A: The scar on your forehead that runs vertically down through your eyebrow and into the top of your nose can definitely be improved. But one reality that needs to be faced about scar treatments is that such outcomes as ‘being erased’, ‘gotten rid of’ and ‘removed’ are not possible. Scars can be improved but, in general, there is no such result as being removed like it was never there. The realistic result of scar revision efforts is to lessen its appearance. Some remnant of the scar will always be there. The features of your scar would be best treated by surgical scar revision and an irregular closure pattern.  Because the scar will be initially red and will take time to mature and lose its color, having scar revision done three months before your wedding is the minimum amount of time you should allow.

Dr. Eppley

Indianapolis, Indiana

A: Forehead augmentation (onlay cranioplasty) by virtue of adding volume would potentially make the skin tighter. There may even in some cases be a slight browlifting effect, although this would be greatest with the brow bone is directly built up. Whether this would occur or not would also depend on how much volume is added. To ensure that this stretching and lifting effect occurs, it would usually be best to do a browlift with the forehead augmentation. This would be easy enough to do since there would be a coronal incision already present. It would not add any appreciable time or expense to do so because of then existing scalp approach for the forehead augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

A: Thank you for your interest in facial rejuvenation surgery which may possibly include a facelift. You are correct in assuming that you would need to quit smoking at least one month before surgery and for at least one month after any procedure. In addition, however, you have multiple other medical problems that need to be addressed before you should consider any type of elective facial surgery. It would be best that you loss some weight before surgery, getting you down to at least the 155 lb to 160 lbs range. This may also help your high blood pressure and back pain. Because of your rheumatoid arthritis medications, they do place you at risk for healing problems. I would have to talk to both your primary care doctor about your general health and your rheumatologist about your medications and their dosages to see if any of these can be reduced for a short period of time around surgery. You would also need to be done some supplements to help with collagen production and healing, such as temporary high doses of Vitamin A and C. While you may benefit greatly by a facelift, you have numerous medical issues that must either be improved or management strategies implemented for them for you to have a successful and uncomplicated outcome from any type of facelift surgery.

Dr. Barry Eppley

Indianapolis, Indiana

A: How any surgeon secures their facial implants is a matter of personal preference and experience. I prefer to screw all facial implants into place when possible to get the best aesthetic result (assured position) and never have to worry about them every moving or sliding from where I want them. That is my personal preference and has served me and my patients well over the years. Just because other surgeons make not choose that technique of implant fixation, or any fixation at all, does not make them wrong. That is obviously what works for them.

Dr. Barry Eppley

Indianapolis, Indiana

A: One key question is how long has it been since this head injury has occurred. Often times small hematomas may occur and this, combined with swelling, can take months to resolve on their own. But they usually will go away completely on their own if given enough time. If the hematoma is big enough, and one can tell that it is if it feels very spongy and compressible, then the hematoma should be aspirated for more rapid and assured resolution. If the injury was more than 3 to 6 months ago, a hematoma may becoming calcified which could result in a bump which will not go away on its own without surgical intervention. (limited cranial reduction)

Dr. Barry Eppley

Indianapolis, Indiana

A: I see that you have two distinct skull contour problems. The first is a deep groove on the top of your head along the course of the original coronal sutures on both sides. It runs identically along the suture line into the temporal regions. The second issue are the multiple irregularities, lumps and bumps, on the back of your head. There are two approached that can be used to improve these skull contour irregularities. The first approach is an open technique where the entire skull can be filled in and smoothed out. While this would produce the best result, the placement of a scalp scar makes it unacceptable for most male patients. The second approach, as you have mentioned, is an injectable technique using Kryptonite cranioplasty material. While this can certainly be done, an external ‘blind’ approach will help fill in many of these cranial depressions but it will be perfectly smooth. The trade-off of not having any significant scalp scar is that the skull contour can not be made perfectly smooth. You have to accept the concept of improvement but not perfection of your skull reshaping effort.

Dr.  Barry Eppley

Indianapolis, Indiana

A: There is little question that limited or mini-facelifts are very popular today and are widely advertised. Many surgeons and companies have even named their own versions of these mini-facelifts. Their premise is based on being performed under local anesthesia for a quick recovery and usually a lower cost. While there is merit to this approach, the key is whether a more limited facelift result will meet a patient’s expectations based on their degree of neck and jowl sagging beforehand. While eliminating the risks, cost and recovery from anesthesia is appealing, that can be a poor trade-off if the ‘problem is bigger than the solution’. Such mini-facelifts are best used in younger patients who have early signs of facial aging or in older patients, while really needing a fuller facelift, simply doesn’t have the time, resources or desire to completely address the extent of their aging issues.

Local anesthetic facelifts can be made fairly comfortable through the use of oral or IV sedation drugs. The wonders of modern pharmacology allow one to reach a pleasant and relaxed state of mind so local anesthesia can be adequately injected for the facelift procedure.

Dr. Barry Eppley

Indianapolis, Indiana

A: On a volume ratio basis, the difference between a 450cc and 500cc implant is not that significant, around a 10% size difference. A sized difference in implants that is barely visible. Since you appear to have no fears about being too big, I would definitely go with the slightly larger 500cc implant. While there are no health risks with larger silicone breast implants, there is always the consideration however of loss of tissue support over time. When a breast implant becomes too big for the tissues that must envelop and support it, there is the risk of bottoming out or dropping of the implant position. Whether this is a potential issue with you can not be determined based on this discussion alone. The key determinant of that is whether the base diameter of the implant stays within your own natural breast base diameter. That is a simple measurement that can quickly be done in an examination. The use of HP or high profile implants is helpful in keeping a good implant-breast base compatibility.

Dr. Barry Eppley

Indianapolis, Indiana

A: Inverted nipple correction has a high rate of recurrent contracture/inversion after release. Your experience is not completely rare. Many methods have been described in plastic surgery for the correction of inverted nipples which speaks to the fact that it is both a difficult problem and that none of them work that well. Once the nipple has been released and brought out by suture traction during surgery, there remains a dead space or tissue deficiency underneath. I have found that filling this in with either a dermal-fat grafts or allogeneic dermis is the best way to prevent recurrent inversion. The fill must be immediately underneath the released nipple. The push from a much deeper breast implants will not work.

Dr. Barry Eppley

Indianapolis, Indiana

A: By your description, I could not imagine a more ideal candidate for Exilis fat reduction treatments. This is a spot reduction problem and undoubtably is not a large area. In addition, with your high level of physical activity you will helping the treatments work better by enhanced fat breakdown. One of the really nice things about Exilis is that there is no recovery or restrictions after any of the treatments. Each treatment is about 30 to 40 minutes so you can just get and go right afterwards. It usually takes 4 to 6 treatment sessions to get the best result and we like to space them, if possible, no more than a week apart.

Dr. Barry Eppley

Indianapolis, Indiana

A: Thank you for sending your pictures. What you have is a a very specific type of aesthetic nasal deformity in which the lower alar cartilages are very thick and strong. They overproject beyond the tip of the nose making it very broad and fleshy. With that comes broad widely-spaced nostrils. Since the tip is so broad, the area above it (known as the middle vault) looks collapsed and sunken in on profile. This then makes the upper part of the nose where the bones are also appear wide. This can be treated by an open rhinoplasty procedure that narrows the nasal tip cartilages, narrows the width of the nostrils at their base, builds up the middle vault and narrows the upper nose by osteotomies. Together this will help change your nose to one that is less broad and more refined looking. This is a 2 hour rhinoplasty procedure done as an outpatient under general anesthesia. All costs combined place the price of such surgery between $ 6,000 to $ 7,000.

Dr. Barry Eppley

Indianapolis, Indiana

A:  It is very common that many of the stretch marks and loose skin that results from pregnancies is around the belly button. This is because this is the region of the stomach that undergoes the greatest amount of skin expansion. After delivery, wrinkling and belly button deformities are common. While the type of ‘high’ tummy tuck that you are describing can certainly be done, I would advise against it. Regardless of how flat and tight the abdominal skin would be, having a horizontal scar across the center of your stomach without a bellybutton would create a secondary cosmetic deformity of its own that would not be very natural looking. You would be better served by having a mini tummy tuck with an umbilical float technique. This would create a very low horizontal scar just about the pubic hairline and keep a belly button that is positioned lower with less wrinkled skin around it. While this may not create the supertight abdominal skin that you desire, you would have substantial improvement but having a more natural look.

Dr.  Barry Eppley

Indianapolis, Indiana

A: Let me clarify some misconceptions that you have about various ‘lipo’ procedures. Lipodissolve injections are only useful for very small fat collections, no more than the size of one’s hand. I suspect your lower abdominal issue is bigger than that in size. Laser liposuction (aka Smartlipo) is simply an advanced form of liposuction and is just as invasive, it is not a minimally invasive procedure. In short, there is no non-surgical way to get rid of your abdominal fat concerns that would be as effective as liposuction. You could try Exilis radiofrequency treatments which does have some fat reduction effects.

In reality, there would be no better time than doing abdominal liposuction with your breast reduction and this is a common combination of cosmetic procedures. Otherwise you will have to have liposuction done separately where the out of pocket expenses will be higher.

Dr.  Barry Eppley

Indianapolis, Indiana

A:  It is important to recognize that there will be a scalp scar in any open cranioplasty procedure. That does not mean, however,  that it is necessarily a bad scar that is wide and highly visible. It almost never is. But in men, whose hair pattern is less than stable over their lifetime in over 50% of the male population, it is important to consider this aesthetic trade-off. It is obviously a lot more relevant issue in men who are bald or shave their head. You do not so this is one favorable factor for you. I harp on this issue so every patient gives it careful consideration. The incision/scar usually runs from about one inch above the ear across the top of the head. It is hard to get good pictures of the scalp scars to show since most patient’s hair obscures it.

Dr.  Barry Eppley

Indianapolis, Indiana

A: Thank you for your inquiry and sending the photo attachments. What you are talking about is a cranial reduction/forehead reshaping which would be done by a burring removal technique. The important question is whether it can be reduced enough to achieve the result you are looking for. That is best answered by knowing how think the outer table of the cranial bone is. That can be evaluated by simple plain x-rays of the skull (AP and lateral views). From these films the amount of bone that can physically be removed (outer table) can be measured. There is no question some reduction be done, I (and you) would want to know the best we can beforehand if it is enough to justify undergoing surgery for it.

Dr. Barry Eppley

Indianapolis, Indiana