Your Questions

Q: Dr. Eppley, you did such a wonderful job informing me of all the options during my initial consultation and taking time to explain details.  Here are a few additional questions for you. 

1. How would we determine if I would need vertical lengthening as well as horizontal movement with chin implant in place?  Imaging? I have always felt my chin/ lower facial third was too “short” pre-implant.

2. If a very slight V shape is desired, would that require a  T- osteotomy in my case or would the genioplasty naturally provide that?

3.  Are there potential complications with teeth root damage?  How long does it typically take for the teeth tightness to disappear?  Any chance of permanent gum numbness?

4. My main motivation for the implant removal + genioplasty is to alleviate overall chin tightness and likely capsular contracture of implant-  if the incisional tightness persists post-genioplasty, would the fat graft and release of labiomental fold be a viable option?

Thank you, 

A:In answer to your questions:

1) Your are correct in that imaging is the way to determine if any vertical lengthening would be beneficial. I would compare the prior imaging sent to you, in which no significant vertical lengthening was done, with the new attached imaging in which vertical lengthening is added.

2) If you are getting vertical lengthening i would do a T-shaped genioplasty for the sake of a ‘slight’ V shape. That may occur naturally and also runs the risk of added scar tissue and tightness which is exactly what you are trying to treat.

3) There are no potential complications with tooth root damage as the osteotomy cut is well below the tooth roots. Most patients will experience some temporary lower incisor tooth numbness but that is not due to root damage.

4) Your secondary plan for persistent chin tightness is the appropriate one with the highest change of success.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m 43 y.o.and all my life I’ve got complex about my deep set small eyes. I’ve seen your answer on your website about it and that make me write to you Dr. 

When it comes to trying to improve deep set eyes, there are few options. You can not move the eyeball forward by any method, all that can be done is to reduce the surrounding orbital bone along the brow ridge and the lateral orbital rim. Depending upon the prominence of the brow ridge, this can be particularly effective. It is important, however to separate the terms ‘deep set eyes’ and ‘hollow eyes’ for they represent different orbital morphologies. A deep set eye is when the globe (eyeball) sits far behind the surrounding orbital rims, particularly the superior and lateral orbital rims. Reducing the projection of the surrounding overprojecting bone is what can make the eye seem to come forward. Conversely, a hollow eye appearance implies that the relationship between the globe and the surrounding orbital rims is normal but that there is a lack of fat in the lid areas, having them retract posteriorly. The hollow eye or lid deficiency/retraction can be treated by fat injections. 

And is any change I could have it done ?

A:Thank you for your inquiry and detailing your periorbital concerns. The first place to start is to have me look at some pictures of you, particularly the side (profile) and oblique views, in which computer imaging can be done to see what type of periorbital reduction can be accomplished in your case.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m considering a custom jawline implant and have a few questions. I live in Montana so could the initial consultation be virtual? I also have a short to medium length beard and would really rather not shave before the surgery so would I need to shave or trim my beard for the consultation? How long would recovery time be before swelling would go down? And when would be the soonest I would be able to have this procedure done?

Thank you

A:In answer to your jawline implant questions:

1) All initial consultations are done virtual.

2) In designing a custom jawline implant it is important to do computer imaging to determine the patient’s specific goals. Having a beard that makes the jawline completely invisible makes that challenging/impossible. The other option is to use the bone (3D CT scan) and make the design based on the bone deficiency that I would need to interpret.

3) The design and fabrication process (getting the implant ready for surgery) typically takes 3 months so that provides a base timeline for surgery scheduling.

4) Recovery is largely about swelling. While its entire resolution takes months, most people look reasonable in 2 to 3 weeks after surgery.

Dr. Barty Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had custom jaw/mandibular angle implants installed by another surgeon. My right and left sides naturally had some asymmetry, the left a fair bit more deficient. The right implant worked out well, but the left came loose and shifted forward. The surgeon performed a revision on the left. He shaved it down a little bit and placed it once again, this time with bigger screws. But it looks like it has shifted a second time! The implant isn’t super ambitious in size at all so I’m wondering what my options are? Is it reasonable to try again? Should I go to a different surgeon? Is there anything else my surgeon can do to guarantee it doesn’t shift again? I’m quite distressed and I know Dr Eppley is a master of the field so I’m just looking for any answers or expertise he can share. I feel like I should have gone to him to begin with!

A:What you need to answer your question is three pieces of information to provide a qualified opinion:

1) Before and after patient photos

2) The original implant design file

3) a current 3D Ct scan of the lower jaw

Any comment or decision made on less than this information would be an uninformed one.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 32 years old male. Since a long time I’d like to reduce my temporal head breadth a bit and I was also never satisfied with my too wide cheekbones. 

As for this matter, I had a cheekbone reduction in January 2020 in South Korea, and I’m not 100% satisfied with the result. Especially after the screws came out. It’s still a bit too wide, especially at the end of the zygomatic arch near the ears I got some small “bulges” which I hate! It’s probably a mix of scar tissue and bone. Unfortunately, I can’t reach the Korean surgeon anymore for a post-correction. 

I’m very unsatisfied with this and would like to consult Dr. Eppley for this matter. On photos or video, it’s very difficult to see what I mean. As far as I understood, he offers these kinds of operations and hopefully could bring the result to a satisfying finish for me. 

For this a personal meeting would be important for which I could bring the current 3D DVTs (digital volume tomography). 

I’m looking forward to hear from you.

A:What I need to see is a postop 3D CT scan. Most likely this represents a prominent posterior zygomatic arch which has either not been reduced or continues to have a prominent arch shape to ir which is very common.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, 2 questions for you how much would a mouth widening procedure cost? Also, would you have any idea what’s “wrong” with my smile? I’ve scoured the internet looking for similar smiles and answers to what could be causing it too no avail. My smile looks kind of “forced” and wonky. Could it possibly be paralysis of some sort? I also get tightness in my chin when I smile, chin ptosis perhaps? I’m at a loss as too what could be causing my smile too look odd. I attached 2 photos. 1 of me smiling and one of a smile I’d consider more normal I guess. You can see that mine looks forced and uncomfortable and his looks natural and relaxed. Thank you in advance dr!

A:You have overactive depressor lip muscles and poor excursion of the lateral upper lip elevator muscles, creating a forced or abnormal mouth shape when smiling. There is no surgical solution to that facial muscular activity. You can always try Botox to the lower lip depressor muscles and see if that helps. I would not be certain that mouth widening would provide much benefit for your smile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello Doctor! My primary facial concern would be my lower third, particularly my chin/jaw. From my side profile, I believe that I have recessed chin. I looked into sliding genioplasty and it looks promising, but I want get your opinion on it first. My goal is to have a more masculine chin/jaw. Would a sliding genioplasty help me achieve this goal, or do I need more than that? Thank you for the help and have a great rest of your day!

A: Thank you for your inquiry and sending your pictures. You have a significant chin deficiency which is the result of a high angle or overall lower jaw growth deficiency,. This gives you a very short but long chin and high jaw angles. You are correct in that a sliding genioplasty is the correct procedure for the front of the jaw as the chin needs to come forward and up. (vertically shorter) This is a chin dimensional change that an implant can not do or does so very poorly. This will leave the jaw angle ‘behind’ meaning they will remain high and may even look higher afterwards as the anterior mandibular plane angle is altered by the sliding genioplasty. Whether the jaw angle deficiency should be managed and, if so, how (standard vs custom jaw angle implants) is a topic for more in depth discussion that this format allows in an effective manner.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello 🙂 I’m a transgender woman considering MTF body contouring to finish off her transition. I generally have a very fortunate, feminine body, but I transitioned late, so I still have the widened shoulders, small hips, and wide/tall ribcage. HRT is almost miraculous, but it can’t change the post-pubertal male skeleton. 

My shoulders are manageable, and I understand you can’t reduce the entire ribcage volume without damaging the lungs or other organs underneath, but I would still like a more fluted chest with a narrower waist, and some kind of hip widening to compensate for my ossified pelvis. I think those are things you offer? I’m still in the exploratory phase now (seeing how my second year on HRT goes, and planning higher-priority surgeries like ffs/voice/srs), but in 4-5 years I’d definitely like to do some work, just to reclaim some features from puberty and look less uncanny.

A:Thank you for your inquiry and sending your pictures. When it comes to MTF body contouring there are five procedures that can be done which you undoubtably know… shoulder narrowing, breast augmentation, waistline narrowing and buttock and/or hip augmentation. The question always is which of these will produce the greatest perceptible change that the patient feels is important. Based on\ your won description I will eliminate shoulder as a major concern and will eliminate breast augmentation from this discussion as that speaks for itself. That leaves the mid- to lower torso procedures as options to which I have done some imaging to show those potential changes.

Dr Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 22 year old female and I’ve had uneven eyes since I was young, this is my biggest insecurity. I can’t even look my boyfriend in the eyes without feeling insecure. I’m not sure if it’s my eyelids that makes them look uneven or if it’s my literal eyes being uneven. What surgery would help this? Or would surgery help at all?  My biggest wish is to fix this.

A:What you have is aesthetic vertical orbital dystopia (VOD) which means there is a 5mm or less discrepancy between the two orbital boxes. (the eye and all structures that surround it) Your right orbital box is lower by probably 3mms or so. The lower upper eyelid is just one symptom of VOD but it is everything that is lower. (eyebrow, brow bone, upper eyelid, eyeball, infraorbital rim, lower eyelid and cheek bone) Thus any surgical approach to VOD correction must incorporate adjustments of most if not all of the periorbital anatomy to look right. You can’t just correct one component of it (e.g., raise the upper eyelid as more of the iris or sclera of the eye will show just making the asymmetry look worse) A 3D CT scan is needed to clearly show the anatomic differences at the bone level from which VOD treatment planning can be done. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Interested in jaw implants, I had a sliding genioplasty done 1 and a half year ago.

A: Thank for your inquiry and sending your pictures. As frequently occurs in chin augmentation (regardless of the method used) in the short lower jaw high angle patient, the jaw angles get left ‘behind’ as the chin comes forward. In essence the chin augmentation magnifies the pre existing high jaw angles leaving an incomplete lower third facial appearance. While I don’t know what you looked like before the sliding genioplasty nor what exact chin bone movements were done, your chin appears too vertically long even though the horizontal chin projection may now be adequate. The options are to leave the chin alone and make jaw angle implants to merge into it or vertically shorten the chin with the placement of the jaw angle implants. The other debate is whether the jaw angle implants should be standard or custom made…which actually is not much of a debate.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, “I would like to move forward with my paranasal implant surgery, I just have two remaining questions which I hope to get answered before the surgery: 

1. Would it be possible to do a custom or semi-custom made implant, I suppose they will fit better as my two sides are uneven?

2. Will you put screws to secure the implant as I worry they will shift?”

A: In answer to your midfacial augmentation questions:

1) If there is any midfacial asymmetry and to get more maxillary coverage it is always most ideal to have a custom paranasal-maxillary implant design done.

2) For a custom midfacial implant design in particular screw fixation is always used.

Dr. Barry Eppley

Indiana;polis, Indiana

Q: Dr. Eppley, I have a vessel pulsating on my face. It’s on the right side of my mouth and can be seen pulsating but you can’t see the actual artery. What is the cause and how can it be treated?

A: This is a classic pulsative branch of the facial artery that bifurcates outside the corner of the mouth. Unlike the superficial temporal artery in the forehead this pulsatile vessel lies deeper and can not be seen through the skin. But it can be effectively treated by a direct arterial ligation procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for an option\advice to lengthening the front of the head/top of the forhead- a little bit to make my face more manly. I checked in Israel for a lot of doctors and all of them told me that the problem is with the huge scar (after impalnt-even the smallest implant). I am looking for a solution for 15 years if not more. Could be any/even a small solution/option-(implant/injections/fat/…) that can suit me? my head in general is very small and slim -but i covered the sides with hair (which is fine for me) ,but the top-only a small fraction above the forehead would be a dream come true. 

Thank you 

A: Using a custom made skull implant from your 3D CT skull scan to augment the top of the forehead/top of the skull, it can be inserted and placed through a remarkably small scalp incision, less than 5 cms in length. Such a dream is a common place occurrence in the contemporary world of aesthetic skull reshaping surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 36 year old male with a rare congenital fat wasting condition that has greatly affected and deformed my scalp. Over the last few years my scalp has gone from being a normal symmetrical round and smooth scalp to being very asymmetrical switch dents all over the place and prominent bone structures becoming visible. I have included pictures that show what my head looked like before and what it looks like now. Is there anything that could be done to make my head look a normal symmetrical round shape again. I know you work with skull reshaping but it’s not my skull that is the problem it’s the soft tissue. Can anything be done to make it look normal or at least better?

A: Thank you for your inquiry. While you have a soft tissue scalp, there are two potential treatment approaches. First widespread scalp soft tissue augmentation can only be done with fat injections. This would be a logical treatment but, as with any injection fat grafting surgery, these aspects about it must be understood:

1) Injection fat grafting volume retention is highly unpredictable. How much survives and whether it would survive in an even fashion is always a gamble. This would be especially true in the scalp where very little fat grafting experience exists.

2) Why the fatty tissue has deteriorated in your scalp is not known. But more pertinently does this condition make fat grafting less likely to survive ??

3) One has to have enough donor fat to harvest to do the procedure. For the entire scalp you would probably need 250cc of concentrated fat to inject to make the procedure worthwhile. This means that at least 1,000cc of fat aspirate must be able to be obtained to create that concentration. Clearly you have a lean body makeup so getting 1,000cc harvest may be challenging. 

The second approach is to go below the scalp and place an overall thin layer of implant over the entire skull surfaces. This would push out the scalp in a predictable and assured volume retention manner. Even a 3mm layer of bone augmentation around most of the entire head probably replicates what has been lost in terms of scalp thickness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was interested in narrowing my shoulders. I would like to know the cost associated with it, and also, as I am in Canada, how long I would need to stay in the states for before it would be safe to fly home. 

I am also interested in knowing how long I would be unable to work at a desk job (until I can type again) after the surgery. 

Thanks,

A: Most patients can go home in 2 to 4 days. That is somewhat influenced by whether you come by yourself or have someone with you.

Typing at a desk is a not problem even a few days after the surgery. The issue is getting to and from work and all that it takes to do so. That is a recovery topic that requires more in depth discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, how much can be done with aesthetic iliac crest reduction? is it possible to improve the “v taper” look in a bodybuilder with this procedure? is it actually noticeable as a result or are results negligible? how bad is scarring? 

A: I do not think this procedure can remove enough to create the V taper like in body builders.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for Testicle Enlargement Enhancement procedure. I have had atrophy shrinkage of the Testicle due to Testosterone treatment. I am looking for the procedure where you encase the existing testicle. I am in excellent health. What is the cost ? How many of these procedures have you done? This is done as an outpatient procedure correct?

A: Thank you for your inquiry. There are advantages and disadvantages to the testicular implant encasement technique. My experience is that it is only a good technique if the existing testicles are at least 3.5cms or bigger. The risk of slippage out of the implant is much higher the smaller the testicles become. With testicle implants in size they would dwarf testicles 3.5cms or smaller and have no risk of displacement. (side by side technique)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a forehead reduction surgery in a young male with no hair loss, what kind of incision do you use? A hairline incision or coronal incision?

A: For male forehead reduction the use of a frontal hairline, immediate retrohairline or semi-coronal incision can be debated and all of them can be used. Each one has their advantages and disadvantages. It also depends on what type of forehead reduction is needed. Without knowing   the type of forehead reduction it is impossible to determine which of these incisional approaches may be best.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a vertically short undefined jawline and flat cheeks. I was interested in a sliding genioplasty, I’m more interested in vertical lengthening than projection, and maybe submental lipo. My chin is short and points upward and makes my face and neck seem wider than I’d like. I attached some pictures, the first 7 are what my jawline looks like now and the last 3 are edited to show what I was hoping to achieve. 

A: Thank you for your inquiry and sending your pictures and imaging. You have demonstrated a pure vertical chin lengthening procedure that is probably at 8mms vertical increase. As you have demonstrated this corrects the upward chin tilt and creates a smoother longer jawline. (mandibular plane angle) That chin bone change and some submental liposuction would be a good combination.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi…I’m in the beginning stages of exploring breast augmentation surgery. I’m 59 and have never been satisfied with the size nor shape of my breasts. I’ve decided that at my age and stage of life, why not? Any information you can send would be greatly appreciated. Thank you.

A: Thank you for your inquiry. When it comes to breast implants at any age the relevant questions are:

1) Does breast sagging/ptosis exist? (Is a breast lift needed with implants)

2) What type of breast implants does one want? (saline vs silicone)

3) What size of breast implant does one want? (in terms of volume in ccs, that usually requires preoperative volumetric sizing)

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, I’m looking to have a procedure done but I don’t know how any of this works I’m 28 male 360lbs have buried penis was wanting to see how they would want to go about it how much weight they would want me to lose before I had surgery etc 

A: I do not operate on any patients over 300lbs for medical reasons. Your buried penis surgery outcome would also be much improved if you lost 60, 80 or 100 lbs.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Regarding the surgery itself, if there are any current asymmetries in my chin, can they be corrected with this surgery, or would that require an implant?

⁃ Can any width be added to the chin with this surgery, or would that too require an implant?

⁃ Lastly, one of my main objectives is to fill/flatten the labiomental fold as much as possible, so I just want to make sure our current plan is going to achieve this. I’ve read that a bone graft is often used to fill in the fold, but I’m not sure if this would be a separate graft from the one we’ll already be using to achieve the vertical lengthening and lateral projection, or if the same graft will achieve all of the above.

A: In answer to your chin reshaping questions:

1) I am not sure what chin asymmetries they are as I can’t see them but any improvement in them from a vertical lengthening bony genioplasty would be a bonus not an expectation from the procedure.

2) While chin widths can be added to certain bony genioplasties (midline split and graft), I would be cautious about doing that to a vertical lengthening genioplasty due to the risks of instability and devascularization of the bone. That can either be done by adding on a implant at the time of the bony genioplasty or have it done secondarily.

3) By definition when you pull down on the chin (vertical lengthening) the labiomental creases unfolds and becomes less deep due to the stretch of the soft tissue chin pad. The bone graft fills the bony gap created by the vertical lengthening, it does not directly augment or push out the labiomental fold.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would it be possible to do a three in one procedure that reduces the width of the temples, reduces the frontal bossing of the forward that results in excess convexity, and lower the hairline at the same time? 

Simply put I think my forehead is too tall, wide and convex. 

A: You are correct in that frontal bossing reduction , reduction of the bony temporal line and a hairline advancement can all be done at the same time. The frontal hairline incision provides convenient access to do the bone reduction procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello sorry I forgot to send you a pre surgery photo of my chin reduction surgery. This is how it was before I am so upset with how it looks now I would do anything to try and make it look as better as it use to be.

A: Thank you for sending your before and after chin reduction pictures. You did not say how your chin reduction was done but the combination of a wider/flatter chin shape and the chin pad irregularities/dimpling would indicate to me that anterior chin shave was done, most likely from an intraoral approach. With the soft tissues stripped off of the bone and the bone support of the chin reduced, the soft tissue chin pad has limited ability to shrink back down around the shorter bone. Instead it often ends up into a contracted ball of muscle and skin which is why it looks irregular.

The best course of action is to add back some bone support (implant or a sliding genioplasty and release and redrape the soft tissues over a restored bone support. I would lead towards the sliding genioplasty because this can move the bone forward as well as shorten it at the same time which is beneficial aesthetically as well as for the best soft tissue support.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had custom MEDPOR jaw implants four years ago  and I would like to have them removed. I plan to have a revision orthognatic surgery to correct facial imbalance but the surgeon won’t do the surgery unless the MEDPOR implant is removed first. And you know most surgeons don’t like to remove medpor implants. 

I would like to know if would be feasible to remove those implants. Also, I would like to know if they can be totally removed (I read about some patients not having the entire implant removed by their surgeon). I have attached pics of the implants. 

Thank you for your attention.

A: Thank you for your inquiry and sending your jaw angle implant design pictures. Whether they are actually placed as they look in the design file is not known and there is no way to find out since the Medpor material can not be seen on a 3D CT scan. Regardless they can be removed and it has not been my experience, which is extensive with their removals, that they can not be removed in their entirety in a single surgery. This does not mean it is easy or non-traumatic to the soft tissues but it can be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi I have flat head syndrome, my head bulges wide on the sides kind of points up on a cone and is pretty flat in the back. I’m 25 years old and have been self conscious about this since I was a child. I am wondering what procedures can be done.

A: I believe when you say ‘flat head syndrome’ you are referring to a flat back of the head. When the back of the head is flat the posterior parieto-temporal regions get wider and often the crown of the skull is higher…just as you have described in your own situation. The most effective strategy with minimal scarring is a custom skull implant to build out the back of the head.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I did gynecomastia reduction surgery five years ago. Recently did a nipple reduction. Post nipple reduction scar tissue developed around nipples and areolas. I visited previous doctor 4x for the steroid shot. He is now advising me that I will have to do a revision to remove scar tissue. I don’t trust the doctor and want my areolar flat. Please advise and See pics of nipple erect. This drives me crazy and I need this fixed asap 

A: There are only two reasons why an areola remains ‘puffy’ after open gynecomastia surgery. First there may be residual hard breast tissue that remains. (most common reason). Second, scar issue has formed. Either way and given that it has been over five years after the original surgery a secondary open areolar excision is needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my areolar were not puffy right after gynecomastia reduction surgery, but I did notice my areolas did shrink and my nipples seemed to be a lot bigger than normal. So I had a nipple reduction and then after the nipple reduction I noticed irregularities around the areola where it’s not flat. What would be the procedure to get this fixed? My plastic surgeon is telling me to open the areola again to remove scar tissue. What method will you use? How do I ensure that my areolar will be flat and it won’t look awful when nipple and areola is erect. It looks okay when it’s not hard but when my nipples are hard the areolar and nipples are shriveled into one. How would you fix this?

A: What the areola looks like right after surgery is very deceiving as the swelling can make it look flat, only to appear puffy months later. It is an artistic judgment as to how much breast tissue to remove in an open areolar excision and most surgeons are understandably going to err on the more conservative side to avoid the dreaded crater deformity. Thus when it occurs further tissue reduction is needed through an open areolar approach.

Any type of gynecomastia surgery is done in the static situation not a dynamic one (i.e., the patient is laying flat and the nipple-areolar complex is non-erect.) No surgeon can completely predict what the effects of a static surgery are in a dynamic setting.  But it is fair to predict that it will be better when more tissue is removed secondarily.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi – I am very bothered by my asymmetric chin and have been unsuccessful in identifying the best solution for this. I was initially advised a chin implant but think I have too much on the longer side and am scared to add more. 

A: You are correct in that subtraction is the best approach to your chin asymmetry not addition. (see attached) This is best done through a submental approach where the inferior border of the chin can be reduced. 

In reality your chin asymmetry is not just localized to the chin, it extends much further back along the jawline as well. Ideally a 3D CT scan would be beneficial for preoperative planning to both measure how much bone should be removed as well as to how far back the resection should extend.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I was wondering if I would be a good candidate for fat injections under the eyes. I have attached pictures of my problem areas. 

Since I was a teenager I have always felt insecure about my dark circles. It doesn’t matter how much sleep I get, whether I exercise, or eat healthy. My dark circles never go away. 

I’ve heard of Juvederm and Restylane, but I was wondering if fat injections are better and if they last longer.

A: Your congenital dark circles are indicative of an infraorbital rim deficiency. As a result the puffiness you see is pseudo fat herniation. There are a wide variety of approaches to treating what you have, most of which involve adding volume. (synthetic fillers, fat injections, dermal fat grafts, alloderm grafts and various type of implants) There is also a technique of fat grafting known as fat transposition where the herniated fat is moved into the tear trough area.

The wide variety of treatment options speaks to the differing opinions about how to treat it. You can fundamentally break all of these procedures into two categories, non-surgical and surgical. Most people will try a non-surgical method first because it is non-surgical and it can be a test to determine if adding volume would be an effective approach. I would stay away from injection fat grafting as the first procedure because it is a surgery, irregularities are common and such irregularities are difficult to treat. Synthetic fillers are a safer initial volume approach because the use of hyaluron-based fillers are completely resorbable/reversible.

If one graduates to surgery orbital fat transposition or alloderm grafts are a more natural approach that always produce positive results although complete elimination of them is not assured.

Dr. Barry Eppley

Indianapolis, Indiana