Your Questions
Your Questions
Q: Dr. Eppley, I hope you’re well. I have midface hypoplasia and want to correct this. The problem is I believe the recession is too great for just implants. Would getting a malar osteotomy first be ideal? Here is my lateral ceph. Thank you.
A:Thank you for your inquiry to which I can say:
1) What is your anatomic basis for saying that your midface hypoplasia is too great for implant augmentation? What is reasoning behind make that conclusion? I see nothing in your x-ray that would lead me to believe that is true.
2) Malar osteotomies create lateral width not forward projection.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 28 year old male writing to you because of my aesthetic concerns about my wide head. I am interested in your skull reshaping surgery because I have a wide head and it has always bothered me psychologically and I have always wanted to reduce its width.
My current head width from side to side is a little over 6 inches and I find my skull to be wider than almost everyone I encounter. I also work in construction and the fact that my hardhat needs to be set to almost the most loose setting makes me feel more conscious about my head size and makes me look more bulky. I get comments about how I look like an “overgrown baby” because my large head combined with relatively narrow shoulders creates a very neotenous look.
I have read through your aesthetic skull reshaping content on your website and I know you explained that a good amount of temple width comes from muscle and not bone but what I wanted to know was if it was possible to actually reduce the bone width as well because I would like a significant reduction in skull width. For example, if we could reduce or take out the muscle width by 9mm on each side and then remove another 9 to 10mm of bone per side I believe that could be a significant change and very strong improvement for me. I know that removing the muscle alone will result in some degree of change but I really desire the maximum reduction in head width because my starting point is very wide. This is my biggest concern about my face and I know that you are more willing to make significant changes surgically to achieve stronger results so I hope you can facilitate this request. My current head width from temple to temple is a little over 6 inches and the more reduction I can achieve the better and this would really improve my confidence and I would really like a narrower head. I would really appreciate your time for a virtual consultation so that we can discuss how to plan this surgery. Thank you so much for your time and I look forward to hearing from you.
A: To answer the question as to whether removing any temporal bone will add to the reduction benefits that the must provides, as well as makes the additional scar length on the side of the head worthwhile, a CT scan is needed to make that determination.
As a conjecture I would imagine that at least the reduction of the parietal bony eminences would be beneficial.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I don’t like the shape of my chin, how there’s a sharp dip from my lip to my chin, and my cleft. I am a very serious patient. I have spent a lot of time researching surgeons and when I came across Dr. Eppley’s before and after photos I was really amazed.
A:Thank you for your inquiry and sending your pictures. You have a classic horizontal bony chin excess which is why your labiomental fold is so deep. This requires a submental chin reduction approach to remove both excessive bone and soft tissue. (see attached imaging prediction of a potential submental chin reduction change)
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I had a chin implant placed in the fall of 2019. It was placed crookedly, and in my opinion too high. Although I voiced these concern’s to my surgeon, he would ultimately tell me each time that the implant was placed perfectly and I looked great. Even if this was the case, and I did look great, I didn’t feel great, and the chin implant was mightily uncomfortable. My lower lip didn’t have the depression most lips do when you smile, talk, or make general facial expressions. Each time I brought up these concerns, he would say it “takes time”. I am aware of the time it takes for the body to heal, but also aware that it should be at least close to normal after a year, but, it was not. The lip was stiff and seemingly stifled in the middle and the sides. I gave up and gave in, tried to live with it for awhile, but four years is all I could take until I needed to seek help. Finally, I went to another surgeon and got the implant removed in the spring of 2021. When I showed him the implant he was appalled at the placement, and said it was heavily mal-positioned. I hoped that removal would help my lip mobility and tightness, and I wouldn’t say post removal has been net zero, I don’t think it’s even fifty percent better. My question is if anything could be done to improve, my feeling and lip mobility? The feeling is like a chin strap, and shape of the implant still lingers. In a perfect world I would go back to my original chin, but the world is not perfect. Oh well. What is your opinion?
A: While you did not say what route the chin implant was placed (submental vs intraoral) this sounds like a classic post intraoral chin implant placement issues. Usually tightness does not occur from a submental approach. Thus this is scar contracture which really means a soft tissue deficiency. In this situations I usually do an intraoral release and fat graft to relieve the tightness.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I underwent chin implantation (extended anatomical chin, large) 2 years ago, with postop course c/b persistent right lower lip numbness. We later found the right wing of the implant was malpositioned superiorly and could be clearly palpated externally and intraorally. Aesthetically, the malposition isn’t very noticeable. Right lower lip sensation is currently 85% of normal
In a few weeks I’m tentatively scheduled for revision since my projection was insufficient (pictures attached, before implant and after). My surgeon plans to place silicone (cut from a block) behind the implant for more projection. But he said that he wouldn’t feel comfortable revising the implant wing since it could cause more trauma to the mental nerve and risk recurrent or worsened numbness. I’m concerned adding silicone behind the implant may make any minor asymmetric aesthetic differences more noticeable
Is trauma to the mental nerve typical with revisions like these, or would I be better served by obtaining a formal second opinion/consult with you or another surgeon?
A: By your original preoperative picture and the type of chin deficiency you had a chin implant was not the best chin augmentation procedure for you. When the chin excess exceeds 10mms and the chin is vertically long a sliding genioplasty is the best approach. The chin can be moved significantly forward and vertically shortened. (see attached imaging) It is important to remember that chin implants worjk best for modest to mdoerate chin deficiencies not signifincant or major chin deficiences.
Stacking silicone chin implants is rarely a good idea. (if you need that much projection and want to use an implant make a custom one as one piece) There is no biologic validity that removing your silicone implant is going to cause increased mental nerve damage. Furthermore why would you try and stack another implant behind a chin implant that is obviously malpositioned??
I assume you have a 3D CT scan which confirms the exact implant positioning on the bone and where the implant is believed to be sitting is not based on external assessment alone.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 29 year old male who has forehead bossing. I am very self conscious of my side profile and would love to find a fix to the problem. In addition to that, I have a pretty sloped forehead with a hair hairline which does not help. I have thought about doing something with my chin to take the depth of the forehead away, but I don’t know what’s right. I am a cop and train boxing often. I am concerned about options holding up long term. I would love to speak to you and learn more. I am ready to fix the issue!
A: Your forehead only looks sloped backwards because of the brow bone protrusion. Once the brow bones are setback the forehead slope looks improved. (see attached imaging) Increasing chin projection will improve the lower facial shape but will not make the brow bones look less protrusive.
Dr. Barry Eppley,
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have some questions about custom pectoral implants:
- Do you believe it is safe to work out the pectoral muscles in the gym after having pectoral implants (especially if big), and if so, when can one start chest exercises safely after surgery?
- What is the risk of seroma and/or displacement (highly theoretical or actual risk)
- Finally, if the implants are patient specific and made to fit perfectly pectoral muscle, are there any limits as regards to implant thickness i.e., projection?
A: In answer to your custom pectoral implant questions:
1) Just like breast implants there are no postoperative exercise restrictions once fully healed. Pectoral implants stretch out the muscle between origins and insertions but does not damage these attachments. But I would wait a mont after surgery before doing so.
2) Displacement is a non-issue. Seroma is a low risk issue having seen it only one time in my experience.
3) There is always going to be some limits with implant projection thickness, regardless of the footprint dimensions of the implant, due to the size of the incision to insert it and the stretch of the muscle to accommodate its volume.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am inquiring about a genioplasty. I would like to make my chin vertically taller and gain significant forward projection. Ideally around 10-12mm. I would also like to hear your expert opinion on whether my entire jaw looks recessed and if I would need more invasive jaw surgery like a BSSO for example. But ideally, I am fixed on getting a large movement genioplasty. Thank you!
A: I would not be able to determine whether orthognathic surgery would be a better option for your lower jaw based on pictures alone. This requires an x-ray and occlusal assessment to make that determination.
All I can do based on these pictures is have the discussion of what type of chin dimensional changes are your seeking. To begin that discussion I have done some initial imaging of one type of change and await your response to it. But with significant forward projection increases (yet to be determined as to what significance ant means) there are limits as to how much vertical height can be done at the same time.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to know if I would be a candidate fordeltoid implants and or shoulder lengthening/clavicle lengthening. (pictures attached)
A:I would definitely opt for deltoid implants as your shoulders are already broad based on your pictures. It is just that the ‘corners’ of the shoulders are rounded and lack a more defined shape. (the deltoid muscle is underdeveloped) Clavicle lengthening may make them broader but won’t give the upper deltoids a more prominent shape.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley,Hello I am interested in surgery to my chin. I want to increase vertical height, reduce the depth of the labiomental fold and if possible decrease horizontal projection. I have been advised this is not possible as my horizontal projection is caused my muscle and fat and it is too complicated to surgically remove this. Can you please give me your opinion? It’s worth noting that I have filler in my lips, if the lower lip filler is contributing to the downward turn of the lower lip, increasing the harshness of the labiomental fold?
A: By definition when the vertical height of the chin is increased the labiomental fold will get less deep and, if the vertical lengthening is done by wedge or hinge opening some horizontal projection will be decreased as a result. These effects are related to the amount of vertical lengthening done, the greater the vertical lengthening the more profound these effects become..
Whether the lower lip filler is contributing to the depth of the labiomental fold (which I doubt) should be known to you as what did the fold look like before you ever had lip filler placed.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I had 2 really big love bands before I had a lower eyelid surgery. I had little extra skin under my eyes and just wanted to look refreshed and the surgeon removed the extra skin and said she also did fat transpostioning. I now still have a big love band under my eyelashes on one eye but the other eye barely has one now and I was hoping to get my love band back on that eye too. I seen you do the love bands with fat transfer and was interested in it. I got filler in my tear troughs hoping it would make my eyes look better but it actually made them look worse because I have lumps of filler in my tear troughs so I plan on dissolving the filler in my tear troughs soon. I sent a picture of my eyes after surgery but before I got the filler and a picture of my eyes now after I got filler but like I said I am going to dissolve the filler soon. Please help me get my love band back so I will have 2 love bands again. Thank you.
A:T hank you for sending your pictures. Since you already have had a lower blepharoplasty procedure injecting fat is less likely to be successful due to the scar. It would be more effective to use the scar that exists and lay a thin piece of Alloderm graft to recreate the love band.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Would like to know more about this procedure. As you can see in the photo I have a skull bump in the back of my head that i can do without. I have a short haircut and would like to know if scarring will be visible after the operation? And how much healing time before I can go back to work after procedure?
A: Thank you for your inquiry and sending your picture. You have a classic occipital knob skull protrusion which can be effectively reduced. In answer to your occipital knob skull reduction questions:
1) The small scalp incision used for the reduction heals in an inconspicuous manner in most patients. No patient has ever requested a scar revision due to its ‘visibility’.
2) You should be able to return to work the week following surgery almost regardless of what your vocation is.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I want to consider total midface augmentation with custom implant.I know you are one if not the best in the world using implants. I have a question. I suffer for years from chronic allergic rhinitis.I would like to know if a custom midface implant may be effected from allergic or sinusitis. In that case is it any problem if i use implant. Could the implant cause more sinusitis infection or increase allergic symptoms? An opinion from you is very welcome due to your experience.
I thank you in advance
A:Your question concerning any possible adverse connection between a midface implant and the maxillary sinus is a understandable one. While the two are in close proximity there is no direct communication between them. They are separated by the anterior bony wall of the maxillary sinus. The bone thickness of the maxillary sinus wall may be thin but it still serves as a solid separation between the sinus air cavity and where the implant would rest on the bone. So no a midface implant would not cause a maxillary sinus problem nor aggravate an existing sinus condition.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I’m thinking about having a couple of skull reduction surgeries and I was wondering if you could provide a price estimate for all the surgeries together. Overall, through these surgeries I would like to decrease the overall look and size of my skull. Here are the surgeries that I plan on having.
Temporal reduction: I would like my temporal muscles removed to decrease the width of my head.
Occipital reduction: I would like bone at the back of my head reduced so that it looks more flat, and less bulging than it is now.
Forehead bone reduction with hairline advancement/lowering: I would like to the bone under my forehead reduced so that it doesn’t look as bulging as it is now. I also have a pretty long forehead which makes me look like I have a receding hairline. If possible I would like to have my hairline lowered by 1 inch, or 2.5cm.
Top skull reduction surgery: I would like the bone on top of my skull reduced so the vertical length of my skull is reduced. Just like in the pictures of the large skull reduction surgery. So that the distance between the top of my hair and my hairline is not too big after having the hairline advancement surgery.
I also have another question in regards to these surgeries. When I do get them, will they all be done together in one session, or will they have to be done separately? Like will I have to wait a couple of months between each surgery? Just so I can know how long it will take to get them all completed.
Thank you
A:Thank you for your inquiry, detailing your objectives and sending your pictures. All such procedures could be done at once if desired. (see attached imaging) Besides the temporal reductions the back, top of the head and hairline/forehead procedures are interconnected and the effectiveness of one impacts the other two so the ‘front to back’ skull procedures need to be done at the same time. The temporal procedure is independent of the other three and cold be done separately or as part of the other three, that is just a personal choice.
Whether you could get as much as 25mm frontal hairline advancement can not be predicted beforehand and depends on the natural stretch of your scalp. But certainly the back and top of head undermining/bone reductions is going to maximize whatever hairline advancement is possible.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, For a customized jaw implant, do you use a CT scan and special software to design the customized implant?
A: All custom facial implants are designed for each patient off of their 3D CT scan using Geoform implant designing software.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Can midface implant make nasomaxillary complex more forward and change the angle of “cheek line”. By a cheek line I mean a line from lower eyelid to nasal base; on flat midface is it more vertical while on projected midface it is more sloped(I attach photos to make it clean). Standard double jaw surgery with counterclockwise rotation doesnt reach. Probably the best solution to that would be Lefort 2 with counterclockwise rotation or other nasomaxillary osteotomy but its probably more risky. Rhinoplasty also wouldn’t make a difference to cheek line since it would only make nasal tip more projected why the midface is still flat/vertical.
A: A midface implant can very well change the cheek line as you have indicated by improving the projection of the nasomaxillary complex.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I think I am going to have my Terino II implant removed and will be going the custom route. The date for removal will most likely be in around 3 weeks.
However, I thought I should send some more photos in advance of the video consultation so that he gets a better idea of what is going on (in case he thinks it is best to retain the implant for the moment, and that he may prefer to remove the current implant and replace with a custom implant at the same surgery (should I decide to proceed and come across to the USA).
Please can you only show him the photos and ask him whether I would be able to keep what I have until any date of surgery (with him removing the old and replacing with new).
However if there is the SLIGHTEST chance that it would negatively impact the new implants and the final “look” then I will simply have to bite my tongue, remove the current implant and wait till first available date. (and grow a beard)
A: Removing it now is fine. What would be ideal is to have a 3D CT scan done before it is removed so we know exactly its dimensions and position on the bone which can provide invaluable information for a new custom implant. (when you know exactly why an implant doesn’t work it helps how to design a new one that will work better)
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley,Hello. Can i get wider and taller chin with genioplasty?
A:I believe you mean a wider and vertically longer chin and by using the term ‘genioplasty’ (which is a generic term for any type of chin change) you probably are referring to a bony genioplasty by osteotomy. An osteotomy can be used to make the chin longer and a bit wider by a midline split and interpositional graft. But if one wants it to have a definitive square shape this is then best done by a custom designed chin implant.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I made a big mistake ten years ago and did a rhinoplasty. The results are not very good, since I looked better before. Recently I’ve been researching the best plastic surgeons to correct it. My nose is broader, rounder and shorter than before the surgery. They cut off too much bones to the sides of the nose bone. Also the top of the cartilage part is cut. My goal was better symmetry, but it came with these big side effects. Instead of trying to correct the symmetry by realigning the cartilage they just made the nose smaller. I prefer my old nose to what I have today. I want to add bone/cartilage to the left and right sides, but ok if only one side is possible. In the close up you can see there is an edge in the middle of the nose. I want to add to atleast right side. They said they removed at most 3 mm so I dont want to add a lot, but I think it will have major improvements to my looks. It would make the nose look more defined and narrower. Its like a pyramid. Cutting off the top of the pyramid and the top will be broader. I also want to know if it’s possible to fix the slight upturned nose. I am open to use cartilage, bone graft from ribs or artifcial grafts. I am aware this is a complex and costly procedure. I have attached 6 pictures. One is how I looked before the surgery.
Looking forward for a response. Thank you!
A:Thank you for your inquiry and sending your pictures. As you have detailed you had a reductive rhinoplasty which, amongst numerous issues, over rotated the tip of the nose…which men typically do not like. Now what you need is a secondary augmentative rhinoplasty for correction. The key to any augmentative rhinoplasty is to have enough building materials to do the job…which comes down autologous cartilage. Is there enough septum left to adequately add back what is needed or should a small costal rib graft be taken? (ear cartilage is not enough and is curved and structurally weak) Bone grafts are poor rhinoplasty materials and banked or cadaver cartilage is much harder to work with and may be prone to some resorption.
For the nose outside of the tip residual septal cartilage is probably adequate. But to derotate the tip, which requires a tripod structural reconstruction approach, rib cartilage is the best choice. Thus just use rib cartilage and leave the septum and ears alone.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, When I push up the tissue over my chin it creates a better angle and my face looks less long. I think that my issue has more to do with the tissue/muscle and a reposition of the tissue or muscle would make a big difference. But I’m not an expert, this is simply what I think.
I had a lip lift in 2019 and it wasn’t possible to take off more skin due to my chin otherwise I wouldn’t be able to close my lips properly. In the future I’d like to get another one. This is one of the main reasons why I would like to fix my chin now.
Thank you,
A:Thank you for sending your pictures. While pushing up on your soft tissue chin pad creates the desired look, soft tissue resuspension will not work or ultimately have the desired effect. That is not a sustainable procedure unless one has true chin pad ptosis which you do not. You have a vertically long chin which requires shortening of the chin bone. This is done through an intraoral osteotomy technique where an interpositional wedge of chin bone is removed. This largely vertical reduction combined with a slight horizontal movement is what is needed to create the desired effect.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a testicular implant, from torsion and removal at birth. I like the idea of the solid silicone. Are you still implanting those solid silicones?
Do you also have data of infection/removal from all of your procedures? As well as cost? I have a few other questions about high scrotal vs inguinal.
A: In answer to your testicle implant questions:
1) The most common testicle implant that I place are ultrasoft solid silicone styles.
2) In my extensive experience with testicle implants I have seen 1 infection so that infection occurrence rate would be less than 1%.
3) By far the low midline raphe scrotal incision is the superior method of incisional access for testicle implants.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to enquire about buccal fat reversal with dermal fat graft as I underwent it last year. May I asked what is your experience with this surgery and how many cases have you done?
Kind regards
A: It is an effective procedure based on the 3 cases I have done to date. It works because an en bloc fat graft is placed back into the buccal fat fad space through an intraoral approach.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have attached some computer imaging done at a clinic to show me some face changes. I am wondering if these results are attainable as I am suspicious of Photoshop use.
A:The first concept to grasp is that imaging is designed to set the patient’s aesthetic target …from which the operations are then designed to try and achieve it…not the reverse. So I would not assume the images are suggesting this is exactly what is going to be achieved. What imaging is designed to do is elicit a reaction from you about the various changes shown and see what type of changes you are seeking. This is how i do it in my practice.
But for the sake of discussion let us assume the imaging shown is what you have chosen to be the goals of the various facial changes shown. Is that result achievable?…largely yes provided the procedures chosen can create those type of changes. Thus the more pertinent question is HOW are they saying they are going to achieve those results. Once I know what procedures they plan to do I can tell you whether they would have a reasonable chance of being in the neighborhood of those changes, particularly those of the cheek and jawline.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I have a virtual consult with you last year but I’m worried that an augmentative rhinoplasty won’t be enough to create proportions within my side profile since my lips are so protruding, so could you confirm if I need my premolars extracted to bring inward the lips before I get the rhinoplasty or will the rhinoplasty be enough?
A: Good to hear from you again. You have to realize that you have a major nose-jaw size disproportion which can probably never be made ideal. All you can do with the nose is augment it as much as possible with a rib graft as the skin is only going to stretch so much. As for whether it would be enough from your perspective you have to go with what you see on the predictive imaging. (see attached)
Anyone can have their premolars removed and the teeth moved back which will help with the lip protrusion. You would need to consult with an orthodontist to see how this would work in you. With such orthodontic work an augmentative rhinoplasty could be done before, during or after orthodontics. It doesn’t matter since it is known now that you need a maximal augmentative rhinoplasty from which there is no risk that it can end up overdone or too big.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Two years ago I had a displaced fractured cheekbone and other fractures. No surgery was done at the time or since. I have been left with a major cosmetic defect and chronic 24hr/7days pain/painful pressure above my upper center and side teeth -same side as the fractured cheekbone. The pain is very debilitating and the cosmetic defect is destroying my self esteem. I am in search of an experienced and talented surgeon that can re-break the cheek fracture/s and put the cheekbone back in place which I hope will not only mostly correct my facial symmetry but also unimpinge whatever nerve is causing the pain and/or remove the stress that the inward rotation of the cheekbone might be putting on the muscles, tendons, ligaments, etc.
A: Thank you for your inquiry and sending your pictures and x-rays. As you know and have well described, you have the classic untreated ZMC (cheekbone) fracture with its typical and inward rotation into the maxillary sinus. You are correct in that refracturing the cheekbone and repositioning it out and up (derotation) is the correct procedure in your case. Cosmetic camouflage in untreated ZMC fractures is only the best approach if the rotation is very slight or the only issue is soft tissue atrophy over the bone.
The keys to successfully treating the secondary impacted ZMC fracture is rigid fixation and bone gratting after it is cut and repositioned. The plates will hold it into a better position but derotating the ZMC complex will reveal bony defects particularly along the posterior zygomatic buttress and maxillary sinus walls and possibly the orbital floor.
But the first step is to get a 3D face CT scan so the exact ZMC anatomy in the traumatized side is fully understood before surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dr. Eppley, I have a clavicle that is shorter than the left by 3cms give or take, can it be fixed and look like the left and be symmetrical.
A :Clavicle lengthening in a normal non-muscular patient is limited to 15 to 20mm lengthening at best. In a well muscularized patient that lengthening would be more limited. So getting 3cms of clavicle lengthening in you is not possible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been reading about jaw recession and chin recession, which I now realise to be much of the same issue: if the chin is recessed, so usually is the jaw.
I have read that when correcting a recessed chin via genioplasty, chin implant, or both, a problem known as the “crescent moon deformity” can occur, whereby there’s a point in which the advancement of the chin looks unnatural because the jaw is still recessed behind it.
Apparently, the only way to correct this problem would be BSSO, as with a short distance from chin to throat, as is seen in recessed jaws, nothing can compensate other than physically extending the mandible body itself as well as the chin.
I was wondering what your thoughts were in regards to how this problem pertains to wrap around jaw implants? I was considering one of these implants with you myself, but am concerned it would look unnatural if the mandible body is not long enough in the first place. I have attached an image (sorry for the quality. It’s the only one I have as I currently have a beard).
From what I’ve read, it seems plausible to be able to correct a recessed chin, lengthen the ramus (jaw height) and add jaw width with a wrap around, but will it ever look natural if someone’s mandible length from the profile view is too short to begin with?
Many thanks!
A: Thank you for your inquiry and sending your picture. You are not a good candidate for a wraparound jaw implant. Your chin is too short and is tilted downward with a high mandibular plane angle. Short of a BSSO what you need is a sliding genioplasty to bring the chin substantially forward (+10mms) and up. (vertically shorten) Jawline implants behind can be added for a total jaw augmentation effect if desired.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a forward sliding genoplasty almost 20 years ago. It was advanced an estimated 8-10 mm. I was left with a tightness in lower gum line. 3-4 years later after this procedure tightness still existed so the original Dr. did another procedure sliding back the bone half way, so as of now around 4-5 mm advancement forward. This helped the condition a little bit, but the tightness still remains just not as bad after second procedure.
I recently had the bracket removed from chin in May of 2021 hoping this might relieve more of the tightness but that didn’t help. I have no nerve damage.
I have read many good things about you and I’m in need of an expert in this area. Your opinion would be very helpful as I’m running out of ideas. It would be great to live without this tightness !! I have lived with it for so long now.
If there are no other options I would consider moving chin back to its original position.
A:This is not a bone problem, it is a soft tissue problem. Always has been. When you slide out the bone significantly there becomes a relative soft tissue deficiency due to scarring and soft tissue thinning. When the soft tissue is allowed to contract back into the bony stepoff created by the bone advancement (grafting is not done) this is what can happen.
While setting back the bone helps a bit and was the logical treatment to do, it can not fully solve the scarring/soft tissue deficiency. Taking out the plate never provides any real relief because it does not address the problem…the soft tissue and it just makes more scar. (it is just an easy but wrong target)
You solve a soft tissue deficiency in the chin just like you would anywhere else in the body….release and the placement of new interpositional soft tissue. (dermal-fat graft) It takes an additive not a reductive approach. Some may consider fat injections as the soft tissue additive procedure but that injection approach does not create a good release and the placement of injected fat into scar often does not end up where it needs to be.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,I would like a bicep implant. I had a botched tendenesis. Tendon was torn and atrophied. Got tendon reattached. Would like to investigate if an implant under atrophied tissue is possible. The tattoos makes it hard to tell, but it’s retracted toward the elbow. It’s balled up like Popeye. I’m not sure I can be helped, but if you could more normal, that’s what I want.
A:Thank you for sending your pictures which show a classic partially detached distal insertion of the biceps muscle. The problem with this type of bicep muscle deformity is that the arm has two positions, extension and flexion, and the deformity primarily appears in one position (flexion) but looks reasonable in the other. (extension) This poses a reconstruction problem as any treatment done runs into the same issue…looks good in one position but looks abnormal in the other position. Thus you can see the dilemma.
That being said the logical approach is that you have to treat aesthetically both sides of the problem…reduce some of the muscle mass seen in flexion and add some small implant volume below it.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Zygomatic/Malar Osteotomy may be beneficial to my appearance. I have attached a photo of myself when I was very young (around 20 years old) it shows my facial bone structure better then my more recent photo from a couple years ago (im 33 now). Maybe Zygomatic/Malar Osteotomy would be more beneficial than seeking out Orthognathic surgery from another surgeon. What do you think?
A:The malar expansion osteotomy (aka zygomatic sandwich osteotomy) can be an effective procedure for specific cheek dimensional issues. It is intended to widen the cheek bone (zygomatic body-anterior arch) but it will not give it forward projection. At least based on your two attached pictures you do exhibit zygomatic body narrowing. (see attached picture with arrows)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
