Archive for September, 2011
Sunday, September 25th, 2011
Q: Dr. Eppley, I am a 50 year old woman and am fairly thin being 5’3″ and weigh 117lbs. I have had what I think is fat on the back of my neck for as long as I can remember. It looks like a buffalo hump and it runs in my family. I have exercised all my life and continue to this very day. I have always been concerned about my posture so this buffalo hump is quite disturbing. I HATE IT! I have had liposuction on my stomach and thighs but no doctor seems to want to address my neck problem. I have had xrays and I do have a greater curve in my upper back than most people. Looking at me from the front my posture is impressive, but when I turn to the side it looks thick like there is a flap of thick fibrous fat. I can grab and feel it. I am self-conscious about wearing my hair up. Now blouses do not fit properly and often I have to alter clothes for them to fit. Please, I hope that you can help me.
A: Buffalo humps on the back of neck are almost always collections of fat. Why you have it there in an otherwise thin person who is very active is unknown. Seeing that your relatives have it indicates that it is genetic in origin and not from one’s lifestyle. An attempt at liposuction would certainly seem to be worthwhile. The fat in the buffalo hump is different than that in other body areas being more fibrous and not pure fat. This is why an open excision is the most effective approach but the midline scar may not be worth it. I would recommend laser liposuction (Smartlipo) as a better liposuction technique in fibrofatty areas.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buffalo hump liposuction, dr barry eppley, indianapolis, neck smartlipo
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Sunday, September 25th, 2011
Q: Dr. Eppley, I had breast implants with a lift over one year ago. While they do look better than before they are very asymmetric. I had 375cc silicone gel implants and vertical breast lifts. The left breast is considerably larger than the right and the implant sits lower and more towards the side of my chest. My plastic surgeon wants to redo the lift on the left and tighten the pocket. Rather than place a bigger implant in my right breast, he wants to take more breast tissue on the left to make them more even. This doesn’t make sense to me and I think it would be better to place a bigger implant on the right to make them look more even. I think he is wrong with his plan but he won’t do it the way I think it should be done. What do you suggest I do?
A: One of the most difficult body contouring procedures to do and get a symmetric outcome is breast reshaping. The combination procedure of lifting sagging breasts and adding volume (an augmentation-mastopexy or breast implants-lift) is challenging and the need for secondary revisions is remarkably high. (25% to 50%) When planning a revision of this operation, there can be multiple options to manipulate including more of a lift or tightening the breast skin, increasing the size of one or both implants, or even removing some breast tissue. Any or all of these may be needed and there are advantages and disadvantages to any of them. While you would prefer to exchange an implant for a bigger size, your plastic surgeon has recommended otherwise. I would make the assumption that he has a lot more experience in doing this surgery and has a good reason for making this recommendation. I would suggest you sit down with your plastic surgeon and discuss your differences. Unless the final result is perfect, and it is likely that it won’t be (better but not perfect), you will never be happy with any outcome unless you understand and agree with the revisional plan.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant revision, breast lift revision, dr barry eppley, indianapolis
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Sunday, September 25th, 2011
Q: Dr. Eppley, I want your advise on getting suitable cheek implants. I currently have a Medpor midface contour implant. They were placed six months ago. My implants were placed unmodified. Although I have achieved a decent level of midface augmentation, I feel the implant is too large, surface area wise. It is too close to my eyes and is also too low and close to the top of my teeth. I also have visible edges on both the left and right side near my eyes.I did previously have a Lefort 1 osteotomy for my bad bite in the past but the central part of my face wasn’t really improved. What I was looking for in cheek implants was something to improve my midface. The current implants have alleviated midface flatness but I do still feel I look at bit gaunt but less so. However they are just too big, so looking for opinion of porex alternatives which might be appropriate. I was looking at either RZ 5m, or the 4mm extended malar, basically something to emulate the middle third or so of my current implant. I have attached pictures for you to see my face and what my current implants have done.
A: What you are showing is the problems with stock midfacial/cheek implants which are now, by your own illustrations, demonstrating that their shape is not adequate in multiple dimensions. This leaves you with three implant options:
1) Modify your existing indwelling implants by tapering the bothersome edges and adding/removing the areas to create better convexity.
2) Remove and replace your existing implants with new implants that would likely need a combination of infraorbital rim and cheek implants. The medpor RZ4 or the 4mm extended malar are reasonable options but they will need intraoperative modifications.
3) Remove your existing implants and replace with custom-made implants that are designed off of your own skull model.
While all of these are possible, they each have their own advanatages and disadvantages. Modifiying what you have in, while seemingly simple and easy, will not likely make a significant or the desired changes that you want. (but it is always worth a try) Replacing them with new stock implants I suspect will put you in the same position you are now, better in some areas but inadequate in others. There simply are not stock implants that can fully meet your aesthetic goals. Custom-designed cheek/midface implants are the most likely to really meet all of your aesthetic midfacial goals as all of the planning and adjustments of them are thought out before surgery. The only downside is the increased cost to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, custom cheek implants, dr barry eppley, indianapolis, midfacial implants
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Sunday, September 25th, 2011
Q: Dr. Eppley, I was in an accident that fractured my nose, eye socket, cheekbone and jaw. I had 1 reconstructive surgery to place the bones back in place. After the surgery, months past and I was hoping for my face to begin to look the same as before. It has almost been a year and I hate how I look. Afraid of what the world has to think or say, I cover my face with sunglasses. I hate how I look and since then I’ve had a very low self esteem. I want to look for answers. Can my face be fixed? Or will I ever look the same or close to it? I can provide pictures of my face to determine if my face is at all repairable or if it’s just too late. Thank you.
A: Thank you for sending your pictures. I can see that you have a classic post-traumatic facial deformity, known as zygomatico-orbital displacement on your right side. While your initial facial fractures may have been surgically treated, they did not properly place your orbital and cheek (zygomatic) bones back into anatomic position or there were not supported well after reduction. Either way, your right ZMC complex is displaced downward showing the visible problems of orbital dystopia (eyeball in lower position than the other side) and the cheek bone being displaced downward and outward with increased midfacial width.
Your facial problems can be improved by a revision or re-do of your original facial fracture repair. This would be a zygomatico-orbital osteotomy with bone grafts to lift the eye back up and reshape the cheek area. Before considering this surgery, you need to have a 3-D CT scan to confirm this diagnosis and provide a detailed assessment of these and the surrounding facial bones.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial fracture repair, indianapolis, revision of facial fracture repair, zygomatico-orbital osteotomy
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Sunday, September 25th, 2011
Q: Dr. Eppley, I am currently looking to having my Goretex chin implant removed after five years. I have always been unhappy with it as it is simply too big for my face. Can you please let me know how it is removed, any issues I should know and what the process to do it involves.
A: Thank you for your inquiry. When it comes to removing a chin implant, it is often necessary to tighten the mentalis muscle/chin tissues at the same time to prevent chin ptosis or sagging afterwards. This is particularly relevant if it is a large implant and produced a significant stretch of the chin tissues. Much like a breast implant, what happens to the overlying expanded soft tissues on removal? The approach used for chin implant removal, intraoral vs. submental incision, would depend on how it was originally placed and how much loose chin tissues are expected to result. This could mean an intraoral mentalis muscle resuspension or a submental tuckup from underneath. There are, of course, some cases where simple implant removal is all that is needed…but these are only a minority of cases.
Regardless of what needs to be done, this is an outpatient done under sedation or general anesthesia. There is minimal recovery and discomfort afterwards. There are no restrictions after such surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant removal, dr barry eppley, indianapolis
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Sunday, September 25th, 2011
Q: Dr. Eppley, I’m interested in cheek implants and a few other things that might be needed depending on your recommendation. My goal is to have a defined cheek/jaw line like some male model pictures that I have attached. I will get the buccal fat removed also if that is required. The 1st model model might have the cheek implants because the cheek area is not as pronounced as in the 2nd picture. I have attached pictures of myself from different angles so you can see the shape of my face. I look forward to your recommendations.
A: I have done an analysis on the photos that you have sent. The frontal photo is of excellent quality, the side view is not good quality but useable. I have also looked at the model photos that you have shown, and while they illustrate a facial shape goal, I hope you realize you can never look quite like them as you have a completely different facial shape.
Where I think your face can be improved is in multiple areas including vertical chin lengthening with some horizontal advancement (chin osteotomy), cheek augmentation with implants, buccal lipectomies, rhinoplasty with tip thinning and nostril narrowing and earlobe reductions. I have attached some computer imaging to show you a realistic potential outcome.
With your thick skin and existing facial shape, there are limits as to what can be achieved. I thinik this is the best approach to obtain some increased facial angularity.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, dr barry eppley, indianapolis
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Saturday, September 24th, 2011
Q: Dr. Eppley, I have a short face length with a small/narrow lower jaw. From the profile view my face looks even shorter because of my short forehead and short jaw. Could jaw implants fill out my lower jaw and make my lower/overall face look ‘bigger’? I’ve already had a chin implant, but it didn’t do much for vertical length. My plastic surgeon says a sliding genioplasty wouldn’t look good. Should I get a second opinion? Is it safe to get a sliding genioplasty and jaw implants at the same time? Thank you for your time.
A: The right style of jaw angle implants will vertically lengthen the posterior face. But the wrong style of jaw angle implant will only make it wider (fatter) and not longer.
Chin implants will not provide any vertical length, just horizontal projection. No stock chin implants are made for vertical chin elongation.
The statement that a sliding genioplasty won’t look good is a nonsensical opinion. A sliding genioplasty is the only option to provide vertical chin lengthening or lengthening of the anterior face. Just because a surgeon can’t do an osteotomy doesn’t mean it won’t look good or be a good choice for a particular patient.
It is common in my experience to do jaw angle implants with a chin osteotomy and/or an implant. They are often needed together to create an overall change in jaw shape.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, sliding genioplasty
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Saturday, September 24th, 2011
Q: Dr. Eppley, I am interested in having liposuction of my perioral mounds done. I just hate those blobs of fat to the side of my mouth. My only concern about the procedure is that I have read that there are a number of facial nerves near the perioral area. My question is could they possibly be damaged by perioral liposuction. Is this a real concern in your opinion and, if so, what are the risks and side effects of this type of complication?
A: The perioral area is located between the buccal and the marginal mandibular nerve branches of the facial nerve as it comes forward from the ear. Therefore, liposuction is in a safe zone from a facial nerve injury standpoint. So this is not a concern I have as I have yet to see any nerve problems with liposuction in this area.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, perioral liposuction
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Friday, September 23rd, 2011
Q: Dr. Eppley, Hello! I am 31 years old and I used to be 375 lbs until I had gastric bypass surgery two years ago. Today I weigh 157 lbs, but now I suffer from loose skin on my abdomen, arms, buttocks, and thighs. I have a “skirt” of abdominal skin that reaches down to my groin area, and I suffer from irritation, yeast, and sores due to this excess skin. My breast size also went down significantly. I currently am on Medicare and Medicaid, and I was wondering if you offer a procedure that can remove this abdominal “skirt” that is covered by Medicare. Furthermore, I am also interested in getting a breast augmentation, and was wondering if my Medicare will cover it if it will cover the “tummy tuck” surgery. Thank you, and I look forward to your response!
A: Thank you for your inquiry. While you would do well with a circumferential body lift or even a frontal abdominal panniculectomy, I am not a Medicare provider so I can not be of assistance to you.
While there is the chance of some coverage by Medicare for an abdominal panniculectomy, there is no chance that they would ever cover a completely cosmetic procedure such as breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, indianapolis
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Wednesday, September 21st, 2011
Q: Dr. Eppley, I have a very prominent fat pad (?) on the left side of my face. I am 62 years of age and had a facelift eight years ago. I have a rather thin face which has lost with age some fat which I guess is expected. This lump has created a chipmunk effect like I have a big piece of bubblegum in my mouth all the time. What is the cause of this problem? Is it fat? What can be done about it? I have attached some pictures.
A: Thank you for sending your pictures. By your description and pictures, you have the classic findings of a ‘ptotic buccal fat pad’. Underneath the cheek bone sits the large cheek or buccal fat pad. With age, and sometimes after a facelift, this large pad can fall downward as the space in which it normally lives becomes loose and it leaves where it normally sits. This buccal fat prolapses or herniates outward, falling down to the level of the perioral (corner of the mouth) region. Patients will describe it as a wad of tissue that is inside the lower end of their cheek.
That being said, the question is what to do with it. There are two approaches, removal or resuspension of the buccal fat pad. While in some cases I would recommend resuspension, that may lead to some facial asymmetry as where it needs to go above is already symmetric to the other side. (usually done only when the problem exists on both sides) Therefore, removal would seem most judicious in your case. That could be done by small cannula liposuction from a small incision inside the corner of the mouth.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: buccal fat pad liposuction, dr barry eppley, indianapolis, sagging buccal fat pad
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