Archive for April, 2012
Monday, April 30th, 2012
Q: Dr. Eppley, Since you are experienced in migraine surgery, would you mind answering a few questions? 1) How does surgery for migraines work? 2) How many people undergo the surgery? 3) How often does it work? 4) What are the costs? 5) Is it covered by insurance? 6) What should people try before undergoing the surgery? 7) Why are you the only doctor in Indiana who performs this surgery?
A: In answer to your questions:
1) Migraine surgery works on the principle of sensory nerve decompression by removing the constructing muscles around the nerves, known as trigger points. I would recommend you go to www.eppleymigrainesurgery.com to learn more or go to www.exploreplasticsurgery.com and search under migraine surgery where the details of surgery are discussed in multiple blogs in detail.
2) Migraine surgery is for those patients who have very specific types of migraines that have been fully worked up and treated by a neurologist and have received either no or little relief. Surgical candidates are chosen either based on their response to Botox injections or by their migraine history.
3) The one and five year results show that over 70% of people experience significant and sustained relief. About 30% of patients are cured and subsequently experience no or few migraines again. About 10% of patients experience only temporary relief and long-term do not show significant improvement.
4) Costs are based on how many migraine trigger sites are released and the time to do the surgery. Costs could range from $3500 to $8,000.
5) It is usually not covered by insurance. Insurance companies, despite the overwheling evdience, feel that it is still ‘experimental surgery’.
6) As per #2 above.
7) Migraine surgery is usually done by plastic surgeons who express an interest to treat this medical condition. The surgical techniques used are common to board-certified plastic surgeons and come from procedures learned from cosmetic and craniofacial surgery, microsurgery and hand surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, migraine surgery
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Monday, April 30th, 2012
Q: Dr. Eppley, is it possible to lift the ears in a higher position, perhaps for about 10 mm. If it is possible, how is this procedure performed and is there any risk that the shape of the ear changes?
A: Lifting of the ear superiorly is ultimately limited by its cartilaginous attachment to the ear canal. Essentially you have to rotate the superior ear cartilage in an upward direction with either fascial suture plication to the temporalis fascia or using a micro-bone anchor to the posterior temporal bone. This will cause the ear position to elevate, it is just a matter of how much. It is possible that it may move as much as an entire centimeter although it may be less. This type of otoplasty does not generally change the shape of the ear although it could slightly decrease the aurico-cephalic angle somewhat.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, ear lifting, indianapolis, otoplasty
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Monday, April 30th, 2012
Q: Dr. Eppley, first of all I want to say that your site is full of information and i have learned a lot of things. I want to do an osteotomy/genioplasty on my chin to achieve facial balance cause I have a receding chin. I also want to do this surgery to shorten and make my lower lip thinner. Will this surgery tighten the lip and chin musculature and will it cause my chin to look thinner? I am looking forward to hearing from you.
A: In most cases of an osteoplastic genioplasty where the chin is advanced, it will make the width of the chin thinner. This is because a chin osteotomy is like advancing the front part of an upside U forward. It is elongating the U and makes it more narrow. Whether that effect is significant or not depends on how much advancement is being done. But anything over 5 to 7mms, the thinning effect will be seen. It does not usually make the lower lip any thinner however.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin osteotomy, dr barry eppley, indianapolis, osteoplastic genioplasty
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Sunday, April 29th, 2012
Q: Dr. Eppley, I was all ready to go ahead with the chin implant, but I have read some disturbing stories and research papers about how “silastic implants” lead to bone erosion in chin implants only, and how they could be as deep as 1.5 to 4 mm in depth, and their close proximity to root apices. Also, I am wondering why some surgeons, such as yourself, use screws to secure the implant while others just insert and leave it in the created pocket. I never thought of this aspect of chin implants, the complication with bone erosion.
A: You are referring to an old phenomenon that is largely irrelevant today. If a chin implant is placed too high up off the chin point (which is not where it should go), there may be some settling of the implant over many years into the softer alveolar bone under which lie the tooth roots. Some refer to this an ‘erosion’ but it is not an active process but a passive one representing pressure release. (meaning it stops once the pressure of the push of the overlying soft tissues is released) If properly placed on the basal bone of the chin, which is 10 – 15mm below the lowest level of the tooth roots, this is an issue which is not seen. If this is an unsuppressed concern, I can also use chin implants made of Medpor material which have little history of showing the same effect. The difference is that the cost of surgery will increase as these implants are more expensive.
The number one complication of any facial implant, chin implants included, is shifting of the implant causing implant malposition and asymmetry. The most assured way to avoid that problem is to secure it to the bone, a very simple and effective method using screw fixation. It makes me feel the most comfortable that there is no chance the implant will shift either after surgery or later in life for any reason.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant bone erosion, chin implant screw fixation, dr barry eppley, indianapolis
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Saturday, April 28th, 2012
Q: Dr. Eppley, I am thrilled about which intervention I have to have done to my lips. They are both thin and fillers give me a duck look. I can’t decide if a vermilion advancement or a V-Y plasty is the best for me. Thank you for taking the time to answer me!
A: Usually the vermilion advancement or lip advancement works best in very thin lips because they lack adequate vermilion height for exposure. The V-Y advancement is an internal mucosal roll procedure that primarily creates greater central lip pout and increased vertical lip length, in essence a greater effect on mucosa than the vermilion. They actually are quite different procedures on their effect on creating lip size and shape. The vermilion advancement is also much more versatile in shaping the cupid’s bow area of the central upper lip which the V-Y advancement can not do.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lip advancement, lip augmentation, v-y mucosal advancement
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Friday, April 27th, 2012
Q: Dr. Eppley, I am interested in some non-invasive body contouring. (stomach and flanks) I have read about the Exilis device and it seem very promising. I know it uses radiofrequency energy to do its work. But there are other devices out there that all use the same type of energy. Why would Exilis be any better than these other ones?
A: There are many new radiofrequency devices on the market and a lot of them are claiming that they have a similar or superior technology to that of Exilis. Regardless of what their product is called, almost all of them use bipolar radiofrequency. Bipolar radiofrequencies only have the capability to penetrate fairly superficially, generally no further than the deep dermis. Thus they are good for skin tightening but can not reach the fat layer nor reduce it effectively or consistently.
Exilis is different in that it uses monopolar radiofrequency. This allows it to penetrate more deeply generally up to inch (2.5 cms) below the skin. This does reach the fat layer. The cooling component on the Exilis allows it to bypass the dermis to effectively place the energy into the desired tissue (fat) and maintain penetration depth, all while keeping the skin cooled and uninjured. There is also an energy flow control on Exilis that allows the target tissue to quickly reach the desired treatment temperature. The combination of these two technologies allows Exilis to have effective fat reduction and skin tightening capabilities.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, exilis, indianapolis, ology spa
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Friday, April 27th, 2012
Q: Dr. Eppley, I am interested in 1) reduction of large occipital bone by burring and 2) forehead augmentation. Due to a narrow and recessed forehead above the brow bones, this needs to be built up with implant material. Can the scar follow the hairline if it naturally angles back laterally from the most center front couple of inches of the horizontal hairline?
A: Let me answer your two areas of concern with some general statements.
1) Reduction of a large occipital bone is always a question of how much be removed. In other words, is it worth it or not. That is best determined by getting a lateral skull film so measurements can be made to determine how much the bone can be reduced. It definitely can be burred down. The question is…is it enough to make a visible difference.
2) Forehead augmentation does require a scalp incision. generally, it is placed way back in the hairline…more than just an inch or two behind one’s existing frontal hairline. That would be particularly good if one is desiring some occipital reduction as well.
That being said, the first place to start is for you to send me some pictures of yourself for my assessment and then we can have a phone or Skype consultation for further discussion.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead augmentation, indianapolis, occipital reduction
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Friday, April 27th, 2012
Q: Dr. Eppley, I went to see a dermatologist for the first time due to dark marks on my hips and buttocks. I have been getting “boils” for the last 10 years…on and off, but recently it seems to be under control since I have been exfoliating and applying topical creams. My dermatologist tells me that I have “post-inflammatory hyperpigmentation” from folliculitis. He has prescribed a 4% hydroquinone cream which is to bleach these darker spots and will take approx. 6 months. When I asked him about any other method of treatment, he had no suggestions. I noticed on your website that you also offer laser treatments for skin problems. I’m wondering if there is anything more effective that can be done for my hyperpigmentation? I had read about certain types of lasers specific for the treatment of hyperpigmentation online but unsure how effective it would be. Being Asian, I’m not sure if these other treatments would be suitable for me. Could you please advise on the treatment for my case?
A: As you may know being Asian, hyperpigmentation is a common problem and a difficult one. Bleaching creams are the standard approach and, while they don’t pose any risks with use, are slow to work and often not that effective.
One technique that can be effective with a more rapid response is pulsed light therapy, often known as IPL or BBL. While often perceived as a laser, it is different being high intensity pulsed light not focused beam light. With selectivhe filters it can reduce the hyperpigmentation in a single treatment by selectively targeting the brown pigment for elimination. This in combination with hydroquinone can help reduce hyperpigmentation fairly quickly.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: BBL for hyperpigmentation, dr barry eppley, indianapolis
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Thursday, April 26th, 2012
Q: Dr. Eppley, can one have a facelift without any visible scars in front of the ear? I have darker skin and like to wear my hair back. I am worried that someone may be able to see the scars running down in front of my ears. I need a mini-facelift but many results I have seen show the scar in front of the ear. I like to pull my hair back & up!
A: It depends on how you define a scar in front of the ear. All effective facelifts require some type of incision in front of the ear. Most plastic surgeons place this incision behind the tragus of the front part of the ear so that final healed scar is virtually undetectable. A few others, particularly those trained only a mini-facelift technique, still place the incision in front of the tragus so the scar can be potentially detected no matter how well healed it becomes. Why they do this is unclear to me other than it is simpler and makes the operation faster. It clearly does not lend itself to a better scar result. So all facelifts create incisions on the front part of the ear but where they are placed determines whether it is ‘scarless’ or not.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facelift scars, indianapolis
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Thursday, April 26th, 2012
Q: Dr. Eppley, I’m a female and have a steep jaw angle which makes me look witchy from side. I think I may have a long face as well. Would getting jaw angle implants make my face look longer because I do not want this.
A: The best way to answer that question is by computer imaging. Lengthening the jaw angles with implants will increase your posterior facial height but whether that will create a longer look to your face would be best determined by imaging predictions. It obviously will not change the length of the front part of your face but how it would affect the perception of the overall face is very important to viualize. Seeing is convincing…one way or the other.
Please send me some pictures to image.
Dr. Barry Eppley
Indianapoolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implants in females
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