Archive for April, 2011
Sunday, April 24th, 2011
Q: I have a weak jaw in terms of width and projection, coupled with a long and narrow face. I don’t wish to get any implants into my face as this idea scares me. I believe my only option now to add width to my jaw would be dermal fillers. How many mm can dermal fillers like Radiesse and others add to the jaw. I believe I am 10-15 mm deficient in terms of the jaw. What is the maximum the best dermal filler can give in terms of width? What is the name of this filler?
A: I am afraid that the very thing that scares you is the only good option to do. While Radiesse injectable filler can be added to any area along the jawline, it would take a lot of material to create 10 to 15mms of bony augmentation. That cost alone would well exceed $10,000 to $15,000 for a result that would last at best 1 year. That cost is comparable to surgically implanting multiple jaw implants which would be permanent and last a lifetime, provided they suffered no initial complications.
Injectable fillers for bone augmentation is to provide some subtle highlights that do not justify surgery or as a trial to see if implants might be a good choice. Facial implants are for significant volume and contour change that require broad surface areas of material. Your jaw problem is better suited to the latter. Injectable fillers are not a good option for you.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial implants, indianapolis, injectable Radiesse to the jaw
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Saturday, April 23rd, 2011
Q: I saw a tummy operation on a TV show the other day that got me reallly excited. It was a new operation called the Smooth Tuck. It was a impler way of doing a tummy tuck because no muscle repair is done and it uses a much smaller scar above the bikini line. The recovery is only one week. This sounds great! I was scheduled to have a full tummy tuck and I was dreading it. This sounds so much better. Do you think I should have this tummy procedure done instead? Is it too good to be true?
A: While I have no idea what your tummy problem is or looks like, I can make a predictive statement that it is too good to be true. The Smooth Tuck is nothing more than a mini-tummy tuck wrapped up with a slick sounding name. Whether the smooth refers to how your tummy will look after or what it is like to go through and recover from is unknown to me. And I am not saying that it is a bad operation. The key question is whether this is an operation for you. Does the solution it can provide match the size of your problem? If you are better suited to a full tummy tuck, then this lesser operation will leave you disappointed no matter how smooth it sounds. There are some tummy tuck patients who are ideally suited for this approach but it is usually only a minority of them. You understandably are interested in something that sounds easier than the traditional tummy tuck approach. Just be certain that the real limitations of this marketed operation do not leave you with the opposite of your desired result…an unsmooth tummy that should have had a different tummy tuck technique done.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery of the tummy, smooth tuck, tummy tuck
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Saturday, April 23rd, 2011
Q: Dr Eppley, I just read a reply you wrote to a patient inquiring about forehead and orbital rim with either implants or hydroxyapatite paste to which you reply that Kryptonite Bone Cement would be a better option. I want to get your opinion on which material is the best choice for filling out the outer brow bone area(just very slightly). I’m asian, I have eyelids and round shaped eyes but my brow bone looks very weak, which makes me look tired unless i wear eye shadows/shading which I think have lead to my eyelid skin aging prematurely. My eyelids have started looking a bit saggy and I’m only in my late 20s. I want to have the appearance of having more developed brow bones (which looks normal on an asian person) i think this should also help keep my lids from sagging. I want to know if Kryptonite Bone Cement would be a good option for the browbone in my case? Or should i try something else? I’m also considering fat grafts. Please get back to me and let me know what you think is best. Thanks very much.
A: When it comes to brow bone augmentation, it is my opinion that it is always better long-term to add to the bone with a material of similar hardness…provided that the trade-off to doing it (incisional approach) does not leave any significant scarring. Fat injection grafting is a reasonable option nd it does offer simplicity and ease to do with a natural material. (fat) But how volume will stay and what its shape will be is not always predictable.
You have said one key statement in your inquiry…‘filling out the outer brow bone area’. It is critically important to know what specific brow area one wants to augment. If it is just the outer two-thirds or tail of the brow, then that could be done through an upper eyelid approach and adding hydroxyapatite paste. That would by far be the best way to do it and is very straightforward. If one needs the entire brow augmented, then I would use an endoscopic approach with Kryptonite bone cement. By this approach, it could be injected and then molded under endoscopic guidance.
Dr. Barry Eppley
Indianapolis Indiana
Tags: brow bone augmentation, browplasty, dr barry eppley, indianapolis, plastic surgery of the brow bones
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Saturday, April 23rd, 2011
Q: My four year-old child had a surgery for repair of an elbow fracture. Screws were initially inserted to fix the upper arm bone where it attaches to the elbow. It went on to heal well and the screws were removed three months later through the same incision. Now he has an ugly wide scar which lies on the outside of his elbow and is very visible. It is about 3 cms wide. We need it to be removed as soon as a possible.
A: Scars from orthopedic surgery, particularly around a joint area, can often end up less than ideal. This has to do with a variety of factors including the intent of the surgery (fix the bone fracture, the appearance of the scar is largely irrelevant), the pulling on the skin edges from the equipment used in bone repair, repeat surgery through the same incision, age of the patient, and the continous stretching on the scar from the motion of the joint. By far, the latter plays the major role in such scar widening and hypertrophy. While a scar revision will make an immediate improvement the question of whether some scar widening may still occur is relevant given that the elbow joint will be moving after surgery. So pulling and tension on the scar will not be eliminated. What degree of scar widening will occur after revision can not be predicted, but hopefully it would be minimal.
One concept about the treatment of scars that must be tempered is the concept of removal. There is no such thing as scar elimination or removal. Scar revision is all about how much improvement can be obtained. A complete scar ‘cure‘ or total eradication is not possible for any scar.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery of scars, scar revision
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Saturday, April 23rd, 2011
Q: I have recently consulted with a maxillofacial surgeon who has recommended performing a chin osteotomy procedure. He intends to remove a 3mm wedge (for vertical reduction) as well as a 3mm advancement, with the osteotomy performed at a slight upward angle. I seem to have the unique situation of anterior mandibular vertical excess with a very flat labiomental fold (which would be enhanced by the advancement) What are your thoughts on the success of this procedure?
A: Without looking at photos and x-rays, it would be impossible for me to comment on whether this is a good procedure for your concerns or not. That is a technically sound chin osteotomy procedur and is very straightforward to do. The only question I would raise about it is that these bony movements (3mms) are fairly small. Such small movements are unlikely to make much of an external visible change, albeit a very modest one. To take down the chin bone by osteotomy for this amount of bony movement seems like a ‘solution that is bigger than the problem’. For a horizontal advancement of 3mms, an implant would be far less invasive. For a vertical reduction of 3mms, there is no other solution than osteotomy and bone removal. This makes it a difficult decision in my mind as to whether the problem justifies this degree of surgical effort. I would look at your chin concerns carefully and would reconsider carefully the potential benefits and risks of this type of chin surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, plastic surgery of the chin
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Saturday, April 23rd, 2011
Q: I had an injury and got a little scar over my right eyebrow. Because of this I have slightly lees eyebrow hair over that eyebrow. Is this something you can fix? I only need to fix 5-10% of the eyebrow hair on the right side.
A: Lacerations that cross into and through the eyebrow will frequently result in a bald spot or a scar area that is missing hair. This is the result of either actual injury and loss of hair follicles, separation of the eyebrow hairs by scar, or both. Depending upon the size of the eyebrow defect, there are two approaches to restoring eyebrow hair continuity. In many cases, the scar can be excised and the eyebrow hair margins brought back together through simple scar revision realignment techniques. This works well for small eyebrow defects. In larger eyebrow defects, it may not be possible to bring the normal eyebrow margins together without shortening the horizontal width of the eyebrow or distorting its shape. In these size defects, eyebrow hair transplants are needed. The hair grafts are harvested from behind the ear. It may only take 10 to 25 hair transplants to correct most eyebrow defects. Meticulous placement is needed to get the right hair orientation that matches the natural changing orientation of the hairs as they go from the inside of the eyebrow out to the tail of the eyebrow.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, eyebrow hair transplants, eyebrow scar revision, indianapolis, plastic surgery of the eyebrows
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Friday, April 22nd, 2011
Q: I am in the military. I am 40 years old and have been selected for promotion to Commissioned Officer. I have a large build and constantly struggle with the military’s height vs. weight standards. A secondary circumferential method is used for the neck and waist. I am always just at or above the limit. I have found it even harder now that I am older. I think liposuction would get me ‘over the hump’ with some stomach and waistline shaping as I just need to drop an inch or so around the waistline. I have attached some photos for your assessment and would I qualify for the Patriot Plastic Surgery program.
A: I receive a fair number of requests from men and women in the military for plastic surgery and it is almost always about trying to pass the measurements that are used in the service’s fitness evaluations. While the physical part of these required tests are based on push-ups, situps and a 2 mile run, there are also circumferential measurements done with an important one being that of the waistline. To help men get to their desired waistline measurement, liposuction can be very effective by aggressively treating the entire abdomen and the flanks as they head around into the back. For some women this is effective also, but there are some women that really need a tummy tuck to get rid of the excess skin and overhang if they have had children. We do offer discounts for these surgeries for active military peronnel.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, liposuction for military fitness measurements, patriot plastic surgery program, plastic surgery for the military
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Friday, April 22nd, 2011
The Book entitled ‘I Feel Bad About My Neck’, that came out a few years ago, bespoke of an inevitable aging problem. Necks unfortunately don’t lie. The folds of skin hanging down from one’s jawline are like rings on a tree. While Botox, injectable fillers and lasers can do a lot for the face above the jawline, the neck has been the poor sister of non-surgical rejuvenation. The neck can even look comparatively worse as the rest of the face above it gets a few less wrinkles and becomes more plumped with these treatments.
While a necklift is the only sure thing for the most ideal and long-lasting improvement, not everyone has a wattle that is so deserving. Less-invasive options have cropped up over the past few years that are promising and have caught a lot of press. One of the more recent ones uses ultrasound waves to help grow collagen under the skin to create a tightening effect. Targeted towards early neck aging patients, usually under the age of 55 years old, it can improve some of that loose skin under the chin. This has led to it being touted on numerous popular TV shows and magazines.
Enigmatic of many new and inadequately studied cosmetic treatments, Dr. Oz (a heart doctor) proclaimed on his show that this was the equivalent of a non-surgical facelift. He spoke how it could get rid of a sagging neck immediately and that it was pain-free. Its discussion on the show also left a distinct impression that such a device was cleared by the FDA for neck treatments… when it is not.
The reality is that ultrasound, and other collagen-stimulating treatments, do have some skin tightening properties but the effects take months to appear…and numerous treatments. Any immediate effects are temporary due to the heat created in the skin but real collagen takes much longer to form. The manufacturer claims that these results can last up to a year or longer but actual clinical trial data has only followed patients up to 3 months after treatment. Costing up to several thousand dollars, most patients won’t be happy with that investment even if the results did last for one year.
While many people think that surgically tightening the neck also requires that the face be lifted as well are not aware of more recent advances…that catch much less press than trendy devices. There are isolated necklift procedures and many more men get isolated necklifts than women. Most women are concerned about the jowls and the neck while most men are actually more focused on just the neck alone. The influence of time on a man’s face, even including baldness, is pretty well tolerated but a neck wattle is usually not viewed as a graceful sign of aging. I have had many men tell me that the only thing that they think makes them look old is their neck.
While creams, exercises and these newer skin tightening devices all have purported neck benefits, most people by the time they notice their neck problem are beyond the help of these approaches. Something less appealing, but infinitely more effective, is the spectrum of necklift surgery options.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, neck tightening, necklift surgery, plastic surgery of the neck
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Tuesday, April 19th, 2011
Q: I just had a large chin implant placed two weeks ago with neck liposuction. I didn’t really feel I needed the implant in tyhe first place as I had a good chin. The implant is way too large and I don’t like how it feels. I am going to have it removed and I understand there can be sagging skin or nerve damage. Please please give me your advice as to what I can do to correct the sagging skin or rippling in the event that it does occur.
A: The first thing that I can say is it is only two weeks after surgery so there is still swelling, so it is hard to say yet that it may be too large. Also, it is very common to have a chin that feels stiff and wooden for weeks after surgery. This is a very unnatural feeling but it will eventually pass by six to eight weeks after surgery. So whether your feelings about the chin implant would be the same two months from as they are today is hard to say. Since I have no pictures of you, either before and after surgery, it is impossible for me to comment on whether the chin implant should or should not be removed.
That being said, if you are convinced that the chin implant needs to be removed then the sooner the better. The less time the chin soft tissues are stretched out the better. I would have no concern about nerve damage as removal does not cause that problem. It is all about whether the tissues will shrink back down without developing a sag. This problem can usually be averted by doing some soft tissue suspension during the implant removal.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin implant removal, dr barry eppley, indianapolis
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Monday, April 18th, 2011
Q: I would like to know some information for breast augmentation. Specifically I need to know about the recovery time as well as any long term problems associated with breast implants.
A: Depending upon what kind of work you do affects recovery time after breast augmentation. For a less active sit-down occupation, one could return to work with 5 to 7 days. For more physical or strenuous activities, it may take 10 to 14 days until one is completely comfortable with those efforts. There are no restrictions after surgery other than one’s level of comfort. I place my patients on range of motion arm exercises beginning the first night after surgery. The more and the sooner you move your pectoralis muscles, the quicker you will recover and feel better. Breast augmentation is essentially two big pulled muscles. Like rehabilitation from any muscular injury, early active range of motion is important.
While breast augmentation is exposed to all of the traditional risks of surgery (infection, bleeding), those risks are relatively small. The biggest concept to grasp about breast augmentation is that it is an implant-driven operation…meaning that most of the risks long-term are related to having an implant. One has to recognize that the implant is not going to last forever, they will eventually ‘fail’ and need to be replaced. This is not a maybe, it is a certainty. It in just a question of when it will occur. On average, many patients experience 10 to 20 years of use before replacwmwnt of one or both becomes necessary. So one needs to bear in mind that all breast augmentation patients will over their lifetime have more than just the initial placement surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast augmentation, dr barry eppley, indianapolis, long-term risks of breast implants, plastic surgery of the breasts
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