Archive for September, 2011
Friday, September 30th, 2011
Breast augmentation remains a popular body contouring procedure for women. In as little as one hour, a woman can dramatically change her body shape in a very favorable way. Only breast implants can produce such a significant body change in such a short period of time. When it comes to breast implants there are two types currently available, saline -filled and silicone filled. Since 2006, silicone breast implants have returned which are filled with a new cohesive gel formulation that is much better than that used in the past.
Given these two choices, how does one decide which type of breast implant is better for them?
In reality, neither saline or silicone breast implants are perfect. If one was truly better than the other, there would be only one choice not the two that we have. Each type of breast implant is safe (FDA-approved) and has its own unique set of advantages and disadvantages. Both of them will do the job and do what they are intended to do… make the breasts bigger. But there are some differences between them and understanding these differences helps you make the best implant.
Saline breast implants have the advantages of a lower cost and can be placed through a small incision high up in the armpit that is not on the breast. That incision location may be an advantage in the Hispanic woman who may be concerned about any scarring around the breasts. Saline implant disadvantages are that there may be some implant rippling that can be felt on the bottom or sides of the breast and the risk of immediate deflation of the breast should the implant rupture.
Silicone breast implants have the benefits of a slightly more natural feel (no rippling) and the breast will not go flat should the implant rupture. However, they do require an incision in the lower breast crease and have higher implant costs.
Other than these implant differences, everything else about the breast augmentation procedure is the same including recovery time (one week or less) and how long the breasts will be swollen. (two to three weeks)
What is the best type of breast implant for you? I tell patients to make their choice based on which of their disadvantages you can live with the best. Both saline and silicone implants work for breast augmentation…which of their disadvantages is more acceptable to you?
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, saline breast implants, silicone breast implants
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Friday, September 30th, 2011
Q: Dr. Eppley, I am a 46 year-old female. I would like to get an upper and lower blepharoplasty. However, I have problems with my nose due to a sinusitis and a collapsed septum. I got an x ray last week and the doctor said I have a deviated septum as well as thickening of turbines. I have been on antibiotics for five days. This problem wears me out a lot. I am often tired with headaches and my face always looks puffy due to continous allergy symptoms. My question Dr Eppley is what do you suggest for me to have first or not to have- a Rhinoplasty/Septoplasty to correct the nose issue and then a blepharoplasty? Please doctor I would appreciate your advise. I found your website very helpful, thank you again.
A: There is no question that septorhinoplasty and blepharoplasty can be performed together. This is not a technical nor a safety issue. It is an issue exclusively of how much recovery do you want and how long can you tolerate (socially and workwise) the way you will look during this recovery. When combining rhinoplasty and blepharoplasty the swelling and bruising around the lower eyes can be quite severe, particularly when nasal osteotomies are performed. Otherwise, there is no reason why the two facial procedures can not be performed together. There may also be other advantages beyond one single recovery period for combining them, such as cost.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, indianapolis, rhinoplasty
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Friday, September 30th, 2011
Q: Dr. Eppley, I had a primary rhinoplasty over a year ago where my doctor used diced costal cartilage in fascia but I do not feel we had the same aesthetic vision. My nose is still larger and higher than I would like it to be (more masculine than feminine). I would like it to be smaller and more feminine. I am wondering were I to pursue revision rhinoplasty, would the diced cartilage with the fascia be shaved? If so, would new fascia (requiring a second operation site) need to be applied over the shaved sections? I am trying to assess the risks associated with revising a rhinoplasty that was done using diced cartilage and the likelihood that it can be reshaped. I can live with my nose today but don’t like it.
A: When undergoing a rhinoplasty, because it is a facial structural change, it is important to see what the result may be like through computer imaging before surgery. This is an operation that is about changing how you look so there is significant psychological overtones to how the result will impact a person afterwards. While computer imaging is a prediction and not a guarantee of a rhinoplasty outcome, it does shake out whether what the plastic surgeon envisions and what the patient hopes to achieve are closely matched.
Secondary revision of a prior dorsal augmentation with diced cartilage can be done. The augmented cartilage can be shaved down or completely removed depending upon what creates the best aesthetic result. It almost sounds like in your case that the need for an augmented dorsum may not have been desired at all since you now realize that a smaller and lower dorsum is desired. You have correctly pointed out, however, that dependent on how smooth the diced cartilage reduction is done that some graft coverage may be needed. If there are some irregularities that are best covered by a graft, I would choose an allogeneic dermal graft (less than .5mms or less) rather than another fascial harvest.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: diced cartilage grafts to the nose, dr barry eppley, indianapolis, revision rhinoplasty
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Friday, September 30th, 2011
Q: Dr. Eppley, four years ago I had a hair transplant procedure done. The procedure left me with a wide, deep and very visible scar in the back of my head. I want to do anything that is possible to reduce the scar. Can you please help?
A: The traditional method of hair transplantation uses the strip method from the back of the head for the donor hairs. One of the problems with this donor site is that it can leave a large scar due to its horizontal orientation, which exposes it to the downward pulling forces of the lower scalp and neck skin. This can result in a wide scalp scar if not closed properly or if this donor site is used more than once, which is frequent. If a man at some point decides to give up on hair coverage on top and wants to shave his head or have a close-cropped haircut, this scar can become an aesthetic liability. This is why the contemporary approach of FUE, follicular unit extraction (Neograft), is better because it does not leave a single long scar for the posterior scalp harvest.
When it comes to improving the wide horizontal scalp scar from a hair transplant, there are two approaches. A traditional scalp scar revision can be performed which means that the entire scar is removed and re-closed, making it a much finer and more narrow scar. The other approach is to use an FUE technique. The scar is contracted by the punch excision of scar tissue and hair transplants are inserted. Both have their merits and I would need to see pictures of the scar to determine which may be best. If there is significant scalp laxity, then scar revision is a good choice. If the posterior scalp is very tight, then the FUE approach may be better.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, revision of hair transplant scars, scalp scar revision
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Thursday, September 29th, 2011
Q: Dr. Eppley, I am writing to you because I am interested in getting a custom implant made for my jaw/chin to improve my profile. I currently have a chin implant that I am not satisfied with because it only advances my chin horizontally. I am interested in vertically lengthening my chin. I saw on your website the case study of vertically lengthening using a custom implant and I wanted to see if this could help me to achieve the results I desire. Specifically, I want to know if a custom implant can both vertically and horizontally lengthen my chin and front of my jaw. I have attached some pictures of what my face looks like before and after the original chin implant surgery.
A: In looking at your desired chin change, there is no question that a significant vertical lengthening as well as some further horizontal advancement is needed. There is two ways to get there.
1) Custom Chin Implant – There is no off-the-shelf implant that can remotely make this amount of chin change. Based on a mandibular model from a 3-D CT scan, I can custom make an implant to the exact specifications that will work. Your existing chin implant would then be replaced by this new one. This is the ideal implant approach and adds additional costs to the base surgery to make the actual implant and have it ready for surgery. (the CT scan cost would be in addition and is based on the facility fee charge)
2) Chin Osteotomy – Keeping your current chin implant in place, a chin osteotomy is performed above it and the entire chin with implant is brought forward and vertically lengthened with an interpositional hydroxyapatite block used as a graft. This is what I call the extreme chin augmentation approach, combining an implant with an osteotomy.
In looking at your pictures, I think #2 is a viable option but I would need to confirm that by looking at a lateral cephalometric x-ray. (standard orthodontic/oral surgery film.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: custom chin implants, dr barry eppley, indianapolis, vertical chin lengfthening
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Wednesday, September 28th, 2011
Q: Dr. Eppley, I have saline breast implants in now that are 375cc in size. While my surgeon said they would be perfect, I knew from the beginning they were too normal. (maybe perfect for him but not for me) They are under the muscle and are smooth Mentor saline implants. They were placed through an incision under my armpit as I did not want any breast scars. After having had them for six months, I am more convinced than ever that I want to go bigger. I want to go at least 500cc and maybe 550cc. Can my current implants be removed and replaced by going through the armpit again? I still do not want any scars on my nipples or under my breasts. Should I use saline again or go with silicone implants this time?
A: In terms of a size change, you want to make sure that you are having a breast implant volume change of at least 30%, as that usually the minimum it takes to see a real cup size difference on the outside. That is why a change to 500cc (33% is the least you should go) and 550cc (46%) would be more ideal. You do not want to go through a second surgery and still fall short of your size goal.
Since the incision is an important concern for you, the armpit approach can be re-used and your saline implants exchanged for larger ones. While silicone implants can be placed through an armpit incision, there are some limitations of size. The size you have in now is about the limit for inserting silicone implants using a funnel technique through the armpit. There is no limit of size when it comes to saline breast implants through the armpit.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant exchange, dr barry eppley, getting bigger breast implants, indianapolis, saline breast implants
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Wednesday, September 28th, 2011
Q: Dr. Eppley, I have lost a lot of the fat in my face particularly in the cheeks which has left them very hollow and sunken in. The area below my cheeks looks too full because it is indented above it. I havhe been told that fat injections would be the way to go even though fat transfer may not always stay. I know that cheek implants are permanent becuase they can not be absorbed. But I didn’t know of they come big enough to fill out the entire depressed cheek area. What sizes do they come in and do you think they are big enough to fill out the whole cheek area?
A:Your concept of considering cheek implants for helping restore facial volume loss is only partially correct. Cheek implants are not a substitute for fat injections when it comes to facial fat volume loss. The submalar style of cheek implant can help fill out the buccal area of the cheek (right below the cheekbone) but this represents only part of a larger surface area of the cheek and surrounding tissues which makeup the gaunt or skeletal facial look. Therefore, the use of this type of cheek implant may be a companion strategy with fat injections but is not a stand alone treatment for refilling out the deflated or fat-depleted face. Fat injections are more versatile because they can be placed anywhere. Cheek implants, even the submalar style, can not go very far from the edges of the bone and are more limited as to the facial area that they can cover.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, facial fat loss, fat injections, indianapolis, submalar facial implants
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Wednesday, September 28th, 2011
Q: Dr. Eppley, after enduring over twenty years of having an indented tracheostomy scar, I am finally getting it revised. I understand that up to 50% of the fat tissue that is used as a filler gets dissolved by the body while it is healing. Is it possible that one would need multiple visits over the years to keep adding filler injections or something of that nature? Also, if one were to avoid that route in favor of something “off the counter” which product would you recommend? Thanks in advance.
A:Most tracheostomy scars can be revised and the neck skin leveled by simply closing the deeper layers of the excised scar as it is closed. This brings in tissue from the side and fills the defect or area of missing tissue underneath the skin. Larger or more indented tracheostomy scars, however, do have a real subcutaneous tissue deficiency as a result of fat loss due to pressure atrophy caused by the indwelling tratcheostomy tube. When these are merely excised and closed, they will revert to some degree of inversion as the skin is essentially closed over an ‘open space’. This is why the placement of fat grafts can be so helpful in tracheostomy scar revisions. However, the choice of fat grafts is critical and should be a dermal-fat graft and not fat injections. These are small composite grafts that can be taken from many locations with a small resultant scar. There are no ‘off the shelf’ products, such as allogeneic dermal grafts, that are a good substitute for a supple dermal-fat graft.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dermal-fat grafts, dr barry eppley, indianapolis, tracheostomy scar revision
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Tuesday, September 27th, 2011
Q: Dr. Eppley, I have this weird-shaped head in the back sticks out. I have been teased about this since I was a child. As an adult, it has not gotten any better. They call me all sorts of names like football or peanut head. I have very low self esteem from this my whole life and I feel like people are always looking at it. I was just wondering if there is a way to flatten the back of my head or make it not stick out in the back as much. Please help me. This would change my life and give me great confidence.
A: While I can not provide any exact recommendations without seeing pictures of your head first from different angles, I can make the following general comments. When it comes to head or skull reshaping, the question is whether the bone needs to be reduced, built up or some combination to get a smoother and better-shaped skull area. Given that there are limits as to how much the skull bone can actually be reduced and that the amount of build-up is always much greater than what reduction can be achieved, the focus should be on whether an augmentative cranioplasty will help. The second general comment is that most cranioplasties, other than for very small areas, has to be done using an open approach. From a scar standpoint, this makes skull reshaping a more common procedure in women than men due to differences in hair densities.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, head reshaping, indianapolis, skull reshaping
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Sunday, September 25th, 2011
Inadequate training and poor judgment account for a disproportionate number of complications and unsatisfactory results that occur from cosmetic surgery procedures. With so many different types of doctors doing cosmetic surgery, how can one make a safe choice? Historically, the use of the terms ‘board-certified’ and ‘specializing in’ were enough to demonstrate a doctor’s expertise, but today that is not enough.
Are they board-certified in plastic surgery or another specialty? Many new cosmetic surgeons are board-certified but not in plastic surgery. Their board certification may be in General Surgery, Dermatology, Oral Surgery or Ob-Gyn to name a few. Some may even have an additional board-certification in cosmetic surgery. But this self-created board should not be assumed to be equivalent to those certified by the American Board of Plastic Surgery. There is a significant difference between board-certified plastic surgeons and board-certified cosmetic surgeons that makes them not equivalent at all.
How experienced in doing your procedures of interest is the doctor? This can be a hard piece of information that is not easy to ascertain. Certainly asking the doctor is an obvious way to learn how many the doctor does, but that is not the exclusive source I would use. Look at their websites and see how many before and afters of the procedure are posted. Ask for before and after photographic results and to talk to some more recent patients. (done in the past 3 to 6 months) Word of mouth still remains as a good method of recommendation. Willingness to easily and quickly divulge this information is a good sign. Hesitancy or avoidance of doing so would be of concern.
Hospitals are obviously certified and have to meet highs standards of care and comply with stringent regulations. Surgery centers can be quite different and you want to have your surgery in one that has been accredited by either the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This accreditation and a state license to operate means the facility adheres to safe operating conditions. Doctor’s office are fine for minor surgery but most are not accredited for more significant surgeries and any anesthesia that may be needed.
The cost of cosmetic surgery is always of concern and no one wants to overpay for their procedure(s). But the cost of cosmetic surgeries is influenced by market factors just like any other retail business. This makes a fairly consistent price range for procedures in any given geographic region. If after getting several consultations one price is considerably lower than another, the question should be why. Where are the costs being reduced to offer such a lower price? This is what makes the whole concept of Groupon and other discount programs for cosmetic surgery so unnerving.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, qualifications for cosmetic surgeons
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