January 27th, 2012
Q: Dr. Eppley, Can you please tell me the cost of a subnasal lip lift? I am not interested in having surgery on the muscle. I only want the lip lift where the skin is removed.
A: A subnasal lip lift should never have the muscle manipulated in any way. That leads to problems such as tightness, columellar base retrusion and an unnatural upper lip movement and smile appearance. In my hands, it is always a skin only procedure. While this may be associated with a 1 to 2 mm relapse in some cases over the first six months after the procedure, it does not in any way affect how the upper lip moves or alters one’ smile.
A subnasal lip lift for most patients is done as an outpatient procedure in an office setting under local anesthesia. The typical cost would be in the $2,200 range.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, subnasal lip lift
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January 27th, 2012
Q: Dr. Eppley, I would like to send some photos so you could tell me the most appropriate surgery to have. I would like a wider face, a less pointy chin, a chin lift and jaw implants. I wore braces to correct an underbite and I had a mandibular osteotomy and genioplasty – the result is a long face. What can I do to bettr improve my overall appearance. I am 39 years old and terribly unhappy with my profile and double chins etc.
A: You have many of the sequeale of orthognathic surgery of the lower jaw which occur from both the surgery and aging. While a sagittal split mandibular advancement osteotomy and genioplasty have undoubtably done wonders for your bite and improved your facial profile, there are some skeletal deficiences from that surgery that have either been created or unmasked with aging that have affected your lower face. Your face has become narrower with that surgery as the jaw angles are usually lost from the ramus osteotomy and the chin becomes more narrower as its u-shape comes further forward. There also appears top be some asymmetry of the lower jaw with the left angular area being more deificient than the right. There is also the effects of aging as the neck has become fuller and dropped down due to soft tissue sagging. Collectively, all of these give you a narrow and longer appearing face with a double chin and obtuse neck angle.
This could be improved by a single procedure combining a chin-prejowl implant, mandibular angle implants, neck liposuction and a limited or short scar facelift. I have done some computer imaging from the front and sides to illustrate what changes may be possible through this approach.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw implants, mandibular angle implants, neck liposuction, short scar facelift
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January 27th, 2012
Q: Dr. Eppley, I am 19 years old and very thin. But still the skin on my face is very loose. When I pull my cheek and jaw skin towards my ears, my face looks chiseled. Otherwise it looks round and slight chubby. I want to know if a facelift is good for me? If not what I can do to improve my face?
A: It would be hard to imagine under any circumstance that a facelift would be warranted on someone your age. Pulling one’s facial skin back does make everyone’s face look more defined as the bony prominences, particularly the jawline and chin, become more pronounced. But that does not mean that a facelift (neck-jowl lift) is warranted. A facelift’s primary objective and indication is for skin laxity and sagging not to make the face appear more sculpted. (although it can create that secondary effect) You are likely in need of facial procedures that provide enhancement of your facial bone prominences, such as the chin, cheeks or jaw angles. Such facial implants can help create a more defined or chiseled face. But a facelift is definitely not what you need.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, facial implants, indianapolis
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January 27th, 2012
Q: Dr. Eppley, I am 36 yrs old and have been wearing padded underwear since I can remember. I am ready to have a bottom of my own that I can feel good about.This is my only insecurity and I am ready to do something about it. I want to be able to for the first time fill my jeans out and not have a belly that hangs over them.
A: There are two types of patients that seek buttock augmentation. The first and by far the most common is the patient who simply wants to make larger what they already have. They do not really have buttock hypoplasia or underdevelopment but want to enhance what they already have. This is very common in certain ethnic groups, particularly African-Americans and Hispanic women. The second group and the least common is the patient who really has not buttocks at all. They are completely flat and may even have resorted to padding as you have described.
This second group is the most challenging to treat because they have little to no subcutaneous fat in the buttocks and small gluteal muscles. This makes the recipient site for the most common method of treatment, fat injections (aka Brazilian Butt Lift), very limited. Often they may be quite thin as well without adequate fat donor sites. This leaves them the only option of an actual silicone buttock implant. Such implants can be very effective but they are associated with a longer recovery and other implant-related risks.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brazilian butt lift, buttock augmentation, buttock implants, dr barry eppley, indianapolis
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January 27th, 2012
Q: Dr. Eppley, I had breast augmentation six months ago and I feel that my implants are way too small. (I got Mentor 275cc silicone moderate plus gel implants placed under the muscle) I thought they were too small from the beginning but my surgeon said I would get used to them and come to feel that they were just the right size. I never have and I wear the same bra size as before surgery. When can I get new implants and what size implant should I get?
A: While some women come to accept the size of their breast implants, whether they are a bit too small or too big, they do not if the size is way off from what they expected. You have given it enough time after your initial surgery to try and accommodate to them and it is obvious that you can not. You can have replacement surgery at any time at this point. The implant size you should have based on your desires is based on information that I do not have such as breast base diameter, what your chest and body looks like and the ‘look’ of your breasts that you visually desire. But when changing out implants for a breast augmentation revision to go to a bigger size, there is one rule that I have learned. Make sure that the new implant volume is at least 30% or more from what you have now. Otherwise it will not create enough of an external visible difference. This means in your case of at least 100cc or 375cc to 400cc implants.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant exchange, breast implant revision, dr barry eppley, indianapolis
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January 27th, 2012
Q: Dr. Eppley, I had gastric bypass surgery two years ago. I lost 90 lbs and my weight has been stable over the past year. I am now ready to get rid of my loose skin around my waistline. I want an adominoplasty that is extended to lift up the thighs a little, as demonstrated in some photos that I have attached. I don’t know if that will be enough skin removed though so a belt lipectomy / body lift may be necessary. What do you think?
A: Thank you for sending your pictures. They are well detailed and I have reviewed each one. There is no question about the need for a complete abdominoplasty in the front. Ideally the most abdominal tightening would come from a combined horizontal and vertical cutout pattern. (fleur-de-lis tummy tuck) But the addition of a midline vertical abdominal scar may not be worth the transverse tightening that it provides. You are correct in assuming that a circumferential body lift is really needed to get the type of lifting in the upper thigh and buttocks that you have illustrated. Compared to many extreme weight loss patients, you actually have less excess skin around the waistline and into the back than most. Some such patients may consider the scar goiing across the back as undesireable in order to gain a buttock lift. That is a personal decision and it is just a question of the amount of scar created vs the amount/extent of lifting that one desires.
While a circumferential body lift will provide some upper thigh lift, it will not deal with much of the loose skin in the thigh that extends nearly down to the knees. This requires an independent thigh procedure which should not be performed at the same time at the body lift due to concerns about the vascularity of the intervening skin.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: belt lipectomy, circumferential body lift, dr barry eppley, indianapolis
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January 26th, 2012
Q: Dr. Eppley, I had a facelift and upper and lower blepharoplasty a year ago. I always had a youthful round face. The facelift did give me a nice neckline and tighter skin, but changed the shape of my face which now looks thinner and older. Now I am considering fat transfer to restore my face to a more rounder look. Should I have the fat transfer in the malar area or submalar or both. Iam afraid I could get my jowls back. My face used to have the shape of Valerie Bertinelli’s if you know that actress. Thanks for your advice.
A: While facelift do a nice job of redefining the jawline and neck, tightening facial skin in some patients can make their face more gaunt in appearance. This can counteract the favorable anti-aging effects of the skin tightening. This is particularly prone to occur in Caucasian females who have a thinner face to begin with. This is why many plastic surgeons today, myself included, advocate a combination of fat injections for volume and less skin tightening for this type of facelift patient. The injections will usually be in the submalar and lateral facial area. Whether the fat injections should extend up onto and across the malar area would depend on what your facial skeletal structure is like. Flatter cheeks would benefit by some volume but strong cheekbones will not. The real benefit of fat injections in facial rejuvenation/facelifts is in the submalar or buccal area and extending outward and down from that area. I would have no concern about recurrent jowling from the fat injections as they do not fall because of their linear placement.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial fat injections, fat injections after facelift, indianapolis
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January 25th, 2012
Q: Dr. Eppley, I am primarily concerned with the lower third of my face. I think my chin is too long and pointy which contributes to the long, thin face look. Do you think a chin reduction combined with jaw implants or a pre jowls chin implant would do the trick? If so, do you perfom such procedures? Do you have any other suggestions as to how I could improve my facial features? Please do not be afraid to hurt my feelings!
A:Thank you for sending your pictures. Your long thin face is partly the result of a long sweeping jawline with a modestly steep mandibular plane angle. This makes for a lower face that appears vertically long. This is magnified by the observation that your midface (cheek and paranasal areas) is relatively flat/recessed. That combination makes for what you see,, a face that has a greater vertical component than horizontal projection and width.
To address this concern, I would recommend a chin osteotomy which, based on the angle of the cut, allows the chin to become vertically shorter as it comes forward. You need both a mild amount of horizontal increase with an equal amount of vertical reduction. Only an osteotomy can make this bony chin movement possible. In addition,. I would place jaw angle implants that both widen and vertically drop the jaw angles downward. Between the chin and the jaw angle changes, the lower third of your face would become shorter and wider. That will help counter the long thin face look. I have attached some predictive imaging to illustrate these changes.
The other change that would be helpful is cheek augmentation. That would bring the midface more forward, again a manuever that counters the vertical and thin (horizontally deficient) facial appearance. I have attached an image that shows where this cheek augmentation would be. Your pictures are not of a good enough quality to really show what cheek augmentation can do.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, jaw angle implants
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January 25th, 2012
Q: Dr. Eppley, I am a 56 year-old man who has always had a weak chin. While I have always wanted to do something about it, I could just never get the nerve to go in and see a plastic surgeon. My girlfriend has given me the encouragement to now do and I am going to make the move to see what is possible. Could you give me some direction in what you think I need? I think the problem is more than just a short chin, my overall jaw just seems smaller. I don’t want to get a chin implant placed on the end of my jaw if it does not look right or natural. I have attached some photos of me from the front and side for your evaluation.
A: Having a weaker jaw/chin in an older male always raises questions about both bone and soft tissue management since there is some degree of sagging of the jowls and neck. While you would undoubtably be helped along the jawline with a facelift (neck-jowl lift), I am going to pass over that issue for now as dealing with the bony deficiency should always been done first. Since a lower facelift affects the posterior jawline and neck angle the most, it would have its greatest effect on the jaw angle area. Whether you would benefit by jaw angle augmentation or a total jawline procedure is unclear to me at present. (and also unlikely) Therefore for this discussion I am only going to focus on your chin deficiency and submental fullness which are your biggest facial imbalance issues.
What you need is a chin implant and neck liposuction/submentoplasty. The question is whether a preformed or off-the shelf chin implant will work or whether a custom implant is preferred. Both will make positive changes. It is just a matter of degree and how substantial that change is. You do have both horizontal, vertical, and transverse (width) chin deficiency which is common when the chin is very weak. The problem, as you have accurately pointed out, is really an overall jaw growth issue not just a simple short chin. This makes the entire lower face short in every dimension.
I have done some predictive imaging based on both off-the-shelf and custom implant approaches so you can get a feel for how the two type of chin implants differ. A custom chin implant will address all dimensional deficiences. and produce a more profound change..if one finds that look appealing.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin augmentation, custom chin implant, dr barry eppley, indianapolis
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January 25th, 2012
Q: Dr. Eppley, I just had a old tragus piercing split. Is this something that can be stitched back together or will the skin grow back? Or does it require plastic surgery? If the latter, will it look normal after plastic surgery? Thanks.
A: While piercings are common on both the earlobe and the tragus of the ear, there is one anatomic difference between them. The earlobe is completely comprised of soft tissue, skin and fat only, and this is what holds the piercing in place. The tragus, however, has a central core of cartilage with skin on top. It is the cartilage which holds piercing in place and it is usually much more secure and resistant to stretching unlike the earlobe. When a tragal piercing splits, presumably by it being pulled on, the underlying cartilage may have split as well.
Like the earlobe, a tragal split will heal on its own due to the excellent blood supply. Whether it will heal with a notch or cleft in it is impossible to say. I would allow it to heal on its own and see what it looks like later. Scar revision can always be performed of the contour of the tragus is not perfectly smooth.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, ear piercing split repair, indianapolis, scar revision, tragus ear piercing split repair
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