Your Questions

Q: Dr. Eppley, I am inquiring about testicular implants. I take TRT as I am 61 years old and have also had penile enlargement surgery. My testicles now feel small as a result – smaller than before – and this bothers me badly. I am looking to increase their size through implants to the maximum level of safety and practicality. 7.5cm or larger if possible, using the most natural material (gummy bear) and as attached to the existing testicles rather than displacing them (although I will take your advice on which way is best to proceed safely and achieve my objectives).

A: With small testicles due to hormone supplementation and aging you definitely do NOT want the wrap around testicle implant enhancement method. Small testicles have a high incidence  of slipping out of the implants after surgery…. a problem that has not yet been satisfactorily solved as of yet. The displacement method does not have this problem and is very effective as long as the implant size is at least 70% of the natural testicle size. Usually this means at least 6.0 to 6.5cm size. I would be cautions about a size of 7.5cm, as when placed on each side, the volume they create may pose problems for incisional closure in some patients. It would have to be seen whether you have a scrotum that is capable of safely handling that implant size.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, I am 44 year old female. I don’t like how my face asymmetry is noticeable. I want to aquire more symmetrical features on my face, eyebrow, eyes, cheeks. I want to look normal. Can you help me?

A: Like all facial asymmetries the first step is to determine the most important facial features to try and improve that would make the biggest difference. In your case that appears to be the right eye area as you have an obvious vertical orbital dystopia. (VOD) This involves the eyebrow, eye and cheek area. The second step is to get a 3D CT scan so the differences between the two orbital boxes can be determined from which a custom orbital floor-rim-cheek implant can be designed. While the implant is not the only component of the correction (browlift and eyelid changes are also needed) it is the foundation of VOD corrective surgery.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Is there anywhere to see more before and after pictures of angles of the patients with the jaw implants and which type were used besides the website?

A: How do other patient’s results help you understand what you may need when every patient’s jaw shape, soft tissue thicknesses and aesthetic goals are different? That is a very misleading way to try and make that assessment. It has to be determined on an individual basis using computer imaging.

Dr. Barry Eppley

World Renowned Plastic Surgeon

Q: Dr. Eppley, Are malar implants only done with synthetic material? Can you use an autologous graft like cartilage as I am prone to inflammation.

A:While one can use autologous and allogenic tissues for cheek augmentation the amount and size of the graft material that is available (by harvest ot tissue bank acquistion) limits their potential effectiveness. In otherbwords for very small amounts of cheek augmentation they make be effective. In some patents cheekbone osteotomies can be used if the cheek augmentation goal is one dimensional. (cheek widening)

In essence implants allow any type of dimensional cheek augmentation change and the control of the result is preoperative selection. Conversely grafts and osteotomies have more limited effects their harvest size will control the cheek augmentation effect.

These are general statements about cheek augmentation materials. How all this applies to youis  knowing what your cheek augmentation goals are compared to what your cheeks look like now.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had genioplasty + bone graft for chin advancement and lengthening and jawbone osteotomy done in Korea about 11 months ago.I saw some improvements but there were a couple of unsatisfactory results:

In terms of the chin:

1. there is a bony gap now in the chin from the genioplasty

2. there is some asymmetry of the result

3. there wasn’t as big of a difference as I hoped so the chin is still recessed, and length is still not as proportionate

Jawline:

4. gonial angle is not as visible now and jawline is less prominent

I am not looking for dramatic results but was considering getting custom chin and jaw implants to address these issues to improve the results but am also open to any other options recommended that are available since I don’t need dramatic results just a good solution that will work long term to reach my aesthetic goals of:

1. more chin projection (maybe just 4mm) and addressing asymmetry (priority). This is also to make the mouth protrusion look less noticeable but would be open to jaw surgery if it is a better fit. However, After consulting multiple spots I have been told my case is not severe enough for jaw surgery and I should consider just implant, or genioplasty + orthodontics.

2. clearer jawline and angle (not as priority depending on costs)

Let me know your thoughts and what you think the available and best options are.

A:You have had prior V line surgery with the tradeoffs of too much jaw angle bone removed, bony gaps/irregularities in the chin osteotomy and desire for some additional horizontal chin projection. To make these improvements now these can not be adequately improved by further bone surgery. This would require a custom wrap around jawline implant to make all the needed improvements. In other words overlay the bone to get the increased chin projection, a more evident jawline and to smooth out the inferior border.

Such secondary V line surgeries are common in my practice. The custom design approach allows control of all desired changes preoperatively because of the 3D design process.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I believe I had plagiocephaly as a kid on one side of my head is a little pushed in which pushes half of my entire face forward. Teeth slanted, Jaw asymmetry, chin asymmetry, one eye bulging, uneven ears, one side of head sticking out kore, nose asymmetry. How bad do u think it is. Is it just me or it’s bad? Give me on a scale of 1-10. 10 being the worst asymmetry and 1 being basically symmetrical. Thank You

A:I have no opinion on rating the severity of your plagiocephaly. What matters is how you feel about it and whether it is significant enough that you want to do something about it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a sliding genioplasty about 4 months ago, and have become increasingly certain that I have lower lip contraction, as I have to use force to push my lips together and there is a lot of tightness in my lower lip area. It has also become significantly smaller than it was prior to the surgery, which has really affected my smile as well. I was wondering about the VY mucosal advancement procedure that you wrote an article about – do you currently perform such surgeries, and if so how much would you estimate the cost to be? Thank you in advance.

A: A vestibular release and dermal-fat grafting is what is needed for lower lip tightness after a sliding genioplasty not a V-YT advancement which is an ancillary procedure. not a primary one for that problem.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m interested in getting testicular implants. My main reason is I am not currently happy with size of my natural testicles and if I’m to be honest I have yet to see an implant size that I am happy with. That is why I come here, in theory what is the largest implant you could possibly do? I am looking for something truly large a lot larger than extra large implants that I have seen.

A:The custom testicle implants that I have done range from 6.0 to 8.5cms in size. The question in large testicular enhancements is no what can be made but what size your scrotum can accommodate. It is not a design issue but a  tissue tolerance issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, can you remove Bellafill from the cheeks? I had Bellafill injected and the injector put it in the cheeks which I didn’t ask for. I wanted tear troughs only. They look really off, it was put in my medial and lateral cheek. One doctor said it can’t be removed from these areas, but I refuse to believe nobody can help.

A:There is no effective method to remove the PMMA micropheres in an area like the cheeks. Excision is the only method for acrylic particle removal and that is certainly not going to be done in the cheek area without considerable external scarring.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve seen your pelvic plasty and shoulder width reduction results and think they’re quite impressive, but I’m trying to achieve the inverse as I am female to male transgender, primarily a narrowing of the hips. I’m aware that the logistics of reconstructing the pelvis would differ significantly from simply adding an implant onto the existing structure and quite aware of the consequences it could have on my mobility, but I’m curious as to whether any professionals would be willing to perform such a procedure on a patient for cosmetic reasons. 

A: You are referring to iliac crest reduction for the hip width which does not cause any long term mobility issues in my experience. It is generally limited to 1 cm per side at the maximal crest width.

For the shoulder there are clavicle lengthening or deltoid implant procedures to make the shoulders wider. Each has their advantages and disadvantages.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, are there skull reshaping cases where a blood transfusion is necessary? I believe that transfusion of other people’s blood is inherently dangerous. (I am no problem with autologous blood donation.)

A:There is no significant blood loss in any aesthetic skull reshaping procedure. A blood transfusion would never be needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am getting a hair transplant in Turkey next year and was wondering how long after it would be safe to get a forehead implant without damaging the hair follicles.

A: I would wait 6 months after the hair transplants so the newly transplanted hair is fully growing and healthy.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Last year I had mandible contouring that was especially aggressive on the right side due to bony overgrowth. Since then I’ve been hoping my lower lip asymmetry would resolve but has not. I feel the muscle pulling my lip to the right and down. My right lower lip kinda feels swollen. If I lay on my right side I drool a little bit at times. Luckily I don’t have functional problems eating, drinking. I want to try Botox and lip filler for cosmetic improvement but I want to know if there’s a permanent solution? Would a neurologist be able to fix this?

A:What you are describing is classic weakness/paralysis of the marginal mandibular branch of the facial nerve. If you are more than a year out from the surgery no further improvement in motor function can be expected. There is no method to restore motor function to that nerve branch. Botox may help weaken the good side for improved lip symmetry to the paralyzed side. Fillers can temporarily add volume to the smaller vermilion or a permanent lip volume restoration can be done with a vermilion advancement. I would always start by trying temporary measures (Botox and fillers) first.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I  have a small mouth like to get it widened if possible please send me some info about the procedure and the cost of it.I also would like to have a lower face lift.

A:Thank you for your inquiry and sending your pictures. With a small and downturned mouth with sagging facial tissues I don’t think you can get mouth shape improvement without addressing the sagging facial tissues as they overhand and pull the mouth corners down. Thus any efforts at mouth widening/lift is linked to the lower facelift.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in the collarbone lengthening surgery. A few years ago, I had a fall and broke my collarbone. The fracture shortened my collarbone by an inch and since then, my back, shoulder, and arm hurt.

A: Untreated clavicle fractures are well known to shorten as they heal. Clavicle lengthening would certainly be the logical approach to treating the problem. While clavicle lengthening surgery for aesthetic purposes is limited due to the soft tissues of tiger shoulder girdle, in reversing shortening from fractures the shoulder tissues are used to the length that it originally was. Thus, in theory it should be successful. I would need to see x-rays of both shoulders and presumably the osteotomy site would be at the fractured area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello, I wanted to ask a few questions before I schedule a virtual appointment. I’m interested in wraparound testicle implants, but I’m from Poland and if those are custom, I guess I would have to come to the clinic to measure everything or is there another way to do this ? Next thing is, I would have to do blood tests of course, could I do them in Poland and send them to you via email or should it be done right before procedure and here is my next question, if some of the results came back not so good would this disqualify my from the procedure ?

A:I shy away from using wraparound implants in testicular enhancements due to the risks of postoperative separation. I prefer the side by side technique where that risk does not exist. Those seizes are based on an estimate of your natural testcile size which can learned from measurements or an ultrasound.

Whether blood tests are required before surgery depends on your age and your health…none of which I currently know.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, As you can see, my son’s face is not symmetrical. I think the most serious part is his slanted jaw which appears to contribute to differing eye level. Other than that, one side of his cheek seems to be slightly larger than the other. Many doctors I’ve consulted have suggested that this might be due to an injury from a fall during his childhood. However, to the best of my knowledge, he has never experienced such an incident. I would greatly appreciate your insights into the possible causes of this condition and most importantly, your recommendations on surgeries or treatments to consider. Thank you

A:This is a congenital severe facial asymmetry whose in utero cause will never be known exactly. The entire left side of his face is smaller than that of the right…making every left facial feature at a different horizontal level than the opposite side. I would agree that the jaw asymmetry is the most affected and also the faciakl area that can get the greatest improvement. He is in need of double jaw (orthognathic surgery) which is a common procedure that can be successfully performed in  most countries and at least in the regional area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Also my hair is not covering the scar where the forehead was inserted. It’s 2.5 month now since the surgery. Is this expected? Shall I wait longer or do I start considering hair transplant? I think I can see some hair growing but I don’t understand why the gap. I can temporarily hide it with Toppik. What are the other patients’ experiences on this?

A: While some shock hair loss is not common around scalp incisions it can occur. Some to complete regrowth is to be expected. Treatment should include topical minoxidil until 6 months after surgery. Hair transplants would not be considered until maximal regrowth is seen.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a medpor chin implant done about 15 years ago and have felt it’s too masculine (wide) and would love to have it altered (not removed) – customized to fit my face better. I’ve seen several local plastic surgeons but none have experience with Medpor implants let alone modifying one.

A: It is not effective to attempt Medpor implant revisions with the implant in place…that will not work. You have to remove it. And in removing it it will only come out in pieces. So you might as well get a new implant that is better aesthetically suited for your needs.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am the not-so-proud owner of some XXY testicles and one very large empty sac. I swear, I am the typical 70s Ken doll with a nub. While the testicles work modestly, I’ll never want to parade around in a speedo. I’m wondering if you have done the envelope testicles for an XXY patient.

A: The wrap around or envelope testicle implant have their issues with the risk of eventual separation. Thus I prefer the side by side technique which overwhelms the naturally small testicles and never has a separation issue. The key is a large enough custom testicle implant, usually 6.0cm or greater.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I also need the dr opinion on this if he can answer me back : So I want to achieve smaller and more masculine eyes to get to more hunter eyes look. A surgeon in the US proposed lower lid retraction with alloderm graft with canthopexy but I have been reading a lot about the procedure and seems its better to have supra and infra implants with a skull specialist like your self to achieve more natural hunter eyes look and without the need canthoplasty. What do you think kind sir ?

A: Hunter eyes are hard to achieve and it often takes a combined hard and soft tissue approach. If one has good periorbital bony projection then soft tissue procedures alone would be adequate. (alloderm graft with canthopexy) But of the brow bones and infraorbnital rims are less projection or flat then periorbital bone augmentation would be needed as well. Each patient’s needs must be determined individually.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am having paying following a revision chin implant surgery I had 5 months ago. I have a small silicone implant with wings. I believe the chin implant is slightly skewed to the right after rolling over onto my side in my sleep a week after surgery. The implant is visually just slightly crooked, almost not noticeable. I would say aesthetically, it looks alright, just slightly crooked and good projection from the side.

However, I am having an increasing amount of nerve pain at the lower right side of my chin, where the “point” of the implant is skewed to. I have a small implant, though I am not sure what mm it is. This pain has been sharp and increasing in the amount of times I feel it as time goes on. It started about a month or so after surgery, when swelling started to go down.

Before this, I had a small silicone implant with no wings placed 6.5 years ago, and it became dislodged to high after a fall a few weeks after surgery. The implant was uncomfortable and noticeable too high, which I eventually wanted to get replaced. Though, now my replacement is causing a new kind of uncomfortable pain.

I would like to either have the chin implant revised again, or completely be removed and be done with this once and for all. I am worried about chin ptosis upon removal, so I wanted to talk through my options with an experienced surgeon like yourself. I have provided photos of my revised chin causing nerve pain with a little drawing showing where the nerve pain is happening.

A: Your nerve pain indicates, with an extended anatomic chin implant, that its wing is impinging on the mental nerve. This can be proven by a 3D CT scan. The longer you leave the nerve impinged the less likely it will recover once the compression is removed.

The logical approach is to take the chin implant you have, remove its wings, and center it with screw fixation.

Chin implants don’t move or migrate when they screwed down.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to get your thoughts on the process of perhaps moving the alar and columella base on the nose up about 2 mms or so. I’m not sure how close the actual nasal cavity is above the base of the nose, but with a lip lift to hopefully forgive some of the scarring from moving the nose upwards, is this theoretically possible?

The image I’ve attached is the normal nose length on the left, on the right is my nose edited a bit shorter.

Thank you for your time.

A: Nostril/columellar lowering works because it is done by skin removal giving the nasal base a place to go. Conversely nostril/columellar elevation would require filling in the space created by the elevation with a skin graft. Besides leaving a prominent scar from the graft the relapse/contracture rate from skin grafting is high and thus the procedure would be ineffective. In essence going down can work but going up won’t.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’m a 30 year old trans woman that underwent facial feminization surgery earlier this year. The surgery was a success, and I look beautiful and certainly got what I asked for. However, I’ve since realized that I wasn’t quite specific in my instructions with my surgeon about the level of reduction I was seeking in my orbits vs the sinus bone/center of the forehead. While I wanted a flat/round center of the forehead, I’ve now come to recognize that I would still like some slight orbit definition (but certainly reduced from where I once was). However, in surgery they were totally smoothed out.

Is there a way to restore some minor definition to the orbital bones with a custom implant or bone paste?

A: It is not rare to see a brow bone reduction patient vis bone flap setback technique to end up being flatter than they desire. A custom brow bone implant design can be made to do any amount of partial brow bone restoration.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I only have one question I would like to know the answer to. 5 years ago I had a Su-Por cheek implant made of pure high-density polyethylene (HDPE).

I would like to undergo the Zaffiro laser treatment. This is facial thermolifting. The skin heats up to a maximum of 70 degrees Celsius.

Can this damage the implant? Unfortunately, neither a cosmetologist nor a doctor is able to answer this question.

A: This is basic material science. This can be determined by knowing the melting temperature of porous polyethylene. For high-density polyethylene the melting point is typically in the range 120 to 130 °C (248 to 266 °F). The melting point for lower density polyethylene is lower, typically in the 105 to 115 °C (221 to 239 °F) range. Medial grade facial implants are made of high-density polyethylene.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have a pretty severe asymmetric lower jaw. Much more bone on one side than the other. I’m wondering if I am a candidate for an implant that would improve appearance.

A: You would be assuming that the bigger side of the jaw is the preferred side. A 3D CT scan will provide the definitive view of how different the two sides are as well as the platform for building an implant for asymmetry improvement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi I have tightness 5months after sliding genioplasty (8mm) and chin implant removal (10mm) my surgeon is suggesting steroid injections. Is this safe? Does Dr eppley do this and is it good idea to try?

A: The issue with steroid injections is not about safety but effectiveness….particularly 5 months after the surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve noticed asymmetry in my eyes. My left eye and eyebrow sits lower than my right eye. I’ve only noticed this recently because I don’t take a lot pictures ansmd when I do I only take selfies with my head tilted. I’m interested in surgery to correct this and was wondering if I’m candidate for this procedure. I’m interested in visiting your office eventually for a ct scan but since I will be coming out of state, I would like to know more about it before I make the trip. I’m 26 years old by the way. I’ve looked at the before and afters on your website and I hope my results will be like that as well. I was also wondering the long term effects of the implant and the frequency of revisions after this procedure. Thank you and I look forward hearing from you

A: The definitive test for potential vertical orbital dystopia (VOD) surgery is a 3D CT scan. How low is the entire orbital box on the affected side. (needs to be 5mm or less to be successful in my experience with non-orbital box procedures) Yours is close to that limit. (see attached)

The 3D orbital CT scan is one where you get where you live and we place the order for it to be done. Then you send the scan to me. You do not need to come here for the scan.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi there, I’m a 30yo male and am curious about a brow bone reduction. I am bald so I have been hesitant as I thought the scalp scar would be too visible after the procedure. I’m curious if this is not a concern or if there are other options available? Thank you

A: In the bald male one does have to be very thoughtful about the scar tradeoff and a scalp incision would never be used for brow bone reduction. The incision would be much smaller and lower either in a central horizontal wrinkle or even at the top of the eyebrows. (one on each side)

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have 2 bony bumps on the forehead from birth one and bigger than the other in fact it is the upper part of the skull which is asymmetrical 

and I would like to know exactly if it is possible to remove them or file them and if it is possible to have a completely smooth forehead or just reduce them as well as a reduction in the forehead line.

A: You have classic but very prominent asymmetric forehead horns. It would take a 3D CT scan to look at their thicknesses to accurately answer the question of the completeness of their removal. But based on my experience I would suspect they can be reduced but probably not 100%

The other option is to go in the opposite direction with some reduction (or no reduction) and then augment the forehead around and over them to make everything smooth. This would be the absolutely assured method of a completely smooth forehead.

But I would not guess and first get the scan.

Dr. Barry Eppley

World-Renowned Plastic Surgeon