Your Questions

Q: Dr. Eppley, I had a chin implant placed over ten years ago. nI recall the surgeon used a McGann anatomical chin implant. Immediately once the compression bandage was removed and some initial swelling had resolved I could feel the left wing had been positioned or settled lower than the right. It’s not significant (perhaps 5mm or so) and would really only be perceptible to me or a facial plastic surgeon. However I am considering replacing it with a custom implant. I do recall when I went back to the surgeon post operatively, he commented on the imaging stating that there was some bone ‘erosion’ and he was concerned how superficial the pocket was on the left. 

For revision surgery such as mine, would the current implant be removed and the tissue be allowed to settle for say a month before replacing it (particularly given that superficial left pocket) or can it be done in one surgery? Thank you kindly.

 A:Thank you for your inquiry and detailing your surgical chin history. Most chin implants have some degree of asymmetry or tilt due to the nature have How they are placed. Only very rarely are they perfectly positions due to the limited incisional access by which they are introduced in position. Also, most chair implants will have some degree of bone imprinting often erroneously referred to as erosion. I’m not certain what the term superficial placement means but I suspect it refers to some floating of the implant off of the bone of which I’m not sure, short of having a 3-D CT scan, how that assessment was made.

All of these issues aside they are common and is what I see and almost every Chin implant but I remove and replace. Such removal and replacements are done as a single surgery. There is no benefit or biologic bases for staging such replacement procedures.

When it comes to a custom chin implant replacement a 3-D CT scan is required of which details of your exact chin placement and its effect on the bone Will be evident and will validate your perception of its current placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to ask whether you might consider providing some guidance. I have had two rhinoplasty and one septoplasty over the last 1o years. They have not been successful in correcting the columella position to centre of face. I have read your case study External Repositioning of the Deviated Columella and Nostril when I was researching whether simply repositioning the soft tissue could be helpful as I believe it would. However my surgeon doesn’t seem to agree and will not consider another rhinoplasty, of which I don’t want to go through another anyway. Is there a professional medical opinion you could share with me to pass to her? I wonder whether the hesitation is simply because this isn’t a ‘standard’ approach. Thanks so much in advance 

A:Until I see pictures of the base of your nose I can only make a general statement about an external columella repositioning. Having done it numerous times it is effective and there is no reason it couldn’t be done. Everyone that I’ve ever done it on is in the exact same situation like yours. They been through multiple septorhinoplasties which have failed to align the columella centrally and in some patients it may never be possible by internal repositioning. In some cases the external columella realignment may be combined with the caudal septal graft to ensure it’s new position. I can certainly understand why most surgeons would have an opinion that this is an undoable procedure. But until a surgeon has tried it and failed such negative opinions are irrelevant.

The one issue that does have consideration is that it is likely your prior rhinoplasties were done with an open approach, meaning there is an existing mid-columellar scar. This does raise some concerns about a new incision at the columellar base which leaves a very narrow strip of skin for survival between those two scars (aka vascular compromise). So where are that mid columella incision is exactly could influence whether this is a viable procedure for you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there greater risk for bone recession with a chin implant of the size were using? Around 10mm?

A:You are actually referring to bone imprinting rather than recession or erosion from a chin implant. Since imprinting is a self limiting pressure relief phenomenon in theory larger implants should show more of that  than smaller ones. In my experience however it is not alwaya a linear correlation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was also thinking about canthoplasty, is that service available?

A:I am assuming by your pictures that you are trying to achieve either a neutral for elevated outer eye corner position. If one is trying to achieve a neutral I corner position that I’d lateral canthoplasty alone would be sufficient. However if one is trying to obtain a higher than neutral outer eye corner position than the lateral canthoplasty needs to be combined with a small lower eyelid spacer graft.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What happens to the space created between old, unchanged facial implants and aging facial bones? Do the human face “fill in” this space to establish continued stability? Atrophy of muscles, bone, etc. is characteristics of aging. A gap is created.

A: The concept of aging facial bones, often spoken about, is actually largely over stated. It is one of those theories that sounds correct since the body does age and atrophy is part of many other body structures but in facial bones it does not really occur in that dramatic fashion. Facial bone atrophy is somewhat of a ‘truism’ meaning it just sounds like it should be true but the reality is it isn’t in the way atrophy is typically perceived. Until a single patient has a 3-D CT scan taken on their face from infancy to old age you can never validate what actually happens to the facial bones with aging.

Thus the concept that a space is created between the bone and an implant, or a gap is created between the two, simply does not occur in an age-related manner. Understanding what actually happens requires a biologic understanding of the encapsulation process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, in clavicle shortening surgery  you can reduce the overall width of shoulder but the drawback is that the hardware (if left on for life) will show and be palpable. If removed, the holes produced by the removed bone screws will render that altered clavicle bone much weaker than pre-surgery. Depending on the pre-surgery morphology of the shoulder, the shortening procedure might also not give much “shortened” new shoulder appearance. Are these accurate statements?

A: In answer to your clavicle length reduction surgery questions:

1) The screw holes that are left right after clavicle hardware is removed will go on and completely fill in with bone in a few months.

2) Based on my experience with the clavicle reduction surgery most if not all patients find that the postoperative shoulder appearance is much improved and more pleasing. Your  supposition that claviclce reduction surgery does not create a shortened new shoulder appearance does not appear to be born out by actual clinical experiences.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I hope this message finds you well.  I’ve been following your work for some time and I’m very impressed by your expertise in craniofacial and skull reshaping procedures.

I’m interested in learning more about a custom skull implant for one side of the head (unilateral augmentation), primarily for aesthetic purposes. Could you please let me know:

• Whether the consultation and design process can be done remotely (for example, by sharing 3D scans or imaging)?
• What kind of recovery time and visible results I could expect?
• And if you currently perform this procedure regularly for aesthetic asymmetry cases?

I’d greatly appreciate any information you could share, including how I might start the consultation process with your office.

Thank you very much for your time and for your outstanding work in this field.

A:In answer to your custom skull implant questions:

1) All parts of the process from consultation to implant design are done remotely. It is only the surgery that you would need to come here to do.

2) The recovery from skull implant surgery it Is usually fairly quick and Within 7 to 10 days most of the significant swelling has resolved. There are no postoperative physical restrictions.

3) Custom skull implant designs are regularly done for a wide variety of aesthetic head shape asymmetries and deficiencies.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a lower blepharoplasty a few months ago and one of my eyes now looks really hollow.It started out looking great. But it was like overnight it lost all the volume. So I was wondering if a tear trough implant would be an appropriate way to treat it.

A:Right after surgery for the first 4 to 6 weeks due to swelling everything can look perfectly smooth. But whenb all the swelling goes away and soft tissue contraction occurs as part of the healing process any contour irregularities or volume discrepancies becomes apparent. This is why it takes 3 to 4 months to truly see any type the facial surgery result in its fine details.

That being said the question is whether a tear trough implant would be the best approach to addressing your right lower lid/cheek junction concerns. I don’t think it is given that the surface area’s coverage of the problem is greater than that of a  tear trough implant. Such an implant risks creating a prominent bump or lump in the volume deficient area. If one was using an implants approach it really takes a custom implant design to provide adequate surface area coverage that has a smooth transition into the surrounding bone. However I think that solution, effective as it may be, is far greater then is what is needed.

From my perspective your options are twofold. One less invasive option is fat injections which,  if well done, can restore volume. Fat injections have the advantage of being able to be placed over a broad surface area and into the area that is actually the cause of the volume deficiency (loss of fat). The other option is an onlay which is draped over the  infraorbital rim onto its anterior surface. Think of it as an ‘implant’ but it is really a sheet of cadaveric dermis which can be custom cut and shaped along the entire rim area over a broad surface. It is juice like an implant but it is really a tissue graft which will integrate into your own tissues with the volume persistence.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is there a percentage risk of chin imprinting with the chin implant? Or a general idea of how many patients experience it? 

A:As a general rule 100% of chin implants experience it. It is the normal body response to the pressure of an implant when placed over a solitary pony projection that has a tight enveloping soft tissue envelope.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a young woman who was recently diagnosed with Turner Syndrome. I have a noticeable webbed neck and would like to ask if surgical correction might still be possible at my age. Additionally, I underwent two scoliosis surgeries about 20 years ago, so I wanted to mention this in case it may affect any potential surgical approach. Beyond the physical aspects, Turner Syndrome has affected me emotionally as well. It has caused me to struggle with self-confidence for many years. Unfortunately, in my country, most doctors told me that there was no solution or that surgery would be too risky. I often felt dismissed because they did not want to take the risk. Still, I never lost hope. I kept researching on my own and recently discovered your work on webbed neck correction. Reading about your experience gave me hope that improvement might be possible, even after all these years. I would be very grateful if you could provide some guidance regarding possible treatment options.

A:Thank you for your inquiry and sending your pictures. The question in webbed neck surgery is not whether it is risky, as it is not,  but how effective it will be. My concern in your case is that you have a very short wide neck in which using the posterior or indirect webbed neck technique may either not be effective or,  even if good initial results were obtained, would likely have a 100% relapse. Your type of webbed neck is the most challenging to get any sustained improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley I had head trauma four years ago which required a  temporal craniotomy. As a result I have temple hollowing on my left side due to losing the fat during the craniectomy, so now I am left with a dent on the side of my face that is very hard for me to look at when I have to look at myself in the mirror.. 

I am trying to find someone that can help me fix this problem. I happened to stumble across the skullreshaping.com website and it looked like exactly what I could use for my temple hollowing. I am 100% recovered from my accident and I have been so for multiple years.

A:Thank you for your inquiry and sending your pictures. This appears to be a classic temporal depression after a temporal craniotomy of which a major component of it is likely loss of the temporal muscle volume. It is possible that it also represents the depression of the craniotomy bone flap which would be important information to know. That being said, it can be corrected but understanding whether the deficiency is more bone or soft tissue based is an important treatment consideration. A 3-D CT skull scan will answer that question definitively as well as also provide the platform on which to build an implant which would be the most successful method of temporal depression augmentation given your surgical history.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I Get a second clavicle shortening procedure?

A:Thank you for your inquiry and sending your pictures. As best as I can tell from the pictures the aesthetic difference in the prominence of the two clavicles appears to be in the larger midshaft segment of the bone. After 10 years it would be fair to say, short of major clavicle repositioning surgery without the assurance of a guaranteed outcome, that camouflage of the problem through the use of an implant would be an aesthetically  superior and safer choice. This would be a custom 180 wrap around implant made to cover/enlarge the deformed clavicle, in essence making the clavicle bigger or more prominent.

It would be helpful to see current clavicle x-rays to understand the exact differences in shape between the two clavicles.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a sliding genioplasty for recessed chin/jaw and side profile. However, I really like my smile and front profile most of the time. I do not like the double chin I always seem to have, even when my weight is down.

A:Thank you for your inquiry and sending your pictures. From your side view picture with at least a 20 mm chin deficiency you have selected the only appropriate procedure for chin augmentation with this degree of chin recession which is a sliding genioplasty. When one has lived this long with this degree of chin  recession, particularly a female, it is important not to try and normalize the chin position completely is that will likely look unnatural to you and create a face that you might not recognize. For this reason your sliding genioplasty should probably be in the 10 to 12 mm range as estimated in the attached imaging. With this amount of chin of chin advancement it is very likely that your double chin it is very likely that your double chin Will be significantly improved will be significantly improved by the accordion effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Good afternoon,I wanted to inquire about the face shortening surgery. I’m not really sure about the name of the procedure, however, I believe it makes your face look rounder instead of longer, I guess the name is face shortening procedure, correct me if I’m wrong

A:When you are referring to in face shortening surgery is the distance between the eyes and the lips. I don’t believe you are referring to the forehead is it is covered by your head dressing. I also don’t believe you’re referring to the chin which does not look particularly long. There are no effective shortening procedures of the middle part of the face that reduce the external soft tissues. A LeFort 1 impaction surgery can help reduce the long maxilla with excessive tooth show, a.k.a. a gummy smile, but does not reduce the vertical length of the soft tissues of the middle face.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached some pictures below. I would like to inquire about lateral canthoplasty, fat transfer to the upper and lower eyelids, mild ptosis repair and spacer grafts all in one if possible. Does the doctor perform drill hole canthoplasty? I would prefer this technique combined with the spacer grafts to eliminate any chance of the lateral canthus from relapsing over time. Whatever he thinks is best for my anatomy is what I prefer, of course. I’m trying to transform my negative canthal tilt into positive by around 5-6 degrees. I understand what matters most is the harmony of the face and making everything look natural. So I’d like to hear if he thinks it’s possible while not making me look uncanny. I also understand that many times surgeons require the patient to have infra orbital implants done as a support so the lower eyelids don’t droop overtime, although I’ve seen that spacer grafts can offer the same assistance in the concept of making sure it doesn’t relapse. That’s my main concern. I’m also trying to lengthen palpebral fissure length horizontally if possible, as I’ve seen many doctors shortening the eye in order to raise the canthal tilt which is what I’m trying to avoid. I’m also aiming at keeping palpebral fissure height to a minimum. Input would be great, thanks!

A:Thank you for your inquiry and sending your pictures. All of the mentioned Orbital procedures that you have described can be performed at one time and are often done so given the effect at the patient desires to create. To answer your specific questions:

1) The need for infraorbital orbital implants in such a surgery depends on whether actual under eye hollows exist and/or the patient wants to correct them. While you do have lower midface/maxillary concavity your infraorbital and cheekbones seem to be strong. Therefore I do not believe that they are an absolute must in your case.

2) When it comes to a lateral canthoplasty the only effective procedure in my hands that has ever worked and is sustained is a drill hole technique. Therefore that is always how I do it.

3) you have to recognize that correcting a negative canthak tilt and creating increased lateral I with/length are contrarian effects. Elevating the outer corner of the eye will not necessarily make it shorter but I wouldmdoubt that it is going to make it longer.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I am a man but I had Facial Feminization Surgery at one point it my life where I believed I was trans, would it be possible to ‘reverse’ most of the forehead work(type 3 browbone reduction and orbital rims shaving)? I know I won’t look exactly like I did before, but I have CT scans from before the surgery. Would a custom browbone be the best solution in this scenario? My main concern is the lack of projection from my orbital rims and lack of a brow bone “break”. Would I have a greater risk of infection or other issues due to previous trauma at that area? Part of my FFS procedure involved hairline lowering, so my skin is probably tighter than before, is that something I should be worried about when it comes to getting a brow bone implant? Thank you

A:You have correctly surmised that the reversal of forehead feminization would be a custom brow bone implant. I have done this numerous times over the years as you are not the only person has reversed course in the transgender process. While you have had a frontal hairline advancement that does not make the lower for head skin any tighter or more difficult to release and augment. Because of your hairline lowering you also have a convenient point of access to place the brow bone implant. The only concern for infection is whether you having complete healing of the setback bone flap of which exposure to the frontal sinus underneath may occur with soft tissue elevation. A current 3-D CT scan will clarify whether that is a potential issue or not. Most of the time in bone flap setbacks there is generally good bony healing around the flap margins.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m interested in a forehead and upper skull contouring procedure to improve the overall proportions of my head. I’ve seen your case where you performed a full-head reduction by a few millimeters, and I’m curious whether it’s possible to apply a similar technique limited to the frontal area.My main goal is to reduce the vertical height of my forehead, specifically the distance between my eyebrows and hairline. I am not looking for hairline lowering surgery, but rather actual bone removal in the frontal region. I will provide an image to illustrate the cut and shape I am imagining. Would this type of procedure be possible, and would it result in a measurable shortening of the forehead — likely only a few millimeters?

A: Thank you for your inquiry and sending your x-ray. The forehead like all other bony areas of the skull can be reduced by burring which entails removal of the outer cortical layer down to the diploic space. The question is not whether that can be done but how effective would it be for the patient’s goals. Based on your x-ray and the red line you have drawn on it that is about 5 mm of bone reduction which the x-ray shows can be safely done. That will result and I someone increase backwards slope to the fore head which appears to be your primary aesthetic goal. Whether that would result in any measurable decrease in the distance between the frontal hairline and the brow bones is more suspect unlike the slope changes from the bony reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Honestly speaking I’d only like to have an opinion It d be very appreciated if the doctor that is a the best could say me his opinion on this implant shape and thickness.

A: Looking at an implant design by itself is meaningless as there is no context to it. What is the basis of this design? How were the dimensions established? What are the patient’s specific VISUAL goals…meaning using the patient’s face pictures and changes made to them that represent the patient’s ideal outcome (aka setting the target for the implant designs)

Without that information this is just facial bones with some implants on them…just a cool 3D art project.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, Do you perform Xiphoidectomy’s at your office? Thank You.

A: Yes. Xiphoidectomies are performed in my surgery center as an outpatient procedure under general anesthesia.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing with an interest in your opinion on how to go about correcting a minor dent in the upper right side of the back of my skull. I would estimate the overall indentation measures about 2″ x 1″ and indents into my skull about 1 cm. This is not a recent development- I have had it for almost all of my life that I can recall and I cannot pinpoint with certainty any specific incident in my childhood that caused it. Thankfully, it does not present a major aesthetic issue at the moment because my hair covers it, but in the event that I’m bald in the future or have a desire to shave my head, I would desperately desire to have the dent fixed. What do you think my options are?

A: The definitive correction method of any skull indent or contour deformity is a custom skull implant made from the patient’d 3D CT scan. This allows for the most accurate contour correction with the smallest scalp incision to place it.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am looking for quotes to have my butt revised with adding mesh to hold up the implants. I have now had two different butt implant procedures. The doctor said he did his best with what was possible and maybe mesh could work but hes not experinced in this. I can feel the implant falling and do not sit on it ever. I have mesh in my breasts and that has been helpful. I do not need new implants just mesh added and possily moving it into a different spot

A: The mesh concept can be an effective method for implant support. But unlike the breasts, with inframammary incisions which provide access to exactly where the mesh support needs to be added, the intergluteal incision for buttock implants only allows access to the superior side of the implant. Unless one is going to come from below with an infragluteal incision  teh only potential technique would be to remove the implant, wrap them in mesh and then re-insert them. Whether this can be done in your case requires more information about your prior buttock implant surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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

A: To clarify common custom implant misconceptions:

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

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

Dr. Barry Eppley

World Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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

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

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

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

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

Dr. Barry Eppley

World-Renowned Plastic Surgeon