Posts Tagged ‘dr barry eppley’
Sunday, September 5th, 2010
Q: I have a wide circular scar in the middle of my lower forehead from removal of basal cell cancer in the fall of 2009. It measures 5 mm wide by 10mm long and is depressed. (atrophic) The dermotologist used the ’scraping method’ the remove the skin cancer. As the scar is in a very prominent place, I am strongly considering scar revision to make the scar is long and narrow. What are your thoughts?
A: Whether scar revision will be helpful is determined by two primary features of the scar in question. First, what does the scar look like? Scars that have width and height issues (raised, depressed and/or wide) are prime candidates for a positive outcome from scar revision. Narrowing and leveling a scar is one of the main changes that scar revision does well. Second, what is the age of the scar? Most scars must be mature enough to allow for good tissue handling and manipulation. In general, scars should be at least 6 months old if not longer. But the most important feature, not just time, is how pliable or flexible the surrounding skin is. Soft flexible skin is important to make most scar revisions successful.
Because the scar is located on the forehead, it is also likely that simple straightforward excision and closure, while better than what currently exists, is not ideal. Most likely, some form of geometric scar line rearrangement is needed to optimize its ultimate visibility. Scar revision using non-linear closure is best for any forehead scar that is not parallel to one’s natural wrinkle lines.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, forehead scar revision, indianapolis, plastic surgery
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Sunday, September 5th, 2010
Q:I had a breast reduction about 5 years ago. I was left with scars on both sides left and right by the clevage area. The length of each is about 2 inches and they use to be raised scars. However I did go see a doctor and he injected it with some solution which did work and flatten the scar, but you can still see it. It is unsightly and I can’t wear low cut tops because its visible. What are my options? Will a scar revision make it worse? The scar skin feels and looks like nuckle skin its thin and soft. Please advise, Thank you.
A: The breast reduction operation works well but at the price of significant length of scarring. While the scars are extensive, most of them are in more natural locations being around the areola and along the length of the lower breast fold or crease. The only part of the scar that is ‘unnaturally placed’ is the vertical one which runs between the nipple and the lower breast fold. Most breast reduction scars turn out well but there is an occasional patient that is not happy with some of the scar and some scars which become wider or even raised.
While steroid injections will help soften and lower a raised scar, they will not make it more narrow. Narrower scars are less visible than wide ones. Scar revision usually works better because it gets rid of the wide scar in exchange for a more narrow one. Your breast scar problem is the medial tail of the lower breast fold scar. While it can not magically be erased, scar revision can most likely cause an improvement in its appearance. These small scars could be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast reduction scar revision, dr barry eppley, indianapolis, plastic surgery
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Sunday, September 5th, 2010
Q: I would like to schedule a consult with Dr. Eppley. I have migraines and have found that Botox was a big help to me making it at least 50-60% better. I also have neck pain badly. I think his decompression Surgery may be beneficial. I would like to speak to him about this.
A: The debilitating nature of many migraines begs for more effective solutions. In the past, the only approaches to the treatment of migraines has been pharmaceutical, obtaining some symptomatic relief. The most recent pharmaceutical treatment has been the use of Botox injections. For a very specific subset of migraine sufferers, Botox has been shown to be effective if the focus or trigger has been associated with the exit of sensory nerves from the skull base. This is usually the supraorbital/supratrochlear nerves in the brow area and the greater occipital nerve at the back of the head.
Botox works by relieving the spasms of the enveloping muscles as the nerve exits close to or at some distance from the bone. If Botox produces a profound response, this strongly indicates that surgical decompression (removal of muscle around the nerve) could be equally effective and offer better long-term results. In some cases, even a cure might be achieved. Plastic surgeons have long recognized this surgical approach coincidentally with endoscopic browlift procedures where muscle removal around the nerve is done to help decrease wrinkling after surgery and some cosmetic patients comment that their headaches are better.
If the origin of the migraine and Botox injection relief is from the back of the head (occipital area) then decompression of the greater occipital nerve and release of the fascial attachments frm the back of the skull may work quite well. This is done through two small incisions in the hairline where the neck muscle meets the bottom of the skull bone in the back of the head. It is a fairly simple procedure that is done as an outpatient. Migraine relief should be seen quite early after surgery. There is only very mild discomfort after the operation which passes ina week or so.
Dr. Barry Eppley
Indianapolis Indiana
Tags: botox for migraine, dr barry eppley, indianapolis, occipital migraines, plastic surgery, surgical migraine treatment
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Saturday, September 4th, 2010
Q : Hi, I found you in reading an article you wrote. This situation applies to me as I very recently had a subnasal lip lift done and I am still in recovery. I can see that my upper lip is crooked and way over corrected so much that my upper lip may be unfunctional. The worse part is however I had no idea I would not be able to smile, and appear deformed should I try to smile!!! I was told to expect some tightness but this is beyond tightness. What are my options? Can I get my smile back?
A: In the subnasal lip lift procedure, a wavy amount of skin (thicker in the middle) is taken directly beneath the nose with advancement of the lower edge of the incision to the area directly beneath the nose. The final closure is tucked in along the base of the nose from one side of the nostril to the other. This procedure shortens the distance between the top of the upper lip vermilion and the base of the nose allowing for more upper tooth show when the lips are slightly parted. It also everts more of the upper lip vermilion, therefore creating an increased amount of a central pout of the upper lip. It is always slightly overcorrected as there will be some relaxation (mild re-lengthening) of the upper lip afterwards.
While this is a fairly simple procedure, I have seen and read of some problems associated with it. One complication appears to be from manipulating the underlying orbicularis oris muscle besides the skin while doing the upper lip lift. In theory, sewing the orbicularis oris muscle to the periosteum underneath the nose may make for a more stable long-term result. However,such a maneuver creates an unnatural stiffness and deformity of the upper lip when can be evident during smiling. This is not a good trade-off for the theoretical benefits of this manuever. It is far better to run the inconsequential risk of doing a secondary tuck-up the procedure if there has been some relapse. Correction of this stiff lip problem can be done with re-opening the incision and releasing the abnormal attachments, with the possible insertion of a dermal or dermal-fat graft to prevent recurrence. The sooner this is done the better.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, subnasal lip lift, subnasal lip llift revision
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Wednesday, September 1st, 2010
Q: I want to have a breast lift, liposuction on my stomach,thighs,buttocks,under the arms,between my chin and lower neck line, an eyebrow lift, and some under the eye work. (dark and somewhat deep and little wrinkles) I am a mother that is curious of amount of the cost. I’m not even sure that I can afford this but I truly have self esteem issues. My weight topped out at 202 lbs but I i am now down to 178 lbs. I have always been one to want to look and feel good about myself and I do not feel that way at 35 yrs old. I am too young to feel this bad about myself!
A: How we feel about ourselves is one of the most important characteristics of a person. While inner beauty and well-being is all that really counts, there is no doubt that how we look on the outside affects how we feel on the inside. Your plastic surgery wish list is comprehensive and, affordability aside, all of that could and probably should not be done in a single surgery. Therefore, it is important to prioritize this face and body plastic surgery wish list. The best way to approach that, and is what I discuss with all my patients who want an extreme body makeover, is to ask yourself this question. If I could only do one plastic surgery operation and could never return to the operating room, what procedures would you do on this list? I say pick just three and even put those in order of importance to you. Whether you would ever get to phase 2 or not is unknown, but if you don’t, then you will have accomplished the most important changes anyway.
Looking at your list, I can divide it into body and face work. While I am not you, most likely the body work is of greatest importance to you because you have listed/described it that way. It appears that a breast lift (with or without implants) and some abdominal and waistline contouring are your prime targets for change. It may also be possible to do so thigh and arm liposuction at the same time if your budget allows for it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast lift, dr barry eppley, indianapolis, liposuction, plastic surgery, total body makeover
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Wednesday, September 1st, 2010
Q:I was wanting to know if Dr. Eppley has any experience in the repair of stretched (gauged) earlobes and how much a consultation would cost?
A: Repair or reconstruction of earlobe deformities are common in-office plastic surgery procedures. Short of congenital microtia or earlobe loss from injury, the gauged earlobe deformity is of greater complexity that simple earlobe split repairs. Gauging the ear is a form of earlobe expansion. When the gauge size is not too big (not bigger than the original size of one’s natural earlobe) the expanded earlobe has a generous amount of tissue. This enables it to be put back together in a normal size because there is adequate soft tissue. When the gauge becomes much bigger, the earlobe tissues become stretched and actually thinner. (tissue atrophy) When putting this type of gauged earlobe back together, the final appearance of the earlobe will be smaller than it originally was.
I have done lots of ear and earlobe reconstructions over the years of many different causes. The gauged earlobe is but a newer type of deformity but its reconstruction still uses the same basic plastic surgery principles. In many cases it can still be done in the office under local anesthesia.
If you send me pictures of your ear, we can consult for free by e-mail. This is an easily visualized problem that allows photographs to suffice in lieu of an actual office visit. That way, you can schedule a repair and get it done by only having to make one visit. (although a second visit will be needed for suture removal)
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gauged earlobe reconstruction, gauged ears, indianapolis, plastic surgery
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Wednesday, September 1st, 2010
Q:I had a genioplasty to move the chin forward and now i want to do another surgery that doesn’t involve implants to make the chin wider. Is that possible and will the chin resorb after awhile because of splitting the chin and expanding it in the horizontal direction?
A: As you have discovered, moving the chin forward by an osteotomy will usually make it appear more narrow or tapered. This is because of simple geometry. If you move the front part of an arc forward (think of the lower jaw as u-shaped or an arc), it will make the overall shape of the total arc longer but more narrow in front. For this reason in male patients, I evaluate the front shape of the chin very carefully so if an osteotomy is performed for advancement, and the patient wants the chin to end up wider, I factor that into the osteotomy design and plan a central osteotomy with expansion.
Certainly a second chin osteotomy can be done and the downfractured chin segment split and expanded. It will be held apart by the necessary plates and screws needed to fix the overall osteotomy into position. This should not cause the bone segment later to undergo any resorption. A simpler method to get chin width expansion is to place a chin implant in front of or on top of the bone. There are chin implant styles that provide lateral fullness without any significant horizontal advancement and they would be a good choice here also.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant, chin osteotomy, dr barry eppley, indianapolis, making my chin wider, plastic surgery
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Tuesday, August 31st, 2010
Q: I read in Dr. Eppley’s blog about using Kryptonite Bone Cement for pectus excavatum. I had the Nuss procedure done 5 years ago and breast implants done 4 years ago. I got very good results with the procedure and implants with the lower part of my ribs; however, the upper area (below the collarbone) is still indented. I would like to inquire about this procedure and whether or not I would be a viable candidate.
A: Kryptonite bone cement is a new type of bone filler/replacement that works well as an onlay, meaning to build out a bone surface to create a better contour. Currently it is approved in the United States for cranioplasty, the filling in or building out of skull bone contours. While it has never been formally tested for use on the sternum, there is no reason to think that it would not work just as well there as on the skull. What makes Kryptonite a possibility in the sternum is that it can be injected after it is mixed before it sets up into a hard mass. This is a very unique characteristic of a bone cement and no prior ones have ever had this physical property. As valuable as that material property is in the skull, it becomes a critical material characteristic in the sternum as incisions of any size are easily seen there.
For an upper sternal problem, a small incision inside the sternal notch can be used to develop the subperiosteal/supraperiosteal pocket. It is into this pocket that the material is injected and molded. The critical step in injectable sternoplasty, like injectable cranioplasty, is to make a good recipient pocket that matches the external outline of the contour defect.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, injectable sternoplasty, kryptonite bone cement, pectus correction, plastic surgery
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Tuesday, August 31st, 2010
Q : I AM A 39 Y/O FEMALE. WEIGHT 155LBS, 5FT 9′ WITH A B CUP WANTING A LIFT AND C CUP AND SILICONE IMPLANTS. AFTER LOOKING OVER MANY PLASTIC SURGEONS IN INDIANA I HAVE CHOSEN DR EPPLY AS MY FAVORITE IN RELATION TO THE WORK IVE SEEN. A FEW QUESTIONS: HOW MANY YEARS HAS HE BEEN PERFORMING BREASTS LIFTS, & IMPLANTS. DO YOU HAVE AN APPROX OF HOW MANY HE HAS PERFORMED? AND WHAT WOULD BE THE APPROX. COST? ALSO, WITH ME BEING A SMOKER WOULD THIS AFFECT MY BEING ABLE TO GET THE SURGERY PERFORMED? THANK YOU i HOPE TO HEAR FROM YOU SOON
A: Thank you for your inquiry regarding breast enhancement. I have done such cosmetic breast surgery for the past 20 years and have done over 1,000 breast augmentation/lifts patients. The cost of breast augmentation with silicone implants (Mentor memory Gel) is right aorund $ 5,900 all costs included. Adding some form of a breast lift to it does increase the cost but that can not be predicted without seeing you since there are 4 different types of breast lifts which add varying amounts of time to the procedure.
Smoking does not have any significant effect on complications from a routinue breast augmentation. There is a slightly higher risk of wound problems when any form of skin lift is done such as a breast lift. How risky that would be would be based on what type of breast lift is needed…the more extensive, the more risk of wound healing problems. The best way to handle the smoking issue is to refrain 2 weeks before and 2 weeks after surgery if possible.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, smoking and breast augmentation
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Tuesday, August 31st, 2010
Q : I had a chin implant 9 years ago, when I smile its seems to be without form, like flat. And after X-rays I noticed that the implant is placed higher up where it should be (close to my teeth). A doctor told me it would be very laborious, because it would be two operations, one to remove the chin implant which would remain a hole, wait 3-6 months to heal the skin and the second to put the new implant from under the chin. Is there another solution? Thanks!
A: It is very common to have a chin implant that ends up being positioned too high on the chin bone when it is placed from inside the mouth and is not secured with a screw. When the implant is too high on the bone, it loses some of the projection or forward position of the chin that it would otherwise have.
Replacing a misplaced chin implant is fairly easy and can be routinuely done in a single operation. I have never heard of having to do it in two operations nor does that make any biologic sense to me. Going through a small submental (under the chin) incision, a new lower pocket can be made, the old implant removed, and a new chin implant placed and secured. In some cases, I have left the old chin implant where it was and just placed a new one beneath it. If someone has a deep labiomental crease, keeping a ‘spacer’ (old implant) high can help push that area out and prevent it from becoming deeper.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: chin implant replacement, chin implant revision, dr barry eppley, indianapolis, plastic surgery
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