Posts Tagged ‘plastic surgery’
Friday, November 30th, 2012
Q: Dr. Eppley, I'm not actually interested in any plastic surgery, but I was compelled to write a thank you to you for not trying to make anyone think breast augmentation will give you perfect breasts. Your work looks good, and I'm sure they look even more amazing in person, but it's nice that you're up front. I fully support anyone who wants to change their look, or enhance it. I'm a beautician myself. I just felt I should say thanks for being real. Thank you for your time.
A: Thank you for your kind comments. While buy cialis online uk
ppley Plastic Surgery” href=”http://www.eppleyplasticsurgery.com”>plastic surgery can make some very significant improvements, I have yet to see a perfect result. Every result has some flaws and no patient should expect an imperfect problem to turn into a perfect result with surgery. I am sure in your own field every person you do is much better as a result of your work, and some even amazing, but perfection is always elusive. I try to communicate that in all of my work and it is comforting to know that someone else does appreciate that insight.
Dr. Barry Eppley
Indianapolis, Indiana
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Tags: dr barry eppley, indianapolis, plastic surgery
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Wednesday, September 14th, 2011
Q: Dr. Eppley, Ive come to highly respect your opinion, especially regarding the lower face as you’ve done some beautiful work. I have an asymmetric face. In seeing an orthodontist, he said I am not a candidate for jaw surgery. I think he is wrong. I think jaw surgery is probably the only real solution that will properly address my lower face. My jaw is clearly longer on one side than the other in both the ramus and the condyle, its visible in X-rays. The cheekbone is also visibly lower on one side both externally an by Xray.
My questions aside from obvious rhinoplasty and chin augmentation, can anything at all be done to address this “tilted” look to my face and eye area? It bothers the heck out of me . Your feedback would be highly appreciated. I think surgery is my real need and only true solution.
A: I do not have the advantage of seeing any x-rays so my comments can only relate to your photographs. The most significant component of your facial asymmetry is in the orbits with the one being lower than the other. That is potentially improveable through a brow shaving procedure through the upper eyelid and a lateral canthopexy corner of eye tightening procedure done on the lower orbit. That is relatively low risk and is an operation commensurate with the magnitude of the problem.
Straightening your nose through rhinoplasty is of obvious benefit as well as chin augmentation, via an implant or osteotomy, as you are already aware.
As for jaw surgery in terms of orthognathic repositioning…no. Your orthodontist is correct based on what I see in the photographs. I have no clue as to what your occlusion is but this would involve a major effort and years of orthodontic work. There would have to be a major malocclusion to justify that effort. You are far better off camouflaging the jaw asymmetry with chin augmentation and possibly a lower border shave/ostectomy on the elongated side.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, facial asymmetry surgery, indianapolis, plastic surgery
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Friday, February 25th, 2011
Q: Hello, I have had three very large children (all between 9 pounds and 10 pounds) and have had a very large weight gain/loss after each child. I am getting closer to my goal weight at this time from my youngest child. (Currently 165 pounds-my highest weight was 214 pounds) and my goal weight is around 150. Because of the large multiple pregnancies and weight gains/losses, I am in the need of some body contouring. I have multiple areas that need addressed, my loose tummy, excessive skin in my upper arms, sagging breasts and excess skin and resistant fat deposits in my legs. I am interested in a consultation to start the process of repairing some of the damage to my body that my healthy diet and daily exercise will not fix. I plan to have the surgeries over a few years, rather than all at once, due to cost and my schedule.
A: Body changes that have occurred either from bariatric surgery, extreme weight loss or the impact of multiple pregnancies requires thoughtful consideration about the type and timing of surgical corrections. Sitting down with a plastic surgeon and going over all the surgical options is an obvious first place to start. Having had many of these discussions in my Indianapolis plastic surgery practice, most women will focus first on their tummy and waistline often combining it with another procedure such as an armlift.
These more substantative body problems are more substantial that the more traditional Mommy Makeover which is directly to two combined procedures, breast enhancement (implant with or without a lift) and some form of a tummy tuck.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: body contouring after weight loss, dr barry eppley, indianapolis, mommy makeover, plastic surgery
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Wednesday, January 26th, 2011
Q: I am considering scar revision but need some direction. I basically have two small scars on my butt. They are small and they look like chicken pox scars However they are perfectly centered on each cheek. They are from a liposuction surgery I had many years ago. What is the best way to correct them? I hope you can help.
A: The three-dimensional shape or geometry of these scars is an important consideration. Are these scars wide and flat like chicken pox scars as you havhe described or are they wide and indented, having a central depressed component to them? Since they are old liposuction entrance scars, they are probably wide but the key question is are they indented or flat? That distinction is critical in choosing what type of scar revision to perform.
Excising small scars on the buttocks is easy to do and the intent of such an excision is to make the scar ultimately more narrow. While at the time of the procedure, they will be but in the long run they will likely widen again. The pressure of sitting on the buttocks will defeat most attempts at scar narrowing in this area if the scars are anywhere on the rounded portion of the buttocks. If they are around the perimeter or in the buttock crease, then such desired narrowing is more likely to be achieved.
If the scars are indented, however, cutting them and out and closing them make not make them smooth or flat. For this type of scar revision in this area, I would place small fat graft underneath them to prevent recurrent tethering or indentation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: buttock scar revision, dr barry eppley, indianapolis, plastic surgery
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Tuesday, January 25th, 2011
Q: I have an unusual question. I’m half Chinese but my eyes are more Caucasian-looking. So I was wondering if there is a surgery to create an epicanthal fold at the medical canthus? ( the one that half covers/hides the tear duct). Some doctor once told it’s possible with a w-plasty or a jumping man flap to create a fold in the inner most part of the upper lid. And is it possible to lower the height of the eyelid? Like taking apart the previous fold and resetting it at a lower position? Many thanks and sorry for all the questions
A: The epicanthal fold area is composed of very thin and delicate skin that is prone to poor scarring, particularly in the Asian patient. Because of this scarring potential, unless the epicanthal fold is really prominent and bothersome, I generally steer away from surgical manipulation of this delicate skin. Many of the operations described for epicanthoplasty, like the w-plasty and the jumping man flap, create a lot of tiny skin flaps and often scar poorly. They look great on paper and in diagrams, and do get rid of the epicanthal fold, but their scar result may not be a good trade-off. For this reason, I prefer a smaller z-plasty technique for epicanthoplasty which helps open up the narrowing effect that the fold has on the horizontal dimension of the eye.
Your question is one of the reverse of an epicanthoplasty or the creation of an epicanthal fold. I have never heard of that being done and certainly nothing is written about it. In my opinion that is possible through a different orientation of a z-plasty but my concern would be the scarring. As the fold of skin that would normally make up the epicanthal fold would likely have a line of scar on it, that may or may not have a natural appearance.
When you speak of lowering the height of the eyelid, are you referring to the location of the lid margin or the height of the supratarsal skin crease of the upper eyelid?
Please send me some photos of your eyes for my further assessment.
Dr. Barry Eppley
Indianapolis Indiana
Tags: asian eyelid surgery, dr barry eppley, epicanthoplasty, indianapolis, plastic surgery
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Monday, January 24th, 2011
Q: My daughter has grown in the past two years a strange looking abdominal growth. It doesn’t look like any abdominal pannus picture I have ever seen. She is very obese but has a normal looking white abdomen which hangs down a little. However, directly under (and separate from) this normal looking abdomen is a huge purple/red hanging balloon which is ulcerated and infected. It grows out from under the abdomen right above the pubis. She is scheduled for surgery in a month and the surgeon is acting like he doesn’t know for sure what it is. It is estimated to weigh about 50 pounds. Have you ever run across anything like this in your plastic surgery practice?
A: While it is unusual, I am certain it is not a mystery per se. There are only a certain number of conditions that it could be. Possibilities include a granulomatous reaction from a ulcerated wound in the skin fold, an area of lymphedema with resultant ulceration, ballooning subcutaneous fat necrosis or benign growths such as large lipomas, hemangiomas or even a teratoma. Whatever the final pathologic diagnosis, it will be removed by wide excision down to the underlying abdominal wall with a modified abdominal panniculectomy. It does not sound anything like a hernia of which it is in an unlikely location and a CT scan would easily rule that out. A CT scan would also rule out any tumor growths from deeper structures, such as the ovaries.
With a weight of 50 lbs, however, it is much more likely that this is a benign tumor growth of solid tissue rather than any reactive mass.
Dr. Barry Eppley
Indianapolis Indiana
Tags: abdominal panniculectomy, dr barry eppley, indianapolis, large abdominal mass, plastic surgery
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Monday, January 24th, 2011
Q: Dr. Eppley, I would like your opinion on my nose condition. My history is that I have always had a big nose, it being very big and fat particularly at the tip. During my first rhinoplasty, they shortened the bridge between the tip of my nose and the upper lip but the size of my nose remained the same. During a second rhinoplasty, another doctor took out all the cartilages. The nose subsequently increased in size on the top (created like a bump on the ridge). The doctor explained it to me that it was due to the internal scar and the thick texture of my skin. Then I had a third rhinoplasty with the same doctor as the second rhinoplasty. The nose has now increased to an unrecognizable condition. According to the doctor, it is the nature of my thick skin and inner scar. He advised me not to intervene any more, as no improvement is possible with my type of skin. Some time later, I had an injury to my nose and it became bent to the side a little with a hanging tip. The pictures I am sending you shows the nose after the third rhinoplasty and after the injury. After numerous consultations with various doctors, I decided to take a chance with injections of steroids. After 6 injections, my nose has decreased to what you can see in the pictures. But the doctor who has given me injections insists that my nose cannot be any smaller than it is right now. He says that since I need new cartilages to be inserted and the size of the nose will inevitably increase.
So my questions are:questions:
1) Is it indeed possible to make it smaller or at least a little thinner?
2) If new cartilages are inserted, can it still at least become thinner (doctors say that it will be only bigger)
3) Will it be noticeable that I had prior rhinoplasties?
4) How realistic is it to expect a smaller nose with my type of skin and inner scars?
I greatly appreciate you taking the time to look it over.
A: Thank you for sharing your rhinoplasty history and your pictures. While I have no idea what your nose looked like when you started, there is no question now that you have collapse of the lower 2/3s of your nose. Too much cartilage has been removed so the skin has no little support. This explains the nasal appearance after your second rhinoplasty and why it so easily got bent with the trauma. Ironically removing the cartilaginous support underneath the skin, if done excessively, actually makes the skin sleeve look bigger and sag more. A little cartilage tip cartilage removal and reshaping is one thing, a lot removed can turn into a disaster.
The question, of course, is what can you do now? If you are having any breathing problems (and I imagine you might) then rhinoplasty reconstruction with cartilage grafts (probably rib) can be beneficial. That will actually provide some midline nasal support, like a tentpost, and can possibly make the nose look somewhat thinner. When done through an open rhinoplasty, excess skin can be removed from the edges of the incisions which can also be helpful in creating less of a skin sleeve.
As you may have surmised, yours is a very difficult but not an impossible nose problem. All of your prior surgeries and steroids have definitely created scar but that is not a signficant problem in an open rhinoplasty approach. In conclusion, do I think you can be better than where you are right now…yes. You will never have a thin or small nose but it can be better shaped and supported to look less large than it does now.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, plastic surgery, revisional rhinoplasty, rib graft to nose
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Monday, January 24th, 2011
Plastic surgery, unlike some medical specialties, seems to always find its way into the news. 2010 was no exception in this regard. As a plastic surgeon, most of the items that become newsworthy were an incredible mix of the freaky, incredulous and even fantastic events.
Breasts always seem to make the news and the more freaky seems to be better. Whether it is basketball-size implants of quadruple FFFF proportions, dancers subject to IRS scrutiny trying to write off their surgery, or breast augmentation as part of a marathon makeover (aka Heidi Montag), women who seek their ten minutes of fame marr the perception of an otherwise highly successful body contouring surgery. While the real breast augmentation news this coming year will be the introduction of a new form-stable (gummy bear) implants, this will likely be overshadowed by the media’s never-ending focus on celebrities, their breasts and Hollywood’s version of silicone valley.
There is always the continued incredulous news of patients suffering complications and even death at the hands of so-called cosmetic surgeons. This seems to be most evidenced with liposuction, largely due to its popularity and the larger body surface areas that it treats. There is an obvious difference in the size of the trauma to the body from abdominal and thigh liposuction from that of a nosejob or eyelid surgery for example. Liposuction attracts a large number of inexperienced and often unscrupulous practitioners because of the relative ‘simplicity’ of the procedure and easy access to new liposuction devices. It only takes a medical license and a credit card to buy the newer laser liposuction machines. Equipment manufacturers are more interested in sales than safety as evidenced by their marketing and selling behavior. Patients died last year from one coast to the other at the hands of doctors with dubious credentials. The public would think that better regulations would exist but they would be wrong. Doing your homework is your best protection.
Botox continues to show its fantastic benefits and those are not only in those worried about their frown lines or crow’s feet. Last year Botox was approved by the FDA for the treatment of migraines. For some migraine sufferers, Botox injections can be a miracle even if its effects are only temporary. The benefits of Botox have translated into an actual migraine surgery procedure developed by plastic surgeons. If Botox injections relieve one’s migraines, a relatively simple muscular decompression around the nerve trigger points can provide a more permanent amelioration of one’s migraine pain and frequency of attacks. It’s a rare example of a cosmetic treatment turning into a really useful medical or reconstructive surgery, usually that works in reverse.
One other piece of fantastic plastic surgery news from last year has been the emergence of face transplants. While once thought impossible and something more akin to a movie or science fiction, more and more partial or complete face transplants are being done around the world. While the patients who need them are last resort problems of massive facial deformities and tissue loss, that is the history also of all organ transplants which are commonplace today. From the extreme technical advances of today come spinoffs that will benefit many more facial reconstruction patients in the future.
No telling what this coming year will bring, but if past history is any predictor of future events, plastic surgery will continue to make the headlines…let us hope it is largely in the fantastic category.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: botox, breast augmentation, dr barry eppley, face transplants, indianapolis, liposuction, plastic surgery
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Monday, January 24th, 2011
Q: I would like to get my eyelids done as they are very heavy looking and make me look bad. People tell me all the time that I look tired even though I am not. I am sick of hearing that! My only real concern about the surgery is recovery. How long is the recovery and what will I look like?
A: Thank your for your inquiry. Recovery after blepharoplasty surgery is largely social…meaning how do I look? (how much bruising and swelling will you get) That would depend on whether one is doing only upper eyelids, only lower eyelids, or all four eyelids.. When all four eyelids are done, most people will have noticeable bruising and swelling for up to 10 to 14 days after surgery. If only one set of eyelids is done, it will be less than that. Lower eyelids develop more welling and bruising than the upper eyelids after surgery. There are also different types of blepharoplasties done in which the overall swelling and bruising may well be less, what we call limited blepharoplasties which are either of the pinch type or lower eyelid which use only a transconjunctival (inside the eyelid incision) approach.
There are numerous strategies for keeping the amount of swelling and bruising as limited as possible. This includes pre-and postoperative oral Arnica, keeping one’s head elevated above one’s heart for the first few days and a good icing of the eyes the night after surgery. I also use gentle surgical technique with delicate amounts of cautery to keep down the amount of bruising that can develop.
Dr. Barry Eppley
Indianapolis Indiana
Tags: blepharoplasty, dr barry eppley, eyelid surgery, indianapolis, plastic surgery, recovery after eyelid surgery
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Monday, January 24th, 2011
Q: I am interested in getting pec implants. I have always had a very flat chest with little muscle definition at all. I have done a lot of chest exercises but I have not seen a lot of improvement or at least the amount that I want. I have tried protein supplements, testosterone and even some human growth hormone but I just can’t get the size of pecs that I want. This has brought me to the conclusion that the only way I am going to get there is with an implant. Do you think pec implants will finally help me get what I want?
A: There is no question that pectoral implants will increase the perceived size of your pectoral muscles. Increasing the bulk of the muscle is what they do best from their subpectoral or under the muscle position as they push the muscle forward. Implants are not quite as good as improving pectoral muscle definition with the exception of the lower lateral pectoral border. The question you are really asking probably relates more to implant projection…or how big can the pectoral muscles be made to look.
Pectoral implants have, at most, up to 3 cms. of projection or forward push of the muscle. How significant that is depends on how thick the muscle is to start with. In other words, a flat chest with a thinner pectoralis muscle will show more but it will not be a ‘bodybuilder-like’ result. An already thicker pectoralis muscle in someone who is fairly developed will have a much more prominent result.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, male chest enhancement, pectoral augmentation, pectoral implants, plastic surgery
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