Your Questions
Your Questions
Q: Dr. Eppley, do this under IV sedation or local? I’ve done a 6 hour revision open rhijo with rib under local and a breast Aug. I had a feminizing laryngoplasty and don’t want to damage it with a tube for GA. Would like to do rib removal or lux, but without the tube. Is it possible?
A:While I understand the premise of the question you can not do rib removal surgery under any form of anesthesia other than a general. One should not confuse face/neck surgery with invasive body surgery…they are completely different with one being superficial (face ) vs the other being deep. (body) I have have done many transgender patients who have had vocal cord surgery under general with a 6.0 tube and it has never been a problem. But again I certainly understand why you would ask the question.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Currently I have questions about whether or not revision work can be performed on me – specifically if a reverse sliding genioplasty along with a vertical chin length reduction and jaw implants is possible. I had Vline surgery and a sliding genioplasty done 2 months ago and despite not being fully recovered (knowing that ideally I need to wait 10 months before I have another correctional surgery), I am not happy with the results as my surgeon did not listen to what I had wanted during my consultations. The surgeons technique and results are not botched on a technical standpoint but aesthetically it is not what I wanted and it is causing me a lot of mental destress. My surgeon did not reduce the length of my chin vertically at all but rather reduced the width of my face and gave me a sliding genioplasty. I did not need the sliding genioplasty and I believe it’s making my face/chin appear longer in tandem with my overall jaw width reduction. I miss having more width to my face. I am very distressed about my current facial contouring results and I am hoping to get my self confidence and life subsequently back!
A:Thank you for sending your pictures and x-rays. Like many patients who feel they have an overcorrection from their V line surgery, what you would have felt better about is if you have half the V line reduction that was performed. (but that is not how V line surgery can be done…it is a radical procedure where the intraoral access only allows a lot of jaw angle bone removal) Custom jawline implants can help restore some of that missing bone…a subtotal V line reversal) From the chin standpoint you had a classic t-shaped genioplasty where the width of the chin was reduced. This is not a sliding genioplasty per se, it is the typical chin procedure that is commonly done in V line surgery. Not height reduction or increased forward projection was done. The height of the chin can be reduced secondarily as a vertical reduction genioplasty.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello,I had a procedure done at your office a few years back on maker my head smaller that required removing the temporal muscle.would it be worth my while to do the bone burning on the sides of the skull to make it even smaller?as it is still larger than normal.
A:The greatest yield in head narrowing surgery is from removal of the temporal muscle. The convex part of the temporal bone is very thin (less than 5mms) so bone burring usually has a very minimal effect…which is why it is rarely done. The other issue with temporal bone reduction is access. Unlike temporal muscle removal which is done from a hidden incision behind the ear, temporal bone reduction requires an incision that runs up along the sides of the head in a more visible location. Thus between the limited improvement and the scar temporal bone reduction is only done in exceptional circumstances. (the patient who is willing to do everything possible regardless of the scar tradeoff)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m interested clavicle reduction surgery! I’m twenty eight years old, and I transitioned ten years ago to good results. However my comparatively broad shoulders continue to give me a remaining sense of gender dysphoria. I would be interested to learn your assessment of the risks associated with the procedure.
A: The risks of clavicle reduction surgery, and the only ones I have seen in over 100 cases (200 clavicles) are: 1) fixation failure (2) , 2) non-union (1) and 3) prominent hardware that the patient wanted removed secondarily. (2)
Recovery is a progression of limited arm motion to full range of motion over a 6 week postoperative recovery. This is done at 2 weeks intervals after surgery with elbows by one side for the first 2 weeks, arms at 45 degree from week 2 to 4 and arms at 90 degrees from week 4 to 6. At 6 weeks after surgery full range of arm motion can resume. Weight bearing and more athletic activities can resume at 8 weeks after surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I get the brow implants slightly lower in order to reduce the distance between the eye and the brow bone to hide the eyelid and get hunter eyes and make it deeper.
A: Per the custom design process a brow bone implant can be made that has a lower profile on the brow bone which should help decrease the distance somewhat between the eyebrow and the lower edge of the upper eyelid.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m interested in your jawline reshaping procedure.
My main goals are:
– vertical lengthening of the left jaw (to fix the assymetry)
– creating more defined jaw angles on both sides
– creating a more masculine chin
Please note, the pictures were taken with some (half year old) fillers in my chin and jaw.
Could you please recommend some surgical options?
A: With jaw angle asymmetry custom jaw angle implants would be needed for asymmetry correction as well as angle augmentation. The chin can be augmented by either a bony genioplasty or an implant depending on how much forward movement is desired as well as the shape of the chin from the front view. Distilling that information down it com,es down to two basic options:
1) Custom Wrap Around Jaw Implant
2) Sliding Genioplasty with Custom Jaw Angle Implants
UntiI know more specifics the chin augmentation changes with imaging I can not yet say which approach is better for you.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Generally how long is too long for masseteric muscle dehiscence repair? I’ve read on your website that elapsed time since the tear is one of many factors that will determine whether the procedure can be successful.
A: Due to the rapid onset of muscle fibrosis the reality is by the time masseteric muscle dehiscence is fully recognized after jaw angle implant surgery it is almost too late even then. While there is no exact time frame as to when it is too long it is fair to say that there is a linear correlation between occurrence and surgical repair success…the longer the time between occurrence and repair the less successful it will be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know the costs of skull reduction surgery and if you are able to reduce the size of the back of my head it’s kind of long and how long the scar takes to disappear.
A: By your description it sounds like an occipital skull reduction but I would need to see a side view picture of your head to confirm.
No incisional scar completely disappears, it is only a question of how inconspicuous it may appear. Full scar maturation takes a full 4 top 6 months to occur.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I’m considering several plastic surgeries this year – came across your practice and was interested. I’m currently considering a tummy tuck, breast reduction and maybe a bbl – but open to discuss!
A: As a male who has never been pregnant nor has undergone a lot of weight loss you do not have the extra/loose skin thagt would justify a tummy tuck. You should initially do liposuction alone and see how much improvement that creates before accepting a long scar. The success of tummy tuck surgery depends on how much loose skin exists standing up straight, not sitting or bent over. For gynecomastia reduction whether it would be liposuction or liposuction combined with open areolar excision depends on if there is a distinct palpable mass…that can not be determined by looking at pictures alone.
Whether one takes the fat from the liposuction and injects that into the buttocks depends on how much fat is harvested and what your buttock augmentation goals are. But as a general rule in men fat injections work poorly and usually the fat harvest is low. But the reason to do it is because it does not hurt and the fat is going to be discarded anyway.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had facial implants on my mid-face (a “mask” for cheeks and paranasal augmentation). It was done 3 months ago. Since then, I’ve had the right side of my face infected twice. The first infection occurred two months after surgery, inflammation and a hole with a lot of pus coming out. I went on antibiotics and got the zone cleaned up by a doctor. I also got a scanner done after the antibiotics’ treatment, and the infection was “resolved”.
But yesterday, 3 months after surgery, I’ve started experimenting inflammation again. I’m currently taking antibiotics once more. My doctor thinks there’s a relation between cold or flu and the persisting infection of the implants. She thinks this since the two infections occurred after having flu, this because the fixation of the implants generated “holes” in the bones, and a sinusitis or a cold may also infect the implants through these holes. I’ve read about “biofilms” and I think that might be the cause.
Anyway, what would it be the best approach to treat my situation, knowing that I want to at least keep the argumentation in the paranasal zone around the nostrils and mouth, this if saving the whole mid-face implant is not possible.
– An extraction of 3 months old implants and immediate replacement with new ones would be an option?
– Do I have to wait and let my face heal after implant removal before thinking about getting new implants?
A: Antibiotics rarely solve implant-related infections due to biofilm. Thus believing that an implant infection is cured within a short time after going off antibiotics is overly optimistic. While antibiotics are certainly an important treatment frankly purulent infections require a surgical approach. As a general statement the shortest path to getting an implant infection resolved in an assured manner is to remove the implant, let the tissue heal and re-implant it later. I have seen a lot of time wasted and long postoperative courses of treatment ensue when the ‘nuclear’ option is not enacted early. But it actually gets to a satisfactory end a lot sooner.
Having not performed your surgery and not knowing any defails about the implants I can not provide any more imsight other than the aforementioned general statement about aesthetic facial implants and infection.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Just wondering if its 100 safe surgery to remove this knob bone on the back of my head ad it will disappear for good ?
A: The occipital knob region of the skull is its thickest part so complete knob reduction can be safely done. Once removed it can never grow back.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in having a chin implant combined with perioral mound and chin liposuction.
I have attached three photos from three angles with a simulation of the above procedures (next to each other, for comparison).
I was wondering if it would be possible to have a few questions answered (regarding this) before I commit to a consultation?
1. Do you think that the photo simulations attached show a realistic, achievable result?
2. Am I the correct candidate for these 3 procedures, or would I benefit more from undergoing double jaw surgery or genioplasty instead?
3. Can a chin implant improve my lip incompetence? If not, can double jaw surgery or genioplasty improve it?
4. Can a chin implant improve my mentalis strain (possibly combined with botox)? If not, could double jaw surgery or a genioplasty improve this?
I apologise for the many questions!
Thank you so much for taking the time to review my photos and answer my queries! I greatly appreciate it!
A: Thank you for your inquiry and sending your imaged pictures. I think that is a reasonable result provided it is done with a sliding genioplasty and not an implant. The sliding genioplasty will do better for the lower lip incompetence, mentalis muscle function/position and aesthetic result. (by pulling all the surrounding tissues forward)
Double jaw surgery would be better IF you had as a primary goal of improving your excessive tooth show (vertical maxiillary excess) as well as the aforementioned issues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I’m interested in getting shoulder narrowing, rib removal, and hip implants. I have had several rounds of liposuction/BBL previously, but would like to achieve a more feminine hourglass shape. Can these three procedures be done at the same time or is that not advisable?
A: While all three body procedures can be technically performed at the same time I would not recommend to do so because of the involved recovery. I would pick two to do together but not all three.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I recently underwent genioplasty and jaw reduction surgery. The jaw reduction did not go as my expectation as they cut across the entirety of my jaw angle and now I have lost the angularity that I once had. I was expected just a slight elevation in jaw angle but they took more than expected to be used as bone graft on chin lengthening.
I searched about custom jaw implants that may recover and create stronger angularity again and was hoping to learn more about the procedure.
Would the implant between masseter and mandible? Does it wrap around the jaw bone? How long does it usually last? Are there alternatives? Some of my biggest concerns is how difficult is it to remove when there are complications and what is the infection / bone resorption rate like for such a procedure?
A: In V line surgery there is not ‘just a little’ jaw angle removal, it has to be a lot based on how the cuts need to be made from an intraoral approach. This is a common patient misconception. That issue aside the only method to restore some or all of the removed bone is a custom implant design. Such implants are placed between the masseter muscle and the bone and wrap around the bottom of the bone edge. Such implants are easy to remove should there be a need to do so. The infection risk is in the 1% to 2% range. Bone resorption is not an issue seen.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi. I’m curious about your XL-sized testicular prosthetics. I lost both my testicles to orchiectomy due to chronic pain, and unfortunately, the largest prosthetics available are the Torosa 5cm ones. That’s exactly the same size as what were removed. Are your larger-sized implants FDA approved, and if not, do you know of any others that are?
A: All testicle implants beyond 5cms in size are custom made through Implantech using FDA-approved materials and manufacturing process.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had PEEK infraorbital implants placed last year, however there seem to be a step off on my right sided lateral orbital rim that is noticeable in some lighting. How possible is it to burr it down in place? I am quite scarred up in the inner corner of my lower eyelid so I was wondering if it could be shaved down in a way that would avoid messing with the pre-existing scar (e.g. going in though the upper eyelid or somewhere else).
A: The PEEK implant is not modifiable in situ. It is a very rigid material that has to be explanted to be burred and even then it can be changed very little.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, will my chin be as strong after genioplasty as before after surgery , i am a kickboxer so i am worried should I go for this surgery.
A: That would not be a concern. Like any broken bone once full healed (3 months) it can withstand the same stresses as before.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I don’t remember what material was used, and I’m trying to reach the urology surgeon back then, but I’m assuming it’s silicone throughout, feels perfectly round, not oval, and implant feels firm with a very little squish to it, done 2001. Was removed due to a small lump on left testis (cancerous). Did an Orchiectomy, and that was it, No other treatment was required . Been fine all these years.
The reason I’m writing you is because just recently, while away on the islands (Aruba), I noticed a discomfort with the implant when I sit or touch with fingers , the best way I can describe it, is like a perfectly round Christmas Ornament with two heads for an attachment to scrotum, and both of these heads seem to be poking the skin now, one head is pointier than the other. More Noticed especially when scrotum is relaxed /very soft, ie: after hot shower, and much less discomfort when scrotum is cold /tighter, ie: after cold shower.
So I’m not sure what happened, it served me well all these years.
I’m athletic, pretty active, run, sprint, lunge, squat, im a weight-lifter, very built, I train legs regularly and sometime with heavy weights , and not sure if such has contributed to a shift, or reposition, or is it aging/Sagging or something went loose or what?
There are no other symptoms, like swelling, discoloration, major pain or anything like that.
Other testis feels normal, i self check daily for all these years.
My question is, what are my options?
1. Is this normal to happen with an implant at this age, considering I’ve done it over 20 years ago and can live with this with no danger ?
2. Could I fix what I’m dealing with a Minimal Invasive surgery without replacing the implant?
A: In answer to your testicle implant questions:
1) This is not a long term postoperative event that has ever been presented to me before. But remember, it is an implant and it is not meant to be there. So just because it was fine in year 1, 5, 10 etc doesn’t mean changes can’t occur later.
2) I could not say for sure since it is not clear as to what the exact issue is. But as a general rule with implants….once problematic…modify tjhe pocket and replace with a new implant. Who knows what your implant was made of 20 years ago. But I would bet it is a silicone-gel filled style testicle implant not a solid testicle implant. There is a reason it is ‘misbehaving’….such things never happen for no reason.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am writing to inquire about a particular subject of interest that pertains to your expertise. I am curious to explore whether there have been cases where bone reduction procedures have led to observed hair regrowth or an increase in hair thickness in areas where such procedures were performed, especially concerning male pattern baldness.
My curiosity stems from a personal conviction that bone growth might play a contributory role in male pattern baldness. This conviction arises from my own experiences as I have noticed a correlation between overdeveloped bone ridges in certain areas of my head and the occurrence of male pattern baldness. Comparatively, I have observed this phenomenon to be less prevalent in individuals without such pronounced bone structures.
Additionally, I have come across information on hairgrowthsos.com that discusses this correlation between bone structure and hair loss. Moreover, a relevant article in the doctor journal further elaborates on this intersection between bone development and hair loss, contributing to my interest in exploring this subject further.
I would greatly appreciate your insights or any pertinent information you might offer on this topic.
Thanks for your time and consideration.
A: Having done hundreds of skull reductions, all of which have been in men, I have yet to hear back from a patient about hair regrowth or an accelerated amount of hair growth after the surgery. This does not mean that it may not have occurred…just that no patient has yet mentioned that phenomenon. Having a worldwide practice we only see most patients in a virtual manner so I don’ have the opportunity for a close in office assessment of their head shape and scalp hair after surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m inquiring about the brow bone augmentation. I’ve been trying to find a way to have deep set eyes. I went to a doctor in L.A. and he suggested orbital decompression, which sounds dangerous. So I’ve been searching around the internet and I found of Dr Eppley’s before/after picture of a patient , under “forehead brow bone and temporal contouring” patient 8 and 9, (esp 8), desire for more prominent brow bones and forehead.
I’m thinking of doing fillers first to see if it would do the same effect, even temporary. In this case at least I know if it would look good on me. Maybe it’s a waste of money and just go straight to the implant.
A: Thank you for sending your pictures. In the pursuit of deeper set eyes there are two fundamental diametric procedures….orbital rim augmentation around the eyeball and orbital decompression which makes the eye sit a bit further back behind the orbital rims. In looking at your pictures, while you have adequate brow bone (superior orbital rim) projection and hooded upper eyelids, you do have a deficiency in the infra- and lateral orbital rims. Thus your deep eye deficiency is in the lower half of the orbital. You can make an argument for both approaches for deeper set eyes, and the combination is undoubtably best, but infra-/lateral orbital rim augmentation will have the more pronounced effect if one had to choose between the two procedures.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I broke a rib 20 years ago a few years after I noticed a bump on my side and now it has evolved into a Is protruding rib In the front on my right side is there any way to shave this down. I have an ongoing nervous twitch. And I actually broke the rib by bending in a certain way. I was 9 months pregnant at the tim.
A: The bump to which you refer is located at the left subcostal margin and I can envision that the cartilaginous portion of rib #8 or #9 fractured from the bony junction resulting in a protrusion. This can be shaved down or removed through a small direct incision over it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My goal is to elongate my face vertically and fill in pre jowl sulcus with in a chin implant. I could use a slight horizontal projection because my chin projection is decent but it would help my chin shape. Most of all the implant wings will help fill some indentation on the sides of my chin between my chin and jowls (pre jowl sulcus area).
I thought the Implantech “vertical lengthening chin implant” would be great to elongate my face but another surgeon thought the wings may not help with jowls and may cause a little worse indentation. He said no implant is perfect and asked what is more important (elongate of fill the pre jowl sulcus). He thought the Implantech extended anatomical chin would work. I don’t think he has much experience. I have only see 4 pics of the before and afters. He has never done a custom implant either. A custom implant may meet both needs. My face is very square and my chin is not much lower than my jaw. Now my skin is sagging and starting my jowls are drooping and making it worse.
A: Thank you for your inquiry and sending your pictures to which I can say:
1) By your own detailing of aesthetic chin needs you are describing a custom chin implant design. No standard chin implant can achieve all of those reshaping objectives.
2) It is common that surgeons look at what they know how to do or are most familiar and then try to apply it to every patient need they see. The effectiveness of that approach drops dramatically when the patient’s needs are not a good fit for what the surgeon knows how to do. (the old trying to fit a round peg into a square hole)
3) Be aware that you do have some soft tissue jowling for which an extended vertical chin implant design will not completely resolve.
4) The first step is to determine what your exact desired chin dimensional needs are. In that regard I have attached some initial imaging to begin that discussion.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I came across your case study for the Postauricular Sulcus Reduction procedure.I have struggled with the look of the tops of my ears sticking out for as long as I can remember. Many years ago I had the non surgical sutures to reshape the anti-helical fold, but my ears have returned to my natural shape. I have quite hard cartilage and from what I’ve researched, any attempt to suture the fold at the top of the ear won’t give me the results I’m wanting. I have quite a shallow conchal so I think I’m a good candidate for the Postauricular Sulcus Reduction. Your case study is exactly what I would like. I have gone as far as super gluing the top of my ears to my head, it created the smooth outline of the helical rim that I would like.
A:Thank you for your inquiry and sending your pictures. Any form of cartilage manipulation will not change the top of the ears in any sustained fashion. It requires the reduction of the depth of the postauricular sulcus by skin removal on both sides of the sulcus. (extreme setback otoplasty) How the top of the ear moves inward towards the side of the head depends on how much the depth of the sulcus is reduced.Your gluing of the ears to the side of the head for that effect indicates a substantial sulcus reduction is needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this finds you well. I am in the process of selecting a surgery clinic with expertise in skull augmentation. Please take a look at the pics of the current shape of the skull and desired outcome. I am interested to know a minimal incision /PMMA funnel injection technique could be used in my case. While I understand the selected technique shall be decided during a personal examination, I trust you could suggest best procedures/techniques and materials could be recommended for best outcome even by just looking at the pictures.
A:Thank you for your inquiry and sending your imaged pictures. This would NOT be a good indication for bone cement augmentation and, actually, would be the worst possible treatment choice. Bone cements have a very limited role in skull augmentation and are best used for low volume small areas of skull augmentation. (spot areas) What you have imaged is an overall skull augmentation result that, while not particularly thick in any one area, covers a large surface area of the skull. The only way to achieve that effect in the desired shape with the desired surface area of coverage is a custom skull implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,These images are wonderful. I do like them very much.
- Is this what I would look like with the vertical lengthening implant since I mentioned that or is this a customization of my face based on my goals in order to create a custom implant?
- Is it possible to see what my chin would look like with the “extended anatomical chin” implant by Implantech and also the “mandibular pre jowl chin”? The mandibular pre jowl has the best wings for the jowls so I am open to that too.
- These pictures include some chin lipo, right? I was planning to do chin lipo as well but the lipo doc said it wouldn’t help my soft tissue jowling. I also wonder if that is soft tissue jowling or my buccal fat pad?
- If I do decide to do something custom, I would adjust the images slightly. I see little indentions still in front of the jowls (between the jowls and chin) so I would make it more straight by filling it in and the right side of the front view looks less straight than the left side.
A: In answer to your questions:
1) Imaging is a method to evaluate potential facial structural changes both in terms of proof of concept as well as to determine the patient’s tolerance of change. Once the imaging is done to the patient’s liking then it can be determined as to the best way to try and achieve it. In short, imaging sets the goals for the surgery.
2) EAC and pre jowl chin implants provide horizontal projection only, they are not capable of any vertical lengthening…which seems to be the primary change you need.
3) The images do include submental/ neck liposuction. But like many patients with fuller faces more complete facial defatting (buccal lipectomies and perioral liposuction) provides additional facial reshaping improvement.
4) Your reaction to the imaging is exactly its purpose…to determine the specifics of the patient’s goals.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 38 year old male who a few years back as an adult, I underwent reconstructive surgery for a scaphocephalic head shape and frontal bossing which was believes to be do to minor sagittal craniosynostosis. The surgeon burred down the protruding portion of bone in my forehead and did fat grafting to the parasagittal areas to address the somewhat narrowed appearance and give my head a more round and convex shape.
Overall, everything came out very well, my head has a much more proportionate shape, no more frontal bossing and and I am happy with the results. (This was done through a bicoronal incision. The top of the scar healed fine but the sides unfortunately had no hair growth despite it being a trichophytic closure. I had hair transplants put into the scar which you will notice little scabs in one picture as the grafts were taken that same day).
Long story short, despite the shape being much better, there does still seem to be a thickened sagittal ridge on top anterior portion of my head that’s more noticeable when my hair is shorter. You can see in the pictures that the top of my skull is more peaked in the front than in the back where the vertex is.
I was interested in possibly having that corrected within the next year or so and was wondering what your recommendation would be? What is your assessment of the pictures and what do you think I should have done (if anything)?
Since I already had a bicoronal scar which healed pretty wide (except for the top) from the last surgery and I had hair transplants to fix it, I wouldn’t be interested in something that would involve another bicoronal incision, only something that would involve a smaller incision on the top part of my head that could be hidden in my hair since I keep the top a little longer than the sides.
Several pictures are attached of different views of my head wit different lengths of hair.
A: Secondary burring reduction of the anterior sagittal crest can be done using the part of the coronal scalp incision that lies between the two bony temporal lines. (why that was not done in the primary procedure is not clear since it was always there…but that is irrelevant now) But before that is done a 2D CT scan is needed to look at the coronal slices to see the thickness of the desired sagittal ridge reduction. While it is always thicker due to the micro synostosis you have it pays to be prudent and due an evaluation before doing the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 24-year-old female that got double jaw surgery and a genioplasty a year ago for recessed jaws and a small airway. I have been struggling since the surgery with how my new chin looks. It has never resolved but has seemed to stick out more and more as I have recovered since swelling has decreased everywhere else. I feel like it has taken away the more feminine face that I had before the surgery. I attached some pictures of my profile before the procedure because now that I look back on it, I feel like my chin was not a problem and should have not been touched. My surgeon though recommended me getting the genioplasty for my profile. They moved my chin 7mm forward, which is even more than the original 5mm the surgeon had told me. I was wondering if a genioplasty reversal would be possible? If so, what risks are entailed? I already still have numbness in the middle of my chin where the plate would be and I get very weird dimpling and muscle movements. I also feel like my lower lip is smaller/looks odd compared to before. Would love your feedback. Thanks
A:Thank you for your inquiry and sending your pictures. The question is not whether a sliding genioplasty reversal can be done but by how much is needed. (subtotal vs total) To help make that determination there are two key pieces of information thar are needed/missing: 1) before and after side view pictures of your face and 2) a postop x-ray. All sliding genioplasties can be reversed, it is just a question of how much is needed and any challenges posed by the hardware that was initially used in the initial sliding genioplasty procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in swapping out my Older Style Chin Implant for a Square Terino Style Implant or something similar . My issue with the one I have is I am constantly laying Filler over it to keep the look I like . I enclosed some Pictures as well .All I am after is lil more projection in Chin and where it wraps to Mandible I would like a Lil Squareness not so much round.The Pic of the Guy I enclosed is soo Subltle but I like the Squareness of his look which I prefer .
A:My assumption based on your description and picture is that you are looking for a wider (not necessarily more square chin appearance since that is what fillers can achieve) While I am not a fan of the standard square chin implants, because they are poorly designed if a square chin look is the desired result, they do make the chin wider. In that regard the style 1 square chin implant may suffice. But if a truly more square chin look is desired then a custom chin implant design is needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My face is slightly too wide (around 14.6cm) and I would like to reduce it but not in a drastic way, only by around 1.5mm each side. So basically, a very small reduction. Is it possible to do this without a cheekbone osteotomy (which I would like to avoid) and only by precisely shaving the sides ? I would only like to shave the part of the zygomatic which is I think called the zygomatic process (the part closer to the ear).
A:What you are looking for is not shaving of the sides (zygomatic arches), which is impossible to do due to lack of access, but a posterior zygomatic process osteotomy dine through a small sideburn incision. That is how you reduce the zygomatic process. Technically this is the posterior osteotome site of complete cheekbone reduction osteotomies which is necessary with the intraoral anterior osteotomy to make the whole cheekbone move in. But it can be done by itself just for the purpose to which you refer.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My son is 3 years old, unfortunately he has uncured plagiocephaly… We live in Poland, the doctors we went to assured us that the head would take shape as the child grows, but that it is a long process, even 1.5 years, and they left us like that. Do you have any information or is there anyone in Europe who deals with this? We couldn’t find anything on the Internet… Apart from your website and we see that you are doing amazing things here! I understand that now, when my son is still small, we can’t do anything because the skull is constantly growing and so we will probably have to wait until the age of 18 until its growth stops… I am asking you for some information, best regards
A: What I can tell you about your son’s plagiocephaly is:
1) At 3 years of age it would be reasonable to assume he is not going to change the shape of his head by any ongoing growth.
2) For an onlay custom skull implant one needs to have gotten past puberty. Such procedures in teenagers are done around ages 15 or 16.
3) I am not aware of any surgeon performing this surgery in Europe.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
