Your Questions
Your Questions
Q: Dr. Eppley, I would like to ask if you are able to conduct buccal fat rejuvenation surgery.In a previous facial surgery,I had removed about 50% of my buccal fat and I would like to see if it’s possible to restore some of this fat in my cheeks. If there is any information you can provide it is much appreciated, thank you.
A: There are two autologous methods for buccal fat restoration or reversal, external fat injections and intraoral replacement with a solid fat graft. There are advantages and disadvantages with either approach. Fat injections are a scarless harvest and placement but their survival is not completely predictable. The solid fat graft method requires a donor site but the volume of the graft is more stable/predictable.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have lip tightness after genioplasty. Can it be corrected?
A: Most lower lip tightness issues after an intraoral genioplasty represent contracture/tissue deficiency. This is best treated by an intraoral release with a dermal-fat graft. (tissue addition)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to get a large scale partietal skull reduction done. One of your patients on Instagram had great results. Can you please give me an estimated reduction possible in cm and also estimated price. To see if it’s realistic to continue the procedure. I will add the photos of your patient in the appendix.
A: Such skull reductions are done in mms of bone thickness removed (not cms) over the reduced skull area. How much bone can be reduced is determined by a preop 2D CT scan to measure its thickness.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a female with alopecia who keeps my head shaved. I do wear hats and wigs sometimes but also like to be comfortable. I have not found any other information on hiding the scars from facelift and necklift surgery except on your examples of bald men. Have you ever operated on a woman with alopecia? Were you able to camouflage the scarring! Any information would be greatly appreciated.
A:The key to limit visible scarring in any patient with little to no hair coverage, regardless of their gender, is to not have the incision lines extend away from the folds/creases of the ear. That is the best way to not create a scar problem. With more limited incisions comes more modest face/neck lifting results. Whether that tradeoff is a reasonable one depends on the patient’s face/neck issues and their expectations. That would have to be carefully assessed before surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a Custom Skull Implant to help with the top ridge on the side profile and make the back of the head more rounded like a typical skull shape.
A:While a custom skull implant can very effectively add volume to the flat back of the head, it is not clear how it would help the top ridge unless the implant design crossed over onto the top as well.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I plan on gaining weight as I’m not very comfortable with my current weight, I think I’m too skinny. So if i gain weight for the hip implant surgery id maintain that weight and then some probably, i don’t plan on staying this weight or getting any skinnier. Do you think hip implants are good idea of I gain weight?
A:I think even with any weight gain it will never be enough to significantly reduce your risk of hip implant complications.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I have got this skull deformity on the top of my head where it sort of just peaks upwards and looks like a lump. Wondering if it would be possible for you to do a reduction and cut it down to make my head shorter and then carve it so that it is a bit more rounded off instead of sharp and pointy? Or would I still need to have a custom implant to achieve this?
A:You have an uncommon top of the head skull deformity because it is both raised and flat. Usually raised midline top of the head shapes are peaked with a sharper angle. (not flat) The question as to whether an overall reduction in its height and shape can be done depends on the thickness of the bone which requires a CT scan to its thickness and how much of it can be safely reduced. A custom implant would only be used as a second option (and only option) if the bone is not thick enough to do a good reduction. It would very effectively create a more assured shape but it would make the head a bit taller.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I found your information from an online article I came across last night. I am reaching out to request information on your rib removal procedure. I am a middle aged male in very good general health. My 12th rib on my right side however is fractured and will not heal. This happened back in early 2023, so I have been dealing with pain on and off for just over over a year now. My primary care physician was confident in our last meeting that my rib would heal on its own, but this meeting was months ago and I’m still struggling with pain. I am not sure he will even agree to this type of surgery, but I just want to be able to live an active lifestyle again and be pain free once more. Which is why I’m reaching out to other specialists outside my network. My two questions are 1. Am I a candidate that you would possibly consider for this type of surgery even tho this is not cosmetic in nature and instead to alleviate pain? And 2. What type of cost would be associated with rib removal of a single (12th) rib? Thank you so much for your time.
A:The key question from my standpoint is where is the rib#12 fractured along its length? I assume this is shown in an x-ray. That would determine how effectively it could be removed. (get rid of the free floating bone segment distal to the fracture line)
Rib #12 is a very short rib with thin bone so I would doubt it ever could heal back as solid bone so the fact that it hasn’t healed is no surprise.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a Male Deep Plane Face and Neck Lift earlier thus year. I am pleased with the facelift, but not with the chin and jawline.
I am wanting to redo the following:
– Custom chin jawline Implant (Chin Augmentation), I want a longer masculine face (about 3/4 inch down) with a strong jawline (As per before and after pictures included). .
– Upper Eyelids – Eyelid Surgery (blepharoplasty).
I’ve included the following my marked photographs with the dates before and 60 days after surgery, as well as the day of the procedure. I’ve also included before and after photos of third-party custom customised jawline implants to demonstrate my intended outcomes.
A: Thank you for your inquiry and sending all of your pictures to which I can make the following comments:
1) As you have learned, although it was not your primary intent, you can’t lift or defat one’s face into a more defined or stronger jawline. It will merely reveal whatever shape/size jawline that already exists.
2) Your face has thick heavy soft issues, unlike the examples you have provided, so we have to be aware that this is a ‘problem’ in terms of showing jawline shape/definition. Like putting a covering over a ball there is a big difference in how it will look with a thin sheet vs a quilt. In the former you will know it is a ball, it is the latter you would have no idea as to its shape.
3) The method to partially overcome the negative side effects of thick tissues is to expand them or stretch them out. The more you do so the more the underlying shape of the jawline can be seen. But there is a delicate balance between the positive effect of a lot of jawline augmentation and looking too big. Thus more is better to a point. But size tolerance is one of aesthetic preference so in that regard I have attached some potential imaged changes to try and determine your change tolerance.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i understand i have to gain some weight but i’d never be able to gain enough to get a BBL but i think i could deff gain enough to bring me out of the high risk level for implants if i got hip implants. how much do you think i should aim to gain? i weigh 121lbs right now at 5’10
also what would high risk mean exactly, what am i at high risk for ? implant rupture or my body rejecting it ??
A:You never want to gain weight for a BBL or hip implants as, unless you maintain that weight forever, will simply be lost. But that issue aside it is clear from your pictures you are ultra thin so gaining weight is not a viable option for you even if it was a good idea,
The risk of hip implants in a very thin person is implant edge show not implant rupture (these are solid implants so they can’t rupture) or that of rejection. (infection is possible but not true immunologic rejection) There is no way with a thin subcutaneous fat layer that you will not eventually see some of the implant edging eventually, particularly the lower half of the implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have this one face on that shows the issue with a bump on my right side.
Ill take better ones this weekend but from the sides and back it looks fine, seems to just be in certain lighting.that my head shape looks really weird. Could be the camera too, don’t really notice it in mirrors.
Unfortunately my hair is too far gone and have to have a shaved head, insecure about it.
A: Thank you for sending your pictures. I believe you are referring to a right temporal protrusion seen above the right ear. (see attached picture) That area of excess muscle mass could be reduced from an incision in the crease of the back of the ear.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My goal is to have the back of my head, flat without any dip or separation.
A:This is a back of the head problem that I have seen many times. This is due to an excessive of bone and an overlying roll of scalp tissue, both of which have to be removed to get a smoother transition from the back of the head into the neck. There is the tradeoff of a fine line scar across the area and I would need a back of the head picture to show you its location. But as a general rule its length is the same as that of the scalp roll.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been aware of my plagiocephaly since I was 12 and I wish I had neither recognized nor investigated it. Since then, I have had the same haircut, which I cut myself. But now, approaching 30 years old, I am tired of buying hair products, using straighteners, and spending so much time in the bathroom.
So, I would like to have cranial symmetry and a nice skull shape like my mother’s. I don’t really care about facial symmetry, haha. I would like to go to my younger brother’s hairdresser, get the same haircut as him, and travel with him without having to pack hairsprays, straighteners, or anything like that. I want to go boxing with him and wear a helmet on my head (I can’t stand any pressure on my head, it’s like having tickles, I move away from the stimulus at lightning speed). Sometimes I feel ridiculous, to be honest.
A:It appears he has a right flat back of the head, usually the most significant deformity from plagiocephaly, for which a custom skull implant is the best method currently to treat it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, the picture I provided I was wondering how likely can you reduced the width of the head like that I basically have the same wide head that this guy have ? Thank you was very interesting in reducing my width drastically.
A:I don’t know if the picture you are showing is an actual before and after result or just an imaged one. But with temporal reduction surgery that is probably close to what I predict will actually happen. However when it comes to any elective aesthetic surgery the trigger for surgery should not be the best result one could hope for….as that result may not happen. Rather it should be the minimal result one can expect…as that is what is most assuredly will happen. Thus the question then becomes of you got half of that result would you still have the surgery?
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I would appreciate your thoughts on the below given expertise across the below techniques.
I had a lateral canthoplasty in September 2023 but it did not elevate the 3-3.5mm of congenital inferior scleral show, and hardly improved the canthal tilt (relapsed to original position largely after 3 months) – would periosteal flaps with lower lid retractor recession as a standalone procedure; be able to correct the scleral show and canthal tilt? I have read studies where this worked in reconstructive cases of facial palsy – but wondering if it can also be used aesthetically.
I have seen three surgeons with differing opinions:
- Infraorbital rim implant + and/or Orbital decompression., revision canthoplasty with thin spacer graft
- lower lid retractor recession, medial and lateral horn lysis, periosteal flaps and release of arcus marginalis (no spacer graft)
- upper to lower lid Hughes flap with revision lateral canthoplasty and an alloderm spacer graft in the centre of the lid, with ptosis surgery.
Questions
1. Would appreciate if possible to review the second opinions below, and share thoughts
2. Thoughts on an infraorbital rim implant, and/or orbital decompression – to correct scleral show with longer-term results (noting negative vector and anatomy, Hertel measurements). Know we only got to briefly touch on the latter.
3. Different opinions have been given on using an additional spacer graft – one doctor is against this, and feels it would add ‘bulk’ or compromise aesthetically. Is this something you would recommend or not, in terms of desired outcome aesthetically and functionally?
4. s i) the Hughes tarsoconjunctival flap reconstruction, or ii) lower lid retractor recession medial and lateral horn lysis, periosteal flaps and release of arcus marginalis, release of arcus marginalis – more appropriate to address the residual scleral show I still have? I have seen studies stating this can be feasible, albeit unclear if also applicable to patients with a slight negative vector profile.
A: These various and diverse opinions in regards to treating your congenital scleral show are common and are a reflection of the surgeon’s experience, training and how they see the problem. As you have learned and was completely predictable a lateral canthoplasty is going to fail for scleral show and that procedure is best viewed as an adjunct to the needed surgery rather than a primary procedure for it.
The basic concept to grasp is that your scleral show issue, and I seen no pictures so these are general statements, is very challenging and represents a tissue deficiency at multiple levels. (bone and soft tissue) Thus tissue addition is essential not just tissue rearrangement. (e.g., lateral canthoplasty) Also in such challenging issues it is essential to do multiple maneuvers that are diametric in nature to assure some substantial improvement.
To answers your specific questions:
1) An infraorbital rim implant is essential. As opposed to a standard infraorbital implant which merely provides horizontal augmentation, the implant needs to saddle the rim to raise the level of the rim upward as well as forward. This requires a custom implant design.
2) A spacer graft is needed for the lower eyelid with a double hole lateral canthoplasty. A medium thickness Alloderm graft is fine, a palate graft is not needed and is very bulky.
3) The addition of orbital decompression is the diametric maneuver as dropping the eyeball a bit will help make #1 and #2 more effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’ve been heavily considering the brow bone reduction surgery for the majority of my life. I’ve come to realize it’s too hard for me to accept the way I look and I really want some minor adjustments. I want to look more feminine when it come to my forehead. I’d like to know what my most accurate grand total would be based off these images, please.
A:While you do have a low nasal radix/bridge, which always contributes to making the central brow appear bigger, you do have an overall bigger forehead/brow bones. Their reduction would likely produce the attached imaging improvement. The only questions for the brow bones is whether a burring reduction or a bone flat setback would be needed to achieve that effect. This requires a lateral frontal sinus x-ray to make that determination.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, do you perform infraorbital custom implants, more specifically 3D-printed bone scaffolds that gradually transform into real bone over time through the process of bioresorption, effectively replacing the implant with natural bone?
A: There is no such implant technology that currently exists to achieve that biologic transformation. It is a great concept and would be of immense clinical use but it does not yet exist.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How do you think a ligated temporal artery turns into connective tissue? For example, if after a few years the nodules unravel, will blood flow through them again?”
A: Once blood flow is cut off by the sutures the blood flow is stopped and does not return even if the sutures dissolve as the internal lumen of the vessels is now clotted and fibrosed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Will my lip swelling on the right side subside in time or is this a permanent complication at 8 months post op? I had v line surgery with aggressive contouring on the right side, and a genioplasty to shorten length of my chin 8 months ago. I still feel the swelling in lips, on the right side, with a slight pull to the right and down. Will this swelling improve on its own?
A:It would be fair to say that whatever you see at 8 months postop is probably permanent. This is not swelling at this point.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My nose bridge looks low on the upper side. Can a forehead reduction help give a raised nose bridge appearance?
A:Your nasal bridge is low and our brow bones are protrusive so it is the combination of both that contribute to your concerns. While brow bone-forehead reduction would be beneficial you are never going to do that procedure due to the long scalp scar that would be needed to do so. Thus the only acceptable option is nasal dorsal augmentation (see attached imaging)…which not only addresses the low nasal bridge but also makes the brow bones-forehead look less protrusive.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi I had jaw reduction surgery before but they cut too much. Can I have jaw implant surgery to get the old shape?
A:I see lots of overdone and/or V line surgery regrets of which custom jawline implants are the only way to partially of fully reverse the effects of the bone removal surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 39 years old trans woman. I am looking to feminize my upper body. What procedure(s) would you recommend to achieve a feminine upper body? Please get back to me as soon as possible as I am currently planning the next steps in my transition. Thank you ☺️
A:The two most commonly performed procedures for upper body feminization is shoulder reduction and breast augmentation, either done separately or together. (the attached imaging shows the likely shoulder reduction result)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanted to know from the dr If there is a cranio facial surgery that can reduce the height of my top scalp? I feel it’s high abit like a cone shape. Thank you!
A:You are referring to skull reduction in which the outer cortex of the skull bone is removed whose result (how much reduction ) is controlled by the safe amount of bone removal permitted.(see attached imaging prediction)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have healed well from my initial shoulder narrowing surgery and am pleased with the change in my shoulder width. I was curious if the clavicles can be cut a 2nd time for even further narrowing?
A: Secondary clavicle reduction is theoretically possible…although I have never yet done it and your request would be the first. The question is not whether you can cut out more bone but whether the shape of the much reduced clavicle bone would support the hardware needed to hold it together while it heals. A preoperative x-ray may provide some insight into that issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Hello, back in 2018 i underwent cheek augmentation via cheek implant. i wanted a model look, so i wanted auumentation laterally(so that my midface have the classic hollow look in comparison to my high cheek bones). on the quote it was written zygomatic arch implants. however when i looked into my OP report it said M shaped medpor implants(not mentioning zygoma),size small. on the colnsult we agreed on medium size zygomatic arch, allegedly custom made. however i did get a fat transfer into cheeks a bit priorly to implant surgery, awhile back. and after implant surgery he informed me that he had to go with small implant instead. right off the bat, i was unhappy with results. and 5 years later, i finally have to courage to remove the implants. as i look over the OP report, i wonder how would he just come up with smaller size implants on the table, if zygomatic ones are custom? what are M sized implants, is that different from zygomatic arch implant? could it be something like a regular malar implant?as i suspect placement might be different(over bone or soft tissue?). should i inquire that with the surgeon before removal consult with you? to provide you with the fuller picture?
A: I can not address or will respond to what took place between you and your surgeon both before or during cheek implant surgery…..I was not there. My only general comments would be:
1) As I perceive and do zygomatic arch augmentation with implants, there are no standard implants to achieve that effect. They must be custom made to extend back along the entire zygomatic arch. Standard cheek implants are not zygomatic arch implants
2) Contemporary custom facial implants are made from the patient’s 3D CT scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had some questions about a procedure involving the epicanthic fold area. My eyes are a bit close together mostly because of the exposure of my tear ducts. I had been looking around at possible procedures to increase the distance between my eyes, and found a few studies in which reconstruction of an epicanthic fold was done. I was interested in seeing if you would be able to offer something like this. I don’t really have an epicanthic fold, and don’t really desire one, but I would like something similar to increase the distance between my eyes. I’ve attached photos of my eyes & the edited result I desire. Again, I would not really like the “fold” that many asians typically have, but perhaps just more skin covering the tear duct. Thank you for your time!
A: What your edited image shows is a change in the angulation of the inner corner of the eyes, a more downward location of the corner which may slightly increase the distance between your eyes and create the appearance of more skin covering the lacrimal lake area. Since you don’t have an epicanthal fold This is most effectively done with a tissue rearrangement technique as shown in the attached diagram.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this message finds you well. I have been extensively researching jaw implants for over a year. Your expertise and reputation in the field have greatly impressed me, and I am planning to schedule an appointment at your office very soon. I am seeking your professional advice on a few concerns regarding jaw implants, particularly considering my age and current circumstances.
Age and Jaw Growth Concerns:
I recently turned 20, and my orthodontist confirmed that my jaw has stopped growing since 2020. However, there is a possibility of continued growth until I am 25.
Given this, am I too young to receive a jaw implant? What risks are associated with getting the procedure at my age?
Is there a way to determine definitively if my jaw has completely stopped growing, ensuring a successful and complication-free implant procedure?
Concerns About Fillers:
I have a strong preference for a permanent solution over fillers, such as Radiesse and Volux, which I find temporary and unsatisfactory.
Despite this, I have been recommended fillers due to my age. Considering my financial readiness do you think it is worth waiting until I am 25 for a jaw implant, or is it feasible to consider an implant now?
I have attached front and side profile pictures, as well as front and side x-rays of my skull, to provide a comprehensive view of my current jaw structure. I hope these images will assist you in giving me the most accurate and tailored advice possible.
A: In answer to your questions:
1) Whatever mandibular growth occurs after age 18 is minimal and in the sagittal direction, thus making that a non-consideration for any type of jaw implant.
2) The risks of any facial implant procedure is age irrelevant.
3) There is no such thing as a risk-free surgical procedure particularly when it involves an implant.
4) Your jaw deficiency is primarily vertical (height) in its dimensional needs. This is evidenced by the adequate projecting chin but deep labiomental fold, bunched up chin pad tissues and vertically short chin combined with a flat mandibular plane angle behind it. The correct augmentation approach is a vertical lengthening bony genioplasty (6 to 8mms) with custom jawline implants behind it. (see attached imaging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Perusing through your website I realized that there is a section where people ask you questions and your answer them back,since I could find where I could submit you questions I would like to ask you here if you don’t mind!
I would love an advice from a world leading expert like yourself in jaw angle implants,i live in Brazil and here the only material used in this procedure is the off the shelf medpor implant but I found an oral and maxillofacial professional who does custom PMMA jaw angle implants,since information about this procedure done with PMMA implants is very scarce and almost non existent I would like to make you some questions before proceeding with said professional:
A – From what I gathered,PMMA has a higher chance of infection than silicone,but how much higher is this risk exactly?I read that silicone jaw angle implants have a 4% to 6% chance of infection,how much it is for PMMA?
B – MEDPOR is more difficult to remove due to tissue in growth,does PMMA has the same issue?
C – Is PMMA implants visible on CT scan for future removal or replacement?
D – Does PMMA offer any advantage at all compared to other materials available on the market?As I said,I live in Brazil and,unfortunately,due to geographical and financial reasons I could only afford to do this procedure here with the off the shelf MEDPOR or with customized PMMA implants
Sorry if this seems too lenghty,I just think it is vital to ask all of this to the most experienced professional out there in this procedure,I would be kindly thankful to you if you could help me navigate through this all!
A:In answer to your questions:
1) PMMA has a higher infectivity rate than silicone in the face but how much higher is not precisely known.
2) PMMA is non-porous, unlike Medpor, thus its tissue attachments are less. But it is still not an easy material to remove because it is so hard.
3) PMMA implants would not be visible on a 3D CT scan.
4) I see no advantages to PMMA material over Medpor other then the ‘customizable’ part but I really don’t know what that means. The term custom can have various interpretations.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I have a few questions for Dr. Eppley. I came across this youtube video showing a type III forehead reduction being performed, and it highlighted the challenges with dealing with the frontal sinus. Could you ask how you will handle it? Does the surgical facility have a live CT and planning software similar to what was used in the youtube video above?
Finally, I attached some pictures I took when Dr. Eppley marked where he thought he could shave down to without doing a Type III flapback procedure. I now realize CT images are reviewed to see how much bone is available for shaving – is this limited by the frontal sinus? If so, after reviewing the CT footage, does he think those markings are still accurate?
A: In answer to your brow bone reduction questions:
1) I am not sure what is meant by the ‘challenges’ of an open Type 3 brow bone flap setback procedure. Brow bone surgery essentially its frontal sinus surgery.
2) In today’s world as much of FFS is done through insurance new technologies have been developed using the patient’s 3D CT scan to help ‘guide’ the surgery. To those of us who are very experienced in this surgery we feel this is not worth the added expense. ($5,000 +) But if insurance is paying for the costs of such technology then why not get it. It is very cool technology and it is done from the same engineers from which all of my custom implants are made, so I am very familiar with it. But in the aesthetic patient who is paying out of pocket one has to put a value on what it brings to the surgery. (i.e,, does it make for a better outcome)
3) I have your 3D CT scan from your previous surgery so the brow bone reduction prediction by imaging has an anatomic basis for it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously had rhinoplasty 15 years ago with another surgeon who had made my nostrils smaller at the area where the nostrils meet the cheeks. As a result, the nostrils are now too rounded off. I would like for the nostrils to restored as close as possible to what it was originally. I believe the procedure would involve some skin/tissue grafting. Before booking a consultation, I would first please like to know if the doctor performs such a procedure and whether it would lead to unsightly, significant scarring?
A: It is ‘easy’ to make the nostrils more narrow as defined by the usual good scarring as a result of the tissue excision. The converse of nostril widening, however, is a different story. As you have correctly surmised it requires the addition of a graft (chondrocutaneous graft from the ears) to replace what has been removed after the nostrils are released from the cheeks. Such interpositional graft replacements, while increasing nostril width, will have a different skin color from that of the nose and cheeks since it comes from the ear. Thus it will be visible and will not look exactly as it did before even though nostril width may be restored. Such nostril base grafting is really a reconstructive procedure and not an aesthetic one. (unlike nostril narrowing) Thus I would be cautious when considering this procedure for aesthetic restorative reasons.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
