Archive for July, 2010
Saturday, July 31st, 2010
Q: I have always been bothered by these fat collections on the lower part of my stomach and around into my back. Despite working out regularly and really focusing on these araes, I have been unable to lose them. Several years ago I tried fat-dissolving injections (I can’t remember their name) but they were very painful so I never did it more than one time. I have been hearing about the Zerona laser and it seems that these fat treatments do not cause any pain or swelling afterwards. This sounds almost too good to be true. Do you think as a plastic surgeon that it really works?
A: Zerona is the newest and most popular method of non-invasive fat removal. Using cold laser technology, it has the ability to pass through the skin and disrupt the membranes of the fats cells. This causes release of fat when the cell membranes breaks open. This released fat is absorbed and eliminated through the lympatic system. This is proven science and is significant enough that its clinical data passed through and was approved by the FDA. Through the concomitant use of exercise, increased water intake, and oral supplements, the effects of the laser are enhanced.
Is Zer0na a replacement for liposuction….no. It is effective but not that dramatically effective and effiicient as actual surgery. I think it is a proven method that for the right patient can be very effective at making visible fat reduction. Its success is patient-specific and better results are undoubtably obtained when the patient follows all of the adjunctive recommendations.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, zerona body slimming, zerona laser
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Thursday, July 29th, 2010
Q: Hello, I am 27 years old and thin but have always had these little fat pouches that are positioned below the corners of my mouth. It’s hard to explain but it makes my cheeks look like they’re sagging (but they aren’t). If I put one finger in the inside of my mouth, and one on the outside and pinch that area, I can feel the distinct fat pocket. I have two questions. What is this fat called? I can’t find any similar cases online, and I’ve done lots of searches. And secondly, what can I do to remove this?? Thank you in advance.
A: It sounds like you may have a unique facial condition known as pseudoherniation of the buccal fat pad. This is where the normal buccal fat pockets, which lie right under the cheek bone, fall or prolapse through their containing fascia and create a low fullness opposite the corners of the mouth or even lower. While rare, this problem has been described in the plastic surgery literature before. Undoubtably the ‘ball of fat’ that you feel is a part of the buccal fat pad.
The treatment of this facial fat problem is to perform either removal of the descended fat pad (buccal lipectomy) or to resuture the fad pad back up into place. (like a hernia repair) Both are done from inside the mouth. Which approach is best depends on the shape of one’s face. A thinner face may benefit from it being repositioned back up so that one doesn’t develop a very gaunt facial look later. Since the fat isn’t being removed from the submalar area anyway, a more simple removal is usually done in most cases.
Indianapolis, Indiana
Tags: buccal fad pad removal, buccal lipectomy, dr barry eppley, indianapolis, plastic surgery
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Wednesday, July 28th, 2010
Q: I had breast implants originally done about 8 or 9 years ago and am looking to have them redone. My existing breast implants are saline 600cc and I think I am between D and DD depending on the bra. I want them increased but not sure if that is something you do? I know i would like to be DDD cup. I am a body builder and I think it would balance my shape better. Any information back would be great!!
A: Ideally, the size of a breast implant should stay within the base diameter of one’s breast. This produces the most natural looking result and also avoids the potential of the implants bottoming out over time due to loss of tissue support. That being said, some women prefer to go larger than these parameters. While some plastic surgeons have objections to that desire, my feeling is that as long as one realizes there may be a price to be paid long-term with bigger sizes (eventual removal and downsizing with breast skin reduction), then I have no objection.
Since you already have 600cc implants in place, the largest available implants are 800cc, either saline or silicone. At this size increase, that represents a 33% size increase. Saline implants can be further filled up to 960cc, representing an approximate 50% increase over your current size. At these size increases, one should definitely go with a high profile implant to get the base diameter as narrow as possible. Whether these sizes are appropriate are based on your height and chest width and breast augmentation size desires.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, extreme breast augmentation, indianapolis, large breast implants, plastic surgery
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Tuesday, July 27th, 2010
Q: Hi doctor, I have a big forehead and I need a scalp advancement to make it smaller. To do this surgery do you needs to shave my hair? What is the maximum of centimeters that you can reduce? How much does this surgery cost? Thank you.
A: A long forehead can be reduced by moving the scalp forward (hairline advancement) and removing upper forehead non-hairbearing skin. While this does leave a fine line scar along the frontal hairline, that is usually nto a problem for most women. As long as the hairline is distinct with reasonable density, the scar is usually a good trade-off. One of the keys to a scalp advancement is to secure it to the underlying frontal bone in its new position. This will not only prevent relapse but will also take the tension off of the scarline so it heals as narrow as possible.
In answer to your specific questions:
1) No hair is ever shaved for the procedure.
2) Usually at least 2 to 2.5 cms of scalp can be advanced with the same vertical reduction in forehead skin. That tapers off into the temple areas. The greatest amount of advancement is in the center.
3) The overall costs are about $ 7500 – $ 8500
For those women afflicted with a very high hairline, a forehead reduction procedure through a scalpadvancement can be life-changing. One can think of it as a ‘reverse browlift’ so it is an outpatient procedure that takes about 2 hours to perform. The very next day one can wash and style their hair.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, indianapolis, plastic surgery, scalp advancement
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Tuesday, July 27th, 2010
Q: What is Dr. Eppley’s experience in fixing breast implants that have bottomed out? What is the success rate in it staying fixed?
A: Bottoming out in breast augmentation is when the implant falls below the level of the lower breast crease. There are numerous factors which contribute to this problem, but the main one is when the size of the implant exceeds the ability of the tissues to hold it up. This is a problem that is usually seen long-term, not immediately after surgery. The implants may have initially been in good position but have dropped over time. Sometimes this may not occur for years.
When this problem is seen right after surgery it is the result of the pocket dissection going below the attachments of the lower breast fold. This is acute fold attachment disruption not its weakening over time.
Either way, the treatment of breast implant ptosis (bottoming out) can be done by two different methods. The most common approach is to suture the attachment of the breast fold back onto the chest wall, which pushes the implant back up. This is the simplest approach but loosening of the sutures can happen and dropping of the implants can happen again. If this were to happen it would usually occur within the first six weeks after surgery.
The other approach, which is newer, is to insert a lower sling of allograft dermis between the pectoralis muscle and the chest wall. Like an internal bra, this tissue supports the bottom part of the breast better. It is more reliable in terms of success but is much more expensive due to the cost of the dermal graft.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: bottoming out of breast implants, correction of breast implant ptosis, dr barry eppley, indianapolis, plastic surgery
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Tuesday, July 27th, 2010
The recent hullabaloo over the controversial Health Care Reform Act brought to the surface many pertinent issues of our entrepreneurial medical industry. While no piece of legislation will solve most of the really important problems, lost in the fray were economic and legal issues that impact more than just who pays for what and why.
A recent news story from Georgia brings to the surface one of these issues. CBS has reported that a woman almost bled to death during a surgical procedure performed by an ophthalmologist. According to their accounts, the woman awoke during the procedure and heard the doctor calling 911 for help as she was bleeding extensively.
Just this much of the story should raise two pertinent questions. The first being how do you bleed to death from eye surgery? Even the anatomically uninformed would assume there are no major blood vessels around the eye. Contrary to what one would think, he wasn’t performing eye surgery at all. He was performing breast augmentation! And the second question is how was it that she awoke to find herself in this dilemma? She was having it done in the doctor’s office. Luckily, a plastic surgeon was on staff at a nearby ER and helped save her life.
Such a story, while not common, is by no means rare. Today, every medical specialty is suffering from plummeting insurance reimbursements and skyrocketing malpractice premiums. (The Health Care Reform Act has addressed neither of these issues). This sets the stage for economically struggling doctors, and borderline unethical ones as well, to turn to more profitable fee-for-service cosmetic procedures to enhance their income. The public would assume, incorrectly, that there are laws in place to keep doctors practicing outside of their scope of training…but there are not. In most states, Indiana included, there is no law against physicians performing whatever procedure they choose, whether they have qualified training or not. All you need is a valid medical license. Because hospitals protect their own liability and will not allow doctors to perform procedures outside of their training, this can be easily bypassed by performing these procedures in their own office where the only governing body is the providing physician. There is no law against me, a board-certified plastic surgeon, performing Lasik vision correction or cataract removal in my office, even though I have no formal training to do it.
But this disturbing story does not stop there. Months after this event has occurred, the state medical licensing board refuses to suspend his medical license or has yet to even have a formal investigation. This lack of regulatory intervention is not rare. Licensing boards are shockingly slow and often very reluctant to pull any license even when the issue that is being reviewed is one of blatant disregard for the rules and does place patients at risk. The take home message is do not count or give too much credit for any governmental agency looking out for you. The legal roadblocks and delay tactics will often let a rogue doctor continue in practice for years.
The obvious message of the story from Georgia is that the burden is completely up to the patient to determine whether their physician is qualified to perform the cosmetic or plastic surgery procedures they seek. Slick-looking websites and discounted or low-fee incentives can make it easy to overlook the big picture…your safety.
Do your research and bear in mind that most, if not all, physicians in good standing will welcome your questions. An informed patient is a great patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eplpey, indianapolis, qualified plastic surgery
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Monday, July 26th, 2010
Q: What can I have done to make my breasts look fuller but still feel as natural as possible?
A: Breast implants are the only reliable method for increasing the size of one’s breasts currently. Many women have breast implants that look quite natural while others have a breast look after augmentation that some perceive as unnatural or fake. What is the difference between the two?
There are many element that contribute to the appearance of a breast augmentation. How loose or tight is the overlying breast skin and the size of the implant are the major contributing anatomic factors. A large implant with an initial tight breast skin will create a more rounded look with a full upper pole. A smaller implant with loose pre-existing breast skin will end up as more of a tear-drop shape.
The feel of a breast implant, however, is slightly different. Regardless of implant size, either saline or silicone gel implants can feel quite natural. Outside of the body, most people would agree that silicone implants feel more like natural breast tissue. But inside the body that difference is not as obvious. Saline breast implants can feel unnatural if rippling is present on the bottom or sides of the breast or if the implant is significantly overfilled so that it feels too hard.
In general, most breast augmentation patients are quite pleased with the feel of their implants. Unhappiness with implants that are too hard or too soft is a rare reason for revisional surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, natural breast augmentation, natural feeling breasts, plastic surgery
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Sunday, July 25th, 2010
Q: Hopefully someone there can fill me in even though I have no insurance! I want to know the approximate cost for an abdominal panniculectomy. I am very obese, weigh 360 lbs and am 5′ 2″. The majority of my weight is in my abdomen. This apron is like a catch 22, It is getting harder to walk and then I don’t so I eat and don’t walk and gain weight. I fell and hurt my knees 4 years ago, gained 100 lbs since then. Thanks for providing an outlet for me to vent. I liked the idea that you have had experience with this surgery for obese people. I still want to know what the surgery would cost. I maintained a weight of 250 to 260 lbs for over 25 years before the knee injury that never got fixed. Fat never stopped me before and it won’t now. My health history is otherwise remarkably good. My blood pressure is 115/60, fasting blood sugar 70 to 80 and the rest of my blood work is normal.
A: The abdominal panniculectomy procedure provides great physical benefits to those patients such as yourself. By the removal of overhanging weights that often approximate 30 to 40 bs, if not more, the strain on one’s back and knees is significantly reduced. This is in addition to the improvement in groin and genital hygiene.Most medical insurances will cover this procedure as ythey should given the medical benefits that it provides. The abdominal panniculectomy can not really be compared to the more common tummy tuck which is performed in more weight appropriate patients and is smaller in surgical magnitude and recovery.
Unlike a tummy tuck, the cost of an abdominal panniculectomy is out of reach for most patients. Costs could easily approach $10,000 to $15,000. It takes longer to do and will almost always require an overnight stay and often several days in the hospital. Complications rates are high and secondary problems such as fluid collections and wound breakdowns are common. Secondary surgical revision for wound closure is not rare ane exposes one to even greater expense. For these reasons, one should attempt this procedure under insurance for the really large type pannuses that you appear to have.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal panniculectomy, cost of abdominal panniculectomy, dr barry eppley, indianapolis, plastic surgery
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Friday, July 23rd, 2010
Q: I have a few questions that I have been wondering about for a long time. First, what causes frontal brow bone growth? The reason I am asking is because since I turned 21 it seems that my frontal brow bones have grown outward. When I look at the side of my face, there is not that smooth appearance that there once was when I was a teenager and this is because of my frontal brow bones poking out. I have always been considered a good looking guy but since this has started happening, I have gotten to be very self conscious of my looks.
One more question…. and this may seem like a very odd question. Does sleep deprivation or a very weird sleeping pattern have any thing to do with frontal brow bone growth? The reason I am asking this is because just before I turned 21, I developed a sleeping disorder. Not long after this sleeping disorder started, it seems like I started noticing my frontal brow bones getting a little bigger. I am 24 today and I still have a sleeping disorder. I have helped it quit a bit by taking medications to help with sleep. Anyway, my brow bones are bigger than I think they should be and I am just wondering if sleep deprivation has anything to do with frontal brow bone growth.
I have really want to know the answers to these questions for a long time and it would be greatly appreciated if you could please answer them for me. Thank you.
A: The development of the frontal sinuses does not begin until after age 6 and often will nolt be evident on an x-ray until age 9 or 10. The frontal sinuses are air-filled cavities that drain into the nose. Their growth should be consistent with that of the skull which is usually complete no later than age 18. Prominent brow bone often do not become apparent until after puberty for many young males and they seemingly ‘grow’ up until the late teenage years.
Sleep deprivation or any form of sleeping disorder is not a known case for the development of prominent brow bones.
Prominent brow bones can be reduced through forehead reshaping by taking off the frontal layer of bone over the sinuses, reahsping it, and putting it back on. While very effective, a male must consider the trade-off of a fine scar in the hairline which is needed to gain access to the bone to do the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, dr barry eppley, frontal brow bossing, indianapolis, plastic surgery, prominent brow bones
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Wednesday, July 21st, 2010
Q: I was wondering if liposuction can be done on the calfs? Ever since I was little my calfs have always been disproportionate compared to the rest of my body. I have been teased my whole life because of them, even now at 24 I still am teased, and I have tried everything short of surgery to reduce their size. I am 5’7″ and 145 lbs and my calves are 16.5″ around, but if I workout or am on my feet all day, which I usually am, they can be 17″ to 17.5″.
I am tired of not being comfortable in a skirt, or swimsuit, and not being able to find boots that will fit around my calves. I have attached pictures of them so you can see what I mean. They are muscular, but they do have fat, when I flex I can grab a handful of fat from my ankle all the way up to just under my knee. I don’t know if it is possible to remove this. I have contacted a few other clinics, and they said they do not perform the procedure. I have attached some pictures so you can see what I mean.
A: Thank you for sending those excellent pictures. I can clearly see your calf size concerns as they do not seem to fit the rest of youor body frame. Liposuction of the calfs can be done and definitely make a contour improvement. Think of calf liposuction not as completely circumferential but done is select areas that will provide more shape to the calf. Fat removal on the inside of the lower calf, at the outside of the ankle, and in the inside of the upper calf be low the knee are all good shaping areas. Circumferential liposuction of the calf causes a lot of swelling that takes a long time to go away. It is better to think of calf reshaping rather than calf size reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: calf liposuction, dr barry eppley, indianapolis, plastic surgery
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