Your Questions
Your Questions
Q: Dr. Eppley, I am interested in getting a significant augmentation rhinoplsty done using rib cartilage. I have a very specific goal and look that I am after and I have attached a powerpoint presentation to show what I want to achieve. I have chosen many noses that I look and don’t like. I want to be as specific as possible as I want to avoid a revisional surgery at all costs and don’t want to be disappointed in the result. Please review these presentation and tell me what you think.
A: Thank you for sharing the powerpoint presentation. I don’t think anything you could say says it better than these pictures. My general comments about achieving these aesthetic goals are important for you to understand.
Rhinoplasty surgery is nor like Photoshop and there are a lot of other variables, other than how much cartilage graft you insert, that influences how the result will look. There is the thickness of the nasal skin, how well it reacts to injury and shrinkage, the fact that there is an internal cavity with two skin-lining openings, how well any grafting shapes and takes etc. Nasal goals are much more difficult to achieve particularly when the goal is model pictures that have been photoshopped. (most plastic surgeons cringe when they see a photo album of model pictures) While it is important to have ideal goals, the variables of the nose make that a difficult challenge particularly when the changes are going to be dramatic. I think it is important to realize one of the realities of rhinoplasty surgery…the need for revisional surgery is not rare. No one wants to have it…the patient doesn’t, the plastic surgeon doesn’t…it is disappointing for all involved. But the simple reality is that no matter how well planned and executed any rhinoplasty surgery is done…it does not always turn out perfect. The more lofty the goal, the harder it is to achieve. Rhinoplasty surgery is simply not a 1:1 ratio of change to result in every case. I emphasize this point to you, not exclusively because of your attention to detail, but because the tip area of the nose can be very unpredictable as to how refined it can become…and that is a very important aesthetic goal of yours.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My brows and eyes give me a cold look and I’d like to have a softer image. I am consider getting brow reshaping, but what else can be done to improve my appearance. I have attached a front and profile picture to see what you think can be done.
A: Thank you for sending your photos. I would not disagree that your brow bone shape and promience do give your eyes a bit of a harder look. While the brow bones can be surgically reduced, there is always the tradeoff of a scalp scar to do it. That can be a precarious trade-off in men based on their hair pattern, density and potential hairline instability. I am niot ruling it out for you but I think there are other facial issues that I think would be equally, if not more effective, that can be done with no such trade-off. Your prominent nose and short chin create a significant amount of facial imbalance. Their alteration by reduction rhinoplasty and chin augmentation puts your face in better balance and would help to give your face less of a cold look. I have attached some imaging to see what you think of the nose and chin changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m going to ask you a question you probably heard 10000 times. What procedures do I need to perform in order to get “the male model look” and look handsome? I think(I may be wrong) I need: Skull Reshaping, Cheek Augmentation, Chin Advancement, cheek and chin;jaw/mandibular Implants, nose rhinoplasty; lip reduction; Neck Contouring; I’ve attached a few photos of me. My face looks fat. That’s because i have about 20 pounds of excess fat.
A: You are correct in assuming that I have been asked that question a lot….and have subsequently done a lot of male facial sculpting surgery. In getting a better balanced and more defined facial shape in a male, there is a list of procedures to consider most of whom you have mentioned. But each face is different and therefore has different needs to improve its proportions and get closer to a more sculpted look. There is also the issue of priority and the associated cost to do them so making the proper diagnosis as to the anatomic problems is extremely important in surgical procedure selection.
Your most glaring anatomic problem is your severe lower jaw/chin deficiency. A short lower jaw makes the entire lower face both horizontally and vertically short. This is what contributes to your impression that your fat is fat…it is not. It is just that the lower 1/3 of your face is overpowered by the upper 2/3s. This is further accentuated in profile by a moderate nasal hump which makes the facial convexity worse.
Your most important procedure is to get the lower 1/3 of your face in proportion. This is beyond what a chin implant alone can do. You really need a chin osteotomy (sliding genioplasty) combined with a small square chin implant placed in front of it. Removing your nasal dorsal hump would then complement your facial profile. (see attached side profile prediction) These are the two most important procedures. Secondary consideration could also be given to cheek implants. (see attached front view prediction)
While some other procedures may be complementary, this is the foundation for helping you get closer to more of a ‘male model look’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my jaw is small, not much of a jaw line, and have a slight receding chin. Wondering if an implant could achieve a balanced/symmetrical look or if I should pursue Orthognathic Surgery. Interested in Rhinoplasty as well. How long would recovery time be? Would the implant be permanent?
A:In looking at your pictures, I see no evidence/reason to pursue orthognathic surgery. Such jaw surgery is only done when there is a major occlusal (bite) problem which I suspect you do not have. Your facial balance could be improved by chin implant augmentation only. Chin implants are permanent and will never need to be replaced. I have done some imaging of that result which is best seen in side profile. You may also benefit from jaw angle implants for increased lower facial width. But I will await your response to what a chin implant alone does for your jawline. From a nose standpoint, your tip and nostril area is larger the rest of your nose. (out of balance) A rhinoplasty that focuses on narrows the tip cartilages and nostrils with a slight dorsal reduction would make a better balanced nose. I have done some imaging of that potential result which is best seen in a front view.
I would anticipate that recovery, from a return to work and not obviously looking like you have had surgery, would be 7 to 10 days. It would take the final shape and form of the nose and chin up to 3 months after surgery to have subtle changes in swelling to resolve and to see the true final result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m unhappy with my asymmetric face and would like to have a nose job and chin implant to correct it. Would it be possible to correct it with standard Medpor chin implants? Which chin implant it would suit to me better to correct it and can I get a view how would I look after these changes to my face.
A: Thank you for your inquiry and sending your pictures. I have done some imaging on your nose and chin. Your rhinoplasty is straightforward, meaning that tip shortening with narrowing and a little lift and dorsal line straightening with narrowing of the upper nose with osteotomies would be done. Your chin is severely short and I could argue that an implant is not the best choice given the limits of how much horizontal advancement can be obtained with off-the-shelf implants. (only up to 10mms) But I have imaged what I think the most that a chin implant can achieve. When it comes to chin implant type, there are advantages and disadvantages to either silicone or Medpor materials. While some surgeons and patients get focused on their theoretical biological differences, I have never found them to be distinctly different in that way. I am more interested in what styles and sizes of chin implants the various manufacturers offer. In your case, I would likely choose a two-piece square chin Medpor implant of 11mms horizontal projection.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am a 21 year-old make who is trying to achieve a more dominant facial structure. I like the square face more than the oval shape that I have. I would also like a smaller nose feature and more open eyes. I have attached pictures and am open to your suggestions.
A: In listening to your concerns and looking at your pictures, you have the following aesthetic issues:
1) A long and wide chin. This makes your face appear long and oval. In short, it is too vertically long.
2) Your eyelids show a medial epicanthal fold, which is very similar to that of Asians. This makes your eyes look tired/droopy.
3) Your nasal tip is just very slightly long.
To make the facial changes you desire based on these concerns, I would recommend the following:
1) Vertical Reduction of chin by osteotomy (7mms) with slight advancement. (2mms) This could be combined with jaw angle implants. Together this shortens your face and make sit more square.
2) Medial epicanthoplasties to get rid of the overhanging eyelid fold.
3) Tip rhinoplasty with shortening and narrowing of domes and nostril width narrowing.
I have attached some imaging to show what changes these procedures may create.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to have the following done for ssome facial changes:
1) upper lip lift to reduce the distance between the base of my nose and upper lip (lip to nose ratio reduction by more than half my current natural lip to nose ratio) I am a fan of the lip to nose ratio as typically seen in women even on men as well.
2) I would like also a reduction in the bottom lip to the size of my top lip
3) I would like profile surgery, in specific mouth protrusion surgery to westernise the protrusion of my mouth which as you know is commonly seen in Asian and african americans. I understand there are implants and other methods used to achieve a western profile.
4)I would like a medium chin implant to improve my profile, more projection towards the bottom, when carving the shape of such implant, please note the design of my beard which I purposefully shape especially toward the bottom to almost mimic or complement the shape of my cupids bow along the border of my top lip. We can obviously discuss this more in detail if there are any misunderstandings as to the shape chin I am going for. You can best describe such shape as masculine and very edgy.
5) I would like an implant to give more height to my nasal bridge, with a tip that more length and projection without making the nose appear from the frontal view to be more bulky and thicker than its current state.
6) Finally a resection or crescent-shaped or wedge alar flare reduction to address nostril flare. We can discuss what options would be best, maybe an alar suture cinch procedure or wedge resection.
7) Remove fat underneath chin area.
8) Please use computer imaging for what potentially can be done as a valuable tool for us to communicate.
A: Thank you for your inquiry and sending your pictures. Let me respond to your 8 issues/concerns as follows:
1) A subnasal lip lift can reduce the distance between the upper lip and the base of the nose, but not by half. That is too much and would create a very unusual looking upper lip. As a general rule, I reduce it either by 1/4 or up to 1/3 the vertical distance as measured along the philtral columns. This provides reduction but keeps a more natural look without the upper lip looking like a snarl.
2) The lower lip can be reduced by an internal horizontal wedge excision at the wet-dry vermilion line. Most lip reductions can reduce their size by about 1/3.
3) I am not absolutely sure what you mean by ‘westernized mouth protrusion surgery’ but I think you may mean paranasal base augmentation to help improve the concave profile around the base of the nose and the upper lip.
4) Your chin is horizontally deficient and an improved shape could be obtained by a chin implant that provides 7 -9mm increased projection and a more square shape.
5) A rhinoplasty using an implant for dorsal (bridge) augmentation as well as a columellar extension would help improve the nasal height and tip projection. This can also be done with a rib graft and their are arguments for both approaches (implant vs graft) based on their advantages and disadvantages.
6) Without question, the alar wedge resection for nostril narrowing is far superior to that of the alar cinch suture.
7) Submental liposuction for fat removal with the chin implant would be a good benefit.
8)I have attached some realistic imaging to give you an idea of what may be able to be achieved with these procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 55 year-old woman who would like a facelift to remove jowls and improve droopy neck. I also would like my nose done as the tip seems to keep getting lower as I age. (is it really growing at my age?) The question I have is the timing of the nose surgery and the facelift. Should they be done separately or together? If separate, should the nose be done before or after the facelift? My thought would be after because it give my surgeon a better idea to do the nose based on the new way my face looks.
A: You are correct in your impression that the nose is getting longer and ‘growing’. It does not actually grow per se but the tip of the nose does fall as the ligaments weaken. As the tip falls downward the nasal length increases and the nasolabial angle decreases. This means that a very simple tip rhinoplasty to elevate the tip and open up the nasolabial angle can be quite rejuvenating to how the face looks.
There are arguments to be made on both sides of that discussion either combining or separating a facelift and rhinoplasty. In reality, it is not necessary to look at the ‘new’ face afterward to figure out how to change the nose via rhinoplasty surgery. Therefore, I have found it best to combine the procedures for the benefits of one single surgery and recovery and lower costs. In addition, a rhinoplasty is a central facial surgery while a facelift is a lateral or side facial surgery. One does not really impact the other when it comes to facial appearance changes or swelling and bruising. Put together, however, the combined facelift and rhinoplasty procedure can have quite a rejuvenating impact on the aging face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, am very unhappy with the right side of my face. My face is assymetrical; the right side looks smaller, there is less volume in the cheek, and my right eye and eyebrow are lower than the left. Also, the right side of my lower lip is smaller than the left. I feel that the left side of my face is the “good” side. I am very self-conscious of my appearance and avoid having my picture taken. I also feel that my nose is fairly wide from the front, although my profile is not that bad. Most surgeons in my area seem to focus on anti-aging procedures. I am too young (31 years old) that the right facial volume loss is due just to aging. The fact that I have always slept on my right side probably did not help. Please let me know what procedures you would suggest. I’ve attached a picture of my face straight on and also one of my right profile.
A: I would agree with you that you do have some degree of facial asymmetry. All features you have pointed out I can see and agree that it exists. The question is given the asymmetry what is reasonable to consider to do for improvement. I would also agree with youir three procedures of interest. A small right cheek implant with fat injections to the submalar (buccal space compartment) and the perioral mound area are very straightforward low risk procedures that can occur from visible improvement. While asymmetry issues exist in the eyebrow area, I would live with those for now. From a nose standpoint, a tip rhinoplasty to narrow the tip would work nicely. I would leave your profile and the upper portions of the nose alone.
The only point in which I disagree with you is that sleeping more on the right side of your face would not have caused the problem. This is a congenital ‘deformity’ and is a result of in utero development not from postnatal molding influences.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 32 year old and about six months ago an ENT specialist diagnosed me with having a deviated septum. I have not had good sleep in about 15 years, because I have extremely restricted breathing. I do have insurance to cover the surgery but would prefer a plastic surgeon to perform the procedure, so that I may also correct a very large bump on my nose that I have extreme insecurities about. Do you know if your services would be covered by the insurance company? Also, is this a procedure that can be done if I am in my first trimester of pregnancy?
A: Your inquiry has two fundamental misconceptions. First, no elective surgery or procedure is ever performed on any patient who is pregnant. Pregnancy is an absolute exclusion for surgery and anesthesia because unknown and potentially deleterious effects on the developing fetus. Secondly, insurance does not pay for any external change to the nose such as removing a large nasal hump. That is cosmetic surgery and must be paid for as an out of pocket fee. Insurance will usually cover septoplasty and other functional nasal airway surgery but not for any rhinoplasty procedure. The two most certainly, and commonly, are done together but you will have to pay additional surgeon, OR and anesthesia fees for the cosmetic portion.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a straighter more refined nose and a stronger jawline. This may require a chin augmentation but I am not sure what I really need. I just want to look more refreshed and have a more attractive face. I have attached some pictures for you to see and give me your recommendations.
A: Thank you for your inquiry and sending your pictures. I have taken a look at them and can give you the following thoughts.
Your chin deficiency is as much a vertical one as it is a horizontal one. This can not be treated by a traditional chin implant as they can only provide increased horizontal projection. Vertical increase is very important in your chin augmentation. Either a custom chin implant needs to be fabricated or a chin osteotomy needs to be done. Either approach can be successful and I have done many both ways. There are advantages and disadvantages to either approach and they can be discussed in detail further by phone or by Skype.
Your nose shows a lack of tip projection and definition. The nasal tip is rounded and more ball-like. I do not see the lack of straightness in your nose that you have indicated in your inquiry. This can be improved by an open rhinoplasty with the use of a columellar strut graft alar rim grafts and tip reshaping.
I have attached some before and after computer imaging to show the potential changes of the nose and chin based on these approaches.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to achieve a male-model look. I think that I have rather feminine facial features and I would like to look masculine. I was thinking about a square and a big jaw to match my high and curved forehead, a Rhinoplasty, Dimples, and high cheek bones implants. Do you think I will need anything else? I want to look handsome, a 1010 by most women scale. I don’t have a precise male model look that I thought of, but I guess I will choose the one that would naturally suit my face the most. What do you think, can we achieve it? Do I need all of the procedures I listed? Do I need any other procedures?
A: Thank you for your inquiry and sending your pictures. Let me first start off by making some general comments about structural facial surgery, particularly in men. The use of the term, ‘male model look’, really refers to creating some angularity and definition in the facial bone highlights and overall better facial balance and harmony of the features. This does not mean that one will ever look like a male model or may even be considered strikingly more handsome after such features. All plastic surgery can do is help a patient have better facial features and improve the facial foundation and the face that nature has given them. Therefore, while I understand quite clearly your objective and improvements can be made, I do not like young male face patients to have goals such as ‘male model’ or ‘I’ll be a 10’ after surgery. This is a setup for disappointment.
That being said, I will work on some computer imaging and show you what may be achieveable with a variety of procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I plan on getting a rhinoplasty, chin, cheek and jaw angle implants this summer. It makes sense to me to have them all done at once. I have limited time off from work and only have a few weeks to recover at this time of the year. The one plastic surgeon I saw said he wouldn’t do them all at once as it would be too hard on me. I am not sure what he is talking about as I am young and healthy. I am aware that doing more surgery increases the overall risk of potential problems such as infection, but are there other risks to be taken into consideration, such as blood loss, that I am not aware of? Do you think it is safe and reasonable to have all of these facial procedures done at the same time?
A: In my experience and practice, I routinuely perform three, four, five or more facial procedures at the same time. For the reasons you have mentioned, such as recovery and other considerations such as cost, it is desirous to do a ‘facial makeover’ as a single stage procedure. There are no increased health risks for doing combination facial surgery in an otherwise healthy person. Blood loss is not a concern. With that being said, there is one risk that occurs in multiple facial restructuring procedures particularly those that involve facial implants…an increased aesthetic risk of implant asymmetries and the need for revisional surgery. The more procedures you do, the more risk there is for less than perfect results. Each individual procedure comes with its own aesthetic risks which are increased as more procedures are combined. Patients need to appreciate that the likelihood of the need/desire for revisional surgery is multipled as procedures are combined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in reduction rhinoplasty, alar base reduction, cheek bone reduction, and jaw reduction. I have diamond face jaw bones and cheek bones which are prominent and also have a big nose with an asymmetric alar region. I need a beautiful symmetric face with small nose and beautiful cheeks. Do you think this is possible? I have attached some pictures for your review and imaging.
A: Thank you for sending your pictures. I have taken a careful look at them and have imaged an open reductive rhinoplasty. Your nose, as you know, is the largest feature on your face and is disproportionate in size to every other facial feature. While there is a limit as to how refined your nose can become given the thickness of the overlying skin, you most certainly can obtain significant improvement. When it comes to cheek bone or jaw angle reduction, however, I fail to see how those procedures will make any significant improvement. Your facial skin and tissues are too thick to reveal any bone reduction underneath. You are better off leaving the bone structure as it is to support the thick heavy overlying soft tissues. Your soft tissues will simply not permit a delicate and more refined facial structure that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have previously sent you photos of me for consideration of a rhinoplasty and a chin augmentation. You sent back some imaging results and, after reviewing them, I have a few questions:
1) Rhinoplasty – I like the overall effect! I just wanted to ask if there was anyway you could make the bridge a little more concave, and if it would also be narrower from the frontal view, and if the tip might be narrowed as well? I know you said that you usually provide an image of the minimum effect that could be achieved, and if this is it, that’s great – I’d still be happy with the improvement.
2) Chin – I think I like the implant a little more than I like the osteotomy, though of course it doesn’t fix the underlying skeletal problem. I might still consider the implant but I haven’t decided.
3) Cheeks – One more question regarding my “chipmunk cheeks”. While my friends and family call them “endearing”, I”ve always wondered if I couldn’t have a little less of a balloony cheek especially right below the corner of the mouth. Is there any way of filling in the tissue right at that spot, or (I guess) of removing fat from the cheek (though I do like my dimples!
Thank you for taking the time to answer my questions and being patient with me!
A: In answer to your questions:
1) Ideally I would like the front view rhinoplasty result to be more narrow, and it may be possible, but your thicker skin may preclude that from happening. For this reason, I have imaged it so that the amount of narrowing will reflect what I believe will happen… but I am pulling for more.
2) I would agree that the implamt effect, while not providing as much horizontal advancement as an osteotomy, seems to be more ‘natural’ looking. It is always best in chin augmentation in a female to be less rather than more. That still preserves a feminine look.
3) You are referring to what is known as the perioral mounds. a cheek fat area that is below the buccal fat pad. That can be effectively treated by small cannula liposuction done from inside the mouth.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr Eppley, I would like the fat tip of my nose made slimmer and the size of my nostrils reduced. While I like the shape of the upper part of my nose, the lower part is too big and disproportionate to how small the rest of my face is. Is this something that rhinoplasty can do, just change one part of the nose without affecting anything else? I do not want to change the shape or height of my bridge. I don’t know how difficult it is to just change the shape of the tip. I also fear that the tip could become too small and give me a reverse problem than what I have now. I do not want a petite nose with a pinched tip, just one still looks like me only in better balance. Thanks
A: Tip rhinoplasty is a very common nose procedure and only changes the shape and size of the lower third of the nose. Whether that will look more balanced without the need to alter any other part of the nose is best determined before surgery through computer imaging. You may very well be right but it can be surprising sometimes other areas look when one part of the nose is changed. Just be certain beforehand by some computer imaging work. It would be rare to take a big tip of the nose and make it too thin. (discounting Michael Jackson who had many nose procedures and is a result that should not be seen as the norm) Usually the question is whether as much tip refinement can be achieved as the patient hopes, particularly if the nasal skin is thick.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am pursing getting a rhinoplasty to make my nose look better. In fiddling with my own version of computer imaging, I have made some changes to my nose that I would like to get done. Are these type of nose changes possible? If so, Acne X Factor what type of rhinoplasty do I need? I know there are two types of nosejobs, a tip rhinoplasty and a full rhinoplasty. Which do you think is best for me?
A: I would not as a patient get concerned about the different types of rhinoplasties. The differences between a tip and a full rhinoplasty is somewhat artificial. The basic difference that separates the two rhinoplasties is that a more complete technique involves osteotomies or the narrowing of the nasal bones due to hump reduction or bridge modification. A tip rhinoplasty by classic description does not go past the lower tip cartilages. Regardless, many rhinoplasties incorporate techniques that borrow from each basic type of rhinoplasty making the surgical changes that each patient’s nose needs unique. Your attempt at rhinoplasty imaging is pretty good and I think that it is a fairly achieveable outcome. Hump reduction and tip narrowing and elevation are fairly standard changes that can make many noses look better. Your lack of thick nasal skin makes it also realistic that the alterations to the underlying cartilage and bone will be seen on the outside when the swelling goes down. You may call the type of rhinoplasty that you need a more complete one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have reviewed your rhinoplasty computer images of what my nose may look like after surgery. While I like the changes that have been done, what I would like to know is if my nose can get even a bit smaller than what you have showed in your imaged pictures?
A: When it comes to reducing the size of one’s nose, what limits the result is how much skin one has and its thickness. All of the maneuvers in rhinoplasty surgery are about changing the underlying cartilage framework. In reducing a large nose that framework is reshaped and made smaller. While the supportive framework of the nose can be changed, the final result seen will also reflect how well the skin shrinks as well. How well the skin contracts is key and the thicker the skin is the less likely it will contract as much as the cartilage has been reduced. The wild card in every rhinoplasty surgery is how the overlying skin will reshape to the new framework.
I try to show on computer imaging realistic results and often the most minimal changes that I think will happen. While anything can be done on Photoshop that does not mean it can be achieved by actual surgery. You should make a decision about whether surgery is worth it based on the least amount that can be achieved…not on the most that you hope can be accomplished. This is particularly true in reduction rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I’d like to get a more feminine face. I would like to reshape my heavy jawline and brow, correct the weak chin, do liposuction under chin and I would also like to correct any small asymmetries that would improve the appearance of my face. I have attached a front and side for your assessment of what can be done.
A: Thank you for sending your pictures. In looking at our face what is most striking are two things. First, you have a very strong facial structure as seen in your prominent brow bones and cheekbones. This upper part of your craniofacial skeleton is also broad as reflected in the wide base of your nose and its wide tip. Secondly, and in contrast, your lower jaw (mandible) is actually short both in the horizontal and vertical dimensions. This gives you the impression that your jawline is heavy, when in fact, it is really short which makes it wider than it is tall.
I have done some computer imaging projections based on what I think would make the most significant changes towards a more feminine face. These include brow bone reduction, rhinoplasty and chin augmentation. (both horizontally and vertically) One of the key components of this approach is that your lower face (jaw) needs to be vertically lengthened to change the shape of your face from square to more of an angular or triangular shape. Combined with reduction of the brows and thinning of the nose, your face will become softer and more feminine.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I went in recently for a consultation from an Indianapolis rhinoplasty surgeon. During the consultation he recommended a chin implant with my rhinoplasty surgery. While he seemed very honest in this suggestion, I was completely floored as I never thought I had any chin problem. I certainly didn’t think that I had a weak chin. Having had the idea settle in for awhile, I am now more comfortable that maybe I do need one. I like the way my face looks in every way except for my profile which is why I want my nose done. What I am concerned about is that the combination of a rhinoplasty and chin implant will change my face too much. I have attached a profile picture of me for your thoughts. What would you do if you were me?
A: It is not uncommon to perform a rhinoplasty and chin implant together and it can be a powerful changer of one’s profile. But whether it is aesthetically beneficial can actually be determined by you. Make sure that you have done a series of predictive computer imaging. Have shown to you how your profile would look both with and without a chin implant with your rhinoplasty prior to actually undergoing surgery. These images will answer your question better than anyone simply telling you one way or the other. One cautionary note, if you opt for chin augmentation your plastic surgeon needs to be careful about the style and size that is selected for implantation. You have a retruded but long chin. It would be easy to end up with too strong a chin appearance afterwards if the right chin implant is not chosen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to start by saying your website and blog have been so helpful as both a research tool and making me feel so much more comfortable in approaching this issue. It is one of the few sources I have found that really takes the time to properly explain things, that most people in plastic surgery don’t understand. I would like to have more balanced facial features and to improve my asymmetries to improve my facial appearance. I feel that I have a long lower face and chin compared to my forehead, which is very low and slopping. I can’t wear hats and have to spike up my hair all the time so I don’t get teased. I recently lost a lot of weight and with it my cheeks, with used to be very full. But I guess what bothers me the most is my nose – I have a deviated septum which makes me look crooked and my nose is very romanesque in appearance. I think that a rhinoplasty and cheek augmentation would help me best but I’m open to suggestions. I just want to be the most attractive me I can be. From my photos can cosmetic surgery help me?
A: Facial symmetry and proportion are the two most important components of facial attractiveness. In looking at your photos, I would agree that the deviated and dorsal convexity of the nose combined with flat cheeks are the two main areas to try and improve. I would propose a rhinoplasty whose objectives are to straighten the nose in the frontal view and bring down the dorsal line to one that is straight between the frontal-nasal junction and the nasal tip. The tip could also tolerate a bit of thinning as well. For your cheeks, anatomical style cheek implants secured high up along the flat malar prominence will bring some highlights to your midface and more angularity to your face.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 46 year-old female. I would like to get an upper and lower blepharoplasty. However, I have problems with my nose due to a sinusitis and a collapsed septum. I got an x ray last week and the doctor said I have a deviated septum as well as thickening of turbines. I have been on antibiotics for five days. This problem wears me out a lot. I am often tired with headaches and my face always looks puffy due to continous allergy symptoms. My question Dr Eppley is what do you suggest for me to have first or not to have- a Rhinoplasty/Septoplasty to correct the nose issue and then a blepharoplasty? Please doctor I would appreciate your advise. I found your website very helpful, thank you again.
A: There is no question that septorhinoplasty and blepharoplasty can be performed together. This is not a technical nor a safety issue. It is an issue exclusively of how much recovery do you want and how long can you tolerate (socially and workwise) the way you will look during this recovery. When combining rhinoplasty and blepharoplasty the swelling and bruising around the lower eyes can be quite severe, particularly when nasal osteotomies are performed. Otherwise, there is no reason why the two facial procedures can not be performed together. There may also be other advantages beyond one single recovery period for combining them, such as cost.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, The problem with my face is it’s very skinny when I don’t smile. When I smile I have the biggest fattest face ever! I have these fat pockets around my nose. And instead of a smile I look like I’m sneering. I was in an auto accident and it caused nerve damage to my left lip. I want to fix my smile so its even again and you can see more of my teeth. I also have a brow that I hate and would like to get rid of. I also would like some work done on my chin because I hate the way that looks. And also when I smile I have “jowls” and I’d like to get rid of those and my double chin. My double chin is hereditary and being tall and skinny this looks very strange. I would also like to get a nose job because I have my fathers nose and I think it looks very masculine. Overall what I am trying to achieve is a slimmer face, with more feminine features and a better more applying smile. I don’t feel like my face goes with my personality, and how I feel. Also anything else you see that needs to be done please let me know.
A: Thank you for sending your pictures. In looking at your face and reading your objectives I would consider the following procedures. A rhinoplasty is needed to make your nose thinner and less wide, particularly in the tip. I would also recommend buccal (cheek) fat pad removal (subtotal) and small cannula liposuction of the fullness above the nasolabial (lip-cheek) grooves. A lip lift (vermilion advancement) done with differential skin removal (left greater than the right) will help with better lip symmetry and overall fullness. A submental chin reduction is needed to decrease the amount of chin prominence and protrusion. Liposuction can be done in the neck and jowls to remove fat in these areas.
Unfortunately, I can only do limited computer imaging because your pictures are inadequate. Smiling photos make a lot of facial feature distortion.
You mentioned a dislike for your brows but I am uncertain what specifically you do not like about them. Until I know more, I can not make any recommendations on whether they can or cannot be favorably changed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 54 years old and am interested in getting a facelift, rhinoplasty, and blepharoplasty surgery. I’m trying to achieve a more youthful look, less sagging, and not so tired looking appearance. I have attached some pictures of me so you can show me by imaging what the results may be like.
A: Thank you for sending your pictures. Here is some imaging for the following procedures; a facelift (neck-jowl lift) and a rhinoplasty.You could get a really significant improvement in your neck wattle as it is a large amount of loose hanging skin. That would dramatically change your neck-jawline profile. It is interesting as to why you have such a large amount of hanging neck skin even though it appears you are relatively thin. Perhaps you have lost a lot of weight ?? Regardless a full facelift will remove inches of skin from the neck and tighten up the entire jawline.
From a nose standpoint, you tip is wide and thick and turns down slightly. There is also a small bump higher up on the nose. A full rhinoplasty would take down the bump, shorten and narrow the tip with some lifting and narrow the size of the nostrils. This type of nose change at your age changes the structure of the nose and makes it look smoother and more refined, a look that has a more youthful quality.
The combination of these two procedures, as the imaging illiustrates, would make significant rejuvenative changes to your overall facial appearance
As an addendum, I did not do nor is it possible to do realistic blepharoplasty computer changes. It is clear from the pictures that you have some extra eyelid skin that can be removed as well as some herniated fat from the lower eyelid. Your lower eyelid shows no significant skin excess, however, other than a few millimeters. Together, this type of upper and lower blepahroplasties will make you look less tired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to get rid of the little bump in my profile, and I’m wanting to smooth out my nose. It looks really bumpy in pictures and it usually looks bad in certain kinds of lighting. I would really love my nose to look anything like these celebrities: Carrie Underwood, Lauren Conrad or Blake Lively. I think their noses are great but I don’t know if they would look good with my face.
A: In looking at your pictures, your nose is bumpy because of the disproportion or asymmetries between the three regions of your nose. Your upper nose has wide nasal bones, the middle third or upper lateral cartilages of your nose is more narrow and the tip cartilages of your nose (lower alar cartilages) are separated or wide. When put together, this gives your nose an almost hourglass configuration in the frontal view as opposed to straight parallel dorsal lines. In the side view, this gives an uneven straight dorsal line with an upper hump and a downward dip in the middle third. This is why your nose appears bumpy and irregular to you. A full rhinoplasty is needed to reshape all three areas to create an overall more harmonious blending of the three regions to create a smoother nasal appearance. I have done some imaging to show what these changes may look like. In regards to the celebrity noses you have mentioned, it is important to realize that rhinoplasty can not make your nose look like that of another person. Rhinoplasty can only make your own nose look better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr. Eppley, I am an Asian male and want to know if alar plasty can reduce the size my nostrils and reshape my nose? It kind of looks like Eddie Murphy as it is really flared. I want my nose to look like Justin Biebers nose , straight and pointed and not very flared. Can rhinoplasty make this happen?
A: When I hear these type of goals from a rhinoplasty, it brings me to a discussion of expectations and reality of what can be achieved from surgery. The simple answer to the question of whether you can have a nose like Justin Biebers is no. That is not surgically possible. Justin Biebers is Caucasian, you are Asian. The underlying anatomy of the nose stucture is different and, of equal importance, the overlying skin thickness and texture is not the same. This makes it impossible to achieve what is essentially transracial changes. Even if you were Caucasian, you still could not have his nose. Rhinoplasty can not make you look like someone else or give you someone else’s nose. Pictures of famous or other people faces are helpful, as they help to convey what one’s nose shape goals are, but they can not be surgically duplicated. One of the most challenging aspects of rhinoplasty surgery is to meet a patient’s expectations. When patients bring out celebrity or model photos to say what they want, it is always is a concern that their expectations may not be able to be realized.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have a steep angle from the back of my jaw straight to the chin. It looks very odd to me although no one else seems to notice strangely enough. I know it is not very common in women but I think a jaw angle implant would work well to make this look better and give my face more balance in profile.
I also have issues with a very bad rhinoplasty as you will see in the attached pictures. If you could simulate a nice straight nose with a nice narrow tip and not so ‘turned up’ I would very much appreciate it Out of interest, is it possible to make the sides of the nostils narrower to give the appearance of a narrow nose or is that not really worth it?
Attached are a couple of pictures they are not great but I don’ t have any digital pics. Thanks for giving me an opinion.
A: As you surmised, on reviewing your pictures, you do have a high jaw angle and a steep mandibular plane. I have done some imaging which demonstrates the effect of a vertical lengthening jaw angle implant.
From a rhinoplasty standpoint, your nose shows a bulbous tip, a pinched middle vault and a still wide nasal bone area. The side view shows too much upturning of the nose and some nostril rim retraction. I have done some imaging with a rhinoplasty that includes nasal bone narrowing, middle vault spreader grafts, tip narrowing, tip derotation, alar rim grafting and nostril narrowing. This will give you a more balanced and narrow-appearing nose.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi there, I have researched a tremendous amount on the internet to find what I think I need. Although I am from the UK I am willing to travel to you for good results as you are the only surgeon that has a wide range of procedures I feel I need for my long face. I have had prior surgery to my face including chin reduction and fat transfer to my cheeks. However it’s my facial skeleton I feel that just still does not look right. My eyebrows are hooked which I see you do brow reduction which you may recommend but its the whole chin jaw nose balance I am looking for improvement. I constantly am compared to the actress Sarah Jessica Parker which I hate! So you can sort of understand my facial faults. I am looking for improvement in my facial structure and to achieve better looking eyes. Many Thanks and looking forward to hearing from you.
A: While I will obviously need to see some pictures of your face, the long face look is not uncommon. There are certain features to it that create that look besides the fact that the vertical length of the face is measurably long. Often the face is thin and skeletonized with a prominent chin and a long and narrow nose. This is undoubtably why you have had a chin reduction and cheek augmentation to try and create a counteracting effect. While this has probably been somewhat helpful, those procedures alone may not create enough of an effect. Additional procedures to consider would be rhinoplasty, brow bone reduction, jaw angle augmentation and possibly further efforts at chin reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested to find out if you could help me to reduce my facial assymetry. What would you actually perform as I am not able to even guess that, but it seems that my halves are different in jaw and forehead shape. I want to make my face more symmetrical and I want to reduce and minimize the difference of my jaw and forehead. Please advise what kind of procedure do you recommend and what would be the estimated cost. Attached is the photo so you can see and assess the treatment.
A: In looking at your frontal view photograph, I see four isses that are making your face asymmetrical. The first is the difference in the sdie of the jaw angles between the two sides. The right is bigger than the left. That could be addressed by either a right jaw angle reduction or left jaw angle augmentation depending upon which side you like better. Secondly, there also appears to be left cheek deficiency which is less prominent than the right. That would be compatible with the left side of your face being smaller than the right. That could be improved by a left cheek implant. Thirdly, the right upper eyelid has more skin which hangs down onto the lashline. That could be removed by an upper eyelid blepharoplasty. Lastly, your nose is deviated towards the left side with a broader tip. That could be improved by a rhinoplasty. I think the combination of these four procedures would go a long way to improving your facial asymmetry.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in getting my nose fixed and have my upper lip shortened at the same time. I have been some research on lip lifts and it seems wonderful and the results are exactly what I want. But you have written that a rhinoplasty can not be done at the same time. That bothers me because I did not want to recover twice. But I have been doing some searching and som,e doctors do both at the same time but some don’t. Is there a possible reason/ I really want to have my surgery with you because you have the best before and after pictures I’ve ever seen for noses that are similar to mine.
A: The reason that I don’t combine an open rhinoplasty and a subnasal lip lift is because of the potential risk of skin necrosis. When done together, there will remain a small area of columellar skin between the two incisions, that of the open rhinoplasty and about 6 to 8mms below that of the subnasal lip lift. The survival of that skin depends on having an adequate blood supply coming into it. Part, and may be most, of the blood supply to that skin is cut off by making those two incisions at the same time. While it is likely that it would be fine with some blood supply coming from the septal mucosa, there is some risk that it might not be and that skin would then die. That would be a cosmetic disaster and my concern is more then theroetical…I have taken care of a patient who had that exactly happen when those two procedures were done together by another surgeon. Given that the lip lift can be done as a simple office procedure later under local anesthesia with very little recovery, I don’t think the risk is worth it for an elective cosmetic operation.
If one was doing a closed rhinoplasty, in which a columellar incision is not used, then a subnasal lip lift could be done at the same time. It is likely that is the type of rhinoplasty the doctors who say they do it at the same time are performing.
Dr. Barry Eppley
Indianapolis Indiana