Your Questions

Q: Dr. Eppley, Hi there, i would like to lengthen my forehead with implant, is this possible ?

A: That depends on what you mean by ‘lengthening the forehead’. A forehead implant can potentially increase between the eyebrows and the frontal hairline in some people and based on the implant’s design.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have retracting testicles and seem to be always clenched, which make them look even smaller. Would I be a candidate for the “encased” implants or how would that be approached? 

A: Thank you for your inquiry and sending your picture. My concern is that scrotal skin seems very tight and it is unclear how much it could stretch to accommodate more internal volume. That issue aside given your testicle:scrotal size ratio the wrap around testicle implants would be the only effective approach….which also helps with the scrotal sac skin issue as this implant approach uses your existing testicles as part of the implant. (unlike the side by side implant approach where the implant adds entirely new volume)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Due to my remote location (Australia) I won’t have access to a surgeon who works with custom/3d planned implants. I am in need of vertical augmentation, and i also have some asymmetry which means the implants have to differ somewhat. If need be, would it be possible for a surgeon with the vertical lengthening implant to shorten/cut down the vertical length of the implant on the spot, say from 11mm to 9mm lengthening, or would this be impossible?

A:I am bit uncertain as to the exact nature of your question as there are no standard vertical lengthening total jawline implants. You may be speaking in reference to the standard vertical lengthening jaw angle implants which can be intraoperatively modified. (reduced)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am concerned about my lower third and overall facial features from a purely aesthetic point of view. I am planning on signing up for an official consultation but I first want your opinion and some advice. Thank you in advance for your time.

A: Based on just this one front picture it is clear that the major deficiency in the lower third of your face is vertical in nature. What you need for better facial balance/proportions is vertical jaw lengthening which can only be accomplished successfully by a custom jawline implant design. Whether there may be other jawline dimensional needs can not be determined by just a front view picture only.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I’m a former patient for a two step skull implant. First off it was life changing for me! But years later, I still feel flat in the back of my head and I’m also interested in a forehead augmentation. I’m curious what a process like this would be since I already have an implant over the top of my skull? Thank you!

A: Good to hear from you as it has been almost 5 1/2 years since your skull implant placement. I believe the question you are asking is whether you can have a forehead implant with an indwelling skull implant. The answer would be yes as forehead implants do not ever pose the same volume issues as your existing skull implan did. The only questions about the forehead implant are logistical in nature such as its actual design and incision location to place it. The forehead implant would need to be designed to integrate with the existing skull implant, making it essentially like an extension of it for a more complete form of skull augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hello. I had double jaw surgery before. Can a custom made Total jawline implant be placed on it?Is there any risk? 

 A: It is very common to see patients who have had prior jaw surgery (sagittal split osteotomies, chin wing osteotomies, V line jaw reduction) for custom jawline implants. Such prior surgeries pose no issues for performing the surgery nor increase the risk of complications from it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, there’s a small discussion going on (url below) on one your patient’s threads about the shoulder rolling which you write can occur temporarily during healing. The point I’d like to clarify with you please (so I can add to the discussion), is, skeletal wise, how do/can the shoulders go back to being straight/back again despite the ‘geometry’ of the clavicle bones being shorter and thus pulling the shoulders forward? 

Also, post healing, would back arch exercises (which really pull the shoulders back) be contraindicated, or would they be fine?

 A: All I can say about it is that, so far, no patient has told me yet that inward shoulder rolling is a long term problem. The operative words here are  ‘told me’ which could mean maybe some patients have it but have not gone out of their way to tell me about it during our postop virtual followups. 

The medical answer to your question is that, according to the orthopedic literature based on extensive clinical data from patients with unoperated clavicle fractures where length shortening is a common sequeale, shoulder function is not adversely affected when the clavicle length has been compromised by less than 30% of its original length. They do not comment on appearance since this is from the orthopedic surgical literature.

Once the clavicle is full healed (8 weeks) shoulder/back stretching can certainly be safely done which would very likely overcome any inward shoulder rolling from clavicle length reduction if it persisted.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Are the insertion of the forehead implants performed by you? If so, how invasive/risky is it, and would they be placed behind the forehead muscles? 

A: In answer to your forehead implant questions:

1)  Since I am the surgeon I am the one who performs all aspects of every surgery that I do.

2) Having many forehead implants the risks of the procedure are really aesthetic in nature…how well does the implant design achieve the patient’s aesthetic forehead reshaping goals.

3) Forehead implants are placed in the subperiosteal tissue plane directly on top of the bone which places it behind all overlying soft tissue layers.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would I be suited more to the V to Y mucosal advancement lip lift? As there is no scar but not sure it would achieve the look I want?

I like the curved off look going from the top to the sides rather than straight diagonally down, so that it gives a more fuller top lip

I’d like my top lip practically matching my bottom lip for size

Also if you can tell me is the scar noticeable on the Gullwing liplift?

Here are a few photos top 3 are me the rest are how I want my upper lip to look.

A: The vermilion advancement procedure is the correct lip reshaping procedure given your objectives. ironically the scar line in men does better than in women because of the hair bearing skin. (see attached)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley: I am planning to get cheekbone reduction and currently my biggest concern is skin sagging. But i already accepted the risk of skin sag i just want to minimize the severity. I read somewhere cheekbone reduction through coronal incision reduces the risk of skin sagging. Is it true? Which method is better?

A: It is true that the risk of soft tissue cheek sagging with a superior coronal incisional approach in cheekbone reduction osteotomies is less. This is because the stripping of the soft tissues off of the cheek coming from an inferior (below the cheekbones) intraoral incision is avoided. But there are adverse aesthetic consequences to the scalp approach as well, primarily the long scalp incision, the risk of visible scarring and the longer duration of the surgery which will increase the cost of surgery.

Ss you can see no approach to cheekbone reduction surgery is risk free. Your decision as to how to do cheekbone reduction surgery is based, therefore, or which risks you choose to accept if you have the surgery.

Dr Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a cheek implant put in 25 years ago. Due to stress I have been grinding my teeth at night. I do wear a mouthguard. Twice over the past few months, I have woken up in pain where the implant is located. The first time I thought I had an infection in my gums and I took penecilin. It did go away but I was also very careful about managing the grinding. I just woke up 3 days ago with the same pain. I believe it is the implant and not a gum problem. I can’t even chew on that side it is too painful. 

A: I believe what you are experiencing is a problem with your cheek implant. Undoubtably with such old cheek implants they are probably placed anteriorly with a downward angle, putting them close to the maxillary vestibule. Short of a tooth-related problem, which I can not say does not exist, the next culprit would be the cheek implant. The key question now in their management is whether implant removal alone is enough or whether replacement is desired.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in cheek implants hoping to eliminate the concave appearance of my cheeks and if possible strive for a more symmetrical appearance.I had cheek implants last year and think there’s plenty of room for improvement;).

Thank you for your time and I look forward to hearing from you.

A: Thank you for your inquiry and sending your pictures. The key to determining how to augment your cheeks better is to know what type of cheek implants you have in and where they are located. There is no sense in guessing or eyeballing how to improve things. That is why I would get a 3D CT scan which will reveal that valuable information. Once you know what isn’t working well it allows one to determine what will work better.

That is a scan we can order for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question. Is it possible to have a sliding genioplasty for the chin and create a custom wrap around jaw implant together. Reason I ask is that I think I need vertical length in my chin and it’s my understanding that chin implants only give horizontal lengthening.”

A: Combined sliding genioplasties with custom jawline implants are not uncommon. They are done when the desired chin augmentation dimensions, usually vertical, exceed what the soft tissue chin pad can safely cover. This usually is done when the combined vertical and horizontal augmentation dimensions exceed the combined number of 12.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I believe I may have excess perioral fat, and I am writing to enquire exactly what these pockets of fat around the highlighted area is.

I am situated in London England therefore I am asking to get an opinion on what exactly the right procedure could be. I have already had complete buccal fat removal however this treated my middle cheek and not the perioral area.

Could these be treated with an injection such as Kybella or would micro lipo be a more appropriate approach?

A: Kybella never works for fat reduction in that area, it requires liposuction alone or combined with a buccinator myectomy. In thinner faces it is most likely going to require both to create your outlined effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My concerns are that my sagittal ridge reduction will be sufficient enough. That there will be no long term affects from having it done. And that I can fly home the day after the surgery as I was told at my virtual consultation.

A: In answer to your questions:

1) In sagittal ridge reduction the maximum amount of height is reduced that the bone thickness will permit. Whether the line you have drawn can be achieved can only accurately be determined by a preoperative 2D CT scan to visualize and measure the bone thickness.

2) I am not aware of any long term effects from the procedure. 

3) A drain is used and is removed the following day. One can go home thereafter.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I for two years I have been looking for a solution to my problem. I had a genioplasty (periosteal detachment of the mandible with milling of the chin bone relief with the pineapple ball). Since then, my chin is hyperdynamic (spasms all day long) and all the chin tissue is falling (including the mentalis muscle). It is very annoying and my chin is very long like a witch at rest and even more when I laugh. You can see my incivilities and I have to force my mouth shut. Here in France, the problem is little known. I have read your articles, you are an expert in this matter. Can my chin problem be totally corrected? I’m talking about aesthetically because my face is disfigured because of this witch’s chin and medically because I can’t even close my mouth and the spasms make me tired.

The first picture is me before genioplasty. Is it possible to get back the exact same chin I had before the surgery? Can surgery solve all my problems both aesthetically and functionally? Or is it complicated?… What do I have to do to remove the mentalis and the submental skin? I would like to get back the exact same chin I had before.

A: This is exactly what I would expect to happen from a poorly thought out chin reduction procedure. When you detach the soft tissue and reduce the bone support this creates the problem of soft tissue chin pad excess. The chin pad has virtually no ability to contract when the bone support is removed leading to chin ptosis, either at rest, smiling or both. As a result, the redundant soft tissues ball up and the mentalis muscle never works quite the same because it has lost its original working length.

Improvement is possible and the technique to do so depends on whether the chin bone is desired to be restored or not. If so I can consider an intraoral sliding genioplasty with muscle/chin pad resuspension. If not then a submental excision/tuck is needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, , I’ve attached some pictures of my original nose before surgery and then some pictures of how my nostrils are shaped now after surgery due to the alar base reduction. I’ve labeled every single picture so that its clear which one is post op and pre op. I’ve also pointed out with arrows of how the nostrils have been brought down. One of the pictures is immediately post op in operating room.

I did not ask my surgeon to perform this procedure, and he did not give me any information on it prior to the surgery. He basically removed the alar base where I had the natural curvature of how my nose met with my cheeks. He brought the nostrils downwards and now it looks very weird and is causing my nose to look flat and wider than prior to surgery (since he has aligned it with my columella). 

I know there are ways to reverse this with grafting but scarring is an issue. I wanted to show this to Dr. Eppley as I know he has a lot of expertise in reconstructive surgeries and may have methods to reverse this in a natural looking way. 

A: You can not reverse alar base reduction surgery. Once skin is removed you can’t put it back without unnatural and very noticeable scarring.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hey! i was looking to get a chin reduction, I have a wide and boxy chin, very prominent when I smile. how much would it cost to be able to fix it? I’ve heard it could cause jowls, how would that be avoided? thank you:)

A: A chin reduction does not necessarily cause actual jowling in my extensive chin reduction experience. But the best method to avoid ay chance of that is an intraoral approach through an osteotomy with midline resection which will make sure the tissues at the sides of the chin do not become adversely affected by maintaining their attachments to the bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have some questions about temporal reduction”

 1.  In regards to the convexity that starts above my ear, how much does the temporal bone contribute to the convexity, is the convexity all muscle whilst the temporal bone is straight. Please review my cat scans to confirm what my condition is.

2. Have you ever worked on patients where you removed/reduced the anterior section of the temporalis muscle as well as the posterior section and whether they had any post op complications such as jaw movement, lack of blood circulation with the scalp, hair loss etc?

3.  How thick is the temporal bone, is there enough thickness to burr down the temporal line or the temporal bone itself 4. Based off the concept with form following function, considering how the temporal bone & temporal line had expanded due to the well developed temporalis muscles. Down the track after surgery, if I constantly wore a hat tight enough, not to the point of cutting circulation of course, can I reverse the growth and reduce the width of the bone?

A: In answer to your questions:

1) Both the muscle and the bone contribution to the width of the head above the ears. In most people, and you are no exception, they share equally in that effect. The difference in deciding to treat muscle, bone or both is really not what the contribution of the bone is. But whether one can accept an incision on the side of the head to do the bone burring. While muscle removal can be done with a hidden and virtually unfindable scar, the bone must be treated more directly and not from a remote hidden incision.

2) Anterior temporal muscle reduction can be done but it is done differently as it requires a direct incisional approach to do so. Whether it is done in conjunction with posterior muscle removal or by itself, it will definitely have a short term effect of restricting jaw movement in the early recovery period as the bulk of the working part of the muscle (70%) lies in the larger anterior section. I have done both together before but be aware of the short term jaw stiffness that will ensure by so doing.

3) In my observation and experience the thickness of the temporal bone does not allow for much reduction. The temporal bone is the thinnest of the external skull bones.

4) You will not reverse or change the shape of the temporal bone by compression. That only works in infants and very young children where the bones are still forming. But It will not affect the developed adult skull bone.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a genioplasty with you back in June. I am still happy with the results and everything healed up perfectly.

My face no longer looks “short” to me with my new chin, but I still think it looks too chubby for my BMI. My BMI is about 23%, I am comfortable at this weight and am not sure losing a ton of weight would even be healthy. I don’t feel the fat on my face matches my body/BMI. Maybe I am wrong and should try to lose a bit?

I am considering buccal fat removal and know you also do perioral liposuction. My face looks kind of “chipmunk” or even a little jowly to me. I wanted to ask him if he thinks I would be a good candidate for buccal fat removal or if I would need both buccal fat removal and perioral lipo or neither or something else. I attached a couple of recent pictures.

A: Thank you for the longer term followup. Many vertical chin lengthening patients actually do facial defatting (buccal lipectomies and perioral liposuction) procedures either concurrently with the chin or before or after the chin. So your request and goals is not atypical and the dual bone lengthening and fat removal procedures are synergestic. 

Both adjacent midfacial fat locations are of benefit for treatment and usually the lower cheek fat (perioral liposuction) adds as much to it as the buccal fat even though its total volume reduction is less. (as it is closer to where the chubbiness look is the greatest.

Fortunately these cheek reduction procedures are a lot easier to go through with less recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Since I was about 15 I have had this bony growth around upper orbit and brow bone on the left side. It is quite noticeable, and I think it has pushed my left eyebrow down and caused one eye to appear “swollen” – there is a lot of extra skin above upper eyelid compared to right side. Was scanned and was found to be benign, cause unknown and no specific incident of trauma comes to mind as to what could cause it. Curious about the procedure in shaving down/reconstruction if necessary, if its the result of some sinus asymmetry or if the bone lies on top of the thin brow bone. Also curious about costs, recovery time, side effects and tradeoffs of surgery.

A: What you have, as is evident in your plain skull films, is an over pneumatized (overgrown) left frontal sinus. It is benign and why it has so occurred will never be known. What what is known is that in trying to treat it shaving or burring it down is absolutely what should not be done. The overlying bone is too thin to do so. This requires a bone flap setback technique. This is where the overlying bone is removed, reshaped and put back which makes it less protrusive and more normal in appearance.

The major consideration in this form of brow bone reduction for men is the incision to do the procedure and the resultant scar. This has to be done through a scalp incision located either at the frontal hairline or behind it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I’ve spoken to your office a few times and was wondering if getting a custom wrap around jaw implant and sliding genioplasty with some kind of lower/neck lift could all be performed at the same time. 

Thank you 

A: The question is not whether you can have a jaw implant, sliding geniopasty and necklift at the same time but whether you would really need all three. Total jawline augmentation often provides a neck lifting effect that may obviate the need for a formal necklift. 

But to provide a qualified answer I would need to see some current picture.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a lumpectomy and radiation on my right breast in 2013. I would like to have a breast lift and implants. Will radiation prevent me from being able to have surgery?

A: Your question is very appropriate as radiation changes the quality of the tissues in its path and their ability to heal in addition to dramatically increases the risks of implant-related complications, (e.g., infection, capsular contracture) So jumping in and doing a breast lift and implant would likely lead to a high rate of complications.

In radiated tissues the key is to change the quality of the tissues by initial fat injections before doing any invasive surgery. Such fat injections are done three months before any aesthetic breast surgery is undertaken.

These are general principles in irradiated tissues and how they may specifically apply to your breast needs requires a picture assessment of your current breast shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What is the height of the deltoid implant (the width that it adds to each shoulder)? Are there different sizes? Please kindly advise before I schedule a consultation.

A: Since deltoid implants are custom made for each patient (there are no true standard deltoid implants) their width can be made to what the patient wants….provided that it will fit. (which is my call)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read that your office offers skull implants to grow an inch or so in height. I was wondering if it is safe for the implant to remain permanently and if it is okay to resume contact sports (football / kickboxing) after this procedure.

A: Skull implants, once placed, are permanent and, as an unintended purpose, actually acts a bumper on the skull adding a layer of protection. So participation in sports remains possible after having a skull implant placed. There are no known long term adverse effects from an indwelling skull implant that are known at this time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have discussed in the past regarding his thoughts on whether orthognathic surgery could also be done in my case. While my bite is not far enough apart at this point (partly because my lower teeth have developed an forward angle to compensate) , I am considering potentially have my lower teeth replaced with an implant supported prosthesis (all on 4 or 6) at the advice of a prosthodontist due to the condition of those teeth and he seemed to indicate that could make it possible to have my lower jaw advanced. I’d really like to get your opinion on whether you feel this is a possibility (as it’s a procedure we’ve again discussed previously by e-mail). I really feel like advancing my lower jaw would provide further aesthetic benefit (while the jawline/chin implant certainly has helped in this regard, I still feel like my short lower jaw is noticeable — at least to me) and perhaps addressing it could even improve my sleep apnea as well. If he feels it is a possibility, is this a procedure that you perform (I am almost certain I’ve read where you have done it in the past but not really mentioned on the site) and if so, is it something that can be done potentially outpatient? I believe you had indicated to me in the past that it could be if only one jaw is involved. 

A: The key question in orthognathic (jaw) surgery is the patient’s bite. Jaws are moved so that the teeth interdigitate better, thus there has to be a ‘malocculsion’ induced beforehand by orthodontic manipulations. Whether that can be done given your current bite relationship and what those movements would be requires an orthodontic evaluation since they are the ones that would be making those movements so they are in the best position to judge what is possible.

I would also bear in mind that with an indwelling jawline implant doing a lower jaw advancement would require its removal…so I doubt given the effort that has been put into getting it there that is infection free and in good position would be worth undoing it. It is probably better to just ponder increasing the amount of chin augmentation (which is only what lower jaw advancement would accomplish anyway) by either only chin augmentation or moving the chin bone forward with the implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am asking about breast reduction surgery for my overweight friend. She has a BMI of 43. Is it possible for her to get this surgery without losing weight? Her breasts are very large and saggy and cause her back and shoulder pain. She is much less concerned with aesthetics than she is in relief.

A: There would be no reason why one would need to lose weight before a breast reduction surgery, particularly when one has significant musculoskeletal symptoms. Yes it is more ideal to be at a better weight before the surgery if possible but that is not an absolute exclusion criteria.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it possible for the nose to be vertically lengthened, giving a philtrum – shortening effect similar to a lip lift?

A: Your question is really whether a ‘reverse lift lift’ can be done where the nasal base moves downward instead of the upper lip moving up with a subnasal base tissue excision. In general no as the nose is a more fixed structure while the upper lip is not and is very mobile. With the one caveat that the base of the nostrils and the base of the columella can be moved downward a few millimeters…the operative term a ‘few millimeters’ being the key phrase.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if the doctor does permanent lip filler removal? I’ll also need another procedure to give them shape and volume again. 

A: Permanent lip filler, which are most commonly of silicone materials, have to be removed by an open procedure. Reshaping often involves changing the level/position of the vermilion border. The placement of solid fat grafts is usually what is done as the silicone material replacement since an open space has been created by the excision of the material.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am past 6 weeks since my second tummy tuck. I can see a difference however, it is not anywhere near what I was hoping for. I can still grab a hand-full of fat all around my abdomen, my measurements have not reduced at all and I still feel swollen on the inside however, the skin feels normal softness on the outside. I am very concerned because this is the second tummy tuck I have had with this surgeon as the first one left me worse off than my natural body so revision surgery was performed. The scarring is better this time and at least I can see results however, where I am now, is not much better than my natural, pre-opp body. The photo is my pre-opp body but 12 months after TT 1 and 4 weeks after TT2. I am now more than 6 weeks post opp and don’t feel any different from 4 weeks. What can i do to reduce the swelling? I am very concerned that I have been through the procedure twice and for all losses and no gain.

A: Thank you for your inquiry and sending your pictures to which I can make the following comments:

1) For having had two tummy tucks I would agree that the change is far less than expected.

2) What is not clear is what exactly was done in these two procedures. The term ‘tummy tuck’ is a generic one and does not specify as to the particulars of the procedure. I suspect yours was more of a mini tummy tuck and I see no evdience of liposuction of the entire abdominal and flanks areas being done concurrently. But in fairness to all involved without reading the operative notes from the procedure and seeing the actual scar location I can only speculate.

3) What is not speculative, however, is that what you see now is probably more of the actual result than reflective of an overall swelling effect.

Dr. Barry Eppley

Indianapolis, Indiana