Your Questions

Q: Dr. Eppley, I have a Medpor chin implant that I’ve been unhappy with for years. Approximately a year after the initial surgery I had the same doctor shave it down and it’s better but still too masculine. I’m desperate for a slight alteration to narrow it a bit, if possible. Please let me know if I can schedule a virtual consult. Thank you!

A: If you had it shaved down in place then those results are going to be very limited. As a female if you are trying to get rid of the extended wings (which many females are as that style of chin implant is usually not appropriate for most women) it is much better to extract the implant and replace it with a better implant style. This is the more assured corrective approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, The back of my head is small and narrow. The front too is narrow. It doesn’t look good when I tie my hair in the lower back of my head. Can an implant be placed at the sides as well as at the back bottom of the head?]I feel like the top of my head is really flat making the hairline flat and the upper back of my skull feels elongated. What corrections would you suggest, please?

A:When designing a head augmentation implant consideration must be given to how much the scalp can stretch to accommodate it. Thus you can’t cover all sides of the head and the front and back unless one has a first stage scalp expansion first. By your description you have essentially described the entire head as deficient. For a one stage skull implant you must keep its coverage to just three sides of the head.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m looking for several implants for my future surgeries and was wondering if you would be able to help me. I have some questions. 

Can I order cust9m facial  implants in advance for when I am able to have the surgery? Or would it be best for them to go directly to the surgeon. 

How much would it cost me for the following masculine implants: 

Square Chin Implant 

Jawline Implant (Squaring the Jaw) 

Brow Ridge Implant (to make it more prominent)

A: In answer to your facial implants questions:

1) Either standard or custom facial implants are shipped to the surgeon, not the patient.

2) Both jawline and brow bone implants are custom designed and made off of a 3D CT scan of the patient.

3) Custom implants can be designed and manufactured (without having a surgery date or paying the fees to install them. (which I think is the question you are asking) You have to pay, of course, the design and manufacturing costs to make them. This is not an uncommon request.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I spoke with you earlier regarding my daughter’s issue with her jaw. You could see it’s protruding and too prominent for her face. We would like to see what her options are. Her teeth are straight but we don’t know if it would help with her bite and jaw structure m, if she would get braces. We did have a consultation here and they recommended she get braces to align the bite and then proceed with jaw reconstruction but we don’t know? She’s 18 and I don’t want her to go through the extremities of this particular surgical procedure. We took her to a plastic surgeon and that’s when the doctor referred me to you.

 A: The major consideration you have at this point is whether you are going to treat the facial skeletal disharmony (which is really a combination of upper jaw deficiency AND lower jaw excess) with 1) orthognathic surgery (upper and lower jaw surgery which requires before and after surgery braces….braces alone are inadequate) or 2) a facial camouflage technique of chin reduction and midface implant augmentation.(with or without rhinoplasty) There are arguments that can be made for either approach. Because she is so young this is the time to conclusively rule in or rule out the orthognathic surgery approach.

I can’t see her bite but, more importantly, you have seen an orthodontist who has. It will be helpful to see the digital records that they have taken.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How realistic would getting the measurement for both ears at 2 inches exactly be? I do understand that extra unilateral scapha underneath the helicle rim could be removed, but would reducing the lobe so that it connects with my skin be a complexity? (as seen in demonstration with hand) Appreciate your time. 

A: The question is not whether you can remove essentially the entire earlobe (which is devoid of cartilage) but whether the small vertical scar line that will result is an acceptable tradeoff. Because you have an attached earlobe (as opposed to unattached) any reduction of earlobe length will leave a vertical skin closure line beneath it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking for an implant to get the High prominent male model cheekbone, must of them have a flared out look on the sides of the ears and creates a hollow cheek look . With a custom cheek implant with the right size and a long zygomatic arch extension can create that look? Also I heard removing bucal fat is not recommended for young people because ageing we lose face fat and we can end up really thin afterwards but is it necessary to create this look.

A: The custom infraorbital-malar inplant is the only method I know that can potentially create that type of midface high cheekbone look as you have described and shown. Whether a buccal lipectomy would offer a benefit towards achieving that goal depends on what your natural face looks like. I assume none of the pictures you have attached are you so its necessity in your case remains indeterminate.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 25 year old man and I believe I had scaphocephaly as a kid that wasn’t noticed or treated. Regardless, I have some temporal and prominent forehead. I would like my forehead to be smoothed or shaved down. The temporal narrowing bothers me but not as much as my forehead. What would the price range be and what’s the recovery time? Please get back to me asap.

A: Thank you for your inquiry and sending your pictures. I don’t think you have form of scaphocephaly to account for your temporal/forehead concerns. While temporal narrowing can be improved with subfascial implant augmentation in a virtual scarless manner, such is not teh case with forehead reduction narrowing. While that can be effectively done the exposure to do so requires a long scalp incision which ultimately has its own aesthetic drawbacks. I would question in a young male like yourself the wisdom of that aesthetic tradeoff.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was just wanting to confirm whether jaw implants were available to fix asymmetry in the jawline? I have been to see an maxillofacial surgeon who has advised me that one side of the jawline is “shorter”. 

I am hoping to avoid double jaw surgery as I am in my mid 20s and I have been told it is a very invasive procedure which has not been recommend to me for my slight asymmetry. 

Thanks

A: Custom jawline implants are done all the time to fix vertical length jaw asymmetries. (see attached) That can be done alone or often as part of an overall jaw enhancement as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 40 year old female born with a weak chin. I had a chin implant placed ten years ago, which was removed 2 or 3 months later. I waited for another year to get a sliding genioplasty to pull my chin forward.

What I DO like about my current chin:

1height and width from front view. I think it’s proportionate to my face. I don’t want my face to be any longer or my chin to be more pointier.

What I DO NOT like about it:

1From side view, it’s apparent that it’s still a little recessed.

2Slight asymmetry and irregularity. It seems that there is a “ball” or soft tissue sag underneath. I am hoping to “tuck in” the chin and increase the horizontal projection by 3 or 4 mm.

I wonder if you would recommend another chin implant or a revised sliding genioplasty? 

Thank you very much!

A: Thank you for your inquiry and sending your pictures. Since you like the current height and width of your chin, it would be hard to justify a repeat sliding genioplasty for a 3 to 4mm horizontal increase. (unless you are opposed to an implant) Thus a small anatomic chin implant can be used with the only debate as to whether this is placed intraorally or from below.

The other issue of irregularity and asymmetry of the chin has to do with the prior sliding genioplasty in how the bone was set into position and how the overlying soft tissues have adapted to the advanced chin bone. This is probably not completely correctable by adding an implant onto the chin bone unless a custom designed chin implant was used. (which I don’t think you can justify the cost for that type of modest improvement)

If the chin implant is put in from underneath such access provides the opportunity to ‘tuck in’ the overhanging/redundant soft tissues.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, You are the most experienced and informed regarding facial implants in my opinion. Do you know if one can receive ECT (electroconvulsive therapy) if they have chin and jaw implants? Thank you for your time. Best regards

A: I know of no contraindication to receiving ECT with facial implants in place. The implant material is not a conduit or block of any electrical current.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to fix the natural look of my face. I removed cheek implants ten years ago and my face and smile have never been the same. I am assuming that there was residual scar tissue build up that remained and made my cheeks puffy.

A: Your altered facial appearance has little to do with scar tissue. When you take out cheek implants the support is lost for the tissues that were initially elevated to place them. Thus the cheek tissues drop down to a lower position than existed before. There is no assured way to lift those cheek tissues back up, short of providing some implant support to do so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 26 years old and want to have surgery to reshape the skull, and I have deficiency in the anterior sides, and the head back from the top. (scaphocephaly) What is the best type of implant to do so? Plus what is the life span of the implant and the recovery time from the surgery. And what is the possibility of it moving or falling out of place. And knowing the scar, will it stay visible for a long time? 

A: Thank you for your inquiry. In answer to your skull implant questions:

1) The first place to start is to see some pictures of your head to determine its dimensional augmentative needs. Very often in adult scaphocephalic skull shapes a combination of sagittal ridge reduction with parasagittal-temporal augmentation is needed.

2) The type of implant material is one that can be designed from a 3D CT scan, can be placed through the smallest scalp incision possible, and is gentle on the oveyling scalp/hair follicles….the only material that meets all these needs is solid silicone in my experience..

3) Such skull implants last forever and can never degrade or breakdown.

4) Recovery time is about the resolution of swelling which takes about 2 to 3 weeks to largely appear more natural in appearance.

5) Placing such skull implants actually adds a layer of protection to the skull when exposed to trauma. Such implants can not be displaced or dislodged from almost any form of trauma to the head.

6) The scalp incisions used for skull implants are often fairly small and heal well with limited visible scarring.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to get your recommendation about what surgeries should i get to enhance my appearance but stay natural at the same time . 

what i think i need: 

1. lower lip reduction 

2.filler or implant for chin 

3.filer or implant for jawline (i dont want to widen it just want some bone to appear on the gonial angle 

4.filler or lipofilling for sunken upper eyelid hollow (do you think i have protruding eyes ?cuz faceapp filters always make my eyes smaller) 

5.treatment for dark circles (it’s genetic hyperpigmentation) it seems that there are no guaranteed and effective treatment for this problem 

6.what hair style more suitable for my skull and facial features?

A:Thank you for your inquiry and sending your pictures. In regards to your questions I can say the following:

1) Part of the lower lip position is due to the short chin but there is no question that the lower lip is disproportionately big and could benefit by reduction.

2) Your chin needs a sliding genioplasty, not filler or implant. It will help with the lower lip support.

3) Since your jaw angle goals are to just make some evidence of a jaw angle presence, I would go with standard vertical lengthening jaw angle implants.

4) You have a combination of an infraorbital rim deficiency and hyperpigmentation of the lower lids. It is a choice between lipofilling and infraorbital rim implants, each with their own advantages and disadvantages. I would probably opt for the imnplant because of the more assured smoothness that would result.

5) You are correct in that lower lid hyperpigmentation is a difficult problem to improve. But efforts using bleaching creams is a good place to start.

6) I have no expertise in hairstyling.

In conclusion a sliding genioplasty with standard jaw angle implants and lower lip reduction for the lower third of the face and standard infraorbital rim implants with pre- and postoperative bleaching creams for the midface

Dr. Barry Eppley

Indianapolis, Indiana 

Q: Dr. Eppley, I am a 19 year old male, potentially looking to get a chin implant removed. The type of implant is a Terino square chin style 2, size L (attached picture of dimensions). The implant was placed with an incision underneath my chin. I got this implant placed into me this past summer. I was wondering if i get it removed, will my skin around the chin return to where it was before? I am mainly concerned with sagging of the tissue and also if there would be any loss of bone from resorption causing my chin to look more recessed than before implant.

And also would the scar tissue cause a permanent gain in augmentation after implant removal?

Since you say the tissue does not revert back with a style 2 chin implant after removal, would it be possible to make the tissue the same as it was before with something like skin tightening, or anything else if I decide to remove the implant sometime in the future?

And in case there is any resorption like in attached picture, would it be possible to fill in the area with bone graft to permanently fill the resorbed area?

Thanks

A: In answer to your chin implant removal questions:

1) It would be fair to assume that removing your chin implant is not going to allow the chin soft tissues to completely return to their preoperative state. While they have a good ability for substantial shrinkage you can’t release all the ligamentous attachments to the front of the chin and place a big implant (which a style 2 large chin implant is) and expect everything to go back exactly to what it was. The question is not whether there will be some changes but how significant they will or will not be.

2) Any residual scar tissue is not going to create any really visible chin augmentation effect.

3) Certainly device-driven forms of tissue tightening will not hurt. But in the end it is largely about how much soft tissue shrinkage your soft tissue can do on their own.

4) The best approach for such bone recontouring is hydroxyapatite cement not a bone graft.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m a 45 year old male that had submalar implants placed about eight years ago in hopes to give my face a more masculine angular look and help my nasolabial fold area. I feel they are preventing me from smiling fully and created an “overfilled”and feminine look. I think I’d like to remove them and change to something more lateral like a malar implant . I do not want the scars of a mid facelift but would like to improve the nasolabial area in another way with implants if possible.

A: You have unfortunately discovered that most standard cheek implants (technically all of them) feminize the male face. Men need a high horizontal line of augmentation along the cheekbone and zygomatic arch, not the anterior fullness created by current malar and submalar implants. The only question is whether you want to modify a standard malar implant or use a semi-custom vs custom cheek implant approach to replace your existing cheek implants. Such cheek implant replacements are not going to reduce the depth of the nasolabial folds which require a bone-based implant underneath them to help in that regard.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a fat transfer under my eyes to help correct hollowness and dark circles but unfortunately, I am left with an overfilled sausage like mound under my right eye and lumps under my left eye. The mound and lumps are soft. How can the mound and lumps be removed so that the area under my eye is smooth again?

A: One of the real problems with fat injections to the lower eyelids is the unpredictability of volume retention and smoothness. The thinness of the lower eyelid tissue is very unforgiving of any contour irregularities.  To reduce overfilled lower eyelids this would require an open lower blepharoplasty to remove some of the fat transfer…or at least the largest lumps/mounds.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How much bone resorption occurs with a sliding genioplasty? With an 8mm chin movement, per se. I have read implants cause more bone resorption than sliding genioplasty, and sliding genioplasty usually only causes 0.5 mm resorption or less. But a couple articles suggested different amounts for sliding genioplasty bone resorption. Thank you for your input and help.

A: Chin implants will often cause some slight implant settling into the bone of 1mm or less. (this is not bone resorption, it is implant setting) Sliding genioplasty will result in some mild bone resorption of the most projecting part of the chin of which the amount is related to the magnitude of advancement. For an 8mm advancement it will likely be in the range of 1 to 1.5mms.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the following proceduers: Face Lift, Neck Lift, Brow Lift, Temple/Brow and Cheek Fat Grafting or Implants, Lip Lift, Tracheal Shave, Laser Skin Resurfacing.

Can all these procedures be reasonably combined in a single surgery?

My specific questions about these procedures are: 

Face Lift- do you perform Deep Plane and or Vertical facelifts? 

Brow Lift- I’m interested in having the “tails” or outer corners lifted 

Eye area loose and sagging in general 

Temple Filler- I’m interested in either Temple/Brow and Cheek Fat Grafting or Implants. 

Lip Lift- Can I get a Lip Lift without increasing the size of my upper red lip? When I lift the center of my upper lip (with my finger) it leaves the outer corners of my lower lip sagging downward (frowning) and open. Will the facelift raise my lower lip and mouth area or is there another procedure to address this area? My mouth area is sagging in general.

I’d like to make my cupids bow slightly more narrow and raise/accentuate my vertical philtral ridges and white roll. I’d like to improve the delineation between the red border of my lips and the white of the skin surrounding my lips. 

Neck Lift and Tracheal Shave- Does having a Tracheal Shave done simultaneously with a neck lift limit how tight the neck lift can be? 

How are the vocal cords located and protected for the tracheal shave? Can you use a burr instead of knife if necessary on older patients with harder thyroid cartilage? What method of scar treatment is recommended if needed for tracheal scar revision? 

Can I get wound healing treatments at the time of my surgery. 

Laser Skin Resurfacing- I’m interested in the most effective method of skin resurfacing and skin lightening to have done at the same time as my facelift to take advantage of my facelift recovery down time. 

A: In answer to your aesthetic facial surgery questions:

1) All of the procedures you have mentioned can be done in a single surgery with one caveat….when laser resurfacing is done with any form of facial lifting it must be done more conservatively than if done alone because of blood supply and potential healing concerns.

2) The facelift technique I use depends on what the patient’s aging tissue optimally needs…not every facelift technique is for every patient.

3) Males are generally better served by tail of the brow lifts and not the whole brow which feminizes the face.

3) For the temples subfascial implants are superior to fat grafting.

4) By definition you can not do a lip lift and not increase the prominence of the cupid’s bow or red part of the central lip.

5) A facelift is not going to raise the sagging corners of the mouth. That requires a direct corner of the mouth lift to change.

6) Without a vertical prolabial scar you can not narrow the distance between the philtral columns.

7) White roll accentuation requires the placement of either filler or some form of a graft underneath it to cause it to become more pronounced.

8) A tracheal shave does not limit the effectiveness of a neck lift.

9) In performing tracheal shaves the key in protecting the vocal cords is to not over do the resection which can destabilize the two halfs of the thyroid cartilage. This has never yet been a problem I have seen.

10) In most older patients it is necessary to use a burring technique due to the partially calcified cartilage.

11) Laser resurfacing is the likely needed technique for tracheal scar revision.

12) When you refer to wound healing treatments you are likely referring to PRP or other wound healing agents. (e.g., BioBlast)

13) I refer you back to answer #1. The most effective laser resurfacing treatment is one done in isolation not where extensive skin undermining has been simultaneously preformed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, In doing a mid facelift is there any way this can lift the smile to make the upper teeth more prominent?

Also can implants be done after a facelift or does timing matter?

A: In answer to your facial surgery questions:

1) A midface lift can not lift the smile, corners of the mouth or make the upper teeth more visible. This is asking such an operation to do more than it is capabable of doing.

2) Implants can be done before, during or after a facelift.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hello, a friend of mine has recommended Dr. Eppley. I was either born with a flat head (on the backside of my head) or could’ve been from my parents laying me on my back when I was an infant? Either way, I do have a COMPLETELY FLAT HEAD on the back, I wish I had a picture I could send you but I always keep my hair longer on the back of my head than the top of my head to give the image of a round head. But now that I’m starting to lose my hair, I cannot even can consider Shaving my head because of the flat head syndrome that I have. The back of my head it’s like drawing a 90 degree angle a complete flat line that goes all the way down to my neck. I Remember I was in a fire training camp which we had to have our heads shaved and from the staff to crew members they all teased me about my flat head. Someone even said it looks like I’ve been hit on the back of my head with a pan which painted a very clear picture on how it actually looks to others even though I have a perfect idea on what my head looks like. I just want to have a round head, from the front to the top of my head it looks normal however when I look on the mirror the corners On top, towards the back of my head Are somewhat pointed out a bit which I think has also been cause because my skull on the backside is flat causing the sides of my head to somewhat pop out. I am certain Dr. Eppley with his many years of experience has seen it all and might have a good idea what my head looks like. I will draw a picture of the posterior of my skull and also the sinister and dexter of my skull as well to give an idea to what my head is shaped like. I have also filled out a patient form with my information. Thank you for your time and I’ll be looking forward to hear back from your office. 

A: Good drawing, makes it very clear. When the back of the head is really flat the parietal eminences become very prominent. (pointed corners) The key question is not whether the back of head can be successfully augmented but what degree of change is desired and what effort does one want to put forth to do so. The genesis of this question comes from the natural tightness of the scalp which limits how much augmentation can be done in a single surgery. The immediate placement of a skull implant will provide a moderate improvement in the shape of the back of the head. While a two stage skull augmentation approach (first stage scalp expander) provides the optimal back of the head augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Eppley, I have uneven temples and I can’t work out the reason and I’m not sure if they need reducing or the one just needs an implant to make them look even. I just wanted to know the risks of surgery and the chances of serious health issues.

A: It comes down to which temporal side you prefer, the smaller or the fuller. That is a decision you have to make. It is fair easier to augment the smaller anterior temporal side that it is to try and reduce a fuller anterior temporal side. There are no health risks in doing so.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Is a combination of counter clockwise jaw surgery and upper lift lip better procedure for midface shortening better than a lip lift alone? Wouldn’t doing a lift lip alone create gummy smile because you are just moving mouth upwards. 

A: When it comes to shortening the midface, you need to clarify what you want to accomplish. No form of orthognathic surgery will shorten the external soft tissue midface short of correction of excess gingival show. Only a lip lift or vermilion advancement can create a visible soft tissue shortening. Such soft tissue maneuvers do not create gummy smiles.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I highly admire your work and love how you are also available to answer questions of patients in the community. I wanted to ask you specifically about the lip lift procedure. I got one done 8 weeks ago but the philtrum is protruding and the lip, especially the middle part looks too hicked up compared to the sides. I’m trying to hide from the world and have high hopes that the weird look is due to residual swelling ? I saw a reply you made to another patient with a similar issue and you mentioned the lip would most likely drop around two mm within the next few months? Also stretching the lip would help ? Thank you so much for your time and attention to this.

A: A lip lift works by the removal of skin…which makes it an irreversible procedure. But like all things lifted there is some partial relapse or settling that will occurs up to six months after the surgery. Stretching can only help that process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Hi There – I am reaching out in hopes of learning how I can best correct my receding chin and lack of defined jawline. I had a chin implant put in about 6 years ago that certainly improved the area but didn’t achieve the results I was looking for. I would love the opportunity to discuss what the best option may be. Looking forward to hearing from your team soon. I’ve included a photo for reference: one is with my natural bite (receding) and another with my chin pushed forward (this is similar to what I wish it looked like naturally). Thank you!

A: Thank you for your inquiry and sending your pictures. What you are actually demonstrating with your jaw thrust is the attached dimensional changes which are largely vertical. If you add that to your current chin implant your dimensional chin augmentation changes are 5mms forward and 5mms down. Such dimensional changes can only be created by either a custom chin implant design or a sliding genioplasty.

I am assuming when you refer to a ‘lack of a defined jawline’ you mean the chin. If you truly mean the whole jawline (back to the angles) then only a custom jawline implant can achieve that aesthetic effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I recently read the article you wrote on soft tissue augmentation of the jaw angle. Several years ago, I had a custom wraparound jaw implant placed. As your article identified, due to the extent of vertical lengthening achieved by my implant, the fullness of my masseter muscle actually sits above the bottom of the jaw angle. Whenever my jaw is clenched, this issue is exacerbated – but even at rest the fullness of the muscle being higher than ideal seems undesirable aesthetically.  

Your article suggests that dermal grafts or subdermal soft tissue implants are an option for treatment. But can these grafts be shaped in such a way to provide both angularity and fullness lower than the current masseter position, even at rest? I enjoy the angularity of the implant from the side view, but it seems my current masseter position prevents this from being visible from the front view.

A: Only an ultrasoft silicone soft tissue jaw angle implants can add both assured fullness and angularity back to the jaw angle region. I find them to be superior to that of any form of dermal grafts.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 25 years old and I train a lot at different martial arts (kickboxing, wrestling, BJJ, MMA,…) and I even compete in BJJ. I am considering the procedure of a skull reshaping surgery and I would like to know if training and competing in martial arts after the surgery is a problem or not. Furthermore could you give me any recommendations for doctors in europe? Because I only found you here in the states. 

Would appreciate an answer very much. Thanks in advance. 

A: For my patients I recommend they wait three months after any skull reshaping procedure before returning to contact type sports or physical activities.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was in contact with you a while back regarding issues after my sliding genioplasty. It has been 2 years now since the surgery and it’s still tight. The area under the lower lip is very tight, the scar feels very tight and when I move my mouth everything feels even tighter. My lower gums and lower teeth also feel tight and sticky. It’s a weird sensation. 

You did advise that the bone position was high and the chin tissues may be compressed and this could cause the tightness. I also saw on your website that you can use a fat graft in the labiomental fold. I did see this and then try HA filler in the area which does seem to have improved things a little a bit, not significantly but it does help and it seems to help with my speech,

I don’t get as much of the pulling and tugging feelings when speaking like I did before. The filler is voluma so does feel quite hard. It might have been better with a softer filler. I’m not sure the nurse who injected understood my complaint fully too. 

You are the only person in the world it seems who suggests this. I’m astonished that no other surgeons seem to know about this problem!! 

With this in mind, how do you see my revision? If I came to you what would you do with my chin? 

Would you move it down and back and place a fat graft? Is that the way you think it should go or leave the bone and just do the fat graft? 

Here is my X Rays again to remind you and also a 3D scan. 

I’ve been to a facial pain clinic at my local hospital today  and they are telling me this is neuropathic pain as a result of the surgery. They said that this can sometimes, very rarely happen where the brain starts sending the wrong signals causing strange and uncomfortable feelings in the area. They said this is permanent and surgery can make worse and won’t make any better. My surgeon doesn’t agree. 

Your help is so much appreciated.

A: If you are satisfied with the aesthetic result I would do an intraoral release and place a dermal fat graft. That seems to work really well in cases like yours. The observation that injection of HA produced some mild improvement in your symptoms supports this therapeutic approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, After a septorhinoplasty and jaw surgery (upper jaw expansion, impaction and advancement, and lower jaw advancement), I have found that my nose and smile looks much like Bryce Dallas Howard’s after picture on the right. I don’t like how the sides of the nose seem to cave in and the cheeks seem to bulge out and appear artificially bunched up. I much prefer the natural look of the before, and I am not sure what the reason is for looking like that after. Is it due to overexpansion of the upper jaw or is it due to the septorhinoplasty (or other)? Can it be reversed? 

A: These are many of the unspoken soft tissues changes of the midface that can occur after LeFort osteotomies due to soft tissue stripping from the bone and the change of the bone’s shape. Most of these changes are irreversible. The only one that isn’t is nostril widening, the most common adverse aesthetic effect seen after a LeFort osteotomy. This can be treated by secondary nostril narrowing techniques through an external approach.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, This girl isn’t me (I found her pics on reddit) but the area I circled is almost the same exact area where I have protrusion 

I. Is that subcostal rib margin? 

2. If so are they low enough where they could be removed or shaved? 

3. I don’t mind scars but would the surgery make much of a difference? 

4. Even if they aren’t the subcostal rib margin, are they still ribs that can be removed? 

Thank you. 

A: I don’t see any circle area on the picture so I circled what I think you are likely referring to which would be the lateral subcostal margins. (see attached) Those rib margin areas can be reduced by shaving. It is the most common anterior rib area treated for reduction. It does require a small incision over the area to perform the procedure and the acceptance of the resultant scar is the only limiting consideration.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, hello, I am inquiring about clavicle surgery for masculization. My question is whether the clavicle can simply be surgically elongated similar to the limb lengthening surgeries done on femurs. 

I am a body builder with a sub-par shoulder to waist ratio and my waist cannot get any smaller. No amount of muscle development in my shoulders will ever create the taper effect needed. I know that a longer clavicle is what my bone structure needs. Is this possible? And if so, does this surgery have any negative effects on the ability to continue building muscle in the chest and shoulders? 

Thank you.

A: At this time there is no method yet available for distraction lengthening of the clavicles for shoulder width increase. The concept is a valid one but the devices to do so have yet been developed.

Dr. Barry Eppley

Indianapolis, Indiana