Archive for April, 2010
Friday, April 30th, 2010
Q : I had my lower eyelids tucked (blepharoplasty) over 6 months ago. While my lower lids look much better, I have had a problem with dry eyes and tearing since the surgery. It was really bad right after and has gotten somewhat better. It is almost painful to be out in direct sunlight and my eyes really tear if there is any wind. My lower eyelid also doesn’t look right. I think I show more whites of the eye than before and it looks pulled down. My doctor keeps saying to give it more time and it will get better. But it has been some time now since surgery and I just don’t see it happening. What do you suggest? By the way I am a women who is 58 and I still have to work!
A: One of the potential, although fortunately uncommon, risks of lower blepharoplasty surgery is ectropion. This sounds like exactly what you have.
The lower eyelid, unlike the upper, is like a clothesline strung out between the inner and outer eye socket bones. The eyelid is attached to the bone by tendons called the canthal tendons. This clothesline effect keeps the lower eyelid snugged up against the eyeball just at the lower edge of the iris. By being tight up against the eyeball, it is protected from drying out and being irritated. Any slight change, even one millimeter, between the eyelid and the eyeball (out or down) will cause eye symptoms of dryness, irritation, and tearing. Manipulation of the lower eyelid through surgery can disrupt this relationship if the eyelid and the lateral canthal tendon are snugged back up properly as part of the operation.
While small amounts of ectropion may correct itself with the passage of time and upward massage, six months with this degree of symptoms indicates another approach is necessary. Performing a canthopexy or canthoplasty (tendon tightening and eyelid re-suspension) and retightening of the outside eye corner can provide an immediate solution to this very irritating problem. Once the lower eyelid is back tight against the eyeball, it will not only look better and more natural but the eye is protected once again.
Dr. Barry Eppley
Tags: canthopexy, canthoplasty, dr barry eppley, extropion, eyelid surgery, indianapolis, lower blepharoplasty, plastic surgery
Posted in Your Questions | No Comments »
Friday, April 30th, 2010
Q : I am interested in reshaping my forehead. When I was a child I was diagnosed with craniosynostosis of the middle forehead suture which I think is called the metopic? I had infant cranial reshaping which I am sure helped a lot but since I was so young I can’t remember what it used to look like. I have been bothered by the shape of my forehead since I was a teenager. It appears too narrow for a male and has a slight vertical ridge down the middle of the forehead. What can I do about it now? I am a male and am 24 years of age.
A: What you have is the secondary sequelae of correction of an initial metopic craniosynotosis. That initial surgery is designed to bring out the sides of the forehead (temporal area) which helps create a more normal forehead contour. While this initial surgery is often completely curative, older styles of this form of cranial reconstruction often produced suboptimal results, leaving patients with a minor form of residual metopic craniosynostosis. This is seen as a residual bitemporal narrowing and the hint of the vertical midline ridge.
Secondary forehead reshaping can be done that is infinitely simpler than the initial cranial reconstructive procedure. Rather than bone removal, material is added on the outer surface of the bone. This is known as an onlay or frontal cranioplasty. Using the initial scalp incision, the forehead skin is peeled back to expose the bone. Then using either PMMA (acrylic) or HA (hydroxyapatite, my favorite) material, the bone is reshaped through an onlay spackling method. Any irregularities are smoothed out through an additive approach. Deficient areas are built up and made confluent with the surrounding cranial contours. Emphasis for this problem is on both smoothing the forehead and building up the still deficient temporal areas. This is a relatively simple procedure for those plastic surgeons with training and experience in craniofacial surgery.
Dr. Barry Eppley
Tags: craniosynostosis repair, dr barry eppley, forehead reshaping, frontal cranioplasty, indianapolis, plastic surgery
Posted in Your Questions | No Comments »
Tuesday, April 27th, 2010
Q: I am interested in breast implants. After I lost all my weight (was originally 198 lbs), I have a muscular body but I have NO BREASTS!!! When I was heavy, my cup size was 40D. Now I wear 32B and you can see my ribs all the way down to my stomach. I workout every other day to stay in shape.
A: One of the few negative side effects of weight loss, like pregnancy, is the loss of breast tissue and volume. The more weight that is lost, the more breast volume that disappears. This is particularly seen after bariatric surgery where the weight loss may be 100 lbs or more. Many such women end up with no breast tissue at all and just two hanging empty skin envelopes.
Breast implants will definitely provide a return of volume but the key question is how much loose skin remains. If the amount of loose skin is only moderate and the nipple position remains at or above the lower breast fold, then an implant alone will be adequate. If, however, the amount of loose and hanging skin is more significant and the nipple is below the lower breast fold or pointing downward, then a breast lift may be needed as well as a breast implant.
Breast augmentation in some weight loss patients presents challenges to the plastic surgeon than one does not usually have in the typical small-breasted female. How much loose skin exists, and the key issue of current nipple position, can turn what appears to be a simple breast implant procedure into a more complex breast implant and lift procedure.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis, plastic surgery, weight loss
Posted in Your Questions | No Comments »
Tuesday, April 27th, 2010
Q: I have been infected with HIV for 31 years, and have seen every one of my former friends and acquaintances succumb to AIDS. For some reason meds have always become available just in time to save my life. For that I am thankful But my life feels hardly worth living with the disfigurement of facial lipoatrophy and pain of buttock lipoatrophy. My face is so gaunt it is horrible and I have not butt at all!
A: One of the very unique effects of anti-viral medications in the management of HIV/AIDS is their effects on fat wasting or lipoatrophy. While much of the body (but not all) is affected by this fat loss, the face and the buttocks are frequent areas of aesthetic concern.
Facial lipoatrophy can be treated by two potential methods. The non-surgical approach is with the use of Sculptra injections. This is an FDA-approved injectable material that is essentially the placement of crystals or ‘seeds’ of a resorbable polymer that promotes collagen formation. It requires a series of injections over time to get a sustained response. The injections are placed in the cheek and submalar areas where the hollowing is the worst. While there is the possibility of a foreign-body reaction or granulomas with its use, good technique can minimize that risk. This injection material is not permanent and must be repeated every year or so once the desired result is obtained. From a surgical standpoint, cheek or submalar implants can be used which is actually my preferred approach. The procedure is simple, is done from incisions inside the mouth, and the volume obtained is permanent. Once can then use Sculptra to further highlight and feather the result out further into the face if desired.
Unlike the face, there is no good solution for the buttocks. Fat injections are not a good idea as there is no fat to harvest in most HIV patients and it will likely be absorbed anyway even if there was. Buttock implants are a possibility but the pain of recovery and the risk of infection may this procedure unappealing.
Dr. Barry Eppley
Tags: buttock implants, buttock lipoatrophy in HIV, cheek implants in HIV, dr barry eppley, facial lipoartrophy, HIV lipoatrophy, indianapolis, plastic surgery, sculptra
Posted in Your Questions | No Comments »
Monday, April 26th, 2010
Q: I am interested in receiving a jaw and chin augmentation. I live in Canada. I have a consultation scheduled with a local plastic surgeon in a week, however I see that Dr. Eppley is very experienced in the procedures I am interested in. My question is do your do consultations over the web? If so, I would like to schedule one. I would like to have the procedure done this summer.
A: The internet has enabled patients to access information from anywhere in the world. This is no less true in plastic surgery. Through the free internet service, Skype, phone or video discussions are easy to set up and do. While this video conversation method is not a replacement for having an actual consultation in a plastic surgeon’s office, it can be a great first step where you can actually talk directly to a plastic surgeon without leaving the comfort of your own home or city.
I have offered free Skype consultations for over a year and have interacted with people from all over the world. To take advantage of this opportunity, go to the Skype website, download the application and register under your name. Registration is free and takes but a few minutes.You will then need to add me to your contact list. My Skype contact name is dr.barry.eppley. Add my name to your contact list. I will get a message requesting me to add your contact to my list. Once I have done so, you will get a message confirming so. You can then send me a message describing what your plastic surgery needs are. We will then work out a convenient time to get together on Skype for an in-depth conversation.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, plastic surgery consultations, skype plastic surgery
Posted in Your Questions | No Comments »
Monday, April 26th, 2010
Q: I had an otoplasty performed about 2 years ago. Although very pleased with the initial result, I feel the upper third part of my ears have relapsed to a more prominent position. I heard of a procedure using sutures between the root of the helix and the temporal fascia to correct this problem without going through the whole traditional otoplasty procedure again. Is this something that you are familiar with? Are the incisions well hidden? And is this a well accepted method?
A: Otoplasty, or ear pinning surgery, involves the use of sutures on the backside of the ear to reshape it. These sutures are used to create or make more pronounced the antihelical fold, whose absence is often the primary cause of an ear that sticks out too far. These antihelical fold sutures are known as Mustarde or horizontal mattress ear sutures. Another contributing cause to the protruding ear is a large concha. The conchal prominence of the ear can be reduced by sutures between it and the mastoid known as concha-mastoid suturing. Often many otoplasties require a combination of both types of sutures to get the best result.
Many otoplasties experience a mild degree of relapse months to years after surgery. This can be due to slipping of the sutures but is most commonly the result of cartilage relaxation over time. This is usually very mild and not bothersome to the patient as the change has been so dramatic that even some relapse still leaves one with a pleasing change.
In a few cases, the relapse is most noticeable in the upper ear area. This region has the least suture support and is above the level of the concha where both types of sutures may have been used. This is an easy problem to fix by placing an additional horizontal mattress suture or two in the upper area. This can be done by reusing just the upper portion of the original incision on the back of the ear. It can be done under local or IV anesthesia and without the need for a head or ear dressing afterwards.
Dr. Barry Eppley
Tags: dr barry eppley, ear reshaping, indianapolis, otoplasty, plastic surgery, revisional otoplasty
Posted in Your Questions | No Comments »
Sunday, April 25th, 2010
Q: I am interested in forehead reshaping. I have a very large forehead which I know takes away from my appearance and I’ve been teased about it alot. How is this procedure done?
A: The forehead makes up one-third of the total face and is frequently overlooked as having a major contribution to one’s appearance. Only when something about the forehead is ‘wrong’ does one take notice of its facial significance.
When a patient feels that they have a forehead problem, they are usually referring to two potential concerns or problems. The issues are usually its shape, which is a reflection of the underlying shape of the bone, or of its length or height, which is a the result of the amount of skin between the frontal hairline and the brows.
Forehead bone problems could be irregularities, bumps or high spots, prominent brow bones, or the narrowness or width of the forehead from one temple to the other. Such forehead problems are treated with frontal cranioplasty procedures where the bone can be reduced or added by different materials. This does require an open approach with a scalp scar needed for access. But with this wide open visibility, a wide array of bone reshaping and contouring can be relatively easily done to the frontal and brow bones.
Too high a forehead or too long of a forehead is a matter of skin reduction. This procedure is essentially a ‘reverse browlift’ where the skin is removed through an incision at the frontal hairline. Instead of the brows coming up, the frontal hairline comes down thus shortening the visible forehead skin to 7cms or less in vertical length.
Dr. Barry Eppley
Tags: brow contouring, dr barry eppley, forehead reduction, forehead reshaping, indianapolis, plastic surgery
Posted in Your Questions | No Comments »
Sunday, April 25th, 2010
Q: I am interested in having small cheek implants and was wondering who you would recommend I see in the Washington-Baltimore metropolitan area. I have spoken to several plastic surgeons who say they remove more cheek implants than they put in. I am wondering who has had good results with this procedure?
A: I wish I could answer your question in regards to plastic surgery referral in your geographic area. But, unfortunately, I could not tell you with any assurance who gets good results with cheek implants. While I am certain all plastic surgeons say that they do them, who would be better than other is impossible for me to know. (just like you)
What I can tell you about cheek implants is that what you have heard about them are true. Even though it is a very simple operation, they are the most revised and/or removed implant of all the facial implants. The reason that exists, in my experience, is that they are often oversized for the patient. Cheek implants are much better to be done in moderation or ‘underdone’. Cheek augmentation should be subtle, not dramatic. It is not like a breast implant, where many times bigger may be better. That is never true with a cheek implant. The second reason they are revised is that the cheek implant is unique in its position. It is the only facial implant that is literally ‘hanging on the side of the cliff’ in where it is placed on the cheek bone. So they are prone to movement and asymmetry between the two sides afterwards. That is why I prefer to secure them with a screw to the underlying bone to prevent that problem. Lastly, there are at least 5 different styles (not to mention sizes) of the implants, so matching the unique anatomy and patient desires with the right style and size of cheek implant is certainly more art than it is science.
Dr. Barry Eppley
Tags: cheek augmentation, cheek implants, dr barry eppley, indianapolis, plastic surgery
Posted in Your Questions | No Comments »
Sunday, April 25th, 2010
Q: I have a problem with my profile. I wish it would look normal or see my jaw line. I always wished to see it. I think this is because I used to sleep with my mouth open when I was a child. I also a rhinoplasty by a bad doctor who made my nostrils asymmetric.:( This was 4 to 5 years ago. I went to someone who offered the lowest fees since I wasn’t earning much at the time. I would like to come to the states from Egypt for corrective surgery.
A: When most people talk about happiness with their profile, they are almost universally referring to the position of their chin. Based on how the lower jaw (mandible) grows and the bite (occlusion) comes together, the horizontal or forward position of the chin will be affected. For most it is an issue of being too short or not ‘strong’ enough particularly in men. Too much chin is far less of a problem although it does exist and it is more of a concern in women rather than men.
Correction of chin shortness can be done with either an implant or osteotomy. (moving just the chin bone forward) Which is better is determined by multiple factors including the amount of chin shortness, age of the patient, and the position of other chin dimensions. (e.g., vertical height) How much or far forward the chin position should be moved can be determined prior to surgery with computer imaging.
Nostril asymmetry after rhinoplasty is not rare and does not necessarily occur because of a ‘bad’ surgeon or that the operation was performed incorrectly. Even a rhinoplasty executed perfectly can still cause some differences in the shape of the nostrils after all is healed. The nostril shape is influenced by the support of the lower alar cartilages and the overlying skin. Both of these can be altered by the healing forces after rhinoplasty, particularly in the soft triangle area of the nostril where there is no cartilage support to resist the contractile forces of scarring. Secondary correction of nostril asymmetry is possible through cartilage or chondrocutaneous grafting of the nostril rim.
Dr. Barry Eppley
Tags: chin augmentation, chin implant, chin osteotomy, correction of nostril asymmetry, dr barry eppley, indianapolis, plastic surgery, rhinoplasty
Posted in Your Questions | No Comments »
Friday, April 23rd, 2010
For most Americans, the war in Iraq is far away and none of us can really comprehend what it must be like to live there. Living and working in an environment where uncertainty, the military presence from any side, and the potential to not be here tomorrow is an everyday reality that can not be fathomed from afar. More germaine to us is the trivial problems of do I have time to make it to Starbucks today, should I get an iPad or not, and searching for the best travel deal on the internet.
But as some form of normalcy tries to return to war-torn Iraq, there is a phenomenon they we as Americans can recognize. According to a CNN report, beauty salons are beginning to reappear and some people are even looking to cosmetic surgery for personal improvement. Even in Baghdad where buildings are pockmarked and scarred, billboards have appeared advertising for beautification procedures.
As one young Iraqi female was interviewed about her upcoming nosejob (rhinoplasty), she stated she never cared much for her nose and wanted her face to be prettier. When asked about the vanity of cosmetic surgery given her circumstances, she stated that it was nothing out of the ordinary even for an Iraqi. Because of the internet, satellite channels and television, they see people having these types of cosmetic surgeries done and they look better after. Seeing such things encourages them and gives them an incentive to get cosmetic surgery. Iraqi women have always prided themselves in the Arab world for their looks and style and taking care of themselves is a matter of national pride. As a result, the women are happy to spend their hard earned money to make themselves look as good as they can.
An increasing number of Iraqis appear to be electing to undergo cosmetic surgery for the simple reason that most Americans do…because they can. Changing the face of Iraq for some appears to have a different meaning.
But the emergence of cosmetic surgery out of war is not a new phenomenon. Most people don’t know that most of the common cosmetic procedures performed today had very humbling and catastrophic origins. Plastic surgery today has been highly influenced by the world wars of the last century. Working on the war wounded leads to the development of surgical techniques that have more universal applications. The trench warfare of World War I, for example, has led to many modern-day facial procedures. (it was generally not a good idea to stick your head up out of the trench too frequently) Rhinoplasty surgery was highly influenced in World War II by ethnic masking of the Jews through alteration of the nose. Dental implants were first used to bridge jawbone war defects. The list continues for dozens of plastic surgery procedures that we assume came out of pure imagination.
Will anything new in plastic surgery come out of the Iraq/Afghanistan conflicts…one never knows. But the desire for people to look and feel better is universal. Even in a country like Iraq that has been ravaged by decades of war, beauty and cosmetic procedures bring hope and a feeling of self-improvement. When you have so little to say in what goes on around you, making changes in your own little world can provide some personal empowerment.
Dr. Barry Eppley
Tags: dr barry eppley, indianapolis, iraqi war, plastic surgery
Posted in Newspaper Articles | No Comments »
|
|
|
|