Your Questions
Your Questions
Q: Hello, I have several questions regarding cosmetic surgery. First off I want to say I am a single mom of four wonderful children but they have destroyed my once nice looking tummy. But I HATE how I look. I have suffered an eating disorder since my first child being born, to the point I was approx. 90 lbs and I am 5′ 5″. I still do not eat right as I am petrified that I am going to gain weight and make my stomach even bigger. I am also a full time student so I know I cannot afford surgery. There is simply no way. Is there ANYTHING I can do? I hate the way I look, I hate to take showers, I hate to be seen by my fiance naked!!! I literally HATE my body. I currently weigh 135 lbs. So I have done very well maintaining weight. I am at a loss as to how can I rid myself of this awful belly? Please help!!
A: Unfortunately, the short answer is that only surgery can offer any help. After multiple pregnancies, your abdominal wall has been irreversibly changed. The abdominal muscles are no doubt separated along the midline and are lax which accounts for the protruding appearance of your belly despite being at a good body weight. In addition, the overlying skin has been stretched beyond its elastic limit as evidenced by stretch marks. All you can do with your weight is keep the fat layer thin but that will not change your skin and muscle of the abdominal wall. Perhaps one day you will be able to have the tummy tuck surgery that can provide the solution that you are looking for.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I feel like I am ready for a facelift and want to get the best result that I can. In doing my research on the internet, I have come across several recent articles on a procedure called the Stem Cell Facelift. In reading them, they make it seem like it is the best way to go with the best results. But I don’t understand what stem cells have to do with a facelift. Do they help lift the droopy skin or do they make what is already there better. I would like to go to a doctor that does them but I am also worried about whether this is so new that maybe it doesn’t really work that well or it is just some sort of a scam. What is your opinion?
A: The concept of the Stem Cell Facelift is based on two simultaneous techniques, a traditional facelift to lift and tighten loose neck and jowl skin and fat/stem cell injections to add facial volume. The injections are not responsible for any type of skin lifting. They add volume to areas of fat absorption that have happened with age and are purported to help make the skin look better. (which remains far from proven) They may be done together but the fat and the stem cells they contain can not make for any tightening effect on the skin
Is this facelift concept hype or hope. At this point, a little of both in my opinion. The concept is very appealing and the technique uses all natural products from each patient, thus there are no risks involved in doing it. Conversely, whether this facelift approach is better than the traditional proven methods has yet to be adequately studied over the long-term. It may well prove to be an improved method with better results but at this point the promotion of it is ahead of the actual science.
Dr. Barry Eppley
Indianapolis, Indiana
Q: There seems to be a multitude of people out there with chin/lip problems arising from intraoral surgery who don’t know where to turn or what to rely on to remedy their situation. Mostly their problems are attributed to mentalis detachment/loosening and scar tissue, particularly in the labiomental fold region. Chin/lip deformity poses a significant quality of life issues and must be taken seriously. A case study of scar revision in this instance, with before and after photos and details of the surgery, would be of great assistance. Mentalis resuspension seems straight forward enough if its loosened or detached from its origins. The question in my mind with regards to scar tissue excision, is how much mentalis muscle in the labiomental fold or chin pad region, can be safely excised before the mentalis can no longer function properly?
A: Ptosis, or sagging, of the soft tissues of the chin can occur after any form of chin surgery done through an intraoral (inside the mouth) approach. When it occurs, one surgical method to put the soft tissues back onto the chin bone is mentalis resuspension. This is fairly way to do and the most important technique for the procedure is how the muscle is secured back to the bone.
Generally speaking, the only scar tissue that ever needs to be removed during any chin revisional surgery is the scar capsule around an existing chin implant. (if the implant is being removed) This needs to be removed because it will not allow the overlying muscle to heal back onto the bone.
Dr. Barry Eppley
Indianapolis Indiana
Q: I’ve done Botox injections on my frown line and crow’s feet. Thinking about having Botox to treat TMJ pain and maybe some on my face. Please let me know if he accepts insurance for the Botox treatments.
A: The use of Botox to treat “TMJ’ problems is done by numerous practitioners with variable degrees of success. Botox is a very specific treatment for muscle spasms and tightness or overactive muscles. The term TMJ, however, is a broad term that actually is a collection of different pain sites that is not really a unified diagnosis. For this reason, so called TMJ patients are being injected who may not be ideal candidates for a muscle treatment.
The best orofacial pain patients, in my experience, to get relief from Botox injections are the bruxism or clenching patient. This is a very specific masseter muscle problem that can be localized in most cases to the part of the masseter that is near the bony jaw angle. This is also a perfectly safe area to treat without causing any complications. The tight and painful muscle can be easily felt and the most painful part of the muscle specifically injected. These are also patients that have either been through or are currently undergoing some form of traditional mouth splint therapy. Often this treatment has failed or its effectiveness has decreased…as this is why they are seeking Botox injections.
Because the use of Botox for bruxism or as any part of TMJ problems is not FDA-approved, it is not eligible for insurance coverage.
Dr. Barry Eppley
Indianapolis Indiana
Q: Do you offer chemical peels? What is available to forehead and brow wrinkles?
A: Assuming that these two questions are linked, so to speak, points out a basic misunderstanding of what certain procedures can do. Chemical peels, of which there are many types which penetrate from superficial to deep, are good for improving skin texture problems which does include very fine wrinkles. But they will not work on any skin problem which lies deeper, such as scars or deep wrinkles, folds, or furrows. Almost all commonly used chemical peels treat more superficial skin problems. It is best to think of chemical peels as an outer skin treatment.
Forehead and brow wrinkles are not superficial skin concerns. While they may appear on the surface as a skin change, the primary problem is deep. It is the excessive muscle action that eventually causes the outer skin layers to become etched or permanently wrinkled. Since the problem lies deep, no superficial treatment can provide any visible improvement. This is why the initial treatment for forehead and brow wrinkles is Botox injections. As a muscle-weakening agent, it can lessen or stop their movement creating an immediate improvement in the depth of the wrinkles seen. In more severe cases, a browlift may be a better answer. This procedure treats the muscles at fault through their selective removal. With less muscle action, which is combined with skin tightening through a lift, there can be a dramatic reduction in the forehead and brow wrinkling problem.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hello, I went to see a plastic surgeon about repairing my one stretched ear ring hole. I pretty much made it clear why I was in the office. The office workers did not pay attention to my needs and instead pointed out all my other flaws and pushed selling other procedures on me. I wish I could afford to correct all flaws, however at this time, I just want my little ear repaired. After they had me under the bright light and made me feel awful about myself, they finally told me the cost of the ear repair… $800. Just because the way they treated me, I would rather stitch it myself then give that office the money. Can you please tell me how much the procedure would be? Thank you.
A: Earlobe deformities from the use of ear rings creates two basic correctable problems, an enlarged or elongated hole and a complete split or tear. Both can be easily and quickly treated in the office under local anesthesia in less than 30 minutes. There is no pain afterwards or significant swelling or bruising. Tiny dissolveable sutures are used so there is no suture removal afterwards either. One can shower and get it wet the very next day. Once it is healed, re-piercing can be done six weeks later.
From an office standpoint, every plastic surgery practice has differences in philosophy. Some promote and sell harder than others which often, understandably, turns some patients off. That doesn’t make them a bad practice, just one who may not be a good fit for you. From a pricing perspective, fees will vary around the country for any elective cosmetic surgery procedure based on geographic location and the size of the practice. There are no standard fees for cosmetic surgery nationally. It is a simple matter of what value the practice puts on their time and expense to do the procedure and what a patient is willing to pay. Here in Indianapolis, the prices for earlobe repairs is more typically in the range of $300 to $450 per earlobe.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi Dr. Eppley, I have a question regarding my face since it has gotten thinner after a facelift. I had a facelift last summer after losing 45 pounds. My plastic surgeon said he took four inches of skin out of my neck. However I did lose my round face because my cheeks are more sculpted now due to loss of volume. While I like the change it is a weird look for me because I have always had a round face since I was just a kid. I never had sculpted cheeks even at a normal weight. I used to get carded well in my 30’s because of my baby face. So there is some merit to having volume. It is weird for me to see my cheekbones as opposed to my puffy cheeks. I almost feel like I look older without my round face. So my question to you is it possible to add some volume in my lower cheeks BELOW the cheek bone to get my “baby face” back. What would you suggest? I can send pix if you want me to. Thanks for your advice.
A: There is no doubt that between having a facelift and undergoing considerable weight loss, one can end up with less facial volume. This is usually most manifest around the cheek areas when it occurs, specifically in the area below the cheeks known as the submalar area. I prefer to call this area the submalar triangle as it is a soft tissue area that has the configuration of an inverted triangle and has no underlying bony support. That is why it suffers the greatest indentation or hollowing on the face with fat loss…it has no underlying bony support so it sinks in.
There are several ways to build out the submalar triangle. The simplest is to replace what is lost through fat injections. Fat is both natural and easy to harvest through liposuction and its injection is not ‘invasive surgery’. Its downside is that its survival is not always predictable. The other is to use a specific submalar implant which sits on the underside of the cheek bone. This will build out the upper part of the submalar triangle but not the lower area near the corner of the mouth. The total submalar area can also be built out by the insertion of onlay dermal grafts. Using part of your old facelift incision, allogeneic dermal grafts (human dermis out of a box) can be cut and laid underneath the skin to add a soft natural volumetric fill. The dermal grafts will integrate and become part of your natural tissues.
As you can see there are a variety of submalar augmentation options. Which one is right for you depends on which approach offers the simplest, most natural, and predictable outcome.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am very interested in learning more about the Kryptonite Bone Cement for injectable cranioplasty. I am a 36 year old female with a very unusual shaped head in which I have always hid behind various hairstyles for shame of the overall appearance of my head. I strongly believe that the shape of my skull may be the result of some form of untreated craniosynostosis or other undiagnosed craniofacial disorder. Or maybe it might just be plain old bad genes.
My skull is very narrow and somewhat small. The shape of my forehead slopes back at such an undesirable angle and is very flat and narrow in width. The resulting slope of my forehead extends up into the top of my skull of which I can only describe as a point. There is somewhat of a flatness in the center of my skull and the back of my skull is very flat and extremely narrow in width as well. I am also very hollow in the frontal view at my temple area around my eyes with very wide cheekbones and a deficient jaw and chin. I have always wondered if there were any such cosmetic procedure that could help in this kind of skull case.
My questions are: 1) What are the biggest benefits of using the older PMMA and HA methods over the new Kryptonite Cement method? How long has Kryptonite Bone Cement been used? 2) Can it be used for adding volume to reshape an entire skull like mine, making it more rounded and add mass in largely deficient areas? 3) Can it be done with scalp hair in place or does the hair need to be shaved for a better view of the entire head? 4) Is there any chance that the material will become detached from the skull and slide out of position? 5) Will the scalp expand and conform to the newly added volume comfortably? 6) Can it be used in place of such procedures as chin and jaw implants?
A: Thank for your insightful questions in regards to your craniofacial concerns. My answers would be as follows. 1) All three cranioplasty materials will work in an open scalp approach. Only Kryptonite can be injected. There are substantial cost differences between the material cost of HA and Kryptonite being over 10X the price of PMMA. For very large scalp areas, the issue of cost makes PMMA the only practical choice for most patients. 2) All the materials can be used over large skull areas. In larger areas, the cost of PMMA makes it the material of choice. 3) For large skull areas, the hair would have to be shaved to see what one is doing. For an isolated forehead cranioplasty, the hair is not shaved. 4) No, all cranioplasty materials stick quite well to the underlying bone. 5) The scalp can expand to a large degree but the skull must not be expanded (built out) greater than what can be closed over it. 6) No as yet. Kryptonite has not been yet tested for use in this way. For now, standard facial implants are more predictable and far less expensive.
Dr. Barry Eppley
Indianapolis Indiana
Q:I am looking at having a revision surgery on my chin for what I believe is a partial non-attachment of the soft tissue to the hydroxyapatite implant. Some of my chin hang independently from the rest and looks aged. My surgery was two years ago. I am contacting you because I see you have specific knowledge of the intricacies of chin surgery. Could you give me some information about what I should do now and whether you have dealt with this problem before?
A: Thank you for your inquiry. Before I can answer your questions specifically, let me get some details as to your chin surgery from two years ago. You refer to having a hydroxyapatite implant placed. Since there are no off-the-shelf hydroxypatite implants of which I am aware, I assume that this was an intraoperatively carved one that was done from a block of material. Furthermore, I am assuming that it was placed intraorally (through the mouth) as opposed to under the chin through the skin.
Your description of your concern’s sounds like what is known as a ‘witch’s chin deformity’, otherwise known as soft tissue chin ptosis. There is where the chin soft tissues sag off of the end of the bone/implant. Because any type of chin implant augmentation must detach the muscles, there is that risk after surgery although it almost exclusively occurs from an intraoral approach.
Please send me some photos of your chin and provide answers to my questions, then I will be able to confirm this diagnosis. I have seen this numerous times and the appropriate correction (implant notwithstanding) in most cases is a mentalis muscle resuspension procedure.
Dr. Barry Eppley
Indianapolis Indiana