Your Questions

Q: Dr. Eppley, Hello, I am an American residing abroad. I have been looking for a clinic providing custom jawline and cheeks implants.. I saw a video on youtube where you performed such surgery. Because of the distance, I do not have the flexibility to fly in readily, so I would like to know the following:

Will it be possible to create the custom implants if i can get 3D scans done here and mailed to you?

Or, is it possible to get the scan and implants made, and surgery perform all in 1 trip? ( 2-3 weeks)

A: In answer to your custom facial implant questions:

1) I only design implants for patients in which I am going to surgically place them.

2) The custom facial implant process takes about 3 months to go through the design and manufacturing process to have them ready for surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in XL or XXL testicular implants. I’m confident that my testes are 3 cm or smaller. But, unlike your example in the article above, I do not have any redundant skin in my scrotum. Might you use osmotic tissue expanders to provide the additional skin in order to accommodate the implants?

A: There are two methods to expand/stretch out the scrotal skin. A tissue expander can be used and then replaced with a permanent implant later probably two months layer. (Dynamic tissue expansion) Or a larger permanent implant (5.0 or 5.5cms) can be placed and then 4 to 6 months later a 6.5/7.0/7.5 implant can be used to replace itplace. (Non-Dynamic Tissue Expansion)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello. I had a sliding genioplasty 1 year ago and I am so unhappy with the aesthetic result. The step offs are quite noticeable and it makes it seem that my chin doesn’t fit in at all with my face. Is there any way that the step offs puke be corrected at this point? I don’t want to have a revision surgery. Is there a way to correct it that would be less invasive? .

It just doesn’t look like my chin blends in. The nothings on the side really bother me. As well as the muscle pull that is occurring right below my lip.

A: With this many symptoms from your sliding genioplasty (visible stepoffs, excessive horizontal movement and muscle pull below the lip) there is no other method to improve all three without subtotal reversal.

The stepoffs can be treated in isolation by filling in the bone defects without recutting the bone but the other two symptoms wlll remain.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I previously got a genioplasty but am considering getting another one. Would this second genioplasty involve removing the hardware/plate from the first genioplasty? Additionally, if I was to get an implant as well as the second genioplasty, could you perform both in one surgery or would they be separate procedures?

A: In answer to your secondary sliding genioplasty questions:

1) The hardware would need to be removed and replaced with a second genioplasty as it will be in the way of the osteotomy cut.

2) If the soft tissues will permit a chin implant can be done concurrently with the second sliding genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I was just doing some extra research and saw these images that I attached, I was wondering if Dr. Eppley also osteotomized this woman’s ribs and then had her wear a corset? I’m really impressed with these results as before it looked like her rib cage was boxy but it’s quite narrow now.

A: That patient had rib removal surgery with LD muscle modification.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I read an article on this topic in your site.  I read you mentioned if its, well minor or so burring in case, can help.

Can you plz further define that. Also i do have prominent brow bone, that incision around the scalp scares me, does that causes hair baldness in that particular area ?

I’ll look forward to your reply!

A:I believe you are referring to in minor cases of brow bone reduction in a male that burring reduction may suffice.,,and that would be a correct conclusion. It just depends on what the patient refers to as ‘minor’. A side view picture of your brow bones would help me show you what a minor brow bone reduction looks like. Also a small retrohairline scalp incision does NOT cause hair loss.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I am interested in osseous genioplasty or jaw surgery to advance my lower jaw.I have a type 1 occlusion however I also have very heavily proclined lower teeth, as you will see in the cephalogram image (attached).

In the past, I have also had an 8mm chin implant when I was 25 y/o however had it removed in about 3 months because I did not like how it rounded out my chin so much, and greatly deepened my labiomental fold. The small dimensions of my lower jaw made the imprint of the standard, round implant stand out considerably, although the projection was good. (see attached image)

Since then, my chin has returned essentially to normal (with very slight lingering augmentation which is fine), however, at this stage I am interested in doing a forward and vertical lengthening genioplasty (possibly with grafting) to advance my jaw/chin point whilst minimising depth increase of the labiomental fold too much.

I have also previously considered jaw surgery to bring back my lower teeth via pre-molar extractions, then lower jaw surgery to bring the jaw forward. For me right now however, I would prefer not to do jaw surgery as I am hoping that genioplasty can achieve a similar result, whilst being less invasive.

I have seen some very decent results from surgeons (including yourself in the B&As) achieving height, length and width (as the chin comes forward) increase, whilst also giving the impression of shallowing out the fold.

I have also seen cases where deep (nearer to the back of the mandible), flat cuts are made with forward and down advancement which have worked well for protruded lower teeth and low vertical height.

In my country, I have found that surgeons are quite conservative, in particular when it comes to vertical lengthening and significant forward advancement. There are really only two maxfax surgeons in a 100km radius of where I live, one who will only do a kind of one dimension, chin-button forward type advancement (5mm max) with a high bony contact and no grafting – they said it will likely deepen the labiomental fold more than the chin implant I had before. Otherwise, there are a significant amount of surgeons who offer off-the-shelf chin implants but no osseous genioplasty procedures.

Finally, I am interested in how I may go overseas to do this surgery, how health insurance coverage might differ and so forth.

In summary I am interested in:

1) genioplasty to lengthen and advance lower jaw/chin point

2) comparing this to lower jaw surgery and pre-molar extraction

3) limiting labiomental fold increase

4) digital imaging to compare skull dimensions to standard/aesthetic dimensions. From my own assessment viewing B&As, journals and similar, advancement of approx 8-10mm and 5-7mm down seems broadly suitable

5) how insurance might work and the general travel/stay over process (how many days recommended etc.)

A: In answer to your questions:

1) Combined vertical and horizontal chin bone lengthening can be done. (see attached imaging)

2) If you can tolerate the experience lower jaw surgery treats the source of the problem and, at the least, lowers the chin augmentation dimensional movements if needed secondarily.

3) Limiting the deepening of the labiomental fold would be the proper understanding.

4) Determining the chin dimensional changes is done by imaging of the facial pictures looking at variable amounts of change not some theoretical aesthetic standards.

5) This is an aesthetic procedure so the concept of insurance does not apply.

6) Most international patients return home in a few days after the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I had a chin implant with liposuction done a few years ago. I did not like the chin implant so I had it removed a year later. (I got pregnant so I had to wait until after pregnancy to have it removed) once I got it removed, I noticed my chin looked bigger and sagged. Especially when I smiled. Not only sag but just looks all weird and deformed. The same surgeon then went back in and tried to reattach the muscle to the bone and I don’t think it looks any different. I think my chin looks better when I smile if you’re looking from the left side but from my right side, it looks awful like here in the picture.

A:This is the classic soft tissue chin pad excess/ptosis that often occurs from chin implant removal. The chin pad never full shrinks back down and firmly reattaches like it was originally before the implant was placed. This requires a submental chin pad excision/tuck to improve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,What if the slight hump reduction was the only change the patient was seeking, to ensure that the tip of the nose isn’t altered at all, wouldn’t closed rhinoplasty and rasping of a very slight bump be a viable option?

A:If the rhinoplasty goal was limited to the hump area with no tip changes desired then the closed approach would be the best approach to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had rib removal of 11 and 12 but they were not removed from my body. I’m looking for more drastic results.

A: I believe you mean you had the rib fracture (osteotomy) technique done on ribs #11 AND #12 instead of actual rib removal. Where are you scars from that surgery. A plain x-ray of the ribs are needed to see what the anatomy looks like now. But actual removal of the ribs always produces better results than just breaking them.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Before doing a facial surgery, with custom facial implants, if you had to opt for fillers before , the end result with the latter , how close would It be to that given with various facial implants?

I mean , would fillers be a good idea ti have some sort of ” preview” of the end result with implants ?

Thank you i await, the kind response of the legendary Doctor Eppley , which i follow with pleasure on Instagram.

A: The question of the correlation between injectable fillers and facial implants is a good one to which there is no uniform answer. There are a lot of factors that make comparisons between their aesthetic effects from their volumetric expansion difficult. But suffice it to say that because fillers are largely placed in the soft tissues and implants exert their effects by pushing off the bone, fillers create fullness/puffiness while implants have the potential to create more defined facial contours. So there is a loose correlation between injectable filler and implants but their effects are almost never identical.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am thinking of having a chin and jaw implants in Greece but I am afraid because I have read about bone erosion. I am not sure if I need to have the surgery or not. I feel a little insecure about my face but I would like your opinion.

A: It is not a question of need but whether you would benefit from the surgery. The first step in making that determination is that your surgeon should have done computer imaging to look at the potential augmentation changes for your jawline. Forget about the concept of bone erosion as that is a completely irrelevant aesthetic concern.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I am interested in clavicle lengthening. I believe I have a massive chest, but the shoulders are disproportionately narrow. I am interested in discussing this surgery.

A: Thank you for your inquiry and sending your picture. I can certainly appreciate your concern about your shoulder-chest width ratio. The question is not whether you would get some benefit from this surgery but whether the achievable result and the recovery justifies the effort. In all men so far I have not seen the amount of clavicle expansion exceed about 15mms per side. The weight and resistance of the shoulder girdle soft tissues have proven to be far harder to push outward than it is to collapse them inward. (clavicle reductions for shoulder narrowing) As a result at this time I am very cautious about undertaking this type of aesthetic shoulder widening surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Would the implants speed up bone degradation? If the jaw bone shrinks in size with age, will the implant no longer touch the bone and can that cause problems? Also if the implant is removed to be swapped out for a smaller one with age, what can be done about the stretched and loose skin present on the jaw and chin?

A: I am not aware of any long term ‘bone degradation’ with facial implants in looking at many 3D CT scans of patients who have been implanted for 20 to 30 years. I am not sure where this concept emanates from but it does not come from any scientific study. Similarly where does the concept of jaw size decreae with age come from? That only occurs if all teeth are lost and much of the alveolar bone, where the implants do not sit, resorbs.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Not ready for a consultation yet, just had a quick question before I decide. Today I can “feel” the implant in my chin even though it’s been years after healing. Would getting it taken out and having genioplasty done instead be a good solution? Or would I “feel” that too?

A: A bony genioplasty will have its own palpable irregularities at the back end of the osteotomy lines, often called stepoffs. Whether they are significant or not depends on the amount of forward movement as well as the surgical technique. (angle of the bone cuts) If the only goal of the chin replacement surgeruy is to have a better feeling chin with a sliding genioplasty over an implant I would question that decision. 

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Can a cleft nose rhinoplasty be done on a foundation of a midface that has been augmented with custom silicone implants? Or should the augmentation be done first followed by a secondary rhinoplasty?

A: Good question. In a building the foundation needs to be done before you do the roof. Similarly the midface augmentation, on which the nose will sit, should be completed first before the nose is done

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I have been looking into skull reshaping. The back of my head is flat, and the top portion is peaked and feels like there is a large bump. And we’ll my forhead ain’t perfect either. Overall, I would love to shave my head, but would never be able to.

If you can provide me some insight it would be greatly appreciated.

A: The flat back of the head can be augmented and at the same ime the posterior sagittal peak (bump) can be reduced. I can not speak to the forehead since I don’t know what it looks like.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interesting in having the protrusion on the back of my head (as seen in the attached photos) removed.

A few questions/concerns I have are as follows:

1) I’m unsure if my case is only a skin fold or bone as well. There is definitely a skin fold that I can securely grab onto with two fingers, but I suspect the occipital knob may need reducing as well.

2) I’m in the process of losing weight and want to know if I should reduce my body fat before having any type of surgery to get the best results. For context, even when I was lean and in great shape there was still a protrusion there, albeit it may have been slightly smaller.

A: While there may be some excess scalp over it due to its size there is definitely a significant occipital bony knob underneath it. As to the merits of weight loss before the surgery that depends on how much weight loss is anticipated. Unless it is a large amount (greater than 25 to 30lbs) I don’t think it affects the aesthetic outcome of the surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley,I am a 69 year old male with extreme, chronic lower back pain. I am certain that it is due to iliocostal impingement syndrome (I am 4 inches shorter than when I was younger, due to degenerative disc disease, scoliosis, and a vertebral compression fracture at L1). I have had a recent surgery to remove a portion of ribs 12 and 11 on the right side. The surgeon removed about 4 cm of each. It has not helped me, and I believe the reason is that he did not remove enough of #11. I am hoping you can answer just one question for me. You describe a case https://exploreplasticsurgery.com/plastic-surgery-case-study-subtotal-11-and-12-rib-removal-for-rib-tip-syndrome/ that is, I believe, exactly what has happened to me. You described that you would wait 4 – 6 weeks to assess the results of that case, but there is no more info. My question is, can you offer any more follow-up as to the success of that case…did the more extensive surgery help that patient? Thank you

A:I believe that patient went on to have substantial improvement. If you had an anterior approach to ribs 11 and 12 than the amount that can be removed is very limited. It takes a posterior approach to get out a substantial length of those ribs. If you really want to know the rib lengths that exists or have been removed you get a 3D CT scan.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I’m about 11 weeks post op from a 7mm horizontal advancement sliding genioplasty and have been left with a very deep labiomental fold. Not only that I feel as if I am a bit recessed still. I have been told to give it 3 more months of healing and that it should get better, but I just don’t see it getting any better with time. What are my options for fixing this? Should I get a revision or am I will that not make a difference with my deep labiomental fold?

A:Your deep labiomental fold will not improve with more time and healing. No soft tissue depression ever gets better with more time. I would agree that your chin projection remains horizontally and a bit vertically short. But that comment is made without knowing what you looked like to start and what chin bone movements were done intraoperatively.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I have some papers about Dr. Barry Eppley’s Shoulder Width Reduction Surgery? I hope to find some more specialized literature about this.

A:There are no published papers on Shoulder Narrowing surgery in the medical literature. Everything that I know and have done on this surgery has been written about in many blog postings in the website www.exploreplasticsurgery.com which can found searching on the home page under Shoulder Narrowing Surgery or Shoulder Reduction Surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Both me and my partner are interested in either getting the scrotal enlargement or if our balls are small enough to not have the look of 4 balls having the testicular implants (pushing our natural balls up). I assume we would fall into the later category.Thank you.

A:I believe the question is whether the side by side testicular enhancement technique using custom implants would be effective. (not have a 4 ball appearance) That depends on two factors; 1) the size of one’s natural testicles and 2) the size of the custom implants being placed. As a general rule there needs to be at least a 50% difference in size and more ideally a 75% size difference for adequate displacement. For example a 3.5cm testicle is adequately displaced by a 6 cm implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a patient looking for clavicle shortening surgery. I would like to learn about the procedure and cost. I had a shoulder injury last week which causes right AC joint dislocation, with 100-200% displacement. I am resting at home and would like to know this specific injury will interfere with the possibility that I can receive the clavicle shortening surgery. Do I need to seriously consider a surgery to correct this dislocation, or it is fine without correction surgery to have the narrowing surgery in the future as long as I recover well in case of function and pain? Shall we setup an initial consultation about it？

A:This is a good question to which I have to admit that I do not know the definitive answer since it is not a preoperative consideration I have seen before. I think the real question is whether shortening the clavicle on the AC separation side, once it is fully healed and recovered, will have any negative arm range of motion effects on what may be a ‘lax shoulder joint’. Does moving in the lateral clavicular head aggravate or increase the risk of subsequent AC separation? This is really a question for an orthopedic shoulder surgeon although they likely will not a have a definitive answer either unless they have done clavicle shortening on a patient with a similar history. (which has not been done to the best of my knowledge) My suspicion is it would not in a fully healed shoulder. But no one can say with absolute certainty whether it would or would not be an issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am contacting you because I am in very great pain. To redo the chronology of what happened to me, it turns out that I had a buttock implant placed 4 years ago by a surgeon who did not know how to advise me on the right volume. (remember) Following this, I found myself with 530 cc which literally made my buttocks fall with a crease under the buttocks, banana under the buttocks and a disgrace due to the excessive weight of the implant. Following this, I ended up having the implant removed in favor of a smaller one (370 cc) but in the meantime the buttocks had been enlarged and the new implant was moving inside. I have therefore undergone many procedures in recent months. (A Bodytite under general anesthesia) no results. A first butt lift -12 cm (no result). And a second butt lift 2 weeks ago, again -12 cm (again no results.) the skin is flaccid and the implant wanders around in the completely enlarged buttock pocket

What can we do? Thank you in advance for your response. 

A:To your buttock implant dilemma I can make the following comments:

1) When you downsize  a buttock implant in volume the diameter or footprint of the implant also gets smaller. With an established pocket size the smaller implant no longer ‘fits’ and it will slide around in the now larger pocket…this is exactly what can be predicted to happen. The pocket does not shrink down contrary to what most surgeons think and there is no practical way to surgically reduce pocket size. This is why when do go for a smaller implant volume make sure the implant footprint stays the same and only the projection gets smaller (custom implant), thus keeping the implant ‘locked’ into place. Or you will end up with what you have now.

2) In the correction of buttock ptosis (bottoming out, banana roll deformity, inferior migration of infragluteal crease) the only effective treatment is a lower buttock lift/tuck. Trying to pull it up from above is a conceptually flawed approach that never works. (as you have now proven x 2) The force of the pull/lift is to far away from the problem to be effective. In short you can lift away a distant problem, it has to be treated by direct excision.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m so pleased with the results from my temporal artery ligation!! I’m having laser treatment to minimize the blue veins on my temples via V- beam laser. I’m considering scar treatment at ligation points but only if it’s cohesive with the ligations I’m curious to know if laser scar treatment at ligation points would be safe or not. I’m concerned with undoing anything you did and wanted to check to see if it’s a good idea or not.

A: You would be perfectly fine to do any form of scar treatment at the temporal artery ligation sites. It will not cause any undoing of the underling suture ligations. They lie much deeper than the effects of any laser can reach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I am interesting in surgery to increase by brow ridge, and masculinize it that way. I’m wondering what an estimated price range would be for this procedure, and what implant options there are? I have heard of some surgeons using implants, and others using cartilage from other parts of the body.

A:The use of bone or cartilage grafts for brow augmentation is associated with irregularities/asymmetries and a generalized lack of a smooth brow augmentation effect. Not to mention the need to harvest the graft as well as requiring a full coronal scalp incision to place them. Custom designed brow bone implants create far superior aesthetic results as well as bypass all of these issues and can be placed through a limited scalp incision using an endoscopic technique.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been looking into options to reduce the disproportionate nature of my head, specifically the convexity above the ears and am interested in pursuing a surgery through you after looking at your before / after results. I believe that my issue is due to a combination of thick temporal muscles (as the convexity of my skull noticeably changes when I open / clench my jaw) and bone around the parietal area. I was wondering how much more effective an open scalp incision would be as I am also considering skull reduction for the top of my head and would like to maximise the effectiveness of both procedures. I understand that due to the thinning of my hair across my scalp that such an incision would leave a significant scar, but I believe I would be accepting of this as long as a visible improvement is made. I have attached a couple of pictures displaying the convexity of the skull as well as the excessive height. Thank you in advance.

A:The combination of temporal (side of the head) and top of the head reductions can be done concurrently for a combined skull reshaping effect. (see attached) While that could be done through a full coronal scalp incision that is not how I would do it. I would do the temporal reductions through the traditional behind the ear incisions and the top of the head reduction through a superior scalp incision limited to between the bony temporal lines. The goal is to keep the incision away from the more visible side of the head.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a Medpor implant placed approx 12 years ago custom made into my chin.

I’ve not had any difficulties with it, but my surgeon should have also done my jaw too due to the asymmetry.

12 years later, I’d like filler to my chin to hide the jowls and increase it’s projections (overall shape). I’m wondering if this is too high a risk for infection? 

I did have botox injections to my chin to decrease dimplings a month ago and I’m concerned about the risk from that now too, although I have no symptoms and I am well.

Hoping you could offer me advice or options?

A: I see no issues with gettting injectable fillers and Botox around the existing Medpor chin implant. The risk of infection is so low that I consider it not significant. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, May I ask specific which kind of examinations (Endoscopic, CT-scan, through the nose, through the mouth etc.) do you perform on patients before you perform an Adam’s apple reduction surgery on them?

A: The most meaningful preoperative examination for thyroid cartilage reduction is a 3D CT scan of the neck.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi received 22units of botox in each side of my masseters and 0.7 ml in total of voluma in my upper cheeks on the 20th of April. I now see the slimming of my masseters and it looks terrible because I have a weak chin and already had prejowling. Now my face looks like a blob with no definition. I don’t look like myself now and the jowling is worse. What can I do to return to my previous look? I was trying to fix the signs of aging with the dermatologists suggestions but it’s made me look plain and older. How soon will my jaw return if ever and will chewing gum all day stop the atrophy? Can you offer any advice? Thank you, Lisa Boxell

First pic is last summer

This is last summer and a few weeks before I got the cheek filler and masseter botox. You can see face dropped

This is about 3 weeks after masseter botox and cheek filler. I lost how my face used to be. My eyes look smaller and when I smile that’s smaller too. Can I reverse all this?

A: Botox to the masseters will wear off in 2 to 3 months so I would let that natural process occur. (you can’t reverse it anyway by an ‘antidote’)

Fillers to the cheeks is a different story as that will last much longer (up to a year) so using hyaluronidase to dissolve it would be the more timely reversal method.

Dr. Barry Eppley

World-Renowned Plastic Surgeon