Archive for May, 2011
Saturday, May 28th, 2011
Q: I am a single mom and have a daughter who will soon be 12 years old. She is suffering from a lot of teasing because her ears really that stick out. I think they are adorable but she has become very self-conscious and is dreading going to middle school in the fall because of her ears. I am writing to inquire of how much ear pinning would cost. Not sure if I can afford it at all as I am a single mom and have another daughter in college. So my question is how much is it and is there a possibility of payments? Thank you.
A: When the ears excessively protrude or stick out, it is not rare that a child or teenager receives a lot of unwarranted criticism because of it. While parents have been with their children since birth, they often can fail to see how bothersome their ear position or shape can be. Children frequently will not say anything to their parents about it. Fortunately you have perceived her distress and recognize that otoplasty surgery can make a dramatic difference. Otoplasty is a fairly simple procedure that reshapes the cartilages of the ear from an incision on their backside. In a one hour operation, the ears can be dramatically reshaped so they blend in naturally and inconspicuously to the side of the head. The average costs of an otoplasty is generally in the $4,500 to $5,000 range, all costs included. You may be able to work out a discounted fee with a plastic surgeon and I would not be afraid to have that discussion with their office. Perhaps you will be able to work a ‘single mom’s’ fee reduction for your daughter’s otoplasty surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cost of otoplasty, dr barry eppley, indianapolis, otoplasty
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Saturday, May 28th, 2011
Q: I had a SMAS facelift earlier this year in February. I also had my eyelids done as well. I have several problems from this surgery. My eye opening is smaller than before and one of my lower eyelids is hanging down. In addition, you can not tell that I have had a facelift. It doesn’t look different or improved at all. The Dr. said he will not redo it. Will I have to get a complete facelift again? Do you do redos?
A: Anytime there is an outcome that does not meet a patient’s expectations, it is important to determine why. There are only two fundamental reasons; there has been a complication that mars an otherwise acceptable result or there has been a fundamental miscommunication between the doctor and the patient as to what to expect afterwards. Having one lower eyelid than hangs down or is pulled away from the eyeball after surgery is known as ectropion. That is a postoperative complication that can occur after a lower blepharoplasty. If it is a small amount of ectropion and it is not that far out from surgery, then time and patience are acceptable for now. But since it is four months after surgery and there is still some noticeable lower eyelid malposition compared to the other side, revisional lower eyelid surgery may be needed. Why you see no result from your facelift is another matter. That would be an unusual outcome given the nature of how a facelift is performed. I think you need to go back and discuss your results with your original plastic surgeon. Most likely what he said was that he would not revise or redo your surgery at just 4 months after surgery. A different answer may be forthcoming with more time and if your lower eyelid ectropion persists. Only after you have given the original surgeon ample opportunity to come to a mutually acceptable decision should you pursue an outside opinion for revisional surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, ectropion after lower blepharoplasty, facelift, indianapolis
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Saturday, May 28th, 2011
Q: I am going to get a breast augmentation next month. I am 23 years old. My plastic surgeon never mentioned or suggested about getting a mammogram before surgery. I have read that some plastic surgeons require it while others do not. What is your recommendation?
A: Whether a mammogram is needed before breast augmentation has no uniform answer. Every plastic surgeon has a different perspective on this issue. My practice is to not get a mammogram under the age of 35 unless there is a family history of breast cancer or a history of breast problems such as cysts or fibromas. While breast cancer does rarely occur in younger patients, the statistical likelihood of a young patient having it is so low that I do not feel that the extra expense and radiation exposure justifies the effort. After age 35, I follow the recommendations of the American Cancer Society in regards to a baseline mammogram and subsequent studies. Some plastic surgeons routinuely get mammograms regardless of age before breast augmentation and this is a perfectly valid approach as well. You need to discuss this issue with your plastic surgeon and reach a mutually acceptable approach to the need for this presurgical breast screening study.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, indianapolis, mammograms before breast implants
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Friday, May 27th, 2011
Q: I want a bigger butt and am interested in silicone injection buttock augmentation. How much does it cost?
A: As you may not be aware, the use of silicone injections is poor medical practice (if not illegal) in the United States..not to mention that it is a terrible procedure associated with a lot of complications. It seems to be performed only by the most nefarious of practitioners some of whom are not even physicians. I would advise you to stay well clear of this approach to buttock augmentation. Fat injections to the buttock, however, are a different matter and are an accepted method of natural buttock enhancement. This is the injectable procedure you should be considering. It has the advantage of not only being safe but gives one the secondary benefit of liposuction done elsewhere, usually on the stomach, waistline and back. Its one drawback is that how well the fat survives and takes is not always assured and only so much fat volume can be done at a single time. But that is a much better ‘problem’ and easier to recover from than infection, granulomas and skin pigmentation changes that are not infrequent problems with silicone injections into the buttocks. Not to mention that the silicone can never be removed no matter what problems it may be causing,
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat injection buttock augmentation, indianapolis, silicone buttock injections
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Friday, May 27th, 2011
Q: My nose is fatty from the tip area. When I smile it becomes even more broad. Should I get just the tip changed or should I go for whole nose plasty. I have attached some photos for you te see what my nose looks like.
A: When considering rhinoplasty, it is important to first look at the whole nose. While it may be that just the tip area seems to bother you, the problems with the tip may extend up into the upper two-thirds of the nose as well. This would be very common in the broad or wide nose. ln reviewing your pictures, you have a rather classic ethnic nose. (Indian) The nose skin is thick, the tip is broad, the nostrils are slightly flared, there is a hump that extends up into the upper third of the nose and the nasal bridge (bone) area is wide. In essense, your broad nose is not just limited to the tip area. Rather it is an aesthetic issue that extends throughout the entire nose. Doing just a tip rhinoplasty alone may likely leave you unsatisfied with the final result. I would recommend a complete rhinoplasty in which the hump can be removed, the bones narrowed, the tip reshaped to be less broad with increased tip rotation and the nostrils narrowed. I think you will be far more satisfied with this rhinoplasty result. The differences between a tip and full rhinoplasty can be easily illustrated with computer imaging before surgery.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty for broad nose
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Friday, May 27th, 2011
Q: I desire a larger more prominent but one that is more sculpted. Can you do the a cleft chin implant with the y fissure? Or a chin dimple? I am looking for a square chin implant with the y fissure. I have a implant now but it is not squared and not exactly what wanted.
A: Chin implants today come in a vareity of styles and sizes. Some of those styles from different manufacturers include square chin implants and chin implants that have a central vertical groove or cleft in them. I find the square chin implants very effective for those men that need more transverse chin width. The cleft chin implants, however, look good on drawings and would theoretically appear to create an often desired chin cleft. In reality, however, the external appearance of the cleft may not always appear due to the effect of the overlying thickness of the soft tissues of the chin. That is why I also create a vertical groove in the muscle and sew the tissues into the clefted chin implant to be sure that an external effect is seen. Chin clefts in implants can be done with either a dimple or a vertical fissure or groove. When trying to place one in conjunction with a chin implant, it is more reliable to have a vertical groove or notch whether the implant has that shape or not. You can always take a squate style chin implant and cut a cleft or vertical groove in it at the time of surgery. That is a simple intraoperative manuever to do during chin implant augmentation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cleft chin implants, dr barry eppley, indianapolis, square chin implants
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Friday, May 27th, 2011
Q: I am interested to find out if you could help me to reduce my facial assymetry. What would you actually perform as I am not able to even guess that, but it seems that my halves are different in jaw and forehead shape. I want to make my face more symmetrical and I want to reduce and minimize the difference of my jaw and forehead. Please advise what kind of procedure do you recommend and what would be the estimated cost. Attached is the photo so you can see and assess the treatment.
A: In looking at your frontal view photograph, I see four isses that are making your face asymmetrical. The first is the difference in the sdie of the jaw angles between the two sides. The right is bigger than the left. That could be addressed by either a right jaw angle reduction or left jaw angle augmentation depending upon which side you like better. Secondly, there also appears to be left cheek deficiency which is less prominent than the right. That would be compatible with the left side of your face being smaller than the right. That could be improved by a left cheek implant. Thirdly, the right upper eyelid has more skin which hangs down onto the lashline. That could be removed by an upper eyelid blepharoplasty. Lastly, your nose is deviated towards the left side with a broader tip. That could be improved by a rhinoplasty. I think the combination of these four procedures would go a long way to improving your facial asymmetry.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek implant, dr barry eppley, indianapolis, jaw angle reduction, rhinoplasty, surgery for facial asymmetry
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Friday, May 27th, 2011
Q: I am interested in getting a subnasal lip lift as my upper lip is way too long and is getting worse as I age. I have several concerns about the procedure, hwoever, and wonder what could be done if undesired results happen. I had a previous rhinoplasty dne through an open rhinoplasty several years ago that I am quite happy with. Since the subnasal lip lift puts an incision at the base of the columella could that stretch or distort the space between my nose and lips and make it appear freakishly short? I know initially it may look a little short and that it does relax and stretch out somewhat later, but what if it doesn’t. Can any secondary correction be done if things didn’t resolve on their own? Thanks for your opinion.
A: Your concerns about overcorrection in a subnasal lip lift, also known as the bullhorn lip lift, are very valid and it is something I think about every time I do this procedure. This is because of it is overcorrected, too much lip skin removed, there is no recovery from it. There is no aesthetic method of putting skin back once too much is removed. It is for this reason that it is always better to be more conservative than aggressive with this procedure. My rule of thumb on subnasal lip lifts is too never remove more than 1/3 of the vertical distance of skin as measured from the based on the columella down to the height of the cupid’s bow along the philtral column. Sometimes I may only remove 1/4 of that distance. Yes it is too true that it may relax and be undercorrected in some cases later. But it is always easy to repeat the procedure, it is impossible to reverse it if too much is removed.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, subnasal lip lift
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Wednesday, May 25th, 2011
Q: I am trying to make my face symmetrical. My jaw is not aligned, making my mouth and smile crooked and my nose is wide with a pronounced bump. I have attached some pictures for you to evaluate, image, and give me recommendations as to what to do. Thanks!
A: An analysis of your pictures shows that you do have a deviated nose with a hump and a wide tip. But in addition, you have left facial hypertrophy. This is the origin of why you feel that your jaw and smile is crooked. The left side of your face, from the orbit down to the jaw angle is bigger and wider. This creates your facial imbalance/crookedness. I have done some imaging of your rhinoplasty, with and with adjustment of the left facial enlargement. In facial asymmetry it is always a question as to whether to build up the smaller side or reduce the bigger side. In your case, I think it is better to try and make the larger side smaller through cheekbone and jaw angle reduction. This is shown in your rhinoplasty front view imaging, both with and without it being done. From a side view, I have also added a small chin augmentation as your profile shows some mild horizontal chin deficiency.
I think the combination of rhinoplasty, cheekbone and jaw angle reduction and chin augmentation can make for a more symmetrical and balanced face. This will not change the asymmetry in your smile as that is soft tissue-based and can not be adjusted like the underlying harder facial structures.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek bone reduction, chin augmentation, correction of facial asymmetry, dr barry eppley, indianapolis, jaw angle reduction
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Wednesday, May 25th, 2011
Q: I have lipoatrophy and would like to perhaps have my face lifted and cheeks implants placed in order to achieve a fuller, rounder appearance so I am able to appear the age that I am which is age18. I sent in earlier pictures and I was smiling in them and was told they were unusable so I sent these.
A: Thank you for sending your additional pctures. You probably have the most severe case of facial lipoatrophy that I have ever seen in someone your age. Facial lipoatrophy is classified on a scale of 1 to 5 based on its severity. You are clearly at least a 4 if not a 5. You face is completely skeletonized with essentially no fat, thus resulting in hollowing of the temporal, submalar, maxillary and lateral facial areas. This problem is not treated by any form of facelifting. Rather it requires volume addition, most of whcih must be fat not implant. Submalar implants would be helpful in the cheek area but most of the volume addition must come from fat injections due to the size and location of the hollowed areas. The important question is….do you have enough fat to harvest and transfer? Most medically-sound people with severe facial lipoatrophy are also thin in their bodies, thus having little fat to harvest for the procedure. At a minimum, you need about 30 to 35 cc of concentrated fat per facial side (in addition to the submalar implants), which means that 150cc to 200cc needs to be harvested from somewhere, usually the abdomen or thighs. While that is not much and easy to get from most people, your body may be a different matter.
The pictures you sent are not easy to show the results of volume addition, which is virtually impossible to image from the side view. The front view imaging is not great but it demonstrates what happens when your facial hollows are filled in or expanded. Just think of your concave facial regions becoming more even with the surrounding bone structure.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, fat injections for facial lipoatrophy, indianapolis, submalar cheek implants
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