Archive for January, 2011
Monday, January 31st, 2011
Q: I have read that paranasal implants can be done in local anesthesia. Is this right? Is local anesthesia possible also with malar implants which are placed right next to paranasal implants? Does not the lifting of the periosteum from the bone hurt in spite of the local anesthesia? Thank you very much for your information.
A: Cheek and paranasal implants are placed from an incision inside the upper lip. Besides the mucosal incision, muscles and the periosteum covering the maxillary and zygomatic bone must be lifted up and a pocket made to place the implants. Given the proximity of the paranasal area to the upper lip compared to the cheek area, it would be ‘easier’ to position paranasal implants under local anesthesia as opposed to cheek implants where greater dissection is needed and the feeling in this area has more contributing nerve endings. You are correct in that it is the periosteum that is the most sensitive part of the surgical dissection. I also prefer to us screw fixation for the implants that I place in the midface which can cause more discomfort from the bone drilling.
While just about any surgery can be done under local anesthesia, I am not sure if I was a patient that I would ever do it that way. (particularly cheek implants) Unless there is some compelling medical reason why IV or general anesthesia could not be used, it would be more comfortable and slightly less costly to use some form of anesthesia for this type of facial implant surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, indianapolis, paranasal implants, plastic surgery of the face
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Monday, January 31st, 2011
Q: I have sleep apnea and a very thick fat neck. I was wondering if liposuction of the neck would help my sleep apnea? My thought is that if the fat was removed from my neck it would not be so heavy when I laid down. That way it would not push down on my neck and obstruct my throat as much when I was sleeping/ Does this make any sense? What are your thoughts?
A: While liposuction of the neck may help improve the shape and profile of it, I doubt very highly if it would make any improvement in your sleep apnea. Your logic seemingly makes sense but the flaws in it are that fat doesn’t weigh very much, the thyroid cartilage protects the voice box and lower area with a stout shield of protecive armour and the usual sites of anatomic obstruction are usually higher and are closer to the base of the tongue. While I don’t think liposuction of the neck will have any negative effects, it is not an acknowledged procedure in the surgical treatment of sleep apnea. Procedures such as septorhinoplasty and turbinate reductions to open the nasal airway, maxillary and mandibular advancements to open up the entire posterior oropharyngeal airway, shortening of the soft palate (fading in popularity) and bony chin advancement and genioglossus procedures to bring the base of the tongue forward are well recognized sleep apnea operations. Other non-surgical efforts include weight loss and various dental appliances. Before considering any of these options, one should be fully worked up by a sleep apnea specialist to search for the most effective solution.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, neck liposuction, sleep apnea surgery
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Monday, January 31st, 2011
Q: I am interested in trying to get my face to look less fat. I want to make my face slimmer if possible. I have a small double chin and fatter cheeks and jowls. I have read about Lipodissolve injections and this seems like a good and easy solution for my small areas of facial fat as I know these injections are for small areas and not big ones. Do you think this will work for me?
A: While Lipodissolve injections can provide some minor benefit in fat reduction in the neck and jowl areas, they require three or more injection sessions (spaced 4 to 6 weeks apart) to get the best result. After each injection session, the treated areas will double or triple in size for one week as part of the inflammatory by which it breaks down the fat. . Because of this socially visible recovery, most patients will opt for a more effective set of procedures that actually has less total recovery even though it is surgery. I would recommend a combination of submental, jowl and lateral face liposuction and buccal lipectomies. This reduces all available fat compartments in the face that can easily and safely be treated. This is is the best way to get a slimmer face through fat reduction. It has less recovery than Lipodissolve injections because the swelling is only one time and is largely over after a few weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, dr barry eppley, indianapolis, lipodissolve, liposuction of the face and neck, submental liposuction
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Monday, January 31st, 2011
Q: I am 30 yrs old and am tried of people telling me that I am in my mid to late 40s. Ugghhh! I usually just walk away and cry and I am tried of crying over this and want to get something done about it. I have had a brow lift and a neck liposuction about 2 yrs ago. I would like to see what it would look like with eyelid lift and filler. Would you also recommend something else? Maybe a chemical peel? Thank you for your help! I really appreciate it!
A: Thank you for sending your pictures. Unfortunately computer imaging is good at changing structures of the face but not very good at soft tissue manipulations such as those that you have asked for. An eye lift can not be done as it distorts the whole eyelid. However, I think there is no question you have upper eyelid hooding and you would clearly benefit by an upper blepharoplasty or eyelid lift. Putting in fillers along the nasolabial fold and lips is also not very accurate and often just distorts the lips in trying to image it. You have reasonable lip size so injectable fillers will make them nicely bigger. As you have suggested, a chemical peel is good for skin texture and brightening the glow of the skin and for fine wrinkles as well.
As for other recommendations, I have done some other changes just to look at how to soften your facial features and make your face more ‘youthful’. These have included the following:revisional browlift to lower hairline (reduce long forehead) and correct existing brow asymmetry, rhinoplasty to make nose look slimmer and more narrow and chin reduction to soften chin point and make softer looking.These are structural facial changes which are different than just anti-aging procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: browlift, chin reduction, dr barry eppley, indianapolis, plastic surgery of the face, rhinoplasty
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Sunday, January 30th, 2011
Q: I have had severe migraines for years. My migraines start in the back of my head and shoot up into my scalp and down into my shoulders. It usually feels like there is a vise on the back of my head. I have been to a lot of doctors and have tried everything from every drug out there to chiropractors, acupuncturists, massage therapists and even Chinese oriental practitioners. A few things worked for several days or a week but nothing lasts. I went to the local university and saw a neurologist there who did an MRI and other blood tests and came up with nothing. His drugs didn’t work any better. I have read recently on the internet about some type of migraine surgery. While I am desparate to try anything, the thought of going through surgery and then not have it work would be disappointing to say the least. What is the success of this new migraine surgery?
A: Migraine surgery is based on the concept that there is a peripheral trigger or site of nerve compression which is the stimulus for the attack. One of the four recognized trigger zones is at the greater occipital nerve at the back of the head at the base of the skull which causes occipital migraines. Whether surgery would be effective can be predicted beforehand through the use of Botox injections into the area. A positive response to Botox, which includes a significant and sustained relief of the migraines, correlates highly with surgical success. While about 1/3 of patients will have a near complete elimination of their migraines, 2/3 s will have reduced frequency, intensity and duration of attacks. A recent clinical study reported that 90% of patients treated maintained good relief out to five years after surgery which as the time limit of the study.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, migraine surgery, plastic surgery for migraines
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Sunday, January 30th, 2011
Q: I would love to have breast augmentation before my 21th birthday which is later this spring. My preferred approach would be breast augmentation with an incision through armpit area But I also considering the option of an inframammary incision using Memory gel breast implants. Which do you think would be better for me? Thank you.
A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.
But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture. (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, indianapolis, plastic surgery of the breast, saline breast implants, silicone breast implants
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Sunday, January 30th, 2011
Q: I am going to get a facelift and want the scars to heal to that no one will know that it was done. I have read about a Laser-Erase procedure that can get rid of the scars almost immediately. Does this really work? What are your thoughts?
A: Over 100,000 facelifts and an equal if not greater number of eyelid tucks (blepharoplasty) are performed each year in the United States. While the incisions in the eyelids and around the ears generally scar imperceptibly, patients are understandably motivated to get the best scar result as possible. Getting a more youthful appearance at the expense of poor scarring would not be a good trade-off.
Concerns about the possibility of less than ideal scarring, numerous plastic surgeons have touted an early laser scar treatment program. Laser-Erase is just one ‘branded’ name of this treatment approach. The concept is that about two weeks after facial surgery including facelifts, eyelid surgery or any other facial procedure that requires an incision, the incision line is then treated with a light laser resurfacing procedure. Some use high intensity light or IPL treatments as opposed to an actual laser. It is touted that the ‘incision is then erased with the laser’. The theory is that the laser disrupts a scar from forming in the very early stages of the healing process, thus to quote one treatment provider, ‘the incision line is banished from sight with a zap of the light.
While this early treatment of a scar sounds very appealing, there is no science to back up its touted benefits. Plus it goes directly contrary to how wounds heal in general. No scar can be prevented from occurring between two closed edges of skin. Scar formation is inevitable, and a little burning or heating of the upper part of the wound edges, will not make it disappear. Any scar benefits that subsequently occur are a result of a natural healing and scar fading process. Such early scar treatments are more about marketing and sales than they are about any form of a new revolutionary scar treatment approach.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, laser scar treatment, laser-erase scar treatment, plastic surgery of facial scars
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Sunday, January 30th, 2011
Q: For my bulgy forehead, is it possible to burr down the forehead and then do a forehead/eyebrow lift at the same time, just removing the extra skin? The reason I ask is because my head is misshappen and my hairline is too high. I want my hairline to be lower so burring down some of the forehead and then making and eyebrow lift would help alot. After that is done I was going to get a hair transplant on my hairline to cover up the scar. Does this sound like it will work? Will it work if I get a hair transplant over the scar and can I do the eyebrow/forehead lift thing?
A: Your approach to a forehead or frontal contouring is conceptually correct. While I don’t know exactly where your exact hairline is now or what its shape is, making a scalp or coronal incision there allows one to access the forehead area. Probably about 5mms across the forehead bulge can be taken down. A browlift can then be performed and the redundant skin removed at the scalp incision line. This will shorten the perceived length or height of the forehead skin. Thereafter, no more than 3 to 6 months later, a hair transplant can then be done to put a camouflage to the scar. Such a scar in the scalp can often heal remarkably well due to the uniqueness of hair-bearing (or past hair-bearing) scalp skin.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: browlift, dr barry eppley, forehead reduction, indianapolis, plastic surgery of the forehead, scalp scar
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Saturday, January 29th, 2011
Q: I was wondering if it is possible to shave down certain parts of the skull. My forehead isn’t the way I want it to be shaped. I am trying to get my forehead to stick out a little less. Is it possible to shave the skull down? And if so how much can be taken off?
A: The thickness of one’s skull can be taken done by burring. How much it can be reduced is determined primarily by the thickness of one’s outer cortex. The skull has three bony layers, an outer hard cortex, an inner spongy marrow space and and an inner hard cortex. While the burring reduction can be taken down past the outer cortex into and through the marrow space, that causes a lot of bleeding and can make for an irregular surface. Therefore for practical reasons, the outer cortex is usually the only skull thickness reduced when done for cosmetic purposes. That can vary in different skull areas but in the forehead in a man, that may be up to 5mms or so.
The more significant rate-limiting step for male forehead reduction is the incision needed for access to do the procedure. A scalp incision is needed to turn down the scalp so the bony forehead is exposed for reduction. Given the unstable frontal hairlines and hair densities of most men, forehead surgery of any kind may not be worth the trade-off of a scalp scar.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead recontouring, indianapolis, plastic surgery of the skull, skull reduction
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Friday, January 28th, 2011
Q: I had a chin reduction a couple of years ago and although I am happy with the new shape of the bone, I now have hanging soft tissue. Needless to say I am not happy with these results. I have visited five plastic surgeons and none of them wanted to fix this problem saying that it was dangerous to cut or reattach the muscles and the ending results could be worse. I am very dissapointed and have attached some before and after pictures for your review. I hope you can help.
A: Your pictures show quite clearly some soft tissue sag or ptosis off of the chin bone. It is most pronounced centrally which is what one would expect given that your chin reduction was most likely an intraoral burring approach done to the central button. To improve this problem there are two approaches, intraoral muscle resuspension or a submental tuckup. The intraoral approach uses a suture anchor to the bone to reattach the muscle and tighten it back done. This is a scarless approach. The submental tuckup uses an incision under the chin where the loose skin and muscle is removed and tucked or tightened to the bone. Each has its own advantages and disadvantages. The intraoral approach avoids a scar under the chin but the submental tuckup is a more reliable method.
There is no danger to performing this procedure and there is no chance of making the problem worse. Whoever has said has either never treated the problem or is completely unaware that such surgical correction exists.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin ptosis correction, chin reduction, dr barry eppley, indianapolis, plastic surgery of the chin
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