Newspaper Articles
Newspaper Articles
While women have always made up the majority of plastic surgery patients, the percentage of men is steadily increasing. More men today acknowledge what women have known all along…appearance does matter regardless of age.
While the goals are always the same, to look as good as one can, a man’s age influences why it matters. Younger men are motivated by optimal attractiveness or to correct features that they consider embarrassing. Older men are motivated by divorce, job competitiveness and countering the effects of time. The common procedures that men choose, not surprisingly, are also influenced by age. Droopy eyelid skin and neck wattles are the concerns of older men while the removal of excessive body fat and reshaping noses, ears and chins captivate younger men.
While age may make a difference in what plastic surgery procedures men desire, there is one characteristic that they all share. Men are less patient than women, particularly when it comes to appearance issues. This means that cosmetic treatments that require regular maintenance, like Botox and injectable fillers, are not that appealing. Men prefer more of an immediate fix like what surgery does. And men do not want a lot of recovery or downtime after surgery if possible. Discretion is paramount in male cosmetic surgery. While everyone knows that men having plastic surgery is not rare, the male patient does not really want to broadcast it.
One observation that has reverberated amongst plastic surgeons for decades is that men can be difficult to please and are less satisfied than women after surgery. They also are more prone to want revisional surgery. That has not been my experience…with the exception of the younger male patient. Facelifts and eyelid surgery in the middle to older-aged male gets good results and satisfaction is just as good as women. When it comes to structural changes in the face or body contouring surgery in the younger male patient, there is some definite truth to that belief. Younger men today grow up today playing with action figures, looking at men’s magazines and seeing great emphasis placed on exercise and sports which exposes them to more pressure to have a very masculine face and body. This makes managing the expectations from surgery in younger men extremely important.
One male quality that seems to be true…and most women will probably second it as well… is that many men are not very tolerant of pain. They are less comfortable with after surgery discomfort and that is to be expected as men have never endured pregnancy and child delivery. That gives women a decisive advantage in the early after effects of many plastic surgery procedures. This is not to say that men are not tough, just not as tough as women when it comes to appearance alteration.
Last year over one million men underwent some form of cosmetic alteration in the U.S. The stigma of men paying more attention to their appearance and grooming habits has changed alot in the past ten years. The beauty gap between men and women is closing to some degree as an increase in the desire of men to use their improved looks to remain competitive professionally and personally is on the rise.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley I am interested in revisional surgery. Over a year ago I had a rhinoplasty done. While there have been some improvements, there are numerous features about it of which I am not happy. I would like tip size reduced/refined to reduce the overall size. I might be intereted in some more narrowing of the bridge depending on upon complexity and down-time. I have attached some pictures for you to review of where I am now.
A: Thank you for sending your pictures. I can tell by the appearance of your nose and your description that you have had prior rhinoplasty surgery. Based on your desires, I see an upper third (bridge area) which can be further narrowed by osteotomies, an indentation of the right osteo-cartilaginous junction between the right nasal bone and right upper lateral cartilage, and a tip that is a little too wide and with a slight amount of over-projection. The nose has a fairly good dorsal profile and tip rotation. (nasolabial angle) These are features that you don’t want to change. For a revisional rhinoplasty, I would do low lateral narrowing osteotomies for the bridge small cartilage graft for the right upper middle vault indentation, and tip shortening and narrowing. This would be done through an open rhinoplasty which I assume is how your first rhinoplasty was done. I have attached come projected imaging. Since it has been over a year since your first rhinoplasty it is reasonable to critique the result and consider any revisional rhinoplasty at this time.
Dr. Barry Eppley
Indianapolis Indiana
Q: What is the cost of tummy liposuction?
A: This seemingly simple question is actually more complex that it appears. When people request liposuction of their stomachs, and its associated fees, they often are under a false perception that this is what will work for them. About half of the patients that I see for tummy liposuction do not need or do not get that procedure. Many actually need a tummy tuck due to their excess and loose tummy skin. But assuming that liposuction of the stomach is the right procedure, there are other variables that will affect the time and cost of performing the procedure. Does the whole stomach need to be done or just the lower half? Does the flanks or muffin tops along the waistline need to be done in addition to the stomach to get a better overall result? All of these affects both the results and cost of the liposuction procedure. This makes for a cost range of between $4000 to $5500 depending upon how much work needs to be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in doing a ” Brow ridge reduction “, at least that is what I think it is. Also I would like a chin reduction. So my questions are; Are these types of surgeriess even possible? How far in advance do I have to schedule them? Have you ever done similar work to this? I have attached some pictures for you to see what I mean. Sorry as they are not the best quality.
A: Thank you for sending your pictures. Your requests for brow bone and chin reduction surgery is not uncommon and these are established procedures. I am very familiar with doing them and get requests for them all the time. Brow bone reduction (technically frontal sinus reduction since the brow bones are largely sinus cavities not solid bone) is done through a scalp incision. The outer table of the frontal sinus is removed and set back which makes the brow bone less prominent. It is a very effective surgery and the only significant issue in men (which are by far those who request the procedure) is the need for a scalp incision and the resultant fine line scar in the scalp to access the forehead and brow areas. Chin reduction surgery is done different ways based on which dimension of the chin one wants to shorten. If it is a vertical chin shortening that is done by an intraoral osteotomy and bony wedge resection. If both a horizontal and a vertical chin reduction is needed that is usually done by a submental (under the chin) incisional approach and the bone is burred down and the soft tissues shortened and tightened to the smaller bone.
This will give you a general overview of your requests. Both surgeries are possible and are part of cosmetic craniofacial reshaping surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi, I have one very prominent ear that is a big source of embarrassment for me. I am fifteen and this is a huge deal for me. I would love to get this fixed but I am worried about cost.
A: First, it is important to know that I, nor any plastic surgeon, can communicate or have any medical discussion with a minor. It is critical that all minors have parental consent before any discussion can be done even by e-mail. An e-mail communication is no different than an office visit when it comes to providing medical advice to any patient. This can be done by having your parents fill out a form and return it to us so that we have confirmation of their knowledge of any future medical communications between my office and you. This issue would eventually be crossed at some point if surgery ever becomes a reality, not only for consent for the operation but for payment as well.
Indianapolis, Indiana
Q: Dr. Eppley, we talked about1 month ago about forehead reduction. Subsequently I have gone to a hair transplant specialist where I live and he told me that he thought that I would not lose anymore hair in my life. Now this was of course only his assumption. Anyway, I’m really struggling with my forehead problem and it’s limiting my days and is taking a toll on my mind. I would like to know if it’s strictly not done on men or if this operation is only done on men at a certain age. And if I would actually lose my hair in the front in a couple of years, how big is the scar and is it very noticeable? Because I’m thinking about this operation all the time knowing that there is something that can be done. Thank you for your time.
A: It is not that it forehead reduction/contouring is never done in men because that is not true. It is just that one has to think about it much more carefully than a woman because of the hair issue. The forehead problem is men has to be more ‘significant’, in terms of either its shape or its psychological impact on the patient, to justify the effort and the scar risk. Scalp scars generally heal fairly well actually and usually end up as just a fine white line in most cases. Scars in hair tend to heal well provided the hair follicles are not damaged during the making or closing of the scalp incision.
Dr. Barry Eppley
Indianapolis Indiana
Q: My upper arms are huge and flabby. I can’t get rid of it. My arms hurt to move. I’ve had rotator cuff surgery on both shoulders and bicep reattachment on my right shoulder. I have Medicare and Tricare insurances. My shoulders and arms hurt terribly. What can I do?
A: Based on your description of your problem, you appear to have the intent or belief that one’s medical insurance will cover you upper arm surgery. What you really need is an arm lift or brachioplasty. This is where all the loose skin on the back of the arm is removed with the trade-off of a long scar. While you have shoulder and arm symptoms, no insurance company is going to cover this type of cosmetic surgery. While an armlift can make a dramatic difference in the appearance of your arms, there is no medical evidence that it will improve shoulder pain or the function of the arm. That is not my medical opinion but the written stance of every insurance company. Your only option is to consult with a board-certified plastic surgeon and get a fee quote for this type of surgery. It can be done as an outpatient in a 90 minute to two hour operation. Arm lifts generally do not cause a lot of discomfort after surgery and recovery is fairly quick. While it does result in a long arm scar, it makes an immediate and dramatic change to the arms… that might even make your shoulders feel better. Dr. Barry Eppley Indianapolis, Indiana
Q: I am interested in SmartLipo on the upper arms. I have lost over 100 pounds with lap band surgery and would still like to lose some additional weight. I was wondering about the effectiveness of having the liposuction while still planning and needing to lose weight. I may want to have additional procedures in the future but would like to get my arms now if that is feasible.
A: When it comes to losing a lot of weight, the arms in women will always show the result of that effort…with sagging ‘bat wings’ in many patients. The use of liposuction for the treatment of saggy upper arms (back of the arms or triceps area) is not the right treatment approach. Liposuction only removes fat and not skin. The problem in the weight loss arm problems is about 85% to 90% skin. Therefore, what you really need is an arm lift or brachioplasty. This is where all the loose skin on the back of the arm is removed with the trade-off of a long scar. What undoubtably drew you to Smartlipo for your arms is the perception that it can tighten skin. This is a frequently touted property of laser liposuction. While Smartlipo can tighten skin, it does so as measured in millimeters. Patients, however, want and need centimeters of skin tightening. Simply put Smartlipo can not tighten the skin on the back of arms, it needs to be cut off.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Can you please advise of any plastic surgeon that does breast lift/augmentation at a discounted rate? I have a birth defect that has hindered my ability to become intimate for years. I am ashamed/embarrassed to have anyone see/feel my breast. I am 40 yrs old & desperately want to be normal for once in my life, I just want the chance to have what other women have in their lives. I cannot express enough how very important this is to me. I would like to have the opportunity to love/be loved in my life. Please, if you know of any surgeons, it would be greatly appreciated. Thank you for your time.
A: The desire to try and get cosmetic plastic surgery procedures at the best price, or even for free, is a common one. It is an understandable request and I get many of them each week. As a general rule, one will find few if any plastic surgeons that will provide their services for free or significantly discounted for cosmetic surgery procedures. Quite frankly, there are several reasons why this is so. First, there are many other expenses incurred during surgery besides the plastic surgeon’s time. Operating room supplies and anesthesia fees are two of the most prominent. These have to be paid and are out of the control of the plastic surgeon. Secondly and of equal importance are the medico-legal risks that a plastic surgeon is exposed to from any surgery and patient, regardless of what fees are or are not paid. There is simply more to the cost of providing a surgery other than just the plastic surgeon’s time. This is why you will not find a plastic surgeon that will provide breast augmentation at a fee rate that most patients who like it discounted to.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have two surgical pitted crater-like scars on the side of my nose which are really annoying. I have previously tried erbium laser, two courses , nine months apart, and punch excision surgery, but neither treatment helped me. I noticed that your Doc had some impressive photographs of before and after scarring online and would like to know if I can be treated by way of any suggestion the Doc can make. I can send a photograph if you like.
A: The nose is one of the most difficult areas on the face for effective scar revision. The skin of the nose is tight, stretched over bone and cartilage and very thick. This leaves little skin laxity that can close easily after excisional scar revision and skin so thick that even deep laser resurfacing can not smooth out. In looking at your pictures, your two nasal scars are wide and very saucer-shaped. It is a wrong concept to try and bring the surrounding skin down to the level of the scar through any form of laser resurfacing. They are too deep. It is also not possible to excise them as they are too large and the nose has no skin laxity. What you what to think about is building up the scars from underneath with either cartilage or dermis/dermal grafts. They could be placed underneath the scars through an incision inside the nose. Building up the base of your nose scars is the only approach that will likely make them less noticeable by making their concave contour less so. Your nose scar revision is augmentative in nature.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, several months ago I had a lip surgery involving the removal of a fairly large mucocoele. Before the surgery there was a soft but noticable bumb just on the inside of my lower lip. After the surgery, however, I now have a huge knot of scar tissue that makes my lip protrude. Not only is it hard and gets in the way when rubbing my lips together, its very noticable when I smile and even when my lips are relaxed. We asked the surgeon about a steriod injection but were told that this doesnt always minimize scar tissue but can even have the opposite effect. Is it possible to remove or soften up the knot without making it bigger? Or will it go away in time? What is your advice?
A: Mucocoeles are common lip growths that are usually seen on the inside of the lower lip. While they are easy to excise, it is not uncommon that they are incompletely done resulting in a residual lump or bump. which could end up just as big or bigger than the original one. It would not be common to have excessive scar tissue from a mucocoele excision that made it look bigger than when you started. I would think more about an incompletely excised mucocoele. There is nothing wrong with injecting steroids as it will not make it worse (I have never heard of that happening), it is just a question of whether it will make it better. If you are less than 3 months from surgery, I would try steroids. If you are more tan 3 months from surgery, then a re-excision (lip revision) procedure is in order.
Dr. Barry Eppley
Indianapolis Indiana
Q: I want to achieve a completely caucasian look, I am Asian. Do you have any recommendations for my forehead? I am doing a hairline lowering procedure soon, should that be done before or after a forehead/browbone augmentation? Since there will be a scar from the forehead procedure right? I have attached some pictures for you to see me.
A: Thank you for sending our pictures. It is not clear to me what type of hairline lowering procedure you are doing. If it is being with a frontal hairline incision (scalp advancement), then the forehead augmentation should be done at the same time. If the hairline lowering is being done by hair transplants, then the forehead augmentation should be done first so the scalp scar will lie behind the grafted area. Improving the convexity of the forehead is what many women want to achieve, particularly those of Asian ethnicity.
As for other facial recommendations, it is not possible for you to have a ‘completely caucasian look’. Some facial areas may be tweaked but you can’t change the basic foundational look of your face. Tell me what you think would make the greatest difference in your face. In other words, what facial areas do you think would make you look less ethnic? In looking at your pictures, I do not see major areas of change but options do include the creation of an upper eyelid crease, buccal lipectomies, rhinoplasty, chin augmentation and jaw angle reduction.
Dr. Barry Eppley
Indianapolis Indiana
Q: So I wrote to you a few weeks ago. I had an implant placed and then removed after 4 weeks. The doctor said he didn’t remove bone structure but he did. My chin bone is round now instead of the two points (square) I had before, which I loved. He said he wasn’t removing bone structure, I can’t believe he did for a silicone implant. I wish he told me he was doing that and the side effects, I wouldn’t have done it. I liked the shape before. The implant was a huge mistake and I have stippling now after 4 weeks of removal. Can you fix that? Is there anything that can be done permanently to repair the orange peel/stippling? I was mostly scared of getting hanging skin, but this is way worse.
A: There would be no reason to remove bone structure when putting in an implant. What you are seeing is the remaining capsule/scar tissue that surrounds an implant after its removal. That combined with the extra or stretched soft tissues that has been created will make for a rounder chin appearance. It will not return exactly like it was before. Some of these effects, including stippling, will get better with time (months) as the tissues settle and much of the capsule eventually goes away since it has no reason to be there. But it is unlikey your chin will ever return 100% to the way it was. It will get a lot better with time as scar tissue softens but there is no magic to do now to help the problem..short of putting back some form of a chin implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi Do you do premaxillary augmentation? I had a lip lift and I lost the subnasale curve so that now the subnasal is pushed in and sits a little behind the pink lip. The curve was removed from the subnasal area which I would like this procedure to put the curve there I would like to augment the area with something other than an implant. I came across this article on premaxillary augmentation and wondered if you can do it this way? Thanks.
A: Premaxillary and/or paranasal augmentation is one of the least implanted of all facial areas. Its ‘need’ is based on some degree of maxillary or low level midface deficiency. It is more common in certain ethnic groups where the maxillary profile is concave to flat rather than convex. Premaxillary augmentation specifically refers an anterior nasal base and anterior nasal spine deficiency. It is the smallest of all facial implants and is made as an off-the-shelf implant by very few manufacturers. Its implant position is unique in that it has a vertical placement at the base of the nose, which makes it more prone to shifting, and the soft tissue coverage between it and the linings of the mouth and nose is thin.
Mersilene mesh is an implant material that has been around for a long time. It is a traditional preformed implant but rather sheets of non-resorbable mesh material (intended for hernia) that it rolled and made into an implant by the surgeon. It finds its greatest use if chin augmentation. Its drawback as a facial implant is that it has no form of its own and must be rolled and cut into a crude-looking implant. However, in the small area of the paranasal/premaxillary region with no complexity to its needed shape, it will work quite well. It does have an advantage in this area as scar tissue will quickly grow into it holding it into place. Mersilene mesh is a very acceptable material for premaxillary augmentation is my experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in learning more about abdominal etching. I am into bodybuilding and and love to sculpt my body. However, even when I diet down my love handles take away the full V-taper appearance. Also, my abs are never really etched like I want them to be. Right now I am actually pretty lean and do not have a lot of fat around my mid-section. It seems like from various pictures on the web, most after images are not really that great. Granted they were not in the best shape to begin with, but I would feel better seeing more pictures of a better after-shot. I was wondering if you had a computer program or are able to manipulate a photo to show what the end result could look like after the surgery?
A: Contrary to whatever pictures you may have seen, I have found that abdominal etching gives very good results. The key is proper patient selection. Not everyone is an ideal candidate as the most lean patients are those who benefit the most. The results are also affected by how aggressive one is with the technique and what expectations the patient has. Etching is basically linear liposuction done with the intent to remove almost all fat between the skin and the underlying abdominal fascia. (this is not what you normally do in liposuction) There is always a central vertical line and at least 3 horizontal lines at select levels. Occasionally additional vertical rows are put in out laterally. It is a very simple recovery since this is really liposculpture and not volume liposuction removal. I find the use of the Smartlipo probe to be very helpful in performing this procedure.
I would need to see a picture of your abdominal area to see if you are a candidate. Computer simulations I do not find helpfulfor this procedure for patients as anything can be done with Photoshop, that does not mean it will turn out that way from actual surgery. Marking the lines on the photo, however, can be educational for the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in tumescent liposuction. I’m in the Army stationed overseas. I have a permanently damaged leg from being in Afghanistan and I’ve gained a lot of weight due to my workout limitations. I’ve lost 20 pounds but can’t seem to lose anymore. I will be visiting family in your area this year and I am researching doctors that may help me shed some fat in the abdomen area.
A: Sometimes people do need some help surgically with their weight issue. Liposuction can be beneficial when one has ‘hit the wall’ in their weight loss despite their best efforts, when they need a jumpstart to get them motivated to make or continue with their lifestyle changes, and to help those that simply can not work out due to physical limitations. While liposuction is not the long-term solution to troublesome body areas with excess fat, it can be a successful part of one’s weight loss efforts if properly understood.
When it comes to liposuction, there is nothing special or new about using the tumescent concept. Perhaps 20 years ago, tumescent liposuction was an advanced technique. But today, every liposuction method uses tumescence or the infiltration of fluid prior to the actual extraction of fat. This fluid is essential, not only for numbing the tissues, but to help control bleeding from the trauma to the tissues. Whether it be Smartlipo (laser liposuction), Vaser, or ultrasound methods, tumescent fluid infiltration is a part of all of them.
Dr. Barry Eppley
Indianapolis, Indiana