Your Questions

Q: Dr. Eppley,I did have a small size chin implant inserted several years ago which I am very happy with. I think a larger one would leave me with a boxy chin. I do not want to try to look younger either. But I do feel I have a somewhat weak lower facial profile and I wish it were otherwise. 

I had the thought that bringing the lower jaw forward a little and slight lengthening of the lower face could be a solution but I am unsure. I do not think a larger chin implant by itself will provide the answer. I have read many on articles on your website and on Real Self online. As example, “What Can Be Done To Give My Face More Of A Sculpted Masculine Look?” “What procedures could I do to make my face more masculine (low straight eyebrows, defined jawline and chin)?” “The Vertical Lengthening Custom Jawline Implant – Making the Lower Face Longer.” I have a lot of respect for your expertise and aesthetic eye in these matters which is why I contacted you to arrange a consultation. 

I do feel a stronger profile would help. And a face with stronger features is an investment I am very interested in. What procedures would you suggest I do to obtain this stronger profile and perhaps more handsome appearance.

A: Thank you for your inquiry and sending all of your pictures as well as congratulations in finding that second career. You are correct in that in the congenitally smaller lower jaw a modest chin implant provides improvement and looks natural. However when a larger chin implant is placed it becomes out of proportion to the small jawjine behind it and looks unnatural. Thus enlarging the whole lower face through total jaw augmentation is an appropriate consideration. The key to total jaw augmentation is still not to go too large and I have attached what I would consider one version of a reasonable jaw augmentation effect. One of the side benefits of total jaw augmentation in the older male is that it picks up loose skin in the neck and with the more evident transition between the face and neck (more visible jawline) a bit of a necklift is achieved as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering about follow-up to https://exploreplasticsurgery.com/plastic-surgery-case-study-outcome-assessment-of-transgender-male-to-female-shoulder-narrowing-surgery/?doing_wp_cron=1633484309.4748740196228027343750 

Specifically,I was wondering if you had any photos showing a back view after the patient had time to recover from the surgery? In the “1 day after” photos, the patient appears to have extremely hunched posture which looks to compromise the aesthetics.

A: As stated in that case study, every shoulder narrowing patient in the first few weeks after surgery will have a hunched appearance as that is the most comfortable position to protect the healing clavicles. That is not a long term shoulder appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, As a trans woman considering iliac crest implants does one need to be on hormones prior to the surgery?

A: While many transgender women are on hormone therapy, and I would consider this to be the normal, it does not have a beneficial or adverse role in successful implantation onto the iliac crest. Good healing ix expected whether one is or is not on hormone therapy.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, what is the recovery time for iliac crest implants?

A: The recovery time from iliac crest implants is a direct reflection of having raised part of the TFL fascia off of the iliac crest to place the implants. This causes some discomfort with walking as would be expected initially. This will take several weeks to fully resolve so exercise is going to be delayed for a month or so after the surgery. There often is some numbness in the front of the thigh but this will usually subside within months after the surgery.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley: I weigh 375lbs highest weight was 400. I am trying so hard to loose weight but my “fat appron” is causing a lot of issues for me. Rubbing raw and so painful when I try to exercise. I feel I hit a wall. I really want to get a panniculectomy and was curious if this could be done at my weight. I need it gone to continue my weight loss journey!

A: Thank you for your inquiry and sending your picture. I believe you are correct in that only a removal of the double/triple roll abdominal tissue excess can provide the psychological, and perhaps physical, springboard for continuing on your weight loss process. I have seen this many times and, although classic teaching is that weight loss should be first maximized before surgery, that is often not effective and many patients like yourself hit the proverbial wall. Such surgery provides very positive feedback so the patient’s motivation for further body reduction efforts is reignited.

Unfortunately I will be unable to help you as my surgery center has a patient weight limit of 300lbs due to the beds that we use. At such a weight the surgery will have to be preformed in a hospital where they have operative tables that are made for such patient weights.

Dr Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a chin that is a little but long when I smile. Also I feel my chin is a bit short. I would also like liposuction under the chin at the same time. What would be the approach for optimal correction?

A: Thank you for your inquiry and sending your picture. In the chin that has a dynamic chin pad ptosis in which it is also a bit horizontally short, a chin implant placed through a submental incision (not intraoral) is the corrective approach. Submental/neck liposuction can be performed at the same time through the same access incision as the chin implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can shoulder narrowing surgery and hip implants be done at the same time? This has some obvious advantages in terms of efficiency but what about the recovery?

A: The question is not whether one can have both shoulder narrowing and hip implants done at the same time, as that can be done technically, but whether it makes the recovery very difficult in he short term. (which it would)

From that perspective it makes sense to do the hip implants first (as it requires laying on your side for each side and requires a drain which needs to stay in for awhile) and then the shoulder reduction. Or do them separately months apart when one is fully recovered from the first procedure.

I hate to separate them as described due to the logistical impact on the patient but i also don’t want to put a patient into an adverse and very difficult recovery. Each procedure affects mobility from their respective upper and lower torso involvements. It is one thing to affect one torso range of motion/movement but it can be quite another when the entire torsi is affected. (high and low)

Dr. Barry Eppley

Indianapols, Indiana

Q: Dr. Eppley, I am a young man who is due to undergo bimaxillary advancement for health reasons. The planned procedure involves a Le Fort 1 osteotomy. I have researched this topic in depth, so I am aware the different Le Fort osteotomies and their aesthetic implications. I have learned that I not only have a recessive lower maxilla, but my entire nasal region (both upper and lower) is recessive. I understand that this is the area moved foward with a Le Fort 2 osteotomy. I now have to make a choice between going forward with the Le Fort 1 osteotomy, or scrapping my plans and finding a surgeon who would perform the full Le Fort 2 osteotomy. The key aspect that will inform my decision is whether it is possible to (almost) achieve the results of a Le Fort 2 osteotomy with a combination of a Le Fort 1 osteotomy and a customized implant (or more than one of them). I envisage the customized implant to move forward the entire circumference of the piriform aperture in addition to the nasal bone and the frontal process of the maxilla. If this is possible, I would come to you for this implant after undergoing bimax. What do you think about this?

A: It is important to remember that facial bone surgery is not always as it appears in a diagram. LeFort II and III osteotomies look great on a diagram but executing them and accepting the tradeoffs and their more limited aesthetic effects is a different matter. The more assured result is a LeFort I, which is a very predictable operation, followed by addressing the remaining superior aesthetic midface needs secondarily with custom implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had an orchiectomy nearly twenty years ago due to an undescended right testicle. I have an implant which I have never found satisfactory. It is too small and has been stitched in place, so it does not hang or appear correct. I’m interested in your much larger implant. Can you please provide more information? I am desperate to have a better implant that looks more satisfactory. 

A: Thank you for your inquiry and sending your pictures. Undoubtably you have a small saline testicle implant which it is sutured in placed using  a permanent suture through a tab on the implant. (why Urologists do that I do not know) Because it is saline-filled is why it is very firm.

To create a soft more mobile implant it needs to be replaced with an ultrasoft solid silicone implant probably of a size of 5.5cms which would be a much closer match to the remaining testicle, if not a bit bigger. The suture needs to be removed and the residual capsule released with the new implant placement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in fat injection breast augmentation. Attached are a few photos that I took this morning. As for the breasts I do not want large breasts, I just want to fill out the skin that I have. You can see in my side profile that the top half is pretty flat and empty. i like the look and feel of natural breasts which is why I am more interested in fat transfer but I am not completely opposed to a small implant if we can keep them natural looking. I do not like the look of my indentions in my hips. I have had them for as long as I can remember, no matter how small I was. I do like the curvature of my body in my waist so I would like to have liposuction of my tummy and use the fat to fill in my hips so that I have a smooth curve. In the last photo you can see that I have a small overhang of belly skin, I do not want a tummy tuck because I do not want to be left with a large scar. I have heard of SkinTite being used with liposuction to help reduce this and wanted to know if you offer that or have any other suggestions. 

A: Thank you for sending your pictures to which I can say the following:

1) While you do have some fat to harvest any amount of fat injected into your breasts is not going to round them out or provide the upper pole fullness you lack. Fat works best in breasts that have a good skin sleeve/tightness. It doesn’t have the stiffness or push, no matter what the volume injected is, to have an expansive effect in the breast with loose skin. Only an implant can provide the push needed to have that effect.

2) Thus fat harvested would be better used for the hips even though that is a notoriously poor area for injected fat survival. But enough volume injected can overcome much of that anatomic unfavorability.

2) While you can have liposuction, which will have some reductive/flattening effect on your stomach, there is no benefit to the use of SkinTite afterwards as the ability to tighten skin that has stretch marks is negligible. You have to rely on whatever natural skin elasticity remains in which yours is limited.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I know you claim the buccal myectomy produces just modest results but for a highly motivated patient that is willing to accept risks, would you be able to remove more and tighten more muscle for a more dramatic result? 

What kind of risks are there if you try to tighten more? 

A: I suspect the main risk with an ‘aggressive’ buccinator myectomy would be excessive tightness of the cheeks. (scar contracture)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, So I have a very small head. So small that I’m convinced I have the smallest head on earth for a healthy adult male. I know for sure it’s smaller than 54cm. I have a few questions about this procedure but rest assured I will be making an appointment in the future. 

How much does the surgery cost? That way I know how much to save 

What can I do in the meantime to maximize the enlargement potential? Collagen supplements? 

Will there be scars? If so where? Will the cuts be anywhere hair is located? 

I’m worried the head enlargement will throw off the rest of my features. If so will there be an option to enhance those as well?

A: In answer to your head enlargement questions:

1) The cost of head enlargement surgery depends on how it is done. (one vs two stage)

2) Head enlargement surgeries are maximized by doing a two stage approach which employs a first stage scalp expansion which permits a larger implant to be placed.

3) The scalp incision is usually placed near the crown of the scalp.

4) Most head enlargement surgeries are probably not going to be big enough to make the face look too small.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I love your work and I am very interested in your shoulder narrowing surgery! Have you done any cis-gendered women? Also, do they end up looking hunched over? Thank you !!!

A: About 25% of shoulder narrowing patients are cis-females so they do request the procedure just not as much as the transgender patients.

Patients do not develop a hunched shoulder appearance afterwards. That is only a posture you see in the early postoperative period because it is the most comfortable position for the shoulders. It also results from keeping the elbows close to one sides in the first few weeks after surgery to protect the healing clavicle osteotomy sites.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The testicle implant I have was placed nearly twenty years ago. My actual testicle size is about 3.5 – 4 Cm approx….I used a simple ruler to measure them. I would like to get a large implant for both sides to improve size and also a softer and natural to the touch.

You suggested new size implants of 5.5 Cm for both sides. Are these medium or large implants?. I’m a little concerned that a 5.5 Cm wraparound might strangle my actual testicle. Is it possible? Is it better unrestricted or restricted? No dancing around in the wraparound.  I’m looking for the perfect fit physically and visually and since I have a small frame, nothing ridiculous, too big .. 🙂

Thank you so much again!

A: In answer to your testicular implant questions:

1) Most likely your natural testicle size is about 4 cm+. I assume the testicle implant is smaller, probably more in the 3 cms size range.

2) The largest standard off the shelf testicle implant is 5 cms. Most men who get testicle implants would still consider that ‘small’.  Thus either 5.5 seems reasonable for both sides as that is an upgrade but not by an unreasonable amount.

3) Wrap around testicle implants do not strangle or compress the existing testicle or the attached cord. In fact the risk with them is the opposite of your concern…having the testicle slipping out of the wrap around implant. That is why they are sutured into the implant to prevent that potential postoperative issue.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a male and I was wondering if u could fix my asymmetrical face and one of my eye brows go up higher than the other side and on one side of my lip is bigger than the other side and the other side of my face is sagging than the other. 

A: Thank you for your inquiry and sending your picture. What you have is a right side of the face asymmetry caused by a developmental shortness on that side compared to the left side. That is most manifest mainly by the right vertical orbital dystopia (right eye lower than the left eye) which is the cause of the lower right eyebrow. Like all facial asymmetry corrections it comes down to determining what is most important to improve vs the tradeoffs (scars) in doing so. What I tell all my facial asymmetry patients is to make a liost of thge priorities so I can go through it with them and discuss what can be done and the potential tradeoffs in doing so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a male and I was wondering if you could fix my asymmetrical face and one of my eyebrows go up higher than the other side and on one side of my lip is bigger than the other side and the other side of my face is sagging than the other. 

A: Thank you for your inquiry and sending your picture. What you have is a right side of the face asymmetry caused by a developmental shortness on that side compared to the left side. That is most manifest by the right vertical orbital dystopia (right eye lower than the left eye) which is the cause of the lower right eyebrow. Like all facial asymmetry corrections it comes down to determining what is most important to improve vs the tradeoffs (scars) in doing so. What I tell all my facial asymmetry patients is to make a list of the feature priorities so I can go through it with them and discuss what can be done and the potential tradeoffs in doing so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want to ask Dr Eppley 3 quick questions regarding brow bone reduction.

– what is the average bone thickness over the frontal sinus? 

– how much bone can we shave over the frontal sinus? (in mm)

– and what is the minimal bone thickness we can let over the frontal sinus?

 (without risks of tissue dying)

A:In answer to your brow bone reduction questions:

1) The average of the frontal sinus table in men is 3mms.

2) Since 1mm needs to be left, 2mms can be reduced by burring.

3) As stated in #2, 1mm.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, If the effect of temporal muscle injection is relatively small, can the anterior temporal bone and the posterior temporal bone be erased about 1cm by bone grinding? At the same time, I have another question, that is, the zygomatic arch, temple and forehead in my CT are relatively wide, can I remove about 1cm of bone on both sides by bone grinding? Thank you very much!!

A :How do yo know that the effect of temporal muscle reduction is small/inadequate? The temporal bone is fairly thin so a 1 cm bone reduction is not possible.

As for the forehead/temporal/zygomatic arch, a 1 cm per side reduction can not be done as the bone is not that thick. More realistically it is 5 to 6mms per side for a 1.0cm collective cheek width reductions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, In regards to the Pelvic Plasty procedure (iliac crest implants) where is the incision made to place them and what type of scar does it leave?

A: The incision for iliac crest implants is made at the posterior iliac crest region and is about 3 cms in length. This requires the surgery to be done in the prone position. (face down) The incision is made in the panty line so it is in a good location for being hidden in underwear. It is closed for fine sutures using a subcuticular suture technique in which all sutures are buried under the skin. As a result they don’t need to be removed and also leaves no suture track marks. It usually heals as a fine line scar and rarely requires the need for scar revision.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,I was wondering if it would be beneficial to do the Scrotox injections to keep things relaxed while healing from getting large testicle implants? Worried about the incisions being pulled due to the natural swelling that will occur after the surgery. Maybe not a issue but curious…

A:Incisional dehsicence has never been a problem in large testicle implants in my experience so I think the expense of Botox injections may not be a good expediture. It certainly does not hurt but am not sure if the benefits are worthwhile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I shave one eye lower than the other one and it has been so since birth. After researching on the internet I believe I have Vertical Orbital Dystopia. What can be done to make my eyes more symmetrical in appearance?

A: Thank you for your inquiry and sending your picture. To learn in detail what can be done for moderate VOD I would refer you to one of my websites, www.exploreplasticsurgery.com where you can place in the search box the term Vertical Orbital Dystopia and read the various articles about its surgical treatment. The first step in the process begins with obtaining a 3D CT scan of your face so the measured differences between the two orbital boxes can be determined.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, I really appreciate your medical service. Thank you for posting superior medical job at this site. I`m living at Asia and preparing for MTF surgery. I have two questions about body contouring surgery. 

First, how long should I stay for healing process? (Essential hospitalization term) Second, Which surgeries can be done at once? For example, subcostal rib removal and shoulder reduction go on first and later rib removal. Or all at once. Also if none of them can`t be done together, please tell me. 

Once again, I feel truly thankful that your hospital provides such a beautiful surgery. 

Thank you for all.

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

1) Shoulder reduction and rib removal can be performed together in the exceptionally well qualified patient but we will assume for now that they would be done separately.

2) The subcostal rib removal procedure can be combined with either shoulder reduction or rib removal. Whether that is a good procedure for your remains to be determined.

3) When to return home from either procedure partially depends on whether you are traveling along or with someone. For now I will assume the former. Thus for shoulder reduction one could return home 10 days after surgery. For rib removal it would be quicker in the 4 to 5 day time period.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How many custom implants can be placed in one session? Is it possible for chin, jawline, zygomatic arch and temporal implants in one session?

A: Placing multiple custom facial implants during the same surgery is common in my experience. I have seen as many as ten custom skull and facial implants placed in a single surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been looking for plastic surgery for  supraorbital augmentation because my eyes are like Asian eyes and i like caucasians eyes. The  Caucasian supraorbital bone covers eyes and it makes the deep and shadowed which I find attractive. It sounds like that I am trying to change my race. But if i can do the surgery i want to get the surgery So my question is “is it possible” ? Thank you for reading my text. 

A: What you are referring to is brow bone augmentation, sometimes referred to as supraorbital rim augmentation, which I do with a custom brow bone implant. While it is more commonly done in males there is no reason it can not be done in females as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a long time I have had some major insecurities with forehead. I liked my look but not side profile.I went to a FFS doctor to do a forehead reduction since I felt it was so masculine and people have always said I look different from my side profile and this was a huge problem for me. I could not even wear sunglasses because my forehead stuck out too much. I told the doctor to not remove to much bone, nothing from my forehead but only the bone you take out and put in. I said to him to not shave my brow bones to much since I like my look around my eyes and to NOT give me the «surprised look» 

My brow bione is almost completely shaved and not existing. I am so so so sad, and this has ruined my whole facial expression. I have been deeply depressed since the surgery.. I found you and you brow bone implant, and I think now you are my only hope to get back my look and protection around my eyes. Is it possible to fix this?

A: Thank you for your inquiry and sending yiour pictures.You unfortunately represent an overcorrection brow bone reduction result. Fortunately it can be improved/partially reversed by a custom brow bone implant. To avoid going completely back to where you started you probably only need a 3 to 4mm thick implant at most. Attached is an example of such an implant footprint although your implant thicknesses would be different. You already have the access incision to place ot of which scar revision could be done on it at the same time

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, I am just inquiring if you are able to correct SCAPHOCEPHALY, which is when the head shape is slightly narrow and abnormally long? 

If so, are you able to help children and adults? 

Thank you

A:I do have an approach to treat adult scaphycephaly as seen in the attachments which consists of some anteroposterior bone reduction and widening skull augmentation by a custom skull implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a tummy tuck 7 weeks ago and I am concerned the results are below my expectations. I found your details through a google search and am wondering if you can give me your opinion please

I had liposuction, muscle tightening/stitches and skin removed from the upper and lower abdomin. 

I would have expected to have a pretty tight and flat abdomen by now but I still have cellutite and soft skin that I can grab handfuls of. My weight and measurements have not reduced and I am quite underwhelmed by the results.

Are my expectations too high? I was told 6 pack definition was not impossible and I am very far away from that result. Will it get better as time goes on or is this as good as it gets? 

I have an appointment with my surgeon in 1 week and will express my concerns. 

This is the second time I have been through the surgery, as the first time was a complete disaster and the surgeon was happy to redo the work. 

I have attached some photos to help explain. 

Thank you for your time. 

A:Thank you for sending your pictures to which I can add the following secondary comments:

1) You had an inverted T type tummy tuck which was appropriate if the goal was to keep the horizontal part of the scar very low. This type of tummy tuck does not remove as much skin as other more extended types of tummy tucks but less skin removal is the price to be paid for the scar location. A supraumbilical type full tummy tuck would have produced a more significant result with much greater skin removal but at the price of a much higher and longer horizontal scar. The aesthetic danger is this approach in you is that you may have been a lot flatter and tighter but may have hated the scar…in which there is not going back. (aka poor tradeoff)

2) I think your expectations (after this secondary surgery) may have been too high. A 6 pack ab result was never a remotely realistic expectation or anything even close to that outcome.

3) I suspect the fundamental issue here is one of miscommunication or lack of adequate preoperatve education/understanding between patient and surgeon. You are what I would call a ‘tweener’ meaning a traditional full tummy tuck may have produced a better ooutcome but with an unfavorable scar location vs a more limited type of tummy tuck which has a better scar but less of an aesthetic improvement. I am not sure you clearly understood your situation before surgery. In patients like you I go to great lengths in making sure they understand their choice and the involved tradeoffs before the surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am in love with the results that can be achieved with forehead reshaping/temporal line reductio. I want to do the same for myself. Only problem is I have had hair transplant where they take strip of skin from back of head. So to do the temporal line reduction, I don’t think I’ll be able to do hairline incision like the guy did from the Web page as doing so will drastically reduce blood flow to head. Are you able to do a thin 1-2 cm incision at near ears and then use endoscope to do burring? Or I can do the thin 1-2cm incision right in top of the anterior temporal line. I don’t mind the scar.

A: In answer to your questions about temporal line reduction:

1) The frontal hairline incision has nothing to do with decreasing the blood flow to the head, it is all about the scar.

2) You can not do burring using an endoscopic technique.

3) A more limited incision at the top of the temporal line can be used probably in the 3cm length range.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am planning to get cheekbone reduction surgery. I have done lots of research and understood and accepted the certain risk of skin sagging. My surgeon recommended me lifting the muscle while doing the cheekbone reduction surgery to precent from sagging. Can this help the sagging? Even if i sag would smas facelift help? Because you mentioned that it is hard to fix skin sagging from surgery with facelift. Thank you.

A:I do not know what ‘lifting the muscle’ means or how that would be done at the time of cheekbone reduction surgery. Once the muscles are lifted off the cheekbones to do the surgery there is no method to put them back.

The definitive treatment for significant cheek sagging is a SMAS based facelift or some form of a lower eyelid or temporal cheeklift.

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley: I have some questions about vertical orbital dystopia (VOD) surgery which I would appreciate if you could answer for me.

1. For VOD surgeries like mine, what risks/complications should I be aware of?

2. Out of all the VOD surgeries you’ve performed, have you seen any cases of severe or irreparable complications (e.g., loss of eyesight, severe nerve damage, etc.)?

3. I got a second opinion from another surgeon, who recommended against an implant, saying it involves too much risk.  He recommended I proceed in stages – trying blepharoplasty + brow lift + fat transfer first to see if I’m satisfied with that. I am skeptical this would give satisfactory results, but what are your thoughts? If we did something like this, would we still have the option of adding the implant later?

4. I feel unclear on some important details of the surgical plan, like where the incisions will be made, where the brow bone will be reduced, etc. Do you have an article or other description of these procedures that closely matches what you are planning in my case? Or how can I best get educated on these details? (I have been reading articles on the website, but don’t know how closely they apply to my case.)

A: In answer to your VOD questions:

1) The major risks are aesthetic in nature and mainly revolve around how well the eyelids follow the eye superiorly. In VOD perfect symmetry is rarely obtained, it is a question of the degree of improvement.

2) I have never yet experienced any significant complcations from this type of orbital surgery.

3) I can only comment on what I do. I can not speak for other surgeon’s experience or techniques. Certainly doing the procedures that have even mentioned can be done as they do not burn any bridges for doing other procedures later.

4) I would go to www.exploreplasticsurgery.com and search under vertical orbital dystopia where the procedure is fairly well explained, both in description and with pictures.

Dr Barry Eppley

Indianapolis, Indiana