Archive for May, 2010
Monday, May 31st, 2010
Q: Where to start? I had a chin reduction at a hospital overseas in 1992. I have never been happy with it. I have always been so self conscious that it looks odd to people when they see me from certain angles. I also felt that it was too extreme and not what I had pictured the result would look like. I also have a metalplate in my chin and too much fatty tissue in the front chin area. Is it possible to have the chin operation redone so it looks better? Or is a chin implant the answer for me?
A: Chin reductions can create unhappy results if not done properly. When you reduce bony support, you have to account for the overlying soft tissue. Reducing bone requires stripping off all of the chin pad tissues, there must be a way to satisfactorily reattach it and reduce or tighten these soft tissues. If not done, the chin bag will sag down and look like a lump of fatty tissue. Doing a chin reduction without simultaneous soft tissue management is akin to doing a breast reduction but without reducing and tightening the loose overlying skin.
There are three approaches to managing a sagging or ptotic chin pad. They include an intraoral muscle resuspension, a submental chin tuck-up, and the placement of a chin implant. Which approach is best depends on how on much the chin pad sags and one’s facial profile and appearance. If one is happy with their profile (chin not deficient), then either a muscle suspension or a submental tuck-up will work. The difference between the two depends on much tissue there is to tighten and whether one can accept a scar under the chin. If one feels that their horizontal chin position is short, then a chin implant would be preferable.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implants, chin ptosis repair, chin reduction, dr barry eppley, indianapolis, plastic surgery
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Monday, May 31st, 2010
Q: I want to get my outie turned into an inne bellybutton. I don’t care for how it looks now, I think it looks weird. I have always wanted to get it fixed so I could look like everyone else. Can you tell me about how this is done and what is involved?
A: Belly buttons are nothing more the formation of scar and is actually the body’s first scar. The umbilical cord, which supplied precious nutrients to the unborn baby, is clamped off shortly after birth. It is clamped off an inch or two from where it exits from the baby’s stomach and the placenta and much of the cord is removed. The remaining stalk of the umbilical cord goes on to die and fall off, leaving a small scar we know as the belly button. For most people (90%), the scar is concave and is an innie. For the remaining 10%, the scar tissue protrudes slightly from the body creating an outie.
An outie can be changed to an innie with an umbilicoplasty procedure. This is a small outpatient operation done under IV sedation or local anesthesia. A small incision is made on the inside of the belly button. Scar tissue between the underside of the bellybutton and the abdominal wall is removed. The underside of the outie is then swen down to the abdominal wall, changing its appearance to an innie. Dissolveable sutures are used and the only dressing is a band-aid. One can shower the next day and not worry about getting the area wet. One should avoid strenuous exercise for one week and no sit-ups or crunches for one month after the procedure.
In women who have had children, their outie could be an umbilical hernia particularly if it did not exist prior to pregnancies. This is a common finding during tummy tuck surgery. Since you are a male, your outie is unlikely to be a hernia.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, innie bellybutton, outie bellybutton, plastic surgery, umbilicoplasty
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Monday, May 31st, 2010
Watching the crowd today at the Indy 500 in 90 degree heat with open skies, many no doubt wished that they had a better sunscreen. Perhaps some wished they had some sunscreen, any sunscreen for that matter. But for those who had the forethought to pull some sunscreen out of the closet or buy some on the way to the race, they probably couldn’t tell the difference between the numerous brands. The usual public mindset is that they are pretty much all the same and slathering on something is better than nothing at all.
What most people don’t know is that most sunscreens only protect against ultraviolet B rays. Most sunscreens don’t provide sufficient protection against skin damage that is caused by a much larger percent of the ultraviolet spectrum, ultraviolet A rays. (UVA) It is these UVA rays that contribute to wrinkling, freckling, brown spots and skin cancer since they are the same strength all year, all day long. They penetrate glass and is why your left face and left arm frequently develop greater skin damage from the sun exposure gotten during decades of driving.
While some sunscreen manufacturers now carry combined UVA and UVB protection ingredients, the lack of FDA regulation makes their claims confusing and often misleading. One would think that the same federal agency that regulates medical drugs would have long ago set standards for sunscreen performance and ingredients. But that is not the case. This is particularly peculiar given that every other industrialized nation uses UVA protection with specific guidelines. The FDA has stated that they will be releasing sunscreen recommendations in the fall. But until then another summer will pass with most people not knowing what they are actually putting on their skin.
If you are a teenager or in your 20s, the thought of skin cancer is as remote as the need for Botox or developing an unflattering neck wattle. But recent statistics show that more than 2 million people in the United States are diagnosed with skin cancer per year. This is an almost shocking two to three times increase from just twenty years ago. And most of these are directly related to sun exposure. The seeds of these skin cancers are sewn at the very age when one thinks the least about it.
The myths of sunscreen claims are numerous. Besides not knowing whether they really are as effective at blocking the sun rays as they state, many other label claims are more than just misleading. Such proclamations as ‘all day protection’, ‘waterproof’ and ‘sweatproof’ have no scientific basis and are simply not true.
The only reliable sunscreen claim is SPF (sun protection factor) which blocks UVB rays. But manufacturers use this well recognized sunblock factor to sell more sunscreen. With common SPF numbers of 15, 30, 45 and greater, one would logically think that the sunburn protection would be substantially better as the number gets higher. But the truth is that SPF 15 blocks 94% UVB and SPF 30 blocks 97% UVB. Beyond that there is no real improvement in sun ray blocking effect.
Until the FDA regulates sunscreen, the best approach is to use a dual protection UVB/UVA combination that is SPF 30 rated. UVA blockers avobenzene and meroxyl are becoming more widely used now in these broader spectrum sunscreens and they may last up to five hours. Reapplication should be done if the one sweats heavily or goes swimming. They are certainly pricier than what most are used to paying for it but is worth it for not getting skin cancer.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, skin cancer, sunburn, sunscreens
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Sunday, May 30th, 2010
Q: I am 65 years old and am extremely bothered by my turkey wattle. I do not look my age except this makes me very self conscious. I want to get rid of it with some type of neck procedure. What do you recommend?
A: Sagging or drooping of one’s neck is one of the most bothersome features of facial aging. While some people would never consider undergoing a ‘facelift’, they want some type of neck procedure to deal with their most troublesome age-related issue.
Aging necks are referred to many uncomplimentary names such as turkey neck and neck wattle. Some people become initially aware of it when they see themselves in profile in a photograph. Others notice it, particularly men, when wearing certain shirts and certainly in a shirt and tie. Others do not like, understandably, that it can be felt to move or flop when turning their head. (in more advanced aging)
Interestingly, some people would consider a necklift but wouldn’t dare undergo a facelift. This comes from a misunderstanding of the two procedures, not realizing that they are largely one and the same. I have found only a handful of patients in my Indianapolis plastic surgery practice who actually knew what a facelift really was.
A facelift is primarily a necklift. The type of facelift determines how much improvement in the neck is obtained. A limited facelift (aka Lifestyle Lift) has a minor effect on neck sagging and is best for just minor neck problems. It is primarily a jowl changing procedure. A full facelift is a powperful changer of the aging neck. The differerence between the two is the location and extent of the incisions around the ears. To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the occipital scalp. It is the pull from behind the ear that changes the neck. You can demonstrate this quite simply with your fingers in front of a mirror. A manuever that many patients with aging faces have done regularly.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, facelift, indianapolis, neck aging, neck wattle, necklift, plastic surgery
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Sunday, May 30th, 2010
Q: I have a large bump on my nose and a long pointy nose to boot. My girlfriend tells me it looks ‘birdlike’. I also have trouble breathing through the right side of my nose. Can you help me get my health insurance to pay for my nose surgery?
A: Nose surgery can be divided into two areas, internal and external. Internal nasal surgery, often called septoplasty, is done to try and improve one’s breathing through the nose. This usually involves straightening of a crooked septum (septoplasty) and reduction of the size of the inferior turbinate bones. (turbinectomy) External nasal surgery, known as rhinoplasty, is done to change the shape of the visible external nose. When internal and external nasal surgery is done together, which is common, is called septorhinoplasty.
Internal nasal surgery is almost always covered by health insurance because its purpose is to improve a medical function, breathing through the nose. External or rhinoplasty surgery is not covered by insurance because it is changing appearance which is a cosmetic objective…unless the shape of the nose is the result of a traumatic injury, a birth defect (such as cleft lip and palate) or from removal of cancer.
Many patients are under the false belief that they can get their rhinoplasty covered by insurance because they have trouble breathing through their nose. While the breathing part may be covered, the rhinoplasty portion is the responsibility of the patient. The costs of that portion of the nose operation is given to patients in advance of the surgery date as it has to be paid prior to surgery being performed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, health insurance, indianapolis, plastic surgery, rhinoplasty
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Saturday, May 29th, 2010
Q: have a older button style chin implant and would like to replace it with a new one. I want a chin implant that creates a more masculine look with lateral fullness in the mandible area and a more squared off appearance to the chin. I would also like to have a lip reduction to rebalance my facial proportions so that the jaw line is more prominent and the lips less so. Let me know if this is something you can do all at the same time.
A: Older style chin implants were much smaller in size and ‘non-anatomic’ in shape. They usually just fit over the central part or button of the chin, providing only central horizontal augmentation. While such chin augmentation shape can be acceptable in some patients (usually females), it does not provide the best chin shape in most males. It makes the frontal chin shape too triangular. In men, squaring of the chin shape produces a much more pleasing facial change. While profile views shows good horizontal advancement, patients do not usually see themselves that way and using that view as a judgment of the final result can be deceiving.
Today, chin implants come in a wide variety of styles and shapes that can achieve more than just a simple gain in profile lengthening. Men, in particular, often want a more masculine chin look which means a more square frontal shape and one that blends into the side of the jaw without an obvious transition. In addition, some increase in vertical length is often aesthetically desireable.
Chin implants can easily be exchanged in styles and size, regardless of whether they were placed from under the chin (my preference) or through the mouth. Pocket size and positioning may need to be altered but this does not usually involve the extent of dissection and postoperative discomfort that occurred from the first chin implant placement procedure.
Lip procedures can easily be done at the time of chin augmentation, particularly if the path of implant insertion is done from under the chin. (submental incision)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin augmentation, chin implant, chin implant exchange, dr barry eppley, indianapolis, plastic surgery
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Friday, May 28th, 2010
Q: I was in a car accident several years ago and had some bad lacerations to my face. While they were sutured up by a plastic surgeon thaty same day, they have turned into some bad-looking scars. I would really like them to look a lot better. I know they can not be made to go completely away but do you think laser surgery would help? Thanks for your time.
A: The use of lasers in scar revision is useful but largely over rated. Lasers are not a magic tool for erasing scars or other skin imperfections. The public’s perception of that highly desirous quality is a function of adventurous marketing and the ‘Star Wars’ effect which still persists even today.
Most scars are a full-thickness skin injury, meaning what you see on the outside exists the whole way through the skin. Lasers are a partial-thickness skin removing tool. As a result, it is easy to see why a laser can not remove a scar. The problem and the solution are not well-matched.
Lasers have a role is scar revision but it is more for creating a smoothing effect and often is used after other scar treatments are done. The most common scar treatment is surgical excision, cutting out the scar (full-thickness) and making the scar line thinner or changing the way the scar line runs.
Because of their more superficial effect, lasers are better at removing or lessening wrinkles and other more minor skin imperfections.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, laser scar treatment, plastic surgery, scar revision
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Friday, May 28th, 2010
Q: I am tired of looking older. My jowls are getting bigger and my neck is starting to really sag. I hate to consider the thought of a plastic surgery procedure like a necklift but I am going to have to do something in the near future. I don’t mind getting old per se, I just don’t want to look old! I have read that there are different types of facelifting procedures. How do I know which one will work for me?
A: A facelift is a plastic surgery operation that changes the lower third of the face, the neck and jowls only. So it is a good match for the jowl and neck issues which bother you. Like many plastic surgery procedures, there are different ways to do them and they come in different ‘varieties’. No one type of facelift is right for everyone. Your plastic surgeon must ‘match the solution to the problem.’
Fundamentally, a full facelift changes both the neck and jowls and is best for someone whose primary problem is their neck. The jowls get improved as well and get swept alone in the changes that occur far away in the neck. The mini-facelift, aka Lifestyle Lift as called by some, changes the jowls primarily and a little bit of the neck. Any limited improvement in the neck is the result of the changes that have occurred in the jowls. The mini- or limited facelift is best for someone whose primary concern is in their jowls. Since jowling proceeds any significant changes in the neck, one can appreciate why a limited facelift is for younger people who have less signs of facial aging.
Another way to think about it is by looking at the incisional pattern around the ears. Mini-facelifts have use an incision that runs into and around the front the ear. Pulling upward from there only impacts the jowls primarily. A full facelift uses incisions in front of and behind the ear. By moving tissue upward from behind the ear, excess neck skin can be worked out to be cut off behind the ear.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley indianapolis, facelift, lifestyle lift, mini facelift, plastic surgery
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Friday, May 28th, 2010
Q: I am interested in making my nipples less prominent. I think they stick out too far and it can be embarrassing sometimes with different types of clothes and in colder weather. How big of a deal is it to go through and what is the recovery?
A: Nipple reduction surgery is really a very simple procedure. While nipples are undoubtably very sensitive, they can easily be made numb with a little injection of local anesthetic. The actual size of the nipple is quite small so the procedure is appropriately a minor operation. When done by itself, it is an office procedure that takes less than one hour for both nipples.
There are two basic nipple reduction techniques. Which one is best for any patient is determined by how much nipple reduction is needed and how much nipple sensation one wants to preserve. Either way, small dissolveable sutures are used so there is no need for a follow-up suture removal appointment. A small band-aid is used for the dressing. One can shower the next day and not be concerned about getting the area wet. A little dab of antibiotic ointment and a daily band-aid change is all that is needed for one week after surgery. There are no physical restrictions and one can return to running and working out the very next day. I would not, however, immerse the breast in a hot tub or swimming pool for at least one week after the procedure is done.
Nipple reduction surgery creates an immediate change. Even with the little bit of swelling that occurs, the change is readily apparent. Complete settling of the nipple takes about three weeks until its final shape and amount of residual projection is seen.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, nipple reduction, plastic surgery, prominent nipples
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Friday, May 28th, 2010
Q: I am interested in getting my cheekbones slimmer or smaller. Is there any way to apply pressure to them everyday or put something on them to make them gradually get smaller without the need to undergo plastic surgery?
A: The concept of making facial bones smaller is a surgical one. No amount of pressure or any form of outward manuevers will change the shape of a facial bone. Outward pressure, even if it were possible to do, would only make the overlying soft tissues thinner (pressure resorption) but would not change the shape of the underlying bone.
Cheek bone reduction requires cutting the ‘legs’ of the bone and allowing it to sit down or inward. In some cases, only the front legs of the bone need to be cut (body of the zygoma).In other cases, the back legs (zygomatic arch attachment to the temporal bone) need to be cut as well. By inward positioning of the cheek bone and its backward bony arch, the width of the face is narrowed. When done on both sides of the face, the narrowing effect can be quite noticeable.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek bone reduction, cheek bones, dr barry eppley, indianapolis, plastic surgery
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