Your Questions

Q: Dr. Eppley, I am transsexual and have a very boxy torso as seen in the pictures attached, I have read through Dr. Eppley’s numerous blog posts and seen some amazing improvements, however, I am worried that my torso may not be able to be sufficiently feminised. Along with the usual 12, 11 and 10 rib and latissimus muscle strip removals, would it be possible to remove ribs 9 and 8 as well? I’m unsure if its the 9th or 8th rib primarily contributing to my boxy torso but its one of them. I’m aware of the complexities of rib removals while trying not to disrupt nerves and as Dr. Eppley mentioned, the pleura; could Dr. Eppley shave down rib 9 or 8 or both completely in order to remove them instead of using the traditional cutting methods used for the other ribs? I know in the blog posts its been mentioned that rib 9 has been shaved, I understand it wasn’t completely shaved to the point it was removed, though I could be wrong.

I am not particularly concerned with scars and am willing to go the extra mile to fix my body. 

A: It is not prudent to remove 5 levels of the ribcae  of which a portion of the rib rejmoval  lies directly over the lower 1/3 of the lung. However ribs #8 and #9 could be shaved thin with removal of the overlying LD muscle which would be safer and provide some benefit.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I got my medpor jaw angle implant procedure over 2 years ago.  One year ago I had one side of the implant shaved down to make my face look more symmetrical.  But, the second procedure caused a mandibular nerve injury, which has impacted my smile and caused a dimple in my chin.  My smile and chin are improving, but very slowly.  I’m confident that my smile and chin will heal eventually on its own. 

If I go ahead and get these implants removed by Dr. Eppley, what are the chances of getting another nerve injury?  I was planning to get a 3D CT scan soon, which would probably help Dr. Eppley see where my nerves are and if it’s possible to safely remove my implants?

A: You  are referring to an injury to the marginal mandibular branch of the facial nerve. A nerve that is not seen on a bone scan unlike the inferior alveolar nerve that runs through the bone which is a sensory nerve not a motor nerve. It is not clear to me how that nerve got injured if the jaw angle implants were placed intraorally. It could have occurred if they were placed externally through a skin incision near the jaw angle but not intraorally.

There is a good motto to remember about recurrent surgical risks….past history predicts future behavior.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My son is now 7 years old, he  developed Plagiocephaly just two months after he was born. I was a young new mom with severe postpartum with no help and knowledge on soft skulls of babies. I noticed his head being oddly shaped. I informed his doctor at the time and he said do more tummy time and didn’t really express the issue as something abnormal. I was under the impression that it rounds out as he gets older.  As time went on, after tummy time, rotating his head, etc, it never rounded out at all and once I realized I needed to help him, it was too late. Everyone including family members, the doctor and my husband just brushed it off. It wasn’t until my friend who was a doctor who saw him when he was 9 months and said it was bad and he needed a helmet, by that point it was too late and my husband at the time still didn’t think much of it. Since that time I haven’t had a day of regret and depression over it. I feel sad, upset and resentful! for I feel let down and hurt by the doctor who didn’t treat it as a medical issue! Dr. Eppley is my only hope! I researched for hours and hours and cried for hours trying to find a solution for this. Please let me know if there’s any hope for him, my prayers will be answered. 

A: I don’t treat plagiocephaly as an external skull augmentation technique until the skull has come closer to full maturity. (aka 16 years of age) It is an effective approach but one with un known long terms risks in the developing skull.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.

A: In answer to your questions:

1) No.

2) Yes.

3) Yes.

4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I think the cheek and infraorbital rim implants that I had placed in 2014 ended up moving upward from the orthognathic surgery I had in 2017. I just noticed this by comparing their current position to the position they were supposed to be in according to the original design, which I’m attaching. I think they are intruding upon the infraorbital cavity and causing some symptoms consistent with nerve compression. I’m worried that they are damaging the optic nerve. Could we have a consultation to talk about this? I think the implants might need to be repositioned surgically.

A:I have seen the IOM implant positions previously. They would not have moved upward from the effects of the LeFort osteotomy, that is just how they were placed. Custom implant placements rarely look exactly like the designs, close but never identical. One of the ‘downsides’ to see a postop scan is that patients can become aware of these discrepancies which exist in every case. The impetus for surgery should be what it looks like on the outside not what it looks like on a scan. It has been almost 10 years since those implants were placed and they would not cause any orbital compression being out of the orbital cavity and only sitting on the infraorbital rim. The optic nerve is located 35mm to 45mms behind the infraorbital rim so this is not an issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,Are you doing shoulder augmentation for women as well ?  My shoulders are too narrow and I want to change that. I included the pictures here for you see what I would like to make , could you confirm if it’s possible? And maybe you could send me more pictures similar surgery? 

I hope you understood me correctly, I want to increase my shoulders so that the body proportions are looking more right, but naturally not a fake , hope you know what I mean 

Thank you so much !

A:I have never done shoulder lengthening on a female so I can not say whether such a change is possible. But if I borrow from my experience in men I would say such a change is not possible. What I learned from men is that the amount of shoulder lengthening by osteotomies is more limited than desired because of the strong shoulder soft tissue attachment to the scapula and surrounding tissues. Whether in females this is less of an issue due to less strong soft tissue attachments can only be speculated.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there a surgery I could get to reduce my temple width so glasses can fit without looking too small? My temple width is 165mm and I’d like to reduce at least 5mm per side. I’ve heard that removing the temporalis muscle can do, but when I press against my temple I barely feel muscles, but bones. So is there a surgery to reduce the width of my temporal bones? Or maybe it’s normal to not feel the temporalis muscle by pressing the temple, and muscle removal would work just fine?

A:The temporal muscle on the side of the head is quite thick often being up to 10mms in thickness just above the ear. Everyone says the same thing about the feel of the side of their head…it feels more like bone than muscle. The reality is that there is more muscle thickness than bone. But the muscle is soft and its backing (bone) is firm and that creates the illusion that there is not much muscle there. Muscle removal works just fine for reducing temporal width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I see that you do thigh implant surgery (do you know how hard that is to find :-p) I was wondering, though, if you would do Hamstring implants, perhaps 1 in each back muscle or 1 big one.Thank you in advance for any of your help, have a great day!

A:In regards to thigh implants they are placed in the quads or the front of the thigh (adductor magnus and vastus lateralis) usually as one single implant with the option for an additional small implant for the vastus medialis.  You mention the ‘hamstring muscles’ which refers to back of the thigh (semimembranous, semitendinous and bicep femoris) for which I have not yet placed such thigh implants nor am I familiar with anyone who ever has. It is theoretically possible to do so but it has not yet been performed to my knowledge.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my face is getting increasingly crooked as I think my implant is displaced. it feels like its sitting on an angle. i would like a video consultation to understand what went wrong and my options now. I feel awful and it doesnt look good. its also hurting a little where the implant sits very high.

A: I assume you are referring to a chin implant since you didn’t specifically say what implant. Based on your preoperative chin recess one can debate whether an implant was initially the best choice. But that being said I think it is clear that it has an asymmetric positioning. If we wanted to have a clear indication of exactly how the implant is positioned a 3D CT scan is needed. But there are several important pieces of information I don’t have. (incision used for placement, implant material, implant style and size)

But as overview there are three secondary chin augmentation options:

1) Reposition the current chin implant

2) Remove and Replace with New Chin Implant

3) Remove current chin implant and Replaced with Sliding Genioplasty

Such decisions would be based on how you feel if the chin implant you have in did not have any asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some images for potential hip reduction surgery. I would also like to say that I’ve had liposuction before, it was a quick fix but the issue is the structure of the bones.I will also attach an image of when I’m at my thinnest, the hips are quite prominent.

My hips are wide everywhere to me. They’re wide at the top and wide at the bottom. Widest area is probably at the bottom, at the hip joints, I’m aware that nothing is really possible at this area without potentially damaging the joints.

The upper hip area gives me lots of dysphoria.

When I had my liposuction, the operator said that one of my hips is more prominent/ protruding outward more than the other side.

I’d just like smaller more masculine hips/pelvis in any way, shape or form. Whatever is possible medically.

A: As you have astutely pointed out there is no surgical remedy for the lower hip fullness due to the width of the greater trochanter of the femur as it is a movable joint. However the iliac crest of the upper hip area does allow for some reduction. In your earlier leaner pictures you have a prominent anterior crestal area. Such iliac crest reduction offers benefits close to the attached imaging.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Im a 32 year old transgender Man. I am wondering if it’s possible to make hip bones smaller or more narrow by shaving/removing bone from my pelvis? It’s something that I think about constantly and it bothers me a lot. Please let me know if there is anything available like this that could help narrow the pelvis.

A:The only surgical method top narrow the hip bones is an iliac crest reduction procedure. (see attached image) Whether this would be effective for you would require seeing some pictures of your hips and where you see them as the widest.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there a surgery I could get to reduce my temple width so glasses can fit without looking too small? My temple width is 165mm and I’d like to reduce at least 5mm per side. I’ve heard that removing the temporalis muscle can do, but when I press against my temple I barely feel muscles, but bones. So is there a surgery to reduce the width of my temporal bones? Or maybe it’s normal to not feel the temporalis muscle by pressing the temple, and muscle removal would work just fine?

A:The temporal muscle on the side of the head is quite thick often being up to 10mms in thickness just above the ear. Everyone says the same thing about the feel of the side of their head…it feels more like bone than muscle. The reality is that there is more muscle thickness than bone. But the muscle is soft and its backing (bone) is firm and that creates the illusion that there is not much muscle there. Muscle removal works just fine for reducing temporal width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Are you doing  that for women as well? Mmy shoulders are too narrow and I want to change that.

I included the pictures here for you see what I would like to make , could you confirm if it’s possible? And maybe you could send me more pictures similar surgery?  I hope you understood me correctly, I want to increase my shoulders so that the body proportions are looking more right, but naturally not a fake, hope you know what I mean.

Thank you so much!

A:I have never done shoulder lengthening on a female so I can not say whether such a change is possible. But if I borrow from my experience in men I would say such a change is not possible. What I learned from men is that the amount of shoulder lengthening is more limited than desired because of the strong shoulder soft tissue attachment to the scapula and surrounding tissues. Whether in females this is less of an issue due to less strong soft tissue attachments can only be speculated.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I think the cheek and infraorbital rim implants that I had placed in 2014 ended up moving upward from the orthognathic surgery I had in 2017. I just noticed this by comparing their current position to the position they were supposed to be in according to the original design, which I’m attaching. I think they are intruding upon the infraorbital cavity and causing some symptoms consistent with nerve compression. I’m worried that they are damaging the optic nerve. Could we have a consultation to talk about this? I think the implants might need to be repositioned surgically.

A:I have seen the IOM implant positions previously on your 3D Ct scan. They would not have moved upward from the effects of the LeFort osteotomy, that is just how they were placed. Custom implant placements rarely look exactly like the designs, close but never identical. One of the ‘downsides’ to see a postop scan is that patients can become aware of these discrepancies which exist in every case. The impetus for surgery should be what it looks like on the outside not what it looks like on a scan. It has been almost 10 years since those implants were placed and they would not cause any orbital compression being out of the orbital cavity and only sitting on the infraorbital rim. The optic nerve is located 35mm to 45mms behind the infraorbital rim so this is not an issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I have some sliding genioplasty questions. I have severe TMJ, would this be an issue? I use an anterior repositioning splint for my TMJ, would i be able to use the splint during post op? Will i be able to talk without pain? For work i need to talk so might be an issue Also how long post surgery an i prone to infection.

A:In answer to your post sliding genioplasty questions:

1) No.

2) Yes.

3) Yes.

4) I have never seen a sliding genioplasty infection but the infection window closes after 6 weeks postop.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My son is now 7 years old,  he developed Plagiocephaly just two months after he was born. I was a young new mom with severe postpartum with no help and knowledge on soft skulls of babies. I noticed his head being oddly shaped. I informed his doctor at the time and he said do more tummy time and didn’t really express the issue as something abnormal. I was under the impression that it rounds out as he gets older.  As time went on, after tummy time, rotating his head, etc, it never rounded out at all and once I realized I needed to help him, it was too late. Everyone including family members, the doctor and my husband just brushed it off. It wasn’t until my friend who was a doctor who saw him when he was 9 months and said it was bad and he needed a helmet, by that point it was too late and my husband at the time still didn’t think much of it. Since that time I haven’t had a day of regret and depression over it. I feel sad, upset and resentful! for I feel let down and hurt by the doctor who didn’t treat it as a medical issue! Dr. Eppley is my only hope! I researched for hours and hours and cried for hours trying to find a solution for this. Please let me know if there’s any hope for him, my prayers will be answered.

A:I don’t treat plagiocephaly as an external skull augmentation technique until the skull has come closer to full maturity. (aka 16 years of age) It is an effective approach but one with un known long terms risks in the developing skull.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I got my Medpor jaw angle implant procedure over 2 years ago.  One year ago I had one side of the implant shaved down to make my face look more symmetrical.  But, the second procedure caused a mandibular nerve injury, which has impacted my smile and caused a dimple in my chin.  My smile and chin are improving, but very slowly.  I’m confident that my smile and chin will heal eventually on its own. 

If I go ahead and get these implants removed by Dr. Eppley, what are the chances of getting another nerve injury?  I was planning to get a 3D CT scan soon, which would probably help Dr. Eppley see where my nerves are and if it’s possible to safely remove my implants?

A: You  are referring to an injury to the marginal mandibular branch of the facial nerve. A nerve that is not seen on a bone scan unlike the inferior alveolar nerve that runs through the bone which is a sensory nerve not a motor nerve. It is not clear to me how that nerve got injured if the jaw angle implants were placed intraorally. It could have occurred if they were placed externally through a skin incision near the jaw angle but not intraorally.

There is a good motto to remember about recurrent surgical risks….past history predicts future behavior.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The post cheek reduction X-rays look pretty even but the cheekbones seem off and there’s some hollowing I wasn’t expecting. I’m not sure how much is due to swelling. It’s been almost five months since the procedure. Some areas of skin seem to be very loose. And one cheekbone does seem to be farther forward facing than the other one. I’m not sure if a cheekbone or temple implant could fix this. I’m worried they took too much off my cheekbones.

A: These post cheekbone reduction issues are not rare. The execution of the operation is not easy in terms of bony symmetry and loss of structural support will cause some amount of soft tissue laxity/sag.

You are correct in that implant augmentation is how these issues are treated for which improvements are usually obtained. The only question is whether these should be standard or custom cheek implants.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I was wanting to get your opinion if a Large vertical lengthening chin implant (VLC) can help achieve these results.

A: That will not create that imaged effect as that is a square chin result and the VLC implant has a rounded shape. That  specific chin shape effect requires a custom chin implant design to get both vertical length and a square chin shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my skull has a congenital deformity, which looks like a melon (they say due to premature closure of the skull sutures), which is elongated from the back of the head and protrudes from the forehead and The width of both sides of the skull is small, and this matter has bothered me a lot in these 25 years. During school and in the army, I was ridiculed by others. Even now that I have reached this age, I don’t appear in the crowd much, I don’t have the energy to do anything, and my self-confidence has taken away Is it possible to make my skull rounder?

A: Thank you for sending your head pictures. While you have an elongated back of the head  and some slight forehead protrusion the actual diagnosis would not be a true sagittal craniosynostosis. Probably some lesser variant of it. But diagnosis aside all that matters is what can be done for it which is burring reduction of the upper forehead and back of the head. The question is not whether this can be done but the extent of reduction achievable. This would require a 2D CT scan to assess the thickness of the bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a few questions about sliding genioplasty surgery.

1. I had a sliding (osseous) genioplasty last summer, but I still have a decent labiomental crease. I am not experiencing tightness unless I really pull by lower chin down, but it’s not bothersome. My surgeon is suggesting hardware removal (since he says it’s pulling the skin in, and scar tissue accumulates there), some bone shaving, and fat grafting. Hardware removal doesn’t seem promising, and bone shaving seems counterintuitive. Do you think these suggestions will help reduce the fold?

2. Does hardware add any projection, and will removal reduce projection?

3. Does cutting into the mentalis muscle and soft tissue again increase the chance of nerve damage? (Luckily I had no permanent numbness from the first procedure.)

4. Unrelatedly, I’m considering jawline implants, but I am fearful of bone resorption. (This is why I avoided chin implants.) Is this a risk of jawline implants?

Thanks so much!

A: A deeper labiomental fold is not going to be improved by hardware removal or bone shaving after a sliding genioplasty. That is a failure to appreciate the anatomic basis of the problem. This is the resilt of a change in the shape of the chin bone which now has a deeper concavity or stepoff beneath the labiomental fold. This bone area needs to be built up on top of the plate for which a dermal-fat graft works well for this problem.

Numbness comes from injury to the mental nerves which lies way to the sides of the mentalis muscles.

The best way to avoid the remote risk of bone resorption with jaw implants is to not do them.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Given your vast experience within every type of jaw implant, and all the designs on implantech are made by you, I thought it would make sense to ask you these questions.

Out of the standard implants, I noticed in a previous blog you had mentioned you would not recommend the conform mandibular angle implant (CMA) for the given male model look that the question was asking and would rather go for the widening angle implant (WMA). My 1st question is, what instance would make the CMA an appropriate implant? Given you said it gives a rounder/ fatter shape of the jaw which is usually undesired for people going for this type of surgery. My 2nd question, is in your experience have you found that the WMA is harder to attach and higher chance of migration than the CMA since it lacks the inner piece that looks into the jaw angle? (I have attached a photo of the CMA and highlighted in yellow the part I am talking about) Lastly, what is your preferred off the shelf implant design from implantech when trying to achieve a more defined angle, from the front and highlighting the jaw line from the side as well?

Thank you so much for your time

A: You have to separate whether one is trying to achieve primarily a widening effect or a vertical lengthening effect when choosing a jaw angle implant style. Your question appears to be directed to the former to which the WMA style has a more pronounced and lower jaw angle shape. I have only designed the WMA and VLA implants for the specific reason that these are my preferences for these two jaw angle augmentation effects.

Proper placement and prevention of migration has nothing to do with implant designs. Those issues are ones of surgical technique and experience.

The jaw angle implant picture you have attached and the highlighted yellow areas at its perimeter is an original jaw angle implant design from the early 1990s…with the flawed premise that this rim of material will catch the edge of the bone and hold it into place. Fixation today is more assured using screws and does rely on implant design which does not work.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to increase chin width and mandibular length and I wanted to ask based on the pictures attached which procedures could make sense. I already consulted with a few surgeons and I got varying answers and I am unsure what to do. The left side shows my current face and the right side shows the desired result. I am also not entirely sure if it’s achievable. Your input would help me a lot! Thanks!

A: What you are demonstratng by your own imagung is a vertical and horizontal incdease of the chin that extends back along the jawline but does not augment the jaw angles. (widens the jawline behind the chin) This dimensional chin-jawline change can only be achieved by an extended custom chin implant design.  (see attached implant design examples) The oinly question is how far back along the jawline from the chin does it need to go.

No form of an osteotomy can make a smooth transiiton back along the jawline from the widened chin.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 22 year old female with prominent brow bone looking to correct this issue as it’s an insecurity of mine that weighs me down on a daily basis. Also wondering if an transpalpebral brow bone reduction would be possible for me, and the average cost of that procedure. I would greatly appreciate this information to direct me. Thank you

A: Transpalpebral brow bone reductions are only effective for the tail of the brow bone. While your brow bone tail is prominent your central brow bone is even more so over the frontal sinuses necessitating a superior hairline or scalp approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does the doctor practice reduction of the temporal muscles on the sides of what is on both sides of the eyes (so i don’t mean only skull reduction on the sides of the Head, but temporal reduction like the botox Can Do for an hypertrophy of the temporalis of what is on the face, not around the skull).

I didn t see results of that on his website. I know that this Can be achieved by botox but Can it be achieved permanently with that operation. Does that skull reduction Surgery include thé reduction of that region of the temporal muscle as well. I sent to you a picture to get what i mean.

A: What you are referring to is reduction of the ANTERIOR temporal muscle region of the side of the head. This is different than reduction of the POSTERIOR temporal muscle  in which the muscle is fully removed. Such muscle reduction can NOT be done in the ANTERIOR  temporal muscle as this is the thickest part of the temporal muscle and there is no open surgical access to do so.

I treat the ANTERIOR temporal muscle by release and transpositon which does have a reductive effect although not one as dramatic as that of the POSTERIOR muscle removal procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested in a chin implant. Have had Botox/Radiesse injections in the area previously, seeking more permanent treatment. I have attached photo which show the effects of Radiesse. Other photos are most recent with Radiesse having gone away.

A: There is not a true matched side profile of a before and after injectable filler outcome. The only black and white jacket outcome that i see is an oblique view,..,.,which does not tell me how much chin augmentation change you have achieved with the filler or some indication of what you are seeking.

I would question the wisdom of an implant given your very recessed chin with hyperactive mentalis muscle. Its indication in your type of chin would only be if the amount of chin augmentation was small/modest. (e.g., under 5mms) Anything more than that in your chin type is better off long term with a sliding genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in having testicles implanted. I currently have an empty scrotum. Years ago I had one testicle removed due to suspected testicle cancer that proved to be false. Long story short, I have had both testicles removed, implants placed, and then those removed due to two different reasons.I now have an empty scrotum and would like to have new implants placed. 

A: The only question then is whether these would be standard or custom size implant. Given that the scrotum is empty I would assume that standard size implants (up to 5cms in size) should suffice.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I am still thinking about trying to get some volume to the back of my head using fat grafting.

It sounds quite promising that it could work for smaller changes even though it is not safe to say how it will stay on long term.

However, I think I have enough fat available for harvest.

Since you also used fat for some of your patients to achieve more volume in some areas of the head/neck – would you say that there are good chances I could achieve a volumce increase like shown in the attached picture?

I have also heard of the possibilty to prepare the fascia of the skin and double it in the area where some more volume is needed to create a rounder head shape. Have you heard of this technique and could you please give me your professional feedback on a combination of this and fat grafting for a (longterm) volume increase?

Your opinion is highly appreciated. Thank you very much for your education and sharing the knowledge and experience.

A: There are several fundamental concepts about injection fat grafting that are universal no mattrer where the fat is injected. First and foremost it is a gamble, no one can tell you with any scientific precision how much fat will or will not survive.  It could be 0% to 100%. It is a metabolically active tissue in which there are dozens of factors that affect its transplantation survival. But what is known is that it survives best in tissues that have some fat natuirally present and in tissues that are not overlying tight. (two factors which don’t bode well for the scalp recipient site) Thus you undergo fat grafting under two specifics circumstances…..when no other procedure is available for the desired effect or whether the alternatives are so unappealing that you want to try something ‘simpler’ first. Second, any fat that survives is metabically response to numerous influence like that of fat anywhere in the body. Thus its long term volume retention is suspect…whether that means it can get bigger, smaller or remain the same is unknown.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interestedIn a genioplasty full reversal but I was wondering if it’s necessary to leave 0-11mm of movement forward because of the genioplasty cutting tool thickness or is it a non factor once the bone heals? I know the hardware also leaves some 1-2mm projection forward during a reversal but I’m still young enough that I’m hoping I can have my hardware removed after a 1 year healing period without significant nerve damage.

A: Your assumptions are correct  on both counts:

1) The thickness of the bone cut with healing will be irrelevant.

2) After 6 months the hardware can be removed. There is no risk of nerve damage from hardware removal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have seen your comment about swelling and the timeline it takes to go down on a weekly basis for jaw augmentation. However since this is based off the custom implant, I was wondering if you could give a similiar breakdown for a standard implant and how long the swelling would take to come down?

A: The recovery process is the same regardless of the implant type. The only difference between standard vs custom facial implants is usually size and the scope of the swelling.

Dr. Barry Eppley

World-Renowned Plastic Surgeon