Your Questions

Q: Dr. Eppley,  I would like to know if Botox could also be an option for temporal reduction, since it’s a muscle and I have already received injections to reduce the muscles in my jaw and it works very well. If that’s the case, I would start with Botox, which is less invasive, by getting injections from my surgeon near my home. thank you for your time.

A: Botox is a good place to start. Its effects are not the same as surgery, which produces a more dramatic head narrowing, but usually you will see some modest head width reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, In 2018 I had a neck lift & chin implant. I have included a profile picture pre-surgery as well as a profile & frontal post surgery. Although I am pleased with the implant from the front… the profile angle, I do not like. I feel it is not positioned correctly as well as projecting too much. During the procedure in 2018 the doctor over liposuctioned the areas along my neck line and left dimples. In 2019 the same doctor transferred fat into those area to get rid of the dimpling. After having the neck lift my submandibular glands were more noticiable and cause my neck to look fuller since they were not addressed during the neck lift.

A: I would agree that the chin implant has provided too much projection. Without knowing exactly the implant material and its style and size I can not say exactly how to downsize it. I am not so sure that is positioned improperly but implant positioning is something i never guess at. A 3D CT scan will erase the ‘mystery’ of implant position on the bone as well as its shape and size. (provided it is silicone, Medpor can not be seen in a scan.

Correcting exposed submandibular glands after a facelift is usually best done by subtotal or total gland removal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had hairline lowering surgery three year ago. The doctor removed almost 1.5 inches and left me with an uneven scar as well as a significantly lowered forehead that is unnatural and disproportionate to my features. I have read and saw a comment from Dr. Eppley online that with the help of tissue expanders over the course of weeks/months, it could help stretch the skin and restore the length of the forehead. I would really like to discuss this with him as I want to restore the size of my forehead to it’s original state.

A: While I don’t know whaf your original forehead length was, even if it was an inch (25mms), no amount of tissue expansion is going to reverse that amount of forehead tissue removal.  At best it may be half that amount.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 23 year old woman, who had a chin implant removed over a year ago. I had it removed because I didn´t like how big/wide it was. Both the implantation and removal went fine (both were done from under the chin) and I am now fully healed. However, my chin is not the same as before.

The main issue is that the chin itself feels (and looks) loose and like the tissues are no longer attached to the bone, but just rests on top of it. I also believe there is excess tissue now as I can sort of “fold” the fat in my chin by pinching it. At rest my chin looks slightly uneven with a bumpy texture and when I smile/talk, one side of the chin is pulled forward and the other down, which gives an uneven appearance.

I would like my chin to be firm again, but not much bigger as I like the size my chin is now.

I was wondering if it might be possible to put in a small medpor implant that is visibly insignificant to give the muscles and fat something to adhere to and at the same time removing the excess soft tissue.

Do you think that could be an option? And if not, what else (if anything) can be done? I can live with scarring under the chin as I already have a 4 cm scar there from the other surgeries.

Additionally, the two surgeries has left me with what appears to be loose skin under the chin. I was hoping that could be addressed at the same time as the chin itself.

Looking forward to hearing your thoughts!

A: When a chin implant is removed the chin almost never goes back to what it was before the implant was placed. Besides the created excess of the soft tissue chin pad the tissues have lost their ligamentous attachments so some degree of ptosis can occur.

A submental chin pad excision and tuck is the correct treatment. Whether a thin layer of Medpor or ePTFE for tissue adhesion can be debated  but there is some theoretical merit to it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in having a custom forehead implant designed and surgically placed. The surgery/design that fits my case is highly similar to your cases:

– https://exploreplasticsurgery.com/plastic-surgery-case-study-custom-forehead-implant-in-male-forehead-reshaping-with-pseudo-brow-bone-protrusion/

– https://exploreplasticsurgery.com/plastic-surgery-case-study-combined-sagittal-crest-skull-reduction-and-custom-forehead-implant-augmentation/

– https://exploreplasticsurgery.com/plastic-surgery-case-study-correction-of-an-upper-forehead-slope-with-a-custom-skull-implant-and-bone-bump-burring/

Since there are not many surgeons out there who have experience in designing/placing these specific implants there is very little information online about the recovery/healing process for the 3 specific abovementioned cases: so similar implant design and volume Could you elaborate on the healing proces of these cases: the invasiveness of the procedure is my main concern in deciding to go ahead – since I have not much days to take off from work.

– Can I drive one/two days after surgery?

– What will swelling/bruising be like 3 days after surgery?

– What will swelling/bruising be like 1 week after surgery?

– What will swelling/bruising be like 2 weeks after surgery?

– From what day will people not be able to tell that I had any surgery done?

I am in good physical condition, 29 yrs old and normal swelling/bruising reactions.

Thank you very much for your consideration.

A: The physical recovery from a custom forehead implant (that does not incliude the brow bone) is mainly related to swelling and how long it persists. In answer to your specific quesi0ons about the recovery:

1) You can drive 1 to 2 days after surgery

2)  Forehead swelling peaks at 2 days after the surgery, 50% is gone by one week, 75% is gone by 2 weeks and most if not all of the swelling is gone by 30 days after the surgery.

3) Generally 7 to 10 days after the surgery one appears socially acceptable/passable.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was thinking of having a genioplasty I would like to bring it forward as well as widen/broaden it I was thinking maybe 4mm forward and 2-4mm broadening but I’m scared if I broaden it 4mm and bring it forward 4mm It will look the same but broader (still recessed if that makes sense)

Question 2 (this question is referring to the photo attached).

is there any way to prevent this from happening in my genioplasty?

A:I am not sure I understand the premise of your question. If you bring the chin forward and widen it it is not going to look more ‘recessed’. But what I think you are really referring to, as indicated by the red dots in your picture, is that is where you see the chin as narrow and that is exactly where widening the chin will NOT affect. It widens it centrally not laterally. Only a custom chin implant can reliably create horizontal chin projection as well as increased lateral chin width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a consultation with you regarding undergoing a possible revision sliding genioplasty.  I am 1 week s/p SG elsewhere — my surgeon reports we did a 10mm horizontal advancement. Recovery afterwards has been easy and unremarkable, but after doing comparison photos now I can see that we didn’t achieve near as much projection as we anticipated. I’m 100% aware that full results won’t be apparent for some time still, but my understanding is the horizontal projection is not going to meaningfully improve. I’ve attached a photo comparing pre, my surgeon’s prediction via morph, and now 1 week post. Any thoughts on why this may have happened? Is the predicted morph something you think you would be able to realistically achieve, and if so is it more optimal to do a revision within 6 weeks?

I am going to call your office today regarding scheduling a full consultation, but I understand it can be easier to revise an SG within 6 weeks of surgery and hence was hoping to get your input sooner if possible. I can also proceed with getting any recommended imaging sooner this way.

Greatly appreciate your time and input —

A:My first question is whether that was really a 10mm forward movement. While one can debate about how much forward movement the morph actually is (looks somewhere in the 10 -14mm range) your one week after surgery picture (which would have some swelling) doesn’t look anything like a 10mm movement to me. That doesn’t mean it wasn’t (I wasn’t there) but that is not what I would think a 10mm advancement would do at one week postop. The absolute way to know is a lateral cephalometric x-ray. To some degree how much movement was done is somewhat irrelevant as no matter what it was it was not enough. It clearly needs to be double what was done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in having my chin/jaw asymmetry fixed. I was wondering how much would it cost to shave down one side of the chin or jaw. I have an x ray of my jaw and I could send a picture of my face currently. But let me know please!

A:Thank for sending your pictures and x-rays. When it comes to jaw asymmetry corrections in which the chin is in the midline it is always a debate between reducing the longer side or augmenting the shorter side. While this is always primarily driven by the patient’s aesthetic desires such a decision is also influenced by the type of surgery needed to make the those changes. Augmenting the longer side is always ‘easier’ because a preoperative implant design controls matching the symmetry to the opposite longer side. It is also done by a combined submental skin incision in front with an intraoral incision to position the implant in the back. Conversely reducing the longer side is technically more challenging because the chin-jaw bone cut initially made from the front submental incision can not extend all the way to the back of the jaw angle due instrumentation and access limitations. The completion of the bone cut through the jaw angle can also not be done intraorally as the power equipment used can not make such a small amount of inferior border bone removal. It requires the second incision to be a small one at the back end of the jaw angle externally to be completed. In other words you need a dual incisional linear access for the bone removal. (see attached image)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in getting an orbital rim implant with you. Would this be possible to get if I have had a prior canthoplasty? My main concern is if my new lower eyelid would be too thigh to have the implant placed through the lower eye lid.

A: I don’t have any concerns that the higher position of the lower eyelid would pose a problem for placing orbital rim implants. I have seen many patients with a long distance between the lower eyelid and the orbital rim with significant IOM hypoplasia. You would always like to avoid making a lower eyelid approach is someone who has had prior lower eyelid reshaping surgery…but that is not rare to run across the need to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am hoping to travel for revision ZMC fracture repair surgery. I am concerned about the asymmetry of my face since my injury.

A: Asymmetry after ZMC fracture repair is not uncommon, either due to bone alignment issues or soft tissue volume loss.  The latter is often overlooked. But to determine the exact cause of why the asymmetry exists a 3D CT scan should be done to accurately assess the difference. A submental or Towne’s view plain film is not precise enough to determine discrete bony differences.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, So, ‘wrapping’ my head around leaving my natural testicles and acquiring larger sized implants to ‘hide’ them.My main concerns are: not having four testicles visible, how the silicon objects feel inside me (movement, weight, etc), and the effects on sexual function (pleasure, discomfort from pressure when the scrotum tightens during erection/intercourse, etc.)

Would you offer any guidance to these questions?

A: In answer to your testicular enhancement questions:

1)  The way to avoid a ‘4-pack’ scrotum can be avoided with the side. by side testicle implant technique is to have the implants be at least 60% to 70% bigger than the natural testicles…which requires c custom testicle implant approach. As a general rule that makes most side by side technique using a 6.0 to 6.5cm size.

2)  I am not aware of any postoperative issues with feel on negative effects on sexual function. The average weight of a 6.0/6.5 size testicle implant is 75 to 90 grams. ( one lb = 454 grams)

3) Unlike natural testicles which are tethered by a cord (neurovascular pedicle) testicle implants have no such attachments this they are free to move around and generally settle lower in the scrotum than the natural testicles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, here were a few questions I completely forgot to ask you about my custom infraorbital-malar implants surgery and was wondering if you could pass them along:

1. I had Photorefractive Keratectomy (PRK) surgery done several years ago to correct my myopia. Is this a problem with respect to my upcoming surgery with Dr. Eppley?

2. Regarding the implants: does adding the “saddle” to the implants create or increase a risk of blindness or double vision resulting from the surgery?

3. Would it be possible to get a quote for revision surgery that would be done in the event that I do not like the final result?

4. Just to make sure: will the “lateral” projection in the zygomatic arch region be 4mm, or 3mm as previously planned? It is a bit hard to tell from the 2nd IOM implant design document. I would like to keep the lateral projection in the cheekbone area subtle.

A: In answer to your custom IOM implant questions:

1)  The risks of any form of eyelid surgery after corneal reshaping is an increased risk of corneal drying should lid competence be compromised. (in the first 6 months after the surgery) This is more pertinent in traditional lower blepharoplasty where eyelid tissues are removed. That risk is significantly reduced when the lower eyelid procedure is one of access rather than tissue removal.

2) The saddle on the infraorbital rim has no risk of blindness or double vision. The saddle sits on the infraorbital rim and does not extend back onto the orbital floor.

3) Such a quote would rely on knowing what the revision would be for and how it would be done. That could be anything from the gamut of a lower lid adjustment, implant adjustment to implant replacement. That woulo be hard to predict before surgery if it  was ever needed.

4)  Currently that is 3mm but can be adjusted to less in surgery if needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Curious what the recovery time is for the tear trough implant procedure?

A: The recovery from any infraorbital rim implant is completely about the swelling and the bruising which usually takes about 2 to 3 weeks to fully resolve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I would like to get a jaw implant sometime in the next month or two, or whenever your next availability is. I got dermal fillers in NYC 3 months ago but would like something more permanent. Essentially I would like a more 90 degree jawline, i’m already pretty happy with my chin although I would still like to consult about all the options.

A: In answer to your jaw augmentation questions:

1) I mainly do 3D jaw implants made specifically from the patient’s 3D CT scan…a design and manufacturing process that 3 months to complete.

2) Standard jaw angle implants do exist and they may be appropriate for some patient’s aesthetic needs but that requires computer imaging of pictures to determine exactly what the patient wants to achieve. Standard jaw angle implants have their aesthetic limitations as well as higher risks of asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What type of vertical chin lengthening procedure do I need?

A: The correct vertical chin lengthening procedure depends on three factors; 1) how much vertical lengthening does one need, 2) shape of the lengthened chin, and 3) whether one prefers an implant or prefers to move their own bone.

Assuming #2 and #3 are not relevant issues it comes to #1 in which 5mms or less of lengthening can be done by an implant but anything greater than that requires a vertical bony chin lengthening procedure. To help you think about those potential changes the attached imaging shows a more modest effect with an implant vs a stronger effect with the bone lengthening procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, do this under IV sedation or local? I’ve done a 6 hour revision open rhijo with rib under local and a breast Aug. I had a feminizing laryngoplasty and don’t want to damage it with a tube for GA. Would like to do rib removal or lux, but without the tube. Is it possible?

A:While I understand the premise of the question you can not do rib removal surgery under any form of anesthesia other than a general. One should not confuse face/neck surgery with invasive body surgery…they are completely different with one being superficial (face ) vs the other being deep. (body) I have have done many transgender patients who have had vocal cord surgery under general with a 6.0 tube and it has never been a problem. But again I certainly understand why you would ask the question.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Currently I have questions about whether or not  revision work can be performed on me – specifically if a reverse sliding genioplasty along with a vertical chin length reduction and jaw implants is possible. I had Vline surgery and a sliding genioplasty done 2 months ago and despite not being fully recovered (knowing that ideally I need to wait 10 months before I have another correctional surgery), I am not happy with the results as my surgeon did not listen to what I had wanted during my consultations. The surgeons technique and results are not botched on a technical standpoint but aesthetically it is not what I wanted and it is causing me a lot of mental destress. My surgeon did not reduce the length of my chin vertically at all but rather reduced the width of my face and gave me a sliding genioplasty. I did not need the sliding genioplasty and I believe it’s making my face/chin appear longer in tandem with my overall jaw width reduction. I miss having more width to my face. I am very distressed about my current facial contouring results and I am hoping to get my self confidence and life subsequently back! 

A:Thank you for sending your pictures and x-rays. Like many patients who feel they have an overcorrection from their V line surgery, what you would have felt better about is if you have half the V line reduction that was performed. (but that is not how V line surgery can be done…it is a radical procedure where the intraoral access only allows a lot of jaw angle bone removal)  Custom jawline implants can help restore some of that missing bone…a subtotal V line reversal) From the chin standpoint you had a classic t-shaped genioplasty where the width of the chin was reduced. This is not a sliding genioplasty per se, it is the typical chin procedure that is commonly done in V line surgery. Not height reduction or increased forward projection was done. The height of the chin can be reduced secondarily as a vertical reduction genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello,I had a procedure done at your office a few years back on maker my head smaller that required removing the temporal muscle.would it be worth my while to do the bone burning on the sides of the skull to make it even smaller?as it is still larger than normal.

A:The greatest yield in head narrowing surgery is from removal of the temporal muscle. The convex part of the temporal bone is very thin (less than 5mms) so bone burring usually has a very minimal effect…which is why it is rarely done. The other issue with temporal bone reduction is access. Unlike temporal muscle removal which is done from a hidden incision behind the ear, temporal bone reduction requires an incision that runs up along the sides of the head in a more visible location. Thus between the limited improvement and the scar temporal bone reduction is only done in exceptional circumstances. (the patient who is willing to do everything possible regardless of the scar tradeoff)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m interested clavicle reduction surgery! I’m twenty eight years old, and I transitioned ten years ago to good results. However my comparatively broad shoulders continue to give me a remaining sense of gender dysphoria. I would be interested to learn your assessment of the risks associated with the procedure.

A: The risks of clavicle reduction surgery, and the only ones I have seen in  over 100 cases (200 clavicles) are: 1) fixation failure (2) , 2) non-union (1) and 3) prominent hardware that the patient wanted removed secondarily. (2)

Recovery is a progression of limited arm motion to full range of motion over a 6 week postoperative recovery. This is done at 2 weeks intervals after surgery with elbows by one side for the first 2 weeks, arms at 45 degree from week 2 to 4 and arms at 90 degrees from week 4 to 6. At 6 weeks after surgery full range of arm motion can resume. Weight bearing and more athletic activities can resume at 8 weeks after surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I get the brow implants slightly lower in order to reduce the distance between the eye and the brow bone to hide the eyelid and get hunter eyes and make it deeper.

A: Per the custom design process a brow bone implant can be made that has a lower profile on the brow bone which should help decrease the distance somewhat between the eyebrow and the lower edge of the upper eyelid.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in your jawline reshaping procedure.

My main goals are:

– vertical lengthening of the left jaw (to fix the assymetry)

– creating more defined jaw angles on both sides

– creating a more masculine chin

Please note, the pictures were taken with some (half year old) fillers in my chin and jaw.

Could you please recommend some surgical options?

A: With jaw angle asymmetry custom jaw angle implants would be needed for asymmetry correction as well as angle augmentation. The chin can be augmented by either a bony genioplasty or an implant depending on how much forward movement is desired as well as the shape of the chin from the front view.  Distilling that information down it com,es down to two basic options:

1) Custom Wrap Around Jaw Implant

2) Sliding Genioplasty with Custom Jaw Angle Implants

UntiI know more specifics the chin augmentation changes with imaging I can not yet say which approach is better for you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Generally how long is too long for masseteric muscle dehiscence repair? I’ve read on your website that elapsed time since the tear is one of many factors that will determine whether the procedure can be successful.

A: Due to the rapid onset of muscle fibrosis the reality is by the time masseteric muscle dehiscence is fully recognized after jaw angle implant surgery it is almost too late even then. While there is no exact time frame as to when it is too long  it is fair to say that there is a linear correlation between occurrence and surgical repair success…the longer the time between occurrence and repair the less successful it will be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I would like to know the costs of skull reduction surgery and if you are able to reduce the size of the back of my head it’s kind of long and how long the scar takes to disappear.

A: By your description it sounds like an occipital skull reduction but I would need to see a side view picture of your head to confirm.

No incisional scar completely disappears, it is only a question of how inconspicuous it may appear. Full scar maturation takes a full 4 top 6 months to occur.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi! I’m considering several plastic surgeries this year – came across your practice and was interested. I’m currently considering a tummy tuck, breast reduction and maybe a bbl – but open to discuss!

A: As a male who has never been pregnant nor has undergone a lot of weight loss you do not have the extra/loose skin thagt would justify a tummy tuck. You should initially do liposuction alone and see how much improvement that creates before accepting a long scar. The success of tummy tuck surgery depends on how much loose skin exists standing up straight, not sitting or bent over. For gynecomastia reduction whether it would be liposuction or liposuction combined with open areolar excision depends on if there is a distinct palpable mass…that can not be determined by looking at pictures alone.

Whether one takes the fat from the liposuction and injects that into the buttocks depends on how much fat is harvested and what your buttock augmentation goals are. But as a general rule in men fat injections work poorly and usually the fat harvest is low. But the reason to do it is because it does not hurt and the fat is going to be discarded anyway.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had facial implants on my mid-face (a “mask” for cheeks and paranasal augmentation). It was done 3 months ago. Since then, I’ve had the right side of my face infected twice. The first infection occurred two months after surgery, inflammation and a hole with a lot of pus coming out. I went on antibiotics and got the zone cleaned up by a doctor. I also got a scanner done after the antibiotics’ treatment, and the infection was “resolved”.

But yesterday, 3 months after surgery, I’ve started experimenting inflammation again. I’m currently taking antibiotics once more. My doctor thinks there’s a relation between cold or flu and the persisting infection of the implants. She thinks this since the two infections occurred after having flu, this because the fixation of the implants generated “holes” in the bones, and a sinusitis or a cold may also infect the implants through these holes. I’ve read about “biofilms” and I think that might be the cause.

Anyway, what would it be the best approach to treat my situation, knowing that I want to at least keep the argumentation in the paranasal zone around the nostrils and mouth, this if saving the whole mid-face implant is not possible.

– An extraction of 3 months old implants and immediate replacement with new ones would be an option?

– Do I have to wait and let my face heal after implant removal before thinking about getting new implants?

A: Antibiotics rarely solve implant-related infections due to biofilm. Thus believing that an implant infection is cured within a short time after going off antibiotics is overly optimistic. While antibiotics are certainly an important treatment frankly purulent infections require a surgical approach. As a general statement the shortest path to getting an implant infection resolved in an assured manner is to remove the implant, let the tissue heal and re-implant it later. I have seen a lot of time wasted and long postoperative courses of treatment ensue when the ‘nuclear’ option is not enacted early.  But it actually gets to a satisfactory end a lot sooner.

Having not performed your surgery and not knowing any defails about the implants I can not provide any more imsight other than the aforementioned general statement about aesthetic facial implants and infection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Just wondering if its 100 safe surgery to remove this knob bone on the back of my head ad it will disappear for good ?

A: The occipital knob region of the skull is its thickest part so complete knob reduction can be safely done. Once removed it can never grow back.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in having a chin implant combined with perioral mound and chin liposuction.

I have attached three photos from three angles with a simulation of the above procedures (next to each other, for comparison).

I was wondering if it would be possible to have a few questions answered (regarding this) before I commit to a consultation?

1. Do you think that the photo simulations attached show a realistic, achievable result?

2. Am I the correct candidate for these 3 procedures, or would I benefit more from undergoing double jaw surgery or genioplasty instead?

3. Can a chin implant improve my lip incompetence? If not, can double jaw surgery or genioplasty improve it?

4. Can a chin implant improve my mentalis strain (possibly combined with botox)? If not, could double jaw surgery or a genioplasty improve this?

I apologise for the many questions!

Thank you so much for taking the time to review my photos and answer my queries! I greatly appreciate it!

A: Thank you for your inquiry and sending your imaged pictures. I think that is a reasonable result provided it is done with a sliding genioplasty and not an implant. The sliding genioplasty will do better for the lower lip incompetence, mentalis muscle function/position and aesthetic result. (by pulling all the surrounding tissues forward)

Double jaw surgery would be better IF you had as a primary goal of improving your excessive tooth show (vertical maxiillary excess) as well as the aforementioned issues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello. I’m interested in getting shoulder narrowing, rib removal, and hip implants. I have had several rounds of liposuction/BBL previously, but would like to achieve a more feminine hourglass shape. Can these three procedures be done at the same time or is that not advisable?

A: While all three body procedures can be technically performed at the same time I would not recommend to do so because of the involved recovery. I would pick two to do together but not all three.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I recently underwent genioplasty and jaw reduction surgery. The jaw reduction did not go as my expectation as they cut across the entirety of my jaw angle and now I have lost the angularity that I once had. I was expected just a slight elevation in jaw angle but they took more than expected to be used as bone graft on chin lengthening.

I searched about custom jaw implants that may recover and create stronger angularity again and was hoping to learn more about the procedure.

Would the implant between masseter and mandible? Does it wrap around the jaw bone? How long does it usually last? Are there alternatives? Some of my biggest concerns is how difficult is it to remove when there are complications and what is the infection / bone resorption rate like for such a procedure? 

A: In V line surgery there is not ‘just a little’ jaw angle removal, it has to be a lot based on how the cuts need to be made from an intraoral approach. This is a common patient misconception. That issue aside the only method to restore some or all of the removed bone is a custom implant design. Such implants are placed between the masseter muscle and the bone and wrap around the bottom of the bone edge.  Such implants are easy to remove should there be a need to do so. The infection risk is in the 1% to 2% range. Bone resorption is not an issue seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. I’m curious about your XL-sized testicular prosthetics. I lost both my testicles to orchiectomy due to chronic pain, and unfortunately, the largest prosthetics available are the Torosa 5cm ones. That’s exactly the same size as what were removed. Are your larger-sized implants FDA approved, and if not, do you know of any others that are?

A: All testicle implants beyond 5cms in size are custom made through Implantech using FDA-approved materials and manufacturing process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon