Archive for May, 2012
Thursday, May 31st, 2012
Q: Dr. Eppley, I was reviewing your Patriotic Program for plastic surgery. Honestly, I never in my wildest dreams thought I could receive a military discount for cosmetic surgery. I’m interested in having a consultation for an Tummy Tuck and liposuction around my knees. I have been waiting for close to 10 years to do this surgery. I think now is the time. My husband of almost 20 years is now serving in Afghanistan.
He should be home in the next two months. That being mentioned, I would like to be healed buy the time he comes home and look fantastic or at least as good as it gets. My husband has been telling me to go ahead and do it but I never do. I always find other ways to spend the money. I know I will feel so much better when my clothes fit nice and I don’t have to wear spanks…especially in a formal gown. Yep, I know I have at least 4 more formals to attend before retirement because of my four children. Thank you so much for taking your professional time to support our troops and their families using your gift.
A: Tummy tuck surgery can make a dramatic difference in your body shape and how you fit in clothes. Since you are done having children the results of a tummy tuck can last a lifetime and is one investment that cap pay dividends for decades.
We have offered military discounts for years for a wide variety of cosmetic surgery procedures. We are happy to do so and try to make a small contribution to those that serve or have served to protect the freedoms for what we have the opportunity
to choose to do every day.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, military plastic surgery, patriot plastic surgery program, tummy tuck
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Tuesday, May 29th, 2012
Q: Dr. Eppley, I had an otoplasty for protruding ears one year ago. From the beginning my left ear has not been symmetrical to my right ear. The top part sticks out a little bit more and it bothers me. I want to have revisional surgery for it. I am assuming that a revision otoplasty is simpler with less recovery than the first one? Also, how likely is it that the ears will end up the same? It would seem like it is easier now that only one is being changed as opposed to two ears. Lastly, since the left ear will have had two surgeries will it end up being weaker than the right? If it gets hit is it more likely to spring back out again if it is weaker?
A: You are correct in assuming that only one ear is less invasive and easier than operating on both ears. Also a revision of an otoplasty in any one ear is less invasive than the original since usually only an additional plication suture or two has to be placed. Given that yours is just the top part of the ear, only the upper half of the incision has to be re-opened for suture placement. This also means that such a revision can usually be done under local anesthesia. Certainly a revision is going to get your ears closer in symmetry but I would not expect perfection. It is unlikely that your ears were perfectly the same before surgery so you should not expect perfect ears after surgery either. The revised ear will not end up being weaker since no cartilage is removed, it is just folded back further.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, revision otoplasty
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Tuesday, May 29th, 2012
Q: Dr. Eppley, My nose has a lot of things about that I don’t like and want to change. It has never been broken or anything so I think I was just born with this shape of a nose. What bothers me about it are several things. First, I don’t like the thick broad tip that I have. It needs to be thinned and made more narrow. I also think the tip is too long. Second, I don’t like the nasal bump that I have. My nose is not smooth from between the eyes down to the tip due to this bump. I also think that the bump makes the nose broader up top. I guess when you put these two things together, I pretty much want a whole new nose. I am wondering if a lot of these changes are possible.
A: Essentially your redo of your whole nose is known as a complete septorhinoplasty. Through an open approach all segments of the nose are addressed. The hump is taken down, the upper nasal bones are narrowed, the tip is reduced and narrowed and the dorsal line of the nose is made smooth. If needed the septum is also straightened, or at the least, used for cartilages grafts which are almost always needed. This is a complete overhaul of the nose and substantial changes can be obtained. All of what you are describing is both possible and also common im rhinoplasty surgery. Make sure you get some computer imaging done before surgery so you will be prepared for what these structural changes will potentially look like.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, septorhinoplasty
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Sunday, May 27th, 2012
Q: Dr. Eppley, I am a 34 year old woman who has had two children. I am done having children and now want to address the damage done to my breasts by pregnancy and breast feeding. I have lost all of my breast volume and they sag. I want breast implants but I don’t want a breast lift. I don’t want the scars from the lift. I would be ok with small hidden scars but nothing that goes beyond the border of the nipple and the skin. I have attached some pictures of my breasts. Can you tell me if what I am asking is reasonable?
A: Unfortunately, there is a significant difference between what you need for a good breast result and what you want. You are not alone in this position as many women need a breast lift but don’t want the scars. You have too much sagging to get a good result using breast implants alone. In fact, implants without a lift is going to make your breasts look worse not better. They will create a mound above the current level of your hanging breast tissue and will merely end up placing your nipple on the bottom half of the implants. This will create a breast appearance that you will likely not find better. It will just be trading into a different type of breast deformity.
If you are not ready to accept scars as of yet, you can always have breast implants first and let the result prove to you whether that look may be acceptable.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implants, breast lift, dr barry eppley, indianapolis
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Sunday, May 27th, 2012
Q: Dr. Eppley, I am entertaining the thought of a breast lift only. So I am researching a little bit. I am 50 yrs old and have always had nice naturally large breasts but with age they are hanging low but not flat yet. I’m a Size D now. My question is with a lift only does the procedure reduce the size when they are lifted? I’m sure some liposuction etc is needed so that seems to me it would take them down at least one size naturally. Is that correct? I’m thinking it would not be so bad as with age our backs take a toll carrying them around our whole lives, so smaller could be a good thing. Thank you for your time.
A: A breast lift, in its purest form, does not reduce the size of the breast. It lifts it, tightens the skin envelope and moves the nipple position into a more central position on the breast mound, but it removes no breast tissue. This is what separates it from a breast reduction procedure which also removes a significant amount of breast tissue. But variations can be done to a breast lift procedure to provide both a lift and a small amount of breast reduction. It is this procedure that you appear to be seeking by description. This combination breast lift-reduction procedure involves the removal of between 100 to 200 grams of breast tissue which will reduce the size of the breast by a ½ cup or so. Liposuction can also be done on the side of the breast into the back, an area which is outside the direct effect of any breast reshaping procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift, breast reduction, dr barry eppley, indianapolis
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Sunday, May 27th, 2012
Q: Dr. Eppley, I have finally decided as an adult to have my cleft lip scar and nose asymmetry repaired. What I don’t like about my face is that I have a prominent lip scar, a downturned and twisted nose and an overall flatter face. I have attached some pictures so you can clearly see what I mean. What specific procedures do you think I will need and how are they done?
A: Thank you for sending your pictures. You have many of the very typical lip/nose/midface cleft-induced deformities that many so affected patients have. In analyzing how to make a significant improvement, I would recommend the following approach. A full septoprhinoplasty is needed to straighten out the whole nose and give the tip more projection and some narrowing. You would need a cartilage rib graft to build up the base of the nose (pyriform aperture/paranasal regions) by onlay grafting and as a columellar strut to improve tip projection and support. Your cleft lip repair is pretty good at the cupid’s bow area but I would excise the philtral scar and re-unite the underlying orbicularis muscle better.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cleft lip repair, cleft rhinoplasty, dr barry eppley, indianapolis
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Saturday, May 26th, 2012
Q: Dr. Eppley, I have one calf that is extremely lager than the other, I always had nice legs and nice calves, I dont have bulging veins, but because I am very fair in complexion, my veins were very visible, so i had the vein injected by a podiatrist . ever since that my left calf has progressively gotten bigger. Please let me know if I can get plastic surgery to reduce this calf as to me it is unsightly, so much i dont want to wear a dress. Help!!!!
A: The first question is how long ago was the vein injected and why did it become bigger after. Calf enlargement is not an expected outcome from sclerotherapy, unless has developed a deep vein thrombosis. If the injection was done recently and you have pain in that calf, then I would recommend that you have it evaluated with an ultrasound to make sure you have not developed a DVT.
From a calf reduction standpoint, there are only two approaches. Either reduce the fat around the calf via small cannula liposuction or muscle reduction. Muscle reduction can be done by Botox injections or denervation but there are considerable costs and some surgical risks with either approach. Liposuction contouring is the simplest and whether that would be effective depends on how much subcutaneous fat exists around the calf area. At a minimum I at least need to see a picture of calfs to determine if that is possible.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: calf reduction, dr barry eppley, indianapolis
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Friday, May 25th, 2012
Q: Dr. Eppley, I currently have mandibular angle implants but they are just slightly too large and I would like to get them shaved or switched for a slightly smaller pair. 1.) How difficult is the process of shaving them down? 2.) Is the recovery time just as bad as when they were first placed? 3.) Do you recommend shaving them down or switching them out for a smaller pair? Thank you in advance for your response.
A: Modification of jaw angle implant size is certainly easier than the first procedure. This is because the submuscular/subperiosteal pockets have already been made. This is what causes the real trauma and swelling from their original placement. While there will be some swelling the second time around, it will not be as bad as the first. Whether you modify in size or get new jaw angle implants depends on what type of implant was placed (silicone vs medpor) and what is the dimension that you want changed. If it is a silicone implant, I would just replace it with a smaller size as their cost is very low. If they are porous polyethylene (Medpor), I would shave down the existing implants because their cost replacement is substantially higher and they are easy to shave down after they have been implanted for awhile. (get softer with hydration)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, jaw angle implant modification
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Thursday, May 24th, 2012
Q: Dr. Eppley,I would like to know if I am a candidate for short scar upper arm lift. I had liposuction of the upper arms done 1 1/2 years ago. Since then, my upper arms sag moderately. Thank you
A: Without seeing pictures of your arms, I can only conjecture as to the utility of a short scar armlift in your case. But having had liposuction previously with ‘moderate’ sagging now present, you may well be a candiddate. It depends on exactly where the greatest amount of sagging skin is. The closer it is to your armpit or upper half of the arm, the more likely a limited armlift may be of benefit. It will result in no improvement near the elbow or lower half of the arm.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, limited armlift, short scar armlift
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Thursday, May 24th, 2012
Q: Dr. Eppley, I have what I would consider a significant amount of lipoatrophy in my face (and I’m HIV positive for almost 4 years). I also unfortunately had a small amount of buccal fat removed when I was younger. That, combined with the lipoatrophy, has left my cheeks, buccal, and temporal areas looking quite thin (and in my view, gaunt). What do you feel is the best way of treating this fat loss? I’m not really interested in an implant due to cost and I really am interested in restoring volume. I have had Sculptra treatments previously, but the results were not long lasting and did not restore an adequate amount of volume in my view. I have considered facial fat grafting, but am concerned about the reliability of whether that fat would survive (especially in someone with HIV). I am interested in your thoughts as to what the best course of treatment may be for something that is not short lasting and not outrageously expensive.
A: The only reliable permanent method of restoring volume in the malar, submalar and temporal regions are with implants. Malr shell and temporal implants will do well in those areas. Injectable fat grafting is another alternative, and the least costly one, but its reliability on someone on antiviral medication is very suspect. Even in a patient not on such medication, fat grafting is not always reliable anyway. Unfortunately, there are no treatment options that combine the concepts of ‘not short lasting and not expensive’ when it comes to facial volume restoration. Your best choice under these circumstances is fat grafting and one has to accept that it is unknown what will happen with volume persistence. Another option is to combine temporal implants with malar/submalar fat grafting. Temporal implants are the easiest and least costly of all facial implants to put in and can easily be done under IV sedation as can fat grafting.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial fat grafting, indianapolis, malar implants, temporal implants
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