Your Questions
Your Questions
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
Q: Dr. Eppley, i! I got some stock jaw and chin implants and am not 100% pleased with the results. I was wondering if you do contouring/shaping post install and how the recovery would be.
A: I am not sure of your question. When jaw augmentation is done with standard implants and are not happy with the results, how to proceed depends on the nature of the problem. Is the problem implant size, implant positioning or the type of implants used? In my extensive experience it is rarely that a few implant adjustments gets the patient to a satisfactory outcome. More times than not the problem is that what the patient wants to achieve could never have been achieved with standard implants and they then have to convert to a custom implant approach.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to inquire about rib removal surgery (shortening of ribs: #12, #11, #10) with latissimus dorsi muscle reduction. I am wondering if it’s possible to undergo this surgery if I plan to have children in the future.
A: Good question. Such surgery has no adverse effects on getting pregnant or carrying the baby to term.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m really interested in waistline narrowing, I’ve tried Lipo and had a BBL but I still do not have the feminine waistline I want . I saw there is such a thing as rib repositioning as opposed to traditional removal and wondered if this would be a good option for me since I really want minimal scar and to recover as quickly as possible so I can get back to my normal activities.
A: There is no real scar difference between rib fracture and rib removal for waistline narrowing as both require access to the ribs. The former relies on 3 months of postop compression to produce a result that averages less than 50% of rib removal outcomes. There is no real recovery difference as rib fractures take just as long to feel goods again as rib removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would the muscle I have on my frame restrict the amount of length that could be attained from the surgery? If so would I be able to stretch my muscles out for a extended period of time prior to surgery to negate this?
A: What I have found is that in all shoulder lengthening patients the shoulder girdle is tight, whether one has muscle hypertrophy or not. (although it certainly feels tighter in the more muscle developed patient) Whether a stretched out shoulder helps or not for this surgery can be debated. But it certainly can only help particularly when significant muscle development is present.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wish to pursue cheekbone augmentation. Is it possible to achieve that through a malar osteotomy rather than implants, or will I require implants?
A: The first step in any form of facial augmentation, cheek augmentation included, is to determine the dimensions of change desired. While you did not specify what your cheek augmentation goals/dimension were your pictures show a flat infraorbital and anterior cheek area but what appears to be adequate.
A malar osteotomy is a one dimensional operation as it only can create cheek width. A cheek implant has a three dimensional effect which appears to be more suited to your aesthetic needs.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 26 year old female and I have been researching how to fix my perioral mounds for a couple years now and cannot seem to find a solution that I find suitable for myself.
I’m not sure why this is such a hard issue to fix but it is becoming VERY bothersome to me and I’d like to find a solution. It does not matter if I am slightly overweight or in perfectly good shape my perioral mounds never go away.
I can tell they are definitely a combination of fat and very thickened mucosa, I feel like I could just bite off the very inside corners of my mouth and it would completely take care of the problem.
A: Based on your pictures you are referring to a combination of perioral mound liposuction for the external lower cheek bulge and an inner buccal mucosal elliptical excision to treat both sides of the cheek contour issue. Those insights are diagnostically correct and you are also correct in that this is a straightforward surgery to do. (at least for me)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Am I a good candidate for hip implants?
A: 1) If you have adequate fat to harvest (and you do) you always try fat injections first. While fat retention in the hips is not known to be great you always try it first and see how much is retained. Even if the fat augmentation result is inadequate it prepares the hips better for implants…which needs all the subcutaneous fat thickness around them you can get.
2) The risk of complications in hip implants improves when one doesn’t get too ‘greedy’ in size and thickness…which I have illustrated in the attachments.The question thus is not whether one can have hip implants but whether the size that lowers the risk of complications is aesthetically acceptable.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 21-year-old young man. I get a lot of stress when I look in the mirror because my head circumference is 62cm, and I found out about your existence while looking for surgery.
I have a few questions.
First, is it possible to have a bone-cutting operation in every part of the skull?
I’m wondering is it possible to reduce the bone under my ear (so that the length between my two ears is reduced), and is it possible to reduce the skull bone under my cheekbones.
Secondly, I would like to ask you is it possible to reduce the Temporal bone and parts of the parietal bone attached to the temporal muscles above the ear (so that the length of the parietal bone decreases from the front),
and if you can, how much mm did you shave on average for the average patient?
Also, I would like to ask how long the cut bones were in the case of the patient who cut the most.
I would really appreciate it if you could answer a long and complicated question. Also, I hope everything I asked is possible.
A: In answer to your skull reduction questions:
1) Bone reduction can not be done ob every part of the skull. The sides of the skull have a large muscle component which is what is reduced. (temporal resuction) That is infinitely more effective than temporal bone reduction.
2) There is no skull bone underneath the cheekbones.
3) Parietal skull reduction can be done.
4) The average skull bone reduction is 5 to 7mms. The average temporal muscle reduction is 7 to 9mms.
5) I do not understand the question of ‘how long the cut bones were’. I assume you are referring to surface area of the bone to which I have seen/done entire surface areas of the skull reduced. The only limitation as to how much of the skull can be reduced is surgical access….where and how long does the scalp scar need to be done to do the amount of skull reduction wanted/needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I have done blepharoplasties only on my left upper eyelid so I can’t close it fully and my left eye is more open. Could we put a tissue expansion for ”growing” extra skin?
A: Short of a skin graft (you can’t tissue expand an eyelid) time and stretching the eyelid is the answer to allow secondary tissue relaxation to help get back to a more competent eyelid closure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, According to what I have seen in several web pages the orbital box osteotomy is the only way to separate the eyes. As I have seen this operation is very complex, so I was wondering if you do it in patients with close eyes but within normal parameters, simply for cosmetic reasons. I mean adding 6-8 millimeters between both pupils, making the inner canthal distance about 6 millimeters wider.
A: It is not a question or whether orbital box osteotomies can be done in someone with ‘normal parameters’, but it how it should be approached. Doing traditional orbital box osteotomies using a coronal scalp incision and a frontal craniotomy seems to be a mismatch between the magnitude of the problem and the solution. A more acceptable approach, where the surgery seems better matched for the problem is a modified orbital box osteotomies which avoids a coronal scalp incision and a frontal craniotomy. Going through the combined approach of lower eyelid and intraoral incisions only the interpupillary distance can be increased by 3 to 4mms per side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
