Your Questions

Q: Dr. Eppley,Hello, I have been a big fan of your work for years and have gone through your Q&A’s to answer a lot of my own questions. Last July, (10 months ago) I got a sliding genioplasty. My chin looks fantastic, however, I do have lots of tightness at the incision area. I would say that there has been no change in the tightness since November. Everything else has been healing nicely. My bottom teeth/gums are no longer numb, flossing is pretty much back to normal etc. Although my bottom lip feels tight, I would say I have 98% of my movement back. So all really looks and feels pretty good, minus the tightness. The tightness feels more severe than it looks. I feel sometimes like I may look like my lip is stiff while I am speaking, but it actually looks pretty normal. The tightness feels like a combo of it being pulled and like having a lot of food stuck in that area. Not sure if that makes sense. Its not painful, but feels very uncomfortable yet still pretty much works the same as before the surgery. Based on all of my internet research, I am thinking that my chin was pulled so far out (doctor said 13mm), that my tissue is most likely falling into that new empty space where my chin was extended. I love the way that I look and do not want to change it, but I also am slightly miserable with this tightness. I read that you do intraoral release and place of dermal fat graft. Not sure if that is relevant to my case, but if it were, how might that change what my chin looks like and what is the general cost for something like that? I am attaching before and after photos so that you have an idea of how much my chin was moved forward. Thank you for being quite the online resource.

A:Your diagnosis and the treatment for it would be the corrective approach. The bone has been expanded but the soft envelope remains the same. In essence you now have a bone shape that is beyond what the soft tissues were designed to contain.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to inquire aabout if 30mm of clavicle lengthening per side is possible.

A: One of the major limiting factors in clavicle lengthening is how much resistance is met by the shoulder girdle tissues. When lengthening the clavicle you are pushing out against the AC joint and all of its surrounding bony and soft tissue attachments. As a result, once the bone is cut (sagittal split completed) the shoulder does not unfortunately just fall to the side. (lengthen) This is quite different than in clavicle reduction where upon removing a segment of bone it does indeed fall inward. It requires a fair amount of force to get the bone lengthened due to the shoulder girdles tissue whose resistance must be overcome. This is why it is a challenge to just get 20mms of lengthening…and even that can be a struggle. This is why I thing there is merit in shoulder stretching exercises preoperatively to try and ‘loosen up’ the soft tissue attachments.

The other limiting factor is the length of the clavicle plate. The longest 10 hole clavicle plate is only going to permit three screws per side even up to a 25 mm lengthening.

Thus for anatomic and fixation plate restrictions a 30mm increase in any patient is not a technical possibility. I wish it were as more is always better but we are asking the body to do something beyond what it was designed/developed to be. As a result it does pose limitations sometimes from our ideal aesthetic goals.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in knee and thigh Lifts. I have a few questions:

1. On the site i saw picture of the knees after knee lift surgery ( see attachment). To get such a thin scar is there a special surgical technique or are products for scars enough? 

2. after how many days I can fly after knee lift surgery? 

3. How long I will be not able to bend my knees?

4. Does yo do a mini thigh lift?

5. in case of both procedures ( knee lift and thigh lift) after how many weeks I can fly back home oversea? It is long flight, about 12-14 hours.

Thank you very much for your reply.

A: In answer to your knee lift questions:

1) The key to having an acceptable knee lift scar is to avoid over resection and do the preoperative excisonal markings taking both the extension and flexion of the knee into consideration. A multilayer closure is done with subcuticular suturing for the skin.

2) You should be able to fly home within 48 hours after the surgery.

3) You should avoid bending the knee more than 45 degrees for 4 weeks after the surgery.

4) Please define your thoughts on what a mini-thigh lift is.

5) Even with a combined knee and mini-thigh lft procedure you should be able to fly home within 72 hours after the procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I am a trans woman. I am extremely interested in your work on shoulder reduction surgery and I find myself consistently returning back to the few photos you have of before and afters online.

I have two questions for you, which I hope can be answered: 

1. Are there more photos of before and after results from further away than just the shoulders available so i can get a better idea of what results will be like with respect to the entire body? Your case study post on the trans woman was exceptionally enlightening, but I would like to see a few more in order to decide if it’s something i actually want. I am curious how this surgery improves the shoulder to hip ratio and whether it can help shift patients from a more triangular body type to one more hourglass or pear shaped. Below is the case study i am discussing. Being able to see how she looked in the mirror helped quite a bit, but I think the most enlightening pictures would show full body shots. 

https://exploreplasticsurgery.com/plastic-surgery-case-study-outcome-assessment-of-transgender-male-to-female-shoulder-narrowing-surgery/?doing_wp_cron=1650927706.0061049461364746093750 

2. Have you had any experience getting this procedure covered by insurance? I have Blue Cross Blue shield, which recently updated its policy to cover breast augmentation for trans women, as well as a few other affirming procedures, but I know as this procedure is relatively new it may be some time before we ever see it formally implemented into insurance policies. If any individuals you have seen previously for this surgery have managed to get it covered somehow, I would love to hear some anecdotes about their experience and how they may have accomplished this. 

As of now, this procedure is really one of the only things i’ve ever wanted, and would relieve years of painful dysphoria I’ve experienced as a result of my shoulders. Its effected me to the extent I find it progressively harder to focus and has impaired me in school and my social life because it has followed me wherever I go. If I could relieve this I can imagine my life would improve significantly. 

Anything you could do with respect to above would be absolutely fantastic! Please let me know when you can. 

A: In answer to your shoulder narrowing questions:

1) In respect of patient’s privacy I am limited as to the views I can show. In addition since all of my patients are not local, there is no return for an actual in office followup. All such followups are done in a virtual manner by Zoom.

2) I do not participate in insurance so I can not comment on whether shoulder narrowing surgery would be so covered.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I just found out that there is a possibility to change the shape of the skull and searched a bit about the ways to do so. When you use bone cement how much of the result can it show, dose it only change the shape or can it also get a bit bigger?

A: The use of bone cements for aesthetic skull augmentation is a near historic procedure. The use of custom skull implants is the contemporary method which adds 3X the volume, has an assured shape and can be placed through smaller scalp incisions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in 3d printed glabellar region implant. The result I want is natural and minimal. Currently I have has chin implant, check bone implant, temporal region implant and nasolabial implant. They all looks natural and conservative.

A: By your description you are most likely seeking a glabellar forehead implant similar to the concept as seen in the implant design attachments. To keep it as natural as possible I wold definitely stay under 3.5mm in thickness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Also, want to double check that, given the clavicle(s) have had adequate time to heal, I should be able to resume heavy weight workouts–I am benching and rowing above 200 lbs multiple times per week, definitely not power lifting, but also potentially putting more strain on the clavicles than is standard. Not sure if these particular exercises would even be the ones I ought to be concerned about, but yeah, wondering if its possible to get some reassurance that this operation shouldn’t limit my ability to workout (again, assuming adequate time is allowed to heal the clavicle(s))

Thanks!

A:Provided adequate time is given for full bone healing, there should be no restrictions for those activities after clavicle lengthening surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in consulting about getting chin and jaw implants. When I was six I had cancer and extensive radiation delivered to my facial region resulting in a stunt of growth in my mandible.

Q:Thank you for your inquiry and sending your pictures. With the history of radiation in the area we have to be very cautious about treatment selection as that affects the involved tissues lifelong and their ability to respond to trauma and exhibit normal healing from it may be compromised. (at the least it has a higher risk of infection) I will need to see a 3D CT scan of your lower face (jaw areas) to have a better appreciation of the bony anatomy. With the history of radiation a custom wrap around jawline implant is out as the infection risk is too high. Thus, for now, I am thinking a bony genioplasty (you need mainly vertical lengthening anyway and jaw angle implants. The bony genioplasty will be fine, it is the jaw angle implants in the back we have to assess very carefully.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Here are some of my desired results from rib removal.

Waist: 28-30

Hips: 40
Inseam: 32

I really want that golden ratio of a .6 waist to hips. I think that a 26-27 inch waist with a 42-44 inch hips is a buffer. Here are photos of what I would like, I will attach photos of myself currently, with as little fat and showing abs for best results.

A:Thank you for your inquiry and sending your pictures. I think with your lean body frame the only way you are going to have a more narrow waist is with rib removal surgery. How much waistline reduction you can achieve with this surgery is never completely predictable so I would not specifically provide a waist measurement number for what can be achieved. The only outcome aspect of rib removal surgery that is assured is that once this is done there are no longer any further anatomic reductions that can be done. Rib removal surgery is the last stop on the waistline narrowing train.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is such a skull implant possible for women with no effect on hair color and heat on it ??

A:Correct, the implant material only changes shape/breaks down at 375 degrees F.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Questions about how to correct a sloping forehead with a very strong low brow bone with temporal hollowing. 

A: That would be done with a custom forehead implant (minus the brow bones) that has temporal extensions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I live in Sweden and I’m interested in cheek augmentation for the high cheek bone look. The thing is I’ve done an operation with cheek augmentation here in Sweden (intra-oral) but I didn’t get the high cheek bone result. 

Is it possible doing this operation , going through the lower eyelid as shown?

A: There is no standard form of cheek implant that can achieve the high cheekbone look…which is largely a horizontal augmentation along the zygomatic body and arch. Whether that would also include the more anterior infraorbital rim is determined on an individual case basis. Most of the time the preferred method of accurate implant placement/positioning is through the lower eyelid.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I was looking into forehead contouring surgery to reduce frontal bossing and had a few questions that I hope you can answer: 

What is the average cost for forehead contouring to reduce frontal bossing? 

How are nerves and expressions affected after the surgery? 

Does the hairline look natural after patients are fully healed and what’s the recovery time? 

When you start shaving the bone, are you making the bone super thin and is that dangerous? Or does frontal bossing create a thicker layer of bone that can be shaved down to a normal thickness. If that could be explained, I’d like to know. 

I’m looking for information to get started, but there’s not much to go off of online, and all the info varies greatly. Any help would be appreciated. Thanks

A: In answer to your forehead contouring questions:

1) My assistant Camille will pass along the cost of the surgery.

2) Some temporary numbness of the front part of the scalp and forehead stiffness will occur right after the surgery…all of which resolves in a month or two later.

3) The key question in approaching the upper forehead is whether a hairline incision is used or whether it is placed behind it. But most hairline incisions heal well and look natural provided one has a good initial hairline density.

4) To determine how thick the forehead bone as it relates to the frontal bossing a preoperative x-ray is taken to determine its thickness and see how much bone can be safely reduced.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,Also I got a rhinoplasty and chin implant and lipo done several days ago. But I would like to do more lipo (I believe you call it a buccal myectomy) and custom implants that might replace the existing chin implant if required. How long should I wait before getting another procedure done?

A:Three months after the last procedure would be sufficient. If a custom chin implant is needed for a replacement for the standard chin implant just done now would be a good time to get started since that will take 3 months to design and have ready for surgery.

Dr. Barry Eppley

Indianapols, Indiana

Q: Dr. Eppley,Hello. I love your work.  It is so wonderful to see a surgeon that is so talented and passionate about the outcomes of every procedure.

I wanted to ask in regards to a sliding genioplasty in your experience what is the risk of severe bleeding during and post operatively on a healthy patient that does not take any medications. 

Thank you.

A: Of the potential risks and complications of a sliding genioplasty, severe bleeding during surgery or a postoperative hematoma is not one of them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I know after shoulder narrowing surgery patients are released for full activity after 12 weeks but what is your recommendation for returning back to work? (more range of motion at weeks 5 and 6). 

A:That is probably not unreasonable. Given the type of work a dental assistant does the range of shoulder motion at one month after the surgery should be adequate.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, So as you can see i have a certain eye area that looks nothing like my desired result (below), and i would like to know the best and most efficient surgeries and augmentations that would take me from what i have to something with the same characteristics as the model below. (a Fair amount of Hooding, 0 sclera exposure and positive canthal tilt). Also it might not be visible in the photo, but i also have a negative orbital vector that is especially striking whenever i squint or lift my eye. 

A:I would say the major difference between you and the model eye look  is that you need a lateral canthoplasty, spacer grafts to the lower eyelids and infraorbital-malar implant augmentation for the lower orbital area. The upper orbital area needs filling of the supratarsal area with some form of a fat graft. (fat injections or an en bloc fat graft) Your brows seem to be sufficiently low.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a rhinoplasty done 5 years ago to correct the contour of the sides of my nose. While the surgery made a very significant improvement, the left side is still a little curved from front view, while the right side is straight. I met with a different surgeon recently about whether or not a non-surgical liquid filler could correct this issue, and they said they wouldn’t recommend injecting a filler after a previous surgical rhinoplasty, as it’s “a little dangerous”. 

I’m not sure what the danger is they’re alluding to, but if it’s the vision loss I’ve read about, and the risk is high enough, it might not be worth it. If the risk is very low, though, maybe it would be worth it.

A: If the goal is to augment the flatter side of the nose to better match the curved side, then the use of injectable fillers is a reasonable non-surgical approach.

When it comes to the use of injectable fillers in the nose the risk to which is being referred is that of an ischemic event. This means the pressure of the filler causes a compression of the blood supply to the overlying skin resulting in an area of necrosis or eventual skin loss. In the scarred nose (prior rhinoplasty) this risk is higher due to this scar tissue. How significant that risk is can be debated but I can’t fault the surgeon from passing on doing it as for him/her the reward:risk ratio is just not worth it. Its occurrence may be uncommon but it would create a deformity worse than the original aesthetic problem.

Dr. Barry Eppley

Indianapolis, Indianapolis

Dr. Eppley, Do you perform mouth widening surgery and do you feel it can be done with acceptable scarring. Conversely is there an alternative surgery that can achieve this. My goal is to widen my mouth and smile.

A: Mouth widening is a procedure that I essentially developed from an aesthetic standpoint. Whether the scarring is acceptable is a matter of individual interpretation. What is an issue not open to interpretation is that the need for scar revision in mouth widening surgery is 50% or greater.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I hope you are well. I have a few questions regarding the clavicle lengthening procedure I have scheduled with you in June and was hoping you’d be able to help.

The first thing is regarding a potential complication. It appears I may have either a Type 1 or Type 2 acromioclavicular joint injury (I’ll attach pictures). I don’t recall any particular trauma, and it may have just been caused from weightlifting over time, or by something that I didn’t think was painful enough to seek out medical attention or suspect an injury. Either way, this was taken a few months ago and it appears to be the same (no further healing). From what I’ve read (but I may be incorrect of course), it seems that if a few months has passed and the injury persists, it likely will not heal on it’s own. I’m curious if you think this is any reason to be concerned when planning lengthening of the clavicles. 

Although it is not causing me trouble now, I’m not sure if it may need to be corrected by surgery if it gets worse (or possibly now to prevent it from getting worse). If you think clavicle lengthening is still feasible, would you think it may cause any complications to a potential A/C joint repair in the future? I ask because I wonder if this is something best corrected now, or if it can probably wait until later (if needed at all) after a recovery from clavicle lengthening. I just wanted to make you aware of this before my X-rays the day before surgery, and to get your opinion.

The second question is regarding exercises and preparation for surgery. Since the lengthening procedure will stretch some muscles, I would imagine it would be beneficial to stretch affected muscles as much as possible beforehand. Would you think this is a good idea, and if so, would you be able to provide a list of muscles that I should be stretching?

Thank you for your time and insight.

A: In answer to your questions:

1) I am not an AC joint authority but I don’t see the correlation between a lengthening osteotomy done on the inner third of the clavicle to whatever injury exists at the distant outer joint. The clavicle bone is of good bone stock so I see no reason why it would have any trouble healing. 

2) The reverse question seems more pertinent….how does a lengthened clavicle affect an injury at the AC joint? That is a question outside my field of knowledge but I would think important to know. This would have to be answered by an Orthopedic Shoulder Surgery specialist.

3) I would certainly see no harm in any shoulder strengthening or stretching exercises before surgery…although I can say they are absolutely essential. The amount of clavicle lengthening achieved in the surgery is not going to be limited by the natural flexibility of the tissues. But I think it is always a good idea to ‘train’ for body surgery almost regardless of what that surgery is.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had orbital floor surgery on my right side for a fracture. I do some acting but feel I lose parts because my eyes are no where symmetrical. I think the surgery was rushed leaving my replacement floor on my right higher than my left. Thoughts?

A: While I don’t know what you looked like before the injury and before the surgery, and your face is a bit tilted in this picture, the eye asymmetry is obvious. (see attached) It is clear the right orbital floor reconstruction is higher then the left unaffected side. That can be remedied but a 3D CT scan should be done first to have a precise measurement of the different orbital floor heights. That would then be matched with the differences in the external horizontal pupillary levels. (which presumably is 1:1 with the differences in the level of the orbital floors. Do you know what material was used to reconstruct the orbital floor?

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I workout 6 days a week and it seems that no matter what I do it’s hard for me to get any real definition in my pecs. I have a very broad chest. I’m 6ft 3 and weight approx 208 lbs. I would be curious if I could get the results I’m wanting for my build with a standard implant or if we would need to go custom to get an idea of $. I have attached a few pictures for reference. Please let me know if you have any other questions.

A: The decision between standard vs custom pectoral implants comes down to what your augmentation goals are in the amount of projection as well as your muscle measurements. (height and width, see attached image) If I could see some examples of your pec augmentation looks as as well as these measurements I could answer what type of pectoral implant would work best for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had facial feminization surgery with very bad results. My chin was amputated instead of contoured or a genioplasty. My mandibular angles were totally obliterated too. This has left my face looking unnatural and with a U shaped. My chin pad hangs below my chin bone now. 

I’m interested in Rib reduction too as i have a rather straight waist, very short torso, 5’7″ tall, ~30″ waist inspite of being thin due to being born a man (I transitioned 3 years ago) 

Question: 

My question is can my ribs be reduced by a couple of inches? 

Can the rib bone be grafted to make my chin better and give me some mandibular angles. (Even if only a slight augmentation is desired) 

Even if rib reduction is not possible can I still get a rib bone or other graft to make my facial harmony better? Im also scared of losing more bone as I age and having danger to my teeth. 

Attachments: 

I have enclosed CT scan images post op and can provide complete ct scan zip folder too. 

Please do help, if possible. After all this I still look male in person. 

My main concern is my face shape, and I’m terrified of choosing implants as I barely have a few mms of bone left in my chin.

A: Thank you for your inquiry and sending your 3D CT scans. Like all 3D facial CT scans they speak for themselves about the state of your chin (an amputation chin reduction is a very unusual procedure given the objective) and the not atypical amputation of the jaw angles in V line surgery. (albeit with a very high starting point to begin the bone cut)

While custom implant designs are the far superior method of subtotal chin and jaw angle reconstruction after any form of V line surgery, and there are no long-term bone loss issues with such implants, your question of whether bone from rib removals can be used for the chin and jaw angle reconstructions is a logical and reasonable one. 

The length of ribs removed varies depending upon which rib is being taken. Rib #12 is usually in 5 – 6 cm range, and ribs #11 and #10 are in the 10 to 12 cms range. Such ribs are usually 1.5 to 2 cms wide. Given these bone lengths their additive amount should suffice for the chin and jaw angle reconstructions.

The issue with using rib bone for the chin and jaw angles, and this applies to any bone graft on the jawline whose objective is to expand the existing contours, is how much of it will survive. Onlay bone grafting can have different volumetric fates than inlay bone grafting in the face.

But the recycling of bone from rib removal instead of merely being discarded is not completely novel. Its most common recycled use in my experience is in augmentative rhinoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I just want to clarify that after the surgery, once the clavicle is healed and strength restored, the procedure can be done again, this time lengthening both clavicles. It is my understanding that a clavicle lengthening procedure can be done more than once as long as adequate healing time is given in between. My end goal is to have the right clavicle lengthened twice, and the left lengthened once.

A: That is a correct concept. The clavicle is a very robust healing bone and as long as it is fully healed and has a normal cross-sectional diameter, the lengthening osteotomy can be repeated.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The left side of my face appears entirely flattened and hollow. My forehead is hollow on the left, my left cheek bone is pushed in, my left jaw is flattened, and my lip is also misaligned. My eyes are also uneven (one smaller than the other) due to plagiocephaly, and my nose tilts and sinks in towards the left side of my face

Therefore, what surgical procedures could improve the deformities mentioned above?

A: Based on this description alone the possibilities include:

Left Custom Forehead/Cheek and Jawline Implants

Left Paranasal Implant

Rhinoplasty ??

Upper Lateral Lip/Mouth Corner Advancement/Lift

Hard to say about the smaller eye without seeing pictures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had cheek implant removed a year ago along with chin implant, wondering how long it takes for the implant capsule to fully go away or if it will fully go away, it was a silicon implant that was only in for 8 months. 

A: Facial implant capsules take 6 to 12 months to be completely absorbed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I suffer with chronic infections at the corners of my mouth, due to saliva tracking there, I wanted to ask my dermatologist if surgery was a option, as summer approaches when I suffer the most. I`m concerned my insurance will consider it cosmetic. At this point, I`m just asking questions. (I`m 71 and live in California, I realize you`re in Indiana)

A: It is fair to say that with your very downturned mouth corners which causes an overhang, this is a frequent cause of angular cheilitis. The mouth corners need to be lifted to remove the overhang and not allow the moutb corners to be chronically wet.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would it be unwise to undergo total periorbital augmentation, potentially including the zygomatic arch, PRIOR to orthognathic surgery in both jaws? I suppose this is an issue mainly for the infra orbital rim part of the implant design process. The aesthetic concern is, for the most part,vertical deficiency that results in round, saggy – retracted lower eyelids as shown in attached photos. However, since some degree of horizontal augmentation may be necessary, wouldn’t that impact either the implant design process with you or the surgical planning with the maxillofacial surgeon? 

Thank you in advance.

A: The level of a LeFort I osteotomy is below the infraorbital rim (technically below even the infraorital nerve) As a result, periorbital augmentation and orthognathic surgery are done at two different facial bone levels. Thus their order of execution is more of an aesthetic choice. While it may seem that one area affects the other from a treatment planning standpoint, it does not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I noticed that your clavicle lengthening results usually add about two inches overall. Since the pectoral muscle attaches to the clavicle does this usually result in a broader chest?

A: Your supposition would be correct. As the clavicle is lengthened it pushes the shoulder out. Since the insertion of the pectoralis muscle is attached to the humerus (upper arm) it will also get pushed out laterally. This will move the lateral pectoral muscle border, which is what defines the width of the chest, outward. Thus the chest does get wider as the clavicle gets longer.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, Hello, I have dynamic/ hyperdynamic chin ptosis. I‘ve planned to get a V-line Surgery in Seoul in some months, where the blunt and wide tip of the chin is cut off by osteotomy, and unnecessary bone parts are cut out, which are reassembled at the bottom center. My question is can I have the surgical treatment for dynamic/hyperdynamic chin ptosis afterwards? I would like to get both surgeries done. 

Have a nice day!

A: I am very familiar with that form of mini V line surgery since I frequently perform it myself. There is no question that hyperdynamic chin ptosis correction should be done AFTER this surgery since the loss of supportive bone structure will make the hyperdynamic chin ptosis worse. Or if done before would eradicate any positive benefit from the hyperdynamic chin ptosis correction.

Dr. Barry Eppley

Indianapolis, Indiana