Archive for November, 2010
Tuesday, November 30th, 2010
Q: I read an article by you on non-surgical fat reduction and understand from your writings that you have one of Erchonia’s Zerona cold laser devices. I was wondering if you have had any experience or success with reducing large lipomas?
A: Your question represents a common and understandable misconception about lasers in general and the Zerona device in particular. Almost everyone envisions a laser as a device which shoots a beam which melts, explodes or destroys the target. This would be a high energy focused ‘hot’ laser and is the most typical laser concept that is employed around the world. The Zerona device, however, is a ‘cold’ laser meaning it does not shoot high energy beams toward its target. Rather it is a very low energy photochemical light which causes a reaction that has a much different effect on the targeted fat cells. It passes through the skin, without injury or discomfort, and causes the fat cells to become temporarily ‘leaky’. This releases some fat and, if done enough times, the fat volume in the targeted area will decrease in size.
Because of the way the cold laser works, its effect will not have any impact on the concentrated tumor fat of a lipoma. It simply is the wrong type of laser energy.
There is a laser method for lipoma treatment that does use a hot focused laser. Under local anesthesia, the fiberoptic probe of the Smartlipo (laser liposuction) machine can be introduced into the lipoma and activated for a few seconds. This melts the center of the lipoma and can definitely shrink its size and/or destroy it completely. This does require a tiny little incision into the skin to pass the probe through so it is a minimally invasive approach but would not properly be called a non-invasive procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: lipoma laser injections, lipoma treatment by smartlipo, zerona laser
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Monday, November 29th, 2010
Q: I am a 21 year old male who was involved in a car accident when I was 16 years old. As a result, I have a depressed area on my forehead. I would like to know if Kryptonite Bone Cement could be injected to fill the depression?
A: The reconstruction of frontal bone defects or contour issues is often done using onlay cranioplasty techniques. It can be a highly successful procedure as synthetic material is added onto the bone defect area. Various materials have been used over the years, most commonly acrylic (PMMA, polymethylmethacrylate) and hydroxyapatite. (HA) While there may be advocates and some minor advantages and disadvantages with them, both will do the job equally well from a bone reshaping standpoint. Both materials require, however, an open approach for placement. For men in the forehead area, a scalp incision may not be worth the trade-off depending upon the size of the forehead problem. If an existing scalp scar is present from a prior neurosurgery procedure, then that is a different matter and an open cranioplasty would be the best approach.
Kryptonite bone cement is the first cranioplasty material that has physical properties to make it injectable. This means it still requires an incision but it can be as small as less than an inch through which scalp tissue elevation is done around the bone defect area. The material is then mixed and injection through a long flexible introducer tube into the defect site. Shaping of the injected material is done from the outside by external pressure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, frontal cranioplasty. kryptonite bone cement, indianapolis, plastic surgery
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Monday, November 29th, 2010
Q: I am interested in getting a breast augmentation but also have concerns about my nose. I think a rhinoplasty would almost help me as much as the breast augmentation in both appearance and my self-confidence. My questions is can I do them at the same time and is there any discount on getting more than one surgery at the same time?
A: Multiple operations during a single plastic surgery encounter is very common. Since one is going to be asleep under general anesthesia, it just makes sense to do as much as is medically safe and reasonable from a recovery standpoint. I have seen all sorts of different types of plastic surgery procedures put together and there really is no limitation as to what can be combined. The only limitation is whether the plastic surgeon feels comfortable doing all that the patient needs…and that the patient is healthy and can tolerate the surgery.
Breast augmentation is a relatively short operation, generally an hour or so, while rhinoplasty can take two or three hours to do depending on what type of rhinoplasty it is. These two operations combined are well within a safe operative time period of 3 or 4 hours and can even be done as an outpatient. I have performed these two plastic surgery procedures together more than one time. Younger women are exactly the type of patient who would commonly have one or both of these cosmetic concerns.
Any time multiple cosmetic procedures are combined, there is some economy to be had in both recovery and costs.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, indianapolis, plastic surgery, rhinoplasty
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Sunday, November 28th, 2010
Q: I have drooling from the corners of my mouth and its embarrassing. I am 73 years old and have not had a stroke and I am still working everyday. What can be done for this corner of the mouth drooling problem. It was also occasionally get red and sore and painful. When this happens, it takes a fair while until it finally gets better. I have tried all sorts of antibiotic creams and salves but nothing seems to be that effective. I have read about a procedure called the corner of the mouth lift that removes the overhanging skin. Do you think this will help?
A: Downturning of the corners of the mouth, combined with aging which creates a skin overhang, creates a gutter effect at the corner of the mouth. This is the perfect setup for a runway for saliva. This problem can be further magnified with one has overclosure of their lower jaw due to a loss of teeth or ill-fitting dentures. This overclosure causes a lower lip inversion which makes the drool problem at the corner of the mouth worse. Localized infection at the mouth corners can happen due to the chronic wetness of skin that is not normally so like the lining inside the mouth. This is known as angular cheilitis. Topical steroids and antifungals can help but a change of the anatomy is more effective.
The corner of the mouth lift can be really helpful for this problem as it removes the skin overhang and lifts the mouth corner. This eliminates much of the spillway problem. There is a trade-off of a small scar that tails away from the mouth corner but this is not usually a significant cosmetic concern.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: angular cheilitis, corner of mouth lift, dr barry eppley, indianapolis, plastic surgery
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Sunday, November 28th, 2010
Q: I am bothered by my puffy cheek look. I feel that the area under my cheekbones is full and, as a result, does not give good definition to my cheek area. I had cheek implants placed but they didn’t give me that more sculpted look that I was looking for. I think the problem isin the full area below the cheek. I have read this is called the submalar area. Is it possible to have a tightening of the submalar soft tissues area. Is there such a procedure? I have simulated this concept in front of the mirror many times without knowing it was possible outside of a full facelift and really liked the improvement it makes in highlighting the cheekbone. How would such a procedure be done? Is there any external scarring or is it done completely intraorally? I would like to pursue this procedure seriously so any information you can provide would be much appreciated. Thanks again.
A: The submalar area of the face is a non-bone supported area beneath the cheek bone (malar eminence) that is influenced exclusively by the volume of soft tissue that it contains. Thinning, or creating an indentation, in the submalar area is commonly done by buccal fat removal. While this simple procedure can be helpful in the right patient, it does not work well for every fuller face. And can even create too much of an indentation later in life when one gets older as natural fat atrophy occurs in most people.
An alternative procedure is submalar tightening. It is not nearly as well known but can also create a narrowing of the submalar triangle. Using the same intraoral incision and approach as one does for a buccal lipectomy, the underlying soft tissues are cinched down with a suture anchor placed into the underside of the zygoma. This can be done in conjunction with buccal fat removal for a combined submalar indentation effect.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, dr barry eppley, indianapolis, plastic surgery, submalar tightening
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Saturday, November 27th, 2010
Q: Dear Dr Eppley, I underwent a chin reduction with a jaw contouring operation about one year ago. As for the result, have always found that it looked odd. My chin was reduced by 1cm and now my mouth does not close properly at rest and there is a ‘balling’ shape to the muscle and a wrinkled look. I recently had a MACS lift as my jaw muscles also looked slack after the op. However my chin is unchanged and still feels loose, unattached and ‘balled up’. I have come across your writing online and think your expertise may help resolve this. What do you suggest?
A: If your chin reduction was done through an intraoral vertical osteotomy reduction technique, then you would likely end up with soft tissue excess over the chin area when a large amount (1 cm) is vertically reduced.. (mentalis muscle and skin) These excess soft tissues could very well end up looking like a ‘ball’ over the chin area. This could really be predicted beforehand as where is all of the soft tissue that covered the 1 cm that was removed supposed to go?
No form of a facelift would solve the excess tissue problems in the chin area nor should it be expected to. A MACS lift, like any form of a limited facelift, is a lateral or side of the face operation based on soft tissue pull. So it will tighten up any loose skin over the side of the jaw/jaw angle area/jowls, but will do nothing for the chin area. The chin area excess is a central problem that requires direct excision and tightening, most commonly done through a submental incisional technique.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin reduction, dr barry eppley, indianapolis, plastic surgery, submental tuck-up
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Saturday, November 27th, 2010
Q: Dr. Eppley, I had a Medpor Lateral Augmentation Onlay Mandible Angle Implant for mandibular augmentation about nine months ago. While I am satisfied with the results, I desire more lateral augmentation of his mandible. I know from reading that it is possible to reduce Medpor Implants in a second operation if the patient feels the implant provides too much augmentation. Is it also possible to enhance an implanted Medpor implant, by placing some further Medpor material on top of the implant surface in a second operation? I thought it could be useful to place smaller pieces from Medpor sheets and place and secure (screw) them over the existing mandibular implants in order to increase their lateral projection. Would you advise to place additional Medpor over an incorporated Medpor implant? Do you know if Medpor is designed for this or are there any problems that might occur by enhancing an existing Medpor implant with further Medpor material? Thank you in advance for your efforts.
A: I see no problem why you can’t add more material on top of an existing Medpor implant. The important issue would be good security (screw fixation) to the underlying implant. I would be concerned about shifting or palpability of a multi-implant reconstruction not any interactive material problem or reaction.
It would be far better and easier, I think, to remove the existing implant and add to it on the back table…to assemble a good solid construct and then re-insert during the surgery. This may make it surgically easier to do. Or why not change just to a whole new bigger implant and be assured you have a solid one-piece construction?
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, mandibular angle implants, medpor mandibular implants, plastic surgery
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Friday, November 26th, 2010
Q: I have been developing droopy jowls over the past few years and it is getting worse. I am 50 years and I don’t want a facelift or surgery. Is there anything that may help them go away that doesn’t involve any cutting and scars? I have read about some fat dissolving injections which they say can make jowls get better. Is this true?
A: The development of jowls or jowling will occur in everyone eventually. These classic aging signs are when the skin and fat that used to be up on the side of the face comes sliding down due to time, gravity, and weakening of the skin’s attachments. There is no question that the preferred as well as superb treatment for isolated jowling is some form of a facelift. If jowling and not the neck is the main issue, then a more limited type of facelift will work quite well. These smaller facelifts (jowl lifts or tuckups) go by many different names, most popularly known as a MAC Lift or a short scar facelift. Regardless of the branded name, they are all essentially the same type of limited facelift operation.
Short of surgery, fat dissolving injections have been used for mild jowling. Known as Lipodissolve injections, these chemical concoctions do have the ability to break down small areas of fat and tighten just a little bit of skin. I have used them very rarely in the jowl area but, in the handful of cases that I have done, there was a definite amount of improvement and several of those patients were absolutely thrilled. The key is in patient selection. They must not have too much loose skin or too much jowling or these injections will have no benefit.
There are also other device-driven methods of jowl tightening such as Thermage, Skin Tyte and others. The concept is to treat the deeper skin and underlying tissues with heat, ultrasound or radiofrequency energy to create the tightening. These device approaches to jowling would be more mainstream and accepted as opposed to Lipodissolve injections.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, lipodissolve, non-surgical treatment of jowls, plastic surgery
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Friday, November 26th, 2010
Q: I have several questions in regards to scar revision. When you perform a geometric broken pattern scar revision, then will you be cutting out more skin beside the original scar? What is the role of injecting Botox in the scar revision surgery?
A: Your assumption in how geometric scar revision works is correct. To make the various limbs and angles, some normal tissue in addition to the scar must be removed. This does not lengthen the scar in total visual length as the small tissue areas are taken from the sides of the scar not from the ends. If you straightened out the scar ins a single straight line, it would in fact be longer than the original scar by actual length measurement. But this increase in scar length is ‘internal’, staying within the original length of the scar.
The use of Botox in scar revision remains, at this point, entirely theoretical. Its use in scars is more hope than proven science. While Botox does seem to be good for a lot of problems, it is not good for everything. Botox works by decreasing nerve output, usually to muscle. Scar and any resultant hypertrophy or widening is not usually a muscle or nerve problem in most cases. Poor scarring is more related to tension on the wound edges and the type of skin and mechanism of injury. It is not clear why Botox would work for most scars unless it is weakening any pull on the scar edges from the underlying muscles in the critical scar phase of the first six months after its creation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: botox for scars, geometric broken line closure, scar revision
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Wednesday, November 24th, 2010
Q: I am considering breast augmentation but am just insure about what size to go to. I have been an A cup all my life and have no real idea what would like right on me. Do you have any suggestions to offer in choosing size?
A: When it comes to breast size, beauty is truly in the eyes of the beholder. While there are certainly trends in each culture that reflect the ‘average breast size’, that has little to do quite frankly with what you want for yourself and how you want to look.
Breasts should be proportionate to a woman’s body frame and build. The historic concept of 36-24-36 inches, though quite exaggerated, basically refers to breast size being equal to the hips, with a significant narrower waist in between. This creates that classic hourglass figure but that may not be right for everyone and probably is more uncommon than common.
It is important to consider a woman’s body build in determining the most suitable breast size because if one’s arms or tummy is bulky then the breasts will have to be bigger to give the right profile. In thinner women smaller sized breasts will give the same look of fullness in the breasts.
With all of that being said, the one single parameter that seems to work for most patients is to choose a breast size (implant) whose base width matches the natural base width of your breast. This is a simple horizontal measurement. As breast implants increase in diameter as they get bigger, having an implant that is no wider than your natural breast will never give one a final breast size that is too big. (which is the most common fear of most breast augmentation patients before surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast augmentation, choosing implant size in breast augmentation, dr barry eppley, indianapolis, plastic surgery
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