Archive for July, 2011
Wednesday, July 27th, 2011
Q: Dear Dr. Eppley, I am not sure if I need a lift or lipo on the love handles. That decision I would leave up to the expert. But I would love to have breasts that look like actual breasts and not deflated socks. I have never had breasts. Growing up there was just a small protrusion of breast itself but was mostly at the nipple.(hard to explain) My stomach has stretched out due to 4 pregnancies, 3 in quick sucession. I run sprints, lift weights, and eat very healthy, I have attached pictures for you to see what I am left with.
A: Thank you for sending your pictures. In reviewing them you can see many of the typical changes that have occured with multiple pregnancies and having very small breasts to start with. The little breast tissue you have has stretched out and the nipple now hangs down over your existing high lower breast fold. You will need both breast implants and a small vertical breast lift to get a much improved breast size and shape. The vertical breast lift is a key component of the procedure as an implant alone will provide volume but will not get the nipple up and centered on the newly enlarged breast mound. This results in fine line scars around the nipples and then down vertically towards the lower breast fold. Whether one wants saline or silicone gel implants is a matter for further discussion of their benefits and liabilities. From abdominal stand point, I would recommend a mini-abdominoplasty with flank liposuction. While there are stretch mark across a lot of your trunk areas, there does not appear to be enough of loose abdominal skin to justify a full abdominoplasty procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation with lifts, dr barry eppley, indianapolis, tummy tucks
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Wednesday, July 27th, 2011
Q: Dear Dr. Eppley, do you perform scarless breast reduction? If so how is it done and how small and what shape will my breasts be afterwards?
A: There is no such thing as true scarless breast reduction. The only ‘scarless’ method of breast reduction is liposuction. This can remove some volume of breast tissue but it can not improve any shape features of the breast. It can not lift or tighten skin, reduce the size of the areola, elevate the position of the nipple-areolar complex, nor give the breast a rounder or even a more conical shape. For most breast reduction patients, these changes are just as important as the amount of breast tissue removed. Liposuction of the breast, in fact, can even make the shape and the sagging of the breast worse. As you reduce the breast volume, but do not change the skin that contains it, the breast will sag worse. At the least, the amount of breast sagging will certainly not improve.
There is a very limited role for liposuction or scarless breast reduction for a few select patients. But they have to have large breasts which sit adequately high on the chest wall, have a good nipple position and fairly tight breast skin. Most women with large breasts that want a reduction do not have these breast shape features. This is why the traditional method of breast reduction with scars is needed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, scarless breast reduction
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Tuesday, July 26th, 2011
Q: Dr. Eppley, I am interested in getting my nose built up. I think it is too small. I really don’t want to have a rib graft taken so I am looking at synthetic implants. I am trying to decide between a Voloshin and a Shirakabe nasal implant. Does a Voloshin or Shirakabe implant give a more streamlined appearance? Which implant enhances the nasal tip more? Is the Shirakabe Nasal tip too narrow? Secondly,what is the purpose behind using the Brink Peri-Pyriform Implant in rhinoplasty?
A: The fundamental difference in the Shirakabe nasal implant from that of the Voloshin is that it provides some augmentation to the base of the nose. But that is irrelevant if one is going to have a peri-pyriform (premaxillary) implant. The Shirakabe tip is a morenarrow, particularly across the tip, compared to the Voloshin. One thing you have to be very careful of is to not make the entire nasal tip cartilages (dome) completely covered by the implant. While one can get away with big sizes in facial implants that are covered by muscle, the risk for implant problems (infection, extrusion) that are covered just by skin (such as the nose) is not so foregiving. So I would not get hung up in trying to give the nasal tip too much projection with an implant. That places the skin under tension and is a setup for the aforementioned problems. If one wants to push the envelope of size and tissue tension in the nose, it is far better and less risky to do this with a rib graft.
The purpose of the peri-pyriform (premaxillary) implant in rhinoplasty is to build out the base of the nose in cases of midface deficiency and a smaller nose. This opens up the nasolabial angle, increases the fullness of the upper lip and pushes out the base of the nostrils. This in effect creates a pulling out of the nasal base.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, synthetic nasal implants
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Monday, July 25th, 2011
Botox is commonly recognized as an injection treatment to either turn back or slow down the hands of time. By reducing the wrinkle lines of the forehead and around the eyes, a more relaxed and often a less scowling appearance is achieved. But the use of Botox continues to find new medical problems for which it is effective. Allergan, Botox’a manufacturer, is already a multibillion company which continues to experience record revenue and earnings growth.
The newest FDA-approved indication is in the treatment of migraines. Approved last year it works for migraines just like it does for wrinkles, by relaxing muscles. But it is injected around those nerves in the head which are being squeezed by muscles and thus serve as the trigger for the migraine headache. These are commonly in the eyebrow, temple and at the base of the skull in the back of the head. For some patients the temporary relief is a near-miracle which will last about four months. Botox in migraines is also a test which proves that doing surgery by removing this muscle around the nerve can have a more permanent effect.
Botox has long been approved for halting severe underarm sweating, an embarrassing condition known as hyperhidrosis. This disorder causes so much perspiration that some sufferers are forced to carry several changes of clothing to make it through the day. The excessive sweating is caused by over stimulation of the sweat glands by the nerves of the autonomic system. Botox interferes with the nerves responsible for this drenching. It has a similar benefit to those who also suffer excessive sweating in the palm of their hands. (palmar hidrosis)
Botox is effective for cervical dystonia, a condition that causes the neck to twitch, twist, and go though repetitive movements and carry the head in abnormal postures. This happens because of involuntary muscle contractions which the injections directly weaken. It is similarly effective in cerebral palsy in which patients have stiff spastic arms and legs caused by abnormal signals from the brain to the muscles. Botox interrupts this communication between the nerves and the spinal cord which then causes the muscles to relax.
Overactive bladders are also benefiting by these injections. Caused by muscle spasms of the bladder muscles, urinary incontinence can make it difficult for some patients to undergo even short car trips. Some patients end up wearing adult diapers. Botox overcomes bladder incontinence by weakening or paralyzing those muscles which contract inappropriately and squeeze out the urine involuntarily.
Botox can also stop chronic pelvic pain which can make it difficult to have sexual intercourse or undergo an examination or a pap smear test. This type of pelvic pain is caused by tight over-contracted pelvic muscles.
While often perceived as a drug of beauty, the many medical benefits of Botox makes its few precious drops life-changing for more just a better look in the mirror.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, dr barry eppley, indianapolis
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Sunday, July 24th, 2011
Q: Dr. Eppley, I would like to have a chin implant to add length to the lower half of my face. However, I am 21 years old and have partially erupted wisdom teeth that I have neglected to have removed for several years. Is it necessary to have them removed before getting a chin implant?
A: The only thing that a chin implant and wisdom teeth have in common is that both occur on the mandible or the lower jaw. But beyond being on the same bone, there is no correlation between the two. The wisdom teeth or third molars are located at the junction of the body and ramus of the mandible at the back. A chin implant is done on the symphysis or front part of the lower jaw. One does not affect the other. However, if you need both done it would be most convenient that they are done during the same surgery. I have done that combination numerous times. The key to this surgical ‘opportunity’ is to find a surgeon who is qualified to perform both procedures.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, dr barry eppley, indianapolis, wisdom teeth removal
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Sunday, July 24th, 2011
Q: Dr. Eppley, I have suffered an accident to my lip. I cut my lip pretty deep and it resulted in the need for stitches. The cut is not that big, however, it’s been 3 weeks and its healed fine apart from a little bumpy scar tissue. It’s the same color as my lip and slightly raised. Do you think this is a scar or is it still healing? I have been applying Vitamin E twice a day and massaging it. It’s quite a new scar so is there anything I can do to minimize the appearance and do you think I’ll be permanently scarred? Please help Thank you.
A: All incisions and lacerations will leave a permanent scar, it is just a question of how significant it will be. Any laceration that is deep enough to require stitches has entered or passed the dermis of the skin. That is going to evoke an inflammatory response and collagen production to heal the wound. Collagen production equates to the formation of scar tissue. Many factors affect whether that scar will be particularly noticeable or not. Fortunately on the lip, most lacerations run parallel to or along one of the visible lines or grooves of the vermilion of the lip. This is the most favorable location for the least amount of scarring on the lip.
Because collagen and scar production is in full swing during the first month after the injury, the lip scar will become both firm and usually raised. It will require many months until this scar tissue relaxes so one can not predict what you are currently seeing will be like that six months from now. While there is nothing wrong with applying Vitamin E and massaging it, you are trying to treat a natural healing process. Quite frankly, these maneuvers are more psychotherapy than making any real difference in the scar outcome. Time is the best scar therapy on the lip. If it seems to be a persistent problem after six months, then I would consult with a plastic surgeon about possible scar revision.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lip scar therapy
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Sunday, July 24th, 2011
Q: Dr. Eppley, I’m trying to remove my cauliflower ear in which I been having for years. Can it really be improved in the way the ear looks and how is it done?
A: The well known cauliflower ear, in appearance much like the vegetable plant, is the result of ear trauma. Specifically it is the production of cartilage as a response to its covering, known as the perichondium, being sheared off from its underlying cartilage. Ear cartilage is an avascular tissue that receives its blood supply and nutrition from its enveloping perichondrium. When it gets torn away from the cartilage, it bleeds and creates a blood clot between the two. This serves as a stimulus for the cartilage to grow and eventually replace the space where the blood was. Since the ear’s shape (with the exception of the earlobe) is determined by the shape of the cartilage, the traumatized ear becomes deformed in appearance.
Surgical treatment of the cauliflower ear is done by removing a flap of skin over the deformed area, shaving down and reshaping the cartilage, and then putting the skin flap back in place. The key to the success of the procedure us two-fold. First the skin flap over the deformed ear part must be raised in such a way that its blood supply is not destroyed and skin necrosis results afterwards. Secondly, the skin must be held into place with intimate contact to the cartilage after it is reshaped so blood does not form between the two and re-create the original problem. This form of ear reconstruction is done as an outpatient procedure under anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery for the cauliflower ear deformity
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Sunday, July 24th, 2011
Q: Dr. Eppley, I would love to know how to book appointments for people outside the U.S. I plan to come to the U.S. and have some work done. Can a consult be done without actually having to visit you first? I obviously want to minimize my travel due to the cost and my work schedule. Thanks.
A: Thank you for your inquiry. I have many patients that come from all over the world so plastic surgery consultations are done by numerous convenient methods. Usually we start by having the patient send some photos of their concerns. Then we can consult by phone or Skype video to discuss their concerns and treatment options. Much can be accomplished by this form of indirect consultation as almost everything in plastic surgery is visible to the eye. If one develops confidence and is comfortable, a surgery date and all the details involved can be done from afar. The patient then arrives the day before surgery where an actual hands on consultation is done to review and/or modify the next day’s surgical plan. Surgery is done (e.g., sutures and any dressings) to try and ensure that the patient does not have to return for any regular follow-up care. Any postoperative concerns or questions can be handled similarly by sending photos and discussing by phone or Skype.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, online plastic surgery consultations
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Sunday, July 24th, 2011
Q: Dr. Eppley, I am interested in getting rid of my sagging jowls and neck. Do you think Thermage or radiofrequency treatments would work? If not, would you recommend a lifestyle lift or a mini lift? What about laser tightening for face & neck vs these lifts?
A: While I have never seen what you look like, I can only speculate about your neck and jowl concerns. However, almost any patient that I have ever seen with a sagging jawline and neck rarely would benefit significantly by any non-surgical or non-invasive treatment method. By and large, the use of non-surgical methods of neck and jowl improvement produce very minimal benefits and most patients would consider them unsatisfactory. They are best used when the patient has a very minimal problem or when the patient is fairly young with just the very beginning of any sagging. Most certainly, what often is paid for the hope of some of these non-surgical methods would have been better invested in a surgical solution. In short, any non-surgical method of jowl and neck tightening does not compare to the results achieved by more conventional surgical techniques.
There is no difference between a Lifestyle Lift, minilift or any other branded and marketing name for an operation that has been around for decades…a reduced version of a facelift.
It is understandable why patients seek anything but surgery for their aging concerns of their lower face, but they often end up chasing a solution that does not exist…and waste money along the way.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lifestyle lift, mini facelift, neck and jowl sagging
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Sunday, July 24th, 2011
Q: I am a former patient of Dr. Eppley. I had buccal fat removal and love my results… however, I am still interested in having facial liposuction to sculpt my cheeks out a bit. I am wondering if he can do this and this is possible.
A: The removal of the buccal fat pads is the largest fat depot that can be surgically removed on the face aside from the neck. Its removal creates a slimming change in but one region of the face, the submalar region or the area right below the cheek bones. There are no other distinct or encapsulated fat areas to remove on the face. The rest and majority of facial fat is located in the subcutaneous level or right under the skin. This is much more difficult to remove and can only be addressed by small cannula liposuction. Many such facial fat areas are not even treatable by liposuction.
When patients seek a slimming effect of the face, they often are referring to the side of the face from the cheeks down to the jaw line. This leaves a lot of facial areas beyond the submalar or buccal fat region. Most of these areas can be treated by liposuction if done carefully and not done too deep. The buccal branches of the facial nerve lie on top of the muscle layer just underneath and injury to them should obviously be avodied. The question is not whether it can be done, but whether any significant change can be achieved. In general you can not make a wholesale facial slimming change by facial liposuction but small discrete areas may be able to be improved.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal lipectomy, dr barry eppley, facial liposuction, facial slimming, indianapolis
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