Archive for March, 2011
Thursday, March 31st, 2011
Q: I am interested, I think, in some fillers, Botox and perhaps a partial facelift. What I would like to achieve is a firmer jawline, reduce my crow;t feet and just have a refreshed look. I am attaching some pictures for you to review and give me your recommendations. Thanks!
A: Thank you for sending your pictures. I have done some imaging looking at firming up your jawline. You hve the typical jowling the comnes with aging and this also creates a prejowl indentation as the jowl sags. That is best corrected by a lower facelift (neck-jowl lift) and adding in a small chin-prejowl implant to bring the chin out slightly (yours is a little short) and filling in the prejowl deficiency. The combination of these two makes for a smooth jawline. At the same time, I would place some fat injections in the nasolabial folds (lip-cheek grooves, parentheses) as this is the best ‘filler’ to use when you have are doing a facelift as it is the only filler that potentially can be more permanent. Botox for the crow’s feet can be done either during a facelift or anytime in the office. Just for the sake of one additional suggestion, I have also imaged a rhinoplasty by doing some nose narrowing and lifting the tip a little as this can also have a rejuvenating effect as one gets older.
These computer images will help you think more about what can be done for a refreshed look.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin-prejowl implant, dr barry eppley, facelift, indianapolis, rhinoplasty
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Wednesday, March 30th, 2011
Q: Six years ago I had a mandibular implant placed as well as malar implants. I am unhappy with the end result and do not feel the result was what I requested. I think, as I did then, that a geniomandibular groove implant with extended malar implants would provide my desired results.
A: I am assuming when you say mandibular implant you are referring to a chin implant. Since you feel that a geniomandibular groove implant is better, it appears that you feel that the transition between the chin and jowl area is not a smooth or confluent one or that the jowl area needs to be more enhanced as well. Do you know what type of chin implant you have in now?
From a cheek standpoint, the desire for further malar extension suggests that either you desire more fullness out across the zygoma to the zygomatioc arch or that your desire more fullness in the submalar area suggesting more of a malar shell design. Do you know what type of malar implants you have in now?
Please send me some photographs of your face and let me know, if you can, what type of implants you have in place. A copy of your original operative note can also be very helpful as often the type of implants used are described there. Once I have this information, I can offer a more qualified response as to the best replacement facial implants for you.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek implants, chin implants, dr barry eppley, facial implants, indianapolis
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Wednesday, March 30th, 2011
Q: I’m planning on having a tummy tuck and have read that they can be done without using any drains. I don’t want a drain because it creeps me out thinking about a tube coming out of my body. I have also read that some plastic surgeons still use drains because they think it is better. What are your thoughts as to which way is best?
A: I have done tummy tucks both with and without drains. There are pluses and minuses each way which is why drain use is controversial and variable amongst different plastic surgeons. The purpose of a drain is to remove fluid that the body produces in the healing space of the tummy tuck area. When doing a tummy tuck without a drain, this open space is closed down with extra sutures which takes time and does add to the cost of the operation. Even though a drain might not be used, there is a small chance that fluid can still accumulate and have to be tapped later. When doing a tummy tuck with a drain, it will stay in for 7 to 10 days. There is about a 1/3 chance later that some fluid will still accumulate and have to be tapped.
Having done tummy tucks both ways, I have seen numerous cases where fluid still had to be tapped later whether a drain was placed or not. Unless a patient is possessed about not having a drain, I will use a drain most of the time. When a patien is opposed to a drain, I will use extensive plication sutures and extra OR time to perform it. That will add about a one-half hour to the cost of the operation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, drains in tummy tucks, indianapolis, plastic surgery of the tummy
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Wednesday, March 30th, 2011
Q: I have a 3 years old with mild plagiocephaly. I’m very interested in kyptonite injection to correct that problem in the future. Here’s my question about that technique: what is the method you are using to determine where (on the head) and how many (what quantity) kyptonite you will inject? Can we see a proposed “corrected headshape” before the procedure?
A: The determination of where to place the injectable cranioplasty material is determined before surgery by what everyone feels is the flattest area on the back of the head. That area is marked out prior to surgery. The location and size of the area to be filled in is a joint decision between the parents and myself. The amount of Kryptonite material needed is the greatest variable and the real guesswork in doing the procedure. What I know from experience is that 5 grams is inadequate and 20 grams would likely be too much. Usually 10 to 15 grams of material is needed. But the diameter of the defect is measured and then a benchtop test is done to determine whether 10 or 15 grams is best prior to surgery. Computer imaging is also done based on a superior view of the back of the head to get a prediction as to what may be obtained. It is important to realize that computer imaging is a prediction and not a guarantee of the exact outcome.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable kryptonite for cranioplasty, plastic surgery of the skull
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Tuesday, March 29th, 2011
Q: Hi Dr. Eppley, I emailed you about a month ago about getting 5-FU injections for lumpy scar tissue underneath my nipple for a revision gynecomastia surgery I had about 4 1/2 months ago. I have been really busy at work and unable to get time off to make an appt. Last time you emailed me about a month ago you said I could schedule an appt. and possibly get a 5-FU or kenalog injection. I would really like to do this but an injection of kenalog makes me nervous due to the possibility of skin atrophy and other side effects I have heard about. I have heard that 5-FU mixed with a small amount of kenalog does not really carry these side effects and can work quite effectively. I have to travel about two hours or so to get there so I just want to make sure that 5-FU injections are a possibility before I make the trip. Also I have an issue about the scar I have from the surgery I had and I saw on your website that you deal with scar management. I know that the scar I have is only 4 1/2 months old but it does not seem to be getting any better and I was wondering if there are any non-surgical procedures or techniques, such as laser therapy, that you specialize in that could help to minimize this scar? Thank you for any help you may be able to give me.
A: We can certainly do 5-FU injections for scar therapy as that is an item I keep stocked her for injection treatments. While it is uncertain whether 5-FU is really better than Kenalog, it does have a higher safety profile. Kenalog done judiciously (low dose), however, can be done without significant side effects as well. As for scar management, there are numerous options regarding non-surgical approaches depending upon the scar issue such as hypertrophy or redness. Most commonly we do pulsed light therapy (Broad Band Light, BBL) or laser treatments. That decision would have to be made at the time of examination.
Dr. Barry Eppley
Indianapolis Indiana
Tags: 5-FU scar injections, dr barry eppley, indianapolis, kenalog scar injections, plastic surgery for scars, scar treatments
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Tuesday, March 29th, 2011
Q: Dr. Eppley, I had a rhinoplasty six months ago. My main goal was to make my nose larger in the middle. I have breathing problems and when I use nasal strips it makes me breathe better. I didn’t want to change my nose very much but just add support and width to the middle part. My rhinoplasty surgeon said he would put in spreader grafts and a columellar strut. After surgery when the splint was removed, he said he had also put in an onlay dorsal graft to make my nose look more balanced and masculine. My problem is that I didn’t want the dorsal graft. Now that I have more support in the middle vault, the dorsal graft makes my nose higher which I do not like. Can this dorsal graft be removed?
A: Dorsal grafts are onlay materials, usually cartilage, that is simply put on top of the bridge of the nose. How long it is and its size is largely irrelevant when it comes to removing it. The graft should be fairly easy to remove through a closed endonasal rhinoplasty approach. Unlike a bone graft, a cartilage graft never really becomes part of or truly incorporated into the underlying cartilage and bone but simply sits there with a surrounding capsule. This makes its secondary removal fairly easy. Since you are six months out, it is fair to say that you have a good idea of what your nose looks like and are certain that the dorsal graft does not fit into the desired aesthetic shape of your nose.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dorsal grafts in rhinoplasty, dr barry eppley, indianapolis, plastic surgery of the nose
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Tuesday, March 29th, 2011
Q: Dear Dr. Eppley, I am interested in both malar and paranasal implants and I have learned a lot about facial implants on your homepage! In one article you stated that some areas in the face are more sensitive to implant size than others. For example, the orbital rim is one of these areas where the size of implants have to be chosen very carefully because 1 mm can make a huge difference. I guess it is the opposite with paranasal implants because (although they can be tailored) they are only available in such big sizes like 4.5 mm and 7 mm. I am not sure if I should choose the 4.5 mm or the 7 mm implant, but I am sure that I want rather a more dramatic look than a very subtle outcome. Do you think 2 mm difference in the paranasal area can make such a huge difference? Is the paranasal area more tolerant towards a slight overcorrection? Is my assumption, that paranasal implants are less sensitive to size, right? The worst thing that could happen to me after the implantation of the paranasal implants would be an increase of my nose tip projection, an increase of my nasolabial angle and a lengthening of my upper lip. Of course I know that paranasal implants usually don´t do this, but I am a little bit afraid that this could be different with the large 7 mm implants. Have you ever implanted the 7 mm paranasal implants and what are your experience with patient´s satisfaction? Did they rather wish to have more or less projection after they saw their final paranasal implant result?
A: The paranasal area is less sensitive to implant size for a variety of reasons. The first is that the skin around the base of the nose is thick so implant thicknesses are easily masked. A paranasal implant also has to push the base of the nose (nostrils) outward so it takes a bigger implant to do that. Lastly the surface into which the implant is placed is curved inward and not outward, further decreasing its influence. In general, small paranasal implants placed at the bone level has little effect so thinking bigger (7mms or more) will have a more visible effect. I don’t recall using a paranasal implant that was ever smaller than 7mms at its thickest portion.
A paranasal implant has no influence on the projection of the nasal tip, regardless of size. Only when a premaxillary implant is placed across the anterior nasal spine will it change the nasolabial angle with a small influence on the nasal tip.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, paranasl implants
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Monday, March 28th, 2011
The large number of stem cells in fat has led to a new wave of treatments in plastic surgery that hopes to harness the potential of this ‘wonder’ cell. Since a stem cell can turn into any type of cell if properly stimulated, it is not hard to see why any treatment attached to it is being hyped as a rejuvenative or regenerative therapy. These R words translate to anti-aging or make me look younger.
Given the ease from which fat can be extracted through liposuction, fat is being reprocessed and injected all over the body by plastic surgeons mainly because it is easy to do and perfectly safe. You might say it is the ultimate form of recycling, a green procedure if you will that is most certainly organic. Injected fat can be used from body contouring to facial rejuvenation. For the body, buttock augmentation and breast reconstruction (lumpectomy defects) are being widely done. Breast augmentation using fat instead of implants is being approached more cautiously. The other good body use is in the aging hands, using injected fat to make the hand look more plump and have a less bony appearance.The face, however, is the most common area for fat injections. Research has now shown that we loss fat in our face as we age. This facial deflation is one of the reasons that we look old and contributes to skin sagging. This has led to younger people getting fat injections at an early age and fat injections being used as part of a facelift procedure for more advanced degrees of facial aging. For the aging gaunt-looking face (or even a younger gaunt face), fat injections can be a good complement to traditional skin removal and tightening procedures.
In the most contemporary spin of fat grafting to the face comes the Stem Cell Face Lift. The concept is that stem cell-rich fat grafts combined with skin tightening makes for a better facelift result. Proponents claim that the stem cells provide a regenerative effect that makes the fat take better and helps the quality of the overlying skin as well. By mixing the fat with a little of your own blood, a theoretical youthful elixir is created.
Is the Stem Cell Facelift actual science or more science fiction? Is it hype or hope? At this point I would say a little of science and a lot of hype. The real scientists of stem cells would most certainly tell us that it just isn’t that simple. While stem cells have been extensively studied, how to make them work is far less clear. Conversely, the hopeful part of stem cells in facial rejuvenation is that it exemplifies the concept of ‘heal thyself’. Our tissues have a remarkable ability to heal themselves from injuries throughout our entire lives. It just seems that we should be able to use that to our advantage at some point.
One of the benefits of fat grafting to the face, whether the stem cells really make a contribution or not, is that it adds volume. And with our current appreciation of what happens as most faces age, becoming a little more cheeky might not be a bad thing.
Dr. Barry Eppley
www.eppleyplasticsurgery.com
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, stem cell facelifts
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Monday, March 28th, 2011
Q: I am interested in a corner of the mouth lift. I have checked in my area but have been unable to find anyone as of yet. How would it work if I was to choose to see you? How many trips would I need to make? Have you done many of the corner mouth lift procedures? I am 48 and do not feel I need, nor do I want at this point, a face lift as it is really only the beginning of slight mouth droop/marionette lines that really bothers me.
A: In answer to your questions, We have many patients how come from afar so we are very familiar with working with out-of-town patients. Ultimately, a corner of the mouth lift is done as an isolated procedure in the office done under local anesthesia. One only needs to come once, for the procedure only. An initial consult can be done by phone or Skype with photos of the mouth area sent in advance. Everything that needs to be discussed and determined can be done from afar. Once the procedure is done, there are no sutures to remove as they are just tiny dissolveable ones on the skin. There are no restrictions after surgery. Any follow-ups can be done like the initial consultation by phone or Skype with photos. A corner of the mouth lift is really a simpl;e proedure with the minor trade-off of a small scar. I have performed many of them either as a sstand alone procedure or often in conjunction with facelift surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: corner of the mouth lift, dr barry eppley, indianapolis, plastic surgery of the mouth
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Monday, March 28th, 2011
Q: I am a 24 year old male who was born with a right cleft lip and palate and have been through five surgeries so far in my life. Besides my inital cleft lip and palate repairs, I underwent iliac crest bone grafting at age 11 and a Lefort 1 osteotomy combined with alveolar cleft bone grafting again at age 21. I have a fixed bridge across the alveolar cleft site. My current complaint is that I feels my upper jaw is collapsing again causing poor fitting of the bridge and thus pain. A CT shows a very small, but present, bridge of bone across the alveolar cleft. Also, the Lefort 1 plates appear in good position. I have no visible fistula but I can force air into my nose from the upper buccal sulcus. What, if anything would you recommend to try and solve my current orofacial problems? Thank you sincerely for your help.
A: It sounds to me like you still have a small oro-nasal fistula through the original alveolar cleft site with inadequate bone stock. I would look at repeating your alveolar cleft site grafting using a combination of some marrow and a cortical onlay graft screwed into place across the cleft site. It is very common to have resudal alveolar fistulae even though the site has been grafted more than once. If you can force air through it then there is a fistula. Plus if you have been grafted twice and it was done well, you should have more than just a small bridge of bone across the alveolus. I would wager you have a fistula going behind that bridge of alveolar bone. While alveolar cleft grafting seems simple, it actually is technically difficult and results can be less than ideal in many cases.
Dr. Barry Eppley
Indianapolis Indiana
Tags: alveolar cleft bone grafting, cleft lip and palate, dr barry eppley, indianapolis, plastic surgery of the alveolar cleft
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