Your Questions
Your Questions
Q: Dr. Eppley, Hello you will find two pictures attached My head circumference is 62 cm Please tell me about realistic results That are possible. I had one doctor who told me at the forehead and back of the head its only possible to grind down a maximum of 5 millimeters which wouldnt make a big difference about the look.Thats why im curious.I really want to let do my forehead and back of the head to make the head as a whole look smaller.
A: The only way to absolutely tell how much skull thickness can be safely removed are x-rays. A plain lateral skull film will show the three layers of the skull bone from which it can be determined the actual millimeter thickness of removal possible. But that being said I have outlined on your picture what I am certain can be removed based on my skull reduction experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m primarily interested in getting custom infraorbital-malar implants to gain a positive eye vector and positive/neutral canthal tilt. Is this achievable? I really like the androgynous pretty boy aesthetic, so I would want an implant that could provide me with a mildly angular, fuller feminine high cheekbone look.
My secondary concern, is having a more define jawline. As I mentioned, I really like the androgynous look so I was wondering if I could achieve with implants a more prominent jaw angle from the side, while also decreasing the “square-ness” from the frontal view with a little bit of frontal growth.
A: Thank you for your inquiry and sending your pictures. In answer to your questions:
1) To achieve the best orbital-midface effect it would take a combination of custom infraorbital-malar implants with lower eyelid reconstruction with spacer grafts and lateral canthoplasty.
2) When it comes to the jawline I believe you are referring to a custom jawline implant design that has a chin component that creates a less square/more round appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I live in the UK and am interested in having thigh /calf / and buttock implants. I’m a 40 year old male and have done weights for years to no avail. and have always been top heavy with a fair amount of muscle mass, and would like information on the procedure. I would like to know if multiple operations can be done at once.
A: Thank you for your inquiry. In looking at buttock/thigh/calf implants the first concept to understand is that these three body implant areas pose formidable challenges when it comes to recovery. None of them are easy recoveries and the concept of putting them all together is not an option. Even any of the two body areas put together I would be very hesitant to do particularly in an international patient. To even conisder putting two body areas together one would have to be here for 30 days to ensure an adequate fumctional recovery and assurance that the osyt common complications are avoided/managed.
The ‘easiest’ of the body areas are calf implants followed by thigh implants and always the most challenging are buttock implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to achieve an ultra-feminine body type and get my ribs removed (3 each side if possible). I want to narrow the waistline, maybe liposuccion on the flanks, and add hip implants if it’s possible to get large ones. From the side I love the look of my butt implants. However, from the front my body is still sort of boxy and I’d like to change that to achieve an hourglass shape. My ribcage is square shaped and so are my hips so these are the 2 things I’d like to target to achieve the most radical results possible in one surgery.
A: Thank you for your inquiry and sending your pictures. Certainly the three lower ribs per side can be removed and flank liposuction done to maximize the waisltine reduction. Large hip implants in particular have a high rate of complications (chronic seroma, edge show), particularly in thin patients, so I can’t encourage their placement at this time. They have a much higher rate of problems than buttock implants and the complication rates between them are not comparable due to the different types of issue pockets.
Regardless I wouldn’t do rib removal and hip implants at the same time as that is a very hard and unnecessary recovery. So you maximize your waistline reduction first and then make the decision about hip implants later. Other than the fine line scar rib removal has had almost no complications in my experience. So you get that benefit first before ever considering a final hip implant procedure where the complication risk is much higher.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my only question for you at this stage is with regard to recovery time from getting pectoral implants – I’d like to know how much time I’ll need to plan for the various stages of practical recovery (casual movement, normal return to work for a “sit at my desk and wiggle a pen” computer job, and return to regular exercise and activity). I’ll have my family available throughout recovery, so I’ll have no problem with support during the trip recovery time, I just want to plan accordingly.
A: In answer to your pectoral implant recovery questions:
1) Like breast implants I don’t restrict arm movement after the surgery.
2) I don’t see any reason you would not be at the computer within days after the surgery.
3) Exercise and more strenuous physical activities will take up to 4 to 6 weeks after surgery to resume.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would assume the placement of a new testicle will warrant an orchiectomy, correct ? Does that mean the patient will therefore be infertile ?
A: With a wrap around implant style the testicles are maintained and they are encircled by the implant. No one is going to do an orchiectomy merely to have larger testicle implants placed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a male fitness competitor and I am interested in the surgery to remove the ribs, I would like to reduce my waist to the maximum, what are the costs of the operation and the results ??? Can I also do with the muscle that I marked in the picture ??
A: Thank you for your inquiry and sending your pictures. It is hard to predict what effect rib removal surgery would have in a male because I have never had such a request before. Thus I can only theorize about its effects which I would assume it would be similar to that in a female particularly a female body builder to which I have done one such patient. (which in her was very effective) As for the muscle to which you refer that is the external abdominal oblique. Some of that muscle can probably be removed from the same incision as that used for rib removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Im from Switzerland and I saw Dr. Eppley‘s work on Instagram and i was very impressed. I wanted to make a custom jaw and chin implant. I was wondering if this procedure can be done in three weeks , so i can take vacation from my work place for the procedure. I hope to hear from you very soon and wish you a nice day .
A: Thank you for your inquiry. The custom jawline implant design and manufacturing time is an 8 to 10 week duration. But all of that is done from afar and the patient only comes here for the actual surgery. The 3D CT scan is obtained locally and the collaborative implant design process is done in a virtual manner. This is how it is done for anyone anywhere in the world whether one is in Chicago, Sydney or Zurich.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! Before I book an appointment I wanted to know if I can get shoulder shortening at the same time as getting breast implant? And if not, should I get breast implants before or after getting a shoulder shortening?
A: Shoulder narrowing and breast augmentation surgery can be done at the same time. They are also in the same surgical ‘neighborhood’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Since I was very young I’ve had very “bony” shoulders because my top bone of the scapula shows a lot. This is something I’ve been very insecure about my whole life. I’ve been Googling a lot to see what you could do about this and that’s when I found you. In 2015 a girl posted about this exact issue and her pictures looked a lot like my body. You answered her post and said that you believe it’s possible to do some kind of fat injection/transfer or implant to the shoulder to give it more of a round contour. That really gave me hope so I would really appreciate if you could try and help me.
A: Thank you for your inquiry and sending your picture. Your shoulder ‘bump’ is the AC joint of the shoulder which is more prominent in some people than others. There are two potential aesthetic approaches to lessening its prominence, fat injections or implant coverage. Fat injections would be the easiest to place with the caveat that their volume retention is not predictable. (how much survives/retained) Utltrasoft thin silicone implants can also be used, whose volume retention is assured, but requires a small incision to place.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Are your implants secured in place by titanium screws? Facial bones never completely “settle,” and the fear here is that eventually implants can eventually shift out of alignment via trauma or just gradual changes. Plenty of imaging on the site shows older misaligned implants. The imaging of your own implants don’t show this, but of course those are taken right afterwards. As far as I’m aware, securing with screws is the only guarantee. Without such security, even the idea of an implant eventually becoming misaligned would weigh on me.
A: The debate about the value of screw fixation in aesthetic craniofacial implants is not one in which I engage. It would be rare that I would ever place a facial or skull implant without screw fixation. Over the course of a single year I use almost 1,000 1.5mm or 2.0mm self tapping screws for implant fixation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a relatively wide face already, and additional width added to the cheekbone area would not be harmonious with the rest of my face as it would highlight my smaller IPD. However, my jaw and cheekbones have a sort of ‘blocky’ look, as to where there is no cheekbone projection. They are very ‘flat’ and do not show from a 3/4 view (OGEE curve). I suspect they have poor projection? Would it be possible to increase cheekbone definition and get the “male model” look of sorts while maintaining my faces width as to not highlight close set eyes?
Would the best way to go about doing that be a form of implants, or a combination of fat removal procedures? I am concerned that buccal fat removal would give issues as I age, and that perioral liposuction and buccinator myectomy would be a negligible aesthetic improvement. Thank you!
A: I believe what you are referring to is cheek augmentation that creates more of an Ogee curve but without adding facial width in the zygomatic arch area. The question then becomes not whether that is possible through implant design/placement, as it is, but whether that would have the desired aesthetic effect. That would require some computer imaging to determine but I don’t think a reductive soft tissue approach can accomplish that effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I am an Asian female who is looking for more eye depth with brow implants. Is that possible or are those only for males?
A: While brow bone augmentation is most commonly performed in males, it can also be performed in females. It is not necessarily a gender specific procedure. It is an aesthetic brow bone augmentation/increasing eye depth procedure for whomever desires it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, l’ve read that you are a very experienced maxillofacial and reconstructive surgeon and I have also read that sometimes it’s possible to remove fillers through facelifts. Is it possible to do it? 3 months ago I had the bad idea of getting a filler to my jawline and chin (2 ml total of juvederm volux, 25 mg vycross hyaluronic acid). I just wanted a little more definition and a sort of lifting effect, instead I only got an heavy, square, wide and fat face … I have always had a thin face and I don’t look like myself anymore !!! Hyaluronidase didn’t work (5 rounds, with my original injector, poor results). A week ago my new doctor gave me low dose diluted steroid injections … they have worked in reducing the swelling a little, but my face is still different. It’s not saggy, but more voluminous and heavy than it used to be (because of the filler). Is it possible to surgically remove the jawline filler (injected under the muscle) through a lower facelift? I’m young (42 years old) and I look younger than my age, but I want my face back whatever it takes. Thank you for your time and your attention. Kind regards.
A: I think what you have discovered is that the expansive effect of the fillers on the lower facial tissues is not going to be completely solved by enzymatic dissolution treatments. You have correctly surmised that a jowl tuckup procedure is the definitive solution. With the raising of the skin flaps residual filler is removed and with the SMAS flap and skin tuckup the lower face is again slimmer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in correction of my temporal hollowing which I have circled on my pictures. It is greater on the right than the left side.
A: When it comes to temporal augmentation it is extremely important to differentiate whether the objective is to treat pure temporal hollowing (soft tissue only) or whether what the patient calls temporal hollowing crosses the bony temporal line which really includes the side of the bony forehead as well. In the attached picture I have illustrated where your bony temporal lines are and it is clear by the temporal areas you have circled that yours is a combination of temporal muscle and bony forehead. That anatomic distinction is key as it changes the type of temporal implant needed to treat it. Pure soft tissue temporal augmentation is usually treated by standard styles of temporal implants that are placed on top of the muscle but under the enveloping fascia. But when the deficiency crosses over on to the bony forehead the implant must be custom designed and it must sit on top of the muscle fascia and over onto the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My ears are low set and rotated backwards- would like to be pulled up and rotated forwards.( not sure if it makes any sense but my eyes have always been tired since I was little. not sure if it was because of hooded eyes or pull from the low set ears.
A: The ears cannot be moved in a superior direction. The cartilage of the ear is fixed to the side of the ear by its continuation into the bony external auditory canal. This effectively pins the ear into position. While the ear cartilages can be reshaped around this fixed position (e.g., pinned backwards) the base of the ear can not be moved in any direction to relocate his current position on the side of the head. I know this particularly by experience as I have tried to move the war superiorly numerous times…and it never works.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read your article about pec implants below and I am a bit confused.You say that male pectoral implants are placed in a completely submuscular pocket whereas breast implants are placed in a partial submuscular pocket
What does you think about placing male pec implants in a partial submuscular pocket- dual plane with only the lower part of the pec implant sub-fascia instead of sub-muscular.
Surely this would give a more natural look when the man raises his arms above his head- see the attached photo of pec implants vs real pecs?
As with a completely submuscular pocket when the man raises his arms, the muscles raise but the implants do not they just sit there.
A: It is important to understand why there are two pocket differences between pectoral implants and breast implants. The goal of breast implants is to create a soft tissue mound onto which the nipples are largely centered as much as possible on this created mound. This is why breast implants have to have a dual plane pocket creation, if a submuscular pocket is used, as the breast mound is not really muscular based. (the implant just happens to be partially under the muscle…which is also why it could also be above the musce as well) In essence the dual plane is necessay for a breast mound effect.
In contrast the goal of pectoral implants in the male is to create muscle enhancement/enlargement only. If the lateral pectoral line is violated in the creating the submuscular pocket more of a mound effect will be created which is an unnatural male chest appearance.
When pectoral implants are placed in the proper pocket and not oversized they will not bulge out to the sides when one raises their arms and will usually move up with the muscle.The raised arm pectoral implant patient picture you are showing illustrates pocket violation beyond the lateral muscle border…which would also be evident when his arms are not raised as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Has there been any new advancements in iliac crest implants? How long do you see before this procedure is cleared for use in the US?
A:Iliac crest implants can be done in the U.S. as of right now using the custom implant design process. But you will likely never see a formal FDA-approved iliac crest implant made as an off the shelf device because the demand for its use is too low to justify the economic effort of any company to do so for an aesthetic product.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I had a pre-jowl chin implant placed 25 years ago, 15 years ago, had orthodontic surgery. The doctor recommended removal of the implant due to projection. As the photos indicate, my mentalis muscle is apparently damaged. Doctor made an attempt to fix after the surgery, but it didn’t help much. Now, 15 years later my gums are visible. I’m so unhappy and I’d be thrilled with even a little improvement. V-y plasty perhaps?
A: Thank you for your inquiry and sending your pictures. Lifting up the lower lip and maintaining it is a challenge. Because of this challenge you have to do as many manuevers as possible to even get some sustained modest improvement. Thus I have learned to do the following three intraoral procedures combined when trying to improve a lower lip sag…a mentalis muscle resuspension, an elevating vestibuloplasty and a V-Y mucosal advancement
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard good things about your work! I have always been self conscious about my head for two reasons. First, I have a very strong brow with a slanted forhead (not picured) and I have a head that seems to be very short in length and not fit my body. I would be interested in a surgery that could add an implant an lengthen my head to match my body. Also, being a 5’8″ male, any extra height would be grealty appreciated. Based on the picture, do you have any advice or experience simular to mine?
A: Unfortunately I do not see any attached pictures. But conceptually what you are referring to in regards to lengthening the head with a skull inplant and maybe even raising it some is very possible. The key questions are the amount of volume needed to do so, how much can the scalp stretch to accommodate this needed volume and whether this can be done in one stage or would require two stages. (1st stage scalp expansion)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about extra-oral placement of a vertical jaw lengthening implant and infection rates. I had a 7mm width jaw angle implant placed, which for my extremely short/stocky face with almost no ramus/mandibular distance from the earlobe made my face puffy and squirl like (i am a male). It got worse because my jaw joints over time degenerated and moved even more backwards and vertically, to the point I will be needing a total jaw joint replacement and removal of the jaw implants. My question is: is it possible to have a vertical lengthening implant after the jaw joint replacement. In theory in the pictures it looked like it should be possible, but the lack of room for screw placement is what bothers me, i have added photos of the joint replacement prosthesis. My second question is: intra oral placement risks infection, not just of the implant, but also the artifical jaw joint, which would be pretty bad. Would a extra oral approach significantly reduce the risk of infection? I saw some studies on hip and knee replacement giving a number of 0.3-1% infection rate which is extremely acceptable, would this number be comparable to a jaw implant placed extra-orally? Some sources ive found have stated that extra vs intra orally placement of chin implant is only 1% vs 2% risk, that barely seems to make a difference in route of placement. My last question is, would the jaw angle implant be delivered through a new scar, or would the same scar be opened up to place the jaw angle implant.
A: I don’t think there is any question that if you had indwelling TMJ joint replacements with the external approach to put them there would be no reason why you would not use the existing external scars for jaw angle implant placement…which would appreciably lower the infection and make the recovery easier by staying out of the mouth. In addition custom jaw angle implants would be needed so they mesh with the lower end of the condylar prosthesis and better manage any asymmetries between the two sides which will inevitably be present.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am contemplating this temporal reductio b surgery. My skull is already wide and in addition those muscles are very prominent on me. My hairline is also thinning on the sides which has been exposing them even more Into my mid 40s. I was also wondering about a jowl lift and how much that will benefit me in the long run if I got one this early in life. My mother’s are very pronounced and mine are getting there but, I’m only 43. I thought I should at least ask if I end up going for the temporal reduction anyway. Do you have any suggestions or recommendations for me? Thanks
A: Thank you for your inquiry and sending your pictures. I believe you are referring to the temporal reduction surgery in which the posterior temporal muscle is removed which appreciably narrows the side of the head. It is actually a very uncommon requested procedure for females because of hair coverage on the side of the head but how the operation is performed and the merits of doing so remain the same.
What you are referring to for the early onset of jowling is a jowl-tuckup type of lower facelift…what I call a Level 1 Facelift. (some call it a ‘mini’ facelift etc) You are at the right age for this type of limited lower facelift in which patients want to get early correction to keep the jawline and neck clean and smooth.
Temporal reduction and any form of lower facelift surgery can be combined if the patient so desires.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What exists for myself is well over 10mms of temporal contour excessand I know removing the posterior temporal muscle completely would make immense changes in my appearance. I’m based in Australia and I’m truly surprised that you’re the only surgeon going around that offers this procedure so I’m considering of traveling over. Have you had patients travel to you from overseas before?
Just a couple of questions, can you by any chance perform more than one procedure in one operation? I’m questioning that because I want a brow bone reduction done as well as a posterior temporal reduction done on myself.
A: In answer to your temporal and brow bone reuction questions:
1) The vast majority or my practice is with patients who did not live where I am located. So geographically distant patients, including patients from Australia, is the norm not the exception.
2) Brow bone reduction can be performed at the same time as temporal reduction. The key question is what technique is needed to do it. But regardless of technique it can be performed during the same surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a dime size dent in my brow/forehead area from forehead reconstruction surgery, I had done 3 years ago. I was wondering how much for bone cement in that area?
A: Thank you for your inquiry. Bone cement is one option for placement into the brow bone defect…but not the only option. That is a difficult area to get bone cement into without wide open access. The concept of injectable bone cements would not apply to a brow bone defect area for a variety of reasons. Thus I would opt for an endoscopic approach where ePTFE (Goretex) sheeting could be more easily and reliably placed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley ,Hi, I’m 25 years old and have had hollow under eyes all my life. I used to think it was just thin skin but I’ve realized I believe it’s a suborbital deficiency after seeing images. I wanted to see if I would be a better candidate for filler, fat transfer or a suborbital implant. My dermatologist said she wouldn’t do filler on me because under eye filler migrates. I also attached a photo of me at 19 showing a particularly bad photo of the hollows.
A: Thank you for your inquiry and sending all of your pictures. When you have significant undereye hiollows due to a bony deficiency, which is almost always the cause of significant undereye hollowing, the most significant improvement with the longest duration of effects is going to be a suborbital implant. Or more specifically custom infraorbital implants made from the patient’s 3D CT scan. To optimally correct the bony deficiency it requires an implant design that creates both horizontal and vertical augmentation of the infraorbital rim which no standard implant can do. (see attached)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, how long does it take for hair to start growing through a trichophytic incision, and once it does, how short can you wear your hair?
I am a male and about a year ago I had forehead contouring surgery through a bicornal incision and they utilized a trichophytic incision. They hair never seemed to grow through and I had two big visible scars down the sides of my head. I just had a scar revision a month ago with another trichophytic closure and there still are visible lines down the sides of my head and there’s only very sparse hairs through the scar.
A: You will find getting a good scar result in the temporal area is very challenging and it is almost better to hair transplant it if this scar revision ‘fails’. Hair should be growing through the scar line within one to two months after surgery…if it is going to do so at all.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering are infraorbital-malar silicone implants inserted through a transconjunctival incision or intraoral? Thanks.
A: Those are two incisional options for custom infraorbital-malar implant placements both of which are associated with a higher risk of infection (intraoral), implant malposition (intraoral and transconjunctival) and infraorbital nerve injury. (intraoral) Whether those incisions are even options worth considering depends on the extent of the infraorbital part of the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question for about lateral orbital rim rimmorbital augmentation using bone cement. Does it work and could you do that please.
A: Bone cement is very hard to place in a complete and smooth manner at the lateral orbital rim through a small eyelid incision. It is not a question as to whether it can be done but whether that is a good technique to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, With regards to skull augmentation, instead of placing implants under the skin, would it be possible to extend the bone and place implants or some kind of bony material in place of the gap in between the bone when it gets split open? For instance, you can extend the forehead by making a horizontal incision on the frontal bone and extending the top portion above the cut, and then fill the empty space with something. If hair gets uneven, there can be hair transplants done. What are your thoughts?
A: That is not a viable skull augmentation concept. If you separate the outer layer of the bone and place a synthetic barrier between it and the underlying bone the detached bone will die/atrophy as it has no blood supply.
This concept also does not account for smooth contours around all edges of an augmented skull areas which is one of the primary determinants of a favorable aesthetic outcome.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Rib Removal and Clavicle Reduction surgeries. I had a few questions :
– what is the expected reduction in waist size for rib removal (width and circumference)?
– does you have experience with comparing outcomes between the two procedures?
A: In answer to your questions:
1) Rib removal patients report an average of 1 to 3 inches in circumferential waistline reduction. (by the patient’s own measurements) I focus more on the improvement in shape or how it looks.
2) Clavicle reduction is very different and is a completely predictable operation in terms of outcome because the amount of clavicle bone removed correlates 1:1 with the visible reduction in shoulder width. Thus if 2.5cms of bone is removed per side than the shoulder width reduction is 1 inch per side.
The difference is that the clavicle bone is linear in orientation and the reduction is completely dependent on the bone length removed. Conversely, the lower ribs are oblique in orientation and the length of bone removed does not correlate to the horizontal waistline reduction directly. In addition waistline shape/circumference is controlled by more than the just bone with a substantial contribution of soft tissues as well.
Dr. Barry Eppley’
Indianapolis, Indiana
