Your Questions
Your Questions
Q: Dr. Eppley, I had a sliding genioplasty reversal 10 days ago of 5mms. I’m really worried that the chin area looks like a fat, round, fleshy block, and that it has no shape or contour . It is affecting my whole face shape, since now my lower face looks so rounded and has lost it’s V shape. Is there hope that the muscles and soft tissue will adhere to the bone? What are the possible treatments for this? Can I place a small implant to give the soft tissue the contour and support it needs.
A: The first concept to grasp is that at 10 days after surgery you certainly are far removed from the final result. It will take 3 to 4 months to see the true final outcome to let all the swelling resolve and the soft tissue wrap effect has occurred.
Secondly when you reduce the projection of the chin it is going to lose some of its tapered shape.
Third, should an increased tapered shape be desired after 4 months of healiong a V-shaped chin implant can be placed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to schedule lipo with 3D etching with another surgeon. Would you recommend that I do this surgery first before a back lift or would it be better to do the back-lift first? I’m worried about loose skin afterwards.
A: Absolutely do the liposuction first and the backlift later for the very loose skin reason you have mentioned. It will also make the backlift more effective.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in thigh and leg implant/augmentation. I had a BBL three years ago.
There was fat grafted to my thighs but it didn’t all stay and I don’t want to risk that happening again which is why I think I would be better suited for implants
Ultimately I just want to be more proportionate on my lower half
I don’t wear shorts or dresses that expose my legs because they are so thin compared to the rest of my body.
A: While I would agree that thigh implants are your only potentially effective treatment option there are some reservations I have in your case. It appears that the greatest deficiency is in the lateral thigh where such implants have their greatest complications due to their more superficial location. (implant show/edging) Thigh implants work best in the anterolateral thigh where they are placed under the fascia…but this appears to be of less aesthetic value in your case.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will the sagittal ridge reduction surgery leave a big scar or any scar visible tissue?
A: Every incision leaves a scar, it is just a matter of how noticeable it is. But scalp incisions do exceptionally well and sagittal skull reduction incisions are very small (usually less than 4cms)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know how many centimeters it is possible to reduce in a reduction of the temporal region of the skull. I do not have a large head, I am a man who is 164 cm tall and has a 53 cm head. My face is narrow (14 cm from one end of the zygomatic bone to the other), but the temporal region is approximately 16 cm, which creates a mismatch between the face and the upper part of the head, as if my head were inflated. Would it be possible to equalize these measurements? Would it also be possible to reduce the top of the head in the same surgery? I appreciate your answer.
A: While temporal reduction is a very effective operation for narrowing the side of the head it is not a procedure which has measured outcomes …meaning I don’t evaluate the results by circumferential head measurements or temporal thickness. Outcome are determined by visual changes. (Does the head look less wide or have less convexity.
From a measurement standpoint all I can say is that the average temporal muscle thickness at the level of the top of the ear is 7 to 9mms in most male patients. Thus removal of the posterior temporal muscle will reduce the bitemporal posterior distance in the range of 1.2 to 1.5cms for most patients.
But the best way to estimate preoperatively of the potential head width change is predictive imaging based on the patient’s pictures.
Top of the head reduction can be combined with temporal reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some questions about large skull augmentations using a first stage scalp expansion.
- I know you said the procedure would raise the hair line’s position, by how much do you estimate it would? I would just like to know if you think it would be a noticeable amount.
- Aside from the two phase expansion, are there any downsides to a large augmentation?
- Since you said this was similar to a lefort I, would this lower the philtrum? And or increase the width of the alar base?
- I understand it is a substantial augmentation, do you think it would be advisable to further reduce the amount being augmented?
- If I were to do just a temporal and top augmentation without the frontal augmentation would there be noticeable margins from the front view?
- Would the skull augmentation affect the position of my eyelid/eyebrows
A: In answer to your large skull augmentation questions:
1) Since how much hairline change, if any, can not be accurately predicted beforehand make the assumption in considering the procedure that a hairline change will occur and it will be noticeable.
2) In general a large skull implant does not necessarily have more risks than a smaller skull implant.
3) A midface mask implant has some similar effects to that of a LeFort I advancement with the exception that it does not change the upper lip because it does not affect the incisor tooth position.
4) Imaged changes may be a goal but in the end the amount of skull augmentation will be controlled by what the scalp tissues can tolerate.
5) The risk of implant edging is always eliminated when the edge of the implant stays at or behind the hairline.
6) Large skull augmentations may have a limited eyebrow lifting effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Good morning/afternoon, my question is do you perform hip bone shaving and if yes how much can you remove in one procedure in grams or kilograms?
A: In my experience with iliac crest reduction it is done in a linear amount not by weight. In most cases 1.0 to 1.5cms of bone removal is performed in the more prominent anterior half of the iliac crest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to you with great respect for your extensive experience and contributions in the field of craniofacial and aesthetic surgery. I have been researching potential avenues to address a specific aesthetic concern I have, and your name consistently comes up as a leading expert regarding more niche but possible surgeries. My concern relates to the spacing of my eyes. While my interpupillary distance is within a normal range, I feel that the inner corners of my eyes (the medial canthi) are positioned relatively close together. This gives my eyes a narrower appearance in relation to the rest of my facial features than I would prefer, and I believe it detracts somewhat from overall facial harmony. I understand that altering the structural relationship between the eyes can be complex. I am not seeking a drastic change (the change seems to be a few millimeters), nor am I approaching this lightly. However, I am keen to understand if there are any established surgical techniques or approaches that could potentially help increase the intercanthal distance, even modestly, to achieve a more balanced look. I would be very grateful for your perspective on whether this type of concern is something that can realistically be addressed surgically. If procedures do exist, could you perhaps offer some general insight into what they might entail, their potential effectiveness for achieving a subtle widening of ICD, and importantly, the typical risks involved? I am trying to carefully weigh whether the potential aesthetic improvement could justify the complexities and risks associated with any relevant procedures. Like I said, moving the eyeballs is not what I’m looking for but rather narrowing the horizontal eye width by changing the medial canthi position (through whatever means you would consider to be safe and direct). I am serious about exploring viable options and am prepared for the associated costs. However, my primary aim at this stage is to first understand the general possibility and validity of such a procedure before proceeding further, for example, with a formal consultation, should a potentially suitable and reasonably safe approach exist. I am happy to provide photographs if that would help clarify my concern at any stage. Thank you very much for considering my inquiry. I appreciate your time and expertise.
A: Essentially what you are describing is the reduction/elimination of the lacrimal lake area of the inner eyes. This could be done by a v-shaped incision along the medial edges of the upper and lower eyelids, excision of the lacrimal lake mucosa and a straight line closure. This moves the inner eye corner more laterally. It is not clear to me yet what the role of any medial canthal tendon manipulations would be or if even needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to flatten to narrow my skull and have it more inward like normal skull. I had a children’s hospital provide me a surgery in my teens because my skull grew outward randomly on one side of my jaw and on the side of my head
I had another surgery over a year ago on the back occipital to reduce that bone, which helped me, but they weren’t able to do the mastoid around the ears because they didn’t have the proper scan and didn’t wanna risk damage to air cells I believe.
A: The mastoid bone is thin as it is largely composed of air cells. Whether a reduction effort is worth it depends on the thickness of the layer of bone over the air cells. This requires a 2D CT scan to make that determination.
Having done mastoid reductions numerous times that experience indicates that some reduction of the mastopid prominence can be achieved but usually not a complete flattening of it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am unhappy with a medpor chin implant that was placed 5 months ago. It is too long, wide, square, and adds to the the asymmetry of my chin. I am interested in replacing it with a smaller implant but I am worried that it will still add to the asymmetry. Is there a way that I can put a smaller implant in without wings while also countering or just not increasing the assymetry? Would a standard implant be able to achieve this or would it have to be custom?
A: This is a self-answering question….persistent asymmetry after a standard chin implant means the next proper step is a custom implant approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a kidney transplant recipient currently taking Tacrolimus (Prograf) as part of my immunosuppressive therapy. I am exploring the possibility of undergoing breast reduction surgery due to ongoing physical discomfort and quality-of-life concerns. Given my medical background, I am seeking guidance and potentially a consultation with a specialist experienced in performing cosmetic procedures on patients with organ transplants. My priority is to ensure that such a procedure would be safe and appropriate in my current condition, with coordination between the surgical and transplant teams if necessary.
A: In the past I have safely performed breast reductions and tummy tucks on several kidney transplant patients. Barring any unknown medical reasons immunosuppression therapy alone is not an exclusion criteria.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, what size is a safer hip implant?
A: The best way to think about it is the size of the hip implant would fall short of your expectations/goals. Big hip implants have a very high rate of problems. The concept is it is better to have 50% of what you want with less risk of complications than 100% of what you want with a complication. As the only way to solve most implant problems is to remove them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I live a very healthy lifestyle, I work out daily I go to the gym, I lift. All with the want to have visible abdominal muscles. After all everyone has abs they just aren’t always defined. I worked out for going on 3 years now and combined with a healthy diet. I was wondering if based on the photos if you think I would be a “good” candidate for Abdominal sculpting. I have researched it in my free time, but it’s very hard to find pre-op “good candidate” photos to tell if I match.
A: The best candidates for abdominal etching are the thinnest where the subcutaneous fat distance between the skin and the abdominal wall is limited.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have too much fat grafting in my cheeks, i see in his webpage Dr, Eppley could help me. I would like to be more natural as I was before the fat grafting.
A: Reversing facial fat grafting is very difficult and there is no ‘returning home’ again. Minor reductions are usually achievable but looking like one did before is not going to happen. Fat grafting has many merits but complete reversability is not one of them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is it possible to make the ribcage laterally wider with implants on each rib. Also do you still offer clavicle lengthening. Have you seen dr Leif rogers do clavicle lengthening using distraction osteogenesis? What are your thoughts on distraction osteogenesis of the clavicle bone. The limb lengthening doctor disagrees with the clavicle lengthening.
A: Can the ribcage be widened by rib bone implants….I see no reason why that would not work since the rib provides a stable base on which to place an implant.
While theoretically any long bone can be lengthened the clavicle poses issues for device application. Until improved devices are developed for the clavicle specifically I remain guarded about its success at the present time. But there is definitely a need for it as clavicle lengthening by osteotomy remains limited in its effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have always had the problem of the mental crease, and feeling like it causes a witch chin when I smile and a double chin. I don’t like the crease the most. But I also do not like the protrusion of the chin when I smile and the double chin. I’m not sure if fixing the mental crease would also fix these issues.
A: It is exactly the opposite of what you have stated…making the labiomental crease less deep will not fix a double chin or a witch’s chin. Conversely fixing a double chin or witch’s chin will make the labiomental fold look less deep.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Id like to talk about getting a revision surgery. I received a wraparound custom jawline implant than im unhappy with a year and a half ago. Its too wide laterally, it added 7 or 8 mm width. I think it would be far more aesthetic to add only 3mm laterally. It goes back too far towards the ramus bone which looks unnatural. It doesn’t blend with the natural gonial where it starts curving up. It goes past it which I dislike. It is too round in appearance. I would prefer sharper masculine lines. It also lacks the chin jaw separation that I want. I want to have a more forward projecting chin like 9mm instead of 5mm. I want it to be slightly squared with taper that creates separation between the chin and jaw. I also want to get cheekbone implants to balance the slightly long flat midface. Im not looking to add width laterally just upward and out 5-6mm. Id like them to be sharp and masculine. I want no added submalar fullness. Im seeking that model esque shadow under the cheek that photographs well. Id like them to be well blended so theres no obvious bumps.
A: One of the ‘advantages’ of having a custom implant design implanted and observing the long term outcome is that now you have a better understanding of the cause and effect relationship of an implant’s dimensions. I think you are well on your way to an improved jawline implant design.
For the cheek implants this is a new design concept but one which is fairly common in my experience with male cheek implant augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is it possible to add canine fossa implants? Similar to how you want cheekbone implants for more cheek prominence and angularity. The shallowness of the canine fossa can have a significant effect on the appearance of the ogee curve and midface fullness. I have attached images below of fossa variances and theirs effects. The faces of the models seem to be on each of the ends of the bony fossa image attached. There seems to be a sliding scale for how much shallowness you want. I have seen this fighter who seemed to have a more medium shawllowness and it looked the best. Had the angularity to see the hollow cheek and most lighting but also too shallow of a cheek can make the midface appear fatter as you can seen in the first model where the second looks leaner simply because less bone.
A: The canine fossa, like any area of the midface, can be augmented with an implant. It is a relatively small concave indentation lateral to the paranasal/pyriform aperture. It can be augmented with an implant and whether that would be of a modified standard implant or requires a custom implant design depends on how much surface area coverage is needed beyond of the canine fossa itself.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a previous sliding genioplasty. I’m now exploring the possibility of adding a chin implant on top of the previous procedure and wanted to ask if this is something Dr. Eppley offers. If so, could you kindly walk me through the consultation and photo submission process again? It’s been a while, and I’ve forgotten the exact steps from last time. Thank you very much for your time, and I look forward to hearing from you.
A: Good to hear from you again. The success of adding an implant on top of the sliding genioplasty depends on what further aesthetic augmentative changes you are trying to achieve. Unlike a chin implant alone, where larger amounts of implant volume can be added, once a sliding Junior plasty is done of some significance in your case being 10 mm the overlying soft tissue chin had gets much tighter. Thus, while an implant can be added to it the amount of implant volume is going to be a lot less than an a primary chin implant augmentation patient. That being said what changes are you looking to achieve from a dimensional standpoint?
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to get a set of permanent and customized implants for my cheekbones. As you can see in the photos, I dont have a defined ogee curve whatsoever and it’s only partially visible in certain lighting. My side profile also lacks cheekbone projection. I am looking for a very sharp, masculine ogee curve and Dr Eppley seems like an expert in the topic.
A:Thank you for sending your pictures. I certainly can see your aesthetic cheekbone concerns and you have correctly surmised that the only effective solution would be custom designed cheek implants. However, you also have to be aware that the fundamental reason you lack cheekbone projection is that you have overall midface deficiency or flatness. This also means you have lack of infraorbital projection anteriorly as well as the cheekbones laterally. Therefore what you really need this custom infraorbital– cheek implants. In addition due to the overall lack of midface projection one has to be cautious in any form of cheekbone augmentation to not overdo the design so it does not look out of proportion to the rest of your face.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will inner eye widening cause any problem to the eyes’ tear system? And is there anyway to basically reduce the medial area while keeping the lacrimal lake? Like while keeping the medial canthi reducing the sclera?
A: It is done medial to the lacrimal punctums/ducts. The procedure works because of the lacrimal lake reduction not the medial canthal tendon…meaning you can’t shorten the medlal canthal tendon laterally due to its bony anchorage.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I mostly feel like the bottom half of my face is quite heavy and creates a pear shaped look to my face. A lack of cheekbone definition and the appearance of jowls are all part of this. There also seems to be a concentration of fat right by my nose and lips from the side view. Additionally, I feel like there is not enough forward projection of my chin in my profile, leading to a weak profile and my nose still looking quite large in comparison. Ideally, I would like to remove the heaviness and jowls and gain a lifted appearance overall, as well as a stronger profile.
A:As you have astutely pointed out your skeletal deficiencies certainly make a major contribution treat your current facial appearance. The combination of cheek and shin augmentation possibly with some facial defatting would be helpful. While the cheek augmentation needs to be done by implants your chin augmentation is best done by a sliding genioplasty which will have a more profound effect on improving the jowling and the heaviness in the perioral area than an implant.. The attached imaging provides a visual application of these facial augmentation concepts although the magnitude of the desired changes is open to discussion.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, my question is do you perform hip bone shaving to remove hip dips. If yes how much bone can you remove from hip bone in grams and/or kilograms .Another question what’s the maximum amount of bone you can remove from hip bone to remove hip dips in grams and/or kilograms.
A:I believe I have answered this exact inquiry previously. But to repeat my prior answer we do not measure iliac crest bone removal by weight (grams or kilograms. Rather it is measured in the amount of linear bone projection that can be removed which usually is in the 1 to 1.5 cm range. Whether that would be enough to significantly decrease the appearance of the hip dips would require assessment of her pictures with some imaging predictions as to what the effects of iliac crest reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in hip implants. I want to achieve the hour glass body shape. I am lookin to haver bigger hips/tight because my body is more like an inverted triangle.
A:I am always concerned that patients requesting larger hip implant augmentations are much more prone two complications such as chronic fluid collections and implant edging. Smaller hip implants do much better. When I see the phrases such as hourglass body shape, bigger hips and correction of an inverted body triangle all of this indicates the need/desire for larger hip implants. Such hip augmentation patients quite frankly make me nervous I’m About such potential hip implant surgery. Hip implants are uniquely different from all other body implants particularly in their complication rates due to their relatively superficial soft tissue location.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanted to contact you about my frontal bossing. I want to reshape my forehead. My forehead sticks out in the middle I don’t actually have a big forehead i want to be more flattened.
A:The reality is the forehead bone is not thick enough to make it completely flat. It can become less protrusive but never as flat as you would like. It requires a combination of building the sides a bit and reducing the central protrusion to get the best forehead contour.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Last August, I sent you a question about hip implants and their possible complication of inferior edge show, if it would be possible to inject fat or synthetic fillers around the visible implant edge to try to camouflage it and your answer was yes. Would this camouflage only work while not bending or leaning, like when standing normally? Will it show if I ‘pop’ my hip out or If I lean? When in dynamic motion or dynamically “posing”? Thanks in advance.
A: A treatment like fat injections around hip implants is done in the static position. What may subsequently happen in dynamic motion is different and cannot be predicted. However, it would be safe to assume that the dynamic show would still persist but perhaps be a bit reduced.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a corner lip lift with Dr Eppley about ten years ago and due to aging, I am interested in having another one and want to see if that’s possible.
A:In looking at your preop pictures from ten years ago I suspect you had lateral vermilion advancements due to upper lip vermilion disproportion. Lateral vermilion advancements are often confused with corner of mouth lifts because of some similar effects at the corners. Regardless such lateral upper lip procedures can certainly be repeated.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have long wanted a chin augmentation procedure. What procedure is best for me?
A:Thank you for sending your pictures. You have a major chin deficiency which is really representative of a more global lower jaw deficiency. Barring getting lower jaw advancement surgery your chin augmentation can only be done by a sliding genioplasty. A chin implant is not appropriate in your case given the magnitude of the of the deficiency, which is in the 20 to 25 millimeter range, and that the chin is sloped backward which makes an implant ineffective. Only a bony sliding genioplasty will be effective and, even when done the maximum amount of 12 To 14 mm (see attached imaging) has no risk of being overdone. Fortunately, being a female, the amount of chin augmentation needed is less than that of a male. You also have to be careful given where you’re now that any major change may be psychologically hard to adjust to as you may not recognize yourself after surgery for some time.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been looking around and I am interested in undergoing shoulder reduction surgery. I would like to know more about this procedure including complications, price and duration.
A:Thank you for sending your pictures. Shoulder reduction surgery is most effective in the leaner patient with a body type like yours. I have tried to do some predictive imaging to show you the potential results from such surgery but your pictures have issues when it relates to imaging. From the front view the picture is taken too close so there is no room between the edge of the shoulders and the side of the picture to do preditive alterations. The back view picture is a bit better but taken against the side of the door there is going to be image distortions in it.
In my extensive experience with shoulder reduction surgery there have been very few complications. While potential complications always exist the biggest consideration in shoulder narrowing surgery in my opinion is the recovery. One has to be properly educated on the recovery since it involves both shoulders and arms and that poses some postoperative limitations that is very different from clavicle fracture repair surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i am 26 years old. I have concerns about my weak chin/jawline and the neck webbing (which i assume i have). I was wondering if you were able to tell me roughly how much it would cost to fix the neck webbing and the weak chin/jawline. I did see you have performed the surgery on the neck webbing before and was also curious if patients prior have had insurance cover any part of the surgery. I look forward to hearing back from you. Thank you for your time.
A:Thank you for sending your pictures. You do indeed have neck webbing as evidenced by the low and laterally displaced hair line. As commonly seen in neck webbing, and maybe as a direct result of it, the chin is often short and the neck and jowl area tends to be fuller even in young patients. From a neck webbing standpoint the posterior approach to its improvement is very effective. As part of the neck webbing correction submental in that jawline like the suction can be performed and I small chin implant placed if , as a female, chin augmentation would be viewed as beneficial.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
