Archive for August, 2010
Tuesday, August 31st, 2010
Q: I read in Dr. Eppley’s blog about using Kryptonite Bone Cement for pectus excavatum. I had the Nuss procedure done 5 years ago and breast implants done 4 years ago. I got very good results with the procedure and implants with the lower part of my ribs; however, the upper area (below the collarbone) is still indented. I would like to inquire about this procedure and whether or not I would be a viable candidate.
A: Kryptonite bone cement is a new type of bone filler/replacement that works well as an onlay, meaning to build out a bone surface to create a better contour. Currently it is approved in the United States for cranioplasty, the filling in or building out of skull bone contours. While it has never been formally tested for use on the sternum, there is no reason to think that it would not work just as well there as on the skull. What makes Kryptonite a possibility in the sternum is that it can be injected after it is mixed before it sets up into a hard mass. This is a very unique characteristic of a bone cement and no prior ones have ever had this physical property. As valuable as that material property is in the skull, it becomes a critical material characteristic in the sternum as incisions of any size are easily seen there.
For an upper sternal problem, a small incision inside the sternal notch can be used to develop the subperiosteal/supraperiosteal pocket. It is into this pocket that the material is injected and molded. The critical step in injectable sternoplasty, like injectable cranioplasty, is to make a good recipient pocket that matches the external outline of the contour defect.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable sternoplasty, kryptonite bone cement, pectus correction, plastic surgery
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Tuesday, August 31st, 2010
Q : I AM A 39 Y/O FEMALE. WEIGHT 155LBS, 5FT 9′ WITH A B CUP WANTING A LIFT AND C CUP AND SILICONE IMPLANTS. AFTER LOOKING OVER MANY PLASTIC SURGEONS IN INDIANA I HAVE CHOSEN DR EPPLY AS MY FAVORITE IN RELATION TO THE WORK IVE SEEN. A FEW QUESTIONS: HOW MANY YEARS HAS HE BEEN PERFORMING BREASTS LIFTS, & IMPLANTS. DO YOU HAVE AN APPROX OF HOW MANY HE HAS PERFORMED? AND WHAT WOULD BE THE APPROX. COST? ALSO, WITH ME BEING A SMOKER WOULD THIS AFFECT MY BEING ABLE TO GET THE SURGERY PERFORMED? THANK YOU i HOPE TO HEAR FROM YOU SOON
A: Thank you for your inquiry regarding breast enhancement. I have done such cosmetic breast surgery for the past 20 years and have done over 1,000 breast augmentation/lifts patients. The cost of breast augmentation with silicone implants (Mentor memory Gel) is right aorund $ 5,900 all costs included. Adding some form of a breast lift to it does increase the cost but that can not be predicted without seeing you since there are 4 different types of breast lifts which add varying amounts of time to the procedure.
Smoking does not have any significant effect on complications from a routinue breast augmentation. There is a slightly higher risk of wound problems when any form of skin lift is done such as a breast lift. How risky that would be would be based on what type of breast lift is needed…the more extensive, the more risk of wound healing problems. The best way to handle the smoking issue is to refrain 2 weeks before and 2 weeks after surgery if possible.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, smoking and breast augmentation
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Tuesday, August 31st, 2010
Q : I had a chin implant 9 years ago, when I smile its seems to be without form, like flat. And after X-rays I noticed that the implant is placed higher up where it should be (close to my teeth). A doctor told me it would be very laborious, because it would be two operations, one to remove the chin implant which would remain a hole, wait 3-6 months to heal the skin and the second to put the new implant from under the chin. Is there another solution? Thanks!
A: It is very common to have a chin implant that ends up being positioned too high on the chin bone when it is placed from inside the mouth and is not secured with a screw. When the implant is too high on the bone, it loses some of the projection or forward position of the chin that it would otherwise have.
Replacing a misplaced chin implant is fairly easy and can be routinuely done in a single operation. I have never heard of having to do it in two operations nor does that make any biologic sense to me. Going through a small submental (under the chin) incision, a new lower pocket can be made, the old implant removed, and a new chin implant placed and secured. In some cases, I have left the old chin implant where it was and just placed a new one beneath it. If someone has a deep labiomental crease, keeping a ‘spacer’ (old implant) high can help push that area out and prevent it from becoming deeper.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant replacement, chin implant revision, dr barry eppley, indianapolis, plastic surgery
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Monday, August 30th, 2010
Q: I am a 43 year-old male who is bothered by my long upper lip. When I smile I show no teeth and this makes me look older in my opinion. In addition, I have almost no red part of my line, it is just like a thin pencil line. I have done some reading and it seems a lip lift work. My measured vertical distance between the base of my nose and the top of the red part of my lip is 23mms. I have not read anywhere or seen that a man has had this type of lip shortening. Can it be done in a male? I have attached a front photo of myself for you to see what my lip looks like.
A:Thank you for sending your facial photo. While it is not a completely closed mouth view, it does show how long your upper lip is. You are correct in assuming that the only option for shortening your upper lip is a subnasal lip lift. As a general rule, I remove about 1/3 of the natural philtral distance. Since you are at 23mms, you could remove about 6 to 7 mms without any difficulty… maybe more. Whether this will be enough to unmask your teeth in smiling is to be seen but, at the least, the upper lip will be centrally shorter. The subnasal lip lift does not shorten or reduce the sides of the lip since the width of the tissue removal is limited to between the nostril bases. The lip near the corners of the mouth will not improve from a subnasal lip lift.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: bullhorn or subnasal lip lift, dr barry eppley, indianapolis, plastic surgery, subnasal lip lift in men
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Monday, August 30th, 2010
Q:I have had a c section with my son and I have no feeling toward the bottom of my belly. I have lost 52 pounds but still over weight. I am so frustrated but I think the only thing that will work is plastic surgery. Based on my readings, it looks like liposuction and a tummy tuck will do the trick. What has been your experience with the amount of improvement that thees two procedures can do?
A: Your question is a bit of a loaded one but the answer is in most cases very well. In fact so well for some people that it can be considered a ‘waistline’ miracle. This may seem a bit of an overstatement but for many tummy tuck patients it is not. The sheer removal of a full-thickness piece of skin and fat (either above or below the belly button) does something that no diet and exercise program ever could for someone who has lost a lot of weight. (50 lbs count as a lot!) When this skin and fat removal is combined with liposuction around the waistline and into the back, significant mid-trunk reshaping is done.
Already having a C-section scar (with numbness) and the extra skin created by your weight loss makes the consideration of a tummy tuck a fairly easy one as there are no viable alternatives. It is hard to predict how many inches may be lost around your waistline but it is fair to say at least 2 to 3 inches and maybe more. As impressive as the frontal change may be, I am always excited to help create the narrowing of the waistline by aggressive flank and back liposuction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominoplasty, dr barry eppley, indianapolis, liposuction, plastic surgery, tummy tuck
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Saturday, August 28th, 2010
Q: I have read about fat injections to the breast but am concerned that it won’t give me enough of a cup increase. In my reading it says that the average increase in volume is around 100cc. Is that only a 1/2 cup increase. I have also read that an external suction device can be used with fat injections to get a better result, is this a hoax?
A: A 100 to 200 ml improvement in breast size for most women (depends on what they have to start with and how wide their breast base diameter is) will only be a 1/2 cup to 3/4 cup at best. You have to remember that much of fat breast augmentation work currently comes from Japan where small breasts (B cup) is the desired size by their cultural standards. That is why fat injections may be more ‘successful’ in this population. In the American population, such small breast size increases would not be considered enough. I have never placed a breast implant that was 200ml or smaller. Occasionally a 250ml to 275ml breast implant may be used but this is very uncommon. Most American breast augmentations are in the 300 to 375cc range.
The concept of external suction on the breasts to increase breast size is not a hoax. It is an actual device known as the Brava system. It has been shown to increase breast in the range of a 1/2 cup or more. The theoretical science is that pulling on the breast tissue stimulates fat or stem cell replication or growth. It is currently being studied in combination with fat injections to the breast. Combining the two makes biologic sense and I would suspect that their combined use is better than either one alone.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fat breast augmentation, fat injections to the breast, indianapolis, plastic surgery
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Saturday, August 28th, 2010
Q: I would like to know more about laser liposuction. I had two C-Section deliveries and abundance of skin because of it.
A: While laser liposuction does have the ability to tighten some skin, it is not a replacement for a tummy tuck. Your description of having had two pregnancies with C-sections and now an ‘abundance of skin’ suggests that your skin excess problem is not slight. In addition, the skin that is there has lost its elasticity (which is why there is an abundance) and does not have the ability to respond to the tightening caused by the heating effect of the laser. Such loose abdominal skin is always more effectively removed by an excisional procedure, aka a tummy tuck.
Laser liposuction, often called Smartlipo, is an improved method of fat removal than traditional liposuction. By using a laser probe to create an elevated temperature in a zone of fat, the fat cells break apart and loose their lipid content. This not only makes it easier to suction out, but fat cell damage continues beyond the surgical period much like the progression of a burn injury on the skin. Even some fat cells which were not directly injured by the laser probe at the time for surgery may go on to die later from the laser injury. This produces more fat loss in the days ahead. Whether that amount of fat loss is significant or not depends on how high and uniform the temperatures were at the time of the laser liposuction procedure.
The skin tightening effect of laser liposuction is similarly caused by the heat created. The temperatures must be high enough and close enough to the underside of the skin for this effect to be created however. Whether that occurs is dependent on the skill and the expertise of the physician driving the laser probe.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, laser liposuction, plastic surgery, smartlipo
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Friday, August 27th, 2010
Q: I have read that there is a cosmetic procedure that cures migraine headaches. I have had migraines for years and sometimes they are so bad I can’t leave the house. If there is an operation to cure this migraine problem, I would sign up for it in a minute! Can you tell what they are talking about?
A: The use of Botox for the treatment of glabellar furrows (wrinkles between the eyes) has been done for decades. One of the very interesting findings from that cosmetic treatment was that plastic surgeons discovered that some patients with frontal migraines got a temporary cure, as long as the Botox lasted. The now proven theory is that in those patients with a focus of their migraines that starts above their eyes in the brow area are caused by the muscles squeezing the sensory nerves that exit from the bone there. This is why Botox relieves those migraines…it stops those muscles from working.
If you take that one step further, a browlift (of any type) can create the same effect as Botox except that its results will last much longer and maybe even permanently. That is because during a browlift some of the muscles are removed to prevent that type of wrinkling action. Recent studies and publications in the journal Plastic and Reconstructive Surgery has shown that certain types of migraines can be cured by performing a modified forehead/brow lift. Therefore, the type of forehead lift used to cure migraines could also lead to one looking younger as well. This type of cosmetic operation has been shown to be safe, effective and can lead to a tremendous improvement in the quality of some migraine patient’s lives.
Dr. Barry Eppley
Indianapolis Indiana
Tags: botox, dr barry eppley, indianapolis, migraines, plastic surgery
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Friday, August 27th, 2010
Q: Hello Doctor, I am 18 years of age, an Asian Chinese and I have big cheekbones. It was almost twice the size of the other people and that makes my face looking round and unpleasant big. I’ve read articles about cheek implants but I was wondering if there is a surgery that reduce the cheeks size, the best case scenario, to make it look flatter? Thanks in advance for helping me.
A: When you are referring to big cheekbones, you are undoubtably referring to them being too wide. Big in cheekbones invariably refers to how far they stand out from the side of one’s face. Wide and prominent cheekbones are most common in Asians as their genetic face tends to be less projected forward (horizontally) and more projected to the side. (wide)
Cheekbone reduction surgery can be done and understanding how it is done requires a knowledge of the bony anatomy of the face. The front part of the cheekbone is a fairly solid bone that is partially made up of bone from the side of the eye socket. This is the location, for example, where cheek implants are placed to make the cheek more full. But the part of the cheek that makes it wide is known as the zygomatic arch which acts as a span of thin bone that arcs out from the cheekbone in front to the temple bone in back. How much this piece of bone arcs determines how wide the cheek bones appears. Cutting the attachments of the cheekbone from the side of the eye socket and the back part where it attached to the temporal bone allows it to fall in. It falls inward (less wide) because not only are the bone attachments cut but there are muscles attached to it that help to pull it in also.
While cheekbone reduction surgery sounds drastic, it is done from inside the mouth with small bone-cutting instruments.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheekbone reduction surgery, dr barry eppley, indianapolis, plastic surgery
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Friday, August 27th, 2010
This is one of those headlines that attract a lot of attention as the concepts of Free and Plastic Surgery go as much together as Peyton Manning and quarterback sacks. One of the not infrequent requests that I get as a plastic surgeon, however, is about this very concept. On my practice website and numerous blog sites, requests come in every week for some form of plastic surgery ‘donation’. Many of the requests go into great detail about why they want a certain procedure and they are often quite moving. While the idea of performing surgery for free seems fairly simple, it actually is not.
This can best be explained by my response to a recent request for a free breast augmentation with a heart-felt plea for an improved perception of herself.
‘I have great empathy for the concerns you have about your breasts, and wish that providing you with a free procedure were an easy choice. Given the number of women who come into my office with similar concerns about their bodies, I can understand how connected self-esteem and a positive self-image are. Providing surgery for free may seem like a simple and straightforward thing to do, but there are many factors involved that make the concept of ‘donated’ surgery not exactly free. While any plastic surgeon can give away his time to perform the operation, a surgeon’s fee represents just a fraction of the total costs of surgery. The cost of the breast implants, use of the operating room, and the fee for the anesthesiologist expertise are other cost factors that must be accounted for and paid. The surgery center or hospital, implant company and anesthesiologist are under no obligation, and usually are unwilling, to provide services and materials at their expense for an elective procedure. Often times, these costs make up more than that of the plastic surgeon’s normal fee.’
One of the hidden costs of any donated surgery in this country is the potential medical-legal responsibility. Unfortunately, donating surgery does not waive any responsibility on the plastic surgeon for the outcome. Should any untoward events happen, such as a rare but possible complication, the surgeon is still liable and responsible. The possibility also exists for the need for revisional surgery after the initial procedure should the result not be ‘perfect’ and the question then arises is the surgeon again expected to waive his or her fees? While many patients say they will sign anything to get the procedure for free, the legal reality is that there are no forms or waivers that a patient can sign that will legally hold harmless the physician for the services that he or she has provided.
One may wonder then how do they do these free makeover surgery contests, either done locally or even on TV? The answer is whoever is doing it most likely is not a board-certified plastic surgeon. The American Society of Plastic Surgery strictly forbids providing any free surgery as a result of a contest, promotion, or any other method of inducement which encourages a patient to undergo surgery based on an economic incentive. Doing so is an ethical violation of its membership and could be grounds for dismissal from the Society. Those non-plastic surgeons who do offer such free surgery are not bound by these ethical guidelines and merely see the risk as a marketing expense.
While a plastic surgeon may choose to donate his or her skill and experience for free, the rest of the costs of surgery remain, and are usually out of the surgeon’s control. The legal and ethical issues, that are completing unaware to most patients, makes donating an invasive operative procedure not quite the same as giving away a more traditional retail product.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, free cosmetic surgery, free plastic surgery, indianapolis
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