Your Questions

Q: Dr. Eppley, Hello, I am interested in getting a custom wrap around implant for my jaw and chin. My overall goal is to have a more defined lower part of my face. I would like to have a more defined jaw line, especially toward the back of my jaw where I have little definition. I would like to extend my chin out to align with the lower lip. Right now I have some filler there but it has never made me happy, I would dissolve it prior to surgery. I am also possibly interested in doing a fat reduction on my cheeks, I have very fully cheeks that make my face look rounder, perhaps with the implant I would not feel the need any more. I was curious as to how the design process works, is it possible to have a photo of you augmented to see what your face would look like with the implant prior to ordering it? Also, could you please provide me with an estimated cost for the implant, and possible fat reduction separately? Thank you so much for your time.

A: There is no technology that currently can take a designed implant and show what it would look like on a patient. That may occur some day but is not yet available. Rather custom implant designing is based on targeted imaging of the patient’s facial pictures from which estimates are made as to what implant dimensions can come close to achieving that effect. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a sliding genioplasty 4 years ago and I am still struggling my chin is in pain and has complete spasms I get Botox but it’s not lasting more than 7 weeks I don’t know what else can be done my surgeon just sent me to a neurologist they done scans ect and can’t find anything in them My surgeon just says he hasn’t seen this. Before I am desperate is there anything else I can do.

A: This is certainly a very unusual problem after a sliding genioplasty. Given that the procedure requires cutting through and then putting back together the mentalis muscle right at its origin, and then requiring the reattached muscle to be stretched over a longer bone distance (assuming that the chin was lengthened) one can see that is a theoretical source for muscle dysfunction. (although this is done routinuely and the problem of muscle spasm is rarely seen) 

While Botox appears to provide some good temporary relief any longer term benefit will require surgical intervention. Surgical options include: 1) reducing the amount of horizontal chin advancement that was done (giving the muscle less length on which two contract) and 2) releasing the muscle introrally and  placing an interpositional fat graft. Given the rarity of the problem I can not say which one may be more effective or whether either one would provide assured muscle spasm relief. But anatomically these are surgical remedies that make sense.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if it would be possible, in addition to reducing the width of the face through cheekbone reduction, to shave down the frontal part of the zygoma (in red) & augment the midface area (in black) so that they are similar to the below image.

A: You are referring to the combination of cheekbone reduction osteotomies combined with paranasal-maxillary augmentation. That is a synergistic approach to narrowing the width of the lateral midface (cheeks) and increasing central midface projection and can certainly be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I want to reduce the appearance of my masculine appearance of my chin and the deep crease, I dislike how long it looks when I smile, and I do want to keep the sharpness with a more soft, feminine approach, kind of like Kylie Jenner.

A: It is important to understand that the chin pictures you have shown are of a dynamic concern (chin pad ptosis) while surgery is a static non-dynamic procedure. Thus the only assured surgical change would be what the chin looks like at rest or in a non-dynamic state. It is from these pictures, front anf side, can only make for a more accurate assessment of what can be done.

Dynamic chin pad ptosis may be improved by static chin reduction procedures. But it is important to point that such dynamic changes are less predictable since the surgery is done in a static moving state.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I got a quote from you for a sliding genioplasty about 3 years ago. I currently have a chin implant and feel like a sliding genioplasty will give me the results I am looking for and also allow me to get back into boxing once it’s healed. The left side of my implants wiggles so maybe insurance will pay for anesthesia.

A: That was 3 years ago so costs have changed. (Iincreased) Insurance does not pay for any cosmetic related procedures.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have read up on your good work. I tore my bicep tendon a year ago and didn’t get it fixed. I have a Popeye style muscle with a gap between its end and the elbow. I would like to get an implant to give the size back again.

A: You have correctly surmised that your bicep muscle is now permanently shortened and only an implant can fill in the now contracted distal end. While such an implant to do so is not large consideration has be given to the dynamic change in the muscle end from when the arm is fully extended to when the elbow is bent at 90 degrees or more. Also the overlying soft tissues are not thick and consideration also has to be given to preventing implant migration or revealing its edges through the skin. This is where it is important to encase the implant in a lining that is similar to the fascia that normally surrounds the muscle. For this I use an Alloderm sheet or Galaflex sheet to encase the implant and attach it to the fascia of the muscle end.

The bicep extension implant is made by either measurements you take at home or we can send a moulage kit to make an impression of the missing muscle segment.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Interested in the surgery to fix my flat head. I been dealing with it my whole life. I’m a 27 year old male. And I wanna get this fixed

A: The first place to start is to get some side view pictures of your head to make assessment and then did imaging to see what type of back of head augmentative change you seek.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, yesI am a 25 years old and all my life I had a webbed neck and could not find a solution for it. Two years ago, I did physical therapy for a month, it helped a little bit and my neck got slimmer from the sides, but when I stopped, my neck got back to its usual shape. Sometimes my neck is slimmer, some days it is wider. My neck is not so stiff usually. Here are the pictures, I wonder if there are any solutions for fixing it from both sides, and from the profile, the access skin under my chin. I do feel any pain around my neck, and my concern is that I just want to have a normal and slim neck, like everybody. If there is any more information I can provide, please let me know. Best regards.

A: In webbed neck surgery the improvement it provides is reduction in the visible webbing from the front and back views. I can not say that much aesthetic improvement is seen in the side view where the webs do not cause any major aesthetic visibility. There is going to be benefit in the stiffness or movement of the neck.

Many webbed necks have a shorter chin projection which I think is an effect of the webbed neck. This will not improve by webbed neck surgery alone. It requires some form of concurrent chin augmentation and/or submental liposuction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a barely noticeable dent”on my brow which was caused by  microneedling done years ago. (It seems it killed the flesh.)  You seem like the brow expert so I was wondering if you had a permanent solution you could perform–an implant? (That’s super thin, only thick enough to smooth out the dent on my brow)

A: Need to see a picture of the brow concern. Since the problem originated from a soft tissue injury it would seem like a soft tissue solution may be more appropriate. (e.g., filler, fat injections) Not that an implant could not be used just an initial insight based on a description of the problem origin.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a car accident about 30 years ago and had tracheostomy done. I have scar from that and want to see if you can provide options to remove it.

A: That trach scar can be improved by total scar excision and closure. But there will always be s acar. The goal of scar revision, which should be called scar replacement, is to have an improvement in its appearance. There is no way to completely get rid of it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello doctor, I am 2 months after a mandibular advancement + genioplasty and I do not like the result at all because it has lengthened my face. So I want to shorten the bottom of my face, reduce the chin in length and move it back a little + reduce the lower edges of the mandible without touching the angles. However, I am extremely afraid that the soft tissues, muscles, could relax. And therefore end up with a “wizard’s” chin that goes down. And so, I do not know which technique is best for me between shaving or osteotomy. These are slight modifications I think no more than 8mm of reduction in height and maybe 3 of recession. According to you what would be the best technique for me and why? Thank you in advance!

A: Those are big bony changes that are best achieved by redoing the osteotomy not by shaving for the very concern that you have. (tissue sagging)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  i would like to know how long it takes to get customized chin implant. I would like to enhance my chin to make it look more square and well-defined with just a little more projection. I don’t want anything too dramatic—just a subtle improvement that gives my face better balance. My local doctor uses implants they are more round shaped. I had jaw implants 9 years ago but it make my face so bulky.

A: You have correctly surmised that when you need a very specific facial implant augmentation change you need a custom implant design. Standard facial implants are made for now historiic facial changes which are different today.

Once a have the 3D CT scan it is a 2 to 3 month process to get designed, manufactured, sterilizied and shipped for surgery. This is largely due to the large number of  implant cases that in the process at any one time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Please see attached images of my eye area and CT scans from after orthagnathic surgery. I’m trying to address the under eye volume loss and sunken look. I think it also makes my cheek look flat as well by extension. Not sure if I should pursue under eye filler or just do a Infraorbital rim implant for a more permanent solution

A: Eye filler is useless for a skeletal deficiency. Custom infraorbital implants is what is best since through their rim saddling design they provide the best undereye hollowing correction effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does masseter muscle dehiscence resolve itself if the jaw implants are removed or does the masseter still need to be surgically reattached? Thanks.

A: Masseter muscle dehiscence/retraction will not resolve itself by implant removal altbough its aprpearance may become less.

There is no consistently effective method for masseter muscle dehiscence repair.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Dear Dr. Eppley I recently came across information about your chin asymmetry correction surgery using the bone shaving technique. I have a few questions regarding post-surgery care and maintaining the results: Maintaining Chin Results: Is there anything I should do to maintain the state of my chin in the long term after this type of procedure? Are there any recommendations to avoid potential issues such as sagging skin or asymmetry? Botox Use: Would it be necessary to use Botox in the chin muscles after the surgery to prevent muscle activity issues or asymmetry? Excess Tissue Removal: If further adjustments are needed in the future to correct the chin’s shape, would simply removing excess tissue be sufficient, or would more invasive procedures, such as osteotomy, be required? I would appreciate any recommendations you may have. Thank you in advance for your response. https://exploreplasticsurgery.com/bony-chin-asymmetry-correction/

A: Bony chin asymmetry correction may involve bone removal only or a combination of bone removal and soft tissue removal. Each case has to be evaluated on an individual basis. Either way the procedure is intended to provide a permanent correction. Botox injections are not needed for chin asymmetry correction or maintenance after surgery. 

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi there, I have two forehead horns/bumps on my upper forhead that I am interested in having burred down. I still want a feminine and more rounded forehead but I just dont like the two asymetrical bumps on the sides (I did have two head injuries as a child that may have caused these). I wanted to know if a) this can be done with two smaller perpendicular incisions rather than along the front of the hair line (I have seen this in some of your photos) and b) is it possible to get this done under local anesthesia with drugs/gas to make me drowsy? I am very hesitant to go under general and have had other surgeries under local + drugs that have worked well. C) do you ever see cases where scar tissue fills in after the bone burring to be just as bad as before or close to? D) do you need x-ray or CT imaging beforehand? Thanks!

A: Forehead horns are congenital frontal eminence developments that have no coorelation to prior forehea trauma. They can be reduced by bone burring  and whether they can be fully reduced is a function oif the bone thickness. This is the value of the CT scan to make that preoperative determination. Access to do the procedure can be done using a limited frontal hairline incision. To keep the incision(s) limited it can not be any further back or perpendicular to the hairline as this prohibits the linear access/visibility to do the procedure.  I have not yet seen bony forehead horn regrowth nore would expect that to occur.

Local anesthesia is not an option for me to perform it. Patients that need that technique will need to seek out other surgeons who may be willing to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Does scapula reduction reduce the length of the shoulders ? Does scapula reduction have any effect on shoulder width?

A: It does not. It is done to reduce the prominence of the scapular spine. It has no effect on shoulder width.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. I have a facial artery on the left side near the corner of my mouth that is visibly protruding and noticeably pulsating. I have seen a vascular doctor on a few appointments and after close examination, ultrasound, and CT Scan, he has concluded that it is indeed a Facial Artery with Prominent Pulsations. It has become socially uncomfortable and is effecting my occupation/employment. Upon research we learned that this specific facial artery condition is something Dr. Eppley has experience with. Thank you

A: This is a classic presentation off a prominent loop of the facial artery its bifurcation point into the lip and nasolabial fold area. Why it occurs is unknown but I have seen and treated a handful of these cases. Successful ligation/loop removal can be done through a small incision directly over it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi. Sure to a chronic pain issue, I’ve already lost both my testicles to orchiectomy. Having received the largest saline prosthetics available, I’m still not happy with the size, and would like to “upgrade” to a larger size. Do you offer implant revision surgery to place larger prosthetics? Thanks so much for your time and help

A: If you have the largest saline testicle implant that is only 5.0cms in size. My ultrasoft solid testicle implants can be made any size from 5.5cm to 9.0cms.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Good afternoon. I would be interested in a skull augmentation and reshaping with the use of scalp expanders. Could you tell me how long I need to keep the expanders on so that the skin can be wide enough for the operation? And what are your prices for this operation, including the cost of the implant? Thank you in advance.

A: Most scalp tissue expanders in two stage skull augmentation procedures are in place from 6 to 8 weeks.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I’m interested in calf implants to straighten my legs . How does the procedure work and any side effects?

A: Calf implants make the calf muscles look bigger but I am not aware that would necessarily make the legs look straighter. I would need to see some leg pictures and do some imaging to see if that makes the legs look straighter.  I can see that it might but imaging will prove if that is an actual aesthetic effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon.

Q: Dr. Eppley, Hello I am interested in getting tricep implant surgery. My main concern and goal is, I need them to be sub-muscular. I see Dr. Barry Eppley does the triceps VIA sub-fascia, would it be possible to get them sub-muscular. Please let me know as soon as possible, thank you.

A: Submuscular (on the bone)  tricep implants can be done through a medial arm incisional approach.  Be aware that the size of submuscular implant is much less in size due to the tighter more limited pocket.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve always had a high hairline/large forehead (shown in my attached photo) and have been exploring surgery to lower my hairline. Is this something that you could help with – or perhaps something with hair transplant surgery coupled with hairline lowering? I do use topical minoxidil (I have a little bit of hairless that this has helped with). Happy to schedule a consultation if you think it would be appropriate. Thank you!

A: Thank you for your inquiry. Frontal hairline advancement in men is a challenging procedure that must be considered very carefully. The male frontal hairline poses many different considerations than that of women. Issues such as hair density, pattern of the frontal hairline, patient expectations of where they like their hairline to be and how much natural scalp laxity they have or play a role in whether is a good candidate for the surgery. This is not to mention that the risks of having a frontal hairline scar are different than that of women whose frontal hairline is likely much more stable.

To make a better determination of whether this is an option for you I would need pictures of your frontal hairline from different angles as well as what you envision or where you would like your frontal hairline to be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I would like to schedule a virtual consultation with Dr Eppley to ask about custom implants to fix my deep undereye hollows and lack of midface volume. I would like to hear his solution for my case.

A:Thank you for sending your pictures. You have general periorbital rim weakness/flattening which is most manifest in the infraorbital rims which is why they look so hollow. Infraorbital rim augmentation would be the best approach. (see attached imaging) The only question is whether that is best done with a custom infraorbital implant or a sheet Alloderm graft….both which can be effective. Given your young age I lean towards the latter but that is a topic up for further discussion.

But if the goal is also to have some midface volume as well then the custom midface implant is the way to go.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello ,a question regarding muscle implants can they be implanted in any visible muscle ? l await Your response Regards

A:In theory that would be correct. The only question would be implant pocket location…whether that would be on top of the fascia, subfascial, intramuscular or submuscular. That would depend on the specific muscle location

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am trying to improve flat sagging buttocks as an older female?  I’m hoping to get a more full shape with some outward volume as well. Fitting for my size and shape but significantly more than the flat bottom I’ve always had.

A:Thank you for sending your buttock pictures. Your buttocks has a two-fold tissue issue…lack of volume and lower buttock sag or ptosis. While the volume of implant will certainly be helpful in filling out the upper and mid-buttock areas, and will help pick up loose skin in those areas, it is not going to lift up the lower third of the buttocks or get rid of the lower buttock tissue sag. (see attached diagram) That can only be corrected with a lower buttock excision/tuck/lift. The question in that regard is whether the lower buttock sag excision correction should be done at the same time as the buttock implants. From an efficiency/convenience standpoint yes. But from a recovery/scarring standpoint maybe no??  An issue that merits further discussion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a few questions about webbed neck surgery:

So if I understand, the posterior approach will slightly straighten the neck?

Can you briefly describe what happens during the posterior and how long does the recovery process last?

Will it be possible to loosen the trapezius muscles with some physical therapy or kinesiotherapy?

Can the side profile be fully fixed with sliding genioplasty and a chin filler?

A:In answer to your webbed neck surgery questions;

1) The posterior approach does NOT straighten the neck. The posterior approach is used tp put the scars in a more favorable location than the side of the neck.

2) I would recommend that you visit www.exploreplasticsurgery.com and search under Webbed Neck surgery where you read and see that posterior approach to fully understand it.

3) The trapezius muscles can NOT be surgically loosened.

4) The chin position can be fully corrected in side profile and illustrated in the prior imaging. The amount of chin augmentation shown was just one potential type of change, more or less can also be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I underwent a frontal craniotomy due to a brain tumor, and it left a bone dent and a bulging bone part in my forehead.. What options would you recommend for surgery? And would it be possible to give an estimation of the cost? Thank you

A:Give that this was from a prior craniotomy where a large incision exists for access and there remains bone gaps in the depressed bone flap the use of hydroxyapatite bone cement to fill and smooth over the defect would be the most prudent material approach for forehead recontouring.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am an adult with what I believe to be scaphocephaly that was untreated as a baby and wish to have it looked upon by a specialist that can help me I would really want this fixed for me and my future.

A:In adults I typically treat the long narrow scaphocephalic skull shape with custom head widening implants. (see attached example of the implant concept) This may also involve some bony reductions as well if aesthetically beneficial and incisional access will permit of the sagittal crest as well as the front and back of the head.

I would need to see a front and side view pictures of your head for an assessment and imaging.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 28 years old and all my life I had a webbed neck and could not find a solution for it. Two years ago, I did physical therapy for a month, it helped a little bit and my neck got slimmer from the sides, but when I stopped, my neck got back to its usual shape. Sometimes my neck is slimmer, some days it is wider. My neck is not so stiff usually. Here are the pictures, I wonder if there are any solutions for fixing it from both sides, and from the profile, the access skin under my chin. I do feel any pain around my neck, and my concern is that I just want to have a normal and slim neck, like everybody. If there is any more information I can provide, please let me know. Best regards

A:You have what I call a mosaic type webbed neck which means it is a moderate webbed neck that is associated with tighter tissues than the full expression of a Turner’s webbed neck where the neck webs are wider with looser/more supple tissues. Improvement in the neck webs is possibloethrough a posterior approach. (see attached imaging)  But I would never call it a complete correction or the making of a perfectly normal straight line neck profile. The widened trapezius muscles prevent that complete degree of correction.

Many webbed necks are associated with shorter chins which is a result of the webbed neck. Unless one undergoes a concurrent sliding genioplasty (see attached imaging) the excess tissue under the chin will remain as the submental area is too far away to be affected by the posterior neck tissue movement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon