Archive for April, 2011
Saturday, April 30th, 2011
Q: I am interested in getting a rhinoplasty done. I want a more streamlined look to my nose. It needs to be straighter with less of a downward slope or dip in the bridge area. I think the dip is the result of a barbell bar that I dropped on my nose when I was about 12 yrs old. I have attached some pictures of my nose for you to see. What are your rhinoplasty recommendations?
A: Your pictures and your history show a classic saddle nose deformity. Your nasal bones and middle vault (upper and middle third of your nose) are collapsed and your internal septum is underdeveloped. This also results in a low and broad nasal tip, short columella and flared nostrils. The key to a successful result in the saddle nose deformity is building up of the entire dorsal line from the bridge down to the nasal tip. Without question the best material for this is your own cartilage. Your septum, however, would not provide adequate donor material. Ideally a rib graft should be used. This provides the best amount and shape that this buildup requires. One could use a synthetic implant, which is easier, but there is a definite risk of long-term problems with foreign materials in the nose. Otherwise, your rhinoplasty would be done through an open approach with dorsal graft and columellar grafting, nasal tip refinement and nostril narrowing. This would provide a more streamlined and straighter look to your nose as the attached computer imaging illustrates.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianaoplis, plastic surgery of the nose, rhinoplasty for saddle nose deformity, rib graft rhinoplasty
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Friday, April 29th, 2011
Q: I am 24 years old and have familial multiple lipomatosis as my father has it. I have multiple lipomas (relatively small) in arms, trunk and thighs and some of them cause me pain. Looking for excision of the lipomas which number about a dozen. I don’t know who exactly to go to or what to do. I’d appreciate it.
A: While many people have single or isolated lipomas, a few patients will have many more than one and lipomas that continue to occur over their lifetime. This is a condition known as familial lipomatosis. No one understands why it occurs or what causes it. Since there is no definitive cure for this recurrent problem, it is usually best to wait until there are enough symptomatic (painful) ones that justify surgical removal. There is an injectable treatment which is best reserved for those that are smaller and not near any important structures such as nerves. Injecting can help suppress their growth and may for some small lipomas be curative of them. Otherwise, intermittant excision will be needed as their numbers and size dictate.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, familial lipomatosis, indianapolis, lipoma removal
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Friday, April 29th, 2011
Q: I was wanting to know if you guys do laser stretch mark removal? If so I’d like to kow more about it and maybe get a consultation to see what it would cost.
A: Stretch marks remain a cosmetic problem that defies any effective treatment. If there was one really good treatment that consistently worked, we would all know about it as there are millions of women that siffer from this aesthetic concern. While there have been and are many types of treatments that promise the elimination of stretch marks, none have ever been shown to really work well. Therefore, there is no effective treatment strategy known as laser stretch mark removal. That is not a realistic expectation of what lasers can do or any type of stretch mark treatment.
Why do stretch marks elude treatment success? Because a stretch mark is not a superficial skin problem. It may appear that way when looking and feeling them from the outside, but a stretch mark represents a full-thickness skin problem. The dermis of the skin is damaged and permanently thinned. A stretch mark is really a scar with loss of pigment, although they can appear red rather than white. The skin has been stretched to the point where it is partially torn on the underside. This is why no outer or topical treatment will really make them less visible.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, laser stretch mark removal, stretch mark treatments
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Tuesday, April 26th, 2011
Q: Hello Dr. Eppley, I was wanting to know if you do fat transfers to the arms? I had liposuction done to my arms over a year ago that left me with a lot of dents and irregularities. It has improved a lot over the past year and now there is just some loose skin that bothers me. I think these arm areas could could benefit from some filler. I wanted to get some fat removed from my stomach which has always been a problem area for me. Thank you for your time.
A: Arm liposuction is very prone to irregularities given its thinner skin and that the liposuction technique can not really use a cross-tunneling method, which is really useful to prevent large irregularities in fat removal. It is good that you have waited until the arm sites have matured and all the tissues have settled. Many arm liposuction irregularities will improve with time although they rarely go completely away. For small remaining areas, injected fat would be the only good treatment option. Only a small amount of fat would be needed so your stomach sounds like it would provide more than an adequate donor area. The fat that is harvested is washed and concentrated so that the highest percentage of viable fat and stem cells gets transplanted. This should help fill in some irregularities and expand out some loose upper arm skin.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat injections, indianapolis, liposuction arm irregularities
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Tuesday, April 26th, 2011
Q: I would like my brow bones enhanced but I think I only need the outer 2/3rds of the browbone or even just the outer 1/3 (the area underneath the eyebrow) plus a little bit on the temple that’s connected to the brow. I want the area to look flat but padded up and not stuck out like a ridge. I don’t want to end up looking like a neanderthal. So I think only the outer brow bone needs enhancement but I do not know how it would look esthetically in practice. I’m not a plastic surgeon. Have you done many outer 2/3 of the browbone enhancement surgeries before? How do they look? Would you mind sending me some before and after pictures? I am thinking of getting juvederm to the area first to see how it would look with the permanent filler. Should i do that? I also have a low nose bridge which I want to enhance a little bit. If you don’t mind I’ll send pictures. What are the chances of scarring with the upper eyelid approach? Where is the incision going to be? In the eye crease? I think saw you mention to someone else the Q&A about preparing the periosteal, what does that mean? Why do you prefer the hydroxyapatite paste instead of kryptonite bone cement for this procedure? I’m sorry for asking too many questions Dr. Usually when you search about enhancing the brow bone on the web, only the stuff about silicone forehead implants come up, which seems rather drastic and scary to me. You’re the first Dr who have said the 2/3 browbone enhancement is a viable option.
A: For the area of brow bone that you want enhanced, an upper eyelid approach is the best way to go. It is much closer to the bone area to be augmented and is done through an upper eyelid crease incision. This is the same incision used for standard upper blepharoplasty procedures. The material of choice is hydroxyapatite cement. This material must be placed through an open incision, contours nicely, sets up quickly, and is less expensive than Kryptonite bone cement. Many people are enamored with the injection approach with Kryptonite but they misinterpret it like it is the same as injectable fillers for soft tissue. It still requires an open pocket dissection and then must be contoured from the outside by hand without actually seeing the bony contours. That may be fine for a large skull area but when it comes to working with very discrete contours this is not good and will very likely pose irregularities that will have to be revised later.
The tail of the brow can be either reduced or augmented (lateral brow bone augmentation) through the upper eyelid approach. I have done both very successfully. A scalp approaach is needed, however, when the entire brow needs to be modified.
Dr. Barry Eppley
Indianapolis Indiana
Tags: brow bone augmentation, dr barry eppley, indianapolis, plastic surgery of the brow bone
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Tuesday, April 26th, 2011
Q: I want a stronger chin and jawline. I currently have a 7 mm winged chin implant in now (with rhinoplasty last year), but feel the asymmetry lies more in the vertical dimension. I also feel that my mandible does not have enough lateral dimension or width. It seems that my lower face is somewhat deficient in multiple planes and I’m unsure which would be better for me, a chin osteotomy with vertical and horizontal augmentation combined with a widening of chin, or a custom wrap around implant. It might be helpful to see the predicted outcomes of both. And, of course, I would love to hear what you think might be best based on the picturesI have attached. Any other suggestions you might have would be appreciated also.
A: I think factoring in all considerations and looking at some imaging predictions, I would opt for the chin osteotomy. The recovery time is actually shorter with the implant but the photographic projections shows what an osteotomy can do and that seems to be the bulk of where the change needs to be to get your face more balanced. Given your 7mm implant that is already in place, your osteotomy needs to come forward 11mms and down at least 7mms. This will require plate fixation and hydroxyapatite block grafts.
Also I have noted that you could benefit from nostril widening. That parft seems to have been overlooked in your original rhinoplasty as well as some additional tip refinement. I would also consider adding in buccal fat removal for submalar narrowing and this would add nothing to the recovery time.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin lengthening, chin osteotomy, dr barry eppley, indianapolis
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Tuesday, April 26th, 2011
Q: I want to make my forehead appear a bit broader. Is it possible to remove some hairs permanently? This I think would help give me more forehead/scalp skin.
A: I assume you mean that to make the forehead broader, you want to move back your temporal hairline. This is an uncommon request as most people have trouble with their hairlines being too recessed or too far back. But can the temporal hairline be repositioned through hair removal? Yes, this could be done through laser hair treatments. Scalp hair is difficult to remove by any method, including laser hair treatments, but it is possible. Because the scalp is thick and the hair follicles lie quite deep with an extensive blood supply, their eradication is not easy and multiple treatments will be needed.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead widening, indianapolis, laser hair removal
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Monday, April 25th, 2011
Q: I`m considering having some plastic surgery and that`s the reason I`m writing to you. I am 28 years old and I`ve got a very rounded face with lot of babyfat and I want to make it more sharp/angled and more masculine looking. I have had a rhinoplasty done on my nose when I was 18 and it looks great from the profile, the only thing is that from up front one of the sides is indented and I was thinking that either an injectable filler to build up that side up or a silicone implant to make that side more fuller and match the other side. I don`t need a major or new nose job, just to fill up one side of my nose. I`ve got a double chin and even when I was thinner I still didn`t have a 90 degree angel between my neck and chin. So I want a liposuction and tightening of the neck muscles. I think this will also help to make my jawline stand up a bit more. I have a very round and big chin. It`s not too big but it`s very round so I was thinking that the liposuction of the double chin and platysmaplasty will also help to give my chin more angles but I`d also like to have a small dimple there. This will give me that masculine clefted chin look. I`d also like to have liposuction of my lower face (removal of buccal fat) to give it more angles and make it less rounded and more masculine. I think some cheek implants will give my face more bone structure. I want to remove the bags under my eyes. I`d like the procedure where the incision is from the inside of my eyelid. My upper lip is a bit uneven. One side is more rounded than the other, so I`d like to correct and get more symmetry to my lips. It`ll be nice to get them a bit bigger too. I have attached some photographs for you to review and await your comments/recommendations.
A: In reviewing your photographs and your concerns, I can make the following suggestions/recommendations:
1) Nose. Your nose is asymmetric because you have left upper cartilage/middle vault collapse. That is why it appears deviated due to the inward turning of the dorsal line. This is the result of your prior rhinoplasty. That is best corrected not by an implant or an injectable filler, but by cartilage grafting. The use of a left spreader graft and a crushed cartilage onlay graft over the indented area is the treatment of choice.
2) Lips. Fat injection grafting would be best. Although a vermilion advancement would perfectly correct the left upper lip asymmetry (lack of vertical height), that fine line scar in a male would be unacceptable.
3) Lower Eyelids. The lower eyelid bags could be removed by a transconjunctival lower blepharoplasty with fat removal only.
4) Cheeks. Cheek implants would be a good choice for your malar-infraorbital hypoplasia. I would also add fat injections above the cheek implants along the infraorbital rims.
5) Cheeks. Buccal lipectomies are needed to get rid of the fullness below the cheek bones which are going to be highlighted with the implants.
6) Chin. A square-shaped chin implant is needed with the placement of a central dimple or cleft, whichever is your preference. The chin implant would have minimal forward projection but is more to create fullness on each side.
7) Neck. it could be improved by some liposuction and a corset muscle plication (platysmaplasty ) to maximize the cervicofacial angle.
Lastly the Jaw Angle. A would do some liposuction around the jaw angle area to try and make it a little more distinct although the result would be fairly subtle.
Most of these procedures you had already surmised but here is what can be realistically done in an effort to achieve more of a sculpted masculine facial appearance.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, cartilage graft to nose, cheek implants, dr barry eppley, indianapolis, platysmaplasty, rhinoplasty, square chin implants
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Monday, April 25th, 2011
Q: I had a botched chin and jaw implant procedures from an inexperienced surgeon who had never done the procedures before and things didn’t turn out well. I have had both the chin implant and the jaw implant taken out. That was about a year ago. Now there is significant scar tissue and also sagging along the jaw implant lines (but not so much on the chin). Could I send photos to you? Could you be able to fix my problem and me go back to the normal chin and jaw I had before? I have read much of your material on the web and would be very grateful if you could deal with my problem and fix it to the best of your abilities.
A: Facial implants expand the contours of the implanted bone site at the expense of soft tissue stretching as well. When implants are removed, the overlying soft tissue may or may not shrink back down to its former position. The larger and bigger the implant, the less likely the soft tissue will have any recoil. This is also affected by how long the implants have been in place.
In the jaw, chin implants typically pose the greatest problem with ptosis or soft tissue sagging after removal. Jaw angle implants usually cause less of a problem because most are of the lateral augmentation design and don’t disrupt the attachment of the pteryomasseteric muscle sling at the inferior border of the jaw. This is more of a potential concern in inferolateral augmentation jaw angle implant styles.
Correction of soft tissue problems as you describe may require muscle repair back to the bone or it may be improved by overlying soft tissue suspension. I would need to see some pictures of your issues and what type of implants were initially placed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial implant removal, indianapolis
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Sunday, April 24th, 2011
Q: I was wondering if you had any experience using Acell Matristem tissue regeneration products? It is the stuff that was used to regrow finger tips, for scar revision/removal, and now in hair transplants. The reason I ask is because I have a medpor jaw implant and was considering having it removed but I understand that one of the difficulties with this is soft tissue damage. I’m under the assumption that the Matristem product would make this a non-issue but I wanted to know what your thoughts and possible experience has been with it.
A: I have used Acell Matristem and am very familiar with its working properties and its results. I have also revised and/or removed many Medpor facial implants and do not their removal as problematic as many suggest. They are not difficult to remove and do not leave behind significant soft tissue damage or tissue loss. They are only ‘difficult’ when you compare them to silicone facial implants which slide right out. So that assessment is a comparative one.
Your consideration of Acell particle implantation at the time of facial implant removal I assume is to repair the soft tissue damage left behind. That can certainly be done and may or may not be of benefit. If your intent is to implant Acell in the hope that it can replace the volume lost by removing the implant would not be a reasonable expectation.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: acell matristem, dr barry eppley, facial implant removal, indianapolis
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