Your Questions
Your Questions
Q: Dr. Eppley, I hope your well. I am writing to you in regards to having a few questions about custom forehead, temporal widening implant as I am interested in getting this procedure done .
Lastly, I would love to see some before and after pictures to get a better understanding of what I could expect.
A: You are going to find it very hard to find any before and after pictures due to patient confidentiality. Most young people, who make up the majority of custom facial implant patients, are exquisitely sensitized of having their face shown in any capacity…..most likely how you might feel as well.
But in designing custom forehead-temporal implants what results other patients have is not all thaf relevant since every custom design is unique in its shape and thicknesses based on the patient’s aesthetic desires. Such implant designs are based on initially doing imaging of the patient’s pictures to determine their specific aesthetic goals. (known as setting the target) That is how you find out what the aesthetic outcome may be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a couple of questions regarding clavicle lengthening surgery.
Firstly, it appears on your social media that clavicle shortening* is far more prevalent? Is there a reason for this? Are there additional cases of lengthening that can be shared or perhaps a follow up photo of the bodybuilder from your article https://exploreplasticsurgery.com/plastic-surgery-case-study-shoulder-widening-by-clavicle-lengthening-in-a-muscular-male/
Secondly my question is regarding the procedure itself. I’m happy to see that you offer a sagittal split cut for increased stability and thickness. As surgeons often use ground cow bone powder for grafting purposes in surgery, I would like to know if it is possible to use human bone as a solid graft for the same purpose? For example in the saggital split, the two gaps created need to be filled with bone putty. It is possible to completely clean out a donated piece of clavicle from another human for the purposes of placing this in the gap instead of bone putty? This would act to physically prevent relapse/the clavicles sliding backwards and presumable be far more stable than putty.
If this is the case, then can the same graft be applied to a single osteotomy in the middle of the clavicle as opposed to a saggital cut?
Thank you and kind regards,
A: In answer to your clavicle lengthening questions:
1) Clavicle reductions are performed in far greater numbers because there is a greater medical need as well as being a surgery that is more effective and with a much lower risk of complications.
2) As for grafting the bone defects in the lengthened clavicle bone demineralized human bone particles is the most common graft material used in my experience. Other options include human cadaveric corticocancellous blocks as well as the patient’s own bone.
3) The reality is that clavicle lengthening has two distinct features that make it far more problematiic than clavicle shortenng in my experience. First to lengthen the clavicle you have to push out all of the shoulder soft tissue aftachments so the bone can lengthen. This not only is not easy but limiting in the lengthening amount possible. While clavicle reductions can easily shorten the bone 2.5cms or greater per side the maximum lengthening is around 1.5cms per side. Secondly, and a major issue, is that in the lengthened clavicle the shoulder soft tissues act like a fulcrum pushing down across the osteotomy site…often bending even a 3.5mm rigid plate. In short the biomechanical forces applied to the clavicle bone are very different between lengthening vs shortening.
3) Compared to the issues in #3, the choice of bone graft is the least important element in the whole clavicle lengthening process. If the expanded bone can not be maintained structurally stable in the short term the long term effects of the different types of bone grafts are irrelevant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Thank you very much for your reply, and for taking the time to do the imaging! After investigating the matter in greater depth, and taking into account your feedback and the imaging, here are some thoughts that may help to advance the discussion:
– It would appear that the lack of “strength” I perceive is a result of jaws that are a bit recessed, although not to a degree where they have caused any problems that I am aware of. However, since the issue is merely aesthetic, I question the wisdom of undergoing an aggressive treatment like DJS.
– I believe that chin projection is okay as it is and that moving it further forward would not provide an aesthetic benefit.
– Similarly, I don’t have a problem with the width of my jaw and feel that increasing it would change my face more than I would like.
– The main goal is, I believe, to moderately increase the height of the chin and the entire jawline. I originally considered a genioplasty to augment ching height but discarded it for two reasons. The first one is that I’ve been told that it leaves a step in the jawline which can be visible and certainly felt. The second is that it would give the appearance of a longer/narrower face, which is something I would not like.
– My conclusion so far is that I seem to be seeking a result along the lines of what could be achieved with a chin wing procedure that only adds height, without any forward movement. Would you agree with this, based on the previous comments? Is this something that Dr Eppley performs, or is it something that can be replicated through customized implants?
Again, thank you very much for your help, and hope to hear your thoughts.
A: I think we both agree that vertical jawline lengthening is the correct aesthetic goal to which there are 3 ways to try and achieve it with varying effects along the length of the jawline:
Vertical Bony Chin Lengthening – affects chin area only (a 1/3 jawline augmentation procedure)
Chin Wing Osteotomy – affects chin and body of mandible (a 2/3s jawline augmentation procedure)
Custom Jawline Implant – affects the total jawline from chin to jaw angles.
With that understanding the chin wing is a good procedure as long as you understand it will have no lengthening effect on the jaw angles. Once you understand where the osteotomy line is (see attached) it becomes clear it provides no improvement at the jaw angles and its effect fades as one moves back from the chin. In essence it is a 1/2 or 2/3s jaw lengthening procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was curious about shoulder reduction surgery. I live in Australia, and I am not a US citizen. I was wondering about the logistics with having it done via traveling to America.
A: I have had many patients from Australia over the years including patients for shoulder reduction so this is not novel to my practice. But whether from the U.S. or around the world the key element in shoulder reduction surgery is immediate postoperative management and how soon one could go home….with the goal of getting you home as soon as possible so you can complete your recovery is a more familiar setting and support. This will vary a bit per patient based on where one lives and whether one is coming alone or with someone. We help you think this through and plan accordingly way before the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello..I’m looking for a permanent fix for my nasolabial folds. I was considering an implant to this area. What are suggestions or recommendations?
Thank you
A: Nasolabial folds like yours are very difficult to fix because they are largely a soft tissue overhang issue which is somewhat magnified by your flatter midface projection. (although only minimally so) Nasal base implants can help the very upper part of the fold by the nostril but will do nothing else for the majority of it below that level. Thus I don’t see implants of being much value in your case as the deepest areas with the most overhang tissue overhang is at the bottom ½ of the fold. With an inverted V shape to it the only effective approach is going to be a lower facelift/jowl tuckup to move the soft tissues back away from the fold to lessen its depth.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if 9 years old is too young to do surgery? My son definitely has flattening of the back of his head with one side being worse than the other. I brought it up many times to his Pediatrician when he was a baby and they said it would correct itself overtime, which it never did.
My son hasn’t complained too much since he is still young, but I definitely think he will be more self conscious as he gets older. I am just wondering what the best time is to get surgery to try and correct the problem. Thank you so much for any information you can provide.
A: Such custom skull implant surgery is not done until the skull growth is more fully developed, usually after piuberty around age 16 at the earliest.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty over 10 years ago and suffer from nerve damage in my whole lower face. Numbness tingling etc. Is there any treatment options for this?
A: That would depend on where the osteotomy cuts are relative to the mental nerve foramen. A panorex x-ray wouild be helpful in that regard. But at 10 years after the event improvement is not likely.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi i’m looking for a solution. Please see attached video. I had double jaw surgery to close open bite 8mm one side 5mm the other lower jaw. Top jaw inpacted down and now I can’t close my mouth at rest without real force and it pulling my bottom lip down.
A: While there are some moderately effective surgeries for lower lip incompetence, the operative words are ‘moderately effective.’ When trying to get 1 cm of lower lip elevation that would classify as an extremely effective procedure which does not exist in lip incompetence surgery. In your case the maxillary downfracture (lengthening) is the real culprit and I don’t see anything done to the lower lip as really overcoming that facial lengthening effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I have thin wrists. Is there a way to increase my wrist size? Increasing the size of my wrist bones? Or injecting fat?
A: Injecting fat into the wrists (distal forearms) does not work, it wlll quickly be absorbed. Implants are the only option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m interested in the forehead horn reduction surgery but I have a few questions.
What is the cost of procedure? Is the incision made within hair line? Does incision cause hair loss? Does the scar heal to the point where it’s not noticeable on darker skin tones? Living out of state, how long would I have to be in Indiana for the whole process?
A:In answer to your forehead horn reduction surgery questions:
1) The incision(s) can be made at or just behind the frontal hairline.
2) The incision does not cause hair loss.
3) Patients have never reported to me that they thought their scars were noticeable, regardless of their skin pigment.
4) Less than 48 hours. Come in surgery, go home the next day.
5_ To provide accurate cost of surgery quotes I would need to see some pictures of your forehead.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I currently have Medpor jaw & chin implants, I’m getting them removed next month. I had them installed 2 years ago. The reason I’m getting them removed is because I am starting to develop sleep apnea & need double jaw surgery however the surgeon I am going to told me that the implants must be removed first. Will I suffer any bone loss or complications from implant removal?
A: I can not provide a qualified answer based on a description alone without any knowledge of your implants or their history…nor should I. These are questions that are best answered by the surgeon who is going to do the actual procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been reading many of your articles on exploreplasticsurgery.com on jaw angle implants and jawline implants. The information on bony overgrowth and tissue ingrowth has been helpful.
I recently got custom jaw angle implants in the Medpor material in late September. While I am still healing, I can tell that the implant on one side is displaced, and I wish to get it revised. Do you think a revision surgery 6-12 months after the original surgery will present problems with tissue ingrowth or bony overgrowth? Or will those features take longer to manifest? I will consult with the original surgeon soon about a revision surgery. If I feel that the surgeon’s plan for revision is insufficient, I may consult your clinic in the future about a removal.
Thank you very much for your time.
A:Given the nature of Medpor material with tissue ingrowth and a high probability of bony overgrowth, if an implant revision is needed it is better to do it sooner rather than later as it is going to be more difficult and less predictable. Later is 6 to 12 months after their initial placement.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I am 40 yrs old and since birth I have aproblem with having a bigger head. My problem is that the skull is too wide and I had a lot of problems from other kids and even now it is problem to have some relationship with girl. I am looking for procedure like this for years, but previously these operations were not possible.
Would it be please possible to reduce the size of my skull, mainly in the area above ears, where the head is too wide and I have long time depression due to it. I am also quite small (only 170cm and 50kg), so the size of my head is much more noticable. Is it possible to help me somewhat please??
A:I believe you are referring to the Temporal Reduction procedure in which muscle is removed from the side of the head not bone. The temporal bone is too thin for its reduction to have any visible effect. (less than 5mms) While the posterior temporal muscle is quire thick above the ears (up to 10mms) and can be removed in its entirety without adverse functional effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Hello there. I read that you removed 6 ribs on Pixee Fox. I just want to ask, if you can operate on an ongoing rib after injury, when I was a child? Or remove it entirely? For some reason the rib is getting wors, pushing my organs. It’s the rib right next to the heart/left nipple. Also, if possible, can you send me some informations about the procedure? Prices, consequence, things that are no longer possible/allowed to do etc.? It’s not because I want to, but I have no choice, if not removed, the consequences are far worser. Also, I am having big troubles with it, when I exercise, just sit in front of the PC, constant pushing etc. It’s life devastating at this point. I can send you pictures of my case?
A:It would strike me that you are referring to a subtotal removal of the problematic rib. It would be important to determine the exact rib location and its deformed shape before removing it. This is best done with a 3D chest CT scan which shows the ribcage in beautiful detail. With the description of your concerns the location of the deformed rib should be readily apparent in such a scan.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have 1050cc breast implants currently and am wanting to go larger, preferably 2000cc + if possible.
A: I assume that your existing 1050cc volume implants are 800cc saline implants overfilled to 1050ccs. The key questions in increasing their size are:
- Can you just fill the implants you have with more volume or do you need new implants?
- How much more much volume can your breast tissues immediately stretch to accommodate? As a general rule 50% over the original volume is what can be done. Whether more than that is possible can not be known until doing it in surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My surgeon wants to do midface / malar implants as well as jaw angle implants during jaw surgery.
Do you think the smartest choice is to get the jaw surgery first then assess from there how much augmentation I need and where? I hear some people say you should do them separately since you can’t predict soft tissue changes. Especially with the angle implants, I risk the uncanny look.
Thank you so much for your help!
A:Between the increased risk of implant infection and the unknowing of what your exact implant needs are I would never put the two together. Reassess the augmentation needs 3 to 6 months after the double jaw surgery…that is the prudent choice. Never confuse can you do it with whether you should do it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Recently I have been going through older photos and realized my midface is completely sinked in compared to when I was younger. This is shocking because I’m only 21. My cheeks were more pronounced and my scleral show was less prominent. I look very haggard for my age as a result. Could there be any reason for this? I’ve attached a collage below, the top left being me now and the others being when I was younger. I am very insecure about my appearance as a result.
A:The explanation is simple…growth and development. As the lower jaw and the dentoalveolar processes only fully develop in the late teenage and early adult years the once fuller midface now becomes recessive by comparison. That and losing some midface fat from testosterone effects. Your face has now become what it is genetically programmed to be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in forearm implants. I previously had a fat transfer to my wrist areas that did not work.
A:While fat grafting to the wrist (technically the distal forearm) was reasonable to initially try I have never seen it work there as there is little subcutaneous fat to help it survive. Technically you are referring to wrist (distal forearm)and not proximal forearm implants. That is more than a semantic difference. Proximal forearm implants are in the upper 2/3s of the forearm and are muscle type implants that are under somewhat thicker tissues and are not exposed to wrist join movements. Distal forearm or wrist implants are subcutaneous implants placed right under the skin, the tissue cover is very thin and they are exposed to flexion and extension movements of the wrists and hands. The point being is the proximal forearm is a better implant location in terms of potential postoperative problems than the distal forearm closer to the wrist. That being said distal forearm implants can be done with the understanding that they can come up to but not cross the bony bump closer to the wrist which are the ends of the ulna laterally and the radius bones medially. (see attached image, red arrows) Whether one or both sides need to be done (in green) is up for discussion. Such implants are made using a moulage or measurement technique to create their computer designs.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to get more information on the CVG (cutis verticis gyrata) Can Foperation the doctor performed on the scalp using fat that was harvested from the body, was it successful at adding volume to the lines of the cvg and what side effects did the patient get? I have some lines and was wondering if this operation would be successful, if you can message me back at me email for more information I would greatly appreciate it.
A:Fat injection grafting works best in mild CVG where the linear lines are not deep and inverted depressions…like yours. It does help soften them but doesn’t completely eliminate them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting a custom midface implant to try and project my maxilla more, but will this implant alone not cause my upper jaw to appear more forward then my lower jaw causing and unattractive look. If this would happen what other treatment could I do along with this in other to even out the appearance.Thank you very much
A:I am confused by your question. By definition a custom midface implant is done for its aesthetic effect of increasing midface projection not for its maxillary protective effect. Thus it will make the midface (not the lower dentoalveolar area most anatomically accurately called the upper jaw) to have more fullness. That issue aside how increasing midface projection will affect the balance of your face is best determined by doing so initially computer imaging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had Double Jaw Surgery three years ago and was very happy with the results. But as swelling went down, the HA paste turned out to not add much augmentation at all to my gonial angle/jaw width/cheeks. Two years laterI had a custom wraparound implant and infraorbital implants done and then a revision shortly after to fix a chin asymmetry and protruding infraorbital implant on my right side (you could see it sticking up a bit on my skin).
I’m unsure if I like the level of anterior projection in my cheeks from the infraorbital implant and wish I had more lateral/zygote projection.
However, the main issues are, essentially, asymmetries in the chin and possibly too much augmentation (my chin passes the line of congruence with my bite). As well as fixing the visible/palpable stepoff in the right infraorbital implant.I was told by my surgeon that a revision would be further sculpting the already-placed implants but I’m wondering if remaking them would lead to a more “perfect” result.
One major difficulty of my implant surgery was the HA paste from my double jaw surgery–he had to scrape it off to try and get the implants to fit flat and said it was one of the toughest implant surgeries he’s had to do. And also that my right infraorbital issue is because it’s sitting on top of a plate from my double jaw surgery..
I’m looking to get a different opinion and inquire if you would have any suggestions for me and possibly having a revisional surgery done.
A: In reading your inquiry I can make the following comments:
- I would be very cautious about the pursuit of perfection in facial augmentation results, particularly when it involves implants. You have already learned some valuable lessons from your prior surgeries….each surgery leads to its own unique set of postoperative issues. The closer you get get to good the more relevant these tradeoffs become. (risk vs benefit ratio)
- You have chosen an implant material, which while reversible, is very traumatic to the tissues to remove…much more so than putting it in. That has great relevance in the risk vs benefit ratio consideration.
- Without even reviewing any information on your case my initial response is to fix the most obvious problems (chin projection and right IOM implant) and accept that result as it is once that is completed. That is the most obvious path to concluding your facial surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Recently, a plastic surgeon noted that my frenulum was attached and performed a surgical procedure to release it. While it did improve my gummy smile slightly, unfortunately, it exacerbated my double lip issue. I currently reside in Tampa, Florida, and have been diligently researching experienced plastic surgeons who specialize in this procedure. During my search, I came across your website and was impressed by your expertise.
I’m a healthy individual, and although this deformity has bothered me for some time, I’m understandably concerned about the potential risks of further intervention. However, I’m determined to find a solution and would like to schedule an appointment as soon as possible to discuss the best course of action.
Thank you for your attention to my inquiry.
A:The interesting aspect of your double upper lip is that you have a significant gummy smile with it. And by your own history release of the maxillary frenulum (which is not an effective treatment for a gummy smile) further exposed an already present double lip. This poses a treatment dilemma as should just the double lip be treated (which may make the gummy smile worse), should the gummy smile be treated (which may not fully correct the double lip) or should both be treated concurrently. My suspicion is that the latter applies through a lowering vestibuloplasty technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I currently have braces and will be widening my mouth. I am looking to get the double jaw surgery to move my mandible and maxilla forward and then eventually getting implants to widen my face. Can you ask Dr.Eppley if he would be able to apply the implants after I get the surgery done? Also what implants would Dr.Eppley use to widen my face. I think I can cover my small head with hair but would definitely like to widen my face and make it bigger. My face is not far from square shaped so I would like to get a square shaped in my lower face but not anything that looks too unnatural.
A :Implants can be done after double jaw surgery in which custom cheek-arch and jawline implants are needed to do so. This is a fairly common request after double jaw surgery to maximize the aesthetic facial outcome.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,Thanks for getting back to me. I had scalp reduction surgery back in April which improved my condition somewhat. I still have some wrinkled and I’d like to see of I can get a smoother appearance through fat grafting. I wanted to wait about a year to let my scalp really heal before trying other treatments. Here are some pictures where you can see the improvement. I’m currently in South Korea on an international assignment but at some point I’d like to consult with you to determine if fat grafting can improve my condition. My timeline would be April 2024.
Please let me know if you think I’d be a good candidate for fat grafting.
A: Given the prior scalp reduction for your CVG fat grafting would be a reasonable option now. You don’t have any hair follicles of concerns (given that you shave your head) so there is no risk of affecting hair growth from the fat injections.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am wondering if theres a specific procedure to get more of a ”hooded” eye look. I will attach two images, one of my eyes and one pic of what I mean by hooded eyes.
Let’s say I want to have a result in the middle between what my eyes look right now and the hooding on the second pic, so not 100% as hooded as the second picture but more like 60%. Would that be possible and what procedure would you recommend that is not too invasive?
Thank you for your time and I am looking forward for your reply.
A:The difference in shape between your upper eyes and that of your example is that you have a retracted supratarsal sulcus. (v profile shape compared to the hooded eye which has no sulcus and more skin) Since you can’t add skin the approach has to be to make the supratarsal sulcus less deep by volume. This could be done by synthetic fillers, fat injections, dermal-fat grafts and/or infrabrow implants. It is not clear which one of these is the best option since so few procedures like this have been done. Nor is it clear how effective it is on your scale of 0 to 100% of the goal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, about the lengthening limits for clavicle masculinization, the maximum achievable amount is around 25mm, would more lengthening be possible with a second clavicle lengthening surgery later in time ? (for example a year or more)And what would the second lengthening amount be if such a scenario is possible.
Thank you
A:The limits of clavicle lengthening is 15 to 18mms. It is only a clavicle reduction that can be done 25mms or more. Seeing how these lengthening osteotomies heal I do not see doing a second stage osteotomy without a significant risk of non-union.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,From my understanding from other surgeons there are a lot of risks associated with rib removal surgery. After reading the Dr. Eppley’s website, he lays out the case for it being a rather safe procedure. I am a single mother and can’t afford any major complications.
Can you let me know what complications Dr. Eppley’s patients have encountered with rib removal and how or what specifically does he do to mitigate major risks/issues. Has he ever had a deaths doing this procedure? What can or should I be concerned about long-term with removing ribs?
A: I have never encountered one single complication, major or minor yet from rib removal surgery….so it is fair to say it is a safe procedure in the way I do it. I would try to avoid putting much stock into surgeons commenting on the procedure unless they have actually done it. Admitredly it is a procedure, by name, that sounds risky but the reality is that is has far fewer problems than tummy tuck or BBL surgery which are also torso reduction procedures.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I was interested in getting a temporal brow lift. But I also would like to have a custom forehead implant.. so my question is would it be worth getting a brow lift before the implant? Would the implant throw off the dimensions of the browlift.
A:You would not get a browlift before forehead augmentation as that would be a wasted effort. You either do it during the forehead augmentation or wait until after. But before would be the worst timing for it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I’m a 5’6 Trans woman who is interested in clavicle reduction/ overall shoulder narrowing. However, my main question is if you’d be able to reduce the size of my ribcage alongside this procedure?I know you’re able to re-section the lower ribs, but I was hoping you’d be able to reduce the width and overall size of the mid/top ribs too? I just think if that were a possibility, it’d change my life drastically and would go great with the shoulder reduction surgery.I just feel really bulky and large for my height, and I’d love more than anything to have a smaller ribcage.
A: Thank you for your inquiry and sending your pictures. In answer to your ribcage narrowing question, there is no safe method to reduce the overall width of the fixed ribcage above the level of rib 10. If there was a way that it could be done I would be doing it. Unlike the lower ribs the rest of the ribs play an important role in respiration and their circumferential support can not be lost at more than one rib level.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I had double jaw surgery to correct an underbite a few years ago. It improved my facial harmony but I still have facial asymmetry. It seems extreme but from my left side I literally find myself quite handsome, and from my right side I truly despise the way I look. The difference is subtle, but it must be noticeable. The jaw angle is different (and worse) on my right side, as well as my cheekbone is much less pronounced, and nearly flat under the eye on the right. It results in a much worse look on that side. Hopefully the pictures make that clear. I have very noticeable asymmetry from the front as well. I would love to find out what could possibly be done implant-wise on the right side. Thank you sir.
A:In any facial asymmetry, subtle or major, the first step is to get a 3D CT scan of the face to determine the exact bony differences between the two sides. Given that your left facial side is the goal what are the bony differences between the right cheek and jaw angles from the lefgt that makes them asymmetic shape. Between the scan and using mirroring software for implant design this will provide the most accurate asymmetry correction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
