Your Questions

Q: Dr. Eppley, How can I get rid of this lower fullness in my midface that did not exist prior to a LeFort I osteotomy?

A: In regards to trying to reduce lower midface fullness after a LeFort I osteotomy, a significant maxillary advancement does create a bony shelf that was not there previously. This bony shelf combined with the indwelling hardware can create some projection after surgery that was not present before where the face of the maxilla was concave and now has some bony ledge in the middle of a normally completely concave maxillary surface. In these cases removing the hardware and burring down the bony ledge to recreate a completely concave maxillary surface may help reduce some of the lower midface fullness.

As this relates to you, it can be seen that you have four plates and 16 screws and that your maxillary advancement probably was no greater than 5mms. (as judged by the bend in the lateral plates) This is not the type of maxillary movement that creates a large bony shelf. But it is possible that removing the plates and screws and burring down any existing bony ledge will provide some reduction in your lower midface fullness. But probably going back to exactly what it was before your surgery is not possible as some of the fullness is related to irreversible soft tissue changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m considering face implants with you but I also have thick skin, so not sure if this is the correct procedure for me, fellow researchers have said bimax and other bone cutting surgery’s are more effective in providing a non bloated face. These two people below with thick skin got implants placed and they look bloated instead of angular after, could it be a design issue?

A: In answer to your questions:

1) Let’s first get the concepts correct. A full bloated face is NEVER going to end up with a thin sculpted face…so that end goal should be eliminated as unrealistic. 

2) The better question is the how much improvement/slimming effect can be achieved which is a function of tissue stretch (implant augmentation) and tissue reduction. (defatting) The degree of facial change is going to be a function of these combined effects. In the thicker skinned patient both of these diametric tissue changes must be maximized.

3) While I have no idea as to why the implant was designed for the particular patient you have shown, it is an implant design that has its greatest effect in the chin area. The jaw angle portion is so small that it would not have much tissue stretching effect. (But this may be what the patient wanted) It is also unknown what facial defatting procedures were done, if any, for this patient.

4) Orthognathic surgery and custom facial implant augmentations are done for very different reasons. They are not comparative operations and thus their aesthetic effects are going to be different.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is Medpor implant removal more difficult if they are placed long time ago ? Thank you.

A: The time duration of implantation (short of a few days after surgery) does not affect the ‘difficulty’ of Medpor implant removal. I have removed hundreds of them from months to years after they have been placed and the time differences of how long they have been in there does not seem to change how they are removed. In other words, whether it is months or years they offer the same amount of tissue ingrowth. They never get direct bone ingrowth into the material. (some times there is some bone overgrowth but not ingrowth)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I currently have 1350 cc saline implant with internal bra(alloderm)my implant is under the muscle i would like to get around 1800-2000cc and i would like to get a lift too but many doctor have told me that its not worth it if i do a lift because I have a poor skin quality (my skin is too thin and too elastic)and my breast will always get saggy  no matter what I do…

Do you think you could help me?

A:An increase in implant volume fights against any lifting effecting effect as well as vice versa. You have to pick one or the other. A lift risks wound dehiscence and poor scarring when done on a very expanded breast skin envelope. It would be more predictable and safer to go with the volume increase only.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Many years ago I had an endoscopic brow lift that left my brows significantly higher than expected, leaving me with what is typically described as a startled, or ‘deer-in-the-headlights’, look. I’m researching as to whether my brows can be lowered and, if so, how much? I have read where, yes, brows can be lowered through reverse brow lift brow surgery, but my case is perhaps more difficult. 

Subsequently I underwent FFS (Facial Feminization Surgery). My FFS was somewhat extensive, leaving me to wonder now whether reverse brow lift surgery is even possible. 

Besides a brow lift I also had a scalp advancement to bring my hairline forward, rhinoplasty, and supraorbital rims were shaved to reduce brow protuberance. This left me with 2 post-surgical effects I find particularly bothersome: 

1. I cannot frown; that is, I have no ‘down’ muscle control. I can raise my brows, but I cannot lower them. 

2. I still have a fair degree of numbness in my upper forehead region, extending into my scalp to such an extent that the top of my head feels like I’m wearing a bike helmet. 

To both of these concerns I was told by my surgeon that they would self-resolve over a year or so. They did not. 

So I leave you with this question: do you believe I’m a candidate for reverse brow lift surgery? 

Thanks for your time.

A: Thank you for your inquiry and sending your pictures. Normally a reverse browlift is based on the concept of an epicranial shift…meaning the entire scalp is mobilized and brought forward rather than back as in an endoscopic brow lift. But having had a hairline advancement as well as a browlift (and having lost some forehead skin in the process) would suggest that this approach would not work. You need a more reliable solution to release the scarred tissues AND create more scalp tissue (or at least stretch it better) and that would be a scalp tissue expander. Placed on the back of the head and gradually inflated you would create enough tissue mobilization to get a reverser browlift effect as well as improve the tightness across the top of your head. This would, however, not change the lack of depressor forehead/brow function.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, As a child I had an orthodontist to a lot of extensive grinding of my teeth. Later, a car accident damaged my right TMJ joint. Over time, my face has shifted and to the right side. Four years ago I found the best orthodontist in the city and we have worked hard to undo the damage. Now, my bite is repaired and the “melting” right condyle has been stabilized. I am left with the last piece to fix: Correcting my facial tissue asymmetry! I already have a silicone chin implant. I have a large forehead that could balance well with an augmented jaw appearance.

Is there a high risk of the implants failing and has it happened in any of your cases? Is there a risk in my individual case for destabilizing my right TMJ due to the trauma from the pressure and inflammation from the surgery of this implant addition?

Photo Notes: 

1)This shows the apparent asymmetry with tissue pulled and favoring the damaged right side. Note this is including recent botox to the masseter muscle with no change in appearance. 

2) Please note that the R condyle is practically a toothpick in comparison to the L condyle in the TMJ region.

A:Thank you for your inquiry, sending your picture and detailing your history. In answer to your questions about a custom jawline implant:

1) Failure in any type of facial implant is defined as infection in which the implant needs to be removed. That is about a 5% risk in any standard jaw angle or custom jawline implant.

2) A jawline implant is laid on top of the bone and does not affect its function (opening/closing and chewing) other than during the recovery period from the trauma of surgery.

3) In looking at the panorex (which is a limited 2D assessment) the jawbone has no obvious asymmetry other than the diminutive right condyle.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Eppley, I have some type of plagiocephaly. The right side of the back of my head is flatter and weirder looking than the other side, and my face bulges out on the right side. I have included pictures, and want to know if its anything severe. What my goal is, is for my head to be how it would’ve looked if I didn’t have the disorder. If being able to make my face look normal is an option that would be of best interest. Thank you so much!

A:Like most plagiocephalic patients the flatter back of the head side is also associated with a right facial protrusion. These are aesthetic issues so the severity of them and the desire to treat them is based solely on how much they bother the patient and what they are willing to go through to correct it. Most plagiocephaly patients that do so focus on augmenting the flatter back of the head and occasionally some reduction of the protruding ipsilateral face. Without a completely straight on facial picture I can not speak as to what may benefit your face.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a part time male model considering cheek implants. I have flat cheeks that creates a sad look when not smiling. I’m in my mid forties and have had a mini lift to help improve my mid face and soften my nasal labial folds. It was very helpful, but due to flat checks, I still seem to have what appears to be too much check tissue that lends the sad look. I like the chiseled male model look, in that the cheek bones are more prominent while maintaining a lean area below and do not want a round face associated with most cheek augmentations. It seems most surgeons are focused on submalar implants which does not address my needs which are more prominent bone structure. 

Can you share a few before and after pictures of patient to better demonstrate the look that custom implants can produce? 

A: Thank you for your inquiry. You are clearly, as most men would, seeking a high cheekbone augmentation look which is not all what standard cheek implants create. This can only be done by a custom cheek implant design which keeps the augmentation located directly along the horizontal zygomatic body-arch line. Whether this would be limited to the zygomatic body-arch skeletal area, which is placed through an intraoral approach, or whether you need a design that incorporates the infraorbital rim (infraorbital-malar style) I can not obviously yet say. For now I will assume it is the former.

In regard to before and after pictures almost all of my male patients are extremely private and thus passing around or showing their pictures is prohibited. What few patients have been generous enough to allow their pictures to be shown would be in the website, www.exploreplasticsurgeruy.com searching under Male Custom Cheek Implants and Custom High Cheek Bone Implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a transgender woman, fairly early on in my transition and I am very interested in having the shoulder reduction surgery you offer. I have some questions… 

1. How long is the current lead time from booking to surgery? 

I would like to try to get the surgery done this year well before Christmas, perhaps early November. Is this realistic? 

2. I have previously broken my right clavicle and I think I have a slight deformation in the bone from where it healed (I’ve not included pictures for now as it’s not particularly noticeable but I can of course supply you some if you wish). Could this be a problem? Have you operated successfully on similar patients? I certainly hope it is not a deal-breaker. 

3. I will be flying from Finland and then back again when possible. How long will the recovery time in the US be before I can return on the plane? 

4. Can you provide a good estimate on the cost? 

I hope you can help me! Thank you!

A: Thank you for your thoughtful inquiry in regard to shoulder narrowing surgery to which I can provide the following answers to your questions:

1) My assistant Camille will provide all logistical information in regard to cost and scheduling.

2) I do not think that a previous well healed clavicle fracture is a contraindication to the surgery. Most clavicle fractures are in the middle and lateral portion of the bone well away from the inner third where the osteotomies are done. (eve if it as in the inner third even better because the healed fracture site would then be cut out) But if you have a post injury x-ray that would be prudent for me to review. I have not yet seen a shoulder narrowing surgery patent that has had a prior clavicle fracture….but it was only a matter of time before that scenario was encountered given the common occurrence of clavicle fractures.

3) I have had previous patients from Scandinavia and Europe for shoulder reduction surgery so we are well acquainted with the recovery time for a transatlantic flight to return home. If you are coming by yourself I would plan on a 5 day stay before returning home.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have the same problem your lady seen in pictures has.Case study with the 67 year old female. Does a crooked or larger chin implant make the bunching under chin as seen in picture. My chin looks like this and I have a terrible scar. I have had my chin implant for about 15 years. Just curious as I am doing some research. 

Thank you, 

A: What you are describing can certainly be due to either an asymmetric or overly large chin implant. But the only way to know for sure is to get a cone beam scan (CBCT scan) so the exact position on the bone and size/style of the chin implant will be precisely known.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Im interested in a rough estimate for infraorbital malar implants AND lateral and supraorbital rim projection to give the appearance of upper midface and masculine dimorphic forward growth with minimal upper eyelid exposure. 

Would you advise these put together? would the result look too artificial? Ill be fixing the forward growth in the lower third so I would assume it would look harmonious enough in time.

A: As long as both combined periorbital implants (brow bone + inferolateral rim-malar implants) don’t have excessive thicknesses, they should not look unnatural. When periorbital augmentation is performed it is easy to forget the powerful effect of such bony surface area coverage that wraps around the eyes.

Whether one does one or both at the same time depends on several factors, most prominently the prolonged appearance recovery that it takes. (4 to 6 weeks)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I may get a hair grafting procedure two months before my custom facial implant surgery with you. Do you have any objections to that?

A: That is really a question for the hair transplant surgeon as to whether this major facial surgery may stress the newly implanted hairs. It would make more sense to me to do it afterwards when a major surgery/anesthesia stressor on the body will be over. It is known that such systemic stressors can adversely affect hair growth or even cause shedding.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I have a few questions about temple implants. Firstly, whether they are secured with screws or not, and if not, then wouldn’t they get displaced from their place? Maybe come lower due to gravity of move with trauma? Specifically the bigger temple implants that are longer. 

A: Temporal implants are muscle implants not bone based implants. Thus screw fixation is not needed nor could be done. They maintain their position by a subfascial pocket created on top of the muscle and the narrow apex of the sub zygomatic arch opening which prevents them from ever shifting inferiorly.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a transwoman and contouring my body would greatly help my dysphoria. I am seeking a surgeon who does Iliac crest implant or the Pelvic Plasty surgery in the U.S. I read about it also on your website. Have you performed this surgery? Thank You so Much. 

A: Iliac crest implants are not an FDA-approved device in the U.S.. As a result, they can only be made on a custom basis for each patient. No U.S. orthopedic company will manufacture any metal iliac crest implants as that does not fall under the FDA reconstructive implant regulations. As a result I have designed ultrahard solid silicone iliac crest implants from a major cosmetic implant manufacturer. But the first patient has not yet been implanted.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in jawline augmentation and custom square chin implant. I have a couple of basic questions: 

1. Is the incision intraoral or outside? Is the incision visible? Will there be any scars? 

2. Will I be conscious or anesthetized during the surgery? 

3. What is the average expectation after the surgery? 

A: I believe you are referring to a custom wrap around jawline implant in which the chin part is more square. Thus in answer to your questions:

1) Most such jawline implants are put in through a combination of a small external skin (submental) and intraoral incisions.

2) This procedure is done under general anesthesia.

3) I am not sure what you mean by ‘average expectation’ after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in shoulder narrowing surgery. I was curious if you performed this procedure; if so, how many times have you performed it? (if you do not offer the surgery I would appreciate a referral) I was interested in the healing time for the procedure and if it would make sense to do 1 arm at a time due to mobility issues. Also for the left over support hardware is it frequently removed with a subsequent surgery after healing or left inside the body?

A: Thank you for your inquiry. In answer to your questions:

1) I have performed shoulder narrowing surgery for the past five years in over 40 shoulders.

2) There is a specific arm motion protocol in which it takes 4 to 6 weeks to return to full range of motion.

3) Patients always have the option to remove their metal hardware 6 months after the surgery. To date no one has requested to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 23 year old female from the UK wanting to enquire about shoulder feminiation surgery. I have significantly broader shoulders in proportion to the rest of my frame that bother me a considerable amount as no clothing sits right on me and it they make me look larger than I actually am. I was wondering if you could give me some more details regarding the surgery and whether it would be possible for a UK citizen to travel to have the surgery. I have attached a photo for reference and please let me know what other details are necessary.

A: Thank you for your inquiry and sending your pictures. The most definitive source of information on shoulder narrowing can be found on one of my websites, www.exploreplasticsurgery.com, where you can place in the search box the procedure term and everything I have written on the topic will appear. My assistant Camille will pass along the cost of the surgery to you.

There are no restrictions from anyone coming from the UK to have surgery. That has not been a problem from an entry and having surgery standpoint over the past year. The only issue I am aware is that patients traveling from abroad must consider is what their country’s requirements are when they return home.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a somewhat long philtrum and was wondering what the options were to correct this? I have heard of lip lifts, but am hesitant as I feel it would look too feminine or unnatural (I am a guy).

My nose is also somewhat short (contributing to the long philtrum). I was wondering whether the nose could be elongated, fixing two birds with one stone.

Thank you for reading!

A: Thank you for your inquiry. The only methods to shorten a long philtrum are excisional, either a lip lift or a vermilion advancement. Many men do them and I am not aware that it feminizes their mouth area. But the only way to know for sure is to have computer imaging done to see how it looks from your perspective.

Nasal lengthening can be done and always takes cartilage grafting to do so. The only question is how much lengthening is needed and what type of cartilage grafts are needed to do so.

For the both the lip and nose I would need to see some pictures for both an evaluation as well as to perform computer imaging of potential changes for you to see.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, My whole midface is kind of recessed which makes my mouth look protruding and my chin look large. Besides I feel my eye socket is too shallow and my eyes look tired. I had rhinoplasty before, the surgeon used cartilage to reshape my nose tip and placed ePtfe implant on my nasal bridge. He also placed 2 small paranasal implants(also eptfe) but they didn’t help much with my condition. I wonder whether midface implant will help with my situation. And if so, how the implant should be designed including the area the implant covered, thickness of the implant and how many pieces of implants are needed etc. I am Asian and usually Asian people prefer round face instead of edge face. I personally don’t like faces that are too round cause they seem lack of bone support. My face is wide and I don’t want to make it wider but I want the apple cheek look. As you can see from the photo my cheek is sort of flat. Thank you for your time and patience and I am looking forward to your reply. 

A: Thank you for your inquiry and detailing your midface concerns and objectives. You are referring to the midface mask implant which is most commonly done in Asian patients. It covers the entire midface from the infraorbital rim down to the maxillary alveolus with the objective of pulling the midface forward but not making it any wider. (see attached) It is a one piece implant placed intraorally. Your existing ePTFE implants would be removed and replaced with this broader surface coverage.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Very interested in deltoid fat transfer to make my shoulders wider. I lift weights but have a a small frame naturally. I have never gotten lipo surgery before and am currently at 17% body fat. I would like to have the procedure done if it is feasible and can be successful. Thank you.

A:Thank you for your inquiry and sending your picture. Like all fat transfers the key questions are: 1) Does one have enough fat to harvest and transfer? and 2) how much fat will survive and persist in a young lean athletic frame? On both of these questions you are admittedly on the perimeter of whether the procedure would work. But since the deltoids are a small surface area and do not need a large amount of fat you probably have enough to do so. The more challenging one is survival in someone with a high metabolism into an area that otherwise does not have fat present. But as long as one can accept that unpredictable fate there is no harm in undergoing the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, we went over this possible procedure during our last consult few months ago, I have attached pictures. The area I’m pointing at is by might right sideburn right by where the hairline meets with the beard line. I would prefer for that not to protrude as much as it widens my face and becomes noticeable with certain angles. 

I wanted to hear your opinion because this seemed simple to me at first, specially since we would be talking about maybe 1 to 1.5mm of shaving; but after more research I know that there are some important nerves around that area and I wouldn’t want the risks to outweigh the reward.

A: You are referring to a reduction of the right posterior zygomatic arch area. That is an area that is commonly accessed in cheekbone reduction surgery for the posterior zygomatic arch osteotomy. You are correct in that the frontal branch of the facial nerve is closeby but it has never been a problem in my experience as techniques are used to avoid it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have lip incompetence, and I think I have Long Face Syndrome. I assume the cause of the lip incompetence is due to my allergies. I have a really long philtrum (about an inch long) What is the solution to this? I don’t think I have an overbite or a gummy smile. 

How would I go about on fixing my face? Would IMDO or bimax fix it? 

Is it possible to do 20-30 degree CCW of bimaxillary rotation to get to the ideal gonial angle of 128 degrees? 

A: With no x-rays and one partial full face picture I can only make incompletely informed comments:

1) Your lip incompetence is not due to allergies, it is due to a very short chin/lower jaw. At the least a sliding genioplasty of double digits is needed.

2) A long upper lip can only be reduced by a subnasal lip lift. No form of upper jaw shortening/impaction will make the upper lip length any shorter.

3) Orthognathic surgery (bimax aurgery) never creates any improvement in the gonial angles and in many cases actually makes it worse. Jaw angle shape changes can only be done with implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am the photo in the middle. My hope was to change my eyes and nose to look more like Justin Bieber. Is that possible with how my face looks? I’m a senior in high school and hoping to get the surgery sometime in the future. Just wanted to know if it would be a success to look the same.

A: In comparing the present differences your nose would need to be narrowed at the tip and the bridge smoothed over…although one front view picture does not provide a full assessment of a nose which is needed before any rhinoplasty surgery. From an eye standpoint your lower eyelids have a sag which shows more sclera and the lower iris. That can be addressed by raising the lower eyelids with spacer grafts and tightening down the outer corners.

I can not say whether you would look more like Justin Bieber if you had your eyes and nose done as described but those are changes that can be surgically done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I currently have a rhinoplasty surgery scheduled for later this summer with another surgeon.

Please find attached images of my face at various angles. My main goals with this procedure would be: from the front, a wider jaw and bigger/wider chin; from the side, enhancing the overall look of my profile view / chin projection / etc.

Here are a few questions that would be useful to know:

– Rate of infection for custom wraparound jaw implants / how many that he puts does he end up needing to take out?

– Is there a “constant” risk of infection over the course of your life with the implant, or is the main risk really just in the first 6 months or so?

– Since I’m getting rhinoplasty, would it make more sense to get this implant done before or after that other procedure?

– Do I look like I would be a candidate for sliding genioplasty, or would custom implants be better?

A: Thank you for your inquiry and sending your pictures. In just looking at the pictures you are not an obvious great candidate for the wrap around jawline implant approach because of:

1) Your thick skin…which often makes the jawline look bigger but not necessarily better defined…sometimes it may just look fuller/fatter.

2) You have reasonable chin projection as seen in the side view picture. Your jaw angles are deficient/not defined but your chin projection and jaw angles are disproportionate in size. (the chin may be a little undersized? but the jaw angles are much more so.

While I could see a combination of a sliding genioplasty and jaw angle implants (the three corner approach) I worry that connecting them may just make the jawline look big but not defined. The jaw angle implants may have to be custom or semi-custom made because of the width needed. (greater than 10mms) to really see them.

In regards to whether a rhinoplasty or jawline augmentation should be done first, that is a pure aesthetic/personal decision. You do the one first that has the greatest aesthetic importance to you. In other words ask yourself if you could only do one and never the other (which is obviously not true but a good way think about it) which one would you do?

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Eppley, Hello doctor, my case is unusual, I would like to know If you can remove Ellansé filler from the cheek and replace it with implants to give the ogee curve on a male?

A: Your request is not unusual (remove filler and replace with implant) but doing it successfully (remove the filler part) is the challenge. I wouldn’t recommend trying to remove this semi-permanent filler as it is going to cause a lot of tissue damage in so doing. This will result in a lot of cheek irregularities and contour defects.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I supposedly have a Peek chin implant, it does not project enough and is skewed pointing off to my left. I would like my chin to be symmetric with more outward projection. It was interesting that you wrote that the flesh adheres more readily to the Medpor implant as apposed to Peek, as I feel that this could/might also produce a better outcome (my bottom lip has no overhang anymore and when my mouth is relaxed all my lower teeth and gums show). Could you please tell me my options, thank you.

A: The outcome from any facial implant surgery, chin implants included, are based on the shape and size of the implant not its material composition. Material composition of an implant affects how it is inserted and removed but not its aesthetic outcome.

Thus when considering a new chin implant the key issue is the exact shape and dimensions of what lies in you now. Knowing the exact dimensions of what you have is invaluable information in how to design an implant with better dimensions for your needs. Any PEEK implant would have to be custom made and thus there would be an implant design file for it. I would need to know more about your existing chin implant. Your implanting surgeon should have this information.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in pectoral and testicle implants. Do I need custom implants or will standard implants work for both? How much does a testicle implant weigh? 

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

PECTORAL IMPLANTS The key in pectoral implant selection is to have an understanding of the patient’s exact chest shape goals. Then the implant is selected by knowing the height and width measurements of the chest and the amount of projection and is location along the implant that the patient wants. This is how one knows whether a standard vs custom pectoral implant can most effectively achieve the desired outcome.

TESTICLE IMPLANTS Many of the testicle implants I do are in patients that seek enhancement of what they already have, not replacement of a missing testicle. Thus by definition these are almost always bigger in size than what standard testicle implants (max size 5.0cms) can achieve. Most custom testicle implants are in the 6.0 to 7.0cm size. (90 to 120cc volumes per each implant) The weight of a solid silicone testicle implant is completely controlled by its size. While size is obviously important the other major decision is the choice of the side by side vs wrap around implant technique. There are advantages and disadvantages with either approach. 

Pectoral and testicle implants can be done during the same surgery.

For now I will initially assume you need standard pectoral and custom testicle implants with the wrap around technique. But this open to further discussion and at the least is a starting point of that discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have another question which I think we may have covered during my consultation but I want to confirm…

I currently have and have always had low blood pressure. My last blood pressure reading was 90/70, but it sometimes goes lower. I want to confirm that temporal artery ligation is safe in my case and won’t cause problems such as dizziness, lightheadedness or more serious complications. I will also double check with my neurologist. The first time I checked with him he didn’t seem to think the procedure would be unsafe for me.

I very much want to have this procedure and hope there is nothing that will prevent me from doing so.  I will probably have more questions that I forgot to ask Dr. Eppley during our consultation, but I think we covered most everything!

Thanks very much!

A: Low blood pressure is not a contraindication to temporal artery ligation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking for my cheeks to be more prominent and have a good Ogee curve? What should I do, giving the photos. What would you recommend?

A: Thank you for your inquiry and sending your pictures. While the concept of ‘prominent cheeks’ in a male can have different interpretations, most commonly they seek a so called high cheekbone look which has a good Ogee curve. This can be seen in the attached custom cheek implant design.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have some questions about skull reduction. The height of my skull bothers me and I want it reduced. I read your blog and three procedures got my attention: grid pattern skull reduction, occipital skull reduction and sagittal crest reduction and I have the following questions: 

1. Are the occipital and sagittal crest procedures encompassed in the grid pattern skull procedure? If yes, then the first one is for someone who would like the entire skull to be reduced and the other two are for specific areas only? 

2. Is the technique used for reduction in all three the same or different? 

Thanks in advance. 

A: In answer to your skull reduction questions:

1) Sagittal crest reduction is reducing linear line of bone while occipital reductions are usually done by a grid or sunray technique.

2) In the end any form of skull reduction is done by a burring technique. The pattern by which the reductions are done is just a method to ensure an even bone reduction across generally what is a curved surface.

Dr. Barry Eppley

Indianapolis, Indiana