Q: Dr. Eppley, I am interested in having the following procedures done:
* Ear surgery – ear pinning + fix right ear that sits lower than left ear or fix left ear that sits higher than right ear + improve general appearance of ear cartilage
* Blepharoplasty – lower eyelid of my left eye (when I smile, it creates a prominent bag under the eye – not the case with my right eye though)
* Septoplasty – nose veers a little bit to right (possibly due to deviated septum)
* Rhinoplasty – remove slight bump & also looking to have a thinner nose
* Lip augmentation – improve general appearance
* Liposuction under chin – just to get rid of dreaded dubble chin
* Other possible procedures (if doctor recommend them): cheek implants, jaw implants and chin implant – I would like to have more masculine facial structure
Other possible procedures, if you offer them: tear trough implants, cheek lift
First pic: how I actually look
Second pic: alterations I made to my face on your website (not perfect, just played around).
A: In answer to the facial procedures:
1) It is possible to raise an ear .5 to .75 cms but it is not possible to lower an ear. Ear pinning or antihelical fold setback can effectively reshape the outer ear cartilage.
2) The ‘bag’ of the left lower eyelid is hard to appreciate in your non-smiling views so I am not sure if it is a skin issue or a fat issue.
3 and 4) A septorhinoplasty is needed to straighten the nose, reduce the bump and have a thinner tip.
5) To make that amount of lip augmentation change, you would have to think about fat injections even though their survival in the lips is anything but assured.
6) Submental liposuction can be done but, more importantly, significant chin augmentation will eliminate that concern on its own. Cheek and jaw angle implants would be complementary to the chin and, in your thin face, would make it very sculpted and angular.
7) Cheek implants will obviate the need for a cheek lift. Tear trough implants can be done to fill out the under eye hollows.
Dr. Barry Eppley
Q: Dr. Eppley, I believe you are a real specialist in the matter of lips aesthetics and procedures and will greatly appreciate your advice if I should undergo a lip lift or fat transplant. Temporary fillers don’t work for me. I have attached some pictures from different angles for you to see the shape of my lips.
A: Thanks for sending your photos. I think they illustrate well your longer upper lip and you have always illustrated to some degree the effects of a subnasal lip lift. I think you are a good candidate for the procedure. I think with your vertical upper lip length that you are much better off with a lift rather than fat injections. Also the result from a lift will be more predictable than with fat injections. Fat injections also will not shorten your upper lip length nor will they create a more prominent cupid’s bow. This can be done under local anesthesia in the office as I do many isolated lip lifts that way. The biggest issue is the fine line scar along the base of the nose but if well placed it fades very nicely and quickly. (a few months)
Q: My friends had fat taken from her stomach and put into her upper lip lines. Is this a procedure you do or recommend?
A: The search for a long-lasting injectable filler to the lips has naturally led to the use of one’s own fat. Even the thinnest person has a little bit of fat which can be harvested and recycled to the lips. In injecting fat to the lips, one accepts two caveats with its use. First, it is good for bulk filling (making the lips overall bigger) but is not useful for injecting into individual lip lines. It is not like synthetic injectable fillers which are injected using very small needles and can be selectively placed into a line as thin as the width of the needle. Fat is injected with a very large needle as the material is quite thick and does not come out in a true linear flow pattern. Secondly, its take or how well it survives is unpredictable. While the theory and expectation with its use is some or complete permanency, that outcome varies amongst different patients. One can not predict whether any one specific patient will have a long-lasting result. My experience has been to overfill (which can look really overfilled with the lip swelling that happens from the procedure), taking into account that there will be some fat resorption. By three months the size of the lip, and the amount of remaining fat, will then be permanent.
Dr. Barry Eppley