Your Questions
Your Questions
Q: Dr. Eppley, I’m a transsexual female and I am wondering if you are able to reduce skull and face width. I have already had a cheekbone reduction so I am not sure if any more can be taken off.
A: I am not sure whether your cheekbone reduction was by shaving osteotomy which would determine whether any more with reduction can be done in t6he midface. The skull and jawline which you did not mention as being yet treated can have width reduced thtrugh temporal muscle and jaw bone reduction. But I would need a front view picture of your head/face to do some imaging to show you how much further craniofacial width reduction can be achieved.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, When considering skull reduction surgery, is the removing include outer cortex of skull, the periosteum and the thin muscle above or just the bony part of the skull ? And if only the bony part , is its possible to remove the muscles fiber that are covering the whole skull in seeking to get more reduction?
A: in skull reduction the entire soft tissues of the scalp are lifted off the bone and it is the bone that is reduced. There are no muscle fibers that attached directly to the bone except at the its ends. (brow bones and nuchal ridge of the occipital bone) The periosteum and all the soft tissues above it are left untouched as all that would do by doing any excision would create a soft tissue contour deformity.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am not overweight/ but no matter how much weight i lose, i can’t seem to gain a prominent collarbone. I’m looking to change that and am open to suggestions.
A: Having done hundreds of aesthetic clavicle reshaping surgeries I have obsreved there is great variability in the thickness of the soft tissues overlying the bone. Those with prominent clavicle show have a thinner soft tissue cover while those with no clavicle show are buried under a thicker soft tissue cover.. Clavicle show or prominence has very little to do wirth the size of the bone.
That being said I would have little confidence in liposuction to reduce the soft tissue thickness to make the bone appear more prominent. I would have more confidence that enlarging the bone by a sleeve implant would be more effective in that regard.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, If I change up the midface implant for just cheek implants that are smaller and more designed like the first design as attached (but still with the brow ridge section), will there be sagging in the cheeks and if yes, where?I’m mainly concerned with the area in between my nose and cheeks.
A: When you reduce the size of an implant, particularly one that ‘hangs off the side of the cliff’ (aka all midface implants) there is always the risk of soft tissue sagging. How likely that is depends on what level of the midface that the implant is reduced. The higher on the midface it is the higher the risk of soft tissue sagging that could occur.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What will happen when I grow older and my mandible shrinks but the implant will stay the same size. Wouldn’t that be an issue to have custom implant for my whole jawline? Sorry I am ignorant about this. Thanks
A: Your mandible does not shrink with age…unless you lose most or all of your lower teeth.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, If I have a step off and my lower lip is thinner and tight after a recent genioplasty, is this a fault on the doctor’s side? Do I have the right to ask him for a revision or at least a partial refund.
A: These are known risks of the surgery, not signs of negligence or a deviation of the standard of care.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello i have a question about this surgery. I don’t have any injuries in my face but i just want higher cheekbones and i would like to know if this is possible? I know cheek implants might seem like a good option for this but thats not really rhe look i want. I was picturing this as moving or reconstructing the bone so the most peominent part is closer to the eyes and most importantly the cheek below the bone is bigger so the lowest part of the cheekbone is higher. Is this possible?
A:There is no bone moving method (osteotomy) thar can make the cheekbone higher or closer to the eye. Cheekbone osteotomies are lateral inward or outward movements not vertical.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had an Intraoral chin reduction in 2023 and am seeking a second opinion. I’m still unhappy with the aesthetic look of my chin after having it burred down 6mm. It totally changed the appearance from the front and side making it more pointy and projected. I’m not sure if I have excess soft tissue that could be removed or if I need another bone reduction. My chin projects further when I smile rather than resting. After my surgery I now experience sagging skin on my chin that I didn’t have before. From the side it gives off a crescent moon profile which I would hope to be corrected. I would like my chin to be shorter in length as well as less projected. What could be done to give me my desired appearance. (Photos) would this be possible and realistic outcome?
A:The problem with intraoral chin reductions, and is why I wouldn’t do them, is that it does not reduce the overlying soft chin pad. Since the chin is a solitary projecting structure any excess is a combination of bone and soft tissue. Reducing only the bone leaves the soft tissue which has very limited to no capability of shrinking down and getting smaller in size. Thus every postoperative symptom you describe is due to the residual soft tissue excess. Only a submental chin pad reduction will be effective now for improvement in both its static and dynamic shape.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had silicone jaw implants done by another doctor which were subsequently removed during a jaw revision surgery. I have included the original design for your reference. Certain aspects of it, such as the subtle notch, outward gonians, and the ratio of bigonial width to bizygomatic width being 1:1, appealed to me. These implants are what I would like Eppley’s design to be if not better.
Currently I have Medpor implants that are a bit too wide and not as appealing as the initial silicone jaw implant design.
A:Your current extended jaw angle extended implants are about 8mms wide while the ones you prefer are about 3mms wide at most. These differences are in the jaw angle areas primarily, there is not much difference in the anterior extension in either implant design. Since your existing implants are Medpor there are going to be some challenges in their removal, particularly the thinner part of the implant that heads into the chin to merge into the side of the previous bony genioplasty.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to proceed with the “Special Design Back of Head Skull Implant” option. However, I do have a follow-up question:
How would this pre-designed implant be adjusted to fit the unique shape of my head, considering that it was not created based on my specific CT data? Additionally, would my preferences regarding the shape—which I illustrated during my consultation with Dr. Eppley using the images I shared—still be realized with this option? Finally, is there any risk that the implant might not fit properly?
I apologize for the slight confusion and for asking so many questions, but it is important for me to have more clarity to ensure I am making the best possible decision. I truly appreciate your patience and understanding.
A: The only reasons a patient choses a Special Design (SD) implant is 1) economics (it costs less) and 2) I think what I have available to use will work reasonably well. What counts in any skull implant is the outer contour change, not an intimate fit underneath. Any discrepancy between the implant and the bone will get filled in with scar tissue. The implant sits in place with screws and is stiff enough that it does not flex. What really makes the SD implant possible in your case is the wide open coronal incisional approach where adapting the implant to the shape of the skull can be seen under direct vision. The SD concept does not work as well as when a more traditional ‘blinded’ limited incision approach is used as is done in the vast majority of skull augmentation cases.
That being said the way to obviate any of the SD implant concerns is to just do a true custom design. You choose the SD approach not because it is better but because it lowers the cost of the surgery somewhat.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m looking into getting this fat tissue on the back of my head removed. I’ve uploaded a picture as well. Please let me know if this is possible.
A: This is a classic occipital scalp roll which can only be improved by an elliptical excision and closing it to place the scar line in exactly the same place as the horizontal crease which already exists.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, My forehead is overly large. It is excessively convex, especially at the sides. Although my forehead is a littl than I’d like to be, I do not think it warrants a hairline lowering procedure with the cost of a coronal scar and more invasive procedure. My question is, can the reduction of the bony protrusions of my forehead be reduced endoscopically or via some means that does not include a large coronal scar? My hairline has also somewhat receded, although very little and I have been maintaining with minoxidil and finasteride to prevent further recession. That issue also discourages me from hairline lowering due to the scar being revealed by further thinning/recession.
A:You can’t do forehead reduction via an endoscopic technique, you need more of an open field to do it whether that is a coronal scalp scar or a more limited anterior retro hairline incision. It would take seeing some pictures to determine how much forehead reduction can be done and whether the more anterior retro hairline incision is even an option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, On Dr Eppley’s website, it states that there has to be an immediate effect with arterial ligation but that the real test is what it is like 3-6 months after the surgery. With previous cases, has the appearance of a visible pulse been completely eradicated or is the appearance of it diminished? I don’t suppose he has any before and after results he could show? I also wondered what ‘presumably, secondary vessel ligation or inflow recruitment does not occur’ means.
A:Most patients have near or complete eradication of the visibility of the artery long term. A few patients (3 to 4 patients over the years) have had some recurrence years later, not as visible as before, but some partial return. I have no long term results from most patients as they never come back just to show me how good they are doing. This is the bane of an international practice, nobody is seen again physically unless they have issues. But the one thing about having a virtually based practice is I will definitely hear about by email or text if they have concerns.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley,These are my pictures, Hypertelorism they treat detached eyes with box osteotomy. So is there a way to pull the eyes down from above? Is this possible with Lefort 3 surgery?
A:There is no orbital box technique to pull the eyes downward. A LeFort 3 is not an orbital repositioning procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am actually a former patient of yours. I had your 3 prong approach to reducing cheek fat (buccal lipectomy, perioral mound lipo, and buccinator myectomy) back in 2021. The results have been more amazing than I could have hoped and I never thanked you! It is life changing. Anyways, I was recently looking removing a deep glabellar frow line and I saw that you recommend an implant for very deep frow lines. I wanted to know what the cost would be for that? I have included some pictures (which also show the cheek results) of the deep frow line. Thank you
A:Thank you for the long term follow up and good to hear that the results were favorable. In regards to the glabella furrow I don’t see any attached pictures. However I do have pictures of you from 2021 and I can see what you are referring to. I assume that its depth is about the same. I don’t think yours is deep enough to yet justified an implant. I would look more at placing and Alloderm graft right under the furrow to treat its depth closer to the skin surface. Implants are indicated when it is a deep V shaped indentation that cannot be pushed out by any other soft tissue method.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I have had Porex implants (mandibular area of the jaw) by another doctor. I talked to the other doctor two years ago if it were possible to have one of the implants reduced (it is a bit too prominent on one side). He said it would be possible with access through existing scars, but I waited too long with the decision and now the doctor is retired. Would it be possible, in principle, to have the implant revised by Dr Eppley?
A:The question is not whether a Medpor jaw angle implant can be revised but whether it can be done so in vivo (in place) as your inquiry suggests. To more accurately answer that question I would need to understand dimensionally what type of implant reduction is needed and where the existing scars are located.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m reaching out to you again regarding the reduction of the temporal muscle and I have a question about it.The superior and inferior temporal muscles are both responsible for mastication. If I were to undergo a total removal of the superior temporal muscle, would the inferior temporal muscle, located around the cheek area, along with other muscles like the masseter, compensate for the activity of the superior temporal muscle? Would this result in these muscles gaining volume and becoming stronger over time, leading to a swelling of the cheeks and face? If so, is there another way to reduce the temporal area without removing the temporal muscle, such as altering the bone structure in this region, or by reducing the superior temporal muscle by 1 cm or less without fully removing it?
A: Your temporal muscle reduction questions are very common. While removing normal muscle seems like it would cause functional or compensatory muscle issues it does not. The proper terms are posterior and anterior components of the temporal muscle in which the entire posterior portion of the the muscles removed and a little of the anterior part. But this reduces 30% or less of the total temporal muscle volume which explains why no dysfunctional jaw motion results as well as no enlargement of the remaining muscle.
The temporal bone is fairly thin so its reduction does not make a significant difference in head width reduction plus it requires a visible scar along the side of the head above the ears. It is muscle removal which provides the greatest benefit in width reduction as well as can be done with no visible scar.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello! I’m from Arkansas and I’m contacting due to my chin length. Ideally I would like to shorten my chin. From frontal view it isn’t too bad but when smiling i feel it throws off my facial proportions. I was just wondering if this possible? Thanks so much!!
A: When a chin changes length by animation (smiling) this suggests a chin pad ptosis rather than a primary bone length issue. It may be what is needed is a combination of both bone and soft tissue reductions and the procedure to treat it varies based on how much of each needs to be removed.
I would need to see a front and side view pictures of your chin, smiling and non-smiling.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, you hav suggested vertical lengthening genioplasty and a custom implant for my desired jaw augmentation effects. If the 3D custom implant is made based on my current anatomy (i.e. before the genioplasty), how will that work to enhance the chin? Especially for symmetry and shape.
A: The vertical lengthening bony genioplasty movement is simulated on the 3D scan and then the jawline implant is built around it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I am looking to remove bone cement that was done about two months ago on top head region. Too much was added on top. Only wanted top side head to fill in and also a bit of back.
A: In regards to your skull augmentation bone cement removal:
1) What type of bone cement was used…PMMA or HA?
2) Where is the scalp incision used to place it and how long is it?
3) Regardless of the cement used, unless it was put in through a bicoronal scalp incision you have to remove all of it not just part of it,
I am going to assume but the volume of material that appears to be added that is was PMMA bone cement in which complete removal is needed as there is no way to partially remove it due to how it is fractured to remove it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is it also possible to get It less sticking out with out changing the shape of my forehead?
A: That question is an oxymoron…if you reduce the protrusion by definition the shape of the forehead will change.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, What method will be used to make them permanently protrude?
How close will it be to the picture?
Is there anyway we can replicate what’s in the picture?
If I use filler afterwards to increase the protrusion to match the picture, will it eventually be remodeled to match that protrusion?
A: When you are trying to change the natural shape of a facial structure by surgery there is no exact predictability as to how the tissues will respond. What the imaged pictures do is set the goal which will influence how the surgery is done.
In creating increased protrusion of the ear the antihelical fold must be released from behind and a cartilage graft placed to act as a buttress to hold it out. (cadaveric cartilage graft) But the exact outcome can not be exactly predicted beforehand. You push the ears out as far as they will allow to be released and out the largest graft possible and hope that the final result will be close to the goal picture.
Injectable fillers create temporary effects, they do not turn into tissue or create a permanent effect. The material will eventually be absorbed and the effect will be lost.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a consultation regarding forehead augmentation to address asymmetry caused by a recessed frontal bone on one side. The imbalance is structural rather than soft tissue-related, and I am exploring options such as custom implants or bone cement to achieve a more symmetrical appearance. I would appreciate the opportunity to discuss the best approach for my case, potential outcomes, and the overall process.
A: When you have an asymmetry on a highly visible area like the forehead it is always best to use a 3D CT scan and make a custom implant. Bone cements are a very imprecise method of skull augmentation that will only end up creating a new version of the asymmetry.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, just had genioplasty Do you think that if the surgeon’s plan was to advance the chin forward 6mm and I asked for 5mm will make a significant difference? I’m so scared of having ruined my results and that now the chin will look too small.
A: 1mm is not going to make the difference between a result that is just right or too small.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello I would like to change my 600cc hp silicone for 800cc uhp silicone I’m 5’4 with a bwd of 14 the first pics are of me the other 2 are wish pics. Thank you
A: Given that 800cc ultras high profile silicone breast implants exist and the volume change (200cc or 33%) is under 50% this should be very achievable.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am distressed by the outcome of my surgery, I just had this midface and temporal lift in Turkey on January 23rd 2025, it’s been 3 weeks last saturday. I find the temporal lift (canthis and eyebrows) too high, too pulled up, I would like to lower it and have a natural look that’s closer to how I was before but without the negative canthal tilt I had. I thought I explained my doctor that i just wanted a subtle lift but his hand is strong because the fox eyes is the fashion over there and that’s what he does more I guess. He says I over worry and that it will come down with time but I feel disfigured, I cant heal 2 months hidding I have a lot to do. I had a negative canthal tilt before, I wanted to elevate my outter corner of my eyes a little bit but, it’s over done to my taste, I feel too much tension and my eyes are blurry I can’t read comfortably cellphone or computer, even with my reading glasses I see blurry, so it strains my eyes because it’s more effort I have provided. I attached picture of me before and after surgery. He used the endoscopic method. his incisions are 1 cm behind the hairlines on each side, And for the mid face lift he went intra oral to lift the tissues and fat pad from the bone and pushed them up. Please help!
A: While 3 weeks may seem like an eternity it is not when it comes to any procedure on which some form of lifting of the face is performed. The effects of gravity and tissue relaxation will make the result less lifted as it heals so what you see now is not the final result.
The only reason to intervene now to take it down is if the goal is to try and return to what you were before as much as possible. Otherwise I wold wait it out and see how it settles out by 2 to 3 months after the surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to tell you about a problem with my head shape. It is a condition that I have noticed since my childhood. I have a problem with my head looking too wide from the sides. My father has the same problem. He also has a wide head when viewed from the front, but the back of his head is flat and curved, but mine is normal. Is this because the skull bone is too wide or the temporal muscles are too big? Could it be because both are too wide? Because when I clench my jaw, my head expands quite a bit, and when I open it, it becomes quite thin. Is there a solution to this problem? If so, what is the solution?
A: In the wide head both the bone and muscle are at fault. But on a practical basis it is the muscle removal that offers the greatest benefit in reduction and can be done in a scarless manner from an incision in the crease of the back of the ear.
You also have demonstrated the value of the posterior temporal muscle removed and anterior temporal muscle release by your mouth opening manuever.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How long do you estimate recovery time to be: am I going to need another person to assist me with daily necessities (preparing meals, showering)?
2.1. Given that’s correct (I am going to need a caregiver), then for how long?
3. How much narrower can the shoulders be made?
A: These are very important shoulder narrowing recovery questions which are better answered in depth in a virtual discussion. But in summary:
1) While a full recovery takes 6 weeks the most important recovery period is right after surgery until you can return home. It can be done alone or with someone and, of course, recovery is easier when here with someone and one can return home sooner that way Most patients return home 4 to 6 days after the surgery.
2) To really understand the effects of shoulder reduction surgery and the effects of removing 2.5vcms odf bone per side I need to see pictures of your shoulders (front and back vews) to do some imaging of the potential effects.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a lipo for the banana rolls 5 years ago and the suction was probably too strong. Since then I have had a deep crease, especially on the right side.
This causes me pain and discomfort. Do you think I would be a good candidate for a lower buttock lift?
Would this pulling, sagging discomfort improve and how severe would a scar be?
A: A lower buttock lift after liposuction is usually done because it has either caused a lower of the infragluteal fold or has created a banana roll deformity….neither of which you have. An overly deep infragluteal fold with discomfort is a scar contracture issue for which release and interpositional fat grafting is needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I didn’t notice my MARPE changing the width of my mouth at all, which I’d hoped it would. I’m just curious, is there another way to slightly widen the mouth? Also, I’ve heard that you need time for your palate sutures to fuse again until you have jaw surgery. Is that true?
A: I would not expect MARPE to widen the nostrils. Mouth widening is done by a direct softy tissue Y-V corner movement. There is no correlation between any facial suture developments at the bone level and this external soft tissue site.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
