Your Questions

Q: Dr. Eppley, I would like to give my face a little bit more definition and therefore lengthen the lower third of my face, while achieving a more harmonic chin – / jawline in profile view. 

Thus I would like to know your opinion on, if a standard anatomical style chin implant placed very low at the border of the mandible, could create to a certain extend such an effect? 

Additionally I have pinned a photo of a girl that achieved exactly the kind of transformation in profile I`m looking for, with as far as I know some kind of chin augmentation and rhinoplasty. 

Thank you very much in advance. 

A: As a general rule you should not use a standard implant in the way it was not designed or intended to be used. That is a setup for positioning/placement/shape issues. Thus taking any standard anatomic chin implant and trying to increase vertical chin height by hanging it off the end of the bone is not a good idea in my opinion. Unique dimensional needs for facial augmentation are why the custom implant design process exists.

I can not speak for what exact chin procedure the female to which you refer underwent. It may have been an implant but,, more likely, could have been a sliding genioplasty which is commonly used to create increased vertical chin height.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a T genioplasty in my chin recently and I am left with an extremely pointy and asymmetrical chin. I used to have a beautiful chin that was just a little too long and wide and I am so unhappy with what he did. Would it be possible to have an implant that gave me a slight bit more vertical length and also created more of a round shape as opposed to a pointy v shape? 

A: Thank you for your inquiry and describing your current chin concerns. A t-shaped genioplasty is an aggressive procedure for a chin that was just a little too long and wide. I have done numerous custom chin implants for that exact female postoperative problem.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Please see the pictures attached. What can be done to reduce or remove the fat roll from the back of my scalp? 

A: Thank you for your inquiry and sending your pictures. What you have is excessive scalp tissue (not just fat) which creates a roll above the horizontal skin crease which exists. This can only be improved by a horizontal excisional procedure of the redundant scalp. Fortunately a very pronounced skin crease exists in which the fine line scar can lie. (which is actually common in such occipital scalp skin rolls)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Very unhappy with my double chin which has been an issue side since I was 20 . Looking at a procedure with liposuction and tightening the little bit of lose skin I have. 

A: Thank you for your inquiry and sending your pictures. In improving your double chin the debate is between liposuction alone vs a submentoplasty. (liposuction, deep subplatysmal fat removal and midline platysmal muscle tightening) Given the thicker tissue of your neck I would favor the latter since it more completely treats the fuller neck. I don’t think you have enough loose skin to justify a jowl tuck procedure

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Ive wanted my hips and buttock enlarged for a really long time now. Is it possible to do so on my body with implants.

A: Thank you for your inquiry and sending your pictures. You are correct in that the only way for you to have buttock and hip enlargement is with implants given that you have little fat to harvest. The question in regards to implants is whether the size limitations imposed by the intramuscular placement of buttock implants (under 400ccs) and small hip implants is adequate for your aesthetic needs. I will not do the subfascial placement of buttock implants or place large hip implants because the complication rates are too high.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an overbite. I hate the way it looks. To compensate, I’ve been walking around with my jaw unhinged and chin thrust forward all day for years. The deception is effective, but it’s started to cause me TMJ pain. I’ve included both front and profile photos of what I look like when I’m thrusting my jaw as usual, and what I look like at rest. Is there a solution for this?

A: Thank you for your inquiry and sending your pictures. The very jaw maneuver you are demonstrating is a 45 degree change of the chin projection. (mainly vertical but with a little horizontal) This jaw thrusting maneuver can be replicated by an opening wedge bony chin genioplasty. While this will leave your overbite as is at least you will not have to do the artificial jaw maneuver to achieve the desired aesthetic effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, After under eye implant removal, is it possible for there to be soft tissue/fat loss under the eye? After mine were removed I noticed extreme hollowing where I can feel the bone right below my eyelid. There is little to no soft tissue there. 

Also, when operation on patients who have previously had implants, is the soft tissue reattached to the bone, or after implants will it float over the bone and never reattach? 

Lastly, is there any minor procedure to tighten the soft tissue after implant removal, such as skin pinch? A subperiostial dissection scares me after my negative experience. 

Thank you 

A: By definition any facial implant placement requires soft tissue detachment which then floats on top of the implant. When the implant is removed, unless the tissues are elevated and resecured from whence they came, they will ‘fall downward’ over the orbital rim making the tissue over the rim thinner. Short of resuspending those fallen soft tissue, there are no other effective procedures. No form of a lower eyelid skin removal is going to create that lifting/tissue thickening effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My daughter is 18 and so self conscious of her chin. It appears normal when she’s not smiling but gets large when she smiles. Also when she makes a “duck face” it seems small like the bone structure isn’t big. Is this ptosis? How can this be treated? What is the recovery time?

A: Thank you for your inquiry and sending the pictures. At rest in profile she has a borderline protrusive bony chin in which the soft tissue chin pad becomes protrusive when smiling as a result. This common female chin excess is treated by a submental chin reshaping/reduction technique in which both bone and soft tissue excesses are removed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it possible for the occipital knob to continue to increase in mass or grow?  I ask because more recently I’ve experienced a pressure or pain while lying on back on my head and it is sort of alleviated if I lift up on the area or back of my head.  I can feel the pressure in that area & my neck…is this normal or a situation that you have heard of before?

A: While some patients complain of discomfort from an occipital knob, they are not known to grow in adults to the best of my knowledge.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have very hollow tear troughs and I am pale enough that the darkness is noticeable. I’ve done regular fillers in them in the past but was looking for a more long term option to fat graft to them. I am mostly interested in seeing if it is possible.

A: Thank you for your inquiry and sending your picture. While injection fat grafting to the lower eyelids/undereye hollows is an appropriate treatment for them, it is a procedure in my experience with a high rate of irregularities in the unforgiving thin tissues of the lower eyelids for which revision is very difficult to remove and/or eradicate them. Thus it is not a procedure that I am comfortable doing any longer knowing that most patients will end up with the need for a revision. I only treat under eye hollows today with either standard or ustom undereye implants where the issues of irregularities and asymmetries are minimized.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Has you can see from the photos, the center of my forehead caves in. I seem to be a little confused over the type of surgical procedure I require in order to fix it.

A: You are referring to the suprabrow bone break hollow that exists just above your brow bones. While every male has that to some degree yours is magnified by the upper forehead protrusions often called forehead horns. Your options to get rid of it is to either fill the hollow or reduce the upper forehead protrusions…that is merely a matter of personal aesthetic choice.

Assuming you want to fill in the suprabrow bone indentation/hollow, the forehead augmentationoptions ae either the use of bone cements or a custom suprabrow bone implant. Besides cost the one difference that separates these two options as the length of the scalp incision needed to place them. The custom implant can be put in through a very small 4cm incision while bone cements would require an incisional length closer to 15 cms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I saw an ear surgery on your site a while back, it was to do with bringing top of ear closer to head, but not by increasing the fold. It was at the point of the helix root I guess, and it mentioned something about people with a bald head, how moving in ear at this point reducing the look of the ear sticking out. So again it wasn’t increasing the fold, it was pulling the helix root area to the scalp. I have an ear with a weak helix root, fold is fine, but ear lops out a bit at top, and I can see how this surgery would fix this, as it’s clearly visible how it’s so weak at his point. Can you send me a link to this surgery on your website, I recall seeing it but can’t locate it now.

A: You are referring to bringing in the top of the ear at the superior helical root area. You are correct in that no traditional form of ear reshaping, like used in setback otoplasties, will work for this type of ear protrusion. You can’t find or bend the cartilage in this area to create that effect because it is not caused by the lack of a cartilage fold. Te technique that I have found to be effective is to reduce the postauricular space by removing skin from both sides and sewing the cartilage to the temporal fascia

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking for a total face makeover to maximize my look and my pic and morph pic uploaded, is it possible to achieve the look of that morph pic realistically? Or whats the maximum bar i can reach? 

Some of my flaws noted were bad chin/mandible, vertically, horizontally, non forward/widen jaw, malocclusion, long midface, negatively tilt eyes and small but fat lips. 

And these are some surgeries I studied that I think might help me. 

DJS/Bimax/CCW Rotation Jaw Corrective Surgery/Lefort 1,2,3 osteotomy/BSSO/Wraparound Custom Jaw Implant/Sliding Genio/Chin Wing/Chin Implant/SARPE/MSE/Lateral Commusuroplasty/Orbital Decompression/Ptosis/Infrainfraorbital rim implants/Canthoplasty /Fillers/Orthodontic treatment 

A: Thank you for your inquiry and sending your morphed facial picture. From a skeletal standpoint I do not find the morphed changes terribly unrealistic. What is important in these morphed predictions is to see more than just the front view. A side and oblique morphed images would also help validate the realistic nature of these morphed changes.

It is not clear where orthognathic surgery, if indicated, has a role to play in these type of facial makeover. Without seeing x-rays and an occlusal assessment, the potential role of orthognathic surgery can not be determined.

In short, more information is needed to provide an assessment of what is and is not possible and how to accomplish such changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a genioplasty along with double jaw surgery 2 months ago, the chin was cut in a way so as to make it narrower (although my chin wasn’t wide at all it was already narrow and feminine) and was increased 10mm horizontally and 15mm vertically. The chin looks very very pointy now, as there is almost no width left and it further sticks out because of the intentional 15mm increase which in my opinion was a bit too much. The surgeon at first only said that I will take it back after a few months and now has denied and is insisting on plate removal. I’ve talked to another surgeon who hasn’t told me his plan yet, I’ll have to physically go to his place and ask, but he said to come as soon as possible. My requirement is to get my lower third to be more angular again. The width of the chin can not be increased now, but I’m hoping that reducing it vertically about 8 to 10mm should make it look much better. I know the measurement 10mm in vertical reduction is quite huge but I’m afraid that without that much reduction the chin will not look good at all. My chin is sticking out from the rest of the jaw and has very very less width, almost none. I also plan to take it back slightly by 3mm or so. I’d be really grateful if you could tell me if it’s possible and advisable to reduce 10mm vertically, and also, when it should be done. I’m 2 months out of my surgery and I am sure that even if the other issues, like the pain in chin and the rolled-in lip, might get resolved in coming months, despite that I will be going for a vertical reduction of the chin as my face looks too long and the chin looks very very pointy and is not going with my wide face. I’m worried about getting saggy skin after the reduction and also any other complications that may arise with a revision genioplasty. Please suggest me the best option and also when to go for the revision.

A: Certainly a 10mm horizonal advancement and 15mm vertical lengthening is going to make any chin more pointy…which would be even more emphasized if narrowing was done as well. In my opinion you do a revision when you are certain that the desired changes is not the desired result AND you have a clear plan as to what type of revision would be beneficial. Without seeing before and after pictures and x-rays I can not make any further constructive and informed commentary about how to improve your current chin situation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Questions for Dr. Eppley regarding PMMA bone cement for skull augmentation: is it safe and permanent? Are there long term complications associated with its use? Why isn’t this procedure not commonly performed? 

A: While PMMA bone cement for skull augmentation is both safe and permanent, it is an aesthetically inferior technique because of its limitations in volume addition, the need for a long scalp incision for placement and a higher risk of contour irregularities. Custom skull implants are aesthetically superior due to more controlled aesthetic outcomes, less risk of contour irregularities and they are placed through smaller scalp incisions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had infraorbital implants and lower eyelid spacer grafts with canthopexy of which I am very satisfied as they have made a great improvement. I wonder now of custom infraorbitalmalar implants might provide even further facial improvement. I really don’t want to one up my lower eyelid incisions again since I have had such a good result. What are your thoughts on this potential procedure? I know it create a more compact orbit bit what are the other benefits?

A: As a general statement what I would tell any patient who has undergone an aesthetic procedure which has made a good improvement…be very cautious in trying to take a good result and make it a great one. The reward:risk ratio changes and just because you have had a uncomplicated experience the first time is no assurance it will be so the next time.

That being said it would be fair to say beyond a somewhat more compact orbit it provides an extended high cheek look as well. Based on your one limited side view picture I would not be an advocate of this procedure in your case because of the risk vs reward benefit.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a review of my case and photos. Your practice is very appealing to me because you offer a wide array of treatments and surgeries. I want the procedure(s) that give me the BEST chances of reaching my aesthetic goals. I am open to all suggestions. I am specifically interested in learning if I could benefit from facial lipo, kybella, threads and/or facetite OR should I just go straight to a facelift or other surgery. I have attached 5 photos: current frontal, side, 45 degree and smiling pics with areas that bother me marked. I also attached a frontal version photoshopped to show how I’d like my lower face to look. I am not adverse to surgery or down time if the procedure gets me what I want preferably permanently. My only restriction is I want as minimal scars as possible and no silicone facial implants. I am 40 yrs old, 5’2, 123 lbs and have had the following aesthetic procedures done several to many years ago: buccal fat removal of entire pad, open rhinoplasty, upper eyelids, ultherapy of lower face and neck, chin implant and then removal of implant years later. Please let me know if any additional info is needed. Thanks

A: Thank you for your inquiry and sending your pictures. The lower facial slimming effect you are trying to achieve is best obtained by a surgical jowl tuckup procedure. (aka limited lower facelift, mini-facelift etc) All other less invasive procedures you have mentioned are for those that are not ready to jump to a surgical procedure. They do not create the same result but serve as methods to delay a surgical approach until more significant signs of facial aging are present or that their results have proven they are inadequate for the patient’s aesthetic goals.

I have attached an example of such a younger type of limited facelift with a close up of the scars around the ears. (6 weeks postop)

FYI no facial rejuvenation procedure, surgical or otherwise, is permanent. They all degrade over time…it is only a question of how much and over what time does one eventually return to baseline. That would be particularly applicable at a young 40 years old.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am concerned about the asymmetry on my face. My jaw slopes to my right and my right eye, lip, and nostril area are dragged downwards. My right eye is lower than my left, I don’t consider it to be too severe but it is quite noticeable and I would really like to fix it. My right brow, nostril, and lip corner are lower as well. I think an orbital floor augmentation/ implant and any procedures accompanying it would solve my VOD, however I’m not sure if I’m the right candidate. My desire would be for the affected areas on the right to be symmetrical to the left accept for my jaw which I would like address in the future. I am very curious to know your informed opinion and ballpark prices for each of the procedures that would be needed to fix the asymmetries on my right being my lip, nostril, and eye + (brow). A response and price estimation would be greatly appreciated, thank you so much!

A:Thank you for your inquiry and sending your pictures. In the assessment and treatment planning of facial asymmetry it requires a good quality frontal picture (yours does not include the full face, is not current and are very grainy in clarity) and a 3D CT scan of your face to have full knowledge of the underlying facial bone structure. 

But those issues aside, what is equally important is for the patient to make a list of their specific facial asymmetry concerns AND to prioritize them in order of importance. This allows the patient to focus their resources on the procedures that have the greatest value to improvement of their facial asymmetry concerns. 

In short a better picture and knowing your priority concerns would allow some more useful information to be provided.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a chin implant which is a medical grade silicone implant by Implantech. Over the last couple years my chin has changed. I think the implant shifted. Recently in the last few months I felt a tearing sensation on the left side, along with pain and itching. Now there’s a little divot along the left side and to me it looks like it shifted up closer to my mouth. I’m concerned that it shifted up or scar tissue tore as well as bone erosion. I want it out my face. I’m concerned about my skin not shrinking back after having it for 20+ years and I’d rather not go back to a recessed chin. My mouth is moving normally and I’m not in pain. It does feel weird compared to the left side. I can almost feel it now being closer to my mouth on that left side.

Questions/ideas: 

Can the implant be removed and hydroxyapatite be used to create a chin? 

How about a sliding genioplasty without another implant? 

A: Normally I would get a 3D CT scan of the lower jaw to fully understand the chin position on the bone and what style/size the chin implant is. But since it is clear that you want it removed and not replaced with another implant then the scan will not be useful. The question then is not whether it needs to be removed but what to replace it with and what should those dimensional changes be. 

Hydroxyapatite cement is a theoretical replacement but it is a hard material to control its shape and would only be viable if just a few millimeters of augmentation were needed in the central chin. A more controllable autologous option is a sliding genioplasty. The only question with it is what are the dimensional movements needed. That can be determined by how you feel about current chin look and what contribution the indwelling chin implant is making towards your current chin shape. (which can be accurately determined intraoperatively with its removal) That would then guide the amount of horizontal chin bone advancement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,I was born with a large nose and recessed chin and had rhinoplasty and chin implant twenty years ago.  The rhinoplasty left me with a bump so I had a revision several years later. During the revision he scooped out my slope and took a chunk of my ear cartilage and put it on the tip, and angled the whole thing up. You can now see inside my nostrils. He also narrowed my left nostril at the base and the right nostril now sticks out and up. The tip is kinda pinched-looking and my slope is gone. It does not fit my face and I can’t breathe properly. After the revision he tried to shrink the tip using a steroid injection called Kenalog (0.1 mL).  I think he tried to do the Barbie-style of nose. My left nostril wall is collapsed and I’ve recently found a huge benefit wearing breathe right strips at night. I’m now sleeping through the night and it’s amazing. Several years ago two stitches worked their way out through the tip area on the inside of my nose. That was scary. I feel like the entire nose is unstable. I’ve had a couple consults in my area and they’re not what i need… I need functional and aesthetic rhinoplasty. 

A: By your nose surgery and symptom description you have both functional airway and aesthetic nasal shape concerns. Positive improvement with the Breath Right strips demonstrates that there is internal nasal valve collapse +/- weak lower alar cartilage support. This often happens when the structural support of the nose has been over reduced. This is best approached by the combination of middle vault spreader grafts and batten grafts to the lower alar cartilages using septal cartilage grafts. Septum is the best source and it is unknown to me whether your septum has previously been harvested or not. (I suspect it hasn’t given that ear cartilage has been previously used) This functional surgery can be combined with the needed aesthetic changes which appear to be bridge augmentation, columellar support, tip scar removal and right nostril adjustment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have complex muscular issue on the left side of my head and face, impacting the temporalis and masseter muscles. I had this issue for around 3 years and it currently has caused a TMJ issue. My temporalis muscle is very painful and causes a lot of twitch and it becomes very painful when goes by the ear down to cheek bones. There is a severe muscle pressure putting stress on my ear and jaw. This makes it difficult to do daily task as causes it causee much stress on muscles around the body. My upper cheek is bigger, hurt sand puts pressure on cheek bone as well. When moving my face, the pain gets stronger. I cannot wear a splint anymore as it pushes muscle more towards the TMJ bone and ear. TMJ was clean and steroid was injected and the steroid has caused more muscle issue in temporalis then was there before. TMJ specialist define muscle root cause but cannot seems to get any treatment answers. I have seen a few TMJ specialists and plastic surgeons. In addition, I have occipital neuralgia. I had migraine surgery where the greater occipital nerves were decompressed and the arauriculotemporal nerves removed. Based on your experience, I have seen you have worked on the temporalis muscle and was wondering if you would be able to resolve my issue. Botox was used with some relief which was a good indication the root of the issue was there. it feels like I have a knot around that area. MRI of head and TMJ did not indicate anything. 

A: The critical question is what part of the temporal muscle is involved….anterior, posterior or both. Temporal pain reduction by surgery only works if it exclusively or primarily involves the posterior portion of the muscle. By your description it appears that the anterior portion of the muscle (ear to cheekbone) is the culprit for which muscle reduction/removal can not be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am considering a mouth widening procedure in the future as my mouth is a bit small for my face. What do the finished results of lateral commissuroplasty look like? There are no photos online showing what post operation heal scarring from commissuroplasty look like. Is the scarring bad? If you were face to face with someone is the scar noticeable from 1 feet distance? Please help me, I would like to know bad the scar from commissurplasty is before I determine whether it is really worth scar or not.

A: In my extensive experience with mouth widening surgery, while it is an effective procedure, scars are a concern and just about 100% of patients undergo secondary scar revisions from it. The corner of the mouth is an exquisitely sensitive area for incisions and scar formation. It is not like the rest of lips due to its location and frequent exposure to stretching forces.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, is a jaw implant good if you don’t want fillers but want to build up your jaw line? As you age and your skin thins will you see the implant?

A:Jaw implants are made to fit the bone and look like a natural extension of the bone. No one’s skin can ever thin enough to show the outlines of a jaw implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, you seem very experienced in custom chin implants. My question is if you want to increase vertical chin height using an implant, will the implant blend with the sub mental skin under the chin (neck) perfectly using custom chin implant?

A: I am not sure what you mean by ‘blend with the submental skin under the chin’. The implant blends into the bone as that is what it sits on. But I think you mean will the skin from the bottom of the chin from the vertical lengthening stretch out below the chin and not look indented…and that answer would be yes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in thick skin rhinoplasty. I had a consultation that wasn’t successful as he said he was unsure of how the result would come out due to some thick skin. My nostrils are also small and collapse in when I breathe in deep.

A:There are lots of rhinoplasty patients that have thick skin which does not preclude them from having surgery. One just has to acknowledge that there are limitations as to how much nose reduction/reshaping can occur, that postoperative steroid injections may be needed and that it can take up to a year after surgery to see the very final result. With nostril collapse on inspiration this indicates that your rhinoplasty would need batten cartilages grafts or turnover alar rim grafts to support the lateral ala as part of your procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have always had facial asymmetry and was unhappy with my profile bc I had a weak chin, so I decided to fix the profile issue. It appears the chin implant, though centered, made the asymmetry worse. I’m interested in trying out jaw fillers (potentially cheek as well if necessary) and visiting the option of removing or correcting the chin implant, as I also THINK it might be too low or angled to low since it seems almost alien to my face and interrupts any facial harmony I had before. Granted, the side view is better than before.

A:Thank you for your inquiry. You are correct in all of your assumptions about the chin implant….in the presence of chin/jaw asymmetry a standard chin implant will exaggerate the asymmetry appearance, it is positioned too low because of the backward inclination of your chin bone (creating more of a 45 degree angled augmentation effect) and it is an implant style that is too wide for a female chin. And like many undesired chin implant results in females it offers an improvement in profile but looks worse in every other facial view.

The question is not whether you are going to remove the chin implant but what are you going to replace it with that would be better. Of that the options are between a custom chin implant vs a sliding genioplasty, each with their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a sliding genioplasty procedure. Since the sliding genioplasty is usually done through a diagonal cut as I have seen on the internet, I am interested in knowing if every horizontal advancement always has some degree of vertical shortening? Is it possible to advance the chin just horizontally without changing the vertical dimension? If so, how does the cut look then? I am scared that the side effect of advancing the chin forward might be some vertical reduction. 

Thank you very much for your time.

A:In answer to your insightful sliding genioplasty question, control of the vertical dimension of the chin is affected by the following:

1) Even if not change is done to the vertical dimension with a sliding genioplasty it will usually look a bit longer as it is advanced due to the changes in the overlying soft tissue chin pad. (this is similarly true with implants)

2) The risk of vertical shortening is sliding genioplasty is related to the bone fixation method used. With a diagonal bone cut, if wire fixation or bicortical screws are used (neither of which I use) then vertical shortening can happen as these are bone compression techniques. And by definition almost always happens) If plate fixation is used the vertical dimension is controlled much better because there remains a bone cap with the advanced chin bone segment as the plate allows the chin bone movement due to be done in any horizontal or vertical dimension. (in essence it is a bone suspension method

As you can see this is a geometric function of the bone fixation method used.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hi I was wondering whether if not satisfied with your head shape after removal of the muscle in posterior temporal head reduction (temporal reduction surgery) are you able to have another consultation regarding bone structure or is their certain risks.

A: The posterior temporal bone is quite thin and only a few millimeters can be removed….which makes for a negligible reductive change. It is the muscle removal that makes the major difference. But it can be done but it will not make for any further major head width change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Looking to improve the rounded appearance/protrusion to the chin on the side profile. On the front view I would like to achieve a slightly shorter and more rounded/feminine look to the chin. I also have a chin dimple that I have corrected with filler but it is still slightly visible in certain lighting and I would like to have that resolved.

A: Thank you for your inquiry and sending your pictures. It appears that much of your chin excess is from the soft tissue pad which will take a submental approach and some bone removal as well to adequately reshape it smaller. Fat injections would be the logical approach to the chin dimple which could be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Interested in rib removal. I have a very big thorax for my body size. Is it possible to reduce the scope of the thorax?

A: No it is not. You can’t reduce rib protrusions that high up on the chest wall. This is a common question but is beyond what rib removal surgery can do.

Dr. Barry Eppley

Indianapolis, Indiana