Archive for June, 2012
Friday, June 29th, 2012
Q: Dr. Eppley, I’ve been reading on your website and found a lot of interesting information. I was looking at pictures for patients, but did not see any that resemble my condition. Do you have any with flat spots that have been filled out in the back of the head? From what I have gathered while reading your site, you can only build out up to 10 cm. I’m just trying to picture how a fix for my condition would look after. My head is normal except for the back and then it has a slope. However, the slope is not uniform. It’s less of degree on one side vs the other. So from the top down there is a slope in the back, but from left to right it is almost like it is angled. Meaning if you looked at me from the back, the right side is not as sloped as the left. In fact, the right side is a little more “normal” I guess. Thanks for your help and information.
A: The most common skull augmentation procedure that I do is an occipital cranioplasty for a flat spot on the back of the head. You are correct in assuming that the buildup would be about 10 to 12mm maximum. Much greater buildup than this may pose problems with incisional scalpclosure or undue tension on the wound which usually lies directly over it. Bony asymmetries are dealt with by a differential application of the material.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, flat back of head surgery, indianapolis, occipital cranioplasty
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Friday, June 29th, 2012
Q: Dr. Eppley, Have you performed many/any superficial temporal artery procedures, either removals or ligations? I am considering this route to rid myself of the unsightly and anoying pulsation feeling. I am concerned about possible negative effects of tampering with an artery, especially one in the head. Thank you for any help or advice you may offer.
A: Improvement of a large and prominent superficial temporal artery can be successfully done. Patients may desire that the artery be diminished in size due to its appearance or from uncomfortable pulsations in it. Manipulation/ligation of the branches of the superficial temporal artery will have no negative effects on vascularization of the scalp and forehead. Thus I have seen no adverse effects from its manipulation other than some minor scars for entrance to the ligations. Generally, at least two small access incisions are needed, one in the temporal hairline and another in the forehead. The artery must be ligated from different areas since there are multiple backflow points into the artery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, superficial temporal artery ligations
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Friday, June 29th, 2012
Q: Dr. Eppley, my 18 year old son had his ears gauged several years ago to a size of about 2 1/2 inches. I have attached pictures as he is now. I was never for it but what can a parent do. He is now ready to have them fixed. I have Anthem insurance. How much would it cost and do you have payment options?
A: Thank you for sending your son’s picture. I have seen many gauged ears such as your son’s. Such earlobe reconstructions can be done very successfully and a normal sized earlobe, albeit with a fine line scar, canc be achieved as an office procedure done under loca; anesthesia. It would be important that the gauges are removed at least 6 weeks before earlobe reconstruction is done. That will allow the earlobe to shrink somewhat and get a better vascular supply to the remaining rim of earlobe skin for optimal healing after the procedure. These are not procedures covered by insurance since the origin of the problem is a cosmetic alteration not a medical one. The cost range is between $1500 to $2,000 for both earlobe repairs.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gauged earlobe repair, indianapolis
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Thursday, June 28th, 2012
Q: Dr. Eppley, I am interested in making my forehead wider. I think it is too narrow for my face. My face has good features and dimensions but starting with my lower forehead it goes up into scalp like a triangle rather than having a forehead width that matches my lower facial width. I think it would look better of my forehead was wider and more prominent. Is this procedure possible and, if so, how is it done and what are the potential complications?
A: Widening a forehead as you have described means expanding its bony contours. Traditional forehead augmentation is done through a scalp incision to build out the forehead with onlay cranioplasty materials but it usually lies on the bone within the edges of the anterior temporal lines. Building out or widening a forehead behind the temporal lines is problematic as that requires lifting up part of the temporalis muscle, which will can easily be done, but almost always results in muscle atrophy seen months later. This potentially can expose the edges of the built out area (cranioplasty material) if they are not perfectly smooth and may make a once smooth transition between the two become more noticeable. Some may refer to widening the forehead as augmentation of the temporal hollows, although that would not normally be considered part of the forehead.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, forehead augmentation, indianapolis
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Monday, June 25th, 2012
Q: Dr. Eppley,I have read that you are familiar with using platelet-rich plasma. (PRP) I have an unusual inquiry. In certain countries in Europe, they inject PRP into the nasal lining and sidewalls and turbinates to restore function and regrowth of the lining. I can send the article and I was wondering if you could do this. They say it adds volume and helps the lining function better from prior surgery.
A: I have read many ‘unconventional’ uses for PRP, but must admit that I am unfamiliar with its potential use in the nasal linings. As an autologous material, its use there would certainly be safe with no untoward effects. I could not attest, obviously, to its effectiveness for this use and would be happy to review any article that reports on it. Doing the procedure would be no different than any other PRP procedure using a 60cc blood draw from the patient. Centrifugation of the extract is then done to create an approximate 3cc concentrate of platelets.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, prp injections, prp rhinoplasty
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Monday, June 25th, 2012
Q: Dr. Eppley, I’ve lost more than 200 lbs. The extra skin is making it harder every lb I lose for me to get around. How will I know when I need to have surgery to take off the skin?
A: I would say that after losing 200lbs, almost no matter what weight you started out at, that you have a substantial abdominal pannus that would benefit by being removed. If this weight loss was achieved by bariatric surgery, then you should get the advice of your bariatric surgeon as to when would be a good time for some body contouring surgery. Usually bariatric surgery patients have to be at least one year from their bypass surgery and they have stable and normal laboratory studies. If this weight loss was achieved by dieting alone, then you may be ready at any time with this amount of weight loss. You may be getting to the point where not much further weight loss can be achieved because of having to drag around this large amount of loose skin. It would be important before this surgery that you have laboratory studies that show a good blood count, normal electrolytes and adequate protein levels that would support good healing.
I would recommend that you get an evaluation by a board-certified plastic surgeon at this point and be evaluated for your readiness for abdominal plastic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: abdominal panniculectomy. tummy tuck, dr barry eppley, indianapolis
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Sunday, June 24th, 2012
Q: Dr. Eppley, even though I am fairly young (35 years old), I have some bags over my cheeks. These are not lower eyelid bags but cheek bags/puffiness. I tried injectable fillers in the tear trough but that just made me look puffy and did not solve my problem. I have heard about using some external devices to help shrink them and tighten the skin. In talking to several doctors and reading, I am looking at the Exilis device for the treatments. But one doctor is saying the Exilis is the first generation radiofrequency device (RF) and they now use this Ultherapy instead. There is also an Apollo device whichi is powered by TriPollar technology which is the 3rd generation of RF, allegedly the most advanced RF technology currently in the market. Many clinical studies published on the TriPollar technology demonstrated that it is very effective for wrinkle reduction, skin tightening and body contouring I don’t understand why or what to do. I have set up some consultations with some docs but I am worried. Can you tell me what I should do?
A: The world of non-surgical fat reduction and skin tightening devices is very confusing. It is filled with much inaccurate and sometimes deceiving information. Between manufacturer promotions of the devices that they make and doctor’s pushing the devices that they own, it is impossible for any patient to weave their way through this maze of voluminoos and often contradictory information.
What I can tell you with great certainty is that there is no single device out there that has been proven to be superior to any other…no matter what you are told or have read. Many devices may have comparative results but none can claim to be more effective at fat reduction or skin tightening than another one. We know this because no comparative studies have ever been done between the devices that exist nor it is likley any will be done.
I mentioned Exilis only because I am familiar with it and use it in my practice so I know its effects. This is what I would try if you were coming to my practice. This does not mean it is the best device available or that there may be others that worko just as well and perhaps even better. Exilis is not a first generation RF device nor is it similar to ultherapy which uses a different enegy to creates its tissue effects.
I think the conclusion is that some effort using any of the available energy-based devices is what you should try. I would not get hung up on which one. Availability and reasonable costs are the parameters to use on what device to try. The point is that if it does not have any effect, it is not likely any other device will be any better.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek bags, cheek puffiness, dr barry eppley, exilis, indianapolis
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Sunday, June 24th, 2012
Q: Dr. Eppley, I have a significant flat spot on the back of my head. Starts at the area of my crowns and then goes out. It is kind of big in size (12 oz can circumference). It is really a flat spot/slope down. Is there a procedure for fixing this or can material be injected to build up the low area? What options are available to help make an area like this look normal? Thanks in advance for your help.
A: There is only one basic option for your concern, a procedure known as an occipital cranioplasty. That is a sophisticated medical term meaning to build up the deficient or flat bone area. This is done with a variety of potential cranioplasty materials including PMMA, hydroxyapatite and even custom silicone implants. These materials need to be placed through an 8 to 10cm posterior scalp incision. This is a fairly straightforward procedure that is done as an outpatient surgery. Since the buildup is on the outside of the skull, there are no major medical risks in having it done.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, occipital cranioplasty
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Sunday, June 24th, 2012
Q: Dr. Eppley, I would like a straighter more refined nose and a stronger jawline. This may require a chin augmentation but I am not sure what I really need. I just want to look more refreshed and have a more attractive face. I have attached some pictures for you to see and give me your recommendations.
A: Thank you for your inquiry and sending your pictures. I have taken a look at them and can give you the following thoughts.
Your chin deficiency is as much a vertical one as it is a horizontal one. This can not be treated by a traditional chin implant as they can only provide increased horizontal projection. Vertical increase is very important in your chin augmentation. Either a custom chin implant needs to be fabricated or a chin osteotomy needs to be done. Either approach can be successful and I have done many both ways. There are advantages and disadvantages to either approach and they can be discussed in detail further by phone or by Skype.
Your nose shows a lack of tip projection and definition. The nasal tip is rounded and more ball-like. I do not see the lack of straightness in your nose that you have indicated in your inquiry. This can be improved by an open rhinoplasty with the use of a columellar strut graft alar rim grafts and tip reshaping.
I have attached some before and after computer imaging to show the potential changes of the nose and chin based on these approaches.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, chin osteotomy, dr barry eppley, indianapolis, rhinoplasty
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Sunday, June 24th, 2012
Q: Dr. Eppley, I had orthognathic surgery three years ago when my upper jaw was moved forward. While the surgery was successful and my underbite was fixed, I have a persistent problem with my lower lip. My lower lip hangs down and I have too much tooth show. I notice now that when I pull my lower jaw back, the lower lip comes up and corrects the problem. I am now thinking that instead of having my upper jaw brought forward, I should have had my lower jaw moved back. What do you think?
A: It is hard for me to pass any comment on your previous orthognathic surgery, not having seen any preoperative x-rays or work-up. It can be difficult to determine in a Class III malocclusion (cross-bite) whether the upper jaw should come forward or the lower jaw to go back. Either manuever will correct the malocclusion but they can have different aesthetic outcomes, even if that can be somewhat subtle.
Everyone when they move their jaw backward creates more lower lip and allows it to move upward on the front teeth. So I don’t necessarily think that you doing so proves that a sagittal split setback of the mandible was a better procedure than the LeFort advancement.
At this point, this discussion is somewhat irrelevant. You can’t undo your jaw relationship without repeating your orthodontics and undergoing further orthognathic surgery…a process that would take years and likely result in some permanent loss of sensation of the lower lip from the mandibular setback.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, orthognathic surgery
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