Your Questions
Your Questions
Q: Dr. Eppley, My forehead has a weird shape to it. I’ve had two bumps (horns) on it for as long as I can remember. I would like them removed if possible. My concern is that my hairline is receding badly, so I’m unsure if I’m even a candidate to have the procedure done. I know that affects the placement of the incision(s). How much does the procedure cost. Please inform me of what you think. Thanks for your time.
A: Thank you for your inquiry and sending your forehead picture. While such forehead horns can be successfully removed the challenge is the incisional access to do so. With your hairline being so far behind the front of the forehead it can not be used for access to perform the procedure. While incision further forward can be used for access my concern would be that you would just be trading off one aesthetic problem for another. (forehead horns fora visible scar)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Are there any procedures that would allow trans man’s hips to become more narrow? I read about iliac crest reduction but I was wondering if there other possible procedures that could make a bigger difference. Is there such a thing as cutting through a specific section of the upper ilium and tilting it closer to the belly button (I hope that doesn’t sound ridiculous)? I understand that even if such a thing did exist it would be high risk, but it’s definitely something I would be interested in.
A: The answer is that there are no other hip narrowing procedures. Trying to cut and move/tilt the pelvic bone is an interesting mechanical drawing concept but not a practical one in terms of medical safety and complication risks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, hopefully this is my last question regarding hyperdynamic chin ptosis. I am really happy with my chin at rest, and believe if my chin was to be slightly reduced, it will make my face unbalanced.
Regarding this chin tucking/ reduction surgery, will there be any changes to my chin? what part of the soft tissue is stripped away?
A: Yes there would be some very slight change in horizontal chin projection. And for this reason I would advise against in your case because of your stated concern. Every aesthetic procedure has aesthetic tradeoffs…be very careful about trading off one problem for another that you may dislike just as much. The correction of hyperdynamic chin ptosis works best in the female who also has some dimensional excess of the chin that she also wants changed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read your articles on mentoplasty with great interest. If it is not too much trouble, I would very much appreciate your advice pertaining to chin reduction surgery.
I would like to ask please:
(I) If undertaking a bony reduction of the chin by way of bone shave/bur, what is the maximal amount that is generally achievable, anteriorly (and vertically)? I appreciate that soft tissues resuspension is vital.
(ii) What are your thoughts on mentalis or soft tissue pad reduction?
(iii) I am a young female that is requesting a downsize in my chin implant. The previous implant was placed by another surgeon overseas (~1yr ago) via a submental incision, and revised shortly after by the same surgeon. It unfortunately resulted in a pigmented and widened submental scar. Mysubmental tissues are somewhat firm. I want an intra-oral approach in light of this adverse scar outcome. My proposed new implant will only drop anterior projection by 1-2mm, so I do not anticipate a significant issue with chin pad ptosis/excess. If proceeding with an intra-oral approach, do you do anything in addition to re-opposing the mentalis msucle? Ie Does one need to also anchor mentalis back to the mandible? And if so, do you use a screw and suture, or Micromitek?
Your expert advice is greatly appreciated.
A:In answer to your chin reduction questions:
1) When doing any form of shaving/burring for a bony chin reduction I never do that intraorally. That is only going to result in soft tissue chin pad ptosis no matter what suspension technique is used. I only do that through a submental approach where the soft tissue excess can be managed by an excisional tuck.
2) Soft tissue chin pad reduction, as mentioned above, can be effectively done through a submental approach.
3) If an existing submental scar exists, particularly if it is widened and pigmented, you have nothing to loss by cutting out that scar and performing the chin implant reduction inferiorly. There is a good chance you will make the scar better (and certainly no worse) and any concerns about soft tissue redundancy can be definitely managed. The only reason to ever go intraorally would be if a submental scar did not exist.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have Medpor jaw angle implants andI’m not satisfied with the result. I want them to be removed and I know it can be difficult. I´d like to know if we don’t wait long time after surgery can it be easier ? I’m just 2 months post surgery.
Thank you
A: I have removed many a Medpor implant and really once they are in place a few weeks to a month it is about the same whether it is 2 months or 2 years in terms of the ease of their removal. It is all about how quickly do the tissues attach to the bone and form an adhesed capsule.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to get custom implants and contouring to fix asymmetry in my face, mostly my jaws and orbitals, as well as add depth to the back of my head.
I’m also interested in more, but worry about how much you could do in one procedure. “More” being a facelift that includes my lips and brows and neck.
Lastly I understand you do orthognathic surgery. Could you perform maxillomandibular distraction osteogenesis? If so I want that procedure more than anything. I choose distraction over advancement because its results are more controllable, will help with my sleep apnea (undiagnosed but suspected), and will help advance my palate to better support my lips and help reduce marionette lines.
A:Thank you for your inquiry and sending your picture. You have described three types of facial procedures (orthognathic surgery (1), onlay bone augmentation with custom facial implants (2) and soft tissue rejuvenation surgery (3)) which involve different levels of tissues and which can not or should not be performed together as each one impacts the other one. These three ‘layers’ have to be done separately for a variety of reasons. If layer 1 (orthognathic surgery) is important then it absolutely has to be done first. Layers 2 and 3, however, can probably be done together.
Distraction osteogenesis of the maxilla and mandible is not a practical procedure in adults. Unless the movements are 10mms forward it is not going to help much with sleep apnea and it would also cause great aesthetic distortion of your face. But regardless of what method is used you have to have solid preoperative studies that prove that OSA exists and is obstructive in nature before ever doing any surgery for it.
You have to decide whether layer 1 surgery needs to be done before proceeding on to layers 2 and 3.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to add complete wrap around orbital implants to square out my orbitals and to give my orbitals a compact look. I was wondering if the photoshop look on the right image is a achievable with a wrap around orbital implant?
A:Thank you for your inquiry and sending your pictures. I would think that in order to achieve your photoshopped image that periorbital augmentation as you have shown in the implant design would go a long way in that regard. But I don’t think the upper eyelid change you have shown will occur just by periorbital augmentation alone. That change involves dropping down the upper eyelid which will likely require adding volume to the actual upper eyelid as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, 33 year old male, I’m interested in your custom jawline & cheek implants. Last year I had full dental implant surgery, after having the teeth extracted, I lost some volume in my lower Jaw & chin area. I already had a recessed chin so it just made it worse to the point I wanted to restore some volume back in a more permanent way. Would this procedure be right for me to help restore added volume in my jaw/chin & cheek area? It looks like it would. Any opinion on the matter would help. Thank you.
A: I believe you are correct in that creating volume along the chin, jawline and cheeks would be best permanently done with custom facial implants. The only area where it will not help is is the trampoline area between the cheekbones and the jawline which is soft tissue based.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, my main concerns are the following:
1) is my forehead too inclined?
2) my lower jaw is visibly weak. What can be done?
3) the angle between my upper lip and nose seems too wide. Is it possible to fix it? And also, is it maybe that my maxilla should be more forward as well?
I’d like to have your opinion as many have already dismissed my concerns.
Thank you.
A: Thank you for your inquiry and sending your pictures. In answer to your questions:
1) The slope of your forehead is a bit retroinclined. (see attached imaging)
2) Options are either isolated chin augmentation or a total jawline augmentation. (see attached imaging)
3) You are referring to your nasolabial angle. But when you say wide do you mean too acute or obtuse? Should the angle be bigger or smaller? I believe you mean the angle is too open or greater than 90 degrees. Yours is that way because of protrusion of anterior nasal spine which can be reduced. Moving the maxilla forward will actually make it worse.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you for your reply. I didn’t mention in my previous message that I had a prior genioplasty of some kind by an oral surgeon some twenty years ago. He removed the plate quite a few years ago. I want to be sure you are willing to perform this surgery on me after learning of my previous surgery before I set up a consultation with you. I have attached x rays, the first was taken two years ago and the second taken a few weeks ago.
Thank you for your time.
A :Thanks for the additional information. Having had a prior sliding genioplasty does not affect getting a submental chin reduction. If anything it supports why the submental approach would be more effective as moving the chin back from an intraoral approach is not an effective chin reduction method.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 29 year old male and I have had an asymmetrical/V-shape head shape since puberty around 12-13 years old. Prior to this period, my head shape was NOT significantly deformed and my nose was not deformed or large (but they are now).
But when I hit puberty, my facial structure changed profoundly, because my nose became more prominent and my head shape became significantly unequal and somewhat lopsided. I have a theory that essentially a nose of my mothers side came through during puberty (a kind of genetic mistake) and this has altered/affected my whole overall facial appearance and head structure (including head shape, jaw, back of head, nose).
My head is asymmetrical (right side more deformed and lower than the left), slightly lopsided (right side sticks out more), V-shaped, lumpy and some bones or muscles in the side of my head move when I clench my teeth (to an unusual degree from what I can see in the general population). I try and hide my weird headshape by styling my hair a certain way, but this is futile as ultimately the hair just reflects the contours of my head, so as the day goes on my hair reflects the head’s asymmetric/deformed shape.
Along with my nose, my head shape has affected my quality of life, After googling and seeing your work, which I think is simply excellent, I am therefore interested in having skull correction surgery, an implant or a combination of works done to correct my head shape. Ideally, if surgery is possible with you, I would want there to be a significant improvement such that for all intents and purposes the overall deformity of my head shape is corrected to a large degree.
A: Thank you for your inquiry and detailing your head shape concerns to which I can answer the following questions:
1) Any number of additive/reductive changes can be made to the shape of the skull. You have enumerated your areas of head shape concern and nothing about that description implies that it could not be adequately addressed/improved. It would take a 3D CT scan to correlate what lies underneath to your external concerns and then devise the specific plan to treat it.
2) Custom skull implants can be made in any design (as long as its overall added volume is not excessive) that is needed so your specific shape request can be done.
3) No patient has yet reported to me that they had bothersome persistent scalp numbness after the placement of a skull implant.
4) My assistant Camille will pass along the general cost of the surgery to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! I’m interested in the bone cement filling in the back of my head. I also have migraine so is it possible that this could be partly covered by my insurance? Thank you!
A: Thank you for your inquiry. No form of back of the head skull augmentation, whether done by bone cement or a custom skull implant, is intended to or will relieve migraine symptoms. This is an aesthetic procedure not a medical one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I mentioned in my consultation that I have a small amount of filler in my chin to fill the dimple. He said it’s not necessary to get it dissolved before surgery. My question is will that filler stay in place or will the surgery itself cause it to migrate/dissolve? I just want to know if I should expect to need more filler placed in the dimple afterwards since I decided not to proceed with the fat graft. Or if the filler will stay intact after surgery?
A: Injectable fillers in close proximity to a surgery site often tends to dissipation afterwards due to the effects of surgery. (swelling) This is particularly true for hyaluronic acid-based fillers which are sensitive to the hydrolysis process induced by swelling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In 2016 I sought facial surgery and had cheek implants to correct some asymmetry. The cheek implant surgery has exacerbated the asymmetry. What do I do now?
A:Thank you for your inquiry and sending your pictures. For the cheeks, since I don’t know what you looked like before, I can not say what is exactly wrong with your current cheek implant(s). I would need to have some more specifics such as when was the surgery done and what type of cheek implants were placed. But those questions would actually become a bit irrelevant since a 3D CT scan of your cheeks would answer the questions of what is your natural cheek bone shape and the exact reason for your cheek asymmetry as well as the style/size/placement of your current cheek implants. It is very common that the use of standard cheek implants when asymmetry exists actually make it more apparent. It just seems like this approach would work and surgeons frequently think that ‘eyeballing’ the implant style/size and placement will work. But the symmetry of the cheeks is so unforgiving and the eyeballing technique almost never works. This is where the use of a custom cheek implant design is so superior. The first step is to get a 3D CT scan and see how your current cheek implants look on the bone as well as the bony shape of your cheeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I found your very interesting website. If I may, I would like to ask you a question please. I did a mentoplasty/sliding genioplasty exactly one year ago. But recent tomography still shows a bone gap which looks unexpected to me. I am pasting the photo below so you can see. But I am curious to know if you think this is a normal situation and I should wait longer for the gap to be completed filled. Probably my picture only shows bone with high density and I am not sure if I am missing any ongoing calcification process there. Thank you!
A: The bone gap you are seeing is real, it is not just imaging not being able to detect thin bone. No further bone healing would be expected at one year after surgery. I have seen thousands of 3D CT scans with sliding genioplasties and residual bone gaps do occur in large chin advancements, which clearly you had. It occurs in such advancements because there is virtually no bone contact between the two segments of bone in the middle as a result of the advancement. This may also explain the very uncommon plate and screw fixation used to secure it. (bilateral lateral straight plates)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to have the temporalis head reduction surgery performed however I thought if it’ll be better if I explored the option of Botox injection in the area to achieve muscle atrophy first. Do you believe this method is effective and is worthwhile looking at before surgery?
A: There is certainly no harm in trying Botox Injections to try and shrink the masseter muscle a bit. The problem is that it is a big muscle and it takes a large number of Botox units to create an effect…that is far less than what surgical removal accomplishes. While not as effective and it could be argued that it has a relatively poor ROI (return on investment) it can still be called a good starting point when surgery is not readily available for the muscle reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking at getting my 12th rib removed on the right side. This is not for aesthetic purposes but due to chronic pain. I have a hypoplastic 12th rib that has supposedly been fractured and healed incorrectly and is causing me severe amounts of pain. Looking to get it removed and want to see if this is possible.
A: Thank you for your inquiry and describing your rib removal needs. Certainly the 12th rib can be removed. I would need to see an x-ray of the rib so I understand its shape and possible fractured state.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Just wanted to ask you a quick question about potential supraorbital rim implants. My lower eyelid is a good shape and covers my 1-2 mm of my lower portion of iris and does not need to be raised.
My goal is a more narrow eye shape, so is it plausible to expect that augmentation of the supraorbital rim, would push the upper eyelid down, thereby covering more of the upper part of the iris? I understand this is an obscure request, but I just wanted some advice on how to proceed.
A: The question you are asking, and it is common one amongst men who seek brow bone augmentation, is whether this will either lower their eyebrows and/or the upper eyelids. The answer is it may push the eyebrow down a bit but the level of the upper eyelid is much lower. I have yet to see the lowering of the upper eyelid as an effect that occurs from brow bone augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Is it possible to reduce the whole of my skull (reduce each area of the skull) by 0.5mm or is this limited to only certain sections of my head. I feel as though any reduction in size will really help.
Many thanks
A: If the goal is to reduce all four skull surfaces (minus the forehead I presume) by 0.5cm (5mms….I don’t think you mean 0.5mm) then that can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, About two years ago, due to some teeth maloccIusion, I underwent a maxillofacial surgery, specifically a sagittal osteotomy and a Le Fort 1 osteotomy, combined with a sliding genioplasty. As you may notice in the followed x-rays, my lower maxilla is still recessed, which is the object of my present message.
I consulted with a surgeon which, without seeing the x-rays (they were not at my disposal at this given instance), suggested me a profiloplasty, precisely a rhinoplasty associated with the placing of a two-piece Medpor chin implant.
However, after observing my chin’s inclined tip on the x-ray, I am concerned that an implant would not give the best forward projection and I wonder whether there would be a better option (revisional genioplasty ?) you would suggest or on the contrary you would advise me to opt for the Medpor implant.
A: It is difficult to give an opinion just based on x-ray alone. It all depends on how far forward the chin need to be augmented as well as what does the chin look like now from the frontal view. Do you care if the chin becomes more narrow as it comes forward or do you prefer it to get wider as it comes forward? You have to have a clear 3D concept of the dimensions you need to change from which the best chin procedure can be selected for it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My daughter has a type of frontal bossing goin on her forehead sticks out and has horns I wanted to get it fix I wanted to know could give me advice on what she may need she is 7 about to be 8 yrs old I want to fix it while she is young.
A: At this young age the frontal bone of the forehead is probably not thick enough to be able to do much reduction. But it would take an x-ray to know for sure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Attached are pics of my current scrotum size as well as an ideal scrotal enlargement I’m attempting to achieve with testicle implants.
A: The difference in your scrotal size from your ideal is considerable and you have little natural scrotal skin laxity. You would probably not be able to achieve that degree of scrotal size/stretch all at once. It would require a staged approach to do so. The other issue to consider is whether it should be done with side by side testicle implants or wrap around implants. As a young man I would favor the former.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, As you can see if my photos attached, I have a lump at the sagittal ridge. It makes me very complex. I would like to know if it is possible to reduce it. If so, how many centimeters and can the bone grow back? Is it a malformation of the skull ? Does this surgery involve any risks? Can the skull bone grow back after the operation? I thank you in advance
A: Thank you for your inquiry and sending your pictures. You have the classic posterior sagittal ridge skull deformity (thickened posterior end of the sagittal suture) which can be completely reduced as illustrated. Such ridges are usually 4 to 5mms high which are well within the amount of bone that can be safely removed. The bone will not grow back. The 3 cm long scalp incision used to do the procedure heals in a near imperceptible manner.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the temporal reduction surgery you offer. I have attached a couple pictures of what I look like, one of which was screen shotted from a video; basically I’m unhappy with how wide the sides of my head are, I also have a big forehead but this doesn’t concern me at all. I usually don’t get my head shaved and I do look better with my hair longer, but still my head is very wide. I hope to hear back from you soon.
A: Thank you for your inquiry and sending your pictures. I have attached a picture of what I believe you are referring…which is exactly what temporal reduction surgery accomplishes in changing a convex/wide side of the head to a straighter/narrow side of the head.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering whether it would be possible to “fill in” the gap between my lower two pectoral muscles? I understand some people get implants to fill in their chest muscles, however I was curious whether this was possible for someone with a chest gap? What would be the options here? I feel like despite lifting weights and staying lean the gap prevents me from having a truly nice physique if that makes sense. Thank you for reading.
A: I would have to see pictures of your chest to provide a qualified answer. But I assume you are referring to the lower end of the vertical sternum when you speak of the ‘gap between the two lower pectoral muscles’. (sternal gap) I have attached an example of the area to which I think you are referring. This is usually treated by designing a small sternal implant to provide the missing volume.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a skull reshaping surgery a month ago, but due to incorrectly selected implants, my head shape improved slightly. I am depressed, I am very suffering from this condition. I wonder if additional procedures can be performed to correct its shape and not make it necessary to remove the implants. I have physical, emotional and financial losses after this operation and I expect an answer from you on what can be done.
A: I would have to have a lot more information to answer the question as to what can be done now:
1) when was done in the surgery exactly?
2) Where is the scalp incision and how long is it?
3) What type of implant material?
The best information would come from getting a copy of the operative note from the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a couple questions that I wanted to ask. I am getting extremely nervous about surgery. I think this is because I’m not completely sure of what to expect with recovery and the final result. My biggest concern is that I do not want people to be able to tell that a dramatic change had been made to my face. Especially considering I’m only bothered with my profile while smiling. Although the issue with the sagging when smiling destroys my self confidence. As far as swelling, I am curious as to just how big my chin will look because i’m nervous about how I will react afterwards. Before committing I wanted to ask if there have been ANY less invasive treatments for a case like mine that have made a positive difference? Thanks in advance.
A: I am not aware of any non-surgical treatments that can improve dynamic chin ptosis. I don’t think submental tucks really create any significant change in one’s appearance long term. You are probably thinking about the procedure exactly opposite of how I think about it. You are worried that the procedure may do too much…while I am always worried about whether the procedure does enough.
But always remember…this is purely elective surgery. As I would advise any patient, when in doubt don’t do it. It has to be a surgery that the patient has 100% confidence in doing. Elective surgery results are highly influenced by the patient’s preconceived notions of it. This is why one should never have a procedure if which they do not have high confidence in.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, here are photos of the jaw and chin structure I like and hope to accomplish. I have a hard time expressing what it is exactly I want, so these photos will be better at showing that – I like the soft “three point” heart shape/soft inverted triangle shape, with the defined yet soft jaw angles. I would say my main concerns are adding width to the sides and more of that soft inverted three point triangle shape like below:
A: The question is never whether a custom jawline implant is the best and most assured approach for the ideal jawline…because it always is. The real question is how close (or far away) would the aesthetic effect of standard implants create and whether the patient is willing to accept the increased risks of asymmetry. (due to three separate independently placed standard implants that are not connected)
In short if one throws out the economic differences between the two jawline augmentation methods one would never choose the use of standard implants. One chooses standard implants for pure economic reasons only. (which is a perfectly valid reason)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been looking into surgery for my chin for quite some time and am not having much luck. My chin protrudes from my face and it’s something I’m extremely conscious of. I believe the main problem is excess soft tissue, however I have recently had a CBCT scan to see how the bones sit and have attached images of this for you to see.
I am based in the UK and have seen 2 surgeons about this, however I don’t seem to be getting a definite answer for a solution, it doesn’t appear to be a common thing to fix here.
I came across your name and details when searching the internet for cases like mine, and have seen your comments on various posts on Real Self. Also looking at some of your before and after photos, it seems you have dealt with similar cases to mine.
I really would appreciate any guidance you can give on what surgery you think I would need. If I cannot get the surgery here in the UK it’s something I would definitely consider travelling for.
I have attached images of my chin from all angles, and have also attached screenshots of my scan (I do have the link to view the scan properly so this is something I could provide if necessary).
I look forward to hearing from you.
A: Thank you for your inquiry and sending all of your pictures. Based on your side view x-rays your prominent chin does appear to be due to an excessively thick soft tissue pad. That can only be reduced by a submental excisional technique. In some cases to create the space for the soft tissue pad to be tucked after the excision, some chin bone may need to be reduced. That would probably not be necessary in your case.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, how much would female custom forehead and midface implants cost? How long does the surgery take? And how long is recovery?
A: The first thing we need to do is to figure out exactly what type of forehead and, particularly, midface implants you need. The term ‘midface’ is very broad and includes a family of different implant styles that take different lengths of time to perform.
To provide qualified answers to your questions you will need to describe exactly what facial changes you are seeking to achieve and supplement that with pictures so I have a clear idea of the very specific surgery you need.
Dr. Barry Eppley
Indianapolis, Indiana
