Your Questions

Q: Dr. Eppley,I had a couple questions about my eye area:

1. The first two pictures show my current eye area completely relaxed. Do I have ptosis of the upper or lower eyelid? If not, would ptosis surgery or any other procedure work to lift my lower or upper eyelids a bit?

2. One of my desired outcomes is moving the inner corners of my eyes a couple millimeters inward, as shown in picture 3 as a slight morph of the second picture. I notice I get this result when I pull very slightly with my fingers inward, and the eyelids still remain attached to the eyeball. This makes me think I have loose skin or medial canthal tendons. I have seen mixed opinions online, and you stated in a post that this would be difficult to achieve without risking scarring. Suppose we didn’t really care about scarring. I have seen procedures designed to achieve this effect, such as C-U plasty (picture 4), which cuts the medial canthal tendon and moves one end inward, as shown in picture 6, and W-V plasty, which simply removes some skin to tighten the area. These generally are designed to correct telecanthus. Would one of these procedures, or any other ones that tighten skin or the tendons, realistically work for my case?

A :In answer to your eye reshaping questions:

1)Do you have true ptosis….not really. Maybe a 1mm. But one does not have to have true ptosis to have ptosis (upper lid elevation) surgery.

2) Lengthening the inner eye corner towards the nose is not done by any medial canthal tendon surgery or any of the procedural diagrams which you shown. (those are for webbing/hypertelorism surgeries) It is done  by a tissue rearrangement technique known as a Y-V lengthening surgery. This has more favorable scar formation than its cousin, V-Y narrowing.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I recently had bilateral mandibular angle implants done, and it’s been around 2 months today. However one side of my face is still extremely swollen and after reading your online forms where you state that in 3 months you should be able to see your final results. I’m getting close to that 3 month mark and one side of my face is still swollen and the other side is a little around and not sharp at all. Is there any hope of my angle implants Turing out the way I wanted them to be, nice and sharp.

A:The simple answer is no. What you are seeing at this point is about 85 to 90% of what it is going to be. So what you are looking at is the result of the style and size of the jaw angle implants, their positioning on the bone and the thickness of your overlying soift tissues. There are numerous factors that control what the final result will be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in hip reduction as per the attached diagram.

A:The diagram shows an incorrect approach to hip reduction. Hip reduction refers to the iliac crest which is the widest bony part of the hip/pelvis…which is possible. The diagram shows reduction of the greater trochanter of the femur…which is not possible due to the musculofascial attachments to it and that it is a leg bone not a hip bone.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi would like to reduce the back of my head. Is it possible?

A: Yes it is. Such an occipital protrusion is almost always the result of having thicker bone. How much it can be reduced requires an x-ray to determine. Normally I would take your side view picture and show you how much reduction I think is possible but with you hairstyle I can not do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m looking to get surgery to help my eye area and have more almond shaped eyes, as well as get a more defined jawline, as well as any other surgeries you would recommend to elevate my appearance. I’m just looking for what procedures you would recommend.

A:It may be the way the picture was taken but it appears you have upper eyelid ptosis with the right eye having more ptosis than the left. Almond shaped eyes are created by elevating the outer corners and the lateral 2/3s of the lower lid by lateral canthoplasties combined with lower lid spacer grafts. In some cases an infraorbital implant may be beneficial.

The optimal method for improved jaw definition is a custom jawline implant.

Using just the front view pictures you submitted I did some initial imaging but I would need a side and oblique view pictures to ultimately define your jaw augmentation goals

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to seek your expert advice regarding a challenging situation I’ve been facing with my blepharoplasty results. I initially underwent the procedure with an American surgeon, who informed me that scarring was inevitable. However, I was not prepared for the outcome of developing atrophic scars.

To address these concerns, I opted for a revision blepharoplasty with an oculoplastic surgeon in the UK. Unfortunately, the results were not as I hoped. While one scar has widened and atrophied worse than before, the second scar was traumatized when it reopened, leaving it very wide and aesthetically displeasing. Despite undergoing laser treatments for the past year, I have not seen any noticeable improvement.

This situation has left me feeling extremely self-conscious, and I am unsure of the best way forward. I would greatly appreciate your professional opinion on potential solutions for these scars, as well as any recommendations you might have for improving their appearance.

Thank you in advance for your time and expertise. I look forward to hearing from you.

A:The success of almost any scar revision depends on how much loose tissue is present and the laxity of the surrounding tissues. When wide scarring develops after an excisional procedure (now loee of skin)  in a limited space area (e.g., the eyelid) the success of a scar revision is going to be limited and could even make the scars worse. You have unfortunately proven that concept by the revisional surgery you had. While unpleasant and unsatisfying the surgical motto of… past behavior is a good predictor of future performance...should be well heeded. Or to phrase it another way as another surgical motto….if it was an easy problem to fix it would be so by now. While I think the revisional surgery was worthy of trying, its outcome tells you that for now anither revision is not going to work. In time with the benefit of aging and the creation of more and relaxed tissues another scar revision could actually be successful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I get a skull implant where bone grows into it and replaces the implant material?

A:There is no skull or face implant material in which bone will grow into or over that becomes integrated into one’s tissue. It is a great augmentation goal but for now that remains an elusive biologic outcome.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, If i was looking at a chin implant , jawline implant and mid face implant does that require multiple visits? Thank you

A:I assume the question is whether these implant surgeries can be done together or do they have to be done separately. (jawline and midface implants) That is a personal choice., It can be done either way. If you are certain both are needed then most people would do them all together in the same surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I am i 38 yo male with asymmetry on the right side, my left side mandible is fine but the right side angles away and i’d like to have it corrected. I’d need an implant only on the one side. Let me know what is possible. thx

A:Such jaw asymmetries are treated by a custom implant designed from a 3D Ct scan of your face. So the treatment of such facial asymmetries can be improved without just trying to ‘eyeball’ the problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’m MtF and I’m interested in more information on iliac implants. Thanks!

A:The first place to start is to determine of you are a good candidate for this unique type of hip augmentation. (iliac crest implants) To do I would need at least a front view of your hips to do some imaging of potential changes so you can see what it may look like.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,I am a male looking to improve my facial definition, so as to shape it into a more stereotypically-masculine face. I have already performed buccal fat removal and a chin implant, which I am happy with, but would like to further improve my facial definition. 

A:With a lean face and prior procedures you have a good foundation for further facial masculinization results. You are a good illustration that a ‘little bit in the right places’ (the five corners of cheeks, chin and jaw angles) can create a good composite effect. I have attached some initial imaging to begin the thought process as to what to change and by how much.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Hello there I’m interested in a possible rib removal surgery. I have some questions. Can you estimate how much smaller my waist would be? I have Xrays I can provide as well so you can see ribs. I am unsure if I should just do t11/12 ribs or do t10 as well. Does removing t10 have any long term effects on respiration and lung function? Can I have the ribs removed without removing any of my lats? I’m a bodybuilder.

I feel as though my anatomy of narrower hips and a wider rib cage does not give me the tiny waist I’m looking for. Your work is amazing and I’m excited to hear from you.

A:Thank you for your inquiry and sending by your pictures and x-rays. Having done rib removals in body builders before I can make the following comments:

1) I have attached some prediction imaging of the result that I think is possible in you. Lean patients always get the best results but the concept of a ‘tiny waist’ is subject to personal interpretation.

2) The decision between taking 11/12 or 10/11/12 is really a question of the location and extent of the surgical scar to do either one. (Type 1 vs Type 2 rib removals) Type 2 is always better but the scar is longer and more vertical to do so. There are no adverse effects on lung function or respiration.

3) I would definitely take some LD muscle as it improves the result. It has no negative effect on LD muscle function or body building.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, is temporal reduction surgery life-threatening? Is it true that after it someone has a headache forever?

A:There is nothing life threatening about temporal reduction surgery. It is as safe as any other aesthetic surgery. No patient has ever experienced long term headaches after the surgery in the hundreds of patients I have done. So no that assertion about chronic headache is not true nor does it have a biologic basis for it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley ,Sir my brow bones have continued to grow and are very large. What is the reason and treatment of this disorder?

A:You have very over developed frontal sinuses. It is the frontal sinuses that make up in the inner half of the most prominent part of the brow bones. Some men do naturally develop very string brow bones . Why this occurs is usually not known unless one has a growth hormone excess due to a pituitary tumor. As an adult if the brow bones appear to be continuing to grow, along with other facial bone growths, then you should be assessed for a pituitary tumor. But if the brow bones are large but stable in size then you simply have idiopathic or naturally strong brow bone development.

The treatment for reducing brow bone size is a surgical procedure known as bone flap setback. If I had a side view picture of you I could show you the type of reductive change possible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi – I am interested in getting a sliding genioplasty to address my weak chin. At this point, I really don’t want Jaw Surgery. I want to understand if I am a good candidate for a genioplasty. I can also send some scans if needed as well.Thanks

A:Anyone can have a sliding genioplasty for their chin augmentation of they desire…that is not the question. The more pertinent question is what type of chin augmentation change can one expect. The first thing to appreciate is that your horizontal chin deficiency is in the 25 to 30mm range. Thus ideally you would need lower jaw advancement with a sliding genioplasty to get the ideal/best result. If you eliminate the jaw surgery then you have to rely on the maximal amount of bone movement a sliding genioplasty can do, which is probably in the 16 to 18mm range. While this would produce a good improvement it is not going to be the same as the ideal chin projection. Thus you are a good candidate for a sliding genioplasty as long as you understand what it can and can not achieve.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is it possible to order just the design of the implants from you? I would like a design similar to the one you featured in your article (https://exploreplasticsurgery.com/plastic-surgery-case-study-large-custom-infraorbital-malar-implants-in-a-male/), but customized to my dimensions. How much would this cost?

A: I believe your question may be can I get implants designed and made by you and then have them sent to you to have them surgically  implanted elsewhere. If that is the correct question Then the answer is yes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was born with a disproportionate facial structure where my head size overall is rather small but my forehead on the larger side. Complimentary to the larger vertical size, i think that, because my forehead sticks out (vertical slope, no incline) it amplifies the forehead too much.

My desired look would be something like when i raise my eyebrows to their fullest. Could such a look be achieved ?

Thank you in advance.

A: Thank you for your inquiry and sending your pictures. I am assuming that the lifted eyebrow maneuver is to simulate the reduced distance between the eyebrows and the frontal hairline…as opposed to a true eyebrow lift. Estimating that eyebrow lift to create no more than 10mms of decreased  brow-hairline distance I believe that is a realistic outcome/result. With that exposure the frontal bossing  can be concurrently reduced.

With the question of an achievable result out of the way the only remaining question is the acceptability of the frontal hairline scar to do so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I have Perioral mounds corner of my mouth on both sides. It really effect my confidence and self esteem I would like to know more about this treatment and would like to proceed further

A: While micro liposuction is an effective and only treatment for perioral mounds this is not a surgery I do as a solitary procedure due to its limited scope.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I am a 33 year old female year old who about two or three years ago,I noticed that I started having a lot of facial pain and that my eye was sinking in on the right side of my face. My cheekbones on that side flattened as well. I have been trying to manage this with fillers but believe that I may have a mild case of Parry Romberg syndrome. I don’t have significant tissue loss but it’s enough that it is noticeable and I plan to see a neurologist and try to get some scans. In either case I feel I could be a candidate for an orbital rim implant. Am I a good candidate for this surgery?

A: With the spontaneous change in infraorbital-malar fullness it is reasonable to suspect PRS as a possibility. If the problem is active/progressive fat injections would be the appropriate as a temporizing effect. If the contour change has stabilized then an implant would be an acceptable approach.

Usually in these cases a custom implant is the preferred approach. At the least a 3D CT scan is needed to determine the extent of the bony infraorbital-malar asymmetry.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I need a skull graft operation (frontal cranioplasty) or frontal cranial bone reshaping.

I had previously been in an accident that led to the fracture of the frontal skull bones. I had the skull patched with a 3D print (peek), but it became higher than the original skull bone, so I needed to either sculpt or file the existing impression so that it was equal to the frontal skull bones, or replace the current impression.

A: In theory the existing frontal skull implant should be able to be burred down. But because it is a PEEK material this is an incredibly firm material so its intraoperative reduction can noi be assured.

Given its custom design and the obvious over correction/protrusion I am suspicious that this was originally a partial thickness bone defect. This makes the use of a material like PEEK ill advised since it simply can not be made very thin. It is more indicated in full thickness skull defect swhich requite thicker implant thicknesses.

I would need to see the implant design file which will show the original skull contour deformity so I can advise a more appropriate frontal skull contouring method.  (either bone cements or a different implant material.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 32-yo male  looking for a custom jaw implant. I have a preliminary proposal from a NYC-based surgeon but am uncertain around the proposed design and his skill level. Dr. Eppley is highly experienced and I’d like to consult with him about what he thinks, including about having him do the surgery (scheduled for December).

Here is the morph they made me, attached.  I’m very focused on “fixing” the jawline from the side profile, like the first and third picture.  My mandibular angle is too flat – almost like a congenital condition – so that is what I want fixed and that is my key concern.  I don’t think I need much width and only want a tiny amount of new width, at most.

A: You would be astutely correct based on that imaged goal. When you add vertical length to the jaw angles you will by definition add width without even trying. Thus if the goal is minimal jaw angle width with vertical lengthening/reshaping, the custom jaw angle implant width should be minimized …like no more than 3mms. It is very easy to make the face look too heavy from the front view with the creation of lower aw angle even though the jaw angles may look great from the oblique and side view.  This third dimension (front view)  must always be factored into any jaw angle implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am very close to arranging appointment for mandibular implant surgery. A consultation would be very helpful. Beforehand, could you please help me understand the difference between the vertical mandibular implants and the lateral implants. I am not sure which would suit me better. As photos show, I have a narrow face. I want a more chiselled, masculine look but want to avoid the bulkiness or full cheeked look that can sometimes be a result of jaw implants.

A: Based on this one picture alone I would suspect that you only need widening jaw angle implants. Buit a more informed opinion would require additional face pictures from the side and oblique views along with some imaging done to look at these potential changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The procedure I had done was facial feminization surgery. I didn’t like the jaw and chin portion. I have post (initial plastic surgeon never gave me the before scans) CT scans of sliding genioplasty and Vline jaw contouring. The iover aggressive work left me with a sagging face along with chin ptosis. I went to another plastic surgeon who did a deep plane facelift to address the sagging. I’d like to see what can be done to correct over aggressive jaw and chin work.

A: Having seen a lot of V line surgery that is a very unusual angle in which the entire jaw angle was removed but the body of the mandible remains. In essence the bone cut was angled way back. So I would have expected significant soft tissue sagging and a disconnect between the angle, body and chin mandibular segments.

Restoration of some or part of the jaw angles and chin can be done and the restoration goal would be what makes the bone look more normal as opposed to what the original bone looked like since we will never known what that was.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Dr. Epply mentioned he removes the outer third of the ribs. Is there a way to request a more aggressive resection? Half or most of the ribs?  Has he done this on trans patients?”

A: 2/3s of the patients that have rib removals are transfemales in my experience.

There is no aesthetic benefit to taking more rib length and the risks of complications increases. The only part of the rib that affects the sides of the waistline and torso is what lies lateral or beyond the outer border of the erecvtor spinae muscle.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, – I’m also looking at doing a hair transplant will this be a problem or how long time should there be in between those procedures

Noticed first time when I was about 21 now 37 it has grown a bit too much for my liking.

A: Given where the occipital knob is located and how the surgery is done I don’t see much of a need for a large gap, either before or after, a hair transplantation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Since I have chin filler present that I opine would block placement of a chin placement, would it not then be necessary to use hyaluronidase?

A: Fillers do not block placement of any implant so dissolving the filler is not an absolute necessity….and thus I don’t routinuely have it done. But there never is any harm in doing so.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a couple of questions regarding the torso narrowing procedure performed by Dr. Eppley.

Is the surgery suitable for trans women?

How many inches will the thorax lose in circumference?

A: 2/3s of the patients who  undergo rib removal surgery are transfemales. (Type 2 Rib Removals)

I don’t think of rib removal surgery results as in circumferential inches reduction. It is more accurate tuse body pictures to show the typical results that can be expected.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, does the combination of temporalis muscle reduction and forehead implant reduce the possible need for an scalp expander (compared to only doing a forehead implant)? Thanks in advance.

A: If scalp expansion is really needed temporal reduction will not create enough scalp looseness to avoid it.

I have never seen a situation where a forehead implant ever needed scalp expansion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Usually, when smiling, the blue line in the image is very short and the lips appear to be in approximately the same position. However, since I am Class II, my chin is receding and the blue line is longer. Would this be possible to try genioplasty, labiomental sulcus filler, etc. to shorten the blue line even a little?

A: No form of chin surgery can change the position of the lower lip, either at rest or in dynamic motion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  have a bone spur,or piece of bone sticking out the back of my head it causes headaches , it hurt, and it stings been dealing with this most my life , and I never new there’s a alternative for this.

A: The spur on the back of the head to which you refer is known as an occipital knob and can have a sharp edge to it. While usually asymptomatic it can occasionally be a source of chronic discomfort. It can be removed in a straightforward surgical procedure done as an outpatient.

Dr. Barry Eppley

World-Renowned Plastic Surgeon