Archive for July, 2011
Sunday, July 31st, 2011
Q: Dr. Eppley, I would like to know how much of a cup size is lost after having a breast lift. I am currently a 42 DDD and my breasts really hang down after a 75 lb weight loss. I want them lifted but I definitely don’t want to be any smaller than a D or DD cup. I wonder if having implants would make up for any loss of size after a lift. I really don’t want to get implants but I don’t want to be any smaller either. What are your recommendations?
A: In a breast lift procedure, only skin is removed to create the lift and breast reshaping effect. So a loss of cup size should not really occur since no breast tissue is removed. But there is often a perception that the breast can seem smaller because the conical reshaping of the breast results in less overall surface area. What most women expect from a breast lift is to have not only an uplifted breast but one with more upper pole fullness as well. While this most certainly occurs early after a breast lift, the settling of the breast after surgery will cause some loss of upper pole fullness. That is the role that a breast implant plays in many breast lift surgeries, to get and maintain upper pole fullness. Given the size of your existing breasts and the amount of lifting that will be required, it is understandable why you would be on the fence about the need for implants in your lift. When in doubt, do the breast lift without the implants first. Let the six month results determine whether implants would really be beneficial.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift with implants, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Sunday, July 31st, 2011
Q: Dr. Eppley, I would like my nose to be in better balance to my face. I feel that my nose is too long for my face. Also I think that the tip and the nostrils needs to be narrowed. Can a rhinoplasty reasonably achieve these goals for my nose. I have attached some pictures for you to image so I can see what can possibly be done.
A: Thank you for sending your pictures. I have done some predictive computer imaging based on a rhinoplasty that shortens tip projection, does some slight upward tip rotation, tip narrowing, spreader grafts to the middle vault and narrowing of the width of the nostrils. In looking at your profile there is a mismatch between the projection of your nose and a horizontal maxillo-mandibular deficiency. Both your jaws are recessed which is also reflected in your thin upper and lower lips. This horizontal jaw projection deficiency makes the nose look longer than it really is. It is a bit long but not as long as it may seem which is confirmed by actual measurements of the nose. Only so much de-projection (shortening) of the nose can be achieved so combining a rhinoplasty with some increased jaw projection would be aesthetically helpful. I have added a chin augmentation to the rhinoplasty prediction with that concept in mind.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty for long nose
Posted in Your Questions | No Comments »
Sunday, July 31st, 2011
Q: Dr. Eppley, I have a small bump on my nose from when i was kicked in the nose when i was younger. I want a more curved shape nose like I used to have. Also I think my nose looks too big towards the end. Here are some pictures for you to see. What type of rhinoplasty do I need?
A: Your nose shows a great disproportion between the tip and the bridge. The tip of your nose is incredibly wide and thick. The lower alar cartilages can be seen to be very large and your nasal skin is quite thick. This is in contrast to the bridge or upper area of your nose which is much smaller in size and lower in height, albeit wide at the base. While there may be a small bump on the bridge of your nose, the key in your rhinoplasty approach is to not take down the bump. Rather in an effort to create better balance on your nose, the upper bridge needs to be built up while the tip needs to be narrowed. This will make for a more pleasing nasal appearance by creating better proportions between the upper and lower nose. This is of particular importance in your nose given your thick nasal skin which will limit how much reduction can be done in the tip of your nose. By building up the bridge this will help improve the appearance of the lower nose narrowing. I have attached some images which shows how these rhinoplasty changes would look.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty for large nasal tip, rhinoplasty for small bump
Posted in Your Questions | No Comments »
Sunday, July 31st, 2011
Q: Dr. Eppley, In early June I had Botox injections for migraines through my neurologist. I’ve suffered with migraines for over 20 years and tried just about everything protocol. The neurologist did a lot of injections in the forehead and temples and then a bunch in the back of my head/hair and at the base of my skull and a few along my shoulders. I was migraine free for a week for the first time in I don’t know how long. After a week, my neck became progressively weaker until it was like a bowling ball on my shoulders and I could no longer hold it up for simple things like looking down, brushing teeth, vacuuming, simple picking up the house, etc. It’s been almost two months now and while it’s not as bad as it was a month ago, my neck is not recovered to its former strength, and gets tired very easily. My neurologist has stated that we can do a lower strength and a different pattern in the future. I am leery of ever doing this again based on my reaction and unsure. Have you ever heard of this reaction?
A: I think you are merely experiencing the effects of Botox in the neck muscles which has resulted in some temporary muscle weakness. This is not a reaction but an expected response based on the muscles that were injected. In the treatment of migraines with Botox, the key is to inject the potential trigger points that are where the sensory nerves come through the muscle. In the back of the head, this is a very specific location that relates to the path of the greater occipital nerve. This is at the base of the occipital skull and can be precisely palpated. While this does involve injecting into the upper end of the splenius capitus muscles, this will not cause any neck muscle weakness. It sounds like neck muscle was injected below this point which is not helpful in determining the location of a trigger point and can cause some neck muscle weakness, particularly if a high number of units was injected. The good thing is that in another month or so your neck muscle problem will be self-solving as the Botox wears off.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox for migraines, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Sunday, July 31st, 2011
Q: Dr. Eppley, I was born with a face that to me looks a little crooked. It seems my jaw line is shorter on one side and it looks like my face is bent in one direction. Would you be able to look at the pictures I am enclosing and please tell me what you think. My face is definitely not even and my chin is crooked. I think it is too big, but is it also receded? I am so self conscious that I hide behind my hair and makeup. Thank you so very much for your time and please, any advice and recommendations would be greatly appreciated!
A: I have taken a look at your pictures and your concerns. I think there is no question that you have facial asymmetry that is almost completely due to the shape of the lower jaw. The differences in the jaw length has resulted in frontal chin asymmetry with the midportion of the chin being deviated to your right side. This can be corrected (straightened) through a chin osteotomy, sliding it over to the left until its midportion is in alignment with that of your nose and upper and lower lips. This may also require some vertical chin adjustment with a reduction of the left side or an opening lengthening on the right side, depending upon which aesthetically looks better. Your side view shows a mild amount of recession which, given that an osteotomy would be done, I would take the opportunity to give more horizontal projection to the chin as well. I have attached some predictive imaging of the potential outcome with this sliding chin osteotomy procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin asymmetry, chin osteotomy, dr barry eppley, facial asymmetry, indianapolis, plastic surgery of the chin
Posted in Your Questions | No Comments »
Sunday, July 31st, 2011
Q: Dr. Eppley, I have a long pointy head that is completely abnormal. It has looked this way since I was born. I have managed to get along in life and be a very productive person at 30 years of age. But I always wear a hat and never let anyone see me without it. My other brothers have completely normal head shapes. I would do anything to have a more normal head shape and live a more normal life. I know you have a lot of experience in reshaping of skulls, so I am very interested in your recommendations. I have attached pictures of me with a closely cropped haircut. Please help me.
A: Thank you for sending all of your pictures and describing your situation. I have great empathy for your head concerns. It appears you have a rather classic case of undiagnosed and untreated sagittal craniosynotosis. The AP cranial dimension is long, the transverse cranial dimension is narrow and there is frontal bossing which is wider than the occiput. This condition is rare to see in adults these days since almost all of them are treated as infants with the advent of widespread craniofacial surgery since the 1980s.
First, let me start off by saying what can’t be done. The traditional approach to sagittal craniosynostosis is complete cranial bone remodeling. But that can only be done in infants where the bone is very thin and pliable and one can work with the molding influence of the growing brain. As an adult, such a procedure can not be done as the bone is too thick and not pliable, the extent of surgery and the bleeding would have a high risk of significant complications, and there is not growth of the brain to fill the underlying dead space that is created.
While the bone can not be removed and reshaped, a camouflage skull reshaping approach can be done. This would consist of some burring reduction of the sagittal ridge and the frontal bossing and augmentation of the parasagittal skull and temporal regions. The combination of these reduction and augmentation procedures, while not making any shortening in the cranial AP dimension can give an improved appearance to the skull shape. I have attached some imaging which I think is achieveable.
To embark on this cranioplasty approach, good treatment planning is needed. This would consist of getting a 3-D craniofacial CT scan and then have an exact skull model made from it. It is off of this patient-specific skull model that the exact dimensional changes can be planned and the volume and shape of the needed implants fabricated.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranial reshaping, dr barry eppley, head reshaping, indianapolis, plastic surgery of the skull
Posted in Your Questions | No Comments »
Saturday, July 30th, 2011
Q: Dear Dr. Eppley, I would like to replace my existing saline implants which are now 10 years old with new ones. The original size was 800cc shells filled to 960cc which I was told was the maximum fill at that time. My annual mammogram is coming up and I worry about my decade old implants failing under the pressure (yes I know it is a remote possibility, but I still am concerned). In doing a replacement, I want much larger implants. It would have to be done with either custom made implants or largely overfilling the largest saline breast implants that are made. In doing a replacement I would want a lot more volume than 960cc with as much as a 200% fill to give me more upper pole fullness and more projection. In effect a “mastopexyless” breast lift (had one masto, don’t want to do it again). There are several surgeons in US who are doing very large fills of 800cc saline shells at a patient request. Fills of 1400cc to as high as 2000cc are documented in various internet implant breast forums.
A: While available at one time, custom breast implanrs are no longer made by any US manufacturer. Neither breast implant manufacturer will custom make any implant size at this time. The largest off-the-shelf saline implant are still 800cc of which the manufacturer recommended maximum fill is 960cc. (which you obviously know) The 800cc imlants only come in moderate plus projection. (Mentor) What any plastic surgeon is willing to fill to beyond the recommended fill is between the surgeon and the patient. Beyond the manufacturer’s recommended maximum fill, the patient risks losing the lifetime implant replacement warranty from the manufacturer. Nobody knows for sure how much overinflation affects the potential for deflation or rupture, although it may be fair to say that it has a negative influence. As the implant becomes highly overinflated it also becomes quite hard and unnatural feeling. These are all issues that a patient needs to consider when requesting and/or receiving high volume overfills.
I have heard rumors that the manufacturers have requested from the FDA approval to manudfacture and sell larger breast implant sizes than that which is currently available. (I can not verify that this is true) So larger implants with a base size over 1000ccs may be available in the future.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, extreme breast augmentation, indianapolis, large breast augmentation
Posted in Your Questions | No Comments »
Thursday, July 28th, 2011
Q: Dear Dr. Eppley, I have a question for you concerning the removal of some subtle scar tissue. The scar is above my lip and was caused from a small burn from a do it yourself type laser hair remover. The initial wound was not very deep and I didn’t think it would even cause a scar, but it has in fact left my skin a bit irregular in a very noticeable place on my face. I was curious if the irregular area could simply be excised, since the effected tissue is not very deep, and then the new wound could be healed with ACell to restore normalcy to the skin in the area. Would that be possible?
A: Burns create unique scars that can be very difficult to treat. Rather than a more discrete amount of scar in a linear pattern, most burn scars have a larger surface area geometry. This often makes it very difficult to simply excise them because they are too wide. With burn scar excision, the surrounding tissues will often become distorted with the closure. There are exceptions to the burn scar problem which can do well with excision but they are in the minority.
I suspect when you are talking about excision combined with Acell you are referring to a topical approach. Rather than a full-thickness excision, you probably mean just remove the surface burned tissue and cover it with Acell. Your premise is that it would heal completely normal in appearance. Unfortunately, this is not what would happen and the result would not be an improvement and likely will look even worse. I believe you are assigning healing properties to Acell that are beyond what it can really do.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: Acell therapy for scars, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Thursday, July 28th, 2011
Q: Dr. Eppley, I’ve read the section with patient questions about lipomas and I have a similar case. I had surgery 3 years ago that removed the biggest lipomas from my body but I still have multiple smaller ones all over my arms, upper legs and back. Maybe 20 on my arms, 20 to 30 on my legs and 3 to 4 on my back ( half of them are the size of a walnut). I’ve read that a combination of injections and laser treatment would be the best approach in my case . I completely understand that it would be just an estimate (and multiple treatments might be required) but I would like to know at least what would be the general range. I would appreciate your help in this matter.
A: While lipomas can be treated effectively by lipodissolve injection therapy and Smartlipo laser probe ablation, this approach is best used for a limited number of lipomas. This is because each lipoma so injected is associated with a significant inflammatory response (and pain) and will definitely require multiple treatments. When the lipomas number more than a handful, one is better off having an outpatient procedure where they are completely excised as this is simply more efficient and cost-effective….not to mention has less discomfort and an easier recovery compared to a multi-stage non-excisional approach. I would only consider an injection approach in a limited number of them to bother determine their response and a patient’s tolerance for it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injection therapy for lipomas
Posted in Your Questions | No Comments »
Thursday, July 28th, 2011
Q: Dr. Eppley, I would like to get my upper arms reshaped. I am most interested in Smartlipo and having it done under local anesthesia.
A: The first question is whether any form of liposuction is appropriate for the upper arms. I ask this because I have seen many patients, particularly those interested in Smartlipo, who believe that the procedure can do more than what is possible. Most of these patients have more than fat with some amount of skin excess. While Smartlipo has some minimal skin tightening capability, what most patients need is far in excess of minimal. Smartlipo tightens skin in terms of millimeters, what most patients need is in the centimeters range. Millimeters signifies that just a small pinch of skin can be tightened. Many patients that want upper arm reshaping need inches of skin tightened/removed. What shape your upper arms have I obviously don’t know. So this would be my first concern. You may feel free to send me some pictures of your arms and I can tell whether Smartlipo liposuction is the appropriate procedure for your upper arm reshaping.
Secondly, while upper arm liposuction can be done under local anesthesia, I do not recommend it. This is because of two important reasons, results and cost. Arm liposuction done under local anesthesia will not get the same results as that done when the patient is asleep. It is a simple matter of you can only remove what the patient deems is comfortable. Because any procedure done under local anesthesia takes longer to do, the cost of doing it rises accordingly. Patients often mistakenly assume that a procedure done under local anesthesia will create the same result and cost the same as that done under an anesthetic…this is a wrong assumption.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, upper arm smartlipo
Posted in Your Questions | No Comments »
|
|
|
|