Your Questions

Q: Dr. Eppley, I am interested in skull reshaping as well as jawline reshaping. Would insurance cover my surgery since it is due to congenital plagiocephaly? Also, any doctor in my area that you know of that could do the same surgery that I need? Thank you for everything you do.

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

1) It would be impossible to answer any of your questions without knowing what exact procedures that you need. What I could envision what they may be, I would need to see pictures of your face and a more specific description of the skull and facial asymmetries that you have. Skull reshaping and jawline reshaping are broad terms that apply to a variety of different procedures.

2) Only the insurance company can say whether any of the proposed procedures would be covered. To make that determination the treating physician would have to file a predetermination letter complete with a 3D CT scan (to show the deformities) so they can pass judgment on the operative plan. At best, it would be a 50% or less chance that they would cover any of the procedures.

3) Without knowing the exact problem and the needed procedures, I could not say what expertise exists in your geographic area. Skull reshaping and jawline reshaping are very specialized areas in plastic surgery that very few plastic surgeons do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in essentially reducing my mandible to a more “V” shape, and the only place I could find that does this procedure is in Thailand (which, is alright, I have the resources to get there. But I’d feel more comfortable with surgery in America). I wanted to know if you knew anything about this surgery and if it would be possible for you to do? My second question would be how far you can go with a chin reduction. I have a really prominent chin and it’s completely destroyed my self-confidence, it’s hard not to be when you’re called Jay Leno as a young teenager and being told you have look like a man. I’d love to get a more feminine, small chin that is in proportion with the rest of my features. I do have example pictures of chins I love and I have to wonder if it’s even possible for me to get that type.

A: These are procedures that I do all the time so I am quite familiar with what can be done and can’t be done with them. You can not achieve your desired chin reduction based on where you are right now. You may be able to get about halfway there between what you have now and those images. The fundamental problem is the soft tissue excess, that is the major limited factor. I can reduce the bone all I want but the overlying soft tissues have to adapt to it to be seen. Too much reduction and the soft tissues will just hang or sag, a worse problem than where you are now. There are two fundamental approaches, intraoral osteotomy reduction with muscle tightening or submental extraoral ostectomies with a soft tissue tuck-up. Each has their own advantages and disadvantages. I would recommend a phone or Skype consultation to discuss further.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in changing my round face to a more shapely one. I have attached a photo of myself for you to show my very round face which I want more V-shaped. My perfect outcome would be something like Kelly Rippa, which is probably impossible, but at least I can dream!My main questions are do you actually break the jaw and how long until I could return to work? I have seen some of your other work and have been very impressed so I know you can help me.

A: It is always good to see what changes other females have been able to achieve in terms of facial reshaping, but each patient is unique. In looking at your picture that you sent, it demonstrates two particular facial features of interest in terms of trying to achieve your facial reshaping and jawline enhancement goals. First, your lower jaw/chin is stronger rather than weaker. It is always ‘easier’ to create a V-shaped face in weaker jaws than stronger ones. Augmentation of the jawline is always more successful than reduction in facial narrowing/reshaping. This means that you would require chin reshaping either through an osteotomy or a submental approach where it is shaving down to more of a triangular shape. Which approach is better for you would depend on seeing some additional photographs from different angles, particularly a side view. Secondly, it is clear that you are older than in your teens or 20s and you have some facial skin laxity or looseness. This is relevant on how the skin will facial skin will respond when there is less support. That is an important consideration to take into accountwhe considering what procedures would be best. You may require some form of jawline tuck-up with chin/jaw reshaping but until I see additional photos I can not be clear on this need.

Dr. Barry Eppley

Indianapolis, Indiana