Archive for May, 2011
Tuesday, May 31st, 2011
Q: Does fat from flaps (such as TUG, DIEP for breast reconstruction) have as high of a concentrated stem cell as fat from liposuction (fat grafting alone to rebuild the breast ie with or without BRAVA)?
A: That is a most interesting question. The simple answer is that no one knows that with any certainty. At this point, it is not even clear whether stem cell concentrations differ in various fat compartments throughout the body although it seems logical that it should. But the decision to use flaps that contain fat vs. injectable fat grafting has so many other considerations that rank much higher on the decision tree than their stem cell count. Thus making that issue an academic one but clinically irrelevant. Injectable fat grafting has a very limited role in breast reconstruction, relegated to being used in primary reconstruction of lumpectomy defects and more commonly used as a secondary contouring method to breast reconstructions done by flap method first.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fat grafting in breast reconstruction, indianapolis, stem cell concentrations in fat
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Tuesday, May 31st, 2011
A common question that some women face today is…are they for real? With more women than ever undergoing breast augmentation, this is not a far-fetched question. It may be inappropriate to ask but the statistical reality is one may be more right than wrong many of the times. According to statistics from the American Society of Plastic Surgeons, the number of women who have had breast augmentation had risen nearly 40% over the past decade. In 2010, nearly 300,000 American women received cosmetic breast enhancement.
One other trend in breast augmentation is a noticeable size difference. Many plastic surgeons have commented that women are asking for bigger breasts than they were a decade ago. Historically women would usually ask to go a cup size bigger. Today it is not uncommon for a women to want two or three cups bigger, particularly the younger they are. Women state they want to get a good value for their investment and they want to make a noticeable difference in their clothed appearance.
What accounts for these trends in breast augmentation? By far I would say that it is simply more accepted than ever before. As we enter the upcoming decade of 2010 to 2020, this is the beginning of the third generation of women who have had access to breast implants for cosmetic enlargement. It is a normal part of society now and younger women’s mothers and soon grandmothers will have had the procedure.
Breast augmentation has a track history of safety as well as effectiveness. Despite the hullaboo of what transpired in the early 1990s, the procedure has been proven to cause no medical problems or makes people systemically sick.. While it is far from a perfect procedure, because after all it is an implant in the body, its complications are local in nature and often aesthetic in significance.
The social trends of today play a major role in its popularity as well. Just go through the checkout counter at the local grocery store and the magazines are full of articles about celebrities who have had or are assumed to have had some form of plastic surgery. Many of these are women actors and performers who have enhanced their top half. The influence of these magazine, TV shows and now the internet have made it seem that having breast enhancement is now the new norm.
There are more choices in breast implants today than ever before. Since 2006, both saline and silicone implants are available in not only differing sizes but projection and styles as well. With the potential for gummy bear breast implants to be available perhaps later this year, increasing implant options appeal to an even broader spectrum of women. Just like the many aisles in a drugstore, multiple options for a single product line result in more sales.
The rise in breast augmentation is a result of greater societal acceptance, safety of the devices, influence of famous people, and a wide variety of implant options. I suspect the upcoming decade will see the number of implanted women continue to rise.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis
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Tuesday, May 31st, 2011
Q: I had a lip lift performed several months ago. I have attached some before and after pictures. As you can see the incision isn’t on the borderline and its now indented and puckers. I’m really so unhappy and paranoid with the scar and am now so desperate for revision. I was so impressed with your website you actually used 48 stutures on the womens top lip, I did count  In my surgery the surgeon only used 8 stiches. as you can see in the pics. In you lip lift proceedure do you actually cut right through all the skin lares? Only when I had my lip lift surgery the surgeon did numb my upper lip with a dental block, but the pain was still horrendous. Also as I wasn’t having my bottom lip operated on it wasn’t numbed, therefore I actually felt my actual top lip resting (flipped over) onto my bottom lip. Is this normal procedure to actually sever top lip so completely that it is able to flap over like that? What I’m asking really is do you cut so deep and if so do you place internal stiching of any kind? Its all a bit complex for me but I really need to know the whole procedure. Thank you in advance and looking forward to your reply.
A: Thank you for sending your pictures. Technically, what you had done is known as a lip advancement or vermilion advancement. A true lip lift is done with an incision under the nose. I prpare patients with a dental block first and then inject directly into the upper lip once one is numb. It should be a virtually painless procedure to go through after the dental blocks and local infiltration. During the procedure, only full-thickness skin is removed and no underlying muscle. There is a two -layer closure with some deeper sutures for the dermis and fine sutures for the skin closure.
Your scar is a bit wide and indented compared to a typical result lip advancement result in my experience. That could easily be improved and a little more skin removed and more of a cupid’s bow made to get a better result.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, lip advancement, lip lift, vermilion advancement
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Monday, May 30th, 2011
Q: I have a few dents on the right side of my head. I have a nice sized depression on the top right side of my head. I have a noticeable depression that runs all the way along the top right side of my forehead down to my eyebrow. I also have a small depression underneath my temporalis muscle on the right side of my head. I have done a significant amount of research and I have seen that Kryptonite bone paste can either be injected externally or you can open the flaps of skin and insert the kryptonite internally. Basically, I wish to have this type of operation done some day. What I really want to know is what is the price range of this type of operation for the three areas I described above?
A: The cost of this type of skull reshaping/dent restoration can be highly influenced by the type of cranioplasty material that is used. Also knowing why these dents are there, from prior surgery, injury, or just natural development, is important to know. If these are there from just natural development, then only an injectable Kryptonite technique would be used because new scars from incisions may be unacceptable. Assuming that about 10 grams of material would be needed the total cost is in the range of about $9500. If there are existing scars or incisions, then some form of an open technique can be used. In this case, a less expensive material like hydroxyapatite cements or acrylic (PMMA) could be used. This would lower the cost about $1,000 to $1,500.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, fixing skull and forehead dents, indianapolis, skull reshaping
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Monday, May 30th, 2011
Q: I am in need of an abdominal panniculectomy but my insurance has denied me saying it is cosmetic. They denied me saying it is not medically necessary because it is not preventing me from being functional. I have plenty of documentation with all my medical care providers in support of this need. What can I do?
A: The request for abdominal panniculectomies , or an amputation of overhanging abdominal skin and fat, from insurance companies is very common. As a result, they have a very specific set of criteria to be eligible for coverage. These typically include the following; a pannus that hangs down onto the thighs (photographs are required), a documented history of recurrent skin infections underneath the pannus that requires topical medications, and a six month history of these recurring skin infections that has failed non-surgical treatments.
If a proper predetermination has been done and the insurance company has denied it, then there is nothing you can do. You are legally entitled to an appeal of which they tell you how to do it on their denial paperwork. But once an appeal has been denied then that debate is over. The insurance company controls what they will pay for or won’t pay for. Their determination is based on their policy requirements and the determination of their medical director. They obviously have determined, no matter how unfair you think it may be, that your abdominal pannus does not qualify. Your only option is to have the procedure done on a cosmetic fee basis.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal panniculectomy, dr barry eppley, indianapolis, insurance coverage for abdominal panniculectomies, tummy tuck
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Sunday, May 29th, 2011
Q: Hello Dr. Eppley, I am a 24 year old male. I wanted to ask a question concerning forehead recontouring. I dislike my big forehead as it sticks out. I want to make my forehead smaller and flatter. I see you perform surgeries such as burring the forehead bone down. My problem is the slope of my forehead above the eyebrow area. I have attached a picture for you to get a better opinion. Do you think this surgery is possible for me? Please and thank you.
A: Thank you for sending the pictures. I can see exactly your forehead concerns. There is a bulge that starts above the brow area and extends upward, stopping short of your frontal hairline. There ius no question that can be made more flat by burring. Probably at least 5mms to 7mms can be reduced down into the diploic space to remove this bulge and make your forehead more flat rather than bulged. The only issue is one of the incisional access to do the forehead contouring procedure. It is no more complicated than a traditional open browlift procedure. That means there would be a fine line scar inside your hairline from the incision needed to turn down the scalp flap. You have good hair density presently it is just unknown, like any male, what the future may hold for your hairline. The scalp scar would be the trade-off for a flatter forehead.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead contouring, forehead shaving, indianapolis
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Sunday, May 29th, 2011
Q: Hi there, I have researched a tremendous amount on the internet to find what I think I need. Although I am from the UK I am willing to travel to you for good results as you are the only surgeon that has a wide range of procedures I feel I need for my long face. I have had prior surgery to my face including chin reduction and fat transfer to my cheeks. However it’s my facial skeleton I feel that just still does not look right. My eyebrows are hooked which I see you do brow reduction which you may recommend but its the whole chin jaw nose balance I am looking for improvement. I constantly am compared to the actress Sarah Jessica Parker which I hate! So you can sort of understand my facial faults. I am looking for improvement in my facial structure and to achieve better looking eyes. Many Thanks and looking forward to hearing from you.
A: While I will obviously need to see some pictures of your face, the long face look is not uncommon. There are certain features to it that create that look besides the fact that the vertical length of the face is measurably long. Often the face is thin and skeletonized with a prominent chin and a long and narrow nose. This is undoubtably why you have had a chin reduction and cheek augmentation to try and create a counteracting effect. While this has probably been somewhat helpful, those procedures alone may not create enough of an effect. Additional procedures to consider would be rhinoplasty, brow bone reduction, jaw angle augmentation and possibly further efforts at chin reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin reduction, dr barry eppley, indianapolis, ja angle augmentation, plastic surgery for the long face, rhinoplasty
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Sunday, May 29th, 2011
Q: How is cheek shaving done and what effect does it have on the face?
A: Cheekbone reduction is done to either reduce a prominent anterior zygomatic prominence or to help narrow the width of the face in the cheek area. It can be done through either a cheek shaving technique or cheek (zygomatic) osteotomies. Cheek shaving is best used to reduce an isolated anterior zygomatic prominence. While it will result in some narrowing of the front part of the cheek, it is not a good procedure to make a big difference in the width of the face which is composed of the body of the zygoma and the entire length of the zygomatic arch. Cheek shaving is done from an intraoral incision and a burr is used to take down the projection of the zygomatic buttress from the lower lateral edge of the orbital rim down to the lower edge of the zygomatic buttress where the masseteric tendon attaches. Conversely, cheek osteotomies are more extensive and use a ‘front to back’ approach. Bone cuts (osteotomies) are made through the zygomatic buttress anteriorly and the attachment of the back end of the zygomatic arch to the temporal bone. This requires a small incision in the temporal scalp as well as from inside the mouth. This allows the whole length of the zygomatic bone to move inward, thus creating a narrowing effect in the width of the face. These two cheek procedures use different surgical techniques that result in degrees of cheekbone reduction. The selection of either technique is based on the anatomy of the patient and what their specific midface goals are.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheekbone osteotomies, cheekbone reduction, cjeekbone shaving, dr barry eppley, indianapolis
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Sunday, May 29th, 2011
Q: Have you ever done rigid hip implants to make the iliac crest appear wider/bigger?
A: Let me offer you my opinion and experience on this currently rare plastic surgery procedure. The placement of an implant over the iliac crests, known as hip implants, is both possible and I have done one case previously. It is done through a small incision placed over the anterior superior iliac spine. The implant is placed in a soft tissue pocket directly on top of the ridge of the iliac crest. It does not go back as far as the posterior iliac spine. While the placement of the implant is not difficult, there are several potential problems with the procedure. First, there is no preformed or off-the-shelf hip implant that is available. To make a hip implant, a buttock implant is used and carved to shape during surgery. The implant material should not be rigid like the iliac crest but needs to be soft. Therefore, flexible silicone elastomer implant material is used. Secondly, it is not possible to rigidly secure the implant to the iliac crest without making numerous incisions along its course which would be aesthetically undesireable. Lastly, the concept of having a soft moveable implant over a rigid underlying rim of bone may pose issues of feeling the implant or discomfort when wearing clothes that ride up against them. This last issue is more theoretical than proven given that so few hip implants have ever been performed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buttock implants, dr barry eppley, hip implants, indianapolis
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Saturday, May 28th, 2011
Q: I recently had an otoplasty done and I like the way my ears are set back. They have a nice shape and position to the side of my head. I just have a problem with my ear lobes and was wondering what could be done to make them look better.
A: Otoplasty is largely a cartilaginous procedure. This means that the effects of the procedure is caused by the bending of the cartilage structure and giving it a new shape with suture stabilization. The earlobe, however, has no cartilage in it and is not affected by whatever method of cartilage manipulation is done. This can make for the upper two-thirds of the ear having a nice new position but the earlobe may still stick out afterwards.
An important aesthetic goal of otoplasty is to have a smooth and uninterrupted line of the ear’s outer helix as it goes from the top of the ear down to the earlobe. This is why I almost always reposition the earlobe back as well during an otoplasty through a concomitantly performed fishtail excision of skin on the back of the earlobe.
Secondary earlobe reshaping after an otoplasty can be done as a simple office procedure under local anesthesia. The fishtail skin excision can still be done on the back of the ear and the finishing touches to the otoplasty can be done.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, earlobes in otoplasty, indianapolis, revisional otoplasty
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