Your Questions

Q: Dr. Eppley, I had a bad facelift that changed my jawline completely. The left side is lacking definition and it looks like there was valuable tissue removed.The right side still has some of my jaw left but it to is lacking tissue. There is a nodule on the right where the gonial angle is. When l clinch the masseter muscle it really stands out. I’m not sure why my chin looks bulbous now but it could be fat?I would like to send you pics of my face prior to the procedure and you will get a better idea of what l am trying to say.i believe with implants they can fix the symmetry problem and fill out the deficiency issues.

A:Based on previous pictures sent there is a clear ‘jawline’ asymmetry/deficiency it is not clear to me whether  a bone procedure will adequately address a soft tissue created problem…as there is no a 1:1 ratio of bone augmentation to soft tissue change and it would be difficult to accurately what is the needed augmentation even of there was a 1:1 ratio change as 3D CT scans measure bone and not soft tissue. I am not saying it may not work I am merely pointing the challenges in doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: D. Eppley, \ I was wondering in Otoplasty if it is possible to remove some bone from behind the ear in order to put the ear back. The reason being is one ear sticks out and the other is generally pretty flat against the head. I also notice the right side of the skull protrudes out a little bit more. Would this even be otoplasty or would this be along skull reshaping?

A:Skull bone removal is not going to help the ears set back further. That requires cartilage and/or sulcus manipulations. It is the differences in the ear structure as to why one ear sticks out further not the skull bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How much is the treatment to remove the dark eye circles?

A:Don’t think of them as removal but rather as treatment to reduce them. All that can be done is to reduce the undereye hollows which will help reduce their appearance but I doubt will make them go completely away. If the only goal is to reduce the color of the dark circles then this will not be accomplished by surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a somewhat specific question about a nose operation that I have not seen before. It is about putting the nose down so that it no longer looks as if it is connected to the forehead and is no longer so high. Is it possible in any way?Because I have never seen this in any surgery, but this would be really important to me.

A:You are referring to reduction about the high radix (frontal nasal junction ) in rhinoplasty. The high radix nose can be reduced but not the degree that you have imaged due to the location of the frontal sinus and nasal airway cavities.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I recently saw a post about the inferior orbital box osteotomy. I’ve seen the normal orbital box osteotemy but it is too complex and extreme in my opinion. How does the inferior orbital box osteotemy differ from the normal orbital box osteotemy. Can I still expect the same results? I want my Intercanthal distance widened about 5mm and Ipd widened 5mm. Is that possible with the inferior orbital box osteotomy? If not what is the limit on the amount of intercanthal distance and interpupillary distance one can get with the proceducre.

A:Those ICD and IPD changes are likely beyond what an inferior orbital box osteotomy can achieve. While the inferior orbital box osteotomy is a lesser surgery than a full 360m degree orbital box osteotomy as a result it produces less significant  changes. (less than 5mms)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, There is a surgeon in Turkey that said they think they can remove my rib hump bilaterally with just doing a  3cm incision to remove rib cartilage, how much of the rib flare could I realistically expect to lose?Would pec implants or a sternum implant WITH pec implants be enough to overcome the mild pectus excavatum?

A:You are referring to subcostal rib flare treatment by subtotal cartilage excision. While this can be effective for some rib flare patients, as an older male with more calcified cartilage and significant rib flare I would be less optimistic as to its effectiveness.  If you had to put a percent on it at best I would say a 25% reduction is possible. While some reduction would be achieved it is not going to make a major difference particularly with a mild pectus chest deformity above it.

Ideally you need a diametric approach…meaning augment the chest and reduce the rib flare. (see attached imaging to illustrate the concept)  Together that makes each area look better.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was born with bilateral club foot. Surgery was completed when I was 3 months old. I still have thin calf muscles,skinny ankle and short feet which affects my confidence in my personal life. I am 30 years old with no other medical condition. I would like to know more about calf augmentation. Looking forward to hearing from you soon.

A:Compared to many clubfoot patients I have seen you are more favorable for calf implants than some. Your legs below the knees are small but do not appear to be overly tight and constricted. When it comes to lower leg augmentation here are the concepts to know:

1) Calf implants augment the upper half of the lower leg where the gastrocnemius muscle resides, not the whole lower leg. (see attached imaging)

2) Your calf tissues will be tight so implant augmentation is restricted to the medlal gastroc muscle…which is the one that is most seen anyway.

3) Any augmentation below the gastroc muscle to the ankle must be done with fat injection grafting…which has an predictable survival rate but is the only treatment option.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I attached 3 pictures, the cropped one being with my jaw open and the right sided temporalis muscle being significantly smaller. Would this be a possible outcome of the surgery? I’m even open to burring of the lateral aspects of my forehead to help reduce width, if at all possible in my case? 

A:You have correctly surmised that the temporal muscle thinning with the jaw wide open is a very good preoperative test of whether temporal reduction would be an effective surgery.

The only comment you made which gives some pasue to this answer is…  I’m even open to burring of the lateral aspects of my forehead to help reduce width….as temporal reduction surgery does not affect the bony side of the forehead.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Just wanted to look at the possibility of an online consultation for a masculine forehead augmentation.

A:Wiuth your severely backwards sloped forehead but with good br0w projection you would need a custom forehead implant that looks similar to the attached design. The implant’s objective is to normalize the forehead and top of head skull shape that is more consistent with that of a male.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I am interested in getting a custom wrap around implant for my jaw and chin. My overall goal is to have a more defined lower part of my face. I would like to have a more defined jaw line, especially toward the back of my jaw where I have little definition. I would like to extend my chin out to align with the lower lip. Right now I have some filler there but it has never made me happy, I would dissolve it prior to surgery. I am also possibly interested in doing a fat reduction on my cheeks, I have very fully cheeks that make my face look rounder, perhaps with the implant I would not feel the need any more. I was curious as to how the design process works, is it possible to have a photo of you augmented to see what your face would look like with the implant prior to ordering it? Also, could you please provide me with an estimated cost for the implant, and possible fat reduction separately? Thank you so much for your time.

A: There is no technology that currently can take a designed implant and show what it would look like on a patient. That may occur some day but is not yet available. Rather custom implant designing is based on targeted imaging of the patient’s facial pictures from which estimates are made as to what implant dimensions can come close to achieving that effect. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a sliding genioplasty 4 years ago and I am still struggling my chin is in pain and has complete spasms I get Botox but it’s not lasting more than 7 weeks I don’t know what else can be done my surgeon just sent me to a neurologist they done scans ect and can’t find anything in them My surgeon just says he hasn’t seen this. Before I am desperate is there anything else I can do.

A: This is certainly a very unusual problem after a sliding genioplasty. Given that the procedure requires cutting through and then putting back together the mentalis muscle right at its origin, and then requiring the reattached muscle to be stretched over a longer bone distance (assuming that the chin was lengthened) one can see that is a theoretical source for muscle dysfunction. (although this is done routinuely and the problem of muscle spasm is rarely seen) 

While Botox appears to provide some good temporary relief any longer term benefit will require surgical intervention. Surgical options include: 1) reducing the amount of horizontal chin advancement that was done (giving the muscle less length on which two contract) and 2) releasing the muscle introrally and  placing an interpositional fat graft. Given the rarity of the problem I can not say which one may be more effective or whether either one would provide assured muscle spasm relief. But anatomically these are surgical remedies that make sense.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if it would be possible, in addition to reducing the width of the face through cheekbone reduction, to shave down the frontal part of the zygoma (in red) & augment the midface area (in black) so that they are similar to the below image.

A: You are referring to the combination of cheekbone reduction osteotomies combined with paranasal-maxillary augmentation. That is a synergistic approach to narrowing the width of the lateral midface (cheeks) and increasing central midface projection and can certainly be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to reduce the appearance of my masculine appearance of my chin and the deep crease, I dislike how long it looks when I smile, and I do want to keep the sharpness with a more soft, feminine approach, kind of like Kylie Jenner.

A: It is important to understand that the chin pictures you have shown are of a dynamic concern (chin pad ptosis) while surgery is a static non-dynamic procedure. Thus the only assured surgical change would be what the chin looks like at rest or in a non-dynamic state. It is from these pictures, front anf side, can only make for a more accurate assessment of what can be done.

Dynamic chin pad ptosis may be improved by static chin reduction procedures. But it is important to point that such dynamic changes are less predictable since the surgery is done in a static moving state.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I got a quote from you for a sliding genioplasty about 3 years ago. I currently have a chin implant and feel like a sliding genioplasty will give me the results I am looking for and also allow me to get back into boxing once it’s healed. The left side of my implants wiggles so maybe insurance will pay for anesthesia.

A: That was 3 years ago so costs have changed. (Iincreased) Insurance does not pay for any cosmetic related procedures.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have read up on your good work. I tore my bicep tendon a year ago and didn’t get it fixed. I have a Popeye style muscle with a gap between its end and the elbow. I would like to get an implant to give the size back again.

A: You have correctly surmised that your bicep muscle is now permanently shortened and only an implant can fill in the now contracted distal end. While such an implant to do so is not large consideration has be given to the dynamic change in the muscle end from when the arm is fully extended to when the elbow is bent at 90 degrees or more. Also the overlying soft tissues are not thick and consideration also has to be given to preventing implant migration or revealing its edges through the skin. This is where it is important to encase the implant in a lining that is similar to the fascia that normally surrounds the muscle. For this I use an Alloderm sheet or Galaflex sheet to encase the implant and attach it to the fascia of the muscle end.

The bicep extension implant is made by either measurements you take at home or we can send a moulage kit to make an impression of the missing muscle segment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested in the surgery to fix my flat head. I been dealing with it my whole life. I’m a 27 year old male. And I wanna get this fixed

A: The first place to start is to get some side view pictures of your head to make assessment and then did imaging to see what type of back of head augmentative change you seek.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, yesI am a 25 years old and all my life I had a webbed neck and could not find a solution for it. Two years ago, I did physical therapy for a month, it helped a little bit and my neck got slimmer from the sides, but when I stopped, my neck got back to its usual shape. Sometimes my neck is slimmer, some days it is wider. My neck is not so stiff usually. Here are the pictures, I wonder if there are any solutions for fixing it from both sides, and from the profile, the access skin under my chin. I do feel any pain around my neck, and my concern is that I just want to have a normal and slim neck, like everybody. If there is any more information I can provide, please let me know. Best regards.

A: In webbed neck surgery the improvement it provides is reduction in the visible webbing from the front and back views. I can not say that much aesthetic improvement is seen in the side view where the webs do not cause any major aesthetic visibility. There is going to be benefit in the stiffness or movement of the neck.

Many webbed necks have a shorter chin projection which I think is an effect of the webbed neck. This will not improve by webbed neck surgery alone. It requires some form of concurrent chin augmentation and/or submental liposuction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a barely noticeable dent”on my brow which was caused by  microneedling done years ago. (It seems it killed the flesh.)  You seem like the brow expert so I was wondering if you had a permanent solution you could perform–an implant? (That’s super thin, only thick enough to smooth out the dent on my brow)

A: Need to see a picture of the brow concern. Since the problem originated from a soft tissue injury it would seem like a soft tissue solution may be more appropriate. (e.g., filler, fat injections) Not that an implant could not be used just an initial insight based on a description of the problem origin.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a car accident about 30 years ago and had tracheostomy done. I have scar from that and want to see if you can provide options to remove it.

A: That trach scar can be improved by total scar excision and closure. But there will always be s acar. The goal of scar revision, which should be called scar replacement, is to have an improvement in its appearance. There is no way to completely get rid of it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello doctor, I am 2 months after a mandibular advancement + genioplasty and I do not like the result at all because it has lengthened my face. So I want to shorten the bottom of my face, reduce the chin in length and move it back a little + reduce the lower edges of the mandible without touching the angles. However, I am extremely afraid that the soft tissues, muscles, could relax. And therefore end up with a “wizard’s” chin that goes down. And so, I do not know which technique is best for me between shaving or osteotomy. These are slight modifications I think no more than 8mm of reduction in height and maybe 3 of recession. According to you what would be the best technique for me and why? Thank you in advance!

A: Those are big bony changes that are best achieved by redoing the osteotomy not by shaving for the very concern that you have. (tissue sagging)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  i would like to know how long it takes to get customized chin implant. I would like to enhance my chin to make it look more square and well-defined with just a little more projection. I don’t want anything too dramatic—just a subtle improvement that gives my face better balance. My local doctor uses implants they are more round shaped. I had jaw implants 9 years ago but it make my face so bulky.

A: You have correctly surmised that when you need a very specific facial implant augmentation change you need a custom implant design. Standard facial implants are made for now historiic facial changes which are different today.

Once a have the 3D CT scan it is a 2 to 3 month process to get designed, manufactured, sterilizied and shipped for surgery. This is largely due to the large number of  implant cases that in the process at any one time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Please see attached images of my eye area and CT scans from after orthagnathic surgery. I’m trying to address the under eye volume loss and sunken look. I think it also makes my cheek look flat as well by extension. Not sure if I should pursue under eye filler or just do a Infraorbital rim implant for a more permanent solution

A: Eye filler is useless for a skeletal deficiency. Custom infraorbital implants is what is best since through their rim saddling design they provide the best undereye hollowing correction effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does masseter muscle dehiscence resolve itself if the jaw implants are removed or does the masseter still need to be surgically reattached? Thanks.

A: Masseter muscle dehiscence/retraction will not resolve itself by implant removal altbough its aprpearance may become less.

There is no consistently effective method for masseter muscle dehiscence repair.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dear Dr. Eppley I recently came across information about your chin asymmetry correction surgery using the bone shaving technique. I have a few questions regarding post-surgery care and maintaining the results: Maintaining Chin Results: Is there anything I should do to maintain the state of my chin in the long term after this type of procedure? Are there any recommendations to avoid potential issues such as sagging skin or asymmetry? Botox Use: Would it be necessary to use Botox in the chin muscles after the surgery to prevent muscle activity issues or asymmetry? Excess Tissue Removal: If further adjustments are needed in the future to correct the chin’s shape, would simply removing excess tissue be sufficient, or would more invasive procedures, such as osteotomy, be required? I would appreciate any recommendations you may have. Thank you in advance for your response. https://exploreplasticsurgery.com/bony-chin-asymmetry-correction/

A: Bony chin asymmetry correction may involve bone removal only or a combination of bone removal and soft tissue removal. Each case has to be evaluated on an individual basis. Either way the procedure is intended to provide a permanent correction. Botox injections are not needed for chin asymmetry correction or maintenance after surgery. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi there, I have two forehead horns/bumps on my upper forhead that I am interested in having burred down. I still want a feminine and more rounded forehead but I just dont like the two asymetrical bumps on the sides (I did have two head injuries as a child that may have caused these). I wanted to know if a) this can be done with two smaller perpendicular incisions rather than along the front of the hair line (I have seen this in some of your photos) and b) is it possible to get this done under local anesthesia with drugs/gas to make me drowsy? I am very hesitant to go under general and have had other surgeries under local + drugs that have worked well. C) do you ever see cases where scar tissue fills in after the bone burring to be just as bad as before or close to? D) do you need x-ray or CT imaging beforehand? Thanks!

A: Forehead horns are congenital frontal eminence developments that have no coorelation to prior forehea trauma. They can be reduced by bone burring  and whether they can be fully reduced is a function oif the bone thickness. This is the value of the CT scan to make that preoperative determination. Access to do the procedure can be done using a limited frontal hairline incision. To keep the incision(s) limited it can not be any further back or perpendicular to the hairline as this prohibits the linear access/visibility to do the procedure.  I have not yet seen bony forehead horn regrowth nore would expect that to occur.

Local anesthesia is not an option for me to perform it. Patients that need that technique will need to seek out other surgeons who may be willing to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does scapula reduction reduce the length of the shoulders ? Does scapula reduction have any effect on shoulder width?

A: It does not. It is done to reduce the prominence of the scapular spine. It has no effect on shoulder width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. I have a facial artery on the left side near the corner of my mouth that is visibly protruding and noticeably pulsating. I have seen a vascular doctor on a few appointments and after close examination, ultrasound, and CT Scan, he has concluded that it is indeed a Facial Artery with Prominent Pulsations. It has become socially uncomfortable and is effecting my occupation/employment. Upon research we learned that this specific facial artery condition is something Dr. Eppley has experience with. Thank you

A: This is a classic presentation off a prominent loop of the facial artery its bifurcation point into the lip and nasolabial fold area. Why it occurs is unknown but I have seen and treated a handful of these cases. Successful ligation/loop removal can be done through a small incision directly over it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. Sure to a chronic pain issue, I’ve already lost both my testicles to orchiectomy. Having received the largest saline prosthetics available, I’m still not happy with the size, and would like to “upgrade” to a larger size. Do you offer implant revision surgery to place larger prosthetics? Thanks so much for your time and help

A: If you have the largest saline testicle implant that is only 5.0cms in size. My ultrasoft solid testicle implants can be made any size from 5.5cm to 9.0cms.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Good afternoon. I would be interested in a skull augmentation and reshaping with the use of scalp expanders. Could you tell me how long I need to keep the expanders on so that the skin can be wide enough for the operation? And what are your prices for this operation, including the cost of the implant? Thank you in advance.

A: Most scalp tissue expanders in two stage skull augmentation procedures are in place from 6 to 8 weeks.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I’m interested in calf implants to straighten my legs . How does the procedure work and any side effects?

A: Calf implants make the calf muscles look bigger but I am not aware that would necessarily make the legs look straighter. I would need to see some leg pictures and do some imaging to see if that makes the legs look straighter.  I can see that it might but imaging will prove if that is an actual aesthetic effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon.