Your Questions

Q: Dr. Eppley,Hello there I’m interested in a possible rib removal surgery. I have some questions. Can you estimate how much smaller my waist would be? I have Xrays I can provide as well so you can see ribs. I am unsure if I should just do t11/12 ribs or do t10 as well. Does removing t10 have any long term effects on respiration and lung function? Can I have the ribs removed without removing any of my lats? I’m a bodybuilder.

I feel as though my anatomy of narrower hips and a wider rib cage does not give me the tiny waist I’m looking for. Your work is amazing and I’m excited to hear from you.

A:Thank you for your inquiry and sending by your pictures and x-rays. Having done rib removals in body builders before I can make the following comments:

1) I have attached some prediction imaging of the result that I think is possible in you. Lean patients always get the best results but the concept of a ‘tiny waist’ is subject to personal interpretation.

2) The decision between taking 11/12 or 10/11/12 is really a question of the location and extent of the surgical scar to do either one. (Type 1 vs Type 2 rib removals) Type 2 is always better but the scar is longer and more vertical to do so. There are no adverse effects on lung function or respiration.

3) I would definitely take some LD muscle as it improves the result. It has no negative effect on LD muscle function or body building.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, is temporal reduction surgery life-threatening? Is it true that after it someone has a headache forever?

A:There is nothing life threatening about temporal reduction surgery. It is as safe as any other aesthetic surgery. No patient has ever experienced long term headaches after the surgery in the hundreds of patients I have done. So no that assertion about chronic headache is not true nor does it have a biologic basis for it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,Sir my brow bones have continued to grow and are very large. What is the reason and treatment of this disorder?

A:You have very over developed frontal sinuses. It is the frontal sinuses that make up in the inner half of the most prominent part of the brow bones. Some men do naturally develop very string brow bones . Why this occurs is usually not known unless one has a growth hormone excess due to a pituitary tumor. As an adult if the brow bones appear to be continuing to grow, along with other facial bone growths, then you should be assessed for a pituitary tumor. But if the brow bones are large but stable in size then you simply have idiopathic or naturally strong brow bone development.

The treatment for reducing brow bone size is a surgical procedure known as bone flap setback. If I had a side view picture of you I could show you the type of reductive change possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi – I am interested in getting a sliding genioplasty to address my weak chin. At this point, I really don’t want Jaw Surgery. I want to understand if I am a good candidate for a genioplasty. I can also send some scans if needed as well.Thanks

A:Anyone can have a sliding genioplasty for their chin augmentation of they desire…that is not the question. The more pertinent question is what type of chin augmentation change can one expect. The first thing to appreciate is that your horizontal chin deficiency is in the 25 to 30mm range. Thus ideally you would need lower jaw advancement with a sliding genioplasty to get the ideal/best result. If you eliminate the jaw surgery then you have to rely on the maximal amount of bone movement a sliding genioplasty can do, which is probably in the 16 to 18mm range. While this would produce a good improvement it is not going to be the same as the ideal chin projection. Thus you are a good candidate for a sliding genioplasty as long as you understand what it can and can not achieve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to order just the design of the implants from you? I would like a design similar to the one you featured in your article (https://exploreplasticsurgery.com/plastic-surgery-case-study-large-custom-infraorbital-malar-implants-in-a-male/), but customized to my dimensions. How much would this cost?

A: I believe your question may be can I get implants designed and made by you and then have them sent to you to have them surgically  implanted elsewhere. If that is the correct question Then the answer is yes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was born with a disproportionate facial structure where my head size overall is rather small but my forehead on the larger side. Complimentary to the larger vertical size, i think that, because my forehead sticks out (vertical slope, no incline) it amplifies the forehead too much.

My desired look would be something like when i raise my eyebrows to their fullest. Could such a look be achieved ?

Thank you in advance.

A: Thank you for your inquiry and sending your pictures. I am assuming that the lifted eyebrow maneuver is to simulate the reduced distance between the eyebrows and the frontal hairline…as opposed to a true eyebrow lift. Estimating that eyebrow lift to create no more than 10mms of decreased  brow-hairline distance I believe that is a realistic outcome/result. With that exposure the frontal bossing  can be concurrently reduced.

With the question of an achievable result out of the way the only remaining question is the acceptability of the frontal hairline scar to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I have Perioral mounds corner of my mouth on both sides. It really effect my confidence and self esteem I would like to know more about this treatment and would like to proceed further

A: While micro liposuction is an effective and only treatment for perioral mounds this is not a surgery I do as a solitary procedure due to its limited scope.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I am a 33 year old female year old who about two or three years ago,I noticed that I started having a lot of facial pain and that my eye was sinking in on the right side of my face. My cheekbones on that side flattened as well. I have been trying to manage this with fillers but believe that I may have a mild case of Parry Romberg syndrome. I don’t have significant tissue loss but it’s enough that it is noticeable and I plan to see a neurologist and try to get some scans. In either case I feel I could be a candidate for an orbital rim implant. Am I a good candidate for this surgery?

A: With the spontaneous change in infraorbital-malar fullness it is reasonable to suspect PRS as a possibility. If the problem is active/progressive fat injections would be the appropriate as a temporizing effect. If the contour change has stabilized then an implant would be an acceptable approach.

Usually in these cases a custom implant is the preferred approach. At the least a 3D CT scan is needed to determine the extent of the bony infraorbital-malar asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I need a skull graft operation (frontal cranioplasty) or frontal cranial bone reshaping.

I had previously been in an accident that led to the fracture of the frontal skull bones. I had the skull patched with a 3D print (peek), but it became higher than the original skull bone, so I needed to either sculpt or file the existing impression so that it was equal to the frontal skull bones, or replace the current impression.

A: In theory the existing frontal skull implant should be able to be burred down. But because it is a PEEK material this is an incredibly firm material so its intraoperative reduction can noi be assured.

Given its custom design and the obvious over correction/protrusion I am suspicious that this was originally a partial thickness bone defect. This makes the use of a material like PEEK ill advised since it simply can not be made very thin. It is more indicated in full thickness skull defect swhich requite thicker implant thicknesses.

I would need to see the implant design file which will show the original skull contour deformity so I can advise a more appropriate frontal skull contouring method.  (either bone cements or a different implant material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 32-yo male  looking for a custom jaw implant. I have a preliminary proposal from a NYC-based surgeon but am uncertain around the proposed design and his skill level. Dr. Eppley is highly experienced and I’d like to consult with him about what he thinks, including about having him do the surgery (scheduled for December).

Here is the morph they made me, attached.  I’m very focused on “fixing” the jawline from the side profile, like the first and third picture.  My mandibular angle is too flat – almost like a congenital condition – so that is what I want fixed and that is my key concern.  I don’t think I need much width and only want a tiny amount of new width, at most.

A: You would be astutely correct based on that imaged goal. When you add vertical length to the jaw angles you will by definition add width without even trying. Thus if the goal is minimal jaw angle width with vertical lengthening/reshaping, the custom jaw angle implant width should be minimized …like no more than 3mms. It is very easy to make the face look too heavy from the front view with the creation of lower aw angle even though the jaw angles may look great from the oblique and side view.  This third dimension (front view)  must always be factored into any jaw angle implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am very close to arranging appointment for mandibular implant surgery. A consultation would be very helpful. Beforehand, could you please help me understand the difference between the vertical mandibular implants and the lateral implants. I am not sure which would suit me better. As photos show, I have a narrow face. I want a more chiselled, masculine look but want to avoid the bulkiness or full cheeked look that can sometimes be a result of jaw implants.

A: Based on this one picture alone I would suspect that you only need widening jaw angle implants. Buit a more informed opinion would require additional face pictures from the side and oblique views along with some imaging done to look at these potential changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The procedure I had done was facial feminization surgery. I didn’t like the jaw and chin portion. I have post (initial plastic surgeon never gave me the before scans) CT scans of sliding genioplasty and Vline jaw contouring. The iover aggressive work left me with a sagging face along with chin ptosis. I went to another plastic surgeon who did a deep plane facelift to address the sagging. I’d like to see what can be done to correct over aggressive jaw and chin work.

A: Having seen a lot of V line surgery that is a very unusual angle in which the entire jaw angle was removed but the body of the mandible remains. In essence the bone cut was angled way back. So I would have expected significant soft tissue sagging and a disconnect between the angle, body and chin mandibular segments.

Restoration of some or part of the jaw angles and chin can be done and the restoration goal would be what makes the bone look more normal as opposed to what the original bone looked like since we will never known what that was.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Dr. Epply mentioned he removes the outer third of the ribs. Is there a way to request a more aggressive resection? Half or most of the ribs?  Has he done this on trans patients?”

A: 2/3s of the patients that have rib removals are transfemales in my experience.

There is no aesthetic benefit to taking more rib length and the risks of complications increases. The only part of the rib that affects the sides of the waistline and torso is what lies lateral or beyond the outer border of the erecvtor spinae muscle.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, – I’m also looking at doing a hair transplant will this be a problem or how long time should there be in between those procedures

Noticed first time when I was about 21 now 37 it has grown a bit too much for my liking.

A: Given where the occipital knob is located and how the surgery is done I don’t see much of a need for a large gap, either before or after, a hair transplantation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Since I have chin filler present that I opine would block placement of a chin placement, would it not then be necessary to use hyaluronidase?

A: Fillers do not block placement of any implant so dissolving the filler is not an absolute necessity….and thus I don’t routinuely have it done. But there never is any harm in doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a couple of questions regarding the torso narrowing procedure performed by Dr. Eppley.

Is the surgery suitable for trans women?

How many inches will the thorax lose in circumference?

A: 2/3s of the patients who  undergo rib removal surgery are transfemales. (Type 2 Rib Removals)

I don’t think of rib removal surgery results as in circumferential inches reduction. It is more accurate tuse body pictures to show the typical results that can be expected.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, does the combination of temporalis muscle reduction and forehead implant reduce the possible need for an scalp expander (compared to only doing a forehead implant)? Thanks in advance.

A: If scalp expansion is really needed temporal reduction will not create enough scalp looseness to avoid it.

I have never seen a situation where a forehead implant ever needed scalp expansion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Usually, when smiling, the blue line in the image is very short and the lips appear to be in approximately the same position. However, since I am Class II, my chin is receding and the blue line is longer. Would this be possible to try genioplasty, labiomental sulcus filler, etc. to shorten the blue line even a little?

A: No form of chin surgery can change the position of the lower lip, either at rest or in dynamic motion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  have a bone spur,or piece of bone sticking out the back of my head it causes headaches , it hurt, and it stings been dealing with this most my life , and I never new there’s a alternative for this.

A: The spur on the back of the head to which you refer is known as an occipital knob and can have a sharp edge to it. While usually asymptomatic it can occasionally be a source of chronic discomfort. It can be removed in a straightforward surgical procedure done as an outpatient.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I need some advice from someone experienced with chin implants. I have had two failed surgeries in 7 months. Now I need a third one. I prefer if that is the last one.

I have been looking at Implantech for the third surgery. The one my norwegian doctor used is sebbin:

 My face was “long enough” as it was. I didn’t want any downward projection of the chin implant. I wanted forward projection. As Dr Eppley will see from the CT scans. Its the opposite of what I am after. Now its a lot of downward projection. An not much forward. This is due to the wrong placement downward and also that it has be sinking down after surgery as well. I prefer not below my own original chin at all if that is possible. Which implant would be best for me is the quest here.

My surgeon for the first two surgeries would be very happy to join med on a call 

A: As your scan clearly shows this is an implant placement problem not an implant style-size problem. It doesn’t matter what the chin implant is if it can not be placed properly.

I do not talk to surgeons to teach them how to handle their complications, that is not my responsibility nor what I am willing to do.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My right eye brow bone is getting a little larger than normal I feel like the bone has grown a little and I feel pressure between my eye brows all the time so if there is a doctor or a way to help this would be a lot.

A: You should have a 3D CT scan to evaluate the fractured brow bone area to see if it is really bone overgrowth or just scar tissue/nerve injury.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a couple questions about my eye area:

1. The first two pictures show my current eye area completely relaxed. Do I have ptosis of the upper or lower eyelid? If not, would ptosis surgery or any other procedure work to lift my lower or upper eyelids a bit?

2. One of my desired outcomes is moving the inner corners of my eyes a couple millimeters inward, as shown in picture 3 as a slight morph of the second picture. I notice I get this result when I pull very slightly with my fingers inward, and the eyelids still remain attached to the eyeball. This makes me think I have loose skin or medial canthal tendons. I have seen mixed opinions online, and you stated in a post that this would be difficult to achieve without risking scarring. Suppose we didn’t really care about scarring. I have seen procedures designed to achieve this effect, such as C-U plasty (picture 4), which cuts the medial canthal tendon and moves one end inward, as shown in picture 6, and W-V plasty, which simply removes some skin to tighten the area. These generally are designed to correct telecanthus. Would one of these procedures, or any other ones that tighten skin or the tendons, realistically work for my case?

A:In answer to your eye reshaping questions:

1)Do you have true ptosis….not really. Maybe a 1mm. But one does not have to have true ptosis to have ptosis (upper lid elevation) surgery.

2) Lengthening the inner eye corner towards the nose is not done by any medial canthal tendon surgery or any of the procedural diagrams which you shown. (those are for webbing/hypertelorism surgeries) It is done  by a tissue rearrangement technique known as a Y-V lengthening surgery. This has more favorable scar formation than its cousin, V-Y narrowing.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to get the rib removal done, I’m wondering if I’m a good candidate and if I’d be one of those patients that would have a dramatic difference or subtle difference. I’ve looked into getting a BBL but I’m hoping maybe a rib removal will slim my waist enough where I wouldn’t care to enlarge my hips. My waist currently is about 25in and my hips are about 33/34. I would like my waist to go down closer to a 21/22 so wondering if that’s possible with my anatomy. 

A:Thank you for your inquiry and sending your pictures. Your question is a good one in that with your body type (tall and thin but with a vertically long buttocks) you could go either direction of a BBL or rib removal. I don’t think either one is a bad choice. Whether rib removal results are subtle or dramatic is open to personal interpretation. But what I can say is the following: 1) Dio I think your waistline results will drop from 25″ to 21″… no (tall and thin patients do get the best results but that would be expected too much in my experience) and 2) an expected change in your waistline shape I have shown in the attached image prediction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a 42yo Male to Female Transgender Person. Im intrested in your Scrotoplasty. Do you also offer Orchiectomy Surgery ? As atm im using Androcur as a Testosteron Blocker.

A:Testicle removal can be done with scrotoplasty although if the eventual goal is to have SRS (sexual reassignment surgery) then this procedure would be unnecessary. The transfemale that may be considering such a scrotoplasty usually is not progressing onward to SRS.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My head big size 61 sm. Can it be reduced?

A: The question is not whether it can be reduced but whether it can be done enough to justify your efforts and goal. In reality skull reduction is best suited for spot area reductions rather than a major overall head size reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello. I have a flat spot located at the parietal area. It is very noticeable to my hairstylists and although it also is not appealing cosmetically I would like to get this looked at by someone as I believe it could be a cause of my migraines. Does your office have the ability to a virtual approx. 30 minute free consultation via Zoom meeting? Is it possible for my severe flat spot on my head to be causing migraines?

A:I am not aware of any association between a flat spot in the skull and migraines. Augmentation of such areas is done for cosmetic purposes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had orthognathic surgery in April to correct jaw misalignment and a pretty serious overbite. I now have hollowness in my midface and some asymmetry of soft tissue between my left and right side of my face, and I am looking to get opinions on which midface implants would be the best option for me.

A:This is a pretty common sequelae post LeFort I, particularly if one had some infraorbital-malar deficiency to start. This is treated in many such cases by a custom infraorbital-malar implant design as per the attached images.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, How safe is the rib removal surgery? I’d it safe to have those ribs removed and gone?

A: Despite its name and misconceptions about the surgery. it is a very safe procedure in experienced hands and very few complications or side effects. (an occasional self-resolving seroma is the only ‘complication’ I have ever seen. It is far fewer side effects and risks compared to more well known body contouring procedures such as tummy tucks and BBL surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to tell just based on the photos I sent earlier alongside these pics of my design if the implant can be totally camouflaged with those techniques as well as perhaps with a midface lift? I notice when I simulate one it improves not only my nasolabial folds (which seem to have gotten more pronounced after this implant was installed in addition to the double jaw surgery I had at the same time which included 8 degrees CCW and 2mm impaction) but also improves the step off beneath the implant. The upper portion of the infraorbital contour is still visible though.

 If I opt to have the implant removed, do you think I would experience midface sagging based on the design shape and my anatomy? I am 27yo for reference.

A: A midface lift has zero chance of making any improvement in the visible outlines of these implants. Lifting with your fingers is not replicative of what will happen from a midface lift in a young person with otherwise taut skin.

Camouflaging implant edges comes from volume addition.

The question is not whether you will have tissue sagging after implant removals, as you will, the more pertinent question is how significant it will be and whether the sagging is a better aesthetic problem than that of the implant show.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello is there a procedure to make the chin less prominent and not make the smile look so “forced”? I don’t want that under bite look. I got cheek filler and it looked how I wanted.

A: I could see how cheek implants would make the chin look less prominent as it helps ‘pull out the midface above it. Fillers a good test to see if that effect is a positive one which clearly it was. You might also combine those with paranasal implants to enhance the midface augmentation effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon