Archive for July, 2010
Tuesday, July 20th, 2010
Q: Four years ago I had a rhinoplasty for a tip deformity. After the surgery my nose looked extremely nice and I was receiving excellent comments. However, about one year later a dimple appeared on the tip of my nose. I asked my plastic surgeon about it and he referred me to a dermatologist. I have spent a year going from one dermatologist to another and no one was able to help me. One of the dermatologists took a biopsy but the biopsy revealed nothing. After being exhausted I went back to my plastic surgeon and he diagnosed that the cause of this dimple may be some stitches that did not go away after the surgery. He operated on my nose again and told me after the surgery that his diagnosis was correct and he removed all the stitches from my nose. However, the dimple was not removed. He asked me to be patient. I went to him several weeks later as my situation didn’t change so he did a minor surgery in his clinic and again with no success. I then went to another plastic surgeon who was able to remove the dimple and he said there was some white cheesy stuff behind it that he completely removed. However the surgery resulted a scar in my nose. What do I do now?
A: Your rhinoplasty problem is rare but not unheard of. Your explanation of the events is perfectly understandable and it paints a very clear picture to me. Undoubtably what has happened are sutures reactions to internal sutures used to reshape the nose cartilages. This is common practice. I use dissolveable sutures for this purpose but other surgeons do not always do so. While rare, they can cause a delayed inflammatory reaction which is the initial culprit in your case. Now because of the biopsy and subsequent excision, there is an indented scar.
This leaves two options for treatment. First, and it sounds like you have already done it, is to try and excise the indentation to get a more level scar. Unfortunately, that frequently fails on that part of the nose. (tip) If that has not been done, I would try that first because the worst thing that can happen is that it ends up where it started. The alternative approach is to build up the indentation from underneath using a dermal graft. The graft can come previously prepared from allogeneic dermis or can be harvested from the back of your ear.
It will likely require several small procedures to get the best result.
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, rhinoplasty, rhinoplasty complications
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Tuesday, July 20th, 2010
Cosmetic plastic surgery has long been unintentionally gender-biased. Since the field began, the vast majority of patients who seek cosmetic enhancements, albeit it surgery or office-based treatments, have been women. Men have always made up less than 10% of most plastic surgery practices. Hollywood would lead you to believe otherwise but it just isn’t so. The only rare exception to that has been the more recent popular treatment of laser hair reduction. When it comes to hair removal, men make up about half of the patients seen with the hairy back and shoulders being the prime targets.
But more men are finding their way into the plastic surgeon’s office in the past few years. Besides a steady increase in male numbers, what is noteworthy is the change in what what men are requesting. While there remains some traditional procedures that have always been of interest, technology, societal trends, and younger men have opened up new areas of the face and body for change and improvement. Here are four of the most popular younger male (teenage to early 40s) procedures today.
Liposuction still remains the most requested male procedure. The culprits are always the same, the stomach and love handle areas. But most men that want liposuction are not fat and many are not even overweight. To the contrary, they are lean but have fat collections at the side of the waist and flanks. Even in men that work out regularly, those love handles can be impossible to work off. Today’s liposuction techniques can even give that ‘six-pack’ look for those leaner men that are not opposed to a little surgical cheating.
Chest recontouring is the one male plastic surgery procedure that is really on the rise. Male breast enlargement, known as gynecomastia, has always been an issue. But with increasing teenage weights and the present young male aesthetic for a completely flat and smooth chest, improvement in the male chest is sought out like never before. Even small nipple protrusions can be bothersome for the teenage male. Obvious man boobs are not desireable at any age.
Nose reshaping (rhinoplasty) has always been a popular male operation and that has not changed. It is the one procedure of the face that young men are not afraid to change. Noses that are big with prominent humps and wide nasal tips are bothersome and distracting to an otherwise balanced face. Sports and recreational activities make the young male nose a good target for injury causing twisted and deviated noses that often pose problems for breathing as well.
One set of procedures that is really new and undoubtably influenced by movies and models is structural facial reshaping. Creating that chiseled and angular face is what some young men aspire to achieve. A good jawline in particular is associated with enhanced masculinity. While one perceived just as making a strong chin with an implant, modern plastic surgery implants can be extended all the way to the back of the jaw. With the development of jaw angle implants, the jaw line can become more defined than just with a chin implant alone.
A new generation is redefining male plastic surgery. Have a lean body, flat chest, and a nose and jaw line that creates a well defined face has probably never been out of style. But modern surgical developments make them more attainable than ever before.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin and jaw angle implants, dr barry eppley, gynecomastia reduction, indianapolis, liposuction, male plastic surgery, plastic surgery, rhinoplasty
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Monday, July 19th, 2010
Q: I have had 2 c-sections and they were emergency so they cut me the “old” way- and my abs have never recovered. So my main question would be, what areas will show the differences of before and after? It seems like I currently have 2 “tubes” around my belly. The top where my abs used to be (and even when I have lost a lot of weight still seemed to appear puffy) and then my belly button kind of creates a line that goes into the bottom innertube. The idea of a tummy tuck in my head will smooth everything down so I would not have these 2 rolls of fat around my waist as well as the fat that is on my back. Does that sound right?
A: I think you have hit the general concept right on the head. You are right for two specific reasons. First, to get rid of what is not desired between your belly button and the pubic region, it has to be cut out. That is the definition of a full tummy tuck, a horizontal excision of skin and fat that goes just above the belly button. Secondly, the only way to unravel the excess tissue around the belly button is to allow the skin and fat above it to be stretched down over it, again the definition of a full tummy tuck. The only concept you have in error is the rolls of fat along your waistline and into your back. A tummy tuck will not remove those, only liposuction will. That is why most tummy tucks incorporate liposuction into the flanks area as well to avoid the dreaded ‘muffin tops’ afterwards if it is not done.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominoplasty, dr barry eppley, indianapolis, plastic surgery, tummy tuck
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Monday, July 19th, 2010
Q: My initial breast augmentation was over ten years ago. Two years later, my left breast implant suddenly ruptured. I have had my current saline Mentor Round textured implants in since then and have recently noticed some slight soreness and what seems to be a section that is possibly hardening in the center, all of this is in the left breast again. I do not want to have revision surgery if it is not necessary at this point. I realize that I will again as I am only 35. I am not against it if it is recomended now,I just want to prolong the life of my implants as long as possible. I have read that there are some asthma medications that have been used to treat early stages of capsular contracture with some success. I would like advice on treatment, either trying out the asthma medication or revision surgery or waiting it out to see. I really need advice on what is needed in my situation, an educated opinion would be greatly appreciated. I look to you because your video says you do not believe in selling the surgery, you listen and help clients make informed decisions. That is exactly what I need right now. Thank you very much.
A: Capsular contracture is far less frequent today due to improved implants and the general trend of placing the breast implant under the pectoralis muscle. Even when it was far more prevalent, what causes this excessive scarring and potential breast distortion is not well understood. When medical conditions are not well understood that usually means the treatment(s) for it does not work that well either. Capsular contraction treatment consist only of release and excision (surgery) or a drug medication. The use of Singular, an asthma medication, has been reported to have some success with preventing recurrent capsular contracture. These reports are largely anectodal and are not the result of information of a controlled clinical trial nor is it FDA-approved for this use. From those that report some success with it, it is in the use after a capsulotomy or capsule excision and is given with the intent of prevention. I am not aware that it has any effect on an ongoing or pre-exiting capsular contracture.
Because Singular is expensive and unproven in established or progressive capsular contracture, I would not recommend its use in your case. If the capsular contracture is significant, then surgery should be performed. If it is only minor, which it sounds like, then I would wait it out and see if it becomes more severe.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, capsular contracture, dr barry eppley, indianapolis, plastic surgery
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Monday, July 19th, 2010
Q: I would like to have my skin tone more even. Due to the sun, my skin color on my face and neck is much darker than rest of my body. I was born with darker private areas as well as my butt. I am an African American with a yellow skin to light brown complexion similar to Beyonce complexion in the L-oreal ad.
A: Skin lightening is a well known pharmacologic treatment that is well proven for the treatment of dark spots, primarily from aging and sun exposure on the face and hands, as well as reactive hyperpigmentation from injury or ablative skin treatments. Using established agents, such as hydroquinone and kojic acid, they work to inhibit the cells (melanocytes) that are responsible for creating the pigment in our skin. They are many combination products today that combine these pigment treatment agents with our adjunctive topicals such as exfoliants.
What you are referring to, however, is a more global color treatment of an area. Rather than treating a specific pigment problem, your quest is to lighten the base pigment in the skin. This has become recognized as a possibility by the plastic surgery exploits of Michael Jackson who definitely used skin lightening agents. While often conjectured, it is now proven after his untimely death last year after police investigations found many tubes of skin lightening creams. Whether he was treating a medical condition such as vitiligo or just overall lightening his skin is unclear.
The concept of skin lightening one’s base pigment is possible but is fraught with several concerns. First, it would take a lot of cream used continuously to create a lightening effect. Given the volume needed, one may be able to lighten small areas such as the face and neck but ot larger body regions. Second, how effective topical creams are for base pigment lightening is not a certainty. Lastly, these drugs do have side effects and the high doses done over a long time may have undesired effects that are not known. These topical creams were never designed and studied for a more overall skin bleaching effect.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, skin bleaching, skin lightening
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Monday, July 19th, 2010
Q: I am a 35 year-old heterosexual male who is interested in getting my adam’s apple reduced. I do not want to look feminine but the way it sticks out is bothersome to me. How is the operation done, how bad is the scar, and what is the recovery like?
A: Most of the Adam’s Apple reductions (technically known as reduction chondrothyroplasty) that I do are in heterosexual males and they make up most of the patients. Contrary to popular perception, transexual patients requesting this procedure are in the minority. That is not surprising given that the ratio of heterosexual males far exceeds the number of patients requesting a transgender change. While once done mainly for feminization, that has changed today. It is becoming an increasingly requested procedure amongst men in general who find a large thyroid bulge detracts from a pleasing neck contour.
The operation is a one hour outpatient procedure done under general anesthesia. There is minimal pain and swelling afterwards. The small incision is just an inch and a half long and heals with an imperceptible scar. I have never had to perform a scar revision for it. There are not sutures to remove. The typical result reduces the prominence of the thyroid cartilage but 50% to 75%. You usually can not get the neck profile completely flat but the improvement is substantial and patients are uniformly pleased. The location of the vocal cords, and the necessity to protect them and the patient’s known voice quality, prevents the cartilage to be reduced to the point that the neck has a smooth profile.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, thyroid cartilage reduction adam's apple reduction
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Monday, July 19th, 2010
Q: Greetings. I have a problem that I hope Dr. Eppley can address. I had a light therapy treatment (IPL) to my face that ended up too deep or too hot. It not only burned my skin but I also developed underlying fat loss as well. My skin is a series of pockmarks, holes, scars, lines. The problem that bothers me the most, however, is around my mouth. It appears to be scarred and my mouth has gotten smaller. It concerns me that may still be getting smaller. I have found that Dr. Eppley does many mouth revisions and am hoping he will take interest in my case. I am in need of help. Thank you in advance.
A: Such a reaction from a pulsed light facial treatment is certainly unusual. While I have seen some superficial skin burns from IPL or BBL treatments, deeper or more partial thickness burns have not been previously reported that I am aware.
Like all burn injuries around the mouth, the most restrictive area is usually around the corners or commissures. This is the side union between the upper and lower lip and needs to be the most flexible of any area on the lips. Tightness in this area makes mouth opening more difficult and may actually make it look smaller if there is scar contraction.
Early mobilization or physical therapy is important in the initial phases of healing after any burn injury around the mouth. It can help scar contraction from significantly tightening the commissures. In established commissure scar or restriction, surgical help may be needed. This could consist of scar release or a commissurotomy. This procedure can help open up the corners, making the mouth a little wider and lessen the tightness on opening.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: commissurotomy, dr barry eppley, indianapolis, mouth scar release, plastic surgery
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Sunday, July 18th, 2010
Q: I have a hairline which is so far back I can’t stand it. In addition, I have a buck forehead which bulges out. I would like my hairline to be lowered and my bulgy forehead to be reduced. I know that this involves a scar along the hairline in the end. I am African-American. Would this be a good procedure for me? I have attached some pictures for your review.
A: Thank you for sending me your series of photographs. They do show quite well your concerns, the far back location of your frontal hairline and the prominent bulge of your forehead. There is no question that you can bring your hairline further forward. It would be fair to say that it could be brought forward at least an inch (25mms) and maybe up to an inch and a half (35mms). That advancement is greatest in the middle and tapers off as one goes into the sides. (temple) About 5mms of forehead bone protrusion can be brought down in the very center of the forehead. You can never get it as reduced as one would like, due to the thickness of the skull bone, but some lessening of the protrusion can be obtained.
One could argue that there is little to lose by the procedures because it will be better than where you are now. Any forward movement of the hairline and forehead bone reduction will be viewed by you as a plus. However, the one trade-off is a fine line scar along the new hairline. While in most patients this is never a significant issue, in darker pigmented individuals this is something to consider. There is also the type of hair you have, meaning I suspect you don’t wear bangs because of the kinky texture of your hair. (although the purpose of doing a scalp advancement is so I can feel comfortable wearing their hair back) I have never done a hairline lowering in someone of your ethnicity so I can’t speak for how that scar will look. At it worst, it is a fine line white scar. While that would be an almost irrelevant issue in skin of lighter complexion, there is always the possibililty that a scar revision may be needed if it is too noticeable.
The key to any elective cosmetic plastic surgery procedure is that we are always trading off one problem for another. You just want to be sure that the scar ‘problem’ is a more tolerable one than the hairline that is too far back. Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction, forehead reshaping, hairline advancement, indianapolis, plastic surgery
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Saturday, July 17th, 2010
Q: My friend who just had a facelift had a slim face before and it’s even slimmer after the facelift. I am considering a facelift but I don’t want to lose any volume in my face or lose my round face. I think a round face keeps you looking younger. I have that St. Bernard look and is why I want a facelift. Could you explain better the SMAS part of a facelift? I want to have the volume that is now around my mouth back up in my cheeks without having that “alien” look (inverted triangle). That to me is the tell tale sign of a facelift. I want a smoother transition between my cheeks and my lower face and not all the fat in my cheeks. In other words, I don’t want to lose my round face. Would you mind explaining this some more to me please. The best facelifts I have ever seen is when the volume is added to the outside of the cheeks (side closest to ears) making the face wider hence more volume. Is it possible to ask the doctor where to reposition the fat as he marks up my face next week for my nip tuck?
A: A facelift fundamentally works by pulling the skin and the underlying tissues back up along the jaw line and neck towards the ear. In thin faces, tightening these tissues can often make it look even slimmer or more gaunt. That is a simple function of having very little subcutaneous fat between the skin and the muscle. It definitely can give the impression of being pulled too tight even though it really isn’t.
The SMAS part of a facelift is the separation and lifting of the tissue layer between the skin and the muscle. It s usually lifted up in a more vertical direction than the way the skin is moved back. (which is up and back at about 45 degrees) It can help add volume to the side of the face if the SMAS layer has enough bulk. In thin-faced patients, it is quite thin.
In really round faces, a significant slimming effect will not happen after a facelift…even if you wanted it too. It will make the neck and jawline better shaped (which is the lower face) but it will not change what most people interpret as the ‘meaty’ part of the face, the cheeks and side of the face. The change in the neck is what creates the impression that you have lost weight, which is what many people comment on afterwards. (provided they didn’t know you had a facelift)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, facelift results, indianapolis, plastic surgery
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Saturday, July 17th, 2010
Q: I am interested in getting a deltoid implant but am having a hard time finding out much about it. I know it is not commonly done but have read that it is done. I would like to get my one shoulder to look more like the other rather than deformed and asymmetric. What can you tell me about this type of implant?
A: The deltoid muscle is a bulky triangular muscle that covers the shoulder joint and contributes to movement and stability of the upper arm, particularly when it is lifted away from the body. The rounded curve of the shoulder is due primarily to the bulk of the deltoid muscle. Deltoid muscle atropy is most commonly caused by injury to the axillary nerve or muscle wasting after shoulder surgery or injury.
Placing silicone implants into the arm or shoulder has been historically avoided by plastic surgeons. Besides being rarely done, there is an understandable fear that the complication rate is higher than many other implant locations. To avoid complications, implants are placed beneath the muscle and just on top of the humerus bone. The deep location of the implant then acts as a spacer providing a deep push on the outer contour for volume enhancement. Placement of the implant right under the skin is easier but has a much higher rate of infection and capsular contracture and often results in visible outlining of the implant on the shoulder.
The type of implant used is the same as any other body implant, a soft and flexible form of silicone rubber.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: body implants, deltoid implant, dr barry eppley, indianapolis, plastic surgery
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