Your Questions
Your Questions
Q: Dr. Eppley, Good day. Would it be advisable to do jaw implant surgery before or after a deep plane neck and face lift?
A:I would definitely advise doing jaw implant surgery before any type of facelift procedure. This is due to the swelling that results from the placement of the implant which can have a negative effect on the face and neck tightening results from a facelift procedure. There are some rare indications for during a jaw implant and facelift surgery together but how that may apply to you I would not know without some additional information such as pictures and your surgical goals from which I can make an assessment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I figured out i have plagiocephaly but i don’t think a severe case because anyone have ever noticed it in 27 years of my life. Now i started loosing hair and it has mecome more visible so i am looking for a resolution.
A:The definitive and most effective treatment for plagiocephaly is a customs skull implant made to augment the flattened side of the back of the head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, For my vertical lengthening bony genioplasty do I need to arrange for any imaging/CT-Scans before coming over? Or will any required scans be done during the pre-surgery consultation as well? How and when is the total vertical lengthening estimated? Is it during the surgery, or is it through prior scans during the pre-surgery consultation?
A: Unless one has had prior chin surgery there is no need for preoperative 3D imaging of the lower face.
The amount of vertical chin lengthening that is needed/desired is determined the day the before the surgery with clinical measurements. X-rays do not provide any help in determining what is the most ideal amount of vertical chin lengthening. You have to walk into surgery knowing the exact amount of vertical length needed done to the millimeter.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am looking for a possible spiral thigh lift and butt implant. Address excess lower butt sag.
A: Thank you for sending your pictures. When it comes to buttock and thigh implants, based on your pictures, I believe what you’re trying to achieve cannot be done by these implant considerations. In the back view what you are showing his lower buttock ptosis and loose skin in the upper thigh. This will not be improved with buttock implants. Buddy came plants treat and augment the upper half to two thirds of the buttocks and will not change the loose skin in its lower third. The only way to treat loose tissue in the lower third of the buttocks iand n the upper thigh is with a lower buttock lift. One may get buttock implants with a lower buttock lift but that would only be because they wanted overall buttock augmentation as well.
In the thigh area you have loose skin in the medial thigh s as well as in and around the knees. Thigh implants will likely not change that significantly except maybe in the upper knee area…. but even in this area it will not completely make the loose skin go away. One gets thigh implants because their main goal it Is to improve the appearance of a small upper leg not to get rid of loose skin.
In addition I do not recommend any form of thigh lift in your case. The scars from the thigh lift would be worse then the skin problem you now have.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was looking to try and find male pec implants before and after in the photo gallery but wasn’t able. Can you provide me with a direct link?
A: You should be looking at the Body Implants gallery on Eppley Plastic Surgery and search under Pectoral Implants on Explore Plastic Surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Would Dr. Eppley be willing to remove titanium mesh that is covering part of the skull? I would be paying out of pocket but what I would like done is essentially removal due to infection and inflammatory reaction due to internal fixation device. The mesh was placed five years ag0 after a craniotomy & there has been ongoing and increasing pain at the location of the mesh
A:I would need to see some x-rays that show the location of the mesh as well as the size of the bone defect that it is covering. In removing this mesh it would need to be replaced with split thickness cranial bone grafts as you obviously can not leave the dura/brain exposed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I saw your case study on iliac crest reduction in a male patient and am interested in more information about this. I am in my early thirties, and I am thin with an athletic build but my iliac crests are overdeveloped and this ruins the harmony of my physics, since I have a small waist and broader shoulders and chest, it creates more of an hourglass shape rather than a V shape. I’m looking for more information about the price for this procedure, recovery, functional implications and to what extent the soft tissue that is mentioned in the case study (TFL Fascia, etc) is damage / removed / altered, as well as what other risks may exist, how long recovery timeline, etc. I had no idea this was possible so I was excited to see your article!
A: As I have learned from doing iliac crest augmentation there are no long term functional issues with iliac crest reduction. The small amount of fascia that is released along the crest to do so is not significant enough to cause any functional problems. There is some discomfort with ambulation in the first few weeks after the surgery but that dissipates quickly and one is back to normal activities within 30 days after the surgery.
Whether iliac crest reduction would be effective for your anatomy and aesthetic goals would require hey picture assessment of your iliac crest prominences.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in getting the Hunter Eye look. I have attached some information from using titanium brow and infraorbital implants with a patient who had the surgery with his result.
A:First and foremost I would need stand to see some pictures of your face and eyes to determine how realistic such a change may be. The custom implant example that you have shown is quite deceptive in the way the pictures are presented. In the before picture the head is tilted slightly back while in the after picture of the head is tilted down which overestimates the exact change that may have occurred making the brows look a lot lower than they actually are. Patients need to be wary of such false advertising.
Custom periorbital implants often have a roll often have a roll in trying to achieve the Hunter Eye look outcome. But that does not mean every patient can achieve it or can achieve the type of change that may make the surgery worthwhile. This has to be determined on an individual patient basis. This is where the role of predictive imaging is useful to show the patient what type of changes based on their facial anatomy.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I do have injected silicone on my butt not on my hips can that still be possible?
A:As long as in placing hip implants there is no silicone material in the path of placement it is fine.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I always thought the size of my head is a bit big and I would like it to be smaller. So no medical issues here and I just want to achieve a smaller head size. Is this at all possible and if so what would the cost be? Would the results be noticeable?
The part im pointing to, I always thought. That part could be smaller. Is facial contouring/reshaping is also possible along with skull reduction as I think one side of my cheek is bigger than the other, thanks.
A:Thank you for your inquiry and sending your pictures. What you are pointing to on your head is known as the temporal line of the skull. This is often the widest part of teh upper temporal/ side of the top of the skull. That is the junction of the bony top of the head with where the upper temporal muscle attaches. This is why it is often a prominent line along the side of the skull which can clearly be seen in a 3-D CT skull scan. That can be surgically reduced to desquare the top of the head into a more round shape as per the attached picture. Not to be too obvious but there would be a little purpose in doing the surgery if the results were not visible.
Your more prominent left cheekbone can be surgically reduced by a procedure known as a cheekbone reduction osteotomy. That can be performed at the same time as the skull reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have this scalp roll in the back of head. What should I do about this fat? What is the solution?
A:These scalp roll at the upper back of your neck to which you refer is not just fat alone. Scalp rolls are composed of excess skin, fat, and muscle of which fat makes the least contribution to it. Such scalp rolls are treated by excision which can be very effective albeit leaving a fine line scar as the aesthetic trade-off for its removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Attached please see images of face prior to accident 20 + years ago and current. implants that aren’t too bulky and cheek projecting. More refined, higher, and angular up the side. Refined and medium, not too big. I already have a square jaw so I don’t want a block face.
A:You have correctly surmised that only a custom cheek implant design has any chance of achieving that aesthetic outcome. The key component of that is the design of which I done many times before. As a male your request for this type of cheek argumentation is not rare in my experience.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is eye asymmetry surgery worth pursuing? Am I likely to see worthwhile improvements from it? I was also wondering whether you think it could be one of those surgeries that will improve in the relative near future? What I mean by that is perhaps technological improvements like custom implants or things that can make the surgery more precise and effective? Is that far away?
I really, really appreciate this because nobody has given me this level of insight yet.
A:This is exactly how I do the surgery. Custom implants is a foundational basis for VOD surgery based on the patients 3D CT scan.
To understand contemporary VOD surgery concepts you need to go ti www.exploreplasticsurgery.com and search under Vertical Orbital Dystopia and read all about the surgery.
In terms of surgical outcome can you improve vertical orbital dystopia and lessen the asymmetry between the two eyes… absolutely. But can you make teh eyes so symmetric that the VOD is essentially undetectable or nonexistent and that answer would be no. Like all asymmetry surgeries it’s about improvement not absolutely the attainment of a perfectly symmetric outcome. There are just some differences between the two sides that can never be surgically eliminated.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My goals is to not have a bulbous chin and a more defined jaw line.I wanted a more squared off sharper chin and sharper jaw line and to remove the “divots” right past my chin and make it one linear plane to my jaw, instead it kind of concaves in. I just had the terino “square” style 1 implant put in with a platysmaplasty, and it is not at all what I wanted. Even with swelling I can tell it only will accentuate what I wanted to get rid of.
A:Your surgical results is a classic example of surgeons doing what they know rather than what the patient actually wants. This occurs simply because the surgeon does not really know how to get what you want which can only be achieved with a custom jawline implant. Adding a spot implant augmentation onto a short and high angled lower jaw is only going to accentuate what actually existed beforehand. Standard chin implants are most effective when the general augmentation needs are very modest and the jaw structure behind it has a good shape. It also illustrates the common problem that I’ve see that preoperative imaging to determine the patient objective was probably never done. I would be pretty certain that had these potential results been shown to you before surgery you would’ve said that is not what I want to accomplish.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m seriously looking into skull reshaping. I’m just not happy with how my head looks—it’s a real confidence killer. My forehead’s too long, the back of my head’s uneven, and it’s not that nice oval shape I want. Plus, I’ve got this depression on top that bugs me. I’m aiming for something smooth and normal, like Chris Brown’s head, you know? I want to ditch the hats and feel good about myself. Can you break it down for me—exact costs, financing options, the whole deal? I need the facts so I can finally get that perfect head and walk with confidence. I have attached photos of my head for your review.
A: Your skull shape has multiple contour issues including a protrusive frontal and occipital bones and a central sagittal dip. The occipital bone can be burred and the sagittal dip augmented with a custom skull implant. Both can be treated with a single incision at the top part of the occipital bone.
The real challenge is the protruding forehead because of the need to have a different incision which must be placed at the top of the forehead. In the shaved head male the location of the incision location is a questionable aesthetic tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a flat skull at the back and a flat forehead, and I don’t have a defined chin. Is it possible to have surgery to reshape my skull and define my chin more (neck lift?)? Thanks.
A: It is not uncommon to do combined skull and facial augmentations.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m hoping my brow bone can be fixed back to original 1st picture with CT scanned bone cement implant.
A: While hydroxyapatite bone cement would be the appropriate material to augment a previous brow bone reductionit can not be made as a custom implant as that technology does not yet exist for that material. Even if it did exist HA could not be manufactured as a thin implant as it is too brittle to do so.
Hydroxyapatite cement is applied as a putty when mixed, shaped and then allowed to set.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 28 year old ciswoman and have had temple augmentation with bone cement (hydroxyapatite) around 8 years ago. At the same time, I also had some of my brow bone burred down through a coronal incision (to get rid of that neanderthal look) and a brow lift to reattach the muscles and skin in a natural position.
I was initially very happy with the results, but over time the hydroxyapatite has somehow disintegrated and I am now back to having hollow temples (and a narrow head shape in general).
I am now looking for a more temporary solution and am thinking of temporal implants. Specifically, I am looking into custom-made temple implants starting at my temples and extending to the side of my head (I attach pictures of similar augmentations I found on your website).
Further, I am thinking about further burring down my brow bone bossing and – while the coronary incision is already open – potentially also reducing the radix of my nose (not sure if this is possible through a coronary incision though, but I thought this may be possible and would be really interesting to know). More precisely, I asked the surgeon back then to undercorrect the bossing and not lift my brows more than necessary as I wanted the most subtle of results. After eight years during which my brows have had time to drop again, I am now looking to redo this (but this time properly without undercorrection).
Before scheduling a consultation with you, I wanted to reach out and make a quick inquiry about feasibility and cost (I understand that this is very individual but a ballpark price would be really helpful to know whether I can afford surgery with you) to make sure that I don’t waste your time with an unnecessary consult. If possible, I would be really grateful if you could give me some initial answers on following questions:
1) Very roughly, how much would an augmentation with custom-made implants (similar to the ones attached to this email) cost including the implants?
2) Can the radix of the nose be shortened through a coronary incision?
3) Very roughly, how much would burring down the brow bone and (if possible) radix – using a coronary incision and closing with a brow lift – cost?
A: Using your existing coronal scalp incision the placement of custom temporal implants, radix nasal reduction and a bro9w lift can be performed. The radix reduction will need to be supplemented by an intranasal approach as well as the verst high radix reduction needs bidirectional osteotome bone cuts to be successful. The browlift is the tricky one as using a coronal incision to do it sacrifices scalp which I don’t like to do if it can be avoided.
These are all good cost questions and I will have my assistant pass along some cost estimates to you.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 19 year old female who will go trough double jaw surgery with Lefort 1 and Genioplasty for aesthetics in around 3 months. From what I understand, jaw surgery cannot change negative canthal tilt and sunken in cheekbones. This is an aspect I really wish to fix after my double jaw surgery. I have been told I should do a fat graft to the face, but I am looking for something more permanent. Do you think infra orbital implants with cheek implants could fix my canthal tilt and sunken in cheekbones to give more of a model look? And how much time do you think I should wait after double jaw surgery to get the other procedure ? Thank you
A: In answer to your facial augmentation questions:
- The definitive treatment of infraorbital-malar augmentation is custom implant designs. While these are great for skeletal augmentation it needs to be supplemented with lateral canthoplasties to help lift up the outer corner of the eyes.
2) I would wait 6 months after double jaw surgery before doing these finishing aesthetic surgeries.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently got some feminization filler recently but I would love my brow bone to be less pronounced and a nose job and possibly my Adams apple.
A: Brow bone reduction, rhinoplasty and tracheal shaves are all common FFS procedures that can done in a single surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, One important point for me is also the overall head size.
I’m very self-conscious about my head circumference, which is only about 56.8 to 57 cm. I’d like to ask realistically:
- With the type of augmentation shown in the simulation (including the possibility of some light lateral fill if needed), what would my new head circumference be approximately?
- What is the maximum size I could realistically reach while still keeping an aesthetic and natural result?
A: In answer to your skull augmentation questions:
- Custom skull implants provide augmentative changes for head shape contour improvements. They are not done for a measured circumferential head size change. Some benefit in those measurements may occur but is not an effect I would predict or comment on.
- The implant volume/size any patient’s head can accommodate is based on the stretch of the scalp. That is the limitation of head size change and is determined on an individual basis.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How soon after a mini facelift and lateral brow lift can I get temple implants? I’ve always had hollowed temples but after getting the mini facelift they look even more depressed. I have gotten fillers before and they worked very well for me. I’m now interested in getting temple implants. My plastic surgeon doesn’t offer this.
A: Three months after brow and facelift surgery when you are fully healed temporal implants can be placed.
Dr. Barry Eppley
World-Renowned Plastic SurgeonHow Soi
Q: Dr. Eppley, I’m trans MTF I saw your article about reduce the shoulders I have width prominences deltoid also is the possible to reduce ? How much? Thanks
A: If you are asking if the deltoid muscles can be reduced along with clavicle reduction osteotomies…that is a procedure that has never been done as there has never been a need/request. But the scarring from doing so would not seem, to be a good tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 26 year old woman who is a candidate for jaw surgery, but I’m unsure if I want to go through with it. I would be doing the surgery only for aesthetic reasons and am worried that the front of my face will look worse after the operation. I’m interested in paranasal augmentation because I have pronounced nasolabial folds due more to my bone structure and less to soft tissue sagging. However, I’d like for any method of paranasal augmentation I choose to not interfere with a future lefort if I change my mind. I was reading about hydroxyapatite cement, which, assuming a surgeon can cut through bone bonded with HA, seems like the perfect method except for maybe allergic reactions/soft tissue redness? I am not sure. Could you explain my options for the material used in paranasal augmentation (if any) and the pros and cons for each? Thank you for your time!
A: What you are really asking is what the easiest reversal method for paranasal augmentation should a LeFort I osteotomy be desired in the future. Silicone or ePTFE paranasal implants are the easiest to remove since there is no or limited tissue ingrowth into the material. While hydroxyapatite cement can be cut through with a saw it is not an easy material to remove due to the bone bonding that occurs to it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi I want to reduce the width of my skull at the top most part. Please find the pictures attached and suggest whatever is suitable.
A:With a high temporal bulge you would like to know if muscle reduction would be successful as this would be the only scarless treatment with an incision in the crease of the back of the ear. I suspect it would be but it would be important to get a 2D skull CT scan so it can determined what is the composition of that bulge (bone vs muscle) in theory at that level of the temporal area it should be more bone than muscle. However having done the temporal reduction procedure many times in similar cases muscle removal alone has been very successful. You can’t tell by feel whether it is going to be muscle because all muscle feels just like bone on the side of the head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a special surgery inquiry about reshaping/minimizing the trapezius muscles and I’m wondering if that’s at all possible as mine are quite large and I’m a transgender woman.
A:The question is not whether the trapezius muscles can be surgically reduced but by how much can they be reduced and what would be the scar trade-off in doing so. I would have to see some pictures of your shoulders from the front and back views to make a better assessment in that regard.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to schedule a virtual consultation. I recently had a BSSO when I should’ve had double jaw surgery. I really do not like the deep hollows next to my nose and my recessed looking cheeks. I am wondering if a revision jaw surgery that includes the upper jaw would make sense, or if paranasal implants or fat grafting would produce the same effect.
A: What I can say in general is that the aesthetic effects of onlay augmentation to the central midface versus LeFort one advancement is not similar as it relates to the effect on the base of the nose in the upper lip. When it comes to deep in for orbital hollows and deficient cheeks a Lefort I osteotomy will make no improvement to those recessed area and will likely make them look worse. This is where implants can provide improvement that moving the bone can’t. Fat grafting is rarely a satisfactory treatment for a skeletal deficiency.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dr. Eppley, Do you have any experience in reversing hairline lowering or somehow improving a forehead that has been overly shortened.This patient is now 2 weeks out.
A:When it comes to a frontal hairline advancement that has been accompanied by a brow lift this is largely an irreversible procedure as the procedure works by sacrificing tissue to do so. A frontal hairline advancement alone can have some degree of reversal by a posterior epicranial shift. But when a brow lift has been done as part of the procedure there is no room to shift the entire scalp backwards without overly elevating the eyebrows. Unlike some procedures wear time and tissue relaxation can be beneficial this will not be of any assistance in helping the short forehead look better.
This does not mean it is impossible to lengthen a short forehead but it would take tissue expansion which very few patients would be willing to undergo and certainly wouldn’t be considered before 3 to 6 months after the original procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I wanna know if is possible add volume in my occipital and top of my head cause both areas are flat, and how much would cost.
A:The question is not whether you can have skull implant augmentation to add volume to the back and top of your head but rather how much of a change do you seek and how much effort are you willing to put into it. Skull and taste and Zara ultimately limited by this stretch of the scalp tissue. Modest changes can occur with the immediate placement of a custom scholar implant. However significant changes require a first stage scalp expansion or a two stage skull augmentation procedure. As a female what you are requesting it is very common in my experience and in most patients the story will play out as follows… An immediate placement of an implant will provide improvement but generally about 50% of what the patient ideally wants where as a two-stage augmentation approach provides the most that the patient can hope to accomplish. Whereas the easiest route will be helpful but will leave one wanting. The harder route requires more effort and expense but achieves the most hat is humanly possible in any patient.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I found your contact information online ( https://www.eppleyplasticsurgery.com/chin-surgery-gallery/) and saw that you perform “mentoplasty,” specifically ” Chin Augmentation ( Chin Implant)” in one-day procedure.I would like to have implants (not Botox injections, and I’m not looking for the surgical procedure that involves cutting off the jawbone) placed in two areas of my jaw:
– One implant on each side at the end/corner of the jawbone,
– One implant at the chin tip.
Could you please confirm whether you perform this type of procedure? If so, how many weeks in advance should I schedule an appointment?
Since I am a foreigner, I am interested in having the procedure done on the same day I visit your clinic. Also, I do not speak English, so I kindly ask that all communication be conducted via email. Would that be possible?
If so, could you please provide me with the total price of the procedure, in euros, for the implants in the areas I have specified.
Thank you in advance for your response and offer.
A:Thank you for sending your pictures. What they show is a classic vertical chin deficiency with a deep labiomental fold. The chin otherwise has reasonably good horizontal projection. The correct treatment for this problem is a vertical lengthening bony genioplasty as you ideally need at least 10 mms of increased chin height. This is illustrated in the attached prediction images. While you can use an implant for vertical chin lengthening it cannot achieve the same amount of increased chin length due to the restriction of the soft tissue chin pad. It will achieve roughly half or 5 mm of what lengthening the chin bone can do. W there is nothing wrong with using a chin implant it is just important to know that the aesthetic outcome will be more limited.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
