Archive for September, 2010
Thursday, September 23rd, 2010
Q: I have been researching getting breast implants for some time. I know the differences between saline and silicone types of implants but am confused about these ‘gummy bear’ implants. I know it is some form of silicone but it is the best type of implant to get? Why is it different and are there any known problems with it? Is it the best type of breast implant to have?
A: The first thing to appreciate is that there are numerous type of breast implants from which to choose. They all will work and are FDA-approved with the exception of the gummy bear implant to which you refer. It has yet to be shown that there is one type of breast implant that is superior to any of the others. They all have some advantages and disadvantages and each woman has to weigh out those implant differences to determine what is the best breast implant for them. If there was one specific type of breast implant that was definitely superior that would be the only one that I would be using in my Indianapolis plastic surgery practice.
The gummy bear implant is a different type of silicone that is more firm than regular cohesive silicone gel. Hence the name gummy bear as it resembles this consistency. It is a textured anatomic implant that remains under clinical trials through the sponsoring company Allergan. It has not received FDA-approval as of yet. Because of its textured surface and its more form consistency, it must be placed through a larger lower breast fold incision than would be used for either saline or cohesive gel breast implants. Whether its added firmness is an advantage in cosmetic breast augmentation is a matter of debate. Its physical properties seem to offer advantages in breast reconstruction where the breast tissue may be thinner and more prone to contracture deformity. Gummy bear implants can and do ‘fracture’, requiring removal and replacement.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, dr barry eppley, gummy bear breast implants, indianapolis, plastic surgery
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Thursday, September 23rd, 2010
Q: I could not find info on your website regarding earlobes. Mine are large and I think it would look much more aesthetic if they were trimmed. Was wondering how it would be done. Thanks!
A: Large earlobes can be the result of one’s natural genetics or from aging and the use of heavy ear rings. In women, it is often the latter. In men, since they don’t wear heavy hanging ear rings, it is the result of one’s genetics. There is some component of aging and gravity that can make the marginally large earlobe larger and longer in later life. Either way, the surgery to reduce them is the same.
Earlobe reduction is a fairly simple surgery that often can be done under just local anesthesia. Like all earlobe surgery, it is not extensive because the earlobe is relatively small compared to the rest of the ear. There are several different methods of cutting out extra earlobe tissue and the differences are all about where the scar ends up on the earlobe. The wedge excision technique removes a triangular piece of earlobe from the central part. It is very effective at making the earlobe smaller and better shaped but does place the scar right down the middle of the earlobe. This scar usually ends up looking fairly indistinct but one must know beforehand that is where the scar will be. The other technique of earlobe reduction is to remove the lower hanging portion of the earlobe. This places the scar along the more hidden location of the rim of the earlobe. Both methods are effective and the choice between the two is partially influenced by the shape and size of one’s earlobe and preference for scar location.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, earlobe reduction surgery, indianapolis, plastic surgery
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Thursday, September 23rd, 2010
Q: I have a divot in both of my shoulders from Vitamin B12 injections in which one became infected. I am a fitness competitor. Vitamin B12 is used for energy when dieting and also temporarily enhances the roundness of the shoulders (it is not discussed but used by competitors – injectable Vitamin B12 can be ordered from Canadian pharmacies). I no longer do this of course, but I am not happy with the divots left in my shoulders because of these injections. I was interested in fat grafting to replace the lost fat.
A: Loss of fat beneath the skin, known as subcutaneous atrophy, is not an uncommon sequelae of numerous types of injections. In plastic surgery, it is frequently seen in repeated steroid injections in the treatment of scars. I was not aware that Vitamin B12 has a similar effect and it is unclear if the fat destruction occurs as a result of the vitamin or the solution in which it is suspended to make it injectable.
The treatment (recontouring) of these divots is best done and is ideal for fat injections. While dermal-fat grafts can also be used, they require an incision to be placed and that requires an additional cosmetic burden that may be just as distracting as the original depression. Any of the off-the-shelf injectable fillers can also be used but there effect is only temporary and not a good long-term economic approach. Small divots like these are perfect for fat injections as their small volume makes it more likely that the fat will take and survive long-term.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat injections for soft tissue defects, indianapolis, injection fat atrophy, plastic surgery
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Thursday, September 23rd, 2010
Q: Is there some place on the web to view close up frontal photos of scars from direct excision neck lifts? Do surgeons use traditional sutures that can leave trackmarks or are there other methods to close the site that won’t leave tracks?
A: Like a traditional facelift, the closure and the subsequent scar of the direct necklift is critically important. Since the direct necklift is fully exposed, it can be argued that the final scar is even more important than a more hidden facelift scar.
To see good close-up pictures of direct necklift scars, go to my blog…www.exploreplasticsurgery.com…and search under direct necklift. There are several blogs that address direct necklift scars and show photos of them. If you can’t find them let me know and I will send some to you to review.
The closure (suturing) of the neck wound is done with very small sutures that are removed a week later. Because the size of the suture is so small, they can not leave track marks. In my out of town patients who can not come back for suture removal as they have returned home, I use small dissolveable sutures that do not leave track marks either. Track marks are primarily the result of using large sutures that are left in a long time.
Another way to judge the outcome of a specific type of incisional scar is to look at the number of scar revisions that have been needed from the procedure. In my Indianapolis plastic surgery practice, I have yet been requested to do a scar revision from a direct necklift in a man. This can be explained by the great healing capability of bearded skin and the incidental scar therapy of daily microdermabrasion. (shaving)
Dr. Barry Eppley
Indianapolis Indiana
Tags: direct necklift scars, dr barry eppley, indianapolis, plastic surgery
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Wednesday, September 22nd, 2010
Q: I have a small tattoo of my upper arm that was put there years ago. While it is nothing gross or has anyone’s name on it, my boyfriend now does not like it and would like it to be gone. I have used some stuff bought over the internet for it but it hasn’t worked like they said it would. I looked into having laser treatments done for it but it was too expensive and it was going to be painful. I spent less than $200 to have it placed and with laser treatments it was going to cost over $3,000 to have it treated with no guarantee as to how much of it would be gone. Are there any other options for tattoo removal?
A: While laser tattoo removal can be effective, it is fairly costly because the laser machine has to be paid for and that is understandably factored into the cost of the treatment. A new non-laser method of tattoo removal does exist known as Tatt2Away. With this method a special fluid is placed into the tattoo using the same technique that got in there known as micropigmentation. This fluid causes the tattoo pigments to leach out of the skin. While it takes several treatments for optimal clearing (three or four), it offers results that are as least as good as that of the laser without the cost and potential risk of skin scarring. Unlike lasers which can not effectively treat all pigment colors, hues and blends, Tatt2Away is color blind and removes pigments regardless of their color base. It is also less painful than laser tattoo treatments because no heat is generated during the treatment. At roughly half the cost of a laser treatment, Tatt2Away now offers an effective alternative for tattoo removal.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, laser tattoo removal, plastic surgery tatt2away tattoo removal, tattoo removal
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Wednesday, September 22nd, 2010
Q: I would like to know few things about butt implants Dr. Eppley did my breast implants few years ago and now i would love for him to do my butt. I want to go big. What sizes and shapes can I pick from?
A: Buttock augmentation is similar to breast augmentation in some ways but different in others. Buttocks implants, unlike breast implants, are made from a very soft and flexible solid silicone rubber material. They are not fluid-filled. Like breast implants, they can be placed above (subfascial) or under (actually into) the gluteal muscle. Those two different locations carry greater significance in buttock implants than in breast implants,, particularly in terms of recovery. Intramuscular implant placement is preferred but that also limits the size of the implant that can be used and makes the recovery much more prolonged and uncomfortable. One’s anatomy also can also drive this choice because if there is little subcutaneous fat present over the buttocks, the intramuscular location will produce a smaller but more aesthetic looking result. (concealing the implant edges better)
Buttock implants come in either round or oval shapes and have volumes ranging from about 150cc to 400ccs. Unlike breast implants, in which the size range that can be used is much more variable, the size and shape of buttock implants must be more closely matched to the surface anatomy and measurements of one’s buttocks. In the buttocks you don’t have the luxury of just putting in whatever size implant you want. The risks of postoperative problems and complications is higher when you do so.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buttock augmentation, buttock implants, dr barrry eppley, indianapolis, plastic surgery
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Tuesday, September 21st, 2010
Q: Hey doc, I’m a girl who is of Chinese and Siamese descent. My question is, is it possible to reduce the size of my face in general through plastic surgery? The thing is I don’t have a specifically prominent area of my face as it is generally very wide and big. There is little to no fat and just very wide bones and I would like them to be smaller. My cheekbones are the most prominent while my jaw is simply wide but not very defined This gives me a very flat looking profile from the side but a very ‘big’ face from the front. So what is your take on this?
A: The best way for me to answer your question is to let me see some photos of you. The description is helpful but is not the same as actually seeing you. That being said, changing a facial ‘look’ is about picking a few facial areas that can help create a different facial gestalt or general appearance. Changing a ‘flat face’ requires providing more anterior projection and maybe doing some spot areas of reduction. In the Asian face, cheek and jaw angle reduction possibly combined with augmentative rhinoplasty helps change facial projection. While you can not really make a face smaller by actual measurements, you can make it appear more proportioned and this not look ‘so big’.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: changing one's face, cheek and jaw angle reduction, dr barry eppley, indianapolis, plastic surgery, rhinoplasty
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Tuesday, September 21st, 2010
Q: My ears stick out and I am looking into getting them fixed. Can you tell details of the procedure to do it?
A: The correction of protruding ears, known as otoplasty, is a relatively simple procedure that makes for a dramatic change in the shape of one’s ears. Using an incision on the back of the ears, the shape of the ear cartilage is changed primarily by using suture techniques. The primary reshaped areas of the ear are the antihelical fold, which often is missing or poorly developed, and the concha which is often too big or too strong. Both the size of the concha and the absence of an antihelical fold make the ear stick out too far from the side of the head. Once the cartilages are reshaped, the incision is closed with small dissolveable sutures. A wrap-around ear dressing is used in adults for just one day. It can be removed the next day and one can shower and wash their hair normally.
While the change is immediate and clearly visible once the dressing is removed, the ears after otoplasty will definitely be swollen and sore. The swelling will go away in about a week. The tenderness will remain for several weeks longer however. Complications from otoplasty are not common. The most significant ones would be over- or undercorrection, asymmetry between the ears, and delayed extrusion of one of the permanent sutures. (which can occur years to decades later) Of all of the otoplasties that I have done, revisional surgery has been limited to less than a handful.
Dr. Barry Eppley
indianapolis, Indiana
Tags: dr barry eppley, ear pinning, ear setback surgery, indianapolis, otoplasty, plastic surgery
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Tuesday, September 21st, 2010
Q: I have a high forehead along with a long face and I think it would look better if my hairline was brought forward and my forehead shortened. Is this something you could do in a male? I am 27 years old.
A: Shortening the vertical length of one’s forehead can be done by bringing the hairline forward. Much like a ‘reverse browlift’, the hairline is lifted up and brought forward rather than the eyebrows lifted. As a simple variation of the hairline or pretrichial browlift, forehead skin is removed to allow the hairline to come forward into a new and lower position, usually 1 to 2 cms of forehead reduction can be obtained. For women with long foreheads (greater than 7 cms. of length between the frontal hairline and the eyebrows), this is a very effective procedure that may allow them to change their frontal hairstyle afterwards.
In men, however, a long forehead is usually due to a receding hairline. The frontal hairline position in most men is not stable and naturally lengthens with age as hair loss ensues. While a young male does not yet have this problem, and it may not occur in every male, it is impossible to predict which male hairline may or may not recede. If a hairline lowering is done in a man, the scar line will eventually be seen as the hairline recedes later in life. I do not think this is a wise risk to take in just about any male patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, hairline lowering, indianapolis, plastic surgery, pretrichial browlift
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Monday, September 20th, 2010
For those who don’t know, the “wattle” is that fleshy fold of skin hanging down from the neck or throat. While not seen as an endearing piece of anatomy as one gets older, it is quite common in birds be it the pelican, common rooster or a Thanksgiving turkey. While it may be cute in a bird and makes it identifiable as a species, I have found no human yet that finds it flattering. Common amongst men and women alike as they get older, this sagging piece of skin and fat is often what bothers them the most about their aging face.
The wonderful world of digital cameras and cell phones have helped some people discover their neck wattles by seeing themselves in side view in a picture. Men make the discovery when wearing certain shirts and often feel it ‘flopping’ around when they move their heads. (swinging a golf club seems to bring on this sensation)
The good news is that neck wattles can be successfully eliminated and usually much easier than one thinks. The trick is matching the proper solution for the size of the neck wattle. Some wattles are small, others are quite large. Different wattles need different approaches.
The two things that we know about neck contouring is what doesn’t work. There has yet to be a cream that has a real ‘neck rejuvenation’ effect. The winner in that transaction is always the manufacturer and seller of the magical potion. If there was a cream that could really change your neck, we would all know about it and it would cost hundred to thousands of dollars per jar. (wrinkles are one thing, wattles are quite different) The other hopeful but unsuccessful effort is that of neck exercises. If the loose neck was primarily due to muscle looseness, this approach might have some benefit. But for the skin and fat that has become loose and is sliding off the face into your neck, the ‘neck gym’ remains more theoretical than useful. Neck exercising will have about the same benefit as it would for lifting the sagging breast or those eyebrows that just keep getting lower.
While many people would consider having a necklift, they wouldn’t dare undergo a facelift.This comes from a misunderstanding of the two procedures, not realizing that they are largely one and the same. I have found only a handful of patients who have ever actually known what a facelift really was. A facelift is really a necklift. But facelifting comes in two varieties which differ based on how much improvement in the neck is needed. A limited facelift (popularly known as a Lifestyle Lift or jowl lift) is great for jowling but not so much for the neck wattle. For small neck wattles, a Liftstyle Lift combined with liposuction in the neck may just do the trick. For a neck that hangs more, a full facelift is what is needed. It has a powerful change effect on making that neck more shapely and tucked up again.The difference between the two is the location and extent of the incisions around the ears. To really change the neck in more significant wattles and sagging, the facelift must have an incision that goes up behind the ear and back into the scalp. It is the pull from behind the ear that draws up and tightens the loose skin in the middle of the neck.
The other neck wattle surgery that few people have ever heard of is the direct necklift. It is the real wattle reducer and is the simplest of procedures to go through with but a few days of recovery. By cutting out the wattle directly, it is gone forever and creates a neck shape that hasn’t been seen for decades. The price for this most effective and simplest of wattle solutions is a fine line scar down the center of the neck. For the beard skin of men, this scar heals beautifully and may be the procedure of choice in the older male. For women, the location of this scar must be thought about carefully to determine if this is a good trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, indianapolis, lifestyle lift, neck wattle surgery, plastic surgery, turkey neck surgery
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