Archive for August, 2012
Friday, August 31st, 2012
Q: Dr. Eppley, I have been interested in maybe some breast implants with a lift, but also a tummy tuck. I am 46, with three c-sections and have had laparoscopies and I have a tendency to keloid. For many years, my belly button has developed keloids, and my Ob/Gyn would attempt to remove them permanently, this last time (2-3 years ago), gave me a “mini” tummy tuck during the revision surgery and all was paid for by insurance. The keloids came back, it frequently smells and oozes, and of course, is painful to the touch underneath all the bumpy skin. Do you think I could have this corrected and have some of it covered by insurance due to the ongoing medical issue of infection?
A: Without seeing some pictures of yoru abdominal concerns, I can not give a definite answer as to what may be the best treatment. But as a general concept about scars, tummy tucks and insurance, I can say that this is not a likely scenario to get it covered by insurance. It is understandable why you would think they should, and they may provide coverage for excision of the hypertrophic/keloid scars on their own, but it is not reasonable or ethical practice to expect to get some form of a tummy tuck as part of it. The tummy tuck is a cosmetic procedure and is not instrumental in solving the scar issues.The insurance industry views such physician behavior with one word…fraud. So this is not a practice that board-certified and reputable plastic surgeons would endorse or participate in.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: belly button scars, dr barry eppley, indianapolis, tummy tuck
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Friday, August 31st, 2012
Q: Dr. Eppley, I am currently going through menopause and I am considering a tummy tuck and I am on hormone replacements. I am having a lot of difficulty loosing the belly weight. Should I wait till menopause is over? Will the weight come back somewhere else as I have read this is what happens?
A: Going through menopause is not a contraindication to tummy tuck surgery. It in no way affects how the surgery is done, the success of the procedure, or your recovery. Its only relevance is how you feel and whether you feel good enough to go through a tummy tuck surgery with the physical and mental challenges that menopause unfairly inflicts on women. As for what happens after a lipo-abdominoplasty procedure (combined tummy tuck and waistline liposuction), there is a common misconception that fat reaccumulates elsewhere known as the fat homeostasis theory. Recent studies have shown that this is not the case and the result can be very stable if your weight does not significantly increase.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, tummy tuck during menopause
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Friday, August 31st, 2012
Q: Dr. Eppley, I would like a more toned looking armpit, upper back, and upper arm. I feel that, although I am relatively lean and well proportioned throughout the rest of my body, where my arms attaches to my shoulder and chest is just too thick. I have attached some pictures so you can see what I mean. There is also a glob of fat in my upper breast next to the arm that sticks out in clothes.
A:What you have is a very common problem, known as axillary breast fat. When combined with some circumferential fat around the upper arm and back, it makes the whole area look undesireably thick and full. Liposuction (technically liposculpture given the small volumes and discrete areas) of the axillary breast (upper lateral breast quadrant) and front and back of arms (extending into the upper back) would be a good approach to help contour this area and create a more sculpted look of the upper arm/chest area. That could be performed as an outpatient procedure done under anesthesia to get the best result in the most efficient time period. While there would be some swelling and maybe mild bruising, it would not be much of a prolonged recovery. It could be done late in the week, for example, and you could be back to work by Monday or Tuesday. (albeit with sore upper arms) Be aware that the final result from such a procedure would take a minimum of six weeks to become fully evident.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: arm liposuction, dr barry eppley, indianapolis
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Friday, August 31st, 2012
Q: Dr. Eppley, there is an overall lack of definition to my face (flat cheeks and very prominent and long chin) which you will notice here. It’s my belief that with some cheek contouring and possibly jaw as well, I may look as beautiful as I feel. When I smile and when the lighting is even I have a much more appealing appearance as it seems to round out my face if you know what I mean. When I’m not smiling and when the light is harsh (as it usually is unless one is in a photography studi0 and manipulating light!) I feel like my face is a sliver- very long with nothing to break it up or draw the eye up. I look forward to hearing what you think!
A: In looking carefully at your facial features, there are three areas that could be altered to help make the transition from a long flatter face to one with better proportion and angularity. As you have mentioned, your cheeks/infraorbital areas are flat, your chin is long and slightly retruded and your nose is slightly prominent and a little deviated. Changing all three would make the greatest change but I just want to focus on your cheeks and chin for now. Cheek implants with anterolateral augmentation and a chin osteotomy that vertically shortens the chin and brings it forward is the best way to help vertically shorten your face and ‘pull’ it outward. I have demonstrated that on the attached imaging pictures in the side and front views. I think a reductive rhinoplasty would also be very helpful to shorten and deproject the nose, which would make the midface look more full, but the pictures you have sent are not of good enough quality to do the rhinoplasty imaging justice. But these initial images will give you some good material to think about.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cheek implants, chin osteotomy, dr barry eppley, facial reshaping for flat long face, indianapolis
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I was just wondering do you do liposuction on teenagers? If so, will you guys take payments or do I have to pay it all at once??
A: Liposuction can be performed on many body areas regardless of patient age. Any cosmetic surgery, including liposuction, can be done under the age if 18 if one has parental consent. Teenage plastic surgery requires the blessings from one’s parents or guardians. Like all cosmetic surgery, the fees are all paid up front in advance of the surgery. While many patient do finance through outside companies, such as Care Credit, that is not going to be possible for anyone under age 18 or maybe even under age 21. This is why all teenage cosmetic plastic surgery is authorized and paid for by the parents in every case that I have ever done.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, teenage cosmetic surgery, teenage liposuction
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I have a double chin that I hate. I am only 32 years old but my neck makes me look much older and heavier than I really am. I am interested in a double chin reduction surgery that I have read about. My question is does the double chin reduction grow back after certain time due to weight, age, etc… Thanks!
A: Most double chins are due to a combination of a full neck in the submental area and a weak chin. The upper bump chin is one’s real chin (short) and the lower bump of the bubble is neck fat and skin. Therefore, double chin reduction surgery usually consists of a combination approach of submental/neck liposuction (reduction) and a chin implant and/or osteotomy (augmentation) to eliminate the double roll. In my experience once this is done it is a long-term sustained result because the anatomy is permanently changed. The short chin bump will never return because it is been permanently brought forward. The neck roll usually stays away unless one gains a lot of weight in the future. This combined approach has a great influence on making the face and neck appear more slim and well-defined. Often when combined with buccal lipectomies (cheek fat removal) the slimming effect can influence the face above the jawline as well.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin augmentatiion, double chin reduction, dr barry eppley, indianapolis, neck liposuction
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I am interested in having one ear of my previous otoplasty partially reversed. It is pulled back too far and needs to come out 4 or 5mms so the helical rim is seen again. I have a few questions about the specifics of the operation.
1) Could it be performed under local anesthetic?
2) Roughly what size would the cartilage graft be?
3) Does the graft become knitted in place by new scarring or remain somewhat movable under the skin?
4 Should I expect lumps from the cartilage/scars to be visible following healing?
5) Have you performed the operation before and if so, what success rate have you had?
Thank you for your time.
A: In answer to your questions:
1) The procedure can be performed under local anesthesia given that it is one ear and fairly limited in scope.
2) The cartilage graft needs to fit in between the released folds and generally is no bigger than 10mm x 5mms.
3) The graft is sewn in and heals to the other cartilages so it is not moveable.
4) The graft fits between the folds of the cartilage on the back of the ear so it can not be seen or felt from the front. You may or may not be able to feel it from behind the ear.
5) I have performed this ‘reverse otoplasty’ several times successfully. There is nothing new or magical about this procedure. It is a technique borrowed from my days when I regularly performed microtia reconstructions, the most complex form of external ear surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, reverse otoplasty
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I am interested in having the upper and lower lip advancement like the woman featured on your site who found that fillers did not make her lips large enough. I have this same problem. I am also interested in the price.
A: In thin lips, injectable fillers often produce unsatisfactory results as there is not enough vermilion (pink part of the lips) to fill. Without enough vermilion, the injectable filler material can only push outward rather than upward as well. This creates an abnormal looking often call ‘ducklips’. If one’s lips are very thin and injectable fillers have failed to produce a good look, the lip advancement procedure is an alternative. By physically moving the vermilion border up (upper lip ) or down (lower lip), the size of the lips is increased. Usually lip advgancements are done as an office procedure under local/oral sedation. The cost is $2,00 0 per lip or $3,500 for both lips. Because they permanently change the amount of exposed lip vermilion, they can have a powerful effect on the appearance of lip size. While lip advancements are the most effective procedure for making bigger lips out of thin ones, there are some minor trade-offs. There will be a resultant fine line scar at the junction of the skin and the vermilion which for most patients is barely perceptible. But it is important to know that there will be a residual scar, fine as it may be.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, lip advancements
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I had saline implants placed under the muscle 12 years ago. There were fine until about three years ago when I noticed rippling on the undersides. I am a thin woman being 5’7” tall and weighing 126 lbs. Why has this rippling appeared now years after surgery? Will it get better or is it permanent? Will it get worse? What is the best way to get rid of it?I am very unhappy with the shape, size and asymmetry, along with the rippling, so am leaning towards having them redone anyway.
A: Rippling is common feature of saline breast implants and every women will develop some degree of it unless they had a fair amount of breast tissue initially. It will be felt along the bottom and sides of the implants where there is not a muscular interface underneath between the implant and the skin. While perhaps not noticeable early after surgery, it may appear months to years later as the swelling goes away and the breast tissue thins over time. This rippling issue is particularly relevant in thin women with little breast tissue. This is an important consideration to know before breast augmentation surgery so this is not a surprise when it appears later. The best correction of the rippling problem is an exchange to silicone implants where the amount of rippling is considerably reduced due to the thicker and more congealed silicone gel material. This is one of the advantages of the newer gummy bear breast implants.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gummy bear breast implants, indianapolis, saline breast implant rippling
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Tuesday, August 28th, 2012
Q: Dr. Eppley, I have indentations/notching at the sites of my previous mandibular osteotomies. (sagittal split advancements three years ago) I want to get implants to build the bone back out as well as make my jaw angles more prominent. Given the differences between the two sides, I think I will need custom-made implants. How are custom implants made? Do you secure them to the bone somehow so they do not move afterwards? How painful is the procedure?
A: In answer to your questions:
1) Custom are hand-made off of a 3-D model obtained from a CT scan of the patient’s mandible.
2) All facial implants are secured to the bone by screws.
3) Since you have had a prior mandibular osteotomy that is a good reference point point to discuss pain and recovery. Suffice it to say it is less than that process although there are numerous similarities such as the area of facial swelling and the temporary issue of some mouth opening restriction. But if sagittal split osteotomies are a 10 on the scale of pain/swelling etc, jaw angle implants by comparison are a 2 or a 3.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: custom facial implants, custom jaw implants, dr barry eppley, indianapolis
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