Your Questions
Your Questions
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
Q: Dr. Eppley, I have my lower ribs protruding in both sides, and I’m interested in exploring cosmetic surgery options to make them less noticeable without complete removal. Are there procedures available for this?
A: The rib removal surgery that I have performed over the past decade for waistline narrowing is exactly that…subtotal removal of ribs 11 and 12 and sometimes 10 as well.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recall originally he was using a single bracket instead of a double to support the clavicle, and I’m wondering if he might again use a single on mine instead on only the back of the clavicle to prevent any chance of the bracket showing through the skin. I know he mentioned this was a possibility and I’d love to minimize the aesthetic risk even if that means longer healing time.
“Scapular Shave” – could this be performed during my clavicle reduction procedure?
A: Clavicle fixation plates are applied to the top (superior) and front (anterior) portion of the clavicle. There is no way to ever place such plates on the back (posterior) part of the clavicle.
Of the superior and anterior plates the superior plate is the most important for structural support. This is also the plate location in which the risk of plate show exists. Thus going to a single plate fixation does not eliminate the risk of plate show.
In consideration of trying to reduce the risk of plate show options include; 1) using a lower profile siuperior plate (3.5 to 2.5mm) on top or 2) only plsce a 3.5mm anterior plate. Neither of these fixation techniques i have yet used so I can not speak as to their long -term, fixation stability in this application. The question is not whether they can be intraoperatively applied and have immediate stability but how do they resist any bone displacement weeks later.
As for scapular spine reduction (aka scapular shave) that can be performed at the same time as clavicle reduction osteotomies.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking to fix my severe orbital dystopia among other glaring obvious asymmetries (chin, nose, cheeks, etc.) that make me look unusual, extremely asymmetric/unattractive. I believe that these asymmetries are congenital (it has been suggested that I was born with a mild hemifacial microsomia). I am extremely depressed about my appearance and it is worsening as I am aging. I am working with a surgeon who was going to perform a OBO, but decided that, after virtual surgical planning, the vertical mm’s I would gain weren’t worth the hassle of the surgery. Now, the plan is to appeal with insurance to get an orbital implant placed. I received the “after” morphs of what that could look like and am upset that, even with the implant, there will likely not be much of an improvement on the orbital dystopia (and the medial canthus would remain at the low placement it is currently sitting at). I am hoping to see what you have to say about this situation.
A: The answer to your question in my experience is that you need an OBO. No non-OBO procedure is going to make much of a difference in your case. As a general rule non-OBO VOD procedures are indicated when the VOD is 5mms or less. Any amount greater than 5mms needs an OBO procedure.
Why your surgeon won’t do the procedure I can not say but he likely was trying to do it without a frontal craniotomy…which is not going to work.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have read a lot of articles at your website and I was fascinated! I would like your first opinion , since I live far away. If we agree to a satisfying solution , I am thinking in coming .I send you photos and video as well.
My problem is saggy skin..I am 43 years old , 1.67 cm height and 53 kg weight. I do exercise a lot , but the skin is loose. I have not lost a lot of weight. My skin especially at buttocks is very saggy .
I am interested in buttock lift. I would like you to tell me your professional opinion. Which would be the best decision for me to make ? I understand that he upper lift does a better work at saggy skin but it has extended scars as I have seen and I fo not like that. Also , I have also saggy skin at the banana area below the butt, so I suppose it will not make any difference there. On the other hand , the lower buttock lift maybe combined with an implant could be another option. I am not sure though if that will make a significant difference at the saggy skin at the profile.
Also , I read a lot of future implications about implants – such as malpositions etc – and I am a bit afraid.. Are they safe? I am not interested in BBL , since I have done that 4 years ago. At that period I gained weight in purpose , in order to undergo the operation. I weighted 59 kg then. Now I am 53 and the result of the fat transfer has disappeared. I know that when – and if – I gain weight , my butt will be bigger.
I am so confused. I would like to get rid of saggy skin , to have more round , lifted butt and NOT FLAT butt – due to the lift – I like projection as well – not extreme but more natural to the whole body.
I am looking forward to hearing from you as soon as possible!
A: I think you have largely correctly summarized the options including their advantages and disadvantages. Saggy skin is always a challenge and you can not reduce/excised your way out of it nor can you augment with enough volume to fill your way out out it. It takes a combination approach of which the best choices are lower buttock lift and buttock augmentation with implants. (intramuscular implants don’t have many of the historic complications associated with buttock implants) Whether they should be performed together or separately can be debated, each way has its merits.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a narrow forehead, jaw, and narrow, flat (square) cheekbones. I would like to expand my head. Does this affect my eyes, meaning they appear close together?
A: Logically you would assume it would since as the head gets wider and the eyes stay the same they should look closer together by comparison. But whether that effect is signifincat is the question. Computer imaging of pictures will answer that question.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, if I choose to get a genioplasty. Should I remove the plates and screws? If I don’t remove them would I be able to get fillers or Botox in the future? Would there be a potential risk for infection? In addition, how long after genioplasty would you recommend getting fillers or Botox?
A: In answer to your sliding genioplasty questions:
1) Hardware removal later is optional. Most patients never choose to remove it.
2) There is no infectious concerns with injections into or around the fixation hardware.
3) Allow 3 months after the surgery before doing any injectable treatments.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’ll explain more in depth what is going on and what I want to accomplish.
Implant used – implantech terino style II size large
Method – inserted from under the chin
Imaging – whatever a maxillifacial surgeon uses. I don’t know the name
I had the implant placed in October 2020. Haven’t really had any issues with it. I went to a maxillofacial surgeon to discuss my options for issues with my jaw alignment which is causing issues with my molars. Long story short I’ve been told double jaw surgery + sliding genioplasty is the answer. Orthodontists unable to fix the alignment issues.
While doing the scans he incidentally found that I have around 3mm of bone resorption from the implant. Visually it looks no different and I am still quite pleased with the result.
I was told by the doc who did the chin implant that some “settling” is completely normal. He didn’t seem concerned but I am exploring options in the event the erosion worsens.
I saw your reply to a post on Real Self with some more info about what can be done to remedy the erosion. So this is mainly what I am interested in learning more about. If he has a good solution then I would have no issues with getting a revision done with him in 1-2 years if the erosion continues getting worse.
A: This is not bone erosion, it is implant settling…a passive self-limiting process that is not progressive. If you are happy with the chin augmentation results there is not need to treat this radiographic phenomenon.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, what procedure is the best for me? My eyes is too bulgy and flat I want feminine eyes how to achieve that?
A: You have a significant undereye (infraorbital-anterior malar) bone deficiency with excessive scleral show (due to lack of lower eyelid vertical height) This makes your eyes appear bulging but the eye position is actual ly normal. (pseudoproptosis) Infraorbital-malar augmentation with lower eyelid reconstruction (spacer grafts and lateral canthoplasties) is needed for an improved appearance.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi there, I’m a 27 year old male, recently gone bald to reveal what seems to me to be a mild case of brachycephaly. It seems like you have treated patients with the same problem to some great results. Looking to discuss possible solutions. I consulted with a craniofacial specialist in the UK and he said he didn’t think there was much he could do, besides shaving down the actual skull, which I wouldn’t do. Hoping there’s a less drastic remedy available.
A: Brachycephaly implies a flatness to the back of the head for which augmentation would be the best aesthetic procedure…not shaving the bone which is exactly the opposite of what should be done. A custom skull implant works well for this type of augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am due to have calf augmentation post Achilles tendon repair due to severe fatty atrophy of the soleus muscle. I saw that you have done this surgery before and the patient is in your photo gallery under Body Implants – Patient 21. Dr Eppley used 2 implants in this circumstance and I was wondering what type/brand of implant they are? The surgeon I am booked in with is willing to do the surgery and we only have the Implantech Calf Implants available here. My question is do you think the Implantech implants are the best ones and, if not, can you suggest any other brands?
A: There is a very broad selection of calf implant shapes and sizes offered by Implantech. Your surgeon can surely find implants that will suit your individual needs based on leg measurements.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m considering the removal of a silastic implant that was placed under the chin (6mm anterior projection), what realistic complications are there to expect? It was placed 2ish years ago. It’s hard to know what to expect with ptosis, chin balling, nerve damage, and all sorts of complications being thrown around on forums. Could you maybe explain how the time the implant was in, may affect the chances at returning to post-op appearance?
A: I would say the only significant risk, and I would not call it a complication but an expected outcome, is that of soft tissue chin pad ptosis. The question is not whether you will have it but how significant it will be. There is no returning to 100% of your preop appearance. Whether it will be 75, 85 or 95% can not be predicted beforehand.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
