Archive for November, 2010
Wednesday, November 24th, 2010
Q: I have a burn scar on my leg from several years ago. I am sending a picture of my burnt leg, which I can stretch and bend easily meaning I can move it freely. I would like to know what you can suggest for getting the best scar result. I have heard about scars and that its impossible to make them disappear. Thanks in advance.
A:Thank you for sending your picture of your leg burn scar. Burn scars (deep 2nd and degree burns) create the worst outcomes in terms of eventually doing much with the scar because they have changed the entire thickness of the skin into one complete scar. The tissues are just never normal and do not have the ability for much normal tissue regeneration.
The good news is that you can move your leg freely without scar contracture or restriction. The bad news is that I don’t believe there is anything that will provide a substantial improvement in its appearance by any form of scar revision. Hypertrophic burn scars have changed the entire thickness of the remaining skin into one large white scar. It may be possible to get some improvement with combined fractional and CO2 laser resurfacing but the improvement may not be significant enough to justify the effort. That form of laser treatment may make it a little flatter but it will not make the scar disappear nor make it look like normal skin. Those goals are not possible. If the objective is some level of improvement then such effort may be worth it. But if the objective is to make it look like there is no scar there then any form of treatment should not be pursued as disappointment will surely follow.
Dr. Barry Eppley
Indianapolis Indiana
Tags: burn scar revision, dr barry eppley, indianapolis, plastic surgery
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Wednesday, November 24th, 2010
Q: I am 36 years old and have had fairly deep forehead lines for quite a few years now, which appear to be getting worse. Is there something other than plastic surgery or Botox that I can do to help my problem? I am desperate!
A: The simple answer is…no. But let me explain why. Wrinkles on the face form perpendicular to the direction that the underlying muscles move with facial expression. The well known horizontal lines on the forehead are a result of the large frontalis forehead muscle that attaches to our eyebrows and goes across our forehead the whole way to the back of our head. As you move your forehead with expression, the muscle lifts the eyebrows and creates the horizontal lines. The only way to stop them from forming, therefore, is to stop moving your forehead. Notice the difference in the depth of the forehead wrinkles when your forehead is still and not moving versus when you are lifting your eyebrows. (that difference is important for treatment considerations below)
There are only two non-Botox and non-plastic surgery options that can reduce your forehead wrinkles. A state of permanent facial paralysis is one option, otherwise known as death. Very effective but not appealing. The other option is to retrain your facial expressions so you don’t move your forehead anymore. Theoretically possible but if you are successful you will be the first human to have successfully done so.
I tell you this so in your desparate state so you don’t chase worthless treatment options and throw away money…or actually transfer your assets to the benefit of someone else. So do not chase the illusion of innumerable skin lotions, potions and facial exercises that promises a miracle wrinkle cure.
That leaves you with exactly what you want to avoid, Botox and forehead surgery, Unappealing but actually the only things that will work. Back to the depth of your forehead wrinkles when they are still versus moving. If the depth of the forehead wrinkles is acceptable when your forehead is still, then Botox would be the preferred treatment. If the depth of the forehead wrinkles at rest is still not acceptable, then a forehead lift with muscle removal would be the better treatment.
Dr. Barry Eppley
Indianapolis Indiana
Tags: botox, dr barry eppley, forehead lift, forehead wrinkles, indianapolis, plastic surgery
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Wednesday, November 24th, 2010
Q: Is it possible to have a vertical chin that points downward as a result of fleshy tissue and not bone? My chin is vertically too long for my face and projects downward especially when I smile. I’d hate to have complications from having the bone burred down on the tip but would also hate to have titanium plates & screws in my chin from a wedge of bone being cut out to reduce the chin. I live in Texas and I don’t’ know any surgeons here that are properly certified and experienced in chin reductions. Please let me know. Thanks.
A: A long vertical chin can be the result of too much bone, too much soft tissue, or a combination of both. In most cases, vertical chin excess is a combination of both. By definition, a chin that is too long because of bone must have extra soft tissue to go with it. Making the proper diagnosis helps one correct the right chin reduction procedure. Not properly addressing the right problem, or inadequately treating it, is the reason so many chin reductions have unsatisfactory results.
A physical exam can usually tell which component make up the vertically excessive chin. In some cases, a simple panorex dental x-ray can also be helpful. The observation that your chin soft tissues pull downward when you smile is common and indicates that it a combined bone and soft tissue problem.
Chin reductions can be done by bone only reductions (intraoral horizontal reduction osteotomy) and bone and soft tissue reductions. (extraoral submental bone burring reduction and soft tissue resection and tightening) Because these two procedures are so different, one can see the importance of making the correct diagnosis of excessive tissues.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin reduction, dr barry eppley, indianapolis, plastic surgery, vertical chin excess, vertical chin reduction
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Wednesday, November 24th, 2010
Q: Does Dr. Eppley perform non-surgical rhinoplasty? If so, how many has he done and what does it cost?
A: I have performed non-surgical rhinoplasty, otherwise known as using an injectable rhinoplasty. It is about using an injectable filler most commonly in the upper part of the nose (radix) to treat (hide) a hump. I have done that office procedure numerous times. It is only good to fill the bridge area above a hump to make it smooth. In a few other cases, I have used injectable fillers for small areas of fill-in for dents and asymmetries in other parts of the nose. But you can’t do a complete rhinoplasty or even a partial rhinoplasty in a non-surgical fashion. So the concept of an injectable rhinoplasty is for filling in small defects in the nose. It is also important to realize that these effect are temporary (one year or less) and not permanent.
I would have to see pictures of your nose to determine if this procedure is for you. If so, the usual injectable filler used is Radiesse because it lasts the longest although other fillers can be used. (e.g., Juvederm)The cost of the procedure is based on how much filler is used and what type. It could range anywhere from $350 to $850 depending on those factors.
Another form of injectable rhinoplasty is that using diced cartilage. While it does require a septal graft harvest, the cartilage is diced and injected through small syringes from an incision inside the nose. This injectable rhinoplasty procedure does require an anesthetic to perform and so it is better called a minimally-invasive rhinoplasty.
Dr. Barry Eppley
Indianapolis Indiana
Tags: diced cartilage grafting to the nose, dr barry eppley, indianapolis, injectable rhinoplasty, non-surgical rhinoplasty, plastic surgery, radiesse
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Wednesday, November 24th, 2010
Q: Several of my friends have had breast augmentation with you and have loved their results. I am 41 years old and have always wanted larger breasts. My problem is my doctor has informed me that it would not be a good idea go under general anesthesia. The reason being is my mother at age 45, my brother at age 29, and a sister at age 22, all passed away all while under general anesthesia. They never identified a specific cause although my doctor said it is genetic and has told me if I want to do any sort of plastic surgery it would need to be done under a local. Is there any hope for me finding a plastic surgeon who would do my breast augmentation under a local, epidural or something while I am conscious. This is something I have longed for over 15 years. Please respond as soon as possible. I don’t want to go to a cosmetic surgeon and have this done. I want a reputable plastic surgeon such as yourself to perform this. Thank you so much for your time.
A: That family history is the most tragic that I have ever heard in all of my surgical experience. One family member dying under this general anesthesia is rare enough, but three is beyond comprehension. While their diagnoses may not have been known at the time, it is highly likely that your family has the gene for Malignant Hyperthermia. (MH) While not recognized decades ago, it now is and every operating room that does general anesthesia has an emergency kit for its treatment. There is no blood or genetic test for MH. Family history is the only ‘test’ for its presence. Your family history is more than suspicious for this diagnosis.
While you have a likely family history for MH, this does not mean you can not have general anesthesia. The known anesthetic drugs that trigger MH is the muscle paralyzer, succinylcholine, and all of the inhalation agents. General anesthesia without these drugs can be done using narcotics and a propofol infusion, a common combination used in many plastic surgery procedures.
But given your family history, it is also understandable that no matter how a general anesthetic is done you would never feel completely comfortable. Therefore, having a breast augmentation under local anesthesia is possible. (with some oral sedation drugs beforehand) The key to this approach is to place the implant above the muscle (subglandular) and infiltrate the breast first with a tumescent solution for local anesthesia. (much like what is done for liposuction surgery)
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast augmentation under local anesthesia, dr barry eppley, indianapolis, malignant hyperthermia, plastic surgery
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Tuesday, November 23rd, 2010
Our skin is the largest body organ that we have and has more medications and treatments per surface area than any body part. The skin care world is chocked full of thousands of products that claim to either protect it or make it look younger. The sheer cacophany of skin care products clamoring for our attention leaves most women (and a few men) completely confused about what to use.
One newer type of skin care technology is that of antioxidants. Besides the obvious psychological appeal of not wanting to be ‘oxidized’, products containing antioxidant ingredients are popping up everywhere. While the scientific benefits of antioxidants and how they work are better reserved for a classroom or as a replacement for melatonin before retiring, it strikes me that we are seeing what’s old becoming new again…through the wonders of modern chemistry.
Antioxidants in skin care is actually a bit nostalgic and reminds us that our great grandmothers had the right concept all along. Most of today’s antioxidant skin care potions derive their properties from the naturally available fruits, vegetables, and whole grains that were once the main ingredients of age-old facials and historic healing compounds. They may not have known why it worked, and may not have had the right proportions of ingredients, but their organic approach was rooted in science after all.The fruit acid facials of today (also known as alpha hydroxy acids, or AHAs) derive their ingredients from extracts of grapefruit (procyanidin), lemon (vitamin C) or apple cores (vitamin C and phenols), are actually quite old. I have had more than one older patient who has told me they used to rub lemon juice or the cut edge of an orange on their face to reduce wrinkles or on their scars to make them look better. The ancient use of green tea facials (and you thought it was only for drinking) has been found to contain catechin which has potent antioxidant properties.
Old vegetable masks contained tomatoes, which are rich in lycopenes and carotenoids, to help control oily skin and reduce wrinkles. Oatmeal powder and other grains contain ferulic acid which has an antioxidant effect…not to mention the skin calming benefits of the well known oatmeal bath. Curd contains lactic acid which is a chemical peel. Cucumber and pumpkin have high levels of the potent antioxidant vitamin C. (the benefits of reducing eye puffiness from sliced cucumbers is not because they have a magic ingredient, it is that they are cold…a cool washcloth works just as well) Honey and egg yolk have been used in facials dating back to ancient Egypt. Honey contains flavinoids and vitamin C while egg yolks have the antioxidant carotenoid in them.
Before we wax romantically and start rubbing lemons and green teas leaves on our face, it is important to realize that science has several advantages over nature. Through purified and concentrated extracts from these natural sources and using technologically advanced delivery systems, what does come out of that expensive bottle is easier to use and does work better.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: antioxidants in skin care, dr barry eppley, indianapolis, plastic surgery
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Monday, November 22nd, 2010
Q: I am currently faced with several problems. My face looks wide because I have prominent cheekbones. I have deep set eyes because of very prominent and bulgy orbital rims. It’s not so much the width of my face that bothers me but it brings everything out of place. Because of the small eyes and the rest of my face is pretty crowded together. When looked from the side, the orbital rim covers nearly everything of my eye while other people still have a part of the eye visible. My cheekbones are bulgy both in the front and the side. Is there any procedure to help me?
A: What you are referring to is prominent orbital rims which make up 3/4s of the orbital ‘box’ that encases the eye. When this outer circle of bone is prominent, it makes the eye seem deep or hidden. It is possible to reshape the orbital rims, particularly the brow bone (upper orbital rim) and the side. (lateral orbital rim) It is not so much whether it can be done but whether the trade-off for doing so is worth it. To surgically access this area, a scalp or coronal incision is needed. This allows the skin to be lifted to get to the area for reshaping. For many women this is not a rate-limiting consideration. But for many men it understandably is.
The width of the cheek bone can be narrowed by a vertical wedge bone removal right below the eye bone which is done from inside the mouth.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek reduction, dr barry eppley, indianapolis, orbital rim reshaping, plastic surgery
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Monday, November 22nd, 2010
Q: I have an extremely deep acne scar on my cheek from cystic acne that has tunneled under the skin. Subsequent healing has resulted in some type of contracture and folding of the skin so that an indentation extends under the skin itself. The indentation extends for about 15 millimeters and seems to follow the track of a hair follicle. The opening is broad, about 9 millimeters and regular. I would happily trade this scar for an excision scar. Can you tell me if this can be done and is it a good idea?
A: Acne scarring can be quite severe and deep. This is particularly true on the cheek area which shows such scarring prominently due to the tighter skin stretched across the bone. I have seen this exact cheek acne scar situation that you have described several times before. What it really represents is the loss of subcutaneous fat underneath the skin due to the infection with the skin edges healing inward. You have described it quite accurately as a scar contracture.
As a result, the problem with this type of cheek scar is that it is not only indented but is missing tissue underneath. So while cutting it out is an important step (scar excision), replacement of deeper fat at the same time is also important. If not replaced, there is a chance of the wound edges pulling downward as it heals to a space with less fill underneath. For this reason, I would do a scar revision with the simultaneous placement of a fat graft underneath the skin edge closure. This would be particularly important in the tight skin that overlies the cheek.
Dr. Barry Eppley
Indianapolis Indiana
Tags: acne cheek scar revision, dr barry eppley, fat grafting for scars, indianapolis, plastic surgery
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Monday, November 22nd, 2010
Q: I am looking to have what I think is called a Mommy Makeover. I have it on TV shows and read about it on the internet. For the breast implants, I am looking to have saline implants done. I would like them placed behind the muscle if possible. I am not sure what my ‘true’ cup size is. I know it is between an A and B. I would like to be a full C to a small D. I do need a slight lift but I am concerned about scarring. I would like the incisions to be as discreet as possible. As for the tummy tuck, I think I only need a mini-tuck. I have a little bit of fat in my lower stomach that stays and I cannot get rid of it. I also have a little bit of stretched skin that needs to be removed. I am looking to have the problem fat suctioned out and the muscles to be sutured back together and the little bit of stretched out belly skin removed. After looking at pictures and watching animated videos on tummy tuck; I realize that my tummy problem is quite small compared to majority of the pictures I have viewed. I am a small frame as it is. I am about 5’2” and weight about 115 pounds.
The issues I have may not seem like anything to someone else; but they are BIG to me. I look at myself each day and do not see a young beautiful woman. I wonder each day how in the world is my husband still attracted to me. I am wanting to do this for my self. I would love to love myself again! Does this sound like it can be all done in a single operation?
A: Mommy makeovers are typically a combination of breast and abdominal reshaping. Improving the very problems that being a mommy has created. Saline breast implants can be placed from a remote incision high up in the armpit that will never be seen. The most limited incision breast lift is that of the superior crescent mastopexy, also known as a nipple lift. It puts a fine line scar at the top of the nipple only right at the junction of the areola and skin. Given your body frame size, you are describing perfectly what a limited or mini-tummy tuck accomplishes.
Both breast augmentation with a lift and a mini-tummy tuck can be done in a single outpatient procedures. The combination of the two truly makes for a new body for Mommy!
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast lift, dr barry eppley, indianapolis, mini-tummy tuck, mommy makeover, plastic surgery, saline breast augmentation
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Monday, November 22nd, 2010
Q: I need a chin augmentation because my chin is definitely short. I know there are two ways to do it, either with an implant or an osteotomy. I would ultimately prefer the implant over an osteotomy. Is it possible to get some vertical lengthening with an implant, maybe in the range of 2 or 3 mms? Is it possible to get an implant without making the labiomental indentation deeper?
A: When significant vertical lengthening of the chin is needed, an osteotomy is really needed. But when the vertical height increase needed is small, a chin implant can achieve that dimensional change. It is necessary to place the implant as low as possible on the chin bone, almost as if it was on the edge of the bone. To maintain that position, I prefer to place a single metal screw into the bone to secure it. That way there is no risk that it can move upward even a single millimeter.
The labiomental sulcus or groove is located below the lip and really represents the location of the mandibular vestibule inside the mouth where the mentalis muscle attaches to the bone. Because of its superior fixed location, it will usually become a little deeper after chin implant augmentation. This is because it doesn’t change but the soft tissue of the chin moves forward, making it look a little deeper. When the amount of chin advancement is significant (8 to 10mms), the labiomental fold will get deeper in most patients. That effect will be lessened when the implant is placed on the lower end of the chin bone with vertical lengthening as the push underneath the labiomenal fold is less due to the lower position of the implant.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chim implant, dr barry eppley, effect of chin implant on labiomental sulcus, indianapolis, plastic surgery, vertical chin lengthening
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