Archive for August, 2010
Thursday, August 26th, 2010
Q : I am a 55 year-old male and am bothered by low hanging brows. It makes me look angry all the time and I am actually a good-natured and upbeat person. It seems my eyebrows are falling off of the brow bone and they look so heavy. My mother had a facelift and browlift several years ago and I am wondering if this would work for me.
A: While a man can aesthetically tolerate a lower brow position than a woman, there is a point when the brow descent is too excessive. When the eyebrow is below the brow bone, the look that is created is a perpetual scowl or frowning. At the least, it makes the size of the eye look small and the forehead look very long.
Browlifting in men poses unique challenges that are not present in most women. The lack of a well-defined and permanent hairline with good hair density makes the options for a browlift more limited and less effective. Browlift scars are not easily hidden and the risk of visible scarring is beyond just a theoretical possibility. None of the hairline or scalp approaches that are most commonly used for lifting the brows are worthy of that scar trade-off. In some cases, an endoscopic approach can be used but it stills creates small scars that can be visible through most men’s hair patterns.
There is a mid-forehead incision approach to a browlift but it requires a man to have a deep and prominent horizontal wrinkle in which to use. The scar with this approach takes a long time to settle and the redness to fade. While effective, this central forehead scar should be reserved for a few select patients.
This leaves the eyelid or transpalpebral approach as the only browlift option without the risk of adverse scarring. The eyebrow is lifted and sewn back up to the bone through an upper eyelid or traditional upper blepharoplasty incision. It is not as effective as a ‘superior-based’ browlift but the risk of adverse scarring is eliminated.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: browlifting in men, dr barry eppley, indianapolis, male browlift, plastic surgery
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Thursday, August 26th, 2010
Q : We have a potential new hire for our company that has about a ¾ inch insert gauged in both ears. This person regrets having this done and wants to abide by company requirements and have them removed. How is this done and what does the earlobe look like afterwards. Also, what would the potential cost be to have both earlobes repaired?
A: Gauging of the earlobes creates a central hole surrounded by a thinned out or thin ring of earlobe skin. The size of the gauge determines how thin the ring of earlobe skin is. As long as the gauge is not too big (greater than one inch), the expanded earlobe can be put back together and have about the same size as it was before having the insert. When the insert becomes much bigger, it not only stretches out the earlobe but the tissue becomes much thinner as well. (pressure atrophy) When put back together, the final size of the earlobe will likely be smaller than before.
Earlobe reconstruction is done by cutting out the skin along the central hole, including some of the rim, and putting it back together in the shape of a more normal earlobe.
Like the split earlobe deformity, reconstruction of the gauged earlobe can be done under local anesthesia. This can usually be done in the office which saves a lot of expense when the cost of an operating room and anesthesia is not used. The typical cost of such earlobe surgery is in the range of $750 to $1,000 per ear.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, earlobe reconstruction, gauged earlobe repair, indianapolis, plastic surgery
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Wednesday, August 25th, 2010
Q : Hi, I read online that other girls have the same problem as me. I had a jaw reduction and the doctor shaved too much bone and side of the jaw, is uneven to the other side. You gave advice to them to have jaw implant. My question is that since the jaw is now uneven, how can you make it even by putting jaw implant? Will the implant be different since it is not the same? How much does it cost for chin augmentation? Not the implant but the moving if the chin. Thank you.
A: It sounds like you had a jaw angle reduction. Often times, too much bone is removed and the sides are uneven as more bone is taken from one side than the other. The only way to improve that problem is to replace the lost bone with an implant. The size and shape of the jaw angle implant is taken from tracings off of a panorex x-ray as both implants can not obviously be the same when asymmetry is involved.
Jaw angle reduction must be carefully done as it is easy to remove a large bone segment from this intersection of the posterior and inferior border of the jaw. This not only makes the jaw angle blunt but can make one look more aged as well.
A chin osteotomy is done much less frequently than an implant for chin augmentation. But in the right patient, it can offer some different dimensional changes that may be more ideal for facial balance. (e.g., chin lengthening) The average cost for a chin osteotomy is around $6500 when done as a one hour outpatient procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, jaw angle reduction, plastic surgery
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Tuesday, August 24th, 2010
Q : Last year I had a facelift which made my sagging neck and jowls look so much better. I love the result but have developed some raised and mildly painful scars behind my ear. My plastic surgeon said they would eventually go away but I am not so sure. They have not changed in size and they feel like small ropes along the backside of my ears. What do you suggest?
A: Nearly one-half of the incisions that are used in a facelift are behind the ears. Going along the grooves where the ear connects to the side of the head, these scars run along this groove where they go back into the scalp near the top of the ear. The skin behind these scars is used to pull up loose skin from the neck where it is trimmed off.
These skin flaps behind the ears are very thin and often are the slowest to heal after a facelift…even though they are not easily seen. Because these incisions behind the ears are stitched back together under some tension, a few patients can develop hypertrophic or raised scars because of it. Once the scar thickens it will become and stay sensitive.
Sometimes these raised behind the ear scars will settle down on their own with just time and scar maturation. If these raised scars persist beyond a few months, I recommend steroid injections. I repeat these injections every month for up to three injection sessions. They will usually cause the raised scars to settle. If they have not gone away by then, cutting out the scars is needed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift scars, hypertrophic scarring, indianapolis, plastic surgery
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Tuesday, August 24th, 2010
Q: I am getting saline breast implants in the next several months. I am getting them because they are less expensive and the size of the cut to put them in is much smaller. What I want to know is where is the best place to put them through…my armpit, nipple, or under my breast in the crease?
A: One of the two advantages to saline breast augmentation, besides a lower cost, is that they can be inserted through very small incisions. Because they are put in deflated, they are rolled up to about the size of a small burrito. This enables them to pass through incisions as small as one inch or 2.5 cms. Once in place, they are the inflated to their desired size.
While all three incision locations will work (armpit, nipple, lower crease), choosing one of them is based on the patient’s preference for scar location and how soon they must return to work and what type of work they do. If one has darker skin color (e.g., Asian or Hispanic), they I would definite choose the armpit or axillary approach. This is because this puts the scar away from the breast and women of these ethnic backgrounds are very sensitive about any visible scarring. Conversely, if one needed to return to work quickly and their job involved lifting, then I would choose the lower breast crease. Becasue the entire pectoralis muscle does not need to be elevated (only the lower half is), one will have less pain and a quicker recovery due to the more limited muscle trauma.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, saline breast augmentation
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Tuesday, August 24th, 2010
Q: I am interested in getting breast implants but only want to go up maybe one cup size. I don’t want anything drastic just a little change. I want the result to be completely natural looking and not fake. How can I be sure that will happen?
A: The concept of natural breasts can mean different things to different women. In general, however, what most women are referring to is a breast that is not disproportionate to their body and chest size and one that does not have a completely round shape. (too much upper pole fullness)
The most assured way to avoid an unnatural breast augmentation result is to have properly sized breast implants. In short, don’t get too big of an implant for your chest or the amount of breast skin that you have. The single best way to avoid that problem is to keep the diameter of the implant at or less than your own breast base diameter. Implants that are wider than your breast base will always look unnatural or too big. This may also mean to avoid a high profile implant which can have a tendency to look rounder after surgery, particularly if you have small breasts with tight skin to start.
Natural breasts are also those that don’t have palpable (able to feel) implant rippling. This is more of a concern with saline implants who have a greater tendency to develop implant rippling, which may also be able to be seen as well.
In summary, natural breast augmentation is best done by choosing a silicone gel implant that is slightly narrower than your breast base width. For many women this means that implants sizes will run between 250cc to 350cc.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, natural breast augmentation, plastic surgery
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Tuesday, August 24th, 2010
Q: How do you do mouth widening? I have a relative that is scheduled for that procedure and we are hesitant to do it. We have never heard of such a thing. How safe is the procedure? Thank you for any information that you can share with me.
A: The concept of making one’s mouth wider is possible but very rarely done. I can only assume that your relative has a small horizontal width to their mouth (small mouth) and wants it to be extended further horizontally.
Such an operation is possible by using the principles of commissure creation or modification. Known in plastic surgery as a commussuroplasty, the corners of the mouth can be either shortened (closed down) or opened up. (made wider). To make the mouth wider, a modified isoceles triangle of skin is removed out to the distance you want and the inner lining of the lip (mucosa/vermilion) is advanced out and sewn to it. (a Y-V advancement) This relatively simple procedure will make the mouth wider but does so by leaving small scars at the corners of the mouth at the junction of the skin and the lip tissue. If not overdone too much, it can definitely make a difference and look fairlu natural. Such a technique is used in the more commonly done corner of the mouth lift, where downturned corners are turned up and made more horizontal to get rid of frowning or a downturned smile.
Conversely, the reverse can be done to make a wide mouth small. (a V-Y advancement) This leaves a more noticeable scar in its wake as the lip lining is moved further inward.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: commisuroplasty, corner of mouth lift, dr barry eppley, indianapolis, making a small mouth wider, making a wide mouth smaller, mouth widening, plastic surgery
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Monday, August 23rd, 2010
Q: I want to know more about a procedure that will lower my upper lip. I show a lot of gum when I smile and this bothers me. I have read about a ‘mucosal roll-out’ operation that brings down the upper lip. Please tell me more about it.
A: An upper lip mucosal roll-out will have only a very minimal effect on actual upper lip lowering. That is used more to make the upper lip fuller but, in and of itself, will only lower it maybe a millimeter or two at best. To lower an upper lip for the purposes of a gummy smile treatment, the upper lip must be treated by levator myotomies (release of one of the main lip elevators) , an upper lip spacer insert (to keep the muscles from healing back together and to help push it down) and a V-Y mucosal release (frenulectomy, although technically it is a frenulotomy) and advancement. Moving the inner lining of the upper lip (mucosa) only will not be effective.
Lowering an upper lip is even more difficult to achieve than raising a depressed lower lip. While bone shortening (maxillary impaction) is the most effective way to bring the horizontal lip level down closer to the teeth during smiling, most patients do not want that much surgery to achieve that goal. Soft tissue surgery to lower the upper lip can be expected to achieve about 3 to 5mms of actual lip lowering. This can be combined with other dental procedures (crown lengthening) to get an even greater amount of gummy smile reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gummy smile treatment, indianapolis, plastic surgery, upper lip lowering
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Monday, August 23rd, 2010
Q: Dear Dr Eppley, I am contacting you with interest in stem cell-enriched breast augmentation. I think it is an interesting new technique and it has raised many questions in my mind. Here is my list of questions.
1) First of all, how is the surgery done and how much fat do you need to do it?
2) Specifically, I would like to know whether it is possible to transform my small A-cup to a preferred C/D cup. Is this possible with the procedure. What is the average gain in ml when you have an A-cup?
3) What are the risks? From other plastic surgeons I hear that the long-term effects are very uncertain.
4) I am kinda slim, so I am wondering if I have enough fat on my body to do the procedure?
I am looking froward to our answers.
A: In answer to your questions about breast augmentation with fat injections and stem cells, here is some current realities with it:
1) It is not possible to go from an A/B cup to a C/D cup with this technique. The only reliable method to make that amount of change are implants. Fat injections can increase breast size about a 1/2 cup, in some cases maybe a full cup. It may take more than one injection session to achieve a full cup increase.
2) If you are very thin, and it sounds like you are, then you do not have enough fat to perform even a small breast augmentation. Even in a 1/2 cup to full cup increase, the volume per breast must be at least 100 to 150ccs. At that volume represents concentrated fat after harvest. Which means about twice that amount needs to be aspirated before concentration.
3) The risks of the procedure are largely what happens to the fat after injection. Currently, no method can guarantee how much fat will survive. And there is always some fat resorption of the injected volume. With resorption there is the possibility of lumps or hard spots and breast irregularities.
While the concept of breast augmentation with fat remains very appealing, it is a work in progress currently. Breast implants still offer the most assured, simplest, and reliable for safely increasing one’s breast size. Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation with fat injections, dr barry eppley, indianapolis, plastic surgery, stem-cell enhanced breast augjmentation
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Monday, August 23rd, 2010
Q: I am interested in having a jawline tuck procedure. The only part of my face that bothers me as I have aged is along the jowls. That is the only place where I have some excess skin that affects my appearance. Please tell me where the incisions area and what part of the face this operation does, and does not, affect. Thank you!
A: Basically, a jawline tuck is a simple modification of a limited or mini-facelift. It is similar to the advertised and marketed ‘Lifestyle Lift’ which is a franchise approach that offers a very similar procedure. As the name would imply, it is a facial rejuvenation procedure that has very little downtime hence the branded name. The fine line incision starts at the top of the front of the ear, goes inside the ear behind the tragus, and then around the back of the earlobe. Through this hidden incision, any loose skin along the jawline (jowls) is lifted smoothing this area out. There is some benefit in the neck area but not as significant as that of the jowls. This procedure is as described….a tuck for the jawline or jowls. It does not affect any other part of your face.
Many times other facial procedures are done with this ‘little’ facelift such as neck liposuction, laser resurfacing or chemical peels, and eyelid tuck procedures. But when done alone, there is less than a week of any visible swelling and bruising so recovery is quite rapid.
The key concept to grasp is that a facelift is an isolated jowl and neck procedure. A limited facelift or jawline tuck is just a smaller version of it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jawline tuck, lifestyle lift, limited facelift, plastic surgery
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