Posts Tagged ‘plastic surgery’
Friday, January 21st, 2011
Q: I would like a normal chin size without cutting or moving bone. Just with a chin implant or injectables. is it possible? I´m not interested in a major surgery such a sliding genioplasty. It seems that I have overbite but my dentist says that my bite is ok and I don’t need any orthognatic procedure. I ´d like to have neck liposuction too. I have a little extra fat below my chin and round the neck. The truth is that I don´t want to go under a major surgery but I also want a stronger chin. Can I achieve this result? I want it to look like a good male chin and not weaker or like a girls´s chin. I have looked at different projections of chin implants and I think that an 8 mm implant would work. I think that an implant with some little liposuction would be ok. I want it to be bigger but maybe more than 8mms kwill make my chin to look like very big. Please tell me what you think?
A: When it comes to chin implant size, there is a fine balance between too much vs too little. For a male, the chin position should ideally be even with the most protrusive part of the lips when see in a side view. While this is a classic anthropometric measurement, and one that is historically espoused in the concept of male beauty, that does not mean it is the most ideal aesthetically for any individual. Some men prefer their chin to be stronger than this measurement suggests while others prefer it to be a little shorter. When trying to decide between two chin implants sizes of a few millimeters difference ask yourself this question…would I prefer to ‘error’ on the side of having the chin turn out to be a little too strong or a little too weak? Obviously you want it perfect but knowing that choice will help make the decision between those two implant sizes.
Dr. Barry Eppley
Indianapolis Indiana
Tags: chin augmentation, chin implant size selection, dr barry eppley, indianapolis, plastic surgery
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Friday, January 21st, 2011
Q: I am a 52 year old female that weighs 127 pounds. Several years ago I was down to 117 pounds and the lower belly pouch didn’t get much better. At that time I was exercising 4 days a week and doing everything I could to lose that belly. This seems to be a family trait as both my mom and her sisters had it. Do you think liposuction can remove this lower belly pouch?
A: There is no question, even without seeing most patients, that the description of a lower belly pouch signifies that they have some excess fat there. So the use of liposuction for abdominal fat reduction is going to be useful. Whether liposuction would be of benefit, therefore, is not really in question. The issue is how much lower abdominal skin do you have and what will happen to it when the lower belly is deflated so to speak. In other words, do you need some type of a tummy tuck with the liposuction? The aesthetic outcome of liposuction is predicated, partially, on how well the skin contracts down once there is less volume. If there are a lot of stretch marks and you can pinch more than an inch or two of skin, then it is likely than some skin removal (mini-tummy tuck) may be helpful also. If there is a question as to whether skin removal is really needed, you can always do the liposuction first and let that outcome make that decision for you. I would use Smartlipo (laser liposuction) for your abdominal liposuction as that has the best chance of shrinking down the skin you have the best.
Dr. Barry Eppley
Indianapolis Indiana
Tags: abdominal liposuction, abdominal smartlipo, dr barry eppley, indianapolis, plastic surgery
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Friday, January 21st, 2011
Q: Dr. Eppley I need your help with my cheek. Several years ago I was involved in a fight and got struck on the left side of my face. At the hospital they diagnosed me with a cheekbone fracture but I never got it fixed since I didn’t have insurance at the time. The left side of my face is asymmetric now to the other side and I want to get it fixed. I will describe the problem as I see it. If you look at about an inch down from my left eye, that area from the middle of the top portion of the cheek toward the edge of my nose is flattened. It has no definition like my other cheek. The flatness extends down toward the middle portion of my ceek also. It appears to me as the complete area is shaped like a sideways triangle toward the rear. Also in the same area about an inch under my left eye, right on top of the upper portion of my cheek, it appears as if that area has dropped down. Do you think the bone needs to be rebroken to be fixed or can some type of implant be used to fix it? Thanks for your time.
A: Your description of the left cheek/midface deformity is exactly what one would anticipate from an incomplete zygomatic or cheekbone fracture. As the zygomatic complex, when fractured, can only rotate downward and inward toward and into the maxillary sinus you will lose some cheek and underlying anterior maxillary projection. Because you have described no changes in the eye area or numbness of the cheek and teeth (infraorbital nerve impingement) your original zygomatic fracture is incomplete and less severe than a fully displaced fracture. Given the age of the injury and the now healed bone, a modified cheek implant placed across the anterior maxillary wall and up onto the anterior zygoma should do nicely to restore the bone fullness lost. Given the modified position of such a cheek implant, it would need to be secured by multiple screw fixation.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek implant, cheek reconstruction, cheekbone fracture, dr barry eppley, indianapolis, plastic surgery
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Wednesday, January 19th, 2011
Q: I have had two babies in three years and have lost nearly 50 lbs through an aggressive diet and execise program. While I have defnitely seen some body changes, I am not happy with the way my breasts and stomach look. I thought with all of this working out that my stomach would look better. I have loose skin and stretch amrks around my belly buttonm and my breasts droop and are floppy. I have read about a plastic surgery procedure called the Mommy Makeover. What is sone in this procedure and can it be done all in one surgery. I am worried about recovery time and getting back into the gym for my workouts. Thanks!
A: The Mommy Makeover has become a popular plastic surgery procedure amongst mothers between the ages of around 25 to 45, although it can be done at any age. It has gotten this catchy name because the procedures involved help reverse the effects that pregnancy has ravaged on a woman’s body. These procedures have been commonly done for many decades so they are not new. They have just been put together and ‘packaged’ for this specific set of female body problems, that being the breasts and the stomach areas. Breasts frequently have lost volume (deflated) and sag and the tummy has loose skin and stretch marks. The combination of breast reshaping (implants with or without a lift) and some form of a tummy tuck (with or without liposuction) is the backbone of a Mommy Makeover. They are almost always done together if a patient’s economics permits. While this combination of a breast augmentation and tummy tuck will have a dramatic change on one’s body, you must tone down the concern about getting back to working out as soon as possible. This is a setup for after surgery problems. It is understandable that you have an addiction to working out as you would not have gotten this far without doing so. But that same addiction, which you think is good, is not so good after this kind of surgery. You must mentally plan on 6 weeks before getting back to working out like you are now. Remember that in a span of a few hours you are going to make changes that you can’t do by working out for the rest of your life. The risk is not worth it for a few extra workouts that, in the big picture, will gain you nothing.
Dr. Barry Eppley
Indianapolis Indiana
Tags: breast augmentation, dr barry eppley, indianapolis, mommy makeover, plastic surgery, tummy tuck
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Wednesday, January 19th, 2011
Q: I am going to get cheek implants but am concerned about them moving around afterwards. I am an extremely athletic person who works out a lot. This involves running and jumping around a lot. I do participate in conatct sports such as basketball and flag football. However, I don’t do boxing and am not planning to get punched in the face. (who does really?) My cheek implants will be the Conform malar shell type so they are not small. Do you think just suturing them in is enough or should they be secured with screws. Which method is best for me?
A: What makes cheek implants different from other facial implants is their bony position. Sitting on the side of the cheek bone, with no bone support underneath them, makes them more prone than many other facial implants to shifting or malpositioning. This risk is magnified by their path of insertion from inside the mouth which opens up the southern avenue for shifting. While most cheek implants do not experience these problems, the risk is not zero. Because of this concern, it is my preference to almost always screw fixation for cheek implants. This makes me feel the most comfortable that the postoperative risk of implant shifting is virtually eliminated. the appeal to me of screw fixation is that it is also easy to do, involves no risk, is done at minimal extra cost, and adds essentially no extra time to complete the procedure.
Dr. Barry Eppley
Indianapolis Indiana
Tags: cheek augmentation, cheek implant screw fixation, dr barry eppley, indianapolis, plastic surgery
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Wednesday, January 19th, 2011
Q: I am interested in Female Feminization Surgery which would encompass brow bossing reduction, hairline lowering, rhinoplasty, chin and jaw shaving and breast augmentation. I am considering doing the FFS either all at once or in two parts. I am male to female transgender. Can you provide me some details or specifics about what I need to consider for each of these procedures.
A: All of those Facial Feminization Surgery (FFS) procedures certainly can all be done as a single procedure and are not too excessive for one operation. If you were to do them in stages, I would separate them into the facial procedures as one set of procedure and the breast augmentation as a separate procedure.
A few comments about your proposed FFS procedures:
Hairline lowering – Whether that is possible would depend on your hairline now and where it is located. Some FFS patients have to consider hair transplants instead if their hair density is very thin or too far back.
Brow Bone Bossing – There are two methods based on the degree of bossing, burring reduction (tail of brow only) or frontal sinus wall setback (if the whole brow is very prominent) It is impossible to know which is best for you without seeing a picture. The relevance to this difference is prinarily a cost issue. Frontal sinus wall setback requires some tiny plates and screws to hold the reshaped bone and takes a little longer to do.
Rhinoplasty – There are two different types of rhinoplasty, limited and full. The full rhinoplasty requires more work and is almost always needed when there is a hump reduction needed. Limited rhinoplasty is where only the tip is manipulated/changed.
Chin and Jaw Shaving – For most FFS patients, this is largely burring reduction or saw shaving of the inferior border although sometimes the chin bone may need to be shortened vertically as well as setback.
Adam’s Apple – Any issues here? I am supposing not since you didn’t mention it.
Breast Augmentation – The only issue here is saline vs silicone gel breast implants. That is just a cost difference issue
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, facial feminization surgery, indianapolis, plastic surgery
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Wednesday, January 19th, 2011
Q: Hi, I’m 25 and have a really flat area at the back of my head. I’m very self-conscious about this since I was 15. Is there any way that I can fix this for a cosmetic purpose. Can something be implanted at the back of my head? You are my only hope now. If I can get the new round back of the head, I will also get a new life with your help. I have attached some of the pictures of my head taken on the side. Whenever I look at it, i just want to cry. And I’ve mentally suffered from this flat head shape since I was a teenager. If you could possibly please tell me, what needs to be done, and how long does it take to recover after the operation, I would appreciate your help and time so much.
A: Thank you for sending your pictures. I can see how flat the back of your head. The best and most economical way to augment and expand the back of your skull is through an onlay cranioplasty method. This involves putting a material on top of the bone to build it out. Given the amount of material needed, I would recommend acrylic or PMMA. Other materials exist but they are exponentially more expensive. There is even an injectable technique using Kryptonite Bone Cement, and that would be a good option for you, but that would be a cost issue.
To summarize, you can do an occipital cranioplasty by either:
1) An open cranioplasty approach with acrylic or PMMA, PMMA is a very firm material, is the least costly and must be put in through an open approach. (meaning a long fine line scar in the hairline) It would be a two hour procedure under general anesthesia.
2) The other option would be an injectable approach using Kryptonite cement. This would only need about a 2 inch incision. This procedure would take about an hour to do.
The fundamental difference between the two procedures, besides the incision/scar, is the cost of using the material.
Dr. Barry Eppley
Indianapolis Indiana
Tags: dr barry eppley, indianapolis, occipital cranioplasty, plastic surgery
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Wednesday, January 19th, 2011
Q: I am 23 years old and am interested in breast augmentation. I know that there are different types of implants but I am most intrigued by the gummy bear implants that I have read about. They sound like the best type of breast implant to get but are there any real downsides to them? What do you think of them?
A: The term, gummy bear breast implant, is a layman’s term and not an actual name of a breast implant. I am not sure of the history of this name but I have heard the term was coined by a plastic surgeon. It is a new generationand innovation of a silicone breast implant, technically a third-generation gel filler material. Think of the original silicone filler material as a Type I which is more runny like thinner molasses syrup and existed up until 1991 when it was removed from the market, A type II gel implant filler is in newer and current breast implants, released commercially again in 2006, and is more cohesive like very thick molasses syrup. A gummy bear implant would be a Type III gel filler and is much more cohesive or stiffer like the gummy bear candy. (hence the name)
From a manufacturer’s standpoint, they have been known as the 410 implant (Allergan) and the CPG implant (Mentor) and have been in clinical trials for years. All manufacturer’s clinical trials with these implants are now closed and under FDA evaluation. It is possible that they may be commercially released by the FDA in 2011 but that is not a certainty.
The biggest advantage to the gummy bear implant is that the gel filler material is more cohesive and has no risk of leaking. It does feel more firm which some patients may feel is an advantage. It will be introduced initially as an anatomically-shaped (tear drop) shape with a textured surface. Because of these features, it must be placed through a lower breast fold incision to ensure proper positioning of the shaped breast implant.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, gummy bear breast implants, indianapolis, plastic surgery
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Wednesday, January 19th, 2011
Q: I had saline breast implants placed in 2003. Last week I developed some mild discomfort in my right breast which was just sort of achy. I thought my right breast was getting smaller right after but now I know for sure. My right breast looks much smaller than my left now so I think I have developed the dreaded deflation. I remember something about a warranty program in case this happens. What do I have to do now to get my breast implant replaced for free?
A: The risk of saline breast implant deflation is always a lifelong possibility. While most patients will enjoy the benefits of their saline breast implants for an average of 10 to 15 years, deflation can certainly occur much earlier. Since breast implant failure is one of the known complications of breast augmentation, patients need to be aware of the manufacturer’s warranties. There are two levels of implant manufacturer warranties; implant replacement and monetary contribution to the cost of replacement surgery. Over the years these two warranties have changed and it is important to contact the manufacturer (Mentor or Allergan) and find out what was in effect from that manufacturer in 2003.
In general, replacement of a failed breast implant is usually lifelong and never goes away. Money to be provided to help defray the cost of replacement surgery is usually time limited at 10 years currently. (less in 2003) That amount was $3500 in 2010 but likely was only $1200 in 2003. That money is not given up front to the patient but only months after the surgery is completed so patients have to wait to get their partial reimbursement. (the failed implant must be returned and evaluated first to determine the cause of failure)
One important point of confusion in replacement surgery is that the warranty is given by the breast implant manufacturer as it is a medical device. These warranties do not apply to the implanting plastic surgeon, operative facility or the anesthesiologist.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast implant warranty, dr barry eppley, indianapolis, plastic surgery, saline breast imlant deflation
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Tuesday, January 18th, 2011
Q: Dr. Eppley, I am interested in getting my fatter face and neck thinned out if possible. I am sending pictures for your review (frontal and profile) so you can see what I mean. I am interested in a buccal lipectomy procedure and submental lipectomy. I have always thought my face has made me look, in pictures, 30-40 lbs heavier than I actually am. I have also looked at people that are obese or considerably heavier than I am in pictures, comparatively, and noticed that my face make me looks extremely heavy which I am not. I would like to have the procedures done if the changes are significant. I would also like to know if the procedures can be done under local anesthesia. Please advise.
A: Thank you for sending the pictures. I can see your concerns with the fuller tissues around the jawline and into the neck. Certainly fat reduction by neck liposuction and buccal lipectomy is all that is appropriate or should be done. The good question is how much improvement will be seen. That is a tough one to answer as the final result is determined by how well the skin adapts and shrinks down. The limiting factor in your result, and in other male patients who look just like you, would be controlled by the subplatysmal fat at the cervicomental angle (it is not all just above the platysma in the neck angle area) and the subcutaneous fat layer around the jaw angle and over the parotid. Subplatysmal neck fat can be removed by direct excision but the jaw angle fullness is more limited because it can not be treated neither by liposuction or direct excision because of the marginal mandibular branch of the facial nerve. While changes will clearly be seen, I would use the term moderate improvement rather than a dramatic change. Because of the variabiity of the result, you should only undergo the procedure if you can accept modest to moderate improvement. If it turns out to be significant or dramatic in your view then that would be a bonus.
To get the best result possible, doing the liposuction and lipectomy procedure under local anesthesia would not be my approach. That limits how much can be done as patient comfort then takes precedence over the extent of the result.
Dr. Barry Eppley
Indianapolis Indiana
Tags: buccal lipectomy, dr barry eppley, indianapolis, neck liposuction, plastic surgery
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