Archive for May, 2010
Friday, May 28th, 2010
Q: Hi, I am in the military and am unable to make tape or weigh ins. I had two c-sections and my stomach looks like I am still pregnant. I am also having trouble passing my sit ups. I will not be able to be promoted until I am able to make at least tape and pass my fitness test. I have tried everything to lose the weight from my tummy but I haven’t had any luck. Not even basic training has helped slim my tummy. I am desperate to do something and I think a tummy tuck may be the only answer. How long does it take to recover from this procedure?
A: This is a tummy story that I have heard quite often in my Indianapolis plastic surgery practice. Women often come in for a tummy tuck (abdominoplasty) when they have exhausted all of the conventional options for trying to make it look better. Most women do view a tummy tuck as a last ditch effort.
When you have suffered the ravages of pregnancy, no amount of dieting or exercise will improve stretch out loose skin and muscles. The protruding floppy stomach is not just a ‘fat’ problem. It is tissues that have been irreversibly damaged. While I think it is prudent to get in the best shape as possible before undergoing a tummy tuck, those efforts will not repair the tissue damage which exists.
While a tummy tuck is a wonderful body shaping operation, it should be considered major surgery. With major surgery comes a significant recovery. While recovery can be defined different ways, complete recovery that would allow one to perform strenuous activities will take six weeks for most people.
Dr. Barry Eppley
Indianapolis Indiana
Tags: abdominoplasty, dr barry eppley, indianapolis, plastic surgery, tummy tuck
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Thursday, May 27th, 2010
Q: I have a tear trough and orbital deformity. One year ago I had surgery in which malar implants were placed. But it is too big and was the wrong choice for me. I only wanted to make my midface look healthy. I want make another surgery in 3 months and I now think an orbital rim implant is the right choice for me. Do you have experience with this type of facial implant and what are your feelings about it? Are the risks for an orbital rim implant surgery higher than a malar implant which I have now? Thank you very much.
A: The use of malar vs. orbital rim implants are for completely different facial problems or concerns. Even though they are anatomically close and contiguous, what effects they have on facial structure is completely different. If a malar implant was used in the treatment of a tear trough (orbital) deformity, it would have likely made it look even worse.
The midface has six structural components to it including the orbital rim, malar, lateral malar, submalar, paranasal and maxillary regions. The tear trough deformity represents a central and medial soft tissue recession even though the underlying bone deficiency may extend out into the malar area. Tear trough, also known as orbital rim, implants come in several different shapes and sizes which differ in the extent of the orbital rim that they cover and in how much projection they provide. It requires a careful assessment of the lower orbit and cheek to see which implant is best. Even with good implant selection, tailoring and shaping for fit is almost always required.
Unlike malar (cheek) implants, orbital rim implants must be placed through a lower eyelid (blepharoplasty) incision. This induces one potential risk that does not exist with an intraoral approach for malar implants, that of ectropion or lower eyelid retraction. Careful handling of the eyelid tissues and orbicularis muscle and canthal suspension are needed to avoid this potential problem.
Of all available facial implants, orbital rim implants are the most sensitive to size, placement and incisional access. To those with a lot of experience in maxillofacial trauma and craniofacial surgery, orbital manipulations is a comfortable place to work.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, malar implants, orbital rim implants, plastic surgery, tear trough deformity
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Thursday, May 27th, 2010
Q: Over a year ago, I had a medium-sized chin implant placed from inside my mouth and I HATED it. Last month I finally had it removed but I don’t look the same. My chin seems to droop a bit. I am going CRAZY over this! Please tell me what I can do!
A: To understand the problem and how to fix it, you must appreciate what any implant in the body does that changes the size of an area. Like a breast implant, a chin implant pushes off of the underlying bone stretching out the overlying soft tissues. As a result, you are gaining more soft tissue which the area needs to look bigger.
This soft tissue expansion can really be appreciated when and if the implant ever comes out. Without the implant’s support, the now extra soft tissue sags creating a classic chin ptosis condition. Some refer to it as a ‘witch’s chin’ deformity. There now is too much soft tissue for the amount of bone or underlying soft tissue support. Furthermore, the mentalis muscle has been detached from the chin bone and likely was not resuspended at the time of implant removal. This muscle problem can particularly arise when chin implants are placed from inside the mouth where the superior muscular attachments are completely separated.
Correction of chin ptosis can be done by two different approaches, based on the severity of the soft tissue sag. If the laxity is mild, then an intramural approach with muscle resuspension using bone anchors works very nicely. If the soft tissue sag is more severe, then an approach from the underside of the chin known as a submental tuck-up can be done for soft tissue removal and reattachment back to the bone.
Another option would be to replace the chin implant with another one (even if it is smaller), but that doesn’t sound like an option in your case.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin implant, chin ptosis, dr barry eppley, indianapolis, witchs chin deformity
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Wednesday, May 26th, 2010
Q: My 12 year old daughter has had both ears repierced due to holes closing, but now the newer holes have closed due to infections and she now has unattractive scar tissue. Is there a surgery that she can have done to remove the scar tissue so she can wear earrings again? She has been very upset about this for a couple of years now. Thank you!
A: Despite the large number of earlobes (and ears) that get pierced, the number of infection and scar complications is remarkably low. This is a testament to the good blood supply to the ear and its relative resistance to typical skin bacteria. But minor complications to piercings do occasionally occur and, while they all resolve, they often end up with excessive scar tissue formation over and around the original ear hole.
Removal of earlobe scar tissue can easily be done with minimal to no visible deformity of the earlobe later. It is a simple ear plastic surgery procedure. Under local anesthesia, the scar tissue can be cut out and the earlobe defect closed. Because the earlobe has no cartilage framework, it is very elastic and flexible. This makes for closing most earlobe defects relatively easy without causing a visible deformity such as a notched earlobe or making it significantly smaller than the opposite earlobe.
There is one difficult type of earlobe scar, that of a keloid. While many earlobe scar patients think they have a keloid, they really have a hypertrophic or typical scar. A keloid is an abnormal form of scar tissue formation that will not stop growing, often causing a cauliflower-like appearance to the scar and distorting the entire earlobe. These have high rates of recurrence after being removed.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, earlobe deformities, earlobe repair, earlobe scars, indianapolis, plastic surgery
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Wednesday, May 26th, 2010
Q: I am interested in cheek bone reduction surgery. I want to know if there are any permanent side effects or can they develop years later.
A: Reduction of prominent cheek bones is not nearly as common as augmentation or enhancement of deficient ones. Cheek bone reductions are almost always an ethnic request, usually commonly from patients with Asian or Pacific Rim heritages. Usually the concern is that the cheeks are too wide and the goal is to try and have a more narrow or ‘slimmer’ facial appearance.
Narrowing the cheek area is done by first understanding the shape of the bone. The zygoma (cheek bone per se) and the zygomatic arch (which extends back to attach to the temporal bone like a spanning bridge) together form the width of the middle part of the face back from the eye area. Reducing its width comes from cutting the bone (zygomatic osteotomies) at the two attachments of the bridge and allowing it to settle inward. Sometimes only the front part needs to be cut through the cheek bone itself. (done from inside the mouth) Other times the back part where the zygomatic arch attaches to the temple needs to be cut as well. (done from a small incision in the temple hair)
The biggest potential side effect or risk of the procedure is asymmetry, one side not being as far inward as the other. In theory, if the zygomatic arch goes in too far (unlikely), it may impinge on the masseter muscle causing some pain on oral opening and eating. (that I have never seen)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek bone reduction. narrowing the wide face, dr barry eppley, indianapolis, plastic surgery
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Tuesday, May 25th, 2010
Q: I would like to have a consultation but live far away. Can I get some answers to my questions on the phone or by e-mail? I have read that some plastic surgeons consult with patients online. Is that possible?
A: The large amount of internet material on cosmetic surgery has helped to fuel the demand for these procedures. But access to the internet is not, unfortunately, always the best way to get accurate information. Prospective patients still need a professional to help them decipher what all they read means and how it applies to their individual needs. While an actual visit to a plastic surgeon and a face-face consultation is a necessary step before ever scheduling surgery, the accessibility and low expense of the internet provides a very convenient method to answer some basic questions from afar.
In my Indianapolis plastic surgery practice, I use the internet service, Skype, for webcam video conversations. For the first time in medical history, it is now possible to have an online video discussion with a plastic surgeon from anywhere in the world provided you have a webcam on your computer or laptop. (you can even do it from your smartphone)
To take advantage of this option, first find a plastic surgeon who offers Skype and performs the type of cosmetic procedures in which you are interested. Then go to the Skype website, download the application and register under your name. This process is free and takes less than five minutes to do. You will need to add the plastic surgeon to your contact list. That requires knowing how their name is registered and that should be available on their website. In my case, it is dr.barry.eppley. Add the name to your contact list and then send a message requesting a video conversation.Tell briefly in the message what your subject area or concerns are.
While this video conversation method is not a replacement for having an actual consultation in the plastic surgeon’s office, it provides a unique opportunity to ask questions directly to a plastic surgeon without leaving the comfort of your own home or city. It can be a great first step in your informational gathering process.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, internet plastic surgery, plastic surgery, plastic surgery consultation, skype plastic surgery
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Monday, May 24th, 2010
Q: I was wondering if you had any procedures that would reduce severe stretch marks. I just had a baby and my baby tummy is very loose and I have really bad stretch marks.
A: Stretch marks are a very common skin deformity that results from tissue expansion(e.g., pregnancy, weight gain) followed by deflation thereafter. (e.g., delivery, weight loss) What stretch marks really represent is IRREVERSIBLE skin damage from partial tearing of the dermal component of the skin. The thicker collagen layers have been partially split due to the stretching of the skin. That is why when you run your fingers over them they feel rippled or indented over the stretch mark. There has been a loss of some of the skin’s thickness.
Why some women get them from pregnancy and others don’t is a result of numerous skin factors. These include their native thickness and elasticity of the skin and how much and how fast the skin was stretched. There probably is some merit to apply a topical emollient or moisturizer to the skin during the pregnancy process. Anything that can hydrate the collagen layers to allow it to stretch without deformation (irreversible breaking of the molecular bonds, like a broken spring) would be helpful.
Once the stretch marks exist, however, solving or eliminating them is virtually impossible. While many urban legends exist about ‘magical potions’ and patients who have completely gotten rid of them, there has never been any scientific or documented evidence that these often touted methods really work. It is simply not possible to thicken back up or repair the split dermis anymore than you can restore the tighten of a stretched out rubber band.
That being said, however, there are some treatments that may help reduce their final appearance if they are done early. Early means within less than 90 days after delivery or when they have appeared. The redness of the stretch mark can be reduced by pulsed light treatments (BBL) in my Indianapolis plastic surgery experience. Early treatment may help make the stretch mark do some collagen repair so it is less deep. The key, however, is EARLY treatment.
It is possible to lessen the appearance of new stretch marks if done early enough. In established stretch marks, there are no effective treatments. Stretch marks are not responsive to laser or skin resurfacing and any attempts to do so may result in a worse scar appearance.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, stretch mark treatments, stretch marks
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Monday, May 24th, 2010
Q: I have breast implants originally placed in 2002. I got pregnant shortly afterwards and once I delivered my breasts changed afterwards and I developed some drooping. So I went back and had new implants placed in 2007 that were bigger and helped to fill out some loose and droopy skin. After having these implants for a while, I have decided that I want to go back to my original augmentation size. But I fear in doing so that I will get saggy breasts again. What do you recommend?
A: Going up in breast implant size is always easy because loose skin is expanded and filled out. While breast implants alone are often not the sole solution to a really saggy breast, they do help tremendously and are very forgiving of less than ideal breast skin.
Going down in breast implant size, however, is not so forgiving. Even the smallest amount of loose or droopy breast skin will get much worse as the ‘balloon deflates’ so to speak. As a result, some form of breast lift is often needed in many breast implant downsizings. What makes this aesthetically difficult is that this will involve creating breast scars which is another form of a cosmetic breast deformity.
If the nipple is fairly centered on the breast mound, a smaller implant replacement may not involve any type of lift or only a very small one such as a nipple or circumareolar type lift. If the nipple is off-center or points any amount downward, then a more significant lift with breast skin scars may be necessary when the breast implants are down-sized.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, breast lift, dr barry eppley, indianapolis, plastic surgery
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Monday, May 24th, 2010
Q: I’m interested in learing more about dermabrasion or micropeeling. Can this be done on the eyelids? (above and below) Will this help reduce the beginnings of a fold in the top eye crease? I live two hours away. If you can answer these two questions about this procedure would help me determine if I should come in for a consultation.
A: By the way your question is phrased, it appears that you seek a non-surgical solution to the appearance of wrinkles on the eyelids. There are a variety of skin resurfacing methods that are commonly used on all other areas of the face so it is reasonable to ask about their use on the eyelids.
The eyelids represent skin that is very unique from that of the rest of the face. It is different primarily because it is so thin. Being thin makes it very sensitive with higher risks of scarring if the skin resurfacing method is not carefully selected and performed.
Microdermabrasion (superficial) and dermabrasion (deep) are not effective (microdermabrasion) or safe (dermabrasion) skin resiurfacing methods for use on the eyelids. Traditional laser resurfacing is not either for the same reason that dermabrasion should not be used, it penetrates too deep.
The use of laser micropeeling and chemical peels, however, are both effective and safe methods for the eyelids. Laser micropeeling at the depth of 20 microns or less, TCA (trichloroacetic acid) chemical peels of 15%, 25% and 35% as well as the newer Vi chemical peel are all potential choices. Which one of these is best for your eyelids will require an actual consultation to determine.
Another very effective option is the combination of ‘mini-blepharoplasties’ with chemical peeling. The actual removal of a small amount of excess skin and then tightening the rest can be a very effective eyelid wrinkle-reducer.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, chemical peels, dr barry eppley, eyelid wrinkles, indianapolis, laser resurfacing, plastic surgery
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Monday, May 24th, 2010
Q: I’m a 62 year old female interested in widening a narrow face with a chin/jaw widening implant that would also help with jaw lifting and mild jowls. Is this possible for someone my age?
A: It is unusual for a female at any age to desire a wider lower face. This is almost always a male procedure for the obvious reason of making the jaw line more prominent to create a masculinizing effect. It would be particularly rare, and the first time in my Indianapolis plastic surgery experience, to have an older woman make that request.
I suspect that the real reason for this request is to help improve the classic signs of facial aging which is that of jowling, loss of the jaw line, and neck sagging. While it is true that jaw line enhancement at the chin and even more posteriorly at the jaw angles can help fill out a lower face, I question whether the effect would be significant enough to achieve your goals.
While I will have to see your pictures, it is possible that chin and jaw widening in combination with a limited or tuck-up facelift may create a more ideal result. Widening and lifting along the jaw line is a diametric movement of soft tissues that will usually result in a better outcome than either procedure done alone.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implants, dr barry eppley, facelift, indianapolis, jawline enhancement, plastic surgery
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