Your Questions
Your Questions
Q: Dr. Eppley, I had cheekbone reduction surgery via osteotomy 2 weeks ago. The bones were reached and fractured intraorally and with exterior incisions. On my sideburns where the exterior incisions were made there are really hard lumps which are a concern to me because I don’t know if it’s swelling that will eventually dissipate and flatten out or the zygoma arch is sticking out. What is it?
A: All I can say is that it is either swelling or the back ends of the zygomatic arch sticking out. It is either one or the other. But that would be impossible for me to say based on just your description alone. A x-ray of course would provide the definitive answer if you must know immediately.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What are your thoughts on Vermillion Advancement and why is this better or worse than the bullhorn/gullwing? I have very thin upper lift and downturned mouth.
Thank you!!
A: FYI bullhorn = subnasal lip lift, gullwing = vermilion advancement
While you can have a subnasal lip lift you should not have it by itself as this will result in an A frame deformity. With the sides of your upper lip absent/folded in and the mouth corners turned down the subnasal lip lift by itself will make the upper lip look even more disproportionate. The subnasal lip lift only changes the central upper lip and not the sides. Thus a subnasal lip lift in you must be combined with a lateral vermilion advancement/corner of mouth lift to look right.
You could also have a total vermilion advancement but with some cupid’s bow presence and a long upper lip I would go with the former which will produce a greater upper lip shortening effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting to fix dents in my butt cheek that I might have gotten from a steroid shot when I was younger. I’ve had this noticeable set of dents/dimples for as long as I can remember. These dents show more when I’m simply standing or wearing tight clothes. I am always covering it up with shirts and long clothes. I don’t want butt implants. I am okay with my butt size. What are my options to fix this deformation?
A: This is a classic soft tissue indentation from exactly what is known to cause it…previous injection therapy. This is not a problem that would be improved by buttock implants anyway. This requires contouring reconstruction with fat. Given the broad and fairly shallow base of the indentation fat injections would be the appropriate treatment choice.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested into getting a few things done in your Clinic. I would like to get Hip Implants, Rib Removal and my Shoulders narrowed. Is it possible to get it done in one surgery? And how long would you recommend to stay in your clinic?
About me: I’m trans (mtf) and have no medical problems.
I’m looking forward to hearing from you.
A: Thank you for your inquiry. The question about whether all three body contouring procedures you have mentioned could be done at once is a recovery issue not a technical one. Since you would most likely be coming by yourself it would be very tough on you to do all three at once. I would choose which two of them have the highest aesthetic priority for you. Those two alone would make recovery hard enough. From an aesthetic standpoint it would also be important to look at some imaging changes to determine what can realistically be achieved from these procedures on you. That may also help with establishing procedural priorities.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m wondering if a submalar cheek implants works effectively on African-American skin for someone with facial lipodystrophy?
A: I am not aware that there are any racial differences when it comes to the aesthetic effects of submalar cheek implants. If someone is a good candidate they can be effective regardless of race, age or gender.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a couple quick questions regarding the posterior temple reduction surgery that I have been very interested in. I’ve been reading up on it and it says that after the surgery, the full results won’t be shown until 6 weeks after. Why is this? Is it because there’s a shrink wrap effect that takes place to where the skin flattens and tightens over where the muscle was removed? Or is it because it takes 6 weeks for swelling to go down and for the muscle to atrophy? I understand you have two methods of either removing the whole muscle or tapering it off towards the back. Is there a significant difference between the two? Thanks in advance
A: To see the operation’s full effect it takes complete resolution of all the swelling. Like any other face or skull surgery this is the expected time for the full aesthetic effect to be seen. Most patients are well into the benefits phase by 2 or 3 weeks after surgery but its 100% result takes the full 6 weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to email you in regards to the cost of a chin augmentation using either an implant or sliding genioplasty. I have a slightly recessed chin I would like to bring forward. I can provide photos. I would like some more information about the custom implant process and how that would work.
A: Thank you for your inquiry and sending your picture. I have done some initial imaging to try and get a feel for what amount of chin augmentation looks sufficient to you. In terms of selecting how to do the chin augmentation:
1) standard chin implants are indicated when the chin deficiency is modest to moderate in size. (like yours)
2) a sliding genioplasty is best done when the amount of chin deficiency is large or the patient very specifically is opposed to an implant.
3) custom chin implants are indicated when the patient’s aesthetic goal can not be achieved by the use of a standard implant. (e.g., very square chin shape)
Based on just this one picture, #1 seems appropriate for you.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, Looking to correct previous gynecomastia surgery. I have bilateral surface irregularities/depressions and scar tethering during flexion. Original surgery completed one year ago with fat grafting completed six months later. Pre and post pictures included.
A: Thank you for your inquiry and sending your pictures. As I understand your history you had an open areolar approach to your gynecomastia reduction complicated by a postoperative crater deformity. This was followed by a second surgery of fat injections in attempt to release the adhesions and improve the contour.
Fat grafting as a treatment for the crater deformity after gynecomastia reduction is an appropriate approach. One can debate whether that should be by injection or the open placement of a dermal-fat graft. Each has their advantages and disadvantages. Fat injections are a more simplified and convenient approach to the problem but how much survives and their contour effectiveness is very unpredictable and far from assured. Dermal-fat grafting is more effective in terms of a successful release and volume retention but it is an open surgery and involves the need for a donor site harvest.
Most surgeons and patients when presented with the two options would understandably opt for the fat injection method. The question moving forward is whether another effort should be made at fat injections or whether one feels better about moving on to a ‘Plan B’ correction method. I can make arguments either way.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I like the first chin augmentation imaging that you did the best, I believe that is the smallest correct? For some reason though I just think I may Iook too masculine. I mean I know I have a boyish face but sometimes I feel like my recessed chin is the only feminine thing about my face lol. I would like to see what it would look like from the front profile because honestly that’s what bothers me the most. I feel like my lower face does not add up to my mid face and I feel like my lower face is sagging— perhaps what I need is a face lift. I honestly don’t know. Maybe you have other suggestions? I’m so lost. You’re the only surgeon I would feel comfortable getting anything done from so I really appreciate your input. Ultimately I guess I just want a more v shaped jawline and chin to look the most feminine that I could possible look. I just gotta figure out what needs to be done. Thank you so so much
A: In answer to your chin augmentation imaging responses:
1) I think it is wise for a female with a significant chin deficiency to be very careful about doing too much, Such patients often have a hard time recognizing themselves afterwards and can never adjust to a so called normal chin position. So the use of computer imaging has helped flush that concept out in you.
2) Since the chin augmentation would be small I would just go with an implant which is probably no more than 5mm horizontal projection and has no extended wings. (anatomic style chin implant) It also would need to be hand modified so it looks just like a V. With implants you have to exaggerate their design on the bone as the overlying soft tissues will blunt their effects. So to have a more narrow chin the implant must literally look like a V.
3) Not doing frontal imaging was not an oversight. You can’t really pull the chin forward with imaging so It won’t show much of anything. Unless one is interested in increased chin width (which you aren’t) frontal imaging is not useful. For chins and jawline the combination of the side and oblique views is the most informative and accurate.
4) A jowl tuckup procedure always makes the jawline sharper as it pulls the soft tissues back over the jawline bone. So the question is not whether that is beneficial but rather how far does one want to go for how much effect. At the least submental/neck/jawline liposuction is needed with the chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Has you ever had patients post-operation suffer from weakness in chewing or keeping the jaw closed after having done the posterior and/or anterior temporalis muscle removal/reduction?
-What sort of feeling should I expect post-operation and during the healing process when Dr Barry performs bone burring on my enlarged temporal line?
-Just to confirm, is it the over-developed anterior section of the temporalis muscle that contributes to forehead width ? I say this cause reducing my forehead width is one of my main goals with this operation.
-Roughly how long would it take for the major swelling to settle down post-operation and for me to comfortably go out in public ??
-Will I lose much sensation on the scalp post-operation from the coronal incision ?
-What medication would I get prescribed with post op and is this medication available back home in Australia ? If not what’s an alternative ?
Looking forward to hearing from you.
A: In answer to your temporal muscle and bony temporal line skull reductions:
1) No patient has ever experienced any lower jaw motion or chewing difficulties after the surgery. When the anterior temporal muscle is manipulated there can be some temporary tenderness with wide mouth opening.
2) Skull bone has no sensroy innervation so no pain/discomfort comes from bone reductions. It is the scalp that has sensory innervation.
3) The width of the forehead is ultimately defined by the prominence of the anterior temporal line.
4) Most patients have a reasonable appearance 10 to 14 days after the surgery.
5) Postoperative pain medication can consist of either narcotics (e.g., Percocet) or potent anti-inflammatory medications. (e.g., Toradol Ketolorac) That is a patient’s choice.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How many centimeters can you extend your shoulder reduction surgery? There are many places where triangular muscles, seolsang muscles, and chest are connected. What are the side effects? Please explain this in detail.
A: The amount of clavicle bone removed in shoulder narrowing surgery is 2.5cms per side. This has consistently shown to be effective and safe and within what is clinically supported by the orthopedic surgery literature for the amount of clavicle shortening that can occur without untoward shoulder function effects. (based on unoperated clavicle fracture repairs)
Other than the small scar in the supraclavicular fossa through which the surgery is performed, there have not been any functional side effects.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What are the chances of getting brain infections or any other risks during the cranioplasty?
A: There is a zero chance of brain infections with cranioplasy. All aesthetic skull reshaping procedures are performed on the outside of the skull not the inside. We do not come close to the dura mater let alone violate it into the subdural space.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m thinking about getting a skull reduction surgery sometime in the future. I’m thinking about specifically getting a temporal reduction surgery, mainly because my head appears overly wide. And I’m hoping to have my head appear more narrow after the surgery is done. I just had one question about the procedure. I read online about the temporal reduction surgery and how it will be carried out. I understand that to reduce the width of the head, you can remove the posterior temporal muscles located on the side of the head. But isn’t it also possible to remove some of the outer layer of the bone located on the side of the head if this bone is thick enough? Just like how it is done with the occipital reduction surgery, where the amount of reduction is limited to the thickness of the outer bone located at the back of the head. I’m asking this because when I plan to get this surgery, I’m hoping to make my head not appear as wide as it does now, and I’m hoping to get the most results from this surgery.
Thank you for answering my questions.
A: In answer to your temporal reduction surgery questions:
1) In every case of temporal reduction I have done removal of the muscle alone has been adequate…even in those that believed that bone reduction was needed as well.
2) Temporal bone reduction can always be done if one is willing to have the incision located on the side of their head. (as opposed to hidden behind the ear when the muscle is removed)
3) The temporal bone is very thin and just a few millimeters can be removed. Thus the minimal benefits gained is usually not worth the scar burden to do it…particularly if one has no hair to hide it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had cheekbone reduction surgery last week. Upon having my post op CT scan — I noticed my right cheekbone was slightly separated. My doctor said this will heal fine, but I’m still concerned because every time I open my mouth or touch my right cheek—I can feel my cheekbone moving slightly and making tiny cracking sounds. It’s also a little difficult to chew on my right side. I know I’m very early I’m my recovery process, but my main concerns are that this will cause asymmetries in addition to malunion requiring further corrective surgeries and longterm complications such as skin sagging. What are your thoughts based on your experiences, doctor?
Thank you
A: You had the classic oblique cut cheekbone reduction surgery with plate fixation at its most inferior part closest to the intraoral incision. While the left side is ideal the appearance on the right side is not uncommon. There is a slight rotation of the right cheekbone segment which can happen as the superior part of the bone is not accessible for direct plate fixation.
Everything you are feeling on the right side is not abnormal and the bone segment should go on to heal. (it will probably heal with a fibrous union rather than a bony union…which does not matter in a non-mandibular facial bone) The sensation of movement should pass in a few weeks. This slight osteotomy line should not cause any asymmetry.
The risk of soft tissue sagging has nothing to do with the osteotomy line as long as the bone is stabilized from falling inferiorly. Soft tissue cheek sagging often occurs because of the way the procedure has to be done. (stripping of the soft tissues off of the cheekbones) and then reducing the projection of the cheekbone)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve looked over the imaging pictures of my sliding genioplasty chin augmentation and I like the medium and large chin projection changes for my side profile. I wouldn’t want any larger than the large so if youhad to go bigger or smaller from that id prefer smaller. In between medium and large would also be perfect.
I forgot to add, how much do the different changes affect the view from the front and 3/4 view? I know you said it’ll look narrower. How much narrower would the large change be compared to the medium change? And how much longer from the front will my chin be in the end?
Thank you so much!
A: What you are really saying from a dimensional standpoint is keep the projection of the chin behind a vertical line drawn down from the lower lip. And to no surprise in females with naturally smaller chins ‘less is more; so to speak.
The larger forward movement the more narrow the chin will become from the front view.
Dr. Barry Eppley
Indianapolis Indiana
Q: Dr. Eppley, Last year I had bilateral testicular wrap around implants. Overall I am pleased, the left one is perfect. The right one however has a strange “pointed” shape at the bottom that is bizarre and sometimes causes pain, I was wondering if this could be rounded?
A: I would assume that this is related to the implant and, thus, it could be depointed (rounded off) in place.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had two sets of hip implants and both were plagued by bulging on the lower end of the implants. How can this be fixed?
A: I have pulled and looked at both your 1st and current hip implant designs. I would suspect that the first lower bulge occurred because the bottom of the implant developed a bend or fold in it. (thin lower edge) The second hip implant design is much thicker (and also heavier) and this probably occurred for the same reason. My thoughts are as follows:
1) This is not an easy problem to solve mainly because there is no assured outcome based on anything that may be done. Good fixes are those where high confidence is in the knowing the exact problem and having a treatment that is known to work for it.
2) I am not sure a change in implant design/shape is the solution. The profile shape of the bottom half of the implant does not match the shape you see in you externally. (see attached side by side comparison) This still suggests a bending problem at the bottom of the implant.
3) If we knew that the implant shape was the issue I would then just hand modify the bottom of the implant to make it have a lower better taper to it. (this is tempting to do and probably has little downside to doing it…probably can’t make it worse but would it work??)
That being said there are only three options:
1) hand modify the current implants as described above
2) Make new implants of higher durometer (stiffer with with better lower half profile shape)
3) Injection fat grafting around the lower half of the implant to make a more gradual transition.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, On Real Self I saw a few answers of yours to questions with regards to vertical augmentation of the chin. You were saying that using chin implants the chin can be vertically augmented up to about 7 mm (but no more) whereas with a vertical bony genioplasty the chin can be vertically augmented up to even 15 mm. The question I had was: from your experiences, what’s about the limit with regards to how much the chin can be vertically augmented with fillers? I’ve heard fillers are usually only good for horizontal augmentation of the chin (but not vertical) but I’d imagine that they could also vertically augment the chin to at least some degree. How much mm would that limit generally be?
Thank you for your time.
A: Injectable fillers can probable increase the vertical length of the chin by 2 to 3mms.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have always been curious to know if it is possible to increase the pupillary distance between the eyes? I feel it gives a more feminine look and I just wanted to know if this surgery is possible? If not, is it possible in the near future with new technological advancements? Thank you for your time.
A: The eyes can be made wider if one is willing to undergo orbital box osteotomies as an adult. That is a major commitment that requires a full bicoronal scalp incision and a frontal craniotomy to perform. I do not see this surgical approach changing any time in the near or far future.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can temple implants and tear trough implants make my face more symmetrical? I had BSSO advancement which made the jaw angles more obtuse and desire jaw angle implants too. Would like to know your views via a possible consultation.
A:Thank you for your inquiry and sending your picture. The aesthetic benefits of temporal and infraorbital augmentation are fairly clear when imaging your front view picture. (see attached) The jaw angles are harder to properly visualize from just a front view picture. BSSO surgery is well known to adversely alter the shape of the jaw angle bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Am I a good candidate for reverse abdominoplasty and what’s the approximate cost of this procedure that only addresses the upper abdomen?
A: A reverse or superior-based tummy tuck is indicated in the following:
1) Loose abdominal skin is located above the umbilicus while there is no excess/loose abdominal skin below the belly button. In essence the loose upper abdominal skin ‘hangs around the fixed central umbilical area.
2) The patient does not prefer to undergo a traditional lower tummy tuck with umbilical repositioning or has been through a previous tummy tuck and does not wany to undergo that procedure again.
3) A well defined inframammary breast crease exists that is hidden by some degree of breast ptosis. (sagging)
4) The patient is not opposed to a scar line across their inframammary creases that may cross the midline between their breasts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a trauma to the scrotum and testicles secondary to an assault where an effort to “pop” the testicles through the scrotum occurred. This eventually resulted in the loss of one testicle and caused the posterior skin behind the scrotum to become very stretched out and thinned. Now the remaining testicle hangs low and slides out of the muscular part of the scrotum into the stretched out skin below the scrotum. This feels uncomfortable while sitting and especially while exercising even though I use supportive underwear. The discomfort and appearance reminds me of the assault and restoring things as much as possible would be a great help from this devastating and humiliating injury. In cold conditions when the muscular part of the scrotum contracts, the testicle is pushed into the stretched out area of skin towards my leg and feels uncomfortable. My hope is that if the stretched areas were tightened to keep the testicle in the muscular part of the scrotum, I would be much more comfortable. While I did not have a prosthetic testicle implanted when the more severely injured testicle could not be saved, I am not interested in a prosthetic testicle being added because comfort is a great concern and I feel with one testicle my prospects for comfort is greater since a certain amount of chronic discomfort exists; nevertheless, I would like some of the extra scrotum cleaned up and made to look more tidy. I am not concerned about having large and impressive looking scrotum and testicles, but really want to be comfortable and would prefer to have a smaller, higher positioning of the remaining testicle.
A: Thank you for your inquiry and sending your pictures. What you appear to have is disruption of the enveloping Dartos fascia/cremasteric muscle which allows the remaining testicle to prolapse into the enlarged and thinned skin sac under certain conditions. In essence you have a scrotal hernia. You are correct is that excision of the stretched out skin/tissues with a reinforced closure (aka scrotoplasty) will very likely help with the discomfort as well as its appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I wanted to know if you’re able to do a tummy tuck on a kidney transplant patient?
A:Yes I have done it before. (twice) You just have to know that the transplanted kidney is in the abdominal area so it may not involve rectus muscle plication depending upon where the transplanted kidney lies. It also requires clearance from your nephrologist for this elective body contouring surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was born with a congenital mishaped head. Do you do craniotomy’s? Do you work on adults? I had a forehead implant in 2009, it held up for nearly 3 yrs then started sliding. I let it go, saw a surgeon and he was going to take out implant & in 6 months do the craniotomy. As we thought I’d torn my dura mater, it was just a very, very severe infection and now he doesn’t want to do it! I was heart sick. I then saw a colleague of his & she wants to do bone paste. I’m just checking out all my options.
A: As I understand your skull situation, you had some type of forehead implant which became infected and had to be removed. I am assuming there is a remaining frontal bone albeit misshapen and recessed. I assume they have done an updated 3D CT scan of your forehead/skull so that the residual bony anatomy is known. I could not give a qualified opinion as to what your options are now without seeing that scan. Whether any form of synthetic material should be now used is the question. I assume the original implant material was PMMA. Certainly that material should not be used again and HA bone cement would be a better option.
Dr Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a skull implant surgery which was performed using 50CC of PMMA bone cement at the back of my head. There is now also a sizeable dent at the top of my head at the site of the incision ( its very hard to see in these photos due to my hair). This dent is palpable and visible to me after i shower and my hair is wet. I assume it’s because of how the PMMA was molded and where it was placed. How can this be fixed?
A: Thank you for sending your pictures. Nothing went ‘wrong’ with your skull augmentation. It is just that the use of PMMA bone cement is a very limiting technique for skull augmentation because of the low volume of cement that can be used and the frequent irregularities of it due to having to insert it and mold it ‘blind’ as it sets. I abandoned this antiquated skull augmentation technique ten years ago due to such inferior results.
By comparison today’s custom skull implants average about 150cc of volume (3X what you have now) with an assured smooth outer surface and good non-palpable edging into the surrounding bone. You would have to have this bone cement removed and replaced with such a custom skull implant for a much improved result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Could the crease in the back of my head be removed?
A: You have a common horizontal deep scalp crease at the bottom of the occipital bone on the back of your head which is not rare in thicker scalps. Because of its v-shaped indentation it must be treated just as if it was an indented scar. The indentation needs to be excised (cut out) and the scalp edges closed with a more level surface contour
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am emailing you to ask a very particular question. In the times you have performed the Temporal Artery Ligation Surgery, have you ever witnessed hair loss occurring in any of your patients? In fact, have you ever witnessed hair loss occurring in ANY procedure that relates to any procedure or ligation of the head and neck. I am asking because there are wild theories about blood flow being the cause of hair loss. Please get back to me!
A: The answer to your question is no nor would I expect that to ever occur. The scalp is simply too vascular with such an extensive anastomotic network that no single artery ligation effects an overall inflow at all.
I will tell you of a not so wild scalp blood flow fact known as homestasis flow. To maintain a vascular flow input to which it is accustomed if one or multiple inflow vessels are ligated the remaining arterial vessels dilate to increase their inflow, thus maintaining the amount of inflow which originally existed.
This is the vascular basis of pedicled skin flaps which have been used in plastic surgery for over 100 years.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I appreciate if you can provide feedback to my inquiry for ear surgery. Basically I have large size ear which requires upper pole and earlobe surgery and at the same time I am concern that if I do ear reduction surgery (upper pole + ear lobe) my ears might look lower from their position sort of become low set and I am wondering if you can perform AUROPEXY surgery ( lift & rotate) after ear reduction surgery. The purpose is to have smaller size ear but not low set. If this is possible then I would like to book for both surgeries and it is understood that they had to be done with some time distances and can not be done together. I appreciate if you can provide your feedback if this is possible. Thank you and regards
A:While ear reduction surgery can be performed with a very visible alteration in its vertical height, changing the position/orientation of the ear on the side of the ear is more limited. The ear is basically pinned to the side of the ear by the cartilaginous external auditory canal. The position of this canal is fixed as it passes through the skull into the inner ear. The ear canal can be partially released to allow for some ear rotation and the stretch of the ear can allow for some very modest elevation but these changes are less substantial in appearance than that of the ear reduction surgery.
The one question I would ask is how do you know the ear will look too low on the side of the head after ear reduction surgery? The best way to determine if this would even be an issue is to have some computer imaging of the ear reduction done and then see how it looks to you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a young trans person who has extremely bad dysphoria, especially around the shoulder and hips area. I have searched online and even asked on forums to no avail, I even called surgeons in my country but no one is doing anything that can help. Then I found you.
I have some questions regarding the shoulder width reduction surgery, does the surgery actually reduce shoulder width? I saw on some forums that apparently it just gives the illusion of being reduced and gives bad posture, is this true?
I’ve also looked into any surgeries that can possibly reduce my frame, when asking about it I was met with hostile responses that I’d end up dying 24 hours later because it would put pressure on the heart.
My last question is regarding the pelvis and hips, are there any surgeries or even experimental surgeries that are being developed to bring the hips closer to that of a female? I’ve been looking up anything relating to this and all I’ve found are resources that may aid in helping to change bone structure like https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.610.BJR-2017-0094.R1 and https://www.ypo.education/orthopaedics/hip/pelvic-osteotomy-t12/video/ . I’m not a surgeon so I don’t know a whole ton about this, all I can do is look at a skeleton and ask questions, like if the clavicle is reduced, wouldn’t the upper rib cage bones also need to be slightly reduced in order to achieve more width reduction? Looking at pictures of a skeleton it looks like the shoulders are connected to a few of the rib cage bones specifically the sockets for the shoulders. I have heard stem cells have been used to help in surgeries, are there any stem cell therapy that’s being developed to help in changing body shape?
Thank you so much for taking the time to read my message, I’m so grateful.
A: In answer to your questions:
1) Shoulder narrowing surgery effectively reduces external shoulder width by removing a segment of the clavicle, the horizontally oriented bone that keeps the shoulder outward. It also does not adversely affect posture. Whomever would say otherwise on these two aspects has no working knowledge of the actual surgery.
2) You can not reduce the ribcage that lies above rib #10 for a variety of medical and surgical execution reasons.
3) Iliac crest implants exist for giving narrow pelvic patients more of a feminine curve.
4) While stem cells have a role in wound healing and the treatment of certain diseases, they have no role in structural body reshaping surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had a silicone testicle implant for many many years I had it implanted when I was 25. I’m now 50.. I have been told that they should be replaced after a time. Is this true ? Also the implant is rock hard and I’d prefer something more natural is that available now?
Thanks
A: In answer to your testicle implant questions:
1) There is no recommended time deadline by which testicle implants should be replaced. As long as one has no concerns/problems with them there is no need to replace them.
2) Today’s testicle implants are superior to those of 20 years ago in terms of being much softer and with many larger sizes available.
Dr. Barry Eppley
Indianapolis, Indiana
