Your Questions

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

Q: Dr. Eppley, I would like to know if the temporal constriction/reeduction is feasible. My forehead and the left and right sides of my skull above my ears are wide, which makes my head bulky in a beatle or tie. Maybe the temporalis muscle resection isn’t going to be as effective as I’d like. The hair transplant was done but made it look bigger. Is it possible to reduce the width of my upper skull by bone grinding or excision?My CT is attached to the file. Thank you very much.

A: Thank you for your inquiry and sending your pictures. The traditional temporal reduction procedure is done further back than you have illustrated, that is why it is called the posterior temporal reduction. You are illustrating an anterior temporal/bony temporal line/side of the forehead reduction…which can be done but requires a coronal scalp incision to do so. The key to the anterior procedure is the large amount of muscle thickness that has to be reduced and not the bine which is quite concave underneath it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is it achievable via liposuction or removing of excess skin to get a uniform “smile” gluteal fold across both glutes. This problem has deeply affected my self esteem and i am looking for someone with experience in correcting the issue with beautiful results. Your response and considerations will be greatly appreciated. 

A: Thank you for your inquiry and sending your picture. What you are seeking is to have a uniform infragluteal crease on both sides. Right now you have a partial double fold, a higher medial partial crease and a lower complete crease.

One can not liposuction between the two and create a single infragluteal crease. This is often tried but never works. Rather this requires an excisional approach where the skin is removed along the lines of the existing two creases and put together into a single crease. (lower buttock lift/tuck) Whether the resultant scar to do so would be viewed as a worthy tradeoff is patient dependent.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a lip lift done last year in which 11 mm of skin was removed from my philtrum, which was 24 mm, and I’m wondering if there are any procedures that could be done, for example tissue expansion or skin grafting, that could add some mm back to the philtrum. 

I scar pretty well so I’m willing to risk a potential scar to restore the proportions and function of my face and philtrum.

A: There is no lip lift reversal procedure…short of a skin graft which would produce unacceptable scarring. This is why in a lip lift the amount of tissue removed should be cautiously done as there is going back. You can always do more but never can less be done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a very serious facial problem, the left side is different from the right, and the left eye is smaller than the right and the mouth goes more to the left. Please let me know if you can perform surgical corection. Thank you

A: Thank you for your inquiry and sending your pictures. You have classic congenital facial asymmetry which is superiorly based which is why your lower eye/VOD is the most visible part of it. (VOD = vertical orbital dystopia = lower eye) The VOD can be effectively improved usng a 3D CT scan of the patient’s face to create a custom implant that raises the eye which also needs to be accompanied by upper and lower eyelid/eyebrow adjustments to go with it.

Correction of the VOD is the most significant way to untwist the face/lengthen the shorter side. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I read about your procedure to shave a Subcostal Rib Protrusion. I had a trauma to my left rib. After it fully healed there is a pointy protrusion that interferes with laying on my stomach or side on hard surfaces (like yoga, Jiu Jitsu, or even just crawling under a car to work on it). 

Can you tell me how often you have done the surgery? Do you have any before and after photos? What is the recovery time? How bad is the scarring? 

Thanks 

A: I have done a handful of subcostal rib protrusion patients…all with the same history of trauma. Usually what occurs is a disarticulation of the costochondral junction with a resulting protrusion of the more mobile cartilage side. You are correct in that the protrusion can be be reduced by shaving of the cartilage to make it more level with the bony side. I would need to see a picture of the chest wall protrusion to confirm this supposition based on your description of it. The scarring from the surgery is very small as the surgery uses the ‘mobile window’ concept. There are no physical restrictions after the surgery as you can not harm the surgical site. There will be some expected soreness and it usually takes about a month until one can comfortably return to any form of strenuous physical activity.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the clavicle lengthening procedure and have several questions about it.

1. What is the overall cost of the procedure? 

2. Will the bone restore the full diameter after a complete recovery or will the bone remain thinner in the expanded area? 

3. How long after the surgery will I be able to do sports again involving overhead movement? (For example lifting weights, basketball or swimming) 

4. How long will I have to stay in the U.S before returning home? 

5. During the recovery process, is it possible to use the arms for a few times a day, for daily uses like using the bathroom or showering? 

6. How exactly will the surgery change the proportions of the body? Is there a visible difference in shoulder width and will it change the shoulder to hip ratio? Are the surrounding muscles going to stretch, widen and change shape? (For example the chest) 

Thank you for your time. 

A: In answer to your clavicle lengthening questions:

1) My assistant will pass along the cost of the surgery to you layer today.

2) The bone should approximate the normal thickness of the clavicle once it it fully healed.

3) It would 3 months after the surgery until I would recommend returning to strenuous sports activities.

4) It would be reasonable to fly out of the country within 7 to 10 days after the surgery.

5.) The protocol is to generally limit significant arm elevation for a few weeks after the surgery. There are some obvious activities of daily living that you have to do.

6) The operation creates a visible increase in shoulder width of about 1″ per side. This causes no muscle dysfunction anymore than if you pull your shoulders way back now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in chin reduction of soft tissue chin pad with no bone removal? I was wondering if I could get a chin reduction of the soft tissue chin pad only with no bone removal…my bone is fine. I just have a lot of chin pad..looks like a ball on the end of my chin…I hate my profile and I will never take pics because of this…Thanks so much!

A: In ‘fleshy’ chins reduction of the soft tissue chin pad is the definitive treatment and is the only method to reduce the chin prominence. In some patients no chin bone needs to be removed if the soft tissue chin pad is loose enough. In other cases a little bone is removed to allow the reduced soft tissue chin pad to close properly without undue tension on the incisional closure. That is an intraoperative judgment but the role of bone removal, if needed, is to allow more chin pad to be excised.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I came across your website while searching for skull reshaping solutions. I was interested to know a little be more about sagittal skull reshaping. The back of my head and a bit on the top are flat. I had 2 questions: 

1 – Are you the only people in the country that perform such a procedure? Is it something invested here? I ask because I am from New York and I am having a tough time finding a clinic here. 

2 – Is this a relatively new procedure? Are there any long term studies on any negative effects? 

Thank you!

A: Thank you for your inquiry. In answer to your skull reshaping questions which appears to be an augmentation issue of the crown area of the skull:

1) I can not speak for whom else may perform such skull reshaping surgery. It is not information I would know.

2) I have performed such skull reshaping surgeries for decades. Technology has changed but the basic concepts of the procedure are not new and I have taken techniques and technology rom reconstructive craniofacial surgery and applied to aesthetic head shape concerns to develop a whole niche area of plastic surgery heretofore not previously developed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, i am interested in rib removal. I am a fitness trainer and I need a narrow tail. What is the effect after the treatment plus wearing a corset? Is it possible to reduce the lateral abdominal muscle ?? 

A: Thank you for your inquiry and sending your picture. Having done someone similar to you before, the combination of rib removal and some inward modification of the LD muscle over it will maximize whatever amount of waistline narrowing that is humanly possible. The wearing of corsets after rib removal surgery is only recommended for the following two circumstances: 1) as a method of short term postoperative maximal compression to get rid of swelling or 2) to be used in conjunction with rib osteotomies/fracture to help shape the now mobile lower ribcage as it heals.

While a section of the external abdominal oblique muscle can be removed, this requires a separate incision to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, At the age of 42 I have decided to get testicular implants. As it is purely for aesthetic purposes my approach is: go big or go home. So I have decided on an implant  size of 7cmx5cm. We have decided on orchiectomies for both testes which will be followed by hormonal replacement. I am writing to you due to curiosity concerning two matters: 1- the orchiectomy ( should we re-explore just adding the implants (however there will be 4 testicles then) 2- what have been the largest testicular implants you have done ( if I’m going to go big, I am going to go impressive ). Regards

A: My suggestion would be if you really want to end up at 7cm or or even 7.5cm testicle implant size, you should at least place 5.5/6.0 cms implants at the same time as the orchiectomy. This will allow for a tissue expansion effect to occur or at least prevent significant scrotal skin retraction. This would then be followed by the larger implants 3 to 4 months later. It is important to remember that the the best time to place implants, particularly at the larger ‘extreme’ sizes, is in a non-scarred issue bed. 

The largest testicle implants I have done is 7.5cms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m hoping you can get back to me. Essentially my main issue is the lack of mandible width and asymmetry in my lower jaw. There is absolutely no definition and I have a long, narrow face. The other problem is that one side is a lot “worse” than the other, it’s as if my jawline goes into my neck. When I look around I don’t see anyone else with this issue.

I’d like to explore the use of filler or implants to add a considerable amount of width to make the jawline more “square”. (I’m not saying I want or need to achieve a supermodel look, I’d just like more width on both sides), and to also add “definition” and to “sharpen” the mandibular angle on the side/profile view (In other words… Make it actually visible). 

Can you tell me why exactly I look this way? Is it due to the shape of the mandible/the way it grew? A lack of fat/tissue? Both? 

The chin is also somewhat weak, and slightly more “recessed” on that same side mentioned, so I would consider the use of filler here as well (if I went that route) 

My concerns are that: 

1) I’m not sure if what I want to achieve is realistically possible with dermal filler (I know other options exist… Like implants) 

2) If it is possible, then roughly how much would be needed? 

3) Would it need to be injected along the entire “edge” of the mandible? Or can it be concentrated in one area to achieve the desired result? 

I think that is all I have for now. If there’s any other information or things to note that the doc can tell me, I would love to hear it. 

If you need any other pictures please let me know. 

Thank you for listening to, and reviewing my case.

A: Thank you for your inquiry and sending your pictures. What you have is a high mandibular plane angle deformity due to significant and asymmetric ramus development. This is not a jaw deformity you can treat very effectively by injectable fillers as the volume to do so is so high that it is cost prohibitive for most people and certainly not a long term solution. The best treatment is probably a sliding genioplasty combined with custom jaw angle implants. This provides good chin augmentation and also the needed jaw angle vertical length and width that is missing.

But first a 3D CT scan is needed to fully see the shape of your lower jaw. That visual information is invaluable in treatment planning.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello! I have a few questions about the waist narrowing procedure. How much inches do you lose off your waist? And is it possible that it will make your shoulders look too big? I have a big waist and not much fat, so liposuction wont work and was looking for a way to make my ribcage smaller. Can you also exercise after the procedure? 

Thank you 

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

1) Most patients lose in the range of 1 to 3 inches based on their body type.

2) I think it would be impossible to ever make someone’s shoulders look too big after any waistline narrowing procedure. That is giving more credit to the surgery that it is possible to achieve.

3) There are no physical restrictions after the surgery.

4) Whether this is a procedure that may be effective for you requires an assessment of a front or back view picture with computer imagng to show you what is possible with this surgery on you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering if a chin wing osteotomy is possible, after a sliding genioplasty was done? Was looking for someone in my area to ask about this but I’m not sure if there is anyone – maybe you would know. But either way I figured I would reach out to you with this inquiry as I see you have extensive experience with these types of matters.

Thank you for the info!

A: Suffice it to say that once the oblique bone cut is made from a traditional sliding genioplasty the ability to do a chin wing procedure is then lost.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am currently scheduled to have a consultation regarding shoulder narrowing and rib removal surgery. I wanted to ask if it was realistic to talk about having facial feminization surgeries/procedures done during the same operation, unless the shoulder narrowing and rib removal surgeries are too demanding. I understand that computer facial imaging is required for FFS. So if it is possible to have FFS done during the other procedures, would I need to reschedule or schedule another appointment for more time? Currently my appointment is set to be a 30 minute consultation. I look forward to hearing back from you! 

A: We can talk about everything (face and body) during our consultation. In the properly selected patient facial feminization surgery and body contouring procedures can be done at the same time. I will define what properly selected means during the consultation.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, How long does recovery take from masseter reattachment surgery, how many months for swelling, how many months till i will look normal etc.

A :In my experience actual masseter muscle reattachment surgery is often not advised as its success is so low. Camouflage with soft tissue implants is far more effective, can be done under local anesthesia and has a very minimal recovery. How that may or may not apply to you would require a picture assessment of the soft tissue contour deformity of your jaw angles. (clenching and non-clenching pictures) But in actual masseter muscle reattachment surgery the success of the procedure can be fairly well judged by 6 weeks after surgery when most of the swelling has subsided.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, had a chin implant inserted a couple months ago and the result is not what I’m looking for – it widens my lower face too much and does not give me the vertical length that I was hoping to achieve. I’ve attached a few pictures of my current face with the chin implant. I would like to remove the chin implant and do a sliding genioplasty instead. However, I do like the profile projection that the implant gives me and would like the genioplasty to give me the same projection. 

Additionally, I would like to do a T-Shaped Osteotomy for a V Line chin.

A: Thank you for your inquiry and sending your pictures. I believe you are correct in that removing the chin implant (will reduce the width) and replacing it with a lengthening/narrowing form of bony genioplasty will add length and be able to restore the lost projection of the chin implant. (although I don’ know what that is currently) The combination of bony lengthening with advancement will create more of a tapered appearance which would be enhanced by adding a 4mm midline resection.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the skull reshaping surgery. I really don’t know how to explain it. The photos are a better demonstration. It’s like around my temples and upward it’s “caved in” or like slants not really sure how to describe. I have already submitted the consultation form but there was no photo upload option so I’m sending this one also thanks. 

A:Thank you for your inquiry and sending all of your pictures. They illustrate well your concerns, an anterior temporal-lateral forehead deficiency. One treatment option is fat injections as they offer the least invasive approach. The issue with fat injections is how well they will survive but it is a valid treatment option. The second approach with assured volume although more invasive is the placement of custom anterior temporal/lateral forehead implants with the goal as seen in the attached imaging prediction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have already undergone an ablation of the frontotemporal muscles of the skull to obtain a cranium of less wide appearance combined with a fracture of the zygomatics but I would like to know if it is possible to carry out a bone cranioplasty which will consist of cutting the bones of the skull and to file them to then reattach them with small vices because I find that my skull has not sufficiently lost in width with the procedure of removing the temporal muscles and I would like to be able to file the bone directlyIn advance, thank you for your answer.

A: I am not sure what you mean by ‘ablation of the frontotemporal muscles’ as this would imply electrocautery treatment to induce some muscle atrophy. This is very different and far less effective than temporal muscle removal techniques which create very visually effective head width reductions. So my first question is what was actually done and was the muscle reduction effect maximized as this will always be the most effective approach to skull width reduction. I would have to read the operative note to understand what was actually done.

That being said what you are asking is whether bone flaps can be created and pushed inward as a method to reduce skull width…and the answer is no in adults. The brain occupies the intracranial space and it requires the space that it now has. Any skull bone efforts that impinge on the territory of the brain (aka compress the brain in any way) has adverse medical consequences.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had bilateral silicone gel breast augmentation in 2013. I was listening to a blogger and the blogger said you’re not supposed to do certain chest exercises if you’ve had breast implants (i.e. push up and chest press).  I wants to know if there are certain chest exercises I am not supposed to do. 

A: I am afraid the blogger is passing along incorrect/uninformed information. There are no chest exercise restrictions after breast augmentation surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,What would happen if I get fat transferred to my scalp and end up getting fat necrosis?

A: Fat necrosis means the fat dies and is absorbed which means the procedure basically did not work….which is the risk of any fat transfer no matter where it is performed on the body.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I need a Chin ptosis correction Hello I had a chin medpor implant ten years ago. i decided to remove the implant with maxillofacial surgeon and this was the report. (Clinical and radiographic exam revealed : Poorly placed medpor chin implant. Based on that the patient underwent the following surgery under general anesthesia : -Removal of old medpor implant – Genioplasty advancement of 6mm. Intraoperatively it was found that the old medpor implant caused severe bone resorption in the area because it was not fixed in place. Following the surgery the patient was not happy with the final result) After that i went to another maxillofacial surgeon and he decided to make another surgery and this was his report: (Under GA nasoendotracheal tube previous chin plate exposed and found to be only 2mm advancement done in the previous surgery plate removed reduction Genioplasty 2mm anterior and 0 posterior of chin fixation with two L shape plate size 1.5mm in the thickness with 4 screws 6 mm in length). After 6 months i go back to him i was not satisfied with the result as you can see in the pictures drooping chin and drooping of the soft tissues in the chin pad when i smile. The doctor said i have two things First fibrosis and increased chin soft tissues. After the chin muscle droop it caused sagging of the tissues that the reason of the shape you have from the side view. I do not want just a surgical correction i also want an aesthetic shape if it’s possible .

A: Thank you for your inquiry, detailing your history and sending your pictures. You have chin pad ptosis but without lower lip incompetence. Presuming you are happy with your current chin projection the correct procedure would be a submental resection of the low hanging soft tissue chin pad. This would be the most effective procedure for eliminating the soft tissue chin pad overhang albeit with a fine line scar under the chin. If you are not happy with your current chin projection then I would need to see some x-rays to look at what has been done to your chin from the prior bony genioplasty procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like your advice. I had a rhinoplasty 5 years ago and along with that procedure the doctor recommended a sliding genioplasty which I agreed on. I believe he did a 5 mm advancement. He was an oral maxillofacial surgeon that fixed my sisters cleft lip. Well I recently got braces and the orthodontist became a little concerned and said my chin goes to the side a little bit. I see what he is saying and do feel it is a little longer on one side. Would this issue be able to be fixed or is it too complicated and not worth it? I actually really loved my chin before it was symmetrical and fit my face better I think. Do you think I should get it reversed? Or would fixing the asymmetry be safer? Not sure what to do or if I should just leave it alone all together. I have become self conscious about it and realized I only take pictures on an angle because of the asymmetry. I’ve attached my before and after pictures the before picture is the one with the mask haha I don’t have many pictures from that long ago. Your advice on this would be greatly appreciated! Thank you. 

A:Thank you for your inquiry, detailing your history and sending your pictures. Whether it is worth the effort to straighten your chin is a personal decision, not one I can make for you. What I can tell you is the options for improvement. First I would not completely reverse it because that may create another aesthetic issue….chin ptosis or soft tissue sag. Rather I would focus on straightening it which can be done one of two ways. Intraoral realignment of the bone or a submental shave technique of the asymmetric larger side. Further insight into which approach is better would require a look at an x-ray. (even a simple panorex would be helpful but a cone beam scan of your chin is most ideal)

Dr. Barry Eppley

Indianapolis, Indiana