Your Questions
Your Questions
Q: Dr. Eppley, I am interested in the facial feminization procedures of Forehead Brow Bone Reduction, Zygoma Reduction, and Jaw Reduction I was about to have these procedures done by a well-known FFS plastic surgeon on the east coast. But my trans friends’ results were either very bad or unnoticeable after 6 months of recovery. My friends felt like the surgeon had his students do the procedures.
I’m hoping to have very good and noticeable results with you.
A: Thank you for your inquiry and sending your pictures. When it comes to your brow bone-forehead reduction I believe that will create a very noticeable change as seen in the attachment predictions. But when it comes to the lower 2/3s of your face there are some significant limitations in potential reductive effects due to your thick soft tissue layer over the bone. Cheekbone reduction osteotomies combined with buccal lipectomies and perioral/facial liposuction is needed to make for any visible change for the middle face. However, your wider and vertically shorter face poses a real challenge for changes in the lower third. The good news in that regard is that the chin needs to be lengthened and brought forward (mini V line surgery) which will help the most for making the lower face a bit thinner. While the jawbone behind it is wide the thick masseter muscle and overlying soft tissue poses real limitations of any visible results done to the bone. The width of the jaw angles and the masseter muscles need to be thinned as a combined effort, which will help, but it will never be as narrow or ideal as you would ever like it to be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 19 year old girl who are planning facial contouring surgery. After reading a lot of reviews facial sagging was a big problem for cheekbone reduction surgery. In one of your article you said that sagging can be prevented. I saw a lot of type of method for cheekbone surgery. I am not a doctor hence it is hard for me to say which is better and which is not. Can you recommend me a method which can prevent any soft tissue, skin sagging. Someone advised me, if i get to choose best method and take good aftercare then there would be no sagging. Is it true. Can there be no sagging at all. After the surgery what should i do to prevent from sagging.
Thank you,
A: The risk of soft tissue sagging after cheekbone reduction is always possible no matter what technique is used to do it. That has to be an acceptable risk if one is to consider having the surgery. No surgeon can ever tell you that it can never happen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Over ten years ago I was diagnosed with bilateral viral-induced brachial plexopathy. This resulted in loss of function and the eventual atrophy of my deltoid muscle groups. I have perhaps 50% recovery on my left side and 0% on the right. I have no functional limitations. I did have a fat grafting (24 cc) procedure done last year to the right deltoid area. The improvement was minimal.
A: Thank you for your inquiry and sending your pictures. That is certainly a most unusual medical event and the first I have seen such in the shoulder area. While fat grafting is always the first treatment approach it would be difficult to get much of a result with only 24cc of fat injected. Your probably needed at least 50 to 60cc at a minimum. But moving beyond fat grafting the definitive deltoid augmentation procedure is implants. Normally in typical aesthetic shoulder augmentation deltoid implants are placed under the muscle. But whether that would be possible with such deltoid muscle atrophy, particularly on the left side, I can not say just by looking at pictures. But deltoid implants can also be placed on top of the muscle under the fascia as well.
Such deltoid implants would have to be custom designed due to the differences between the two deltoid muscle sizes. This is actually done by making drawings over the shoulder areas and then taking measurements of them. I usually have the patients draw on themselves and take their measurements of length and width of the resultant footprint of the implant shape. We would obviously havhe to account for the differences in the two muscle thicknesses.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Thank you for reading my message. I am curious what solution, if any could achieve a specific type of width reduction in the lateral temporal cheek area with a concave curvature below the cheekbones and above the jaw angle to create a more heart shaped face. Basically I want use a cheekbone implant combined with some sort of soft tissue manipulation to pull back/up the skin to highlight the skeletal structure and reduce the fullness in this area.
I have attached three reference images to illustrate my goals.
One image shows me squinting to accentuate the cheekbones while applying a small amount of pressure with my finger in the temple/masseter region to very gently “push in” or pull back the skin and simulate a roughly .25 inch/6mm reduction in width with a concave curvature to highlight the skeletal structure to create the heart shaped look.
The second image shows me squinting but without applying pressure with my finger, which shows the normal state without the width reduction or concave curvature.
The third image shows a patient who has undergone masseter reduction with Botox which achieves this exact width reduction/concave curvature below the cheekbones that I’m looking for.
The problem is that I don’t have particularly large masseter muscles. I am assuming mine are “average” and are roughly ~12 mm thick, so if they are average in size they would need to be reduced in thickness by roughly 50% in order to achieve the 6mm reduction I’m seeking. I’m not sure how anatomically viable this is.
I also understand that the ramus portion of the jawbone sitting underneath the masseter muscle is extremely thin and I’m assuming it would not be feasible to shave this area of bone very much or at all without compromising the nerve running through it.
In summary I’m trying to figure out how to create this .25 inch/6 mm width reduction with a concave curvature below the cheekbones given my skeletal/soft tissue profile? Would cheekbone implants be be sufficient to pull the skin to simulate what I’m doing in the over by pressing my finger? Masseter muscle reduction? Liposuction of the lateral cheekbone area? Could a mini-facelift pull the skin back slightly to highlight the skeletal profile?
Is this achievable at all?
Thank you again for reading.
A: The facial reshaping effect you seek is not going to come from a masseter muscle reduction as that is not the area in which you are indicating. That is the parotid gland/SMAS area above the level of the bulk of the masseter muscle…and you are obviously not going to do a superfical parotidectomy to achieve that effect. An aggressive buccal lipectomy that gets the pterygoid extension and a SMAS excision in front of the parotid gland…..with cheek-arch implants will likely achieve that effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Your blogs were really helpful and made understand more about surgery. I am interested in cheekbone reduction. But i do not want flat face , i still do like cheekbone curve. But my cheekbone is way too big so i just want to reduce it little bit and make it look aesthetically pleasing. First is my face, second and third are my goal. One thing i am afraid is skin sagging. Since i am 20 many surgeons said i will not sag but reading your blogs i nderstood anyone is in risk. I read usually ligaments do not re attach to the bone and it droops down. I heard ligaments, soft tissue heal in 12 weaks if we take good post care then ligaments can attach back. Is it true?If i do not talk, make facial expressions in 12 weeks would my soft tissue attach back? If not how can i prevent from sag? Would ligaments attach back? Sorry for long questions. Thank you.
A: Thank you for your inquiry. What you are describing is a modest cheek bone reduction of perhaps 3 to 4mms per side. As you have stated in your inquiry the risk of cheekbone reduction osteotomies for soft tissue cheek sagging can never be completely zero…no matter what technique is used. I think what you are saying is correct in that if you get out 3 to 4 months after the surgery and no soft tissue sagging has occurred then it probably will not occur later. Facial expressions after surgery will not effect whether soft tissue sagging occurs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,for the submental chin reduction why do you prefer to do the incision under the chin vs inside the mouth?
I’ve read other surgeons have used rib bone for the maxillary augmentation curious on why do you prefer to use eptfe implant material?
Thank you for your help and time.
A: In answer to your questions:
1) Chin reductions done intraorally have a very high risk of soft tissue sagging and can not manage the soft tissue excess that results from reducing the bony support of it. From a submental approach both bone and soft tissue excesses can be removed producing a better result. The tradeoff, of course, is the fine line scar under the chin.
2) Rib grafts can be used for midface augmentation and I have done so numerous times. Usually, however, patients don’t want the scar and recovery from doing the rib graft so the vast majority of patients choose an implant. But the decision between rib graft vs implant midface augmentation is a personal one and that is up to the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, So I’m currently doing some research on different places where I can get a Forehead Reduction/Recontouring done. And I just wanted to ask what is the average cost. I understand that it depends on how I start off but if I could just get a rough estimate that would help a lot. I am an out of town patient. So what can I do if I were to come to your practice.
A:You are correct in that not knowing what needs to be done it is hard to provide an accurate cost of the surgery. Usually when a female uses the term ‘Forehead Reduction’ they are referring to a frontal hairline advancement. Then when the term ‘Forehead Recontouring’ is used, whether it is male or female, this typically refers to bony reduction. Thus when you use these two terms together this implies a combination frontal hairline advancement with bony reshaping. I will assume that is the procedures you need to achieve your aesthetic goals until told otherwise.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello again, I first reached out to back in 2013 (inquiring about correcting my ocular Dystopia in my left eye.
I feel I’m ready to finally have the procedure done.Attached Image on the Left was in 2013 , image on the right was a few months ago.
As I mentioned before this has always effected my confidence and has been a large contributing factor to the depression I struggle with.
You said I you felt you could improve my situation and that from the photos it appears that I have 3mm to 4mm of dystopia. Since last we spoke I’ve reviewed your website and noticed that plastic inserts are sometimes used to raise the orbital floor. I’ve also read in some cases you also lower the higher eye in addition to lifting the lower one.
Two concerns that I have is that in addition to the lower position of my left eye, my tear ducts are also not aligned, would this cause a separate issue as that is fixed tissue?
Also the shape of my right eye level slants up toward the inside where my left slants down. I’m concerned that if we are able to raise the eye, this might actually make things worse due to the eye lids also being different.
Does that make sense?
In addition to the eye surgery, I’d like to consider having my chin corrected to be more symmetrical as well. It slants (left) to the side of my lower eye.
A: Thank you for your repeat inquiry as I still have your initiual inquiry and picture on file from 2013. In answer to your question:
- It does appear that the left eye is a few millimeters lower than the right. It would take a 3D CT scan to confirm what the actual differences are. Most patients get their CT scans in their local area but one can also be obtained here.
- You are correct in that the tear duct position is fixed.
- In almost all cases of VOD surgery the eyelids/eye corner must be addressed at the same time. Moving up the eye will make the overlying soft tissue asymmetries more apparent.
- Most VODs do not exist in isolation. They are often part of an overall facial asymmetry in which other facial features have differences as well. Your chin would be an example of that more global facial asymmetry effect. How best to correct that would come from information obtained in the 3D CT scan.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin implant performed about 6 months ago and the tightness/ stiffness persists. If I talk more during work, sing or make more movement with my mouth, my chin starts swelling up again and the stiffness increases. The middle area of my lips is still numb. At this point, I’m really doubting whether the stiffness/ swelling will ever resolve. Appearance-wise I think it looks fine but truly the discomfort is causing me to want to have my chin implant removed. My questions are:
1. What are the side effects of implant removal?
2. Will there be sagging/ ptosis of chin after removal?
3. The numbness was probably the most bothersome for me after the chin implant was performed and the recovery was very slow. Will removal of the
implant cause a new loss of sensation all over again?
4. Would scarring/ capsule have developed within these few months and can cause cosmetic irregularities in the chin?
5. When I make an upward movement with my lips, I can see a ridge/ bumpiness along the labiomental fold where the incision is. Will that remain or get
worse after implant removal?
I would greatly appreciate any answers to my questions!
Many thanks!
A:In answer to your chin implant removal questions:
1) The only side effect from chin implant removal, besides the loss of chin projection, is whether soft tissue chin pad sagging will occur.
2) Always assume there will be post removal saggjng and then hope that it does not occur.
3) Removal of the chin implant will not cause an exacerbation or recurrence of the menal nerve numbness.
4) A capsule forms around every implant in the body very quickly after surgery so you do have one for sure. But that is the least of your concerns and is not the source of any subsequent irregularities of the chin
5) I don’t think any bumpiness along the labiomental fold will get worse with inplant removal.
While not one of your questions, it sounds like you had an intraoral chin implant placement and it is likely the implant is sitting high on the bone…which would account for every symptom you have described.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was curious about buccal fat removal and other suggestions to remove “baby face”.
A:Thank you for your inquiry and sending your pictures. Most ‘baby faces’ are really a combination of excessive soft tissue and weaker facial skeletal support. While fat removal (buccal lipectomy and perioral liposuction) will make an improvement it is important to realize that these changes will be modest and will not make a dramatic transformation. But for many this can be a good and fairly straightforward starting point with little downside to see how much improvement can be obtained from soft tissue reduction alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what are the procedures needed to correct vertical orbital dystopia? Will just putting an implant under the eye alone work?
A: I use a 6 step approach to VOD correction. Step 1 = placement of custom orbital floor-rim implant to raise the eyeball up. Step 2 = transpalpebral brow bone reduction to raise up the lower than normal tail of the brow bone. Step 3 = drill hole lateral canthoplasty to raise up the lower eye corner position. Step 4 = transpalpebral brow lift to raise up the lower eyebrow through the upper eyelid in the bald/shaved head male where traditional browlifting techniques are not good options, otherwise an endoscopic browlift technique is used, Step 5 = spacer graft to the lower eyelid to support the middle part of the lower eyelid in a more upward position. Step 6 Upper eyelid ptosis repair, needed as the eyeball moves but the position of the upper eyelid will remain the same if not treated.
This comprehensive approach to VOD is necessary as just raising the eyeball alone will create other undesired changes around it if the posiions of the eyelids/eyebrows are not addressed. It would be like raising the window frame but keeping the shades in the same place. It is easy to get focused on the custom implant because it takes more than that to imporove the overall eye asymmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’d like to inform myself whether it’s possible to dissolve the fat pads by the mentalis muscle in the middle of the chin (it makes my chin look square) – or, if it’s necessary to shave the chin bone, and why those fat pads would be needed.
A: The mentalis muscle fat pads can not be dissolved or removed. They are not traditional fat and access to them surgically would result in muscle and nerve dysfunction. They exist not as a metabolic type off fat but to permit muscles to move unaffected by the adjacent muscles…much like that of the buccal fat pad. Chin bone modification is the only approach to desquaring the chin. (narrowing genioplasty)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a full skull reduction and hairline lowering procedure. I have always had an issue with my large head and I do want to make it smaller. In addition, is it possible to make my face less wide as I feel like the sides of my face are chubby? With both surgeries, do you think I will be able to receive a significant change in my head shape? I have put a black line on where I would like my reduction results to be. If not, what would you recommend? With my larger forehead, Im not really sure what head shape I have. Overall, I just want to have a nice head shape for my facial features as I feel like my head shape doesn’t compliment it.
A:Thank you for your inquiry and sending your pictures. When it comes to skull reduction and frontal hairline advancement surgery, because of the different incisions needed for both they are contradictory to ever being performed together. As a result you should focus on the frontal hairline advancement. Once any incision is ever made behind the frontal hairline the hairline advancement can never be subsequently performed.
For the frontal hairline advancement the degree of advancement you are showing would require a first stage scalp expansion. Your scalp is too tight to ever move that much on its own. The first stage scalp expansion is also best for the frontal hairline scar. I suspect that when your hairline is advanced and the amount of forehead show reduced your head shape size will no longer be an issue.
As for ‘chubby’ cheeks typical defatting procedures of buccal lipectomy and perioral liposuction are performed for that type of facial fullness reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I figured that I would check with you to be on the safe side about root canal treatment. I had a scan done when I was looking into getting a missing tooth replaced. They informed me that I have an infection above another tooth and suggested that I go to another dentist and get a root canal. I wanted to check with you to be on the safe side since my premaxillary implant is in that region.Is there anything that the doctor should be aware of.
A: Having to get a root canal and having an implant in the immediate overlying area is extremely pertinent. Because they have to give local anesthetic injections there are two considerations:
- There is a very good chance that local anesthetic injections may not work as they rely on diffusion and the implant will likely block it from having an effect. If you look at a picture of the general area where the implant is and the location of the tooth in question (right upper canine) you can see that they are ‘neighbors’.
- There is an equally good chance that the local anesthetic injection will be injected right into the implant, which besides not having it work, could get the implant infected.
Thus it would be prudent that I speak to the treating dentist so they are aware of this issue and devise an anesthetic approach that will work as well as avoid causing an implant infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 29 years old. Used to weigh 320lbs but now about 230-235. I have been doing bodybuilding and competitions for at least the last 5-6 years. I stay around 12-18% body fat yearly. But no matter how clean I eat, or strict my workouts are I can only see my abs when I’m down to 3-5% body fat. Would ab etching benefit me?
Here are the pictures per request. Interested in ab etching.
A: Thank you for sending your pictures. Abdominal etching is unique in liposuction because it does something that is not done in any other form of liposuction…the removal of fat to deliberately create a contour depression. (in this case the etch lines) One of the basic principles of success in liposuction surgery, abdominal etching included, is the ability of the skin to shrink and contract down around the areas where the fat is removed. Your abdominal skin is challenged in that regard because of the weight loss where much of the elastic fibers in the skin have been irreversibly stretched out and the ability of the skin to shrink and contract has been compromised. (as evidenced by the stretch marks)
Theoretically abdominal etching in you should not be that successful because of the condition of your abdominal skin. I suspect what that really means is you will get some improvements but one should not expect typical well demarcated etch lines to appear from the procedure…. probably more of a hint of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been meaning to get a vertical lengthening chin implant and I’m looking for a 8 mm vertical increase. However, I think the biggest on-shelf VLC implant only provides 6 or 7 mm vertical increase. I was wondering if it is possible that a VLC implant can be customized to provide 8 mm vertical increase or is 7 mm the maximum?
A: There is a reason no standard chin implant exceeds 7mms in vertical length…as that is about the limit of how much the chin bone can be expanded by an implant and still get the soft tissue chin pad over the end of the implant during closure. Whether the additional 1mm of increase would be excessive is hard to predict before actually placing the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I can do fat transfer into breasts and buttocks at the same time?
A: You can if one has enough fat to do so but that would be very unlikely after concentration of the fat aspirate. For the vast majority of patients they have just enough fat that devoting it all to one site (buttocks or breasts) is usually what is done. It would be exceptionally rare that any patient would have enough fat to harvest to treat four ‘mound’ areas in a single surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In shoulder widening surgery does the slope of the shoulders change?
A: In clavicular lengthening, regardless of the angulation of the clavicle, there is a direct translation of the bony lengthening to the bideltoid width. Because the clavicle is not a straight bone but an s-shaped bone, lengthening it widens AND pulls the shoulders back a bit. (desloping if you will) This is the reverse effect of what is seen in clavicle reduction where the shoulders narrow and slope in a bit because of the bone’s s-shape curve.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if you guys have ever experienced a patient that had undergone a sagittal crest reduction at your clinic if he (or she) ever got hair regrowth as a result from it, did you guys ever experience such a case? Like lets say for example a person that was experiencing hair thinning or male pattern baldness and after the surgery he started to grow his hair back.
A: That I have not seen or been told by any patient that it has occurred. Nor would I expect it that biologic reaction to occur. The skull bone and its shape has no influence on hair growth in the overlying scalp.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My past history of testicle enlargement, I had surgery to get his XXL size cup style implant in 2015 and everything was great for about a year then the left on fell off the testicle. I had another surgery to fix it in 2016 and the same thing happened again in 2018 and then again in 2019. My right testicle has never had an issue with the implant coming off, but it is an odd shape and pretty hard. I am on TRT and have been from the age of 28, I am now 50 and not sure if that maybe part of the issue. I have spent a lot of money on this. I am really interested in your largest wrap around style implant. I have a lot of room in my sac and believe it would work. I would really like to hear what you think and see what all the costs would be to get the procedure. I live out of state and would like to come home a day or two later if possible. Thank you in advance and CAN’T wait to hear your thoughts.
A: In my custom large testicle implant experience the wrap around style for the properly selected patient can be very successful. However how that implant style might fare in a scarred scrotum where testicle implants already exist as replacements I can not say as that situation has not yet arisen. (until your inquiry) Whether it would be the ultimate solution or turn into another eventual ‘problem’ (back out of the implant) can not really be predicted.
The only sure bet in your situation, in which I imagine the natural testicles are fairly small due to TRT and age is a side by side technique. Using 7.5 cm testicle implants that would overwhelm/camouflage the existing ones removes any risk of the implant complications you have already incurred or may occur with any future enveloping implant techniques.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Have you had cases where any of your scalp bone lowering surgeries such as “sagittal crest reduction” , “Sagittal Dimple Correction” or by making the scalp flat at the top caused hair to regrow with people that had male pattern baldness?
Because i think that scalp bone growth plays a huge role when it comes to male pattern baldness and me myself i suffer from scalp bone growth like extensive sagittal crest growth and at these same spots it looks as if male pattern baldness occurs.
Have you had reports and results from people that they also got hair growth after having had a surgery for scalp bone lowering?
A: Your question is a good one and is not the first time this conjecture has been posed. Unfortunately no patient has reported to me that hair regrowth has occurred over any area of skull reduction to date. This does not mean it may not have occurred, just that it has never been brought to my attention.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Zygomatic Sandwich Osteotomy. I want to know, if you need to cut through any muscles or shift their position or reattach them in this procedure?
A: In the ZSO procedure the osteotomy cut is done just in front of the anterior tendinous attachment of the masseter muscle…so no muscles are detached or need reattached during the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, in regards to shoulder widening surgery by osteotomy. Does the sagittal split osteotomy + oblique osteotomy require a bone graft from the body or just putty? And how long will the patient be in a sling?
A: In answer to your shoulder lengthening questions:
1) Bone putty is used not an autologous bone graft.
2) I don’t put patients in arm slings.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello you will find two pictures attached My head circumference is 62 cm Please tell me about realistic results That are possible. I had one doctor who told me at the forehead and back of the head its only possible to grind down a maximum of 5 millimeters which wouldnt make a big difference about the look.Thats why im curious.I really want to let do my forehead and back of the head to make the head as a whole look smaller.
A: The only way to absolutely tell how much skull thickness can be safely removed are x-rays. A plain lateral skull film will show the three layers of the skull bone from which it can be determined the actual millimeter thickness of removal possible. But that being said I have outlined on your picture what I am certain can be removed based on my skull reduction experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m primarily interested in getting custom infraorbital-malar implants to gain a positive eye vector and positive/neutral canthal tilt. Is this achievable? I really like the androgynous pretty boy aesthetic, so I would want an implant that could provide me with a mildly angular, fuller feminine high cheekbone look.
My secondary concern, is having a more define jawline. As I mentioned, I really like the androgynous look so I was wondering if I could achieve with implants a more prominent jaw angle from the side, while also decreasing the “square-ness” from the frontal view with a little bit of frontal growth.
A: Thank you for your inquiry and sending your pictures. In answer to your questions:
1) To achieve the best orbital-midface effect it would take a combination of custom infraorbital-malar implants with lower eyelid reconstruction with spacer grafts and lateral canthoplasty.
2) When it comes to the jawline I believe you are referring to a custom jawline implant design that has a chin component that creates a less square/more round appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I live in the UK and am interested in having thigh /calf / and buttock implants. I’m a 40 year old male and have done weights for years to no avail. and have always been top heavy with a fair amount of muscle mass, and would like information on the procedure. I would like to know if multiple operations can be done at once.
A: Thank you for your inquiry. In looking at buttock/thigh/calf implants the first concept to understand is that these three body implant areas pose formidable challenges when it comes to recovery. None of them are easy recoveries and the concept of putting them all together is not an option. Even any of the two body areas put together I would be very hesitant to do particularly in an international patient. To even conisder putting two body areas together one would have to be here for 30 days to ensure an adequate fumctional recovery and assurance that the osyt common complications are avoided/managed.
The ‘easiest’ of the body areas are calf implants followed by thigh implants and always the most challenging are buttock implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to achieve an ultra-feminine body type and get my ribs removed (3 each side if possible). I want to narrow the waistline, maybe liposuccion on the flanks, and add hip implants if it’s possible to get large ones. From the side I love the look of my butt implants. However, from the front my body is still sort of boxy and I’d like to change that to achieve an hourglass shape. My ribcage is square shaped and so are my hips so these are the 2 things I’d like to target to achieve the most radical results possible in one surgery.
A: Thank you for your inquiry and sending your pictures. Certainly the three lower ribs per side can be removed and flank liposuction done to maximize the waisltine reduction. Large hip implants in particular have a high rate of complications (chronic seroma, edge show), particularly in thin patients, so I can’t encourage their placement at this time. They have a much higher rate of problems than buttock implants and the complication rates between them are not comparable due to the different types of issue pockets.
Regardless I wouldn’t do rib removal and hip implants at the same time as that is a very hard and unnecessary recovery. So you maximize your waistline reduction first and then make the decision about hip implants later. Other than the fine line scar rib removal has had almost no complications in my experience. So you get that benefit first before ever considering a final hip implant procedure where the complication risk is much higher.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my only question for you at this stage is with regard to recovery time from getting pectoral implants – I’d like to know how much time I’ll need to plan for the various stages of practical recovery (casual movement, normal return to work for a “sit at my desk and wiggle a pen” computer job, and return to regular exercise and activity). I’ll have my family available throughout recovery, so I’ll have no problem with support during the trip recovery time, I just want to plan accordingly.
A: In answer to your pectoral implant recovery questions:
1) Like breast implants I don’t restrict arm movement after the surgery.
2) I don’t see any reason you would not be at the computer within days after the surgery.
3) Exercise and more strenuous physical activities will take up to 4 to 6 weeks after surgery to resume.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would assume the placement of a new testicle will warrant an orchiectomy, correct ? Does that mean the patient will therefore be infertile ?
A: With a wrap around implant style the testicles are maintained and they are encircled by the implant. No one is going to do an orchiectomy merely to have larger testicle implants placed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a male fitness competitor and I am interested in the surgery to remove the ribs, I would like to reduce my waist to the maximum, what are the costs of the operation and the results ??? Can I also do with the muscle that I marked in the picture ??
A: Thank you for your inquiry and sending your pictures. It is hard to predict what effect rib removal surgery would have in a male because I have never had such a request before. Thus I can only theorize about its effects which I would assume it would be similar to that in a female particularly a female body builder to which I have done one such patient. (which in her was very effective) As for the muscle to which you refer that is the external abdominal oblique. Some of that muscle can probably be removed from the same incision as that used for rib removal.
Dr. Barry Eppley
Indianapolis, Indiana
