Archive for June, 2011
Sunday, June 26th, 2011
Q: Dr. Eppley I had a chin implant placed over a year ago. While I like the amount of projection the implant gave me, I feel that my chin would look better if it was also longer. I suggested to my doctor that a chin osteotomy would be a good idea so that the chin is angled downward as well as brought forward. He felt that it would make my face too long and discouraged me from it. While I respect his opinion, my artistic sense of my own face disagrees with that assessment and I strongly feel that my small and round face would look better with some lengthening. I have attached a side picture for you to give me your opinion.
A: The debate of whether one facial change or another is better can be largely answered by computer imaging. This is particularly true in a profile facial structure such as the chin which is one of the most accurate areas for predicting facial bone to soft tissue alterations.
There are two ways to get create vertical lengthening of the chin. One way is to position or reposition a chin implant lower on the bone so that it is just not sitting exclusively on the front edge. If the implant is moved down to be between the front and lower edge of the bone, some mild vertical lengthening of chin and lower face can be achieved. (2 – 4 mms) The implant has to be secured in this position by screws for stability as you can’t rely on the containment of the soft tissue envelope only. The other option which you have already mentioned is a chin osteotomy which can make for more significant vertical lengthening of 6 to 8mms.
By making these chin changes on the computer, you can visually determine whether your belief for more vertical chin lengthening is correct.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lower facial lengthening, veritical chin lengthening
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Saturday, June 25th, 2011
Q: Hello Dr. Eppley, I would like to know anything you can offer to tell me about plastic surgery! I would love to be a plastic surgeon as a career in the near future! (: Right now i’m going into my senior year in high school. So any advice of how I can reach my dreams would be great! Thank you!!
A: Few things can be achieved in life without a dream or goals. So it is good that you have a focus at this early age in your life. I have no idea what has captured your attention of plastic surgery as a career. While plastic surgery may seem glamorous, it is far cry from what you may have seen on TV or other mediums. It is hard work and a long arduous process with the foundation of becoming a physician first. This not only requires the traditional effort with college and then medical school but, equally importantly, some exposure to medicine and health care in some capacity along the way. Whether it be volunteer or part-time employed work at a hospital, emergency clinic or a doctor’s office, you need to see what being a physician is like up close. You need to discover if you have the interest and ultimately the passion for it. For it is these attractions to the field that will keep you going when you have to outstudy many others in the eight years of preparatory academic work (while others are at the football game, frat party or on that ski trip) or those six to eight years with many long nights on call during general and plastic surgery training.
It is never too early to begin your research into medicine as a career and I encourage you to begin now in any way you can. Plastic surgeons in many commnunities are always willing to allow observers either in the office or the operating room…and can give you a lot of good insights and information about the field.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery as a career
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Saturday, June 25th, 2011
Q: Dr Eppley, I had Juvederm injected into my upper and lower lips yesterday. My lips are very swollen now and my lower left lip is noticeably larger than the others. What can be done to make this better as they are much larger than with what I left the doctor’s office yesterday. Could this be an infection? I am quite concerned. Please advise. I’m freaking out!
A: Most lip injection patients do experience some mild swelling for the first day or two after the treatment. The lips are exquisitely sensitive to any type of trauma so swelling may occur. Some patients experience it more than others. This would be particularly true if all the lip injected areas seem swollen. As long as the lips are not hot, red and swollen, then this is the likely reason for their appearance.
Of the thousands of lip injections that I have done, I have only ever seen three adverse reactions. One was an actual infection of the lower lip that eventually required antibiotics and drainage. Both upper and lower lips had been injected and the upper lip was fine. An infection would be more likely to affect just one of the lips or even just one side of a lip than the entire area. Suspected infections are initially treated with oral antibiotics. Infections often don’t occur for days as it takes time for bacteria to multiply. The other two were inflammatory reactions to the injected material which is known to occur as the Juvederm material, while a known and fairly natural substance to the body, is nevertheless synthetically manufactured. By the manufacturer’s package inserts, these inflammatory reactions can occur in about 1% of all injected patients. My experience has been much more uncommon than that. If both the upper and lower lips are swollen (all injected areas) then this is the likely explanation. This is treated by oral steriods.
Lip asymmetries are much more common issues after injectable fillers that often don’t become evident for hours or days after the treatment. If one area feels lumpy or a little bigger, it is perfectly fine to massage or “strip’ the lip (between your fingers) to attempt to smooth it out. Injectable fillers are very much like clay after they are injected and they can be molded and moved slightly by such manipulations for a few days after the treatment.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, juvederm lip injections, lip reactions after injectable filler treatments
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Friday, June 24th, 2011
Q: Dr. Eppley, can a lower jaw setback be combined with a lower gfacelift during the same procedure? Have you yourself done this before?
A: The technical capability of performing a combined orthognathic procedure, like a mandibular setback, with a facelift is certainly possible. The need for it is so rare, however, that it would be hard to a surgeon that had ever done it together. There are several reasons for its rarity. By definition, a facelift would be done in an older patient while orthognathic surgery is usually done in a younger patient. Thus, the mainstream population of each procedure are at diametric ages. There is also the consideration that the type of surgeon that performs these procedures are quite different. Most maxillofacial surgeons have little or no training for facelift surgery and most plastic surgeons have little or no training in orthognathic surgery. While plastic and maxillofacial surgeons certainly can work together and coordinate these surgeries, most plastic surgeons would probably prefer to defer the facelift to a later date due to swelling considerations.
With all of that being said, a mandibular setback and a facelift can be done together. The question is not whether they can be done together but whether they should. While each operation poses a ‘surgical opportunity’ to do additional procedures, you want to make sure that the patient can still get a result that would be comparable if either procedure was done alone. Surgical opportunity should not be more important than an outcome. In that regard, I would have to know more about how much mandibular setback is needed and the proposed technique (sagittal split ramus osteotomy vs vertical oblique osteotomies) and the degree of neck and jowl sagging that exists. Then I could answer the question better about whether such a combination is a good idea.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, indianapolis, mandibular setback osteotomy, orthognathic surgery
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Friday, June 24th, 2011
Q: Over 10 years ago, I was involved in a car accident and ended up getting a craniotomy and evacuation of a subdural blood clot. Afterward, the craniotomy flap got infected and had to be removed. Because I was a child at the time, some bone actually grew back over the upper forehead defect. But it was not of the same thickness or amount and I have been left with a flat and irregular upper forehead area around my hairline and into the very visible part of my forehead. It is quite noticeable and embarrassing for me and I have always wanted to get it fixed. I have read recently through your writings that it can be repaired with some types of materials that are applied to the outside of the bone. That has given me great hope that there is a solution to this embarrassing problem. I am tired of people staring it! Please tell me about this procedure and how it is done.
A: Based on your description alone, it sounds like you would be an excellent candidate for an onlay cranioplasty procedure. Compared to what you have been through previously, this is a relatively simple operation that produces immediate results. Since you had a craniotomy previously, you have an existing scalp scar. The scalp ius lifted up again and a synthetic cranioplasty mixture is used to apply to the defect and make it perfectly smooth with the rest of the forehead. The available mixtures are a powder and liquid, which when combined, turns hard after it is shaped within a few minutes. There are three specific cranioplasty materials. I would choose hydroxyapatite, specifically Mimix, for your cranioplasty as it is the most like bone and has excellent working charcteristics. I have worked with it for over 15 years, including through its research and development phase, so I know its working properties very well. This is an outpatient procedure under general anesthesia that would take about 90 minutes to do.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead contouring, forehead reconstruction, frontal cranioplasty, indianapolis
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Friday, June 24th, 2011
Q: Dr. Eppley. I went online and looked at your breast implant pictures. As I can tell it looks GREAT. I have been looking at different work from different doctors. I am a very small A. What do you suggest? What type of implant do you recommend for me? What is the total price? Do you have any financing available for people like me? I really want this bad! For a very long time. I feel unsure about my body and the way I look. I am going to be 32 and I have 2 kids. I have always wanted larger breasts ever since I was in school. Can you help me?
A: What would make you look like a full B cup would depend on numerous factors including the base width diameter of your breast, tightness of your overlying breast skin, and your envisionment of what a full B cup is. Since I have no images of you, I will have to assume your base breast width is likely in the 11 to 13 cms. range. This would make an implant in the range of 250cc to 350cc a likely possibility. That would have to be determined by an examination and some images of breast augmentations that you like. Given your described financial situation, you would be best served by a saline breast implant which can be done at a lower cost than silicone breast implants. Total costs are in the range of around $ 4,700.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation implant sizing, dr barry eppley, indianapolis
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Thursday, June 23rd, 2011
Q: I’m a 6 year old male looking to remove a bump on my skull bone on the back of my head. I believe this skull bump resulted from a forceps delivery during my birth. I had an MRI of my head done and it came back normal. This is something that has plagued me psychologically all my life and I’m looking for any options to improve the appearance of the back of my head. I’ve provided photos of the back of my head. As you can see from the pictures, aside from the bump, there is also a ridge that leads to the more protrusive bump. I look forward to your assessment.
A: Thank you for making the effort to take the pictures. They are more than sufficient. What you have are two specific occipital bony uprisings, one ‘abnormal’ and the other a natural part of the occiptal skull bone. One is a small round bump at the top of the occiput which is a small osteoma or benign bony ‘tumor’ That can be burred down through a small vertically-oriented incision over the bump measuring about 3 cms. or just slightly bigger than an inch. Incisions in the hair-bearing scalp in men heal remarkably well and would eventually be such a fine line scar that it would be virtually undetectable. The horizontally-oriented bony ridge across the bottom of the occiptal skull bone is known as the nuchal ridge. It is where the top of the neck muscles attach to the lower edge of the occipital skull bone. It is raised and visible, as it is for some people, for unknown reasons. It may be raised because of the need for a strong bony attachment for the neck muscles. That can actually be reduced by burring down the ridge but the issue is incisional access. It requires a linear horizontal incision across the back of the head along the nuchal line, probably of a width of about 5 cms. Either skull reshaping procedure can be performed alone or in combination. Either way it is an outpatient procedure under general anesthesia that would have a minimal recovery. The incisions would be closed with tiny dissolveable sutures and one could shower and wash their hair after two days. There would be some temporary swelling which would go away in two or three weeks.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery of the skull, skull bump reduction, skull shaping surgery
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Thursday, June 23rd, 2011
Q: Dr. Eppley, Can you tell me how close a surgical result will be compared to the computer imaging that has been shown to me? Since it is done on the computer I assume that it is fairly accurate and representative of the result. I am desiring to get a rhinoplasty and chin and jaw angle implants and want to see if the result wiould be worth the effort and the expense.
A: A very important consideration when looking at predictive computer imaging is to realize how it is done and that it is not an exact science. The only thing ‘computer’ about it is that it is done on a computer. The computer does not create the images nor portray them on some one-to-one basis from the nose or jaw implant to the patient. In other words, the computer does not take the dimensions of the implant(s) or the amount of nose structure that is removed and directly transfer that onto the patient so the changes will identically match. Rather, computer predictive imaging is done on Photoshop by the plastic surgeon with their best guess of what the changes may be. It is an art form not an exact science. Thus, computer imaging can easily overpredict or underpredict what the final result may be. Since patients view computer imaging as a more exact science than what it is, I always slightly underpredict what I think will happen. It is important for the plastic surgeon to not overpredict as this may easily overpromise or oversell the surgical procedure. This can lead to postoperative disappointment in the result if these expectations are not met.
The very valuable feature of computer imaging in rhinoplasty and jawline implants is that it can be a very good predictor compared to many other facial plastic surgery procedures. Because these are silhouette or profile facial structures, they are easy to morph and see the potential changes.
Dr. Barry Eppley
Indianapolis Indiana
Tags: computer imaging in jaw implants, computer imaging in rhinoplasty, dr barry eppley, indianapolis
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Wednesday, June 22nd, 2011
Q: Dr. Eppley, I need to lose 145 lb and I have tried everything. Can liposuction help and how much does it cost? I also I need a tummy tucks and my breasts lifted.
A: With the need to lose a lot of weight, liposuction is absolutely not the answer that you seek. Liposuction is best used for spot fat reduction and for those patients who may need a ‘jumpstart’ for relatively small amounts of weight loss. (10 to 25 lbs) For near or over a 100 lb weight loss, you need to seek a consultation with a bariatric surgeon if everything to now has failed. That amount of weight loss can only be achieved through gastric banding or gastric bypass surgery. Any other desired body changes, such as a tummy tuck to get rid of the skin overhang around the waistline or lifting sagging breasts, must wait until after this weight loss have occurred. Attempting to do such surgery in the face of being significantly overweight is not only ill-advised from a health standpoint but any benefits gained will be wiped out by significant weight loss. Not to mention that the amount of improvement one can achieve in the obese patient is relatively limited.
The foundation of your body reshaping begins with the need for a large amount of weight loss. The first place to start is a consultation at a Bariatric Center.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, liposuction for weight loss
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Wednesday, June 22nd, 2011
Q: I am interested in reducing the size of my adam’s apple as it sticks out like a bulge in my neck. In reading about tracheotomies, I wonder if there was an at-home method in which a man could try the look, feel and sound of having a more feminine adams apple appearance just for say a few weeks before taking surgery. Have you ever heard of anything like this?
A: For the sake of clarification, tracheal reduction and tracheotomies are two different completely different operations with diametric objectives. A tracheostomy makes a hole through the skin and down into one’s windpipe below the thyroid cartilage for the sake of breathing. A tracheal reduction, technically known as a thyrochondroplasty or adam’s apple reduction, reduces the protrusion of paired thyroid cartilages as they bulge out into the neck. If done properly and without removal of too much cartilage, it will not change the pitch or sound of one’s voice. (a tracheostomy will definitely affect one’s voice) If you wanted to see what a tracheal reduction would look like, that is what computer imaging does. You can get a good visual approximation of the final neck contour result. It can help one see what the change would look like on them and is the best way to ‘try it on’ before surgery. There are no non-surgical methods to try and simulate that change in neck appearance.
Dr. Barry Eppley
Indianapolis Indiana
Tags: adam's apple reduction, dr barry eppley, indianapolis, tracheal reduction
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