Your Questions

Q: Dr. Eppley, Will inner eye widening cause any problem to the eyes’ tear system? And is there anyway to basically reduce the medial area while keeping the lacrimal lake? Like while keeping the medial canthi reducing the sclera?

A: It is done medial to the lacrimal punctums/ducts. The procedure works because of the lacrimal lake reduction not the medial canthal tendon…meaning you can’t shorten the medlal canthal tendon laterally due to its bony anchorage.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I mostly feel like the bottom half of my face is quite heavy and creates a pear shaped look to my face. A lack of cheekbone definition and the appearance of jowls are all part of this. There also seems to be a concentration of fat right by my nose and lips from the side view. Additionally, I feel like there is not enough forward projection of my chin in my profile, leading to a weak profile and my nose still looking quite large in comparison. Ideally, I would like to remove the heaviness and jowls and gain a lifted appearance overall, as well as a stronger profile.

A:As you have astutely pointed out your skeletal deficiencies certainly make a major contribution treat your current facial appearance. The combination of cheek and shin augmentation possibly with some facial defatting would be helpful. While the cheek augmentation needs to be done by implants your chin augmentation is best done by a sliding genioplasty which will have a more profound effect on improving the jowling and the heaviness in the perioral area than an implant.. The attached imaging provides a visual application of these facial augmentation concepts although the magnitude of the desired changes is open to discussion.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, my question is do you perform hip bone shaving to remove hip dips. If yes how much bone can you remove from hip bone in grams and/or kilograms .Another question what’s the maximum amount of bone you can remove from hip bone to remove hip dips in grams and/or kilograms. 

A:I believe I have answered this exact inquiry previously. But to repeat my prior answer we do not measure iliac crest bone removal by weight (grams or kilograms. Rather it is measured in the amount of linear bone projection  that can be removed which usually is in the 1 to 1.5 cm range. Whether that would be enough to significantly decrease the appearance of the hip dips would require assessment of her pictures with some imaging predictions as to what the effects of iliac crest reduction.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in hip implants. I want to achieve the hour glass body shape. I am lookin to haver bigger hips/tight because my body is more like an inverted triangle.

A:I am always concerned that patients requesting larger hip implant augmentations are much more prone two complications such as chronic fluid collections and implant edging. Smaller hip implants do much better. When I see the phrases such as hourglass body shape, bigger hips and correction of an inverted body triangle all of this indicates the need/desire for larger hip implants. Such hip augmentation patients quite frankly make me nervous I’m About such potential hip implant surgery. Hip implants are uniquely different from all other body implants particularly in their complication rates due to their relatively superficial soft tissue location.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I wanted to contact you about my frontal bossing. I want to reshape my forehead. My forehead sticks out in the middle I don’t actually have a big forehead i want to be more flattened.

A:The reality is the forehead bone is not thick enough to make it completely flat. It can become less protrusive but never as flat as you would like. It requires a combination of building the sides a bit and reducing the central protrusion to get the best forehead contour.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Last August, I sent you a question about hip implants and their possible complication of inferior edge show, if it would be possible to inject fat or synthetic fillers around the visible implant edge to try to camouflage it and your answer was yes. Would this camouflage only work while not bending or leaning, like when standing normally? Will it show if I ‘pop’ my hip out or If I lean? When in dynamic motion or dynamically “posing”? Thanks in advance.

A: A treatment like fat injections around hip implants is done in the static position. What may subsequently happen in dynamic motion is different and cannot be predicted. However, it would be safe to assume that the dynamic show would still persist but perhaps be a bit reduced.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I had a corner lip lift with Dr Eppley about ten years ago and due to aging, I am interested in having another one and want to see if that’s possible.

A:In looking at your preop pictures from ten years ago I suspect you had lateral vermilion advancements due to upper lip vermilion disproportion. Lateral vermilion advancements are often confused with corner of mouth lifts because of some similar effects at the corners. Regardless such lateral upper lip procedures can certainly be repeated.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have long wanted a chin augmentation procedure. What procedure is best for me?

A:Thank you for sending your pictures. You have a major chin deficiency which is really representative of a more global lower jaw deficiency. Barring getting lower jaw advancement surgery your chin augmentation can only be done by a sliding genioplasty. A chin implant is not appropriate in your case given the magnitude of the of the deficiency, which is in the 20 to 25 millimeter range, and that the chin is sloped backward which makes an implant ineffective. Only a bony sliding genioplasty will be effective and, even when done the maximum amount of 12 To 14 mm (see attached imaging) has no risk of being overdone. Fortunately, being a female, the amount of chin augmentation needed is less than that of a male. You also have to be careful given where you’re now that any major change may be psychologically hard to adjust to as you may not recognize yourself after surgery for some time.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been looking around and I am interested in undergoing shoulder reduction surgery. I would like to know more about this procedure including complications, price and duration.

A:Thank you for sending your pictures. Shoulder reduction surgery is most effective in the leaner patient with a body type like yours. I have tried to do some predictive imaging to show you the potential results from such surgery but your pictures have issues when it relates to imaging. From the front view the picture is taken too close so there is no room between the edge of the shoulders and the side of the picture to do preditive alterations. The back view picture is a bit better but taken against the side of the door there is going to be image distortions in it.

In my extensive experience with shoulder reduction surgery there have been very few complications. While potential complications always exist the biggest consideration in shoulder narrowing surgery in my opinion is the recovery. One has to be properly educated on the recovery since it involves both shoulders and arms and that poses some postoperative limitations that is very different from clavicle fracture repair surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, i am 26 years old. I have concerns about my weak chin/jawline and the neck webbing (which i assume i have). I was wondering if you were able to tell me roughly how much it would cost to fix the neck webbing and the weak chin/jawline. I did see you have performed the surgery on the neck webbing before and was also curious if patients prior have had insurance cover any part of the surgery. I look forward to hearing back from you. Thank you for your time.

A:Thank you for sending your pictures. You do indeed have neck webbing as evidenced by the low and laterally displaced hair line. As commonly seen in neck  webbing, and maybe as a direct result of it, the chin is often short and the neck and jowl area tends to be fuller even in young patients. From a neck webbing standpoint the posterior approach to its improvement is very effective. As part of the neck webbing correction submental in that jawline like the suction can be performed and I small chin implant placed if , as a female, chin augmentation would be viewed as beneficial.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in shoulder widening surgery. It would be great if you could tell me what’s the maximum shoulder widening we can do. 

A: In very muscular patients like you the limits of shoulder widening are increased due to the tightness of the shoulder girdle soft tissues which cause restructions as one tries ti lengthen the clavicles. This is what I think 10 to 15mm of bone length can create.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I must correct myself in my language regarding frontal bossing reduction through deburring.  I’ve provided a number of pictures including two x-rays.  We have similar bone structure.  Hopefully, between these images you might have a better idea of how much frontal bossing you can remove by deburring.  As you said it may be enough to give me a more feminine profile by debossing using a small incision.  Can this procedure result in nerve damage or long term numbing of the area?  Would you be able to also debur the tail of the brow bone over the eyes to open them up more?  

Thank you for your information regarding the rhinoplasty & lip lift as one procedure.  To confirm if you did both together you would perform a closed rhinoplasty to eliminate/reduce scarring?

A:The determination of How much brow bone projection can be reduced, otherwise known as thinning of the outer table of the frontal sinus, is ultimately determined by a 2-D CT scan to make an accurate assessment. Any picture imaging done is an estimate based on experience of  how much likely could be achieved. The tail or outer aspect of the brow bone is not subject to the limitations of the medial brww bones as there is no frontal sinus in this part of the brow bone. While the medial brow bones may be able to be treated due a small scalp incision the outer tale of the brow bones cannot. Using such a limited approach it is better to do the tail of the brow bone reduction using an upper eyelid approach. You are in need of an upper blepharoplasty anyway due to the large amount hooding that you have. Reducing the tail of the brow bone alone is not going to open up your eyes given the large amount of U\upper eyelid skin that exists.

Any method of elevating the forehead tissues is going to result in some temporary numbness which is almost never permanent.

With the type of nasal changes that you need a closed rhinoplasty would be a poor surgical approach. You need an open rhinoplasty to optimize the amount of reduction and reshaping. The scarring from an open rhinoplasty is virtually nonexistent and I’ve never yet seen a scar revision requested from an open rhinoplasty. The concern about an open rhinoplasty in your case is the potential concomitant subnasal lip . There is a small strip of columellar skin that would exist between an open rhinoplasty and the subnasal lip lift incisions which has the rare risk of vascular compromise. As a result I am very cautious when considering combining these two procedures. In looking at your thin upper lip, which has limited vermilion height from corner to corner, the subnasal lip lift is not a good choice for lyour ip augmentation as you will essentially get a A frame deformity. (the center of the upper lip is elevated but the sides  of the lip is not) You would be better served with a vermilion advancement from corner to corner which can also very safely be done with an open rhinoplasty.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am interested in a forehead widening or augmentation. My head is very small for my height, but I believe just a forehead temporal implant and possibly reducing the slope would work since I do not want an extreme increase (a 1cm gain in overall circumference could be enough).

I’ve attached what my forehead looks like. It is diamond shaped and particularly narrow. Let me know what can be done.

A:I would need to see a side view picture of your forehead as well for a proper assessment and imaging. But you are certainly referring to a custom forehead-temporal implant design as per the attached imaging. It may not need to extend as far posteriorly as this design is but it conveys the general implant design footprint needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I’ve been researching ways to enhance the balance and definition of my facial structure. After reviewing your website and seeing your extensive work with custom facial implants, I am very interested in exploring potential procedures with you.

I naturally have a pear-shaped face, with a relatively narrow upper face, flat cheekbones, almond-shaped eyes, and a narrow forehead and temples. My jawline is stronger in proportion, and I would like to improve the harmony of my facial thirds — specifically enhancing the midface and upper face for a more balanced and structured appearance.

I’m particularly interested in your custom midface implants, infraorbital-malar implants, temporal implants, and possibly forehead augmentation. I am also open to mandibular angle or jawline implants if you believe they would further enhance my facial aesthetics.

I’ve attached a photo for reference and would greatly appreciate your expert opinion on what procedures or implants you would recommend in my case.

Looking forward to your thoughts.

A:Thank you for your inquiry and sending your pictures. Your primary focus in your inquiry has been about mid and upper facial widening which your pictures clearly show a longer more narrow face. This would require custom temporal and infrarbital – malar implants to help widen the upper two thirds of your face as well as provide some augmentation the under eye hollowing. The attached imaging reflects a general concept about the effects of these implants although do not over interpret the details of it. Since you ask about the lower chol augmentation I’ve also done a second set of imaging which includes that of a custom jawline implant.

The purpose of the imaging is to help you think about what changes you feel are best for your facial structure and proportions. I never tell patients what they need. Rather my mission is to help patients think about their problem and potential solutions and the use of imaging guides the patient’s understanding of potential facial changes. In the end it is the patient must decide what they think looks best of them.

Computer Facial Imaging ConceptsAlso, I would read the following attached statement so you can best understand what the role of facial prediction imaging is for facial reshaping surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I am writing to you in the hope of receiving your guidance regarding a previous chin surgery that has unfortunately resulted in deeply distressing and long-lasting complications. Years ago I underwent a chin reduction procedure which n hindsight, I have come to understand the following: My very prominent chin was partially a result of orthodontic treatment that, in retrospect, should have been handled differently. I had an underbite which was corrected solely through braces, when surgery in combination with orthodontics would likely have been the appropriate course of action. I had (and still have) an excess of soft tissue in the chin area, which was largely responsible for the visible protrusion—especially noticeable when I laughed, spoke, or smiled. Unfortunately, the outcome of the surgery was very poor, both aesthetically and functionally. Over the years, I’ve consulted multiple plastic surgeons, including facial specialists, but none have been able to offer any real help. Many have assessed the case as too complex and beyond their expertise. Some even consulted colleagues and returned with the same conclusion—that nothing could be done. This has left me feeling hopeless at times. Regrettably, I have never been in contact with a maxillofacial specialist before—something I now realize would have been essential from the beginning. Through extensive personal research, I now understand that my case would partially fall under the field of maxillofacial surgery. I would like to briefly describe my current issues and have attached some photographs for your reference.

Summary of current concerns: There is a clear asymmetry in my chin. The bone appears to have been improperly treated or fractured, resulting in an uneven shape and a protrusion on the left side. This becomes especially noticeable when I speak or contract the area, as the soft tissues seem to sit unevenly over the bone. I also suspect possible nerve damage in the region. The soft tissue has redistributed unnaturally since the procedure, leading to abnormal facial expressions during speech and movement. This includes unusual contractions and tensions, and I strongly suspect that a nerve may have been affected or injured. Liposuction was also performed under the chin, with an incision about 1 cm below the chin. This scar and intervention have altered the appearance of the area—especially in profile—and contribute further to the unnatural look. Altogether, I experience abnormal movement of the chin, accompanied by tension and deformations that affect both my appearance and my self-esteem. The deformities become even more visible when I speak. As a result, I struggle intensely with being filmed (to an abnormal degree) and avoid having my photo taken unless I’m fully prepared. I know that you are an expert in this are and I am wondering if you might be willing to review my case and assess whether there are any possibilities for correction or improvement.  I hope I didn’t bore you and I hope that i could receive some sort of answer from you. Thank you so much for taking the time to read this. I look forward to hearing from you.

A: Thank you for your inquiry detailing your surgical chin history and your present concerns. From my standpoint there is nothing mysterious for elusive about understanding the anatomy of your current chin problem. This is simply the long term effect of having too much soft tissue chin pad tissue for the bone support that it now has which is a direct result of reducing the chin bone and not factoring in at the initial surgery the ultimate soft tissue contracture that is going to occur. This is a common surgical oversight in my experience with chin reductions and I see such complications of differing magnitudes all the time. Surgical improvement can definitely be achieved which requires a soft tissue chin pad release, reduction, perhaps secondary bone smoothing as well as the introduction of some new healthy tissue via fat grafting. Well this approach may not make your chin have a perfectly smooth appearance like it did before the initial chin reduction it certainly is going to make a major improvement.

The reasons surgeons have told you that your chin problem is not improvable is for two reasons. First and foremost they probably have never seen this chin problem before and therefore have no idea how to properly treat it. Equally they may also understandably feel no need to take on a difficult problem that they themselves did not create. Thus their proper answer to your problem should have been that they either do not know how to treat it or do not desire to take on the assignment.

I would have no idea who in Europe has experience in treating secondary chin problems like yours. This does not mean that surgeons do not exist who are capable of helping you. It merely means I would not know who they would be.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello I was wondering if you guys had a forehead size surgery that will make my forehead not as flat and taller in the front.

A: Forehead reshaping by augmentation, as suggested by your goal of making your forehead less flat and taller, is done by custom forehead implant designs. As a male such a forehead implant design may or may not involved brow bone augmentation as well. Since in your inquiry you did not mention the brow bones your implant design may be relegated to above the level of the brow bones. To give you an idea of such potential for head augmentation changes I would need to see side view pictures of your forehead to do some predictive imaging.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,  I’d like to have a consult on both testicle (Wrapped around my own testicles) implants up to 7.5 cm and fat transfer into the scrotum procedures … purely for cosmetic visual / self improvement. I’m 5’9″ 185 lbs age Caucasian male with an average penis size.

A:Despite having developed the wrap around testicle implant concept I am not its biggest proponent. While the concept has merit and it is most appropriately considered in the younger patient with average sized testicles it does have postoperative problems. The issue is that there is not an insignificant long-term risk of Implant separation from the natural testicle. Having tried numerous technical variations that issue has not been completely eliminated or reduced to the level that I feel the implant concept should be widely used. As a result I reserve its use in patients who are the most motivated by being willing to except that risk. The one factor that seems to have the greatest benefit in reducing that risk is to match the inner chamber of the custom wraparound implants with measurements of the patient’s natural testicles on ultrasound.

Both Fat injections into the scrotum and testicle implants can not be done at the same time, If you get large enough testicle implants there would be no need for fat injections anyway.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi, I’m looking to get an occipital reshaping. I saw a great case study done by Dr Eppley mthat looks similar to what I’d like to have done.

A:Thank you for sending your pictures. This appears to be a classic posterior fontanelle skull deformity where the original baby soft spot closed but did not develop the thickness of the surrounding skull bone. Hence the depression or indentation which id ideally treated by a custom skull implant design.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I recently had double jaw surgery & my ANS was resorbed by the plate. Is there a way a tiny para nasal implant could be placed?

A: A small modified paranasal implant or a bent titanium plate could be used to restore the projection of the anterior nasal spine.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I heard that it is unsafe to remove a facial implant, modify it and then put it right back in as it is then unsterile.

A:That is not an accurate statement. It is common to remove implants and modify them with immediate re-implantation for aesthetic purposes. This is standard practice in face implant revisions.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can permalip implants be put in at the same time as sliding genioplasty?

A:Lip augmentation (e.g. Permalip implants) can be placed during the same surgery as a sliding genioplasty. The combination will cause considerable lip swelling but those effects are temporary.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have been doing some reading on rib removal and LD muscle narrowing. From your professional opinion, could this have benefits as well? I have a lot of shoulder pain from bad posture over the years and I’m curious if these procedures would help with this as well. I’ve had MRIs and assessments, but nothing officially diagnosed. When I’m working out more consistently, the pain is reduced. Are there any health benefits to this? Are there any risks of making anything worse? 

A: These procedures are for cosmetic purposes only. They are not known to provide any functional or medical beneffit. Conversely they are not known to cause any adverse medical effects or functional impairment either.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, What is the tallest vertical chin implant that can be implanted? I don’t need much or any forward projection, but I do need a lot vertically. Dr. Eppley looked at my scans, but the procedure scared me – very tall genioplasty… I’d rather consider the tallest vertical implant instead.

A: The most vertical chin lengthening that can be done with an implant in most patients is 5 to 7 mms due to restrictions of the tightness of the soft tissue chin pad.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Can I remove the titanium mesh that is covering part of the skull? I had a craniotomy six years ago and there has been ongoing and increasing pain at the location of the mesh which I believe is an inflammatory reaction due to internal fixation device. From what I am learning this could be due to galvanic corrosion of the metal. This might not be what is happening to me but the pain is specific to the location of the mesh and not internal like a headache.

A: The reason titanium is the sole metal used in craniomaxillofacial fixation for the past 25 years is its corrosion resistance. Titaniun is highly resistant to corrosion as a stable protective oxide layer forms on its surface after implantation which protects the metal from attack from corrosive agents. Thus I doubt your symptoms are from hardware corrosion. I have removed thousands of pieces of titanium hardware from the face and skull over the past 25 years and I have yet to see any evidence of corrosion. More likely the symptoms are due to its occipital location and the surface area of its coverage.

That being said there is only one way to find out if the hardware is the culprit…remove it. It is certainly possible that its removal will not eliminate your symptoms but then the most obvious source of them will be excluded.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have attached two photos for reference. I’m looking to have the extra skin removed which I’m not sure is visible in the photo. You can also see some horizontal stretch marks which I was wondering would be covered up during the vertical back lift. 

My plan in the next few months is to have lipo on my stomach which may also create more loose skin on my back based on what I’ve been reading (of course results may vary). I don’t have a definitive date booked yet as I had to reschedule my original date due to personal circumstances. I haven’t had excess weight loss but my goal is to find a way to tighten the skin on my bra line as I have issues wearing certain clothing. My surgeon who is performing lipo on my stomach advised me that lipo is not recommended and that I’d have to look consider a bra lift if I wanted to achieve my goals as lipo would not give me my desired results.

Do you also perform rib removal and is this recommended for waist reduction? Will this decrease any chance for rhinoplasty revision in the future as I understand ribs are sometimes used for rhinoplasty revisions? (I like to keep my options open.) Do you think this surgery is recommended for what I’m looking to achieve or are there other recommendations? Am I a good candidate?

In terms of the rhinoplasty I’ve been reading that, based on my goals, a tip plasty and alar plasty are less invasive and more likely to be the way to go for what I wish to achieve (narrowing of nostrils and more refined tip). I also understand that the tip sometimes does require support so I will leave this recommendation up to you.

I look forward to hearing your feedback and thoughts.

A:Thank you for your inquiry and sending your pictures. Your surgeon is correct in that light perception of the back is not a successful approach for managing your redundant tissue issues. Neither would a traditional bra lift be successful either as a horizontal excision is not the direction in which your redundant tissue lies. The vertical backlift is a better orientation for your tissue excision as seen in the attached Image. Whether one chooses to have ribs removed and the LD muscle narrowed as part of a vertical bralift is based on whether one wants waistline reduction at the same time. That is a personal choice.

In regards to the nose I cannot comment on what your reshaping needs are as I have not seen any pictures of your face. The only general statement I can make is, while rib cartilage is sometimes needed for rhinoplasty, rib removal is largely bone and is not useful for rhinoplasty surgery. Therefore rib removal surgery does not compromise any future graft needs for rhinoplasty surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, I have dents on my buttocks due to most likely steroid shots administered to me as a child to regulate asthma attacks. Is it possible to correct these? Plastic Surgery Case Study – Dermal-Fat Grafting Of Buttock Indentations from Prior Injections

A:Fat injections or small dermal-fat grafts would be the appropriate treatment for contour defects of the buttocks. The depth of the indents would determine which one of the fat grafting methods would be best.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley,I’d like to have a quick consultation about the process of skull reshaping. The order of how it works, the cost for an initial 3D scan, ways you can pay for it. Also, I was told a couple of years ago that I needed a 3D CT scan of the skull to send to your office to determine what is needed. Is that still the process? If not, what is it?

A:The term ‘skull reshaping’ is a general one which refers to a collection of over 30 different specific skull procedures. To provide information on what skull reshaping procedure(s) would be appropriate for your needs I would first need to know your exact head shape problem from which I can then determine how to treat it. This will require a more detailed description of your concerns, and head reshaping goals and any pictures which so illustrate. From this information the skull reshaping procedure(s) needed can be determined.

The role of the 3-D CT scan varies based on the skull reshaping procedure needed. For example in skull augmentations the ccan provides the platform on which a custom skull implant is designed. For skull reductions it helps to determine the thickness of the bone and how effective and safe any skull reduction procedures would be. Therefore the scan can be a critical part of the surgical planning process but it is not initially needed to determine what any specific patient needs from a procedure standpoint.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hi do you offer just rib remodeling without the removal of the ribs ?

A:As you know structural waistline surgery can be done buy rib remodeling which includes either their subtotal removal or the osteotomy or fracture method. Each approach to the ribs has its advantages and disadvantages but, in the end, it is the patient’s choice as to which method they prefer. While by far the vast majority of my patients choose the rib removal method I certainly have done the fracture technique which is surgically less complicated and operation of less duration. the key to the rib fracture method is the use of postoperative compression using garments which ultimately is responsible for the final result.

But with either rib treatment method it is first important to qualify the patient to determine if Either approach can provide some benefit. To that end I would need to see some pictures of your body as well as an idea of what you’re trying to accomplish.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Two years ago, I had cheek/infraorbital rim implants as well as jaw and chin implants placed using Medpor material. Prior to that, I underwent orthognathic surgery, and the implants were custom-made. Since the procedure, I’ve been dealing with a low-grade, chronic infection at the site of the right cheek implant, with occasional flare-ups. About a year ago, I had surgical debridement and antibiotic treatment. However, I suspect that the implant may ultimately need to be removed. I would like to ask your opinion on whether it might be advisable to remove both cheek implants and replace them with silicone implants, given the lower risk of infection and the relative ease of removal if needed. Additionally, I am wondering how long the process would take—from removal to replacement—whether this is something you could perform, and if you could provide a rough estimate of the cost. Thank you very much for your time. I look forward to hearing from you.

A:As you have undoubtably learned by now once an implant gets infected the long term success of resolution of that infected implant  is rarely if ever achieved short of removing the implant. Based on your history that time appears to have arrived. What you need to do is first have the infected implant removed which may or may not include the opposite unaffected side. You then need to let the tissues heal before re-implantation. That time should be about three months. That will also give you time to design new implants for the secondary re-implantation. It would not be prudent at this point to do an immediate removal and replacement of the infected implant in the face of a long term chronically infected implant.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Q: Dr. Eppley, Hello! I am interested in surgical removal of a large tattoo on the back of my left shoulder. A staged process is perfectly acceptable to me and scarring is only a minor concern. I prefer not to pursue laser removal as it is a lengthy process and doesn’t completely remove certain colors of tattoo ink. I look forward to hearing your assessment. Thank you!

A:That is a very large shoulder/arm tattoo that is not appropriate for a staged surgical excisional approach. Shot of excision and skin grafting, which seems questionably appropriate given the trade-off of a large skin graft patch, you are left only with laser treatments. I would not disagree that is a long an expensive process for probably what would turn out to be incomplete removal of it.

Dr. Barry Eppley

World-Renowned Plastic Surgeon