Archive for November, 2011
Friday, November 25th, 2011
Q: Dr. Eppley, I want to get rid of my frown lines between my eyebrows. I know that Botox is most commonly used to treat them but I am looking for something more permanent. I have read that a browlift operation can be used to get rid of those scowling muscles. What I am now confused about is whether a coronal or an endoscopic browlift technique would be better.
A: The first thing to understand is that the idea of permanently getting rid of frown lines by surgery does not exist. Browlift methods can help reduce their action but can rarely permanently eliminate their effects. Their action can be reduced by partial muscle avulsion through either an open (coronal) or closed (endoscopic) browlift. There are indications for either type of browlift depending upon the anatomy of the eyebrow and forehead, the location and density of the hairline and the vertical length of the forehead skin. These features are what decides which browlift approach is best, not the action or depth of the frown lines. There are some that would say that an open browlift approach is more effective at getting more frown muscles out due to the open exposure. But those very skilled in endoscopic browlift techniques may be able to offer similar results. For now, however, Botox injections remain as the most effective method of obliterating frown lines even though its effects are not permanent. This effectiveness over that of surgery is one reason why Botox and its competitive analogues are so successful commercially.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox for frown lines, browlift for frowning, dr barry eppley, indianapolis
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Thursday, November 24th, 2011
Q: Dr. Eppley, I am interested in kryptonite bone cement treatment as a craniomaxillofacial treatment for a small skull deformity. I have an area just below my hairline where there is a bonelike material that protrudes a few mm from the rest of my forehead and is unsightly but doesn’t hurt at all. It happened after an accident a few years ago. Can kryptonite be injected into the surrounding area to make the surrounding area more natural in appearance? If so how much? And what are the likely complications?
A: While I don’t know exactly what your skull area of concern looks like, the use of injectable Kryptonite can work very well for small skull contour problems. Done through a small incision close to the skull defect, it can be injected into and around the area of bone irregularity as an onlay contouring material. The biggest challenge with its use is to get an absolutely smooth contour and not to overcorrect the problem or build out too much of a contour. Other than that this is a very simple technique with very little to no real recovery, particularly in such small skull areas The cost of the procedure depends on the size of the defect and the amount of material needed. I would need to see a picture of the problem to determine the suitablity of an injectable skull contouring approach and an accurate estimate of the cost.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable skull contouring, kryptonite bone cement, reconstruction of skull defects
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Thursday, November 24th, 2011
Q: Dr. Eppley, I am going to get breast implants and have had several consultations. One confusing point for me is whether the implants should be above or below the muscle. Of the two consults I have had one says above the muscle and the other is adamant that they go below the muscle. What do you think?
A: There are is no absolutely best position for breast implants in any particular patient. There are advantages and disadvantages to both approaches. The vast majority of patients today have implants placed beneath the muscle for better pocket stability, a more natural look (upper pole shape), better tissue coverage, a lower rate of rippling and less interference with mammograms. The one downside to under the muscle is that there will be animation deformities, meaning the implants will be pushed to the side unnaturally with pectoralis mucle contraction when the arms are extended. The one benefit to an implant being above the muscle is when there is some breast tissue sagging, it can fill out the sagging tissues better. The other under the muscle benefit is for someone who was looking for less recovery time and pain and could not avoid adjusting their fitness regimen or someone who has to have the procedure done under local anesthesia for medical and fear of anesthesia reasons.
In the end, one has to weigh these advantages and disadvantages from the perspective of their own breast anatomy and shape. As a general rule, always remember that any implant in the body always does better in the long run (i.e., less complications) when placed under a thicker soft tissue cover particularly when under well-vascularized muscle.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis
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Thursday, November 24th, 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. Additionally, my upper jaw is recessed. I have consulted with oral surgeons but none believe my problems are severe enough to warrant jaw surgery as my jaw is fully functional. What do you recommend?
A: The use of injectable fillers does have a role in facial reshaping/contouring but it is more limited than most patients appreciate. Because of the volumes of fillers needed to create visible facial contour changes and their temporary effects, the use of fillers must be done judiciously. For lower jaw asymmetry, and particularly for midfacial flattening, injectable fillers have very little role to play in a long term improvement strategy. Lower jaw asymmetry is often the result of a smaller jawline or mandible on one side. That is best addressed with the consideration of a jaw angle implant. Midfacial flattening, particularly done at the upper jaw level (maxilla, LeFort 1 region), needs horizontal volume augmentation. This is best done with either paranasal, premaxillary or both types of lower level midfacial implants. These would be far more effective than any type of synthetic filler injections.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants, paranasal implants
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Tuesday, November 22nd, 2011
Q: Dr. Eppley, I recently had a breast augmentation with a lift six weeks ago. My lift was the vertical type and my implants were silicone gel above the muscle. While I know it is still sort of early and the breasts are still settling into place, I am concerned that I am experiencing that they already sit lower than I would like and they have some rippling on the sides. This rippling is most apparent when I bend over and goes away when I push the implants upward. I am concerned that I will need another lift in the near future if they sit this low already. Should the implants have been positioned higher in the first place?
A: The combination implant-lift breast reshaping procedure (augmentation mastopexy) is a tough one to get just right. It is an artistic balance during surgery of implant size and positioning and how much lift and tissue tightening needs to be done. On top of these difficulties is the unknown variable of how the whole breast settles and what support the breast tissue and skin provides. While six weeks is not the final result, more settling may or may not occur. It would be best to wait a full six months before considering any revision. The rippling you have is a result of the implant being above the muscle and the lack of a substantial breast tissue thickness between the implant and the skin. This might be improved by a higher implant position or a change to an under the muscle position…but there is no guarantee that even with these changes that it will be completely gone.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift with implants, dr barry eppley, indianapolis
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Tuesday, November 22nd, 2011
Q: Dr. Eppley, I have read more and more about people having a tummy tuck and the doctor did not use a drain aftewards. I am interested in getting a tummy tuck but the whole drain scares me. I just can’t get over the idea of having a tube sticking out of me. Is this a safe type of tummy tuck? Are there additional risks to this procedure? Is there an additional cost to have a tummy tuck without a drain?
A: Fluid buildups, known as a seroma, after a tummy tuck is common. The use of a drain is to prevent that build-up from occurring. A drain will stay until there is enough healing inside that the body stops producing so much fluid. Most drains stay in for a week to ten days after surgery. While drains are very effective at decreasing fluid-related problems, they obviously are an inconvenience to say the least. This has led to the concept of a ‘drain-free tummy tuck’ or a ‘no-drain tummy tuck’. This is slightly more than just not using a drain but an actual modification of how a tummy tuck is done. Less skin undermining is done and the underside of the skin is sutured back down to the abdominal wall to decrease the open space where fluid can build-up. This does take more time to do and involves the use of more expensive suture. Whether a plastic surgeon charges more for this tummy tuck technique varies by the practice. I have done many tummy tucks with drains and some without. Some drainless tummy tucks do go on to build up fluid which has to be drained in the office later however…so the technique is not infallible.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, no drain tummy tuck
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Tuesday, November 22nd, 2011
Q: Dr. Eppley, I am a 48 year old female and have begun to notice some fat under my chin, some jowling and some neck wrinkles. I have had gotten two plastic surgery consultations with differing opinions. One said I needed liposuction of my neck with a submentoplasty and fat injections to the jowls. The other said I needed neck liposuction with a jowl tuck-up. These choices seem so different that I am confused. Both plastic surgeons are board-certified and respected in the community.I don’t know which one is right. Any advice would be appreciated.
A: In reality, both are right and these are just two different options for the same facial aging problem. It is clear that you are what I call a ‘tweener’. Your aging issues are not quite enough for a more extensive facelift (neck-jowl lift) but are more than what liposuction alone can ideally improve. In other words, you have a mild amount of excess skin along the jawline and in the upper neck. As these two options are different in technique, they will also produce different results. I think the right answer for you is defined by how much you want to go through for what result. While neither operation is a big procedure, the liposuction/fat injection approach is less invasive but will not tighten the jowl line as much as a limited facelift with liposuction. (jowl lift) It would help to define what bothers you the most, jowling or neck fat. If it is neck fat go with liposuction. If it is jowling, go with the lift.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift, indianapolis, jowl tuckup, neck liposuction
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Monday, November 21st, 2011
Q: Dr. Eppley, I’m a 33 year-old that doesn’t like how my nose and upper lip looks. At one time I was considering a lip lift but decided against it due to scarring. I am in orthodontic braces as I write this and have been told that I would need to postpone any nose surgery until my braces are off. But I wanted to get your recommendations for my nose as I would like to lessen the upturn of my nose and straighten it. I have no hump to be taken down. It is just the tip that needs to be refined. I have attached some pictures for you to see what my nose looks like.
A: Based on your pictures, the upturn of your nose makes the upper lip look longer than what it really is. You were wise to pass on the lip lift. The tip of your nose is short or underprojected as we call it. This makes your nostrils appear bigger and gives you a lot of columellar show. (strip of skin between the nostrils hangs down too much) The type of rhinoplasty you need is one that would lower your nostril rims and decrease your tense septal angle. (high supratip area) This will require some cartilage grafting from your nasal septum to bring the entire tip downward. This rhinoplasty approach will give your nose and lip a more pleasing appearance. It is not that your upper lip is too long, it is that the tip of your nose is too short.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty for short nose
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Monday, November 21st, 2011
Q: Dr. Eppley, I am a 32 year old female that is considering a breast lift. I actually have fairly large breasts being a 36D and with a bra on they look great. But when the bra comes off they look gross. They hang down like two old ladies. I had one child ten years ago and nursed him and this appears to have put the whammy on their once nice shape. What I want is a more uplifted and better shape. I do not want them any smaller or larger They are the ideal size for my body shape in my opinion. Will a breast lift do what I want and is there bad scarring as a result?
A: Many women suffer from age and child-bearing a skin-breast tissue mismatch. As a result they have good size to their breasts but the stretched out skin gives them a low sagging appearance. While some breast sag is aesthetically acceptable, when the nipple sits below the lower breast fold it is rarely pleasing to anyone. This is exactly the condition where breast lifts work the best, removing excess skin and reshaping the breast so the nipple and the entire breast sits higher on the chest wall…many times back where it used to be. While there are some minimal incision breast lift procedures, they are only effective for the most minimal amounts of breast sagging. Most really effective breast lifts requires longer scars, much of which lies in the lower breast crease. Whether the part of the scar that goes around the nipple and vertically downward toward the lower crease is acceptable will vary amongst different patients. Seeing pictures of breast lift results with close inspection of the scars is critical for you to determine your level of scar tolerance.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift, dr barry eppley, indianapolis
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Monday, November 21st, 2011
Q: Dr. Eppley, I have reviewed your rhinoplasty computer images of what my nose may look like after surgery. While I like the changes that have been done, what I would like to know is if my nose can get even a bit smaller than what you have showed in your imaged pictures?
A: When it comes to reducing the size of one’s nose, what limits the result is how much skin one has and its thickness. All of the maneuvers in rhinoplasty surgery are about changing the underlying cartilage framework. In reducing a large nose that framework is reshaped and made smaller. While the supportive framework of the nose can be changed, the final result seen will also reflect how well the skin shrinks as well. How well the skin contracts is key and the thicker the skin is the less likely it will contract as much as the cartilage has been reduced. The wild card in every rhinoplasty surgery is how the overlying skin will reshape to the new framework.
I try to show on computer imaging realistic results and often the most minimal changes that I think will happen. While anything can be done on Photoshop that does not mean it can be achieved by actual surgery. You should make a decision about whether surgery is worth it based on the least amount that can be achieved…not on the most that you hope can be accomplished. This is particularly true in reduction rhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, rhinoplasty
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