Your Questions
Your Questions
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
Q: Dr. Eppley, I am a 38 year old male. I’m interested in getting my adam’s apple reduced. It’s grow too much, honestly I’ve never seen an Adam’s apple protruding like mine. It’s really bothering me since I was a teenager. I’ve been searching about the surgery then I found your webpage with some fantastic results. Have you ever reduced a protruding Adam’s apple like mine? How much it can be reduced? Could you share some before/after photos of similar cases? Thank you so much
A:Unlike transgender MTF tracheal reduction where the goal is to take a normal male thyroid cartilage protrusion and flatten it as much as possible when a cis-male -presents for tracheal reduction it is a bit different. They usually have an abnormally enlarged tracheal prominence and the goal is to reduce it to normal. (not flatten it) Thus I have seen numerous large male thyroid cartilage prominences. Whether yours is larger than anyone i have seen before I can not yet say since I have not yet seen a picture of it. Regardless I am sure it can be reduced. The only question is how much of its prominence can be safely taken down.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have, at least what I believe to be, is an extreme case of scrotal webbing. Is this a condition that your office can treat?
A: All penoscrotal webbing can be improved, it is just a question of how much and with what technique. To do a proper assessment I need to see a picture of the penis at 90 degrees to the scotrum and then at 120 degrees as well.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, If I go see you to remove Medpor cheek implant for 10 years, can you guarantee their removal without causing serious damage? By that I would me only being paid if they are removed? I’m asking because I am right now with a surgeon who wants to be paid but told me it can happen that they are not removable after 10 years. If so, how much do you charge to remove them?
A: All Medpor facial implants are removeable, I have never seen one that can’t be removed and I have removed hundreds. The time of implantation is irrelevant. Once the tissue ingrowth has occurred after the first 6 to 8 weeks tissue ingrowth is complete and whatever challenges exist in their removal is the same at 3 months as it is at 3 or 30 years.
There are no guarantees in surgery other than the surgeon will try heir best to remove them with the least local trauma as possible.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Looking for someone to preform Supraorbital Nerve decompression surgery on my husband for his migraines. Do you offer this?
A: The success of supraorbital nerve decompression for migraines can be predicted by whether the patient has had a positive response to Botox injections in the nerve area. Has that been previously done?
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, Am interested in having testicular implants placed. Had radical right orchiectomy for testis cancer in 2012 and have very, very small left testis. Would like to have the largest possible implants placed. Please advise on steps to be taken.
A: The first question is whether you had any radiation as part of your testicular cancer treatment as such radiation precludes any implant surgery.
Since most testicular cancer patients don’t have post orchiectomy surgery radiation, and I will assume this is you, then implants can be safely placed.
With a small left testis and a missing right testis implants are inserted merely pushing aside the small existing testis. (Side by side technique) What size implants you can have depends on how much scrotal skin you have and it’s laxity. (how well it stretches) There is no exact method to known what size willl fit beforehand but most patients fall in the range of 6.0 to 7.0 cm size.
Dr. Barry Eppley
World Renowned Plastic Surgeon
Q: Dr. Eppley, I want to reduce the sides of my head (the temporal region) to allow my head shape to be less wide shape. I also would like to reduce the forehead bossing to make my head less large looking and more even. I also want to get rid of the bags underneath my eyes permanently with an implant that allows my cheeks and under my eyes to look full (but not unnatural looking). My cheekbones aren’t prominent enough for the look I want. I also wanted to make the ramus longer to give my face a balanced look. I also wanted to see if you could reduce the entire back section of my head due to it sticking out past the back of my neck. If it is possible to reduce the back of the head while you are reducing the width in the sides that would be great.
A: I would need to see some face pictures form different angles for an assessment and imaging. But I interpret your inquiry as desiring the following procedures: 1) bilateral temporal reductions, 2) forehead reshaping, and 3) infraorbital-malar augmentation, 4) jaw angle lengthening, and 5)occipital skull reduction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, . thank you for all the great work you’ve done. I read your articles on the midfacial mask implant, and i’d like your opinion on the following surgical plan: (1) first I will get a lefort 4 (monobloc advancement), to move essentially the entire skull forward. I was going to get a lefort 3 done at first but the monobloc will produce a better “hunter eyes effect” as it will move the whole orbital bone forward. Can you recommend me a skilled surgeon for this? I already found a few in the UK, but I would trust your suggestion more. (2) then after I recover from The monobloc I will have you install your midfacial mask implant. I look forward to hearing your opinion.
A: I think you will find it very difficult if not impossible to find any surgeon that would do a LeFort III or mono bloc advancement in an adult for aesthetic purposes. While the surgery may seem like a carpentry project on.a skeletal diagram there are major risks for this type of surgery not to mention the numerous adverse aesthetic sequelae from it.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a fun shaped head. When i was younger i had a soft spot and my mom tried to shape it and made it worse. So im looking to speak to someone about potentially getting it shaped evenly
A: I have seen your pictures and it appears you have an asymmetric skull shape wirh the top right flatter than the left side. This requires a custom skull implant to correct.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, had a tummy tuck/lipo 360 last May and I believe fluid has gathered, not just fat in the pubic area causing it to be enlarged and raised. I have read online you have a treatment for this as an outpatient, and I need a consultation.
A: Chronic untreated seromas can result in a bursa cavity which in a tummy tuck will end up low and in the center. The definitive treatment is to open part of the tummy tuck incision, excise the entire bursa lining and then quilt by suture the excised tissue cavity down with or withoiut a drain.
These are basic plastic surgery principles so I would assume your surgeon can make the diagnosis and perform the necessary surgical intervention.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I would love to lengthen the forehead with 2cms and without lifting the brows. Which technique would you use?.
A: Such a big movement would definitely require a 1sst stage tissue expander of the upper forehead and anterior scalp…followed 6 to 8 weeks later with its removal and the expanded forehead flap moved up into the hairline.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi I want to get customized implants after a very unlucky surgery done in Korea cheekbone reduction and chin reduction which took my beauty of me I am in a need for a good surgeon who can reverse the suregery within custom implants
A: I have done numerous custom implants for overdone or undesired facial bone reduction results. Chin, jaw and cheek reductions are the most common. Such implant designs are done from a postop 3D CT scan. Do you have one?
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, is it possible to see photos difference between the lateral and widening mandible implants from implantech? I am trying to decide which I would to have a consult about.
A: Looking at other patient results is not a good way to determine how any implant will change the patient’s face as everyone’s anatomy and facial shape is different. This is particularly relevant when it comes to the differences in the jaw angles. The most accurate method is to do imaging on your face of the differences between widening and lengthening of the jaw angle patrticularly from the front and ¾ views.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am a 43 old male who had surgery of my central arch cancer and the entire lower jaw and lip was removed. I got surgery for jaw reconstruction from fibula bone. But after 10 days blood supply was stopped to jaw and fibula bone was removed. At same time skin grafting surgery was done in mouth. I am still unable to eat, drink properly and talk properly. I am keep medical cotton piece in my mouth becouse of a saliva is come out from mouth. Is a titanium jaw implant possible?
A: Any type of jaw implant, regardless of the material, requires good soft tissue coverage to be successful. With the loss of soft tissue from the cancer resection an implant will not work and the fibular bone flap was the correct reconstructive procedure…even if it was not successful. Further flap reconstruction efforts are what is needed not an implant.
Dr. Barty Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi! I was wondering do you do forehead lengthening procedure? I had a forehead reduction in the past. But i think my forehead is too low now.
A:Forehead lengthening can be performed three different ways, direct excision, an epicranial shift and tissue expansion technique, The direct excision works if the lower forehead and brow is lax, can be mobilized and one can tolerate a bit of a browlift result. The epicranial shift is like a reverse endoscopic browlift procedure using wide subperiosteal undermining and shifting the whole scalp backwards. Tissue expansion works by creating more upper forehead skin/scalp so either the direct excision or epicranial shift methods works better. Which technique is best depends on how forehead length you need.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to inquire about mouth reduction surgery. It is very wide when smiling.
A:Two important issues about mouth reduction:
1) The scars for mouth reduction are not good and I would be very cautious about ever doing it as a result. You will likely make the adverse aesthetic tradeoff of a problem you dislike just as much or worse than the problem you are trying to improve,
2) You never do a static operation for a dynamic problem. Any surgery works best when the problem being treated is best seen static (non-smiling) as that is how the surgery is performed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a right pectoralis major tendon tear in last year. My orthopedic surgeon repaired the tendon and I am back to training chest however I have some deformity and am hoping to get xxl pectoral implants. I also have some bilateral nipple deformity from having pierced nipples. I’m wondering if the xxl (largest possible) pectoral implants and nipple augmentation could be completed at the same time. I like large pointy nipples and I’d like mine to look more uniform. Currently as you can see in the pictures they have scars from the piercing that’s almost looks like a 3rd nipple. I’m hoping you can do pectoral implants and nipple correction while increasing the length and size and symmetry of the nipples as well. Thank you!
A:The concept of XXL pectoral implants is open to interpretation as to what that actual implant size is. But what is most relevant is whether the XXL implant is the largest standard (Powerflex Plus, 690ccs) or whether a custom implant must be made. I think you would probably be fine with the off-the-shelf PowerFlex Plus implant. With your height, chest size and thick strong tight pectoral muscles that would be the most implant you could probably get in. It is the ‘big daddy’ of standard pectoral implants made for the male seeking XL or XL size.
While numerous forms of nipple plasty can be performed at the time of pectoral implant placements the combination of a pierced nipple repair and nipple elongation can be problematic. (as nipple elongation usually requires placing a graft)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am 18 year old guy, and it has been pointed out to be that i have a convex profile, this makes my nose look bigger witch i hate. My facial convexity angle is about 159 and i was hoping there was a way i could get it to 165. And i was a permeant solution filler is not an option for me. I wouldn’t mind surgery if i needed it, but i also don’t know weather my sutures are closed. Any advice is appreciated.
A:With a convex facial profile this usually means there is a recessed chin as the primarily culprit. Surgical chin augmentation would be the only effective solution and the options are either a chin implant or a sliding genioplasty procedure. To verify is this is an effective approach as well as how much chin augmentation is needed I would need a side profile picture to do some imaging.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I am inquiring about the procedures for buried penis and testicular implants. I am 58 years old. Over the years my testicles have shrunk in size to the point where I have one testicle that is about 3.0 cm and the other is about 2.0 cm. The smaller one is sometimes hard to find due to its size. Does this situation sound like I am a good candidate for the displacement procedure? I think I have the required amount of space in the scrotal sac. If it is possible, I am interested in custom 7.5 cm testicle implants pending whether my scrotum has the space for them.
A: While in anatomic proximity and that surgical correction can be done at the same time your two objectives, testicular enhancement and buried penis repair, are very different. You are correct in that with small testicle sizes of 2 and 3 cms the implant displacement method will work very well. Whether your scrotum can accommodate the implant size of 7.5cms can never be known before surgery and we have to accept that inraoperative implant adjustment may be necessary if they don’t.
Buried penis repair can be done by either suprapubic liposuction, penile release and lengthening or both. What is best for you requires a picture assessment as well as an actual examination to make that decision. Since I only do the liposuction and not penile surgery I can only offer combined suprapubic liposuction and custom testicle implants in the same surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley ,Hi, I had lip lift and corner lip lift 1 year apart. Corner lip lift was done last fall. The extreme corners are downwards and makes me look sad. Is there a solution?
A:You just didn’t get enough lift from the lateral vermilion advancements/corner lifts. That needs to be repeated with a greater lateral arc to the lateral vermilion excision. You got enough initially out of it so that the upper lip vermilion show was balanced with the subnasal lip lift from one mouth corner to the other. It just needs more excision/lift.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, will you be performing the hip augmentation with the metal plates in the future?
A: As for iliac crest hip augmentation with metal plates, this is a procedure I am currently performing since it has received FDA approval in the Spring of 2024. It is a composite skeletal and soft tissue hip augmentation method using a mental iliac crest plate with a silicone hip implant attached to it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
