Q: Dr. Eppley, I wanted to ask a question regarding iliac crest reduction. I have a wide bony iliac crest (photo attached) and as a man, it kinda bothers me. You are the only surgeon I could find online that does iliac crest reduction. I was wondering do you have any before and after photos to see how much of an iliac crest actually gets removed? From my understanding, just a little, and I’m not sure if it’s worth it to go through a procedure.

A: Thank you for your inquiry and sending your picture. I believe you are referring to the two anterior points of the iliac crest known as the anterior superior iliac crest points. (see attached) They could be reduced by a small 3 cm incision over them. Ironically those who have the least prominences benefit the most. (meaning get complete reduction)

Dr. Barry Eppley

Indianapolis, Indiana

The post Is Iliac Crest Reduction Worth It? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, Hello! I am very interested in the shoulder narrowing surgery since my shoulders are about 43-45 cm wide (not really sure). I should inform that I am a dancer and a big concern of mine would be that the surgery might constrict certain movements that require a lot of force. Would that be an issue? (Of course I mean after a healthy recovery). 

A: Requesting shoulder narrowing surgery and being a dancer is a new combination for me. Having never seen his combination before I can not say with absolute certainty that it poses no long-term issues in regards to exposing one’s arms to a large range of motion with a lot of force. But it would be logical to assume that when one is fully healed (3 months) that would not be a problem since the bones would be fully consolidated and back to normal bone strength. While my current recommendation is that patients can return to all normal not highly strenuous activities in 6 weeks I would push that recommendation to 12 weeks in this more highly strenuous activity.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can I Have Shoulder Narrowing Surgery If I Am A Dancer? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I think as a female my current chin implant is a bit wide (smile is squarish). What type of chin implant repalcement do I need?

A: Thank you for your inquiry and sending your picture. In regards to your chin implant:

1) When was the surgery done?

2) Was it an intraoral or submental incision placement?

3) What type of chin implant material was used?

4) What was the style and size of chin implant used?

Knowing this information is critical when deciding if a different chin implant may be better. It is also enormously valuable to know where on the bone the chin implant is actually placed which is why a cone beam or 3D CT scan of the chin would also be needed.

While your first chin implant was a guess as to what the outcome would be, we use the information that has been gained from the first surgery to make the second surgery (chin implant replacement) have a more predictable/desired aesthetic outcome.

Dr. Barry Eppley

Indianapolis, Indiana

The post As A Female With A Wide Chin And Now Squarish Smile What Type of Chin Implant Replacement Do I Need? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I had a sliding genioplasty lengthen 7mm down and advanced forward 8mm. I also had lipo under the chin and buccal fat removal. I now deeply regret my decision and am extremely unhappy with my end result which has given me an Over projected chin, a chin and jawline that do not match, decreased lower lip size, constant tightness and pain, a chin that is off to one side and a more aged appearance.

My surgeon is making me wait over a year before he will revise and wants me to decide on a full reversal or a partial revision (setback 4-5mm). This is the part I am unsure of, as I was happy with my face before. But with the complications associated with the changes in the soft tissue I am unsure how much to revert the chin by. I also do not understand why I have to wait so long before I can have the revision.

A: I can not answer the the timing decision made by your surgeon. My approach is that when the patient has identified an aesthetic dissatisfaction after the swelling has resolved then one can proceed with a revision. I would be cautious about complete sliding genioplasty reversal as they are now going to to be some softt tissue redundancy issues.

Dr. Barry Eppley

Indianapolis, Indiana

The post Should I Have Complete Or Partial Sliding Genioplasty Reversal? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, Hello – I have Permalip implants along with some really tight scar tissue, so I was thinking of having them removed. Will removal eliminate the scar tissue? Or is the tissue not stuck to the implants since the implants are smooth?

A: Removal of your lip implants will not completely eliminate the scar tissue. The surrounding capsule of the implants will be left behind…which will shrink down over time but probably never 100% go away.

Dr. Barry Eppley

Indianapolis, Indiana

The post Will Removing My Lip Implants Get Rid of The Tight Scar Tissue? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I have another question which I think we may have covered during my consultation but I want to confirm…

I currently have and have always had low blood pressure. My last blood pressure reading was 90/70, but it sometimes goes lower. I want to confirm that temporal artery ligation is safe in my case and won’t cause problems such as dizziness, lightheadedness or more serious complications. I will also double check with my neurologist. The first time I checked with him he didn’t seem to think the procedure would be unsafe for me.

I very much want to have this procedure and hope there is nothing that will prevent me from doing so.  I will probably have more questions that I forgot to ask Dr. Eppley during our consultation, but I think we covered most everything!

Thanks very much!

A: Low blood pressure is not a contraindication to temporal artery ligation.

Dr. Barry Eppley

Indianapolis, Indiana

The post Is Low Blood Pressure A Contraindication For Temporal Artery Ligation? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I am interested in pectoral and testicle implants. Do I need custom implants or will standard implants work for both? How much does a testicle implant weigh? 

A: Thank you for your inquiry and sending your pictures to which I can provide the following information:

PECTORAL IMPLANTS The key in pectoral implant selection is to have an understanding of the patient’s exact chest shape goals. Then the implant is selected by knowing the height and width measurements of the chest and the amount of projection and is location along the implant that the patient wants. This is how one knows whether a standard vs custom pectoral implant can most effectively achieve the desired outcome.

TESTICLE IMPLANTS Many of the testicle implants I do are in patients that seek enhancement of what they already have, not replacement of a missing testicle. Thus by definition these are almost always bigger in size than what standard testicle implants (max size 5.0cms) can achieve. Most custom testicle implants are in the 6.0 to 7.0cm size. (90 to 120cc volumes per each implant) The weight of a solid silicone testicle implant is completely controlled by its size. While size is obviously important the other major decision is the choice of the side by side vs wrap around implant technique. There are advantages and disadvantages with either approach. 

Pectoral and testicle implants can be done during the same surgery.

For now I will initially assume you need standard pectoral and custom testicle implants with the wrap around technique. But this open to further discussion and at the least is a starting point of that discussion.

Dr. Barry Eppley

Indianapolis, Indiana

The post Do I Need Standard Or Custom Pectoral And Testicle Implants? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I supposedly have a Peek chin implant, it does not project enough and is skewed pointing off to my left. I would like my chin to be symmetric with more outward projection. It was interesting that you wrote that the flesh adheres more readily to the Medpor implant as apposed to Peek, as I feel that this could/might also produce a better outcome (my bottom lip has no overhang anymore and when my mouth is relaxed all my lower teeth and gums show). Could you please tell me my options, thank you.

A: The outcome from any facial implant surgery, chin implants included, are based on the shape and size of the implant not its material composition. Material composition of an implant affects how it is inserted and removed but not its aesthetic outcome.

Thus when considering a new chin implant the key issue is the exact shape and dimensions of what lies in you now. Knowing the exact dimensions of what you have is invaluable information in how to design an implant with better dimensions for your needs. Any PEEK implant would have to be custom made and thus there would be an implant design file for it. I would need to know more about your existing chin implant. Your implanting surgeon should have this information.

Dr. Barry Eppley

Indianapolis, Indiana

The post What Is The Best Material For My Chin Implant Replacement? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Dr. Eppley, Hello doctor, my case is unusual, I would like to know If you can remove Ellansé filler from the cheek and replace it with implants to give the ogee curve on a male?

A: Your request is not unusual (remove filler and replace with implant) but doing it successfully (remove the filler part) is the challenge. I wouldn’t recommend trying to remove this semi-permanent filler as it is going to cause a lot of tissue damage in so doing. This will result in a lot of cheek irregularities and contour defects.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can Ellanse Filler Be Removed and Replaced With Cheek Implants? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I currently have a rhinoplasty surgery scheduled for later this summer with another surgeon.

Please find attached images of my face at various angles. My main goals with this procedure would be: from the front, a wider jaw and bigger/wider chin; from the side, enhancing the overall look of my profile view / chin projection / etc.

Here are a few questions that would be useful to know:

– Rate of infection for custom wraparound jaw implants / how many that he puts does he end up needing to take out?

– Is there a “constant” risk of infection over the course of your life with the implant, or is the main risk really just in the first 6 months or so?

– Since I’m getting rhinoplasty, would it make more sense to get this implant done before or after that other procedure?

– Do I look like I would be a candidate for sliding genioplasty, or would custom implants be better?

A: Thank you for your inquiry and sending your pictures. In just looking at the pictures you are not an obvious great candidate for the wrap around jawline implant approach because of:

1) Your thick skin…which often makes the jawline look bigger but not necessarily better defined…sometimes it may just look fuller/fatter.

2) You have reasonable chin projection as seen in the side view picture. Your jaw angles are deficient/not defined but your chin projection and jaw angles are disproportionate in size. (the chin may be a little undersized? but the jaw angles are much more so.

While I could see a combination of a sliding genioplasty and jaw angle implants (the three corner approach) I worry that connecting them may just make the jawline look big but not defined. The jaw angle implants may have to be custom or semi-custom made because of the width needed. (greater than 10mms) to really see them.

In regards to whether a rhinoplasty or jawline augmentation should be done first, that is a pure aesthetic/personal decision. You do the one first that has the greatest aesthetic importance to you. In other words ask yourself if you could only do one and never the other (which is obviously not true but a good way think about it) which one would you do?

Dr. Barry Eppley

Indianapolis, Indiana

The post Should I Have SA Sliding Genioplasty or Would A Custom Jawline Implant Be Better? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I am the photo in the middle. My hope was to change my eyes and nose to look more like Justin Bieber. Is that possible with how my face looks? I’m a senior in high school and hoping to get the surgery sometime in the future. Just wanted to know if it would be a success to look the same.

A: In comparing the present differences your nose would need to be narrowed at the tip and the bridge smoothed over…although one front view picture does not provide a full assessment of a nose which is needed before any rhinoplasty surgery. From an eye standpoint your lower eyelids have a sag which shows more sclera and the lower iris. That can be addressed by raising the lower eyelids with spacer grafts and tightening down the outer corners.

I can not say whether you would look more like Justin Bieber if you had your eyes and nose done as described but those are changes that can be surgically done.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can Rhinoplasty Give Me A Nose Like Justin Bieber? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I have lip incompetence, and I think I have Long Face Syndrome. I assume the cause of the lip incompetence is due to my allergies. I have a really long philtrum (about an inch long) What is the solution to this? I don’t think I have an overbite or a gummy smile. 

How would I go about on fixing my face? Would IMDO or bimax fix it? 

Is it possible to do 20-30 degree CCW of bimaxillary rotation to get to the ideal gonial angle of 128 degrees? 

A: With no x-rays and one partial full face picture I can only make incompletely informed comments:

1) Your lip incompetence is not due to allergies, it is due to a very short chin/lower jaw. At the least a sliding genioplasty of double digits is needed.

2) A long upper lip can only be reduced by a subnasal lip lift. No form of upper jaw shortening/impaction will make the upper lip length any shorter.

3) Orthognathic surgery (bimax aurgery) never creates any improvement in the gonial angles and in many cases actually makes it worse. Jaw angle shape changes can only be done with implants.

Dr. Barry Eppley

Indianapolis, Indiana

The post Will Bimax Surgery Give Better Defined Jaw Angles? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, we went over this possible procedure during our last consult few months ago, I have attached pictures. The area I’m pointing at is by might right sideburn right by where the hairline meets with the beard line. I would prefer for that not to protrude as much as it widens my face and becomes noticeable with certain angles. 

I wanted to hear your opinion because this seemed simple to me at first, specially since we would be talking about maybe 1 to 1.5mm of shaving; but after more research I know that there are some important nerves around that area and I wouldn’t want the risks to outweigh the reward.

A: You are referring to a reduction of the right posterior zygomatic arch area. That is an area that is commonly accessed in cheekbone reduction surgery for the posterior zygomatic arch osteotomy. You are correct in that the frontal branch of the facial nerve is closeby but it has never been a problem in my experience as techniques are used to avoid it.

Dr. Barry Eppley

Indianapolis, Indiana

The post Is Posterior Zygomatic Arch Reduction Safe? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, Very interested in deltoid fat transfer to make my shoulders wider. I lift weights but have a a small frame naturally. I have never gotten lipo surgery before and am currently at 17% body fat. I would like to have the procedure done if it is feasible and can be successful. Thank you.

A:Thank you for your inquiry and sending your picture. Like all fat transfers the key questions are: 1) Does one have enough fat to harvest and transfer? and 2) how much fat will survive and persist in a young lean athletic frame? On both of these questions you are admittedly on the perimeter of whether the procedure would work. But since the deltoids are a small surface area and do not need a large amount of fat you probably have enough to do so. The more challenging one is survival in someone with a high metabolism into an area that otherwise does not have fat present. But as long as one can accept that unpredictable fate there is no harm in undergoing the procedure.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can Deltoid Augmentation (Wider Shoulders) Be Effectively Done With Fat Transfer? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, My whole midface is kind of recessed which makes my mouth look protruding and my chin look large. Besides I feel my eye socket is too shallow and my eyes look tired. I had rhinoplasty before, the surgeon used cartilage to reshape my nose tip and placed ePtfe implant on my nasal bridge. He also placed 2 small paranasal implants(also eptfe) but they didn’t help much with my condition. I wonder whether midface implant will help with my situation. And if so, how the implant should be designed including the area the implant covered, thickness of the implant and how many pieces of implants are needed etc. I am Asian and usually Asian people prefer round face instead of edge face. I personally don’t like faces that are too round cause they seem lack of bone support. My face is wide and I don’t want to make it wider but I want the apple cheek look. As you can see from the photo my cheek is sort of flat. Thank you for your time and patience and I am looking forward to your reply. 

A: Thank you for your inquiry and detailing your midface concerns and objectives. You are referring to the midface mask implant which is most commonly done in Asian patients. It covers the entire midface from the infraorbital rim down to the maxillary alveolus with the objective of pulling the midface forward but not making it any wider. (see attached) It is a one piece implant placed intraorally. Your existing ePTFE implants would be removed and replaced with this broader surface coverage.

Dr. Barry Eppley

Indianapolis, Indiana

The post Will A Custom Midface Mask Implant Help My Recessed Midface Situation? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I’m looking to make my eyes a bit more symmetrical but I don’t know what sort of surgery that requires or how it might be possible. Looking for more information and potentially surgery! I’ve attached a photo of my face, front camera, and a photo of my face in selfies ! Would love to look more like the selfie (inverse) photo 🙁 

A: As best as I can tell from your picture, you appear to have a left upper eyelid ptosis as the primary reason for your eye asymmetry. Eyelid ptosis surgery therefore would be the appropriate correction. Before any surgery, however, an ophthalmologic evaluation is necessary to determine if there is a medical reason for the ptosis.

Dr. Barry Eppley

Indianapolis, Indiana

The post How Can I Fix My Eye Asymmetry? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, When i was younger my head wasn’t that wide but with time and some jaw problems my temporal muscles got bigger and bigger because of the jaws. Now i feel like my head is a little bit ”too wide” in the temporalis place. When i press the muscles in with my hands i look way better and my skull looks more natural. I don’t know what to do because there aren’t any surgeons who do these kinds of surgeries where I live. Can you reduce the muscles with botox? and how long do that last?.

A: Botox is always a first place to start for temporal muscle reduction when surgery is not an option. It will not have the same effect as temporal reduction surgery but it will produce some modest temporal reduction effects…albeit of a temporary nature.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can Botox Be Used For Temporal Reduction? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I had two questions regarding clavicle lengthening. 1. How much is achievable for bideltoid width for each shoulder? I’m looking for 1.5-2cm on each shoulder. 2. How many times have you performed this surgery and what was the average amount of actual shoulder width gained per shoulder? Thanks.

A: Thank you for your inquiry. In answer to your clavicle lengthening questions:

1) The aim of each clavicle osteotomy is 2.0 to 2.5cms of lengthening per side.

2) Unlike clavicle reduction osteotomies, which I perform regularly, clavicle lengthening is a new shoulder procedure that has been performed just a few times.

3) Like clavicle reduction and shoulder width reduction, the effects of clavicle bone lengthening are essentially a 1:1 relationship of bone length:bideltoid width increase.

Dr. Barry Eppley

Indianapolis, Indiana

The post How Much Can Clavicle Lengthening Increase The Shoulder Width Per Side? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, I’m a relatively young male and over the last 2 years my scalp has been gradually depleted of soft tissue due to a connective tissue disease that I have. I now have several indentations all over my head that were never visible until recently. You answered my RealSelf question about this, stating the surgical options were either fat grafting , or implants. My question is you said that fat grafting doesn’t always work well on the head, why is that? And two, if it were to be implants, would they be super visible on the edges and what would happen if my scalp continued getting deeper dents underneath the implant?

A: Since these indentations are soft tissue based the logical approach would be soft tissue grafting with fat injections. While injection fat grafting placed anywhere always has unpredictable survival/volume retention rates, certain body areas are more favorable while others are known to be less favorable. The scalp is an unfavorable site because it is composed of tight tissue layers that do not naturally have much fat in them. (fat survives best in areas which naturally have more fat) But that being said fat graftng is still the way to initially go and does not mean it would not be effective. Implants would only be considered when fat grafting has proven to be ineffective.

Dr. Barry Eppley

Indianapolis, Indiana

The post Will Fat Grafting Work To Fix My Scalp Indentations? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.

Q: Dr. Eppley, Interested in custom facial implants to balance out facial assymetry caused following orthognathic surgery. This means I have titanium plates (screws?) In my face. Can you still perform facial implants for me? Thank you so much! I have some xrays from a few years back when they took them right after surgery if you needed to see those. I would love to have a balanced profile if you think this could help? Thank you very much!

A: Thank you for your inquiry and detailing your objectives to which I can say the following:

1) The use of custom facial implants to correct disproportions and asymmetries after orthognathic surgery is very common in my experience.

2) All such patients have indwelling metal hardware which is not an impediment to placing implants and in some cases is even removed in the process. (if not overgrown with bone)

3) Custom facial implants require a 3D CT scan for designing which will fully reveal in detail not precisely seen your facial bony anatomy and metal hardware. Thus there is no need for any prior x-rays that you may have.

4) I would a description of your specific facial areas of concern and any pictures that so illustrate for my assessment. My assistant Camille will contact you to schedule a virtual consultation time to discuss further.

Dr. Barry Eppley

Indianapolis, Indiana

The post Can Custom Facial Implants Fix Asymmetries After Orthognathic Surgery? appeared first on Plastic Surgeon | Dr. Barry L. Eppley, MD.