Your Questions

Q: Dr. Eppley, I tell you my case, I had surgery first with a lobuloplasty doctor for the use of expansions in my large ears.which amputated part of the lobe, I went to a second doctor who performed an otoplasty and joined part of the lobe to my neck. The truth is that I don’t feel good about the results tbecause I feel that my ears are not proportional to the face or my nose. The first photo is of the right ear and the second is of the left ear (I think it is the worst one) 

I appreciate your time and my question would be if there is any possibility of lengthening the ear, could it be a graft?

A: While ears can be shortened they can not be lengthened. There is no graft that can be done to lengthen or expand an earlobe.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello. I have heard about you through some of my friends. My concern is about orbital rim, premaxillary and infraorbital areas. My wish is augmentation on the infraorbital area, and orbital rim contouring around the eye to correct the hollowness, so orbital rim and premaxillary zone augmentation. I want all of these done with HA- hydroxyapatite.

My question is can HA be used on the infraorbital area, orbital rimm  and premaxillary areas. I need to have an idea if HA  can used on such area of faceYou can see an image on attachment , drawn the area with red color which I want augmentation using HA.

Thank you

A:When it comes to the use of hydroxyapatite cement that material is going to work better for bony concavities than bony convexities. Thus the paranasal region is a good place for it. The lower orbital is OK but not great and you simply can’t build the material out into space. (upper orbital rim) HA is intraoperatively mixed to create a paste which is then applied and molded into the desired shape and then allowed to set. So the base upon which it is applied is a major determinant of its predictable augmentative effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello. I need face reshaping and i want to use cranium bone grafts to augment my retruded midface and floor of orbits. Some surgeons told me that i have to do a 3D CT scan for evaluation. This is important because my doctor left me know that the thickness of the skull bone is different on all patients. So when I do the  3D CT will it show in detail the thickness of my skull in  milimeters to understand how much bone grafts can be taken from my head to reconstruct my midface and orbits?

A: While a 2D or a 3D scan will allow the various skull bone thicknesses to be measured it is not really necessary. Short of the forehead and temporal region split thickness cranial bone grafts can be harvested anywhere inside the bony temporal lines of the skull. Since the skull has three distinct layers it is the outer cortical table that is taken for cranial bone grafts, not the full thickness of the bone. Scan or no scan you have plenty of good bone to harvest for orbital and midface augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, so Ive read that you use a bone graft from the fibula in order to fill the gap created during clavicle lengthening surgery. 

My question is, will this affect one’s eligibility to get leg lengthening surgery if they are lengthening the tibia and fibula? 

A: I no longer use a bone graft for clavicle lengthening. It is now a non-bone graft sagittal split clavicle lengthening procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to inquire about a small chin/jaw shave. I would like to have a slightly more heart-shaped face and a less prominent jaw. I also have some slight asymmetry. I’ve attached a photo below. 

A:Thank you for your inquiry and sending your picture. I am not certain what you mean by a ‘small’ chin/jaw shave. I envision from a jaw angle/jawline standpoint that would mean a literal shave (cortical bone burring reduction) which I think would be effective for your purposes. For the chin usually just shaving is often not that effective. The most effective chin narrowing procedure is a t-shaped osteotomy in which a little extra length could be added as well as narrowing which would create the most effective facial reshaping change. (see attached)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a mid 20s male looking to get custom cheek/midface implants and maybe brow ridge implant as well. My cheeks/infraorbitals have always been VERY flat and give a tired appearance. My face looks chubby because my buccal area sticks out farther than my cheekbones. I have no ogee curve from 3/4 or rear view. Additionally I have always had nasolabial folds thatI hope can be corrected with paranasal implants. 

I am also considering a custom brow ridge implant to give a more masculine, deep set eyes look. I am 50/50 on whether I want this however because it seems to be an uncommon procedure and may look uncanny on my face.

A:Thank you for your inquiry and sending your picture. Your observations are spot on as you have an overall flatter midface compared to your nose and upper/lower facial thirds. I have done imaging which provides some insight in the areas of midface augmentation. (see attached) Whether this should be done by a custom IOM implant combined with standard paranasal implants or but an overall custom midface mask implant is for discussion. I would also agree that the brow bone augmentation is of more dubious benefit but certainly would have to be in the smaller size range. (see attached imaging of midface aug + brow aug)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a specific question and i want your opinion. In general i have long face…especially lower jaw.

The problem is that the nerve on lower jaw is ery close to the bottom edges of mandibular body.According to the dr, the CT shows that inferior alveolar nerve is laying very close to the end of lower jaw edges. So it is not possible to reduce lower jaw due to the nerve.

I really want to reduce my face because it is very long especially the lower jaw. Now i wanted to ask you, on your experience, is there any way to reduce lower jaw without injuring the nerve, maybe by making a horizontal resection on the middle of the  mandibular ramus and moving the lower jaw upward? I’m confused about what to do and i just wanted an opinion from you if there is any option to reduce (upward) the lower jaw.

A:While that is an operation that can be executed on paper, doing so in real life is a very difficult proposition. Besides that fact that it has to be combined with a LeFort I impaction procedure (which may have undesirable aesthetic effects with loss of all maxillary tooth show) it would be technically very difficult to rigidly fix the bones back together. Thus this is a not a practical procedure.

It would be very unusual, in my experience, to have a naturally low position of the inferior nerve that makes an inferior border shave impossible/unsafe. I would have to see the x-ray on which that judgment was made to provide further insight.

The alternative bony method to shorten a long lower face, at least anteriorly, is a vertical reduction genioplasty…an operation that avoids the nerve issue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 30 year old male with very pronounced frontal eminences and temporal fossa. I’m guessing that I’ve always had these cranial features and that they have only become prominent as I’ve aged due to fat pad loss and a receding hairline. Although, given my age I’m surprised that these features have become so prominent so quickly and I am slightly concerned it could be due to an endocrine issue (e.g., pituitary tumor). Aside from potential health issues, I was hoping to get an expert opinion on what options I might have to address this cosmetic issue. Would filler help reduce the appearance of these features or would I need surgery? Thanks for your time! You do incredible work! 

A:You have classic prominent frontal eminences (aka forehead horns)which are congenital not due to an underlying endocrine disorder. The treatment options are to either fill around the eminences by building up the lower forehead areas (fillers vs surgical augmentation) or to have the forehead eminences reduced. (surgery) When in doubt about surgery one can always try injectable fillers first.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am currently scheduled for Bilateral Rib Removal, Circumferential Abdominal Liposuction and Fat Injections to the Hips. My integrative medicine Dr. Would like me to start pellet therapy because I have extremely low testosterone. The pellets would be placed in the hip area. Will this cause any issues with the fat transfer to the hip area? 

A: Good question and thanks for the heads up. I will assume that the pellet will be in the hip area that will receive the fat injections. Just like the lack of any damaging impact on nerves and blood vessels with fat injections around them it should similarly not harm a hormone releasing pellet either.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I had a chin implant removed after 4 months, its been 3 months since removed and I’m worried it wont go back to how it was before. Its not tremendously bigger, but its noticeable to me. I’m estimating its about 1-1.5 mm bigger all around than it was pre-operatively. I’ve heard that it may take around 6 months to go down as much as possible, but in case it doesn’t, is there something you could do to help me? This is my biggest regret, and its killing me that it may not go back. Thank you.

A: Almost undoubtably the way your chin appears now is what it will likely be. Because of the ligamentous release needed for the placement of a chin implant the ability of the soft tissue chin pad to return to what it was fully before the implant was placed is unlikely. More healing time, of course, will answer that question completely.

But if it does not then a submental tuckup procedure will be of benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a young male and I had a chin wing about 1 year ago, which pushed my chin forward by 4mm. Initially I wanted to get my overbite (4mm) corrected with a lower jaw surgery (BSSO) but my surgeon convinced me that a chin wing would be sufficient. 

I hate the result and want to get it reversed. I know that getting a full reversal might cause skin sagging. For this reason I might pursue orthognatic treatment/ surgery afterwards, which i wanted in the first place. 

Does having had a full chin wing and a second subsequent full reversal surgery, disqualify me from pursuing orthognatic treatment/ surgery for my 4mm overbite in the future?

A: I see no reason why you can not have the chin wing reversed and get a BSSO later if desired. The chin wing has very little impact on the actual ramus so a successful split can still be done later.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I just found out that you offer a shoulder reduction surgery. Since my broad shoulders have always bothered me, I am basically very interested. 

I just read your blog but I still have two questions, I hope you can help me. 

You write that patients afterwards are not allowed to sleep on their side. Since I am almost not able to sleep on my back I am wondering if it would be possible to sleep on the stomach? 

How long is the waiting period if I decide to make this surgery? 

Thank you for the answers and best regards 

A: I don’t think sleeping on your stomach is that much better than sleeping on your side. You still have to get on your stomach which involves a maneuver to get there which inevitably involves at some point rolling on your side even if momentarily. It is all about lowering the risk of hardware fixation failure whose risk is greatest in the first four weeks after surgery.

My assistant Camille will be able to answer the waiting list question.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to know if he can help me with a congenital condition I was born with. Unfortunately I was born with Muscular Torticollis where one of my neck muscle are contracted and no longer a ordinary muscle. It’s is shortened and stuff to the point where I have never have a adequate rotation of my neck. I wanted to see if the doctor knows about my current condition and is willing to set up a consultation online for hopefully surgery. I will attach some photos of my neck. Thank you for your time.

A: I have surgically treated tight/short SCM muscles in young children previously from torticollis….but never in an adult. My concern would be that even if the muscle was released that it would have no beneficial effect on your neck range of motion. Even in children such a release and with postop physical therapy the degree of improvement in neck range of motion is underwhelming. This is because the problem is not just in the SCM muscle but often there are vertebral anomalies as well.

I would imagine that in an adult who has had this issue since birth that neck muscle release would produce equally limited improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, A few years ago I had a zygomatic arch reduction. Part of the zygomatic arch in front of the ear was removed so that I no longer had such a wide face when seen from the front. But although the bone mass was reduced, the facial skin in that area (just in front of the ear) did not retract, so this operation had almost no effect. The facial skin in this area is very, very saggy and also very thick. Would it be possible to tighten this skin?

A: While a deep plane facelift approach could be used to treat the excess facial skin the scar tradeoffs and hairline displacement that would result in a male would be a dubious aesthetic tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, i recently got a sliding genioplasty and all though the procedure went great, I found a new dent that appeared between my bottom lip and chin and every time i pull my bottom lip it appears, I wanted to know if you can fix it after my genioplasty.

A: The dent to which you refer is the deepening of the labiomental fold which is a natural occurrence in any sliding genioplasty in which significant horizontal projection is done. It can also occur, however, if the labiomental fold tissues/mentalis muscle closure gets sewn down too tight combined with failure to fill in the stepoff bony defect from the sliding genioplasty…which appears to be what your video is showing.

This is treatable but it depends on how far postop you are…which you did not provide your surgery date in your inquiry.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I got a buccal fat removal and would please want to do anything to make my cheeks fuller again please help!

A: Buccal lipectomy reversal can be treated by fat replacement done by either cheek fat injections or the placement of a dermal-fat graft directly back into the buccal space.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Although you state on your  website that you have performed rib removal on women who participate in sports and maintain an active lifestyle, many doctors refuse to do the surgery because it would expose certain internal organs. I understand that the surgery itself is safe, but what about life afterwards? Are you more in danger of dying from e.g. a car accident that puts extreme pressure on the exposed area?

Finally, is there a way to determine beforehand how much waist reduction you’ll achieve? The website says 1-3″, but, for a petite woman, that could be the difference between an attractive waist:hip ratio and looking like a circus freak.

A: In answer to your surgical waistline narrowing questions:

1) Rib removal surgery leaves the inner half of the ribs so concerns about subsequent organ injury or an unguarded posterior abdomen are unfounded.

But if there are concerns about any of the rib lengths being reduced, there is also the rib fracture technique which leaves the entire rib length in place.

2) When having a concern about looking deformed (aka circus freak) after rib removal surgery, that is an outcome that would fall into the category of overcorrection. That is giving the operation way too much credit for what it can accomplish. The aesthetic concern with the operation is making sure that it does enough for the patient to see a noticeable difference. In other words undercorrection not overcorrection is the potential concern.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have two very distinct bumps/horns on my forehead. Only directly noticeable with “above-lighting”. Is there a proven surgery method for evening my forehead?

A: What you have are classic forehead horns (aka prominent frontal eminences) which I have seen and treated many times. They are reduced using a high speed burring technique through a small incisional frontal hairline approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if waist narrowing / rib removal can be done concurrently with other procedures? Specifically a butt and/or thigh lift? Could fat be harvested from these procedures and also be used for a BBL ? 

A: In answer to your questions:

1) Rib removal waistline narrowing surgery can be combined with other procedures and is commonly done so.

2) Buttock and thigh lifts can be one of those procedures that can be combined with rib removal.

3) The fat harvested from rib removal (flank liposuction) would not be enough for any really noticeable buttock augmentation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Regarding the use of cheek arch implants for the purpose of widening the face, is there a way to bring the forward part of the ear outward along with the implant? (So as to prevent the cheekbone from appearing to be “rising too tall” relative to the ear) 

A: You can not move the ear forward, with or without an implant. It is a fixed structure attached to the side of the head by the cartilaginous ear canal.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’d like to enquire about skull reshaping, due to having a flat back of head as it makes the top of my head have a harsh diagonal slant upwards and It makes it hard for my work as it doesn’t really fit a hard hat properly and the left side of my head sticks out more than the right which is quite noticeable is there anything you can do to make these areas smaller, thank you.

A: Thank you for your inquiry and detailing your head shape concerns. While the areas to which you describe can be reduced to some degree, the relevant question is whether the degree to which they can be reduced would be enough to improve your symptoms related to them.

The only way to help make that determination is would be to look at and measure bone thicknesses on a 3D CT scan.

For the flat back of the head a custom skull implant can treat that nicely. Between whatever skull reduction can be done and the custom skull implant for the flat back of the head it is very likely that a hard hat would fit much better.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, was reaching out about skull reshaping methods and I would like to ask some questions.

– Which method would leave the smallest scar

– Which method allows for best shape control

– How strong is the implant? Is someone after such procedure able to train BOX or MMA?

A: The custom solid silicone skull implant allows it to be placed with the smallest scar, has the best shape control and has no restrictions from any physical activity after full healing.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What are the limitations to a custom skull implant to add ~1 inch in height? Is a specific skull shape required for this? 

A: For heightening purposes the skull implant would have a design that covers the top of the head with edges that cross over the bony temporal lines.

The limitations of any aesthetic skull implant is how much the overlying scalp can stretch to accommodate what lies underneath it on the bone. As an immediate insertion technique (no prior scalp expansion) the limitation is around 150cc in volume or 1.5 to 2cms of maximum projection.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forearm implants. I have worn long sleeve shirts most of my life and finally wanted to look into escaping this dilemma of embarrassment.  Here are photos of the left and right arms. Thank  you.

A: Thank you for sending your forearm pictures. By these pictures your area of arm augmentation is the anterior forearm or the wrist region. In this anterior area of the forearm there are no larger muscle bellies in which to place an implant under its fascia. (unlike the upper forearm with the brachioradialis muscle) That does not mean that wrist implant augmentation can not be done, just that it would have to be done on top of the muscle fascia under the skin. I am envisioning the implant location as shown in the attached picture. With an ultrasoft solid silicone implant design with feathered edges I believe such an anterior forearm/wrist implant can be successful.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, am middle aged male. Looking for guidance on which facial procedures for refresh and masculinization. I’d like custom silicone brow implant, full jaw implant. I have ok mid forehead brow bone, but outer area of eye socket bones is deficient (eyes are vulnerable to impacts due to lack of outer brow bone vs. socket depth). I also need brow lift (approx. 1.5mm lift of eyebrow?), modest blepharoplasty uppers (I’ve had hooded outer uppers since childhood so looking for mild upper job and fat transfer to plump up upper area below eyebrow). 

So, can you tell me if I should get brow augmentation procedure 1st, then wait a few months for my ageing skin to settle in around implant, before continuing on with brow lift and uppers bleth? I plan to get eyebrow transplant also to boost outers of eyebrows. 

Chin angle in profile is a little recessed also, is this always a separate implant to remedy? Separate from full jaw implant that is. I would need neck lift after implant, slight joweling now along with some turkey neck, mid face is still pretty good. I thought to plump up cheeks with fat transfer. I have significant jaw bone loss around teeth due to long time periodontal disease (under control/frequent visits to perio as always). 

OK, looking forward to your recommendations.

A: Thank you for you inquiry and detailing your concerns. Your supposition is correct in most cases….get the foundational work first before doing any manipulation of the aging overlying soft tissues. The swelling from the brow bone augmentation is most cases is counter productive to the soft tissue work. HOWEVER if the brow bone augmentation is limited to the tail of the brow and lateral orbital rim then it would make sense to combine that with upper blepharoplasties and browlift because these procedures are incisionally and pocket dissection synergestic and the swelling from the brow bone augmentation is not much worse than from the browlift alone. The need to separate these procedures is when a full brow bone implant is needed which requires extensive dissection from above.

Otherwise a full jaw implant includes the chin area as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a man from Norway with a uncommon situation. My skeletal proportions are quite un-manly. My shoulders are very narrow, and I have quite wide hips and large head. I understand you perform clavicle lengthening procedure for widening the shoulders. So I have been wishing for and contemplating such surgery for a long time. Do you accept patients from other countries? 

A: Thank you for your inquiry in regards to clavicle lengthening. In answer to your questions:

1) My practice has patients from all over the world, some even from the beautiful country of Norway.

2) Clavicle lengthening surgery is in its infancy so to speak so only a handful of patients have been done. But the techniques developed for it come from its companion procedure, clavicle reduction, where many more patients have been done in the past five years.

3) As part of the preoperative assessment/qualification it would be good to look at some shoulder pictures of you and do some computer imaging of potential changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently ran across this 2021 paper titled  “Waist Narrowing Without Removal of Ribs”. What do you think of it? I have a boxy waist; but I store most of my fat viscerally, which means that I’m not a lipo candidate. I’ve always wondered about rib removal, but I’ve been worried about the possibility of chronic pain or other long-term complications. Would a procedure like described in this paper this be safer? 

A: As I have stated in the past, the concept of rib fracture rather than rib removal is a viable approach. The key to its success is the need to corset regularly for at least 2 months after the surgery to successfully reshape the ribs. It is not a question of which one is safer, as rib removal surgery is very safe and has never in my experience had any complications at all, but that rib fracture offers a shortened recovery period and less operating time to perform. The unknown question is which lower ribcage modification approach, fracture vs removal, offers superior results for waistline narrowing, or are they virtually similar in effectiveness. That answer will probably never be precisely known. So for now and into the foreseeable future potential surgical waistline narrowing patients should make that decision based on what recovery period they need and how motivated they are to adhere to a postoperative corseting garment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to ask your opinion about the appropriate timing of intralesional 5FU to a post auricular scar- Is 8 weeks post surgery sufficient time to commence the intralesional injection?

A: 8 weeks is fine to start scar injections with 5FU, sooner would have been even better.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I got a sliding genioplasty three months ago. I like the projection of my chin on the profile but I have some concerns. First, I have noticed that there are step offs on both side of my jawline. The step off is more pronounced on the left side than on the right. Is there a change that the step-offs will be filled naturally over time? How long should I wait to see if they smoothen naturally? The second concern is that my chin is a bit long. I am wondering if, after three months, I can still expect the swelling to decrease. I have read that after three months not many changes will be produced but I have also read many testimonies of people who said that they noticed significant changes at 6, 9 and 12 months. What should I expect according to your experience? I personally noticed a significant reduction in swelling from month 2 to month 3, can I still expect changes? Also, I noticed that if the swelling is reduced, I would have a more smooth jawline because the chin would blend better with my jaw. What do you think? 

A: In answer to your post sliding genioplasty questions:

1) The bony stepoffs on the side will not improve with further healing. They may even worsen a bit (soft tissue contracture into the induced bone defects) but certainly they will not get better or go away.

2) The vertical length of the chin is also not likely to change with further healing.

The only benefit of time with the lateral stepoffs or the vertical length of the chin is that these aesthetic tradeoffs from the procedure will become more acceptable and you can avoid any additional efforts to improve them. Time also has the benefit of proving whether further healing will reduce their visual appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have noticed just recently you have published a clavicle lengthening result with a video. I am just wondering a few things. 

1. I know you were able to get 18-20mm of actual bone width, how much did the patient gain in bideltoid actual measurable shoulder width? 

2. How can I personally prepare for a procedure? I know you mentioned shoulder stretching, could that actually make a difference? 

3. Could patients move their arms after the procedure? 

I am interested in this procedure personally and would like to get the best possible result. Thank you. 

A: In answer to your clavicle lengthening questions:

1) There is generally a 1:1 ratio of what occurs at the inner third/half of the clavicle to the increased width at the outer deltoid area. This is because in clavicle lengthening there is a roll back effect on the shoulders as well.

2) Decreased shoulder/scapular tightness is of benefit during such surgery to achieve the optimal lengthening. I would refer you to this link to read more on this topic.  https://exploreplasticsurgery.com/preoperative-sho…widening-surgery/

3) While a normal range of arm motion is not permitted during the first few weeks after the surgery, and you wouldn’t be able to do that anyway due to expected discomfort/tightness, limited arm movements are permitted.

Dr. Barry Eppley

Indianapolis, Indiana