Archive for June, 2010
Wednesday, June 30th, 2010
Q: I have a deep vertical line in between my eyebrows that is still noticeable despite having Botox injections. I was wondering if endoscopic browlift could correct this. Im only 27 years old. Please help.
A: The development of vertical wrinkles between your eyebrows, known as the glabellar area, is common and is the result of excessive muscle activity. There are a set of six paired muscles that affect the glabella area and create what has been described as a number system of galbellar wrinkles or furrows. As the popular ad goes, are you a 1, 11 or 111? These numbers describe whether one has one, two or three vertical glabellar wrinkles.
The first approach for glabellar wrinkles is Botox which will be highly effective for most people. For many the wrinkling is completely or nearly completely gone by this temporary muscle paralyzing treatment. For those with more deeply etched glabellar furrows, Botox will soften it to some degree but may not reduce it enough for the person’s satisfaction. This is the result of the skin being ‘etched’ or having a permanent v-shaped change in the skin. Muscle paralysis will not change permanent deformation of the skin.
An endoscopic browlift will not create a better effect than that of Botox because it works on the muscle only. It may help decrease the long-term need for Botox and, rarely, the need for Botox at all.
A companion treatment for the deep glabellar furrow is some type of soft tissue fill. Usually this is an injectable filler but its effect will only be temporary. More permanent options include the threading of an allograft collagen dermis material or actual synthetic implant. (e.g., Advanta)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, dr barry eppley, endoscopic brwlift, glabellar furrow, glabellar wrinkling, indianapolis, plastic surgery
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Monday, June 28th, 2010
Q: I have multiple lipomas over my arms and legs. Is there anything new to having them removed?
A: The standard treatment for lipomas remains excisional, making a small incision over the lipoma and pushing it out. While effective, this does result in a very small skin scar. While this approach is fine for several or even up to ten or so lipomas, it is tedious and results in many fine scars.
An alternative non-surgical approach is Lipodissolve injections. A needle is used to inject each lipoma with about a .5ml solution of phosphatidylcholine and deoxycholic acid. This is a fat dissolving solution that will shrink the size of the lipoma and in some cases get rid of it completely. Usually, however, it takes more than one injection to be assured of its complete eradication. If you are seeking a truly non-surgical approach, these injections are a treatment to be considered as long as one understands that more than one injection may be needed for maximal results.
Another ‘minimally-invasive’ approach is spot laser treatment. Using a Smartlipo (laser liposuction) fiberoptic probe, a nick is made in the skin and the probe is inserted next to or into the lipoma, it is turned on and used to heat up the lipoma until it is melted or destroyed. Like excision, this does require a local anesthetic.
Dr. Barry Eppley
Indianapolis, Indiana
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Tags: dr barry eppley, indianapolis, lipodissolve injections, lipoma removal, plastic surgery, smartlipo
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Saturday, June 26th, 2010
Q: I am interested in getting an inner thigh and knee lift procedure but am concerned about the scarring. I have looked on the internet but pictures of these type of scars seem hard to find. Do you have any suggestions about how I should make the decision for this kind of surgery?
A: Body contouring of almost any kind always results in scars. Short of scars on the face or breasts, most scars that result from body contouring procedures will not look as good as they do on these two areas. Regardless of even seeing good scar outcomes from these procedures, that does not mean that yours will turn out as well.
Therefore, the decision to go forth with any type of ‘leg lift’ should be based on the acceptance that the scarring will not be as good as you would like it. Scars are the lower extremities are never great. They are faced with too much tension and movement after surgery that always stretches them out to some degree. You have to decide which is more acceptable, the loose skin or the scars. If you can not accept the concept of scars or have any hesitancy about them, then you should not do the procedure.
My approach to scarring in body contouring surgery is…it is always about trading off one problem for another. The operation is good one for you if the trade-off into scars is better in your mind that the excess skin problem that you had before.
Quite frankly, mentally going through this thought process is better than looking at pictures of scars from the procedure. The people that are truly happy with the results from this type of body contouring procedure don’t care what the scars look like because they hate what they have now. That is the attitude to have the scarring, no matter how it looks it is better than this loose hanging skin that I have now.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, knee lift, knee scarring, plastic surgery, thigh lift, thigh scarring
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Saturday, June 26th, 2010
Q: I had jaw angle reduction surgery three months ago and I am unhappy with it. I wanted to make the thickness of my jaw angles more narrow and thought that Botox injections to the muscle would work. Instead the doctor told me that I needed bone removed instead. During surgery, the doctor cut off my entire jaw angle and I just don’t understand why? It’s make my face look too short now and I am less attractive than before. I am very sad about having this surgery.
I am only 32 years old and don’t want to live the rest of my life looking like this. I have attached some pictures and x-rays (before and after surgery) for your review.
A: I have reviewed your case and the x-rays. What you had was a classic jaw angle reduction surgery. This is well shown on the x-rays and in your before and after photographs. Overall, I think the surgery was done adequately. One of the jaw angles has been cut off more than the other, accounting for the asymmetry in how the jaw angles look now.
For those seeking to get a narrower and less square face, this can be a good operation. One of the negative aspects to the procedure is that it makes the jaw angles blunted in addition to making it more narrow. In fact, it makes the jaw angles more narrow by virture of changing a square corner into a rounded one. That may not always be a good aesthetic trade-off. (and is what bothers you now)
In the desire to make a square face more narrow in a female, you have to distinguish between keeping the jaw angle square but making the bigonial width more narrow…or narrowing the width of the jaw angles but keeping the squareness to it. That is a very important distinction to make because achieving those looks requires two completely different approaches. The former needs to be done with Botox injections or doing a sagittal bone reduction in a flaring jaw angle (if present). The latter is done by the classic jaw angle reduction osteotomy. They both will make the lower face more narrow but the shape of the jaw angle will look different. Jaw angle reduction surgery makes the face look shorter in the back, muscle reduction or sagittal bone reduction does not create that effect.
The question now is. where do you go from here? Do you want some of the squareness to the angle back? If you do, then one may consider a thin jaw angle implant. (3 -4 mms) This will get the definition of the jaw angle and not add much width to it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox masseter injections, dr barry eppley, indianapolis, jaw angle implants, jaw angle reduction, plastic surgery
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Thursday, June 24th, 2010
Q: How come with breast augmentation the work seems flawless with no scarring at all. But with a breast lift, there appear to be scarring and are not always even. Your augmentation is beautiful, the best i’ve seen so far. I dont think I need an implant because I am already a DD.
A: Breast augmentation is virtually scarless because the small incisions that are used to pass the implants through are placed in very unnoticeable areas. Whether it be in the lower breast crease, around the nipple, or in the armpit, they are undetectable except on the very closest of inspections. Breast implants do all the work of making the breast, including its new shape, and this makes it almost scarless.
Conversely, breast lifts must create their reshaping effect by removing skin. Because all aspects of the breast skin are in view in a well shaped breast mound, the scars are much more visible. In a typical breast lift, the scars will run around the nipple and vertically down to the lower breast crease. In more extensive breast lifts, the scar may also run along in the lower breast crease.
Unlike breast implants, which are symmetric in shape to start with and can be equal in volume, breast lifts are much more artistic in execution. They require a lot of judgment in how and where to cut the skin and, as a result, can not be expected to be as perfect in shape and symmetry as many breast augmentation results.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift, breast reduction, dr barry eppley, indianapolis, plastic surgery
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Thursday, June 24th, 2010
Q: I recently had cheek implants but now one side of my face has hollowed out and both sides of my mouth have developed drooping pouches of tissue . It looks very uneven and has distressed me greatly. I would like your opinion about this.
A: This is certainly a very unusual type of mouth result from cheek augmentation. The reason it is unusual is that cheek implants add volume to an otherwise prominent facial bone area. If anything it may cause a very mild cheek tissue lifting effect but not dropping of tissues as you state around your mouth. Early after surgery, in the first few weeks or month, one could have swelling and some bruising which drifts downward along the mouth and even into the neck. But if this is would not be the case more than a month after surgery. If other facial procedures were done at the same time, which would be common, then this could still be residual swelling which may yet go away.
Uneveness of cheek implants, however, is not rare and is probably the number one complication of cheek augmentation. It is more difficult than it looks to place cheek implants in the identical position on both sides of the face. The thickness of the cheek tissues do not make it easy to see minor differences in position during the actual surgery. I would wait at least three months after surgery to let everything settle before making a final judgment about cheek symmetry.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek augmentation, cheek implants, dr barry eppley, indianapolis, plastic surgery
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Thursday, June 24th, 2010
Q: My breasts are in terrible shape after having had 4 children and nursing them all. They are saggy and disgusting. I think they need a total breast overall. They look so bad I don’t even know if they can be helped. I have read about breast implants, breast lifts, and breast reductions and I think I need all three. Is it possible to have all three of the procedures I am asking for done at the same time?
A: The combination of a breast lift (skin reduction and tightening) with an implant is a very common procedure for the breast that is small in volume but has an excess amount of skin that sags over the lower breast crease. With the breast in this kind of shape, all three procedures are needed simultaneously to give a more pleasing and uplifted breast shape. This is the most difficult of all cosmetic breast procedures and is best thought of a breast reconstruction rather than a simple breast reshaping.
Unlike breast implants alone, this more extensive form of breast reshaping will result in scars on the breast. The scars will be similar to that of a breast reduction. Because of the difficulty of the procedure, secondary revisional surgery is not rare to get the best shape and symmetry between breasts that often start off not only badly shaped but different.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implants, breast lift, breast reduction, dr barry eppley, indianapolis
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Thursday, June 24th, 2010
Q: I am interested in a Thyroid cartilage reduction. I am a male but this is not for any kind of transgender procedure, I just have an oversized adam’ s apple and I do not like it. i am in my 30′s and I’m not looking to have it removed just made smaller. Is it possible to have this procedure at my age?
A: Most of the thyroid cartilage reductions that I do are in heterosexual males, not transgender patients. Like yours, the issue is the same…an adam’s apple that is just too big and sticks out too far. Your age is fine as age is actually irrelevant. As long as one is skeletally mature (fully grown, age 18), it is acceptable to have the procedure. This is a fairly simple operation that is both effective and requires minimal recovery. At the price of a very fine 1 1/2″ horizontal line in a skin crease over the cartilage, it can be substantially reduced.
The thyroid cartilage plays a very valuable role in supporting the vocal cords and certain neck muscles and ligaments. Its removal is not possible. Thyroid cartilage reduction merely shaves down or reduces a portion of the V-shaped prominence of the upper or superior part of the cartilage. Their paired upper borders come together in the front and form a notch whichi is easily felt. Removing this portion of the cartilage does not interfere with vocal cord function or other neck functions.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, thyroid cartilage reduction adam's apple reduction
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Wednesday, June 23rd, 2010
Q: I had a bullhorn lip lift three weeks ago and feel that the scar under my nose is quite hard (harder when I start talking) and still visible. Can you please tell me if the scar will soften and dissappear eventually? I much appreciate a second opinion.
A: The healing of scars from a surgical incision, as well as from any injury, is much different than most people perceive. When people see the dressings or tapes from a surgical incision, or the sutures placed to close it, removed a week or so later, they are often surprised how well it looks. When viewing the same scar weeks to a month later, it will look worse and some patients feel that something is going wrong.
In reality, this is part of the normal healing process. Actual healing of a wound or incision does even start to take place for weeks. That is why it looks so good just a week later, nothing is really going on and the body is not reacting fully to the insult. The scar will naturally turn redder and get firm weeks later as the body recruits the necessary elements to actually heal the incision. Blood vessels grow in and collagen is laid down to help knit the tissues back together. Collectively, this natural healing process creates a red and firm scar for months. Once the incision is getting more healed the redness fades and it will get softer, eventually getting that faded scar and softness of the tissues.
This healing process takes months and often is only complete at close to a year after the surgery. At this point, it will return to what it looked like at just a week or so after the initial surgery. When the incision is just under your nose, from a lip lift, one is forced to look at it daily. One’s awareness and uncertainly as to what will happen with it is understandably high.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lip lift scars, lip scars, plastic surgery, scar healing
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Tuesday, June 22nd, 2010
Q: Hi, I’m an Asian female in my late 20s. Over recent years, my jaws have become really prominent, making me look somewhat masculine and heavy. In ooking for a way to reduce the angle of my jaw, I found the masseter reduction technique with botox injections on the internet. Since I don’t want to change my bone structure, I am considering Botox as a solution. My only concern is how much the cost would be. Could you please let me know the range of cost? Thank you so much!
A: There are two options for prominent jaw angle reduction, surgical jaw angle bone reduction and pharmacologic masseter muscle shrinking. There are advantages and disadvantages to each approach. Which is better for any patient depends on their bone and muscle anatomy and what type of result and effort that one wants to go through.
Botox injections, in my Indianapolis plastci surgery experience, can be an effective masseter muscle reduction method. My protocol is 50 unit injections (25 units per side) into the muscle at the angle done every four months for one year. After three injection sessions, some permanent muscle reduction will be seen. Whether maintenance injections are needed is determined on an individual basis. Cost can be determined by knowing what the provider charges per unit and simply do the math. In general, the costs are around $750 per injection session.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox for jaw angle reduction, dr barry eppley, indianapolis, jaw angle reduction, plastic surgery
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