Archive for June, 2011
Thursday, June 30th, 2011
Q: I had a breast augmentation about 10 years ago. I felt that they were too big right after surgery but my doctor somehow convinced me to keep them at the time. I would them either downsized or completed removed with some type of lift done at the same time. My question is what are the chances of my insurance covering a breast reduction or at least part of it? Have you ever dealt with a situation like this?
A: The simple answer is that this is not a procedure that would be covered by one’s health insurance. While the breasts are being downsized, this does not constitute a medically necessary breast reduction as implants are being removed, not breast tissue. The premise of a true breast reduction is that there is too much breast tissue present and a certain amount must be taken out. A medically necessary procedure has at its origin a health or medical cause. Prior breast augmentation is a cosmetic cause not a medical one. Breast implant removal and any lift that may be associated with it to reshape the loose and sagging breast skin is a cosmetic procedure.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast implant removal, dr barry eppley, indianapolis
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Wednesday, June 29th, 2011
Q: Dr. Eppley, about six months ago I had a medpor chin implant inserted through an intraoral incision and secured with screws. Unfortunately, the wings were too large and malpositioned. I had a revision one month ago in which the implant was removed, trimmed and re-inserted. Now the implant is the right shape and size, but my lower lip feels shorter and tighter. The top halves of my lower teeth show with the lip at rest, and I can barely raise it enough to cover them. When raised, the lip is lower in the center than at the sides. After the original surgery I had the same problem but not as bad, and the lip eventually went back to normal. This time the lip seems worse, and I’m worried it might stay this way. My Dr. said getting the medpor implant out was “very difficult” and it took twice as long as he expected. The implant actually broke when he took it out and he added 2 extra screws to hold it together when he re-inserted it. My chin and lower lip where very swollen for two weeks afterward and the center of the lip is still slightly numb. I’m worried I might have a problem with my mentalis muscle. Does my lip issue sound like something that will go back to normal on its own or like something that will require correction? Thanks for any advice.
A: In your history you have said the key words…intraoral incision. When using this approach for chin augmentation, the superior bone attachments of the mentalis muscle are cut and have to be resutured at the end of the procedure. Besides the numbness,, it is common to have some lower lip tightening and little tethering until the tissues heal and relax again. Going through the muscle twice, particularly in a more extensive revisional procedure, traumatizes and scars the muscle again…making symptoms of tethering and lower lip retraction more significant. It is too early to tell whether this problem is temporary or permanent. If it has not significantly improved by three months after surgery then I would recommend a mentalis muscle v-y lengthening and resuspension procedure.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin implant recovery, chin implant removal, dr barry eppley, indianapolis
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Wednesday, June 29th, 2011
Q: Dr. Eppley, about six months ago I had a medpor chin implant inserted through an intraoral incision and secured with screws. Unfortunately, the wings were too large and malpositioned. I had a revision one month ago in which the implant was removed, trimmed and re-inserted. Now the implant is the right shape and size, but my lower lip feels shorter and tighter. The top halves of my lower teeth show with the lip at rest, and I can barely raise it enough to cover them. When raised, the lip is lower in the center than at the sides. After the original surgery I had the same problem but not as bad, and the lip eventually went back to normal. This time the lip seems worse, and I’m worried it might stay this way. My Dr. said getting the medpor implant out was “very difficult” and it took twice as long as he expected. The implant actually broke when he took it out and he added 2 extra screws to hold it together when he re-inserted it. My chin and lower lip where very swollen for two weeks afterward and the center of the lip is still slightly numb. I’m worried I might have a problem with my mentalis muscle. Does my lip issue sound like something that will go back to normal on its own or like something that will require correction? Thanks for any advice.
A: In your history you have said the key words…intraoral incision. When using this approach for chin augmentation, the superior bone attachments of the mentalis muscle are cut and have to be resutured at the end of the procedure. Besides the numbness,, it is common to have some lower lip tightening and little tethering until the tissues heal and relax again. Going through the muscle twice, particularly in a more extensive revisional procedure, traumatizes and scars the muscle again…making symptoms of tethering and lower lip retraction more significant. It is too early to tell whether this problem is temporary or permanent. If it has not significantly improved by three months after surgery then I would recommend a mentalis muscle v-y lengthening and resuspension procedure.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin implant revision, dr barry eppley, indianapolis, mentalis muscle resuspension
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Wednesday, June 29th, 2011
Q: Dr. Eppley, I am interested in breast augmentation but am concerned about the possibility of bad scarring. As a small child I had chicken pox and developed many of the typical pustules. While they went on to heal, I developed keloid scars scattered across my body. Although I do not feel that I still scar this way, I am concerned that I might and these would look terrible in my breasts! Do you think it will happen from the breast augmentation incisions?
A: Having had a terrible scar situation at an early age, it is understandable why you would be concerned about it occurring again from an entirely elective cosmetic procedure. However, and fortunately, these are not comparable scar circumstances. Chicken pox scars are the result of secondary healing of open wounds. They have a high propensity of resulting in hypertrophic scars which appears as wide as the original wound and are heaped up higher than the surrounding skin. This is not a keloid scar (whose growth goes beyond the boundaries of the original wound edges and often keeps growing) with which hypertrophic scars are often confused. The incision from breast augmentation ,whether it is around the nipple, along the inframammary fold, or in the armpit, is a controlled narrow skin injury which heals by primary healing. Primary healing almost always results in much better scars than from secondary healing. I have never seen a wide hypertrophic scars from any breast augmentation incision. Therefore, I would have no fear about developing the type of scars from any breast augmentation incision that would remotely be close to your existing chicken pox scars.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation scars, dr barry eppley, indianapolis
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Tuesday, June 28th, 2011
Q: Dear Dr. Eppley , I had chin augmentation about two years ago with terino square chin imlpants, style 1. It looked for about two years but it has disappeared somewhat. I would like to know if it is possible to place another square chin implant, a Terino square chin implant style 2 on the top of the existing one and have it secureed with screws to add some more definition, squarnes and some more anterior projection. I think it makes sense to place the bigger one on the the top of the smaller and according to the dimensions on the Implantech website they would fit perfectly. Would you please express your opinion on this matter? I would greatly appreciate it.
A: In regards to your existing chin implant disappearing, that impression is likely a combination of two factors. Many patients after face and body augmentations suffer what I call ‘cosmetic accomodation’. They simply have gotten used to the look and it no longer looks as good or as big as it used to. Secondly, the implant may have suffered a little settling into the underlying bone of a fedw millimeters which is not uncommon particularly if the implant is not directly over the lowest edge of the basal bone. These two issues combined have likely resulted in your implant ‘disappearing’.
In regards to placing a style 2 directly over a style 1 silicone square chin implant, your assumptions fro a chin implant revision based on measurements are correct. There is a 10mm difference in the square width of the implants so a style 2 does fit rather nicely over a style 1. That would also add an additional 8mms of anterior projection as well. They would absolutely have to be secured with at least two screws placed on their lateral edges to prevent the shifting of one smooth surface against the other. The only contour concern is on the edge of the lateral wings where a more noticeable step-off may occur as the transition back to the bone will have a double-thick edge. I would advise the wings of the overlay implant to be trimmed and feathered about 10mms short of the underlying implant to avoid this problem.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, square chin implant revision
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Tuesday, June 28th, 2011
Q: Dr. Eppley, how much is the laser removal for scars for burns?
A: There are several problems with your request. There is no such thing as ‘scar removal’ by any method. Scars can be treated so that they may be less noticeable but there is no such thing as scar removal. Scars can only be improved but never are they able to be removed, hence the term ‘scar revision’. The treatment for burn scars is variable given the very diverse presentation of burn scars. It is fair to say that laser resurfacing is often the only option for many burn scars given the large surface area that many burns have. Whether that approach would even be worthwhile or effective would require a visual inspection of the scars. Until this is done, no reasonable assessment of potential effectiveness or cost can be given.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: burn scar treatment, dr barry eppley, indianapolis, laser burn scar treatment
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Tuesday, June 28th, 2011
Q: Dr. Eppley, I am going to have a breast augmentation done next month. I also wanted my right nipple to be lifted and brought up to the level of my left side. My doctor said that I didn’t need to have it done and that it would put a scar around my nipple and down the breast if I did it. In my reading of nipple lifts this doesn’t make sense to me. Why does my doctor say it can’t be done without a lot of scar and I have read that it can. Can you explain this to me?
A: In solving this discrepancy for you, there are numerous types of breast lift techniques. Which one is best for any particular patient depends on numerous factors including how much sagging the breast has (how low does the nipple hang) and how much scar can the patient tolerate. The most limited scar technique is that of a nipple lift, also known as a superior crescent mastopexy. By removing a small crescent of skin from the top of the nipple, the nipple position can be elevated about 1 cm. For very minor breast lifts with small amounts of sagging this may be all that is needed. I suspect this is what you have been reading about or are referring to. The next type of breast lifts are the circumareolar or donut lift (scar around the whole nipple) and the vertical breast lift. (scar around the nipple and down to the fold, the one to which your doctor is referring) Both of these will move the nipple up higher but with more scar.
Which type of breast lift you may need depends on the difference in the horizontal levels of your two breast nipples. Without knowing that information, I can not recommend what lifting method may be needed in your case.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lifting, dr barry eppley, indianapolis, nipple lift in breast augmentation
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Monday, June 27th, 2011
Q: Hello Dr. Eppley, I was reading some of the information on your site about the use of Matristem (Acell) in scar revision. I was wondering if the several scars on my face from a previous auto accident, including a small raised scar (keloid?) would benefit by this treatment. In my readings I see that it has been used on fingertips and other body areas but it is not clear to me how useful it would be in the face. I really want to do something about these scars on my face and lessen their appearance. Thanks for your time in answering my question.
A: I think it is important to understand that Matristem, nor any known agent, has magical properties in either wound healing or in preventing scar formation. It should be perceived as a potential adjunctive material that can be incorporated into other scar revision strategies. Because it comes in powder form, it can easily be used in traditional open scar revisions done by excision with or without some type of geometric arrangement. Its benefit is that it encourages healing with less scar formation than may otherwise occur. Whether it would produce a better result (scar appearance) than scar revision alone is theoretical but appealing nonetheless. I have used it in numerous types of face and body scars and some open wound problems. Since it is has no known side effects or negative issues with its use, there are no drawbacks to adding it to the scar revision approach. When it comes to problematic scars, every available advantage is needed to get the best result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, matristem in facial scar revision
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Monday, June 27th, 2011
The concept of non-surgical fat reduction has been around for over a century. From belt machine devices in the early 1900s to the infomercial weight loss supplements of today, hope is eternal when it comes to getting rid of unwanted fat. Without question, the definitive way to lose spot areas of fat is liposuction. Liposuction is a proven surgical method to trim down specific body areas, but it is an operation and involves recovery.
Non-surgical fat removal, no matter what the method, will never be as effective as surgery for spot reduction. However, newer non-surgical methods of fat melting have appeared in the past few years. One of these is Zerona, or specifically the Zerona laser treatment program. It is touted as a painless body slimming method that is proven to remove fat and inches without surgery with zero pain and downtime. Does it really work? Is it hype or hope?
Zerona works by using a low frequency ‘cold’ laser that passes through the skin without injury and targets the fat cells. The laser energy targets the fat cells through a photochemical process. Not to be confused with a photothermal (heat) or photoacoustic (vibration) method, this non-heat generating process makes the fat cells ‘leaky’. The fat cells shed their liquid fat content, now known as free-fatty acids, which is then absorbed through your lymphatic system. The lymphatic system transports it to the liver where it is processed and broken down, and most importantly, not re-circulated and stored again as fat.
Zerona is more than just a machine, it is a process. Treatment sessions number six to nine and have been shown to be able to take off three to five inches in the hips, waist and thigh in two to three weeks. But to aid the lymphatic clearing process, one must significantly increase their water intake and take a twice-daily niacin supplement (Curva) or HCG (human chorionic gonadotropin) during the treatment process. The treatment sessions require a commitment and must be done every two to three days to really be effective. Once the fat cells get leaky, you can’t let them heal themselves by missing treatments or having them too far apart. Each treatment session takes just under an hour and is painless. You literally get up and go afterwards. Daily exercise (such as brisk walking, light running, or other cardio training) can increase the final results by aiding in lymphatic clearance and an increased metabolism.
Is Zerona fat reduction too good to be true? It depends on your expectations and how much fat you have from the beginning. We do screen our patients and select those that we think, based on our experience, have the best chance for success. That has resulted in about a 70% satisfaction rating from our treated patients. This means that those patients saw enough of a difference, both visually and by measurements, that they rated the treatment a worthwhile investment. Thus, as part of a jumpstart on the front end of some body slimming or as part of an overall weight loss program, Zerona can make for very visible body changs.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, zerona laser fat reduction
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Monday, June 27th, 2011
Q: Dear Dr. Eppley, I would like to have those chiseled high cheekbones. I have looked at some implant styles online and it seems that the Medpor extended malar implant may work for me. The picture on the website product catalog shows the implant in a high and lateral position and the implant is described to augment the malar region. My surgeon told me that this kind of implant can only be placed under the cheekbone (submalar) and more towards the nose than towards the zygomatic arch and that the picture on this website shows the wrong placement of this implant design. I really don´t want submalar augmentation! Is it true that this implant design is actually a submalar implant and therefore not used for malar augmentation or can it be used for both malar and submalar augmentation? What is your experience with this kind of implant design?
A: Choosing the correct implant design and size is obviously critical for any type of facial implant procedure. This is particularly true in the cheek or malar region as this area has the most complex three-dimensional anatomy to it. It contains five zones of potential augmentation including anterior, lateral, oblique, orbital rim and submalar. Any cheek implant will affect at least three of these zones in any single design. For those interested in more ‘chiseled’ cheeks, by definition this means that the oblique and lateral zones are most important. The submalar zone should absolutely not be augmented as part of this type of cheek implant because it will create more of a rounded full cheek look rather than making higher and more ‘chiseled’ cheekbones. The type of cheek implant to which you refer will not help create the look you are after. That type of cheek implant design creates fullness on the lower or submalar cheek zone and will not achieve that higher angular cheek look.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek augmentation, cheek implants, dr barry eppley, indianapolis
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