Your Questions

Q: Dr. Eppley, I had facial feminization surgery about two years ago. That included placement of hydroxyapatite bone cement in the forehead, but I ended up with a visibly raised area running along the central part of my forehead, above my eyebrows. I know there are surgeons who shave brow bones endoscopically. Is it possible to contour bone cement endoscopically?

Of possible significance is that the surgeon shaved down the bone above the frontal sinus too aggressively, and there’s now a small hole there. I’m not looking to get the glabella area revised, just the areas above and to the sides.

A:  I suspect you had HA bone cement placed in the central/upper forehead as a contouring technique to complement the brow bone reduction…this is a not uncommon technique. But it is a very sensitive onlay bone augmentation technique that is unforgiving in the shape/amount of augmentation as well as edge transition.

While HA material can be removed endoscopically in its entirely it can only be contoured/reshaped by the original method by which it was placed. (open approach) HA is essentially a ceramic material so it is very brittle and easily fractures so remote attempts at trying to reshape it is prone to secondary contour problems.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I had fat transfer to my cheek area and I would like to remove it my face doesn’t look good and the fat that was transfer I can feel the diference what’s the best option to remove that fat.

A: Microliposuction is the only way to treat unwanted facial fat areas from injections or subcutaneous fat excess. It can never be completely removed but at least can be reduced.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q:Dr. Eppley, ‘m a 21 year old man and I’d like to improve my jaw and midface as much as possible aesthetically. I got infraorbital rim implants two years ago but I still seem to lack definition around my midface. My face looks “blobby” to me. I want it to to look sharper, with more hollow cheeks, just more masculine all-around. I’ve never had any work on my jaw- my main thought is a wraparound jaw implant but I’ll probably also need midface implants to achieve what I hope to. Please look at my pictures, I trust that you’ll have a good idea of what to do. Thank you. I’ll be in touch.

A: Your assumptions are correct in that you need cheek and jawline implants to improve your facial definition. Your existing infraorbital rim implants are small so I would not have expected them to make a big difference in improving overall facial definition.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Please see attached my current pictures. The pictures in the brown sweater are current, the pictures in the light grey sweater are before braces, the pictures in the dark grey sweater are 4 months after braces. It has now been 8 months with braces within a total term of 24 months. The orthodontist has been correct a deep overbite.I have noticed that my face has become gaunt and long after braces (my weight is the same as before treatment), my chin is longer and my jawline is not feminine anymore. 

I am interested in any procedure which will shorten my mid face (below eyes to upper lip) ,reduce the length of my chin and feminize my jawline. I am specifically interested in the lefort I procedure for mid face reduction. Please let me know if I qualify for this procedure specifically and how much of a difference I can see with it.

A: There is no effective procedure(s) for shortening the midface. A LeFort I impaction is an effective procedure when a gummy smile exists with excessive teeth/gum show. But when a normal lip to tooth relationship exists all a LeFort I impaction will do is bury the upper teeth under the. upper lip and the overlying midface soft tissues will remain in the same amount and length.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I used to have a small chin and always hated how it looked as it affected my confidence.Earlier this year I decided to do something about it. I went for a chin implant and it as securedwith 2 screws. It looked good at first however after the swelling subsided, I realized the implant was too small and hardly provided any horizontal augmentations which is something I really wanted.

I went back to him and asked if it would be possible to get a bigger implant or one with more horizontal projection, and he said yes, but that your office would be the best place to get this done at.

I have attached pictures from before and after the surgery.

Please let me know if this is enough info or if you need more. Let me know if you have any questions.

A: I would agree that the existing chin implant is underwhelming. The first question is what type and size of chin implant do you currently have as that information will allow the following determinations to be made:

1) Is any standard chin implant available that could provide a substantative change. The largest standard chin implant has a maximum 11mms of horizontal projection. To make for a visible augmentation change the new implant would have to be double in projection what the first one provides.

2) If what is needed exceeds a standard implant then  a custom chin implant design is needed.

3) Based on imaging of your desired goals maybe a sliding genioplasty is a more appropriate chin augmentation procedure

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, This is my current jawline implant design that I had implanted and I have a few issues with it. The front profile doesn’t have enough chisel/definition(width) and the implant has added roundness rather than sharp angles like I wanted. The Gonial angle should be a little wider and have more back projection and create a straight line to the tip of the chin, along with more chin projection outward.  The biggest issue though is on the right side there is a protruding ball below the masseter muscle because of the shape of the “highlight point” I think this should actually be broad and flat instead of spherical. I’d love to talk about this more in depth. Thanks for reaching out and talk soon.

A: The effects of any custom facial implant depends on three factors; 1) implant design, 2) implant placement and 3) the influence of the overlying soft tissues. Don’t ever assume that the implant has been placed as it is designed. Thus you never undergo any implant revision/replacement until you understand how the implant looks on the bone. (need a postop 3D CT scan)

I can see multiple components of the existing implant design that contribute to your concerns.

It is also important to point out that secondary custom jawline implant surgery is a lot harder rthan the first one and comes with increased risks. The existing jawline implant is encased in scar and bone overgrowths that did not exist during the first surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley. I am writing to you regarding possible facial surgeries or solutions for a short lower third, ”short face syndrome”, which has had a substantially negative impact on my life and confidence. Been reading about one of your past patients who had a very similar problem as me, almost never closing his jaw because of the perceived small lower third, and instead always having jaw in an open bite relationship to make it look larger or vertically more aesthetic. This patient had a custom jaw and chin implant done by you. When a jaw surgery is not possible, is a jaw implant/chin implant the best solution do you think?

A: If one can not undergo jaw surgery then a custom jawline implant would be the only treatment option for lengthening the lower third of the face. (jawline).

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley,  I am a 32 year old MTF trans woman. I am 5’7” 135 lbs and would like hip and butt implants. I have always been on the smaller side before transitioning.. I was able to gain some weight during Covid but obviously it did not stick once i returned to my daily cardio routine. I have been small and fit my entire life. For these reasons I have decided to pursue hip and butt implants.

Ideally I am looking to accentuate my shape into more of an hour glass with high hip implants. I’m looking for some outward projection at the top of the hip that tapers off into the natural angle of the hip.

With the butt implants I want a fuller bum but based on my actual dimensions because I want to be as proportionate as possible. I know I can enhance my look in the future with fat transfer should I desire any changes.

This is probably the final piece to my transition puzzle.

A: Given your body now and what your ideal buttock and hip augmentation pictures look like this is not an achievable goal in any safe and low complication risk surgery. Your tight tissues are simply not going to tolerate that much tissue expansion. The reality is you would not get even half that amount of hip and buttock change.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, is there any surgery that can fix my case of mild hypertelorism as an adult, or a surgery that can at least make my mild hypertelorism appear less pronounced?”

A: The question is not whether there is any surgery to treat any form of hypertelorism, as there is (orbital box ostoetomies) , but whether such surgery is appropriate for the degree of hypertelorism one has. For a grade 1 hypertelorism orbital box osteotomies in a child or adult represent a ‘solution that is bigegr than the problem’. Surgically that means the tradeoffs for doing the surgery (scars, bony irregularities as well as other risks) may be viewed aesthetically worse than the mild hypertelorism.

More limited orbital box osteotomies have their role in mild to moderate hypotelorism (widening) but they don’t work well for narrowing.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I had very recently a cheek implant done on my face here in Turkey but unfortunately the cheek implant was put wrongly into my cheeks/face and I would like to replace or correct the position of the cheek implant. 

I have the following cheek implant now:

– Brand: Implantech

– Type: Combined Submalar Shell

– Size: Large

My question is, how much would it cost to reposition or replace the cheek implants?  I would like to keep the same cheek implants (Combined Submalar Shell with the size large), the  issue is that the implants are put in wrongly.

A: Do you have a postop 3D CT scan as this is the only way to know where the cheek implants  are positioned and how better to reposition or replace them.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I want to ask about facial implants, specifically cheekbone and jaw implants to widen my face and make it more angular. Do the implants need to be custom? How much do they cost if they are custom and how much if they’re of the shelf? Can asymmetries also be fixed? My recessed chin is a secondary concern of mine, so how much would a chin implant add to the total costs? Can the chin implant be customized to be angular like mine is at the moment and would it be possible for it to not add any vertical length to my chin and my face?

A: In answer to your facial implant questions:

1) when you look at what you are trying to dimensionally achieve the cheekbone and jaw implants would need to he custom made.

2) When bony asymmetries exist the only effective way to improve them is through custom implant designs.

3) When chin is done with jaw angle implants that is known as a custom wraparound jawline implant.

4) In custom implant designs you make them any way you want…whether that is to mimic the shape of your natural bone or change its natural shape.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am a 28-year-old transferal who would like to undergo waist narrowing surgery, hip and buttock augmentation with implants. However, I might have antiphospholipid syndrome (a type of thrombophilia that’s treated with anticoagulants).Whether I actually have this autoimmune disease is yet to be confirmed by a specialist who I am going to see later this month.

I have two questions which are the following:

1. If I have this condition, will I still be able to get these cosmetic procedures with Dr. Eppley? As far as I know, whether or not an individual suffering from this condition can undergo cosmetic procedures is dependent on their risk profile.

As far as I am concerned, I have no history of blood clots, thrombosis or any kind of symptom that’s consistent with antiphospholipid syndrome. What’s also interesting is that my latent antiphospholipid syndrome (provided I am affected by this condition) has had many opportunities to become active and be aggravated by certain life circumstances that I had in the past. (used to be obese)

So I think that even if I have APS, if I get clearance from my hematologist and in light of my medical history, I should be able to have these procedures but of course, I am only a layperson, so I’ll let professionals make the decision.

I look forward to reading your reply.

A:Given your lack of a confirmed antiphospholipid diagnosis and no evidence of any thrombotic events in your history despite numerous challenges it would be fair to that risks of blood clots from these proposed body contouring surgeries may not be any greater than the normal population. But the additional information to be gained by your upcoming evaluation/workup for this condition will provide further insights into these potential surgical risks.

That being said even with a completely negative workup and history such body contouring procedures would be best broken down into two stages as these surgeries would represent the greatest challenge to your body it would have seen yet.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have V line surgery done on S.Korea last year. They really didn’t You can see that my chin and jawline was pushed back and cut off in these pictures, I’m trying to restore my jawline and chin to how it was before only straighter if possible.

So I think the only way to restore my jawline and chin is a custom implant.

My chin was pushed back and now looks recessed so it might be able to be moved forward again I’m not sure how much. 

A:Thank you for your inquiry and sending your pictures. Your story is an all too familiar one as some S Korean surgeons really don’t listen to what the patient wants…they just do what they want. They are great technicians just not very patient centric in their approach to aesthetic surgery.

You are correct in that V line reversal is done with a custom jawline implant (aka wrap around chin-jaws implant) whose design can be based on the before and after 3D CT scans if they are available or a best guess approach to what was removed looking at your before and after pictures with a current 3D CT scan.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I had a mini facelift procedure done under local anesthesia. Looking back on it, I don’t feel that I needed the procedure at all, but the doctor was a double board certified plastic surgeon, so I trusted his judgment.

The procedure left me with bilateral retracted tragi. It’s as if the tragus on my left and right ear are being pulled forward for the whole world to see down my ear canal.  Also my ear lobes are attached to my face at a weird angle.  My tragi and earlobes look weird and strange.  If I barely press on my tragus my ear appears to look normal again.

I saw on your website where you talked about how to correct a retracted tragus and pixie ears. By the looks of my photos, do you think you can help me?

A:These are the unfortunate ear sequelae of having a mini lower facelift where all the tension from the lift has been placed on the ear skin and cartilage. The fix for the earlobes and tragus is to repeat the lift in a more formal fashion where the uplifted tissues are supported by the deeper tissues (SMAS) and not the ear skin.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have had angular cheilitis for over 2 years. I have tied everything, but the small scars in both moth corners won’t heal. I was wondering if there are some surgeries you can perform to solve this problem permanently.

A:Excision of angular cheilitis can be an effective treatment for sure as it gets rid of the chronically infected tissues.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in forehead augmentation. A big determining factor for moving forward is the amount of downtime.

A:Forehead implant augmentation in females has a fairly limited recovery. (as opposed male brow bone-forehead augmentation) Recovery is really more social (appearance due to swelling) than it is anything physical. One can look non-surgical in 7 to 10 days.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m wondering if you have any more before/after images of the skull reduction surgery? My head size has bothered me my whole life, and I’m very interested despite it being a huge cosmetic surgery. My main concern is where the scars usually are and how well they can be hidden afterwards.

.A:The term ‘skull reduction’ is a general term which described a number of procedures. As to what you mean by that is unclear. I would need to know more specifics to provide more qualified answers to your questions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a 37 year old silicone chin implant that has become infected twice. I am planning on having it removed. I have read that some tissue reapproximation should be done to avoid chin ptosis. The surgeon does not think this is necessary. What do you think? Do you do this ? I’m thinking I may have to have some revision after this doc removes it. I do not want another implant, but i don’t want a droopy chin. Thank you.

A: Since I have not examined you and there is no way to know what size chin implant you have or where it is placed on the bone, I would trust what your surgeon says. Even if some chin ptosis results that can always be manged secondarily.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, The shape of my skull at the back is oval. I would like to correct its shape so that it appears normal. Could you please tell me the price?

A:It is not clear to me whether you need is a skull reduction or a skull augmentation to the back of your head to have a more normal shape. I would guess based on that it is oval that it has too much projection and needs to be reduced…but I am not going to guess. I would need pictures that show your head shape concerns to provide a more informed answer.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I continue my boxing profession with my jaw implant?

A:Lots of patients ask about doing boxing and martial arts after jaw implant surgery and my usual response is yes since it is a really a hobby and I am not concerned about the limited trauma since training is very different than competing. I don’t know how that may apply to someone who does it as a profession. I suspect the answer would be the same…but then I have never had a professional boxer have the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’d like to flatten the temporal convexity and width of the side of my head. I don’t know if Botox would be enough or if the muscle would need to be removed too?

A:It would be fair to say that muscle removal is twice as effective as Botox at reducing the muscle mass on the side of the head. The more pertinent question is whether your temporal muscle is thick enough as a thin Caucasian female that any effort at muscle reduction would make much difference.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been planning and budgeting for an aesthetic surgical procedure to address a flat spot on the occipital region (back of the head) for some time and am now ready to proceed.I am based in Canada and prefer to have the procedure here. However, I am also considering clinics in the United States if necessary.I would appreciate any information or recommendations regarding this type of surgery.

A:The definitive procedure for any type of skull augmentation is a custom implant made from the patient’s 3D CT scan. Whether anyone does this procedure in Canada I would not know.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in the cosmetic rib osteotomy procedure and comparing it to removal. I am a transgender female.

A: I have written an entire blog on the differences between these two structural waistline reduction surgeries…

https://exploreplasticsurgery.com/waistline-narrow…e-they-different/

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m wondering if you have any more before/after images of the skull reduction surgery? My head size has bothered me my whole life, and I’m very interested despite it being a huge cosmetic surgery. My main concern is where the scars usually are and how well they can be hidden afterwards

.A:The term ‘skull reduction’ is a general term which described a number of procedures. As to what you mean by that is unclear. I would need to know more specifics to provide more qualified answers to your questions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m just wondering if u guys do revision surgery on skull reshaping?

A:The question is not whether secondary skull reshaping surgery can be done but what exactly do you need. I would need specifics as to when and what type of procedure was done as well as your current concerns with any pictuers that so illustrate.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been discussing modified aesthetic OBO and I only believe I need about 3mm of IPD increase which is well within the capabilities of your method. I had narrow eyes before skeletal expansion (MARPE) and although it did actually increase my IPD slightly, it widened my cheekbones proportionately. I think a few mm of IPD widening would not only fix my eye spacing itself, but also make my nose look more proportionate, and my face less long. Combined with some implants around the eyes to support them better, I think it would be well worth going through with the procedure, so I hope you don’t consider my eye spacing to be too borderline to be worth such a surgery. After all this I will get double jaw surgery and be done with all my surgeries.

I hope to hear back from you about what can be done about my case.

A: I would certainly agree that for 2 to 3mms of IPD increase any OBO procedure that involved a frontal craniotomy or a bicoronal incision would be a good example of a ‘solution thaf is bigger than the problem.’ Inferior subtotal orbital rim movement done through a combined lower eyelid and intraoral approaches works fine for a few mms of IPD expansion. (not as effective for IPD decrease) How that would/should work with any periorbital implants/augmentation is yet unclear. The first place to start is getting a 3D CT scan for orbital anatomy and treatment planning.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I believe I have plagiocephaly, I want to know how bad it is. All I know is I have a bulging forhead from one side. Also, my teeth are curved, chin, lips, nose etc. Also the side that they are curved to has the side of my head and ear is sticking out. I also feel like my face is bulging too from the side my forhead is bulging. Someone told me I have body dismorphia but I’m not sure. Am I exaggerating or what do you think. Also if I get braces with aligners how much better would this get?

A: How bad any aesthetic problem is depends on the patient’s interpretation of it. I think what you really mean to ask is how improvable is it by surgery. Braces is not going to change anything other than that of the teeth component of it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Is the intraoral cinch suture still effective if i get it 1-2 years post op? This gave me so much clarity on the issue and I feel like I can now move on and try to get the help I need to get it fixed. 

A:The intraoral cinch suture is more effective when done during the original procedure where all of the midface soft tissues have been elevated. It is more of a preventative nostril narrowing maneuver rather than as a therapeutic nostril narrowing procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Do you guys do tracheal augmentation?

A:Tracheal augmentation is done using a firm polyethylene material that has a notched V shape and is placed through a small overlying skin incision. It is placed right below the cervicomental angle over the underyling trachea. To enhance its appearance (show) submental liposuction above it is usually helpful.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have heard that this procedure rolls your shoulders forward slightly. This causes me uncertainty since i don’t want my side profile to look weird obviously but most people who seem to raise this point are people who haven’t done the surgery and most people who have done the surgery say that it is not significant. At the same time I cant seem to find very many pictures taken before and after from the side. I guess I would like to know, just how much does the shoulders slouch forward. Is there a significant risk of it being very noticeable or do most people walk away with shoulders that look narrower.

A: There is some slight anterior rotation of the shoulder but this is really only evident in the first month after the surgery where the position of the shoulders is held that way for comfort/protection. But once fully recovered there is no significant rolling in of the shoulders.

Dr. Barry Eppley

World Renowned Plastic Surgeon