Archive for August, 2011
Saturday, August 27th, 2011
Q: Dr. Eppley, I am interested in getting a browlift and an upper blepharoplasty fro my hooded eyes and low brows. I am now 54 years old. Three years ago I had a facelift done and, although I am happy with the neck and jowl results, the scars around my ears have significantly widened. This has made me afraid of doing any type of browlift as I don’t want a wide scar in my scalp. I wear my hair with bangs and I also have a high forehead. What are your thoughts on the transpalpebral approach to browlift surgery?
A: While a transpalpebral browlift avoids any hairline scars, the ‘price’ to be paid for that decision is that it does a relatively poor job of lifting the brow. At best, it can only make a minor elevation of the tail of the eyebrow. It illustrates a basic principle that you can’t really lift much when all you are doing is pushing up from below. It can not elevate at all the inner half of the eyebrow because the supraorbital and supratrochlear neurovascular bundles are in the way. With your already high forehead, I would strongly consider a hairline or trichophytic browlift technique. That would achieve the dual effect of lifting the brows and shortening the vertical length of the forehead at the same time. Provided you have a good frontal hairline density, the resultant fine scar at the edge of the hairline is one that is usually not associated with any significant scar widening. I would not equate what can happen along the ears from a facelift to that of the effects of a browlift on the hairline. Excellent scars can be obtained, however, from each with good surgical technique.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, hairline browlift, indianapolis, transpalpebral browlift
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Friday, August 26th, 2011
Q: Dr. Eppley, I had a rhinoplasty several years ago that changed the angle of my nose from convex to acute. I would like to have this corrected with a premaxillary implant. Do you prefer silicone, mersilene mesh or hydroxyapatite?
A: Thank you for your inquiry and good question. While arguments can be made for any of the materials you have mentioned, and I have used them all, I prefer mersilene mesh in the premaxillary/pyriform aperture area. While I don’t use this material for most other facial areas, it has several advantages under the base of the nose including easy shaping and fabrication, no need for implant fixation, rapid tissue ingrowth with firm fixation and minimal palpability to the touch. Silicone implants tend to be a little firm and placing them under the thin mucosa of the maxillary vestibule makes them prone to future problems of tissue thinning, exposure as well as palpability. Hydroxyapatite granules is another reasonable alternative as a good long-term facial implant material. Its only problem is that one does not have ideal control over the placement of the material and the granules do settle out so the amount of premaxillary augmentation may not be enough or may be uneven or irregular.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, premaxillary implants
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Friday, August 26th, 2011
Q: I am very interested in a knee lift. I have had liposculpture around the front of my knee and thigh with the hope it would remove the wrinkly look I have around my knees. I am 48 yrs old therefore the loss of skin elasticity has effected the look of my knees. I am desperate for some advice of where I can go to improve this part of my body. I have considered a thigh lift but have been advised that it is not possible to lift my problem area because there is a long distance between my knees and upper thighs.
A: The loose skin and wrinkles above and around the knee area is a difficult problem. As you have discovered, deflating thin older skin by liposuction will usually just create more loose skin. Like anywhere else on the body where there is loose skin, it is possible to do some form of a lift. Essentially a knee lift is the direct removal of skin above the knee cap area. This is actually a fairly simple procedure in concept but is flawed by the creation of a scar. While lifts are done in many areas of the body and they all create scars, the knee lift is unusual in its location. It is placed in an area that is directly exposed to high degree of motion and a high angle of potential flexion…which puts stretching forces on the scar in a perpendicular direction. This will likely result in noticeable scar widening. Whether such a scar is a better aesthetic result than the wrinkly skin around the knee is a critical question. While I would have to see how ‘bad’ your knees look now, I would be suspicious that this may not be a good aesthetic trade-off.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, knee lift
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Friday, August 26th, 2011
Q: Dr. Eppley, How long does it take to heal from a tummy tuck? What is the success rate to keep the contour? How much does the procedure cost?
A: Recovery from a tummy tuck depends on how you want to view the concept of recovery. To be 100% full recovered (feeling like before the surgery and doing all normal and strenuous activities), it will take a full 6 weeks. If you are talking about returning to work in a sitdown job, it will be closer to 10 days. Returning to a more strenuous job will be closer to three weeks. Up and about after surgery around the house will be a few days.
The success of tummy tucks in terms of long-term contour preservation is actually pretty good. The excess or loose skin is never going to return provided one does not get pregnant again, which is the primary skin-stretching mechanism for most women. (extreme weight loss is the other) One can thicken up the fat layer around the trunk and waistline based on one’s weight and diet. I have seen that in a few patients over the years. It all depends on the stability of one’s weight and the type of body build one has.
There are different forms of tummy tucks that may or may not include liposuction. For the sake of simplicity, I would look at the concept of a full tummy tuck with flank liposuction which is the most commonly performed one. As an out patient procedure this more complete tummy tuck is in the range of $6500 to $7500, all costs included. This is an approximation and may change based on an actual examination of the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck cost, tummy tuck recovery
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Friday, August 26th, 2011
Q: Dr. Eppley, I am a 25 year old man and I want to fix the sunken look I have in my midface area. Below my cheeks it is very hollow. In addition, there are indented lines which I call railroad track lines in my midface? I have read about filler injections but I know they are only temporary and may leave a plump, round shape which I don’t want. I would like to have a more narrow/angular look. Do you think cheek implants will work?
A: Hollowing below the cheeks, known as submalar hollowing, is the result of the cheek soft tissue not being supported by bone. Without a large buccal fat pad or thick subcutaneous fat being there, this area will become a concavity and not a convexity. Injectable fillers can certainly be used as a temporary augmentation method but I would agree that it lacks the ability to create sharp definition. Cheek implants are the only other options and they do provide a permanent change. But there are numerous types of cheek implants and it would be very important to get the right implant shape to achieve the desired result. Submalar cheek implants would theoretically be the best choice but they do add some cheek width and lateral fullness.. It may be better to use a combined malar and submalar implant, known as a malar shell, and modify the submalar edge to create medial augmentation of the submalar hollow but not lateral fullness.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, malar shell implants, submalar cheek implants
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Tuesday, August 23rd, 2011
Q: Dr. Eppley, I was wondering if forehead reduction was possible. I have a high forehead and it makes my head look rather large. I also feel like my forehead comes outward too much like bossing. Can anything be done to fix these problems?
A: Forehead reduction is done by loosening and advancing the frontal hairline forward and removing the forehead skin that it overlaps. Since this is an open procedure, the bulging upper forehead (frontal) bone can be shaved down four to five millimeters for some mild bossing reduction. The key to doing this procedure is that the one must have a stable and fairly dense frontal hairline as this is where a fine line scar will result. This means that it is a procedure that can be done for many women but only in a very limited number of men. I actually have never performed a forehead reduction in a male for this very reason.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead reduction in men, indianapolis
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Tuesday, August 23rd, 2011
Q: Hi Dr. Eppley, I was wondering whether trauma to the brow bone early in life could have caused it to grow differently than it should have. I was on a trampoline as a child and fell onto the left side of my face and had large swelling there for about a week before it went away. Now that I am older I have noticed that the side of my brow seems to be lower, giving my left eye a perpetual sad look that I do not like. While I could be mistaken, and it could be scar tissue causing this asymmetry, I am wondering if this is due more to bone. If so, is there a cosmetic procedure to fix this and if the childhood trauma could have been the cause. Thank you.
A: Most certainly trauma to the brow bones can be a source of brow asymmetry. The trauma could have caused an actual deformation of the bone by infracturing the thin bone over the frontal sinus in an adult or causing a compression fracture in children that changes how the shape of the bone grows and expands. Such asymmetry is the result of the edge of the brow bone being lower than the unaffected side. This can usually be corrected by a brow bone reshaping procedure by shaving ‘up’ the lowered edge of the brow bone. This can be done through an upper eyelid incision. It usually takes about two to three weeks until all the swelling and bruising is gone.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: brow bone asymmetry, brow bone reshaping, dr barry eppley, indianapolis
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Tuesday, August 23rd, 2011
Q: Dr. Eppley, I am 72 years old and in excellent health… exercise, good diet, etc. When I was around age 45 I had a blepharoplasty operation as I had developed large bags under my eyes. The surgery was to remove fatty tissue from my eyelids. It did me a world of good, as I was quite self-conscious of my appearance. Those bags have gradually come back and I am, again, very self-conscious of them. I look relatively young except for this excess fatty tissue. I can hardly imagine how I would look now had I not had the first operation! My question is how could this fat come back since I haven’t really gained any significant weight. Can they be removed again and do you think that it would be covered by Medicare? Thank you for your help.
A: Bags that develop from the lower eyelids is a common problem that occurs largely in aging eyes and occasionally in younger people due to genetics. The bags are due to fat which is sticking out from underneath the eyeball. One can think of it as a hernia. Our eyeballs are surrounded for their protection by fat. This fat is held in place underneath the eyeball by a special tissue that runs from below the lashline (tarsus) of the lower eyelid down to the rim of the lower eye socket. As we age this tissue becomes weak and the fat is no longer held back and begins to stick out. (bags) For some people, they have a congenital weakness of this tissue and they may have bags as early as their teen years. Once this protruding fat is removed, it is still possible later in life for it to ‘return’. This is really just more fat that is coming out from around the eyeball as the supporting tissues become weaker. Like the first surgery, further fat can be removed by additional lower blepharoplasty surgery.
Lower eyelid surgery is never covered by insurance because it does not interfere with one’s vision. Only the upper eyelid can create that medical problem.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, eyebag removal, indianapolis, lower blepharoplasty
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Tuesday, August 23rd, 2011
Q: Dr. Eppley, I need advice as to whether I should have a mini- or full tummy tuck. I have attached some pictures of my stomach so you can see. I have been to two plastic surgeons and have gotten two different opinions. In listening to them, both make sense for what they want to do so I am confused.
A: When considering the type of tummy tuck one may need, it is important to look at the components of the excess tissue problem. The most important consideration in choosing between a mini- vs a full tummy tuck is how much skin is present. While you don’t have a large amount above your belly button, there is enough there that a mini-tummy tuck will not fully get rid of it. The other tissue consideration is the amount of muscle laxity or protrusion. You appear to have a protuberance of your abdomen starts way above your belly button. Like the skin excess, this muscle protrusion indicates that you will get a much better result from a full tummy tuck. One issue to consider in doing a fully tummy tuck is the vertical level of the horizontal scar. If the belly button cut out in the skin needs to stretch down to meet the lower incision, the horizontal scar will likely end up a little high. Therefpre, I would recommend that you end up with a small vertical scar in the lower part of your abdomen. That way the scar can stay low and the belly button hole can be closed vertically. I think this would be better given how jeans and underwear are cut and designed today for women.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, full tummy tuck, indianapolis, mini-tummy tuck
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Tuesday, August 23rd, 2011
Q: Dr. Eppley, I am interested in getting breast implants but am having a hard time figuring out the right size. There does not seem to be any specific method about how to select the size. know I should not focus on the cup size but more on what I want it to look like. I do want want them to be large though. I am 5′ 6″, weigh 135 lbs and am athletically built. I want them to be large, but not so large that they will cause me problems down the road. One plastic surgeon I consulted with recommended 500cc implants. But in trying them on inside my bra, they seemed too small. What would you recommend?
A: While there is no exact science to selecting breast implant size for any patient, there are some guidelines to follow. Remember, however, the goal is in how the breast loko after surgery not necessarily what cup size they fit into or what volume of implant it is. It is all about the look. There are two criteria that I use. The first is how wide is your natural breasts, known as the base breast width. Select an implant whose base width does not exceed that of your own breasts. That will keep them from getting too fat to the side or into the swing of the arm. Secondly, what breast look is the patient after. This requires the patient to s look at and select some after breast augmentation photos of sizes (look) they like. When putting the two together, a good breast implant size can usually be chosen that satisfies most patients. If the breast look appears bigger than what one’s breast width can accomodate, then select a bigegr implant that has a high profile. This will allow for more volume while keeping the implant diameter within the boundaries of the side of your breast.
Tags: dr barry eppley, implant sizing in breast augmentation, indianapolis
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