Your Questions

Q: Dr. Eppley, I have a question about the Iliac Crest Reduction surgery want to do this surgery but what about the side effects? Wont this surgery affect our flexibility? Body rotation? What about running and squatting? That would be very painful I think. But I dont know so im asking you. Will I still be flexible enough to live life comfortably after the surgery?

A: You are referring to the potential for long term functional effects from the procedure…which I have not seen. But that answer is modifiable based on how much of the crest has been removed. The less that is removed the less likely any adverse effects will occur.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I saw your good work on scalp reshaping on instagram, and was wondering if you do surgery like that in other country. I live in Sweden and it’s my dream to be able to change my head shape but unfortunately the distance It’s to far away and very expensive. If you only do surgery in America can you recommend me someone that does same surgery but in a nearby country.

A: I do not travel to other countries to do surgery and I am pretty certain no one in Sweden or even Europe does similar skull reshaping surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, When would be the ideal time to apply the allogenic bone chips for sliding genioplasty defects? (stepoffs) Would this be after the bone has healed, or while it is still healing? Are they place intraorally? If yes, how much does that disturb the muscle and nerve?

A: The time to apply bone chips is either at the time of surgery (which is what I do) or within three months after the surgery. Thereafter the bone is healed and the chips will merely dissolve away. This is when the use of implants is more effective. Bur whether it is bone grafts or implants the submental approach is best to access the area and fill in the defects accurately.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I am also looking in to premolar extractions on top and bottom and retracting the front teeth. If I were to also have custom mid face implants done, when in the process of the braces would you recommend having the implants done? Towards the end? Or after the braces are complete? And one last question. Can you do custom implants for the nasal bone area to project the nose more?

A: I would do midface implants on the back half of orthodontic treatment when the premolar spaces  have closed.

Nasal projection can mean a variety of different nasal areas. Implants work well for dorsal (bridge) of the nose augmentation. But for increased tip projection (which you may be referring) cartilages grafts are used. One never uses implant to increase the tip of the nose projection.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’m looking for information about wrap around testicular implants, procedure, time frames for healing. 

A: Despite the appeal of the wraparound testicle implant concept, it is not without its problems. Postoperative detachment of the implant from the testicle is not rare and is a postoperative problem to which there is no assured solution. (as of yet) The one factor that I do know that lowers that risk is to use a preoperative ultrasound to accurately measure both testicle sizes  and then make the implant’s inner chamber size match it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Two years ago I got Medpor chin and mandibular angle implants, but there’s a serious degree of asymmetry which I would like to correct. But before eventual revision I need to do post-op CBCT scan and 3D visualisation of the inserted implants in order to properly recognize the problem. My surgeon ordered me to do a MRI scan of my skull, but we were unable to create a the result that would allow us to create a 3D model of my skull with visible implants on it.

How to visualise the implants post-op via CBCT the same way you do ? I ask because you did sucessfully visualise them as I saw on your website, but I couldn’t find any information about the method or settings used for CBCT device on the internet.

Thank you in advance for your answer

A:One of the drawbacks to the Medpor material is that you are simply not going to see it on a 3D CT scan which makes any type of revision blind. While they are obviously there the density of the material is changed by the tissue ingrowth so they can no longer be visualized as a solid implant. It is not a matter of setting or how the scans are taken. There are proprietary extraction methods to potentially get that information but that is not technology that is available on your end.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, And is there typically much visible bruising or pooling of blood afterwards from temporal artery ligations?

A: Significant bruising is not typically associated with temporal artery ligations. Each ligation site will be a little raised for a while afterwards and then settles down and smooths out over the ensuing month after the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I got in a car accident and my leg got caught under the seat cutting my bottom as it was healing the my buttock fold unfolded making it uneven.

A:That is a most unusual mechanism to develop buttock ptosis but the entire inframammary fold and lower buttock tissues have lowered. This can be corrected by a lower buttock excision/lift. There will be the tradeoff of a scar line along the re-established fold line to achieve improved buttock symmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am seeking vertical jaw angle implants to get a result like the attached pictures.

A:Thank you for sending your pictures. Before deciding on what type of implant to use the first step is to determine what type of jaw shape change the patient is seeking and what amount of such change is acceptable. This is the role of pictures and computer imaging. In looking at your pictures I have significant concerns that with your fuller tissues any type of standard jaw angle implant is just going to get lost (not seen) and may just make the face fuller/heavier/fatter.  If the goal is a more defined and visible jawline that does not appear likely to occur with the thickness/looseness of face and neck tissues you have.

Excess soft tissues can be overcome by jaw implants but it takes a lot of implant size to push the tissues out and then the issue potentially becomes ending up with too big of a result.  With fuller faces concomitant soft tissue reductions are usually done at the same time to help the jaw augmentation result be better.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley I had a consultation with you a few weeks ago and I’m in the process of booking the surgery but forgot to ask you what the recovery for a sliding genioplasty and custom angle implants is like. How long does the swelling last and is it significant? Also is there any bruising?

A: Jaw swelling from these procedures is usually fairly significant and takes about 10 to 14 days until enough of it goes down that the patient feels more comfortable out in public. While the swelling may be significant it is not usually associated with much, if any bruising.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am contacting you because after having studied I am sure that Dr. Eppley is the only one capable – especially since Dr. Botti (who created the Dynamic Canthopexy with drill hole) has retired – to perform the technique of Dynamic cantopexy with drill hole presented in the medical literature article that I attach.

I’m sure Dr. Eppley knows about that and that is the only tecnique able to give an “extreme” and stable result. Consequently, I would like to undergo this surgery with Dr. Eppley and obtain a result equal to or superior to that shown in the last image of the medical journal article i’ve attached.

So I would like to know:

1) If Dr. Eppley performs this specific Cantopexy technique (which he rightly calls canthoplasty) and if he can guarantee me a result similar to the one obtained by the girl in the last image of the article.

A:I am very familiar with the dynamic or double hole lateral canthoplasty as it is the most secure method of a lateral canthoplasty and certainly the only technique to use in extreme outer eye corner lifting. In these extreme efforts I would combine that with a spacer graft whose lateral tail is secured up along the lateral orbital rim. In answer to your specific questions about it:

1)  No surgeon can guarantee a specific result as there are other variables than just technique that contribute to an outcome. What can be guaranteed is the maximal effort to try and achieve a specific outcome.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello! I am a 26 Female who has chin ptosis. My chin to me doesn’t not seem overly large, but when I smile, it droops quite dramatically, creating a weird shape along with a double chin from my side profile. 

A:I think the reason you have dynamic chin ptosis is because of your small chin. There is no support for the chin pad as it gets pulled back when you smile, thus it gets pulled down. This is a natural congenital origin of the problem rather than an iatrogenic one. (from prior surgery)  A chin augmentation procedure in your case is going to probably be more effective than an excisional submental chin pad procedure. The only question in that regard is whether the aesthetics of a chin augmentation would be acceptable. You don’t need much of an implant augmenttion (5mms or less) but it would provide a physical block to prevent the chin pad from being pulled down.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, what’s the % of muscle detachment or displacement that happens with jaw angle implants? it seems muscle issues are the main issue and can ruin ur face.

A:The question you are asking is what is the risk of postoperative masseteric muscle dehiscence after jaw angle implants. That risk depends on many factors including the experience of the surgeon, the type and size of the jaw angle implants, the natural shape of the patient’s jaw angle bone and strength of the ligamentous attachments (as seen on a 3D CT scan) and prior jaw angle surgery. (e.g. V line or SSRO osteotomies) So there really is no specific accurate % you can assign as a general nunber. The significance of that risk has to be assigned on an individual basis which I classify as low, medium and high. For example if it is a primary jaw angle implant surgery and it is a standard widening implant style I would assign that risk as low. Conversely if it a prior V line reduction patient who wants to restore their jawline with vertical lengthening implants I would assign them as a higher risk.

It is being overly dramatic to classify masseteric muscle dehiscence as ‘ruining a face’.  This is a soft tissue contour issue which in many cases is mild and often only seen when chewing or biting down.

And no masseter muscle dehiscence is not the risks of jaw angle implant surgery…..infection and implant asymmetry are the far more significantly encountered complications.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a trans woman who is interested in having surgery with you. Specifically clavicle shortening surgery and hip implants. I was wondering if I am a good candidate for them? If you can get them at the same time? And any other information you can provide me. Thank you!

A:Thank you for your inquiry and sending your pictures. Your shoulder reductions are straightforward.  (see attached imaging)( For your hips I would not first jimp to implants. With your body type I would first do circumferential liposuction and take all that fat and invest it into the hips and see what you get. (see attached imaging) Hip implants are reserved for those patients who have either failed fat transfer or do not have enough fat to do a fat transfer procedure. Hip implants are far from a perfected procedure and they have their own unique risks of complications so you want to maximize any autologous surgery method before going to implants.

Regardless of the chosen hip augmentation procedure it can be done at the same time as clavicle shortening.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,You have correctly surmised that with a long upper lip and many vertical lip lines that an excisional approach would be helpful with two caveats: 1) the amount of vertical lip line improvement will be limited to what is removed in the excisional area (see attached image) and 2) by doing a combined subnasal lip lift and upper vermilion advancement the upper lip will become bigger than the lower lip so a lower lip advancement may need to be considered as well.

A: You have correctly surmised that with a long upper lip and many vertical lip lines that an excisional approach would be helpful with two caveats: 1) the amount of vertical lip line improvement will be limited to what is removed in the excisional area (see attached image) and 2) by doing a combined subnasal lip lift and upper vermilion advancement the upper lip will become bigger than the lower lip so a lower lip advancement may need to be considered as well.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i have severe Craniofacial Facial Asymmetry. i have yet to find a dr to fix my face and then i stumbled on your website. my face is more closer to the shorter side (i can tell due to genetics, my mothers face shape and 3 of my female cousins) please help. i tried adding a lot of photos because some angles it isn’t as noticeable but some they are. the longer side would need to be shaved down and possibly an implant to create “volume” like the other. i just never feel confident with myself.

A:With an asymmetry analysis it can be seen that, while you have an overall left facial side hypoplasia  (vertically shorter, smaller) the major asymmetry is in the lower jaw. It is a classic jaw asymmetry with one side being longer and less wide (right side) and the left side being vertically shorter and wider. (see attached) With that of course comes the chin asymmetry with the right side being longer.

There are multiple treatment approaches which comes down to 1) reduce the right side of the chin and jawline as far back as possible (fundamentally improve the chin asymmetry) or 2) reduce the right side and augment the left side for an overall jaw asymmetry approach. It just comes down to how much effort you want to put into the correction…with the understanding that ideal/perfect jaw asymmetry will never be obtained.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q:Dr. Eppley, I’ve been planning on supraorbital augmentation by fat grafts and I was wondering how much millimeters could be added to the protrusion of the supraorbital/brow ridge at most and at least, at least while still maintaining a natural appearance.

A:I suspect in the long run you will find brow bone augmentation by fat grafting to be a disappointing approach as fat has a very limited ability to do much push in tightly adherent tissue areas like the brows. But like all fat grafting it is about the volume placed and how much survives. Perhaps you will be lucky and end up with a few millimeters of added projection

.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am considering shoulder widening surgery , and I have one question :How much lengthening do you think could be feasible in the case of a healthy flexible professional 26 year old athlete?Would 5 cm on each side be feasible IN SOME CASES (I’m not asking about every case nor one case in particular, I’m just asking, is it a straight up “no” or is it a “in some cases it could be feasible” )?

Thanks in advance.

A: That is a straight up NO.  Never going to happen or be even close to 5cms on each side.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Have you done skull reshaping for a patient with right side coronal craniosynostosis (flatness right side of forehead and back head and protrusion on left side front and back head also sagittal ridge hump)

A: I have treated every variation of skull shape abnormality that probably exists, either as a single or a multiple combined problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello…I am interested in rib modification or repositioning. Do you just perform rib removal or also do rib repositioning? Do you think rib removal is better?

A:Rib removal always produces better long term results than rib bending/modification as it removes the rib protrusion and reduces the thickness of the overlying latissimus dorsi muscle.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Am I a good candidate for thigh implants?

A:With your very thin legs you are a good candidate for thigh implants as long as you understand what thigh implants can and can not. There are a method to enlarge the anterolateral aspect of the thighs. (aka the front of the thighs) The fact that side and back pictures are shown suggests that you may perceive them as a method to circumferentially enlarge the thighs…which is exactly what they can not do.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I would like to know around how much does the procedure cost and do I have to cut my hair for the procedure?

A:The term ‘skull reshaping’ is a general one which refers to a collection of over 30 different specific skull procedures. To provide information on what skull reshaping procedure(s) would be appropriate for your needs I would first need to know your exact head shape problem from which I can then determine how to treat it. This will require a more detailed description of your concerns, and head reshaping goals and any pictures which so illustrate. From this information the skull reshaping procedure(s) needed and their associated costs can then be provided to you.

As a general rule I do not cut hair for most skull reshaping procedures but, until I know what type of skull reshaping procedure you need, I can not provide a definitive answer to that question.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, On the top of my head I have a bump that I would really like to be removed if possible. Not sure what it is.

A:This is a classic skull osteoma which are benign bony growths on the outer surface of the skull. This can be removed through a very small overlying scalp incision. I have yet to see one recur after removal.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in getting a sliding genioplasty surgery to advance my chin both horizontally and vertically in a significant way. I was hoping to schedule a consultation soon and ideally have the surgery completed by the end of this calendar year. I have attached a photo of my current side profile for reference. I suspect a genioplasty will correct a lot of the issues with the proportions of my face and make the nose appear smaller, and I was under the impression it would reduce the size of my lower lip as well. Is this true?

A:I believe you have correctly surmised that the proper dimensional changes to your chin are a combined horizontal and vertical, otherwise known as a 30 to 45 degree chin elongation. You are also correct in that it will improve your facial proportions and make your nose appear smaller. It is not necessarily true, however, that the lower lip will get smaller. While that is possible it has not been my experience.

The key question then becomes how much of a dimensional movement of your chin looks good to you. To begin that discussion I have attached an image to start you thinking about the degree of chin augmentation change you seek.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been doing lip incompetence exercises for w months now and no progress. I also have braces and I still can’t close my mouth.

A:You have lower lip incompetence due to your very short chin/jaw. This is a structural issue for which exercises will not help. Ideally you need lower jaw advancement with a sliding genioplasty…or at the least a sliding genioplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, hi I’m interested in getting a facelift, but I have a shaved head, and if the doctor has done this procedure before

A: In the male facelift in general, and in the shaved head male inj particular, the key is to limit the incisions to the immediate periauricular area. (in and around the ear and to venture out no further) This will limit how effective the facelift result can be so it becomes imperative to see how much loose neck/jowl/facial tissues are present to see how effective a limited incision facelift would be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, My goals are to remove my medpor implant and then perform a sliding genioplasty. I do not like the implant and I don’t like how it makes me chin look longer, and did not give a lot of projection forward (it’s is a 5mm one)

A: Admittedly if that is what you got out of a chin implant, regardless of material, that is a pretty undesired./weak outcome. Very short chin (10mm or greater ) rarely dio well with a chin implant as the chin bone is slanted backwards so any implant is going to create a 45 degree type of chin augmentation effect. (less horizontal than the implant which is unintentoinally converted to vertical lengthening. Very short chins are classic indications for a sliding genioplasty as it needs to come forward and be vertically shortened.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a wider mouth smile. This is an example in which when the woman smiles, wouldn’t it make sense that her smile would be wider if her mouth was widened ? Because the mouth opening is now wider, which means more teeth would show when she smiles no?

A: Maybe  it would but one is smiling against a scar line so it is probably not a 1:1 ratio…meaning the amount of mouth widening at rest may not be the same amount numerically when one is smiling.

Quite frankly it is simply a dynamic assessment of a static operation that I have never assessed before….so I really can’t say for sure what the dynamic effect of mouth widening is.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if there is any possible way to get clavicle shortening done on a 13 year old girl.

A: Patients have to be at least 18 years for shoulder narrowing surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, If one were to do something like full midface implant, would it have a similar effect on the nose as a lefort where the nose becomes wider and upturned?

A:Not necessarily. It would depend on the various thicknesses in the nasal base area. It almost assuredly would not increase nasal tip rotation. But any form of midface soft tissue degloving, even without placing an implant, can widen the nostrils by a few millimeters. But that potential issue is overcome by either intraoral nasal base suturing or external nostril narrowing by sill wedges.

Dr. Barry Eppley

World-Renowned Plastic Surgeon