Archive for December, 2011
Monday, December 26th, 2011
Q: Dr. Eppley, I have some questions about skull reshaping. I have a decent head shape, it’s just that when I cut my hair really short or shave off all of my hair my head shape looks distorted. I’ve been realizing lately that the two sides of my head tend to be larger than the rest of my face and my skull is too large above my ears. It makes me have a very awkward face structure almost like a balloon and was wondering if you had any ways to reduce the size. It isn’t a big reducement, just maybe 1/4 of an inch to make it symmetrical. But would there be any scars left after surgery that would be permanent? Thank you.
A: In a normal shaped head, the sides in the front view stay well within a vertical line that extends upward from the helical attachment of the ears. Any bowing out from this line can make it look disproportionate. The temporo-occipital region of the skull (sides of the head) are composed of a thick layer of temporalis muscle as well as bone. It can be reduced about a 1/4 inch per side. Skull reduction in this area is a combination of muscle and bone reduction. It is done through a small vertical incision on each side so there would be a small residual fine line vertical scar on each side.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Monday, December 26th, 2011
Q: Dr. Eppley, I am Asian and am interested in getting my jaw angles reduced. They make my lower face look too wide. How risky is the surgical reduction? And how long is the down time? Is it possible for me to undergo the procedure during spring break (2-3 weeks)?
A: This is not a procedure that I would consider risky. It is a cosmetic procedure that is about reducing the width and shape of the jaw angle. That being said, it does require the masseter muscle to be lifted off of the bone to do the procedure so there will be some significant swelling afterwards. The procedure is done by either burring down the width of the jaw angle (outer table reduction) or actually removing the jaw angle by an osteotomy. It takes about 3 weeks for most of the swelling to go down after this kind of facial bone surgery and about another month or so to see the lower facial width reduction benefits of having the operation. I tell patients that it takes 3 months to see the final results after jaw angle reduction surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle reduction
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Monday, December 26th, 2011
Q: Dr. Eppley, A friend of mine just had her upper and lower eyelids done. She said that on her lower eyelid, besides removing fat and pinching some skin out, that she also had her cheek muscles repositioned. Is it true that cheek muscle can be lifted with a lower eyelid procedure? If so, what is the cosmetic benefit for doing so?
A: What you are referring to is known as lifting the sagging cheek at the same time as a lower blepharoplasty. Some call this a midface lift or malar resuspension. It is not a true muscle lifting procedure but rather that of sagging cheek fat and skin. As the midface ages, the cheek tissues will slide off the cheek bone particularly if the cheek bone is naturally flat or not that prominent. This creates malar pads that can be seen as an additional fold of tissue below the lower eyelids. This sagging cheek tissue can be lifted through a standard open lower eyelid incision for a full lower blepharoplasty. This is convenient since both the lower eyelid and cheek issue can be addressed through the same incision. The operation you describing that your friend had was a more limited blepharoplasty known as a pinch lower blepharoplasty. Through this limited approach it would not be possible to do a true midface lift or malar resuspension.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek lift, dr barry eppley, indianapolis, lower blepharoplasty, malar suspension
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Monday, December 26th, 2011
Q: Dr. Eppley, I have had several children and am wanting to get my stomach back in shape. I am only 26 years old and I don’t want to live the rest of my life with this stomach. I am too young for that! My question is what will happen to my pubic area after a tummy tuck. I noticed that it got bigger after having children and I would like to see that area flatter as well. Will it be taken care of if I get a tummy tuck? Also I have love handles that I would like to get rid of as well. Will a tummy tuck get rid of those as well?
A: A tummy tuck will only solve the problems that lie within its zone of tissue excision. When looking at the markings of a tummy tuck, you will see that the love handles and the pubic area lies outside the excision zone. However, the addition of flank liposuction is a part of most tummy tucks with the recognition that the goal is an extended waistline reshaping that wraps around to the back. Pubic or mons reduction, if needed, can be incorporated as part of the tummy tuck procedure whether it is reduced with liposuction or it is lifted as part of the tummy tuck design. You can see in planning a tummy tuck that the entire area must be taken into consideration to get the best overall result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, love handle liposuction, mons lift, pubic reduction, tummy tuck
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Monday, December 26th, 2011
Q: Dr. Eppley, I had breast augmentation eight months ago. They were Mentor 375cc moderate profile silicone gel implants. My problem is that the implants are too widely spaced apart. My plastic surgeon told me he could fix them by removing the implants, putting in stitches into the sides of the pockets to move them closer together and then put the implants back in. I would like to have more cleavage but don’t know if this procedure is worth it. Should I have this done and how long does it take to heal?
A: While repositioning implants through suturing of the surrounding capsule (capsulorraphy) can be done to push implants in any direction, the question is how effective would it be. This is particularly relevant when trying to make implant move closer to the sternum. If these are submuscular implants, and I have to assume that they area, you must know the edges of the pectoralis muscle will block the implants from moving very close to the sternum. The reason in my opinion to undergo the procedure is to move implants inward that you feel are too far to the side…not because you think will get more cleavage. Laterally displaced implants can be reliably moved back onto a better position on the chest wall. Moving breast implants with the primary intent of creating more cleavage is less certain to be able to achieve that goal. Either way, recovering from an implant repositioning procedure is much less than the original breast augmentation surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant revision, dr barry eppley, indianapolis
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Sunday, December 25th, 2011
Q: Dear Dr. Eppley, Do you mind sharing some advises of yours regarding to diced cartilage for nose jobs? What is the main difference between a piece of rib cartilage being place directly to augment the bridge and injecting fine diced rib cartilage into the bridge as well? Are the side effects of using this ‘diced cartilage’ technique be higher too? Lastly, are there any limitations pertaining to nasal bone narrowing procedures and tiplasty?
A: Rib grafting of the nose is most commonly done for significant dorsal augmentation. Rib grafts offer the most volume to do the procedure and can be done either as an en bloc or a diced technique. There are advantages and disadvantages to either approach. If one can get a nice straight piece of rib cartilage, in which carving and shaping it will not induce warping, then a single en bloc graft method should be done. The problem is that often a good perfectly straight rib graft can be hard to obtain or carving it straight may not make it stay that way. Also, the tunnel or tissue pathway into which the graft is placed must be very tight so the solid one-piece graft does not slip from a straight midline position When the rib graft is not straight and/or there are concerns about midline graft security/fixation, then a diced cartilage approach is the solution. While this takes intraoperative time to do, the risks of graft warping, graft malposition and a crooked nose are virtually eliminated. A diced cartilage approach can also be used when one has multiple small pieces of cartilage, none of which are long and straight enough for a good dorsal augmentation.
The vast majority of diced cartilages grafts in rhinoplasty are placed through an open approach. The cartilage is diced and placed in a fascia or surgical wrap and inserted like a one-piece rib graft. The injectable cartilage approach is only used for very small defects of the nasal dorsum.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: diced cartilage graft in rhinoplasty, dr barry eppley, indianapolis, rib graft rhinoplasty
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Sunday, December 25th, 2011
Q: Dr. Eppley, I am pursing getting a rhinoplasty to make my nose look better. In fiddling with my own version of computer imaging, I have made some changes to my nose that I would like to get done. Are these type of nose changes possible? If so, what type of rhinoplasty do I need? I know there are two types of nosejobs, a tip rhinoplasty and a full rhinoplasty. Which do you think is best for me?
A: I would not as a patient get concerned about the different types of rhinoplasties. The differences between a tip and a full rhinoplasty is somewhat artificial. The basic difference that separates the two rhinoplasties is that a more complete technique involves osteotomies or the narrowing of the nasal bones due to hump reduction or bridge modification. A tip rhinoplasty by classic description does not go past the lower tip cartilages. Regardless, many rhinoplasties incorporate techniques that borrow from each basic type of rhinoplasty making the surgical changes that each patient’s nose needs unique. Your attempt at rhinoplasty imaging is pretty good and I think that it is a fairly achieveable outcome. Hump reduction and tip narrowing and elevation are fairly standard changes that can make many noses look better. Your lack of thick nasal skin makes it also realistic that the alterations to the underlying cartilage and bone will be seen on the outside when the swelling goes down. You may call the type of rhinoplasty that you need a more complete one.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: computer imaging in rhinoplasty, dr barry eppley, indianapolis, rhinoplasty
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Sunday, December 25th, 2011
Q: Dr. Eppley, I had a gullwing upper lip lift two years ago. I am very unhappy with the resulting scar. The surgeon who did the procedure said that the scar would end up invisible…it did not. The scar sits 2mm above my vermilion line and is very indented so even if I try to cover the scar with lip liner and concealer it still shows. The surgeon cut very deep and used only eight sutures on the whole of the top lip. Please give me your honest thoughts and whether it can be improved by scar revision. I have attached a picture of my upper lip so you can see how bad the scar is.
A: Thank you for sending your pictures. I think without a doubt that the scar and the upper lip shape can be improved. The indentation is so visible because the natural shape of the white roll (where the skin of the upper lip and the vermilion meet) is everted not inverted. While the eversion of the white roll is lost in every lip advancement, it should be flat and not inverted. I suspect that deeper sutures were not used in the closure so that inversion resulted. In addition, I see no definition of the cupid’s bow of the upper lip, which is one of the main benefits that a lip advancement can achieve. In looking at your before pictures, I think you had the wrong lip enhancement procedure from the beginning. You would have been better served with a subnasal or bullhorn lip lift not a vermilion or gullwing lip advancement.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lip advancement, lip lift, lip scar revision
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Saturday, December 24th, 2011
Q: Dr. Eppley, I had a belt lipectomy six months ago. The tummy tuck portion in the front did lift my pubic area a bit but it is still puffs out below the scar line compared to the tight abdomen above it. When I lay on my side, my abdomen is tight but the pubic area is puffy and sags like old wrinkled skin. While standing it just looks a bit puffy but no wrinkles. What pubic reduction method would work the best and can it be done under local anesthesia?
A: It is not uncommon that pubic or mons fullness becomes evident after a tummy tuck or curcumferential lower body lift. While this fullness was always there, it becomes apparent when the tightness of the scar above it is more narrow than the original projection of the pubic tissue. Every tummy tuck does create some degree of a pubic lift but it may not be enough to obscure the larger pubic mounds that exist in those that need a circumferential body lift. If this is diagnosed in advance, it can be incorporated into the frontal tummy tuck design or undergo liposuction for reduction. On a secondary basis, pubic reduction can be done liposuction alone or combined with a pubic lift skin excision pattern. Since it appears by your description that you need more than just liposuction, I would recommend a general anesthesia approach.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, monsplasty, pubic reduction
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Saturday, December 24th, 2011
Q: Dr. Eppley, I am interested in getting an otoplasty but am concerned about how will the scars on the back of my ear look after surgery. I almost always wear my hair pulled behind my ears. I worry that my friends and others will be able to notice the scars from having my ears pinned back. How often do otoplasty scars need scar revision. Will laser resurfacing of the scars help if they look bad and how long after surgery can I have it done?
A: While I understand your concern about the scars on the back of the ears, it is not an issue that I have ever heard a patient who has had otoplasty have. Besides the fact that the scars on the back of ear heal really well, there are also essentially invisible because the ear is folded back obscuring the back of the ear skin completely. If you look at back of the head views of otoplasty patients, you will see that the outer helix of the ear hides most of the skin on the postauricular surface. I think your concern about poor or visible otoplasty scars should not be a significant one. Of all the otoplasties that I have ever performed, I have never done a scar revision on them.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, otoplasty scars
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