Your Questions

Q: Dr. Eppley, I had  a TBI a few years ago. My doctor did covered it after medicaid approved it, but the company who made the implant didn’t do the scan of my head the right way so I still have small dent on my head.

A:If I understand your surgical history it appears that you had a custom skull implant for a craniotomy defect. This appears to have been in the left fronto-temporal area. I suspect the contour defect you are seeing is not the result of an ill-fitting or improperly made implant but due to the loss of the temporal muscle over it. This is very common in the temporal region as the muscle is stripped off to access the bone and, although it is sutured back up, it always atrophies and creates a soft tissue contour depression. You could prove that by a postop 3D CT scan.

So this is more of an issue of soft tissue augmentation than bone augmentation per se. Options include fat injections, ePTFE sheeting or a custom made implant overlay….each  with their advantages and disadvantages.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in receiving a custom chin implant as well as a custom cheek implant for my right cheek (the side with the mole on it). I think the right side of my face is underdeveloped and the main cause of my facial asymmetry. I honestly think i have a mild form of hemifacial microsomia. I like the left side of my face and my goal would be to get the right side to look as similar to the left as possible. I also have asymmetrical lips and the right side lifts up higher than the left exposing more teeth when I talk and smile. Is there a solution to fix this? If you have any other ideas for procedures to correct my facial asymmetry I would be interested. Thank you

A:Like many facial asymmetries they are usually complete (involving the entire of the face) if you look close enough. (see attached grid analysis) These are aesthetic facial asymmetries as opposed to syndromic ones due to their more modest presentations. While all facial features on the side of the face are affected it is best to focus on the ones the patient has identified as most problematic as well as the ones that can be most effectively improved. Not all asymmetric facial features can be effectively improved.

You have identified the bony chin and cheek as your top two targets. The right lip asymmetry is not so effectively improved and as has the tradeoff of some potential scarring so that would be an asymmetric facial feature that I would leave alone.

Likie all facial asymmetries that have a bony component, and almost all do, the next step is the need for a 3D facial CT scan which will allow for more in depth assessment as well as is the platform on which the custom chin and cheek implants are made

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Concerning the result I want to receive from facial surgery, I would like to systematically explain my problem:

Before puberty I was looking like normal but at the age of 15-18 I experienced elongation of my face. So much that I cannot recognize myself anymore in the mirror. The “T” zone of my face became extremely elongated during those years. Making me so insecure about myself. I never understood what was the cause of my problem – why my face deformed so extremely? 

The procedures I was considering for my condition were: Mandible jaw implants, cheekbone implants, maxilofacial sugery, rhinoplasty, lip lift, fat transfer under the eyes, or lower blepheroplasty.

I have very flat sides of the face. At first I wanted to do mandible jaw implants (that goes into width) – to widen my face. But then I was afraid it might make my face masculine, giving the fact that the T-zone of my face is extremely long. How is it possible to reduce the elongation of my face and make my face healthy and feminine looking? Also, I was thinking about fat-transfer to my under-eye and cheeks, but then I was afraid it might just make my face puffy and elongate the T-zone even more.

Ever since I was 16 I dreamed of some operation that would get my face back to normal. Is there any chance of converting my deformed face back to normal?

A: Thank you for your inquiry and sending your pictures to which I can say the following:

1) What has occurred in your face is normal development after puberty. It is not a true facial deformity per se.  You simply liked your more pubescent face than what mature facial development has created. That does not negate that your do not like the facial proportions that have resulted. (long midface and shorter lower face)

2) You can not really shorten the middle third of the face as effectively as changing the lengths of the upper and lower face. That has always been and will always be a challenge. There are only a few limited changes that can be done that can help soften the length of the midface.

3) That being said one surgical approach is chin/jaw augmentation to increase the size of the lower face.  As you have mentioned one must be careful in a female to not masculinize their face. The best way to make that determination is computer imaging to see what such a potential change would look like. Your reaction to that imaged change will determine if this is an acceptable or unacceptable change. (see attached imaging)

4) The aforementioned midface shortening procedure would be  subnasal lip lift and a rhinoplasty that shorten the length of the nose.. I have put those changes on top of the jaw augmentation to show all procedures that may be helpful in improving your facial third proportions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m reaching out to ask if your clinic offers custom brow ridge implants. I’m interested in enhancing the prominence of my brow ridge for a more defined and masculine look and would love to know more about the options available.

If you do provide this service, could you please share some details about the process, including costs and any consultation requirements?

Thank you very much for your help—I look forward to hearing from you.

A: Custom facial implants, including custom brow bone implants, are procedures that I do regularly. The designs you see on the Custom Facial Implants site are from actual patient surgeries. To learn in greater detail about custom brow bone implants from design to placement please visit www.exploreplasticsurgery.com and place the term Custom Brow bone Implants in the search box and you will a large number of articles written  in this topic from various patient surgeries.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in a mouth widening surgery…altogether both sides ½ inch or so

(btw I don’t feel good with my nose). it should be half cm higher from tip to bridge

A:Mouth widening is usually done 5 to 7mms per side which would be consistent with the 1/2inch you have mentioned.

For the nose you are referring to increased tip rotation which is what shortens nasal length.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering how far can the nasal base or apex can be projected for a less flat profile. If you don’t mind. What’s the max on average could be projected by a midrange implant with focus of the nasal base. As you can see with this black and white illustration the nasal base or apex protrudes farther than the brown and chin. And with this model slightly as well.

A:Typical nasal base projections in custom midface implant range from 3 to 8mms based on patient need.In custom implants you can create any implant dimensions so it really comes down to tissue tolerances in larger dimensional needs.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was wondering if custom infra-malar implants would be the best procedure to improve my infraorbital rim hollowness/discoloration, zygomatic arch, cheekbone setness and overall lack of cheekbone mass.

-improving the overall mass and getting that “high set” look are paramount to me.

– is infraorbital discoloration due more to the lack of bone prominence in the area or could their be other reasons that are separate from the bone prominence itself?

A:To improve the number of midface issues that you have described custom infraorbital-malar implants would be the only effective way to do so. Undereye discoloration comes from two sources, shadowing and hyperpigmentation, often occurring concurrently. Custom IOM implants addresses shadowing but not hyperpigmentation.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a problem with the small size of my head, and my head is also flat from the back.

A: The flat back of the head is very clear with widened biparietal-temporal areas. One can make no conclusions about head size based on just a 3D CT scan.

The flat back of the head is a straightforward implant augmentation approach. Addressing smaller head sies requires a multi stage approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been a fan of your work for a while. This is my first time contacting you and I was just hoping to get a few answers to some questions I had. If you could help with any of them, it would mean a great deal!

Is there a difference between a supraorbital implant, a supraorbital rim implant and a brow bone implant?

I understand that every patient is different but how much is the average custom ct guided brow bone implant? (A range is completely okay to give).

How many millimeters does the implant in the attached picture add to brow bone projection? (Not sure if this is the right way to phrase it)

A :In answer to your brow bone implant questions:

1) The terms brow bone and supraorbital are interchangeable.

2) The attached brow bone implant design has 4mm  centrally as seen in profile.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m considering jaw implants but have concerns about potential bone imprinting.

On your website, you mention:

“the average implant settling into the bone… was in the range of 1.5 mm…this is actually not just seen on the chin but can be seen in other facial implant sites as well (eg. jaw, cheek),”

but also state:

“I am not aware that there is any bony erosion with jaw implants. I have removed many from surgeons over the years and have never seen that issue.”

Could you clarify if bone imprinting occurs with jaw implants, and if so, by approximately how many millimeters? Should this be considered in the design—for example, if I need 5 mm of width, would it be better to choose 6 mm to account for potential bone imprinting?

Thank you.

A: Every facial implant gets some degree of bony imprinting, manifest more prominently at the chin and jaw angles. I don’t consider it to have any clinical relevance and you don’t create implant dimensions or pick implant sie based on its potential occurrence.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I realize it depends on individual cases, but generally speaking, would you consider a 3mm orbital decompression to be conservative?

A:For the eye area a 3mm change is likely ‘significant’.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I actually don’t hate my resting face, but when I smile I feel like my chin and maybe even jaws just look terrible.

A:The general concept here is that this is a dynamic facial problem….meaning at rest the face is fine but the problem only appears in dynamic facial motion. (e.g.,smiling) It is also important to remember that surgery is a static action not a dynamic one. In other words surgery is done on a resting face not a moving one.

That being said what I see is a bit of a vertically short chin, which at rest is very acceptable, but when smiling the soft chin pad is pulled down over it creating a dynamic chin pad ptosis. The only way to treat it would be vertical chin lengthening to prevent that dynamic chin pad ptosis. This will change the appearance of the chin at rest, making it a bit longer so one has to be certain that static facial change is acceptable. (see attached imaging)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a chin implant in 1995. Twenty-five years later, I began to have very specific localized pain in the jaw bone directly at edge of implant, and also feel overall tightness and discomfort throughout my chin. There was back and forth that the pain was dental; ultimately had two teeth extracted and still have the pain. CT scan shows the implant is secured with 4 metal screws. I want to have the implant and screws removed and am worried about the risks of this, bone remodeling, etc, after so many years. (The original surgeon has long retired so I don’t know what the implant or screw is made of). I have attached a cone beam xray.

A:While there is nothing ominous in the 3D CT scan and the implant looks normal (well below the tooth roots, has no signs of significant settling into  bone and even has reparative bone overgrowth over the top of the implant) I would agree with you that by the process of elimination the implant should be removed. By the way the implant appears to have been hand carved and appears on the 3D scan it is either silicone or Goretex. (most likely the former) But regardless of its material composition it can be removed along with the screws. If there is any bony irregularities I would just fill them in with allogeneic bone chips/paste.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a transgender person. I have been following your work for some time and have the intention to get shoulder reduction and rib removal done.

I have been bothered by the masculine and broad shape of my upper body for years and have never been able to make dues with it. As a result, I have considered your surgeries for a few years now and am finally in a financial situation where I feel comfortable requesting a consult or for more information.

I have attached some images of the related regions – my shoulders from a front view, and my lower torso/waistline from a rear view. I included pictures of this nature, following the way sample pictures on your site have been taken.

What would you recommend regarding waist narrowing procedures? As a transgender individual, I figured the type 2 would be suggested but I would like to hear your opinion on it. My interest is in reducing the general width of the rib cage but also improving the waistline as much as I can.

In addition, what seems to be the maximum amount that could be reduced in the shoulder regions? I would like to reduce the broadness and ‘masculine’ appearance of the shoulder region. I am not as much bothered by the high shoulder-waist-ratio that I have as I am by the simple fact that my shoulders are just quite broad compared to the average to begin with.

Finally, I was wondering if it would be possible to schedule this for early May 2025 and wanted to discuss financing plans following more information. In addition, would assuming a month for recovery for both procedures (if they can be done at the same time) be a fair assumption?

Thank you very much for your time and I hope you are having a pleasant day!

A:Thank you for your inquiry and sending your pictures to which I can provide the following answers:

1) For maximal waistline reductive effect you are correct in that the Type 2 Rib Removal procedure is best. There is no procedure for overall ribcage narrowing but at least the Type 2 is the most aggressive approach for addressing the lower ribcage.

2) To get an idea of the potential effects of shoulder reduction and rib removal skeletal procedures I have attached the following images.

3) It is not uncommon to have both shoulder reduction and rib removal surgery done at the same time. The key to doing so is to have adequate postoperative care  arranged in the immediate after surgery time period.

4) It would be fair to say that at least one month recovery is needed but this answer is dependent on what one is recovery to…..which will vary based on the activity. (more or less time)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have questions about chin augmentation. Specifically, I’m interested in achieving 10mm of horizontal projection with a chin implant.

I understand that custom implants can also provide vertical length adjustments. While adding vertical length isn’t a priority, if I opt for a custom implant, I would like to add 4mm of vertical height. Could you let me know whether you offer both regular and custom chin implants or primarily focus on custom options? Additionally, I’d appreciate it if you could outline the price difference between the two, as I’d prefer a regular implant if it offers comparable results at a lower cost.

I also wanted to ask about the possibility of combining the chin implant procedure with other surgeries I plan to have with you. My current surgical plan includes a top head skull reduction, temporal reduction surgery with temporal muscle removal, occipital reduction, forehead bone reduction, and a hairline lowering surgery with a 25mm lowering of the hairline.

When I contacted your clinic, I was told that all these procedures could be done together. I am aiming to schedule everything for winter or spring 2025. Would it be feasible to include the chin implant surgery at the same time as these other procedures? I live out of state, and I would be saving a lot of money on airfare if all the surgeries were done together.

Thank you for your time and guidance.

A:i remember you well from an inquiry and imaging done in September 2022. In answers to your questions:

1)  If the goal is 10mm of horizontal projection and vertical lengthening is not a priority (remember that even pure horizontal chin augmentation will add the perception of some increased vertical length then a standard chin implant should suffice.

2) A chin implant can be added to all of the mentioned skull reshaping procedures.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,Hello! I am primarily interested in modestly increasing the anterior projection of my chin, avoiding facial lengthening and jaw widening. I would like to explore which options are most suitable for my face, learn more Dr. Eppley’s custom implant process and pricing for each option that I would be a good candidate for.

I am also interested in assessing my candidacy for subnasal philtrum shortening, as well as associated procedural details and pricing.

A:To achieve the dimensional chin augmentation changes of increased horizontal projection and no width or length increases can be done by two approaches both based on the need to bring the augmentation upward as it comes forward. If you don’t make that compensation in the movement the chin will get longer.  This can be done by either a bony sliding genioplasty or a custom chin implant. When it comes to an implant augmentation it requires a unique design for which no standard implant can achieve. (see attached imaging

For the upper lip you can’t really have a subnasal lip lift alone as the sides of your upper lip have the vermilion disappearing as it goes to the sides. (greater on the right than the left) You would have to combine that with lateral vermilion advancements to avoid an A frame upper lip deformity. (see attached showing the subnasal lip lift without and with lateral vermilion advancements)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, my forehead is slopped on one side and wavy on the other. I was wondering how much it would cost to get that fix? It has been something that I have long felt insecure about.

A:With the combination of an excessively sloped forehead on one side and irregularities on the other side this sounds like a custom forehead implant would be the most effective approach.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m 32 year old female. Through out my life, I’ve never liked the shape of the back of my head but couldn’t do anything about it because i was too young, didn’t have the money or couldn’t afford insurance. Now that I’m older, i have been researching head augmentation through implants . Ever since i was a baby, I’ve been layed on my back and over the years it flatten the back of my head. So i have always had an Afro hair style to cover the shake of my head. But now I’m losing hair slowly and i really want to see if there is anything you can do to change the shape of my head to look normal. One of the implant I’ve looked up is call methyl methacrylate. or if there is any other bone substitution you may recommend. I’ve attached some pictures for you to look at. Please give me a little more information about the procedure with the cost of it and what type of insurance I need. 

A: For flat back of the head augmentations a custom skull implant is the best approach for maximum projection, smoothness and the smallest scalp scar to place it. (see attached image) I have abandoned the use of PMMA  acrylic bone cements years ago because of their limited effects and other issues. Such aesthetic skull augmentations are never covered by insurance since they do not cause any functional problems.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What are the pros and cons of thigh, buttock and hip implants compared to fat grafting? Should they be considered as standard for body feminization as breast implants are for breast augmentation? Or are they riskier?

A:This is a complex question which defies a simple answer. But it speaks to the fundamental differences between implant vs autologous aesthetic augmentations. The ‘simple’ answer is if the area in question can get similar results with both methods then one should undergo fat grafting first as it is ha a lower risk of complications than an implant…and one can always graduate to an implant of the desired result is not obtained with fat grafting.

The complex nature of the question lies in that most aesthetic areas for augmentation can not get similar result with both treatment methods. So each aesthetic area in consideration must be evaluated in that context on an individual basis.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello i would like to ask you if It is possible to solve my condition. I have a problem on my eye area appearance and i think it’s because of my narrow brow bone width and wide byzigomatic distance. I think the eye separation ratio isn’t ideal, i mean the ratio between IPD and byzigomatic distance is too wide and make my eyes look too much at the centre of the face. And i think It s because my brow bone width is too short in relation with my other features.

A:I believe your supposition is correct in that the lack of brow bone width makes your eyes look too close together. The attached imaging proves that theory. This could be achieved with tail of the brow bone augmentation with custom implant designs placed through upper eyelid incisions. (see attached implant designs)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, For the shoulder reduction would the amount removed per side (2-2.5cm) scale as well with height and if so – how much would potentially be removed for a height of 174cm?

A:I always try and remove the maximum amount of bone length based on the length of the clavicle but there are limitations based on the ft of the fixation plates. But it is fair to say that in tall patients they may get 2.75cms…very rarely 3cms removal per side can be done.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello. I was wondering if there was a way to minimize or fix my brachycephaly. Thank you

A: Augmentation of the flat back of the head is done by the placement of custom skull implants. What degree of correction/augmentation you desire would determine whether it is a one stage or a two stage process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I was looking into your forehead surgeries and I was wondering what you’d have in order to get a more forward projected forehead/brow ridge? I’d like to bring the entire thing forward so much so that it shadows over my eyes, but look natural in the way that it isn’t just a protrusion in my forehead.

A:The most effective approach is a custom forehead-brow bone implant which I do often for these exact upper facial male needs.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a complex regarding my chin area, as I think it lacks projection and makes my already thick lips look more protruding. I think a sliding genioplasty would help with my facial profile, but I would like to have your expert opinion on whether this surgery would help. I am also concerned about the presence of titanium screws, as I have read this can offset certain sensitive airport security machines. Would there be a non-titanium fixation option as well, and if so, are there downsides to this as opposed to the traditional titanium fixation? I have attached photos.

Thank you!

A:I do think that chin augmentation would be beneficial for your profile. But in females one must be careful to not try and make the augmentation too excessive which can also make the nasolabial fold much deeper. (se attached imaging) Any form of titanium plate/screw fixation has NO adverse effects on airport scanners or in getting medical MRIs. This appears to be a persistent misconception which is a regular question from many patients.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am reaching out to inquiry about the Correction of Eye/Orbital Asymmetry, as you will see from the attached photos I have some degree of Vertical Orbital Dystopia on my Left Eye due to my low cheekbone on left side. My question is will a customized orbital floor that also correct left cheek bone. My wish result will be to minimize asymmetry of my upper mid face.I’m looking forward to your response!

A:Your type of orbital facial asymmetry appears more horizontal than vertical although it could be a mixture. The best way to make the proper diagnosis as well as determine what can be done is a 3D face CT scan. That will accurately show the true bony differences between the two sides as is the only way to tell how to treat the bony orbito-malar asymmetry. You never make judgments based on an external assessment only.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a lump on my forehead, I want to come in to get it checked and possibly remove it.

A:Saying you have a lump on your forehead is a bit of an understatement. That is definitely a very large lump. A CT scan is needed to determine if this is a benign outer cortical bone growth (osteoma…which can be shaved down) or whether this is an osteoid osteoma (full thickness of the frontal bone involvement( which requires a craniotomy to remove.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a 25 year old male interested in the macrotia/ear reduction surgery. My primary issue is that my ears stick out quite a bit, particularly due to a relatively wide concha.

A:While I can see the desire for ear size reduction you have to be careful in your case because of your elongated conchal bowl. Reducing the ear around the bowl, which is how most macrotia reduction surgeries are done, can make the ear look ‘odd’.  To determine how you would interpret that change I have attached some imaging of the potential change.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to inquire about a consultation regarding potential facial reconstructive surgery. I have several concerns about my facial structure that I would like to address, and I am hoping to explore options for surgical correction.Specifically, my primary concerns include:

Forehead: I have a pronounced or prominent forehead, which I believe may be related to frontal bossing. I am interested in discussing potential procedures to reduce the prominence of the forehead and achieve a more balanced facial profile.

Brow Ridge: I have minimal to no definition of the supraorbital ridges (brow ridges) above my eyes, which gives my face a flatter appearance in the upper facial area. I would like to discuss whether brow augmentation or other procedures could help enhance this region and create a more defined appearance.

Eyes: My eyes have a prominent, rounded appearance, sometimes referred to as “puppy dog eyes.” I believe this might be due to proptosis or larger eye openings (palpebral fissures). I would like to understand if there are options to make my eyes appear less prominent and more in harmony with the rest of my facial features.

A: Thank you for your inquiry and sending your pictures. What you actually have is pseudo frontal bossing…meaning it looks like frontal bossing but only appears that way because the bones around the eye (periorbital) area are deficient.  This can be seen when the periorbital bones are augmented that the frontal bossing goes away. (see attached imaging) The concept of combining a custom brow bone implant with a custom infra/lateral orbital-malar implant  is the only way to achieve this effect (see attached image designs) and optimally addresses your listed forehead, brow ridge and eye area concerns/objectives.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I am very interested in a skull reduction to improve my confidence and treatment of stress caused by body dysmorphic disorder. I’m a 26yo male  who was had anxiety about my head shape my whole life. My main concern is the top of my head being too tall, and a slight outward shape above my ears and around the back. No hairstyles look suitable on me, and I think any improvement could be huge for my health. I can’t slick my hair back, my forehead is very square and feels almost too vertical instead of protruding in a natural shape. I had a horrible hair transplant done which I need to get corrected first. I was hoping reducing my forehead would the the solution, but the issue is more the shape of my head combined with a high and wide hairline.

My main questions are what the scars and usually like, and how hard it is to hide them under hair? I did see one photo on your website but the patients hair looks a lot different and messy in the after photo, which I as wondering is a result of hiding the scars. If you have any more patient before and afters I’d love to see them. I have good hair genetics with my parents having most of their hair still, and use minoxodil daily to help keep it thick. I would be willing to try finasteride at a low dosed and hopefully have no bad side effects, as a hair loss prevention.

A: By your description of the desired skull reduction locations the incision would have to be across the top of the head between the bony temporal lines or may just a bit below them. This would provide access for removal of the outer cortical layer of the top 0f the head as well as onto the sides and even into the upper forehead. These incisions usually heal quite well with minimal scarring particularly in skull reduction surgery where there is no tension on the healing closure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I am reaching out to see if you could help me with my lip incompetence. I have had lip incompetence since I was a teenager, I am now 22. I had Double Jaw Surgery + Genio in April of this year. However, immediately after surgery I noticed that my lower lip was very tight and had limited mobility. Fast forward to today and my surgeon says that it isn’t chin ptosis but I have a lot of lower tooth show and my bottom lip cannot reach the top no matter how hard I try, so I am lost and would like your help if possible.

A: As you can see in your animated picture there is evidence of scar contracture of the soft tissue chin pad which is not rare as the soft tissues heal and settle down into the bony stepoff of the genioplasty. (which I assume was not grafted) Like all scar contractures a release and interpositional fat graft is the definitive solution for the tightness issue which did not exist before the surgery. What that may due for the lip incompetence is a different matter and less assured. By your own description your lip incompetence is long standing and existed before your jaw surgery. Thus it is essentially a congenital deformity not an iatrogenic one like the tightness which is more readily improved.

Dr. Barry Eppley

World-Renowned Plastic Surgeon