’s function and natural outward roll. I do not believe filler would adequately address the issue because the problem seems related to internal tissue deficiency and scarring rather than volume loss. I have also been told that a V-Y advancement is not be feasible because the available mucosal lining appears significantly shortened almost gone.

I have attached photos taken about eight months after my lip lift, before the implant surgeries. They show my fully healed result without filler and demonstrate how much the lip has changed since the repeated upper gumline incisions. I am open to grafts, flaps, scar release, tissue repositioning, vestibuloplasty, or other reconstructive options that may help restore internal lining, reduce tightness, and improve lip position and function.

I have tried to consult other surgeons but alot of them do not know how they can help me. Im very desperate in need for help.

I am not looking for my orginal lips back but just any type of improvement.

A: This is a very difficult problem to improve so it is good that your goal is not complete lip restoration as that is not possible. In terms of improvement you have to separate shape vs function.

Improving lip fullness can only be done by V-Y advancements, which despite having been said to not be possible, remains unproven to me that it can not be done.

Lip mobility is due to scar contracture of which vestibular releases and Alloderm grafting has proven useful in my experience.

Whether both can be done simultaneously is ideal but whether the tissues will permit it remains to be evaluated.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I am writing to seek your expert opinion regarding my situation and potential corrective options.

I had cheek implants placed via an intraoral approach and wore them for two months before having them removed. I am now three months post-removal and have noticed a significant change in my midface — specifically a loss of cheek definition, with the tissue appearing heavier and fuller than it was prior to the implants.

My primary questions are: 

– Do you suspect I will see improvement in the coming months or will it be minimal? 

– What procedure would you recommend to help restore my pre-implant appearance? 

I have come across one of your previous responses in which you mentioned that an endoscopic cheek lift would be the most appropriate intervention in a scenario like this. Would you still consider that the best option in my case, or would a mini SMAS/midface lift be more suitable?

I have attached two photos of before the implants and two photos from now, 3 months after removal.

A: Your situation is classic and is exactly what one can expect when cheek implants are removed…cheek sagging due to loss of osteocutaneous ligament attachments. That situation is now fully established and there will be no further resolution of it.

You are not going to restore your preoperative appearance exactly. Some form of a cheek lift will help but one never go fully back home so to speak. Such a chill lefty can be done numerous ways and there is not exactly ideal approach to it.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I have quite a low eye space ratio of 0.425 with normal ipd. My eyes look close set as a result of a wide face / skull. Orbital box osteotomy is unrealistic and no surgeon does such. Per chance would shaving of the temporal bone on the side of the skull, muscles removal, zygomatic arch reduction be realistic, making the face more slim, masculine and increase ESR?

A: Based on the circled areas on the picture you have shown only zygomatic arch osteotomies would be beneficial in reducing the existing lateral midface projection.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I was botched over 3 yrs ago when I had lipo. This past November I had revision lipo with fat transfer to oversuctioned hips. The fat did not stay so now considering implants.

A: Hip implants are unlikely to be an effective technique for improving the irregularities from liposuction irregularities. Sunce they are placed deeper than the subcutaneous fat layer they are only going to push out the shape and irregularities that are already there.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I feel my eyes are quite high on my face, and lend to an overly long midface, and compressed brow-eye region. I’m not interested in brow lift because it will lengthen the face even more, which is the opposite of my visual goal. After a lot of research I’ve found some information on orbital bone repositioning (orbital box osteomies) and I’m curious as to if it would be effective in moving the eyes lower on the face, around 2-4mm. As well I’m aware this is ann extremely invasive procedure, I am currently just gathering as much information as possible.

A: Orbital box osteotomies can move the eyes from side to side and even raise up an asymmetrical lower eye. But it is not an effective technique  for lowering the eyes.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, These questions are regarding Clavicle Reductions: What are the complications associated with surgery? And your success rate?

A: Success rate = 100% as defined by a bony union after surgery

Complications = only seen 2 fixation failures out of 170 clavicles treated, replated and went on to heal. These failures occurred in the first two years of doing the procedures before I went to double plating.

Dr. Eppley

Q: Dr. Eppley, Is it possible to add a very modest jaw and chin lengthening implant in women without giving any horizontal attention widening effect ?

A: Yes but no. While an implant can be designed to provide vertical lengthening only it has to have some flanges to engage the sides for stability so some slight width increase may occur.

Dr. Barry Eppley

Plastic Surgeon

Q:Dr. Eppley, Can the area between the ears and outer lateral canthus be slimmed down at all? I would assume this would be surgery on the zygomatic arch bone. One side of my face has similar projection to the image attached even with a normal ipd. The wide face makes my eyes small despite being in the normal range.

A: As you have correctly surmised reduction of the width of the side of the midface is a zygomatic arch osteotomy with inward repositioning. This is done by making an anterior osteotomy through the cheekbone from an intraoral approach and the thinner posterior arch is infractured from a very small side burn incision

Dr. Barry Eppley

Plastic Surgeon

Q:Dr. Eppley, I came across your work and wanted to inquire about the possibility of clavicle augmentation for aesthetic purposes. Specifically, I’m interested in achieving a more defined and prominent collarbone appearance. Could you kindly advise: • Whether you offer any procedures (e.g. implants, contouring, or other techniques) to enhance clavicle prominence • What approach you would typically recommend for someone with my concerns • The associated risks, recovery process, and expected outcomes I would also appreciate knowing if you offer consultations (in-person or virtual) to assess suitability. Thank you, and I look forward to your advice.

A: Clavicle augmentation can be done by a wrap around silicone implant that encircles the bone from just lateral to the sternoclavicular out to medial to the acromio-clavicular joint. It is placed through a small incision in the supraclavicular. This is an aesthetic augmentation procedure that evolved from my experience in clavicle reduction osteotomies for shoulder narrowing.

Dr Barry Eppley

Plastic Surgeon