Archive for September, 2010
Thursday, September 30th, 2010
Q : I am interested in cheek implants but am not looking for a drastic change, just enhancement. I want to look better but have people not be able to tell what is different. I have a few questions. What is the recovery time from work and physical activity (running and cross training/weight lifting)? Are the implants inserted from the mouth and fixed to the jaw? Do cheek implants inhibit ability to smile? Approximately what % of patients are happy with the cheek implant procedure?
A: Cheek implants are done as a simple 1 hour outpatient procedure. They are inserted through the mouth and secured to the bone with a screw. There are no restrictions of any kind after surgery. While you will have some cheek swelling (but no bruising), there is nothing you can do from an activity standpoint that will hurt the implant or their position on the bone. One can eat and drink right after surgery. Pain is very minimal although usually there will be some temporary numbness of the cheek skin and a little bit of the upper lip. Cheek implants will not change your ability to smile or how your smile will look. Initially, your smile will feel a little stiff but that is due to the swelling. The vast majority of patients who receive cheek implants are happy but I also feel that it is the one facial implant that undergoes higher revision rates than all others due to inexperience in placing them, size and position selection, and style of implant used. It is a simple procedure to do but there is definitely an artistic flair to doing them well.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek augmentation, cheek implants, dr barry eppley, indianapolis, plastic surgery
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Wednesday, September 29th, 2010
Q : I’m interested in having paranasal implants and I noticed that you have experience in using these implants. Could you please tell me how exactly these implants effect the nose and the upper lip? Does this implant usually widen the alar base of the nose? Does it lift the tip of the nose, which is common in LeFort I osteotomies? Is the upper lip lifted by these implants or is the upper lip seemingly becoming smaller, because of the new relation between the new volume around the nose and the volume of the upper lip? How does it usually effect the nasolabial angle and how does the upper lip change in the profile view? Are there slightly different ways to place the paranasal implants, for example to place the implants closer together towards the spina nasalis anterior or a little bit more apart from each other? I talked to another plastic surgeon and he said they had the same effects on the nose as the LeFort 1 advancement, but I´m not sure if this is correct, because the position of the spina nasalis anterior is usually changed by performing a LeFort I osteotomy. However, by placing the paranasal implants the position of the spina nasalis anterior stays the same. Also the upper teeth stay in the same position and I wonder what effect this might have on the upper lip.
A: Paranasal implants are placed at the base of the ala along the perimeter of the pyriform aperture. They help fill out the paranasal area but will not create the same effect as LeFort I osteotomy. To do so they have to be combined with a premaxillary implant which sits in front of the anterior nasal spine. They have no significant effect on the size, shape, or position of the upper lip or the nasolabial angle.
For central midface deficiency they can help ‘pull the face forward’ when used in conjunction with cheek implants. They add fullness to the nasal base but will not change nasal tip projection. Over the years, the greatest use of them in my Indianapolis plastic surgery practice is in unilateral cleft lip and palate to help build out the upper alveolar and nasal base deficiency.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, midface deficiency, paranasal implants, plastic surgery
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Tuesday, September 28th, 2010
Q: Are you familiar with the wire release for nasolabial folds and does it work? Will it leave a scar?
A: The nasolabial fold, also known as the facial parentheses, is an interesting facial fold that is not really a wrinkle. It develops as the cheek tissues fall with aging over the more fixed and immobile upper lip. This creates a deepening fold as the cheek tissue piles up on top of the lip. While injectable fillers are the most common method of softening the nasolabial fold, they are temporary and don’t address the actual problem. There are surgeries that treat the real problem, cheek sagging, through a midface or cheek lift but that is usually too extreme for most patients and is best done if the lower eyelid has significant signs of aging as well.
Other methods of nasolabial fold treatment have focused on releasing the attachment of the fold. One of these methods has become known as the wire release. Through several small stab incision and a triangulation technique, an actual wire under the skin is used to widely release the dermal attachments of the fold. While the same technique could be done with scissors, it would require a larger, more visible, incision. This is the advantage of the wire technique. The wire does effectively release the nasolabial fold and produce some initial impressive early results. (after the bruising clears) But the long-term results with this method show a fair amount of relapse as the tissues adhere back down. For this reason, I like to place a dermal graft underneath the released tissues to provide a better long-term result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, nasolabial fold grafting, nasolabial fold release, plastic surgery
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Tuesday, September 28th, 2010
Q: Hello, I read about the Patriot Plastic Surgery Program on your website and have a few questions. I was wondering if that included the National Guard as well. I am in the Army National Guard and I am being deployed next summer. I was looking to have a tummy tuck done before my deployment so I would have time to get back in shape. I have lost around 50 lbs from the birth of my daughter and have the excess skin that needs to be removed. I would appreciate any information you may have about the Patriot Plastic Surgery Program. Thank you so much for your time.
A: The Patriot Plastic Surgery program is for all members of the Armed Services and their immediate families. It provides some financial relief for those desiring many popular cosmetic surgery procedures. The costs of surgery are both fixed and variable. The fixed costs of any surgery are the fees associated with the use of the operating room, anesthesia charges, and the costs of any implants used. The only variable fee in cosmetic surgery is what the plastic surgeon chooses to charge for his/her professional time. Dr. Eppley makes an adjustment in his surgical fees to provide some well deserved financial relief for those who qualify for the program.
Many members of the Armed Services have taken advantage of the program since its inception in 2009. Given the young age of most program participants, the most popular procedures include tummy tuck and liposuction, breast reshaping, and rhinoplasty and otoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, patriot plastic surgery program, plastic surgery
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Monday, September 27th, 2010
Q: I have two differently sized nostrils. My left nostril is smaller than my right. It looks like just removing some skin will fix the problem. How easy is this to do? I have attached a picture of my nose from below for you so you can see the problem.
A: There are numerous causes of one nostril being different than the other one. Since the nostril is geometrically a triangle, changes in the any of three legs (columella, alar rim, nostril sill) can cause a change in nostril size and shape. The most common cause of nostril asymmetry is an alteration of the vertical leg. That is the piece of skin between the nostrils known as the columella. It is supported from behind by the end of the septal cartilage, known as the caudal septum. This is frequently deviated or deflected to the side into the nostril space. When this occurs, the oval-shape of the nostril will become deformed making it look smaller. This is exactly what your picture shows…a classic deviated caudal end of the septum.
Whether more of the septum is off of the midline as it goes deep into your nose is unknown. You would probably know that because such a deviation is likely to cause breathing problems of which you would be aware. Regardless, correction of this problem is through a septoplasty procedure. The septum is moved back to the midline behind the columella. This anatomic correction returns the nostril size and shape back to better symmetry with the opposite nostril.
Septoplasty is commonly performed as part of many cosmetic rhinoplasty surgeries.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: correction of nostril asymmetry, dr barry eppley, indianapolis, plastic surgery, septal deformity, septoplasty
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Monday, September 27th, 2010
The desire for fat reduction is a near universal one that crosses all age, gender and ethnic lines. From the countless number of diet and exercise approaches to the opposite choice of liposuction surgery, loss of body fat can be successfully done with varying degrees of individual effort. But between these two ends of the fat loss spectrum lies the developing field of non-invasive body contouring. The concept of losing fat without surgery through an external device is both appealing and promising.
External ‘machine-driven’ methods for fat reduction are not new. Whether it was the belt-driven shaking machines from the first half of the last century to sitting in a sauna box and sweating it off, letting something else do the work and hopefully losing weight will always catch the public’s attention. Taking a pill, of course, is the simplest and requires the least amount of effort. But you probably didn’t get overweight or develop those few fat areas by taking pills, so it seems unrealistic that you can lose this fat by pills alone. While science and technology has come a long way, does today’s non-invasive body contouring devices really work…or are they just a modern-day version of the old ‘shaking machine’?
The newest technology for non-surgical body contouring is Zerona. This is an external cold laser that helps make fat cells leaky and loss some of their lipid contents. While people think of a laser as being a focused beam of light that hits a target and causes it to vaporize or melt, cold laser technology is different. It can pass through the skin without injuring it and penetrate up to 5 cms (2 inches) in depth. This can reach localized fat and exert its photochemical effect. The concept of photochemical-induced leakiness of fat cells is a bit hard to grasp but its physics are a little similar to the way cell phones actually work. I have a hard time wrapping my mind around cell phone technology to understand how all these messages and images are flying around and get to their intended recipients….even when I am on an elevator or a plane. But despite my ignorance I have plenty of evidence every day that it does work. So I won’t hold it against photochemical-induced fat loss simply because I don’t completely understand the science behind it.
The effects of Zerona on fat is very short-lived so multiple treatments are needed, spaced but a few days apart. Over a course of several weeks and multiple treatments, many patients have been shown to lose several inches around the waist, hips and thighs. But along with the treatments it is advised to drink water and take a niacin supplement to support the lymphatic clearance of the released fat. Herein lies the important difference from today’s technology and yesterday’s devices of hope…the use of some modest lifestyle changes and good patient selection.
Non-invasive body contouring is not a substitute for what liposuction can achieve or for the large amounts of weight loss that occur from bariatric surgery. Rather it is intended to benefit those who have some stubborn areas of fat that are just not responsive to what you can do at home with your best efforts. And for those who do not feel they have enough of a fat problem to justify surgery or want to do anything to try and avoid that solution. By using these criteria, most patients that use Zerona have more modest fat collections. This size of the problem and the modest lifestyle changes that are part of the program account for the generalized success and satisfaction that occurs from this non-invasive body contouring device.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, non-invasive body contouring, plastic surgery, zerona fat reduction, zerona laser
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Monday, September 27th, 2010
Q: I have two forehead bumps that are very distressing to me. They have been there since I was very young. They stick out like horns and I am very self-conscious of them. Can they be taken down and made smooth with the rest of my forehead? What is involved in this type of surgery and what are the risks?
A: Thank you for sending your pictures. I can clearly see the two upper forehead bumps. While they are not true osteomas, they are protrusions of the frontal bone. They can easily and simply be reduced through burring reduction. You can take down the outer table of the frontal bone in these areas up to 5mms to 7mms which should make them smooth and even with the rest of your forehead contour. This can be done through an incision either back in your hairline or just along your hairline. This would result in a very fine line scar. The hairline incision, commonly used in pretrichial or hairline browlifts, offers an advantage in that one could advance the frontal hairline forward if one desired. In your pictures, it appears that your forehead is fairly long between the hairline and the eyebrows. That distance could be easily reduced at the same time by bringing the hairline forward. I have found that to be very helpful with burring down upper forehead prominences as the combination of bone reduction and a shorter forehead length makes for a very smooth and more pleasing forehead shape.
This is an outpatient procedure done under general anesthesia that takes less than two hours to do. There is very minimal pain and swelling afterwards. A wrap around dressing is used just overnite. One can shower and wash their hair the very next day. There are are not real risks to the procedure other than the fine line scar which blends in quite nicely and is rarely detectable. Usually one’s hair grows through the very edges of the scar so it is not visible.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead bump reduction, forehead reshaping, hairline advancement, indianapolis, plastic surgery
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Monday, September 27th, 2010
Q: I have had some body changes which have left me looking like a man. My head is also bigger. I have lost the contours of my face and my hips are strapped like boy’s. My hair is shorter too. Is there a way you can help?
A: Questions like this, while well intentioned, are a waste of time for both the patient and the plastic surgeon. The description of concerns are very vague and non-specific. Plastic surgery is about doing very specific procedures for identifiable specific and focused concerns. When a collection of procedures are done, it may very well be possible to change the look of one’s face or body. But plastic surgery is not magic and having plastic surgery does not ensure anyone that they will look different or feel better about themselves.
The most satisfied patients in plastic surgery are those that come in with observable anatomic problems and a reasonable amount of concern about them. As a plastic surgeon, I have no hope of making someone satisfied with a result when the exact problem is not clear beforehand. As the old motto goes, ‘you can not hit a target you do not have’.
When I sit done with patients in a consultation, I want at the end to have a list of specific concerns and have them listed in their order of priority. If we start at the top of the list and only do just one or two procedures gthat are directed to improve them, the patient is likely to end up feeling that their results were worth the effort.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, expectations in plastic surgery, indianapolis, plastic surgery
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Saturday, September 25th, 2010
Q: My son has torticollis which has contributed to his skull and facial plagiocephaly. We did not know about the cranial helmet when he was young and his condition was left untreated. He is now a teenager and very self conscious about his head being flat on one side and his face being skewed. He asked if there were any surgeries or anything we can do to correct it. I found your website and was amazed that you have experience with his exact condition. What can be done for him at this point?
A: Deformational plagiocephaly causes a very predictable pattern of skull and facial changes when untreated as an infant. As the craniofacial bones rotate around an axis, the pattern of asymmetries become flatness on one side of the back of the head and a protruding forehead, brow bone, cheek and jawline on the same side on the front. This can create very visible facial and front (forehead) and back (occipital) skull changes. I have seen a wide range of facial plagiocephaly problems in the degree of expression of the amount of asymmetrical differences.
Since the fundamental problem can not be reversed, changes must be done in an effort to camouflage or improve the different asymmetries. These can include an occipital cranioplasty to build up the flat area on the back of the head and numerous facial structural changes. The face can be altered by forehead and brow bone reshaping, cheek augmentation and jaw angle , and a chin osteotomy, all done with the objective of improving facial symmetry. The combination of skull and facial procedures that are helpful will be different for each patient. It requires an individualized assessment and computer imaging to determine the best plastic surgery plan for each patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial asymmetry from plagiocephaly, indianapolis, plagiocephaly, plastic surgery, torticollis
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Saturday, September 25th, 2010
Q: Hi. i am an 18 year old male who is looking at getting something done to flatten my forehead and reduce my brow ridge, as I am unhappy with how it looks. i just wanted to know if I am a bit young to be getting something like this done? Also I play a fair bit of soccer so would like to know if it would affect how I header the ball permanently if I was to get surgery like this? Also would the scarring be noticable if it were not on the hairline?
A: From your description, it appears that one side of your forehead is more protrusive than the other, giving you forehead and brow asymmetry. The surgical technique for brow reduction is more effective than forehead reduction. The middle and tail of the brow bone (which is usually the most noticeable) can be burred down fairly significantly. The forehead bone that extends above it, however, can not be so significantly reduced. The outer table of the forehead bone (cranium) is only about 5mms or so thick before the diploic space is entered. From a practical standpoint, you don’t want to be reducing the bone into the diploic space so only about 4mms or so of bone can be reduced. While this would make some difference, the brow reduction and shaping would be more significant. The other important issue is that to do the forehead reduction, a large coronal scalp incision would be needed. This creates it own aesthetic issues and the trade-off of the scar for the amount of forehead reduction may not be a good one.
Doing the brow bone reduction, however, can be done through an upper eyelid incision. Given this hidden scar and for the amount of brow improvement, this would be a much better trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone reduction, brow bone reshaping, dr barry eppley, forehead reduction, indianapolis, plastic surgery
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