Archive for November, 2011
Wednesday, November 30th, 2011
Q: Dr. Eppley, I am possibly going to have a chin reduction. Here is my serious concerns. I have a very thin face with hollow cheeks. My forehead is large and my chin is small. The problem is I have a projected or jutted out chin which is very pointy, especially when I smile. I have a very strong jaw line, and I just want to to get rid of the witch’s chin look but keep the exact same frontal look. I cannot afford to have my chin shortened. I want a softer look, but I am terrified that I am in for serious dissapointment. If I did this, I would want to do the submental approach and the burring teqnique because I don’t have a long chin. It seems safer, and by your articles it seems I may be correct. I want a softer, more feminine look without making my face look any thinner, and the projection gone. Is this possible?
A: Thank you for sending your inquiry and your pictures. I would take a slightly different approach to your chin. In the frontal view your chin is very square for a female and it needs tubercle reduction (side chin reduction) to soften it. From the side view, it needs some slight horizontal reduction and soft tissue tightening. I would not do any vertical length reduction. You need the length to fit the rest of your face.
This chin reduction procedure is best done, as you have mentioned, from the submental approach to manage the excess soft tissues that will result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin reduction, chin reshaping, dr barry eppley, indianapolis
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Tuesday, November 29th, 2011
Q: I am interested in a rhinoplasty to build out my nose as it is very short. I am of Asian background and have a small flat nose which is inherited. I have read that it can be done with either a rib graft or using a synthetic implant. I would definitely prefer using rib as that would be more natural. I have done some imaging of my nose in profile to show how I would like it to look afterwards. Can this type of result be done?
A: In looking at your profile and predictive imaging, I would make two points. First, using a rib graft for the short nose is the best long-term approach. This is particularly true when there is a significant amount of augmentation desired. Large amounts of synthetic material will put the nose skin under tension ultimately leading to thinning of the skin and tissues and risks of exposre or extrusion. A little synthetic material on the dorsum of the nose can work well. A lot is a recipe for complications. Secondly and of equal importance, you have unrealistic results. That amount of augmentation is not possible no matter how it is done. The skin of the nose will simply not stretch enough to accommodate that much augmentation. And even if it would, you would not want it to. You should realistically expect about half of that rhinoplasty result that you are showing.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rib graft rhinoplasty
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Tuesday, November 29th, 2011
Q: I have a big overhanging belly that I want to get rid off. I have two small children and have lost over 30 lbs since my last one but the sagging belly persists. Will exercise be enough or do you think I need a tummy tuck?
A: While I have not seen a picture of you, your description alone of your belly has already answered the question. The idea of an overhang suggests a lot of loose abdominal skin. If some weight loss has not made a difference in its size, then you know exercise is not the final answer. Undoubtably some form of a tummy tuck is what you need. You can’t exercise off loose skin no matter how hard you try. Just ask any gastric bypass patient who undergo a lot more weight loss than you have. This is a surgical problem. When it comes to exercise and weight loss, however, I would recommend that you get in the best shape as possible for a tummy tuck. Preparing for such surgery, like training for an athletic event, will have you recover faster and may also help you achieve a better result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, overhanging belly, tummy tuck
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Tuesday, November 29th, 2011
Q: Is Xeomin used in masseter hypertrophy? If it is, is the amount of diluent used the same as Botox. Thanks.
A: Xeomin will work the same as Botox for masseter muscle hypertrophy. It is just as potent and has the same onset of action as a full week after the injections. Like Botox’s other competitor Dysport, the unit dosing may be somewhat different from Botox and an exact replicative dose is not well established. For a cosmetic effect in the frown lines, reports indicate that Xeomin has similar dosing to that of Botox on a 1:1 unit basis. Whether such a dosing method works the same in the masseter muscle is completely unknown. If I was a patient knowing what I know, I would not switch from Botox for massteric hypertrophy if it is working. It will take a lot more clinical experience to determine what dosing comparisons are between Xeomin and Botox. For now, there is no known advantageous reason to make that switch and there is the risk of less effectiveness.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, dr barry eppley, indianapolis, masseter hypertrophy, xeomin
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Tuesday, November 29th, 2011
Q: Hello, I have been researching for a while now on getting a procedure done before my husband whose is in the service returns home from Afghanistan. I came across your page and was wondering if I could have a little more information on your Patriot Program? I am interested in getting a tummy tuck done. After having 3 children and losing a lot of weight, i am left with a loose stretch marked covered skin. I only weigh 120 lbs and am happy at the weight I’m at. But I just do not the appearance of my stomach. Any information would be greatly appreciated. Thanks so much!
A: It sounds like what you may need is some form of a tummy tuck. Whether this is a full tummy tuck or a more limited variety will depend on how much loose skin you have. In most cases if one can tolerate a longer scar, a much better abdominal result is obtained with a full tummy tuck. The Patriot Plastic Surgery Program was established to provide some reward for those and their families that are in the active military. It is not a free surgery program but substantial cost reductions are offered. To get an exact cost, please send me some pictures of your stomach for my review and my assistant will forward you that information.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, patriot plastic surgery program
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Monday, November 28th, 2011
Q: Six months ago I had breast implants with an around the nipple type of lift, I had 350cc silicone implants placed in each breast. Right after the surgery, there were a noticeable difference in the shape of my left breast. It sat lower on my chest and appeared smaller than my right breast. Can this be fixed? I have attached pictures from different angles so you can see the difference.
A: In looking at your pictures, I see a fairly good result. While I do not know what you looked like before surgery, this is an overall nice result, I do see a slight difference in the breasts with the left breast having a small amount of inferior and lateral positioning, This may or may not have to do with the location of the implant.
For the sake of discussion, let us assume that it is an implant location issue. One of the most common reasons for revisional surgery after breast augmentation surgery is implant asymmetry or malposition. This presents in many ways from an implant being too high, too low, too far to the side, to being too far to the middle. Invariably, there is always the good breast and then the bad one. (or as I call it the good sister and the bad sister)
Implants that are too low or too far to the side can be corrected using an internal suture technique decreasing the size of the pocket and moving the implant to a more symmetric position to that of the other side. Expect improvement but not perfection. It is unlikely that your breasts were perfectly symmetric from the beginning and this surgery has likely unmasked that pre-existing issue.
I would also think very carefully about revisional surgery for a minor amount of breast asymmetry. All surgery involves risks which are always greater when a synthetic implant is involved. Those risks are not necessarily less than that of the original breast augmentation/lift surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant revision, breast lift revision, dr barry eppley, indianapolis
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Monday, November 28th, 2011
Q: I had liposuction surgery of my stomach and waistline four months ago and I think it was botched. My surgeon removed too much on one side of my waistline and left the other side straight. I can still feel that there is fat remaining at the love handle area of the straight side. It is very odd looking in appearance to me. How can there be such a difference between the two sides? There are also dents in different areas across my stomach. Can all of this be fixed and made to look better? I am very upset about the way it looks as I used to have a very smooth and even waistline before even if it was too fat.
A: While I can understand how you feel, calling your result botched is most likely an inaccurate assessment. Liposuction is an art form and not an exact science. Irregularities and asymmetries are not rare from liposuction even in the best of hands. It is a blind procedure done by feel and how it looks from the outside in the face of fluid distention and the patient laying horizontal….distortions that assure some degree of imperfections in most results. There is also the influencing issues of your skin and how well it adapts to the fat removal…a variable not controlled by the surgeon. Your issues can most likely can be improved by some refining liposuction of the bigger love handle and fat grafting into the stomach indentations. Expect improvement but not perfection from any revisional liposuction procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, liposuction indentations, liposuction revision
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Monday, November 28th, 2011
Q: Dr. Eppley, I had a breast augmentation about three months ago. My problem is that my implants are literally touching each other. There is no gap between them. While I wanted better cleavage, this is too much. In addition, when I move my arms more than just a little bit, both implants jump to the sides which is freaky. I now know that my implants are too big and I want to go smaller. I currently have in 450cc and want to go down to 350ccs. Will I need a lift if I go down to that size? Will switching to smaller implants stop them from touching each other? I’m attaching a picture, how would you correct my problem?
A: What you have are several implant issues. First, the implant pockets nearly join over the sternum, This is known as symmastia. Downsizing your implants will not correct that problem. Correction requires the pockets to be sewn down in that area and may even require an allogeneic graft placed along the sternum to prevent recurrence. Secondly, your implants are definitely too big as they are wider than the base of your natural breasts. This is why you have both symmastia and that the implants go too far to the sides. Downsizing your breast implants by 100ccs and changing to a high profile implant will make them look more natural. Based on your pictures, you will not need a lift if you go smaller in implant size.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant revision, dr barry eppley, indianapolis
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Sunday, November 27th, 2011
Q: Dr. Eppley, I had gynecomastia surgery one month ago. I have noticed that my nipples are depressed inward. Is this just a temporary look and will it go away and the nipples even out with more time? The tissue directly under my nipple is still hard and stiff. I know I may be panicking but I don’t want it to stay like this.
A: At only one month after surgery, it is too early to say that what you are seeing is the final result. However, a retracted nipple appearance this early after gynecomastia surgery is not a good sign. This indicates that either too much tissue has been removed directly underneath the nipple or the surrounding tissues beyond the nipple have not been adequately feathered to make for a smooth transition into the nipple area. I would much rather see a slightly puffy nipple at this point as all of the swelling from surgery has not yet gone away. Once it does the nipple will likely retract some more. The other reason is that too much residual nipple tissue is an easier problem to treat than when too much is removed. I would wait a full three months and even as long as six months to make your final assessment. This length of time is needed to not only allow the chest tissues to fully heal and relax but because revisional surgery would not be done before this time anyway. If the nipple retraction persists, this is going to fat grafting for correction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gynecomastia revision, indianapolis, nipple depression after gynecomastia surgery
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Friday, November 25th, 2011
Q: Dr. Eppley, I am interested in creating a more symmetrical look to my face via fillers and eventually implants. As a result of my jaw being asymmetrical, the right side of my lower face appears fuller and more defined than the left. I have attached some pictures for you to see.
A: Thank you for sending your pictures. I have taken a careful look at them and the fundamental issue is that the two sides of your face are different. The asymmetry is that the entire right side of the face is lower than that of the left. This can be seen from the eyebrow down to the bottom of the lower jaw. the right eyebrow is lower, the right orbital box and eye is lower as well as the lower eyelid, the cheek is lower and more recessed and the inferior border of the mandible is more inferiorly positioned. In short, you have a classic case of facial asymmetry where the two halfs have developed differently. For the sake of any correction, you have to take the position that the left side of the face is the good side or the objective for the right side to try and achieve. No form of injectable filler can make any significant difference in such facial asymmetry. A variety of surgical procedures can be considered from top to bottom including right endoscopic browlift, right orbital floor-infraorbital rim implant, right lower eyelid tightening by canthopexy, right cheek implant and right inferior border mandibular shave reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: correction of facial asymmetry, dr barry eppley, facial asymmetry surgery, indianapolis
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