Your Questions

Q: Dr. Eppley, I have a question about jaw implant revision surgery 3 years ago when I put two silicone jaw angle  implants. While one stayed in the correct position and I’m very happy with it, the other one moved a bit or was misplaced causing a bit of an asymmetry which I solved these past years with filler on that side. As I’m looking for a more permanent solution I was considering a revision surgery and was wondering if it would be possible to use the implant I already have and maybe fix it with a a screw so it doesn’t move and if there are many risks compared to the first surgery. 

Many thanks for all the help,

A: In theory if the one jaw implant side is satisfactory and the other one isn’t then it is an implant positioning problem not an implant style or size problem. Therefore one should be able to reposition the unsatisfactory side with screw fixation and achieve a satisfactory outcome. BUT don’t ever try to reposition an implant unless you know precisely the position of both implants with a preoperative 3D CT scan.

The risks of jaw implant revisional surgery as the same as the original surgery albeit half since it is only one side.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to improve my side profile of my mouth area and would love to consult with you virtually if possible. 

I am considering a Lip Lift. As well as a Bottom Lip reduction + Chin Implant to address droopy, hanging lip that exposes the bottom gum when mouth is at rest. I also am aiming to address the pronounced outward appearance of the upper mouth. 

Am I a candidate for these procedures ? I have visited 3 orthodontists in the past who have said that I do not have dental issues.

A: Thank you for your inquiry and sending your pictures. What you have is a smaller recessed chin, a large by sagging lower lip and a general bimaxillary dentoalveolar protrusion. (but with a good bite. While your general concepts about treating these are are correct there are some changes to them that would be better:

1) A sliding genioplasty would be far better than an implant when you have a short chin with lower lip incompetence. (sag) A lower lip reduction can be done at the same time. (see attached imaging)

2) I would be very cautions about a traditional upper lip lift when you have lip incompetence (lower lip sag) as that works against improving that issue.

3) You can not improve your bimaxillary dentoalveolar protrusion (pronounced mouth protrusion) with extensive presurgical orthodontics and major double jaw surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in getting chin and jaw implants. I was wondering how long the waitlist is for that. I’m getting married mid November so was hoping he would have an open slot sometime in August.

A: Thank you for your inquiry. I would be very cautious about doing facial implant surgery close to a very important social and life event. By doing so you are banking on that no complications will occur and you will look and feel perfectly normal. Three months will be the minimum time I would do that before someone’s wedding which will be fine…provided no medical (infection) or aesthetic issues occur. (asymmetry, too big etc)

That being said the next question is whether standard chin and jaw angle or a custom jawline implant is needed. I would need some pictures to do imaging to determine what type of aesthetic jaw augmentation change you are seeking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a cyst removed from my left cheek. It left a very noticeable dent on that side of my face. I’ve been searching for a plastic surgeon to fix this issue for a long time. I’ve been getting filler injected into that area, but it dissolves (or moves) from that spot really quickly (about 2 months). I also still have the unfortunate problem of having an active cyst right next to the scar. I don’t want to remove it anymore since it has pretty much destroyed my cheek area. I’m writing to you because one surgeon who I had a consultation with talked about doing a cheek implant which sounds like a better idea than maybe getting a fat graft or more filler. I’d just like your perspective to my problem (and you would definitely be my pick for doing an implant). 

A: I would question the logic of putting a cheek implant deep on the bone with the hope of its push from ‘far away’ would reduce a contour depression closer to the skin area. I would doubt that would work thew way you want. It would also make the right cheek now bigger than the left, creating its own aesthetic issue.

However to make a more informed assessment I would need more than this one picture from an oblique view. I would five pictures. (straight on, sides, both obliques and a view with your head tilted back to show both cheeks from below.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How many weeks after buttock implant surgery will I need to wait to go back to work? iu will need to be able to sit in meetings for up to 3-4 hours comfortably.

How much swelling would I have?

Will I have any restrictions? Driving or Exercising?  

Do I need a special pillow for my bottom?

A: In answer to your buttock implant recovery questions:

1) I think it will be in the 4 week range before she can sit comfortably for extended periods of time.

2) While all implanted tissue swelling after surgery, the amount of swelling in the buttocks has never been a stated concern by patients as I suspect whatever swelling occurs is viewed favorably. Actually you are the first person who has ever asked me about swelling after buttock implant surgery.

3) I would refer back to #1 as it relates to driving. Exercising is closer to 6 weeks.

4) I have never used any special pillows for buttock implant surgery.

The key to the entire recovery process is protection of the intergluteal incision from excessive stress or shearing forces. The rest of the recovery issues relate to patient comfort.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, What are your complication and revision rates for infraorbital rim-malar implants? In particular, I am concerned about asymmetry and eyelid retraction. Fyi, I plan to get lateral canthoplasty too. I had emailed you pictures previously, but am not asking for any evaluation with this particular question, just wondering about complications. Thanks.

A:In my extensive experience with custom IOM (infraorbital-Malar) implants, while potential issues of postoperative implant asymmetry and lower eyelid retraction are possible, they are very uncommon and not what constitutes the main reason for revisional surgery with these implants. The by far most common reason for IOm implant revisions are patients whio make their implants too big initially or are too conservative initially and and bigger later. This size issues is what constitutes 90% of all custom IOM implant ‘complications’.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I really admire your work. I am considering a brow bone implant as well as a custom wrap around jaw implant  with you a few years down the road. I just have a few concerns that I was hoping you could address. 

1. If I have a recessed mandible (my bite is normal) and my chin isn’t recessed, could I still achieve a strong side profile with a chin implant instead of orthognathic surgery? Or would it just look out of place by having a big chin with a small jaw? I love the way my side profile looks when I slide my jaw forward, but my bottom lip moves with my chin, which obviously wouldn’t happen with a chin implant. I’m going to attach some pictures of a celebrity that has basically the same recessed look that I have

2. Would you be able to make the brow bone implant angle downwards instead of a straight?  

3. Is it possible for me to get a vertical chin implant (apart of the wrap around implant) that also has a a custom square shape? 

4. Is the black and white pictures face shape (his face is wide, long, and angular) possible for me to achieve with a wrap around implant that adds both height and width to the mandible, and height, width, and square shape to the chin? 

5. Do you plan on retiring within the next few years? 

Thank you!

A:In answer to your questions:

1) How any facial change looks on a face requires computer imaging to be done to answer the question in any meaningful way. Someone else’s face doesn’t count, only your face does.

2) Custom implant designs are done in any shape to try and achieve the desired effect.

3) But definition a wrap around jawline implant includes the chin which can have a square shape.

4) Refer back to answer #1.

5) No

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have severe plagiocephaly and It is difficult for me to live with it, so I would be very interested in your services. 

But I have a few questions, because this is not a operation that has to be taken lightly. 

So if I understood correctly, to correct the plagiocephaly, you use an implant that you put over the skull. Meaning that you don’t cut, move the bones of the skull, right ? 

So does that mean the technique of the implant over the skull has less risks to fail than the operation where they move the bones of the skull to position them in a bettter way ? 

If it fails what are the consequences? (Brain problems?) 

Other questions, what is the durability of the implant ? Does it last forever ? 

Is it solid ? Will it not move ? 

And how is the implant fixed to the skull ?

A:In response to your adult plagiocephaly surgery questions:

1) You have correctly surmised that in adult plagiocephaly it is treated by an extracranial implant augmentation.

2) Extracranial operations have none of the risks associated with intracranial procedures. They are typical implant-associated risks like any other aesthetic solid face or body implant.

3) Skull implants are solid, do not undergo material degradation, will not move and will last the patient’s entire lifespan without needing adjustments for any of these issues.

4) Skull implants are permanently secured into position by small screws, perfusion holes and an encapsulation process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m interested in having my Perioral Mounds removed. Am I a candidate for that procedure?

A:Thank you for your inquiry and sending your pictures. While your ‘perioral mounds’ can be treated by liposuction that is not the best treatment for them. They are actually tissue that has drifted forward as part of the aging process, creating mounds of skin in the perioral area. Thus they do not represent isolated fat collections with good quality overlying skin which is the requirement for a good liposuction reduction result. Rather the far superior procedure is a lower facial tuckup procedure (lower facelift) which moves these sagging tissues back along the jawline/lower face for a smoother and rejuvenated appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to please ask if you could assist me with forehead reshaping surgery. I find the profile of my forehead very straight, and I’m looking for it to be more convex and backward sloping. Is this an achievable goal?

A: Thank you for your inquiry and sending your pictures. Your forehead profile is very straight for two reasons, 1) the upper forehead is very developed and 2) the brow bones are not. Thus in changing your forehead slope to a more retroclined angle the options include upper forehead reduction and brow bone augmentation. Upper forehead reduction alone is helpful in that regard but because of the limitation of the thickness of the frontal bone it will only change the slope so much. (see attached imaging) Adding projection at the lower end of the forehead (brow bone augmentation) helps tilt the angle back more. (see attached imaging) In the examples you have provided both of those men have more pronounced brow bones.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to give to my scalp a more asymmetric and rounded shape. From my analysis i just needed to fill some spots to achieve the goal.

A: Thank you for your inquiry and sending your pictures. As a general rule you don’t try to ‘spot’ augment a skull shape unless it has only one small area that is the problem. A far more predictable skull shape is assured when the entire surface is covered with a single implant even if it is very thin. Attached is an example of the general concept as well as the type of change you may be seeking.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I got a sliding genioplasty on July 6, 2022. Since I saw my face I thought that it looks long and I look older, also my lower lip is smaller now, it feels very tight when I talk and when I smile my face looks way longer which I hate because I used to have a very pretty and proportional smile. I talked to my surgeon and he said that the proportions are fine so I talked to another surgeon who also said that it looks great and that he would not change it because it would make more harm than good since I had the surgery not so long ago. The Dr moved 7mm and I feel like it was way too much, as a matter of fact I have cried nearly every day since I saw my face and I regret ever doing this procedure. 

I wanted to talk to you before scheduling an online appointment to know what you think. I spent extra money getting a CT scan and X rays for the other surgeon that saw me and in the end he told me he wouldn’t suggest me doing a reversal procedure. I read online that you have experience with this issue and I wanted to know what you think, if it’s possible to reverse it at least 4-5mm, how long I should wait and if you think it may have a good outcome. Thank you for reading.

A:Thank you for your inquiry and sending your pictures and x-rays. I have seen many females in your chin augmentation situation. Yes it is true that you are just two weeks out from surgery and still have a lot of swelling. But I have not yet seen a female who feels the way you do every change their perception of their result months later when all of the swelling has dissipated.

So let’s review what is relevant in your case.

1) You had a well performed and executed sliding genioplasty as per the x-ray. Thus the operation was a technical success.

2) Despite being a technical success, it was an aesthetically flawed operation as the final position of the bone was further forward than what you could aesthetically tolerate. I don’t know how the number of 7mms was chosen or the basis for it. But i would wager you were not given options before surgery using computer imaging to try and determine what looks best to you. On paper and by traditional aesthetic norms bringing your chin out to a line dropped down from the lips is supposed to be the ideal position (see attached)…but for many females with short chins that is simply too much change. Surgeons may look at it and think it is great but the patient may never really adapt to it. Usually a projection less than ‘ideal’ is really ideal for most female patients. (see attached)

3) Since there was a reason you had the original surgery reversing it completely seems counterproductive. A subtotal reversal seems more logical (e.g., 7mms back to 3 or 4) but that is a personal choice of yours.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I dont have pictures of my case right now, but my case is quite similar to this one “Plastic Surgery Case Study – Custom Deltoid Implants for Shoulder Contour Restoration After Muscle Atrophy From An Axillary Nerve Injury”.

I am so excited to find a documented procedure for this deltoid athrophy. Currently, I am living in Europe and I would like to know if there is some chance to do the surgery in Europe. While I am now in my mid 40s and I have this issue since I am 20 (date of my shoulder surgery), so just thinking about finding a solution makes me quite happy.

Thanks for the time and I hope you can help me find a solution for this issue that I have been carrying for more than 2 decades. 

A: The good news is that the muscle atrophy from your axillary nerve injury can be aesthetically improved by a custom deltoid implant design. Unfortunately I only do surgery in the U.S.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had double jaw surgery to correct a severe underbite three years ago. An 8mm sliding genioplasty was also performed at that time. While I look and feel much better now, my jawline still lacks definition from the sides, and my chin falls slightly short of what I believe is the optimal position (the pink of my lip). I would love to discuss custom jaw implants and the options which may exist for me. 

A: Thank you for your inquiry and sending your pictures. Orthognathic surgery provides a good skeletal foundation but it’s effects are largely in the sagittal dimension and thus can never create improved jaw definition, it only creates better chin projection. But now you are seeking the proverbial ‘icing on the cake’ so speak for the lower jaw of which a custom jawline implant is the better procedure to do so. (see attached imaging as one potential type of change) Your fixed deep labiomental sulcus is an issue to be aware of and may need to be addressed as any further chin projection is going to magnify its depth.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to have my lips lengthened via lateral commissuroplasty to have each corner of my lip come directly under my pupils as I feel my lips are too narrow and not ideal.

A:Thank you for your inquiry and sending your picture. I would certainly agree that your mouth width is small compared to the rest of your facial features. In my experience with mouth widening surgery the primary risk is adverse scarring. In such surgery the scars usually do well out to width increases of 5 to 7mms. Beyond that scarring becomes more of a problem. Based on your picture I would estimate you would need 10mms per side to reach a good mouth width on each side. That puts you at great risk of poor scarring which would be my concern for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently found you while searching for temporal reduction, And hoped you can answer my query. I have brachycephaly which I had surgery for to fix the flat spots on the back of my head, however the side of my head is round, I was wondering if temporal reduction by Botox can change the shape of it and make it flatter and reduce the size simultaneously. I understand with brachycephaly The skull bone plays a part, but I was wondering if Botox can give me a less convex shape when viewed from straight on. The width of my head does not bother me as much as I’m a pretty tall and big guy but the round shape does. If Botox can achieve a significant result, I would like to set up a treatment plan with you.

A: The wide back of the head or the temporal-parietal region is the location of the posterior temporal line were the temporalis muscle is the very thinnest. I would doubt that Botox or even surgical removal would make much, if any, difference in this part of the head. There is however one way to know for sure…do it and see what happens. Since it is a non-surgical procedure you can easily find out.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in jaw augmentation for my short lower face. What can be done?

A:Thank you for your inquiry and sending your pictures. You have a fairly severe chin deficiency due an underdeveloped lower jaw. Ideally you should have lower jaw surgery first before any efforts are done from an aesthetic standpoint to create a better chin/jaw foundation. But I will assume for now you are aware of the ideal initial approach of jaw surgery and are bypassing that and are just going to do the best with the shape of the jaw the way it is now.

In that regard the best approach is a maximum sliding genioplasty for the chin. Whether you should try and add on jaw implants with the sliding genioplasty is a subject up for further discussion. Normally I would do some computer imaging to demonstrate some of these potential lower facial changes but your facial hair creates enough distortions that it partially obscures those potential changes.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Interested in forehead contouring, specifically glabellar furrow excision with placement of ePTFE bone implant. Please can you advise on the scar left following this surgery and does it fade?

A: The scar from glabellar furrow excisions usually do quite well since the furrow is already very much like a scar and a vertical scar line is in the natural relaxed skin tension of that area of the forehead. So yes th scar fades/blends in pretty well in the cases I have done.

 Please send me a picture of your glabellar area so I can see how these comments may apply to you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have two very distinct bumps/horns on my forehead. Only directly noticeable  with “above-lighting”. Is there a proven surgery method for evening my forehead?

A:Thank you for your inquiry. Forehead horns are a common forehead concern, particularly in males, that I see for reduction. To fully understand how they are reduced I would refer you to one of my websites, www.exploreplasticsurgery.com and search under Forehead Horn Reduction on the home page. There will a number of cases studies that show the surgical techniques to reduce them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The marked part of my chin is too long in the downward direction. Is there a chin implant that can show this part higher? or can this jawbone be filed from below.Is there an implant to cut the bone or show it higher?

A:Thank you for your inquiry and sending your picture. What you are referring to by your marked picture is a low prominent jaw angle…even though you refer to chin in your description. I assume this is a translation issue/error. The low jaw angle can be treated by two different jaw angle reduction approaches. The first is to reduce it by cutting the bone if the goal is to make it less visible. Whether this is better to be done from an intraoral or external approach can be debated. The other approach is to burr it down slightly and place a widening jaw angle implant above it which is done completely intraoral. Which approach is best depends on the exact aesthetic jaw angle result one finds looks best to them.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to inquire about the removal of my medium medpor chin implant that was placed submentally four years ago with one or two screws used for extra adherence. This request would be for removal only, and not replacement with another implant. It’s my understanding that due to the nature of the implant’s material, removal comes with a higher risk of disfigurement and other complications. I was interested in gaining more information regarding your experience with removing these types of implants, how often you’ve seen long-term issues as a result of removal. I know certain deformities can be mitigated with filler however, I am not interested in filler.

Another issue I’ve had, which is important for me to address, is that the incision site has intermittently presented with soreness/swelling internally just below the scar. I spoke with the surgeon who initially placed the implant and he seems to think that is a result of scar tissue– i’m unsure if that’s accurate. I would be curious if any old scar tissue could be removed during the implant’s removal procedure.

A: In answer to your Medpor chin implant removal questions:

Q: Dr. Eppley, I recently had bimaxillary surgery for sleep apnea and TMJ issues, but I was worried if I was advanced too much? I worry about a “chimp” like look, but strangers online and people I know in person say this isn’t the case. 

A: As you have stated you are early in the recovery process so there remains a lot of swelling yet to resolve. It is probably very unlikely that you will look over advanced when all the swelling subsides.

By definition a bimaxillary advancement always leaves the infraorbital rim and anterior cheekbones behind and is the one significant aesthetic tradeoff of the procedure. There are a variety of implant augmentation methods to augment this newly created area of facial recession secondarily. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, When previously researching the sliding genioplasty procedure locally, I have been told to achieve the best results a neck lift would be best compared to submental liposuction that Dr. yourecommended. Can you explain the difference? 

A: I would never do a necklift in a young male with no real skin laxity. Quite frankly that would never be an option given the scars that would result and that is simply isn’t necessary. The debate can be made between submental liposuction vs submentoplasty in treating your neck but not a formal necklift. But whomever made that recommendation has no understanding of how much improvement the sliding genioplasty alone will have on your neck.

Dr. Barry Eppley

Indianapolis, Indiana