Your Questions
Your Questions
Q: Dr. Eppley, Hello, so basically I have a dent on the right side of my face and am looking for answers on if I can get worked on. I got the dent from a car accident, I had my right bone flap removed then put back in 2.5 months later. Sadly healed up with a dent and haven’t seen any doctors or surgeons for my head since the surgery.
A: You have the classic temporal muscle atrophy that comes from having had a temporal craniotomy from your accident. This soft tissue depression, which may be magnified by some temporal bone settling, can be built up using a variety of methods from injectable fat grafting, bone cements, to custom temporal implants. Each temporal reconstructive method has its advantages and disadvantages.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have jaw denting and sagging due to wisdom tooth removal. Can this be fixed? I have attached a picture of my impacted lower wisdom teeth which were removed.
A: While the picture of the x-ray is of poor quality I believe it shows the impacted state of the third molars…which would require some significant bone removal to remove these teeth. So it certainly seems plausible it could leave external indentations from the loss of bone along the jawline as well as some soft tissue sagging from the subperiosteal degloving of the overlying soft tissues.
My assumption would be that restoration would require fill of the indented bone areas with a possible jowl tuckup for the sagging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can distraction osteogenesis be performed only on chin to increase the vertical length of the chin! It’s because i atleast need an inch of vertical growth in the chin! Can distraction osteogenesis be performed on chin for this purpose?
A: On a practical basis distraction of the chin has many technical problems the first of which is there are distraction devices available for this purpose. More pertinently if 20 to 25mms of vertical chin lengthening is needed a vertical lengthening bony genioplasty with an interpositional graft can be done up to 20mms, negating the need for a complex and lengthy distraction process.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I am interested in skull and face reshaping surgery. I’m not happy with my head being too wide and having a bump on my left side. My head is also flat at the back. Thus, I am interested in having temporal muscle reduction surgery ( bilateral ) and augmentation of the back of my head with hydroxyapatite. I would also like more masculine and prominent forehead bone and would like to have augmentation with hydroxyapatite there as well. I have read that Dr. Eppley recommends implants in many cases, but I’m more interested in hydroxyapatite. However, it would be good to know the difference in price between implants and hydroxyapatite in my case?
A:I will not use hydroxyapatite cement (HAC) for any form of significant skull augmentation…and augmenting the back of the head and the forehead-brow bone qualifies as significant skull augmentations. HAC is a terrible way to try and do skull augmentation. The incisions needed to use it properly are big, it is very expensive, the amount of augmentation is very limited and there is poor control of its shape. The biologic appeal of HAC is great but its clinical application for onlay augmentation is poor. It was never made for skull augmentation, it was made to fill skull defects which is a very different geometric problem. Implants may be implants but their aesthetic results are so superior and the ability to place them through small scalp incisions makes their lack of biologic appeal an acceptable tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to see what I’d look like with potential surgeries. I struggle with facial asymmetry, there’s not really a major area that’s bad it’s more like several minor ones on one side which make it look worse altogether. The eye region, cheek bone / jaw line region and one ear from a botched Otoplasty are the most noticeable to my eye.
A: Short of the ear asymmetry (do you bring the overcorrected left ear back out, reduce the more prominent right ear or some combination of both) I would not recommend any facial surgeries for you. Yes there are some minor facial asymmetries that exist but in an effort to improve them you are just as likely to cause other issues that require more surgeries to fix etc….this is known as going down the surgical rabbit hole. i would consider yourself extremely fortunate that you have as good a facial structure/shape as you have with an overall very handsome face. Most men would love to have your face and I have operated on many such patients who never even get close to where you are despite the best surgical efforts.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can anything done for the left cheek was fractured long ago. Looking for a more sculpted symmetry look. What are the options for this?
A: For the left cheek asymmetry from the original fracture better improvement will come from implant augmentation as opposed to now trying refracturing the bone and repositioning it. This is best done with a custom implant approach using a 3D CT scan to match the left asymmetric side to the normal right side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting chin ptosis correction. I am very insecure about my chin especially when I smile, it seems to get bigger. I’ve seen that you have a lot of experience correcting this type of chin, so I am very interested in scheduling an appointment at your place.
I would like to know how you would correct this. I would like to have no sagging, but without changing the length and width of my chin. I would like to have my jaw and chin to form a straight line, both from profile and front view (for reference, I like Ariana grandes lower jaw and chin :D)
I thought about getting fillers in my jaw, and I want my chin to fit. I don’t want the v-line look, I want a more U/line look, I don’t want my chin to be too pointy.
A: The only effective treatment for chin ptosis is a submental technique which works by removing some of the inferior/overhanging soft tissue chin pad. By definition that also removes some chin length from the soft tissue reduction and may or may not make the chin a bit wider. In your case this work have to be combined with some submental/neck liposuction to get a better chin-neck profile relationship.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a chronic migraine sufferer. I am 30-years old and have tried all kinds of pills, nasal sprays, powders, self-injectables, and tablets for my migraines. I specifically get pain in the frontal area. I do believe that the trigger point is either the frontal or nasal. The pain is behind the eyeballs, on the eyebrows, and the forehead. I am aware that insurance doesn’t cover surgery, although it does in my state of where I reside. It is called Nerve Decompression surgery. I do have some questions from Dr. Eppley if possible:
- Specific treatment for this involves decompressing the supraorbital AND supratrochlear nerves in the glabellar area by resecting the corrugator and depressor supercilia muscles using a minimally invasive endoscopic approach similar to that used for a cosmetic forehead lift. Supraorbital and supratrochlear nerves are decompressed……..
Your website states that a brow bone reduction could help this. I think I am only a candidate for Type 1. Do you believe that shaving the bone could help decompress the nerves? (incision would be via frontal hairline)
- Can you combine this with a slight orbital rim shave?
- Have any of your patients with frontal pain who had surgery had any success? Are they completely migraine free or reduced?
- Dr. Bahman Guyuron started doing forehead lifts/brow lifts and many of his patients had little to no migraines. He also founded the migraine surgery society.
I know this sounds crazy but I do believe this pain comes from the anatomy of my bone structure. I do have masculine features.
A :Thank you for your inquiry and sending your imaging to which I can say:
1) You have very wide open orbits and an exit of the supraorbital nerves that shows no inferior bony containment at the medial inferior supraorbital rim. Thus specific bony decompression of the supraorbital nerve does not seem to be needed as there is no obvious bony constriction of the nerve)
2) You have a perfectly straight septum with no inferior turbinate impingement on it, thus I see no evidence for a nasal basis for your migraines.
3) This brings it back to whether standard release of the supraorbital nerves with muscle resection would be of benefit. No matter what is written about the success rate of the procedure all patients must know that it is unpredictable. While many patients get relief some do not. (In the short term everyone does because of the nerve numbness) It would be fair to say that improvement means a reduction in their symptoms. Do some patients become completely symptom free…rarely.
4) The two methods to perform supraorbital nerve decompression and muscle release is either through a superior endoscopic technique or through an inferior upper eyelid approach. Each method has its advantages and disadvantages. Because you don’t need bone removed below the supraorbital foramen this makes the endoscopic technique a viable options.
5) Shaving the orbital rims for their aesthetic benefits has to be done through a frontal hairline incision not an endoscopic technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I just wanted to ask how long it would be before I could be active after the surgery. I ride horses and would want to get back to it asap. Is there anyway the surgery could affect my posture. Would all my organs still be fully protected if I had a fall? Are there any long term risks?
A: In rib removal recovery, there are no specific postoperative restrictions since you can hurt the surgery site. It is more about discomfort and the recovery from it. You should be able to ride horses again one month or so after the surgery.
The surgery does not affect your posture, there is no loss of organ protection and there are no long term adverse effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to get masseter muscle botox (Xeomin) as well as botox in the Crows feet area around the eyes from my dermatologist, would this be an issue with the implants I have? What would happen if the doctor accidentally injected into the cheek, jaw, temporal, or chin implant? Could it leak or get infected?
A:That should not be a problem. The key is let the dermatologist know there are implants there. In the eye area injections are done right under the skin which is well away from the implant. In the jaw angle area they have to go deeper to get into the muscle, they just don’t want to go down into the implant. But having the implant there actually makes the muscle easier to inject since it is pushed out.
Your implants can not leak since they are solid, not gel-filled like breast implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would you be open to performing a bony genioplasty for vertical lengthening? It is my preferred option vs an implant. Also can a genioplasty add width and squareness?
A:A vertical lengthening genioplasty is a good choice for dropping the chin down and allows for much greater amounts of lengthening if needed. However it can not make the chin wider or more square since it takes the natural chin and moves it down. It will essentially be the same chin width and shape. It would take an implant to add to it to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently got a sliding genioplasty with vertical, horizontal, and widening advancements. My question is, how stable are the titanium plates used to secure my chin in the first 48 hours after surgery. I have been coughing and sneezing a lot and also accidentally bumped my chin once which put a lot of pressure on it. Since I have recently gotten the procedure and (assuming) no new bone has been formed, is there a chance the chin could’ve been displaced? Or are the titanium plates used to secure the chin already very secure immediately after surgery?
A:This is really a question for your surgeon who did the surgery since i would have no idea as to the exact bony movements done and the hardware applied to secure them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i completed the form and have attached some pictures and a video of my body. i find i have a very boxy square mid section with no hips or butt. id like to sculpt the waist and augment the hips/butt. im not sure what procedures dr eppley would recommend. im definitely interested in liposuction + fat transfer. i have a friend who recently went to eppley for the same thing with rib removal and flank muscle reduction. im not as interested in rib removal … it seems extreme but id be willing to discuss it anyways. im also very interested in the flank muscle reduction. basically anything to get me closer to a more hourglass figure.
A: Thank you for sending your pictures and video. When it comes to the waistline there are three options, 1) liposuction only, 2) liposuction and LD muscle reduction and 3) liposuction, LD muscle removal and rib fracture and 4) liposuction, LD muscle removal and rib removal. These are a progression of procedural options whose result increases as one moves from #1 to #4.
When it comes to the buttock/hip area it comes down how much fat do you have to harvest and where is it best used. With modest fat to harvest you have to use it wisely so the options include: 1) intramuscular buttock implants with fat overlay or 2) buttock implants with hip fat injections.
As you can see you have a lot of body contouring options to consider.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I really like the shape of the Custom Infraorbital-Malar Implants for the High Cheekbone Look, but my main deciding factor when it comes to this surgery is how often it’s performed. It seems to be somewhat experimental at the moment and I just wanted to ask why that is, why aren’t more surgeons doing implants with this shape? (Since not everyone wants the lower cheek fullness that traditional cheek implants give). Also if i could see any before / after pictures / comparisons that would really help me in making the decision in whether this surgery is right for me. Thank you.
A: I have performed hundreds of custom infraorbital-malar implants which is of particular benefit for men due to the horizontal augmentation line from the undereye area out along the zygomatic arch. Of all the custom facial implants it has the highest success rate and the lowest rate of revision.
Why other surgeons can not see the value of this implant I can no say…except that they probably don’t have a high percent of male patients in their practice in which this implant style fulfills a common aesthetic need.
Getting male patients to agree to show their full face for the world to see their before and afters is very rare. (less than 1%) Male confidentiality is much greater than womens. Thus what is available online is what patients have permitted.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, was researching procedures for Hip Widening and i happened to come across a website called Osty Meditech. I read about the procedure, it seems as if this were a decent method to the Pelvic widening approach. I notice you were on the medical team as the clinical advisor however i am not yet convinced that this surgery is legitimate as for there is very few information on this procedure online. The reason why i contacted you is because your the one whom i found to be most credible and in english, i wanted to know if this is something that you actually associate with and approve of this surgery.
A: Iliac crest implants were developed and are used in S. Korea. They are not yet FDA-approved for use in the U.S. but may likely be later 2023 or 2024. When they become FDA-approved I will be the surgeon in the U.S. using them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What is the staging order of the 2 procedures below:
1/ forehead-brow implant (to achieve lower brows)
The forehead implant needs to create a wider forehead, more volume at the temple region, more squared look anteriorly, less slope from side
2/ glabella augmentation/rhinoplasty
(which I will get elsewhere. I am Asian)
A: It would make the most aesthetic sense to get the upper face augmented so then the nose can be made to fit with it…rather than the reverse which would be less predictable and harder to do.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, When I saw the photoshop photos of my head, new questions arose:
Stage 1 Questions :
- Will stage 1 correct the flatness of the head?
I know I can’t achieve a big round head but will correct flatness & notice a change.
- If I decide Stage 1, can I come back for bigger augmentation years later?
- Will I need to do tissue expander then?
Stage 2 Questions :
- Will I able to do regular day things for example work, exercise & drive.
2. Is tissue expander visible? Can I hide it in my hair?
- How long will I have the tissue expander in for?
- Shower?
Surgery questions : Is there any side effects?
Will I feel the implant in my head? Like weight? Is headaches a side effect?
Dr. Barry, I need your help in making a decision please please please. I desire a full round head. However, Stage 2 is a more lengthy process than stage 1.
My biggest fear is that Stage 1 won’t correct the flatness. Do you personally think stage 1 will do any difference ??
A: My answers are:
1) The whole purpose of the computer imaging is to show you the differences between a one vs two stage skull augmentation. It is up for you to decide if what you see in a one stage procedure is adequate.
2) Having a skull implant in place does NOT preclude having a large one placed later.
3) A skull implant feels just like bone and does not prohibit any activity after surgery including exercise and contact sports. A tissue expander will feel much softer.
4) With a good head of hair the tissue expander can not be seen. It will remain in place for two months. One may shower and wash their hair whiel having a tissue expander.
5) Skull implants do not cause headaches. They are light weight, most skull implants weight less than ½ pound. So while it makes your head bigger it does not really make it much heavier.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi. I was wondering how much mm can I get as a chin implant? Is it possible to get 13,5 mm? Will this be an issue with the tissue inside my chin (to close)?
A:At 13.5mm, which requires a custom chin implant to do, that is probably beyond what can be placed and the tissues brought to close over it. When the chin requires that amount of augmentation it is small and the overlying chin pad tissues are very tight. This is why most chin augmentations that are over 10mms have a sliding genioplasty as opposed to an implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I feel like my head is too small, I was wondering if I can make it taller with an implant or fat graft?
A: Only an implant can make the head taller. (skull heightening) mFat grafting for skull augmentations does not work. The height increase with the immediate placement of a skull implant is 10 to 12mms. With a first stage scalp expansion that can be increased to 20 to 25mms. of height.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dr. Eppley, Hello, I am 8 months postop now with really thin skin after a closed rhinoplasty and my tip skin was pretty much gone I thought for a while. Now my tip is shrink wrapping even more all of the sudden and causing a bifid tip? The right half of my tip cartilage has been longer than the left all thus time and it’s also really obvious from the front. Can this still be uneven swelling? What can be done to fix it?
A:At 8 months after a rhinoplasty this is not swelling this is the reveal of the shape of the nose that eventually occurs. While there is a lot of appeal to a closed rhinoplasty it does not offer complete exposure of the cartilage structures of the tip so some asymmetries/irregularities would not be uncommon. The key question is where these residual tip cartilage anomalies could be adequately addressed by a secondary closed rhinoplasty. I would think the bifid tip could be treated by a cartilage graft placed between the domes. The differences in the lengths of the lower alar cartilages are more challenging in that regard but could also be done so. Obviously opening the tip is the more visualized and assured method of revision but you have gotten this far into your nasal surgery without doing so so another closed effort at it seems worthwhile.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like more information on testicular implants. I have very very small testicles but I’m scared to get implants and move forward with surgery. Is there any type of information or statistics to reassure me that the testicular implants help instill the confidence I’ve been lacking to move forward and live my life and be proud of who I am?
A:You are asking a question to which there is no assured way to know what effects testicle implants will do for your self-confidence. That being said I would think the most useful question in that regard is….how many men in which I have placed testicle implants for enhancement (not replacement) take them out because they do not like them or because they have ‘learned’ they are better off without them than with them? The answer is so few that I can not recall of a single case. (it is possible they may have went elsewhere to have them removed but if so I would not know)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well. I am writing to inquire about jaw and chin implants for my aesthetic concerns.
Based on my facial structure, I am wondering if a custom or non-custom implant would provide me with a better aesthetic result. Additionally, I am curious about the cost comparison between a custom wrap-around implant versus separate chin and jaw implants.
Lastly, I am interested in your opinion on using PEEK implants for this procedure and their respective pricing. Would you recommend PEEK implants for me based on my facial anatomy?
Thank you for your time and expertise. I appreciate any information you can provide on these matters.
A: A custom jawline implant is always the better jaw augmentation method over the use of three standard chin and jaw angle implants for both aesthetic reasons as well as a lower potential risk of complications. (asymmetry, implant malposition) The only reason to ever use standard implants is cost as long as one can accept their higher risk of aesthetic complications.
When it comes to implant materials, the body doesn’t care. An implant is an implant is an implant in how it reacts to it. It treats them all the same by a normal encapsulation reaction. And they all will feel like bone. There are, however, differences in how they are designed and surgically placed between the completely rigid (e.g., PEEK) and the semirigid silicone materials. There are also major cost differences between them, at least in the U.S.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to ask how can i make my orbital rims more vertically compact to create hunter eyes????
A: To shorten the vertical interorbital rim height (brow bone to infraorbital rim), this requires a combination of brow bone and infraorbital rim implants that drop down (brow bone) and raise up (infraorbital rim) the bony edges.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Have severe plagiocephaly in the back of the head and would like advice on options.
A:Most plagiocephaly patients benefit from building out the flat side of the back of their head with a custom skull implant. How that applies to you is yet unknown to me since I have not seen pictures of your head or a 3D CT scan of your skull.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have had deep dark circles under my eyes since I was a baby. I am looking into tear trough implant surgery.
A :You are headed in the right direction to improve your lower eyelid fat herniation due to lac of infraorbital bony rim support. These would have to be custom infraorbital implants as they need to create a 3D augmentation of the underlying bone not just sit in front of the bone edge which is all that standard infraorbital rim implants. This would be combined with herniated fat removal through a lower blepharoplasty approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, After a custom skull implant, I am still able to get an MRI done, correct? I assume there is nothing metallic used for the procedure? You performed a cranioplasty on me in 2016 and I have been very satisfied with the result! Thank you for all you do!
A: There are no concerns with getting an MRI after a custom forehead implant. There are two small titanium microscrews initially placed to secure it which are MRI-compatible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I previously got lower jaw surgery and genioplasty for a total of 14mm of movement. I am now considering more chin augmentation either in the form of an implant or genioplasty. Please recommend best next steps, thanks.
A: Having had two bone surgeries for your current chin projection it would make the most sense to build on top of what already exists with an implant for the final chin projection effect. The two prior surgeries and the amount of movement needed have made an implant possible at this point for your secondary chin augmentation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting a custom skull implant and I have long hair. Would the surgery cause hair loss in anyway since a silicone will be inserted in between the skull and scalp?
A: Skull implants are placed on the bone beneath the overlying five layers of the scalp. As a result it does not cause hair loss as the hair follicles reside between the 1st and 2nd scalp layers…the implant resides beneath the fifth layer of the scalp.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had radiation to my neck at 10 years old I’m 37 years old now my neck or trapezius muscle won’t grow. Is there any implants for neck and trapezius?
A: Trapezius implants do exist and are placed through a small posterior neck incision. (see attached)
Neck implants can be placed along the sternocleidomastoid muscle. They are a bit trickier because of the crossing of the greater auricular nerve in the midportion of the muscle so I might consider injection fat grafting instead…which may be preferable anyway because of your history of neck radiation.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I believe my upper lips are too thin. Is there surgery to make te thicker?
A: In the thin upper lip male the best procedure for making the lip have more visible vermilion show (look bigger/fuller) is the vermilion advancement procedure. This is a particularly effective procedure when the sides or the whole upper lip are particularly thin. (have scant vermilion exposure)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
