Archive for December, 2010
Friday, December 31st, 2010
Q: Hi Dr. Eppley, I am interested in nose and neck surgery. In the front view the tip of my nose is too fat. My nose profile shows that my bridge projects too much and the line from my top of forehead down through the bottom of my nose is too straight. I wish to have these things changed by a closed rhinoplasty. Also my neck and jowls is sagging and I would like liposuction to tighten them up, I am 49 years old. Additionly I don’t wear face makeup so I wish for no visible scars to show. Thank you for your time and I really enjoying reading all your info on the web and hoping you can improve my nose and neck. I have attached some pictures for you to review.
A: Thank you for sending your pictures. I have some computer imaging on them and those are attached. Here are my comments based on your stated desires and what is realistic.
Your rhinoplasty would be best done open. You have thick nasal bones and cartilages and to effect those changes you would get a better result through an open visual approach. (less chance of need for revision) You have thick nasal skin so there is no risk of having your nose ‘overdone’ or looking like it is too small or has an operated look. Thick nasal skin always make a rhinoplasty result less rather than more in appearance.
You have too much loose jowl and neck skin to just do liposuction alone. That will just make the skin look loose and have more sag. You need a tuck-up neck-jowl lift with liposuction to get the result that you are after. Again, the thickness of your skin and it looseness work against a fat removal only procedure. Your skin quality and amount in the jowl and neck area makes it necessary for a more aggressive approach to get a good result.
One additional thought is that of your chin. It is horizontally short and that works against you getting an improved jaw line and neck appearance. A chin augmentation would really complement the neck-jowl lift.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin augmentation, dr barry eppley, indianapolis, neck-jowl lift, plastic surgery, rhinoplasty
Posted in Your Questions | No Comments »
Wednesday, December 29th, 2010
Q: I had a breast reduction in October 2010, and I am thinking about getting pregnant again. I was a DDD before, and now am a B. Surgery went well, but if I gain roughly 20 lbs during pregnancy, how big do you think that the breasts will get? I had a free nipple graft, so no breast feeding. I just don’t want to go back to the “bigger” me. I love being smaller. Thanks so much!
A: The changes that will occur after pregancy from a breast reduction are fairly predictable for many patients. The breasts will, of course, enlarge during the course of your pregnancy. They will not likely become a DDD again but they will certainly get bigger than a B cup. After delivery, your breasts will almost certainly shrink back down. There are a few patients in which they do not shrink back down considerably but this is fairly rare. What will also happen in this shrinking process is that they may potentially end up even smaller than before, perhaps going all the way down to an A. This is known as breast involution (loss of breast tissue after pregnancy), and is common, but in the breast reduction patient may become more pronounced. I have seen more than one breast reduction patient who lost all of their remaining breast tissue after pregnancy and actually later went on to a have a breast augmentation to get back some breast volume and shape. What will actually happen to you, of course, can not be precisely predicted but I think the fear of ending up bigger again is unlikely.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast reduction before pregnancy, dr barry eppley, indianapolis, plastic surgery
Posted in Your Questions | No Comments »
Wednesday, December 29th, 2010
Q: I would like an opinion by a plastic surgeon. I would like to get rid of the hump on my nose and for it to be smaller and not so wide. My nose is especially wide underneath my eyes. I would like a chin implant to help with my side profile. These are the two procedures that I’m for sure ready to have done immediately. I eventually would like enhance the size of my lips. I had Juvaderm administered to my upper lip about two years ago and did not have good results. My primary focus right now is my nose and chin and would really like to see what I would generally look like after a Rhinoplasty with a chin implant. Thank you so much!
A: The combination of a rhinoplasty and chin augmentation is very common and highly successful. This is particularly true in one’s s profile view even though that is not how one usually sees themselves. (even though most of the world knows you more this way) In this what I call the ‘ying and the yang’ procedure, reducing prominent areas on the nose (hump reduction, shortening or de-lengthening the nose) and bringing a recessed chin forward can make for a significant change in one’s side view. And because two areas are being changed in different directions, it does not take large changes in either the nose or the chin to make a real visible difference. This can be demonstrated before surgery (and always should be) by computer imaging. Rhinoplasty and chin augmentation are two procedures that can be both easily and accurately demonstrated by computer imaging manipulation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin augmentation, dr barry eppley, indianapolis, plastic surgery, rhinoplasty
Posted in Your Questions | No Comments »
Monday, December 27th, 2010
Q: I am in the beginning stages of considering the possibility of rhinoplasty procedure. A large nose runs in my family, but what I’m most unhappy with is that my nose is slightly crooked. I also wouldn’t mind some size adjustment, both length and width. I am truly unsure of what potential costs for something like this may be. I am 30, single and have limited income. Can you provide me with more information that may be helpful to me at this point in my process? I would certainly consider a consultation, and would be extremely interested in seeing photos of what you could do with me, if possible.
A: Rhinoplasty for the crooked nose is one of the more challenging nose operations. This is because a very crooked nose is the result of more than one part of the structural anatomy that accounts for why the nose is not straight. It usually involves a deviated septum, middle vault asymmetry and right down to a twisted tip. It is not usually possible to just fix a deviated septum and have the whole nose.then become straight. Crooked noses involve every cartilaginous element and often the bone as well. For these reasons, correction of a crooked nose involves a full septorhinoplasty.
While computer imaging can make a crooked nose perfectly straight, rhinoplasty surgery is not like Photoshop. It is best to think of a straighter but not perfect crooked nose result than to undergo surgery with the expectation that it will be perfectly straight. While that is the goal, there is a reason (bent and deformed cartilages) that the nose was crooked to start with. And cartilage does have memory so some relapse or recoil may occur even out to 6 months after surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, Rhinoplasty for crooked nose
Posted in Your Questions | No Comments »
Monday, December 27th, 2010
Q: I’m a little self-concious about my lower face. I am now 48 years old and feel lilke the sides of my jaw are lacking. When I was a teenager, I had orthodontics which included removal of four permanent teeth to make room for other teeth. This moved by front teeth and my back teeth forward to close the space. Now that I’m older, I’ve come to believe that I have a shallow jaw because of this earlier orthodontic treatment. I would like some jaw angles as I think my jawline is too steep. From my chin, my jawline just goes straight back and up towards my ears without any definition to the back part of my jawline.
A: For what it is worth, your prior orthodontic treatment (which was and still is standard in many patients) is not the source of a steep jawline. A steep jawline is when the angulation from the jaw angle down along the inferior border of the mandible to the chin is greater than 15 to 20 degrees, often approximating 35 to 40 degrees. As long as the teeth satisfactorily come together, this is an aesthetic issue that is the result of high or underdeveloped jaw angles.
Jaw angle implants can make a big difference in the aesthetics of the jaw angle and jawline. but it has to be the right type of jaw angle implant. It needs to be the type that will lower the jaw angle and not just simply make it wider. In general, jaw angle implants can lower the prominence of the jaw angle by 1 to 2cms with standard off-the-shelf implants.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, plastic surgery
Posted in Your Questions | No Comments »
Monday, December 27th, 2010
Q: Is there no way to bringing out the midface with dermal fillers? Are the results not so good as with implants? What is the material of which midface implants are made of? What the advantages and disadvantages of injectable fillers vs implants for midface deficiencies?
A: For midfacial deficiency, albeit of the cheeks, maxilla, or paranasal region, synthetic implants are the preferred treatment. They are far superior to injectable fillers in both results and cost effectiveness. Injectable fillers are intended to treat small soft tissue deficiencies of the facial skin such as wrinkles or folds. They were never intended to be used for more significant bone-based facial deficiencies but rather to be placed into or just under the skin. The sheer cost of placing large volumes of injectable fillers down at the bone level would quickly equal or come close to the cost of implant surgery. When you factor in that they are all temporary, the value proposition of injectable treatments for facial skeletal deficiencies becomes quite poor.
Most facial implants, including those of the midface region, are primarily composed of solid silicone. Silicone is one of the most biocompatible of all implant materials and also offers the largest array of facial implant designs. All midfacial implants are introduced and placed through incisions inside the mouth so there is no external scarring with their use.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, injectable fillers, midface implants, plastic surgery
Posted in Your Questions | No Comments »
Sunday, December 26th, 2010
Q: Hi, it was so interesting reading your thoughts on cheekbone reduction surgery after a facial injury. I have some questions about almost the same problem. My right cheekbone is bigger than the left one and it is growing bigger. When I look at two year old photos you can see a big difference. I was in a car accident about 15 years ago and hit the right side of face on the dashboard of the car. Is it possible to have some sort of surgery?
A: While cheek bone injuries are common from many types of trauma, they are largely that of fractures and displacement. Secondary reconstruction is often needed to bring out a cheek bone that is too flat or has inadequate projection. The reverse problem, overgrowth or too much projection of a cheek bone is very rare. The presumed cause is that a hematoma has developed above or around the bone, stimulating some bone deposition or ‘growth’. Depending upon the dimension of the cheek bone overgrowth, surgery can be done to reduce. Shaving of the cheekbone is always possible but is not usually my preferred technique unless the overgrowth area can be precisely identified. It is far more common to do a cheek osteotomy and remove a vertical wedge of bone to allow it to move inward. A very helpful diagnostic tool is a 3-D CT scan. This allows one to study the shape of the cheekbones on both sides and determine the exact location of what is making the bigger cheek bone look the way it does. This allows for a precise surgical procedure for bone reduction to be planned.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek bone reduction, dr barry eppley, indianapolis, plastic surgery
Posted in Your Questions | No Comments »
Sunday, December 26th, 2010
Q: Dr. Eppley, I want to get your opinion. I want to get rid of some body fat. I am not obese but need some help getting rid of some fat areas. I really don’t want to get liposuction and am interested in trying the Zerona. What has been your experience with its use? Do you think it is worthwhile to do? Or should I just go ahead and get liposuction?
A: As you have read about it and probably seen it in magazines or on TV, Zerona is a non-surgical device for circumferential fat reduction most commonly used for the waist, hips, and thighs. (although it can be used anywhere) It works by emitting a low-level laser energy that targets fat cells through a photochemical process. This causes the fat cells to temporarily open up and release fat which is then safely removed and broken down without side effects or downtime.
Its manufacturer has done a considerable amount of marketing largely based on his clinical study that was used to get FDA approval. In this study, they showed an average inch loss reduction of 3.65 inches across patient’s waist, hips, and thighs in as little as two weeks.
While this sounds great, I decided in my Indianapolis plastic surgery practice to do my own study. We studied our first 10 patients who underwent a full series of Zerona body slimming treatments. Our results were an average circumferential measurement reduction of over 6 inches. On a patient satisfaction scale, seven (70%) were extremely satisfied and saw significant improvement, two (20%) were satisfied as they saw improvement but had hoped for more, and one (10%) saw little change or improvement and was not satisfied.
Our first Indianapolis results were better than expected. When it comes to the measurements, know how they are derived. When you have an average of 6 inches lost, this does not mean it comes from the waistline or from one single body area measurement. Rather it is the collective number of inches lost from a combined number of cirumcumferential measurements including the waist, hips and thighs.
Should you get Zerona treatments? It is reasonable to do of you understand that Zerona is not magic nor is it equivalent to liposuction surgery. And it may not work well for everyone. But most patients do end up see some visible body changes and were happy that they had the treatments. Because I want to have happy and satisfied patients, and do not want to see patients waste money if avoidable, we credit much of what patients pay for Zerona towards the cost of liposuction surgery should they decide to go that route after a Zerona treatment program.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, zerona body slimming
Posted in Your Questions | No Comments »
Sunday, December 26th, 2010
Q: I am considering liposuction of my stomach. I am not fat but just want to thin it out further than I can do on my own. What is the best liposuction method to avoid any uneven or irregular areas on my stomach area afterwards. Since I am thinner to begin with I think it is more likely on someone like me. Would Smartlipo be best?
A: While highly effective at removing abdominal fat, irregularities after abdominal liposuction are not rare. Since the outer contour of an abdominal liposuction result is a direct reflection of the evenness of fat removal underneath the skin, it is important to have as even removal of fat as possible. While many new technologies have emerged for performing liposuction, they have not necessarily resulted in a lower incidence of contour problems. This is because the technique for performing liposuction is more important than the device.
No matter what liposuction method is used, the tracks or tunnels that are made under the skin by different types of cannulas in the fat layer is ultimately important for the final contour. This has lead to the use of smaller cannulas for fat removal and this has definitely decreased irregularity problems. But small cannula size alone is not enough to guarantee no contour irregularities…and it is probably not the most important.
Superceding cannula size is the precision of the underlying tunnels that are made. This is the in and out pattern of the liposuction cannula that most people associate with the procedure. While this movement may look random, it is not. Rather it should be a deliberate and evenly distributed method of cross-tunneling.
Cross-tunneling, when possible, during liposuction is still one of the most important concepts in liposuction to avoid abdominal irregularities. By cutting tunnels in the fat from multiple directions in any given area, fat is removed in a more even fashion. This is especially important in the abdomen where the cross-tunneling method can be most effectively used.
In short, the operator and not the device is the most important consideration when performing liposuction and avoiding postoperative irregularities.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal liposuction, dr barry eppley, indianapolis, liposuction irregularities, plastic surgery
Posted in Your Questions | No Comments »
Friday, December 24th, 2010
Q: I have consulted Dr. Eppley before about jaw implants and noticed in a recent article that he is using Kryptonite Bone Cement that is injectable. Could this be used to augment the jaw or cheeks and chin instead of having a full blown surgery? Just curious if it can’t because if it can be used in skull recontouring the use for facial recontouring seems like a logical extension of its use. After all, bone is bone and why would it not adhere to the jaw/cheeks/chin as well?
A: Currently, the use of Kryptonite Bone Cement as an injectable method is for skull recontouring only. While in theory it could be used for facial augmentation (cheek and chin implants) as well, there are two major problems with this application. First, the material must be injected and then shaped by external molding. Making a flat shape on a skull by using external digital molding can easily be done, trying to make a more complex shape like a cheek or a chin is another material.Whatever shape you get after four minutes after injection is what it will permanently be. To adhere to bone the periosteum must first be raised just like an implant. Injecting onto the bone does not make go under the periosteum alone. If he material does not completely go under the persiosteum and adhere to the bone, it will rock and be mobile. Secondly, the cost of Kryptionite is 10 to 20X what a facial implant will cost. For the skull, all competitive materials cost thousands of dollars in material cost as well. For the face, however, facial implants are far less expensive and have established shapes that work. It simply is not cost effective for the patient to use Kryptonite for facial bone augmentation, even if it worked just as well.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, injectable kryptonite, kryptonite bone cement, plastic surgery
Posted in Your Questions | No Comments »
|
|
|
|