Your Questions
Your Questions
Q: Dr. Eppley, I was wondering if you also fix torn ear lobes from heavy earrings. If so how long does it take to heal and what is the cost of this for just one ear?
A: The repair of torn earlobes is a common procedure that I do all the time. This is done in the office under local anesthesia. Dissolveable sutures are used and there are no dressings other than some light antibiotic ointment. There is minimal swelling and no bruising. Complete healing, as judged by when you can re-pierce your ears or wear clipons, is six weeks after the procedure. Repair of just one earlobe costs $ 425.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a forehead reduction. I have attached two photos of my forehead for your review. I hope these are enough. As you can see my forehead is massive and it gets me down !! Can you help? Is it always successful? Is there much recovery?
A: Thank you for sending your pictures. What you refer to as a massive forehead is one that is very long. I would estimate that the measurement between your eyebrows and the edge of your frontal hairline is at least 7.5 cms. If the forehead length in females is greater than 6.5 cms it is considered too long. This can be improved with a frontal hairline advancement, also known as a forehead reduction. This is where an incision is placed along the edge of the frontal hairline, the scalp behind it is loosened, lifted and brought forward, and the forehead skin underneath then removed. The amount of forehead skin removed is the amount that the vertical length of the forehead is shortened. Generally, 1.0 to 1.5 cms can be reduced in the middle of the forehead. There is less so taken out from the sides where it tapers into the upper temporal area. This is a very effective and successful procedure. Forehead reduction is an outpatient procedure that takes 90 minutes to do under general anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in facial reshaping. I’d like to get a more feminine face. I would like to reshape my heavy jawline and brow, correct the weak chin, do liposuction under chin and I would also like to correct any small asymmetries that would improve the appearance of my face. I have attached a front and side for your assessment of what can be done.
A: Thank you for sending your pictures. In looking at our face what is most striking are two things. First, you have a very strong facial structure as seen in your prominent brow bones and cheekbones. This upper part of your craniofacial skeleton is also broad as reflected in the wide base of your nose and its wide tip. Secondly, and in contrast, your lower jaw (mandible) is actually short both in the horizontal and vertical dimensions. This gives you the impression that your jawline is heavy, when in fact, it is really short which makes it wider than it is tall.
I have done some computer imaging projections based on what I think would make the most significant changes towards a more feminine face. These include brow bone reduction, rhinoplasty and chin augmentation. (both horizontally and vertically) One of the key components of this approach is that your lower face (jaw) needs to be vertically lengthened to change the shape of your face from square to more of an angular or triangular shape. Combined with reduction of the brows and thinning of the nose, your face will become softer and more feminine.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had orthognathic surgery over a year ago where my upper jaw was shortened and my lower jaw was brought forward. Ever since my septum has somehow shifted off to the left side and my nose is slanted that way as well. The left nostril sags down and looks wider as well. The right side looks more normal. What can be done know to correct these nasal problems? I am certain they are the result of my jaw surgery since my nose didn’t look like this before my jaw surgery.
A: Septal and nasal deformities as a result of a LeFort (maxillary) osteotomy are not rare. A LeFort I osteotomy has three potential adverse effects on the nose if certain steps are not taken during the surgery to avoid them. The septum may become deviated afterwards as the floor of the nose is part of the upper jaw. When the maxilla is impacted (shortened, moved upward), the septum must be similarly shortened. If not, the impacting upper jaw will cause it to be bent or deviated as it impinges on it. The nostrils can become wider afterwards as the paranasal muscles are disinserted with the incision under the upper lip. If these muscles are not brought back together at the time of the intraoral mucosal closure with a V-Y advancement, then the sides of the nostrils will flare outwards. Lastly, the tip of the nose can change due to the altered position or shape of the anterior nasal spine on which the caudal end of the septum and columella resides. It appears that you now have some degree of all three of these nasal problems. All of these deformities can be corrected during a secondary septorhinoplasty procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have lost 65 lbs over the past year through diet and exercise. At 5’4” and 180 lbs, my BMI still says I am obese. I would really like to go ahead and have my abdominal apron removed now because I am sick of it, it makes me look bad and gets in the way of me exercising. Should I lose more weight before having the surgery or just go ahead and have the apron removed now? I know doctors like to have your BMI below 30 before surgery so I am not sure what to do. I have attached some pictures of my gross stomach for you to see.
A: The timing of when to do an abdominal panniculectomy/tummy tuck in the course of one’s weight loss is a common one. There are no absolute guidelines other than the more weight loss the better. BMI is a useful measurement but it is still just a number. What counts is the size of your pannus, what the rest of your body looks like, and how your weight loss is progressing. Many patients with abdominal pannuses ‘hit the wall’ so to speak in their weight loss and the size and weight of the pannus becomes limiting at that point. Based on the pictures you have shown, I think you would be best served by moving ahead now with your abdominal panniculectomy procedure. Your body is not that big compared to the size of the pannus. You would look and feel so much better if it were removed. This would make it easier to function and exercise and you would be more likely to lose weight if you desire after its removal than with where you are currently.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having multiple facial changes done by you and want to look as attractive as possible. I am a 22 year-old male whose face is a little out of balance and proportion. I have taken the golden ratio mask picture of which I am sure you are familiar and applied it to my face. It shows clearly where my facial imbalances and deficiences are. I know you would do what is best for one’s face but would you go for different results if you were masculine or feminine. The one I used was the female golden pic and there’s a male one as well. Of course I would much rather go for the male look. How close can you come with surgery to achieving these golden ratio mask results?
A: I am very familiar with the golden ratio masks and you are not the first person that has presented it to me. They are very interesting for assessing facial beauty and do provide at least a measureable target for which to aim. They can help surgical planning and, for those who may not be experienced in assessing faces and making the diagnosis by examination of where the deficiences are, they can provide a sort of blueprint to follow. What I do not like about them is that they can create unrealistic or artificial goals for patients as surgery is not like Photoshop nor can it create that degree of precision or change. Perhaps worse, those patients that use them before surgery are going to assess their after surgery results with them. This is a near certain setup for disappointment and an initiator of the need for revisional plastic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been getting injectable fillers into my smile lines and lips for several years now. While I really like the effects that it creates, I do tire of having to be stuck by needles and the recurring expense of doing it once or twice a year. Is there any injectable treatment that would be permanent or at least last a lot longer?
A: While current off-the-shelf injectable fillers produce some wonderful facial changes, they are synthetic and will be eventually resorbed and the effect will be lost. While no truly permanent injectable filler can be definitely claimed, there are several promising options that are now being used. Most people have probably heard of using liposuction-derived fat for injection, and it has been used for some time, but its known problem is that its survival is unpredictable. While it does work well is many areas of the face, the smiles lines and lips are not amongst the most favored. Encouraging injectable cell treatments include fibroblasts and stem cells, both harvested and grown from the patient. Taking a skin biopsy from behind your ear allows fibroblasts which make collagen to be grown for later injection. Known as laViv, this is an FDA-approved treatment that allows the injection of millions of fibroblasts into any desired facial site. Comparatively, Cryo-lip (an Indianapolis biotech company) creates large numbers of stem cells for injection into any desired area. Whether any of these cell-based injectable fillers can create a long-term permanent effect is not yet known.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 54 year old female with an overlying abdominal apron. I have had three c-sections with some prominent scarring where they did this surgery. This c-section scar pulls in and the weight of the overhanging apron on it makes it chronically sore and irritated. I am also a diabetic and have high pressure. Do you think removing the fat with liposuction will help me. I am interested in something like Smartlipo since it appears to be the least invasive. Will my diabetes and high blood pressure get better after surgery?
A: When anyone describes having an abdominal apron, also known as a pannus, they are by definition talking about a large amount of skin that hangs over the waistline. In treating an abdominal apron the consideration of liposuction is immediately excluded. While it does remove fat, it will actually make the overhang of the apron worse. What you need is an abdominal panniculectomy, also known as a ‘simple’ tummy tuck. It is the cutoff of the abdominal apron without any manipulation of the underlying abdominal muscles. This will provide both an immediate and effective cure of your problem. Given your age and health conditions, you will need to get medical clearance from your doctor. It is very possible, although not assured, that this surgery may help reduce some of your medication requirements for your blood pressure and diabetes if the apron is big enough.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a fatty area on my very upper inner thighs that is always rubbing even though the rest of my legs are fairly muscular. I also have an area of fat between my breasts and armpits that I cannot stand. I exercise daily and these problem areas are never resolved. Do you think Lipodissolve would be beneficial? Thank you.
A: Thank you for your inquiry. In answer to your question, I do not think that Lipodissolve would be the way to go for all of those fatty areas. Lipodissolve requires a series of injections, which cause swelling and discsomfort for a week afterwards. It would take three or four injection sessions spaced four to six weeks apart to see results. With multiple fat areas you would find that process slow and mildly unpleasant, in essence an inefficient fat reduction method whose results are uncertain. While it is a non-surgical treatment, it just won’t work well for what you want to achieve. It would be far better, achieving more efficient and effective fat reduction, to undergo a one hour Smartlipo procedure under anesthesia. This may be exactly what you want to avoid but you would also want whatever treatment is chosen to work as well. Interestingly, a one hour liposuction procedure will actually cost less and have a quicker recovery than a series of Lipodissolve injection sessions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants but am concerned about the time it may take to recover. I have a 7 year old daughter and need to take care of her daily needs so I can not be limited afterwards. How long will my recovery actually be after surgery?
A: In regards to recovery after breast augmentation, I place all my patients on a rapid recovery program. This means that there are no physical restrictions after surgery and there is nothing you can not do if you feel comfortable. Patients start on arm exercises the first night of surgery to help recover quite quickly. Will you be sore…yes. But will you be limited from doing anything for your young daughter…no. In recovering from getting breast implants, the main source of discomfort from the submuscular dissection for the implant pocket, the lifting off of the pectoralis muscle from the chest wall. Therefore, recovering from breast augmentation is really about taking care of a big pulled muscle. What is the fastest way to recover from a pulled muscle? How do athletes recover quickly when they pull a muscle? Early range of motion and stretching is the key. This is why lifting the arms and stretching them, starting within hours after surgery, will get the discomfort to lessen quicker and range of motion of the arms come back quicker. Breast implants primarily affect lifting and moving of the arms as the insertion of the pectoralis muscle is on the upper humerus and not on the shoulder.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a tummy tuck done three weeks ago. I developed a problem within the first week after surgery. At the crossing zone of the inverted T incision, I developed necrosis and infection. Now it is just a big black patch around it. Is there anything that can be done to make it heal and heal faster?
A: What you developed, as you have described, is a zone of tissue necrosis at the areas of a tummy tuck which has the least blood supply to the skin. It appears that you have had a combined vertical and horizontal tummy tuck and that junction where all the incisions come together would be at the greatest risk for exactly that problem. While initially dark in the first few days after surgery, it turns black and becomes hard as the zone of demarcation between good and dead skin becomes quite clear. This dead skin and its underlying tissue is known as an eschar. It would be wise at this point to do nothing and allow this area it to heal on its own. Removing the black eschar now will likely reveal a full-thickness tissue defect right down to the abdominal fascia. It would be best to treat this eschar like a scab. Allow healing to take place to the point where it gets loose and is ready to come off. This will allow for a lot of healing to take under and around the eschar. There is nothing that can speed up this process and it will likely take six weeks or longer before the eschar will lift off to reveal if any full-thickness defect exists underneath. The eschar should only be removed earlier if infection around the area develops.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I went in recently for a consultation from an Indianapolis rhinoplasty surgeon. During the consultation he recommended a chin implant with my rhinoplasty surgery. While he seemed very honest in this suggestion, I was completely floored as I never thought I had any chin problem. I certainly didn’t think that I had a weak chin. Having had the idea settle in for awhile, I am now more comfortable that maybe I do need one. I like the way my face looks in every way except for my profile which is why I want my nose done. What I am concerned about is that the combination of a rhinoplasty and chin implant will change my face too much. I have attached a profile picture of me for your thoughts. What would you do if you were me?
A: It is not uncommon to perform a rhinoplasty and chin implant together and it can be a powerful changer of one’s profile. But whether it is aesthetically beneficial can actually be determined by you. Make sure that you have done a series of predictive computer imaging. Have shown to you how your profile would look both with and without a chin implant with your rhinoplasty prior to actually undergoing surgery. These images will answer your question better than anyone simply telling you one way or the other. One cautionary note, if you opt for chin augmentation your plastic surgeon needs to be careful about the style and size that is selected for implantation. You have a retruded but long chin. It would be easy to end up with too strong a chin appearance afterwards if the right chin implant is not chosen.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 38 year old mother with 3 children. Needless to say, three pregnancies and breastfeeding them all has taken qute a toll on my body. It looks like the proverbial life has been sucked out of me. My breasts are flat and droopy, I have a small skin amount of belly skin that hangs over my waistline and I recently found out that I need a hysterectomy due to chronic bleeding. Other than these issues, I am actually in good health. Since I have to have a hysterectomy anyway, I thought that getting breast implants and a tummy tuck at the same time would be a good idea. It would be great to get a while new body along with fixing my gyn issues. Do you think all of this can be done at one time and is it safe?
A: Combining breast augmentation and a tummy tuck with a hysterectomy procedure is perfectly safe provided you are in good health and have no significant health risk factors such as smoking, diabetes, or high risk for blood clots. Tummy tucks and hysterectomies are very commonly done together as it provides unparalleled access for the Gyn doctor to do the hysterectomy and provides solutions to many body problems in one operation. Adding a breast augmentation to this combined abdominal procedure does not add significant operative time, risks, or recovery. This would be the ultimate ‘Mommy Makeover’, correcting all issues that are associated with one’s pregnancies. Your most challenging aspect in getting this done is to be able to coordinate a plastic surgeon and a gynecologist’s schedule as well as the economics of doing it in a hospital environment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a rhinoplasty done to reduce the bump on my nose.. The doctor told me that he took it off using a rasp which shaved it down. What I am wondering is whether the bump can grow back again? I have read that some people who have had their nose hump removed have had it grow back again a few years after their surgery. Is this true?
A: There is really no such thing as a hump or bump (a dorsal hump in plastic surgery terms) that grows back after it has been treated by a rhinoplasty operation. Once the bone and cartilage have been removed, they do not have the ability to grow new bone or cartilage tissue. That is a regenerative capability that we as adults do not have. (and for many medical problems I wish we did!) The perception of a dorsal hump ‘growing back’ after s rhinoplasty most likely reflects a hump that was never sufficiently removed in the first place. While it may initially look like it was removed, it can ‘reappear’ when all of the surrounding tissue swelling goes away. If you add inj a little scar tissue on top of an inadequate reduction, some hump can once again be seen. Whatever amount of residual dorsal hump that is seen after a rhinoplasty is merely a reflection of what was originally there. Regrowth should not be confused with inadequate removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have alot of scarring on my face. Mostly small scarring from acne and also some from adult acne which includes one very large pocket where a cyst once was, also another very large scar where I had to have a surgeon remove another cyst .There are also a few smaller scars where more cysts were removed and one ice pick also. I’d like to know if you can help to remove some of these in your office or at least help to minimize some of the issues. I am embarrassed to go out into any type setting outside my home wether it be work or any other. I use to be what most would consider a pretty attractive woman. I would like it so much to not feel so awkward about myself because of my complexion. I have been dealing with the the withdrawing from others for about 17 years or so where as I use to be an outgoing and confident person. If you can help me I would greatly appreciate it. Thanks so much.
A: One of the most challenging facial skin conditions to really improve is that of acne scarring. There is no magic solution to this devastating problem and it is compounded by the fact that there are many different types of acne scars by depth and shapes. Surgical methods of improvement can include excision, dermabrasion and fractional laser resurfacing. There is even an occasional role for fillers placed underneath certain types of acne scars. Usually some combination of several of these approaches are needed. Almost always some improvement in acne scarring can be obtained. It is just a question of how much and is it worth the effort involved to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a problem with sores on my breasts. My breasts are very small and extremely saggy having lost most of my breast tissue after breastfeeding four children. I kid you not that they are literally two sacks of skin just hanging there. When I wear a bra they get all bunched up inside it and are folded unto themselves. This causes the skin and particularly my nipples to rub and get weepy,oozing painful areas. Due to these sores, is it possible that I would qualify through my insurance to have a breast lift with implants covered? It would seem that insurance should cover it since it is causing a medical problem. What do you think?
A: Medical insurance will never cover any breast procedure that involves a lift or implant, unless it is part of a breast reconstruction due to breast cancer. While it would seem logical that your skin problems would provide the reason for a surgical solution, that will not happen. Insurance will cover the medical treatments for your breast skin problems but not for breast lifts whether implants are used or not. This will be viewed as a cosmetic procedure, not a reconstructive one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 24 years old and lead a very healthy life style. However, I still cannot get rid of some fat on my stomach. I am interested in the least intrusive means of getting rid of this fat. Smartlipo seams to be a good fit. I am researching it more to be sure it is right for me and that I can afford it. I was wondering what the average cost for Smartlipo on the abdominal region (including all the additional fees such as room and other personnel involved). If you could send me an email with an estimated average, that would be great. I appreciate it!
A: By the tone of your inquiry, I can tell that you likely have a false assumption about Smartlipo. Smartlipo is a method of liposuction which means it is intrusive and it is surgery. There is no minimally invasive or non-surgical method of fat removal that is really effective in terms of what most people want and expect. Smartlipo, for a variety of reasons, is often perceived as if it is a substitute for liposuction surgery and that it is some ‘mild’ form of liposuction that is exclusively performed under local anesthesia with minimal to no recovery. This is unfortunate because Smartlipo is liposuction surgery and is often best done under general anesthesia to get the absolute best result…and there will be some typical recovery. The cost range of abdominal Smartlipo will be in the range of $3500 to $5000.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a chin implant. Two years ago I had a sliding genioplasty chin reduction that reduced my chin about 3 mm. Now that I am fully healed, I am noticing that my chin looks too short for my face. From the profile view, my chin doesn’t look bad, but from the front, it looks too short, rounded/squared. My chin seems to be too wide and not tapered enough from a frontal view (especially when smiling). I have two screws in either side of my chin. Is it possible to put an extremely small (maybe 2mm) implant in even if I have screws in my jaw already? Also, is it possible to position it so that it only affects the vertical length of my chin and not so much the horizontal projection? Would you recommend a button implant (as opposed to an extended implant) since I don’t want my face to widened? Thank you for your time.
A: You are describing perfectly why an osteotomy is not a good idea for a chin reduction. By sliding the bone backward it creates two effects, a more square or wider chin and it can often make the submental neck tissues fuller. As you have pointed out, a chin implant can be done to improve the effects that the osteotomy has created. You are correct is assumed that it should be a central button chin implant that is positioned low on the bone and secured into position by a screw to create some vertical lengthening as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about the postop healing process for a forehead reduction/hairline advancement. It has been just about 2 months since my surgery and my scalp is still not healed. I have some large areas of scabbing over the incision sites and don’t know but it seems like they should be healed by now. I don’t know if I am doing something or taking some medication that would slow this healing process. Please just let me know if this is normal I can also send you some pictures if you would like.
A: It is certainly not common to have a forehead incision that is not completely healed after two months. The scalp is such a well vascularized tissue that it is hard for any portion of it to not heal unless there is a good reason. Most likely, these non-healing areas represent spitting sutures. If you look close at them after removing the scabs, you may see little white threads which are dissolveable sutures sticking out. Many times along the hairline the body will spit them out long before they will ever dissolve. There presence at the incision lines now serves as a chronic source of infection which appears like a pimple or small draining sinus. This is a common problem in many body areas and the hairline is no exception. If you can pick out those white sutures you will remove the source of irritation and the areas will go on to complete healing. I have seen this wound occurrence many times after pretrichial browlifts and forehead reductions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have gained 40 lbs since I had a hysterectomy seven yrs ago. My stomach is now extremely out of portion to the rest of my body. I need to ge rid of this as I believe it’s very unhealthy. I lack disciple in terms of appetite or taking diet pills. I am interested in fat injection treatments, Will insurance cover any type of non-surgical treatment to reduce my stomach fat? What is your input on this fat treatment method?
A: In terms of getting rid of a stomach bulge, no matter how large it is, is not something that would be covered by insurance regardless of the method of treatment. When you speak of injections for reduction of fat you are undoubtably referring to Lipodissolve, a blend of phosphatidylcholine and deoxycholic acid solution. While this can help reduce very small collections of fat, it is not going to be effective for a fat collection of any size. While it was very popular several years, it has fallen out of use because it has proven to be ineffective for abdominal fat collections that many people want reduced. I still use it occasionally but only as a treatment for small postoperative liposuction ‘high spots’. Unfortunately what you are seeking is a non-surgical solution to a surgical problem…and that does not exist.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in pectoral implants and would like any information about the procedure that you can share with me.
A: There are tremendous similarities between transaxillary breast augmentation in females and pectoral implants in men. They both are placed through an incision in the armpit with a pectoral implant needing more length as the implant is bigger. Both are placed under the pectoralis muscle with a pectoral implant not being placed below the lower edge of the pectoralis major muscle. All of the pectoral implant remains covered by the muscle to give it maximum bulk and projection. (a breast implant in contrast often has at least half of the implant below the edge of the muscle) Pectoral implants come in numerous sizes and shapes from oval to a more square design. The implant selection is determined by measurements taken on the chest based on the outline of the muscle. The implants are composed of solid soft silicone elastomer material that behaves like a flexible gel. The material is inert and will never degrade or break down. Pectoral augmentation is performed as an outpatient procedure done under general anesthesia. Dissolveable sutures are used to close the armpit incision. After surgery, there will be some swelling and soreness and a chest wrap is used for comfort. One can expect that it will be about three weeks until one has full range of motion of their arms and can begin to return to working out again if desired.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, when I was a kid I had a problem with my blood platelets. The same thing happened after delivering my first baby and then with the second one nothing happened. Do you think that having breast implants will affect my platelets? If yes, by how much percent? Thanks.
A: Without knowing what your exact platelet disorder is or was, I can’t say with any certainty. You will need to better describe medically what your platelet problem was. There is a big difference between too many platelets, too few platelets, and platelets which just don’t work well as it relates to undergoing.The only thing that really matters with breast augmentation, or any surgery for that matter, is whether you have adequate clotting capability. If there is any question (and it sounds like there is) you should have a bleeding time, PT, PTT (or INR) and platelet count checked before surgery. Given that you had some type of ‘platelet problem’ as a child and after your first pregnancy, you should have a coagulation work-up before any elective plastic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, do you do stem cell facelifts and what do you think of them? Do they really work?
A: Stem cells and their many potential uses are one of the hottest topics in all of medicine today. Much research is going into whether they have healing benefits for many diseases. It is no surprise that their appeal has reached plastic surgery as well, particularly given that fat and its extraction by liposuction is the best method to obtain them. And many people have more than an adequate store of donor fat. Fat has been shown to contain up to 500X more stem cells than bone marrow and plastic surgeons are employing many innovative ways to apply them to both reconstructive and cosmetic procedures.
Stem cells and facelifts seem like an odd combination given that facial aging hardly seems like a disease problem. But some plastic surgeons have been using them for the purposes of an enhanced healing and skin rejuvenation effect.There are two types of so-called stem cell facelifts. Those that use stem cells or stem cell -enhanced fat injections as an adjunct to a more traditional facelift procedure. Then there are those that use the stem cells or stem cell-enhanced fat as the primary method of doing the facelift, which is really known as facial volume enhancement creating some lifting effect by skin expansion. To date, either approach remains appealing in theory rather than a proven science in facial rejuvenation efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I noticed that you also do reconstruction using bone cements.I had sagittal split osteotomy a couple years back which left my face unbalanced and my mandibular angles too small. I’d like to restore balance to my face without the bottom face turning too square. I’m not keen on using plastic implants. So, does hydroxyapatite make a good material for restoring facial contours for the mandible? Unlike bone grafting, it doesn’t resorb, and is comparatively easy to mold.. or so I have read.
A: Of the many materials available for facial bone augmentation, hydroxyapatite has a long history dating back over twenty-five years as a granular bone onlay material. This is a syringe method where the granules are introduced through an open intraoral approach with limited dissection. They do not resorb and are relatively easy to place. Confining them to the desired location was always an issue but it can be an effective method. Hydroxyapatite today is better known as a bone cement and has been widely used for cranial reconstructions in infants as well as adults. It needs to be mixed and applied in an open method as the setting of the material is very technique sensitive. It is not use very often as a facial augmentation material as it works best when used in an inlay bone defect that has borders. would not use bone or hydroxyapatite cement as this material composition is too difficult and unpredictable to place outside of an open cranioplasty where its setting/curing is more assured.
Hydroxyapatite granules, and a very similar material known as HTR granules, can be used for a small amount or moderate amount of mandibular angle augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently underwent a rhinoplasty on September 19th. I found the results to be disappointing so far, it seems that my nose is twisted. Is this normal, and will the swelling go down to create a much better result? Where may I send you a before and after picture for an evaluation?
A: One of the most challenging aspects of a rhinoplasty for many patients after surgery is that the final and expected result can take a long time to see . Of any plastic surgery procedure that I have ever done, I find that a rhinoplasty takes the longest to achieve the final result. The skin of the nose can swell considerably, masking any changes that have been done to the underlying osteocartilaginous framework. And since those changes are ultimately what will make the nose look different, not seeing them for a long time can be disappointing and the wait can be frustrating.
It is important to remember that the results of a rhinoplasty are not a ‘TV moment’. Unlike the way it is frequently presented, the final results are not when the splint and take (bandages) come off. In some patients, some of the changes are immediately seen. But in many patients, particularly those with thick nasal skin or who have had relatively minor changes done, the swelling will mask any changes done and it may even look worse for some time.
This is why it is important to try and ignore what you are seeing right now. Swelling always creates distortions, many of whom may go away as the swelling subsides. Six weeks after a rhinoplasty understandably seems like an eternity to you but, in the rhinoplasty world, this is just a small fraction of time. What you are see at six months after rhinoplasty surgery is more relevant as this gets into a time period when revisional surgery can start to be considered if significant deformities/asymmetries persist.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to change the shape of my chin. It seems too wide. Several years ago I went to a doctor for a rhinoplasty and came out with a rhinoplasty and a chin implant. I went in with no desire for a chin implant but in the consultation he suggested I had a recessed/ weak jaw and that a chin implant would correct it. So as a young naive first timer to plastic surgery I said ok and every doctor I’ve seen since can not understand why that first doctor recommended that.
I’ve had x-rays done of it and showed them to other doctors, one has said it is minor and not causing much protrusion at all. This he thought it best to leave in as removing it could cause a gap or “witches droop” as he called it .
Another doctor said it can easily be removed, and should be, so as usual Im confused. But I am erring on the side of caution and not touching it due to potential resulting problems. (i.e. its been there 15 years so I assume all the nerves/ muscles would have grown around it, thus to a non- medical mind as myself the removal of it seems complex) And by the way, that nose job was a failure too. Its the nose job where I pay $10,000 and come out looking exactly the same except with a round bulky nose.
A: Your chin implant information is very relevant, as while the chin implant may not have provided much horizontal projection, it often adds width. So it could be making a contribution to your chin width issue. This would depend on what type of chin implant it is, but most used today are of the extended or winged type which always adds width. That is usually fine for men but I almost never use them in women because of that issue. Women look better with a more angular or tapered chin.
A chin implant removal is actually very straightforward and not complex at all. The key is to make sure the mentalis muscle is adequately resuspended if done intraorally or a submental tuck-up is done if removed from below.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am thinking that I need something to make my face look better. I realize that I am young to be thinking about surgery, but I’ve never liked the way I looked. I thought maybe cheek implants might help, but I was wondering if you had any other suggestions of how I could make myself look better.
A: In looking at your pictures, I can see that you have some mild cheek flattening or hypoplasia. Higher cheekbones may be an accent to your facial appearance. Should you be so motivated, I would suggest you initially pursue injectable fillers for cheek augmentation. This would be a good temporary test to determine if the placement of permanent cheek implants would be aesthetically beneficial.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 35 years old and I am 5’ 7 “and weigh 246 pounds. I am been married for eight years I have three girls. I feel that I’m now really fat because around five years ago I was a size 16. Now I am a size 24 and I exercise and diet and have tried mesotherapy with very little results. I have skin that hanghs over the sides which really bothers me. Can you help me?
A: Based on your height and weight now, you are close to be over 100lbs from your ideal body weight. I suspect that you were never near your ideal body weight by the numbers so that it is not a realistic goal. While weight is just a number, getting you somewhere between 170 and 190lbs ir probably an achieveable weight target. That being said, you are not a candidate for liposuction or any form of excisional body contouring, such as an abdominal panniculectomy, until you reach the 200lb mark. You are simply too big now to get the best benefits out of any form of plastic surgery. You need to consult with a weight loss clinic or specialist as the first step in your potential body metamorphosis begins with a non-surgical weight loss appproach not plastic surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a genioplasty with iliac bone grafting five years ago. The result was disastrous. I got a long and prominent chin and it was so completely different than I planned. After that, I had several revisions to get an imprrovement. For example the jaw bone had been suspended back and I also I had a chin reduction. This resulted in an unpleasant scar under my chin. Now the chin soft tissue is scarred and hanging down. If my mouth is closed I feel a strain on the chin muscle. During relaxation my lower lip hangs down showing my bottom teeth. The mentalis muscle shows a strong contraction.
I couldn´t find any surgeon who had enough knowledge in this specific area of genioplasty revision and chin ptosis. In various discussion forums about this topic I came across your name. I hope that your skills and experience in this special field could be helpful in my case. Is there any possibility to solve my problem and what could this be? What is the probability of improving my situation? Your help would be very much appreciated. I have attached some pictures for you to see my chin problems.
A: Your chin surgery history and outcome has certainly been that of a nightmare. What you currently have is chin ptosis with severe contracture. What need is an intraoral approach to release the scarred chin tissues, mentalis muscle resuspension with suture anchors and a V-Y vestibular closure. Your submental scar should also be released and revised. The divot (indentation) in your chin would be treated by the placement of a small dermal-fat graft at the same time. All of these procedures would be done simultaneously address all of your current chin problems. My experience in doing these chin ptosis repair procedures is that improvement is always obtained, it is just a matter of the degree of improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to ask about how to get rid of a facial scar. I want to fade or remove my scar in my face on my forehead. That scar was caused by a car accident in 1998. The characteristics of the forehead scar are flat, vertically-oriented above my right eye, its size is 33mm in length and 2.5mm in width. The color of the scar is darker (more red) than surrounding healthy skin. It tends to be flat and is slightly less irregular but, when my facial skin is flexed, the edges of the scar tissue can be unified. What is the best way to repair my scar? Thank you very much.
A: Your scar description describes perfectly that it is best treated by a formal scar revision. This scar revision would include total excision (cut out) of the scar and a geometric closure. (irregular or broken line closure) The appearance of a scar that is wide and flexible can only be narrowed by total excision of the scar. Because the scar has a vertical orientation in the forehead, it runs perpendicular to its relaxed skin tension lines. This means that if a straight line closure is done after the scar’s excision, there will be a tendency for it to widen again. (although it may end up as wide as it is now) Changing the closure pattern to an irregular or broken line closure will redistribute the tension on the scar so that it will be more likely to stay as narrow as possible (less than 1mm) Also an irregular non-straight line is better camouflaged as it is harder for the eye to follow a broken line as opposed to a straight one. This type of scar revision is the best approach based on your scar’s description.
Dr. Barry Eppley
Indianapolis, Indiana