Your Questions
Your Questions
Q: Dr. Eppley, I’m getting in touch to enquire about a possible consultation regarding noticeable eye asymmetry that I’ve had for as long as I can remember. I’m currently trying to understand whether this is primarily skeletal (orbital bone positioning) or if it may be largely soft tissue-related — or a combination of both. I have attached an assortment of photos both relaxed, squinting and with my eyes shut. What’s interesting is that at least in my eyes, the asymmetry diminishes significantly when I am squinting & when I shut my eyes. Is it possible that it could be a combination of both skeletal & soft tissue and as a result, squinting or shutting my eyes improves the symmetry some what? I have quite prominent eyelids (genetic, my dad has the same) and one of them seems lower than the other.
If soft tissue is indeed a factor, would anything improve the symmetry or appearance in general of my eye area, such as a blephoraplasty? I plan on getting a CT scan soon. Appreciate your insights.
A:Thank you for sending your pictures. You have classic vertical orbital dystopia (VOD) of the left eye. (see attached imager) it only looks better when you squint or shut your eyes as you simply see less of the eyeball and thus it looks better for less asymmetric. While there is a soft tissue component to it (the upper and lower eyelids are positioned lower just like the eyeball) a blepharoplasty we’ll not provide any form of a correction. This is a foundational issue in which the entire left orbital box is positioned to lower. This requires a combined orbital floor/rim augmentation with overlying eyelid adjustments.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can i get wider lips?Does it look naturally?Does my face muscles work correctly after that?Is there a scar?
A:You are referring to the mouth widening surgery. This can be done and generally lengthens each mouth corner by 5 to 7 mm. It does not interfere with any of the workings of the facial muscles. It does leave a fine line scar around each mouth corner.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am curious about surgical excision of the tattoo on my foot. I have done 6 laser treatments with little progress. It is rather painful and disappointing to see it barely change. They initially said I would need 17 treatments on my foot, but I fear I’ll need more since it still looks like this after 6. Is excision possible for this area? If so, what does the process and healing involve? These are pictures after treatment that’s why there’s blisters etc. please let me know!
A:That is far too large of an area on the foot (50% of its dorsal surface) to consider elective skin grafting. That would probably cause more problems than it would solve given the proximity of the extensor tendons.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’d like to know if it’s possible to operate the eyebrows due to acromegaly? I have bilateral bulked eyebrows, the corrugator muscle looks as if I were angry 😡. And i got fillers because I was tired of looking with that bilateral bulky eyebrows like an edema. I’d like to know if it’s possible to make my forehead flat normal again? I also want an upper blepharoplasty, both sides look swollen, bulky, like boxer eyelids. And I got fillers the last two years and it migrated, and made it very heavy the eyebrows and heavy. I send photos of how I was before, my eyebrows were normal, flat, and with the changed of eyebrows and eyelids very different and it has affected tremendously my self esteem. Thank you!
A:Thank you for sending your pictures. I believe your concerns are based on the heaviness of your eyebrows/brown bones. Some of your pictures are showing a temporal brow lift through the use of your fingers. If the question is whether the tail of the brow bone scan be reduced combined with a temporal brow lift possibly with a lateral canthoplasty to create an upward sweep of the outer aspect of the eyebrow and eye corner which will help reduce the narrow and heavy appearance s of he upper eyelids/orbital area….then that answer would be yes. That would certainly be the correct approach to your aesthetic concerns
.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am following up the concept of the iliac crest implant as a bony anchor for hip implants. Would an implant like something in the photos be feasible? My thought is to use the interlocking mechanism as a way to prevent migration as well as an anchoring point for slightly larger implants.
A: The biggest advantage of using iliac crest anchorage for any form of a hip implant is this would be the best method for the symmetry of placement. There usually is not any significant concerns about hip implant migrations given their size and location. Technically, the larger the hip implant is the less likely it can really migrate or change position after surgery. (actually I have never seen a hip implant ‘migrate’). But the concerns of hip implant size is not really about their migration but about the increased risk of complications particularly seromas, inferior implant bending and implant edging. This is where there is another benefit of the titanium plate on the iliac crest as it would support the implant better and would likely eliminate the inferior implant bending concerns. It may or may not help with implant edging. it would have no impact on the risk of chronic seromas.
As I look at your hip implant design I could see that it is of a very significant size in terms of surface area coverage. This is exactly the type of hip implant that does have the highest rate of complications. While the iliac crest plate may help with some of them it does not eliminate all of them and still makes it a higher risk implant.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I’m a man interested in “male enhancement”, so to speak. I’m researching testicular implants as a safer alternative to self-administered silicone injection. I’ve been experimenting with saline and dextrose infusions and achieved great temporary results, but what I’m really looking for is a semi-permanent or permanent size increase. I found your implant page through a google search, and was wondering if you could answer a few questions for me. Is 8.5cm the maximum size you would be willing to implant, or is that just the largest you’ve done so far? Are there adjustable implants that could be inflated and deflated as desired? What are the risks and possible complications of implants, particularly when getting into larger sizes? What sort of recovery timeframe should I expect? What kind of costs would we be looking at? Don’t need specific quotes, just a general idea. Thanks for your time!
A:When it comes to the size of an implant in testicular enhancement my only concerns are for the patient’s safety with a low and acceptable risk level of complications. Such complications are primarily infection, chronic seroma or fluid collection and wound dehiscence. There isn’t any question that the size of an implant effects these potential risk levels. There is no absolute size number or scientific method to determine when the size threshold is exceeded. This is a matter of preoperative and intraoperative judgment.
That being said there is a reason the largest size testicle implants that I’ve ever seen is 8.5 cm. That reason is that patients focus on the linear number and have no appreciation for the amount of volume that such an implant size creates. Somewhat like breast implants the effects of testicle implants are more about volume there are about any specific linear measurement. But no matter what larger size testicle implant is chosen before surgery you never know absolutely until you’re trying to place them what will and will not fit. Thus when one chooses an extreme size they have to be prepared that that might not actually fit and would have to be reduced down in surgery.
Unlike breast implants there are no adjustable testicle implants. These are ultra soft solid implants in a specific size has to be chosen before surgery. This does not mean that one could not do an inadvertent two stage procedure, meaning the largest size that will fit is initially placed and then an even larger size can be placed later. This is a form of tissue expansion without using a tissue expander which does not exist for the scrotum anyway.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I just want to get piece of mind that after the reduction of bone on skull it has zero chance of regrowing.
A: In answer to your skull reduction concerns:
- I have never seen bony regrowth in an adult.
- After the bone is reduced it is covered with a layer of bone wax to prevent even a minimal amount of regrowth
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I am a 32 year-old male interested in undergoing your clavicle lengthening surgery. I am 6ft. tall, slender frame, with a bi-deltoid width of approximately 18 inches. Although I am fully aware of the individual factors determining the outcome, I was hoping to gain 2 cm per side without loss of mobility.
A: Unfortunately with the techniques that are available today clavicle lengthening of 1 to 1.5cm per side is what can be reasonably expected given the restrictions of the soft tissues of the shoulder girdle. I would be more enthusiastic about the procedure if 2 to 2.5vms per side could be consistently obtained in every patient.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,I’m a 25-year-old male living in Germany, and I’m reaching out to inquire about custom cranial implant surgery — specifically for occipital augmentation. I have a noticeably flat back of the head and would like to improve the posterior contour with a rounded, visibly projected occiput. My goal is to achieve a clearly defined, aesthetically curved occipital area — one that appears masculine and full, but still remains proportionate and natural to the rest of my skull and face. I am not seeking anything extreme — just a correction that brings balance and proper cranial shape from profile and 3/4 views. I also wonder if you believe a small augmentation to the upper back of the skull (top/vertex) might be beneficial to create a smoother, more continuous curve — or if occipital augmentation alone would be sufficient in my case. If possible, I would greatly appreciate your professional opinion on what you believe would work best for me based on a visual assessment — just from photos at this stage. I’d be happy to send profile photos, measurements, and undergo a CT scan if needed for evaluation.
A:Thank you for your inquiry and sending your head picture. Based on the attached imaging I believe this is the type of change you are seeking. As you have mentioned this would be a small augmentation to the upper back of the head. Imaging of your pictures is what sets the aesthetic goals. A 3-D CT scan is only the platform on which the skull implant is designed. The scan does not tell us what is achievable nor what your exact aesthetic goals are.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My goal is a slimmer, more defined face. I am primarily considering perioral liposuction.Not looking for a wider face by itself (so not sure about adding implants), but if adding width is a way to achieve thinness + definition, then jaw/cheek implants might be a consideration.
In general, I’m not 100% committed to any one procedure and try to keep an open mind to any procedure that might help me get closer to that goal.
A:With an already very lean face the benefits of perioral liposuction on its own would be very limited if much at all. A good facial reshaping concept to remember is that one can never defat their face into improved definition. That rarely if ever works because the cheek defatting procedures have limited or modest effects. Their best benefits are seen in the rounder fuller ace. In the lean face where very little cheek fat exists these procedures do not have great value, certainly on their own
To achieve improve definition in the lead face it would really require small implant augmentations of the corners (cheeks and jaw angles in your case) to do so. (see attached imaging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 29 year old female and have had temple augmentation with bone cement (hydroxyapatite) around 8 years ago. At the same time, I also had some of my brow bone burred down through a coronal incision (to get rid of that neanderthal look) and a brow lift to reattach the muscles and skin in a natural position.
I was initially very happy with the results, but over time the hydroxyapatite has somehow disintegrated and I am now back to having hollow temples (and a narrow head shape in general).
I am now looking for a more temporary solution and am thinking of temporal implants. Specifically, I am looking into custom-made temple implants starting at my temples and extending to the side of my head (I attach pictures of similar augmentations I found on your website).
Further, I am thinking about further burring down my brow bone bossing and – while the coronary incision is already open – potentially also reducing the radix of my nose (not sure if this is possible through a coronary incision though, but I thought this may be possible and would be really interesting to know). More precisely, I asked the surgeon back then to undercorrect the bossing and not lift my brows more than necessary as I wanted the most subtle of results. After eight years during which my brows have had time to drop again, I am now looking to redo this (but this time properly without undercorrection).
Before scheduling a consultation with you, I wanted to reach out and make a quick inquiry about feasibility and cost (I understand that this is very individual but a ballpark price would be really helpful to know whether I can afford surgery with you) to make sure that I don’t waste your time with an unnecessary consult. If possible, I would be really grateful if you could give me some initial answers on following questions:
!) Can the radix of the nose be shortened through a coronary incision?
A:Thank you for your inquiry in detailing your prior surgical history and present concerns. In answer to your specific questions:
1) You are referring to custom temporal implants that provide augmentation to the anterior and posterior temporal areas. Well such an implant would normally be placed doing an incision in the crease of the back of the ears of your existing coronal scalp incision provides unparalleled access for their placement.
2) since your first brow bone reduction procedure was done by burring the critical question is whether are the anterior table of the frontal sinus Will now permit more bone burning reduction or whether it is now so send that any further reduction requires a bone flap technique. Only a 3D CT scan, which would be needed to design custom temporal implants anyway, couldn’t make that accurate assessment.
3) Significant reduction of the high radix typically requires a bidirectional osteotome technique. One cut needs to be made from the internasal approach along the dorsal line and then a 90° superior cut either needs to be made in a percutaneous fashion or, as you have mentioned, from an existing coronal scalp incision. The coronal approach of course would never be used for a high radix reduction but in your case if brow bone reduction is going to be done this would be a convenient way to do the superior bone cut.
4) while a coronal incision does provide the opportunity for a brow lift I would be cautious about the mechanism by which that occurs. Hey Coronel brow lifts by removing a strip of scalp at the incision location. In other words one is going to sacrifice some hair to do it. It is hard for me to be enthusiastic about that concept. I would rely more on the effects of the implant augmentation and some internal suture plication to the bone rather than to sacrifice any hair for a modest brow lift.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello there doctor, is it possible to solve a case where the nose length is too long, creating a long appearance to the midface despite an ideal philtrum length? I have seen a couple of results that appear to have caused this apparent reduction using a technique called the quadrangular lefort 1, but I’m curious as to what your thoughts are.
A:In using the term nasal length you may be referring to the reduction of nasal projection. An increase in tip projection can certainly occur from a LeFort I Advancement as the underlying septum has been pushed forward driving out the lower alar cartilages. There are a variety of standard techniques in rhinoplasty for achieving tip deprojection.
But if you are referring to actual midface shortening in the answer is going to be no. There are no available techniques that are effective for creating an external reduction and midface vertical length.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, had traditional liposuction done to remove saddlebags. There was a massive amount of swelling and bruising afterwards, but as it went down it became evident that the surgeon removed way too much fat. He left with me two very large dents on the hips and a ton of excess skin on my butt that folds over the back of my thighs and bulges out on the sides. The surgeon denied there was a problem and said this was a good result. I knew that was not true so I consulted 2 other surgeons and both said additional liposuction, fat transfer, and a butt lift would be the only solution, but that would leave me with a large scar across my back. One surgeon said I didn’t have enough fat to fill in the dents, but I do have fat in my flanks and my lower butt and thighs. After much research, I found you and I’m hoping I’d be a good candidate for a lower buttock lift. My main goal for surgery would be to remove the lumps bulging out from the sides, fix the indents, and remove the excess skin. I’d also like the appearance of the gluteal fold to be fixed so that I don’t have a square lower butt with the fold extending all the way out to my thighs. I want the fold line to be much shorter and arch upwards, out towards my outer thigh (kind of like a boat anchor).
A:Thank you for your inquiry, detailing your surgical history as well as your present concerns to which I can say the following:
1) While a lower buttock lift is the only solution to your buttock sagging/ptosis I do have concerns about the location or appearance of the outer half of that buttock lift scar. If you look at where the greatest extent of your buttock ptosis is it is in the outer half more than the medial half. To adequately improve the lateral buttock fullness the scar line is going to have to come out of where your existing infragluteal crease is and make it very visible. (as you have aptly described as a boat anchor change) Also to get rid of that fullness it would have to go far more laterally than I think most patients would prefer. This does not mean that it cannot be done but you have to be mindful of a basic aesthetic principle and a lower buttock lift in you would be a classic example of it. Meaning many aesthetic surgeries are merely trading off one problem for another. Thus you have to be certain that you like the other problem much better than the problem that you currently have. Whether a visible scar or how your buttock appears now is better can only be a judgment made by you.
2) When it comes to filling in the dents/over resected areas I do not see where you have fat to harvest to have adequate volume for injection. But given the lack of any other treatment options, and being mindful of not creating additional over resected areas from the fat harvest, fat injections would be your only treatment option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Does skull reshaping make the head smaller?
A:Skull reductions are best thought of as contour reductions not as an overall head size reduction procedure. Skull reduction patients that focus on circumferential head measurements as the barometer for the success of the procedure will be disappointed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I like to know more information in looking to getting a reduction of my brow bone because I’m not happy with the appearance of my forehead. Thank you
A:Male brow bone reductions are different from feminizing brow bone reduction in three ways. First, males that are bothered by other prominent brown bones have significant protrusions and almost always require a bone flap production procedure. Secondly, the goal is not to completely flatten the male brow bone reduction patient but to leave some residual brow bone projection. Thirdly, and perhaps the most significantly, is the issue of surgical access. Where to place the incision for problem reduction in the mail is often the most aesthetic challenging aspect of the procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in cheekbone and jawbone reduction surgery. Am I a good candidate for this surgery?
A: Thank you for your inquiry and sending your pictures. The question is not whether these facial bone reduction procedures can be performed on you, as they can, but whether in so doing they can achieve your aesthetic objectives. While most patients would say they want a smaller face it is important to recognize that the thickness and laxity of the overlying soft tissues will impact how such reductive changes are seen.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. I had a PEEK implant operation on the right side of my jaw on November 2024. This was for the correction of a slight asymmetrical jawline. I feel like everything is healed, but it seems like the masseter muscle is too high up, not where it is supposed to be. My doctor said that the muscle will get stronger over time and move down to its natural position. Is this true, or is there a possibility that the masseter muscle was displaced during the PEEK implant operation?
A: By description you likely have masseter muscle dehiscence, where the insertion of the masseter muscle ligaments have become detached from the bone as a result of the pocket dissection for the implant placement. As a result the muscle retracts upwards from loss of its ligamentous attachments. The muscle is ‘not going to get stronger and move back down’….that makes little biologic sense and is not an anatomic reality.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Now taking another look at the morph of nostril narrowing and mouth widening, im thinking the change is quite conservative. Would it be possible to exceed those in both of the procedures?
A: The purpose of predictive imaging is to show patients realistic results and only show what I believe can be expected from the surgery. While more significant changes can be surgically done the risk of adverse/hypertrophic scarring escalates considerably.
There is a good guideline to remember about certain aesthetic procedures….it is better to have 2/3s of what you want with no complications than 100% of what you want with them. In this surgery scarring is the problem around the nostrils and the mouth corners in particular they can be very difficult to improve.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q; Dr. Eppley, I was looking around online for what the forehead bumps on my temples were and I found your websites which seem to exactly describe the shape as “Forehead Horns” and that you offer a Forehead Horn Reduction procedure. My forehead horns look extremely similar to the first picture you give on your website: https://skullreshaping.com/wp-content/uploads/2023/01/ba-Male-Forehead-Horn-reduction-dr-eppley.webp Reaching out to get an idea of how much this procedure would cost, potential scarring, and the recovery timeline. Hopeful for a response, Thanks and regard
A: Forehead horn reductions are typically done by bone burring if they are not too prominent and the bone is thick enough h to do so. Because of the need for linear access the small incisions needed to do each side can not be too far behind the frontal hairline.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, If an implant is done in the head are there any side effects?
A: When you say side effects that could mean risks associated with the surgery (e.g., infection)n or any adverse immunologic reactions from the implant long term. In the case of the latter that answer is no.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will webbed neck surgery fix my turkey neck?
A: In the webbed neck it is common to have a concomitant turkey neck on the front side…often associated with a short/weak chin. This can be improved with a chin augmentation and submental/neck liposuction. The webbed neck surgery will not by itself improve the chin/neck issues.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I was wondering if you could remove 8 cm off my shoulders? Thank you.
A: 8cm of bone removal can not be done for the clavicles. The most that could be done is 5 to 5.5cms.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. Is it possible to get nose tip rhinoplasty in boy at the age of 16 for purely cosmetic enhancement (nose tip is slightly bulbulous, not severe or anything close case). If so, is parents agreement needed? If this cosmetic procedure is not possible at this age, then can I plan the surgery for future and get it done as soon as I turn 18?
A: Having a rhinoplasty under age 18 requires parental consent.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, im currently questioning about the possibility to remove some “extra” bone in the sides of my skull, easy example of a person who has the same thing as me would be Tyler Steinkamp. Is this even possible? Looking to hear back from you!
A:When it comes to reducing the width at the side of the head it is about muscle removal and not bone. This is a procedure known as temporal reduction. The temporal bone is very thin well the temporal muscle is usually thicker than the bone. Thus successful reduction of the side of the head comes from removal of the posterior portion of the temporal muscle. How that applies to you I cannot say until I see a front view picture of your head.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I’m interested in chin implant. his is the picture of a longer chin that I like.
A: For vertical chin lengthening the options include a custom implant or a vertical lengthening bony genioplasty. However the aesthetic outcomes of these two choices are quite different. If one needs 5 mm or less of vertical chin lengthening then an implant will be adequate. However when more than 5 mm is needed, and that is clearly what your ideal picture shows, one needs a vertical lengthening bony genioplasty. The change from your chin to that of your ideal picture is in the 8 to 10 mm range.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I met with another doctor in FL and he talked about side by side testicle implant procedure, but my testicles are 2x3cm currently and he recommended 4x5cm and I am concerned I don’t have enough skin to accommodate both without forcing my current testicles into my abdomen or possible ending up with a very uncomfortable situation.
You lay out the risks, but go into wrap arounds so I thought it might be a viable option for me as a 61 year old (not as active as a young man may be; more aesthetic for me)
Let me know your thoughts, just trying to be practical and not end up with an uncomfortable situation
A:Thank you for sending your pictures to which I can say the following:
1) For a side to side testicle implants approach to be effective they would need to be larger and the 4 x 5 cm implants recommended to you.
2) While I can appreciate your small and tight scrotal skin envelope the complications of pushing the testicles into the abdomen or causing chronic discomfort due to compression our testicle implant problems that I have never seen,
3) that being said I would agree that if you were to do anything the wraparound implant approach would be preferred over the side-by-side technique.
4) The wraparound testicle implant approach is a very clever concept for testicular enhancement and, although I am the one that has developed it, I remain very cautious about its use. It is associated with a not insignificant rate of postoperative separation of one or both of implants from the natural testicle. That problem seems to have been improved by making implants based on an ultrasound assessment of the exact natural testicle implant size so the inner chamber of the implant matches closely to that of the natural testicles size. Well this appears to have lowered the risk of that problem it does not make it zero. Thus any patient considering this approach must be accepting of this risk. In addition even though implant can be placed back over the testicles in a secondary surgery the rate of re-separation remains high and I do not view that as a viable solution. Therefore the operation either works or it doesn’t.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, when doing my research I’ve seen studies indicating facial bones stop developing as early as 16 but some doctors say in the mid 20s. My question is what age do regions like the mandible, brow ridge and zygomatic bone stop developing because unless there is major growth why do you have to wait before putting on an implant. My final question is ever since I started boxing at around 15 i noticed my brow ridge has become more prominent is this due to bone remodelling due to external forces. Many Thanks.
A: In answer to your facial bone development questions:
1) Waiting to put in implants until age 18 or older is more about psychological concerns and not about bone development. I think once you get past age 16 unless the bone deficiency is minor (1 or 2mms) I don’t have any concerns about implant on subsequent bone development.
2) It could that the frontal sinus is becoming more fully pneumatized (developed) rather than a reaction to the trauma of boxing.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m writing with regard to the sliding genioplasty revision that I was discussing with Dr. Eppley a few months ago. I would like to do this, but I have a question about removing the surgical steel wires that were used. I am experiencing nerve pain and numbness on my lower lip and chin, and I wonder if removing the wires could help with that. I wonder what the best timeline would be. Should I have the original surgeon remove the wires as soon as possible, and allow time to heal from that before doing the revision with Dr. Eppley? Or, would it be best to wait and continue healing and have the wires removed at the same time as the revision with Dr. Eppley? The surgery was done last June, and the step off is visible on my right side. My original surgeon wants to do a revision genioplasty, but I’m not sure he will be able to correct it, and I don’t think I can risk worsening the nerve pain. He is alternatively offering to do a fat transfer to the step off, and to only remove the wires. I have a pretty pronounced inferior border that sticks out, and I also wonder about burring that down a bit before the step off is filled in with the gortex strips. I wonder about additional cost for removing wires, as my original surgeon will charge only the surgical center fee. I apologize for the long email, and appreciate any feedback.
A:When it comes to the wires used for a sliding genioplasty they usually are placed nowhere close to the mental nerve. Persistent numbness and discomfort after sliding genioplasty like you have described is more likely a reflection the original bone cut and the surgery required to do it. Thus I would doubt that the wire removal is going to help much in that regard. However I have not seen a postoperative Panorex x-ray to confirm if that statement is accurate. Fat transfer in general is often not a great treatment for a bony deformity. However if your economic commitment is low to have the wires removed and the fat grafting done I do not think there’s any harm in doing so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can you please tell he what size implants I can go up to? I am currently 1050ccs and would like to go to 1500cc to 1800cc if possible.
A:Using overfilled saline implants the actual volume increase you can reach can be precisely known until you are actually doing it. You reach the maximum stretch/tightness of the breast tissues with the placement of the volume and then you have to stop. It is possibe to go from 1050 to 1500…most likely. Will you reach 1800ccs…I doubt it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi there I am interested in getting more information on your back lift surgery and, potentially, your waist line narrowing procedure and a rhinoplasty revision. I have horizontal stretch marks on my back that I would be looking to cover up with the vertical scar as I understand skin must be excised with the procedure. Is the vertical line typical in your back lift surgeries? Further, with the waist line narrowing procedure, I would like to discuss the risks associated with this procedure. Finally, my plan is to have a rhinoplasty revision which I understand sometimes involves using ribs depending on the procedure. I’d like to have the information to form a plan appropriately while weighing the risks associated with all procedures. I have already had a few cosmetic procedures. I look forward to speaking with you soon.
A:The vertical backlift is an excisional concept for lower torso/waist narrowing when excess back skin in particular exists. The indications for the procedure is if such excessive skin is from weight loss or liposuction….although some may just have it naturally. It differs from the more common horizontal or bra line lift which removes skin horizontally across the back which has a very different torso tightening effect. Through either type of backlift rib removal can be performed.
The key question in your case is what is your primary objective? While horizontal skin stretch marks may get removed in the process that would be an incidental effect and that alone would not serve as the reason to do the surgery given the scar tradeoff.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
