Your Questions

Q: Dr. Eppley, Looking to improve the rounded appearance/protrusion to the chin on the side profile. On the front view I would like to achieve a slightly shorter and more rounded/feminine look to the chin. I also have a chin dimple that I have corrected with filler but it is still slightly visible in certain lighting and I would like to have that resolved.

A: Thank you for your inquiry and sending your pictures. It appears that much of your chin excess is from the soft tissue pad which will take a submental approach and some bone removal as well to adequately reshape it smaller. Fat injections would be the logical approach to the chin dimple which could be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Interested in rib removal. I have a very big thorax for my body size. Is it possible to reduce the scope of the thorax?

A: No it is not. You can’t reduce rib protrusions that high up on the chest wall. This is a common question but is beyond what rib removal surgery can do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi, when my face is expressionless, I don’t have any visible eye bags, it’s quite youthful. But.. when I smile the fat on my face pushes up and gives me eye bags. I think everyone has them, but for me, I feel these smile eye bags make me look worse. They give off a strong dark shadow when in darker/certain lighting and I really don’t like it. 

Is there a specific/custom midface/orbital implant that can completely eliminate my undereye smile bags? Refer to my photos to see what I mean. 

If there is such a procedure that can completely fix my insecurity?

A: Thank you for your inquiry and sending your pictures. What you referring to is what is known as a dynamic problem for which any surgical approach is a static one….meaning static procedures will not fix a dynamic problem. Surgery is basically done an expressionless faces for which it is designed to treat a problem that is seen in these circumstances. While the concept of building up the infraorbital rim may have some theoretical merit in your situation it is not a procedure I have ever done for this issue, thus I can not speak for its potential effectiveness. But it would seem that further underlying support would not diminish the bulge of undereye tissues that occur when you smile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is there typically issues with a jaw implant as one the jaw bone ages and you lose fat and elasticity? Can you see the implant? And do they need replacement? 

A: The answer would be no and no. The implant would never need to be replaced because of device failure. And as you age the soft tissue support provided by the implant is beneficial rather than a detriment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a couple follow up questions regarding both the picture and the operations itself.

1) I’m a little confused by these pictures without labels, is the first one the 8mm advancement and the 2nd one the 12mm? The one that was sent over last thursday was for the 10mm? If that is the case, can I have the front view for the 10mm as Dr. Eppley only did a side view for me for that one.

2) Dr. Eppley mentioned that I have deficient lower jaw growth, which leads me to think that jaw surgery may be an option. I currently do not have any severe jaw related problems (sleep apnea etc. though I do snore quite loud sometimes). What is the aesthetic difference between the jaw surgery and the sliding genioplasty that he recommended? My logic goes like this: If there is indeed no aesthetic difference between the two, then why waste the time and effort to go through Jaw surgery? Are there any additional benefits for me to go consult with a jaw surgeon rather than go through with the sliding genioplasty, with the latter being much more cost effective. What are your thoughts for my case?

3) Given my deficient lower jaw, will the sliding genioplasty accentuate that? In other words, will the lack of a lower jaw become more pronounced after the surgery?

A: In answer to your questions:

1) the pictures are label as pred 1, 2 and 3 in their tags which signify roughly 8, 10 and 12mm horizontal movements.

2) Unlike the profile view, front view imaging can not be predicted based on millimeter movements.

3) Whether orthognathic surgery is an option depends on the state of your occlusion. (bite) If there is no functional bite issues or the bite discrepancy is slight/modest, then orthognathic surgery is probably not an option. But without x-rays, a bite analysis and an orthodontic evaluation the merits or lack of merit to orthognathic surgery can not be precisely known based on external facial pictures. The only definitive way to address this issue, one way or the other, is to get a formal evaluation/workup for it.

4) I would go by what the pictures show you and the effects of the chin augmentation change about its effect on the rest of the lower face/jaw.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Last year I had a tear trough implant placed with the SOOF lifted over it, combined with lateral canthoplasty and lower lid retraction surgery. I didn’t like the outcome of the surgery and had to receive revision surgery a few months ago. This included removal of the implant, restoration of the canthal angles to a more natural position by using drillhole fixation, and a short horizontal lengthening of the eyelid. The SOOF was also raised again to address any any potential hollowness. I had told the Doctor prior to surgery that I did not want the SOOF raised and wanted it to be back in its original position, and he agreed, but unfortunately did the opposite during surgery. The revision surgery was a huge improvement, however I believe that the SOOF lift has left my undereye/midface area looking bloated and fat. Additionally, the creases under my lower lids have disappeared and so have my love bands. I was wondering if it was surgically possible to return the SOOF to its original position without cutting into the canthal incision site where I had surgery before? Could the SOOF be lowered by a lower eyelid incision? Is the SOOF’s fixation to its new, lifted position permanent?

A: That is an interesting question and the first I have ever heard of a patient requesting SOOF lowering. In theory that should be possible with wide subperiosteal release and letting it just drop. That normally would work in the previously unoperated patient but in the situation where it has been deliberately raised it would have somewhere ‘normal’ to go. But having never done such a SOOF lowering procedure my answer is theoretical and not based on any actual clinical experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was wondering what cosmetic surgeries would be needed to achieve this look. I edited the photo on the left to balance the facial features to appear far more graceful from the side: 

Substantial reduction of the nose bridge and depreciation of nasal tip. I realize the reduction shown is drastic and apparent, however I feel that my nose is far too large from the side and this is the best correction. In addition, correct misalignment and deviated septum to improve overall breathing as well. 

Slight chin augmentation to gain slightly more pronounced and remove the “tucked” in profile. 

Straightening of the jawline. Vertical shortening of the jaw bone to obtain the “straight” profile rather than the rounded profile( seen in the pictures). Note: This is the one that is troubling me the most. I am not sure what needs to be done for the jaw in combination with the chin. Some surgeons have commented that jaw shaving is an option. Some have said that fat grafting is the way to go as well but I am having my doubts about this one. Would appreciate your help and thoughts. Thanks:).

A: Thank you for your inquiry and sending your morphed images to which I can make the following comments:

1) As you have suspected that degree of nose reduction is not possible. The large skin envelope controls how much size reduction is possible. Even if it were possible you would likely not be able to breathe through it. A more realistic outcome is halfway between the size of the nose you have now and the unachievable small nose size you have imaged.

2) The modest chin augmentation effect is certainly able to be obtained.

3) Your jawline straightening effect is achieved by an inferior border removal between the jaw angle and chin. That is a very difficult operation to do intraorally and places the mental nerve both in the bone and at its mental foramen exit at some risk. A 3D CT scan would be needed to look at the jaw anatomy and determine exactly where the nerve runs through the bone and see how that correlates to the amount vertical bone reduction that needs to be done.

4) The alternative approach to the jawline, and one with far less risk, is to augment the jaw angle to eliminate the prominent antegonial notch which is the cause of your non-straight jawline in profile.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently removed a mandible angle implant and had a retraction in the masseter, I would like to know about the effectiveness of the masseter muscle reattachment surgery.

A: Reattachment of the masseter muscle, once it has been lifted off the bone and retracted, is very difficult with a low rate of success in my experience. A camouflage approach by building up the soft tissue deficit is more effective, again in my experience..

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to know what the options are regarding shortening the nose and midface. I have yet to see actual nasal shortening described anywhere, rather people focus on tip manipulation for the illusory appearance of a truncated nose, or altering radix position. Post-op from a lefort 1 with counter clockwise rotation or impaction (during which the skeletal housing for the nose would be shortened which begs the question, what happens to the cartilage afterwards?) could a “slice” of the soft tissue nose be excised? Skin, cartilage, and septum. Following this, the nose is then simply adjusted up (the entire structure would slide up) and sutured back together. If there was no excessive gum show prior to the Lefort 1, this would accomplish shortening the nose and midface without inducing any inappropriate levels of tooth/gum exposure. Patient would be left with a small external scar across their nose. 

If this cannot be done, may I ask why? I can only imagine the limiting factor to be blood supply and not wanting a major risk of necrosis, but could the entry point be strategically placed to avoid this? Or perhaps lifting or stretching the artery to gain access without traumatizing it? 

Any help is greatly appreciated.

A: You are asking a classic midface shortening question for which, short of a LeFort I impaction in vertically maxillary excess (which really only shortens tooth show) or a subnasal lip lift (which only shortens the upper lip), there are no other effective procedures for doing so. You are understandably viewing external midface shortening as a structural/geometric exercise…which it is not. The midface soft tissues are not going to shrink or become less so with any underlying vertical structural reduction.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 32 year old female and I have a short and chubby face. I’m considering a custom jaw implant primarily for vertical face lengthening but also a defined jaw line. Attached is a pic of my profile and another pic of someone with the jaw appearance I would like. I would appreciate your expert opinion. Thank you! 

A: Thank you for your inquiry and sending your pictures. You are spot on with your diagnosis of a vertically short lower face. While your thicker facial tissues are never going to be as defined as the ideal picture you have shown no matter what you do, vertical jawline lengthening with facial defatting (buccal lipectomies and perioral liposuction) will produce the most effective result in that regard. Elongating the skeletal structure of the lower face and defatting what lies above it is the most you can anatomically change. (technically you can also do high horizontal cheek-arch augmentation as well to create a skeletal line above it)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a more enhanced, attractive and masculine face.This also goes beyond just the custom jaw wrap around implant that I first enquired about. I am interested and willing to consider other potential enhancements to the face such as in the zygomatic areas – cheek bone implants and other possible recommendations. In short,  I want a rather significant makeover to maximize my full potential.

This issue is I have is that I put on a significant amount of weight within the last two years due to some negative personal incidents in my life – leading to the neglect my health and well being. However 2021 is a new year, and it is time to focus on my health, appearance and happiness. I have a BMI of around 35 and an estimated body fat level of 40% – classifying me as obese. 

My plan over the next 8 months is to lose about 35 – 40 kilos.  And attain a body fat % level of at least around 15%. This should provide a more reasonable analysis of my “natural facial” features.

My question is,  should I do my consultation now – However – significant fat and bloat are covering my facial features – which may impair any analysis and influence any potential recommendations. 

Or 

I have attached four photos to this email. Would you recommend any orthognathic surgeries. I know this is extremely difficult to assess just from a few random photos but an initial opinion would be appreciated ) However I would rather prefer implants or other corrective options if it could be an effective alternative.

I look forward to hearing your feedback and suggestions.

A: Thank you for your inquiry and sending your pictures. Given that weight loss would be of tremendous benefit and I need to see what the ‘real’ facial shape is when it comes time to plan and undergo male facial masculinization implant surgery, it would be better to wait until you have achieved at least 75% of your weight loss goals. At that time better facial assessment, imaging and treatment planning can then be done.

Based on the pictures provided, I do not see any indication of the need for orthognathic surgery. But that is said with the caveat that an informed opinion in that regard requires x-rays and a dental/occlusal assessment.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have unique problem perhaps you can help fix.I had silicone injection in my chin many years ago and had them removed last year. It was a ball of scar tissue. After the removal  my lower lip has fallen due to loss of support. I’ve  had two previous failed surgeries where Drs tried to re-suspend the mentalis muscle. But the mentalis muscle seems to be intact and surgeries to re-suspend it higher have not worked.

Have you ever encountered a similar problem and been able to fix it I would like an appt. I presently have a chin implant but that has not helped. Perhaps something higher might fill in the gap and add support.  I am a 60 yr old transgender women and in my youth silicone injection were quite common.

A: Thank you for your inquiry and sending your pictures. You have to go back to what caused the lip to look like it does now….excision of soft tissue (scar and silicone mass). This is a soft tissue volume deficiency problem with subsequent tissue contraction into the removed tissue area which will pull the lip down. This is not a mentalis muscle problem or a skeletal chin deficiency. 

Thus to any chance of reversing it you have to add soft tissue back in through a release and dermal-fat graft….as you have suggested.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The top of my skull is completely flat and from a side view it looks really bad like if looking at a nail. I have a lot of hair, so you can’t really tell the shape of my head from a photo, but I found 2 pictures that would give a good representation of what I have going on. I was teased a lot as a child and am deathly terrified of going bald. It’s had a huge impact on my life and I just want to know if it’s possible to fix so that I can be confident in how I look and greatly decrease my social anxiety. 

A: Thank you for your inquiry and sending your representative pictures of the flat top of your head. It appears that you would like to have the top of your head augmented to a more convex shape rather than flat. That is best done by a custom skull implant which can be placed on a one hour surgery with a remarkably short recovery period.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have vertical orbital dystopia. My left eye sits lower than my right. I was hoping you could teach me more about what sort of procedures I would need to correct it.

A: Thank you for your inquiry and sending your picture. Like in all cases of vertical orbital dystopia (VOD) it is important to recognize that as the eyeball is raised what lies around it must be changed as well, particularly the position of the eyelids which will not move up with the eyeball as they have separate attachments. Thus most VOD cases consist of a custom orbital floor-rim cheek implant (made from a 3D CT scan) and upper lid lifting (ptosis repair) and lower eyelid raising. (lateral canthoplasty with spacer graft)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello I was just wondering if you can have fillers on the temporal muscles as implants seem risky. I was checking if there are any non surgery ways of doing this I will attach a photo of the temporal muscles.

A: Temporary injectable filler or fat injections can be used for temporal augmentation and is good starting point to see the effects. Ultimately temporal implants offer the only permanent augmentation method and are actually the safest method as they sit in either a submuscular or subfascial position depending upon what temporal area is being augmented.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I did surgery after suffering a brain aneurysm. After the swelling had gone down I noticed this indentation in left temple. How can this be improved?

A: The indentation you have is due to loss of the temporal muscle volume as it retracted from the craniotomy procedure. Since it is a soft tissue issue it should be replaced by soft tissue. Fat grafting for your temporal augmentation would be the logical choice. While the fate of injected fat can never be accurately predicted, and it may require more than one session for the best result, it is a good approach. The other option would be to place layered ePTFE sheeting to build up the temporal depression which would be placed through your existing craniotomy incision line.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley could an orthognatic surgery help to shorten my midface?

A: No as that will make no change on the outside and will only bury your teeth under your upper lip. You can’t shorten the external midface without removing soft tissue…which is not possible in any significant amount. (only a subnasal lip lift in the patient who has a long upper lip)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi! I was googling whether I should have facial surgery or dental work done first and came across an answer left by you. I looked at many before and after photos and am interested in getting information and hopefully getting work done with you in the future. I understand a thorough consultation is necessary before any procedure. With that in mind, I am curious if it would be suggested I get dental work done or facial surgery first. I feel like one side of my face is completely different than the other. They are very subtle in all areas but when I look at pictures of myself I can absolutely tell. Or when I am video chatting with someone. Because my teeth are the same (one side is straighter and symmetrical, the other side has very crooked teeth and is set farther out.) I am concerned that after I get that taken care of, it may assist in making my face look symmetrical because part if the asymmetry in my face is in my cheek/jaw area.

A: To provide an informed answer I would need to see facial pictures. But as a general rule, orthodontic alignment has no impact on improving facial bone asymmetries or shapes. Orthodontics moves teeth and reshapes upper and lower jaw alveolar bone, not the basal bone which creates the external facial shape.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I Am interested in an abdominal panniculectomy. Am I a good candidate? I have attached some pictures for you to review. 

A:Thank you for your inquiry and sending your pictures. While resection of overhanging abdominal tissue would be of benefit your abdominal tissues are too thick as they are right now to get the best result. You would either have to lose significant weight first or go through a first stage abdominal/flank liposuction procedure to decompress the tissues and make them more moveable before the tummy tuck/panniculectomy. Otherwise doing the procedure on you now is going to result in much more limited amount of abdominal reduction improvement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Would in my situation a lip lift + lip reduction work for this purpose? I know that my Philtrum isn’t long. I’d like, however, keep my lips “male” Thank you!

A: What makes a lip look more feminine from a lip lift is the change in the shape of the cupid’s bow….which will not be affected by a lip reduction done at the lower edge of the lip. Effeminate lips are more about shape than the size of the vermilion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Upon doing some research I am very interested in temporal reduction surgery. I am 22 years old and have been losing my hair for the last couple of years. I have always had quite a wide head but when I tried shaving my head I was shocked at how big it looked. It was shaped like a lightbulb, a smaller face with getting wide above the ears. My head has always been noticeably round and big but when shaved it looks huge. Before I heard about this surgery I had contemplated getting some kind of skin tightening procedure done because when I would pull the skin on the sides above my ears, it would give my head the appearance of a much more straight look and the change was rather dramatic. I have included a photo of me with hair. When shaved the head looks significantly wider. 

A: Thank you for your inquiry and sending your picture. You have correctly surmised that temporal muscle removal surgery is the only method that can address your side of head shape/width concerns. Skin tightening/lift is not an effective solution for it no matter what you can demonstrate with your hands. Whether temporal muscle reduction surgery can be effective can be partially demonstrated by widely opening your lower mouth/lower jaw and see what happens to the width at the side of your head above the ears.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, As you see the cheek that I left a red mark on is way bigger/rounder which makes my left part of my left cheek / under eye area look fuller and bigger which makes it look asymmetrical.I know it looks like its mainly fuller/more fat but its really the bone. When i feel that area and compare it to my right side its fuller, bigger, rounder and there are more bone on my under eyes, What can be done for this? My right side contour is slimmer / more lifted because the bone is not so round/big like the left side. I hope you understand me. Fillers or fat are not a option because i want it to look like the right side which is the slimmer/better contoured side.

A: Thank you for your inquiry and sending your picture. You are in need of cheekbone reduction surgery of which the only question is what would be the best reduction technique for its size/shape. I would need toa 3D CY scan of your cheeks to best make that determination but most likely it would be an intraoral cheekbone wedge osteotomy to help narrow it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Here are the photos, I’m not exactly sure which surgery I want. I just want a normal looking forehead. If you can look at the photos and give me suggestions on what you believe is the best option for me that would be appreciated. Thank you.

A: Thank you for your inquiry and sending your pictures. First we have to define what constitutes a normal forehead for you which by your description is one of reduction. Whether that is the forehead above the brow bones or includes the brow bones needs to be clarified. I have attached some side view imaging just to get a feel if this is the type of forehead change you may be seeking. Secondly, regardless of the change desired, you have a major aesthetic concern with any type of forehead surgery as all men who shave their heads do (and even in many men who don’t)…there is no favorable location to put a scalp incision to do the surgery. I would aesthetically question the tradeoff of a scalp scar for a forehead contour change.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to have my forehead augmented using PMMA bone cement. I understand a coronal incision may be needed but I believe bone cement is my best option for permanent results. Silicone has a long term risk of infection. The sides of my forehead have an indented look which makes the middle part look more prominent. I would like to fill in the side part only too make my forehead one even shape (not my temples but my forehead). I’ve spoken to another doctor and he said he’d do it so I would like to know if you feel comfortable doing it. In the pictures below I would include a picture of me in a lighting where you can see what I’m talking about. I also will circle the area I will like to have filled in, it won’t take a large amount of bone cement. Thank you.

A: In answer to your forehead augmentation questions:

1) The incisional approach to your forehead augmentation would be your existing frontal hairline incision not a coronal scalp incision. It would take a long ear to ear coronal scalp incision to access the forehead as it is way far back. It is more direct and safer to use the existing frontal hairline incision.

2) I believe you are looking to augment the sides of the forehead or the bony temporal lines which you have indicated and I have as well. (see attached) This is the transition zone between the bone and the muscle and the actual area you are trying to augment is not bone but largely muscle fascia. Understanding this anatomic concept is extremely important when determining how to augment it.

3) Trying to put any form of bone cement on muscle fascia is an aesthetic complication waiting to happen. That is an unstable surface to which bone cement will not bond to. For that relatively small area that is almost all muscle fascia I would use a soft tissue augmentation material like ePTFE (Goretex) A 2mm piece cut to the size of the defect with the edges feathered and placed through the hairline incisiion would be what I would do. The hardest thing to achieve along the bony temporal line with any material is an edge transition that is not visible on the outside. ePTFE gives one the best chance to do so.

4) In reality a custom premade silicone implant from a 3D CT scan is the best method to augment this area (I have never seen an infection with them in 30 years) but for cost reasons I think ePTFE is a good alternative option.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to know if I could replace my actual 530cc biconvex buttock implants for 1050cc buttock implants on the same pocket?

 Also can I then put the 530cc implants out on the side high hip area?

So i would like to put the 530cc biconvex on the lateral depression area of the buttocks.

A: These are not buttock implant procedures that can be done:

1) you can’t double the size of an existing buttock implant

2) you can’t place implant in the ‘lateral depression’ buttock area

Both are types of implant procedures that exceed what the tissues can tolerate and will have a 100% assurance of complications of attempted.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr. Eppley, Hello, I do have a small lower jaw in general (midpoint of lips to end of chin 3.6cm) and wanted to ask if its possible to vertical lengthen the lower third by approximately 2 to 2.5cm (whether it involved jaw surgery and or/genioplasty/custom implants – or a combined approach) or is a increase that high not doable? 

Thanks

A: I assume when you are referring to lengthening the lower jaw you mean the entire lower jaw from angle to chin. Changes in the range of 2 to 2.5cms are not possible particularly at the chin area as the soft tissues will note permit that type of stretch…and I have yet to see someone who really needs that much lengthening. Patients understandably overestimate the degree of change they need because they can not factor in the effect of what happens at the bone levels to the changes seen in the overlying soft tissues.  Vertical jawline lengthening more in the range of 1 cm is more realistic.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, recently I had buttock implants and although they look nice, my butt now looks too big for my legs. I read in one of your replies where you mentioned that thigh implants are available to be used for behind the buttock area. 

A: Thigh implants are for the anterolateral thigh area known as the quads, not for the back of the leg or the hamstring area.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a sliding genioplasty 7 years ago and have had tightness for years and recently figured out I have adhesions under my chin. I had an area of hair loss under my chin in the beard where there are adhesions. However, with massage of the area for the last few days I’ve noticed the adhesions seem to be improving and also the beard hair is growing back (after years!). Is there any utility in PRP/steroids/5-fu or is just continuing to massage the area best. I also was going to look into surgery but think now perhaps that’s not necessary.

Appreciate your help.

A: There is certainly no harm from massage or any injectable therapy around or into the sliding genioplasty site. Time will answer the question about their long term effectiveness.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, For a forehead, supraorbital implant, how do you prevent the raising of the eyebrows that occurs with this augmentation? 

Ive had a brow bone implant and took it out because it made my eyebrows very high due to the lift and push up and out effect. 

Is there anyway to fix this?

A: That is not an eyebrow effect that I have ever seen from a custom forehead-brow bone implant. That sounds like a placement/implant design issue. Unless one has a lot of experience it is very easy to get a brow bone implant placement too high (inadequate supraorbital release) or have an implant design that does not get the brow bone effect low enough.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a moderately recessed chin and my bite is class 1. What I noticed on my lateral cephalogram (and by felling the chin) is that my soft tissue pad is very thin. The bone is more or less normal size, but the thin soft tissue and thick lips make it look recessed even more. 

Is it possible to bulk up the mentalis muscle a bit to give the impression of a stronger chin? Or would it produce counter results – I read a study that found using Botox to relax the mentalis muscle actually made the chin look horizontally stronger. 

Thank you and kind regards

A: There is no surgical or non-surgical method to make any muscle of facial expression bigger in size. I can not imagine the biologic mechanism by which Botox (which causes muscle atrophy) would make the mentalis muscle bigger nor make the chin look stronger by muscle relaxation. But I know one way to find out…do it and see what happens.

Dr. Barry Eppley

Indianapolis, Indiana