Archive for February, 2011
Saturday, February 26th, 2011
Q: I had a sliding genioplasty just one month ago in January 2011. It was advanced 8mm and I feel it was too much. I do not like how my chin looks. It is not a natural look. I also lost almost 2/3 of my lower lip which make the chin even bigger. It really has changed me a lot. I was wondering what can be done to recover the fullness of my lip. I am even considering a reverse genioplasty to bring it back to 5mm even though the cephalometric analysis says that I am short 9 mms. How long should I wait for a revision and any further interventions?
A: Now that you are roughly 6 weeks out from your initial chin surgery, most (but not all) of the swelling should have subsided. While there is some final swelling and stiffness of the chin that needs to go away in the next few months, that will only change the chin projection by maybe 1 to 1.5mms. Therefore if you feel the chin is too strong at this point, then it is and your decision to set it back some more is reasonable. A change from 8mm to 5mm is reasonable since it takes at 2 to 3mms to really see any difference. The time to make that change is NOW. The bone is not yet healed and it is a relatively easy plate and screw exchange to do the revision.
When you say you have lost ‘2/3s of my lower lip’, I am assuming you mean that you have a drooping lower lip otherwise known as lip incompetence or sag. Unlike chin swelling where time will make some of it go away, time will not lift up a sagging lower lip. This is a function of the mentalis muscle position/resuspension on the chin bone. To imrpove that situation, the muscle need to be lifted up higher in the bone and secured. This will help the lower lip get back to a more normal position. The sooner this is done the better as muscle scarring is occurring. So again, NOW is the time to revisit this with your surgeon and have these discussions.
Reversing/revising the effects of a sliding genioplasty are best done early before complete bone and soft tissue healing has occurred.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, mentalis muscle resuspension, plastic surgery of the chin, sliding genioplasty revision
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Friday, February 25th, 2011
Q: I would like to get a breast reduction on just my right breast. It is a couple of cup sizes bigger than the left and its very painful. I think people notice and I can’t find a bra that fits right and looks good without one of my breast falling out. Also, I can’t wear any cute shirts I like and I’m very self consious when my husband sees it. I know I would be so much happier in life if they were both the same size. How much would it cost to get tissue removed from one breast so that they are the same size and that is all? Also what do I need to do to to get started? Please help!
A: Breast reduction can equally be done on just one breast as it is on two. It just takes half the time and close to half the cost of a two-sided breast reduction. When reducing just one breast, you have the ‘advantage’ of the other breast as the cosmetic goal. While perfect size and symmetry cam never be absolutely achieved, they can be made very close. The trade-off you make is that for better size and symmetry, the reduced breast will have fine line scars that the other breast does not. The best way to get started is to visit a plastic surgeon and discuss the specifics of your breast goals. On average, the cost of one breast reduction done as an outpatinet procedure will run in the range of $ 3500 to $4500.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast reduction, dr barry eppley, indianapolis, plastic surgery of the breasts
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Friday, February 25th, 2011
Q: Hello, I have had three very large children (all between 9 pounds and 10 pounds) and have had a very large weight gain/loss after each child. I am getting closer to my goal weight at this time from my youngest child. (Currently 165 pounds-my highest weight was 214 pounds) and my goal weight is around 150. Because of the large multiple pregnancies and weight gains/losses, I am in the need of some body contouring. I have multiple areas that need addressed, my loose tummy, excessive skin in my upper arms, sagging breasts and excess skin and resistant fat deposits in my legs. I am interested in a consultation to start the process of repairing some of the damage to my body that my healthy diet and daily exercise will not fix. I plan to have the surgeries over a few years, rather than all at once, due to cost and my schedule.
A: Body changes that have occurred either from bariatric surgery, extreme weight loss or the impact of multiple pregnancies requires thoughtful consideration about the type and timing of surgical corrections. Sitting down with a plastic surgeon and going over all the surgical options is an obvious first place to start. Having had many of these discussions in my Indianapolis plastic surgery practice, most women will focus first on their tummy and waistline often combining it with another procedure such as an armlift.
These more substantative body problems are more substantial that the more traditional Mommy Makeover which is directly to two combined procedures, breast enhancement (implant with or without a lift) and some form of a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: body contouring after weight loss, dr barry eppley, indianapolis, mommy makeover, plastic surgery
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Wednesday, February 23rd, 2011
Q: I am interested in getting my upper lip made bigger. It is very thin and it barely shows at all. It is very embarrassing to have such a thin upper lip when so many women have nice full lips. I think a bigger lip would make me look better and more attractive. I want to get injectable fillers into it because that seems to work well for most people. But I don’t want to look like I have a big fat upper lip or have duck lips. How can I get injectable fillers without causing that problem?l
A: Most lip augmentation patients want a natural look. Very few want their lips too look like they have had something done, although some people do end up looking that way.The success of having a natural looking result in the upper lip with injectable fillers is based on how much native vermilion tissue (pink part of the lips) you have. The most common reason one ends up with the infamous duck lips is that too much filler has been placed into the lips. A more full upper lip can take more filler and still loko natural. But a thin upper lip can take very little without creating a pufffy look. This is because in the thin upper lip the injectable filler does more pushing out rathe than up because there is not enough tissue. When it comes to injectable fillers in athin lip like yours, you have to realize that you can never really end up with a nice full lip look that many women desire. You just don’t have enough vermilion to do it.
What you would more ideally benefit from is an upper lip advancement which directly treats the actual problem and is permanent. But because that involves a fine line scar, I would recommend that you first do an injectable filler treatment and see of you like the results. If you do, then just continue with periodic filler treatments. If you don’t, then you know that there is another option which can give a much fuller lip that is permanent.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, injectable fillers for thin lips, lip augmentation, plastic surgery of the lips
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Wednesday, February 23rd, 2011
Q: I have HIV and have been on antiviral medication for the past 15 years. I am now trying to decide if liposuction to remove the fatty deposits under my chin, lower face and around my ears would be beneficial. I read your article and feel that you are someone who is compassionate and could help me wth this issue. I am just tired of being stared at out in public because of the way I look. I don’t want to look like a freak because of my years living with HIV and taking the medications to live a productive life. I want to find out how much this would help and what the recovery time would be.
A: Retroviral medications in the HIV patient can cause very unique fibrofatty deposition about the cervicofacial area. Most commonly a buffalo hump can appear at the back of the neck. But extensive tissue collections can occur around the neck from one side to the other including around the ears. This makes the face look like it is sitting on a tire, so to speak, if they are significant enough. Most of these fibrofatty deposits, however, are more than simple fat that is easily suctioned out. While liposuction can be done under the chin and into the sides of the neck, the deposits around the ears and into the side of the face are best treated by open removal through a facelift approach rather than just liposuction alone. Better debulking results are obtained with this combined approach. Recovery is very similar to that of a facelift with about a 50% reduction in the bulk of the cervicaofacial tissues.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cervicofacial debulking in HIV, dr barry eppley, facelift in HIV patient, indianapolis
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Wednesday, February 23rd, 2011
Q: I am 28 years old and have had 2 kids. I only gained about 25 to 30 lbs with each pregnancy but I still ended up with stretch marks on my lower stomach and loose skin around my belly button. I know that liposuction alone is not the solution for my stretch marks and loose skin. I am at a fairly good weight for me being 5’ 3” and weighing 130 lbs. Which type of tummy tuck do you think would be best for me?
A: While it is impossible to give an accurate assessment without photos, your description of your abdominal concern do make for a philosphic discussion between the two types of tummy tucks. The conceptual difference between a mini- and full tummy tuck is that the more limited procedure produces less of a result (around the belly button area) but has a smaller and lower placed horizontal scar. The key question is which trade-off can you live with better…a flatter and more complete abdominal result but with a much longer and higher horizontal scar (full) or a less long lower placed horizontal scar but with some stretch marks and loose skin still left around the belly button area. (mini-) There is also a belly button scar difference as the full tummy tuck will have one and the mini-tummy tuck will not. It really comes down to which aesthetic trade-off (scar vs amount of improvement) is more important to you.
Many women will less severe lower abdominal concerns (excess tissue) do opt for a mini-tummy tuck. When combined with liposuction in the upper abdomen and around the sides of the waistline, this more limited tummy tuck approach can provide for good improvement with a very acceptable low-placed scar.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, full tummy tuck, indianaplis, mini-tummy tuck, plastic surgery of the tummy
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Tuesday, February 22nd, 2011
Q: I am interested in making my face look thinner. Even though I am not fat (below the neck), my face make me look like I am. I have read about the buccal lipectomy procedure and that seems like it would work for me. I am most interested in getting the lower part of my face thinner. I have attached a front picture for computer imaging to see what the change would look like. Thank you for your help!
A: Thank you for sending your frontal picture. I have imaged the result doing buccal lipectomies (upper submalar triangle) and some perioral mound liposuction. (lower submalar triangle) It is important to realize that these procedures are most effective for the areas below the cheek down to about the mouth level and not for fullness at the jaw angle or in the lower part of the face. Facial defatting procedures work best in areas that are not directly supported by bone where the fullness is more the result of the thickness of the fat and not the bone. In bony-supported facial areas, thickness or projection can only be reduced by bone reduction which is often not only difficult but not that effective. There are no effective lower facial procedures (sides of the face and along the jawline) for defatting or making it look thinner.
Dr. Barry Eppley
Indianapolis Indiana
Tags: buccal lipectomies, dr barry eppley, indianapolis, making a fat face thinner, perioral mound liposuction
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Tuesday, February 22nd, 2011
Q: Dear Dr Eppley. I am wondering if it is possible to get a variation of genioplasty done.
I am wanting to reposition my chin bone higher up. In reduction genioplasty the chin tip is sawn off, a wedge of bone is removed and the chin repositioned back.Is it possible to saw off the end of the chin, then without removing any bone, reattach the sawn off tip at a higher position? This could help address saggying tissue as the higher position of the bone could help lift the surrounding tissue. This would leave a bony ridge on the chin, however this could be hidden with fillers.Does this type of surgery sound like something you could do? Thank you.
A: That is known in chin surgery as a ‘jumping genioplasty’. That places the cut piece of chin bone on top of/in front of the upper chin segment. However this will bring the chin forward and make it more prominent, although it would lift up sagging chin tissues and shorten its vertical length somewhat.
By your descriptions, I think you may have an erroneous concept of how chin osteotomies are done. It is important that the cut piece of chin bone remains attached to the muscles which provide it with a blood supply, otherwise it will die and resorb away. It is not just moved anywhere else one wants to put it.
Perhaps you could send me some pictures so I could see what type of chin problem you and what may or may not work.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin reshaping, dr barry eppley, genioplasty, indianapolis, plastic surgery of the chin
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Monday, February 21st, 2011
Q: I had a septorhinoplasty about six weeks ago. As a male, I was told that my thick oily skin will cause a lot of swelling in the tip of the nose that will take longer to settle down and go away. My concern is not the swelling in the tip of the nose but that it is drooping and the columella seems to be hanging too low. These were two key issues that I really wanted improved but right now it does not look like this has been achieved. Is it possible that my concerns are just do to swelling? Should I be considering early revisional surgery?
A: While it is still early in the rhinoplasty healing process, some improvement in the major focus of the nose should be evident at this point. There is no doubt that swelling is still present at this point and it may be considerable. So all hope is not lost that the final result may still turn out satisfactory. Whether revisional surgery may or may not be needed can not be foretoold at this early sfter surgery point. What you don’t want to do in consideration of revisional surgery, however, is chase a ‘moving target’. Give the nose a full six months after surgery and then go back and get a more useful after surgery evaluation from your plastic surgeon. What matters most at thaty point is how is how much change has occurred from now until then. If improvemenmt has been seen, then more time may be adviseable. However, if there has been no visible significant change between 6 weeks and 6 months after surgery, then revisional surgery is going to be needed.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery of the nose, revisional rhinoplasty
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Monday, February 21st, 2011
Q: Hello, I am looking the best procedure for diminishing marionette lines, over lips, and most importantly, droopy skin on the neck. What do you recommend?
A: In reading your question, I am going to assume that you mean marionette lines that start at the corner of the mouth and hangs over the corners. (hence the phrase ‘over lips’) When you combine those aging facial features with droopy neck skin, you are talking about a combined neck-jowl problem. Heavy marionette lines that hang over the mouth corners indicates that there is likely some jowling and skin that is falling forward and down…the reason thaty most marionette lines exist. While I obviously have not seen any pictures of you nor have examined you, all of these aging facial issues point to one and only one effective treatment option…some version of a neck-jowl lift. The key issue is the droopy neck skin. Nothing short of this type of a tuck or lift can change a loose neck skin issue. This is often combined with a corner of the mouth lift to get rid of the overhang, a small little procedure done at the corner of the mouth. This will most effectively get rid of the loose neck skin, ‘over lips’ and decrease the depth of the marionette lines.
It would be helpful to see some facial photographs or come in for an evaluation to confirm this potential recommendation. These are common facial aging problems where patients are often searching for some ‘simple’ or non-surgical approach where such treatments do not really exist. You want to avoid wasting money on any non-surgical treatments that really have no hope of making a substantive difference…and there are lots out there that sound good but don’t work very well.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, facelift, indianapolis, neck-jowl lift, plastic surgery of the neck
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