Your Questions
Your Questions
Q: Dr. Eppley, I figured that I would check with you to be on the safe side about root canal treatment. I had a scan done when I was looking into getting a missing tooth replaced. They informed me that I have an infection above another tooth and suggested that I go to another dentist and get a root canal. I wanted to check with you to be on the safe side since my premaxillary implant is in that region.Is there anything that the doctor should be aware of.
A: Having to get a root canal and having an implant in the immediate overlying area is extremely pertinent. Because they have to give local anesthetic injections there are two considerations:
- There is a very good chance that local anesthetic injections may not work as they rely on diffusion and the implant will likely block it from having an effect. If you look at a picture of the general area where the implant is and the location of the tooth in question (right upper canine) you can see that they are ‘neighbors’.
- There is an equally good chance that the local anesthetic injection will be injected right into the implant, which besides not having it work, could get the implant infected.
Thus it would be prudent that I speak to the treating dentist so they are aware of this issue and devise an anesthetic approach that will work as well as avoid causing an implant infection.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 29 years old. Used to weigh 320lbs but now about 230-235. I have been doing bodybuilding and competitions for at least the last 5-6 years. I stay around 12-18% body fat yearly. But no matter how clean I eat, or strict my workouts are I can only see my abs when I’m down to 3-5% body fat. Would ab etching benefit me?
Here are the pictures per request. Interested in ab etching.
A: Thank you for sending your pictures. Abdominal etching is unique in liposuction because it does something that is not done in any other form of liposuction…the removal of fat to deliberately create a contour depression. (in this case the etch lines) One of the basic principles of success in liposuction surgery, abdominal etching included, is the ability of the skin to shrink and contract down around the areas where the fat is removed. Your abdominal skin is challenged in that regard because of the weight loss where much of the elastic fibers in the skin have been irreversibly stretched out and the ability of the skin to shrink and contract has been compromised. (as evidenced by the stretch marks)
Theoretically abdominal etching in you should not be that successful because of the condition of your abdominal skin. I suspect what that really means is you will get some improvements but one should not expect typical well demarcated etch lines to appear from the procedure…. probably more of a hint of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been meaning to get a vertical lengthening chin implant and I’m looking for a 8 mm vertical increase. However, I think the biggest on-shelf VLC implant only provides 6 or 7 mm vertical increase. I was wondering if it is possible that a VLC implant can be customized to provide 8 mm vertical increase or is 7 mm the maximum?
A: There is a reason no standard chin implant exceeds 7mms in vertical length…as that is about the limit of how much the chin bone can be expanded by an implant and still get the soft tissue chin pad over the end of the implant during closure. Whether the additional 1mm of increase would be excessive is hard to predict before actually placing the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if I can do fat transfer into breasts and buttocks at the same time?
A: You can if one has enough fat to do so but that would be very unlikely after concentration of the fat aspirate. For the vast majority of patients they have just enough fat that devoting it all to one site (buttocks or breasts) is usually what is done. It would be exceptionally rare that any patient would have enough fat to harvest to treat four ‘mound’ areas in a single surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, In shoulder widening surgery does the slope of the shoulders change?
A: In clavicular lengthening, regardless of the angulation of the clavicle, there is a direct translation of the bony lengthening to the bideltoid width. Because the clavicle is not a straight bone but an s-shaped bone, lengthening it widens AND pulls the shoulders back a bit. (desloping if you will) This is the reverse effect of what is seen in clavicle reduction where the shoulders narrow and slope in a bit because of the bone’s s-shape curve.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if you guys have ever experienced a patient that had undergone a sagittal crest reduction at your clinic if he (or she) ever got hair regrowth as a result from it, did you guys ever experience such a case? Like lets say for example a person that was experiencing hair thinning or male pattern baldness and after the surgery he started to grow his hair back.
A: That I have not seen or been told by any patient that it has occurred. Nor would I expect it that biologic reaction to occur. The skull bone and its shape has no influence on hair growth in the overlying scalp.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My past history of testicle enlargement, I had surgery to get his XXL size cup style implant in 2015 and everything was great for about a year then the left on fell off the testicle. I had another surgery to fix it in 2016 and the same thing happened again in 2018 and then again in 2019. My right testicle has never had an issue with the implant coming off, but it is an odd shape and pretty hard. I am on TRT and have been from the age of 28, I am now 50 and not sure if that maybe part of the issue. I have spent a lot of money on this. I am really interested in your largest wrap around style implant. I have a lot of room in my sac and believe it would work. I would really like to hear what you think and see what all the costs would be to get the procedure. I live out of state and would like to come home a day or two later if possible. Thank you in advance and CAN’T wait to hear your thoughts.
A: In my custom large testicle implant experience the wrap around style for the properly selected patient can be very successful. However how that implant style might fare in a scarred scrotum where testicle implants already exist as replacements I can not say as that situation has not yet arisen. (until your inquiry) Whether it would be the ultimate solution or turn into another eventual ‘problem’ (back out of the implant) can not really be predicted.
The only sure bet in your situation, in which I imagine the natural testicles are fairly small due to TRT and age is a side by side technique. Using 7.5 cm testicle implants that would overwhelm/camouflage the existing ones removes any risk of the implant complications you have already incurred or may occur with any future enveloping implant techniques.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Have you had cases where any of your scalp bone lowering surgeries such as “sagittal crest reduction” , “Sagittal Dimple Correction” or by making the scalp flat at the top caused hair to regrow with people that had male pattern baldness?
Because i think that scalp bone growth plays a huge role when it comes to male pattern baldness and me myself i suffer from scalp bone growth like extensive sagittal crest growth and at these same spots it looks as if male pattern baldness occurs.
Have you had reports and results from people that they also got hair growth after having had a surgery for scalp bone lowering?
A: Your question is a good one and is not the first time this conjecture has been posed. Unfortunately no patient has reported to me that hair regrowth has occurred over any area of skull reduction to date. This does not mean it may not have occurred, just that it has never been brought to my attention.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in Zygomatic Sandwich Osteotomy. I want to know, if you need to cut through any muscles or shift their position or reattach them in this procedure?
A: In the ZSO procedure the osteotomy cut is done just in front of the anterior tendinous attachment of the masseter muscle…so no muscles are detached or need reattached during the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, in regards to shoulder widening surgery by osteotomy. Does the sagittal split osteotomy + oblique osteotomy require a bone graft from the body or just putty? And how long will the patient be in a sling?
A: In answer to your shoulder lengthening questions:
1) Bone putty is used not an autologous bone graft.
2) I don’t put patients in arm slings.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello you will find two pictures attached My head circumference is 62 cm Please tell me about realistic results That are possible. I had one doctor who told me at the forehead and back of the head its only possible to grind down a maximum of 5 millimeters which wouldnt make a big difference about the look.Thats why im curious.I really want to let do my forehead and back of the head to make the head as a whole look smaller.
A: The only way to absolutely tell how much skull thickness can be safely removed are x-rays. A plain lateral skull film will show the three layers of the skull bone from which it can be determined the actual millimeter thickness of removal possible. But that being said I have outlined on your picture what I am certain can be removed based on my skull reduction experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m primarily interested in getting custom infraorbital-malar implants to gain a positive eye vector and positive/neutral canthal tilt. Is this achievable? I really like the androgynous pretty boy aesthetic, so I would want an implant that could provide me with a mildly angular, fuller feminine high cheekbone look.
My secondary concern, is having a more define jawline. As I mentioned, I really like the androgynous look so I was wondering if I could achieve with implants a more prominent jaw angle from the side, while also decreasing the “square-ness” from the frontal view with a little bit of frontal growth.
A: Thank you for your inquiry and sending your pictures. In answer to your questions:
1) To achieve the best orbital-midface effect it would take a combination of custom infraorbital-malar implants with lower eyelid reconstruction with spacer grafts and lateral canthoplasty.
2) When it comes to the jawline I believe you are referring to a custom jawline implant design that has a chin component that creates a less square/more round appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I live in the UK and am interested in having thigh /calf / and buttock implants. I’m a 40 year old male and have done weights for years to no avail. and have always been top heavy with a fair amount of muscle mass, and would like information on the procedure. I would like to know if multiple operations can be done at once.
A: Thank you for your inquiry. In looking at buttock/thigh/calf implants the first concept to understand is that these three body implant areas pose formidable challenges when it comes to recovery. None of them are easy recoveries and the concept of putting them all together is not an option. Even any of the two body areas put together I would be very hesitant to do particularly in an international patient. To even conisder putting two body areas together one would have to be here for 30 days to ensure an adequate fumctional recovery and assurance that the osyt common complications are avoided/managed.
The ‘easiest’ of the body areas are calf implants followed by thigh implants and always the most challenging are buttock implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to achieve an ultra-feminine body type and get my ribs removed (3 each side if possible). I want to narrow the waistline, maybe liposuccion on the flanks, and add hip implants if it’s possible to get large ones. From the side I love the look of my butt implants. However, from the front my body is still sort of boxy and I’d like to change that to achieve an hourglass shape. My ribcage is square shaped and so are my hips so these are the 2 things I’d like to target to achieve the most radical results possible in one surgery.
A: Thank you for your inquiry and sending your pictures. Certainly the three lower ribs per side can be removed and flank liposuction done to maximize the waisltine reduction. Large hip implants in particular have a high rate of complications (chronic seroma, edge show), particularly in thin patients, so I can’t encourage their placement at this time. They have a much higher rate of problems than buttock implants and the complication rates between them are not comparable due to the different types of issue pockets.
Regardless I wouldn’t do rib removal and hip implants at the same time as that is a very hard and unnecessary recovery. So you maximize your waistline reduction first and then make the decision about hip implants later. Other than the fine line scar rib removal has had almost no complications in my experience. So you get that benefit first before ever considering a final hip implant procedure where the complication risk is much higher.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, my only question for you at this stage is with regard to recovery time from getting pectoral implants – I’d like to know how much time I’ll need to plan for the various stages of practical recovery (casual movement, normal return to work for a “sit at my desk and wiggle a pen” computer job, and return to regular exercise and activity). I’ll have my family available throughout recovery, so I’ll have no problem with support during the trip recovery time, I just want to plan accordingly.
A: In answer to your pectoral implant recovery questions:
1) Like breast implants I don’t restrict arm movement after the surgery.
2) I don’t see any reason you would not be at the computer within days after the surgery.
3) Exercise and more strenuous physical activities will take up to 4 to 6 weeks after surgery to resume.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would assume the placement of a new testicle will warrant an orchiectomy, correct ? Does that mean the patient will therefore be infertile ?
A: With a wrap around implant style the testicles are maintained and they are encircled by the implant. No one is going to do an orchiectomy merely to have larger testicle implants placed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a male fitness competitor and I am interested in the surgery to remove the ribs, I would like to reduce my waist to the maximum, what are the costs of the operation and the results ??? Can I also do with the muscle that I marked in the picture ??
A: Thank you for your inquiry and sending your pictures. It is hard to predict what effect rib removal surgery would have in a male because I have never had such a request before. Thus I can only theorize about its effects which I would assume it would be similar to that in a female particularly a female body builder to which I have done one such patient. (which in her was very effective) As for the muscle to which you refer that is the external abdominal oblique. Some of that muscle can probably be removed from the same incision as that used for rib removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Im from Switzerland and I saw Dr. Eppley‘s work on Instagram and i was very impressed. I wanted to make a custom jaw and chin implant. I was wondering if this procedure can be done in three weeks , so i can take vacation from my work place for the procedure. I hope to hear from you very soon and wish you a nice day .
A: Thank you for your inquiry. The custom jawline implant design and manufacturing time is an 8 to 10 week duration. But all of that is done from afar and the patient only comes here for the actual surgery. The 3D CT scan is obtained locally and the collaborative implant design process is done in a virtual manner. This is how it is done for anyone anywhere in the world whether one is in Chicago, Sydney or Zurich.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi! Before I book an appointment I wanted to know if I can get shoulder shortening at the same time as getting breast implant? And if not, should I get breast implants before or after getting a shoulder shortening?
A: Shoulder narrowing and breast augmentation surgery can be done at the same time. They are also in the same surgical ‘neighborhood’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Since I was very young I’ve had very “bony” shoulders because my top bone of the scapula shows a lot. This is something I’ve been very insecure about my whole life. I’ve been Googling a lot to see what you could do about this and that’s when I found you. In 2015 a girl posted about this exact issue and her pictures looked a lot like my body. You answered her post and said that you believe it’s possible to do some kind of fat injection/transfer or implant to the shoulder to give it more of a round contour. That really gave me hope so I would really appreciate if you could try and help me.
A: Thank you for your inquiry and sending your picture. Your shoulder ‘bump’ is the AC joint of the shoulder which is more prominent in some people than others. There are two potential aesthetic approaches to lessening its prominence, fat injections or implant coverage. Fat injections would be the easiest to place with the caveat that their volume retention is not predictable. (how much survives/retained) Utltrasoft thin silicone implants can also be used, whose volume retention is assured, but requires a small incision to place.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Are your implants secured in place by titanium screws? Facial bones never completely “settle,” and the fear here is that eventually implants can eventually shift out of alignment via trauma or just gradual changes. Plenty of imaging on the site shows older misaligned implants. The imaging of your own implants don’t show this, but of course those are taken right afterwards. As far as I’m aware, securing with screws is the only guarantee. Without such security, even the idea of an implant eventually becoming misaligned would weigh on me.
A: The debate about the value of screw fixation in aesthetic craniofacial implants is not one in which I engage. It would be rare that I would ever place a facial or skull implant without screw fixation. Over the course of a single year I use almost 1,000 1.5mm or 2.0mm self tapping screws for implant fixation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a relatively wide face already, and additional width added to the cheekbone area would not be harmonious with the rest of my face as it would highlight my smaller IPD. However, my jaw and cheekbones have a sort of ‘blocky’ look, as to where there is no cheekbone projection. They are very ‘flat’ and do not show from a 3/4 view (OGEE curve). I suspect they have poor projection? Would it be possible to increase cheekbone definition and get the “male model” look of sorts while maintaining my faces width as to not highlight close set eyes?
Would the best way to go about doing that be a form of implants, or a combination of fat removal procedures? I am concerned that buccal fat removal would give issues as I age, and that perioral liposuction and buccinator myectomy would be a negligible aesthetic improvement. Thank you!
A: I believe what you are referring to is cheek augmentation that creates more of an Ogee curve but without adding facial width in the zygomatic arch area. The question then becomes not whether that is possible through implant design/placement, as it is, but whether that would have the desired aesthetic effect. That would require some computer imaging to determine but I don’t think a reductive soft tissue approach can accomplish that effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hi I am an Asian female who is looking for more eye depth with brow implants. Is that possible or are those only for males?
A: While brow bone augmentation is most commonly performed in males, it can also be performed in females. It is not necessarily a gender specific procedure. It is an aesthetic brow bone augmentation/increasing eye depth procedure for whomever desires it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, l’ve read that you are a very experienced maxillofacial and reconstructive surgeon and I have also read that sometimes it’s possible to remove fillers through facelifts. Is it possible to do it? 3 months ago I had the bad idea of getting a filler to my jawline and chin (2 ml total of juvederm volux, 25 mg vycross hyaluronic acid). I just wanted a little more definition and a sort of lifting effect, instead I only got an heavy, square, wide and fat face … I have always had a thin face and I don’t look like myself anymore !!! Hyaluronidase didn’t work (5 rounds, with my original injector, poor results). A week ago my new doctor gave me low dose diluted steroid injections … they have worked in reducing the swelling a little, but my face is still different. It’s not saggy, but more voluminous and heavy than it used to be (because of the filler). Is it possible to surgically remove the jawline filler (injected under the muscle) through a lower facelift? I’m young (42 years old) and I look younger than my age, but I want my face back whatever it takes. Thank you for your time and your attention. Kind regards.
A: I think what you have discovered is that the expansive effect of the fillers on the lower facial tissues is not going to be completely solved by enzymatic dissolution treatments. You have correctly surmised that a jowl tuckup procedure is the definitive solution. With the raising of the skin flaps residual filler is removed and with the SMAS flap and skin tuckup the lower face is again slimmer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in correction of my temporal hollowing which I have circled on my pictures. It is greater on the right than the left side.
A: When it comes to temporal augmentation it is extremely important to differentiate whether the objective is to treat pure temporal hollowing (soft tissue only) or whether what the patient calls temporal hollowing crosses the bony temporal line which really includes the side of the bony forehead as well. In the attached picture I have illustrated where your bony temporal lines are and it is clear by the temporal areas you have circled that yours is a combination of temporal muscle and bony forehead. That anatomic distinction is key as it changes the type of temporal implant needed to treat it. Pure soft tissue temporal augmentation is usually treated by standard styles of temporal implants that are placed on top of the muscle but under the enveloping fascia. But when the deficiency crosses over on to the bony forehead the implant must be custom designed and it must sit on top of the muscle fascia and over onto the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My ears are low set and rotated backwards- would like to be pulled up and rotated forwards.( not sure if it makes any sense but my eyes have always been tired since I was little. not sure if it was because of hooded eyes or pull from the low set ears.
A: The ears cannot be moved in a superior direction. The cartilage of the ear is fixed to the side of the ear by its continuation into the bony external auditory canal. This effectively pins the ear into position. While the ear cartilages can be reshaped around this fixed position (e.g., pinned backwards) the base of the ear can not be moved in any direction to relocate his current position on the side of the head. I know this particularly by experience as I have tried to move the war superiorly numerous times…and it never works.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read your article about pec implants below and I am a bit confused.You say that male pectoral implants are placed in a completely submuscular pocket whereas breast implants are placed in a partial submuscular pocket
What does you think about placing male pec implants in a partial submuscular pocket- dual plane with only the lower part of the pec implant sub-fascia instead of sub-muscular.
Surely this would give a more natural look when the man raises his arms above his head- see the attached photo of pec implants vs real pecs?
As with a completely submuscular pocket when the man raises his arms, the muscles raise but the implants do not they just sit there.
A: It is important to understand why there are two pocket differences between pectoral implants and breast implants. The goal of breast implants is to create a soft tissue mound onto which the nipples are largely centered as much as possible on this created mound. This is why breast implants have to have a dual plane pocket creation, if a submuscular pocket is used, as the breast mound is not really muscular based. (the implant just happens to be partially under the muscle…which is also why it could also be above the musce as well) In essence the dual plane is necessay for a breast mound effect.
In contrast the goal of pectoral implants in the male is to create muscle enhancement/enlargement only. If the lateral pectoral line is violated in the creating the submuscular pocket more of a mound effect will be created which is an unnatural male chest appearance.
When pectoral implants are placed in the proper pocket and not oversized they will not bulge out to the sides when one raises their arms and will usually move up with the muscle.The raised arm pectoral implant patient picture you are showing illustrates pocket violation beyond the lateral muscle border…which would also be evident when his arms are not raised as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Has there been any new advancements in iliac crest implants? How long do you see before this procedure is cleared for use in the US?
A:Iliac crest implants can be done in the U.S. as of right now using the custom implant design process. But you will likely never see a formal FDA-approved iliac crest implant made as an off the shelf device because the demand for its use is too low to justify the economic effort of any company to do so for an aesthetic product.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I had a pre-jowl chin implant placed 25 years ago, 15 years ago, had orthodontic surgery. The doctor recommended removal of the implant due to projection. As the photos indicate, my mentalis muscle is apparently damaged. Doctor made an attempt to fix after the surgery, but it didn’t help much. Now, 15 years later my gums are visible. I’m so unhappy and I’d be thrilled with even a little improvement. V-y plasty perhaps?
A: Thank you for your inquiry and sending your pictures. Lifting up the lower lip and maintaining it is a challenge. Because of this challenge you have to do as many manuevers as possible to even get some sustained modest improvement. Thus I have learned to do the following three intraoral procedures combined when trying to improve a lower lip sag…a mentalis muscle resuspension, an elevating vestibuloplasty and a V-Y mucosal advancement
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have heard good things about your work! I have always been self conscious about my head for two reasons. First, I have a very strong brow with a slanted forhead (not picured) and I have a head that seems to be very short in length and not fit my body. I would be interested in a surgery that could add an implant an lengthen my head to match my body. Also, being a 5’8″ male, any extra height would be grealty appreciated. Based on the picture, do you have any advice or experience simular to mine?
A: Unfortunately I do not see any attached pictures. But conceptually what you are referring to in regards to lengthening the head with a skull inplant and maybe even raising it some is very possible. The key questions are the amount of volume needed to do so, how much can the scalp stretch to accommodate this needed volume and whether this can be done in one stage or would require two stages. (1st stage scalp expansion)
Dr. Barry Eppley
Indianapolis, Indiana
