Your Questions

Q: Dr. Eppley, I would like to know Dr Eppleys assessment of the CT scan and if it confirms what we are suspecting, and if based on the CT scan, the planned procedure remains suitable with the expected outcomes we discussed?

A: To clarify common custom implant misconceptions:

1) The 3D CT scan is merely the platform on which aesthetic  implants are designed. The scan does not  tell us what to do, it merely allows a implant design to be built on it for that patient’s anatomy. It would be different if one was treating a facial bone defect or a major facial asymmetry.

2) The imaging of the patient’s pictures alllows for a concept and degree of change to be understood so the aesthetic goals or target can be determined. Making the translation of an aesthetic target to an implant design is a subjective one.

Dr. Barry Eppley

World Renowned Plastic Surgeon

 Q: Dr. Eppley,you said the limitation of clavicle lengthening was the soft tissue. I was wondering if, just like the 2nd leg lengthening surgery I had, the real limitation of my soft tissue length was due to the fascia. Perhaps if the fascia was released, more lengthening could be achieved.

A: The soft tissue limitations in clavicle lengthening is the entire soft tissue and bony mass of the shoudler girdle not just simple fascial restrictions. Unlike limb lengthening which is more of a tubular elongation where the soft tissue restriuctions are linear, clavicle lengthening is more like erecting a tent where the clavicle is a tent pole. The 360 degree weight of the canopy carries far greater limitations on what the push of the comparatively thin clavicle tentpole can do.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Can you create custom facial implants with a 3D MRI scan instead of a CT? Don’t CT-scans increase the risk of cancer? Wouldn’t MRI remove that risk while still providing a 3D model of the skull? Thank you,

A: Custiom facial implants  need to have CT data for implant design. MRIs unfortunately don’t provide good enough bone definition to do so.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Dr. Eppley, Shoulder width reduction: is there a way for the hardware used to not be so palpable and obvious? On a woman, clavicle is delicate and dainty; the bulkiness of the hardware make that surgery seem not so appealing.

A:The fixation hardware used for any form of clavicle reshaping surgery, albeit lengthening or reduction, has to be thick enough to support a heavy load bearing bone with arm motion so that it can properly heal. When it comes to a highly loaded bone, healing supersedes aesthetics. Yes the visibility of the hardware particularly in thin patients is very likely. Although not common patients that are so affected may elect to remove the hardware 9 to 12 months after the original surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Facial customized implants: your workmanship in this area, I believe, is unmatched. However, these implants are intended to be for life. But faces change – our face grows thinner and saggier with age. How do these facial implants age with the patient? It seems the implants do not and, at some point, the patient needs to return to the plastic surgery office to “tweak” their face to match the implants or get the implants removed altogether. Is this true?

A:Custom facial implants are bone based with materials that do not change shape or degrade which means they themselves do not age. It is true that the overlying sogft tissuesmof the face can age on top of them but the reality is patients that are so augmented age much better than those who are not because of the improved bone support. Any secondary surgery that is needed is related more to the management of any aging or sagging soft tissues  not to adjust the implants themselves. Thus the supposition the patients need to have their implants adjusted or remove secondarily due to aging is fallacious. The aging of the face is heavily affected by the bone support that lies underneath it. Those who have better bone structure age much better than those who don’t all other factors being equal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question about pectoral implants for filling a chest gap. As you can see in the picture below, my pectoral muscles insert very widely against my sternum, creating a big gap which I have always been insecure about. I’m wondering if it would be possible to fill this gap with 1 or 2 small implants to lessen the appearance of it, and make my chest look more “connected”. What material would be best for this? Would this have any impact on weight lifting and exercising? I do like to go heavy on bench press so I am worried of potential injury to the muscle.

A:Thank you for your inquiry and sending your pictures. It is amazing what a significant hypertrophy can do to show the true insertion points of the pectoralis major muscle. I believe you are referring to, as shown in the attached arrows on with your picture, to the pectoral insertion deformity or lack thereof near the lower sternum. I have actually seen this before in other types of pectoiral augmentation patients where a very small solid silicone implants has been used to fill-in this lower pectoral valley between the skin and the muscle. The implant design is created by either taking measurements of its height and width dimensions or taking some molding clay to fill-in the area and allow it to harden where it can then be scanned and used as a computer model for the implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a tattoo on the side of my arm that i would love to get removed. I’m assuming skin graft would be needed. Any info helps. Thanks a ton.

A:In large multicolored tattoos the standard treatment approach would be laser treatments. Between the large number of treatments needed and that complete removal of the tattoo may not be possible these are reasons why patients may seek excision and skin grafting. The problem with skin grafting is that the result is not usually what the patient perceives. A skin graft is going to look like a large patch of scarred skin. It will not look like normal skin. While tattoo will be gone this is a significant aesthetic trade-off particularly when you’re looking at the treatment of the tattoo as opposed to any other form of reconstructive surgery. Depending upon the emotional significance of the tattoo this aesthetic trade-off may be worth it for some patients. But if one is under the perception that is going to look like normal skin that would not be an accurate perception of the result.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if you could check if, based on my scans after my clavicle reduction surgery, Dr. Eppley thinks it’s possible to reduce them further now that I’m all healed and stable?

A: That is a good question and I will preface my answer by saying I have never yet done a secondary clavicle reduction surgery. This does not mean it cannot be done, I am just saying I have not yet done it.

I don’t think the question is whether a secondary clavicle reduction can be done but how much more could actually be safely achieved in terms of the clavicle bone removal. In looking at your postoperative x-ray you have a significant size match difference between the  inner and outer clavicle bone egments that have been brought back together. While every clavicle reduction patient has a mismatch between the sizes of the two bone ends  yours is particularly impressive. While we assume that has gone on to successfully healing, and this is where a long-term postoperative x-ray would be helpful, the very relevant question is if that size mismatch is challenged again would it go on to successful healing like it did the first time. That is the gamble that we take and I am fairly certain the risks of a nonunion the second time would definitely be higher than the first time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I would like to inquire about options for fixing my mental crease/deep labiomental fold.

My chin is further back but I have a deep chin crease and I e read it can make the crease worse. I would be happy if I could at least smooth out my chin

My chin is further back but I have a deep chin crease and I read an implant can make the crease worse. I would be happy if I could at least smooth out my chin.

A:Thank you for your inquiry and sending your pictures. Your deep labiomental fold is really a symptom of having a vertically short chin. This makes the soft tissue chin pad compressed and deepens the fold area between the lower lip and soft tissue chin pad. This also makes the submental area look Fuller when you really don’t have significant submental fat. You are correct in that a chin implant is only going to worsen depth of the fold and the chin appearance a standard chin implants only provide horizontal augmentation which is not the chin dimensional change you need.

You need your chin to be vertically lengthened 5 – 7 mm which will soften the depth of the labiomental fold and produce a more proportionate lower third of your face to what lies above it. This will also remedy any concerns about submental fullness. This is done by an intraoral vertical lengthening bony genioplasty with changes that likely will approximate the attached imaging.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to lessen the occipital ridge area to where it’s not as prominent.

 A:Thank you for sending your picture and describing your concerns. You have correctly identified a prominent nuchal ridge. There are two ways to treat it depending upon one’s aesthetic objectives. The first is the one of which you are aware which is a bone burning reduction. This does require some release of neck muscle fibers to be able to get an adequate reduction although this has no functional issues in doing so. The other approaches to build up the indentation or the valley between the raise new core Ridge and the bone above it via a custom skull implant. This can also be very effective particularly for those may have concerns about a flatter or less projecting back of the head above it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to discuss whether a sagittal crest reduction is possible. I have a small bump on the top center of my head that gives it a slightly elongated “egg” shape. I’m generally happy with the overall shape and am only interested in a subtle reduction to create a more rounded appearance.

A:Thank you for your inquiry and sending your picture. Sagittal ridge reduction is always possible in my experience because a sagittal ridge usually represents thicker skull bone along the suture line and not thinner bone. How much reduction that can be done can be determined by a preoperative 2-D CT scan but, in my experience, always at least a modest reduction can be achieved as per the attached image.  since you used the term subtle reduction that certainly seems to be possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in facial feminization with bone work. My issues are:  brow bone, orbit bone, recessed mandible, uneven face/jaw, flat midface/maxilla, low ears, floppy skin under chin, hollow temporal area, hairline, low brow, chin recess short, Skin texture/pores. Suggestions? Really look forward to hearing back.

A:Thank you for your inquiry and sending all of your pictures. Based on your areas of facial concern as well as the overall objective of female feminization I can provide the following initial comments:

1) Your brow bone protrusion is primarily in the lateral bro and not centrally. This requires hey bone burning reduction in detail of the brow which could be combined with opening up some of the lateral orbital wall as well.

2) Your recessed chin is best addressed by a sliding genioplasty as that will keep it narrow in shape but just as importantly will allow the deep labiomental fold from becoming even deeper…. which is what will happen with an implant. The sliding angioplasty will also best address the loose skin under the chin which gets eliminated as the chin bone moves forward.

3) The flat midface can be addressed by paranasal – maxillary implant augmentation.

4) The low set ears cannot really be repositioned higher. I’ve tried to do that many times and have never found a successful technique to do so. However the earlobe can be reduced and that will create the perception of a less long or higher positioned ear to a minor degree.

5) you have the classic female temporal hollowing which is best treated by a style II 4 mm extended temporal implant.

6) You have mentioned the hairline with a low brow and I am going to assume this means a brow lift would be favorable. It is unclear to me whether you want to keep the hair line at its current position or have a higher or lower. That is important information to know is that will influence how the browlift is done.

7) The only effective way to decreased pore size in combination with improving skin texture is laser resurfacing.

These are some of my initial comments and I have done some initial imaging in the left oblique view to reflect some of these potential changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had 20cc testicoe implants put in a year ago but would like to have larger implants put in as these feel too small.

A: At a 20cc testicle implant size that is 4.0 implants. If one is interested in a visible size increased the general rule is that it needs to be at least 30% or more increase in volume. Thus at a minimum you would need to change to a 5.0 size which has a total volume of 40 cc. That would still fall within the standard testicle implant size options. Obviously you can go bigger, which is a personal choice, but anything over 5.0 requires a custom implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am very interested in the temporal bone reduction surgery that Dr. Eppley performs. I would like to ask a few questions before scheduling a consultation: 1. Is it possible to combine bone reduction with a partial reduction/removal of the temporal muscle if needed for a slimmer head shape? If yes, what are the additional risks? 2. How many cases of temporal bone reduction has Dr. Eppley performed, and are there any before/after examples or references available? 3. What is the usual recovery timeline (return to daily activities, exercise, sports)? 4. For an international patient, how long should I plan to stay in the U.S. after surgery for safe follow-up?  Thank you very much for your time and assistance. I look forward to your reply

A:In answer to your temporal reduction surgery questions:

1) the primary effects of the procedure are achieved by muscle removal and repositioning, not bone removal. The temporal bone is very thin and will yield little in terms of visible reduction. This is why bone reduction as rarely part of the surgery.

2) I have performed hundreds of temporal reduction surgeries. You can find many examples if you search the topic on either of these two websites, www.exploreplasticsurgery.com  placing the term Temporal Reduction in the search box or www.eppleyplasticsurgery.com n the photo gallery.

3) recovery from temporal reduction surgery is fairly quick and is largely just due to the swelling most of which has gone down in 10 to 14 days. Otherwise there are no postoperative physical restrictions

4) most patients return home in 1 to 2 days after the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in exploring a revision for my genioplasty. I had the procedure five years ago and I feel like I’m not completely happy with the results. Specifically, I feel like my chin looks a bit too projected and masculine, and I especially notice it when I smile. I’d like to understand what options might be available for a revision, or whether a chin implant might be something to consider. I’d appreciate any guidance or next steps. Thank you

A:When it comes to a sliding genioplasty that has too strong of a chin augmentation effect one has to look at a reductive approach for which an implant would not be effective in that regard. This can either be done by setting back the sliding genioplasty a bit or using a submental approach from below to shave down the projection as well as narrow the sides and then remove any soft tissue chin pad excess that remains.

In looking at all of your pictures, even though I have no idea as to what you looked like originally, I think it is a tough decision in deciding to do anything. I see what you are seeing and I think the projection and masculine aspects of it are slight in their excess. As a result I think it is a hard decision to try to improve these concerns. I always worry about is the solution and a case like yours greater than that of the problems. As you have just learned from this sliding genioplasty every surgical procedure has its downsides and no procedure is perfect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I saw Dr Eppley respond to a question regarding muscle displacement after a jaw jaw implant and I’ve been told that might have been what happened to me, so perhaps Dr Eppley can help me! 

I had surgery with an oral surgeon and he placed two gore-tex gonial implants in the back of my jaw and two near my chin.  I ended up asking for the gonial to be removed as I did not like the look. Afterwards I unfortunately noticed strange differences to my face that I didn’t understand. One was that I had volume loss on the back sides of my back jaw angle. At first I thought that I had bone loss from the surgery. Multiple other surgical consults have recommended an oral appliance for treatment of it.

A:Indeed what you have described appears to be the correct diagnosis, masseter muscle dehiscence, after the placement of jaw angle implants. Such a postoperative sequelae is not completely rare if the surgeon is not careful about how to elevate the insertion of the masseter muscle in the placement of jaw angle implants.  I have seen many masseter muscles dehiscences as well as having treated them. That being said you cannot reposition the muscle is that is not usually a successful reconstructive surgery. Once the muscle has lost its insertion its fibers are shortened and rarely can they brought back to length. But even if they could most patients would not prefer an incision behind the jaw angles to do so. Does any treatment for it becomes more of an effort of camouflage rather than actually addressing the anatomic nature of it. Most commonly it can be treated by Botox injections to the elevated muscle to reduce its prominent and/or combined with injectable fillers or fat injections to the now deficient jaw angle area. In my extensive experience in treating it I usually find it most effectively treated by a soft tissue jaw angle implants placed 1 cm incision behind the jaw angles which heals well.

The one thing I know for certain, as you have already mentioned, is that no oral device is going to solve or improve this anatomic muscle problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to discuss the benefit and risk involved with shaving down an existing Medpor chin implant. I’ve been informed that removing it to replace with a custom implant, can cause tissue damage. The implant has been in place for about 1 year. I’ve also been informed that shaving down the medpor implant in place could cause damage to surrounding tissue. The current Medpor implant is too large and square, and the lateral wings are palpable which I don’t like. The current projection of 3mm is OK for my face. I found an ideal custom chin implant without lateral wings, on your website.

A:As a general rule don’t ever try to shave down a Medpor chin implant in place. That is not going to work well and it is a flawed concept. Given the nature of your concerns with your current implant shape the most effective strategy s to remove it in its entirety and replace it with an improved implant design. I don’t know where the concept of concerns about tissue damage come from as they are completely irrelevant. Scar will exist in and around the implant and manipulation of that scar is just part of the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m just reaching out to see if there will ever be the possibility of such a surgery being done on a FTM transsexual, since from what I can tell most surgeons would be against it as it’s usually unadvisable to meddle with the hip joint for “cosmetic” purposes. Would it be possible to find someone willing to work with me on surgically reducing the width of the lower part of the hip? What changes to my bone structure would be necessary for this problem to be fixed? My hips are always just a bit too wide at the base and it tends to give me an inherently more feminine shape than if they were more straight. It would be more acceptable if my shoulders were wider, but my shoulders are also quite narrow for a male. I’m already working out and trying to bulk up my upper body, but I can tell that even if I manage to lessen my dysphoria further with CBT and other therapy in general, my hip structure will always be a point of pain for me. I’ve attached the pelvis X-ray for reference if that would help. Is there any chance that needing surgery for this in the future would affect my hip breadth, be it positively or negatively? Thank you for any insight you can offer on this matter. I look forward to your response. 

A:You are referring to reduction of the lateral prominence of the greater trochanter of the femur. This is an area of the femur where a number of musculoligamentous attachments are. Reduction of  this bony prominence requires elevating these attachments which have unknown and potentially adverse short and long-term complications. Most pertinently it may lead to chronic pain and difficulty with walking.  It is also possible that it may lead to long-term osteoarthritis of the femur. As a result it is understandable why surgeons are reluctant for aesthetic purposes to risk this type of complication. It is also possible that such surgery may only create some short-term discomfort and in the long-term be fine. These outcomes and risks are unknown.

That being said I’ve thought about the surgery and patient selection would be of critical importance if it were to ever be done. The patient should be thin where the bony prominence is very palpable and the amount of reduction needed not be excessive. The above unknown risks remain even with good patient selection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. I am a 21 year old male. I have a small head of 51cm as I recently shaved my head. I am perfectly healthy. My father also had a small head. I wanted to ask If there is a way to increase it and if so to how much extent? Can I have a normal male head? I would be extremely grateful for the response.

A:Skull augmentation is largely about Increasing specific areas of the skull rather than an overall head size increase. Augmenting certain areas of the head can make it look bigger but if you’re going to use circumferential head measurements as a measure of success then you are going to be disappointed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in the thigh implant procedure. I have a small frame and have always hated my small thighs. I have a big but and my small legs make it look very unnatural. The last two images are what I am looking to achieve. 

A:Thank you for your inquiry and sending your pictures. On my initial reaction to it I thought initially that this would not be a remotely achievable outcome. However upon closer evaluation comparing your thighs in a side-by-side fashion to the ideal images it became more apparent that the differences is in the anterolateral thigh which is exactly the area thigh implants augment as per the attached diagram as drawn on your thighs. This does not mean that you’re going to get that exact outcome as it is a magnanimous change but at least the concept of implants in this location will improve your current thigh-buttock disproportion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m wondering if you are able to reduce the width of my hard upper ribs? Particularly the 10-7. Would shortening those through bone cuts be adequate in not just narrowing the sides but also reducing front to back width? Are you able to reduce the width of the from to back? I am particularly concerned about the bulkiness of my rib cage when see from the side.

I’m quite happy with my waist line. For me it’s primarily the bulkiness of my upper body I am quite self conscious about.

The flair of my ribs is really upsetting me.

A:Thank you for your inquiry and sending your pictures. When it comes to the side profile view of your chest there are two issues which are related but would be treated differently. The first is that you have a modest amount of subcostal flare which is due to the cartilaginous shape of ribs 8 and 9 which is reduced by removal of the anterior part of rib #9 and shaving of the prominent part of rib #8.

But I don’t think that is your major concern which appears to be the distance from the front to the back of the rib cage as illustrated in the attached picture. You have correctly surmised that removing sections of Rib 8, 9  and 10 and plating them back together on each side does reduce the front to back distance. The only question is how much and whether the reduction gained is worth the surgical effort.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my head is bigger and wider than it looks  in a picture and it is square. I want it to be oval. Is it possible to make a skull oval and reduce the head width?

A:Thank you for your inquiry and sending your pictures. If I am interpreting your objective of making the frontal view of the head shaped less square and more oval I have attached a diagram of what I think you want to accomplish. The square shape of the head is largely controlled by the bony temporal line and the upper temporal muscle. These can certainly be reduced to decrease the squareness of the head shape and make it more oval.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a question. A different procedure I’m interested in is rib remodeling as opposed to rib removal. I believe it is known colloquially as ribxcar. I’m specifically interested in going up to the 8th rib, but I know this requires expertise with this kind of procedure. Does Dr. Eppley perform this kind of procedure, or does he only do rib removal? 

A:I have performed both rib removal and rib fracture techniques although by far most people come to me for the rib removal method. The rib fracture method is a simpler technique that relies heavily on months of postoperative compression to achieve its effects. I have not found the rib fracture method to have less of a recovery and and in some cases the recovery is more painful with fracturing than removal. Rib fracturing requires the bone to heal and develop bony consolidation while rib removal involves soft tissue (muscle) recovery and not bone.

The rib fracture technique only applies to ribs 10, 11 and 12 because they have unattached ends. Fracturing ribs 8 and 9 will be of no benefit since they have stable front and back attachments and thus are not capable of collapsing by being fractured. Regardless of the rib method used ribs 8 and 9 need to have a bone section removed and then the two ends put together with plates and screws to achieve any narrowing reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had cheek implant surgery with Dr Eppley many years ago, and I have a question if the Dr used any metal or screws in my face during the surgery to hold the implants in place. Im writing because im going to have a MRI Scan soon and i need to know if there was any metal, screws, or other matieral atached other then the implants? It would be very helpfull too know this.. Thanks alot for your help!

A: I can not recall the specifics of any surgery from 11 years ago. But since I always use screws for facial implant fixation I will assume that was done in your case. Such medical-grade facial screws since 1991 have been composed of titanium, a non-ferromagnetic metal, they are perfectly safe for undergoing MRIs.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if it’s possible, and safe (low risk for botching/complications), to widen the alar base of the nose. It really adds a strong touch of masculinity that my face is missing. In particular by trying out morphs in a photo editing program, the alar base alone being made wider makes the biggest difference.

A: As long as the nostril widening was not more than a few millimeters that could be done without undue scarring.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have a mild case of Cutis Verticis Gyrata and, while researching possible treatments, I found your article “Plastic Surgery Case Study – The Treatment of Scalp Cutis Verticis Gyrata with Subgaleal Release and Fat Grafting” on the website exploreplasticsurgery. I believe my situation is similar to the patient presented in your article, and after consulting with a plastic surgeon, she was enthusiastic about the procedure. However, since it is not widely reported, she had some doubts, especially regarding the step of releasing the scalp before performing fat grafting. She expressed concern about the arteries in that region. I would like to clarify this point with you and, if you allow, I would like my doctor to contact you directly so she can ask further questions and benefit from your expertise with this procedure, as I intend to undergo the surgery. CVG bothers me a lot. Attached are photos of my scalp. I would also like to know if the procedure proved effective in terms of fat resorption, and whether you have performed other similar cases.

A: As long as the CVG is not too advanced with deep linear V shaped  scalp lines releases with  fat grafting will provide improvement in its appearance in my experience.

If your surgeon is questioning the arteries in the scalp’ with a release this tells me they have little scalp surgery experience.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, big fan of your work. Im looking to get custom jaw and cheek implants, and was looking to replicate this jaw/cheek structure from this male model. Have you designed one that closely resembles his features before? Same cheekbones and that same type of sharp jaw angle.

I’ve seen many custom cheek and jaw implant designs before but curious to see which one directly resembles this model’s approximate structure.

Here is my most recent CT scan, i have standard jaw implants and a chin implant

Im going to get a sliding genioplasty, but in terms of jaw and cheek implant design, i was wondering if doctor Eppley designed ones closest to the model before?

A: You have a completely inaccurate concept of how custom facial implants are designed. No one knows the skeletal shape of these model faces or what implant designs can come close to creating them. The only way to know with any accuracy is to take a 3D CT scan of their face and overlay it on a 3D CT scan of your face to show the bone shape differences. Short of that method custom implant designing is a best guess estimate….and even this assumes you have the right soft tissue thicknesses where such implants can show through enough for their full effect to be seen.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, How long does it take to get custom facial implants made?

A: The rate limiting step in any surgical procedure that includes custom designed implants is the time it takes to go through the design and manufacturing process of them. This is usually around two to three months from when the 3-D CT scan is received on which the implants are designed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been struggling with what i think is Parry Romberg on both sides of my face for the past year. It has been mentally and emotionally draining and is affecting my everyday life. nPlease help!!

A: Thank you for sending your pictures. While you do have a grade III or IV facial lipoatrophy condition this is definitely not Parry Romberg syndrome. Parry Romberg syndrome follows the distribution of the trigeminal nerve and has a very linear pattern of atrophy. It also tends to only occur on one side. of the face. What you have is an overall  lipoatrophy which has affected all of the fat compartments from the temporal down to the buccal spaces resulting in this classic gaunt facial appearance.  Once the fat is lost it is lost and the body is not going to restore it. This is a reflection of a more systemic cause such as significant weight-loss, certain medications and various medical conditions.

Regardless of the cause there’re various methods to treat this type of facial lipoatrophy. The most obvious treatment is that of fat injections into the temporal and submalar/lateral areas of the face provided one has enough donor sites to harvest the needed fat. One could argue how well will fat survive in areas where fat originally was and disappeared. That is a logical debate but the benefit of fat injections is that they are  autologous and have no known medical side effects…. not because it is the most assured treatment. But it remains as a first-line treatment for those patients who are so motivated. The alternative are temporal and submalar cheek implants which provide a more assured and sustained result. These will do well in those two major areas but will not provide any augmentation in the lower facial areas from the mouth along back to the ear. This area can be concomitantly treated with either fat injections or there are various tissue banks tissue grafts and even thin implants that can be placed into this soft tissue area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I got custom infraorbital implants to correct my undereye hollowing which it did not do. I have attached the implant design file.

A:Just because implants were made custom does not mean they are going to create the desired effect. Besides accurate placement the other major component of an aesthetic outcome with custom implants is their design in terms of surface area  coverage and various thicknesses throughout the implant. My first question when I see someone who has had custom implants that did not create the desired shape or created and the fact that they did not anticipate is…. what was the basis of this implant design? Why was this implant designed this way and what were the original objectives?

As I am not privy to all of that prior information I can only look at the current problem… which is persistent under eye hollowing. While this implant design does cross the infraorbital area it only provides horizontal infraorbital rim augmentation which will either maintain or worsen the presence of any pre-existing under eye hollowing. To properly treat under eye hollowing the infraorbital rim area must be augmented both vertically and horizontally known as saddling the rim. This implant design does not do so and even though it provides infraorbital rim augmentation it never had a chance to improve under eye hollowing. This is a flawed implant design to achieve that effect. This undoubtably was done by a surgeon who has never used implants to improve under eye hollowing and tried to do so with an implant design placed intraorally. The only way to successfully treat under eye hollering is an implant design that saddles the rim and is placed through a lower eyelid incision.

Given the benefits that your current implants provided in the cheek area my tendency would be to design new implants that sit on top and round these existing implants place they will lower eyelid incision.. Stacking implants on top of each other has its potential disadvantages but in your case may be the most appropriate approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon