Archive for October, 2011
Monday, October 31st, 2011
Q: Dr. Eppley, I am a 48 yr old female. Over the past few years, the corners of my mouth have started drooping, to the extent that I am often asked if something is wrong (it appears that I am frowning all the time). I don’t want major surgery, and in researching options for my issue, the corner of the mouth lift seems to be a possibility. One additional note; the droopiness is more pronounced on the right side. I have attached some photos for your assessment.
A: Downturning of the corners of the mouth is a common aging issue. The lip line is the union of the upper and lower lip at rest when one is not smiling or has any oral animation or movement. It is like a level and one should be able to draw a straight line between the two end points to create a straight lip line. The corner positions of the lips or the commissures have a great influence on the appearance of the lip line. You don’t want them upturned (Joker look) or downturned (frowning or sad) as it gives one a static expression that is not favorable. Corner of the mouth lifts change the location of the commissures through a very small amount of skin resection and lip vermilion repositioning. It is a relatively simple procedure that can have a dramatic effect. It can be done under local anesthesia as an office procedure. It does the one thing that many people think a facelift does but does not. A facelift can not change the corner of the mouth because its pull is too distant. Changing the corner of the mouth must be done by direct excision.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: corner of mouth lift, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Sunday, October 30th, 2011
Q: Dr. Eppley, I feel like the base of my nose is sunken in and needs to be built up. I know that implants are made for the paranasal area but I just don’t want a piece of synthetic material in me. How else can this be done, injectable fillers, bone grafts etc?
A: Paranasal augmentation is the buildup of the portion of the midface around the base of the nose. It should be differentiated from submalar and premaxillary regions of the midface of which they can often be confused. When considering paranasal augmentation, the most common technique is a preformed synthetic paranasal implant. But an implant is not the only paranasal option. Other choices include injectable materials and an autogenous graft. While there are numerous off-the-shelf synthetic injectable fillers, they all have only a temporary effect. For a permanent injectable material, I would use either hydroxyapatite or HTR granules which can be ‘injected’. This is not done in the typical percutaneous approach through a fine needle. Rather it is done through a small intraoral incision and placed on top of the bone underneath the base of the nostrils. The granules or beads are packed into a syringe but are only injected through the open end of its barrel so it requires an incision and some limited subperiosteal pocket dissection to be injected. These materials are non-resorbable and gets good tissue ingrowth. From an onlay graft option, small rib grafts taken from a very small incision at the bottom of the rib cage will also work well and will not resorb unlike onlay bone grafts.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, paranasal augmentation
Posted in Your Questions | No Comments »
Sunday, October 30th, 2011
Q: Dr. Eppley, I have earlobes that go straight down. They don’t have the curve up, just a straight down line to the side of my face making my ears look big when they are actually very normal. Can you fix this without scarring?
A: What you have is a natural earlobe that attaches to your face without a break or upward curve. This lack of a well-defined earlobe attachment is known as a pixie earlobe. Pixie earlobes are usually thought of as an aesthetic complication of a facelift but they are also a natural earlobe shape for many people. Because of the downward and otherwise low attachment of the earlobe to the face, it does make the ear look longer. While there is a relatively simple solution to changing how the earlobe attaches to the face, it can not be done without some scarring. The earlobe can be released and reattached higher through a procedure known as a V-Y advancement. This will move the earlobe up almost a full centimeter and give it an upward curve to its attachment. This will result in a very fine line scar in the wake of where the earlobe attachment used to be. While it is a scar, it is a very fine line. This simple earlobe reconstruction can be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, earlobe reconstruction, earlobe shortening, indianapolis
Posted in Your Questions | No Comments »
Sunday, October 30th, 2011
Q: Dr. Eppley, I am interested in cheek implants as I think they would make my face look better. My cheeks just seem to be so flat and weak. I would like higher and stronger cheekbones as I think they would match the rest of my strong facial features. I have attached some face pictures from different angles for your opinion.
A: In looking at your pictures, I think your goal with cheek augmentation is to create better facial balance by making your cheeks bigger to go better with your longer face and prominent chin. Your chin and lower jaw is your most prominent facial feature and, by comparison, your cheeks are far less prominent. Ideally, the best way to get better facial balance is a combination of cheek implants and vertical chin reduction. I have done and attached some predictive imaging which shows the result of cheek implants with and without vertical chin reduction. The ‘ying and yang’ approach to facial reshaping is often best as most facial imbalances are usually combination problems and not just one single feature alone. Through computer imaging, you can determine if larger cheek implants alone or medium cheek implants with vertical chin reduction produces a more appealing facial change for you.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek imlants, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Sunday, October 30th, 2011
Q: Dr. Eppley, I am a 24 year-old Hispanic female who is interested in breast augmentation. My breasts have shown very little growth and I don’t think there is any chance that they will grow any further at this point. But besides that they are small, they also look peculiar. My nipples and areolas are so big for someone who has very little breasts. Whatever breasts I have just seem to be like a ball that is right underneath the nipple and makes them stick out and point downward. I have attached some pictures of my breasts so you can tell what type of implants I would need to make my breasts look not only bigger but better.
A: Your breasts definitely show underdevelopment for the size of your chest but the real aesthetic challenge is their very wide spacing and a mild case of tuberous breast deformity. The small amount of breast tissue you have is herniating through the base of the areola, thus the very prominent nipples and protruding wide areolas with a very small breast base. This is the very definition of a tuberous breast deformity. Fortunately, the tuberous deformity is fairly mild and I believe could be adequately treated by breast augmentation alone. Given your ethnicity and to avoid a prominent breast scar, I would do a saline breast augmentation through a transaxillary (armpit) approach. I would wait and see how the nipple-areolar complex appears after being pushed out by the implant. There is the possibility that a revision of it may be needed after breast augmentation if it becomes more rather than less protrusive.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implants in tuberous breast deformity, dr barry eppley, indianapolis
Posted in Your Questions | No Comments »
Friday, October 28th, 2011
Q: Dr. Eppley, I had my ears pinned back six weeks ago. Before surgery one ear did stick out further than the other and, even after surgery, it still does. Although both ears are much better looking they are still not as good as I had hoped. I would be happy if the left ear was brought back further to match the other one. When they get better with more time and, if not, when should I have the left ear revised?
A: The surgical techniques used in otoplasty rely on the use of sutures to reshape the cartilages. The final results are a mixture of skillful placement, tightening and their ability to hold as the tissues heal. Between swelling and tissue relaxation it will take up to six months after surgery to see the final result. Besides a good shape, it is also important to have symmetry between the two ears. Even though both ears are rarely seen at the same time, it is still important to have them look as close as possible. Perfect symmetry between the two ears in otoplasty does not always occur and about 10% of patients in my experience may desire some minor touchups to improve their shape and symmetry. In the case of one ear that still sticks out further than the other, this may require a revision to place another suture or two or to remove a little conchal cartilage to get the ear back into a better position. It is a better problem in otoplasty to have an undercorrection than an overcorrection. Undercorrected ears are infinitely easier to improve by an otoplasty revision. I would embark on that revision six months after your original procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: asymmetry after ear pinning, dr barry eppley, indianapolis, otoplasty revision
Posted in Your Questions | No Comments »
Friday, October 28th, 2011
Q: Dr. Eppley, I am a 35 year African-American woman who is seeking to have a rhinoplasty to make some desired changes in the shape of my nose. Building up the bridge and lifting my tip and making it a little more narrow seems to be a standard rhinoplasty changes to my type of nose. I also want my wide nostrils narrowed but there seems to be different ways to do it. Some plastic surgeons place incisions on the inside of the nose and other place them on the outside. While I don’t want more scar than I need, I do want to see a very visible difference in the width and size of my nostrils? What do you recommend for nostril narrowing?
A: To do nostril narrowing, some nostril skin has to be removed. Whether nostril narrowing is done by incisions on the inside your nose or out is a matter of the extent of the incisions and their locations. Internal nostril narrowing incisions cut through and place scars on the skin of the nostril sill. It does create an external scar but it is very small and vertical in nature. By removing a vertical wedge of sill skin it pulls in the base of the nostril by the exact amount of sill skin removed. (usually around 5mms or so). An external nostril narrowing approach uses a similar vertical sill excision but extends it out to involve a horizontal resection of the side of the nostril as well. It is more effective at changing the width and shape of the nostril but does so with a longer scar that lies in the groove at the alar-cheek-upper lip junction. While poor scarring is possible, if done well the scar is well hidden and not visible.
Either nostril narrowing technique can be a very useful adjunct to the final rhinoplasty result. Which technique is better for you depends on the size and shape of your nostrils and how much of a change is needed.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, nostril narrowing in rhinoplasty
Posted in Your Questions | No Comments »
Thursday, October 27th, 2011
Q: Dr. Eppley, I am a 33 year-old blonde female with fair skin. I think my skin is in fairly good shape as I have avoided the sun much of my life. However, even though I am young I have bags and dark circles under my eyes that are far worse early in the morning as compared to the evening. This makes me look tired and I am tired of always looking tired even though I think I get enough sleep. Do I need an eyelid job or will fillers be the right thing to do? I have attached some pictures to help you see my eye problem.
A: It is hard to imagine at your young age that any traditional form of lower blepharoplasty would be needed. These more ‘complete’ eye jobs usually involve skin removal and that is something you do not need. What your pictures show is some lower eyelid hollowing which creates dark shadows or circles. The use of injectable fillers is the treatment you need. This simple office treatment creates an immediate result that will quickly provide a visible improvement by adding volume into the hollows. This is a bit of a tricky area to inject to avoid bruising, irregularities and over correction. Injectable fillers in the tear troughs and lower eyelid hollows can last much longer than in other facial areas, often 12 to 18 months in duration. .
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable fillers for lower eyelid hollowing, lower eyelid injectable fillers
Posted in Your Questions | No Comments »
Thursday, October 27th, 2011
Q: Dr. Eppley, I had liposuction done in my abdomen, lower back, inner and outer thighs and knees six weeks ago. I was told that just over two liters was removed. The day after surgery I definitely felt smaller. But now, six weeks later, I feel that I am back right where I started. I see no changes and I don’t look any different in the mirror nor do my clothes feel any looser. I know that swelling takes a long time to go away and I may still be swollen but when am I going to see changes in my body? Could this be fat coming back so soon?
A: There is always going to be some considerable swelling after liposuction but the usual course of swelling resolution is as follows. Within the first day or two after surgery when the garments are taken off to shower, it is a very encouraging sign when patients say it is already better. If not does not look smaller already, that is not a bad sign for the long-term result but I would prefer to hear it is already looking better. Swelling will then set in and much of the initial improvement can be seen to ‘disappear’. By three weeks after liposuction, one should be in the visible benefits phase where the improvement is clearly evident. By six weeks after surgery, much of the improvement in the body contours is even better even though further improvement can continue up to three months after surgery.
How much improvement any liposuction patient will see after surgery is largely volume dependent. How much fat has been removed will determine how visible the changes will ultimately be. While I don’t know what you looked like to start with and how much fat you had, removing two liters of fat aspirate from all those body areas seems like a small amount. While the final verdict awaits six more weeks, I would question if you had enough removed to really make a noticeable change. Whay we do know is that it is definitely not fat coming back at this point.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction recovery
Posted in Your Questions | No Comments »
Wednesday, October 26th, 2011
Q: Dr. Eppley, I am 44 years old and have had silicone implants for just over 10 years. I have noticed recently that under my left breast near the sternum it has gotten sore. I also have had chest, back and arm pain on and off over the past year. My doctor sent me for a mammogram and I also got an ultrasound at the same time. Both were negative for any problems. Do you think my breast implants are a cause of my problems.? Can a breast implant release harmful chemicals or toxins? I want tio keep my breast implants but if they are dangerous then I want them out.
A: It is impossible to say with an certainty that there is a relationship of the symptoms you are having and your breast implants. What we do know for sure is that breast implants do not release toxins, poisons, or any other harmful chemicals. While you have had a good breast screening work-up, mammograms and ultrasound are not 100% accurate when it comes to detecting an implant rupture. If anything, that is where my suspicion would lie as it relates to your left breast pain. If it persists or increases in severity, I would consider getting an MRI which is the most accurate test we have to detect breast implant rupture.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implants, dr barry eppley, indianapolis, silicone breast implant rupture
Posted in Your Questions | No Comments »
|
|
|
|