Your Questions
Your Questions
Q: Dr. Eppley, I am interested in forehead advancement as well as shaping. I have a high hairline and vertical central bossing of the forehead. I believe my hairline would need at least 3 cm of advancement so likely would need tissue expansion. Can you provide me with a general idea of timing for an appt and treatment initation and generally how long does it take and number of visits needed for scalp tissue expansion. Thank you
A: In answer to your questions about a two stage hairline advancement procedure:
1) All scalp expander injections are done by the patient at home.
2) The time interval between the placement of a the tissue expander and the hairline advancement is 6 to 8 weeks.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley. I feel like my entire skull is too wide, I know the area above the ear can be narrowed but I was wondering if skull reshaping can be done in such a way that the distance between the 2 ears are reduced.
A: While head narrowing surgery typically refers to decreasing the width of the head above the ears I believe you are referring to the ear themselves which is defined by the location of the eternal auditory canals. Such a reduction is not possible.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I’m a 22 year old female with a narrow face that not proportional with face length typically 12.5 cm face width i want a wider face about 14.5 cm width is it possible to widen each side of my face by 10mm through combination of zygomatic arch and jaw implant temple implant if needed i want to now about the possibility before coming to US.
A: The question is not whether such amounts of facial widening can be done at the temporal, arch and jawline area but whether that amount (10mms) is what is actually needed. Patients typically over estimate their dimensional needs numerically. I would need to see a front view picture for imaging to look at what type of changes are actually needed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Wanted to get some info about testicle implants. I currently have silicone in my sack and would like to get it removed but replaced with silicone testicles. Is that possible?
A: If one has had silicone injections in their scrotum the silicone masses/granulomas first need to be removed before testicle implants can be placed. When done concurrently the risk of complications is significant and thus I don’t recommend it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had Custom Jawline & Custom Bilateral Cheek Implants four years ago. I am considering a lower blepharoplasty (for dark circles and slight bags under my left eye) in Seoul (I’m living in Asia now) and just wondering if there are any limitations or considerations I should be aware of when undergoing the lower blepharoplasty.
A: Your cheek implants involve implant material on the infraorbital rims. This does not preclude doing a lower blepharoplasty but your surgeon should know it is there. The implant material should be treated just like it is bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, This is something I’ve wanted to do for a while, and I would love to know all the information behind the surgery! Here are photos of my goals and what i want to achieve with this surgery. i would love to know his thoughtsall the non-photoshopped photos are on the left side!
I also attached some photos of what I mean. These girls have deep eyes and a tall brow bone!
A: Your imaged pictures, description and examples show a modest brow bone augmentation consistent for a female. Such brow bone augmentations are usually in the 3mm range and cross the brow bones like a ribbon as seen in the attached implant models. (which happen to be for a female Asian brow bone and midface augmentation implants)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Im 37 and I have lop ears that are small and curled. I’m not in your area. I was wondering if you can help me find someone in my area? I found otoplasty doctors but they always say they can’t do my ears. I had one consultation and they said they couldn’t guarantee it doesn’t go back to the way it was? Idk I’m kinda lost. Thanks.
A: I would not be able to identify any surgeon in your area who may be suitable to perform your type of otoplasty surgery. But I could tell if your ears are really correctable without significant relapse. I would need some ear pictures to do so.
Dr. Barry Eppley robbers their daughters
World-Renowned Plastic Surgeon pleasure
Q: Dr. Eppley, I am interested in a custom back of the head skull implant. How many days take to recover or how many days should i stay in USA. How many weeks time does it take to make the implant? It is Is my dream to realize that this type of surgery can be done.
A: The recovery from a skull implant is a lot quicker than most people think particularly on the back of thhe head. The postoperative swelling which is on the back and sides of the head will largely be gone in 7 to 10 days after the surgery. You should be able to return home in 2 to 3 days after the surgery. Getting the implant ready for surgery once we have received your 3D CT scan takes between 2 to 3 months.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am 58 and have been on TRT replacement for about a decade. I workout 5=6 days a week, very muscular in shape health nut of a guy. I was inquiring about testicular implants. (I asked my urologist about fat injection and he said the results are very mixed.) I’ve read your article about side by side and wrap around. I live in Montana. Is it patient choice regarding wrap around or side by side?…what governs that decision. What is the overall down time?…and overall cost. thank you.
A: While both testicular enhancement options are available, there are not equal in terms of their risks. Any time you wrap an implant around an oblong/spherical form there is always the risk of secondary disengagement… a risk that persists lifelong. As a result I would encourage the side by side technique where no such risks exist. The success of the side by side technique, as defined by reliably hiding the appearance of the natural testicles, depends on the size discrepancy of the natural testicles vs that of the implants.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I hope this email finds you well, I am hoping to book in for a online consultation with Dr Eppley as I am not in the states so would not be able to visit the office, the procedure I am interested in is the vertical backlift & rib removal, I have a lot of questions and would love to know some more information about the procedure/recovery as a whole as well as knowing if I am a good candidate, I do have loose skin on my back certainly enough to pinch, but I am not a large person by any means so it is not heaps.
Please find images attached to this email in regard to the possible vertical back lift and rib removal, As you can see I am of petite build and healthy weight so no excess fat but just some excess skin as shown clearly in two of the photos.
A: Thank you for sending all of your pictures. What qualifies someone for a vertical backlift is some degree of skin laxity in which its vertical removal down the center of the back provides visiblle waistline improvement. Usually there is a history of weight loss or pregnancy which would account for the skin laxity. Your picture shows some vertical skin laxity which indicates there is enough for removal. Through the vertical skin excision ribs #11 and #12 and some LD muscle could be removed to further the waistline reduction.
In performing the vertical backlift in your case it is important to not carry the iexision lower than the purple line marked in the attached picture as well as not much further superiorly than the braline
Dr. Barry Eppley
World-Renowned Plastic Surgeon.
Q: Dr. Eppley, Hi there, I wanted to enquire about whether I would be a good candidate for forehead reduction surgery and brow lift. I have a protruding forehead which is quite angular (almost like two horns on either side). I would ideally like this shaved down and then for my hair line to be brought down to allow for better facial symmetry. I’m starting to notice some drooping in my eyelids so a slight lift to my eyebrows may get rid of some of the eyelid folds that’s starting to form with age. Please could you give me some more Information as to what the procedure may entail.Many thanks for your time.
A: Let’s start out with some forehead pictures (front and side views) for my assessment andnimaging to see what changes are possible. But the combination of bony forehead reduction, frontal hairline advancement and a browlift is commonly done.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, . I have an overcorrected right ear from previous surgery. I would like to know if it would be possible to correct using a rib cartilage graft. It’s the mid portion of the ear. And also if possible to create a fold at the top similar to my left ear. I am more than happy to travel to America for the surgery as I am based in Paris France. Thanks
A: In the over corrected ear it is uaually the middle portion which is pulled back too far which can also have an upper third of the ear that lacks a good fold…exactly as you have described. And both ear shape concerns can be corrected simultaneously using a cadaveric cartilage graft for the over corrected middle ear snd suture plication for the under corrected upper ear..
That being said let me see some pictures of your ear to see how these concepts apply.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, How much is forehead augmentation with PMMA bone cement?
A: As a general rule the use of PMMA bone cement is an almost historic method of forehead augmentation due to issues with getting a smooth shape to the forehead,and the need for a bicoronal scalp incision needed top adequately place. As a result the use of PMMA in the forehead has largely been replaced with custom implant designs. There may still be a role for PMMA in forehead augmentation in very select cases where the augmentation is limited.
I would have to see pictures of your forehead and what your goals are to see what is the appropriate type of forehead augmentation material.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I had a chin implant removal and a sliding genioplasty performed in its place. It has been almost 8months and I continue to feel a lot of tightness/ stiffness under around the lower lip.
If I place a finger on a pinpoint location under the lower lip and hold it there it relieves the discomfort and I can move my mouth freely. But when I remove the finger it feels constantly stiff and tight as if a very tight elastic band is clasping into my skin.
During my research I saw that Dr Eppley has a lot of experience with this. What does the doctor recommend for me
A: Intraoral plate removal with dermal-fat graft is the usual treatment for lower lip tightness/sensitivity after a sliding genioplasty.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, What is the youngest age you would do a clavicle shortening on, with parental consent? And why specifically would it be more ridky for adolescents?
A: I only do this procedure on patients 18 years or older. The long term effect of clavicle shortening on growing bones is not known.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, is there are any possibility of augmenting the side of the head? I want to augment thia area…is it possible…and whic type of material use for this augmentation..it is silicone implant or PMMA? If i use silicone implant is there any possibility of infection?If silicone implants are used, is the temporal muscle shaved and placed under it or is there no need to shave the muscle, just cut the top layer of skin and place it between the muscle and the skin?
A:In answer to your head widening implant questions:
1) I believe you are referring to the attached upper head widening image effect.
2) This is an augmentation that covers bone in its superior half and muscle in its inferior half. PMMA, besides being a highly inferior skull augmentation material can never be used to augment muscle. Only a custom silicone implant design will work for this type of skull augmentation. Any form of implant surgery carries the risk of infection, the material used does not change that risk.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Do I need temple implants or skull implants? You told me temple implants were not custom, but are there different sizes? If so, which would these be?
A:I have initially imaged a side of the head submuscular augmentation that did NOT extend and blend into the side of the forehead as the first method to see what you think.
These are what you refer to as skull implants even though they are technically temporal implants. There are five different types of temporal implant styles but only one uses standard implants (which only augment the temporal hollows beside the eye between the hairline and the lateral orbital wall…which seems a bit inadequate for you)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hey Im a 36 yr old male. I had a testicular prosthesis put in when i was 17. At the time the Colopast was the only available brand. As now being older I was wondering is there a softer brand available.
A: Ultrasoft solid testicle implants that I used are much softer than the harder saline-filled implants that have been used in the past and are still used by many surgeons still today. They also fix the implant in place with suture which adds to an unnatural feeling.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have been wanting to get a chin implant for some time. It was just recommended that I need to get my wisdom teeth out and I was hoping to possibly do both procedures at once! I was researching to try and find a surgeon who could do both at the same time and found Dr. Eppley. I would love to learn more and see if this is a possibility! Thanks in advance!
A:I would need to see a panorex x-ray first to determine the current state of the 3rd molars. If they are difficult impactions and require a lot of bone removal I wouldn’t do it as a combined procedure
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello. My question is how patients who are not from America and wanted skull implants have the operation. Do they make CT-scans in our countrys and than send to dr.Eppley, and than when is done they come to operation. And second how long does it take for imlants to be made ? Thanks for answers.
AL We have many custom implant patients that come from all over the world. They routinely get their 3-D CT scans in their own geographic area and then send the scan to me. Once I have the scan then I begin the implant design process which takes, on average, about 2 to 3 months to go through the design, fabrication, and implant delivery to my surgical center for their scheduled surgery date.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I consider to myself if I should get a double jaw surgery lefort one for my maxilia because the nose is way forward compared to the mouth.
A: Your side view picture shows no evidence of a need for double jaw advancement surgery. You would be better served by a reduction rhinoplasty, infraorbital augmentation and possible chin augmentation as well. Your maxillomandibular complex has adequate projection and is not the solution to your facial imbalance problem.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I would like to remove silicone from my lips with an upper lip lift.
A: Silicone can never be fully removed from the lips and it always results in a lot of scarring and lip irregularities and animation distortions in trying to do so.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Could be mouth widening/other lip adjustments and rhinoplasty be done with a drill hole canthoplasty?
A:Yes, all three could be done at the same time.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have some mobility in one of my teeth. Will jaw and chin augmentation surgery affect that tooth? So, I am wondering if I should come after I get that fixed.
A: Chin/jaw augmentation will not affect the teeth in any adverse way. But it is always prudent to resolve any necessary dental issues before undergoing elective aesthetic surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in options for reducing a male mons pubis. Compared to past sexual partners, I have always felt like my mons pubis is excessively fat, and seems to be an inch in depth. Is a male mons pubis reduction possible?
A:Prominent mons pubis are typically due to excessive fibrofatty tissue in the mound which is treated by liposuction. How that may apply to you requires a picture assessment. (front and side views)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in a rhinoplasty. I don’t need the bridge augmented i just need the nostrils narrowed and commisuroplasty with it would be great. I have a short in width mouth.
A:You are requesting the combination of nostril narrowing (not a true rhinoplasty in the traditional sense) and mouth widening. These two procedures by their proximity and diametric effects are synergistic…meaning deceased nostril width makes the mouth look wider and a wider mouth makes the nostrils look less wide. (see attached image) In his regard they are a perfect combination and can be performed under IV sedation anesthesia. Each procedure has very minimal swelling and recovery other than the healing of the incisions to maturity which takes several months.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am just emailing to ask a few things about a cheek implant surgery that I am thinking of getting with you sometime this year.If I have filler in my lateral cheeks at the time of surgery, is it possible for you to remove it and place the cheek implant in during the same surgery or will I have to get two separate surgeries? I’m using Radiesse so I’m unable to dissolve it.
A: Radiesse filler in the cheeks you do not try to surgically remove as that will cause unnecessary soft tissue damage and there is no really effective way to removing it anyway. I am not usually concerned about the presence of filler in the cheeks as the trauma and swelling of the surgery will expedite its reabsorption and the subperiosteal dissection is below the location of the filler in the overlying soft tissues. The only time filler in the cheeks is a potential issue is if the filler volume placed is very large and distorts the cheeks so proper implant selection is more predictable. But for most patients thew volume of the filler in the cheeks is 1cc or less per side and thus is not an issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am interested in an occipital reduction. Could you please provide more details about the procedure, including the recovery time and any associated risks? I have attached my pictures.
A:This is a classic occipital bun protrusion which can safely be reduced in the amount shown in the attached picture. It does require a 2D CT scan prior to surgery to confirm that the thickness of the bone is adequate to do so. Such skull reshaping surgery has a fairly quick recovery, is medically safe and the small tradeoff is a fine line scar over the central nuchal ridge through which the procedure is performed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Can I get better cheek and neck definition?
A:One of the major limiting factors in achieving cheek definition is the thickness of a patient’s skin and underlying soft tissues…which in your face as you know has very thick skin. While I am certain the buccal lipectomy has provided some benefit it is not a complete cheek defatting procedure. But the question is not whether perioral liposuction and buccinator myectomy would provide further benefit it is given with thicker soft tissues how much further improvement will occur.
Conversely the submentoplasty is a bit different in that it has never been treated and would definitely provide further cervicomental profile improvements to the previous sliding genioplasty result.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Is it possible to reduce the forehead prominence and advance the hairline at the same time? Does the age factor affect the procedure?
A:It is common to do both at the same for a combined bony and soft tissue forehead excesses. Age has no factor in the success of the procedure. Rather the thickness of the frontal hone and the laxity/elasticity of the scalp are the determinants of a successful outcome
Dr. Barry Eppley
World-Renowned Plastic Surgeon
