Your Questions
Your Questions
Q: Hi I actually live a few hours away and before I set up a consultation, there are a few questions I have. I am currently a small A cup and am wanting to go to a C cup. I was wondering how much that would be, just an estimate is fine. I know you can’t tell me exactly and also I was wondering how the payments work and what kind of insurance you take. I have Medicaid. i hope to hear from you soon. Thank you!
A: When it comes to the expense of breast augmentation, there are numerous misconceptions about that aspect of the surgery. The cost of getting breast implants is the same regardless of the size of the implant used. Cost differences in implants do exist, but it is based on the type of breast implant selected not its size. Saline implants will cost less than silicone gel as the cost of the devices from the manufacturer is different. Many patients do finance their breast surgery through outside companies such as Care Credit. Plastic surgeons do not finance the cost of the surgery for patients nor can patients make monthly payments until their breast implant surgery is paid off. Payment for the surgery must be all paid up front which is why patients acquire the necessary funds from a financing company and pay them back over time with interest. No health insurance covers breast augmentation or any breast implant surgery unless it is associated with reconstruction from breast cancer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I just have a question about tummy tucks. I have wondered whether it is important to have the stomach muscles tightened. I met a surgeon and he said it is not necessary for me, as I am young (23) and have not had any children. He did assess me. In your opinion (without examining me), could you agree with his statement?
A: Tummy tuck surgery has the capability to address all three components of the abdominal wall, skin, fat and muscle. While it may be fairly routinue to perform muscle tightening as part of tummy tuck surgery, it is not always necessary. The important question is whether muscle laxity or midline rectus separation is making any significant contribution to the protruding shape of the stomach area…or whether an umbilical or ventral hernia is present. If a woman has never been pregnant and does not a hernia then it is unlikely that muscle plication will be of any benefit. Interestingly, tummy tucks done in men do not usually involve muscle tightening as those muscles have never been stretched out due to pregnancy. Muscle manipulation is what causes the greatest amount of pain in a tummy tuck and should only be done if there is a compelling reason to do so. Skin and fat removal is always done and is the backbone of tummy tuck surgery. At 23 years of age and having never been pregnant, I would agree with your plastic surgeon that it is not necessary for your tummy tuck to include muscle manipulation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Thank you for reviewing my photos and my desire to make some facial changes, particularly that of my jaw line. In looking at your computer imaging predictions, the jaw angle implants seemed to have lengthened my jaw angles quite a bit in the side view. I like the shape of my jaw for the most part and was looking mainly to add width from the front view. I know there’s only certain jaw angle implants available so would that be possible or even advisable? Also, do you think I’m a candidate for chin implants? I’m now thinking those may help as well.
A: Thank you for your comments on the computer imaging as that clearly tells me what the right style of jaw angle implant/change that you desire. The one I depicted was the style known as an inferolateral jaw angle implant which does just what you have described and seen, it makes the jaw angle longer and wider simultaneously. Having seen that you have described and preferred what is known as the other jaw angle implant style which exists known as a lateral projection or width only style. That is a very distinct jaw angle implant style and is easier and less traumatic to place as the tissues at the lower border of the jaw do not have to be stripped off to place the implant.
As for chin implants, there are a half dozen styles that make different chin dimensional changes. What type of chin change do you think you would like? That helps in selecting the best type of chin implant style for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello! Dr. Eppley performed an open brow lift for me several years ago before I moved out of state. The results are fabulous! I have a question regarding the procedure however. What material are the screws made of? I am asking as I might consider Thermage in the future, and I am not sure if this is advisable with the metal screws. Thank you!
A: When I perform an open browlift, also known as a pretrichial browlift, the uplifted side of the forehead flap is secured to the bone. This not only provides an anchoring point for the upper end of the forehead flap but also takes tension off of the hairline incision closure to prevent scar widening in what could be a visible area. With the fixation technique that I use, drill holes are made on the outer cranial cortex through which slowly resorbable sutures are passed and tied to the forehead flap. No screws, metal or resorbable, are used although this is a perfectly acceptable method of browlift flap fixation. Therefore, you should have no problem or concerns with any method of skin tightening through any device that heats the underside of the skin in the forehead after an open browlift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have had forehead reshaping surgery about a year ago with PMMA resulting in a very unsatisfactory result. None of the areas I was concerned with have been addressed and there is significant visible irregularities as a result of the surgeons incompetence at the task. I wanted to know how long I should wait before seeking revision surgery? I would ideally like to have it nine months after the first surgery. Also how would the existing material (PMMA) affect how the surgery will be performed? Is there a greater risk of infection or is the surgery going to be significantly more difficult??
A: Sorry to hear of your unsatisfactory outcome from your cranioplasty procedure. From a technical standpoint, you could have revisional surgery at any time. There is no advantage or disadvantage to doing it now or years down the road. The material is set and stable and can be smoothed and rehaped, or added to, at any time. There is no increased risk of infection or increased difficulty in performing the procedure at any point. Revisional cranioplasty, when PMMA is the indwelling material, is actually slightly easier to do as the scalp tissues lift off of the material very easily as they do not bind or adhere to the PMMA. PMMA becomes encapsulated rather than integrated to the overlying soft tissues and the underlying bone. My observation is that patients having secondary scalp flaps raised report little to no pain afterwards although the swelling and the bruising will likely be similar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in having several plastic surgery procedures done. Do you know if I can use my health insurance for plastic surgery?
A: Your health insurance is intended to cover medically necessary procedures. From a plastic surgery standpoint, operations such as breast reduction, large abdominal panniculectomies, repair of cleft lip and palate deformities, traumatic facial injuries, removal and reconstruction of skin cancers, breast reconstruction after cancer removal, and numerous other face and body problems constitutes reconstructive plastic surgery. They are reconstructive because they are directed toward returning the body part back to what it once or should be (e.g., breast reconstruction) to relieving medical symptoms such as pain and skin rashes. (e.g., breast reduction) Cosmetic plastic surgery, conversely, changes a normal body part to have another look (e.g., breast augmentation) even though there are no medical symptoms with it. Not liking the way something looks and being bothered by it, even if that degree of bother borders on some level of impairment, does not constitute a medical necessity. Therefore, cosmetic surgery is not covered by any known medical insurance program in the world. There are a few instances where a body part can have both reconstructive and cosmetic needs. The nose would be a prime example where the internal breathing parts can be covered by insurance when they are dysfunctional (septoplasty), while changing the outside appearance of the nose (rhinoplasty) would be considered cosmetic. When done together which is common, such a procedure is known as a septorhinoplasty.
Dr. Barry Eppley
Indianapolis, Indiana
Q: My friends had fat taken from her stomach and put into her upper lip lines. Is this a procedure you do or recommend?
A: The search for a long-lasting injectable filler to the lips has naturally led to the use of one’s own fat. Even the thinnest person has a little bit of fat which can be harvested and recycled to the lips. In injecting fat to the lips, one accepts two caveats with its use. First, it is good for bulk filling (making the lips overall bigger) but is not useful for injecting into individual lip lines. It is not like synthetic injectable fillers which are injected using very small needles and can be selectively placed into a line as thin as the width of the needle. Fat is injected with a very large needle as the material is quite thick and does not come out in a true linear flow pattern. Secondly, its take or how well it survives is unpredictable. While the theory and expectation with its use is some or complete permanency, that outcome varies amongst different patients. One can not predict whether any one specific patient will have a long-lasting result. My experience has been to overfill (which can look really overfilled with the lip swelling that happens from the procedure), taking into account that there will be some fat resorption. By three months the size of the lip, and the amount of remaining fat, will then be permanent.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello! Do you perform the laser eyelid rejuvenation procedure? I am 48 and have eye hooding and really don’t want to have the surgery at this time. I have read that there is laser treatment that is quite successful. Thank you for your help!
A: I am not aware of any laser eyelid procedure that does not involve making incisions to do a blepharoplasty or eyelid tuck. The term ‘laser eyelid rejuvenation’ may suggest that there is some type of a laser which magically tightens eyelid skin without surgery, but that is not the case. When eyelid hooding exists, the only known effective treatment is actual skin removal. When upper blepharoplasties are done alone, they can be performed under local anesthesia and, in some cases, may even be done in an office setting. Mini-blepharoplasties exist using a pinch technique which is also an office procedure done under local anesthesia. Given the effectiveness of even these more limited skin removal procedures, any non-surgical approaches have never yet been developed that remotely compares.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I would like to have breast augmentation. I have never had because I feared the curvature of my spine might be a problem. I have curvature of the spine, two curves to be exact. I have NEVER really had any problems with it. However, I am not even an A cup and want to go to a D cup. Any issues I should be aware of??
A: Curvature of one’s spine could pose two potential problems for breast augmentation, although neither is preventative from having the operation. The first issue is the potential impact of any significant curvature might have on the lungs or pulmonary capacity. If severe one would have some obvious pulmonary restrictions and this could be a problem for general anesthesia. But your curvature does not sound that severe since you have never had any known problems with it. The second issue is an aesthetic one. Curvature of the spine may give the chest some asymmetry when standing which could give the breasts small differences in size or horizontal position. Any breast asymmetry from spine curvature could be magnified when the breasts become enlarged, particularly up to a D cup size. While all breast augmentation patients must accept the risk of implant asymmetry, that risk may be increased in patients with visible spine curvatures. Short of these potential issues, I see no other issues that would not be standard in you having breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I was just curious about whether I am a good candidate for liposuction on the buttocks and my abdominal oblique areas. I am pretty small as it is but I have always had stubborn fat no matter what I do. I work out and eat right, I only weigh 105lbs and I am only 5 ft tall. My buttocks is a lot bigger than my size and that is what I consider my worst problem. I have been trying to get sculpted for a couple of years, but nothing has worked. I have thought about getting this procedure done, but never had the nerve to get it started. If you could e-mail me back your thoughts that would be great.
A: Small discrete areas of fat on someone who is absolutely weight appropriate for their height, despite working out and eating right, is a common problem that I see in many patients. As such a slight frame and build you can be assured that these fat collections are genetic in nature and not metabolically responsive, which is why you can’t get rid of them by your own efforts. Such small areas I would refer to as liposculpture (shaping) more so than liposuction. (significant volume reduction) Small areas such as these respond quite well to small cannula liposuction.
One caveat about any type of liposuction is in the buttocks area. You have careful to not be too aggressive with the fat removal in this area as one can end up with a ‘deflated’ or sagging buttocks after volume is removed. Fat removal in the buttocks should be more conservative and carefully done to avoid this potential problem. Most likely in a small frame such as yours that is not a significant concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have been attempting to learn the pros and cons of chin surgery. I really want my chin longer and want to know in your opinion if it would stretch my lower lip and expose too much of my lower teeth when I smile? In addition, if I had a chin implant could a widening chin implant be used to square my jaw and length it?
A: Lengthening of the chin usually means increasing the vertical height of the bony chin. Some may use lengthening in terms of a horizontal increase or projection. I am assuming by your question that you mean a vertical increase. Whether the vertical height is increased by an osteotomy with an interpositional graft or an implant, neither approach will stretch your lower lip and expose any more tooth show. That simply doesn’t happen with vertical chin lengthening and is not a concern. But there are differences, however, in how much vertical lengthening can be achieved by the two techniques. An implant can only lengthen the chin by being placed on the edge of the bone, creating a lengthening of maybe 2 or 3 mms. In contrast, an osteotomy can lengthen a chin up to 10 or 12mms which is a significant difference.
Square chin implant styles do exist but they will have only a minimal, if any, vertical lengthening effect.
Dr. Barry Eppley
Indianapolis, Indiana