Your Questions
Your Questions
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
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
